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A fludarabine and melphalan reduced-intensity conditioning regimen for HSCT in fifteen chronic granulomatous disease patients and a literature review. Ann Hematol 2022; 101:869-880. [DOI: 10.1007/s00277-022-04751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 12/22/2021] [Indexed: 11/01/2022]
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2
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Timing of Alemtuzumab With Respect to Day of Bone Marrow Infusion and its Effects Upon Engraftment and Graft-Versus-Host Disease in Patients With Sickle Cell Disease: A Single-Institutional Study. J Pediatr Hematol Oncol 2020; 42:e718-e722. [PMID: 32890079 DOI: 10.1097/mph.0000000000001930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The possible impact of "late" alemtuzumab (administered on days -10 to -8) versus "early" alemtuzumab (-19 to -17) with respect to engraftment and acute/chronic graft-versus-host disease (GvHD) in a group of 25 pediatric patients with sickle cell disease undergoing bone marrow transplantation following conditioning with alemtuzumab, fludarabine, and melphalan is reported. The first 9 patients received "late" alemtuzumab followed by bone marrow transplantation from HLA-matched sibling donors. The next 16 patients undergoing matched sibling transplants received "early" alemtuzumab. In the "late" group, 1 patient (11%) developed acute GvHD. Six patients (67%) achieved sustained engraftment. Three patients (33%) experienced graft rejection, leading to termination of enrollment of patients on this regimen. In the "early" alemtuzumab group, acute and chronic GvHD developed in 43% and 25% patients, respectively. None of the patients experienced graft rejection in this group of patients. Three patients developed stable mixed chimerism and 13 patients demonstrated 100% donor chimerism at 1 year post-transplant and beyond. These results suggest a benefit with respect to engraftment of administering "early" versus "late" alemtuzumab in this reduced-intensity conditioning regimen, however, with the possible cost of an increase in acute, and possibly chronic GvHD.
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Outcome of allogeneic hematopoietic stem cell transplantation for hypoplastic myelodysplastic syndrome. Int J Hematol 2020; 112:825-834. [PMID: 32803698 DOI: 10.1007/s12185-020-02969-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022]
Abstract
The prognosis of patients with hypoplastic myelodysplastic syndrome (hMDS) after receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. This study aimed to evaluate the outcomes of patients with hMDS after allo-HSCT. Between September 2013 and October 2019, a total of 20 consecutive patients with hMDS and 1 patient with clonal cytopenia of undermined significance (CCUS) who underwent allo-HSCT, which included procedures with 9 matched sibling donors, 2 matched unrelated donors, 4 mismatched unrelated donors and 6 haploidentical donors, were enrolled in this study. The median time for myeloid engraftment was 11 days (range 9-17 days), and that for platelet engraftment was 10 days (range 7-17 days). The cumulative incidence (CI) of myeloid and platelet recovery was 95.2 ± 6.0% and 90.5 ± 7.3%, respectively. The CI rates were 40.0 ± 11.3% for grades II-III acute graft-versus-host disease (GVHD), 36.8 ± 11.5% for chronic GVHD and 23.8 ± 9.6% for nonrelapse mortality. No patients experienced relapse. Sixteen surviving patients were followed up for a median of 1113 days (range 110-2305 days), and the overall survival and relapse-free survival rates were both 72.7 ± 10.6%. This limited retrospective analysis suggests that patients with hMDS had a favorable survival after allo-HSCT.
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4
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Kobayashi T, Nannya Y, Ichikawa M, Oritani K, Kanakura Y, Tomita A, Kiyoi H, Kobune M, Kato J, Kawabata H, Shindo M, Torimoto Y, Yonemura Y, Hanaoka N, Nakakuma H, Hasegawa D, Manabe A, Fujishima N, Fujii N, Tanimoto M, Morita Y, Matsuda A, Fujieda A, Katayama N, Ohashi H, Nagai H, Terada Y, Hino M, Sato K, Obara N, Chiba S, Usuki K, Ohta M, Imataki O, Uemura M, Takaku T, Komatsu N, Kitanaka A, Shimoda K, Watanabe K, Tohyama K, Takaori-Kondo A, Harigae H, Arai S, Miyazaki Y, Ozawa K, Kurokawa M. A nationwide survey of hypoplastic myelodysplastic syndrome (a multicenter retrospective study). Am J Hematol 2017; 92:1324-1332. [PMID: 28891083 DOI: 10.1002/ajh.24905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/06/2022]
Abstract
Hypoplastic myelodysplastic syndrome (hMDS) is a distinct entity with bone marrow (BM) hypocellularity and the risk of death from BM failure (BMF). To elucidate the characteristics of hMDS, the data of 129 patients diagnosed between April 2003 and March 2012 were collected from 20 institutions and the central review team of the National Research Group on Idiopathic Bone Marrow Failure Syndromes, and compared with 115 non-hMDS patients. More RA and fewer CMMoL and RAEB-t in French-American-British (FAB) and more RCUD and MDS-U and fewer RCMD in World Health Organization (WHO) classifications were found in hMDS than non-hMDS with significant differences. The overall survival (OS) and AML progression-free survival (AML-PFS) of hMDS were higher than those of non-hMDS, especially in patients at age ≥50 and of lower risk in Revised International Prognostic Scoring System (IPSS-R). In competing risks analysis, hMDS exhibited decreased risk of AML-progression in lower IPSS or IPSS-R risk patients, and higher risk of death from BMF in patients at age ≥50. Poor performance status (PS ≥2) and high karyotype risks in IPSS-R (high and very high) were significant risk factors of death and AML-progression in Cox proportional hazards analysis.
