Allogeneic Peripheral Blood Stem Cell Transplantation In 29 Patients With Hematologic Malignancy:a Retrospective Clinical Analysis

OBJECTIVE To evaluate the effects and complications of Allogeneic peripheral blood stem cell transplantation(Allo-PBSCT) in the treatment of patients with hematologic malignancy.PATIENTS AND METHODS twenty-nine patients with hematologic malignancies receiving Allo-PBSCT have been included. Diagnoses were as follows: acute lymphoblastic leukemia in first complete remission (CR1) (5 cases), acute myloid leukemia in first complete remission (CR1) (8 cases),cbronic myelogenous leukemia (CML) in first chronic phase (10 cases), chronic myelogenous leukemia (CML) in accelerated or blast crisis phase (4 cases), non-Hodgkin's lymphoma in PR (1 case) and myelodysplastic symdrom (MDS) ( 1 case).The median age of patients was thirty-four years old. Preparative regimens included either total body irradiation and cyclophosphaniide (TBI/Cy) or TBL'Cy / cytarabine (or etoposide or 6-mercaptopurine). The graft versus host disease(GVHD) prophylaxis included cyclosporin-A (CsA) and methotrexate (MTX),CSA with mycophenolate mofetil(MMF) and MTX , as well as CSA and MMF.The median age of donors was thirty-one years old.PBSC were collected after mobilization with 5 uglkglday of G-CSF(filgrastim) for five days. RESULTS The 28 patients showed a rapid hematopoietic reconstitution except of one patient did not have hematopoietic reconstitution .The median time for neutropils count to reach 0.5 x 10(9) /L was 15 days ,and for platelets count to reach to 20 x 10(9) /L 17 days . The incidence of cytomegalovirus infections after stem cell transplantation was 34.5%,but patients been monitored for CMV antigenemia by leukocyte expression of the CMV-pp65 antigen had a decreasd transplant-related mortality. Oral mucositis (OM) occured in 26 patients (100%) and in 12 patients it was grade III or LV. Multivariate analysis showed that the only independent risk factor for oral mucositis was MMF rather than MTX. In this series, grade II-IV acute GVHD occurred in 14 patients (50%) and Chronic GVHD developed in eight of twenty patients surviving beyond 100 days(47%)2(limited: 2 cases; extensive :6 cases). After a median follow-up of 11 months, seventeen PBSC patients are still alive(58.6%).CONCLUSIONS This clinical analysis suggests that allogeneic PBSC transplantation performed in hematologic malignancies is practical and acceptable, and may be associated with a rapid hematopoietic reconstitution, a higher transplant-related mortality ,and a slightly increased risk of acute and chronic GVHD.MMF can decrease the incidence of oral mucosis.Cytomegalovirus infections can be early diagnosed by monitoring CMV-pp65 antigen,and CMV disease can be effectively prevented by the use of GCV in early stage.