Haematopoietic Stem Cell Transplantation: A Single Centre Experience from Army Hospital (Research & Referral), New Delhi, India

Haematopoietic stem cell transplantation {HSCT} is being offered as a definitive mode of therapy in various hematological disorders. We present retrospective data of 113(39 females) patients who underwent HSCT in High Efficiency Particulate Air {HEPA} filtered unit. Of these, 36 underwent Autologous HSCT {Auto-HSCT} comprising of 15 patients for Acute Myeloid Leukemia {AML} and 21 for Multiple Myeloma{MM}.). The indications for Allogenic HSCT {Allo-HSCT} were Chronic Myeloid Leukemia{CML}-19;AML-17; Thalassaemia Major-18;Myelodysplastic Syndrome{MDS}-01; Acute Lymphoblastic Leukemia-09,; Severe Aplastic Anemia {SAA}-09; Pure red cell Aplasia-02 and Juvenile Myelomonocytic Leukemia-02. All allogeneic recipients, received stem cells from HLA matched siblings. The conditioning was done with standard busulfan-cyclophosphamide (Bu-Cy) based protocols for leukemia; fludarabine, cyclophosphamide & Anti-Thymocyte globulin {ATG} for SAA; Bu-Cy-ATG for thalassemia and melphalan for MM. The mean age was 25 years (2–60). The median cell dose was 6.0×10⁸MNC/Kg (2.2–11.7). The median day of engraftment for neutrophils (ANC > 500/mm³) was on day 11(7–22) and for platelets (Plt >20,000/mm³) it was on day 13(8–37). Peripheral blood was used as a source of stem cells for all patients who underwent Auto-HSCT, except for two patients where bone marrow was also harvested in addition, to achieve adequate cell dose. For Allo-HSCT, peripheral blood was used for 47 patients and bone marrow for 29 patients. Both bone marrow and cord blood was used in one patient for Allo-HSCT.

Analysis of All-HSCT: Analysis revealed 13/77(16.88%) patients developed sinusoidal obstruction syndrome {SOS}. Of these 06 had severe SOS and 04 of them died. 5/77(6.49%) patients developed hemorrhagic cystitis who responded to conservative management. Incidence of grade III/IV acute graft versus host disease {GVHD} was 10/77 (12.98%), of which 4 patients died. Of these, 3 were Thalassemia Major patients who underwent bone marrow stem cell transplant {BMSCT} while the remaining were hematological malignancies (CML-04; AML-01; ALL-02) who underwent peripheral blood stem cell transplant {PBSCT}. Also, 20/77 (25.97%) patients were noted to have chronic GVHD (Limited-12 & Extensive-08). Interestingly there was strikingly higher incidence of chronic GVHD in the PBSCT group i.e. 19/47 (40.43%) as compared to BMSCT group where it was only 1/30 (3.34%). This was found to be statistically significant (p<0.05).

The overall mortality in Allo-HSCT group was 27/77 (35.07%) which included 10 deaths due to relapse of the underlying disease. Transplant related mortality (TRM) was 17/77(22.08%). In the TRM group, 11 were PBSCT while 6 were BMSCT. TRM <100 days comprised of 13/77 (16.88%) patients and causes of death were sepsis (06); severe VOD (04) and acute GVHD (03). Overall survival was 50/77 (64.94%) with a median follow up of 450 days (90–2329).

Analysis for Auto-HSCT: Only two i.e. 2/36 (5.56%) patients developed mild SOS. Overall mortality in this subset was 6/36 (16.67%). This included only one TRM i.e. 1/36 (2.78%) and 05 deaths due to relapse of the disease (AML-3 & MM-2). Two patients have died due to unrelated causes (one due to heat stroke and one due to head injury). Two patients have been lost to follow up. Overall survival was 26/34(76.47%) with a median follow up of 579 days (90–2414).