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Fludarabine based conditioning chemotherapy For Allogeneic Hematopoietic Stem Cell Transplantation in acquired Severe Aplastic Anemia.

Author(s): Al-Zahrani H, Nassar A, Al-Mohareb F, Al-Sharif F, Mohamed S, Al-Anazi K, Patel M, Rasheed W, Saleh AJ, Bakr M, Ahmed S, Ibrahim K, Hussain F, Elkum N, Elhassan T, Nurgat Z, Chaudhri N, Aljurf M

Affiliation(s): Adult HSCT Program KingFaisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.

Publication date & source: 2010-08-21, Biol Blood Marrow Transplant., [Epub ahead of print]

Thirty eight patients who met the criteria of severe aplastic anemia were transplanted. Median age was 20 (14-36) years. 24 patients were treatment naive, 11 failed one or more previous immune suppressive therapy and 3 failed a previous HSCT. Conditioning regimen included Fludarabine 30mg/m(2)/day for 3 days (-9, -8, -7) and cyclophosphamide 50mg/kg/day for 4 days (-5, -4, -3, -2). GVHD prophylaxis consisted of Cyclosporine and short course Methotrexate. All patients were transplanted with unmanipulated bone marrow as the stem cell source. The median total nucleated cell (TNC) dose was 2.43 (0.60 - 6.7) X 10(8)/ kg. The conditioning regimen was well tolerated with minimal TRM. Engraftment was observed in all the patients after transplant. The median time for engraftment of neutrophils and platelets were 18 and 23 days respectively. 25 out of 27patients with available chimeric study at day 180 maintained donor chimerism. Acute GVHD >/= grade II was diagnosed in 4 (11%) patients. Extensive chronic GVHD was observed in 8 (25%) of patients who survived beyond day +100 at a median observation of 43 month. Graft rejection with relapse of aplais was observed in one patient only. The overall survival (OS) for the whole group was 79%. A trend of improved OS was observed in treatment naive patients (83% Vs 71%) but this was statistically insignificant (P= 0.384). The Fludarabine-based conditioning regimen used in this study with relatively young cohort of patients was well tolerated with low rate of rejection and treatment outcomes comparable to other more intense and potentially more toxic conditioning regimens. However, the above results need to be validated in a larger study, optimally in a randomized controlled manner. Copyright (c) 2010. Published by Elsevier Inc.

Page last updated: 2010-10-05

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