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Affiliation(s)
- Takashi Kobayashi
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yasuhito Nannya
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Motoshi Ichikawa
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Kenji Oritani
- Department of Hematology and Oncology; Graduate School of Medicine, Osaka University; Osaka Japan
| | - Yuzuru Kanakura
- Department of Hematology and Oncology; Graduate School of Medicine, Osaka University; Osaka Japan
| | - Akihiro Tomita
- Department of Hematology and Oncology; Nagoya University Graduate School of Medicine; Nagoya Japan
- Department of Hematology; Fujita Health University School of Medicine; Aichi Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Masayoshi Kobune
- Department of Medical Oncology and Hematology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Junji Kato
- Department of Medical Oncology and Hematology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Hiroshi Kawabata
- Department of Hematology and Oncology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Motohiro Shindo
- Division of Gastroenterology and Hematology/Oncology; Department of Medicine, Asahikawa Medical University; Asahikawa Japan
| | | | - Yuji Yonemura
- Department of Transfusion Medicine and Cell Therapy; Kumamoto University Hospital; Kumamoto Japan
| | - Nobuyoshi Hanaoka
- Department of Hematology/Oncology; Wakayama Medical University; Wakayama Japan
| | - Hideki Nakakuma
- Department of Hematology/Oncology; Wakayama Medical University; Wakayama Japan
| | - Daisuke Hasegawa
- Department of Pediatrics; St. Luke's International Hospital; Tokyo Japan
| | - Atsushi Manabe
- Department of Pediatrics; St. Luke's International Hospital; Tokyo Japan
| | - Naohito Fujishima
- Division of Blood Transfusion; Akita University Hospital; Akita Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology; Okayama University Hospital; Okayama Japan
| | - Mitsune Tanimoto
- Department of Hematology and Oncology; Okayama University Hospital; Okayama Japan
| | - Yasuyoshi Morita
- Division of Hematology and Rheumatology; Department of Internal Medicine, Kindai University Faculty of Medicine; Osaka-Sayama Japan
| | - Akira Matsuda
- Department of Hemato-Oncology; Saitama International Medical Center, Saitama Medical University; Hidaka, Saitama Japan
| | - Atsushi Fujieda
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu, Mie Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu, Mie Japan
| | - Haruhiko Ohashi
- Clinical Research Center; National Hospital Organization Nagoya Medical Center; Nagoya Japan
| | - Hirokazu Nagai
- Department of Hematology; National Hospital Organization Nagoya Medical Center; Nagoya Japan
| | - Yoshiki Terada
- Hematology, Graduate School of Medicine; Osaka City University; Osaka Japan
| | - Masayuki Hino
- Hematology, Graduate School of Medicine; Osaka City University; Osaka Japan
| | - Ken Sato
- Division of Hematology; Department of Internal Medicine, National Defense Medical College; Saitama Japan
| | - Naoshi Obara
- Department of Hematology; Faculty of Medicine, University of Tsukuba; Tsukuba Ibaraki Japan
| | - Shigeru Chiba
- Department of Hematology; Faculty of Medicine, University of Tsukuba; Tsukuba Ibaraki Japan
| | - Kensuke Usuki
- Department of Hematology; NTT Medical Center Tokyo; Tokyo Japan
| | - Masatsugu Ohta
- Department of Hematology; Fukushima Medical University Aizu Medical Center; Fukushima Japan
| | - Osamu Imataki
- Division of Hematology; Department of Internal Medicine, Faculty of Medicine, Kagawa University; Kagawa Japan
| | - Makiko Uemura
- Division of Hematology; Department of Internal Medicine, Faculty of Medicine, Kagawa University; Kagawa Japan
| | - Tomoiku Takaku
- Department of Hematology; Juntendo University School of Medicine; Tokyo Japan
| | - Norio Komatsu
- Department of Hematology; Juntendo University School of Medicine; Tokyo Japan
| | - Akira Kitanaka
- Department of Gastroenterology and Hematology; Faculty of Medicine, University of Miyazaki; Miyazaki Japan
| | - Kazuya Shimoda
- Department of Gastroenterology and Hematology; Faculty of Medicine, University of Miyazaki; Miyazaki Japan
| | - Kenichiro Watanabe
- Department of Pediatrics; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Kaoru Tohyama
- Department of Laboratory Medicine (Laboratory Hematology); Kawasaki Medical School; Okayama Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Shunya Arai
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yasushi Miyazaki
- Department of Hematology; Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Keiya Ozawa
- Division of Hematology; Jichi Medical University; Tochigi Japan
- IMSUT Hospital; The Institute of Medical Science, The University of Tokyo; Tokyo Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
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5
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Marsh RA, Rao MB, Gefen A, Bellman D, Mehta PA, Khandelwal P, Chandra S, Jodele S, Myers KC, Grimley M, Dandoy C, El-Bietar J, Kumar AR, Leemhuis T, Zhang K, Bleesing JJ, Jordan MB, Filipovich AH, Davies SM. Experience with Alemtuzumab, Fludarabine, and Melphalan Reduced-Intensity Conditioning Hematopoietic Cell Transplantation in Patients with Nonmalignant Diseases Reveals Good Outcomes and That the Risk of Mixed Chimerism Depends on Underlying Disease, Stem Cell Source, and Alemtuzumab Regimen. Biol Blood Marrow Transplant 2015; 21:1460-70. [PMID: 25865646 DOI: 10.1016/j.bbmt.2015.04.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
Alemtuzumab, fludarabine, and melphalan reduced-intensity conditioning (RIC) regimens are increasingly used for the hematopoietic cell transplantation (HCT) of pediatric and young adult patients with nonmalignant diseases. Early experience suggests that these regimens are associated with good survival but a high incidence of mixed chimerism, which we have previously shown to be influenced by the alemtuzumab schedule. We hypothesized that the underlying diagnosis and donor graft source would also affect the development of mixed chimerism and that the majority of patients would survive RIC HCT without graft loss. To examine this, we conducted a retrospective study of 206 patients with metabolic diseases, non-Fanconi anemia marrow failure disorders, and primary immune deficiencies who underwent 210 consecutive RIC HCT procedures at Cincinnati Children's Hospital. Ninety-seven percent of the patients engrafted. Mixed donor and recipient chimerism developed in 46% of patients. Patients with marrow failure had a low risk of mixed chimerism (hazard ratio [HR], .208; 95% confidence interval [CI], .061 to .709; P = .012). The risk of mixed chimerism was high in patients who received a cord blood graft (HR, 3.122; 95% CI, 1.236 to 7.888; P = .016). As expected, patients who received a proximal or higher dose per kilogram of alemtuzumab schedule also experienced higher rates of mixed chimerism (all HR > 2, all P < .05). At the time of last follow-up (median, 654 days; range, 13 to 3337), over 75% of patients had greater than 90% whole blood donor chimerism. A second transplantation was performed in 5% of patients. Three-year survival without retransplantation was 84% (95% CI, 71% to 98%) for patients who underwent transplantation with an HLA-matched sibling donor. Survival without retransplantation was negatively affected by lack of a matched related donor, increasing age, and development of grades III and IV acute graft-versus-host disease. We conclude that alemtuzumab, fludarabine, and melphalan RIC HCT offers good results for many patients and that the risk of developing mixed chimerism is influenced by underlying diagnosis, graft source, and alemtuzumab dosing.
