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Background Due to increased rates of secondary solid organ cancer in patients with severe aplastic anemia who received an irradiation-based conditioning regimen, we decided some years ago to use the combination of cyclophosphamide and antithymocyte globulin. We report the long-term follow up of patients who underwent hematopoietic stem cell transplantation from an HLA-matched sibling donor after this conditioning regimen.Design and Methods We analyzed 61 consecutive patients transplanted from June 1991 to February 2010, following conditioning with cyclophosphamide (200 mg/kg) and antithymocyte globulin (2.5 mg/kg/day × 5 days).Results Median age was 21 years (range 4–43); 41 of the 61 patients were adults. Median duration of the disease before hematopoietic stem cell transplantation was 93 days. All but 2 patients received bone marrow as the source of stem cells and all but 2 engrafted. Cumulative incidence of acute grade II–IV graft-versus-host disease was 23% (95%CI 13–34) and 18 developed chronic graft-versus-host disease (cumulative incidence 32% at 72 months, 95% CI 20–46). In multivariate analysis, a higher number of infused CD3 cells was associated with an increased risk of developing chronic graft-versus-host disease (P=0.017). With a median follow up of 73 months (range 8–233), the estimated 6-year overall survival was 87% (95% CI 78–97). At 72 months, the cumulative incidence of avascular necrosis was 21% and 12 patients presented with endocrine dysfunction (cumulative incidence of 19%). Only one patient developed a secondary malignancy (Hodgkin’s lymphoma) during follow up.Conclusions Cyclophosphamide and antithymocyte globulin is an effective conditioning regimen for patients with severe aplastic anemia and is associated with low treatment-related mortality. Long-term complications include avascular necrosis and endocrine dysfunction.

background: data on early treatment-related morbidity after radiotherapy alone (rt; 217 patients) or combined with chemotherapy (rt + ct; 182 patients) of head and neck squamous cell carcinoma are analyzed. patients and methods: the patients were treated between november 1985 and november 1996 in four swiss centers that independently introduced combined-modality therapy in selected cases of head and neck cancer. rt schedules varied among the four centers, but within each institution all patients received the same dose-fractionation schedule irrespective of whether they had ct or not. the following early morbidity items were evaluated: skin, mucosa, larynx, salivary glands, dysphagia, weight loss, and toxic death. toxicity was scored using the eortc/rtog scale. results: although considerable variation was noted among the treatment schedules/centers, the main findings are as follows: (1) early morbidity was significantly enhanced after all five rt + ct schedules compared with rt alone; (2) typically, a third of the patients lost > 10% of their body weight during concurrent rt + ct as compared with 10% of the patients receiving rt alone; (3) at 12 weeks, the prevalence of grade 2 morbidity was 25-60% after rt + ct as compared with 4-20% after rt alone. conclusion: a number of early morbidity items were found to be more prevalent and/or more severe after rt + ct than after rt alone. hintergrund: vorstellung der akuten nebenwirkungen nach alleiniger radiotherapie (rt; 217 patienten) oder kombinierter radiochemotherapie (rt + ct; 182 patienten) bei patienten mit hals-nasen-ohren-tumoren. patienten und methodik: die patienten wurden zwischen november 1985 und november 1996 in vier schweizerischen spitälern behandelt. dabei kamen verschiedene unabhängige, kombinierte behandlungen für fortgeschrittene hals-nasen-ohren-karzinome zur anwendung. ct- und rt-protokolle waren unterschiedlich, innerhalb jedes einzelnen zentrums wurden jedoch alle patienten nach dem gleichen bestrahlungsschema behandelt (mit oder ohne ct). folgende akute nebenwirkungen wurden erfasst: haut, schleimhaut, larynx, speichelfluss, dysphagie, gewichtsverlust und tod durch komplikationen. die beschreibung der akuten toxizität erfolgte nach der eortc/rtog-skala. ergebnisse: trotz erheblicher unterschiede in der bestrahlungstechnik zwischen den spitälern sind die wichtigsten ergebnisse folgende: 1. die akuten nebenwirkungen waren bei kombinierter rt + ct signifikant stärker als bei alleiniger rt; 2. ein drittel der patienten verlor > 10% ihres körpergewichts während der kombinierten rt + ctc; 3. 12 wochen nach abschluss der behandlung stand eine grad-2-toxizität in 25-60% nach kombinierter rt + ct und in 4-20% nach alleiniger rt im vordergrund. schlussfolgerung: die akuten nebenwirkungen waren nach kombinierter rt + ct stärker und häufiger als nach alleiniger bestrahlung. [ABSTRACT FROM AUTHOR]