Hematopoietic stem cell transplantation in hematologic malignancies and solid tumors: Hacettepe University Institute of Oncology experience

Abstract

Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) have emerged as a frequently used treatment modality in patients with hematologic malignancies and selected solid tumors. Hematopoietic Stem Cell Unit of Hacettepe University Institute of Oncology is recently inaugurated and activated in January 2000. Until January 2003, 57 autologous HSCT and 14 nonmyeloablative allogeneic transplantations (NST) have been performed. The median age of patients at the time of transplantation was 41 (range 17-75). The mean time elapsed from diagnosis to transplantation was 3.7 years and patients had received a mean number of 2.7 salvage regimens prior to transplantation. During the mean followup period of 12.7 (1-35) months, 9 patients relapsed and 11 died. Of the 51 (82%) surviving patients, 46 (92%) were in complete remission. The estimated 3-year overall survival (OS) of all patients was 81%. Fifty-seven autologous transplantations were performed in 55 patients and transplant-related mortality (TRM) was 5%. Three out of 55 patients died within 100 days, due to CMV pneumonia, veno-occlusive disease and infection secondary to poor graft function. Three patients died during the late post transplantation period, two due to relapse and one due to infection. The estimated 3-year disease-free survival (DFS) and OS of 42 patients with lymphoma undergoing autologous HSCT were 74% and 79%, respectively. Eighteen autologous and allogeneic transplantations were performed in 12 patients with myeloma. Six patients underwent double transplants, i.e. 3 patients double autologous, 2 patients autologous followed by NST and one patient conventional allogeneic followed by NST. As a result of these transplants in 10 evaluable patients with myeloma, 9 (90%) were in CR and 1 (10%) was in PR. All patients are alive and 3-year OS is 100% in the myeloma group. NST was performed in 13 patients with the diagnosis of relapsed Hodgkin's disease, non-Hodgkin's lymphoma and multiple myeloma, metastatic renal cell carcinoma, relapsed AML , resistant CLL, CML, and large granular leukemia. The survival rate at day +100 was 84.6% for all patients undergoing NST. To date, with an observation period ranging between 1 to 21 months, 10 of 13 patients are alive, majority being in CR. In 11 patients in which tumor response could be evaluated, CR was achieved in 9 (82%). The estimated probability of 20-month OS in these patients was 76%, with an overall TRM of 14%; 0% in patients without previous HSCT and 25% in patients with previous HSCT. Acute GVHD (grade I-III) was observed in 5 of 13 patients all following donor lymphocyte infusion, none developing within the first 100 days. None of our patients developed grade IV acute GVHD and mortality related to GVHD was 0%. Achievement of successful outcome in autologous and allogeneic transplantation in the unit highly depends on our multidisciplinary team approach.