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العنوان
Association of CD34 Positive Cell Count
with chronic Graft Versus Host Disease
in patients with Acute Myeloid Leukemia
who had Allogeneic Peripheral Blood
Stem Cell Transplantation /
المؤلف
Amin,Nermeen Mamdouh Salah.
هيئة الاعداد
باحث / Nermeen Mamdouh Salah Amin
مشرف / Hoda Ahmed Elsayed Gad Allah
مشرف / Mohamed Abdel-Mooti Mohamed Samra
مشرف / Walaa Ali El Salakawy
تاريخ النشر
2018
عدد الصفحات
275p.:
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
أمراض الدم
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - امراض الدم
الفهرس
Only 14 pages are availabe for public view

from 275

from 275

Abstract

Acute myeloid leukemia (AML) is characterized by an
increase in the number of myeloid cells in the marrow and an
arrest in their maturation, frequently resulting in hematopoietic
insufficiency (granulocytopenia, thrombocytopenia, or anemia)
with or without leukocytosis.
Allogeneic and Autologous HSCT have been an established
option for consolidation for more than two decades. Prospective
randomized trials have not shown auto graft to be superior to
chemotherapy but it is an effective approach. Allografting
produces the best antileukemic effect of any treatment in any risk
or age subgroup.There is general consensus that patients who have
good risk disease do not require transplantation and patients with
poor risk disease do benefit even though the post transplant
survival is still only 30% to 40%. The debate focuses on the 60%
of patients who have intermediate risk disease.
G-CSF-mobilized PBSC are increasingly used instead of
BM cells for G-CSF-mobilized PBSC are increasingly used
instead of BM cells for allogeneic transplantation because they
provide faster engraftment and better survival in recipients with
poor-risk disease.
Important difference among the sources of stem cell is the
amount of mature T cells present. PBSC usually contains a lot
more mature T cells compared to BM, which in turn contains more T cells compared to CB, and this partly explains the
differences in the risk of graft rejection and graft-versushost
disease (GVHD). Depletion of T cells is associated with
increased risk of graft rejection and disease relapse, but lower
risk of GVHD.
One of the main reasons for preferring PSC worldwide is
the important advantages provided by this method to the donor.
These advantages are avoidance of anesthesia, lack of the need
for hospitalization or blood transfusion, and very low serious
adverse event risk.
Most of the randomized controlled trials (RCTs)
comparing matched related donor BM and PBSC
transplantation for patients with hematological malignancies
found no significant differences between the two stem cell
source in important outcomes including overall survival,
disease-free survival, transplant-related mortality, relapse,
acute GVHD and chronic GVHD. However, all trials
showed significantly faster neutrophil engraftment in PBSC
transplants, and all but one trial showed significantly faster
platelet engraftment in PBSC transplants, which may result in
earlier hospital discharge for PBSC recipients and lower cost
for PBSC transplantation. Lymphocyte recovery was also found
to be better in the PBSC group in one trial.Some trials showed PBSC recipients had significantly
more grade 2-4 acute GVHD, chronic GVHD and extensive
chronic GVHD compared with BM recipients, which resulted
in significantly more patients who underwent PBPC
transplant needed immunosuppressive treatment, and longer
periods of corticosteroid use and hospitalization.
There was no difference in performance status, return
to work, incidence of bronchiolitis obliterans, hematopoietic
function, and secondary malignancies between the two
groups in the long term in one trial. In contrast, another trial
showed that late mortality due to chronic GVHD was more
frequent in PBSC recipients compared with BM recipients.
The number of peripheral-blood stem cells is estimated
with use of the cell-surface molecule CD34 as a surrogate
marker. The number of CD34+ cells in blood can be increased
by mobilizing them from the marrow with granulocyte colonystimulating
factor (G-CSF), which causes the proliferation of
neutrophils and the release of proteases. Proteases degrade the
proteins that anchor the stem cells to the marrow stroma and,
together with protease-independent mechanisms, free the cells to
enter the circulation.
In out study we have found that there was a significant
relationship between CD34+ cell count and engraftment of platelets till it reaches 100000 and there wasn’t a significant
relationship with incidence of cGVHD.