Allogenic hematpoetic stem cell transplantation is a cure for hematological malignancies and certain of immune system diseases,but is associated with high morbidity due to immunological reaction between donor and recipient:Graft versus host disease
repport our experience in management of post allograft complications
this is a retrospective descriptive study,between 2007 and 2018,including 28patients
The follow up was done in the clinical departement of hematology of Rabat,but allograft was performed in Percy military hospital in Paris
In this study, spread between 2007 and 2018, all patients included were sent to the Percy military hospital for an allograft of hematopoietic stem cells between 2007 and 2018, the median age was 32 years (15 years and 60 years), 55% were male, 17 patients were followed for acute leukemias including 09 myeloid type, 04 myeloproliferative neoplasms (01 CML, 03PMF), 03 patients for aplastic anemia, 01 MDS, 03 patients for lympho-proliferative syndrome (01 Hodgkin's lymphoma, T lymphoma and multiple myeloma). The duration between diagnosis and bone marrow transplant was around 12 months (2 months and 6 years), 75% of patients were transplanted from a geno-identical donor, 17% from a 10/10 pheno-identical voluntary donor, while one patient received a haplo-identical transplant and another a transplant of placental blood units. A peripheral stem cell graft was used in 75% of patients, several conditioning regimens were used, including: Busulfan / Endoxan in 30% (acute leukemias) Fludarabine-Busulfan-thymoglobulin in 28%. Anti-GVHD prophylaxis was done by Methotrexate / ciclosporin in 58% of cases, ciclosporin alone in 22% and ciclosporin-mycophenolate mofetil in 18% of cases. The immediate consequences of the graft were marked by the occurrence of bacterial infections in 71%, the reactivation of CMV in 9 patients, acute GVH was found in 38% of patients, cutaneous type with a good response to corticosteroids. During our follow-up, 35% of patients showed signs of chronic GVH -with 35% of patients who had acute GVH. All types was present:cutaneous and oral (71%), pulmonary (58%), ocular (58%), hepatic (28%), muscular (28%), digestive and gynecologic GVHD. (14%), immunosuppressive treatments (ciclosporin) and corticosteroids were used in the first line in all patients with a response less than 30%. In the second line, Rituximab was used in 71% of patients, ITK (Imatinib) in 28% (pulmonary GVH), and extracorporeal photophoresis in a patient with musculoskeletal GVHD.
The median follow-up was 45 months with an overall survival of 67% and an event-free survival of 60%.
Allogenic stem cell transplantation is a real challenge in under-developing countries, The post-transplant represent a heavy multidisciplinary approach and a very expensive
In our series 10% of patients have died from chronic GVH, then we need a better understanding and mastery of this complication.