¹Department of Hematology 2, Azienda Ospedaliera Universitaria San Martino, Largo Benzi, Genova, Italy

Correspondence: Dr A Bacigalupo, Department of Hematology 2, Azienda Ospedaliera Universitaria San Martino, Largo Benzi 10, Genova 16132, Italy. E-mail: andrea.bacigalupo@hsanmartino.it

Received 19 April 2005; Accepted 9 July 2005; Published online 3 October 2005.

Abstract

We have developed a reduced-intensity conditioning regimen for patients with severe aplastic anemia (SAA) undergoing alternative donor transplants, which includes fludarabine (120 mg/m²), cyclophosphamide (1200 mg/m²) and antithymocyte globulin (7.5 mg/kg). Graft-versus-host disease (GvHD) prophylaxis consisted of cyclosporine and methotrexate. We have enrolled 38 SAA patients in this trial: median age of 14 (3–37) years, transplanted from unrelated (n=33) or family mismatched (n=5) donors, with unmanipulated marrow (n=36) or peripheral blood (n=2). Seven patients (18%) had evidence of graft failure, 11% developed grade II–III acute GvHD and 27% developed chronic GvHD. The actuarial 2-year survival is 73%, with a median follow-up of 621 days. Younger patients (14 years) had a lower risk of rejection (5%) and improved actuarial survival (84%). Causes of death were infections (n=3), graft failure (n=2), Epstein–Barr virus lymphoma (n=2) and hemorrhage (n=2). In conclusion, the actuarial 2-year survival is encouraging in young SAA patients receiving a radiation-free conditioning regimen. The significant risk of graft failure in patients 15 years or older may require modification of the conditioning regimen in adults.