Allo-SCT is the treatment of choice for patients with SAA. Reduced intensity Conditioning (RIC) has been used in the past to ensure adequate engraftment and reduce mortality related to the procedure. Here we report a retrospective analysis of our experience using a fludarabine based RIC in patients with SAA. Since 2006, 12 patients (1 Fanconi Anemia, 11 adquired SAA), mean 38 years (13-60), 10 males, 2 females, have been treated with HLA identical related RIC allo-SCT. Conditioning regimen consisted of Flu (30 mg/m2/day × 4 days), Cyclophosphamide (Cy 10 mg/kg/day × 4 days) and horse antithymocyte globuline (ATG 2 mg/Kg/day × 4 days). GVHD prophylaxis consisted in Ciclosporine and metrotexate for 4 patients, cyclosporine and MMF for 4 patients and cyclosporine alone in 4 patients. All grafts were obtained from peripheral blood stem cells. All, but 1 patient, were considered high risk because of more than 20 transfusions before transplantation, co-morbidities (morbid obesity, renal dysfunction, hepatic toxicity), age (3 patients were over 50) or previous transplant (2 patients had previous secondary graft failure after conditioning containing Campath). Mean time from diagnosis to transplantation was 21.1 months (4.1-118.7). One 13 year old patient, with history of multiple infections expired before stem cell infusion due to severe sepsis. 11 patients engrafted, average at 11 days (range 9-16) for neutrophils and 11 days (range 8-14) for platelets. Transfusion and antibiotic support required was minimal. None of the patients developed mucositis, diarrhea or required parenteral nutrition. Acute GVHD was seen in 2 of evaluable patients; both of them grade IV gastrointestinal disease, one required ATG treatment due to corticoid refractory disease. Chronic GVDH was seen in 1 patient who developed a nephrotic syndrome. At a mean follow-up of 15 months (range 1-42), 11 patients are alive and in remission of SAA. This experience suggests that Flu based RIC protocol allows rapid and sustained engraftment with minimal early toxicity even in high-risk patients. Multicenter prospective clinical trials with longer follow-up are warranted to confirm our observation.