Audit of peripheral stem cell transplantation for aplastic anemia in multitransfused infected patients

Tulika Seth (Corresponding Author), Uma Kanga, Prashant Sood, Vandana Sharma, Pravas Mishra, Manoranjan Mahapatra

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    ABSTRACT
    Introduction. Allogeneic hematopoietic stem cell transplantation is a curative modality for aplastic anemia; the preferred stem cell source is bone marrow. However, allogeneic peripheral blood stem cell transplantation (PBSCT) used in high-risk patients is associated with higher risk of chronic graft-versus-host disease (GVHD). Our center receives multitransfused, alloimmunized, infected, late referrals for transplant.
    Methods. Forty-one patients of median age 22 years (range 8–37) received allogeneicPBSCT from human leukocyte antigen (HLA)-matched sibling donors. The median time since diagnosis was 12 months (range 4–65) and median pretransplant transfusions were 37 (range 6–160). Six patients were platelet refractory and one alloimmunized for pan-red blood cell (RBC) antigens. Several patients had pretransplant icterus or renal dysfunction and 26 (63.4%) had unresponsive bacterial/fungal infections. Our conditioning regimen included fludarabine 30 mg/m2 for 6 days (days –10 to –5), cyclophosphamide 60 mg/kg/d for 2 days (days –6 to –5), and antithymocyte globulin (ATGAM) 30 mg/kg/d for 4 days (day –4 to –1), which was reduced to 2 days in 2 patients. We used standard GVHD prophylaxis with cyclosporine and methotrexate on days 1, 3, 6, 11.
    Results. The median follow-up period was 29 months (range 6–78) and median engraftment time 10 days (range 8–17). Thirty-one patients (75.6%) were treated for infections, with 20 of these on antifungals for preexisting infections. There were two graft rejections and 10 (24.4%) deaths, with three intracranial hemorrhages, two rejections with infection, three cases of refractory GVHD (acute/overlap syndrome) with cytomegalovirus reactivation, and two
    invasive fungal infections. Overall incidence of acute GVHD was 39% with 2 grade IV cases. Ten (25%) cases developed chronic GVHD, with extensive GVHD in four.
    Conclusion. With more experience using shortened course of ATGAM, HLA-matched donor transfusions, and availability of newer antifungals, we have been able to decrease PBSCT-related mortality. Further improvement will be possible with early referrals.
    Original languageEnglish
    Pages (from-to)922-924
    Number of pages3
    JournalTransplantation Proceedings
    Volume44
    DOIs
    Publication statusPublished - May 2012

    Fingerprint

    Peripheral Blood Stem Cell Transplantation
    Aplastic Anemia
    Graft vs Host Disease
    Antilymphocyte Serum
    Mycoses
    HLA Antigens
    Referral and Consultation
    Infection
    Tissue Donors
    Intracranial Hemorrhages
    Hematopoietic Stem Cell Transplantation
    Graft Rejection
    Jaundice
    Cytomegalovirus
    Bacterial Infections
    Methotrexate
    Cyclophosphamide
    Cyclosporine
    Siblings
    Stem Cells

    Keywords

    • APLASTIC-ANEMIA

    Cite this

    Audit of peripheral stem cell transplantation for aplastic anemia in multitransfused infected patients. / Seth, Tulika (Corresponding Author); Kanga, Uma; Sood, Prashant; Sharma, Vandana; Mishra, Pravas; Mahapatra, Manoranjan.

    In: Transplantation Proceedings, Vol. 44, 05.2012, p. 922-924.

    Research output: Contribution to journalArticle

    Seth, Tulika ; Kanga, Uma ; Sood, Prashant ; Sharma, Vandana ; Mishra, Pravas ; Mahapatra, Manoranjan. / Audit of peripheral stem cell transplantation for aplastic anemia in multitransfused infected patients. In: Transplantation Proceedings. 2012 ; Vol. 44. pp. 922-924.
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    abstract = "ABSTRACTIntroduction. Allogeneic hematopoietic stem cell transplantation is a curative modality for aplastic anemia; the preferred stem cell source is bone marrow. However, allogeneic peripheral blood stem cell transplantation (PBSCT) used in high-risk patients is associated with higher risk of chronic graft-versus-host disease (GVHD). Our center receives multitransfused, alloimmunized, infected, late referrals for transplant.Methods. Forty-one patients of median age 22 years (range 8–37) received allogeneicPBSCT from human leukocyte antigen (HLA)-matched sibling donors. The median time since diagnosis was 12 months (range 4–65) and median pretransplant transfusions were 37 (range 6–160). Six patients were platelet refractory and one alloimmunized for pan-red blood cell (RBC) antigens. Several patients had pretransplant icterus or renal dysfunction and 26 (63.4{\%}) had unresponsive bacterial/fungal infections. Our conditioning regimen included fludarabine 30 mg/m2 for 6 days (days –10 to –5), cyclophosphamide 60 mg/kg/d for 2 days (days –6 to –5), and antithymocyte globulin (ATGAM) 30 mg/kg/d for 4 days (day –4 to –1), which was reduced to 2 days in 2 patients. We used standard GVHD prophylaxis with cyclosporine and methotrexate on days 1, 3, 6, 11.Results. The median follow-up period was 29 months (range 6–78) and median engraftment time 10 days (range 8–17). Thirty-one patients (75.6{\%}) were treated for infections, with 20 of these on antifungals for preexisting infections. There were two graft rejections and 10 (24.4{\%}) deaths, with three intracranial hemorrhages, two rejections with infection, three cases of refractory GVHD (acute/overlap syndrome) with cytomegalovirus reactivation, and twoinvasive fungal infections. Overall incidence of acute GVHD was 39{\%} with 2 grade IV cases. Ten (25{\%}) cases developed chronic GVHD, with extensive GVHD in four.Conclusion. With more experience using shortened course of ATGAM, HLA-matched donor transfusions, and availability of newer antifungals, we have been able to decrease PBSCT-related mortality. Further improvement will be possible with early referrals.",
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    AU - Kanga, Uma

