Second marrow transplants in patients with aplastic anemia rejecting the first graft: use of a conditioning regimen including cyclophosphamide and antithymocyte globulin.

摘要: Sixteen (11%) of 146 consecutive patients with severe aplastic anemia prepared for engraftment cyclophosphamide (200 mg/kg) rejected marrow grafts from their HLA-identical siblings. They were given a second transplant either the same (n = 13) or 3) sibling between 23 and 743 (median 86) days after first transplant. The preparation included cyclophosphamide, 50 mg/kg, on each four successive days. Twelve hours three doses antithymocyte globulin, 30 mg/kg/dose, was infused. One 16 died infection too early to be evaluated, two had failure infection, one graft is surviving almost 5 years later full autologous recovery, 12 successful sustained grafts. Of these 12, six are 11 months 7 3/4 years. Four have no graft-v-host disease (GVHD), while chronic GVHD requiring treatment. Five Karnofsky scores 100% 90%. Six 63 38 transplantation, infections (related in GVHD), acute GVHD, hemorrhage. average interval 308 during past five years, compared 61 earlier patients. seven recent surviving, nine In conclusion, transplants globulin possible most who grafts; however, mortality remains high, only 40% becoming long-term survivors.