PMID:
     16518427
Authors:
     Kumar R, Prem S, Mahapatra M, Seth T, Chowdhary DR, Mishra P,
     Pillai L, Narendra AM, Mehra NK, Saxena R, Choudhry VP.
Title:
     Fludarabine, cyclophosphamide and horse antithymocyte globulin conditioning 
     regimen for allogeneic peripheral blood stem cell transplantation performed in 
     non-HEPA filter rooms for multiply transfused patients with severe aplastic 
     anemia.
Journal:
     Bone Marrow Transplant. 2006 Apr;37(8):745-9. doi: 10.1038/sj.bmt.1705321.
Abstract:
     Multiply transfused patients of severe aplastic anemia are at increased risk of 
     graft rejection. Five such patients underwent peripheral blood stem cell 
     transplantation from HLA-identical siblings with a fludarabine-based protocol. 
     The conditioning consisted of fludarabine 30 mg/m(2)/day x 6 days, 
     cyclophosphamide 60 mg/kg/day x 2 days and horse antithymocyte globulin (ATG) x 4 
     days. Two different ATG preparations were used: ATGAM (dose 30 mg/kg/day x 4 
     days) or Thymogam (dose 40 mg/kg/day x 4 days). Engraftment: median time to 
     absolute neutrophil count (ANC) >0.5 x 10(9)/l was 11 days (range: 8-17) and 
     median time to platelet count >20 x 10(9)/l was 11 days (range: 9-17). At a 
     median follow-up of 171 days (range: 47-389), there has been no graft rejection 
     and all patients are in complete remission. Acute GVHD (grade 1) occurred in one 
     patient only. Chronic GVHD developed in two patients (extensive in one and 
     limited in another). The transplants were performed in non-HEPA filter rooms. In 
     only one patient, systemic antifungal therapy (voriconazole) was used. The use of 
     Thymogam brand of ATG for conditioning is being reported for the first time. Our 
     experience suggests that this fludarabine-based protocol allows rapid sustained 
     engraftment in high-risk patients without significant immediate toxicity.

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