Bone marrow transplantation for transfused patients with severe aplastic anemia using cyclophosphamide and total lymphoid irradiation as conditioningtherapy: long-term follow-up from a single center

In transfused patients with aplastic anemia, incidence of graft rejection r emains significant, Seventeen transfused patients with severe aplastic anem ia received BMT from HLA-identical sibling donors after conditioning with c yclophosphamide (CY, 50 mg/kg/day for 4 days) plus total lymphoid irradiati on (TLI, 750 cGy in a single dose). For graft-versus-host disease (GVHD) pr ophylaxis one patient received methotrexate, five patients received CsA and 11 received CsA in association with methylprednisolone, All patients had s ustained engraftment, The actuarial survival of patients was 76% with a med ian follow-up for surviving patients of 11 years (range 0.3-14.5 years). Th e incidence of grade II-III acute GVHD was 24%, and chronic GVHD 35%, Media n Karnofsky score of surviving patients is 100 (range 90-100). Only one pat ient developed interstitial pneumonia, None of the patients has developed a malignancy after BR IT. The role of limited field irradiation in developme nt of malignant neoplasms after BMT for aplastic anemia is discussed, We co nclude that a conditioning regimen using CY + TLI in sensitized aplastic an emia patients results in a high survival rate on longterm follow-up.