Search

Background: Mesenchymal stromal cells (MSCs) have emerged as a promising candidate for the treatment of steroid-refractory graft-versus-host disease (GVHD). Methods: In this uncontrolled, pilot clinical study, we report safety and efficacy of allogeneic bone marrow MSCs administered intravenously to steroid-refractory GVHD patients. Results: A total of 33 MSC infusions were given to 10 patients suffering from acute GVHD (n= 3), chronic GVHD (n= 5), and overlap syndrome (n= 2). Eight out of ten patients are alive after a median follow-up of 11 months with five having sustained complete remission (CR). Three patients with partial response received further doses to sustain the response. One of them died of lung infection while others are still alive. One out of the two non-responding patients died after 17 days of MSC therapy due to advanced liver GVHD while the other is having a stable disease course. The overall and GVHD-free survival was 80% and 50%, respectively. The patients developed no complication or toxicity related to MSC infusion. Luminex analysis revealed a modest drop after MSC infusion in pro-inflammatory cytokines like TNFα, IL-1β, and IL-6 whereas serum IL-10 levels were slightly raised. Conclusion: Allogeneic donor-derived bone marrow mesenchymal stromal cell therapy is a safe and feasible treatment for steroid-refractory GVHD patients (NCT02824653). Lay Summary: We report the safety and efficacy of allogeneic bone marrow mesenchymal stromal cell therapy in 10 patients suffering from steroid-resistant graft-versus-host disease. Eight out of ten patients are alive after a median follow-up of 11 months with five having sustained CR. The response rate was better in acute GVHD patients compared to chronic GVHD patients. MSC therapy within 20 days of steroid-refractory acute GVHD resulted in sustained CR. Initial and sustained response was superior in pediatric patients compared to adults. The Luminex analysis showed a modest decrease in pro-inflammatory cytokines in those responding to MSC therapy.

Management of rare hematological disorders pose unique diagnostic and therapeutic challenges due to unusual occurrence and limited treatment options. We retrospectively identified 45 patients receiving matched related donor transplant for rare hematological disorders from 2006 to 2019. Patients were divided into two groups (1) malignant and (2) non malignant. The malignant disorder group included four patients while the nonmalignant group included 41 patients divided into immune dysregulation (n= 23), bone marrow failure (n= 10), metabolic (n= 5), and bleeding diathesis (n= 3). Twenty-six (57.8%) patients received myeloablative conditioning (MAC) and 16 (35.6%) received reduced intensity conditioning (RIC), while 3 (6.6%) patients with severe combined immunodeficiency received stem cell infusion alone without conditioning. The cumulative incidence (CI) of grade II–IV acute GVHD (aGVHD) was 39.1% (n= 18) and chronic GVHD (cGVHD) 15.2% (n= 7). There was no primary graft failure while CI of secondary graft failure was 9%. Overall survival (OS) and disease-free survival (DFS) was 82.2% and 77.8% respectively. Group wise OS was 75% in the malignant group, 82.6% in the immune dysregulation group, 80% in patients with metabolic disorders and bone marrow failure, while 100% in patients with bleeding diathesis. This retrospective analysis shows that hematopoietic stem cell transplant can be a feasible treatment option for rare hematological disorders.

Hematopoietic Stem Cell Transplantation (HSCT) is the only potentially curative treatment option for the hematologic complications that occur in patients with Fanconi anemia (FA). In this study, we present a retrospective multicenter analysis from the Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT) of matched related donor HSCT for FA in adolescents and adults transplanted between 1988 and 2015. Forty-five patients received HSCT with a median age at transplant of 18 years, the interquartile range (IQR) (15–23.5); 25 (55.6%) patients were females and 20 (44.4%) were males. Conditioning regimen was fludarabine-based in 29 (64.4%) patients, irradiation-based in five (11.1%) patients, and the remaining patients received other combinations. Indication for HSCT was bone marrow failure in 39 (86.7%) and myelodysplastic syndrome in six (13.3%) patients. Stem cell source was bone marrow in 22 (48.9%), peripheral blood in 20 (44.4%), umbilical cord blood in one (2.2%), and combination of bone marrow and cord blood in two (4.4%) patients. Twenty-seven (60%) patients engrafted and five (11.1%) had primary engraftment failure. The median time to neutrophil engraftment was 14 days (range 10–21 days); median time for platelet engraftment was 17 days (10–33 days). The probability of developing grade II–IV acute GVHD for all patients was 7.0% and chronic GVHD 36.6%. No new malignancies were reported. The OS probability was 53.6% (95% CI, 38.3–68.9%) with a median follow-up of 13 months (95% CI, 1–240). Our HLA-matched related HSCT results in AYA patients with FA compare favorably with other reported international registry data.