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Affiliation(s)
- Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Marepalli B Rao
- Division of Epidemiology and Biostatistics, Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Aharon Gefen
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Denise Bellman
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Parinda A Mehta
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Pooja Khandelwal
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Grimley
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Javier El-Bietar
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashish R Kumar
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tom Leemhuis
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kejian Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jack J Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael B Jordan
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexandra H Filipovich
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Tan YM, Fu HR, Luo Y, Shi JM, Ye XJ, Zheng YL, Xiao HW, Hu YX, Huang H. Haploidentical allogeneic haematopoietic stem cell transplantation as salvage therapy for engraftment failure after unrelated and autologous stem cell transplantation: a case report and review of the literature. J Int Med Res 2011; 39:950-9. [PMID: 21819729 DOI: 10.1177/147323001103900330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Engraftment failure is a rare but life-threatening complication of haematopoietic stem cell transplantation (HSCT) and treatment of this condition is often challenging. This case report describes a patient with acute myeloid leukaemia and engraftment failure after unrelated donor allogeneic stem cell transplantation. Rescue treatment with granulocyte-colony stimulating factor and reinfusion of autologous 'back-up' stem cells failed, but transplantation of haploidentical donor stem cells following a fludarabine and antithymocyte globulin (ATG)-based conditioning regimen resulted in haematological reconstitution and long-term disease-free survival. The use of haploidentical donor stem cell transplantation as salvage therapy after engraftment failure in adult patients has not, to the authors' knowledge, been previously reported. Additionally, a review of the relevant literature is presented. This case report and literature review suggest that reinfusion of cryopreserved 'back-up' haematopoietic stem cells is a safe and effective salvage therapy for engraftment failure after allogeneic HSCT. Haploidentical donor stem cell transplantation after a fludarabine and ATG-based conditioning regimen could provide effective second-line therapy in adult patients.
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Affiliation(s)
- Y-M Tan
- Bone Marrow Transplantation Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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7
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Liu H, Wang X, Geng L, Tang B, Tong J, Yao W, Wang Z, Sun Z. Successful second transplantation with non-myeloablative conditioning using haploidentical donors for young patients after graft failure following double umbilical cord cell transplantation. Pediatr Transplant 2010; 14:465-70. [PMID: 19732379 DOI: 10.1111/j.1399-3046.2009.01231.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
GF is a common and life-threatening complication of UCBT. Here, we report that successful second transplantation of five patients using G-CSF-mobilized maternal stem cells with non-myeloablative conditioning after GF following double UCBT. The median interval between the two transplants were 38 days. The first transplantation was administered after myeloablative conditioning for hematologic malignancies (n=3), and rabbit ATG in combination with cyclophosphamide for SAA (n=2). The second conditioning consisted of Flu and ATG-based non-myeloablative regimen. All five patients acquired quick and sustained engraftment after the second transplant. Treatment-related toxicity was minimal. Three patients developed acute GVHD (>grade II=1). Three patients developed chronic GVHD (limited=1, extensive=2). Severe infectious episodes were significant but manageable. With a median follow-up of 713 days (592-1127), all patients have currently had an event-free survival. These results indicate that a second transplant with non-myeloablative conditioning using mother as the donor for young patient after GF is feasible.
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Affiliation(s)
- Huilan Liu
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui, China.
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8
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Gómez-Almaguer D, Jaime-Pérez JC, Garza-Rodríguez V, Chapa-Rodríguez A, Tarín-Arzaga L, Herrera-Garza JL, Ruiz-Argüelles GJ, López-Otero A, González-Llano O, Rodríguez-Romo L. Subcutaneous alemtuzumab plus cyclosporine for the treatment of aplastic anemia. Ann Hematol 2009; 89:299-303. [PMID: 19705116 DOI: 10.1007/s00277-009-0816-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 08/09/2009] [Indexed: 11/28/2022]
Abstract
Aplastic anemia (AA) is most frequently due to autoimmune attack on its own stem cells. Alemtuzumab is a monoclonal antibody which recognizes the CD52 antigen on the surface of T and B cells. It has proved useful in autoimmune diseases, lymphoproliferative conditions, and graft versus host disease. Based on its immunosuppressive properties, we treated 14 AA patients with alemtuzumab. Median age was 23 years. Ten milligrams of alemtuzumab were injected subcutaneously each day for five consecutive days. Cyclosporine A was also administered orally at a dose of 2 mg/kg every 12 h for 3 months, and then gradually tapered. Response to alemtuzumab was followed for a median of 20 months. There were eight responses (57.1%), two complete and six partial. Whereas six (42.8%) patients were non-responders. Median complete blood count values on alemtuzumab responders were Hb 13.1 mg/dL, absolute neutrophil count 2.4 x 10(9)/L, and platelets 97.5 x 10(9)/L. A good response was produced in 57% of AA patients with the administration of alemtuzumab, who lacked a stem cell donor.
