What can reduce the risk of graft rejection in unrelated donor transplantation for aplastic anemia?

Updated: Jan 29, 2021
  • Author: Sameer Bakhshi, MD; Chief Editor: Emmanuel C Besa, MD  more...
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It should be noted, however, that early results from a cyclophosphamide de-escalation study in a fludarabine-based conditioning regimen for unrelated donor HCT demonstrated life-threatening adverse events (excessive organ toxicity) at predefined cyclophosphamide dose levels. [81] The investigators reported an association between such toxicity and cyclophosphamide 150 mg/kg plus TBI at 2 Gy, fludarabine at 120 mg/m2, and ATG. [81]

Conditioning regimens without TBI have also been studied. These include fludarabine, ATG, and cyclophosphamide [48] and fludarabine, low-dose cyclophosphamide, and alemtuzumab. [82] Hamad and colleagues reported on HCT using a conditioning regimen with intermediate-dose alemtuzumab (50 to 60 mg) and high-dose cyclophosphamide or fludarabine in 41 adult patients with aplastic anemia, and reported excellent survival with a favorable impact on GVHD and long-term health outcomes, but frequent viral complications. At 3 years, survival was 96% in patients younger than 40 years of age and 67% in those 40 years and older. [83]

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