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A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia

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Abstract

Conditioning regimens consisting of reduced-dose cyclophosphamide (CY) and fludarabine (FDR) have been investigated for use in allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with aplastic anemia to reduce the toxicities associated with CY. However, the ideal dose of CY has not been identified. In addition, little information is available regarding donor cell chimerism after allo-HSCT with these regimens. Therefore, we retrospectively analyzed 13 patients who underwent allo-HSCT with half-dose CY (100 mg/kg in total), FDR, and anti-thymocyte globulin at total doses of 2.5–10 mg/kg at our center. All the patients except one, who died due to encephalopathy on day 20, achieved neutrophil engraftment a median of 18.5 days after HSCT with complete donor-type chimerism. Two patients who received a graft from an HLA-matched donor subsequently developed mixed chimerism (MC) associated with transfusion-dependent cytopenia. One became transfusion-independent after donor lymphocyte infusion, but continues to exhibit MC. The other regained complete donor-type chimerism after the cessation of cyclosporine, but remains transfusion-dependent. These findings suggest that a conditioning regimen with half-dose CY and FDR is effective for achieving neutrophil engraftment and complete donor-type chimerism. However, subsequent MC may be observed, especially after HLA-matched HSCT.

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Authors and Affiliations

  1. Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, Saitama, 330-8503, Japan

    Masahiro Ashizawa, Yu Akahoshi, Hirofumi Nakano, Tomotaka Ugai, Hidenori Wada, Ryoko Yamasaki, Yuko Ishihara, Koji Kawamura, Kana Sakamoto, Miki Sato, Kiriko Terasako, Shun-ichi Kimura, Misato Kikuchi, Hideki Nakasone, Shinichi Kako, Junya Kanda, Rie Yamazaki, Aki Tanihara, Junji Nishida & Yoshinobu Kanda

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  1. Masahiro Ashizawa
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  2. Yu Akahoshi
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  3. Hirofumi Nakano
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  4. Tomotaka Ugai
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  7. Yuko Ishihara
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  8. Koji Kawamura
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  10. Miki Sato
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  11. Kiriko Terasako
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  12. Shun-ichi Kimura
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  13. Misato Kikuchi
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  14. Hideki Nakasone
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  15. Shinichi Kako
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  16. Junya Kanda
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Correspondence to Yoshinobu Kanda.

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Ashizawa, M., Akahoshi, Y., Nakano, H. et al. A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia. Int J Hematol 99, 311–317 (2014). https://doi.org/10.1007/s12185-014-1501-6

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  • DOI: https://doi.org/10.1007/s12185-014-1501-6

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