Severe aplastic anemia (SAA) appears to be an immunologically mediated disorder that results in deficient and defective hematopoietic stem cells. Both immune suppression and hematopoietic stem cell transplantation provide effective treatment for SAA. Optimal choice between these therapies depends upon a complex interaction of patient age, disease severity, overall patient health, and donor availability. Recent publications provide additional information on the long-term efficacy and toxicity of both treatments. Prospective studies with long-term follow-up are needed to put these and newer treatments in proper perspective.