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Blood, 1 September 2006, Vol. 108, No. 5, pp. 1485-1491. Prepublished online as a Blood First Edition Paper on May 9, 2006; DOI 10.1182/blood-2006-03-005041. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2006-03-005041v1 108/5/1485    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Deeg, H. J. Articles by Storer, B. Search for Related Content PubMed PubMed Citation Articles by Deeg, H. J. Articles by Storer, B. Related Collections Transplantation Clinical Trials and Observations Immunobiology Red Cells Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Optimization of conditioning for marrow transplantation from unrelated donors for patients with aplastic anemia after failure of immunosuppressive therapy H. Joachim Deeg, Margaret O'Donnell, Jakub Tolar, Rajni Agarwal, Richard E. Harris, Stephen A. Feig, Mary C. Territo, Robert H. Collins, Peter A. McSweeney, Edward A. Copelan, Shakila P. Khan, Ann Woolfrey, and Barry Storer From the Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; the City of Hope National Medical Center, Duarte, CA; the University of Minnesota, Minneapolis, MN; the Stanford University, Stanford, CA; the Cincinnati Children's Hospital Medical Center, Cincinnati, OH; the University of California Los Angeles (UCLA), Los Angeles, CA; the University of Texas, Southwestern Medical Center, Dallas, TX; the University of Colorado, Denver, CO; the Ohio State University, Columbus, OH; and the Mayo Clinic, Rochester, MN. In 87 patients with aplastic anemia who failed to respond to immunosuppressive treatment, we determined the minimal dose of total body irradiation (TBI) required when added to antithymocyte globulin (ATG, 30 mg/kg x 3) plus cyclophosphamide (CY, 50 mg/kg x 4) to achieve engraftment of unrelated donor marrow. TBI was started at 3 x 200 cGy, to be escalated or deescalated in steps of 200 cGy depending on graft failure or toxicity. Patients were aged 1.3 to 53.5 years (median, 18.6 years). The interval from diagnosis to transplantation was 3 to 328 months (median, 14.6 months). Donors were HLA-A, -B, -C, -DR, and -DQ identical for 62 patients, and nonidentical for 1 to 3 HLA loci at the antigen or allele level for 25. The dose-limiting toxicity was diffuse pulmonary injury. The optimum TBI dose was 1 x 200 cGy. Nine patients did not tolerate ATG and were prepared with CY + TBI. Graft failure occurred in 5% of patients. With a median follow-up of 7 years, 38 (61%) of 62 HLA-identical, and 10 (40%) of 25 HLA-nonidentical transplant recipients are surviving. The highest survival rate with HLA-identical transplants was observed at 200 cGy TBI. Thus, low-dose TBI + CY + ATG conditioning resulted in excellent outcome of unrelated transplants in patients with aplastic anemia who had received multiple transfusions. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Unrelated transplants in aplastic anemia: are we making progress? Andrea Bacigalupo Blood 2006 108: 1431. [Full Text] [PDF] This article has been cited by other articles: Y. Kosaka, H. Yagasaki, K. Sano, R. Kobayashi, H. Ayukawa, T. Kaneko, H. Yabe, M. Tsuchida, H. Mugishima, A. Ohara, et al. Prospective multicenter trial comparing repeated immunosuppressive therapy with stem-cell transplantation from an alternative donor as second-line treatment for children with severe and very severe aplastic anemia Blood, February 1, 2008; 111(3): 1054 - 1059. [Abstract] [Full Text] [PDF] S. Maury, M.-L. Balere-Appert, Z. Chir, J.-M. Boiron, C. Galambrun, K. Yakouben, P. Bordigoni, A. Marie-Cardine, N. Milpied, J. Kanold, et al. Unrelated stem cell transplantation for severe acquired aplastic anemia: improved outcome in the era of high-resolution HLA matching between donor and recipient Haematologica, May 1, 2007; 92(5): 589 - 596. [Abstract] [Full Text] [PDF] J. C.W. Marsh Treatment of acquired aplastic anemia Haematologica, January 1, 2007; 92(1): 2 - 5. [Full Text] [PDF] N. S. Young, R. T. Calado, and P. Scheinberg Current concepts in the pathophysiology and treatment of aplastic anemia Blood, October 15, 2006; 108(8): 2509 - 2519. [Abstract] [Full Text] [PDF]

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