Assesment of non-relapse mortality (NRM) and long-term survival after autologous stem cell transplantation (ASCT) in patients with lymphoproliferative diseases.

A balanced risk-benefit approach to haematopoietic stem cell transplantation (HSCT) is the key for maximized chances of cure with acceptable quality of life for patients with advanced haematological malignancies. The aim was to try to assess the prognostic value of comorbidity and other independent variables concerning pretransplant mobilization strategies that affect auto SCT in patients with lymphoproliferative diseases.We stratified outcomes among 90 consecutive adult autologous recipients with lymphoproliferative diseases. 55% of patients were classified in the low index group for haematopoietic stem cell transplantation with comorbidity index (HCT-CI) scores between 0-1, 27% of patients with lymphoproliferative diseases had intermediate HCT-CI scores 1-2 and 12% of patients were in high HCT-CI group with a score≥3 and 6% undetermined. Two year NRM was 36% (95% CI: 17-36%), 26% (95% CI 15-39%) and 30% (95% CI: 22-39%) in the low, intermediate and high-risk HCT-CI groups respectively. The HCT-CI has been shown to sensitively capture organ comorbidities and provide valuable prognostic information for assignments of patients to clinical trials. Still, many questions remain to be answered, auch as good sample size, equal stratification of patients into risk groups, and also implementing better pretransplant assessment.

Iron overload in patients with transfusion dependent myelodisplastic syndrome.

The myelodisplastic syndrome is a heterogeneous group of diseases, characterised by ineffective and dysplastic haematopoesis and pancytopenia in the peripheral blood, followed by progressive disturbance of differentiation of the haematopoetic stem cell, resulting in evolution of the disease towards acute leukaemia. According to the latest WHO classification, the term myelodisplastic syndrome includes diseases with an indolent course, as well as diseases with a fast evolution towards acute leukaemia. Because of this diversity, haematologists base their therapeutic decisions on prognostic scoring systems which incorporate all the significant factors with an influence on survival in this group of patients with myelodisplastic syndrome. Bearing in mind that anaemia is the most frequent form of cytopenia in patients with myelodisplastic syndrome, it is common that at some point of the disease almost every patient with myelodisplastic syndrome is transfusion-dependent. Frequently applied transfusions secure the correction of anaemia in these patients, giving them a good quality of life, but at the same time endangering them with the potential threat of iron overload, when the physiological mechanisms of iron excretion from the organism become insufficient. There is a clear correlation between transfusion dependence and the overall survival in patients with myelodisplastic syndrome. Chelators secure the lowering of the iron surfeit and are indicated in transfusion-dependant patients with myelodisplastic syndrome ( need for two blood units monthly, during one year ), when the ferritin level increases over 1000, in patients who are candidates for transplantation as well as in patients from good prognostic groups with median survival over one year. The therapy with chelators lasts as long as the patient is transfusion-dependant.

Autologous stem-cell transplantation in patients with multiple myeloma.

BACKGROUND: - Multiple myeloma is a malignant plasma-cell proliferative disorder, the second most common haematologic cancer. Treatment with high-dose therapy (HDT) and single autologous stem cell transplantation (ASCT) is a category I recommendation of the National Comprehensive Cancer Network. Double transplantation can be proposed for patients failing to achieve small a, Cyrillic very good partial response (VGPR) after a first ASCT. Aims - The aim of this study is to analyse the effect of treatment with high-dose chemotherapy and autologous stem-cell support on survival in patients with multiple myeloma, and to compare our results with the results from other transplant centres. MATERIAL AND METHODS: - during a 7-year period we have performed 20 high-dose chemotherapy courses and autologous stem-cell transplantation on 17 patients (3 tandem transplantations) with multiple myeloma. In this trial we retrospectively analysed the epidemiology characteristics of these patients. Female: 9 Male - 8. Median age: 53 years (from 43-64 years). RESULTS: diagnosis was made according to Salmon and Durie criteria. High-dose regimen consisted of Melphalan doses of 200mg/m2. In tandem transplantations the dose of the second high-dose regimen was 140 mg/m2. The volume of CD34+ cells was approximately 3.8 x 10exp8/Kg.bw. In 3 patients we used phlebothomy as a source of added stem cells. The period from diagnosis to transplantation was 12 months. Of 17 patients 70% are alive, 5 have died (3 renal failure, 1 fatal cerebral bleeding and 1 with multiorgan failure). The disease-free survival was 22 months in our group of patients. Overall survival was 48 months and survival after transplantation was 35 months. The probability of 7 years' overall survival exists in 50% of patients. CONCLUSION: Patients treated with high-dose chemotherapy followed by autologous stem-cell support have a better survival and quality of life compared with patients treated with standard chemotherapy.

Stem cell transplantation - new treatment approaches.

Stem cell research still remains one of the most controversial fields of science today on account cell plasticity and its capability of transdifferentiation or de-differentiations to certain tissue types, as well as the clinical application of this scientific concept. Stem cells derived from bone marrow, peripheral blood or the umbilical cords are a common therapeutic approach for treatment of haematological malignancies as part of established transplant procedures (allogeneic, autologous, syngeneic stem cell transplantation). But recent clinical data have revealed the potential role of stem cells in the treatment of other nonhaematological diseases, degenerative disorders, cardiovascular diseases and autoimmune diseases. The experience with stem cell transplantation in haematological malignancies at the Hematology Department, Skopje, has been established since it was set up 7 years ago, with more than 130 patients undergoing transplant procedures (87 autologous and 43 allogeneic recipients). Encouraging results were also reported from the Skopje Cardiology Clinic in the field of intracoronary application of bone marrow derived stem cells for the treatment of patients with acute myocardial infarction. But this new rout in tissue regeneration should still be further extended and evaluated in clinically randomized studies that will confirm the therapeutic potential of stem cells.