| Vol. 6, No. 5: September/October 2006 |
Cord blood transplantation vs. related marrow or PBSC donors
A retrospective study of 171 adults with hematological malignancies undergoing myeloablative unrelated donor cord blood transplantation (n=100), or related donor transplantation using bone marrow (n=55) or peripheral blood stem cells (n=16). Although cord blood recipients experienced significant delays in platelet engraftment
(> 20 x 109/L) compared with marrow/PBSC recipients (median 40 vs. 22.5 days; p<0.01), overall engraftment rates were similar. There were no significant differences in three-year disease-free survival between cord blood transplantation and marrow/PBSC transplantation (70% vs. 60%, respectively). The researchers conclude that unrelated donor cord blood can be as safe and effective as marrow or PBSC from related donors.
Takahashi S, et al. Blood 2006; E pub ahead of print, Oct. 12. (More)
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Long-term outcome of marrow or PBSC transplantation
A long-term follow up of 413 patients from a previous report of 706 leukemia patients transplanted at 20 North American and European transplant centers using marrow (n=272) or peripheral blood stem cells (n=141) from HLA-matched sibling donors. Chronic GVHD was more frequent in PBSC recipients than in marrow recipients (RR 1.65, p<0.0001). Six-year overall survival was higher in the PBSC group than in the marrow group for patients with advanced chronic myeloid leukemia (CML), 33% vs. 25%, respectively. However, survival was lower in PBSC recipients compared to marrow recipients transplanted in first chronic phase CML (41% vs. 61%). These PBSC recipients experienced significantly to higher rates of late transplant-related mortality. The researchers conclude that although patients with advanced CML may benefit from PBSC transplantation, patients with acute leukemia or early CML may not.
Schmitz N, et al. Blood 2006; E pub ahead of print, Aug. 31. (More)
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Comparison of non-myeloablative and myeloablative regimens in advanced AML and MDS
A retrospective analysis of 136 patients with advanced acute myelogenous leukemia or myelodysplastic syndrome undergoing hematopoietic cell transplantation between 1997 - 2002 at the Dana-Farber Cancer Center with either myeloablative (n=39) or non-myeloablative (n=97) conditioning. Non-myeloablative patients were older (median 57 vs. 43 years) and more likely to have undergone previous myeloablative transplantation (54% vs. 2%) than the myeloablative patients. Two-year overall survival was 28% in the non-myeloablative group and 31% in myeloablative patients. A regression analysis showed similar results in both overall survival and progression-free survival, despite the high-risk features of the patients receiving non-myeloablative conditioning. The authors conclude that the dose-intensive therapy is of no benefit in patients over 50 with advanced AML or MDS.
Alyea EP, et al. Biol Blood Marrow Transplant 2006; 12(10): 1047-1055. (More) |
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Non-myeloablative transplantation in CLL
A study of 46 patients with advanced chronic lymphocytic leukemia (CLL) undergoing non-myeloablative transplantation from related (n=15) or unrelated (n=31) donors. Median age of patients was 53 years, and the median time from diagnosis to transplantation was 6.5 years. Low-dose intravenous busulfan and fludarabine were used for conditioning. At a median follow-up of 20 months, two-year overall survival was 54% and progression-free survival was 34%. The researchers state that because CLL remains an incurable disease with standard chemotherapy, non-myeloablative transplantation with low-dose intravenous busulfan and fludarabine is a reasonable treatment option for patients with advanced CLL.
Brown JR, et al. Biol Blood Marrow Transplant 2006; 12(10): 1056-1064. (More) |
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Unrelated donor HCT for Wiskott-Aldrich syndrome
A retrospective analysis of 23 patients with Wiskott-Aldrich syndrome (WAS) undergoing related donor (n=7) or unrelated donor bone marrow transplantation from 1990 to 2005 at the University of Brescia, Italy. The median neutrophil engraftment occurred at day 18, and there were no cases of grade III or IV GVHD. Overall survival (OS) was 78.2% (18/23), and in the unrelated donor group OS was 81.2% (13/16). Full donor engraftment was achieved in 12 of 18 survivors, and stable mixed chimerism was achieved in four patients. The authors conclude that their results demonstrate the safety and efficacy of matched unrelated donor transplantation in WAS patients, especially when performed early in the clinical course of the disease.
Pai S-Y, et al. Bone Marrow Transplant 2006; E pub ahead of print, Oct. 2. (More) |
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ABO mismatching has no effect on HCT outcome
A retrospective analysis of donor-recipient ABO mismatch patterns and transplant outcome measures in 240 consecutive allogeneic transplant recipients at Temple University. The analysis showed no significant associations between donor-recipient ABO match and overall survival, event-free survival, transplant-related mortality, and incidence of acute or chronic GVHD. The researchers conclude that their study does not support recent reports that donor-recipient ABO mismatching is a major risk factor in allogeneic transplantation, and that therefore ABO matching need not be an important factor in selecting donors.
Klumpp TR, et al. Bone Marrow Transplant 2006; 38(9): 615-620. (More) |
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Review: Allo-HCT as treatment for myelofibrosis
Allogeneic hematopoietic cell transplantation represents the only treatment for idiopathic myelofibrosis with proven curative potential. This review discusses outcomes using different conditioning regimens and levels of intensity, comparing myeloablative and non-myeloablative. The influence of age and prognostic factors on outcomes is also discussed.
Papageorgiou SG, et al. Bone Marrow Transplant 2006; E pub ahead of print, Oct. 2. (More) |
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Review: Implications of the NIH consensus project on chronic GVHD
A review of the six consensus documents produced by the National Institutes of Health-sponsored chronic GVHD consensus project from December 2005 through May 2006. These documents focused on diagnosis and staging, histopathology, strategies for the development and validation of biomarkers, response criteria, ancillary therapy and supportive care and the design of clinical trials. The authors summarize and discuss the implications of all six reports, with a focus on diagnosis and scoring and response criteria.
Pavletic SZ, et al. Bone Marrow Transplant 2006; E pub ahead of print, Sept. 18. (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/ASBMT issue 2006 Recommended Timing for Transplant Consultation
These guidelines for transplant consultation are published jointly by the NMDP and the ASBMT and are based upon current clinical practice and the medical literature.
Download PDF or order laminated copies. |
NMDP GVHD audioconference now available online or on CD
Order a CD-ROM or view an online presentation of the NMDP audioconference "A Clinician's Guide for Diagnosing and Caring for Patients with GVHD" presented by Corey Cutler, M.D. Online presentation carries CME credit.
Register for online CME |
Post-transplant patient care: Tailored prevention and management strategies
Plan to attend this NMDP symposium preceding the 2006 ASH annual meeting in Orlando, Fla., on December 8, 2006, from 12:30-4:30 p.m.
View invited faculty and agenda |
Register for 2006 Council Meeting
The 2006 NMDP Council Meeting will be held Nov. 10-12, 2006, in downtown Minneapolis.
Register online |
2007 Growth Factor Conference
Register for this NMDP-supported program on the use of hematopoietic growth factors in normal blood donors.
March 15-16, 2007, Bethesda, Md.
Sponsored by the University of Minnesota Biomedical Engineering Institute.
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