| Vol. 7, No. 3: May/June 2007 |
Cord blood transplant vs. bone marrow in pediatric acute leukemia
A study of 503 children (<16 years) with acute leukemia transplanted with cord blood compared with 282 patients transplanted with bone marrow. Data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the New York Blood Center were used in this retrospective analysis. Five-year probabilities of leukemia-free survival were 38% after HLA-matched marrow transplants, 37% after mismatched marrow transplants, 60% after HLA-matched cord blood transplants, and 45% after one-mismatched cord-blood transplants with high cell dose (>3.0 x 107/kg). The researchers conclude that their results "support the use of HLA-matched and one- or two-antigen HLA-mismatched umbilical cord blood in children with acute leukemia who need transplantation."
Eapen M, et al. Lancet 2007; 369(9577): 1947-1954. (More)
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Equivalent survival for sibling and unrelated donor HCT for AML
Unrelated donor grafts should be considered in acute myelogenous leukemia (AML) patients without a matched sibling donor, according to a study published in Biology of Blood and Marrow Transplantation. The study examined 105 AML patients (age 16-59 years) transplanted with unrelated donors (URD) and reported to the Australasian registry between 1992-2002. Outcomes were compared to a matching set of 105 HLA-matched sibling donor transplants. Five-year disease-free survival (DFS) was not significantly different for good-risk URD and sibling donor recipients (62% vs. 40%, p=0.2), or poor-risk URD and sibling recipients (21% vs. 25%, p=0.2). There was no significant difference between the URD and the sibling donor groups in the cumulative incidence of grade II-IV acute GVHD at 100 days.
Moore J, et al. Biol Blood Marrow Transplant; 13(5): 601-607. (More)
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New cytogenetic classification in AML and MDS better at predicting transplant survival
A multivariate analysis of the involvement of cytogenetics in survival, relapse, and non-relapse mortality of 556 de novo and therapy-related AML and MDS patients at a single institution. Based on the analysis, the researchers developed a three-group cytogenetic classification scheme that was the strongest prognostic factor for overall survival in patients. The classification was a superior determinant of outcome than disease type, conditioning regimen intensity, use of T-cell depletion or type of GVHD prophylaxis. The authors state that their results "underscore the necessity of stratifying patients by cytogenetics in clinical trials."
Armand P, et al. Biol Blood Marrow Transplant 2007; 13(6): 655-664. (More)
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Drug treatment is superior to allografting as first-line therapy in CML
A randomized study comparing hematopoietic cell transplantation (HCT) with drug treatment in newly diagnosed chronic phase CML patients treated at 29 European transplant centers between 1995-2001. Patients received either a related donor transplant (n=123) at a median of 10 months from diagnosis or best-available drug therapy (n=219), either interferon and hydroxyurea (pre-1999) or imatinib mesylate and other tyrosine kinase inhibitors (1999-2001). At a median observation time up of 8.9 years, survival was superior for patients with drug treatment (p=0.049), leading the researchers to conclude that allogeneic HCT as first-line treatment in chronic phase CML can no longer be maintained. In an accompanying editorial in Blood, Dr. François Guilhot notes that there is still a role for transplantation, writing that "... these new inhibitors could also be used for reducing the tumor burden before performing stem cell transplantation."
Hehlmann R, et al. Blood 2007; 109(11): 4686-4692. (More)
Guilhot F. Blood 2007; 109(11): 4592. (More)
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A novel regimen for allo-HCT in adult acute leukemia
A single-center report on a novel myeloablative conditioning regimen using fludarabine, daily intravenous busulfan and 400 cGy total body irradiation in 64 adults transplanted for acute myelogenous leukemia (AML; n=36) or acute lymphoblastic leukemia (ALL; n=28) in first and second remission. Thirty-one patients received matched related allografts, and 33 patients received grafts from either mismatched related donors (n=5) or unrelated donors (n=28). Three-year disease-free survival (DFS) for AML and ALL patients was 83% and 65%, respectively. There was no significant difference in DFS between related and mismatched related and unrelated donors. The research conclude that "this combination appears to offer a well-tolerated alternative to more conventional myeloablative regimens."
Russell JA, et al. Biol Blood Marrow Transplant 2007; 13(7): 814-821. (More)
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ATG may not improve BMT outcomes in severe aplastic anemia
Adding equine antithymocyte globulin (ATG) to a regimen of high-dose cyclophosphamide may not improve the outcome of patients with severe aplastic anemia (SAA), according to a Center for International Blood and Marrow Transplant Research (CIBMTR) study. Results from a prospective clinical trial of 134 SAA patients who received cyclophosphamide alone or in combination with ATG revealed no significant difference between the two groups in five-year overall survival: 80% (ATG) vs. 74% (no ATG) (p=0.44). Incidences of graft failure and GVHD were also comparable in the two groups. The authors note, however, that a larger study (n >300) would have a greater chance of detecting whether a difference truly exists between the two treatment groups.
Champlin RE, et al. