RESUMEN
BACKGROUND: Hematopoietic stem cell transplants are an accepted treatment for several malignant and nonmalignant hematologic diseases. Recently, the peripheral blood, after mobilization of stem cells with growth factors, has become the source of choice for hematopoietic stem cells. We report on a series of patients who received peripheral blood stem cell transplants at the Instituto Nacional de Cancerologia (INCAN) in Mexico City. METHODS: Between May 1995 and December 1999, 33 patients received peripheral blood stem cell transplants to treat hematologic diseases. Sixty percent of our patients had chronic myelocytic leukemia (CML). All had a matched related donor. Patients were conditioned with one of five different conditioning regimens and subsequently received one of two different graft-vs.-host disease prophylaxis regimens. Stratified Wilcoxon rank-sum, chi square, and Mann-Whitney tests were used to analyze the results. RESULTS: In our series, median time to achieve a total neutrophil count of 0.5 x 10(9)/L was 14 days and to achieve a platelet count of 20 x 10(9)/L, 15 days. Acute graft-vs.-host disease occurred in seven patients. Chronic graft-vs.-host disease occurred in 69% of surviving patients. Survival for low-risk patients was 67% and for the high-risk group, 9%. CONCLUSIONS: Peripheral blood stem cells produce a faster hematopoietic recovery. The rate of acute graft-vs.-host disease is not increased using the peripheral blood as source of stem cells; however, chronic graft-vs.-host disease continues to be a significant problem. Donors tolerated the procurement procedure without complications.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Acondicionamiento Pretrasplante/métodos , Adolescente , Adulto , Niño , Contraindicaciones , Femenino , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/mortalidad , Enfermedad Injerto contra Huésped/terapia , Trasplante de Células Madre Hematopoyéticas/métodos , Trasplante de Células Madre Hematopoyéticas/mortalidad , Humanos , Masculino , México , Persona de Mediana Edad , Factores de Riesgo , Tasa de Supervivencia , Trasplante HomólogoRESUMEN
Chronic myelogenous leukemia (CML) is a clonal disorder that presents with a stable period followed by an accelarated phase. The most frequent chromosomal abnormality described is t(9;22). Alterations of chromosome 17, where p53 is located, have been described during transformation. We studied a 23-year-old male who presented with chronic myelogenous leukemia. The karyotype demonstrated 46,XY,t(9;22) (q34;qll) in 12 percent of mitoses and hyperdiploidy in 43 percent. Forty six months later the patient suffered a blast crisis characterized by absolute basophilia; the cytogenetic study demonstrated 48,XY,+8,t(9;22(q34;qll), +der(22)t(9;22)(q34;qll),+i(17)(q10) in 18 percent of the mitoses, 46,XY,t(9;22) (q34;qll) in 34 percent and hyperdiploidy in 23 percent. Since there was i(17)(q10) during this stage, a retrospective DNA study of the biopsy material before and after the transformacition was performed. In the chronic phase, p53 was present in normal amounts, during transformation there was loss of genetic material from the p53 region. The protein product of suppressor gene p53 normally works holding the proliferation of cells. When there is the formation of an isochromosome, genetic material is lost; thus, in this patient, p53 was delted upon the observation of i(17). Lastly, this case shows how DNA can be extracted from slides; this technique is novel and can be used for retrospective studies when parafin block or fresh tissue are not available