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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.

Publication ,  Journal Article
Storb, R; Weiden, PL; Sullivan, KM; Appelbaum, FR; Beatty, P; Buckner, CD; Clift, RA; Doney, KC; Hansen, J; Martin, PJ
Published in: Blood
July 1987

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.

Duke Scholars

Published In

Blood

ISSN

0006-4971

Publication Date

July 1987

Volume

70

Issue

1

Start / End Page

116 / 121

Location

United States

Related Subject Headings

  • Male
  • Immunology
  • Humans
  • Graft Rejection
  • Female
  • Drug Therapy, Combination
  • Cyclophosphamide
  • Child, Preschool
  • Child
  • Bone Marrow Transplantation
 

Citation

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Storb, R., Weiden, P. L., Sullivan, K. M., Appelbaum, F. R., Beatty, P., Buckner, C. D., … Martin, P. J. (1987). Second marrow transplants in patients with aplastic anemia rejecting the first graft: use of a conditioning regimen including cyclophosphamide and antithymocyte globulin. Blood, 70(1), 116–121.
Storb, R., P. L. Weiden, K. M. Sullivan, F. R. Appelbaum, P. Beatty, C. D. Buckner, R. A. Clift, K. C. Doney, J. Hansen, and P. J. Martin. “Second marrow transplants in patients with aplastic anemia rejecting the first graft: use of a conditioning regimen including cyclophosphamide and antithymocyte globulin.Blood 70, no. 1 (July 1987): 116–21.
Storb R, Weiden PL, Sullivan KM, Appelbaum FR, Beatty P, Buckner CD, Clift RA, Doney KC, Hansen J, Martin PJ. Second marrow transplants in patients with aplastic anemia rejecting the first graft: use of a conditioning regimen including cyclophosphamide and antithymocyte globulin. Blood. 1987 Jul;70(1):116–121.

Published In

Blood

ISSN

0006-4971

Publication Date

July 1987

Volume

70

Issue

1

Start / End Page

116 / 121

Location

United States

Related Subject Headings

  • Male
  • Immunology
  • Humans
  • Graft Rejection
  • Female
  • Drug Therapy, Combination
  • Cyclophosphamide
  • Child, Preschool
  • Child
  • Bone Marrow Transplantation