Unrelated donor bone marrow transplants for severe aplastic anemia with conditioning using total body irradiation and cyclophosphamide.
The outcome of unrelated donor bone marrow transplantation for aplastic anemia is inferior to that of sibling donor bone marrow transplantation because of a higher rate of transplant-related mortality (TRM), which is closely associated with the intensity of pretransplant conditioning to overcome graft rejection. We conducted a prospective trial with an intermediate to high dose of total body irradiation (TBI) in combination with a fixed dose of cyclophosphamide (120 mg/kg) to use for pretransplant conditioning for unrelated donor bone marrow transplantation in adult aplastic anemia. The number of patients who received doses of 1200, 1000, and 800 cGy of TBI were 5, 9, and 26, respectively. The corresponding probabilities of overall survival (OS) at 3 years were 40%, 44%, and 92%, respectively. The incidence of regimen-related toxicity with grade III-IV and graft rejection in the patients who received a dose of 800 cGy of TBI were 0 of 26 patients. The significant factors associated with OS were the TBI dose (800 cGy vs. >or=1000 cGy; P = .001), chronic graft-versus-host disease (less than or equal to limited vs. extensive; P = .013), the method of HLA typing for the donor-recipient matching (serologic typing vs. DNA-based typing; P = .006), and the transfusion amount before transplantation (<or=90 vs. >90 units; P = .020).
Kim
Sung-Yong
SY
Division of Hematology, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, Seoul, Korea.
Lee
Jong-Wook
JW
Lim
Jihyang
J
Cho
Byung-Sik
BS
Eom
Ki-Seong
KS
Kim
Yoo-Jin
YJ
Kim
Hee-Je
HJ
Lee
Seok
S
Min
Chang-Ki
CK
Cho
Seok-Goo
SG
Kim
Dong-Wook
DW
Min
Woo-Sung
WS
Kim
Chun-Choo
CC
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016026:Bone Marrow Transplantation; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014019:Tissue Donors; D014916:Whole-Body Irradiation
D019653:Myeloablative Agonists; D003520:Cyclophosphamide