Full Text:
영남의대학술지 Vol.24_No.2 Suppl. P.S569-579, Dec. 2007
Original Article
조혈모세포이식 후 치료관련사망의 원인
Etiology of Treatment Related Mortality after Hematopoietic Stem Cell Transplantation
이용직, 하정옥
영남대학교 의과대학 소아과학교실
책임저자：하정옥, 대구광역시 남구 대명 5동 317-1, 영남대학병원 소아과학교실
Tel: (053) 620-3530, Fax: (053) 629-2252
E-mail: johah@med.yu.ac.kr
December 30, 2007
Abstract
Bactground：The etiologies of treatment related mortality (TRM) after hematopoietic stem cell transplantation (HSCT) have been variable according to the disease status or the centers. We evlauated the etiologies of TRM for the pediatric patients at Yeungnam University Hospital (YNUH). Materials and Methods：The records of 66 patients, 19 years of age or younger, who had HSCT at YNUH from September 1995 to August 2007 were reviewed. Results：Among 66 patients, allogeneic bone marrow transplantation (Allo-BMT) was done in 21 (19 related, 2 unrelated), allogeneic peripheral blood stem cell transplantation (Allo- PBSCT) in 1, cord blood transplantation (CBT) in 12 (1 related, 11 unrelated), autologous peripheral blood stem cell transplantation (Auto-PBSCT) in 32 patients. The TRM rates of Allo-BMT, CBT, and Auto-PBSCT were 19%, 33.3%, and 12.5%, respectively. Among four patients who had TRM after Allo-BMT, two were related transplantation and the others were unrelated. All four patients developed severe acute GVHD of at least grade Ⅲ. Sepsis developed in three patients, acute renal failure (ARF) in two, veno-occlusive disease (VOD) and thrombotic microangiopathy (TMA) in one patient each. All four patients who had TRM after CBT had two mismatches in HLA-A, B, DR, and engraftment syndrome developed in three. Sepsis developed in all four patients, VOD in two, encephalopathy in two, TMA and ARF in one patient each. All four patients who had TRM after Auto-PBSCT developed sepsis and ARF in two, VOD and TMA in one patient each. Conclusion：Although the number of cases were not large enough for firm conclusion, sepsis was the most common TRM after HSCT. Therefore, prevention and control of sepsis are very important in reducing TRM after HSCT. Outcomes of severe acute GVHD after Allo-BMT and engraftment syndrome after CBT are very poor and contribute for TRM. Continuous effort to reduce the incidence of GVHD and engraftment syndrome are needed.
Key Words: Hematopoietic stem cell transplantation, Treatment related mortality, Etiology
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