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Graft-versus-host disease following marrow transplantation for aplastic anemia: different impact of two GVHD prevention strategies. Bone Marrow Transplant 2008; 42:51-6. [PMID: 18372907 DOI: 10.1038/bmt.2008.88] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prevention of GVHD is one of the most desirable goals of BMT in aplastic anemia (AA). We reviewed the medical records of 24 consecutive patients treated with BMT for acquired AA using two different GVHD prevention strategies. Ten patients were given alemtuzumab-based GVHD prophylaxis (50-60 mg in three divided doses on days -8, -7 and -6), and 14 patients were given conventional GVHD prophylaxis with calcineurin inhibitors plus MTX before the introduction of the alemtuzumab-based protocols. The incidence of acute, chronic and 'serious GVHD' was significantly reduced in alemtuzumab-treated patients compared to conventionally treated patients [11 vs 64% (P=0.03), 0 vs 78% (P=0.002) and 0 vs 57% (P=0.007), respectively]. Engraftment time and rates of graft failure appeared similar in the two groups. A significantly higher proportion of alemtuzumab-treated patients developed CMV reactivation compared to control patients (83 vs 12%; P=0.03); none developed CMV disease. The rates of other infectious complications did not appear significantly different. Our data suggest that 50-60 mg of alemtuzumab given according to the current schedule significantly reduces the risk of GVHD without increasing the risk of graft failure or serious infections.
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Kunisaki Y, Takase K, Miyamoto T, Fukata M, Nonami A, Kamezaki K, Kaji Y, Gondo H, Harada M, Nagafuji K. Marked improvement of cardiac function early after non-myeloablative BMT in a heavily transfused patient with severe aplastic anemia and heart failure. Bone Marrow Transplant 2007; 40:593-5. [PMID: 17618320 DOI: 10.1038/sj.bmt.1705764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Armand P, Antin JH. Allogeneic stem cell transplantation for aplastic anemia. Biol Blood Marrow Transplant 2007; 13:505-16. [PMID: 17448909 DOI: 10.1016/j.bbmt.2007.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 02/12/2007] [Indexed: 11/18/2022]
Abstract
Aplastic anemia encompasses a heterogeneous group of diseases with distinct pathophysiologies and a common clinical endpoint of marrow failure. Patients with severe aplastic anemia can be treated with immunosuppressive therapy (IST) or hematopoietic stem cell transplantation (HSCT). Over the last 30 years, advances in both treatment modalities have significantly improved the prognosis for this disease; yet this evolution complicates the central therapeutic question in aplastic anemia: which patients should receive IST and which ones should receive HSCT as front-line therapy? In this review, we describe the major improvements that have occurred in transplantation for aplastic anemia in the last 3 decades. We then outline a framework for deciding which patients should be considered for upfront transplantation.
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Affiliation(s)
- Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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13
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George B, Mathews V, Viswabandya A, Kavitha ML, Srivastava A, Chandy M. Fludarabine and cyclophosphamide based reduced intensity conditioning (RIC) regimens reduce rejection and improve outcome in Indian patients undergoing allogeneic stem cell transplantation for severe aplastic anemia. Bone Marrow Transplant 2007; 40:13-8. [PMID: 17450183 DOI: 10.1038/sj.bmt.1705669] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Thirty-five patients (25 men and 10 women) with a median age of 20 years with severe aplastic anaemia (SAA) underwent HLA identical stem cell transplantation (HSCT) using a combination of fludarabine and cyclophosphamide +/- anti-thymocyte globulin between 2004 and 2006. Cyclosporine and mini methotrexate were used as GVHD prophylaxis. Graft source included peripheral blood stem cells (28) or G-CSF stimulated bone marrow (7). Two patients expired < 7 days post-HSCT while 32 (91.5%) patients engrafted with a median neutrophil and platelet engraftment time of 12 days each. Three patients (8.5%) developed veno-occlusive disease while acute GVHD occurred in 29% of evaluable patients, with chronic GVHD in 32%. At a mean follow-up of 22 months, 29 (82.8%) are alive and well. When compared with 26 patients previously transplanted using Cy200/antilymphocyte globulin, there was faster neutrophil engraftment (12 vs 16 days; P = 0.002) with significantly lower rejection rates (2.9 vs 30.7%; P = 0.003) and a superior event-free (82.8 vs 38.4%; P = 0.001) and overall survival (82.8 vs 46.1%; P = 0.005). A combination of fludarabine with cyclophosphamide +/- anti-thymocyte globulin reduces rejection and improves overall and event-free survival in Indian patients undergoing HSCT for severe aplastic anaemia.
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Affiliation(s)
- B George
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India.
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