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The use of a fludarabine‐based conditioning regimen in patients with severe aplastic anemia – a retrospective analysis from three I ndian centers
Author(s) -
George Biju,
Mathews Vikram,
Lakshmi Kavitha M.,
Melinkeri Sameer,
Sharma Ajay,
Viswabandya Auro,
Sharma Sanjeevan,
Das Satyaranjan,
Ahmed Rayaz,
Abraham Aby,
Nair Velu,
Apte Shashikant,
Chandy Mammen,
Srivastava Alok
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12263
Subject(s) - medicine , fludarabine , cyclophosphamide , aplastic anemia , gastroenterology , surgery , hematopoietic stem cell transplantation , transplantation , bone marrow , chemotherapy
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 I ndian 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 .