Alemtuzumab, Fludarabine and Melphalan as a Conditioning Therapy inSevereAplasticAnemiaandHypoplasticMyelodysplastic Syndrome—Single Center Experience

Background: Allogeneic hematopoietic stem cell transplantation is the treatment of choice in young patients with severe aplastic anemia. The main causes of failure after this procedure are graft versus host disease, infections and graft failure, often exacerbated by large numbers of transfusions and prolonged disease duration before transplant. Methods:We report the results of allografting following conditioning with fludarabine, alemtuzu-mab and melphalan in: five patients with severe aplastic anemia and one with hypoplastic myelodysplastic syndrome. All patients had matched sibling donors. Source of hematopoietic stem cell was: bone marrow—2, blood—3, bone marrow and blood—1. The age of recipients was 18–26 years. Four patients received their graft as the first line therapy and two after failure of cyclosporine and antithymocyte globulin treatment. Number of transfused units including red blood cells and platelets before transplantation was 8–100 (median: 22) and 10– 32 (median: 11), respectively. All donors and recipients were CMV-seropositive. Conditioning consisted of: alemtuzumab 30 mg/d (day 7 to 5), fludarabine 30 mg/m2 (days 7 to 3) and melphalan 140 mg/m2 at the day 2. Results: The time to granulocytes and platelets recovery was 15 and 25 days, respectively