aot2022v55i2

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Acta Oncologica Turcica 2022; 55: 109-115110CD 34 (+) hücre sayısının kronik GVHD gelişimi (p=0,01) ve geç dönem komplikasyonları (p=0,016)üzerinde anlamlı etkisi olduğu belirlendi. Yüksek CD 34 (+) hücre sayısı verilen grupta kronik GVHDve geç komplikasyon oranları daha düşük bulundu.Hastalar hazırlık rejimlerine göre gruplandırıldığında miyeloablatif rejim grubundaki hastalarda %78,8oranında istatistiksel olarak anlamlı derecede daha fazla komplikasyon gözlendi (p=0,005).Nakil sonrası 90-120. günlerde primer hastalık, böbrek komplikasyonları ve nörolojik komplikasyonlarıntekrarlama oranlarının daha yüksek olduğu gözlendi. Oküler ve GVHD komplikasyonlarınındaha sonra gelişmesi daha olasıydı. Endokrin komplikasyonların hem erken hem de geç dönemlerde eşitoranda görüldüğü gözlendi.Tartışma: Allojenik HKHT yapılan hastalarda geç komplikasyonların sık görüldüğü ve bu komplikasyonlarındaha çok GVHD ve GVHD tedavisi ile ilişkili olduğu görüldü.Anahtar kelimeler: Hematopoetik kök hücre nakli, Geç komplikasyonlar, non-infeksiyöz komplikasyonlar,GVHDIntroductionHematopoietic stem cell transplantation(HSCT) is a treatment method that is beingused more and more in the curative treatmentof many malignant and non-malignantdiseases. In allogeneic HSCT, donors areclassified as fully matched, haploidentic(semi-matched) and incompatible accordingto their HLA compatibility with the recipient.Regimens in which the patient's bone marrowis suppressed with high-dose cytotoxicchemoradiotherapy are myeloablativeregimens, and regimens in which bonemarrow is suppressed with minimal immunosuppressionare non-myeloablative regimens[1]. Non-myeloablative regimens aregenerally applied to people over 55 years ofage with comorbidities [2].Early and late complications of treatment aremore common [3]. Early and latecomplications have a great impact onmortality and morbidity [4]. The maincomplications that occur in the late period are;chronic Graft Versus Host Disease (GVHD),secondary malignancies, infections,pulmonary complications, cardiac toxicity,endocrine complications. In addition to these,complications of some other organ systemsrelated to treatment may also be seen [5].Between 01.02.2011-31.12.2018, 143 patientswho had allogeneic HSCT at İnönü UniversityTurgut Özal Medical Center adult stem celland bone marrow transplant center were followedup in our center for at least 3 monthswere included in the study. Approval wasobtained from the Inonu University Malatyawww.actaoncologicaturcica.comGVHD, which is one of the latecomplications, can also be seen in HLAmatchedtransplants and affects many organsand systems. Standard prophylaxis regimensgiven to prevent the development of GVHDand drugs used in its treatment may also leadto various complications in the late period.Late complications were attributed to theprimary disease, donor compliance,preparation regimen, steroid use, variousdrugs used, and many other factors.The important thing is to anticipate thesecomplications and manage them successfully.Successful treatment of early and latecomplications will contribute to prolongingsurvival and improving quality of life. Noninfectiouscomplications in patients wıthallogeneic hematopoietic stem cell transplantationis may be important in thesepopulation.It is aimed to investigate late stage noninfectious complications and the factorsaffecting it.Materials and MethodsClinical Research Ethics Committee with thedate of 02.07.2019 and the approval numberCopyright©Ankara Onkoloji Hastanesi
Acta Oncologica Turcica 2022; 55: 109-1151112019/277. The study was conducted inaccordance with the Helsinki declaration.Age, gender, disease subtype, preparationregimen, late complications of our patientswere determined through the hospitalautomation system. Late complications of thepatients were considered as complicationsoccurring 100 days after transplantation. Ourstudy was retrospective and no invasiveprocedure was performed on the patients.Statistical analysesResearch data was uploaded to the computerenvironment via “SPSS (Statistical Packagefor SocialSciences) for Windows 22.Descriptive statistics were presented asmean±standard deviation, median (minimummaximum),and percentage. Pearson Chi-Square Test and Fisher's Exact Test were usedto evaluate categorical variables.The conformity of the variables to the normaldistribution was examined using theKolmogorov-Smirnov Test. The Mann-Whitney U Test was used as a statisticalmethod for the statistical significance betweentwo independent groups for the variables thatwere not found to fit the normal distribution.Statistical significance level was accepted asp<0.05.ResultsOf the 143 patients included in the study, 60(42%) were female and 83 (58%) were male.The median age was 41 (18-65) years. In ourstudy, 7 different preparation regimens wereused before hematopoietic stem celltransplantation. Peripheral-derived stem celltransplantation was performed in all patients.The demographic and clinical characteristicsof 143 patients are given in Table 1.The distribution of the patients included in thestudy according to the chemotherapypreparation regimen they received beforeHSCT is given in Table 2.When the amount of CD34 (+) cells given tothe patients was examined, the minimumamount of CD34 (+) cells was 4.76 x 10 6 /kg,the maximum was 15.75 x 10 6 /kg, and themedian value was 7.45 x 10 6 /kg.When the donors of 143 patients whounderwent allogeneic HSCT were examined,57 were female and 86 were male. The agerange was 12-67 years and the median valuewas 40.In total, 123 patients underwent relative and20 patients underwent unrelated transplants,and nine patients underwent haploidentictransplants.One hundred and twenty five of the patientswere transplanted in the first completeremission and 18 in the second completeremission.When the development of chronic GVHD ofthe patients was examined, it was seen thatchronic GVHD developed in 43 patients(33%). The distribution of GVHD developedin patients who underwent allogeneic HSCTaccording to the site of involvement is givenin Table 3.There was no effect of patient age, donor age,blood group compatibility, gender, gendermatch, engraftment time on the developmentof chronic GVHD. It was determined that thenumber of CD 34 (+) cells had a significanteffect on the development of chronic GVHD(p=0,01) and late stage complications(p=0,016). Chronic GVHD and latecomplication rates were found to be lower inthe group given high CD 34 (+) cell count.The development rates and times of hepaticcomplications in the patients were examined.Liver function tests elevation was detected forTable 1. Demographic and clinical characteristics of our patientswww.actaoncologicaturcica.comCopyright©Ankara Onkoloji Hastanesi
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