    AU - Sood, Prashant

    AU - Sharma, Vandana

    AU - Mishra, Pravas

    AU - Mahapatra, Manoranjan

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    N2 - ABSTRACTIntroduction. Allogeneic hematopoietic stem cell transplantation is a curative modality for aplastic anemia; the preferred stem cell source is bone marrow. However, allogeneic peripheral blood stem cell transplantation (PBSCT) used in high-risk patients is associated with higher risk of chronic graft-versus-host disease (GVHD). Our center receives multitransfused, alloimmunized, infected, late referrals for transplant.Methods. Forty-one patients of median age 22 years (range 8–37) received allogeneicPBSCT from human leukocyte antigen (HLA)-matched sibling donors. The median time since diagnosis was 12 months (range 4–65) and median pretransplant transfusions were 37 (range 6–160). Six patients were platelet refractory and one alloimmunized for pan-red blood cell (RBC) antigens. Several patients had pretransplant icterus or renal dysfunction and 26 (63.4%) had unresponsive bacterial/fungal infections. Our conditioning regimen included fludarabine 30 mg/m2 for 6 days (days –10 to –5), cyclophosphamide 60 mg/kg/d for 2 days (days –6 to –5), and antithymocyte globulin (ATGAM) 30 mg/kg/d for 4 days (day –4 to –1), which was reduced to 2 days in 2 patients. We used standard GVHD prophylaxis with cyclosporine and methotrexate on days 1, 3, 6, 11.Results. The median follow-up period was 29 months (range 6–78) and median engraftment time 10 days (range 8–17). Thirty-one patients (75.6%) were treated for infections, with 20 of these on antifungals for preexisting infections. There were two graft rejections and 10 (24.4%) deaths, with three intracranial hemorrhages, two rejections with infection, three cases of refractory GVHD (acute/overlap syndrome) with cytomegalovirus reactivation, and twoinvasive fungal infections. Overall incidence of acute GVHD was 39% with 2 grade IV cases. Ten (25%) cases developed chronic GVHD, with extensive GVHD in four.Conclusion. With more experience using shortened course of ATGAM, HLA-matched donor transfusions, and availability of newer antifungals, we have been able to decrease PBSCT-related mortality. Further improvement will be possible with early referrals.

    AB - ABSTRACTIntroduction. Allogeneic hematopoietic stem cell transplantation is a curative modality for aplastic anemia; the preferred stem cell source is bone marrow. However, allogeneic peripheral blood stem cell transplantation (PBSCT) used in high-risk patients is associated with higher risk of chronic graft-versus-host disease (GVHD). Our center receives multitransfused, alloimmunized, infected, late referrals for transplant.Methods. Forty-one patients of median age 22 years (range 8–37) received allogeneicPBSCT from human leukocyte antigen (HLA)-matched sibling donors. The median time since diagnosis was 12 months (range 4–65) and median pretransplant transfusions were 37 (range 6–160). Six patients were platelet refractory and one alloimmunized for pan-red blood cell (RBC) antigens. Several patients had pretransplant icterus or renal dysfunction and 26 (63.4%) had unresponsive bacterial/fungal infections. Our conditioning regimen included fludarabine 30 mg/m2 for 6 days (days –10 to –5), cyclophosphamide 60 mg/kg/d for 2 days (days –6 to –5), and antithymocyte globulin (ATGAM) 30 mg/kg/d for 4 days (day –4 to –1), which was reduced to 2 days in 2 patients. We used standard GVHD prophylaxis with cyclosporine and methotrexate on days 1, 3, 6, 11.Results. The median follow-up period was 29 months (range 6–78) and median engraftment time 10 days (range 8–17). Thirty-one patients (75.6%) were treated for infections, with 20 of these on antifungals for preexisting infections. There were two graft rejections and 10 (24.4%) deaths, with three intracranial hemorrhages, two rejections with infection, three cases of refractory GVHD (acute/overlap syndrome) with cytomegalovirus reactivation, and twoinvasive fungal infections. Overall incidence of acute GVHD was 39% with 2 grade IV cases. Ten (25%) cases developed chronic GVHD, with extensive GVHD in four.Conclusion. With more experience using shortened course of ATGAM, HLA-matched donor transfusions, and availability of newer antifungals, we have been able to decrease PBSCT-related mortality. Further improvement will be possible with early referrals.

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    JO - Transplantation Proceedings

    JF - Transplantation Proceedings

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