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Autologous hematopoietic stem cell transplantation—what determines the outcome: an experience from North India

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Abstract

Limited information is available from developing countries about complications, pattern of infections, and long-term outcome of patients following high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ASCT). Between April, 1990 and December 2009, 228 patients underwent ASCT. Patients’ median age was 48 years, ranging from 11 to 68 years. There were 158 males and 70 females. Indications for transplant included multiple myeloma, n = 143; lymphoma, n = 44 (Hodgkin’s, n = 25 and non-Hodgkin’s, n = 19); leukemia, n = 22; and solid tumors, n = 18. Patients received HDCT as per standard protocols. Following ASCT, 175 (76.7%) patients responded; complete, 98 (43%); very good partial response, 37 (16.2%); and partial response, 40 (17.5%). Response rate was higher for patients with good Eastern Cooperative Oncology Group (ECOG) performance status (0–2 vs. 3–4, p < 0.001), pretransplant chemo-sensitive disease (p < 0.001) and those with diagnosis of hematological malignancies (p < 0.003). Mucositis, gastrointestinal, renal, and liver dysfunctions were major nonhematologic toxicities, 3.1% of patients died of regimen-related toxicities. Infections accounted for 5.3% of deaths seen before day 30. At a median follow-up of 66 months (range, 9–234 months), median overall (OS) and event-free survival (EFS) were 72 months (95% CI 52.4–91.6) and 24 months (95% CI 17.15–30.9), respectively. For myeloma, OS and EFS were 79 months (95% CI 52.3–105.7) and 30 months (95% CI 22.6–37.4), respectively. Pretransplant good performance status and achievement of significant response following transplant were major predictors of survival. Our analysis demonstrates that such procedure can be successfully performed in a developing country with results comparable to developed countries.

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References

  1. Gratwohl A, Baldomero H, Aljurf M, Pasquini MC, Bouzas LF, Yoshimi A et al (2010) Hematopoietic stem cell transplantation. A global perspective. JAMA 303:1717–1724

    Article  Google Scholar 

  2. CIBMTR Center for International Blood and Marrow Transplant. Research newsletter. August 2009; 15(1): 7–8 (Summary slides)

    Google Scholar 

  3. Ljungman P, Urbano-ispizua A, Cavazzana Calvo M, European Group for Blood and Marrow et al (2006) Allogeneic and autologous transplantation for hematological diseases, solid tumours and immune disorders: definitions and current practice in Europe. Bone Marrow Transplant 37:439–449

    Article  PubMed  CAS  Google Scholar 

  4. Nivison-Smith I, Bradstock KF, Dodds AJ et al (2007) Hematoloietic stem cell transplantation in Australia and New Zealand,1992–2004. Biol Blood Marrow Transplant 13(8):905–912

    Article  PubMed  Google Scholar 

  5. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M et al (2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet 359(9323):2065–2071

    Article  PubMed  CAS  Google Scholar 

  6. Schmitz N, Linch DC, Dreger P, Goldstone AH, Boogaerts MA, Ferrant A et al (1996) Randomised trial of filgrastim-mobilised peripheral blood progenitor cell transplantation versus autologous bone-marrow transplantation in lymphoma patients. Lancet 347(8998):353–357

    Article  PubMed  CAS  Google Scholar 

  7. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF, Intergroupe Francais du Myelome et al (1996) A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. N Engl J Med 11(335(2)):91–97

    Article  Google Scholar 

  8. Matthay KK, Villablanca JG, Seeger RC, Stram DO, Harris RE, Ramsay NK, Children’s Cancer Group et al (1999) Treatment of high-risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis-retinoic acid. N Eng J Med 341:1165–1173

    Article  CAS  Google Scholar 

  9. Breems DA, Boogaerts MA, Dekker AW, Van Putten WL, Sonneveld P, Huijgens PC et al (2005) Autologous bone marrow transplantation as consolidation therapy in the treatment of adult patients under 60 years with acute myeloid leukemia in first complete remission: a prospective randomized Dutch–Belgian haemato-Oncology Co-operative Group (HOVON) and Swiss Group for Clinical Research (SAKK) trial. Br J Haematol 128:59–65

