Allojeneik hematopoetik kök hücre transplantasyonu yapılan hematolojik maligniteli hastalarda kronik kutanöz graft-versus-host hastalığı gelişenlerin retrospektif incelenmesi
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Date
2019
Authors
İpek, Fatma Doğan
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Allojeneik hematopoetik kök hücre transplantasyonu yapılan hematopoetik maligniteli hastalar retrospektif olarak incelenerek kronik kutanöz graft-versus-host hastalığı gelişenlerin sıklığı, zamanları, eşlik eden faktörler, klinik tutulumu, verilen tedaviler ve yanıt oranları, mortalite oranlarının ve nedenlerinin saptanması amaçlanmıştır. Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı, Hematoloji Bilim Dalı Kök Hücre Transplantasyon Ünitesi'nde Haziran 2011-Haziran 2018 tarihleri arasında allojeneik hematopoetik kök hücre transplantasyonu yapılmış hematolojik maligniteli 81 hasta retrospektif olarak incelenmiş olup, cinsiyet, primer hastalık, transplantasyon yaşı, doku uyumu, alıcı-verici arasındaki cinsiyet uyumu, CD34(+) kök hücre kaynağı ve miktarı, akut ve kronik graft-versus-host hastalığı oranları, kronik graft-versus-host hastalığı gelişme zamanları, kutanöz kronik graft-versus-host hastalığında eşlik eden faktörler, skoru, tutulumu, tedavileri, tedavi süreleri, yanıt oranları, nüks, mortalite oranları, nedenleri değerlendirilmiştir. Hastaların %44'ünde akut graft-versus-host hastalığı, %39'unda kronik graft-versus-host hastalığı, %22'sinde her ikisinin geliştiği, kronik graft-versus-host hastalığı gelişenlerin %40,6'sında kutanöz kronik graft-versus-host hastalığı geliştiği, ortalama gelişme süresi 5,6 ay olduğu saptandı. Akut graft-versus-host hastalığı, kutanöz kronik graft-versus-host hastalığı gelişmesinde risk faktörü olarak bulundu (p<0,05); cinsiyet, yaş, primer hastalık, donör-alıcı cinsiyet uyumu, verilen CD34(+) kök hücre miktarı kutanöz kronik graft-versus-host hastalığı gelişiminde risk faktörü olarak saptanmadı (p>0,05). Hastaların %92,3'ünde birden fazla organ tutulumu olduğu, klinik olarak %92,3 oranında likenoid tutulum geliştiği görüldü. Birinci basamak tedavi kortikosteroid tedavisi, üst basamak tedavilerde fototerapi, ekstrakorporeal fotoferez, mikofenolat mofetil, metotreksat, topikal takrolimus tedavileri seçildi. Tam yanıt %38, kısmi yanıt %61,5 oranındaydı. Nüks %15,3, eksitus %76,9 hastada meydana geldi. Kronik graft-versus-host hastalarında nüks açısından anlamlı azalma saptanmadı (p>0,05). Ölüm nedeni %60 sepsisti. Sonuç olarak kutanöz kronik graft-versus host hastalığı ile ilgili veriler yapılan çalışmalarla benzer bulunmakla birlikte, çalışmanın retrospektif olması, tedavinin çeşitliliği ve hasta sayısının azlığı; hastalık oranını, klinik özelliklerini, çalışma sonuçlarını etkileyebilmektedir. Tedavi algoritması tanımlamak için prospektif büyük ölçekli çalışmalar gereklidir.
