| Vol. 5, No. 6: November/December 2005 |
ASBMT evidence-based review: Allo-HCT in children with ALL
A systematic evidence-based review by the American Society for Blood and Marrow Transplantation (ASBMT) of hematopoietic cell transplantation in children with acute lymphoblastic leukemia (ALL). The report includes a summary of treatment recommendations for pediatric ALL unanimously agreed upon by an ASBMT steering committee for evidence-based reviews. The ASBMT reviews define current medical practice and specify the role of cytotoxic therapy with hematopoietic cell therapy in the treatment of diseases. The reviews also identify areas where evidence is insufficient and where additional research is needed.
Hahn T, et al. Biol Blood Marrow Transplant 2005; 11(11): 823-861. (More)
An accompanying editorial explains how the process of developing evidence-based reviews has evolved and improved, and how the ASBMT expert panels judge the quality and strength of clinical evidence. |
 |
Comparable results in patients with ALL after related and unrelated HCT
This study compares allogeneic transplantation results of 84 patients with high-risk or very high-risk acute lymphoblastic leukemia (ALL) using related (n=46) or unrelated (n=38) donors. The mean age of patients was 23 years (range, 1-60). The majority of patients (n=76) were conditioned with total body irradiation, etoposide, and cyclophosphamide. At a median follow-up of 18 months (range, 1-133), there was no statistically significant difference in three-year overall survival in the unrelated donor group (44%) and the related donor group (46%). There was no significant difference in transplant-related mortality and relapse rate in both donor groups. The researchers conclude that unrelated donor transplantation for high-risk ALL patients with no HLA-compatible family donor is justifiable.
Dahlke J, et al. Bone Marrow Transplant 2005; E pub ahead of print, Nov. 14. (More)
|
|
NIH Consensus Report: Criteria for clinical trials in chronic GVHD
A report from the Diagnosis and Staging Working Group of the NIH that 1) standardizes the criteria for diagnosis of chronic GVHD, 2) proposes a new clinical scoring system that describes the extent and severity of chronic GVHD, and 3) proposes new guidelines for global assessment of chronic GVHD severity. The Working Group also proposed that diagnosis of chronic GVHD requires the presence of at least one diagnostic clinical sign of chronic GVHD or the presence of at least one distinctive manifestation confirmed by pertinent biopsy or other relevant tests in the same or another organ.
Filipovich AH, et al. Biol Blood Marrow Transplant 2005; 11(12): 945-956. (More) |
|
Effect of conditioning regimen in unrelated donor BMT
This retrospective study compared the outcomes of four conditioning regimens used in unrelated donor bone marrow transplantation: cyclophosphamide/total body irradiation (Cy-TBI), intensified Cy-TBI (Cy-TBI+), busulfan and Cy (Bu-Cy), and Bu-Cy with total lymphoid irradiation (Bu-Cy-TLI). The outcomes of 1875 adult patients who underwent unrelated BMT for leukemia or myelodysplastic syndrome between 1993 and 2002 were analyzed by the Japan Marrow Donor Program. The researchers concluded that Cy-TBI is the preferred regimen in unrelated donor BMT unless the patient has a condition that precludes the use of TBI. The Bu-Cy regimen (using oral busulfan without plasma monitoring) had an increased incidence of engraftment failure and veno-occlusive disease and the Cy-TBI+ regimen had a higher non-relapse mortality.
Kanda Y, et al. Biol Blood Marrow Transplant 2005; 11(11): 881-889. (More) |
|
Reduced-intensity transplants feasible in CML patients
Reduced-intensity allogeneic transplants are feasible in patients with chronic myeloid leukemia (CML) in first or second chronic phase, according to an article published in Blood. This conclusion was based on the outcomes of 186 reduced-intensity transplants for CML reported to the European Group for Blood and Marrow Transplantation. The median age of patients was 50 years, and 64% were in first chronic phase. Transplant-related mortality (TRM) was 6% at 100 days post-transplant and 23% at two years. The three-year overall survival and progression-free survival were 58% and 37%, respectively. The authors conclude that a conditioning regimen of fludarabine, busulfan, and antithymocyte globulin, which had the lowest TRM at one year (11%), should be considered as baseline in future prospective trials.
