الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Acute lymphoblastic leukemia has a relatively poor prognosis in adults with
long-term survival only 30–40% of newly diagnosed individuals. High risk
disease defining includes advanced age, very elevated WBC at presentation, the
presence of adverse cytogenetic changes (eg; Ph chromosome +ve) and Pro-B
cell ALL immunophenotype. As outcome in high-risk disease is significantly
worse than for standard risk disease. Adult ALL remains a challenging disease.
While the only treatment that results in long-term DFS in patients with ALL in
CR2 is allogeneic HSCT and outcomes from transplantation are better if
performed in CR1 rather than CR2.
In this retrospective study, fifty-five adult patients with ALL were submitted
and followed up after allogeneic bone marrow transplantation from HLA
identical sibling donor during the period between April 1997, and June 2006.
Twenty eight of them presented initially with high-risk disease and underwent
an allo-BMT in first CR. The remaining twenty seven patients were those who
relapsed after attaining first CR and were transplanted in second CR. We
evaluate both groups regarding the transplant related mortality (TRM), disease
free survival (DFS) , the overall survival (OS) and correlation between OS and
age, gender, graft versus host disease (GVHD), CD34+ cells dose and also the
correlation between GVHD and CR, gender, pre-transplant virology of the
recipient and conditioning regimen with comparing the whole results to the
international one.
In our study TRM (100 day mortality) was (32.2%) in CR1 and (51.9%) in
CR2. OS at one year was (64.2%) in CR1 and (51.85%) in CR2. While tow
years OS was (46.4%) for CR1 and (48.1%) for CR2. DFS was (46.4%) in CR1
and (40.7%) in CR2 at one year. And it was (25%) and (33%) for CR1 and
CR2 at tow years respectively. OS was higher in patients who developed
chronic GVHD with significant P value (P=0.05).The incidence of
development of chronic GVHD was higher in CR1 than in CR2 with significant
P value (P=0.006). While the increase in the age of patients was significant
factor in development of acute GVHD with P value (P=0.05). Also incidence of
acute GVHD was high in patients with HBs Ag +ve (P= 0.03).
In conclusion: The incidence of chronic GVHD was higher in CR1 than in CR2
with significant P value (P=0.006). older age was found to be a significant
factor in development of acute GVHD with P value (P=0.05). In addition,
incidence of acute GVHD was high in patients with HBs Ag +ve (P= 0.03).