Allogeneic bone marrow transplantation for severe aplastic anemia patients with risk factors poor prognosis: is fludarabine a requirement?

Transplante de medula óssea alogênico para pacientes com anemia aplástica grave de mau prognóstico: fludarabina é necessária?

EDITORIAIS EDITORIALS

Allogeneic bone marrow transplantation for severe aplastic anemia patients with risk factors poor prognosis: is fludarabine a requirement?

Transplante de medula óssea alogênico para pacientes com anemia aplástica grave de mau prognóstico: fludarabina é necessária?

Frederico L. Dulley

Professor Livre-docente - Chefe do Transplante de Medula Óssea do HCFMUSP-SP

^{Correspondência}

Bone marrow hematopietic progenitor cell transplantation is a curative treatment for severe aplastic anemia.¹ Many attempts have been made to decrease rejection after transplantation adding antithymocyte globulin to the conventional dose of 200 mg/kg cyclophosphamide,² or total body irradiation at 300 cGy in one day³ or low dose of busulfan 4 mg/kg in one day.⁴ All these regimens have been proven to decrease rejection in patients who had been submitted to transplantation.

The question that raises concern, of Medeiros CR et al.⁵ as published in this issue, is whether fludarabine is a requirement in the conditioning regimen. The answer is probably no.

This answer is based on two observations: first, the results published by Medeiros CR et al⁵ using cyclophosphamide and busulfan are very good in this population of poor prognosis patients, despite of the low number of transplants.

Second, the published studies on fludarabine (FLU) in the conditioning regimen are anedoctal with small sample sizes.

So, in order to test if fludarabine-based conditioning regimens benefit severe aplastic anemia patients, prospective clinical trials should be performed, perhaps involving many Brazilian centers.

Recebido: 28/07/2008

Aceito: 30/07/2008

Avaliação: O tema abordado foi sugerido e avaliado pelo editor.

• 1. Ades L, Mary JY, Robim M, Ferry C, Porcher R, Esperon H et al. Long-term outcome after bone marrow transplantation for severe aplastic anemia. Blood. 2004;103(2):2490-7.
• 2. Storb R, Etzioni R, Anasetti C et al. Cyclophosphamide combined with antithymocyte globulin in preparation for allogeneic marrow transplants in patients with aplastic anemia. Blood. 1994;84(3):941-9.
• 3. Feig SA, Champlin R, Arenson E, Yale C, Ho W, Tesler A et al. Improved survival following bone marrow transplantation for aplastic anaemia. Br J Haematol. 1983;54(4):509-17.
• 4. Dulley FL, Vigorito AC, Aranha FJ, Sturaro D, Ruiz MA, Saboya R, et al. Addition of low-dose busulfan to cyclophosphamide in aplastic anemia patients prior to allogeneic bone marrow transplantation to reduce rejection. Bone Marrow Transplant. 2004;33(1):9-13.
• 5. Medeiros CR, Coutinho E, Carmers ER, Bitencourt MA, Ruiz J, Bonfim CS et al. Allogeneic bone marrow transplantation for severe aplastic anemia patients with risk factors poor prognosis: is fludarabine a requirement? Rev. bras. hematol. hemoter. 2008;30(4)292-6.

Publication Dates

• Publication in this collection
  28 Oct 2008
• Date of issue
  Aug 2008