Bone Marrow Transplantation (2002) 29, 205–211  2002 Nature Publishing Group All rights reserved 0268–3369/02 $25.00 www.nature.com/bmt Fanconi anemia CsA-based post-graft immunosuppression: the main factor for improving outcome of allografted patients with acquired aplastic anemia. A retrospective survey by the Spanish Group of Hematopoietic Transplantation R Arranz 1 , E Conde 2 , F Rodriguez-Salvane ´s 3 , FJ Pajuelo 1 , R Cabrera 4 , MA Sanz 5 , J Petit 6 , J Bueno 7 , J Maldonado 8 , J Odriozola 9 , JG Conde 10 , S Brunet 11 , E Carreras 12 , A Iriondo 2 , JM Ferna ´ndez-Ran ˜ada 1 and P Marı ´n 12 for the Subcomite ´ de Aplasia Medular del Grupo Espan ˜ol de Trasplante Hemopoye ´tico 1 Hematology Department, Hospital Universitario de la Princesa, Madrid, Spain; 2 Hematology Department, Hospital Universitario Marque ´s de Valdecilla, Santander, Spain; 3 Clinical Epidemiology Department, Hospital Universitario de la Princesa, Madrid, Spain; 4 Hematology Department, Clı ´nica Puerta de Hierro, Madrid, Spain; 5 Hematology Department, Hospital La Fe, Valencia, Spain; 6 Hematology Department, Institut Catala ´ d’ Oncologı ´a, Barcelona, Spain; 7 Hematology Department, Hospital Val d’ Hebro ´n, Barcelona, Spain; 8 Hematology Department, Hospital Carlos Haya, Ma ´laga, Spain; 9 Hematology Department, Hospital Ramo ´n y Cajal, Madrid, Spain; 10 Hematology Department, Hospital Clı ´nico, Valencia, Spain; 11 Hematology Department, Hospital Sant Pau, Barcelona, Spain; and 12 Hematology Department, Hospital Clinic, Barcelona, Spain Summary: A retrospective multicenter study was performed to assess the clinical results in patients with acquired apl- astic anemia (AA) allografted over a 19 year period and to identify prognostic factors influencing survival. From April 1978 to December 1997, 176 patients were trans- planted. Records from 160 receiving related matched bone marrow transplantation (BMT) were reviewed. Fifty-two percent of the patients were older than 20 years, 5% older than 40; 6.3% were untransfused at BMT and 56.2% had received prior treatments. Con- ditioning regimens were with chemotherapy in 43.7% of the procedures and with additional irradiation in 56.3%. Graft-versus-host disease (GVHD) prophylaxis was based on cyclosporin A (CsA) in 58.1% of the patients while methotrexate (MTX) was administered to 41.9%. Transplantation earlier on, a longer interval from diagnosis to BMT, GVHD prophylaxis with MTX, graft failure/rejection and acute severe GVHD were adverse factors for survival. The use of CsA emerged as the main factor for the improvement, inducing a sig- nificant decrease in graft failure/rejection rate and sev- ere acute GVHD when compared with MTX alone. Radiation-containing regimens decreased the graft failure/rejection rate without improving survival due to the increased risk of acute GVHD. Age and number of transfusions pretransplant did not influence outcome. Survival achieved since 1991 is 79.79%, and graft fail- Correspondence: Dr R Arranz, Servicio de Hematologı ´a, Hospital Univer- sitario de la Princesa, C/Diego de Leo ´n, 62, 28006 Madrid, Spain Received 4 June 2001; accepted 4 October 2001 ure and acute severe GVHD rates are 6.0% and 11.8%, respectively. In conclusion, CsA-based post-graft immunosuppression has been crucial in achieving improved survival in patients with acquired AA up to 40 years of age. Regardless of CsA use, further improve- ment in survival was apparent with time, probably due to better skills in patient care. Bone Marrow Transplantation (2002) 29, 205–211. DOI: 10.1038/sj/bmt/1703349 Keywords: acquired aplastic anemia; bone marrow trans- plantation; conditioning regimen; post-grafting immuno- suppression; survival Register-based retrospective studies have contributed to tailoring different treatment strategies in patients with aplastic anemia (AA). 1–4 Apart from the series by the Seattle 5 and Paris 6 groups, single center 7–12 and controlled studies 13–15 are few and often include small populations, due to the low incidence of the disease. Registers, although introducing more biases, allow treatment options to be com- pared with fairly good reliability of results. During 1997, the Spanish Working Party Group for AA decided to com- pile its experience with bone marrow transplantation (BMT) in order to identify the risk factors for treatment failure and to make possible the generation of new thera- peutic guidelines to minimize diversity of indications and therefore improve treatment results. A survey collected pre- viously from 57 Spanish hematology departments had revealed that 80% offered BMT as the first treatment option to patients with SAA and a fully matched sibling donor, although 86% of them used local protocols with different transplant procedures and with a wide age range of eleg-