Treatment strategy in patients with acquired aplastic anemia. Patients are stratified according to whether or not they have an HLA-identical sibling. In young patients (<40 years) with a matched donor, allogeneic BMT is first-line therapy. In patients older than 40 years, and for patients without a matched sibling, ATG+CsA should be first-line therapy. In selected children with very severe disease, an unrelated donor (UD) graft may be considered first-line therapy (dashed arrow). In patients aged 0 to 60 years, nonresponders (no resp) to ATG have several choices, depending on the performance status of the patient, the availability of an HLA-matched UD, and patient age. The options are an UD BMT, a second course of IST (ATG+CsA), or an alternative donor transplant (Alt Donor Tx, indicating haploidentical transplants or cord blood [CB] transplants). At older than 60 years of age, medical treatment is preferable over BMT. d+120 = day +120; EPAG, eltrombopag; HLA = Sib, HLA-identical sibling; Sib BMT, identical sibling transplantation; UD BMT, unrelated donor BMT.