| Vol. 6, No. 3: May/June 2006 |
ATG lowers incidence of chronic GVHD, late transplant-related mortality
Patients receiving antithymocyte globulin (ATG; Thymoglobulin) before undergoing unrelated donor marrow transplantation experience significantly less chronic GVHD and lower transplant-related mortality (TRM) than patients who did not receive ATG, according to a randomized prospective study of 109 transplant patients. After a median follow up of 5.7 years, 60% of non-ATG patients experienced chronic GVHD compared to 37% of patients who received ATG (p=0.05). Extensive chronic GVHD was present in 41% of non-ATG patients and in 15% of ATG patients (p=0.01). The incidence of TRM in the year following transplantation was not different between the two groups, but in patients who survived one year, TRM was 25% in the non-ATG group versus 3% in patients who did received ATG (p=0.03).
Bacigalupo A, et al. Biol Blood Marrow Transplant 2006; 12(5): 560-565. (More)
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No long-term health effects of successfully treated cGVHD
A study of the impact of chronic GVHD (cGVHD) on the overall health status of patients undergoing hematopoietic cell transplantation between 1976 and 1999 at two U.S. transplant centers. Subjects (n=584) completed a 255-item questionnaire on general health, mental health, functional impairment, activity limitation, pain and anxiety/fear. Patients with active cGVHD reported significantly higher rates in all health measurements, with the exception of anxiety/fear. However, no significant differences in health were found between patients with resolved cGVHD and patients who never developed cGVHD, leading the researchers conclude that "those successfully treated for cGVHD do not appear to have long-term impairments."
Fraser CJ, et al. Blood 2006; E pub ahead of print, June 20. (More)
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Related and unrelated donor HCT in children with severe Thalassemia
Unrelated and related donor hematopoietic cell transplantation offer favorably comparable outcomes in patients with severe thalassemia, according to a report published in Biology of Blood and Marrow Transplantation. The study examined outcomes of 49 consecutive children with severe thalassemia who underwent related donor (n=28) or unrelated donor (n=21) transplantation between 1992 and 2005 at Ramathibodi Hospital, Bangkok, Thailand. Engraftment, complications, and disease-free survival (DFS) were similar in the related and unrelated donor recipients. Two-year DFS was also similar in the related donor group (82%) and in the unrelated donor group (71%) (p=0.42).
Hongeng S, et al. Biol Blood Marrow Transplant 2006; 12(6): 683-687. (More) |
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T-cell depletion has no effect on quality of life at one year post-transplant
Although T-cell depletion of hematopoietic cell grafts can reduce the incidence of acute GVHD, it has no significant effect on health-related quality of life (HRQL) at one-year post-transplant in adult patients, according to a report published in Biology of Blood and Marrow Transplantation. The HRQL data were gathered as part of a multi-center randomized trial enrolling 410 patients comparing the effect on disease-free survival of ex vivo T-cell depletion versus methotrexate and cyclosporine immunosuppression. At one year post-transplant, there were no significant differences in HRQL between the T-cell-depleted arm and the conventional treatment arm of the study. The authors further noted that surviving patients in both treatment arms returned to a functional level that approximated general U.S. population norms.
Altmaier EM, et al. Biol Blood Marrow Transplant 2006; 12(6): 648-655. (More) |
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Quality of life after reduced-intensity transplantation
A report on the health-related quality of life (HRQL) of 76 patients undergoing either reduced-intensity (n=41) or myeloablative (n=35) allogeneic transplantation. HRQL was measured at days 0, 30 100, 1 and 2 years following transplant. There were no differences between the two groups during early recovery, and at two years all survivors (n=43) reported HRQL similar or better than baseline. The researchers conclude that reduced-intensity and myeloablative allogeneic transplant recipients experience a similar pattern of HRQL improvement during early recovery.
Bevans MF, et al. Bone Marrow Transplant 2006; E pub ahead of print, June 5. (More) |
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Contingency planning for acute radiation injury
Because acute radiation injury induces marrow suppression and pancytopenia, hematologists, oncologists and transplantation physicians may be needed to administer care to significant numbers of irradiation victims resulting from a military, terrorist, or accidental event. This article outlines the necessary components of contingency plans for the triage, assessment, supportive care, and treatment of acute radiation victims. An important element of any such contingency plan is advance preparation for urgent hematopoietic cell transplantation for individuals with intermediate- to high-dose radiation (4-10 Gy).
Weisdorf D, et al. Biol Blood Marrow Transplant 2006; 12(6): 672-682. (More) |
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ASCO recommendations on fertility preservation in cancer patients
A report from a panel of fertility and cancer experts formed by the American Society of Clinical Oncology (ASCO) tasked with developing guidelines on preserving fertility in patients being treated for cancer. The panel found that although sperm and embryo cryopreservation are standard practice and widely available, fertility preservation methods are infrequently used in cancer patients. To remedy this, the panel urges practicing oncologists to "address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists."
Lee SJ, et al. J Clin Oncl 2006; 24(18): 2917-2931. (More) |
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BCR-ABL measurement identifies CML patients needing further therapy
A report on a polymerase chain reaction analysis of 243 patients with Philadelphia-positive (Ph+) chronic myelogenous leukemia (CML) who underwent allogeneic transplantation over a 20-year period. The analysis revealed that 53% of the transplant recipients had relapsed as determined by either molecular criteria, progression to abnormal cytogenetic states, or progression to abnormal hematologic states. In the remaining 47%, most experienced multiple episodes of low positive BCR-ABL, and these recipients were likely to progress further. Only approximately 15% of all the transplant recipients were classified as either consistently BCR-ABL negative (16 patients, 6.6%) or with only one detectable low-level positive result (20 patients, 8.2%).
Kaeda J, et al. Blood 2006; 107(10): 4171-4176. (More)
In an accompanying editorial, Dr. Richard Maziarz concludes that there is a "critical need" for ongoing serial BCR-ABL monitoring "to identify CML patients early, prior to hematologic relapse, so that they can be assessed for treatment options, such as donor leukocyte infusions, imatinib, or perhaps other second-generation kinase inhibitors." |
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Review: Adult umbilical cord blood transplantation
A review of the factors to be considered when selecting the optimal cord blood unit for transplantation into adult patients. Because clinical results demonstrate that higher cell dose may partially overcome the negative impact of certain HLA disparities, the authors conclude that transplant physicians should choose the more closely HLA-matched unit with a cell dose >2.5 x 107/kg. Other topics reviewed include reduced-intensity cord blood transplantation, multiple cord transplantation, and ex vivo expansion of cord blood units.
Schoemans H, et al. Bone Marrow Transplant 2006; E pub ahead of print, June 5. (More) |
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Other journal articles of note:
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When your child needs a transplant
New content on the NMDP Web site highlights the medical, social and financial aspects unique to pediatric transplantation. |
Pediatric acute leukemias: Two new CDs available from the NMDP
New CDs available free from the NMDP:
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Pediatric AML |
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Pediatric ALL | Both CDs contain audio and slides from recent audioconferences sponsored by the NMDP. Online order form |
Transplantation for the older patient
This CME publication, Blood and Marrow Transplantation Reviews, summarizes presentations from the NMDP-sponsored symposium prior to the ASH annual meeting. Order reprints |
DVD available for transplant patients over 50
Order your free copy of the NMDP DVD and workbook, Transplant as an Option When You are 50 and Older, which can assist patients 50 and older to learn more about the transplant process and how it relates to them. Order DVD | |
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