Analysis of hematopoietic stem cell transplantation programme in UHC Zagreb in the year 2016

UVOD: Transplantacija krvotvornih matičnih stanica je terapijski postupak kojim se primjenom krvotvornih matičnih stanica nastoji nadomjestiti krvotvorni sustav osobe oboljele od stečenih ili kongenitalnih poremećaja krvotvornog sustava. U alogeničnoj transplantaciji bolesnik prima krvotvorne matične stanice od darivatelja koji može biti srodan ili nesrodan. Kao izvor krvotvornih matičnih stanica koristi se koštana srž, periferne krvotvorne matične stanice stimulirane G-CSF i krvotvorne matične stanice umbilikalne krvi. ----- METODE: U retrospektivnoj analizi obrađeni su podaci 75 bolesnika liječenih alogeničnom transplantacijom krvotvornih matičnih stanica u Zavodu za hematologiju Kliničkog bolničkog centra Zagreb. Analizirali smo oporavak pancitopenije, reaktivaciju CMV infekcije, pojavu relapsa, odbacivanje transplantaata i preživljenje kod bolesnika s hematološkim bolestima koji su liječeni alogeničnom transplantacijom krvotvornih matičnih stanica. ----- REZULTATI: Preživljenje nakon alogenične transplantacije KMS je 77,3% te se u skupini preživjelih njih 84,5% nalazi u remisiji. Medijan za oporavak panctiopenije kod bolesnika transplantirane perifernim KMS je 17 dana za leukocite, 18 dana za neutrofilne granulocite, 11 dana za trombocite a kod bolesnika transplantiranih koštanom srži je 18 dana za leukocite i neutrofilne granulocite i 17,5 dana za trombocite. Relaps se razvio kod 19% bolesnika. Kao komplikacija aGvHD se razvio kod 28% bolesnika s medijanom razvijanja od 54 dana. Pojava cGvHD je dijagnosticiran kod 12% bolesnika s medijanom razvijanja od 157 dana. Reaktivacija CMV infekcije je dijagnosticirana kod 46,7% bolesnika s medijanom pojavljivanja od 34 dana. Primarno odbacivanja transplantata razvilo se kod 2,7% bolesnika te se sekundarno odbacivanje razvilo kod 2,7% bolesnika. ----- ZAKLJUČAK: Program alogenične transplantacije je složeni terapijski postupak zbog brojnih i različitih bolesti koje mogu biti indikacije za alogeničnu transplantaciju, razvoja komplikacija povezanih sa postupkom i stalnog unaprjeđivanja samih metoda. Rezultati ovog rada pokazuju kako je liječenje alogeničnom transplantacijom KMS korisno jer je velik broj bolesnika izliječen ili im je omogućeno dugotrajno preživljenje bez znakova bolesti.BACKGROUND: Transplantation of the hematopoietic stem cells is a therapeutic procedure in which hematopoietic stem cell are used to replace a blood-borne system of a person suffering from acquired or congenital disorders of the bloodstream. In the case of allogeneic transplantation, a patient receives a hematopoietic stem cells from a donor who may be related or unrelated to patient. Bone marrow, peripheral stimulated with G-CSF and hematopoietic stem cells from umbilical blood are used as the source of the hematopoietic stem cells. ----- METHODS: In retrospective analysis data selection was done for 75 patients treated with allogeneic hematopoietic stem cell transplantation in Division of hematology in the University Hospital Centre in Zagreb. We evaluated recovery of pancytopenia, reactivation of CMV infection, relapse rates, primary and secondary graft failure and overall survival rate for patients with hematologic diseases who were treated with allogeneic transplantation of the hematopoietic stem cells. ----- RESULTS: Overall survival rate after allogeneic transplantation is 77,3% and the patients who are alive 84,5% of them are in remisson. Median for recovery of pancytopenia in patients with PBSC is 17 days for leukocytes, 18 days for neutrophils and 11 days for platelets as compared with 18 days for leukocytes, neutrophils and 17,5 days for platelets in patients with bone marrow transplant. Relaps developed in 19% of patients. Complication of aGvHD developed in 28% of patients at a median of 54 days. cGvHD was diagnosed in 12% of patients at a median of 157 days. Reactivation of CMV infection has occurred in 46,7% of patients at a median of 34 days. Primary graft failure has occurred in 2,7% of patients while secondary graft failure has occured in 2,7% patients. ----- CONCLUSION: The program of allogeneic transplantation is a complex therapeutic procedure due to numerous and different diseases that may be indications for procedure, development of complications associated with the procedure and continuous improvement of the methods. The results of this study indicate that treatment with allogeneic transplantation is useful because a large number of patients are cured or have long-term survival without signs of disease