| Vol. 7, No. 2: March/April 2007 |
ASBMT position statement on HCT in pediatric AML
American Society for Blood and Marrow Transplantation (ASBMT) guidelines on the role of hematopoietic cell transplantation (HCT) for pediatric (<21 yr.) acute myeloid leukemia (AML). The guidelines are based on a consensus reached by a panel of experts in pediatric AML, and include the role of 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, and the role of biologically targeted agents such as kinase inhibitors.
Biol Blood Marrow Transplant 2007; 13(4): 500-501. (More)
Based on: Oliansky DM, et al. Biol Blood Marrow Transplant 2007; 13(1): 1-25. (More)
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Multiple myeloma: Tandem allo-auto superior to tandem auto
Autologous transplant followed by a reduced-intensity allogeneic transplant from an HLA-identical sibling is superior to tandem autologous transplants, according to a study of 162 newly diagnosed multiple myeloma patients. After a median follow-up of 45 months, transplant-related mortality was not significantly different between the 80 autologous-allogeneic transplant patients and the 82 tandem autologous patients. However, disease-related mortality was significantly higher in the tandem autologous group than in the autologous-allogeneic group (43% vs. 7%, P<0.001). Median overall survival was longer in the autologous-allogeneic patients than in the tandem autologous patients (80 months vs. 54 months, p=0.01).
Bruno B, et al. N Engl J Med 2007; 356(11): 1110-1120. (More)
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Multiple myeloma: Similar results in reduced intensity vs. myeloablative
The strength of the conditioning regimen has no impact on survival in transplanted myeloma patients, according to a study published in Blood. In a study of 516 transplants reported to the European Group for Blood and Marrow Transplantation (EBMT), two-year overall survival was not significantly different between 196 patients receiving myeloablative conditioning and 320 patients receiving reduced-intensity conditioning (50% vs. 38%, respectively). Although a multivariate analysis revealed that reduced-intensity conditioning was associated with a reduction in non-relapse mortality, this was offset by increased relapse risk. In an analysis accompanying the article, Dr. Michele Cavo of the University of Bologna noted that "cytogenetics and molecular genetics should aid a more accurate identification of those patients who are more likely to benefit, or not, from nonmyeloablative allogeneic transplantation."
Crawley C, et al. Blood 2007; 109(8): 3588-3594. (More)
Cavo M. Blood 2007; 109(8): 3134-3135. (More)
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Patient age not a factor in reduced-intensity transplants in AML/MDS
A report on 112 high-risk acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) patients transplanted with reduced-intensity fludarabine/melphalan conditioning. Median age was 55 years (range 22-74), and transplants used related (53%) and unrelated (47%) donors. Two-year survival was 66% for patients in complete remission, 40% for patients with active disease without circulating blasts, and 23% for patients with active disease and circulating blasts at time of transplant. Incidence of non-relapse mortality (NRM) was significantly higher for patients with active disease, but was not influenced by patient age. Use of unrelated donors increased NRM risk only among patients with active disease.
Oran B, et al. Biol Blood Marrow Transplant 2007; 13(4): 454-462. (More) |
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Research agenda of the Blood and Marrow Transplant Clinical Trials Network
A review of the organizational structure, current portfolio of studies, and scientific agenda of the Blood and Marrow Transplant Clinical Trials Network (BMT CTN). The BMT CTN was established to facilitate prospective clinical trials for blood and marrow transplantation by designing and executing multi-center protocols. A major goal of the BMT CTN is to facilitate studies that address rare diseases and unique populations that cannot be well studied in individual centers. This review article also outlines ways in which investigators can propose trials and participate in the BMT CTN.
Weisdorf D, et al. Biol Blood Marrow Transplant 2007; 13(3): 257-262. (More) |
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Major ABO mismatch increases risk of graft failure in unrelated HCT
A report on 224 leukemia patients undergoing unrelated donor transplantation from 1991-2003 at the Karolinska University Hospital in Sweden. The study compared graft failure rates based on ABO, RhD, MNSs, and Kidd blood group antigen compatibility. Conditioning consisted of a busulfan-based myeloablative regimen or total-body irradiation. Six patients (2.7%) experienced graft failure. Graft failure rates were 7.5% and 0.6% (p=0.02), respectively, for patients with and without major ABO mismatch. Multivariate analyses revealed that major ABO mismatch (odds ratio 14.9, p=0.008) and HLA-allele mismatch (odds ratio 6.42, p=0.03) were significantly associated with graft failure.
Remberger M, et al. Biol Blood Marrow Transplant 2007; E pub ahead of print, April 13. (More) |
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Decision-making in pediatric HCT
A description of an individualized care planning and coordination (ICPC) model to facilitate effective and ethical decision-making in hematopoietic cell transplantation for pediatric patients. Three key elements of the ICPC model are: 1) Relationship (understanding the illness from the patient's perspective); 2) Negotiation (establishing goals of care); and 3) Plan (developing a comprehensive treatment plan). The ICPC model is designed to enhance communication among patients, families and clinicians, thereby reducing contentious family-staff interactions that can develop.
Baker JN, et al. Biol Blood Marrow Transplant 2007; 13(3): 245-254. (More) |
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Review: Strong graft-versus-leukemia effect in CLL
This review of relapse data after transplants for chronic lymphocytic leukemia (CLL) concludes that allogeneic transplantation in CLL evokes a strong graft-versus-leukemia (GVL) effect. Still unknown, however, is whether the GVL effect exists in settings where anti-leukemia effector cells and target CLL cells are genetically identical (except for leukemia-related mutations). It is therefore unknown whether immune-based therapy for CLL will work in non-allogeneic settings.
Ben-Bassat I, et al. Bone Marrow Transplant 2007; 39(8): 411-446. (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
Plan to attend this interactive session where the NMDP will solicit input from physicians and researchers involved in cord blood. Preceding the 5th International Umbilical Cord Blood Transplantation Symposium in Los Angeles, Calif., May 10, 2007.
More information |
BMT CTN State of the Science Symposium
The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) is sponsoring a "State of the Science" Symposium at the University of Michigan June 7-8, 2007. This symposium will identify the most compelling research opportunities for the BMT CTN.
Register online |
Post-transplant educational materials available
Ensure that your patients receive the post-transplant care they need. Order free materials from the NMDP:
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Life After Transplant Conference
Living Now - A Survivor's Conference on Life After Transplant is an NMDP conference for adult transplant recipients and others interested in getting the latest in post-transplant information. The conference is in two locations:
- San Francisco, Saturday, June 9
- Philadelphia, Saturday, June 16
Register online | |
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