| Vol. 6, No. 6: November/December 2006 |
Sirolimus is an effective prophylaxis for acute GVHD
Outcomes of related and unrelated donor transplantation are similar when sirolimus and tacrolimus are used as prophylaxis for acute GVHD, according to a report in Blood. The study reports on the outcomes of myeloablative peripheral blood cell transplantation from related (n=53) and unrelated (n=30) donors using sirolimus and tacrolimus alone, without methotrexate, as prophylaxis for acute GVHD. There were no significant differences in two-year overall survival between matched related (69.8%) and unrelated (76.7%) donor graft recipients. The incidence of grade II-IV and III-IV acute GVHD were 20.5% and 4.8%, respectively. There were only two deaths (2.4%) due to GVHD, which occurred among the related donor graft recipients. A phase III trial of sirolimus and tacrolimus is being planned under the Blood and Marrow Transplant Clinical Trials Network (BMT CTN).
Cutler C, et al. Blood 2006; E pub ahead of print, Nov. 30. (More)
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Emergency preparedness for hematopoietic cell transplant programs
Most hospital disaster plans designed to deal with emergencies such as hurricanes, power outages, fire, and terrorist actions do not contain specialized provisions to safeguard patients in hematopoietic cell transplant (HCT) units. This report from an ASBMT committee on emergency preparedness for HCT programs outlines elements necessary to safeguard HCT patients, including emergency handling of fresh and cryopreserved stem cell products, transfusion support, relocating immunocompromised patients, and infection control. The report includes actual case scenarios involving transplant programs and the National Marrow Donor Program.
Wingard JR, et al. Biol Blood Marrow Transplant 2006; 12(11): 1229-1238. (More)
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No effect of pre-transplant imatinib on transplant outcomes in CML patients
A retrospective study of 145 chronic myeloid leukemia (CML) patients receiving imatinib mesylate before undergoing allogeneic transplantation. Patients received imatinib for a minimum of three months, and these outcomes were compared to a historical cohort of 231 transplanted CML patients not receiving pre-transplant imatinib. There was no significant difference between the imatinib patients and the historical cohorts in overall survival, disease-free survival, relapse, and non-relapse mortality. Patients with a weak response to imatinib or who lost their response to imatinib before transplantation experienced a significantly higher hazard of mortality, which the researchers attributed to a more aggressive disease in these patients.
Oehler VG, et al. Blood 2006; E pub ahead of print, Oct. 24. (More) |
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Similar survival for reduced-intensity and conventional HCT for NHL
A report on a retrospective analysis of 88 non-Hodgkin's lymphoma patients undergoing allogeneic transplantation with myeloablative (n=48) or reduced-intensity (n=40) conditioning regimens. Regimens used fludarabine 125 mg/m2 and melphalan 140 mg/m2. Two-year overall survival was not significantly different in the conventional group (52%) versus the reduced-intensity group (53%), despite the reduced-intensity patients being older and having failed more prior autologous transplants. However, a regression analysis showed that reduced-intensity transplant patients had a significantly higher relative risk of relapse.
Rodriguez R, et al. Biol Blood Marrow Transplant 2006; 12(12): 1326-1334. (More) |
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Reduced-intensity HCT using unrelated donors for MDS
A prospective study of 75 successive myelodysplastic syndrome (MDS) patients transplanted using a reduced-intensity conditioning regimen consisting of fludarabine, busulphan and alemtuzumab. The median age of patients was 52 years (range, 19-68), with a median follow-up of 2.8 years. All transplants used unrelated donors. Three-year overall survival and disease-free survival was 43% and 41%, respectively, and the cumulative incidence of extensive chronic GVHD was 22%. The researchers conclude that reduced-intensity unrelated donor transplantation can result in durable long-term survival even in older MDS patients.
Lim ZY, et al. Br J Haematol 2006; 135(2): 201-209. (More) |
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Comparable outcomes of related and unrelated donor HCT in standard-risk patients
A prospective study of 236 consecutive patients with standard-risk hematologic malignancy has revealed similar outcomes in bone marrow transplants using unrelated HLA 10/10 allele-level matched donors and those using HLA-identical sibling donors. The study examined transplants from 2000-2003 at 12 French transplant centers using unrelated donors (n=55) and HLA-identical siblings (n=181). Two-year overall survival was 64.2% and 57.7% for sibling and unrelated donor transplants, respectively (p=0.551).
Yakoub-Agha I, et al. J Clin Oncol 2006; 24(36): 5695-5702. (More) |
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Similar results in related, unrelated transplantation for Wiskott-Aldrich syndrome
A retrospective analysis of 23 patients with Wiskott-Aldrich syndrome (WAS) from 1990 to 2005 at the University of Brescia, Italy, has shown no significant difference in survival between related and unrelated donor transplants. All transplants used myeloablative conditioning, with 16 patients receiving unrelated donor bone marrow and 7 patients receiving matched related bone marrow (n=6) or cord blood (n=1). No patients developed grade III or IV GVHD, and overall survival (OS) among all patients was 78.2% (18/23). Recipients of unrelated donor grafts had an OS of 81.2% (13/16). The authors conclude that unrelated donor marrow transplantation is an appropriate treatment when performed early in the clinical course of WAS.
Pai S-Y, et al. Bone Marrow Transplant 2006; 38(10): 671-679. (More) |
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Review: Cutaneous manifestations of chronic GVHD; early detection is crucial
The initial presentation of cutaneous chronic GVHD can be subtle, but early detection is crucial for successful treatment of this potential complication of hematopoietic cell transplantation. This review article describes the cutaneous manifestations of chronic GVHD, from early through late stages, and focuses on the lesional morphology of the disease. A classification system that may prove useful in early diagnosis is also presented.
Hymes SR, et al. Biol Blood Marrow Transplant 2006; 12(11): 1101-1113 (More)
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Review: Ex vivo expansion of cord blood stem cells
Ex vivo expansion of cord blood stem cells attempts to overcome the limitations imposed by the small number of hematopoietic cells in a cord blood graft, which can lead to delayed engraftment and an increase in post-transplant infections. Current expansion techniques have yet to significantly improve engraftment, most likely due to various defects in the expanded cells. This review examines current ex vivo expansion efforts and discusses the future of this technique, including the possible exploitation of newly discovered signaling pathways and intracellular mediators.
Hofmeister CC, et al. Bone Marrow Transplant 2007; 39(1): 11-23. (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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Post-transplant guides available
Download a checklist of recommended post-transplant screening and preventive practices for patients. From the NMDP's research partner, the CIBMTR.
Download guides |
New Medical Professional's Guide now available
Order the 6th edition of the NMDP's guide to hematopoietic cell transplantation. Designed for physicians and other health care professionals, this guide provides updated NMDP outcomes data, referral guidelines and an overview of the unrelated donor or cord blood unit search process.
Online order form |
NMDP symposium at ASH meeting
If you missed the NMDP's ASH Friday Satellite Symposium, Post-Transplant Patient Care, you can still get a copy of the program handout by e-mailing the NMDP at
rryan@nmdp.org |
NMDP GVHD audioconference now available online (CME) 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 |
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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