Transplant Outcome of Patients with Hematological Malignancies Using Bone Marrow Graft

Abstract

Objective: This analysis aimed to evaluate the outcome of bone marrow (BM) in terms of survival rates, GVHD relapse-free survival (GRFS), and disease-free survival (DFS) in patients who underwent Allo-HSCT for a diverse group of hematological malignancies by comparing various parameters.

Methodology: This cross-sectional study analyzed 118 patients who underwent Allo-HSCT from July 2022 to June 2023 at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. Patients received peripheral blood stem cells (PBSC) or with incomplete data were excluded.

Results: The mean age of the study was 25.5 years, with predominant males (71.2%). Acute lymphoblastic leukemia (ALL) was the most prevalent (34%), followed by acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), each accounting for 29%. In 90.7% of cases, fully matched transplants were performed, and myeloablative conditioning (MAC) was employed in 92.4% of cases. The median engraftment time for neutrophils and platelets was 13 and 22.9 days, respectively. Post-transplant complications included febrile neutropenia (90.7%), mucositis (69.5%), and cytomegalovirus (CMV) reactivation (53.4%). Out of 118 cohorts, 26.3% developed acute GVHD (Grade II-IV), and 34.7% had chronic GVHD (cGVHD) with mild severity in the majority of cases. The overall survival (OS) rate was 54.2%, with a median survival of 2,370 days. Disease-free survival (DFS) and GVHD relapse-free survival (GRFS) were 33% and 41.5%, respectively.

Conclusion: This study indicated that BM as a stem cell source has lower GVHD rates and improved OS compared to PBSC; however, relapse and post-transplant complications remain significant challenges, particularly in high-risk patients. The results highlight the efficacy of BM in reducing GVHD and improving survival in a developing country setting, emphasizing the need for individualized treatment approaches and enhanced post-transplant care.