The aim of this study was to investigate the frequency, time, concomitant factors, clinical involvement, treatments and response rates, mortality rates and causes of patients with chronic cutaneous graft-versus-host disease. Between June 2011 and June 2018, 81 patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation in Uludağ University, School of Medicine, Internal Medicine Department, Bone Marrow Transplant Unit Of Hematology Division, were retrospectively analyzed. Gender, primary disease, age of transplantation, tissue adaptation, gender compliance between the transponder, CD34(+) stem cell source and amount, acute and chronic graft-versus-host disease rates, chronic graft-versus-host disease development times, concomitant factors, score, involvement, treatment, treatment duration, response rates, recurrence, mortality rates, causes of cutaneous chronic graft-versus-host disease were evaluated. 44% of the patients had acute graft-versus-host disease, 39% had chronic graft-versus-host disease, 22% had both developed, and 40,6% of patients with chronic graft-versus-host disease developed cutaneous chronic graft-versus-host disease, and the mean duration of development was 5,6 months. Acute graft-versus-host disease was found to be a risk factor in the development of cutaneous chronic graft-versus-host disease (p<0,05); gender, age, primary disease, donor-recipient sex compliance, CD34 (+) stem cell amount was not detected as a risk factor in the development of cutaneous chronic graft-versus-host disease (p>0,05). It was seen that 92,3% of the patients had more than one organ involvement and 92,3% of the cases had lichenoid involvement. The first-line treatment was corticosteroid treatment, and phototherapy, extracorporeal photopheresis, mycophenolate mofetil, methotrexate and topical tacrolimus treatments were chosen for the top-line treatments. Complete response was 38%, partial response was 61,5%. Recurrence was 15,3%, and in 76,9% of the patients died. There was no significant decrease in recurrence in chronic graft-versus-host patients (p>0,05). The cause of death was 60% sepsis. In conclusion, although the data on cutaneous chronic graft-versus-host disease are similar to those in the present study, the retrospective nature of the study, the diversity of the treatment, and the low number of patients may affect the disease rate, clinical characteristics, and results of the study. Prospective large-scale studies are necessary to define the treatment algorithm.
The aim of this study was to investigate the frequency, time, concomitant factors, clinical involvement, treatments and response rates, mortality rates and causes of patients with chronic cutaneous graft-versus-host disease. Between June 2011 and June 2018, 81 patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation in Uludağ University, School of Medicine, Internal Medicine Department, Bone Marrow Transplant Unit Of Hematology Division, were retrospectively analyzed. Gender, primary disease, age of transplantation, tissue adaptation, gender compliance between the transponder, CD34(+) stem cell source and amount, acute and chronic graft-versus-host disease rates, chronic graft-versus-host disease development times, concomitant factors, score, involvement, treatment, treatment duration, response rates, recurrence, mortality rates, causes of cutaneous chronic graft-versus-host disease were evaluated. 44% of the patients had acute graft-versus-host disease, 39% had chronic graft-versus-host disease, 22% had both developed, and 40,6% of patients with chronic graft-versus-host disease developed cutaneous chronic graft-versus-host disease, and the mean duration of development was 5,6 months. Acute graft-versus-host disease was found to be a risk factor in the development of cutaneous chronic graft-versus-host disease (p<0,05); gender, age, primary disease, donor-recipient sex compliance, CD34 (+) stem cell amount was not detected as a risk factor in the development of cutaneous chronic graft-versus-host disease (p>0,05). It was seen that 92,3% of the patients had more than one organ involvement and 92,3% of the cases had lichenoid involvement. The first-line treatment was corticosteroid treatment, and phototherapy, extracorporeal photopheresis, mycophenolate mofetil, methotrexate and topical tacrolimus treatments were chosen for the top-line treatments. Complete response was 38%, partial response was 61,5%. Recurrence was 15,3%, and in 76,9% of the patients died. There was no significant decrease in recurrence in chronic graft-versus-host patients (p>0,05). The cause of death was 60% sepsis. In conclusion, although the data on cutaneous chronic graft-versus-host disease are similar to those in the present study, the retrospective nature of the study, the diversity of the treatment, and the low number of patients may affect the disease rate, clinical characteristics, and results of the study. Prospective large-scale studies are necessary to define the treatment algorithm.
Description
Keywords
Allojeneik kök hücre transplantasyonu, Kronik graft versus host hastalığı, Kutanöz graft versus host hastalığı, Allogeneic stem cell transplantation, Chronic graft versus host disease, Cutaneous graft versus host disease
Citation
İpek, F. D. (2019). Allojeneik hematopoetik kök hücre transplantasyonu yapılan hematolojik maligniteli hastalarda kronik kutanöz graft-versus-host hastalığı gelişenlerin retrospektif incelenmesi. Yayınlanmamış uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.