Comparative Study between Cyclosporine Dynamics and Other Immunosuppressants in Patients Post Allogenic Stem Cell Transplantation

Abstract

Abstract Background Bone marrow transplant has been successfully to treat diseases such as leukemia, lymphomas, aplastic anemia, immune deficiency disorders, and some solid tumor cancers. There is two types of bone marrow transplantation, one of two types of transplant may be carried out either an autograft, using the patient’s own bone marrow cells or an allograft (or allogeneic transplant), which allows the replacement of the diseased bone marrow with an healthy bone marrow taken from a compatible donor (related or unrelated) and to use the immune system of the healthy donor to fight the recipient’s illness. Aim of the Work To assess impact of cyclosporine introduction post-transplant on different organs and other immune suppressant as regards side effects and prophylactic efficacy against GVHD and good outcome of the transplantation. Patients and Methods The study enrolled two groups, 128 post-transplant patient their ages between 16 and 65, group 1 include 106 patients was taking cyclosporine for prophylaxis of GVHD, group 2 include 22 patients was taking other immunosuppressants mainly Tacrolimus and MMF. Results Incidence of GVHD occurrence was lower in group of cyclosporine as 30.2 % of them has no GVHD with statistically significant difference with P-value 0.007 and was lower in combined occurrence of acute and chronic GVHD,22.6 % in group 1 and 54.5 % of group 2 with P-value 0.006 Incidence of mild anemia was lower in group 1 with statistically significant difference with P-value 0.022 Hyponatremia was higher in group 1 (60.4 %) with statistically significant difference with P-value 0.026 AST levels elevated one fold higher in group 1 with statistically significant difference with P-value 0.009 and elevated three fold higher in group 2 with statistically significant difference with P-value < 0.001 ALT levels elevated one fold higher in group 1 with statistically significant difference with P-value 0.039 21 patients were presented with impairment of renal functions,12.5% with mild impairment, 3.9 % with moderate impairment, all of them from group 1 with statistically significant difference with P-value 0.023, more commonly in females and in age group from 16 to 45 years old. Conclusion Hematopoietic stem cell transplantation (HSCT) is a particularly important treatment for hematologic malignant and nonmalignant diseases. Unfortunately, following allogeneic HSCT, graft-versus-host disease, immunosuppression and susceptibility to opportunistic infections remain among the most substantial problems restricting the efficacy and use of this procedure. Cyclosporine remains the most effective prophylaxis post HSCT for prevention of GVHD, more multi centric studies are needed on wide scale to prove more relevant results that will be significant.