Abstract
Young patients with Hypocellular marrow (SAA, VSAA, MDS) ideally need ALLO SCT or Triple Immunosupression with ATG + Cyclosporin + Steroids therapy. However these therapies are very expensive and affordable to very few in third world poor countries. Majority of these patients are treated with androgens with dismal outcome. IV Fludarabine has been used in the setting of ALLO SCT in the preparative regimens and the immunosupressive effect of IV Fludarabine is well established.We decided to assess effect of IV Fludarabine for these patients. The comparative cost is as follows in our country: Allo SCT-$25000/-, ATG+ CYA Therapy- $ 14000/-, IV Fludarabine150mg / m2 - $ 1300/-. At our center we approximately diagnose 75 new cases of SAA, VSAA every year. About 10% undergo ALLOSCT, 15% are treated with ATG+CYA. Approximately 75% patients are treated with androgens. We started this study in patients who could not be treated upfront with standard therapy. W e totally treated 55 patients with SAA, VSAA upfront with IV FLUDARABINE 30mg/m2/day for five successive days. 20 / 55 (36%) patients showed good response and became RBC, Platelet transfusion independant.All these patients achieved ANC > 1500/cmm. 21 / 55 (38%) patients died in first six months. 14 /55 (25%) patients showed no response. Thus SINGLE COURSE IV FLUDARABINE 150 mg /m2 can be a good, cheaper treatment option for newly diagnosed SAA, VSAA.
Patient data
| Study Period . | Jan 2001 . | June 2007 . | . |
|---|---|---|---|
| DOSE: IV Fludarabine 30mg / m2 x 5 days | |||
| Total Patients | 55 | ||
| Age Group | 15 – 56 years | Males - 37 | females -18 |
| Follow up | 2 – 54 months | Median follow up | 36months |
| Haemogram ranges at diagnosis | Hb: 3 - 7.4 gm% | ANC : 100 – 600cmm | Platelet count - 3 -12 x 10′9/l |
| Dysplasia - 12 /55 | |||
| Cytogenetics | 4/55 patients had cytogenetic abnormality : two had del 7 two had del7q | 21/55 patients had normal cytogenetics | 30/55 patients no metaphases seen on cytogenetics |
| All cellular transfusions were irradiated with 2500 rads. | |||
| Response | 20 / 55 -Response | 14 / 55 - No Response | 21/55 - Deaths |
| Study Period . | Jan 2001 . | June 2007 . | . |
|---|---|---|---|
| DOSE: IV Fludarabine 30mg / m2 x 5 days | |||
| Total Patients | 55 | ||
| Age Group | 15 – 56 years | Males - 37 | females -18 |
| Follow up | 2 – 54 months | Median follow up | 36months |
| Haemogram ranges at diagnosis | Hb: 3 - 7.4 gm% | ANC : 100 – 600cmm | Platelet count - 3 -12 x 10′9/l |
| Dysplasia - 12 /55 | |||
| Cytogenetics | 4/55 patients had cytogenetic abnormality : two had del 7 two had del7q | 21/55 patients had normal cytogenetics | 30/55 patients no metaphases seen on cytogenetics |
| All cellular transfusions were irradiated with 2500 rads. | |||
| Response | 20 / 55 -Response | 14 / 55 - No Response | 21/55 - Deaths |
Author notes
Disclosure: No relevant conflicts of interest to declare.
