Young patients with Hypocellular Bone Marrow ideally need Allogenic Stem Cell Transplant or ATG + CYA + Steroids. In country like India these two treatment modalities are very expensive and very few can afford. We tried to study effect of single course of IV FLUDARABINE 30 mg/m2 x 5 days as an upfront immunosuppressive therapy for these patients.

Study period: January 2001 – April 2004.

Total patients – 29.

Age group: 17 – 47 years

Follow up: 4–37 months. Median follow up 15 months.

Haemogram range at diagnosis

Hb: 3–7.2 gm%, ANC: 100 – 600/cmm, Platelet: 3 – 11 x 10 9/L

Bone marrow aspirate & trephine biopsy showed Hypocellularity on all patients.

8/29 patients had dysplastic features on morphology.

3/29 patients had cytogenetic anamoly, two: del 7 & one: del 7q.

14/29 patients had normal cytogenetics.

12/29 patients no metaphases seen on Cytogenetics.

All cellular transfusions were 2500 rads irradiated.

11/29 ( 38 %) patients died in first six months, causes of mortality being infection and intracranial bleed.

10/29 ( 34 %) patients responded to treatment. They are transfusion independent ( Hb > 9 gm%), platelet > 50000/cmm and ANC > 1500/cmm. All three patients with cytogenetic anamoly responded.

8/29 ( 28 %) patients showed no response.

Larger data is needed to asses the efficiency of single course IV Fludarabine in patients with Hypocellular bone marrow. Single five day course of IV Fludarabine can be a cheaper immunosuppression, for these patient.

Cost: ALLO SCT - Rs. 10 lakh ( $ 20000), ATG + CYA + Steroid - Rs. 4 lakh ($ 3000)

IV Fludara 30 mg/m2 x 5 day – Rs. 40000/- ( $ 800)

Topics:
aplastic anemia, bone marrow, hypocellular, fludarabine, follow-up, steroids, therapeutic immunosuppression, allopurinol, biopsy, blood transfusion, bone marrow aspiration

Author notes

Corresponding author

2005, The American Society of Hematology
2004
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