ABSTRACT
Hematopoietic stem cell transplantation [HSCT] has been accessible to the population residing in Lebanon and surrounding countries since 1997. HSCT programs were developed in two major hospitals in Beirut: American University of Beirut Medical Center [AUBMC] and Makassed General Hospital. Mount Lebanon Hospital initiated an autologous HSCT activity later. Between 2012 and 2016, the HSCT activity in Lebanon reached a total of 897 transplants, among which 303 [33.8%] were allogeneic HSCT and 594 [66.2%] were autologous HSCT. Overall, autologous HSCT activity has remained stable over the past 5 years, whereas allogeneic HSCT activity has seen a steep increase between 2012 and 2013 followed by a modest increase later. Haploidentical transplantation has mushroomed and represented almost half of allogeneic HSCT activity in 2016. AUBMC and Makassed General Hospital are members of the European Blood and Marrow Transplantation [EBMT] and East Mediterranean Blood and Marrow Transplantation groups, and AUBMC has been accredited by JACIE [Joint Accreditation Committee - ISCT and EBMT] since 2016. The past 5 years have seen an increase in HSCT-related research and publications, mainly from AUBMC. These research activities were predominantly focused on personalized conditioning for allogeneic HSCT and post-transplant maintenance therapy
ABSTRACT
High-dose chemotherapy followed by autologous hematopoietic cell transplantation continues to play an integral role in the treatment strategy in patients with newly diagnosed multiple myeloma. Incorporation of newer potent anti-myeloma agents has further improved outcomes. However, disease relapse or proggression remains a challenge after autologous transplantation. Allogeneic hematopoietic cell transplantattion remains the only potentially curative modality for some patients due in part to graft-versus-myeloma effect. High transplant-related mortality, in the range of 30% to 40%, previously seen with myeloablative conditioning regimens including total body irradiation plus cyclophosphamide has been significantly reduced by introducing less ablative preparative regimens, so called reduced-intensity conditioning. Cumulative evidence suggests encouraging prospects for allogeneic transplantation through improved outcomes of myeloma patients [overall survival exceeding 70% at 2 years in some studies]; however, which patient population would benefit most from this treatment remains to be defined. Newer strategies to augment graft-versus-myeloma effect and minimize post transplant toxicities are in need of further improvement in patients with myeloma
Subject(s)
Humans , Multiple Myeloma/therapy , Transplantation Conditioning , Transplantation, Homologous , Disease-Free Survival , RecurrenceABSTRACT
The most important studies about outcome of acute leukemia come from developed countries, whereas most of the patients with this disease are in developing countries. We report predictive and prognostic factors in patients with acute lymphoblastic leukemia [ALL] in a tertiary care center in a developing country. We retrospectively reviewed the records of adult patients with acute leukemia who were referred to the American University of Beirut Medical Center between 1996 and early 2006. Of 105 patients, 36 [34%] patients were diagnosed with ALL, and included 19 [53%] males and 17 [47%] females with a median age of 34 years [range, 14-79 years]. Induction chemotherapy with curative intent was administered to 34 [94%] patients. Twenty-seven patients received intrathecal chemotherapy as prophylaxis [n=24] or as treatment for CNS disease [n=3]. Twenty-eight patients [82%] achieved complete remission [CR] after induction chemotherapy. The median overall survival [OS] time was 22 months and the five-year OS for ALL patients was 38%. The median disease-free survival [DFS] time was 12 months, while the five-year DFS was 38%. Multivariate analysis showed that age <40 years, WBC <30x10[9]/L, achievement of CR after first induction, and CNS prophylaxis were predictive factors for OS and DFS. Despite limitations and the relatively low socioeconomic status of the Lebanese population, OS [38%] and DFS [38%] are quite similar to international data. Trends toward a higher CR and DFS in adults are due to intensified consolidation chemotherapy, the use of stem cell transplantation, and improvements in supportive care