%0 Journal Article
%T Frequency and Outcome of Graft versus Host Disease after Stem Cell Transplantation: A Six-Year Experience from a Tertiary Care Center in Pakistan
%A Natasha Ali
%A Salman Naseem Adil
%A Mohammad Usman Shaikh
%A Nehal Masood
%J ISRN Hematology
%D 2013
%R 10.1155/2013/232519
%X Objective. The objective of this study was to evaluate the frequency and outcome of graft versus host disease after stem cell transplantation for various haematological disorders in Pakistan. Materials and Methods. Pretransplant workup of the patient and donor was performed. Mobilization was done with G-CSF 300£¿¦Ìg twice daily for five day. Standard GvHD prophylaxis was done with methotrexate 15£¿mg/m2 on day +1 followed by 10£¿mg/m2 on days +3 and +6 and cyclosporine. Grading was done according to the Glucksberg classification. Results. A total of 153 transplants were done from April 2004 to December 2011. Out of these were allogeneic transplants. There were females and males. The overall frequency of any degree of graft versus host disease was 34%. Acute GvHD was present in patients while had chronic GvHD. Grade II GvHD was present in patients while grade III and IV GvHD was seen in patients each. Acute myeloid leukemia and chronic myeloid leukemia were most commonly associated with GvHD. The mortality in acute and chronic GvHD was 8.8% and 12% respectively. Conclusion. The frequency of graft versus host disease in this study was 34% which is lower compared to international literature. The decreased incidence can be attributed to reduced diversity of histocompatibility antigens in our population. 1. Introduction Allogeneic haemopoietic stem cell transplant is an established treatment modality for many malignant and non-malignant conditions [1]. Its use over the last decade has extensively expanded which includes nonmyeloablative transplant, donor lymphocyte infusions, and umbilical cord blood transplant [2, 3]. As the numbers of procedures continue to increase with 25,000 transplants being performed annually, the survival benefit, however, is complicated by graft versus host disease (GvHD) leading to significant morbidity, mortality, and limitation of its usage [4]. Most of the laboratories in the world have adopted the high-resolution testing modality for human leukocyte antigen (HLA) typing. Every conditioning protocol incorporates the use of immunosuppression most commonly with cyclosporine and methotrexate. Despite these measures, GvHD remains an important cause of transplant-related mortality and morbidity leading to limitation of its usage [5]. Approximately 30 years ago, the prerequisites of acute GvHD were described by Billingham. These included immunologically competent cells in sufficient numbers to be present in the graft. The host to possess transplant isoantigens not present in the graft and its immune system should be incapable of mounting
%U http://www.hindawi.com/journals/isrn.hematology/2013/232519/