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

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

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)311-317
Number of pages7
JournalInternational Journal of Hematology
Volume99
Issue number3
DOIs
Publication statusPublished - 2014 Jan 1
Externally publishedYes

Fingerprint

Chimerism
Antilymphocyte Serum
Aplastic Anemia
Stem Cell Transplantation
Cyclophosphamide
Tissue Donors
Hematopoietic Stem Cell Transplantation
Neutrophils
Brain Diseases
fludarabine
Cyclosporine
Lymphocytes
Transplants

Keywords

  • Fludarabine
  • Half-dose cyclophosphamide
  • HSCT

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia. / Ashizawa, Masahiro; Akahoshi, Yu; Nakano, Hirofumi; Ugai, Tomotaka; Wada, Hidenori; Yamasaki, Ryoko; Ishihara, Yuko; Kawamura, Koji; Sakamoto, Kana; Sato, Miki; Terasako, Kiriko; Kimura, Shun Ichi; Kikuchi, Misato; Nakasone, Hideki; Kako, Shinichi; Kanda, Junya; Yamazaki, Rie; Tanihara, Aki; Nishida, Junji; Kanda, Yoshinobu.

In: International Journal of Hematology, Vol. 99, No. 3, 01.01.2014, p. 311-317.

Research output: Contribution to journalArticle

Ashizawa, M, Akahoshi, Y, Nakano, H, Ugai, T, Wada, H, Yamasaki, R, Ishihara, Y, Kawamura, K, Sakamoto, K, Sato, M, Terasako, K, Kimura, SI, Kikuchi, M, Nakasone, H, Kako, S, Kanda, J, Yamazaki, R, Tanihara, A, Nishida, J & Kanda, Y 2014, 'A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia', International Journal of Hematology, vol. 99, no. 3, pp. 311-317. https://doi.org/10.1007/s12185-014-1501-6
Ashizawa, Masahiro ; Akahoshi, Yu ; Nakano, Hirofumi ; Ugai, Tomotaka ; Wada, Hidenori ; Yamasaki, Ryoko ; Ishihara, Yuko ; Kawamura, Koji ; Sakamoto, Kana ; Sato, Miki ; Terasako, Kiriko ; Kimura, Shun Ichi ; Kikuchi, Misato ; Nakasone, Hideki ; Kako, Shinichi ; Kanda, Junya ; Yamazaki, Rie ; Tanihara, Aki ; Nishida, Junji ; Kanda, Yoshinobu. / A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia. In: International Journal of Hematology. 2014 ; Vol. 99, No. 3. pp. 311-317.
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T1 - A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia

AU - Ashizawa, Masahiro

AU - Akahoshi, Yu

AU - Nakano, Hirofumi

AU - Ugai, Tomotaka

AU - Wada, Hidenori

AU - Yamasaki, Ryoko

AU - Ishihara, Yuko

AU - Kawamura, Koji

AU - Sakamoto, Kana

AU - Sato, Miki

AU - Terasako, Kiriko

AU - Kimura, Shun Ichi

AU - Kikuchi, Misato

AU - Nakasone, Hideki

AU - Kako, Shinichi

AU - Kanda, Junya

AU - Yamazaki, Rie

AU - Tanihara, Aki

AU - Nishida, Junji

AU - Kanda, Yoshinobu

PY - 2014/1/1

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N2 - 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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KW - Half-dose cyclophosphamide

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