Optimizing conditioning regimen with low-dose irradiation or busulfan enables the outcome of transplantation from a 6–7/8 HLA-matched donor comparable to that from an 8/8 HLA-matched unrelated donor in severe aplastic anemia patients under 40 years

Qin, Xia; Zhu, Yiping; Luo, Chengjuan; Zhou, Ming; Huang, Ke; Chen, Chun; Zhang, Weiping; Sun, Yuan; Luo, Rongmu; Tang, Xiangliang; Yang, Ting; Song, Xianmin; Hu, Shaoyan; Sun, Zimin; Hu, Jiong; Wang, Shunqing; Chen, Jing

doi:10.1007/s00277-021-04540-w

Cited by 7 publications

(2 citation statements)

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“…With this intensi ed conditioning regimen, the rate of MC in this study still reached 26%. We reported an FCA + TBI/BU based conditioning regimen for alternated donor HSCT for AA in 2021 3 . Until now, according to the severity of bone marrow failure, the number of transfusion, and degree of HLA matching, the risk-adapted conditioning regimen has been performed in 580 pediatric AA HSCT patients with a complete engraftment rate of 98% (data not shown).…”

Section: Discussionmentioning

confidence: 99%

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Early withdrawal immunosuppression improved mixed chimerism in hematopoietic stem cell transplantation for pediatric aplastic anemia

Wang,

Qin,

Luo

et al. 2024

Preprint

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Mixed chimerism (MC) occurs frequently with the risk of graft reject (GR) for aplastic anemia (AA) patients undergoing matched sibling donor (MSD) hematopoietic stem cell transplantation (HSCT). So far, no one knows how to adjust immunosuppression (IS) during MC. We retrospectively analyzed 87 consecutive pediatric patients. Early withdrawal (EW) IS and donor lymphocyte infusion (DLI) were attempted to reverse MC. The rate of MC was 26% (n = 23). Low dose cyclophosphamide (CY) (120–150 mg/kg) is an independent risk factor for MC (P = 0.0002) and increase dosage of Fludarabine (FLU) cannot eliminated it. Patients receiving 200 mg/kg CY had the lowest MC rate (8%) and best 3-year graft-versus-host disease (GVHD)/failure free survival (GFFS; 95%). Chimerism in T cells is more sensitive than that in whole blood (P = 0.001). In 17 patients with early-onset MC (ratio of DLI: 83% versus 82%), EW IS strategy is helpful to improving complete chimerism (CC) (63 vs. 295 days, P = 0.008). Our study shows that FLU is necessary to intensify CY + ATG conditioning to maintain the engraftment and 200 mg/kg CY + 150 mg/m2 FLU is recommended as a basic conditioning regimen. EW IS strategy should be considered as an important option to improve donor chimerism in early-onset MC.

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Section: Discussionmentioning

confidence: 99%

“…Aplastic anemia (AA) is a rare heterogeneous disorder characterized by pancytopenia and bone marrow failure resulting from immune-mediated destruction of hematopoietic stem cells [1][2][3] and allogeneic hematopoietic stem cell transplantation (HSCT) remains an important treatment in children [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%