1. ¹Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
2. ²Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India

Correspondence: Professor R Kumar, Department of Hematology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail: rajatkr@hotmail.com

Received 8 December 2005; Revised 26 January 2006; Accepted 27 January 2006; Published online 6 March 2006.

Abstract

Multiply transfused patients of severe aplastic anemia are at increased risk of graft rejection. Five such patients underwent peripheral blood stem cell transplantation from HLA-identical siblings with a fludarabine-based protocol. The conditioning consisted of fludarabine 30 mg/m²/day 6 days, cyclophosphamide 60 mg/kg/day 2 days and horse antithymocyte globulin (ATG) 4 days. Two different ATG preparations were used: ATGAM (dose 30 mg/kg/day 4 days) or Thymogam (dose 40 mg/kg/day 4 days). Engraftment: median time to absolute neutrophil count (ANC) >0.5 10⁹/l was 11 days (range: 8–17) and median time to platelet count >20 10⁹/l was 11 days (range: 9–17). At a median follow-up of 171 days (range: 47–389), there has been no graft rejection and all patients are in complete remission. Acute GVHD (grade 1) occurred in one patient only. Chronic GVHD developed in two patients (extensive in one and limited in another). The transplants were performed in non-HEPA filter rooms. In only one patient, systemic antifungal therapy (voriconazole) was used. The use of Thymogam brand of ATG for conditioning is being reported for the first time. Our experience suggests that this fludarabine-based protocol allows rapid sustained engraftment in high-risk patients without significant immediate toxicity.