Bone marrow transplantation for paroxysmal nocturnal hemoglobinuria

Anna Maria Raiola, Maria Teresa Van Lint, Teresa Lamparelli, Francesca Gualandi, Federica Benvenuto, Osvaldo Figari, Nicola Mordini, Giovanni Berisso, Sonia Bregante, Francesco Frassoni, Andrea Bacigalupo

Research output: Contribution to journalArticle

Abstract

Background and Objectives. Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disease of the hemopoietic stem cell (HSC) characterized by intravascular hemolysis and increased risk of venous thrombosis. There are different therapeutic approaches for PNH which do not cure the disease, but can decrease its complications. Allogeneic bone marrow transplantation (BMT) may cure PNH. We reports here our experience of seven PNH patients who underwent allogeneic BMT. Design and Methods. Between January 1991 and January 1999 seven patients with PNH, aged 23 to 37, were transplanted with unmanipulated bone marrow from HLA identical siblings. Median time from diagnosis to BMT was 2.5 years (range: 1-16). All patients were transfusion- dependent and had received various treatments before BMT: steroids, vitamins, cyclosporin A (CyA), growth factors. One patient had also been treated with anti-thymocyte globulin. One patient was HbsAg positive and one anti-HCV positive. At the time of BMT the median value of hemoglobin (Hb) was 9 g/dL (range 6.511), white blood cells 5x109/L (range: 2.9-7.7), platelets 97x109/L (range: 31-355), LDH: 2726 U/L. The conditioning regimen was cyclophosphamide (160 mg/kg) and busulfan (10-14 mg/kg), followed by unmanipulated bone marrow (median of 5x108 cells/kg) and CyA (+MTX in two patients) for prophylaxis of graft-versus-host disease (GvHD). Results. All seven patients are alive, full chimeras, with complete hematologic recovery and no evidence of PNH, at a median follow up of 51 months post-BMT (6-103). Time to achieve a granulocyte count of ≥ 0.5x109/L, platelets ≥ 30x109/L and Hb 10 g/dL was respectively 16, 19 and 22 days. Acute GvHD was limited or mild in six patients, and severe in one. Chronic GvHD was extensive in two patients. Interpretation and Conclusions. This study confirms that HLA identical sibling BMT is an effective therapeutic option for PNH, also in the hemolytic phase of the disease: It also suggests that HBV and HCV infections are not an absolute contraindication. (C) 2000, Ferrata Storti Foundation.

Original languageEnglish
Pages (from-to)59-62
Number of pages4
JournalHaematologica
Volume85
Issue number1
Publication statusPublished - Jan 2000

Keywords

  • ABMT
  • Paroxysmal nocturnal hemoglobinuria

ASJC Scopus subject areas

  • Hematology

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