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Successful bone marrow transplantation in sensitized aplastic anemia patients using total lymphoid irradiation for conditioning: long‐term follow‐up
Author(s) -
Zapatero Almudena,
Marín Alicia,
López Mario,
Martín De Vidales Carmen,
Cerezo Laura,
Domínguez Pedro,
Pérez Torrubia Armando
Publication year - 1996
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/(sici)1099-1069(199612)14:4<165::aid-hon587>3.0.co;2-u
Subject(s) - medicine , aplastic anemia , cyclophosphamide , immunosuppression , surgery , incidence (geometry) , gastroenterology , methotrexate , bone marrow , transplantation , bone marrow transplantation , radiation therapy , anemia , chemotherapy , physics , optics
Between June 1986 and November 1994, 22 previously transfused patients with severe aplastic anemia (SAA) were treated with high‐dose cyclophosphamide (CY) (50 mg/kg over 4 consecutive days) and 7 Gy total lymphoid irradiation (TLI) in two fractions before allogeneic bone marrow transplantation (BMT) from HLA‐identical sibling. Graft‐versus‐host‐disease (GVHD) prophylaxis included the combination of methotrexate and cyclosporine A in all cases. Actuarial survival at 5 years is 73±9 per cent for the entire group and 86±13 per cent for the seven patients ⩽18 years. The incidence of graft failure was 0 per cent, and of acute GVHD and chronic GVHD was 31·5 per cent and 24 per cent respectively. Prolonged interval from diagnosis to BMT adversely influenced survival ( P =0·03). No hypothyroidism or secondary malignancies have been documented in this series. Our findings indicate that survival with CY‐TLI is comparable to that obtained using preparative regimens without radiation. The changing role of radiotherapy in pretransplant immunosuppression for SAA is discussed. © 1996 John Wiley & Sons, Ltd.