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 place of work:
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 the journal:
Vnitř Lék 2006; 52(12): 1172-1180
Category:
Original Contributions
Summary
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
Zdroje
1. Horowitz MM, Rowlings PA, Passweg JR. Allogeneic bone marrow transplantation for CML: a report from the International Bone Marrow Registry. Bone Marrow Transplant 1996; 17: S5-S6.
2. Clift RA, Storb R. Marrow transplantation for CML: the Seattle experience. Bone Marrow Transplant 1996; 17: S1-S3.
3. Radich JP, Olavarria E, Apperley JF. Allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia. Hematol Oncol Clin N Amer 2004; 18: 685-702.
4. Robin M, Guardiola P, Devergie A et al. A 10-year median follow-up study after allogeneic stem cell transplantation for chronic myeloid leukemia in chronic phase from HLA-identical sibling donors. Leukemia 2005; 19: 1613-1620.
5. Goldman JM, Sobocinski KA, Zhang MJ et al. Long-term outcome after allogeneic hematopoietic cell transplantation (HCT) for CML. Biol Blood Marrow Transplant 2006; 12: S17.
6. Crawley C, Szydlo R, Lalancette M et al. Outcomes of reduced-intensity transplantation for chronic myeloid leukemia: an analysis of prognostic factors from the Chronic Leukemia Working Party of the EBMT. Blood 2005; 106: 2969-2976.
7. Quazilbash MH, Giralt SA, Champlin RE. Nonmyeloablative stem cell transplantation for chronic myeloid leukemia. Hematol Oncol Clin N Amer 2004; 18: 703-714.
8. Gratwohl A, Baldomero H, Horisberger B et al. Current trends in hematopoietic stem cell transplantation in Europe. Blood 2002; 100: 2374-2386.
9. Simonsson B on behalf of the IRIS (International Randomized IFN vs STI571) Study Group. Beneficial effects of cytogenetic and molecular response on long-term outcome in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP) treated with imatinib (IM): update from the IRIS study. Blood 2005; 106: 166a.
10. Hahn EA. Glendenning. Quality of life on imatinib. Semin Hematol 2003; 40(Suppl 2): 31-36.
11. Graham SM, Jorgensen HG, Allan E et al. Primitive, quiescent, Philadelphia-positive cells from patients with chronic myeloid leukemia are insensitive to STI571 in vitro. Blood 2002; 99: 319-325.
12. Baccarani M, Saglio G, Goldman JM et al. Evolving concepts in the management of chronic myeloid leukemia. Recommendations from an expert panel on behalf of the European LeukemiaNet. Blood 2006 May 18; PMID: 16709930.
13. Hrabánek J, Lukášová M, Vítek A et al. Léčba chronické myeloidní leukemie transplantací kostní dřeně v ÚHKT Praha. Vnitř Lék 1995; 41: 682-687.
14. Vítek A, Cetkovský P, Sajdová J et al. Výsledky transplantací od nepříbuzných dárců u nemocných s CML - I. CP se neliší od výsledků transplantací od HLA-identických sourozenců - zkušenosti jednoho centra. Sborník abstrakt XVIII. Olomouckých hematologických dnů 2.-5.6.2004: 10-11.
15. Gratwohl A, Hermans J, Goldman JM et al. Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Lancet 1998; 352: 1087-1092.
16. Borhhäuser M, Kröger N, Schwerdtfeger R et al. Allogeneic haematopoietic cell transplantation for chronic myelogenous leukaemia in the era of imatinib: a retrospective multicentre study. Eur J Haematol 2006; 76: 9-17.
17. Deininger M, Schleuning M, Greinix H et al. The effect of prior exposure to imatinib on transplant-related mortality. Haematologica 2006; 91: 452-459.
18. Mayer J, Brychtová Y, Doubek M et al. Srovnání reálné ceny léčby chronické myeloidní leukemie nemyeloablativní transplantací krvetvorných buněk s hypotetickou terapií imatinibem (Glivec). Zamyšlení nad velmi drahými medicínskými postupy. Trans Hemat dnes 2006; 12: 6-13.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2006 Číslo 12
Najčítanejšie v tomto čísle
- Ultrasound mapping of lower-limb vascular system with regard to occurrence and anatomy of additional front great saphenous vein
- Statins and osteoporosis
- Collagenofibrotic glomerulopathy – rare glomerulonephritis
- Prospective use of EuroSCORE for the short−term risk evaluation of consecutive cardiac surgery candidates: are there any differences in prediction of perioperative risk versus risk of nonsurgical treatments?