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Conditioning Regimens

Fludarabine, cyclophosphamide and anti-thymocyte globulin for alternative donor transplants in acquired severe aplastic anemia: a report from the EBMT-SAA Working Party

Bone Marrow Transplantation volume 36, pages 947–950 (2005)Cite this article

Summary:

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.

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Acknowledgements

This work was supported by Associazione Italiana Ricerca contro il Cancro (AIRC) Milano grant to AB and Associazione Ricerca Trapianto Midollo Osseo (ARITMO), Fondazione Cassa di Risparmio di Genova (CARIGE), Genova.

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

    A Bacigalupo, F Locatelli, E Lanino, J Marsh, G Socié, S Maury, A Prete, A Locasciulli, S Cesaro & J Passweg

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  1. A Bacigalupo
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  2. F Locatelli
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  3. E Lanino
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for the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation (SAA WP-EBMT)

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Correspondence to A Bacigalupo.

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Bacigalupo, A., Locatelli, F., Lanino, E. et al. Fludarabine, cyclophosphamide and anti-thymocyte globulin for alternative donor transplants in acquired severe aplastic anemia: a report from the EBMT-SAA Working Party. Bone Marrow Transplant 36, 947–950 (2005). https://doi.org/10.1038/sj.bmt.1705165

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