In this study, the prevalence and antimicrobial resistance of enterotoxigenic Escherichia coli(ETEC) and enteropathogenic Escherichia coli(EPEC) were investigated. Altogether 100 stool samples were collected from diarrheal patients attending the Sheikh Hasina Medical College and Hospital, Tangail, Bangladesh, during the period from March 1 to May 30, 2018. In vivopathogenic potential of ETEC and EPEC using a Caenorhabditis elegansinfection model was investigated. Among 100 diarrheal patients, 31% were positive for both ETEC and EPEC strains, 23% were ltpositive for ETEC strains, and 8% were bfpApositive for EPEC strains. It was detected that 82.60%, 65.21%, 73.91%, 78.26%, 47.82%, 60.86%, and 47.82% of ETEC strains were resistant to amoxicillin–clavulanic acid (AMC), tetracycline (TE), nalidixic acid (NA), azithromycin, ciprofloxacin, ampicillin (AMP), and erythromycin (E), respectively. Whereas it was detected that 87.5% strains were resistant to AMC, AMP, and E, 75% were resistant to TE and NA, respectively. Both strains developed multidrug resistance to commonly prescribed antibiotics. EPEC showed higher pathogenicity than ETEC as 67.75% and 60% of C. elegansdied after 18 h postinfection with EPEC and ETEC, respectively. The high rate of antimicrobial resistance of EPEC and ETEC highlights the necessity for the prudent use of antimicrobials in Bangladesh.

Hematopoietic Stem Cell Transplantation (HSCT) activity was evaluated in the African (AFR)/EMRO region and compared to the global activity for the years 2006–2013. Data were obtained from 1570 teams in the 6 WHO continental regions. Of these, 29 (1.85%) of all teams were active in 12 of the 68 AFR/EMRO countries. They reported 2.331 (3.3%) of the worldwide 71.036 HSCT, and a transplant rate of 32.8 (TR; HSCT/10 million inhabitants; worldwide 128.5). This reflects still the lowest regional TR despite an increase of 90% since 2006. HSCT activity in AFR/EMRO countries was characterized by a higher use of allogeneic compared to autologous HSCT, an almost exclusive use of family donors, including haploidentical family donors. These findings contrast with the prevalence of autologous over allogeneic HSCT, and a higher frequency of unrelated HSCT in other parts of the world. Of note, the increase by 200% in HSCT for hemoglobinopathies from 2006 to 2013 (72 per year) in the AFR/EMRO region. This reflects the specific role of HSCT for these disease categories with high prevalence and incidence in the AFR/EMRO region. This report provides information for the competent authorities to foster adequate infrastructure. It urges transplant organization to optimize their cooperation.

The Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group has accumulated over 31years of data and experience in hematopoietic stem cell transplantation (HSCT), particularly in hemoglobinopathies, severe aplastic anemia, inherited metabolic and immune disorders, in addition to a wide array of hematologic malignancies unique to this region. A regional update in current HSCT trends is highly warranted. We studied the trends of HSCT activities in World Health Organization-Eastern Mediterranean (EMRO) region, surveyed by the EMBMT, between 2011 and 2012.

This practice survey is conducted to analyze clinical hematopoietic stem cell transplantation (HSCT) practice variability among centers in the WHO Eastern Mediterranean Region (EMRO), as represented by the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group.

The Eastern mediterranean Bone marrow Transplantation (EMBMT) Group has accumulated over 25 years of data and experience in hematopoietic stem cell transplantation (HSCT), most particularly in hemoglobinopathies, severe aplastic anemia (SAA), and inherited metabolic and immune disorders, in addition to hematologic malignancies peculiar to the region and where recent updates in trends in activities are warranted.

