Korean J Hematol 2002; 37(2):
Published online June 30, 2002
© The Korean Society of Hematology
중증 재생불량성빈혈 환자에서 강화된 전처치 요법과 고용량조혈모세포이식(1995∼2000)
박치영, 민우성, 신호진, 김유진, 박윤희, 김희제, 이석, 민창기, 김동욱, 이종욱, 박종원, 김춘추
가톨릭대학교 의과대학 조혈모세포이식센터
Allogeneic Hematopoietic Stem Cell Transplantation Using Intensified Conditioning Regimen and High dose Stem Cells in Severe Aplastic Anemia
Background : Graft rejection as well as graft versus host disease is the main cause of failure after allogeneic hematopoietic stem cell transplantation (HSCT) in patient with severe aplastic anemia. Graft rejection is associated with multiple transfusions before transplant. We added procarbazine (PCB) to the cyclophosphamide (CY) and antithymocyte globulin (ATG) conditioning regimen to overcome rejection since a synergistic immunuosuppressive effect between alkylating agents and ATG had been
reported. In heavily transfused patients, G-CSF primed bone marrow＋T cell depleted peripheral blood stem cell was used as the source of stem cells. Here we report the outcome in severe aplastic anemia patients receiving the intensified
pretransplant conditioning and high dose stem cells to overcome graft rejection in these high risk patients.
Methods : Between January 1995 and December 2000, among 113 patients with severe aplastic anemia who underwent allogeneic- HSCT after conditioning with CY＋ATG＋PCB, 90 patients were enrolled and divided into three groups. Thirty eight patients who received a small amout of transfusion were transplanted with bone marrow stem cells alone (group 1). In heavily transfused patients, 32 patients transplanted with bone marrow stem cells alone (group 2), and 20 patients transplanted with high dose
stem cells (group 3). We evaluated the effect and outcome of a high dose stem cell transplantation, retrospectively.
Results : The median age of all patients was 29 years (range 16 to 50) and median follow up duration was 30 months (range 1 to 80). Male to female ratio was 61 : 52. Six-year estimated overall survival of all patients was 88.4%. Sixteen patients (14.1%) experienced in graft rejection. A significant statistical significancy was observed with result that the lowest rejection incidence (5%) was seen in group 3, compared with 28.2% in group 2 (P= 0.02) and 13.1% in group 1. The incidence of acute
and chronic graft versus host disease among patients with sustained engraftment was respectively 9.4%, 15.6% in group 2, and 20%, 20% in group 3 (P=0.4, P=0.78). Six-year estimated overall survival was 78% in group 2, and 90% in group 3(P=0.24).
Conclusion : These results suggest that allogeneic-HSCT with high dose stem cells is an effective treatment to overcome graft rejection in heavily transfused severe aplastic anemia patients.
Keywords Severe aplastic anemia; Rejection; High dose stem cell transplantation;
PDF
Standard view
Export citation
Share Article
Korean J Hematol 2002; 37(2): 106-113
Published online June 30, 2002
Copyright © The Korean Society of Hematology.
중증 재생불량성빈혈 환자에서 강화된 전처치 요법과 고용량조혈모세포이식(1995∼2000)
박치영, 민우성, 신호진, 김유진, 박윤희, 김희제, 이석, 민창기, 김동욱, 이종욱, 박종원, 김춘추
가톨릭대학교 의과대학 조혈모세포이식센터
Allogeneic Hematopoietic Stem Cell Transplantation Using Intensified Conditioning Regimen and High dose Stem Cells in Severe Aplastic Anemia
Chi Young Park, Woo Sung Min, Ho Jin Shin, Yoo Jin Kim, Yoon Hee Park, Hee Je Kim, Seok Lee, Chang Ki Min, Dong Wook Kim, Jong Wook Lee, Jong Won Park, Chun Choo Kim
Cathilic, Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, Seoul, Korea
Abstract
Background : Graft rejection as well as graft versus host disease is the main cause of failure after allogeneic hematopoietic stem cell transplantation (HSCT) in patient with severe aplastic anemia. Graft rejection is associated with multiple transfusions before transplant. We added procarbazine (PCB) to the cyclophosphamide (CY) and antithymocyte globulin (ATG) conditioning regimen to overcome rejection since a synergistic immunuosuppressive effect between alkylating agents and ATG had been
reported. In heavily transfused patients, G-CSF primed bone marrow＋T cell depleted peripheral blood stem cell was used as the source of stem cells. Here we report the outcome in severe aplastic anemia patients receiving the intensified
pretransplant conditioning and high dose stem cells to overcome graft rejection in these high risk patients.
Methods : Between January 1995 and December 2000, among 113 patients with severe aplastic anemia who underwent allogeneic- HSCT after conditioning with CY＋ATG＋PCB, 90 patients were enrolled and divided into three groups. Thirty eight patients who received a small amout of transfusion were transplanted with bone marrow stem cells alone (group 1). In heavily transfused patients, 32 patients transplanted with bone marrow stem cells alone (group 2), and 20 patients transplanted with high dose
stem cells (group 3). We evaluated the effect and outcome of a high dose stem cell transplantation, retrospectively.
Results : The median age of all patients was 29 years (range 16 to 50) and median follow up duration was 30 months (range 1 to 80). Male to female ratio was 61 : 52. Six-year estimated overall survival of all patients was 88.4%. Sixteen patients (14.1%) experienced in graft rejection. A significant statistical significancy was observed with result that the lowest rejection incidence (5%) was seen in group 3, compared with 28.2% in group 2 (P= 0.02) and 13.1% in group 1. The incidence of acute
and chronic graft versus host disease among patients with sustained engraftment was respectively 9.4%, 15.6% in group 2, and 20%, 20% in group 3 (P=0.4, P=0.78). Six-year estimated overall survival was 78% in group 2, and 90% in group 3(P=0.24).
Conclusion : These results suggest that allogeneic-HSCT with high dose stem cells is an effective treatment to overcome graft rejection in heavily transfused severe aplastic anemia patients.
Keywords: Severe aplastic anemia, Rejection, High dose stem cell transplantation,
Previous Article
