만성골수성백혈병에서의 동종골수이식 : 국내 경험의 후향적 분석

Abstract

Background and Methods : Clinical features of allogeneic bone marrow transplantation (BMT) performed for patients with chronic myelocytic leukemia (CML) in Korea were analyzed retrospectively. Nine hospitals reported a total of 137 cases of allogeneic BMT performed between September, 1986 and June, 1997. Results : There were 85 male (62%) and 52 female patients with median age of 30 years (range 15-50). Ninety five patients (71%) were in chronic phase and 38 patients (28 %) were in accelerated/blastic phase of the disease. Seventy patients (51%) received busulfan-cyclophosphamide (BuCy) regimen for preparation and 42 patients (31%) received cyclophosphamide-total body irradiation (Cy-TBI) regimen. The median mononuclear cell dose given to patients was 1.2×108/kg (range, 0.06-9.5 × 108/kg). All but one patient achieved absolute neutrophil count of 500/ μ1 after median 17 days after BMT (range, 8-100 days). Acute and chronic graft-versus-host disease (GVHD) were reported in 61/133 (46%) and in 57/134 (43%) patients, respectively. The median follow-up time of survivors was 20 months (range, 3-135 months). There were 52 deaths (38%). The causes of death were infection (14 patients, 27%), recurrent/persistent disease (12 patients, 23%), GVHD (11 patients, 21%), regimen related toxicity (8 patients, 15%), graft rejection/failure (4 patients,8%), and unknown (3 patients,6%). The factors influencing event free survival of the patients were disease status before BMT (p<0.001, by log-rank test) and serum hepatitis B surface antigen status (p=0.012). Longer duration of disease before BMT showed poorer outcome but the difference did not reach statistical significance. The factors affecting overall survival of the patients were disease status before BMT (p=0.009) and hepatitis B surface antigen status (p=0.036). The donor hepatitis B antigen status did not influence event free survival or overall survival of the patients. Conclusion : Clinical features and survival patterns of patients with CML treated with allogeneic BMT in Korea were similar to historical data from other countries. Further data analyses are warranted for the role of hepatitis B virus infection influencing the outcome of allogeneic BMT for CML.