Allogeneic stem cell transplantation in chronic myeloid leukemia two and a half year experienceKhalil Ullah1, Badshah Khan1, Parvez Ahmed1, Iftikhar Hussaın2, Shahid Raza1, Muhammad Naeem1, Hamid Iqbal1, Hamid Saeed1, Khalid Kamal11Armed Forces Bone Marrow Transplant Center, Haematology, Rawalpindi, Pakistan
2Combined Military Hospital, Oncology, Rawalpindi, Pakistan
This study is performed to evaluate outcome of allogeneic stem cell transplantation (SCT) in chronic myeloid leukemia at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from Apr 2002 to Oct 2004. Twenty-two patients with CML underwent allogeneic SCT from HLA matched siblings. Patients were divided into standard (n= 14) and high-risk (n= 8) groups. Patients were subjected to conditioning regimens consisting of busulphan and cyclophosphamide. Cyclosporin, prednisolone and methotrexate were given for GVHD prophylaxis. All donors were subjected to PBSC harvest after G-CSF therapy for five days. All patients received G-CSF from day + 5 until ANC > 0.5 x 109/L. The median age of the patients was 29 years (range 7-53 years) with a male to female ratio of 6.3: 1. Engraftment was achieved in all patients. Median time to achieve neutrophil (ANC 0.5 x 109/L) and platelet (20 x 109/L) recovery was 13 days and 12 days respectively. Median stay in hospital was 18 days. Acute GVHD (Grade II-IV) was observed in eleven patients (50%) while chronic GVHD was seen in four patients (18%). One patient relapsed 8 months post-transplant. Two patients (9%) developed VOD liver. One patient had haemorrhagic cystitis. Four patients (18%) developed post-transplant infectious complications, which included Pseudomonas septicemia, aspergillosis, tuberculous pleural effusion and herpes zoster. Overall mortality was 22.7% (n= 5). The major causes of mortality were VOD liver, GVHD grade IV, Pseudomonas septicemia and aspergillosis. Overall survival was 77.2% (n= 17) and disease free survival was (n= 16) 72.7%. Follow up ranges from 23 to 828 days (median 212 days). The preliminary results of SCT in this small series of patients with CML are very encouraging. To improve the long-term survival it is imperative that patients are transplanted early after diagnosis and conditioning regimens are selected carefully. Keywords: Chronic myeloid leukaemia, Allogeneic stem cell transplantation, Graft Versus Host Disease.
Kronik myeloid lösemide allojeneik kök hücre nakli 2.5 yılık deneyimKhalil Ullah1, Badshah Khan1, Parvez Ahmed1, Iftikhar Hussaın2, Shahid Raza1, Muhammad Naeem1, Hamid Iqbal1, Hamid Saeed1, Khalid Kamal11Armed Forces Bone Marrow Transplant Center, Haematology, Rawalpindi, Pakistan
2Combined Military Hospital, Oncology, Rawalpindi, Pakistan
Bu çalışma Rawalpindi Silahlı Kuvvetler Kemik iliği Nakli merkezinde kronik myelositer lösemi hastalarına 2002 Nisan-2004 Ekim arası uygulanan allojeneik nakillerin sonuçlarını değerlendirmektedir. KML tanılı 22 hastaya HLA uyumlu kardeşinden allojeneik nakil yapılmıştır. Hastalar standart riskli (n= 14) ve düşük riskli (n= 8) olmak üzere iki gruba ayrılmıştır. Hazırlama rejimi olarak busulfan artı siklofosfamid kullanılmıştır. GVHH profilaksisi için siklosporin, prednizolon, metotreksat verilmiştir. Tüm olgularda kök hücre toplanması beş günlük G-CSF ardından yapılmıştır. Ayrıca nakilden beş gün sonra başlayıp, MNS> 0.5 x 109/L olana kadar devam edilmiştir. Hastaların median yaşı 29 yıldır (7-53 yıl) olup erkek/kadın oranı 6.3/1’dir. Tüm hastalarda engrafman gerçekleşmiş olup, nötrofil toparlanması (MNS > 0.5 x 109/L) median 13 gün ve trombosit toparlanması (PLT > 20 x 109/L) median 12 günde gerçekleşmiştir. Hastanede median kalma süresi 18 gündür. On bir hastada (%50) akut GVHH (Evre II-IV) gelişmiş ve 4 hastada kronik GVHH (%18) görülmüştür. Bir hasta nakilden 8 ay sonra relaps olmuş, iki hastada (%9) VOD gelişmiş, bir hastada ise hemorajik sistit görülmüştür. Dört hastada (%18) nakil sonrası infeksiyöz komplikasyonlar görülmüştür. Bunlar arasında psödomonas sepsisi, aspergilloz, tuberküloz plevral efüzyon ve Herpes Zoster yer almaktadır. Genel mortalite %22.7’dir (5 hasta). Temel ölüm nedenleri VOD, Evre IV GVHH, psödomonas sepsisi ve aspergillozdur. Genel sağkalım %77.2 (n= 17), hastalıksız sağkalım ise %72.7 (n= 16)’dir. İzlem süresi median 212 (23-828) gündür. Bu küçük serideki ilk sonuçlar KML açısından yüz güldürücüdür. Anahtar Kelimeler: Kronik mwyeloid lösemi, Allojeneik kök hücre nakli, Graft Versus Host Hastalığı.
Khalil Ullah, Badshah Khan, Parvez Ahmed, Iftikhar Hussaın, Shahid Raza, Muhammad Naeem, Hamid Iqbal, Hamid Saeed, Khalid Kamal. Allogeneic stem cell transplantation in chronic myeloid leukemia two and a half year experience. Turk J Hematol. 2005; 22(2): 79-86
Corresponding Author: Khalil Ullah, Pakistan |
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