The use of a fludarabine-based conditioning regimen in patients with severe aplastic anemia--a retrospective analysis from three Indian centers.

Abstract

Between 2001 and 2009, 121 patients with severe aplastic anemia (SAA) underwent hematopoietic stem cell transplantation (HSCT) using a conditioning protocol of fludarabine and cyclophosphamide at three Indian hospitals. Donors were HLA-identical sibling or family donors. Seventy-six patients were considered "high risk" as per criteria. The graft source included peripheral blood stem cells in 109 and G-CSF-stimulated bone marrow in 12. GVHD prophylaxis consisted of cyclosporine and mini-methotrexate. Engraftment occurred in 117 (96.6%) while two had graft failure and two expired in the first two wk. Neutrophil engraftment was seen at 12.3 d (range: 9-19) while platelet engraftment occurred at 12.4 d (range: 8-32). Grade II-IV acute GVHD was seen in 26.7% and grade IV GVHD in 8.6%. Chronic GVHD occurred in 44% and was extensive in 10%. The five-yr overall survival for the entire cohort is 75.8 ± 3.9% with a survival of 95.6 ± 3.1% in the low-risk group (n = 45) and 64.0 ± 5.6% in the high-risk group (n = 76). Conditioning with fludarabine and cyclophosphamide is associated with very good long-term survival in patients undergoing HSCT for SAA.

• Authors: Biju George, Vikram Mathews, Kavitha M Lakshmi, Sameer Melinkeri, Ajay Sharma, Auro Viswabandya, Sanjeevan Sharma, Satyaranjan Das, Rayaz Ahmed, Aby Abraham, Velu Nair, Shashikant Apte, Mammen Chandy, Alok Srivastava
• Journal: Clinical transplantation (Clin Transplant) 2013 Nov-Dec Vol. 27 Issue 6 Pg. 923-9 ISSN: 1399-0012 [Electronic] Denmark
• PMID: 24304374 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antineoplastic Agents
• Immunosuppressive Agents
• Vidarabine
• fludarabine

Topics

• Adolescent
• Adult
• Anemia, Aplastic (etiology, mortality, therapy)
• Antineoplastic Agents (therapeutic use)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Graft Survival
• Graft vs Host Disease (etiology, mortality, therapy)
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunosuppressive Agents (therapeutic use)
• India
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors
• Survival Rate
• Transplantation Conditioning
• Vidarabine (analogs & derivatives, therapeutic use)
• Young Adult