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 PeriodJan 2001June 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 PeriodJan 2001June 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.