Indications regarding surgical pulmonary embolectomy for treatment of submassive/massive acute pulmonary embolism remain controversial. An institutional experience with pulmonary embolectomy for acute pulmonary embolism (APE) was reviewed. A retrospective analysis of all patients undergoing pulmonary embolectomy for APE from September 2004 to January 2007 was conducted. Demographic data, clinical presentation and outcomes were analyzed. Fifteen patients underwent surgery for APE over a period of 27 months [average age 59.6 (range 35-89) years, (seven male, eight female)]. Six (40%) patients were admitted with known APE and nine patients exhibited post admission APE (seven - after surgical procedures, two - after cerebrovascular accident). Clinical presentation included dyspnea (86.67%), hemodynamic instability requiring continuous vasopressor support (40%), echocardiographic evidence of right ventricular dilatation (80%). Ten patients undergoing early/expedient embolectomy all survived while delayed surgery in the other five patients (>24 h) was associated with 60% mortality. Expanding indications for early surgical pulmonary embolectomy has stemmed from reliable echocardiographic identification of right ventricular compromise and recognition of these findings as harbingers of subsequent hemodynamic embarrassment. Our series underscores the benefit of early consideration and performance of pulmonary embolectomy in these critically ill patients.

No relevant conflicts of interest to declare.

Background:Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). It causes end-organ disease, multi-organ dysfunction syndrome, graft failure, increased susceptibility to infections and GVHD. According to the published western data greatest risk of CMV infection is the seropositivity of the recipient, however, in a high endemic population where seropositivity is up to 100%, risk factors for CMV reactivation are different and are analyzed in this study.

Introduction

No relevant conflicts of interest to declare.

Purpose: To provide evidence-based recommendations for health care professionals on diagnosis and management of diffuse large B cell lymphoma (DLBCL) in resource constraint settings with variable and often limited access to standard of care and advanced diagnostic and therapeutic facilities.

No relevant conflicts of interest to declare.

Abstract: The economics of eucalyptus in agroforestry and its effects on agricultural crops have been studied with the help of observations made during the harvests in agricultural fields and from the information supplied by progressive farmers. Three rotations of eucalyptus in agroforestry were selected for comparative study of its returns and relative loss to the crops, in order to ascertain the optimum rotation: i.e. the one giving the maximum internal rate of return with minimum loss to agricultural crops.

Presents letters to the editor in response to articles published in previous editions of "Newsweek" (International). Response to the article "The London Plot," on the London subway bombings, in the July 18, 2005 edition; Response to the article "Chirac, Europe's Weakest Link," in the May 23 edition; Others.

Presents letters to the editor in response to articles published in previous editions of "Newsweek" (International). Response to the article "The London Plot," on the London subway bombings, in the July 18, 2005 edition; Response to the article "Chirac, Europe's Weakest Link," in the May 23 edition; Others.

Introduction:Hematopoietic Cell Transplantation (HCT) activity in the EMRO/African (EMRO/AFR) region was compared to the global activity in relation to frequency, indication, trends, donor type and geographical distribution.

Objectives: Post transplant erythrocytosis (PTE) is a known complication of renal transplantation, however post allogeneic hematopoietic cell transplant (alloHCT) erythrocytosis was reported for the first time by us in 2011. This paper is a follow up on our initial report. Materials and Methods: Out of 253 alloHCT performed for aplastic anemia, 208 patients with 18 months post-HCT follow up were included in this analysis. PTE was defined as hemoglobin level ≥16g/dL and ≥17g/dL for females and males respectively. Patients with PTE were further investigated to rule out secondary causes. Results: Fourteen patients developed post-HCT erythrocytosis. All were male with median age of 21 years (range 16-28.5). Median disease duration prior to transplant was 7 months (range 1.5-16). Median time from HCT to development of erythrocytosis was 33 months (range 18-51). Maximum Hb level attained was 19.9 g/dL. Median erythropoietin level was 7.98mU/mL (range 2.6-13.65). None of these patients tested positive for JAK-2 V617F mutation. Four patients developed hepatitis post HCT, preceding PTE. Univariate analysis revealed significant association with male gender (OR 8.4; p=0.004), age >15 years at transplant (OR 4.2; p=0.04), pre-transplant high number of RCC (median 72 units vs 31 in non-PTE group; p<0.001) and platelets transfusions (median 249 events vs 66; p=0.001), ciclosporin-induced hypertension (OR 5.9; p=0.015) and viral hepatitis (OR 6.5; p=0.01). Except for number of platelet transfusions (p=0.015) none of the factors noted above had any significant correlation on multivariate analysis. Most patients required 2-3 phlebotomies per year. No thrombo-embolic event was observed.

