Comparison of Conventional Cyclophosphamide versus Fludarabine-Based Conditioning in High-Risk Aplastic Anemia Patients Undergoing Matched-Related Donor Transplantation.

Clinical Hematology International Pub Date : 2020-05-18 eCollection Date: 2020-06-01 DOI:10.2991/chi.d.200426.001
Raheel Iftikhar, Qamar Un Nisa Chaudhry, Tariq Mehmood Satti, Syed Kamran Mahmood, Tariq Ghafoor, Ghassan Umair Shamshad, Nighat Shahbaz, Mehreen Ali Khan, Tariq Azam Khattak, Jahanzeb Rehman, Muhammad Farhan, Saima Humayun, Humera Haq, Syeda Ammaara Anwaar Naqvi, Faiz Anwer, Humayoon Shafique Satti, Parvez Ahmed
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Abstract

Allogeneic stem cell transplant for high-risk aplastic anemia (AA) yields inferior results using conventional cyclophosphamide (CY)-based conditioning. The use of fludarabine (Flu)-based regimens has resulted in improved outcomes in high-risk patients. Limited data are available comparing these two conditioning regimens in such patients. We retrospectively analyzed 192 high-risk patients undergoing matched-related donor transplantation from July 2001 to December 2018. The median age was 19.5 (2-52) years. Patients were divided into 2 groups, Cy200 anti-thymocyte globulin (ATG)20 (Gp1 n = 79) or Flu120-150 Cy120-160 ATG20 (Gp2 n = 113). The risk of graft failure was significantly higher in Gp1, and the majority occurred in patients with >2 risk factors (p = 0.02). The incidence of grade II-IV acute graft versus host disease (GVHD) and chronic GVHD was not significantly different between the two groups. The overall survival (OS) of the study cohort was 81.3 %, disease-free survival (DFS) 76.6 % and GVHD-free relapse-free survival (GRFS) was 64.1%. DFS and GRFS were significantly higher in Gp2 as compared to Gp1: DFS 84.1% versus 68.4 % (p = 0.02), GRFS 77.9% versus 54.4% (p = 0.01), respectively. We conclude that Flu-based conditioning is associated with superior OS, DFS and GRFS as compared to the conventional Cy-based regimen in high-risk AA.

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高危再生障碍性贫血患者行匹配相关供体移植常规环磷酰胺治疗与氟达拉滨治疗的比较
同种异体干细胞移植治疗高风险再生障碍性贫血(AA)的效果较差,使用传统的环磷酰胺(CY)为基础的条件。使用氟达拉滨(流感)为基础的方案已导致改善预后的高危患者。在这类患者中比较这两种调理方案的数据有限。我们回顾性分析了2001年7月至2018年12月接受匹配相关供体移植的192例高危患者。中位年龄为19.5(2-52)岁。患者分为两组,Cy200抗胸腺细胞球蛋白(ATG)20 (Gp1 n = 79)或Flu120-150 Cy120-160 ATG20 (Gp2 n = 113)。Gp1患者发生移植物衰竭的风险明显较高,且多发生在危险因素>2的患者中(p = 0.02)。两组间II-IV级急性移植物抗宿主病(GVHD)和慢性移植物抗宿主病(GVHD)的发生率无显著差异。研究队列的总生存率(OS)为81.3%,无病生存率(DFS)为76.6%,无gvhd无复发生存率(GRFS)为64.1%。Gp2的DFS和GRFS明显高于Gp1: DFS分别为84.1%对68.4% (p = 0.02), GRFS为77.9%对54.4% (p = 0.01)。我们得出结论,在高风险AA中,与传统的基于流感的治疗方案相比,基于流感的治疗与更高的OS、DFS和GRFS相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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