Adult hematopoietic stem cell transplantation in eastern Taiwan: Initial results at Tzu Chi Hospital from 2002 to 2005

Objective: Hematopoietic stem cell transplantation (HSCT) has proved to be an important curative therapy for various hematological disorders. Here we present the first report of adult HSCT at one institution in eastern Taiwan. Patients and Methods: Thirteen patients, 7 men and 6 women, underwent HSCT between July 2002 and March 2005. Their median age was 34 years (range: 22-51). Five patients had acute myeloid leukemia, 2 had acute lymphoblastic leukemia, 2 had chronic myeloid leukemia, 2 had severe aplastic anemia, one had non-Hodgkin's lymphoma and one had Hodgkin's disease. Eleven patients received HLA-identical allogeneic transplantations, including two unrelated donor transplantations. Two patients received autologous transplantations. The conditioning regimens were total body irradiation plus busulfan or busulfan plus cyclophophamide for allogeneic transplantation, and BEAM for autotransplantation. The prevention of graft versus host disease (GVHD) employed standard cyclosporine and methotrexate. Results: The median numbers of CD34 positive cells obtained were 1.9 ÷ 106/kg of patient body weight from bone marrow harvest and 6.5 × 10⁶/kg from peripheral blood stem cell collection. The overall engraftment rate was 100%. The median times to neutrophil and platelet engraftments were 11.4 and 11.2 days, respectively. The one-year event-free and one-year overall survivals were both 90%. Acute GVHD of grade II-IV was seen in 8 out of 11 patients (72.7%) of whom 2 had grade III-IV disease (18.2%). Chronic GVHD developed in 6 out of 10 evaluable patients (60%) with 3 in limited stages and 3 in extensive stages. Eleven patients were alive and free of disease at 124 to 1117 days, with a median survival of 649 days after transplantation. One patient who underwent unrelated transplantation died of CMV pneumonitis on day 67. One patient died of disease relapse on day 485. The median Karnofsky Performance Score of surviving patients was 90%. Conclusion: The study demonstrates that HSCT in our hospital has achieved promising results and patients can obtain long-term disease-free survival and good social function.