title: Combined use of Chinese medicine with allogeneic hematopoietic stem cell transplantation for severe aplastic anemia patients.
abstract: OBJECTIVE
  To determine the effect of combined treatment with Chinese medicine (CM) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) on patients with severe aplastic anemia (SAA).
  
  
  METHODS
  Eleven patients were treated with CM plus allo-HSCT. Nine patients received a conditioning regimen consisting of fludarabine (Flu), anti-thymocyte globulin (pig ALG), or anti-lymphocyte globulin (Rabbit ATG) and cyclophosphamide (CY), and two patients received pig ALG and CY. All patients were treated with Kidney (Shen)-reinforcing, blood-activating, and stasis-removing (KBS) herbal preparation beginning at 1 week before transplantation and ending at 8 weeks after transplantation. Chimerism status was assessed by analyzing short tandem repeat (STR) polymorphisms.
  
  
  RESULTS
  All patients recovered hematopoietic function and none had graft failure. The median number of days required for the absolute neutrophil count (ANC) increased to >0.5×10(9)/L was 15 days (12-22 days) and for spontaneous platelet recovery to >20×10(9)/L without post-transplantation transfusion was 17 days (15-27 days). Nine patients were long-term survivors and achieved full donor chimerism. The overall cumulative incidence of acute graft versus host disease (GVHD) grades I-II and III-IV was 18.2% (2/11) and 9.1% (1/11), respectively. The overall accumulated incidence of chronic GVHD was 27.3% and all patients had limited chronic GVHD. At a median follow-up time of 32 months (range: 12-97 months), 9 patients were still alive. The estimated 5-year overall survival (OS) rate was 81.8%. The incidence of treatment-related mortality, 2-year post-transplantation, was 18.2%. Two patients died from GVHD after transplantation.
  
  
  CONCLUSIONS
  Treatment with the KBS formulation may reduce the rate of graft failure and treatment-related mortality and improve the rate of OS in SAA patients with allo-HSCT.
authors.affiliation: Hematology Department, The First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310006, China, 13588453501@163.com.
authors.forename: Bao-Dong
authors.initials: BD
authors.lastname: Ye
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhang
authors.forename: Ke-Ding
authors.initials: KD
authors.lastname: Shao
authors.forename: Dan
authors.initials: D
authors.lastname: Chen
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Di-Jiong
authors.initials: DJ
authors.lastname: Wu
authors.forename: Qing-Hong
authors.initials: QH
authors.lastname: Yu
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Shen
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Shen
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy*; D000818:Animals; D002648:Child; D003131:Combined Modality Therapy; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D034421:Sus scrofa; D013577:Syndrome; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal