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Between August 1989 and November 2003, 33 patients at our center with acquired aplastic anemia underwent bone marrow transplantation (BMT) from HLA-identical sibling donors with cyclophosphamide and in vivo anti-CD52 monoclonal antibodies (MoAb) for conditioning. The median age at BMT was 17 years (range, 4-46 years). Before BMT, 58% were heavily transfused (>50 transfusions), and 42% had previously experienced treatment failure with antithymocyte globulin-based immunosuppressive therapy. Unmanipulated bone marrow was used as the source of stem cells in all patients except 1. Graft-versus-host disease (GVHD) prophylaxis was with cyclosporine alone in 19 (58%) patients; 14 received anti-CD52 MoAb in addition to cyclosporine. The conditioning regimen was well tolerated without significant acute toxicity. Graft failure was seen in 8 patients (primary, n = 4; secondary, n = 4). Of those whose grafts failed, 4 survived long-term (complete autologous recovery, n = 2; rescue with previously stored marrow, n = 1; second allograft, n = 1). The cumulative incidence of graft failure and grade II to IV acute and chronic GVHD was 24%, 14%, and 4%, respectively. None developed extensive chronic GVHD. With a median follow-up of 59 months, the 5-year survival was 81% (95% confidence interval, 68%-96%). No unexpected early or late infectious or noninfectious complications were observed. We conclude that the conditioning regimen containing cyclophosphamide and anti-CD52 MoAb is well tolerated and effective for acquired aplastic anemia with HLA-matched sibling donors. The favorable effect on the incidence and severity of GVHD is noteworthy in this study and warrants further investigation.

Original publication

DOI

10.1016/j.bbmt.2004.09.001

Type

Journal article

Journal

Biol Blood Marrow Transplant

Publication Date

12/2004

Volume

10

Pages

867 - 876

Keywords

Acute Disease, Adolescent, Adult, Alemtuzumab, Anemia, Aplastic, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Antibodies, Neoplasm, Antigens, CD, Antigens, Neoplasm, Bone Marrow Transplantation, CD52 Antigen, Child, Child, Preschool, Chronic Disease, Cyclophosphamide, Female, Glycoproteins, Graft vs Host Disease, Histocompatibility Testing, Humans, Immunosuppressive Agents, Living Donors, Male, Middle Aged, Retrospective Studies, Siblings, Survival Analysis, Transplantation Chimera, Transplantation Conditioning