Key words : Bone marrow transplant (BMT), peripheral stem cell transplant (PSCT), beta thalassemia major, leukemia, lymphoma, aplastic anemia.
From May 1993 through August 2008 allogeneic bone marrow transplant (BMT) or peripheral stem cell transplant (PSCT) and autologous PSCT was performed on 400 patients (allogeneic= 293, autologous= 107); 153 patient with transfusion-dependent thalassemia major, 132 patients with leukemia (AML=75, ALL=34, CML=23), 70 lymphoma patients (Hodgkin's=20 and non- Hodgkin's=50), 22 multiple myeloma cases, 15 severe aplastic anemia cases, and 6 other diseases, in Nemazee hospital, Shiraz- Iran. The age range for thalassemic patients was 2-22 years (Median 11 years). 22 patients were in class I, 70 in class II and 60 in class III Lucarelli risk group. The conditioning regimen consisted of busulfan (BU) 14-16 hoursmg/kg orally and cyclophosphamide (CY) 120-200 mg/k IV, and antithymocyte globulin (ATG), IV 40-100 mg/kg. The Prophylaxis against graft vs. host disease (GVHD) was with cyclosporine plus methylprednisolone. BMT was performed on 124 of the patients and PSCT on 28 of them. The donors were human leukocyte antigen (HLA) - identical siblings (n=121) or parents (n=20) and one HLA antigen-mismatched siblings (n=11). The second bone marrow infusion was down in 8 patients, including 3 who are still living with mixed chimerism. The second BMT was performed successfully on 4/5 patients with rejection; with Bu 16 mg/gk, Cy 200 mg/kg and ATG 100 mg/kg. The age range for non –thalasssemia patients were from 1-60 years (median 25 yrs). In thalassemic patients the incidence of grade IV acute GVHD was 26.5% in BMT group and it was 74.7% in PSCT group. The incidence of extensive chronic GVHD was 18% in BMT group and was 47% in PSCT group. The survival and disease-free survival for BMT group is 85% and 75% and for PSCT group is 79% and 79% respectively. In non- thalassemic patients very sever hemorrhagic cystitis was developed in six patients with leukemia and was the cause of death in two. The internal iliac artery ligation was done in two and was life saving in one of them. The diseases- free survival for leukemia patients is 65%, for aplastic anemia is 85%, and for lymphoma cases is 50%. The survival for multiple myeloma cases is 90%. In conclusion, allogeneic BMT or PSCT is curative therapy for the patients with beta-thalassemia major, and it is advised for lethal diseases such as leukemia, severe aplastic anemia, and relapsed lymphoma cases.
Volume : 6
Issue : 4
Pages : 24
Bone Marrow Transplantation Unit, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.