Severe Aplastic Anemia (SAA) is a rare condition in which the body stops producing enough new
blood cells. SAA can be cured with immune suppressive therapy or a bone marrow transplant.
Regular treatment for patients with aplastic anemia who have a matched sibling (brother or
sister), or family donor is a bone marrow transplant. Patients without a matched family donor
normally are treated with immune suppressive therapy (IST). Match unrelated donor (URD) bone
marrow transplant (BMT) is used as a secondary treatment in patients who did not get better
with IST, had their disease come back, or a new worse disease replaced it (like leukemia).

This trial will compare time from randomization to failure of treatment or death from any
cause of IST versus URD BMT when used as initial therapy to treat SAA.

The trial will also assess whether health-related quality of life and early markers of
fertility differ between those randomized to URD BMT or IST, as well as assess the presence
of marrow failure-related genes and presence of gene mutations associated with MDS or
leukemia and the change in gene signatures after treatment in both study arms.

This study treatment does not include any investigational drugs. The medicines and procedures
in this study are standard for treatment of SAA.

The goal of this trial is to see if active surveillance monitoring and hormonal therapy in
patients diagnosed with ductal cell carcinoma in situ (DCIS), an early stage of breast
cancer, can be an effective management of the disease.

Participants will be asked to receive control hormonal therapy or an investigational hormonal
therapy treatment. Participants will be asked to return for evaluation with MRI at three
months and six months. Depending on the evaluation participants will have the option to
continue on the treatment. If the evaluation suggests surgery is recommended, the participant
will discontinue the study treatment and will undergo surgery. In addition to the treatment
and MRI evaluation, participants will be asked to provide blood sample to understand their
immune status, provide saliva sample for genetic testing, provide the study with a portion of
the tissue or slides generated from tissue removed during surgery performed as part of their
standard of care.