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KMID : 0869620080250020133
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Journal of Korean Society of Hospital Pharmacists
2008 Volume.25 No. 2 p.133 ~ p.141
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The impact of cyclosporine on graft-versus-host disease and relapse rate after allogenic hematopoietic stem cell transplantation in children with leukemia
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Kang Rae-Young
Son In-Ja
Oh Jung-Mi
Park Kyoung-Ho
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Abstract
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Graft-versus-host disease(GVHD) is correlated with high mortality and morbidity after transplantation. However, GVHD could lower relapse rate through a graft-versus-tumor effect and improve survival. Recent large retrospective studies evaluate that the patient with acute or chronic GVHD is associated with decresed relapse rate. Also, a prospective trial in pediatric patients suggest that low dose of cyclosporine(CsA) is associated with statistically significant reduction in leukemic relapse. Therefore, the purpose of this study was to assess the influence of blood CsA concentration on GVHD and leukemic relapse. From september 1999 to october 2004, we studied 35 pediatric patients(40 transplantation cases) with leukemia who had received an allogenic hematopoietic stem cell transplantation in Pediatric Hemato-Oncology of Seoul National University Children Hospital. We retrospectively analyzed the age of transplantation, body surface area, sex, interval from diagnosis to transplantation, white blood cell(WBC) count at diagnosis, remission status, stem cell source, donor, compatibility of sex and blood type, conditioning regimen, GVHD prophylactic regimen, blood CsA concentration, GVHD incidence, relapse rate, graft failure, and mortality were analyzed. Also, a subgroup analysis was performed in 17 children who had more than three blood CsA concentrations which were sampled at the period of intravenous administration. There was no significant difference in patient related and transplant related characteristics, mean blood CsA concentration and relapse rate between the group with GVHD and non-GVHD. On subgroup analysis, there was no significant difference in patient related characteristics, the incidence of GVHD, relapse rate and mortality between the group of over the mean concentration and under the mean concentration at the period of intravenous administration. The blood CsA concentration was not a significant factor in the incidence of GVHD and leukemic relapse rate. However, the incidence of GVHD was too low to analyze exactly. Therefore, a prospective controlled study is needed for the enough patient number.
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KEYWORD
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children, leukemia, allogenic hematopoietic stem cell transplantation, cyclosporine, GVHD, relapse
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