D+21 for Low at D+21 ( em p /em =0
D+21 for Low at D+21 ( em p /em =0.001); and D+17 for High at D+30 vs. Rabbit Polyclonal to BATF Korea. The patients were grouped based on complete lymphocyte counts (ALC) 500/L or 500/L at D+21 and D+30 after transplant. Results Patients with a High ALC at D+21 and D+30 experienced a faster neutrophil and platelet engraftment. The High at D+30 group experienced a better 5 year overall survival (71% vs. 53%, values less than 0.05 were considered statistically significant. The Cox proportional hazards model was used to examine the impact of multiple prognostic factors on survival. Factors with a value less than 0.1 by univariate analysis were subsequently evaluated by multivariate analysis. All statistical analyses were performed using SPSS version 17.0 for Windows (IBM, Chicago, IL, USA). Ethics statement This study was approved by the Institutional Review Table of Chonnam National University Hwasun Hospital (approved number 2011-37). Informed consent was acquired from all subjects. RESULTS Patient characteristics Sixty-nine children with leukemia who received HSCT were recognized for this study. The patients included 41 males and 28 females with a median age of 7.1 years (range, 0.4-18.2) at transplant. The patient characteristics are shown in Table 1 and ?and2.2. The majority of patients (50/69, 72%) experienced a standard risk at the time of the transplant. The proportion of patients tCFA15 in CR1 was 59% (22/34) for all those and 73% (19/26) for AML. The median follow-up was 26 months (range, 1-134). The patients were grouped based on ALC 500/L or 500/L at D+21 and +30 after the transplant: Low at D+21 (n=28) vs. High at D+21 (n=41); Low at D+30 (n=19) vs. High at D+30 (n=49). Patient characteristics at both D+21 and D+30 were not significantly different between the two groups in regard to age at transplant, gender, remission status, conditioning regimen, stem cell sources and GVHD prophylaxis. Engraftment The numbers of infused stem cells, by the tCFA15 same stem cell sources, were not statistically different between tCFA15 the two groups (Table 3). There was no engraftment failure. The median time to neutrophil and platelet engraftment for all those patients was 17.5 days (range, 11-40) and 25 days (range, 7-74), respectively. Patients with a High ALC at D+21 and D+30 experienced faster neutrophil and platelet engraftment: the median days to neutrophil engraftment ( 1000/L) was D+16 for High at D+21 vs. D+21 for Low at D+21 ( em p /em =0.001); and D+17 for High at D+30 vs. D+20 for Low at D+30 ( tCFA15 em p /em =0.02). The median time for platelet engraftment ( 20000/L) was D+19 for High at D+21 vs. D+38 for Low at D+21 ( em p /em =0.04); and D+22 for High at D+30 vs. D+40 for Low at D+30 ( em p /em =0.07) (Table 3). Table 3 Infused Stem Cell Number and Engraftment Kinetics Based on the ALC Open in a separate windows ALC, complete lymphocyte count; ANC, complete neutrophil count; BM, bone marrow; MNC, mononuclear cells; med, median; PBSC, peripheral blood stem cells; PLT, platelets; UCB, umbilical cord blood. GVHD and TRM The frequency of aGVHD, cGVHD and hepatic VOD did not differ between the two groups. Twelve out of 69 (17%) patients died of non-relapse causes, with a cumulative incidence of TRM of 18.5%. The causes of death were as follows: aGVHD, 4; cGVHD, 3; acute respiratory distress syndrome, 3; invasive pulmonary aspergillosis, 1; bleeding, 1. The Low at D+30 group experienced a significantly increased risk for TRM compared to the High tCFA15 at D+30 group (34% vs. 11%, em p /em =0.019) (Table 4). Table 4 Post-Transplant Complications and Survival Based on the ALC at D+21 and D+30 Open in a separate windows ALC, absolute lymphocyte count; GVHD, graft-versus-host disease; EFS, event-free survival; MSD, matched sibling donor; OS, overall survival; TRM, transplant-related mortality; UD, unrelated donor; VOD, veno-occlusive disease. Relapse and survival Thirteen patients relapsed with a cumulative incidence of 21.3%. The median time to relapse was 5.4 months (range, 2.2-12.4)..