| Vol. 5, No. 4: July/August 2005 |
T-cell depletion has no impact on cGVHD, survival in unrelated donor transplants
A prospective randomized multi-center trial of unrelated donor bone marrow transplantation where 203 patients were randomized to receive T-cell depleted marrow and 207 patients were randomized to receive T-cell replete marrow. Median recipient age was 31 years (0.5-55.6) and median follow-up since randomization was 4.2 years. The two-year incidence of chronic GVHD was similar in the two groups, and there was no significant difference in three-year disease-free survival between the T-cell replete patients and the T-cell depleted patients (34% and 27%, respectively).
Pavletic SZ, et al. Blood 2005; E pub ahead of print, July 26 (More) |
 |
Sirolimus and thrombotic microangiopathy after allogeneic HCT
A retrospective cohort analysis of the incidence of thrombotic microangiopathy (TMA) in myeloablative allogeneic hematopoietic cell transplantation when sirolimus is used as GVHD prophylaxis. This study compared 111 transplant recipients receiving prophylactic sirolimus plus calcineurin inhibitors with a matched cohort of 216 transplant recipients who did not receive sirolimus. The incidence of TMA was significantly higher in the prophylactic sirolimus group than in the non-sirolimus group (10.8% vs. 4.2%, p=0.03). Renal recovery was complete in 92% of patients receiving sirolimus. Overall survival after TMA diagnosis was better in the sirolimus group than in the non-sirolimus group (58.3% vs. 11.1%, p=0.02). The authors conclude that that a careful monitoring strategy for TMA should be employed as part of any GVHD prophylaxis regimen containing sirolimus.
Cutler C, et al. Biol Blood Marrow Transplant 2005; 11(7): 551-557. (More)
Related article: The BMT CTN Toxicity Committee has recommended the use of TMA instead of hymolytic uremic syndrome/thrombotic thrombocytopenic purpura. In addition, the committee concluded that plasma exchange has not been shown to be an effective treatment for TMA, and that withdrawal of calcineurin inhibitors should be the primary intervention after a TMA diagnosis.
Ho VT, et al. Biol Blood Marrow Transplant 2005; 11(8): 571-575. (More) |
|
Review: The graft-versus-lymphoma effect
A review of the clinical data on the graft-versus-lymphoma effect, including comparisons of autologous, syngeneic, and allogeneic transplantation; responses to immunomodulation; and responses to non-myeloablative hematopoietic cell transplantation. Also discussed are approaches for clinical management of lymphoma patients.
Butcher BW, et al. Bone Marrow Transplant 2005; 36(1): 1-17. (More) |
|
Reduced-intensity allogeneic HCT in chemotherapy-refractory NHL
This prospective study examined the effects of uniform salvage therapy on the outcome of reduced-intensity transplantation in 28 patients with relapsed or refractory non-Hodgkin lymphoma. Salvage therapy consisted of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and fludarabine. In multivariate analyses, the response to chemotherapy was the best predictor of overall survival (OS) and event-free survival after reduced-intensity transplant. The researchers observed improved OS in patients who had stable disease during salvage therapy compared to patients with progressive disease. The researchers concluded that the improved OS for stable disease patients was due to donor lymphocyte infusions and that stable disease patients may be more sensitive to graft-versus-lymphoma effects than those with progressive disease during salvage chemotherapy.
Dean RM, et al. Biol Blood Marrow Transplant 2005; 11(8): 593-599. (More) |
|
Reduced-intensity conditioning for AML using TBI and fludarabine
A phase II study of 71 patients with acute myeloid leukemia (AML) undergoing reduced-intensity myeloablative transplantation. Fractionated total body irradiation (TBI) and fludarabine was used as the preparative regimen (8 Gy + 120 mg/m2 in 98% of patients) and 49 patients (69%) received rabbit ATG. Median patient age was 51 years (20-66 yrs.) and engraftment was achieved in all evaluable patients. At a median follow-up of 25.9 months (3.7-61.2) in surviving patients, overall two-year survival for patients transplanted in complete remission (CR) and non-CR were 81% and 21%, respectively. Patients transplanted from siblings and unrelated donors had similar survival. The authors conclude that this reduced-intensity regiment is feasible for AML patients in 1st or 2nd CR with related or unrelated donors, but not for patients with active disease.
Stelljes M, et al. Blood 2005; E pub ahead of print, July 14. (More) |
|
Tandem transplants for multiple myeloma: the role of minimal residual disease
A study of the prognostic value of molecular monitoring (PCR for IgH rearrangement) of minimal residual disease (MRD) in 20 patients with multiple myeloma. All patients underwent tandem transplantation with autologous PBSC followed by non-myeloablative allogeneic transplantation within 6 months. Two-year progression-free survival was 51% and treatment-related mortality was 20%. After autologous transplantation, only three patients (15%) were PCR negative; after non-myeloablative allogeneic transplantation, 12 patients (60%) were PCR negative. PCR status and chimerism were not significantly correlated. At two years post-transplant, 76% of patients with no detectable MRD were alive compared with 34% of PCR-positive patients (p=0.03). The authors conclude that non-myeloablative allogeneic transplantation may be advantageous in multiple myeloma patients who achieve stable disease after autologous transplantation.
