en
Scientific article
Review
English

Improved outcome of patients older than 30 years receiving HLA-identical sibling hematopoietic stem cell transplantation for severe acquired aplastic anemia using fludarabine-based conditioning: a comparison with conventional conditioning regimen

Published inHaematologica, vol. 94, no. 9, p. 1312-1315
Publication date2009
Abstract

Older age is a limitation for HLA-identical sibling hematopoietic stem cell transplantation (HSCT) as first-line therapy for severe acquired idiopathic aplastic anemia (SAA). Fludarabine (Flu)-based conditioning might improve outcome in older patients. We analyzed retrospectively 30 patients older than 30 years receiving such reduced-intensity conditioning HSCT according to recommendations of the European Group for Blood and Marrow Transplantation (EBMT) and compared their outcome to a control group receiving the standard regimen (cyclophosphamide+/-antithymocyte globulin) over the same study period (1998-2007). Patients conditioned with Flu had a higher probability of overall survival than the control group (p=0.04) when adjusting for recipient's age. This might be related to a trend towards a reduced incidence of graft failure in patients receiving Flu (0% vs. 11%, p=0.09), while no difference was observed regarding graft-versus-host disease incidence. Flu-based conditioning regimen may reduce the negative impact of age in older patients with SAA receiving an HLA-identical sibling HSCT.

Keywords
  • Adult
  • Aged
  • Anemia, Aplastic/mortality/*therapy
  • Antilymphocyte Serum/administration & dosage
  • Cyclophosphamide/administration & dosage
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • HLA Antigens
  • *Hematopoietic Stem Cell Transplantation
  • Humans
  • Immunosuppressive Agents/administration & dosage
  • *Living Donors
  • Male
  • Middle Aged
  • Myeloablative Agonists/*administration & dosage
  • Retrospective Studies
  • *Siblings
  • Survival Rate
  • Transplantation Conditioning/*methods
  • Transplantation, Homologous
  • Vidarabine/administration & dosage/*analogs & derivatives
Citation (ISO format)
MAURY, Sébastien et al. Improved outcome of patients older than 30 years receiving HLA-identical sibling hematopoietic stem cell transplantation for severe acquired aplastic anemia using fludarabine-based conditioning: a comparison with conventional conditioning regimen. In: Haematologica, 2009, vol. 94, n° 9, p. 1312–1315. doi: 10.3324/haematol.2009.006916
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ISSN of the journal0390-6078
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