Marrow transplantation from unrelated donors iudt in patients with aplastic anemia (AA) who have failed immunosuppressive therapy

H. J. Deea, M. Amvlon, R. Collins, T. Chauncv, S. Burdach, H. Kaizer, R. B. Gelter, E. Cooelan, R. Storb, C. Anasetti, C. Howe, B. A. Muelter

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Abstract

Under the auspices of the NMDP we developed a network and database for collaborative prospective studies of UDT in patients (pts.) with AA. At 7 centers, 20 pts. with AA who did not have a related donor and had failed immunosuppresstve therapy were entered. Pts. were 5-46 (median 29) years old. Disease duration was 4-96 (median 12.2) months. In 17 pts. the donor was HLA-matched, in 3, one HLA antigen mismatched. All pts. were scheduled to receive cyclophosphamide (CY) 4 x 50 mg/kg/day and anttthymocyte globulin (ATG) 30 mg/kg/day for 3 doses followed by total body irradiation (TBII starting at 3 x 200 cGy (2 fractions/day) to be (de-)escalated depending upon efficacy (engraftment) or toxicity. Methotrexate and cyclosporine were given for GVHD prophylaxis. Three pts. reacted to ATG and received CY, 2 x 60 mg/kg and TBI 6 x 200 cGy; all 3 engrafted and survive at 13, 16 and 25 months, respectively. Seventeen pts. received CY, ATG and 3 {or 2) x 200 cGy TBI. All 3 HLAnonidentical recipients (given 3 x 200 cGy] died from regimen- related toxicity or infection. All 14 HLA-identical recipients achieved engraftment. Four died with regimen-related toxicity (3/7 given 3 x 200 cGy; 117 given 2 x 200 cGy), 2 with fungal infection and one with chronic GVHD. Seven pts. survive at 1 -24 (median 15) months. In conclusion, these results with UDT in patients with AA who have failed immunosuppressive therapy are encouraging; currently 59% of HLA-matched recipients are surviving. Further reduction of the intensity of conditioning may allow to further reduce toxicity.

Original languageEnglish (US)
Number of pages1
JournalExperimental Hematology
Volume24
Issue number9
StatePublished - Dec 1 1996

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ASJC Scopus subject areas

  • Molecular Biology
  • Hematology
  • Genetics
  • Cell Biology
  • Cancer Research

Cite this

Deea, H. J., Amvlon, M., Collins, R., Chauncv, T., Burdach, S., Kaizer, H., Gelter, R. B., Cooelan, E., Storb, R., Anasetti, C., Howe, C., & Muelter, B. A. (1996). Marrow transplantation from unrelated donors iudt in patients with aplastic anemia (AA) who have failed immunosuppressive therapy. Experimental Hematology, 24(9).