الفهرس 
Acute Lymphoblastic Leukemia
Hematopoietic Stem Cell TransplantationOnly 14 pages are availabe for public view
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Abstract
ALL is associated with poor survival outcomes in adults when treated with chemotherapy alone .Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a lifesaving option for those patients. Combination of TBI with cyclophosphamide (TBI/Cy) is the most commonly used myeloablative regimen for adult ALL, have the advantage to reach hidden sites with expected better survival outcomes but with high extra medullary toxicity. Alternative radiation-free regimens containing busulfan are capable of producing comparable clinical results with lower transplant related mortality and morbidity. This study aimed to compare the overall survival (OS), disease free survival (DFS) and other outcomes of allo-HSCT in ALL patients using TBI based versus non-TBI based conditioning regimen. This retrospective study was conducted on data collected from BMT unit registry of Nasser Institute for Research and Treatment, Cairo, Egypt. Adult patients aged >18 to 60 years who underwent first allogeneic peripheral blood HSCT from HLA- matched sibling donor in first CR1 ,CR2 or beyond in the period from January 2000 to December 2016 were included. All patients had adequate performance scale, ECOG ≤ 2. Patient > 60 years old and those who received syngeneic or haploidentical HSCT were excluded. Our patients were categorized into two groups according to type of pre-transplant conditioning regimen: group I (TBI- based): included 78 patients who received TBI plus cyclophosphamide (TBI/Cy) and group II (Non -TBI based) ,included 41 patients who received oral busulfan plus cyclophosphamide (Bu/Cy) .The medical records of those patients were reviewed to extract the following: Detailed history and clinical examination. Information about age, sex, time from diagnosis to transplant, Ph chromosome status and disease status at time of transplantation. Associated comorbidities, viral status, donor type, stem cells source, dose of CD34 cells, GVHD prophylaxis, days on antimicrobials, and transfusion requirements. Allo-HSCT outcome was assessed with the following parameters: time to engraftment, acute and /or chronic GVHD, incidence and severity of infections and conditioning regimen related toxicities. Survival outcomes include OS, DFS, NRM and relapse. Results can be summarized as follow: The majority of cases in both groups aged (19 to 40 years). Males represented 71.8% of patients in group I and 73.2% of group II. The majority of patients in this study received transplant at CR1 and CR2. Female donor to male recipient was present in (60%) of patients in group II versus (39%) in group I. Patients in group II achieved faster engraftment compared with group I, (p = 0.002, 0.017) for neutrophil and platelets engraftment, respectively. Patients in group I had higher RBCs transfusion requirements during transplant, RBCs units ranged from (2 to 9 units) with mean (3.58+1.58), and p= 0.007. Severe mucositis were significantly increased in group I (37.2% versus 9.8% in group II, p = 0.005. Also incidence of infection was significantly higher in group I (48.8 versus 29.3 % in group II, p= 0.037. Incidence of CMV reactivation post- transplant was significantly higher in group II, with 22% versus 6.4% in group I, p= 0.017. No significant difference in incidence of GVHD between both groups. Female donor to male recipient was the only significant risk factor for acute GVHD in multivariate analysis, (HR, 2.213, 95% CI, 1.028-4.762 and p= 0.042). In multivariate analysis, the conditioning regimen was not independent risk factor for OS, DFS and NRM in both groups. The conditioning regimen was independent risk factor for relapse in the non TBI-based (group II) which was associated with significant high risk of relapse (HR, 2.709, 95% CI, 1.106-6.638 and p =0.029). Patients transplanted in ≥ CR2 were associated with significant risk of lower DFS with (HR, 3.670, 95% CI, 1.500 to 8.978 and p= 0.004).