Clinical Hematology International

Volume 2, Issue 2, June 2020, Pages 82 - 91

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

Authors
Raheel Iftikhar1, *, ORCID, Qamar un Nisa Chaudhry1, Tariq Mehmood Satti1, Syed Kamran Mahmood1, Tariq Ghafoor1, ORCID, Ghassan Umair Shamshad1, Nighat Shahbaz1, ORCID, Mehreen Ali Khan1, Tariq Azam Khattak1, Jahanzeb Rehman1, Muhammad Farhan1, Saima Humayun1, Humera Haq1, Syeda Ammaara Anwaar Naqvi1, Faiz Anwer2, ORCID, Humayoon Shafique Satti3, Parvez Ahmed4
1Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
2Department of Hematology, Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH 44195, USA
3National University of Medical Sciences, Rawalpindi 46000, Pakistan
4Department of Hematology-Oncology and Stem Cell Transplant, Quaid-e-Azam International Hospital, Islamabad 44000, Pakistan
*Corresponding author. Postal address: Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan 46000. Tel.: 03335171505. Email: drraheeliftikhar@gmail.com
Corresponding Author
Raheel Iftikhar
Received 16 December 2019, Accepted 24 April 2020, Available Online 18 May 2020.
DOI
10.2991/chi.d.200426.001How to use a DOI?
Keywords
Aplastic anemia; Cyclophosphamide; Fludarabine; Stem cell transplantation
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.

Copyright
© 2020 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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Journal
Clinical Hematology International
Volume-Issue
2 - 2
Pages
82 - 91
Publication Date
2020/05/18
ISSN (Online)
2590-0048
DOI
10.2991/chi.d.200426.001How to use a DOI?
Copyright
© 2020 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Cite this article

TY  - JOUR
AU  - Raheel Iftikhar
AU  - Qamar un Nisa Chaudhry
AU  - Tariq Mehmood Satti
AU  - Syed Kamran Mahmood
AU  - Tariq Ghafoor
AU  - Ghassan Umair Shamshad
AU  - Nighat Shahbaz
AU  - Mehreen Ali Khan
AU  - Tariq Azam Khattak
AU  - Jahanzeb Rehman
AU  - Muhammad Farhan
AU  - Saima Humayun
AU  - Humera Haq
AU  - Syeda Ammaara Anwaar Naqvi
AU  - Faiz Anwer
AU  - Humayoon Shafique Satti
AU  - Parvez Ahmed
PY  - 2020
DA  - 2020/05/18
TI  - Comparison of Conventional Cyclophosphamide versus Fludarabine-Based Conditioning in High-Risk Aplastic Anemia Patients Undergoing Matched-Related Donor Transplantation
JO  - Clinical Hematology International
SP  - 82
EP  - 91
VL  - 2
IS  - 2
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.d.200426.001
DO  - 10.2991/chi.d.200426.001
ID  - Iftikhar2020
ER  -