Graft versus host disease in allogeneic stem cell transplantation--3 1/2 years experience.
OBJECTIVE
To evaluate the frequency and outcome of graft versus host disease after allogeneic stem cell transplant in haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from July 2001 to December 2004.


METHODS
Eighty-six patients with various haematological disorders namely aplastic anaemia (n=32), b-Thalassaemia (n=25), CML (n=22), ALL (n=3), AML (n=1) Fanconi's anaemia (n=2), and Gaucher's disease (n=1), underwent allogeneic stem cell transplantation. All patients received cyclosoprin, prednisolone and short course of methotrexate as GvHD prophylaxis. The patients who developed acute GvHD > grade-II or chronic extensive GvHD received steroids at a starting dose of 2 mg/kg body weight along with gradual increase in cyclosporine dosage (max dose 12.5 mg/kg).


RESULTS
The overall incidence of acute GvHD grade-II to IV was 44.2% (n=38/86) where as the incidence of chronic extensive GvHD was 14% (n=12/86). Acute GvHD was 68% (n=17/25) in beta-Thalassaemia, 50% (n=11/22) in CML, 50% (n=2/4) in Acute Leukaemias and 25% (n=8/32) in Aplastic Anaemia. Chronic GvHD was 25% (n=1/4) in Acute Leukaemias, 18.8% (n=6/32) in Aplastic Anaemia, 18.2% (n=4/22) in CML and 4% (n=1/25) in beta-Thalassaemia. The overall survival in acute GvHD was 84.2% (n=32) where as the overall survival in chronic GvHD was 50% (n=6). The overall mortality in acute GvHD was 15.8% (n=6) and 50% in chronic GvHD (n=6).


CONCLUSIONS
The morbidity and mortality due to severe acute and chronic GvHD remains high despite standard prophylaxis against GvHD. New strategies are needed to prevent and treat GvHD.
Hashmi
KhalilUllah
K
Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
Khan
Badshah
B
Ahmed
Parvez
P
Hussain
Iftikhar
I
Altaf
Choudhry
C
Raza
Shahid
S
Iqbal
Hamid
H
Khan
Mehreen Ali
MA
Malik
Hamid Saeed
HS
Naeem
Muhammad
M
Kamal
Khalid
K
Anwar
Masood
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000453:epidemiology; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine