| Vol. 5, No. 1: January/February 2005 |
| Read the ASH Special Edition of Advances in Transplantation (PDF). |
Lower mortality in non-myeloablative transplants for patients over 50
Patients older than 50 who received non-myeloablative transplants had a significantly lower rate of non-relapse mortality than transplant recipients who received myeloablative conditioning, according to a study in Blood. This retrospective study examined the outcomes of 71 non-myeloablative transplants (fludarabine and I.V. busulfan conditioning) and 81 myeloablative transplants (cyclophosphamide and TBI conditioning). Non-myeloablative patients were more likely to have unrelated donors (58% vs. 36%), prior transplant (25% vs. 4%), and active disease at transplantation (85% vs. 59%). Despite the adverse characteristics, there was a trend for an improved two-year overall survival in the non-myeloablative group (39% vs. 29%; p=0.056). For non-myeloablative transplant recipients, main causes of non-relapse mortality were GVHD and infection. Pulmonary complications, in addition to GVHD and infections, were the main causes of death after myeloablative transplantation. There was no difference in two-year progression free survival (27% vs. 25%) and incidence of grades II-IV GVHD was similar (28% vs. 27%). Non-relapse mortality was significantly lower for non-myeloablative patients (32% vs. 50%, p=0.01), but there was a trend toward higher relapse (46% vs. 30%, p=0.052).
Alyea EP, et al. Blood 2005; 105(4): 1810-1814. (More) |
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Unrelated donor transplants comparable to related donor transplants in JMML
This prospective study of 100 children with juvenile myelomonocytic leukemia (JMML) revealed no significant difference in event-free survival (EFS) between related donor transplant recipients (N=48) and unrelated donor (N=52) transplant recipients when using a preparative regimen of busulfan, cyclophosphamide, and melphalan. Median follow-up was 40 months (range, 6 to 144). Five-year EFS was 55% for related donor transplants, which was not statistically different from the 49% EFS for unrelated donor transplants.
Locatelli F, et al. Blood 2005; 105(1): 410-419. (More) |
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Pulmonary complications in children after BMT
This single-center retrospective study examined the incidence of pulmonary complications (new or persistent pulmonary infiltrates on chest radiograph or chest CT scan, respiratory symptoms, hypoxemia, or hemoptysis) in 363 pediatric patients undergoing bone marrow transplantation from 1995-1999. The 90 patients (25%) who developed pulmonary complications had a significantly higher mortality (65%) than those without pulmonary complications (44%). The median post-transplantation survival for children with pulmonary complications was 258 days, compared with 1,572 days in patients without pulmonary complications. However, pathogen identification via fiber-optic bronchoscopy and bronchoalveolar lavage did not decrease mortality.
Eikenberry M, et al. Biol Blood Marrow Transplant 2005; 11(1): 56-64. (More) |
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Improved survival with reduced-intensity conditioning in children with primary immunodeficiency
A single-center study of 33 consecutive unrelated donor transplantations performed in children between 1998 and 2001 with primary immunodeficiency (6 SCID, 27 non-SCID) using a T cell replete reduced-intensity conditioning (RIC) regimen (fludarabine, melphalan, and alemtuzumab or ATG). Outcomes were compared with a control group of 19 patients (7 SCID, 12 non-SCID) who underwent myeloablative transplantation (busulfan, cyclophosphamide, and T cell depletion). All children in both groups had primary engraftment and there was no statistical difference in the speed of immune reconstitution or incidence of GVHD in the two groups. Overall survival was significantly better in the RIC group: 31 of 33 (94%) patients survived, compared with 10 of 19 (53%) in the myeloablative group. The researchers conclude that the RIC regimen improves survival and reduces transplantation-related mortality compared with myeloablative conditioning in high-risk patients undergoing unrelated donor transplantation.
Rao K, et al. Blood 2005; 105(2): 879-885. (More) |
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Higher risk of extensive chronic GVHD after unrelated donor PBSC transplantation
Extensive chronic GVHD is higher in transplant patients receiving peripheral blood stem cells (PBSC) than those who receive marrow grafts, according to a study published in Blood. This study of 214 unrelated donor hematopoietic cell transplant recipients found similar overall survival for PBSC (42%) and marrow recipients (42%) and similar incidence of overall chronic GVHD (78% vs. 71%). However, extensive chronic GVHD was significantly more common in the PBSC group compared with the marrow group (39% vs. 24%, p=0.03). The researchers conclude that PBSC from HLA-matched unrelated donors results in similar outcome compared to marrow, but may increase risk for extensive chronic GVHD.