Objective:To analyse factors associated with survival, rejection and graft versus host disease in aplastic anaemia patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) from related donors.

No relevant conflicts of interest to declare.

Objective: To compare rabbit antithymocyte globulin (ATG) containing conditioning regimen (group A) with horse antilymphocyte globulin (ALG)-based regimen (group B) for sibling allogeneic hematopoietic stem cell transplant (HSCT) outcome, disease free survival, rejection and complications in severe aplastic anemia patients.

No relevant conflicts of interest to declare.

Tyrosine kinase inhibitors (TKIs) have largely replaced allogeneic hematopoietic stem cell transplantation (HSCT) as first line treatment option in chronic phase chronic myeloid leukemia (CML) yet due to the need for continued administration the cost becomes prohibitive in majority of patients without any health insurance coverage. Therefore allogeneic stem cell transplant remains a reasonable treatment option for such patients especially in resource constrained countries. It is also useful treatment modality in children, CML in accelerated phase and in patients intolerant to TKIs. We report results of 64 consecutive patients undergoing HLA matched sibling allo HSCT at our center from April 2002 to September 2012.

Tyrosine kinase inhibitors (TKIs) have largely replaced allogeneic hematopoietic stem cell transplantation (HSCT) as first line treatment option in chronic phase chronic myeloid leukemia (CML) yet due to the need for continued administration the cost becomes prohibitive in majority of patients without any health insurance coverage. Therefore allogeneic stem cell transplant remains a reasonable treatment option for such patients especially in resource constrained countries. It is also useful treatment modality in children, CML in accelerated phase and in patients intolerant to TKIs. We report results of 64 consecutive patients undergoing HLA matched sibling allo HSCT at our center from April 2002 to September 2012.Patients with Philadelphia positive CML were categorized into standard and high risk based on age >40 years, disease duration > 12 month from diagnosis to transplant and accelerated phase. Conditioning regimens used were oral busulphan 16 mg/kg plus cyclophosphamide 200 mg/kg (Bu16/Cy200), Bu16/Cy120, Bu16/Cy120/Etoposide30 and Bu16/Cy120/ATG. Source of stem cell was peripheral blood stem cells (PBSC) or bone marrow (BM) infusion. GVHD prophylaxis consisted of ciclosporin, short methotrexate (10 mg/m2 on day +1, 8 mg/m2 on day +3 & 6) ± prednisolone. Statistical calculations included Fisher’s exact test, Kaplan-Meier for survival analysis, and Cox regression for multivariate analysis.Median age of the patients was 28 years (range 7 – 54). Female donor to male recipient was seen in 12 cases while 20 patients had major blood group mismatch. Forty seven patients were standard risk while 17 were categorized as high risk. Bu16/Cy120 was the most common conditioning regimen given in 34 cases followed by Bu16/Cy200 in 19 cases. Fifty four patients received PBSC while BM was given in 8 cases. Grade I/II acute GVHD was seen in one-third of the cases while 7 (11%) had grade III/IV GVHD. Extensive chronic GVHD was seen in 10 (16%) cases while 12 (19%) patients had limited chronic GVHD. Complications observed were hemorrhagic cystitis (7), VOD (4), CMV infection (2) and septicemia (3). Five (8%) patients had disease relapse. The overall survival was 70.3% (median 1627 days) while disease free survival was 62.5% (median 1547 days). Nineteen patients died of various complications like extensive GVHD (n=5), septicemia (n=3), VOD (n=3), CMV infection (n=3) and disseminated aspergillosis (n==2).A significant difference was observed among patients bearing standard risk compared with those in high risk group in terms of overall survival (79% versus 47% , p=0.013), disease free survival (72% versus 35%, p=0.031) and incidence of acute GVHD (34% versus 71%, p=0.01) in univariate analysis. Age >40 year was the only factor associated with adverse outcome in multivariate Cox-regression model.Early allogeneic HSCT in CML patients <40 years of age is associated with long term disease free survival in about 70% of cases. It is a reasonable treatment option in situations where TKIs cannot be employed as first line therapy due to various reasons.No relevant conflicts of interest to declare.

