137
A Comparison Between Peripheral Blood Stem Cell Transplantation Versus Bone Marrow Transplantation in Thalassemia Major
A Comparison between Peripheral Blood Stem Cell Transplantation versus Bone Marrow Transplantation in Thalassemia Major
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
Introduction:
HSCT is the treatment of choice for patients with thalassemia. Here, we report our hematopoietic stem cell transplantation experience in the treatment of thalassemia major patients, using PBSCT versus BMT.
Patients and Methods:
From 1992 to 2013, 574 patients underwent HSCT in our centre. 221 patients received HSCT from BMT and 353 patients from PBSCT. The median age in the BMT group was 7years (2-26years) and in the PBSCT group was 8 years (2-29 years) (P-Value=0.001). In BMT group 89(40.3%) patients were class III whereas in PBSCT group were 121(34.3%) (P-Value=0.196).
Results:
Acute graft versus host disease (GvHD) occurred in 141(63.80%) and 253(71.70%) of patients in the BMT and PBSCT, respectively (P-Value=0.048). Chronic GvHD was 19.30% in the BMT and 32.70% in the PBSCT (P-Value=0.001) in survivors after 100days. With a median follow-up of 50months, the 5-year thalassemia-free survival rate (TFS) of BMT and PBSCT were 76.3% and 67.5%, respectively (P-Value=0.294). The 5-year overall survival rate (OS) in BMT and PBSCT were 80.1% and 73.8%, respectively (P-Value=0.119). The rejection was 16.3% and 6.5% in BMT and PBSCT, respectively. The most common causes of death were GvHD and infections in both groups. TFS and OS results stratified by disease class showed better survival rates in lower classes (Table1).
Conclusion:
The PBSCT was an easier procedure for donors with lower cost compared with BMT. Acute GvHD was slightly more in PBSCT but chronic GvHD was more frequent. Chronic GvHD was alleviated over time and also it seems that the rejection is lower in PBSCT. These results show that HSCT should be considered for lower class of thalassemia and PBSCT is an acceptable alternative.
.
Table 1- Overall survival rate (OS) and thalassemia-free survival rate (TFS) of BMT and PBSCT stratified by disease classes:
BMT | PBSCT | |||||||||
OS | 1 y | 2 y | 5 y | p-value | OS | 1 y | 2 y | 5 y | p-value | |
I | 92.3% | 92.3% | 90.1% | 0.148 | I | 81.7% | 80.7% | 78.0% | 0.011 | |
II | 79.7% | 79.7% | 77.6% | II | 87.9% | 85.2% | 79.5% | |||
III | 79.7% | 78.3% | 76.3% | III | 75.1% | 69.5% | 64.0% | |||
TFS | 1 y | 2 y | 5 y | p-value | TFS | 1 y | 2 y | 5 y | p-value | |
I | 80.8% | 80.8% | 78.8% | 0.167 | I | 78.9% | 77.9% | 75.2% | <0.001 | |
II | 68.4% | 67.0% | 65.4% | II | 85.5% | 81.9% | 76.1% | |||
III | 67.7% | 64.7% | 60.6% | III | 66.0% | 59.7% | 55.2% | |||