    Article  PubMed  Google Scholar 

  10. Lorch A, Kollmannsberger C, Hartmann JT, Metzner B, Schmidt-Wolf IG, Berdel WE, German Testicular Cancer Study Group et al (2007) Single versus sequential high-dose chemotherapy in patients with relapsed or refractory germ cell tumors: a prospective randomized multicenter trial of the German Testicular Cancer Study Group. J Clin Oncol 25(19):2778–2784

    Article  PubMed  CAS  Google Scholar 

  11. Kumar L, Ghosh J, Ganessan P, Gupta A, Hariprasad R, Kochupillai V (2009) High dose chemotherapy with autologous stem cell transplantation for multiple myeloma: what predicts the outcome? Experience from a developing country. Bone Marrow Transplant 43:481–489

    Article  PubMed  CAS  Google Scholar 

  12. Chandy M (2008) Stem cell transplantation in India. Bone Marrow Transplant 42(Suppl):S81–S84

    Article  PubMed  Google Scholar 

  13. Mahmoud H, El-Haddad A, Fahmy O, El-Emary M, Nassar A, Abdel-Mooti M et al (2008) Hematopoietic stem cell transplantation in Egypt. Bone Marrow Transplant 42(Suppl 1):S76–S80

    Article  PubMed  Google Scholar 

  14. Ruiz-Argüelles GJ, Gómez-Rangel D, Ruiz-Delgado GJ, Ruiz-Argüelles A, Pérez-Romano B, Rivadeneyra L (2003) Results of an autologous noncryopreserved, unmanipulated peripheral blood hematopoietic stem cell transplant program: a single-institution, 10-year experience. Acta Haematol 110(4):179–183

    Article  PubMed  Google Scholar 

  15. Bedi R, Kumar L, Kochupillai V (2003) Autologous peripheral blood stem cell transplantation: predictors for haemapoietic reconstitution. Nat Med J India 16:209–213

    Google Scholar 

  16. Raju GMK, Kochupillai V, Kumar L (1995) Storage of haematopoietic stem cells for autologous bone marrow transplantation. Nat Med J India 8:216–221

    CAS  Google Scholar 

  17. Gupta A, Singh M, Singh H, Kumar L, Sharma A, Bakhshi S et al (2010) Infections in acute myeloid leukemia: an analysis of 382 febrile episodes. Med Oncol 27(4):1037–1045

    Article  PubMed  Google Scholar 

  18. Bearman SI, Appelbaum FR, Buckner CD, Petersen FB, Buckner CD, Sullivan KM et al (1988) Regimen related toxicity in patients undergoing bone marrow transplantation. J Clin Oncol 6:1562–1568

    PubMed  CAS  Google Scholar 

  19. McDonald GB, Hinds MS, Lloyd RN, Schoch HG, Wolford JL, Banaji M et al (1993) Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients. Ann Int Med 118:255–267

    PubMed  CAS  Google Scholar 

  20. Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting the results of cancer treatment. Cancer 47:207–211

    Article  PubMed  CAS  Google Scholar 

  21. Blade J, Samson D, Reece D, Apperley J, Björkstrand B, Gahrton G et al (1998) Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Br J Haematol 102:1115–1123

    Article  PubMed  CAS  Google Scholar 

  22. Spencer A, Horvath N, Gibson J, Prince HM, Herrmann R, Bashford J et al (2005) Prospective randomized trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation. Bone Marrow Transplant 35:971–977

    Article  PubMed  CAS  Google Scholar 

  23. MerouaniA SEJ, Jones RB, Archer PG, Schrier RW (1996) Renal function in high dose chemotherapy and autologous hematopoietic cell support treatment for breast cancer. Kidney Int 50(3):1026–1031

    Article  Google Scholar 

  24. Ozdogan O, Ratip S, Ahdab YA, Dane F, Ahdab HA, Imeryüz N, Tözün N (2003) Causes and risk factors for liver injury following bone marrow transplantation. J Clin Gastroenterol 36:421–426

    Article  PubMed  Google Scholar 

  25. Ho GT, Parker A, MacKenzie JF, Morris AJ, Stanley AJ (2004) Abnormal liver function tests following bone marrow transplantation: aetiology and role of liver biopsy. Eur J Gastroenterol Hepatol 16:157–162