Crawley C, et al. Blood 2005; 106(9): 2969-2976. (More) |
|
Reduced-intensity transplants in patients with SAA using alternative donors
A reduced-intensity conditioning regimen for 38 patients undergoing transplantation for severe aplastic anemia (SAA) resulted in a two-year survival of 73%, according to a study published in Bone Marrow Transplantation. The regimen included cyclophosphamide (1200 mg/m2), fludarabine (120 mg/m2), and antithymocyte globulin (7.5 mg/kg). Median age of patients was 14 years (range, 3-37), and all but two received unmanipulated marrow from unrelated (n=33) or family mismatched (n=5) donors. Two patients received peripheral blood stem cells. Patients 14 years or younger had a lower risk of graft rejection (5%) and improved two-year survival (84%). The researchers conclude that a radiation-free conditioning regimen is "encouraging in young SAA patients" but that the regimen may require modification for SAA patients 15 years or older.
Bacigalupo A, et al. Bone Marrow Transplant 2005; 36(11): 947-950. (More) |
|
Reduced-intensity transplantation for high-risk AML and myelodysplasia
A report on 76 patients (median age 52 years) with high-risk AML or myelodysplasia undergoing allogeneic cell transplantation using a reduced-intensity conditioning regimen of fludarabine/melphalan and alemtuzumab. Source of the grafts were unrelated donors (n=41) or siblings (n=35). The 100-day transplant-related mortality was 9%, and no patient developed greater than grade II acute GVHD. At a median follow-up of 36 months, three-year overall survival and disease-free survival were 41% and 37%, respectively. The most common cause of treatment failure was disease relapse, which occurred at a median time of six months post-transplant. The researchers conclude that reduced-intensity allogeneic transplantation can produce sustained survival in patients with AML ineligible for myeloablative transplantation.
Tauro S, et al. J Clin Oncol 2005; E pub ahead of print, Nov. 28. (More) |
|
Alternative donor BMT for children with Ph+ ALL
A report on 29 children (median age 10.5 years) with Ph+ acute lymphocytic leukemia (ALL) transplanted between 1987 and 2002 at a single institution using either an unrelated donor (n=23) or a mismatched family member (n=6). Patients were conditioned with cyclophosphamide, cytosine-arabinoside and total body irradiation. GVHD prophylaxis included post-transplant cyclosporine. All 29 patients engrafted, and four patients developed grade III-IV acute GVHD. Event-free survival (EFS) at 3, 5, and 10 years was 56%, 51%, and 46%, respectively. Because children with Ph+ ALL treated with chemotherapy alone experience a long-term EFS of 20%, the researchers conclude that alternative donor transplantation is the preferred treatment option in this patient cohort.
Talano JM, et al. Bone Marrow Transplant 2005; E pub ahead of print, Nov. 7. (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 session on HLA at BMT Tandem Meetings
Save the date: February 20, 2006, 12:15-1:45 p.m. The NMDP is sponsoring a scientific session "Advances in HLA: Practical Implications for Selecting Adult Donors and Cord Blood Units" at the BMT Tandem Meetings in Honolulu. E-mail the NMDP at pallmann@nmdp.org for more information. |
National cord blood program established
President Bush has signed into law a bill establishing a national cord blood program providing federal funding to collect and store cord blood for transplants. The law also reauthorizes the existing national Registry for marrow donors.
More |
NMDP symposium at ASH meeting
If you missed the NMDP's ASH Corporate Friday Symposium, Transplantation for the Older Patient, you may still get a copy of the program handout by e-mailing the NMDP at rryan@nmdp.org |
NMDP outcomes data now online at marrow.org/md
View the latest outcomes data on NMDP transplants:
 |
Survival by disease |
|
Sources of cells for transplant |
|
Age of transplant patients |
|
Treatment-related mortality | More |
Online CME program on MDS
A CME program from the NMDP is now available online:
This program is also available on a free CD-ROM (no CME credit). More | |
| 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. | | |
