The Clinical Observation Of Severe Aplastic Anaemia Treated With Fludarabine,Cyclophosphamide And Ciclosporin

Objective To observe the efficacy and clinic safety of fludarabine,cyclophosphamide and ciclosporin(FCC regimen)in adult severe aplastic anemia patients.Method We retrospectively analyzed 3 patients with SAA treated with FCC regimen from february 2016 to january 2018.Including two SAA and one VSAA,two males and one females.Every patient should be diagnosed and typed before treatment.Fludarabine was used at 50mg/d intravenously for 5d and cyclophosphamide was used at 10mg/kg/d intravenously for 4d,additional cyclophosphamide of 10 mg/kg/week was used until the patient achieved hematology improvement,transfusion interval extension or emerging toxicity.Oral CsA at an dose of 3~5mg/kg/day was administered every 12 h and adjusted to maintain a serum level of 150~250ng/ml or based on renal toxicity or tolerance.Short courses of G-CSF(5μg/kg·d)were administered as clinically indicated when the neutrophils less than 0.5×10^9/L and stopped at ≥1.0×10^9/L.MAP transfusion when hemoglobin<60g/L.Plt transfusion when platelet count<10×10^9/L,platelet transfusion indicator relaxed to<20×10^9/L when there are risk factors for platelet consumption,patients with severe bleeding are not subject to the above standards.Therapy response were measured by the British Hematology Standards Committee standards.Results All patients achieve treatment response within 1 year.Patient 1 and patient 2achieve complete response,by the end of the follow-up,patient 3 was seven months after treatment and by that time he had achieved partial response.All patients tolerated the FCC regimen well,no serious functional damage of organs.Three patients developed mild liver damage,elevated blood sugar in two patients,patient 1 developed hemorrhagic cystitis,patient 3 suffered from septicemia,alimentary tract bleeding and lung infection.All the adverse reactions can be recovered after active treatment.The total cost of treatment for patients 1,2 and 3 was $135,611,$52,338 and $326,952 respectively,total medical cost was $171,633.Conclusions 1.The FCC regimen is effective in treating adult SAA,it can be used as an additional treatment for patients who are unconditionally receiving standard first-line treatments(HSCT and IST).2.The FCC regimen is suitable for basic hospitals or economically underdeveloped areas because of its low requirement for ward conditions and relatively low treatment costs.3.The FCC regimen have the advantage of maintaining treatment after treatment response in SAA patients.