Fludarabine-Based Conditioning Chemotherapy for Allogeneic Hematopoietic Stem Cell Transplantation in Acquired Severe Aplastic Anemia

Hazzaa Al-Zahrani, Amr Nassar, Fahad Al-Mohareb, Fahad Al-Sharif, Said Mohamed, Khalid Al-Anazi, Moosa Patel, Walid Rasheed, Abu Jafar Mohammed Saleh, Mahmoud Bakr, Shad Ahmed, Khalid Ibrahim, Fazal Hussain, Naser Elkum, Tusneem Elhassan, Zubeir Nurgat, Naeem Chaudhri, Mahmoud Aljurf

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Thirty-eight patients who met the diagnostic criteria for severe aplastic anemia underwent allogeneic hematopoietic stem cell transplantation (HSCT). The median patient age was 20 years (range, 14-36 years). Twenty-four patients were treatment-naïve, 11 had failed one or more previous courses of immunosuppressive therapy, and 3 had failed a previous HSCT. The conditioning regimen included fludarabine 30 mg/m2/day for 3 days (days -9, -8, and -7) and cyclophosphamide 50 mg/kg/day for 4 days (days -5, -4, -3, and -2). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and short-course methotrexate. All patients underwent transplantation with unmanipulated bone marrow as the stem cell source. The median total nucleated cell (TNC) dose was 2.43 × 108/kg (range, 0.60-6.7 × 108/ kg). The conditioning regimen was well tolerated, with minimal treatment-related mortality. Engraftment was observed in all patients after transplantation; the median time to engraftment of neutrophils and platelets was 18 and 23 days, respectively. Twenty-five of the 27 patients with available chimeric studies at day 180 maintained donor chimerism. Acute GVHD grade ≥II was diagnosed in 4 patients (11%). Extensive chronic GVHD was observed in 8 patients (25%) who survived beyond day +100, at a median observation time of 43 months. Graft rejection with relapse of aplais was observed in one patient. The overall survival (OS) for the whole group was 79%. A trend toward improved OS was observed in the treatment-naïve patients (83% vs 71%), but this was statistically insignificant (P = .384). The fludarabine-based conditioning regimen used in this study with relatively young cohort of patients was well tolerated, with a low rate of rejection and treatment outcomes comparable to those seen in other, more intense and potentially more toxic conditioning regimens. Our results await validation in a larger study, optimally in a randomized controlled manner.

Original languageEnglish
Pages (from-to)717-722
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Issue number5
Publication statusPublished - May 2011
Externally publishedYes



  • Aplastic anemia
  • Fludarabine
  • Transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Al-Zahrani, H., Nassar, A., Al-Mohareb, F., Al-Sharif, F., Mohamed, S., Al-Anazi, K., Patel, M., Rasheed, W., Saleh, A. J. M., Bakr, M., Ahmed, S., Ibrahim, K., Hussain, F., Elkum, N., Elhassan, T., Nurgat, Z., Chaudhri, N., & Aljurf, M. (2011). Fludarabine-Based Conditioning Chemotherapy for Allogeneic Hematopoietic Stem Cell Transplantation in Acquired Severe Aplastic Anemia. Biology of Blood and Marrow Transplantation, 17(5), 717-722. https://doi.org/10.1016/j.bbmt.2010.08.013