Document Detail


Reduced-intensity conditioning for severe aplasia using fludarabine and CY followed by infusion of ex vivo T-cell-depleted grafts leads to excellent engraftment and absence of GVHD.
MedLine Citation:
PMID:  19079315     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We studied the outcome of individuals with aplastic anaemia (AA) who received reduced-intensity conditioning followed by the infusion of stem cell grafts that had been T-cell depleted ex vivo with alemtuzumab. Consecutive patients with AA who had an HLA-identical sibling received conditioning with fludarabine 30 mg/m(2) daily for 5 days followed by CY 60 mg/kg on 2 consecutive days. Cytokine-mobilized blood grafts were incubated ex vivo with alemtuzumab 'in the bag' and infused without washing. CYA was prescribed until day +90. Engraftment rate, GVHD, EFS and overall survival were studied. Fifteen patients received PBPC grafts. It was the second graft in one of the patients. Ten patients were male and their median age was 23.5 years. The toxicity of the conditioning was minimal. One patient received 1 x 10(7)/kg donor lymphocytes for rising chimerism. At a median of 1107 (294-1778) days, all of them survived with normal blood parameters. None of them developed acute or chronic GVHD. In patients with AA the combination of purine analogue and alkylator leads to rapid engraftment despite T-cell depletion of grafts. This strategy of reduced-intensity conditioning has low toxicity, does not compromise engraftment and seems effective for prevention of GVHD.
Authors:
N Novitzky; V Thomas; C du Toit; A McDonald
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2008-12-15
Journal Detail:
Title:  Bone marrow transplantation     Volume:  43     ISSN:  1476-5365     ISO Abbreviation:  Bone Marrow Transplant.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-28     Completed Date:  2009-08-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8702459     Medline TA:  Bone Marrow Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  779-85     Citation Subset:  IM    
Affiliation:
The University of Cape Town Leukaemia Unit, The Division of Haematology, Groote Schuur Hospital, Observatory, Cape Town, South Africa. Nicolas.novitzky@uct.ac.za
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anemia, Aplastic / therapy*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Child
Cytarabine / administration & dosage*
Female
Graft Survival
Graft vs Host Disease / prevention & control*
Hematopoietic Stem Cell Mobilization
Hematopoietic Stem Cell Transplantation / methods*
Histocompatibility
Humans
Lymphocyte Depletion / methods
Male
Middle Aged
Peripheral Blood Stem Cell Transplantation / methods
Siblings
Transplantation Conditioning / methods*
Treatment Outcome
Vidarabine / administration & dosage,  analogs & derivatives*
Young Adult
Chemical
Reg. No./Substance:
147-94-4/Cytarabine; 21679-14-1/fludarabine; 5536-17-4/Vidarabine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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