Abstract |
First-line therapy of severe aplastic anemia (SAA) with high-dose cyclophosphamide causes toxicity and increased short-term mortality. We investigated cyclophosphamide at a lower, more moderate dose in combination with aggressive supportive care to determine whether severe infections might be avoided and hematologic outcomes defined for this regimen. From 2010 to 2012, 22 patients received cyclophosphamide at 120 mg/kg plus cyclosporine and antibacterial, antiviral, and antifungal prophylaxis. Toxicity was considerable, mainly due to prolonged absolute neutropenia, which occurred regardless of pretherapy blood counts, and persisted an average of 2 months. Granulocyte transfusions for uncontrolled infection were required in 5 patients, confirmed fungal infections were documented in 6, and 9 patients died. Nine patients (41%) responded at 6 months. After a median follow-up of 2.2 years, relapse occurred in 2 patients, and cytogenetic abnormalities (including monosomy 7) were observed in 4 patients. Although cyclophosphamide has activity in SAA, its toxicity is not justified when far less dangerous alternatives are available. This trial was registered at www.clinicaltrials.gov as #NCT01193283.
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Authors | Phillip Scheinberg, Danielle Townsley, Bogdan Dumitriu, Priscila Scheinberg, Barbara Weinstein, Maithili Daphtary, Olga Rios, Colin O Wu, Neal S Young |
Journal | Blood
(Blood)
Vol. 124
Issue 18
Pg. 2820-3
(Oct 30 2014)
ISSN: 1528-0020 [Electronic] United States |
PMID | 25185712
(Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Intramural)
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Chemical References |
- Cyclophosphamide
- Voriconazole
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Topics |
- Anemia, Aplastic
(drug therapy)
- Child
- Clone Cells
- Cyclophosphamide
(administration & dosage, adverse effects, therapeutic use)
- Dose-Response Relationship, Drug
- Humans
- Neutropenia
(chemically induced)
- Recurrence
- Survival Rate
- Voriconazole
(therapeutic use)
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