title: Allogeneic stem cell transplantation for severe acquired aplastic anaemia using a fludarabine-based preparative regimen.
abstract: We reviewed our experience in the treatment of 13 patients with severe acquired aplastic anaemia, using a newly developed non-myeloablative regimen consisting of fludarabine (total dose 180 mg/m2), cyclophosphamide (total dose 120 mg/kg), and antithymocyte globulin (total dose 40 mg/kg). All except one patient received multiple transfusions and had failed prior immunosuppressive treatment. Twelve out of 13 patients achieved sustained engraftment. One patient was not evaluable for engraftment because of early death on day +10. None of the patients developed graft failure. Mucositis of mild-to-moderate severity was the only observed regimen-related toxicity. The cumulative incidence of acute graft-versus-host disease (GvHD) grade II-IV and III-IV was 8.3% and 0%, respectively. With a median follow-up period of 45 months, the 5-year overall survival probability was 84%. Eight out of 11 surviving patients have been followed for more than 1 year and only one developed limited chronic GvHD. All patients enjoy a normal life style, with a Karnofsky score of 100%, and all except three, followed for 3, 5 and 6 months respectively, are free of any immunosuppressive medication. The results of this study look promising, while prospective clinical trials may be required to confirm the benefits of this regimen as an alternative to existing protocols.
authors.affiliation: Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Igor B
authors.initials: IB
authors.lastname: Resnick
authors.forename: Memet
authors.initials: M
authors.lastname: Aker
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Shapira
authors.forename: Panagiotis D
authors.initials: PD
authors.lastname: Tsirigotis
authors.forename: Menachem
authors.initials: M
authors.lastname: Bitan
authors.forename: Ali
authors.initials: A
authors.lastname: Abdul-Hai
authors.forename: Simcha
authors.initials: S
authors.lastname: Samuel
authors.forename: Aliza
authors.initials: A
authors.lastname: Ackerstein
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gesundheit
authors.forename: Irina
authors.initials: I
authors.lastname: Zilberman
authors.forename: Svetlana
authors.initials: S
authors.lastname: Miron
authors.forename: Luba
authors.initials: L
authors.lastname: Yoffe
authors.forename: Alex
authors.initials: A
authors.lastname: Lvovich
authors.forename: Shimon
authors.initials: S
authors.lastname: Slavin
authors.forename: Reuven
authors.initials: R
authors.lastname: Or
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced; D009894:Opportunistic Infections / Q000209:etiology; D010865:Pilot Projects; D011788:Quality of Life; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine