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Second marrow transplants in patients with aplastic anemia rejecting the
first graft: use of a conditioning regimen including cyclophosphamide and
antithymocyte globulin
R Storb, PL Weiden, KM Sullivan, FR Appelbaum, P Beatty, CD Buckner, RA Clift, KC Doney, J Hansen and PJ Martin
Sixteen (11%) of 146 consecutive patients with severe aplastic anemia
prepared for engraftment with cyclophosphamide (200 mg/kg) rejected marrow
grafts from their HLA-identical siblings. They were given a second marrow
transplant from either the same (n = 13) or a second (n = 3) HLA-identical
sibling between 23 and 743 (median 86) days after the first transplant. The
preparation for the second transplant included cyclophosphamide, 50 mg/kg,
on each of four successive days. Twelve hours after each of the first three
doses of cyclophosphamide, antithymocyte globulin, 30 mg/kg/dose, was
infused. One of the 16 patients died from infection too early after the
second transplant to be evaluated, two had failure of engraftment and died
with infection, one rejected the second graft and is surviving almost 5
years later with full autologous marrow recovery, and 12 had successful and
sustained second grafts. Of these 12, six are surviving between 11 months
and 7 3/4 years. Four of the six have no graft-v-host disease (GVHD), while
two have chronic GVHD requiring treatment. Five have Karnofsky scores of
100% and one of 90%. Six of the 12 patients with sustained grafts died
between 63 days and 38 months after transplantation, four with infections
(related in two patients to chronic GVHD), one with acute GVHD, and one
with hemorrhage. The average interval from first to second transplant was
308 days during the past five years, compared to 61 days in earlier
patients. Five of seven recent patients are surviving, compared to two of
nine earlier patients. In conclusion, successful second transplants after
cyclophosphamide and antithymocyte globulin are possible in most patients
with aplastic anemia who have rejected their first marrow grafts; however,
mortality remains high, with only 40% of the patients becoming long-term
survivors.
Volume 70,
Issue 1,
pp. 116-121,
07/01/1987
Copyright © 1987 by The American Society of Hematology
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