الفهرس 
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Abstract
Severe aplastic anemia (SAA) is a life-threatening bone marrow failure disorder whose hallmarks are pancytopenia and a hypocellular bone marrow. Mortality ensues from complications of pancytopenia, but survival has greatly improved since the advent of BMT.
The established standard conditioning regimen of allogeneic HSCT for aplastic anemia from a human leukocyte antigen (HLA)-identical sibling is high-dose cyclophosphamide (CY) with or without anti-thymocyte globulin (ATG). Since a high-dose CY-based regimen is associated with serious organ toxicities, such as cardiomyopathy, the safety and efficacy of less toxic conditioning regimens have recently been evaluated by reducing the dose of CY. Also, in resource-limited countries and where availability of ATG is problematic, fludarabine with cyclophosphamide is an alternative.
• Objective:
To assess overall survival of severe aplastic anemia patients after allogenic peripheral stem cell transplantation.
• Methods:
The study is a prospective study involved 155 severe aplastic anemia patients with matched related donor. The median age of our participants was 27 years. They were divided into 3 groups according to the used conditioning regimen:
group A, included 48 patients received CY/ATG: Cy (50 mg/kg/day on days –6 to –3) and ATG (5 mg/kg/day on days –4 to –1).
group B, included 83 patients received FLU/CY: CY 25mg/kg/d (from d-5 to d-2), FLU 120 mg/m2(d-3, -2, -1).
group C, included 24 patients received FLU/CY post CY: CY 25mg/kg/d (from d-5 to d-2), FLU 120 mg/m2(d-3, -2, -1) Plus, CY 50mg/kg/d (d+3 to d+4).
Transplant data including the median number of the harvested CD 34+ve cells, Donor-recipient pairs were sex-mismatched/matched, CMV status in both donors and recipients and the total median duration between diagnosis and PBSCT.
Post- Transplant parameters total hospital stay after HCT, days on antibiotics, required RBCs and platelet transfusion units, The time required for engraftment, Transplant related morbidity and mortality, acute and chronic GVHD and overall survival (OS).
There was a statistically significant increase in the mean hospital stay in days, days on antibiotics and required RBCs transfusion units in group A when compared to both group B and group C. Septicemia was the most common complication in all three groups and also the most common cause of death.
Acute GVHD occurred in 21 patients, distributed as 8 patients in group A, and 13 patients in group B and none in group C
Chronic GVHD occurred in 19 patients, 7 in group A, 11 in group B and only one patient in group C.
There were statistically significant differences between the three groups in one year OS, being highest at CY/ATG (71 %), then FLU/CY post CY (58%) and the lowest was in FLU /CY (47%) with P value = 0.04.
Conclusion:
The Flu/Cy regimen is well tolerated and not associated with increased risk of GVHD. Hence, it may be an appropriate alternative conditioning regimen for developing countries with limited health care resources. Adding post-transplant Cyclophosphamide to conditioning regimen improves overall survival (OS) and decrease risk of GVHD.