Fludarabine-based regimen allows sustained engraftment without immediate toxicity

06-06-2006

A fludarabine-based regimen allows sustained engraftment without immediate toxicity.

According to a study from India, "Multiply transfused patients of severe aplastic anemia are at increased risk of graft rejection. Five such patients underwent peripheral blood stem cell transplantation from HLA-identical siblings with a fludarabine-based protocol.

"The conditioning consisted of fludarabine 30 mg/m2/day x 6 days, cyclophosphamide 60 mg/kg/day x 2 days and horse antithymocyte globulin (ATG) x 4 days. Two different ATG preparations were used: ATGAM (dose 30 mg/kg/day x 4 days) or Thymogam (dose 40 mg/kg/day x 4 days)."

"Engraftment: median time to absolute neutrophil count (ANC) >0.5x109/L was 11 days (range: 8-17) and median time to platelet count 420x109/L was 11 days (range: 9-17).

"At a median follow-up of 171 days (range: 47-389), there has been no graft rejection and all patients are in complete remission. Acute GVHD (grade 1) occurred in one patient only. Chronic GVHD developed in two patients (extensive in one and limited in another)," reported investigators.

R. Kumar and colleagues at the All India Institute of Medical Sciences in New Delhi continued, "The transplants were performed in non-HEPA filter rooms. In only one patient, systemic antifungal therapy (voriconazole) was used."

"The use of Thymogam brand of ATG for conditioning is being reported for the first time. Our experience suggests that this fludarabine-based protocol allows rapid sustained engraftment in high-risk patients without significant immediate toxicity," concluded researchers.

Kumar and colleagues published their study in Bone Marrow Transplantation (Fludarabine, cyclophosphamide and horse antithymocyte globulin conditioning regimen for allogeneic peripheral blood stem cell transplantation performed in non-HEPA filter rooms for multiply transfused patients with severe aplastic anemia. Bone Marrow Transplant, 2006;37(8):745-749).

For more information, contact R. Kumar, All India Institute Med Science, Dept. Hematology, New Delhi 110029, India.

Publisher contact information for the journal Bone Marrow Transplantation is: Nature Publishing Group, Macmillan Building, 4 Crinan St., London N1 9XW, England.

Keywords: New Delhi, India, Peripheral Blood Stem Cell Transplantation, Fludarabine, Severe Aplastic Anemia, Rapid Engraftment, Toxicity Reduction.

This article was prepared by Hematology Week editors from staff and other reports. Copyright 2006, Hematology Week via NewsRx.com.