Addition of low-dose busulfan to cyclophosphamide in aplastic anemia patients prior to allogeneic bone marrow transplantation to reduce rejection.

Abstract:

:Busulfan was added at the dose of 4 mg/kg to 200 mg/kg cyclophosphamide in 81 patients (3-53 years, median 24) with aplastic anemia to reduce graft rejection. Graft-versus-host disease (GVHD) prophylaxis comprised cyclosporine-methotrexate. The number of prior transfusions was 0-276 (median 26), and 48% had received prior immunosuppressive therapy. Two patients experienced primary graft failure, and 10 secondary rejection at 28-1001 days (median 317 days). The cumulative incidence of rejection was 22%; for heavily transfused patients (>/=50 U) it was 43% compared to 16% for the rest (P=0.06). Overall survival rate at 8 years was 56%; patients who received 15 transfusions was 78 and 50%, respectively (P=0.01), whereas it was 67 and 28% for 50 transfusions, respectively (P=0.002). In multivariate analysis, higher number of prior transfusions, shorter period of immunosuppression with cyclosporine and GVHD were associated with inferior survival; moreover, a higher risk of graft rejection were associated with a higher number of prior transfusions and a trend was observed for a shorter cyclosporine administration. Low-dose busulfan is feasible and may be helpful in patients exposed to <50 transfusions. However, rejection remains a significant problem, mainly in heavily transfused patients.

journal_name

Bone Marrow Transplant

authors

Dulley FL,Vigorito AC,Aranha FJ,Sturaro D,Ruiz MA,Saboya R,Macedo MC,Da Silva RL,Chamone DA,Mehta J,Bacigalupo A,De Souza CA

doi

10.1038/sj.bmt.1704325

subject

Has Abstract

pub_date

2004-01-01 00:00:00

pages

9-13

issue

1

eissn

0268-3369

issn

1476-5365

pii

1704325

journal_volume

33

pub_type

临床试验,杂志文章,多中心研究
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    doi:

    authors: de Gast GC,Boland GJ,Vlieger AM,de Weger RA,Verdonck LF,Zwaan FE,Jiwa NM

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  • Combination antifungal therapy: what can and should we expect?

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  • HLA-DP and allogeneic bone marrow transplantation.

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    journal_title:Bone marrow transplantation

    pub_type: 杂志文章,评审

    doi:

    authors: Moreau P,Cesbron A

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  • Effects of treating marrow with a CD3-specific immunotoxin for prevention of acute graft-versus-host disease.

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    journal_title:Bone marrow transplantation

    pub_type: 临床试验,杂志文章

    doi:

    authors: Martin PJ,Hansen JA,Torok-Storb B,Moretti L,Press O,Storb R,Thomas ED,Weiden PL,Vitetta ES

    更新日期:1988-09-01 00:00:00

  • Prognostic value of bone marrow angiogenesis in patients with multiple myeloma undergoing high-dose therapy.

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    pub_type: 杂志文章

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    更新日期:2004-08-01 00:00:00

  • Very low toxicity and good quality of life in 48 elderly patients autotransplanted for hematological malignancies: a single center experience.

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  • Phase IIa cross-over study of propylene glycol-free melphalan (LGD-353) and alkeran in multiple myeloma autologous transplantation.

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    journal_title:Bone marrow transplantation

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1038/bmt.2014.120

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    journal_title:Bone marrow transplantation

    pub_type: 临床试验,杂志文章,多中心研究

    doi:

    authors: Lazarus HM,Gray R,Ciobanu N,Winter J,Weiner RS

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  • HLA-mismatched hematopoietic SCT without in vitro T-cell depletion for myelodysplastic syndrome.

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    pub_type: 临床试验,杂志文章

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    pub_type: 杂志文章

    doi:

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    pub_type: 杂志文章,评审

    doi:

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    doi:

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    pub_type: 杂志文章

    doi:

    authors: Bacigalupo A,Bregante S,Tedone E,Isaza A,Van Lint MT,Moro F,Trespi G,Occhini D,Gualandi F,Lamparelli T,Marmont AM

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  • Non-radiotherapy conditioning with stem cell transplantation from alternative donors in children with refractory severe aplastic anemia.

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    pub_type: 临床试验,杂志文章

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    pub_type: 杂志文章,多中心研究

    doi:10.1038/bmt.2008.195

    authors: Nieboer P,de Vries EG,Mulder NH,Rodenhuis S,Bontenbal M,van der Wall E,van Hoesel QG,Smit WM,Hupperets P,Voest EE,Nooij MA,Boezen HM,van der Graaf WT

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    pub_type: 杂志文章

    doi:

    authors: Gordon B,Haire W,Kessinger A,Duggan M,Armitage J

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