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09 August 2019 : Original article  

Aplastic Anemia Preconditioned with Fludarabine, Cyclophosphamide, and Anti-Thymocyte Globulin

Dan Yang1BCDEG, Jianmin Yang1AF, Xiaoxia Hu1CF, Jie Chen1EF, Lei Gao1F, Hui Cheng1BC, Gusheng Tang1CD, Yanrong Luo1E, Weiping Zhang1ACDEF*, Jianmin Wang1ACEFG

DOI: 10.12659/AOT.915696

Ann Transplant 2019; 24:461-471

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 AND 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.

Keywords: Anemia, Aplastic, Antineoplastic Combined Chemotherapy Protocols, Peripheral Blood Stem Cell Transplantation, Adolescent, Antilymphocyte Serum, Cyclophosphamide, Transplantation Conditioning, Vidarabine, young adult

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358