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Yang D, Yang J, Hu X, Chen J, Gao L, Cheng H, Tang G, Luo Y, Zhang W, Wang J. Aplastic Anemia Preconditioned with Fludarabine, Cyclophosphamide, and Anti-Thymocyte Globulin. Ann Transplant 2019; 24:461-471. [PMID: 31395850 PMCID: PMC6705177 DOI: 10.12659/aot.915696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Graft rejection and graft versus host disease (GvHD) have impeded the success of hematopoietic cell transplantation for severe aplastic anemia (SAA) patients. There is no sufficient data to identify the outcomes of peripheral blood stem cell transplantation (PBSCT) in SAA patients, especially for adult SAA patients. The aim of this study was to evaluate the outcomes of adult SAA patients undergoing PBSCT with the FCA regimen. The FCA regimen includes fludarabine, cyclophosphamide, and anti-thymocyte globulin (ATG). Material/Methods We report our experience with 46 adult SAA patients who underwent PBSCT with the FCA regimen. Thirty SAA patients who received only cyclophosphamide and ATG (CA) regimen were used as controls. Complications and survival outcomes were evaluated and compared. Results There was a significantly higher percentage of patients who achieved >95% donor chimerism by day 30 in the FCA group. The 5-year event-free survival (EFS) rate in the FCA group was higher than that in the CA group (95.4% versus 73.3%). In addition, the 5-year rejection rate (RR) in the FCA group was lower than that in the CA group (4.6% versus 23.6%). A multivariable model identified the FCA regimen as an independent factor affecting EFS and RR. However, GvHD and serious infection did not differ between the 2 groups. For patients with an unrelated donor, the FCA regimen had a higher EFS and a lower RR than the CA regimen. Conclusions The FCA regimen for PBSCT in adult SAA patients compared favorably to the CA regimen. It can improve EFS and reduce graft rejection, especially for unrelated donor PBSCT.
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Affiliation(s)
- Dan Yang
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Jianmin Yang
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Xiaoxia Hu
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Jie Chen
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Lei Gao
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Hui Cheng
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Gusheng Tang
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Yanrong Luo
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Weiping Zhang
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
| | - Jianmin Wang
- Department of Hematology, Institute of Hematology of People's Liberation Army (PLA), Changhai Hospital, Shanghai, China (mainland)
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Kumar R, Kimura F, Ahn KW, Hu ZH, Kuwatsuka Y, Klein JP, Pasquini M, Miyamura K, Kato K, Yoshimi A, Inamoto Y, Ichinohe T, Wood WA, Wirk B, Seftel M, Rowlings P, Marks DI, Schultz KR, Gupta V, Dedeken L, George B, Cahn JY, Szer J, Lee JW, Ho AYL, Fasth A, Hahn T, Khera N, Dalal J, Bonfim C, Aljurf M, Atsuta Y, Saber W. Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions. Biol Blood Marrow Transplant 2016; 22:932-40. [PMID: 26797402 DOI: 10.1016/j.bbmt.2016.01.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared with mobilized peripheral blood stem cells (PBSCs). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita and region/countries into 4 groups. Groups analyzed were high-income countries (HIC), which were further divided into United States-Canada (n = 486) and other HIC (n = 1264); upper middle income (UMIC) (n = 482); and combined lower-middle, low-income countries (LM-LIC) (n = 142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared with PBSCs in all countries or BM in UMIC or LM-LIC (P < .001). There was no significant difference in OS between BM and PBSCs in UMIC (P = .32) or LM-LIC (P = .23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSCs compared with BM (97% versus 77%, P = .002). Chronic graft-versus-host disease was significantly higher with PBSCs in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSCs may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.
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Affiliation(s)
- Rajat Kumar
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Fumihiko Kimura
- Division of Hematology, National Defense Medical College, Tokorozawa, Japan
| | - Kwang Woo Ahn
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yachiyo Kuwatsuka
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - John P Klein
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo Pasquini
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Ayami Yoshimi
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - William Allen Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip Rowlings
- Calvary Mater Newcastle, HAPS-Pathology North, University of Newcastle, Callaghan, New South Wales, Australia
| | - David I Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Kirk R Schultz
- BC Children's Hospital and Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Vikas Gupta
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Laurence Dedeken
- Department of Hematology-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
| | - Jong Wook Lee
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | | | - Anders Fasth
- Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Theresa Hahn
- Roswell Park Cancer Institute, Buffalo, New York
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Jignesh Dalal
- Rainbow Babies & Children's Hospital/Case Western Reserve University, Cleveland, Ohio
| | - Carmem Bonfim
- Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation and Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wael Saber
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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