title: 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.affiliation: Department of Haematology, Christian Medical College Vellore, Vellore, India.
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: Vikram
authors.initials: V
authors.lastname: Mathews
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Lakshmi
authors.forename: Sameer
authors.initials: S
authors.lastname: Melinkeri
authors.forename: Ajay
authors.initials: A
authors.lastname: Sharma
authors.forename: Auro
authors.initials: A
authors.lastname: Viswabandya
authors.forename: Sanjeevan
authors.initials: S
authors.lastname: Sharma
authors.forename: Satyaranjan
authors.initials: S
authors.lastname: Das
authors.forename: Rayaz
authors.initials: R
authors.lastname: Ahmed
authors.forename: Aby
authors.initials: A
authors.lastname: Abraham
authors.forename: Velu
authors.initials: V
authors.lastname: Nair
authors.forename: Shashikant
authors.initials: S
authors.lastname: Apte
authors.forename: Mammen
authors.initials: M
authors.lastname: Chandy
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D014740:Vidarabine; C024352:fludarabine
keywords: aplastic anemia; fludarabine; survival; transplant