Over last five years 154 patients received HLA matched sibiling transplants at Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. Indications for transplant included Aplastic anemia, B-Thalassaemia major, Chronic Myeloid leukemia, Acute leukemias, and miscellaneous disorders which included Myelodysplastic syndrome, Fanconi’s anemia, Non-Hodgkin lymphoma, and Gaucher’s disease. All patients received standard conditioning regimens and GvHD prophylaxis. Pre-transplant infection surveillance was carried out in all patients and strict prophylaxis against infection was observed as per our transplant policy. During post transplant follow up we encountered certain infective and non infective complications. These included: acute GvHD (grade II–IV) 28.5%, chronic GvHD 15.5%, haemorrhagic cystitis 9.7%, VOD liver 5.1%, acute renal failure 3.2%, bacterial infections 51.2%, fungal infections 15.0%, CMV infection 4%, herpes zoster 4%, tuberculosis 2.6%, pneumocytitis jiroveci infection 0.6%, malaria 0.6% patient, graft rejection 5.2% patients and relapse in 4%patients. We encountered certain rare unexpected post transplant complications which have been rarely reported in literature before. These included Hickman catheter embolization, Guillain Barre syndrome, co-infection with pneumocystis jirovicii and a rare fungus trichosporon beigilii, cyclosporine induced uncontrolled seizures, idiopathic polycythemia, haemorrhagic pericardial effusion with cardiac temponade, deep vein thrombosis, dengue fever and measles. These complications were effectively managed in our centre. There was only one death associated with these complications. Mortality was observed in 27.2% patients. Mortality related to non-infective complications was 14.2%. Major non-infective causes of mortality were GvHD, VOD, disease relapse, intracranial haemorrhage and acute renal failure. Mortality related to infections was 13%. Fatal infections included CMV disease, disseminated aspergillosis, pseudomonas septicaemia and tuberculosis.

One hundred and fifty four patients received allogeneic stem cell transplant from HLA matched siblings for various haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan from July 2001 to Sep 2006. Indications for transplant included aplastic anaemia (n=66), b-thalassaemia major (n=40), CML (n=33), acute leukaemia (n=8) and misc disorders (n=7). One hundred and twenty patients were male and thirty four were female. Median age of patient cohort was 14 yrs (range 1 ¼ −54 yrs). Pre-transplant infection surveillance was carried out and strict prophylaxis against infection was observed. The mean mononuclear cell dose was 4.2 x 109/kg of recipient. Post transplant complications encountered in our patients were: acute GvHD (grade II-IV) 28.5%, chronic GvHD 15.5%, haemorrhagic cystitis 9.7%, VOD liver 5.1%, acute renal failure 3.2%, bacterial infections 51.2%, fungal infections 15.0%, CMV infection 4%, herpes zoster 4%, tuberculosis 2.6%, pneumocytitis jirovici infection 0.6%, malaria 0.6% patient, graft rejection 5.2% patients and relapse in 4%patients. Certain unexpected rare post transplant complications were also observed in our patients. These included hickman catheter embolization, GB syndrome, deep vein thrombosis, haemorrhagic pericarditis with clots leading to cardiac temponade, idiopathic polycythemia, dengue fever and status epilepticus. Mortality was observed in 27.2% patients. Major causes of mortality were GvHD, VOD, relapse, intracranial haemorrhage, acute renal failure, pseudomonas septicemia, tuberculosis, disseminated aspergillosis and CMV infection. At five years, the overall survival (OS) and disease free survival (DFS) was 72.5% & 70.7% respectively.

