Improved outcome of patients older than 30 years receiving HLA-identical sibling hematopoietic stem cell transplantation for severe acquired aplastic anemia using fludarabine-based conditioning: a comparison with conventional conditioning regimen.
Older age is a limitation for HLA-identical sibling hematopoietic stem cell transplantation (HSCT) as first-line therapy for severe acquired idiopathic aplastic anemia (SAA). Fludarabine (Flu)-based conditioning might improve outcome in older patients. We analyzed retrospectively 30 patients older than 30 years receiving such reduced-intensity conditioning HSCT according to recommendations of the European Group for Blood and Marrow Transplantation (EBMT) and compared their outcome to a control group receiving the standard regimen (cyclophosphamide+/-antithymocyte globulin) over the same study period (1998-2007). Patients conditioned with Flu had a higher probability of overall survival than the control group (p=0.04) when adjusting for recipient's age. This might be related to a trend towards a reduced incidence of graft failure in patients receiving Flu (0% vs. 11%, p=0.09), while no difference was observed regarding graft-versus-host disease incidence. Flu-based conditioning regimen may reduce the negative impact of age in older patients with SAA receiving an HLA-identical sibling HSCT.
Maury
Sébastien
S
Service d'Hématologie Clinique, CHU Henri Mondor, 51 avenue du Mal. de Lattre de Tassigny, Créteil cedex, France. sebastien.maury@hmn.aphp.fr
Bacigalupo
Andrea
A
Anderlini
Paolo
P
Aljurf
Mahmoud
M
Marsh
Judith
J
Socié
Gérard
G
Oneto
Rosi
R
Passweg
Jakob R
JR
D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D012189:Retrospective Studies; D035781:Siblings; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine