Impact of cyclophosphamide dose of conditioning on the outcome of allogeneic hematopoietic stem cell transplantation for aplastic anemia from human leukocyte antigen-identical sibling

Takehiko Mori, Hideo Koh, Yasushi Onishi, Shinichi Kako, Makoto Onizuka, Heiwa Kanamori, Yukiyasu Ozawa, Chiaki Kato, Hiroatsu Iida, Ritsuro Suzuki, Tatsuo Ichinohe, Yoshinobu Kanda, Tetsuo Maeda, Shinji Nakao, Hirohito Yamazaki

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6 Citations (Scopus)

Abstract

The standard conditioning regimen in allogeneic hematopoietic stem cell transplantation (HSCT) for aplastic anemia from a human leukocyte antigen (HLA)-identical sibling has been high-dose cyclophosphamide (CY 200 mg/kg). In the present study, results for 203 patients with aplastic anemia aged 16 years or older who underwent allogeneic HSCT from HLA-identical siblings were retrospectively analyzed using the registry database of Japan Society for Hematopoietic Cell Transplantation. Conditioning regimens were defined as a (1) high-dose CY (200 mg/kg or greater)-based (n = 117); (2) reduced-dose CY (100 mg/kg or greater, but less than 200 mg/kg)-based (n = 38); and (3) low-dose CY (less than 100 mg/kg)-based (n = 48) regimen. Patient age and the proportion of patients receiving fludarabine were significantly higher in the reduced- and low-dose CY groups than the high-dose CY group. Engraftment was comparable among the groups. Five-year overall survival (OS) tended to be higher in the low-dose CY group [93.0 % (95 % CI 85.1–100.0 %)] than the high-dose CY [84.2 % (95 % CI 77.1–91.3 %)] or reduced-dose CY groups [83.8 % (95 % CI 71.8–95.8 %); P = 0.214]. Age-adjusted OS was higher in the low-dose CY group than the high- and reduced-dose CY groups with borderline significance (P = 0.067). These results suggest that CY dose can safely be reduced without increasing graft rejection by adding fludarabine in allogeneic HSCT for aplastic anemia from an HLA-identical sibling.

Original languageEnglish
Pages (from-to)461-468
Number of pages8
JournalInternational journal of hematology
Volume103
Issue number4
DOIs
Publication statusPublished - 2016 Apr 1

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Aplastic anemia
  • Cyclophosphamide
  • Fludarabine

ASJC Scopus subject areas

  • Hematology

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    Mori, T., Koh, H., Onishi, Y., Kako, S., Onizuka, M., Kanamori, H., Ozawa, Y., Kato, C., Iida, H., Suzuki, R., Ichinohe, T., Kanda, Y., Maeda, T., Nakao, S., & Yamazaki, H. (2016). Impact of cyclophosphamide dose of conditioning on the outcome of allogeneic hematopoietic stem cell transplantation for aplastic anemia from human leukocyte antigen-identical sibling. International journal of hematology, 103(4), 461-468. https://doi.org/10.1007/s12185-016-1960-z