Volumen: 16 # Number : 2
Publication Date : Mayo - Agosto Year: 2012
Authors: Jaimovich G., Fernandez Escobar N., Requejo A., Brioschi S.,
Puente D., Bonini N., Saa G., Trentadue J., Drelichman G.,
Real J., Milovic V., Feldman, L.
Abstract: Objective: Hematopoietic stem cell transplant from an
unrelated donor offers the only curative option for many
patients with hematologic malignant and non malignant
disorders. In this retrospective study we report a single
center results of consecutive patients with unrelated donor
hematopoietic stem cells transplantation (UDSCT).
Patients and Methods: Between 05/2004 and 01/2011,
61 patients (pts) were treated with an UDSCT (31 adults
and 30 children). Study endpoints include cumulative
incidence of acute and chronic graft-versus host disease
(GVHD), transplant related mortality and overall survival.
Results: Median age 19,6 years (range: 1-54). Most of
the patients had: Acute leukemia (AL), myelodisplastic
syndrome, chronic myeloid leukemia, congenital bone
70 HEMATOLOGIA l Volumen 16 - Nº 2, 69-78, 2012
marrow failure syndrome and congenital immunodeficiency’s.
Fifty one percent of the AL were in complete
remission. Donor selection was according HLA match,
accepting up to 2 mismatches: 8/10 for bone marrow (BM)
or peripheral blood stem cells (PBSC) and 4/6 for cord
blood (UC). CPH source: BM 36%; PBSC 36% and UC
28%. Total body irradiation was part of the conditioning
regimen in 36 patients and the entire cohort received
ATG. Tacrolimus and metotrexate were the most common
GVHD prophylactic regimen applied.
Granulocyte and platelet engraftment media was 19.9
days (D) (PBCS: 16,5 D; BM: 20,5 D and UC 22,7 D) and
23,5 D (PBSC 18,7 D; BM 21 D and UC: 34,6 D) respectively.
Grade 1, 2, 3 and 4 acute GVHD incidence was
16,4%, 23%, 6,5% and 1,6% respectively. Cytomegalovirus
reactivation was detected in 52,4% of the pts and require
preemptive therapy. With a median follow up of 24
months, 27 patients (45%) were alive. Transplant related
mortality was 25%. Septic shock and acute respiratory
distress syndrome were the most frequent cause of death.
Conclusions: The overall survival was 45% after a median
follow up of 24 month. GVHD incidence was similar
using match sibling donors. The use of adjusted donor
selection criteria and a skilled medical management team
could give comparable results with other international
recognized groups.
Key words: Hematopoietic stem cell transplantation.
Unrelated donor. Graft vs host disease. Hematopoietic cord
blood cells. Double cord transplantation.
Pages : 69-78
|