Remberger M, et al. Blood 2005; 105(2): 548-551. (More) |
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Allogeneic transplant for infants with ALL
A study of 40 infants diagnosed with acute lymphoblastic leukemia (ALL) before age 12 months who received a hematopoietic cell transplant between 1982 and 2003 in CR1 (N=17), CR2/3 (N=7) or relapse (N=16). Patients were conditioned with cyclophosphamide with total body irradiation (N=39) or busulfan (N=1). Donors were matched related, (N=8), mismatched related (N=16), or unrelated (N=16). Thirty-nine patients engrafted, 20 developed acute GVHD, and 7 developed chronic GVHD. Patients in CR1 had disease-free survival of 76% compared to 45% for CR2/CR3 and 8% for relapse (p=0.0001). The presence of the MLL gene was not a factor predictive of outcome. The researchers conclude that for infants with ALL in CR1, hematopoietic cell transplantation is warranted.
Sanders JE, et al. Blood 2005; E pub ahead of print, Jan. 6, 2005. (More) |
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Long-term quality of life after hematopoietic cell transplantation
A health-related quality of life survey of 662 hematopoietic cell transplantation survivors surveyed at a median of 7 years post-transplant. Responses were compared to an age- and sex-matched healthy comparison group of 158 individuals. Compared to healthy controls, transplant survivors had poorer status for physical health, physical functioning, social functioning and psychological adjustment. However, relative to the healthy controls, transplant survivors reported more psychological and interpersonal growth, differences that appeared to persist many years after transplant. The researchers conclude that supportive care is essential beyond the acute phase of transplantation.
Andrykowski MA, et al. J Clin Oncol 2005; 23(3): 599-608. (More) |
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Ethnicity may affect the risk for acute GVHD
Ethnicity may influence the risk for acute GVHD, according to a study published in Blood. This retrospective study of HLA-identical sibling bone marrow transplants between 1990 and 1999 evaluated 562 Japanese, 829 white Americans, 71 African Americans, 195 Scandinavians and 95 Irish. Multivariate analyses of adult patients showed that white Americans, African Americans, and Irish patients were at significantly higher risk for acute GVHD than Scandinavians or Japanese. There were no differences in the risk for chronic GVHD, relapse, and overall survival. The researchers conclude that ethnicity may influence the risk for acute GVHD in adult leukemia patients undergoing related donor marrow transplantation, although overall survival rates remain similar.
Oh H, et al. Blood 2005; 105(4): 1408-1416. (More) |
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Chronic GVHD raises risk for squamous cell carcinomas
Clinical screening for squamous cell carcinomas is appropriate among patients exposed to persistent chronic GVHD and/or prolonged immunosuppressive therapy, according to a study in Blood. The study evaluated 58 patients with post-transplant squamous cell carcinomas, 125 patients with other solid cancers, and 501 matched controls within a cohort of 24,011 patients transplanted at 215 centers worldwide. The researchers found that long duration of chronic GVHD therapy, the use of azathioprine, particularly when combined with cyclosporine and steroids, and severe chronic GVHD were all significant risk factors for the development of squamous cell carcinomas.
Curtis RE, et al. Blood 2005; E pub ahead of print, Feb. 1, 2005. (More) |
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Review: Antifungal therapy in invasive aspergillosis
Although potent new antifungal agents are available, invasive aspergillosis (IA) is still associated with significant mortality. This review focuses on how to manage immunocompromised transplant recipients who are especially susceptible to IA. Topics covered include voriconazole versus LipAmB for proven or suspected IA, combination therapy, assessment of treatment efficacy, therapy in patients showing improvement and in those showing deterioration, adjunct therapy and secondary prophylaxis.
Chandrasekar P. Biol Blood Marrow Transplant 2005; 11(2): 77-84. (More) |
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Other journal articles of note:
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