Successful engraftment with fludarabine, cyclophosphamide, and thymoglobulin conditioning regimen in unrelated transplantation for severe aplastic anemia: A phase II prospective multicenter study.

Abstract

Antithymocyte globulin (ATG) has been used in severe aplastic anemia (SAA) as part of the conditioning regimen. Among the many kinds of ATG preparations, thymoglobulin had been found to be more effective for preventing graft-versus-host disease (GVHD) and the rejection of organ transplants. After the promising results of our preliminary study, we conducted a phase II prospective multicenter clinical trial using a fludarabine (Flu), cyclophosphamide (Cy), and thymoglobulin conditioning regimen to allow good engraftment in patients who underwent unrelated transplantation for SAA. Twenty-eight patients underwent bone marrow (N = 15) or mobilized peripheral blood (N = 13) transplantation from HLA-matched unrelated donors with Cy (50 mg/kg once daily intravenously (i.v.) on days -9, -8, -7, and -6), Flu (30 mg/m² once daily i.v. on days -5, -4, -3, and -2), and thymoglobulin (2.5 mg/kg once daily i.v. on days -3, -2, and -1). Donor-type hematologic recovery was achieved in all patients. The estimated survival rate (SR) was 67.9%, and all the events were treatment-related mortality (TRM), which included thrombotic microangiopathy (N = 2), pneumonia (N = 1), myocardiac infarction (N = 1), posttransplantation lymphoprolifarative disease (N = 3), and chronic GVHD-associated complications (N = 2). The SR of patients who received bone marrow (60.0%) was not different from that of patients who received mobilized peripheral blood (76.9%) (P = .351), but the SR of patients who received more than 15 units of red blood cells before transplantation (45.5%) was significantly lower than that of the other patients (82.4%) (P = .048). The Flu, Cy, and thymoglobulin conditioning regimen achieved promising results for successful engraftment, but the TRM was high. This study was registered at www.clinicaltrials.gov (NCT00737685), and now we are performing a new multicenter study (NCT00882323) to decrease the TRM by reducing the dose of Cy.

• Authors: Hyoung Jin Kang, Hee Young Shin, Jun Eun Park, Nak Gyun Chung, Bin Cho, Hack Ki Kim, Sun Young Kim, Young Ho Lee, Young Tak Lim, Keon Hee Yoo, Ki Woong Sung, Hong Hoe Koo, Ho Joon Im, Jong Jin Seo, Sang Kyu Park, Hyo Seop Ahn, Korean Society of Pediatric Hematology-Oncology
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 16 Issue 11 Pg. 1582-8 (Nov 2010) ISSN: 1523-6536 [Electronic] United States
• PMID: 20685256 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Antilymphocyte Serum
• Immunosuppressive Agents
• Myeloablative Agonists
• Cyclophosphamide
• thymoglobulin
• Vidarabine
• fludarabine

Topics

• Adolescent
• Adult
• Anemia, Aplastic (therapy)
• Antibodies, Monoclonal (administration & dosage, therapeutic use)
• Antilymphocyte Serum
• Bone Marrow Transplantation (adverse effects, mortality)
• Cell Count
• Child
• Child, Preschool
• Cyclophosphamide (administration & dosage, therapeutic use)
• Cytomegalovirus Infections (epidemiology)
• Erythrocyte Transfusion
• Female
• Graft Survival
• Graft vs Host Disease (epidemiology, prevention & control)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods, mortality)
• Humans
• Immunosuppressive Agents (administration & dosage, therapeutic use)
• Infant
• Leukocyte Count
• Lymphoproliferative Disorders (drug therapy, epidemiology)
• Male
• Myeloablative Agonists (administration & dosage, therapeutic use)
• Neutrophils (cytology)
• Peripheral Blood Stem Cell Transplantation (adverse effects, mortality)
• Prognosis
• Survival Rate
• Transplantation Conditioning (methods)
• Treatment Outcome
• Vidarabine (administration & dosage, analogs & derivatives, therapeutic use)
• Young Adult