OBJECTIVES: This is a retrospective study in acute myeloid leukaemia (AML) patients carried out at Armed Forces Bone Marrow Transplant Centre Rawalpindi Pakistan between July 2001 and June 2006. Aim of the study was to evaluate outcome in AML patients treated with different remission induction and consolidation chemotherapy regimens in our population. METHODS: During 5 years period between July 2001 to June 2006, 46 patients received treatment for AML at our centre. Twenty nine patients were males and 17 were females. Median age of patients was 21 years (range: 7–56 years). These 46 patients were categorized into two groups on the basis of type of leukaemia and chemotherapy given. In group-I 40 patients (group Ia: 23 patients of M1–M6, less M3 group Ib: 17 patients of AML M3) received anthracycline and cytarabin based chemotherapy. In group- II, six patients (AML- M3) received all trans retinoic acid (ATRA) based chemotherapy. RESULTS: In group Ia, out of 23 patients, 14 patients (60.8%) achieved complete remission (CR) after remission induction chemotherapy,10 patients remained in CR after 3rd and 4th consolidation. Eleven patients died and five patients relapsed during treatment and follow up. In this group overall CR, relapse rate (RR) and mortality was 30.4% (7/23), 21.7% (5/23) & 48% (11/23) respectively. In group Ib out of 17 patients, 9 patients (53%) achieved CR after remission induction. Eleven patients died during treatment while one patient relapsed in this group. Overall CR, RR & mortality was 29.4% (5/17), 6% (1/17) & 55% (11/17) respectively. In group II all patients achieved CR (100%) after 1st course of chemotherapy. Two of these patients unfortunately died of uncontrolled sepsis during 1st consolidation, while remaining 4 patients 66.6% are on maintenance chemotherapy and are still in CR. CONCLUSION: Overall CR, RR and mortality in all groups was 35% (16/46), 13% (6/46) and 52% (24/46) respectively at a median follow-up of 36 ± 8 months. Survival in AML-M3 patients treated with ATRA based chemotherapy is significantly superior than anthracycline based chemotherapy (66.6% vs 29.4%). Infection and chemotherapy toxicity being major causes of mortality.

Allogeneic stem cell transplantation (SCT) from HLA matched sibling donor is the standard treatment option in younger patients with severe aplastic anaemia (SAA). In the current study outcome of 70 patients with SAA undergoing allogeneic SCT at our institution from July 2001 to June 2007 is presented. Median follow up time was 727 days (range 100–2187). Three patients received 2nd SCT due to graft failure or rejection so actual number of SCT in the patients was 73. Median age of the patients was 16 years (range 5–38), 55 males, and 15 females. Seventeen had major ABO mismatch while sex mismatch in the form of female donor to male patient was present in 23 cases, 7 had both major ABO and sex mismatch. Sixty four patients were CMV positive while 6 had CMV negative status. Conditioning regimens included; cyclophosphamide (Cy) 200 mg/kg with either antilymphocyte globulin (ALG) 45 mg/kg (n=33) or antithymocyte globulin (rabbit ATG) 11.25 mg/kg (n=26); Cy plus Campath 100 mg (n=6), fludarabine 150 mg/m2 plus Cy 300 mg/m2 and ATG (n=8). All patient undergoing 2nd transplant received conditioning with Cy, fludarabine and ATG. GVHD prophylaxis was given with cyclosporin (CSA) plus prednisolone (41) with or without short course of methotrexate (29). Patients received PBSC (10) or bone marrow (12) alone or both (48). Mean mononuclear and CD34+ cell doses were 5.59 x 108/Kg and 4.8 x 106/Kg respectively. Median time to neutrophil recovery was 11 days (range 7–24). Neutropenic fever was seen in 60% cases, with mean duration of fever being 8 days. In majority (66%) no focus of infection could be found. Various isolates included gram negative rods (n=6), staphylococcus (n=2) and fungi (n=5). Other post-transplant infections were tuberculosis (n=2), herpes zoster (n=2) and transfusion associated falciparum malaria (n=2). Post-BMT non-infectious complications included acute GVHD (24%), chronic GVHD (08%), hemorrhagic cystitis (14%), seizures (5%), and VOD (3%). Graft rejection and primary graft failure was seen in 3 and 2 cases respectively. Three of them received 2nd transplant and had successful recovery while the other 2 died of septicemia. Six patients died during peri-transplant period, 3 at day 100, and 8 beyond day 100. One patient died of unrelated cause at 2 years post-transplant. Main causes of death were septicemia (n=4), conditioning regimen toxicity (n=3), VOD (n=2), GVHD (n=2) and disseminated aspergillosis (n=2). The overall and disease free survival was 76%. In univariate analysis using Logrank and Wilcoxon test factors correlated with better survival were patient’s age <15 years, disease duration <6 months, previous transfusions <20 events, conditioning with fludarabine/Cy/ATG, and absence of chronic GVHD. SCT from HLA matched sibling donor is effective treatment modality in majority of the young patients with SAA.

