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

Authors

Raheel Iftikhar^{1, *,} , Qamar un Nisa Chaudhry¹, Tariq Mehmood Satti¹, Syed Kamran Mahmood¹, Tariq Ghafoor^1, , Ghassan Umair Shamshad¹, Nighat Shahbaz^1, , Mehreen Ali Khan¹, Tariq Azam Khattak¹, Jahanzeb Rehman¹, Muhammad Farhan¹, Saima Humayun¹, Humera Haq¹, Syeda Ammaara Anwaar Naqvi¹, Faiz Anwer^2, , 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

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 Flu^120–150 Cy^120–160 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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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  -