    Article  PubMed  Google Scholar 

  26. Carreras E, Bertz H, Arcese W, Vernant JP, Tomás JF, Hagglund H et al (1998) Incidence and outcome of hepatic veno-occlusive disease after blood or marrow transplantation: a prospective cohort study of the European Group for Blood and Marrow Transplantation. European Group for Blood and Marrow Transplantation Chronic Leukemia Working Party. Blood 92(10):3599–3604

    PubMed  CAS  Google Scholar 

  27. Afessa B, Tefferi A, Litzow MR, Peters SG (2002) Outcome of diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med 166:1364–1368

    Article  PubMed  Google Scholar 

  28. Majhail NS, Parks K, Defor TE, Weisdorf DJ (2006) Diffuse alveolar hemorrhage and infection-associated alveolar hemorrhage following hematopoietic stem cell transplantation: related and high-risk clinical syndromes. Biol Blood Marrow Transplant 12(10):1038–1046

    Article  PubMed  Google Scholar 

  29. Leung AY, Mak R, Lie AK, Yuen KY, Cheng VC, Liang R, Kwong YL (2002) Clinicopathological features and risk factors of clinically overt haemorrhagic cystitis complicating bone marrow transplantation. Bone Marrow Transplant 29:509–513

    Article  PubMed  CAS  Google Scholar 

  30. Mileshkin LR, Seymour JF, Wolf MM, Gates P, Januszewicz EH, Joyce P, Prince HM (2005) Cardiovascular toxicity is increased, but manageable, during high dose chemotherapy and autologous peripheral blood stem cell transplantation for patients aged 60 years and older. Leuk Lymphoma 46:1575–1579

    Article  PubMed  CAS  Google Scholar 

  31. Saiz A, Graus F (2004) Neurological complications of hematopoietic cell transplantation. Semin Neurol 24(4):427–434

    Article  PubMed  Google Scholar 

  32. Carreras E, Fernandez-Aviles F, Guerrero SM, Guerrero M, de Larrea CF, Martínez C et al (2010) Engraftment syndrome after auto SCT: analysis of diagnostic criteria and risk factors in a large series from a single center. Bone Marrow Transplant 45(9):1417–1422

    Article  PubMed  CAS  Google Scholar 

  33. Sorror M (2009) Impacts of pretransplant comorbidities on allogeneic hematopoietic cell transplantation (HCT) outcomes. Biol Blood Marrow Transplant 15(1 Suppl):149–153

    Article  PubMed  Google Scholar 

  34. Jantunen E, Salonen J, Juvonen E, Koivunen E, Siitonen T, Lehtinen T et al (2004) Invasive fungal infections in autologous stem cell transplant recipients: a nation-wide study of 1,188 transplanted patients. Eur J Haematol 73:174–178

    Article  PubMed  CAS  Google Scholar 

  35. Passweg JR, Rowlings PA, Atkinson KA, Barrett AJ, Gale RP, Gratwohl A et al (1998) Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemia. Bone Marrow Transplant 21(12):1231–1238

    Article  PubMed  CAS  Google Scholar 

  36. Russell JA, Chaudhry A, Booth K, Brown C, Woodman RC, Valentine K et al (2000) Early outcomes after allogeneic stem cell transplantation for leukemia and myelodysplasia without protective isolation: a 10-year experience. Biol Blood Marrow Transplant 6(2):109–114

    Article  PubMed  CAS  Google Scholar 

  37. George B, Mathews V, Srivastava V, Srivastava A, Chandy M et al (2001) Tuberculosis among allogeneic bone marrow transplant recipients in India. Bone Marrow Transplant 27:973–975

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We acknowledge the excellent care and dedication of residents and nursing staff of Medical Oncology Department. Mr. Shanti Swaroop and Narendra Singh helped in harvesting of stem cells and Ms. Mercy Thomas, Dr Sujata Mohanti, and Dr. Sobuhi Iqbal helped in cryopreservation of stem cells.

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Authors and Affiliations

  1. Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 11 00 29, India

    Lalit Kumar, Prabhat Singh Malik, Gaurav Prakash, Ram Prabu, Venkat Radhakrishnan, Smita Katyal & Roopa Hariprasad

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  1. Lalit Kumar
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Correspondence to Lalit Kumar.

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Kumar, L., Malik, P.S., Prakash, G. et al. Autologous hematopoietic stem cell transplantation—what determines the outcome: an experience from North India. Ann Hematol 90, 1317–1328 (2011). https://doi.org/10.1007/s00277-011-1205-4

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