Journal List > Korean J Hematol > v.41(2) > 1032706

Na, Shin, Song, Lee, Yun, Kim, Yoon, Lee, Park, and Kim: Graft-Versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation with Non-Myeloablative Conditioning: Experiences at a Single Center

Abstract

Background:

The use of non-myeloablative stem cell transplantation (NST) has recently been increasing for treating the patients who cannot tolerate ablative hematopoietic stem cell transplantation (HSCT). Although graft-versus-host disease (GVHD) is one of the greatest problems in HSCT, the clinical effect of GVHD following NST is not clear. We undertook this study to evaluate the clinical manifestations of GVHD and the outcomes after NST.

Methods:

From October 2000 to October 2004, 61 patients underwent NST with a fludarabine-based conditioning regimen. The cumulative incidence of GVHD and the survival rates were obtained from the Kaplan-Meier curves.

Results:

With a median follow-up of 195 days, the estimate for overall three-year survival was 32%. The cumulative incidences of grades II~IV acute GVHD and chronic GVHD were 33% (18/53) and 78% (29/37), respectively. The response rates for acute and chronic GVHD were 33% and 89%, respectively. The survival rates of patients with acute and chronic GVHD were 27% and 89%, respectively. The median survival time was 6.5 months

Conclusion:

The incidence of GVHD after NST did not differ from that after ablative HSCT. This study suggests that the aggressive treatment of acute GVHD should be considered to improve the overall survival after NST.

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Fig. 1
Kaplan-Meier survival curve of overall survival after NST.
kjh-41-92f1.tif
Fig. 2
Cumulative incidence of grade II~IV acute GVHD (A) and chronic GVHD (B).
kjh-41-92f2.tif
Fig. 3
Survival curves of acute (A) and chronic (B) GVHD under immunosuppressive treatment.
kjh-41-92f3.tif
Table 1.
Patient characteristics
Characteristic n (%)
Age (years)
  Median 48
  Range 17~67
Sex
  Male 52 (85%)
  Female 9 (15%)
Donor
  Related 50 (81%)
  Unrelated 11 (19%)
Stem cell source
  Peripheral blood stem cell 51 (83%)
  Bone marrow 2 (3%)
  Both 8 (13%)
Conditioning
  Fludarabine/melphalan 38 (62%)
  Fludarabine/cyclophosphamide 23 (38%)
Table 2.
Diseases of patients who received NST
Pretransplantation disease Total number Relapse/ refractory (n
Acute myelogenous leukemia 20 5/11
Acute lymphoblastic leukemia 10 7/3
Non-Hodgkin's lymphoma 8 0/8
Multiple myeloma 4 0/4
Chronic myelogenous leukemia 2 0/2
Mylelodysplastic syndrome 8 -
Renal cell carcinoma 5 0/5
Aplastic anemia 4 4/0
Table 3.
Outcome of NST
Pretransplantation disease Evaluated number n (%)
Chimerism 53 42 (80)
Response 50 20 (40)
Early Mortality 61 13 (21)
Survival Rate∗ 61 33%

∗Three-year survival rate.

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