Allogeneic hematopoietic stem cell transplantation in patients with chronic myeloid leukemia in the Czech Republic - a retrospective analysis of results in years 1988–2005
Authors:
E. Faber 1; V. Koza 2; A. Vítek 3; J. Mayer 4; P. Sedláček 5; P. Žák 6; J. Zapletalová 7; K. Benešová 8; H. Krejčová 8; K. Steinerová 2; I. Marešová 1; P. Cetkovský 3
Authors‘ workplace:
Hemato-onkologická klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Karel Indrák, DrSc.
1; Hematologicko-onkologické oddělení FN Plzeň, přednosta prim. MUDr. Vladimír Koza
2; Ústav hematologie a krevní transfuze Praha, ředitel prof. MUDr. Pavel Klener, DrSc.
3; Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Vorlíček, CSc.
4; Klinika dětské hematologie a onkologie 2. lékařské fakulty UK a FN Motol, Praha, přednosta prof. MUDr. Jan Starý, DrSc.
5; Oddělení klinické hematologie II. interní kliniky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
6; Oddělení biometrie Ústavu biofyziky Lékařská fakulty UP Olomouc, přednosta prof. ing. Jan Hálek, CSc.
7; Český národní registr transplantací krvetvorných buněk, VFN Praha, vedoucí lékařka MUDr. Kateřina Benešová, CSc.
8
Published in:
Vnitř Lék 2006; 52(12): 1172-1180
Category:
Original Contributions
Overview
Analyses of hematopoietic stem cell transplantation (SCT) results are of high importance for treatment strategy decision-making in patients with SCT as a possible therapeutic alternative. the Czech National Registry of SCT and Transplantation Centre in Pilsen are presenting here their collaborative retrospective analysis of the results of allogeneic SCT in patients with chronic myeloid leukemia (CML) performed in the Czech Republic from 1988 to spring 2005. 295 patients (179 men and 116 women) at the age from 6.9 to 59.5 years (median 37.3) were transplanted. In most cases the donor was an HLA-identical sibling (164; 55.6 %) or a voluntary unrelated donor from the registry (110; 37.3 %), in minority of cases another relative of the patient (21; 7.1 %). Myeloablative conditioning was used in 90 % of patients. The source of hematopoietic stem cells was bone marrow in 57 %, peripheral blood in 41 % and combination of both in 2 % of cases. 83.4 % of patients were transplanted in chronic phase of the disease while 7.8 % in acceleration and 6.1 % in blastic phase, respectively. The median interval from the diagnosis to SCT was 316 days. Median follow-up after SCT was 2 years. SCT was complicated with acute graft versus host disease of grade II-IV in 33.7 % of patients and with chronic graft versus host disease in 36.3 % of patients. Median survival was not reached, 18 (6.1 %) of patients died due to the relapse of CML and the cause of 101 (34.2 %) deaths was transplant-related. Significant trends were observed during the study period: SCT were performed more frequently in elder patients, earlier than one year from the diagnosis, reduced-intensity conditioning was used more often and the source of hematopoietic stem cells was peripheral blood in more patients (p = 0.188 - < 0.0001). Also, transplantation activity changed - the annual rate of SCT was steadily increasing until 1999, while there was no such an increase between 2000 and 2005. The use of peripheral stem cells was associated with chronic graft versus host disease (p = 0.007). In Cox multivariate analysis the EBMT risk score and the interval from the diagnosis to SCT were identified as independent factors for survival of patients. An „ideal“ patient aged below 30, transplanted in the chronic phase of CML within one year since the diagnosis after 2000 had survival probability of 88% at three years after SCT. It can be concluded that results of allogeneic SCT in CML in the Czech Republic have been reflecting the actual trends in the world, they have been comparable with foreign studies and they have been continuously improving.
Key words:
chronic myeloid leukemia - allogeneic hematopoietic stem cell transplantation - EBMT risk score
Sources
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Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2006 Issue 12
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