| Vol. 7, No. 1: January/February 2007 |
Read the ASH Special Edition of Advances in Transplantation (PDF). |
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ASBMT evidence-based review: Allo-HCT in children with AML
A systematic evidence-based review by the American Society for Blood and Marrow Transplantation (ASBMT) of hematopoietic cell transplantation in children with acute myeloid leukemia (AML). The report includes a summary of treatment recommendations for pediatric AML unanimously agreed upon by a panel of experts in pediatric AML. Topics covered include the role of risk-group stratification, including: cytogenetics in the selection of patients for transplant and non-transplant options, the appropriate timing and use of alternative donors, the role of reduced intensity transplants to maximize the graft-versus-leukemia effect, and the role of biologically targeted agents such as kinase inhibitors in the treatment of pediatric AML.
Oliansky DM, et al. Biol Blood Marrow Transplant 2007; 13(1): 1-25. (More)
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Transplant in advanced MDS using a cytarabine, G-CSF and TBI-based regimen
A retrospective study of total body irradiation (TBI), granulocyte colony-stimulating factor (G-CSF), and high-dose cytarabine as a conditioning regimen for advanced myelodysplastic syndrome (MDS) patients undergoing matched related (n=12) or unrelated (n=10) donor hematopoietic cell transplantation (HCT) at the Keio University School of Medicine, Tokyo. The conditioning regimen consisted of high-dose cytarabine (3 g/m2 every 12 h for 4 days) and 12 Gy TBI. Cytarabine was combined with a continuous infusion of G-CSF (5 �g/kg/d). The five-year estimated overall survival and disease-free survival are 76.7% and 72.2%, respectively. The relapse rate was 16.6% and the non-relapse mortality was 14.1%.
Mori T, et al. Bone Marrow Transplant 2007; 39(4): 217-221. (More)
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Cross reactive groups have no effect on HCT outcomes
HLA mismatching within or outside of cross reactive groups (CREG) has no significant effect on transplant outcomes, according to a study in Blood. This study of 2,709 bone marrow and peripheral blood stem cell transplants facilitated by the National Marrow Donor Program revealed that an HLA mismatch within a CREG group ("minor") and a mismatch outside CREG groups ("major") had no significant effect on engraftment, graft-versus-host disease and survival (p=0.47). Although HLA-A, -B, and -DRB1 allele-matched transplants had significantly better outcomes than mismatched transplants, outcomes for patients without an allele-matched donor were not improved by the selection of a CREG compatible donor.
Wade JA, et al. Blood 2007; E pub ahead of print, January 3. (More) |
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Short-term methotrexate may improve CBT outcomes
Short-term methotrexate administered as GVHD prophylaxis to adult cord blood transplant patients may lead to improved overall survival, according to a report published in Bone Marrow Transplantation. The study followed 77 adult cord blood transplant recipients at eight transplant centers in Japan between 2001 and 2005. In the 40 patients receiving post-transplant methotrexate (MTX), the last day of MTX administration was on day +7 (n=15), day +6 (n=24), or day +3 (n=1). The 180-day overall survival was 59% for patients receiving short-term MTX and 16% for patients not receiving MTX (p=0.0001).
Narimatsu H, et al. Bone Marrow Transplant 2007; 39(1): 31-39. (More) |
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Transplantation vs. chemotherapy in high-risk childhood ALL
Two studies offer differing conclusions on the treatment of pediatric high-risk acute lymphoblastic leukemia (ALL) patients. One study of 191 pediatric patients with high-risk T-cell ALL transplanted or treated with chemotherapy alone found a five-year disease-free survival (DFS) of 67% for transplant recipients and 42% for patients treated with chemotherapy alone (p=0.01) (Schrauder, et al).
Another study of 106 very high-risk children with ALL found no significant differences in five-year DFS for patients undergoing autologous transplantation (44%), allogeneic transplantation (45%), or chemotherapy (46%) (Ribera, et al).
Schrauder A, et al. J Clin Oncol 2006; 24(36): 5742-5749. (More)
Ribera J-M, et al. J Clin Oncol 2007; 25(1): 16-24. (More) |
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Treating refractory acute GVHD
Another in the series of "How I Treat..." articles appearing in Blood. One clinician's discussion of the treatment options for refractory acute GVHD, including increasing the dose of steroids, adding polyclonal or monoclonal antibodies, administering immunotoxins, initiating extracorporeal phototherapy, and intervening with newer immunosuppressive and chemotherapeutic agents. The author states that optimal results are obtained using custom-tailored therapy dependent on the time GVHD develops post-transplant, the organ(s) targeted, and the severity of the GVH reaction.
Deeg HJ. Blood 2007; E pub ahead of print, January 18. (More) |
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Review: The genomics of allogeneic HCT
This article reviews the non-HLA genomics of allogeneic stem cell transplantation and outlines possible ways to integrate genetic information into clinical transplantation. Topics covered include minor histocompatibility antigens, inflammatory mediators of GVHD, and allorecognition mediated by natural killer cells. Tools such as single nucleotide polymorphism arrays are discussed and their ability to predict those at risk of complications are assessed.
Mullighan CG, et al. Biol Blood Marrow Transplant 2007; 13(2): 127-144. (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 cord blood workshop
Save the date: May 10, 2007. Plan to attend this interactive session where the NMDP will solicit input from cord blood physicians and researchers. At the 5th International Umbilical Cord Blood Transplantation Symposium in Los Angeles, Calif.
Register online |
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 |
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.
Register online | |
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