One hundred and fifty four patients received allogeneic stem cell transplant from HLA matched siblings for various haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan from July 2001 to Sep 2006. Indications for transplant included aplastic anaemia (n=66), b-thalassaemia major (n=40), CML (n=33), acute leukaemia (n=8) and misc disorders (n=7). One hundred and twenty patients were male and thirty four were female. Median age of patient cohort was 14 yrs (range 1 ¼ −54 yrs). Pre-transplant infection surveillance was carried out and strict prophylaxis against infection was observed. The mean mononuclear cell dose was 4.2 x 109/kg of recipient. Post transplant complications encountered in our patients were: acute GvHD (grade II-IV) 28.5%, chronic GvHD 15.5%, haemorrhagic cystitis 9.7%, VOD liver 5.1%, acute renal failure 3.2%, bacterial infections 51.2%, fungal infections 15.0%, CMV infection 4%, herpes zoster 4%, tuberculosis 2.6%, pneumocytitis jirovici infection 0.6%, malaria 0.6% patient, graft rejection 5.2% patients and relapse in 4%patients. Certain unexpected rare post transplant complications were also observed in our patients. These included hickman catheter embolization, GB syndrome, deep vein thrombosis, haemorrhagic pericarditis with clots leading to cardiac temponade, idiopathic polycythemia, dengue fever and status epilepticus. Mortality was observed in 27.2% patients. Major causes of mortality were GvHD, VOD, relapse, intracranial haemorrhage, acute renal failure, pseudomonas septicemia, tuberculosis, disseminated aspergillosis and CMV infection. At five years, the overall survival (OS) and disease free survival (DFS) was 72.5% & 70.7% respectively.

Over last five years 154 patients received HLA matched sibiling transplants at Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. Indications for transplant included Aplastic anemia, B-Thalassaemia major, Chronic Myeloid leukemia, Acute leukemias, and miscellaneous disorders which included Myelodysplastic syndrome, Fanconi's anemia, Non-Hodgkin lymphoma, and Gaucher's disease. All patients received standard conditioning regimens and GvHD prophylaxis. Pre-transplant infection surveillance was carried out in all patients and strict prophylaxis against infection was observed as per our transplant policy. During post transplant follow up we encountered certain infective and non infective complications. These included: acute GvHD (grade II–IV) 28.5%, chronic GvHD 15.5%, haemorrhagic cystitis 9.7%, VOD liver 5.1%, acute renal failure 3.2%, bacterial infections 51.2%, fungal infections 15.0%, CMV infection 4%, herpes zoster 4%, tuberculosis 2.6%, pneumocytitis jiroveci infection 0.6%, malaria 0.6% patient, graft rejection 5.2% patients and relapse in 4%patients. We encountered certain rare unexpected post transplant complications which have been rarely reported in literature before. These included Hickman catheter embolization, Guillain Barre syndrome, co-infection with pneumocystis jirovicii and a rare fungus trichosporon beigilii, cyclosporine induced uncontrolled seizures, idiopathic polycythemia, haemorrhagic pericardial effusion with cardiac temponade, deep vein thrombosis, dengue fever and measles. These complications were effectively managed in our centre. There was only one death associated with these complications. Mortality was observed in 27.2% patients. Mortality related to non-infective complications was 14.2%. Major non-infective causes of mortality were GvHD, VOD, disease relapse, intracranial haemorrhage and acute renal failure. Mortality related to infections was 13%. Fatal infections included CMV disease, disseminated aspergillosis, pseudomonassepticaemia and tuberculosis.

OBJECTIVES: This is a retrospective study in acute myeloid leukaemia (AML) patients carried out at Armed Forces Bone Marrow Transplant Centre Rawalpindi Pakistan between July 2001 and June 2006. Aim of the study was to evaluate outcome in AML patients treated with different remission induction and consolidation chemotherapy regimens in our population.