| Vol. 6, No. 4: July/August 2006 |
The role of transplantation for CML in the imatinib era
This review discusses the rationale for using imatinib mesylate as first-line therapy for adult CML patients and for reserving hematopoietic cell transplantation for second-line therapy should patients not achieve or maintain a good molecular response to imatinib. The authors outline the criteria for moving from imatinib therapy to hematopoietic cell transplantation and present hypothetical case scenarios with evidence-based recommendations on the optimal time to pursue transplantation.
Grigg A, et al. Biol Blood Marrow Transplant 2006; 12(8): 795-807. (More)
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Using parous female donors means higher chronic GVHD
Parous female donors (one or more pregnancies) result in an increased risk of chronic GVHD in transplant recipients, according to a study of 2,636 HLA-identical related donor transplants from 1995-1999 reported to the CIBMTR (Center for International Blood and Marrow Transplant Research). Compared with male donors, the hazard ratio (HR) for developing chronic GVHD when using parous female donors was 1.56 (p<0.001) in male recipients, 1.49 (p=0.008) in parous female recipients, and 2.10 (p=0.009) in female recipients with no prior pregnancies. A pregnancy-induced alloimmune reaction is thought to be the underlying reason why hematopoietic cells from parous female donors result in more chronic GVHD in transplant recipients.
Loren AW, et al. Biol Blood Marrow Transplant 2006; 12(7): 758-769. (More)
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Optimal TBI dose for patients transplanted for aplastic anemia
In a study of 87 patients with aplastic anemia transplanted with unrelated donors after failed immunosuppressive treatment, the optimal total body irradiation (TBI) conditioning regimen is 200 cGy, according to a study published in Blood. All patients also received cyclophosphamide (50 mg/kg X 4) and 78 received equine ATG (30 mg/kg X 3). The researchers used a study design with a TBI starting dose of 3 X 200 cGy and adjusted the dose downward if patients encountered prohibitive toxicity or upward if graft failure increased. The highest survival rate with HLA-matched transplants was a single TBI dose at 200 cGy. With a median follow-up of 7 years, overall survival is 61% in HLA-identical recipients, and 40% in HLA-mismatched recipients
Deeg HJ, et al. Blood 2006; 108(5): 1485-1491. (More) |
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Adult umbilical cord blood transplantation
A review of the clinical data on umbilical cord blood (UCB) transplantation in adult patients focusing on the factors that need to be considered when selecting cord blood units. The authors note that higher cell dose may partially overcome the negative impact of HLA disparities in UCB transplantation, recommending a minimum cell dose of 2.5 x 107/kg of patient weight. Other topics discussed include reduced-intensity conditioning UCB transplantation, using multiple UCB units, ex vivo UCB expansion, and co-infusion of haploidentical cells.
Schoemans H, et al. Bone Marrow Transplant 2006; 38(2): 83-93. (More) |
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ATG may increase EBV reactivation in non-myeloablative cord blood transplantation
A study of Epstein-Barr Virus (EBV) lymphoproliferative disorder in 335 consecutive patients undergoing cord blood transplantation at University of Minnesota hospitals between 1994-2005. Median patient age was 16 years (0.2-69) and patients were conditioned with a myeloablative (n=240) or non-myeloablative (n=95) preparative regimen. The incidence of EBV-related complications in all patients was 4.5%, with no significant difference between the myeloablative and non-myeloablative groups. However, the incidence of EBV-related complications was significantly higher in non-myeloablative patients whose conditioning included antithymocyte globulin (ATG) compared to those who did not receive ATG (21% vs. 2%, p<0.01).
Brunstein CG, et al. Blood 2006; E Pub ahead of print, June 27. (More) |
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Spermatogenesis can be preserved after myeloablative conditioning
Males undergoing myeloablative allogeneic hematopoietic cell transplantation can retain spermatogenesis even if their conditioning regimen included total body irradiation (TBI), according to a study of 39 adult males transplanted at the University Hospital in Basel, Switzerland. Thirty-two of the 39 patients (82%) underwent TBI with 10Gy or more. Median age was 34 years (range, 20-59 years) at the time of semen analysis, and the median time between transplant and sperm analysis was 9 years (range, 2-20 years). Some spermatogenesis was seen in 11 of 39 (28%) patients. Among the 16 patients transplanted under 25 years old, 9 (56%) maintained spermatogenesis. Spermatogenesis was associated with younger age at transplant, longer interval since transplant, and the absence of chronic GVHD.
Rov? A, et al. Blood 2006; 108(3): 1100-1105. (More) |
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Review: cryopreserved vs. fresh stem cells in allogeneic HCT
A comparison of the risks and benefits of using "fresh" versus cryopreserved hematopoietic cells for allogeneic transplantation. Current medical practice is to use non-cryopreserved cells based on concerns that cryopreservation and thawing may worsen clinical outcomes. However, the limited data available from patients transplanted with cryopreserved bone marrow show no significant reduction in engraftment rates or 100-day survival. Issues discussed include engraftment, GVHD, bacterial contamination, transfusion reactions, logistics, and ethical issues.
Frey NV, et al. Bone Marrow Transplant 2006; E Pub ahead of print, Aug. 7. (More) |
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Review: Alternative donor transplants for adult ALL
A review of three sources of hematopoietic cells used in alternative donor transplantation for adults with acute lymphoblastic leukemia: matched unrelated donors, haploidentical donors, and umbilical cord blood (UCB). Matched unrelated transplants most often are performed in Ph+ patients and in patients in second complete remission with a nearly 30% event-free survival. Haploidentical transplants are most successful if patients are in first or second complete remission. Although the clinical data on UCB transplants are limited, in select patient populations they can be as successful as transplants using adult unrelated donors. However, relapse and engraftment failure remain significant issues when using UCB grafts. This review evaluates each stem cell source and its unique potential benefits and disadvantages.
Marks DI, et al. Bone Marrow Transplant 2006; E Pub ahead of print, Aug. 7. (More) |
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Other journal articles of note:
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Advances in Transplantation is an electronic newsletter published six times a year by the Medical Education Team of the National Marrow Donor Program (NMDP).
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NMDP symposium preceding ASH
Save the date: December 8, 2006, 12:30 p.m.
"Post-transplant patient care: Tailored prevention and management strategies."
ASH annual meeting, Orlando, Fla. |
NMDP to host CME audioconference on GVHD
"A clinician's guide for diagnosing and caring for patients with GVHD."
Presenter: Dr. Corey Cutler, Dana-Farber Cancer Institute
Wednesday, September 27, 11:30 a.m. Central Time Register online |
NMDP celebrates 25,000 transplants
In July, the number of transplants facilitated by the NMDP surpassed 25,000. Read more about this significant milestone and the transplant advances that have led to the growth. |
When your child needs a transplant
New content on the NMDP Web site highlights the medical, social and financial aspects unique to pediatric transplantation. |
CDs and online CME on treating AML and ALL
Order free NMDP CDs or take an online CME course on the treatment of:
- Pediatric AML
- Pediatric ALL
Learn more | |
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