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Conditioning Regimen

Addition of low-dose busulfan to cyclophosphamide in aplastic anemia patients prior to allogeneic bone marrow transplantation to reduce rejection

Bone Marrow Transplantation volume 33, pages 9–13 (2004)Cite this article

Summary:

Busulfan was added at the dose of 4 mg/kg to 200 mg/kg cyclophosphamide in 81 patients (3–53 years, median 24) with aplastic anemia to reduce graft rejection. Graft-versus-host disease (GVHD) prophylaxis comprised cyclosporine–methotrexate. The number of prior transfusions was 0–276 (median 26), and 48% had received prior immunosuppressive therapy. Two patients experienced primary graft failure, and 10 secondary rejection at 28–1001 days (median 317 days). The cumulative incidence of rejection was 22%; for heavily transfused patients (⩾50 U) it was 43% compared to 16% for the rest (P=0.06). Overall survival rate at 8 years was 56%; patients who received ⩽15 and >15 transfusions was 78 and 50%, respectively (P=0.01), whereas it was 67 and 28% for ⩽50 and >50 transfusions, respectively (P=0.002). In multivariate analysis, higher number of prior transfusions, shorter period of immunosuppression with cyclosporine and GVHD were associated with inferior survival; moreover, a higher risk of graft rejection were associated with a higher number of prior transfusions and a trend was observed for a shorter cyclosporine administration. Low-dose busulfan is feasible and may be helpful in patients exposed to <50 transfusions. However, rejection remains a significant problem, mainly in heavily transfused patients.

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Acknowledgements

We acknowledge Arlete Rocha for her Secretariat assistance.

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Authors and Affiliations

  1. University of São Paulo, Brazil

    F L Dulley, D Sturaro, R Saboya, M C M A Macedo, R L Da Silva & D A F Chamone

  2. State University of Campinas, Brazil

    A C Vigorito, F J P Aranha & C A De Souza

  3. Faculty of Medicine, São José do Rio Preto, Brazil

    M A Ruiz

  4. Northwestern University, Chicago, USA

    J Mehta

  5. Department of Haematology, San Martino Hospital, Genova, Italy

    A Bacigalupo

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  1. F L Dulley
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Correspondence to C A De Souza.

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Dulley, F., Vigorito, A., Aranha, F. et al. Addition of low-dose busulfan to cyclophosphamide in aplastic anemia patients prior to allogeneic bone marrow transplantation to reduce rejection. Bone Marrow Transplant 33, 9–13 (2004). https://doi.org/10.1038/sj.bmt.1704325

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