Hematopoetic stem cell transplantation activity at A single center: Cerrahpaşa experience

At our institution 94 transplantations have been performed in an 8 year period up to December 2001. Forty-three females and 49 males with ages ranging from 14 to 61 years received 67 allogeneic (allo) and 27 autologous (auto) transplants; 2 patients were transplanted twice. The diagnosis of allo transplants were AML (27 patients-pts), CML (17 pts), ALL (16 pts) and AA (5 pts); those of auto transplants were NHL (13 pts), HD (10 pts), MM (3 pts) and AML (1 pt). Of the patients with acute leukemia 69.7% were in first CR and all but one of the patients with CML were in first chronic phase. Source of hematopoetic stem cells were bone marrow (BM) in 61.9% (allo 81.5%, auto 14.8%) and peripheral blood (PB) in 38.1% (allo 18.5%, auto 85.2%). All donors were HLA-full matched siblings with one exception. Conditioning regimens were BU-CY (31 pts), TBI-CY (28 pts) and Flag-Ida (one pt) for leukemia, CY-ATG for AA, CBV for lymphoma and Mel-200 for MM. Median 2.69 x 108 nucleated cells/kg (BM) and 21.7 x 106 CD34 + cells/kg (PB) were infused to allo transplant recipients; 4 patients failed to engraft and one patient was inevaluable due to early death. Acute GVHD was observed in 11 patients (16.9% - grade II-IV in 10.7%) and chronic GVHD was documented in 18 patients (33.9%-extensive in 9.43%). VOD was seen in 8 patients (12.3%). Early response was CR in 91.6% in patients with leukemia; patients with lymphoma showed a 73.1% response (CR & PR) rate and 23.1% had resistant disease. So far 27.6% of the patients have relapsed or showed progression and 45.7% have died (disease-related 27.2%, transplant-related 18.5%). At a median follow-up time of 32 months (range 0.6-96) DFS is 50.8% and OS is 53.9% in the allo transplant group. With a shorter follow-up (median 16 months, range 1-65) the same figures for the auto transplant group are 51.9 and 55.5%, respectively. In this cohort overall, OS and DFS are significantly superior in patients with early-stage disease: 71.7% vs. 26.7% in advanced-stage disease for OS and 71.4% vs. 36.8% for DFS, respectively and this trend applies to both transplant groups (p< 0.001 for all comparisons).