Myelodisplastik Sendromda Allojeneik Kök Hücre Nakli

Year 2020, Volume: 73 Issue: 2, 113 - 117, 31.08.2020

Pınar Ataca Atilla Erden Atilla , Sinem Civriz , Selami Koçak Toprak , Meltem Yüksel , Pervin Topçuoğlu , Meral Beksaç , Önder Arslan , Osman İlhan , Muhit Özcan , Günhan Gürman

https://doi.org/10.4274/atfm.galenos.2020.65365

Abstract

Amaç: Miyelodisplatik sendrom (MDS) sitopeniler ile seyreden ve lösemi transformasyonun görüldüğü klonal bir hastalıktır. Allojeneik Kök Hücre Nakli (AKHN), MDS hastalarında küratif bir tedavidir. Fakat AKHN naklinin hangi hasta grubuna uygulanacağı, öncesinde verilecek tedaviler, nakil sırasında uygulanacak hazırlık rejimleri tartışmalı konular arasındadır. Bu çalışmamızda ünitemizde tanı alan ve sonrasında AKHN yapılan MDS hastalarının değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: 1992-2016 tarihleri arasında merkezimizde tanı alan ve sonrasında Kök Nakil Ünitemizde AKHN yapılmış 44 MDS hastası geriye dönük olarak değerlendirilmiştir.

Bulgular: Çalışmaya alınan 44 hastanın 31’i erkek (%71), 13’ü kadındır (%29). Ortanca yaş 41 iken altı hasta (%14) 60 yaş üzerindedir. Sitogenetik analizi yapılabilmiş 31 hastadan 22’si R-IPSS risk skorlamasına göre yüksek riskli, dokuz hasta ise orta risklidir. AKHN sonrasında 32 hastada (%73) tam yanıt gözlenirken; 10 hastada engraftman (%22) sağlanamamıştır. İki hasta (%5) tedaviye yanıtsızdır. Tüm hastalarda mukozit ve 39 hastada diyare (%89) gelişmiştir. Mukozit, diyare ve engraftman kinetiklerinin tanı alt tipi, yaş (<60 yaş ile >60 yaş), R-IPSS, HCT-Cl skoru, hazırlık rejiminin tipi ile ilişkisi gösterilememiştir. AKHN sonrası 1 yıllık genel sağkalım %73 iken 1 yıllık nüks olmaksızın sağkalım %71’dir. Tek değişkenli regresyon analizinde hastalık risk kategorisinin yüksek olması, miyeloablatif hazırlık rejimi kullanımı, akut GVHH gelişimi genel sağkalımda istatistiksel olarak anlamlı azalmaya neden olmuştur. Çok değişkenli analizde ise genel sağkalımı etkileyen faktör tespit edilememiştir.

Sonuç: AKHN ile çalışmamıza dahil edilen MDS olgularında nakil ile ilişkili toksisiteler sık görülse bile uzun süreli ve sürdürülebilir yanıt oranlarına
ulaşılmıştır.

Keywords

Allojeneik Kök Hücre Nakli , Myelodisplastik Sendrom , Nakil ile İlişkili Toksisite

Ethical Statement

Etik Kurul Onayı: Çalışma geriye dönük tarama olduğundan etik kurul onayı alınmamıştır. Hasta Onayı: Çalışmaya katılan tüm hasta ve vericilerden AKHN öncesi işlem için ve sonrasında verilerinin kullanımına yönelik onamları alınmıştır. Hakem Değerlendirmesi: Editörler kurulunun dışından olan kişiler tarafından değerlendirilmiştir. Yazarlık Katkıları Cerrahi ve Medikal Uygulama: P.A.A., E.A., S.C.B., S.K.T., M.K.Y., P.T., M.B., Ö.A., O.İ., M.Ö., G.G., Konsept: P.A.A., E.A., G.G., Dizayn: P.A.A., E.A., Veri Toplama veya İşleme: P.A.A., E.A., Analiz veya Yorumlama: P.A.A., E.A., Literatür Arama: P.A.A., E.A., Yazan: P.A.A., E.A. Çıkar Çatışması: Yazarlar tarafından çıkar çatışması bildirilmemiştir. Finansal Destek: Yazarlar tarafından finansal destek almadıkları bildirilmiş

Project Number

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Myelodisplastik Sendromda Allojeneik Kök Hücre Nakli

Abstract

Objectives: Myelodysplastic syndrome (MDS) is a clonal disease that progresses with cytopenias and has leukemia transformation. Allogeneic Stem Cell Transplantation (ASCT) is a curative treatment in MDS patients. However, to which patient group the ASCT transplant will be applied, the treatments to be given before, and the conditioning regimens applied during the transplant are among the controversial topics. In this study, it was aimed to evaluate MDS patients who were diagnosed and underwent ASCT in our unit.

Materials and Methods: Forty-four MDS patients that were diagnosed at our center and underwent ASCT at Stem Cell Transplantation Unit between 1992 and 2016 were evaluated retrospectively.

Results: Of the 44 patients included in the study, 31 were male (71%) and 13 were female (29%). The median age was 41 years, six patients (14%) were over 60 years old. Twenty-two of 31 patients with cytogenetic analysis were at high risk according to R-IPSS and nine patients were at intermediate risk. While complete response was observed in 32 patients (73%) after ASCT, engraftment was not achieved in 10 patients (22%). Two patients (5%) were not responsive to treatment. Mucositis developed in all patients and diarrhea developed in 39 patients (89%). The relationship of mucositis, diarrhea and engraftment kinetics with age (<60 years vs >60 years), R-IPSS, HCT-Cl score and the type of conditioning regimen was not shown. While 1-year overall survival was 73%, 1-year non-relapse mortality was 71%. In univariate regression analysis, high risk disease category, use of myeloablative conditioning regimen, acute graft versus host disease caused statistically significant decrease in overall survival. In the multivariate analysis, none of the factors affected the overall survival.

Keywords

s: Allogeneic Stem Cell Transplantation , Myelodysplastic Syndrome , Transplant Related Toxicity

Supporting Institution

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Project Number

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Thanks

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