Haematologica, Vol 94, Issue 9, 1312-1315 doi:10.3324/haematol.2009.006916
Copyright © 2009 by Ferrata Storti Foundation
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Stem Cell Transplantation

Improved outcome of patients older than 30 years receiving HLA-identical sibling hematopoietic stem cell transplantation for severe acquired aplastic anemia using fludarabine-based conditioning: a comparison with conventional conditioning regimen

Sébastien Maury1, Andrea Bacigalupo2, Paolo Anderlini3, Mahmoud Aljurf4, Judith Marsh5, Gérard Socié6, Rosi Oneto2, Jakob R. Passweg7 on behalf of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT-SAAWP)

1 Department of Hematology, Groupe Henri-Mondor Albert-Chenevier, Université Paris 12, Faculté de Médecine, Créteil, France
2 Department of Hematology, Azienda Ospedaliera Universitaria San Martino, Genova, Italy
3 Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, TX, USA
4 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
5 Department of Haematological Medicine, King’s College Hospital, London, UK
6 Department of Hematology, Stem Cell Transplantation, Hôpital Saint-Louis, Paris, France
7 Department of Hematology, Geneva University Hospital, Geneva, Switzerland

Correspondence: Sébastien Maury, Service d’Hématologie Clinique, CHU Henri Mondor, 51 av. du Mal de Lattre de Tassigny, 94010 Créteil cedex, France. E-mail:sebastien.maury{at}hmn.aphp.fr

Older age is a limitation for HLA-identical sibling hematopoietic stem cell transplantation (HSCT) as first-line therapy for severe acquired idiopathic aplastic anemia (SAA). Fludarabine (Flu)-based conditioning might improve outcome in older patients. We analyzed retrospectively 30 patients older than 30 years receiving such reduced-intensity conditioning HSCT according to recommendations of the European Group for Blood and Marrow Transplantation (EBMT) and compared their outcome to a control group receiving the standard regimen (cyclophosphamide+/–antithymocyte globulin) over the same study period (1998–2007). Patients conditioned with Flu had a higher probability of overall survival than the control group (p=0.04) when adjusting for recipient’s age. This might be related to a trend towards a reduced incidence of graft failure in patients receiving Flu (0% vs. 11%, p=0.09), while no difference was observed regarding graft-versus-host disease incidence. Flu-based conditioning regimen may reduce the negative impact of age in older patients with SAA receiving an HLA-identical sibling HSCT.

Key words: aplastic anemia, stem cell transplantation, conditioning regimen, fludarabine.