PREVENTION OF GRAFT-REJECTION FOLLOWING BONE-MARROW TRANSPLANTATION

  • 1 January 1981
    • journal article
    • research article
    • Vol. 57  (1) , 9-12
Abstract
Bone marrow transplantation from an HLA-identical sibling is increasingly used in the treatment of severe aplastic anemia. One major problem with this approach is graft rejection that occurs in 25%-60% of patients conditioned for transplantation with cyclophosphamide. At most transplant centers, it has been difficult to accurately identify patients at high risk for graft rejection. A conditioning regimen of cyclophosphamide (200 mg/kg) and low-dose total body irradiation (3 Gy [gray] equivalent to 300 rad) was studied in 23 consecutive unselected patients with aplastic anemia followed for a minimum of 6 mo. There was only 1 episode of graft rejection. Graft-vs.-host disease and interstitial pneumonitis were not increased by the more intensive conditioning regimen. Actuarial survival was 61% at 1 yr and 49% at 2.5 yr. Cyclophosphamide and low-dose total body irradiation is an effective conditioning regimen in patients with aplastic anemia. It may be particularly useful when accurate predictive tests of graft rejection are not available as is the case in most transplant centers.