Successful HSCT using nonradiotherapy-based conditioning regimens and alternative donors in patients with Fanconi anaemia - experience in a single UK centre

Seven children with Fanconi anaemia (FA) (five female, two male), who had not undergone transformation, received nine haemopoietic stem cell transplantation (HSCT) between 2000 and 2004. Conditioning regimen was: fludarabine 25 - 30 mg/m(2)/ day for 5 days, antilymphocyte globulin 12.5 mg/kg/day for 3 days and cyclophosphamide 5 - 7.5 mg/kg/day for 4 days. Radiation was not used. One male patient who had multiple HSCT and one female who was retransplanted, received slightly different conditioning regimens. Four patients received fully matched unrelated umbilical cord blood (UCB), two matched unrelated peripheral blood stem cell (PBSC) grafts, and three haploidentical T-cell-depleted (TCD) PBSC grafts. None of the patients had any significant conditioning-related toxicity or severe infections. All engrafted within 2 - 3 weeks. One patient rejected her first HSCT after 10 weeks and had a second successful transplant from the same donor. One male patient rejected his TCD haploidentical HSCT from his mother, and subsequently had a successful fully matched unrelated UCB transplant. Rejection rate was 22%. Acute and chronic graft-versus-host disease (GVHD) was seen in 77 and 22% patients. In all, 57% patients developed autoimmune complications, all of which have resolved. All patients are well with stable or full donor chimerism after a median follow-up of 37 months ( range 13 - 54).