Allogeneic peripheral blood stem cell transplantation in aplastic anemia.

Klebsiella on one occasion. Staphylococcus aureus was grown from central line tip on two occasions. He was started on meropenem and teicoplanin for 3 weeks, when he developed maxillary sinusitis, for which he was started on amphotericin B. He continued to have intermittent fever. He was also given granulocyte infusions for one week. Blood culture was sterile after 3 weeks when a Hickman catheter insertion was done. During this time HLA typing of his 3-year-old sister was done and found to be 6 antigens matched. During the afebrile period patient was started on conditioning with fludarabine (30 mg/m2 IV daily on day 2-4 busulfan (4 mg/kg/d q6h on day 5,6) and cyclophosphamide. 350 mg/m2 IV daily on day 2-4. A peripheral blood stem cell (PBSC) harvest was done from the donor after 5 days of G-CSF at 10 mcg/ kg/d. A volume of 110 mL was collected with an MNC of 3.65 × 108 cells/kg. The CD 34 cell dose was 1.34 × 106 cells/kg. GVHD prophylaxis was IV cyclosporin (CsA) at a dose of 3.0 mg/kg/d. G-CSF was started from Allogeneic hematopoietic stem cell transplantation (HSCT) is the definitive therapy for severe aplastic anemia (SAA)(1,2). The major factors that limit the success of HSCT are graft rejection and graft-versus-host diseases (GVHD)(3,4). Engraftment depends on the conditioning regimen, GVHD prophylaxis, number of donor marrow cells infused and alloimmunization of the patient(3,4). Taking an aplastic anemia with septicemia for transplant is a very high-risk proposition.