-Case Reports-

Umbilical-cord Blood Cell Transplantation Conditioned with a Reduced Intensity-regimen is a Practical Salvage Therapy for Severe Aplastic Anemia Refractory to Immunosuppressive Therapy with Antithymocyte Globulin/Ciclosporin

Kenji Tajika, Taro Mizuki, Kazutaka Nakayama, Hiroki Yamaguchi and Kazuo Dan

Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School

Immunosuppressive therapy and stem cell transplantation from an HLA-identical donor are the major effective treatments for severe aplastic anemia. However, treatments still need to be developed for patients who do not have a HLA-identical donor and have not shown a clinical response to immunosuppressive therapy. We herein report on 2 patients in whom this problem could be overcome by transplantation of HLA-mismatched umbilical cord blood from unrelated donors. Two Japanese patients with severe aplastic anemia underwent conditioning with fludarabine, cyclophosphamide, and low-dose total-body irradiation and then received transplants of umbilical cord blood. Engraftment of the three lineages occurred without problems. We conclude that umbilical cord blood transplantation with a reduced-intensity conditioning regimen of fludarabine, cyclophosphamide, and total-body irradiation for patients with aplastic anemia is a practical treatment and may be an attractive alternative for patients who does not have an HLA-identical donor and have shown no clinical response to immunosuppressive therapy.

J Nippon Med Sch 2007; 74: 424-429

Keywords
severe aplastic anemia, cord blood transplantation, reduced intensity conditioning

Correspondence to
Kenji Tajika, MD, PhD, Division of Hematology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
tajika@nms.ac.jp

Received, June 13, 2007
Accepted, September 18, 2007