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Allografting in patients with severe, refractory aplastic anemia using peripheral blood stem cells and a fludarabine‐based conditioning regimen: The Mexican experience
Author(s) -
GómezAlmaguer David,
VelaOjeda Jorge,
JaimePérez José C.,
GutiérrezAguirre César H.,
CantúRodríguez Olga G.,
SobrevillaCalvo Pedro,
RivasVera Silvia,
GómezRangel J. David,
RuizArgüelles Guillermo J.
Publication year - 2006
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.20467
Subject(s) - fludarabine , medicine , cyclophosphamide , gastroenterology , busulfan , surgery , regimen , aplastic anemia , transplantation , thymoglobulin , stem cell , hematopoietic stem cell transplantation , chemotherapy , bone marrow , tacrolimus , biology , genetics
We studied the effectiveness of a fludarabine/cyclophosphamide‐based conditioning regimen without anti‐thymocyte globulin in 23 aplastic anemia patients who had no response to previous conventional pharmacologic treatment. Patients received oral busulphan 4 mg/kg/day/2 days, IV cyclophosphamide 350 mg/m 2 /day/3 days, and fludarabine 30 mg/m 2 /day/3 days. For GVHD prophylaxis, patients received MTX 5 mg/m 2 days +1, +3, +6, and +11 and oral cyclosporin A (CyA) 5 mg/kg/day, starting on day −1. Peripheral blood stem cell products were used with a median dose of 5.5 × 10 6 CD34 + /kg. The patients were followed for an average of 25 months. By a median of day +11, an ANC > 0.5 × 10 9 /L was reached; and by day +12, the platelet count had reached >20,000 × 10 9 /L. Acute grade I–II GVHD occurred in 4 patients, whereas limited chronic GVHD presented in 6 cases. Twenty‐one patients (91.3%) achieved engraftment. Two patients failed to engraft, and 4 developed late rejection; 2 of these individuals died, 2 have survived with high transfusion requirements, whereas 2 received a second peripheral blood stem cell infusion and achieved sustained engraftment. Currently 21 (91%) of the 23 patients are alive, whereas 19 of 21 (90%) remain in complete remission. The average cost was about USD 15,000 for this kind of reduced‐intensity allotransplant. Reduced‐intensity stem cell transplantation represents an affordable alternative to traditional more cytotoxic conditioning for severe aplastic anemia (SAA) patients. Long‐term effects however, remain to be evaluated. Am. J. Hematol. 81:157–161, 2006. © 2006 Wiley‐Liss, Inc.