Peripheral blood stem cell transplant is safe in heavily pre-transfused aplastic anaemia patients without increased morbidity from chronic graft-versus-host disease

Ref ID: 18573

Author:

P. Mishra, N. Rathod, M. Mahapatra, T. Seth, S. Rathi,
R. Kapoor, N. Gupta, S. Sharma, N. Aggarwal, A.K. Singh,
A. Dayama, B. Dhingra

Author address:

AIIMS (New Delhi, IN)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Objective: We studied the outcome of heavily pre transfused
aplastic anemia patients receiving peripheral blood stem cell
transplant (PBSCT) from matched sibling donor.
Material: The data on 32 consecutive blood/marrow stem cell
transplants in 30 aplastic anemia patients over a period of 5 years
in non HEPA fi ltered single rooms was recorded. Fludarabine
30 mg/m2
D-10 to D-5, cyclophosphamide 60 mg/kg/day D-6 to
D-5 and antithymocyte globulin 30 mg/kg/day D-4 to D-1 were
used as conditioning regimen. Cyclosporine and methotrexate
were used for graft versus host disease (GvHD) prophylaxis.
Results: The data is summarised in Table 1. All but 3 had PBSCT.
27 patients received empirical antibiotics and 15 received empirical antifungals for febrile neutropenia in immediate post transplant phase. Positive blood culture for bacteria was recorded in 4
patients and a biopsy proven fungus (2 aspergillus, 2 mucor) in
4 patients. 22/30 (73%) patients are alive at median follow up of
351 days ranging from 0-1890 days. Chronic GvHD was seen in
the majority and mostly associated with dry skin and changes in
pigmentation which generally subsided over time and well tolerated. 1 patient had nephrotic syndrome 3 years post transplant
which was controlled with steroids. 1 patient developed pure red
cell aplasia which lasted for 3 months and managed with steroids and erythropoietin. The patients who died are summarised in
table 2. 5 patients developed grade III-IV gut acute GvHD; 4 died.
Persistent fever without obvious focus immediately preceding
transplant was noted in 3/8 deaths, 2 of whom had grade III-IV gut
GvHD (2 had CMV reactivation as well) and the third died of disseminated aspergillus infection. Of the 3 who received bone marrow, 1 patient developed a progressive gut GvHD which lingered
on steroids and ultimately died after developing CMV infection 9
months post transplant; 2 had secondary graft failure of whom 1
underwent PBSCT and is a long tem survivor; the third relapsed
on stopping cyclosporine and is back on immunosppressants.
Conclusions: PBSCT is safe in aplastic anemia patients whose
transplant has been delayed and thereby heavily pretransfused. The outcome and survival appears comparable to those
achieved with historical bone marrow transplant data without
apparent increase in morbidity on account of chronic GvHD. No
pre-treatment variable other than baseline febrile neutropenia
could predict adverse outcome.

Abstract Number: P626

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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