Korean J Hematol 2002; 37(2):

Published online June 30, 2002

© The Korean Society of Hematology

발작성야간혈색소뇨증에서의 조혈모세포이식

신호진, 김희제, 박치영, 박윤희, 김유진, 이석, 민창기, 김동욱, 이종욱, 김춘추, 민우성

부산대학교 의과대학 내과학교실,
가톨릭대학교 의과대학 내과학교실,
조혈모세포이식센터

Hematopoietic Stem Cell Transplantation for Paroxysmal Nocturnal Hemoglobinuria

Ho Jin Shin, Hee Je Kim, Chi Young Park, Yoon Hee Park, Yoo Jin Kim, Seok Lee, Chang Ki Min, Dong Wook Kim, Jong Wook Lee, Chun Choo Kim, Woo Sung Min

Department of Internal Medicine, College of Medicine, Busan National University, Busan, Korea
Department of Internal, Catholic Hemopoietic Stem Cell Transplantation Center
The Catholic University of Korea, Seoul, Korea

Abstract

Background : Paroxysmal nocturnal hemogolbinuria (PNH) is an acquired clonal hematological disorder characterized by intermittent episodes of hemolysis, a predisposition to venous thrombosis, defective hemopoiesis, and occasionally, transition to leukemia. Because PNH is a stem cell disorder, treatment with androgen or corticosteroids may only be a palliative measure, and allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment. We report here our experience of eight PNH patients who underwent HSCT.
Methods : Between January 1997 and July 2001, 8 patients, aged 16 to 47 (median 27.5), underwent HSCT for PNH at the Catholic Hemopoietic Stem Cell Transplantation Center. Median time from diagnosis to HSCT was 60.5 months (range 5-165 months). Two different conditioning regimens included busulfan (16㎎/㎏) and cyclophosphamide (120㎎/㎏) or TBI 1,200c㏉ and cyclophosphamide (120㎎/㎏). Graft-versus-host disease (GVHD) prevention was cyclosporine with methotrexate (MTX)(N= 6), FK506 with MTX(N=1) or cyclosporine with T-cell depletion of donor marrow (N=1).
Results : Four deaths occurred in the first post-transplant year. Deaths were from graft failure (N=1), pneumonia (N=1) and veno-cclusive disease/thrombotic thrombocytopenic purpura (N=2). Four patients (50%) remain alive at a median of 26 months (range 1-60 months) and 5-year probability of survival was 66.7% after HLA-matched sibling HSCT. Grade Ⅰ or Ⅱ acute GVHDs occurred in 3 patients and chronic GVHD did not develop in 5 patients other than 3 patients who died within 100 days post-transplant.
Conclusion : This study suggests that HSCT is an effective therapeutic option for PNH. Further studies are needed to decide the appropriate conditioning regimens to overcome treatment-related mortality after transplantation.

Keywords Paroxysmal nocturnal hemoglobinuria; Graft versus host disease; Hematopoietic stem cell transplantation;

Article

Korean J Hematol 2002; 37(2): 114-119

Published online June 30, 2002

Copyright © The Korean Society of Hematology.

발작성야간혈색소뇨증에서의 조혈모세포이식

신호진, 김희제, 박치영, 박윤희, 김유진, 이석, 민창기, 김동욱, 이종욱, 김춘추, 민우성

부산대학교 의과대학 내과학교실,
가톨릭대학교 의과대학 내과학교실,
조혈모세포이식센터

Hematopoietic Stem Cell Transplantation for Paroxysmal Nocturnal Hemoglobinuria

Ho Jin Shin, Hee Je Kim, Chi Young Park, Yoon Hee Park, Yoo Jin Kim, Seok Lee, Chang Ki Min, Dong Wook Kim, Jong Wook Lee, Chun Choo Kim, Woo Sung Min

Department of Internal Medicine, College of Medicine, Busan National University, Busan, Korea
Department of Internal, Catholic Hemopoietic Stem Cell Transplantation Center
The Catholic University of Korea, Seoul, Korea

Abstract

Background : Paroxysmal nocturnal hemogolbinuria (PNH) is an acquired clonal hematological disorder characterized by intermittent episodes of hemolysis, a predisposition to venous thrombosis, defective hemopoiesis, and occasionally, transition to leukemia. Because PNH is a stem cell disorder, treatment with androgen or corticosteroids may only be a palliative measure, and allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment. We report here our experience of eight PNH patients who underwent HSCT.
Methods : Between January 1997 and July 2001, 8 patients, aged 16 to 47 (median 27.5), underwent HSCT for PNH at the Catholic Hemopoietic Stem Cell Transplantation Center. Median time from diagnosis to HSCT was 60.5 months (range 5-165 months). Two different conditioning regimens included busulfan (16㎎/㎏) and cyclophosphamide (120㎎/㎏) or TBI 1,200c㏉ and cyclophosphamide (120㎎/㎏). Graft-versus-host disease (GVHD) prevention was cyclosporine with methotrexate (MTX)(N= 6), FK506 with MTX(N=1) or cyclosporine with T-cell depletion of donor marrow (N=1).
Results : Four deaths occurred in the first post-transplant year. Deaths were from graft failure (N=1), pneumonia (N=1) and veno-cclusive disease/thrombotic thrombocytopenic purpura (N=2). Four patients (50%) remain alive at a median of 26 months (range 1-60 months) and 5-year probability of survival was 66.7% after HLA-matched sibling HSCT. Grade Ⅰ or Ⅱ acute GVHDs occurred in 3 patients and chronic GVHD did not develop in 5 patients other than 3 patients who died within 100 days post-transplant.
Conclusion : This study suggests that HSCT is an effective therapeutic option for PNH. Further studies are needed to decide the appropriate conditioning regimens to overcome treatment-related mortality after transplantation.

Keywords: Paroxysmal nocturnal hemoglobinuria, Graft versus host disease, Hematopoietic stem cell transplantation,

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