Tham khảo tài liệu 'chapter 104. acute and chronic myeloid leukemia (part 14)', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Chapter 104. Acute and Chronic Myeloid Leukemia Part 14 The Patient Patients should have acceptable end-organ function be 70 years and have a healthy histocompatible donor. Furthermore survival after SCT in the accelerated and blastic phases of the disease is significantly diminished and is associated with high rates of relapse. Bone marrow transplantation BMT early in the chronic phase 1-2 years from diagnosis is superior to later BMT. In the imatinib era allogeneic transplantation should be used when possible for patients with accelerated blastic phases of the disease or those whose disease fails to respond or progresses on imatinib. The Donor Transplantation from a family donor who is either fully matched or mismatched at only one HLA locus should be considered for any patient with CML who is a candidate for an HLA-related sibling transplant. Syngeneic BMT in patients with chronic-phase CML results in 7-year disease-free survival in 55 of patients with a 30 relapse rate. BMT with an HLA-identical sibling in the chronic phase achieves 5-year disease-free survival in 40-70 of patients with a 25 relapse rate. BMT from an HLA-matched unrelated donor in chronic phase 1 year from diagnosis and 30 years of age results in 5-year disease-free survival similar to matched-sibling donor transplantation. For all other groups patients receiving BMT from unrelated donors have higher rates of graft failure and acute and chronic GVHD and prolonged convalescence after treatment compared to those who receive allogeneic transplants from related donors. Sex mismatch has an adverse effect on transplantation with worse outcome associated with a female donor and male recipient. This has been attributed to GVHD against the male histocompatibility Y antigen. Peripheral blood is now being studied as a source of hematopoietic progenitor cells it may offer rapid engraftment and less risk for the donor. With unrelated donors some studies demonstrated no difference in GVHD and improved .