Galimberti S, et al. Leuk Res 2005; 29(8): 961-966. (More) |
|
Short- and long-term effects of G-CSF in healthy donors
This prospective study reports on 94 individuals undergoing G-CSF-stimulated peripheral blood stem cell collection at the Sant'Orsola Hospital in Bologna, Italy. Mean follow-up time was 30 months (range 4-84). During G-CSF administration, 23 donors (24%) showed a significant platelet count decrease from the baseline, with normal platelet counts returning within 4-8 months. Moderate neutrophil reduction (25% count drop from the baseline) was observed in four of the 30 donors observed for four years or more. Persistent, slight lymphocytopenia (mean drop of 13% from the baseline) was observed in 14 donors until the third year, with recovery ocurring in the fourth year of follow-up.
Tassi C, et al. Bone Marrow Transplant 2005; 36(4): 289-294. (More) |
|
Transplant patients recovering at home have better survival
A comparison of 36 hematopoietic cell transplant recipients recovering at home during the pancytopenic phase with 54 controls treated at the Karolinska University Hospital, Stockholm, Sweden. The incidence of grades II-IV acute GVHD was lower in the home group compared to the control group (17% vs. 44%; p<0.01). There was significantly lower transplant-related mortality (TRM) in the home care patients than in the control group (13% vs. 44%; p=0.002). The four-year survival was significantly better in the home care patients compared to the controls (63% vs. 44%; p=0.04). The authors conclude that home care after hematopoietic cell transplantation can result in less TRM, similar incidence of chronic GVHD and relapse, and improved long-term survival compared to controls treated in the hospital.
Svahn BM, et al. Bone Marrow Transplant 2005; E pub ahead of print, July 18. (More) |
|
Review: HCT in treatment of severe autoimmune diseases
This review examines the use of hematopoietic cell transplantation to treat severe autoimmune diseases, and summarizes the experiences of more than 700 autologous transplants worldwide for multiple sclerosis, systemic sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. The authors report a steady lowering of transplant-related mortality, which they attribute to more appropriate patient selection. More than a third of transplant recipients sustain durable remissions, according to the authors, and the general success of phase I and II studies have led to the initiation of many phase III studies. Case reports have indicated that allogeneic transplants can induce a graft-versus-autoimmunity effect in autoimmune patients and the authors conclude that this procedure shows promise, but only if the significant morbidity and mortality from GVHD can be reduced.
Tyndall A, et al. Clin Exp Immunol 2005; 141(1): 1-9. (More) |
|
Other journal articles of note:
|
|
Advances in Transplantation is an electronic newsletter published six times a year by the Office of Professional Education of the National Marrow Donor Program (NMDP).
This newsletter is sent only to those
individuals who have requested it.
To unsubscribe or change your subscription options,
see link at the bottom of this newsletter.
E-mail your comments or suggestions | |
|
This e-mail newsletter supported by an unrestricted educational grant from ESP Pharma
 | |
NMDP to host CME audioconference on MDS
"Myelodysplastic Syndrome: Making Treatment Decisions in an Evolving Field." Wednesday, September 21, 2005, 11:30-12:30 CDT Presenter: H. Joachim Deeg, M.D. Program will be available online and on CD-ROM following the audioconference.
Online registration |
CML online CME program now available
Did you miss the NMDP audioconference on chronic myelogenous leukemia presented by Dr. Jane Apperley? The program is now available as an online CME program and on CD-ROM. |
NMDP announces breakfast symposium preceding ASH
Save the date: December 2, 2005, 7-11 a.m. "Transplantation for the Older Patient: More Choices for Improving Outcomes." This NMDP Symposium precedes the 2005 American Society of Hematology (ASH) Annual Meeting in New Orleans.
More information |
Plan now for NMDP Council Meeting
This year's NMDP Council Meeting will take place November 4-6. Attend educational sessions on issues related to marrow and blood cell transplant therapies, scientific advances in marrow and blood cell transplantation, and NMDP-specific operations.
NMDP Council Meeting Agenda and Brochure |
New Web resource for physicians
Visit the NMDP Physician Resources Center for:
 |
Transplant outcomes data |
|
Referral guidelines by disease |
|
Interactive donor search algorithm |
|
NMDP services and education programs | | |
| THANK YOU FOR SIGNING UP! |
Thank you for subscribing to Advances in Transplantation.
To unsubscribe or change your subscription options, see link at the bottom of this newsletter. | | |
