演題詳細

一般口演 / Oral Session

【E】一般口演 21 (Oral Session 21) :Hematopoietic Cell Transplantation

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日程
2013年10月11日(金)
時間
14:25 - 15:25
会場
第5会場 / Room No.5 (さっぽろ芸文館 3F 清流)
座長・司会
石山 謙 (Ken Ishiyama):1
1:Div. Hematology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
 
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Peripheral blood stem cell transplant in heavily pre-transfused aplastic anaemia patients

演題番号 : OS-1-109

Pravas C Mishra:1、Manoranjan Mahapatra:1、Tulika Seth:1

1:Department of Hematology, AIIMS, New Delhi, India

 

Objective: We studied the outcome of heavily pre-transfused aplastic anemics (AA) receiving peripheral blood stem cell transplant (PBSCT) from matched sibling donor.
Material: We recorded 63 consecutive blood/marrow transplants in 61 AA patients over 7 years in non HEPA filtered single rooms was recorded. Fludarabine 30 mg/m^2 D-10 to D-5, cyclophosphamide 60 mg/kg/day D-6 to D-5 and antithymocyte globulin 30 mg/kg/day D-4 to D-1 were used as conditioning regimen. Cyclosporine and methotrexate were used for graft versus host disease (GvHD) prophylaxis.
Results: All but 3 had PBSCT. All except 1 received empirical antibiotics and 28 received empirical antifungals for febrile neutropenia during transplant. Blood culture grew bacteria in 10 patients. Biopsy proven fungus (2 aspergillus, 4 mucor) seen in 6 patients. 51/63(80%) are alive at median follow up of 351 days (0-2450 days). Chronic GvHD was seen in 32 patients; mostly associated with skin changes. 1 patient had nephrotic syndrome after 3 years. 5 patients with major blood group mismatch developed pure red cell aplasia (PRCA) lasting 3-8 months. 7 patients developed grade III-IV acute gut GvHD; 4 died. Persistent fever without obvious focus prior to transplant was noted in 3/12 deaths; 2 had grade III-IV gut GvHD with CMV reactivation and the third had aspergillus. Of the 3 who received bone marrow, 1 patient developed gut GvHD and died after developing CMV infection. 2/3 marrow transplants had secondary graft failure of whom 1 underwent PBSCT and is alive; the third relapsed on stopping cyclosporine and is back on immunosuppressants.
Conclusions: PBSCT is safe in aplastic anemia patients whose transplant has been delayed and thereby heavily pretransfused. The outcome is comparable to historical bone marrow transplant data without apparent increase in morbidity on account of chronic GvHD.

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