Allogeneic stem cell transplantation in hematological disorders: single center experience from Pakistan

One hundred and fifty-four patients received allogeneic stem cell transplantations from HLA-matched siblings for various hematological disorders from July 2001 to September 2006. Indications for transplantation included aplastic anemia (n=66), beta-thalassemia major (n=40), CML (n=33), acute leukemia (n=8), and miscellaneous disorders (n=7). One hundred and twenty patients were males and 34 were females. Median patient age was 14 years (range, 1(1/4)-54 years). All patients achieved successful engraftment. Median time to engraftment (ANC>0.5x10(9)/L) was 14 days. Posttransplant complications encountered in our patients included acute graft versus host disease (GvHD) (grade II-IV) 28.5%, chronic GvHD 15.5%, hemorrhagic cystitis 9.7%, VOD liver 5.1%, acute renal failure 3.2%, bacterial infections 51.2%, fungal infections 15.0%, cytomegalovirus (CMV) infection 4%, herpes zoster 4%, tuberculosis 2.6%, Pneumocystis jirovicii infection 0.6%, malaria 0.6% patients, graft rejection 5.2% patients, and relapse in 4% patients. Certain unexpected and rare posttransplant complications were also observed in our patients. These included Hickman catheter embolization, Guillain-Barré (GB) syndrome, deep vein thrombosis, hemorrhagic pericarditis with clots leading to cardiac tamponade, idiopathic polycythemia, dengue fever, and cyclosporine-induced neurotoxicity. Mortality was observed in 27.2% patients. Major causes of mortality were GvHD, VOD, disease relapse, intracranial hemorrhage, acute renal failure, pseudomonas septicemia, tuberculosis, disseminated aspergillosis, and CMV infection. At 5 years, overall survival (OS) and disease-free survival (DFS) rates were 72.5% and 70.7%, respectively.