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Type: Artigo de periódico
Title: Addition of low-dose busulfan to cyclophosphamide in aplastic anemia patients prior to allogeneic bone marrow transplantation to reduce rejection
Author: Dulley, FL
Vigorito, AC
Aranha, FJP
Sturaro, D
Ruiz, MA
Saboya, R
Macedo, MCMA
Da Silva, RL
Chamone, DAF
Mehta, J
Bacigalupo, A
De Souza, CA
Abstract: Busulfan was added at the dose of 4 mg/kg to 200 mg/kg cyclophosphamide in 81 patients (3-53 years, median 24) with aplastic anemia to reduce graft rejection. Graft-versus-host disease (GVHD) prophylaxis comprised cyclosporine-methotrexate. The number of prior transfusions was 0-276 (median 26), and 48%; had received prior immunosuppressive therapy. Two patients experienced primary graft failure, and 10 secondary rejection at 28-1001 days (median 317 days). The cumulative incidence of rejection was 22%; for heavily transfused patients (greater than or equal to50U) it was 43%; compared to 16% for the rest (P=0.06). Overall survival rate at 8 years was 56%; patients who received less than or equal to15 and >15 transfusions was 78 and 50%, respectively (P=0.01), whereas it was 67 and 28% for less than or equal to50 and >50 transfusions, respectively (P=0.002). In multivariate analysis, higher number of prior transfusions, shorter period of immunosuppression with cyclosporine and GVHD were associated with inferior survival; moreover, a higher risk of graft rejection were associated with a higher number of prior transfusions and a trend was observed for a shorter cyclosporine administration. Low-dose busulfan is feasible and may be helpful in patients exposed to <50 transfusions. However, rejection remains a significant problem, mainly in heavily transfused patients.
Subject: aplastic anemia
allogeneic bone marrow transplantation
Country: Inglaterra
Editor: Nature Publishing Group
Citation: Bone Marrow Transplantation. Nature Publishing Group, v. 33, n. 1, n. 9, n. 13, 2004.
Rights: fechado
Identifier DOI: 10.1038/sj.bmt.1704325
Date Issue: 2004
Appears in Collections:Unicamp - Artigos e Outros Documentos

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