ABSTRACT
Even in the tyrosine kinase inhibitor era, allogeneic hematopoietic stem cell transplantation (HSCT) is regarded as standard care for adult Philadelphia (Ph) positive acute lymphoblastic leukemia (ALL). In this retrospective national study, we have reviewed the outcome after HSCT in Sweden for adult Ph-positive ALL between 2000 and 2009. In total, 51 patients with median age 42 (range 20-66) years underwent HSCT. Mainly allogeneic HSCT was performed (24 related donor, 24 unrelated donor and one cord blood), and only two patients were treated with an autologous HSCT. The 5-year OS was 51 (37-64) %. The probabilities of morphological relapse and non-relapse mortality (NRM) at 5 years were 36 (23-49) and 18 (9-29) %, respectively. For the allogeneic transplanted, the 5-year OS was for patients <40 years 70 (50-90) % and for patients ≥40 years 34 (16-52) %, p = 0.002. The 5-year probability of NRM was for patients <40 years 10 (2-28) % compared to 25 (11-42) % for patients ≥40 years (p = 0.04). Patients with chronic graft-versus-host disease (GVHD) had a 5-year morphological relapse probability of 20 (6-40) % compared to 59 (35-77) % for patients without chronic GVHD (p = 0.03). Age ≥40 years and the absence of chronic GVHD were confirmed as independent negative prognostic factors for relapse and non-relapse mortality in a multivariate analysis although the impact of chronic GVHD was significant only in the older age cohort.
Subject(s)
Hematopoietic Stem Cell Transplantation , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adult , Aged , Autografts , Benzamides/therapeutic use , Female , Fusion Proteins, bcr-abl/genetics , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Imatinib Mesylate , Male , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/epidemiology , Piperazines/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics , Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality , Protein Kinase Inhibitors/therapeutic use , Pyrimidines/therapeutic use , Survival Rate , Sweden , Transplantation, Homologous/adverse effects , Treatment Outcome , Young AdultABSTRACT
Trying to Define "Environmental Medicine", "Environmental hygiene" and "hygienic environmental protection", the relation between Public Health service and environmental medicine are discussed. The study demonstrates that the practice of environmental medicine, in this case illustrated by the work of a Public Health Office, can be classified on the one hand according to the tasks which a Public Health Office has to perform concerning environmental medicine, and on the other hand according to the methods and resources of its work. This classification exercises, consequently, an influence on the personal and technical equipment and on the organisation of a Public Health Office. Finally, an attempt is made to outline the practice of environmental medicine peculiar to a Public Health Office.
