Radiat Oncol J.  2012 Dec;30(4):165-172.

Total lymphoid irradiation based conditioning for hematopoietic stem cell transplantation in severe aplastic anemia

• Lee YH
• Kim JY
• Choi BO
• Ryu MR
• Chung SM

Abstract

PURPOSE
To retrospectively evaluate the outcome and toxicity of total lymphoid irradiation (TLI) based conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) patients who experienced an engraftment failure from prior HSCT or were heavily transfused.
MATERIALS AND METHODS
Between 1995 and 2006, 20 SAA patients received TLI for conditioning of HSCT. All patients were multi-transfused or had long duration of disease. Fifteen (75%) patients had graft failure from prior HSCT. In 18 (90%) patients, the donors were human leukocyte antigen identical siblings. The stem cell source was the peripheral blood stem cell in 15 (75%) patients. The conditioning regimen was composed of antithymocyte globulin plus TLI with a median dose of 750 cGy in 1 fraction. The graft-versus-host disease (GVHD) prophylaxis used cyclosporine with methotrexate.
RESULTS
With a median follow-up of 10.8 years, graft failures developed in 6 patients. Among them, 3 patients received their third HSCT to be engrafted finally. The Kaplan-Meier overall survival rate was 85.0% and 83.1% at 5 and 10 years, respectively. The incidence of acute and chronic GVHD was 20% and 20%, respectively. None of the patients have developed a malignancy after HSCT.
CONCLUSION
In our study, TLI based conditioning in allogeneic HSCT was feasible with acceptable rates of GVHD in SAA patients who experienced graft failure from prior HSCT or was at a high risk of graft rejection. We achieved relatively better results of engraftment and survival with a long term follow-up.

Keyword

Aplastic anemia; Total lymphoid irradiation; Hematopoietic stem cell transplantation

MeSH Terms

Anemia, Aplastic
Antilymphocyte Serum
Cyclosporine
Follow-Up Studies
Graft Rejection
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Incidence
Leukocytes
Lymphatic Irradiation
Retrospective Studies
Siblings
Stem Cells
Survival Rate
Tissue Donors
Transplants
Antilymphocyte Serum
Cyclosporine