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The combined use of Flu/ATG in nonmyeloablative SCT for severe aplastic anemia with multiple earlier transfusions

Bone Marrow Transplantation volume 43, pages 887–889 (2009)Cite this article

The best treatment for young patients with severe aplastic anemia (SAA) is allogeneic hematopoietic SCT (HSCT), which contributes to long-term survival in about 80–90% of cases.1, 2, 3 However, the incidence of acute and chronic GVHD in patients who undergo HSCT with a CY-based regimen is still high, occurring in 24–42 and 25–50% of cases.1, 2, 3 The graft rejection rate is about 5–15%1, 2, 3and even higher in patients who receive transfusion >20 U.4 Fludarabine (Flu) has been found to be effective in T-cell suppression, and is now used worldwide in HSCT for hematologic malignancy and benign hematologic diseases;5 for SAA the rate of hematopoietic cells engraftment and overall survival was 90–95 and 80–95%, respectively.6, 7, 8 There are many articles that advocate the use of combined Flu/CY protocols for HSCT in SAA with multiple earlier transfusions. Here we studied the diverse treatment outcomes associated with the use of Flu-based regimens; we reported five patients diagnosed with SAA who underwent HSCT, using the combination of Flu/antithymocyte globulin (ATG) conditioning regimen.

Four of five patients diagnosed with SAA were referred to our center for consideration for HSCT. Four of the five had failed earlier treatment with immunosuppressants. Three patients were more than 40 years of age. In all cases the diagnosis of SAA was confirmed without evidence of paroxysmal nocturnal hemoglobinurea or myelodysplastic syndrome . The time between diagnosis and HSCT ranged between 2 and 23 months. Two patients received transfusions <50 donor units. In patient #5, HSCT was delayed due to donor recruitment problems. One patient (#5) had a tubo-ovarian abscess with febrile neutropenia for 20 days preceding HSCT. All patients had an HLA-identical sibling. The patients’ characteristics are shown in Table 1.

Table 1 Characteristics of patients with severe aplastic anemia
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References

  1. Kahl C, Leisenring W, Deeg HJ, Chauncey TR, Flowers MD, Martin PJ et al. Cyclophosphamide and antithymocyte globulin as a conditioning regimen for allogeneic marrow transplantation in patients with aplastic anaemia: a long term follow up. Br J Haematol 2005; 130: 747–751.

    Article  CAS  Google Scholar 

  2. Kröger N, Zabelina T, Renges H, Krüger W, Kordes U, Rischewski J et al. Long-term follow-up of allogeneic stem cell transplantation in patients with severe aplastic anemia after conditioning with cyclophosphamide plus antithymocyte globulin. Ann Hematol 2002; 81: 627–631.

    Article  Google Scholar 

  3. Storb R, Blume KG, O’Donnell MR, Chauncey T, Forman SJ, Deeg HJ et al. Cyclophosphamide and antithymocyte globulin to condition patients with aplastic anemia for allogeneic marrow transplantations: the experience in four centers. Biol Blood Marrow Transplant 2001; 7: 39–44.

    Article  CAS  Google Scholar 

  4. Champlin RE, Horowitz MM, van Bekkum DW, Camitta BM, Elfenbein GE, Gale RP et al. Graft failure following bone marrow transplantation for severe aplastic anemia: risk factors and treatment results. Blood 1989; 73: 606–613.

    CAS  PubMed  Google Scholar 

  5. Slavin S, Nagler A, Naparstek E, Kapelushnik Y, Aker M, Cividalli G et al. Non-myeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematological diseases. Blood 1998; 91: 756–763.

    CAS  PubMed  Google Scholar 

  6. Srinivasan R, Takahashi Y, McCoy JP, Delgado IE, Dorrance C, Igarashi T et al. Overcoming graft rejection in heavily transfused and allo-immunised patients with bone marrow failure syndromes using fludarabine-based haematopoietic cell transplantation. Br J Haematol 2006; 133: 305–314.

    Article  CAS  Google Scholar 

  7. Resnick IB, Aker M, Shapira MY, Tsirigotis P, Bitan M, Abdul-Hai A et al. Allogeneic stem cell transplantation for severe acquired aplastic anaemia using a fludarabine-based preparative regimen. Br J Haematol 2006; 133: 649–654.

    Article  CAS  Google Scholar 

  8. Koh LP, Koh MBC, Ng HY, Hwang WYK, Goh YT, Linn YC et al. Allogeneic hematopoietic stem cell transplantation for patients with severe aplastic anemia following nonmyeloablative conditioning using 200-cGy total body irradiation and fludarabine. Biol Blood Marrow Transplant 2006; 12: 887–890.

    Article  CAS  Google Scholar 

  9. George B, Mathews V, Viswabandya A, Kavitha ML, Srivastava A, Chandy MB . Fludarabine and cyclophosphamide based reduced intensity conditioning (RIC) regimens reduce rejection and improve outcome in Indian patients undergoing allogeneic stem cell transplantation for severe aplastic anemia. Bone Marrow Transplant 2007; 40: 13–18.

    Article  CAS  Google Scholar 

  10. Gomez-Almaguer D, Vela-Ojeda J, Jaime-Perez JC, Gutierrez-Aguirre CH, Cantu-Rodrỳguez OG, Sobrevilla-Calvo P et al. Allografting in patients with severe, refractory aplastic anemia using peripheral blood stem cells and a fludarabine-based conditioning Regimen: the Mexican experience. Am J Hematol 2006; 81: 157–161.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    P Niparuck, A Ungkanont & S Jootar

  2. Division of Oncology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. E-mail: pimjai1976@gmail.com,

    T Ativitavas

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  1. P Niparuck
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Niparuck, P., Ungkanont, A., Ativitavas, T. et al. The combined use of Flu/ATG in nonmyeloablative SCT for severe aplastic anemia with multiple earlier transfusions. Bone Marrow Transplant 43, 887–889 (2009). https://doi.org/10.1038/bmt.2008.406

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