ALLOGENEIC PHERIPHERAL STEM CELL TRANSPLANT EXPERIENCED AT INHA UNIVERSITY HOSPITAL

초록

Because of the limited coverage of insurance to the stem cell source from bone marrow only, the performance of the allogeneic peripheral stem cell transplant (alloPBST) is not prevalent in South Korea. From April 1998 through June 2000, we carried out alloPBST for 9 patients (male:female=5:4, ages 20-46 with a median of 33) with acute myeloid leukemia in first CR (n=5), myelodysplastic syndrome (n=2), chronic myeloid leukemia in chronic phase (n=1), or end stage mycosis fungoides (n=1). The interval between the time of diagnosis and alloPBSCT ranged 4-24 months with a median of 7. Preparation consisted of high dose cyclophosphamide and TBI in all patients. The donor stem cell was mobilized with 450ug of G-CSF for 5 consecutive days and harvested on days 4-5 using Cobe Spectra. A median of 14.68X10(8) NMC (range 0.65-18.8) or a median of 5.22X10(6) CD34+ cells were infused on day 0. The NMC contained a median of 3.31X10(8) CD3+ cells (range 0.73-3.79). GVHD prophylaxis comprised cyclosporine and short-term methotrexate (on days 1, 3, 6, and 11). The last dose of methotrexate was omitted in 4 patients. All patients showed good engraftment of WBC (on a median of day 12, range 8-19) and platelet (on a median of day 15, range 8-21). One patient died of disease recurrence at 18 months post PBST, one of veno-occlusive disease (VOD) at 4 months, and one of CMV pneumonia at 4 months. One patient with acute leukemia who relapsed at 7 months received re-induction chemotherapy and 3 courses of high dose cytarabine based treatment to obtain a durable remission for 39 months. Taken together, 6 of 9 patient is alive disease free at a median of 44 months (range 24-48). Complication included acute GVHD (n=4), chronic GVHD (n=6), VOD (n=2), seizure (n=1), interstitial pneumonia (n=2), herpes zoster (n=5), and cataract (n=2).