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Abstract
There are at least two reasons for the improved survival of patients with
AA who were treated by HLA-identical HCT. One is the decreased incidence
of graft rejection.
The decline in rejection has resulted from the more judicious use of transfusions before HCT, the removal of sensitizing white blood cells from transfusion products, and improvements in the immunosuppressive qualities of the conditioning programs used to
prepare patients for transplantation. Irradiation-based programs have been
effective but at the price of more transplant-related complications, and the CY and ATG combination is just as successful in preventing rejection
with better long-term survival.
With regard to transfusions before HCT,
in vitro irradiation of all blood products may further reduce the risk of
sensitization to tninor histocompatibility antigens in the future [STORB, et al 1988].