Addition of low-dose busulfan to cyclophosphamide in aplastic anemia patients prior to allogeneic bone marrow transplantation to reduce rejection

F. L. Dulley, A. C. Vigorito, F. J.P. Aranha, D. Sturaro, M. A. Ruiz, R. Saboya, M. C.M.A. Macedo, R. L. Da Silva, D. A.F. Chamone, J. Mehta, A. Bacigalupo, Carmino A. De Souza*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

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 (≥50 U) it was 43% compared to 16% for the rest (P=0.06). Overall survival rate at 8 years was 56%; patients who received ≤15 and > 15 transfusions was 78 and 50%, respectively (P=0.01), whereas it was 67 and 28% for ≤50 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.

Original languageEnglish (US)
Pages (from-to)9-13
Number of pages5
JournalBone Marrow Transplantation
Volume33
Issue number1
DOIs
StatePublished - Jan 2004

Keywords

  • Allogeneic bone marrow transplantation
  • Aplastic anemia
  • Busulfan

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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