Clinical Features and Treatment Outcomes of Hematopoietic Stem Cell Transplantation During 2006-2016 at a Single Institution in Miyazaki Prefecture

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Background: The elucidation of clinical characteristics in deceased patients is essential to improve outcomes of hematopoietic stem cell transplantation (HSCT) for refractory/relapsed hematological malignancy. Patients and Methods: We retrospectively examined 81 refractory/relapsed hematological malignancy patients treated with allogeneic HSCT (allo-HSCT) (54) and autologous HSCT (auto-HSCT) (27) in our hospital from 2006 to 2016. Results: Consistent with previous Japan Marrow Donor Program annual reports, the overall survival (OS) rate of allo-HSCT and auto-HSCT patients were 59% and 84% at five years, respectively. Among patients receiving allo-HSCT, severe regimen-related toxicity (RRT) (grade≥3) events included cardiomyopathy due to cyclophosphamide (1), idiopathic pulmonary syndrome (1), acute graft-versus-host disease (GVHD) Ⅲ-Ⅳ (3), acute-exacerbated chronic GVHD (2), engraftment failure (2), human herpesvirus-6 encephalitis (2), and fungal infection (7). Moreover, univariate analysis identified disease risk index (DRI) and non-CR status before allo-HSCT as prognostic factors of OS. Among patients receiving auto-HSCT, the severe RRT event was thrombotic microangiopathy (1). The relapse after auto-HSCT in three patients with malignant lymphoma was a serious concern. Conclusion: Our study revealed critical issues in non-CR patients and those with high/very high DRI before allo-HSCT. Furthermore, the occurrence of severe RRT indicated the need for improvements in allo- and auto-HSCT.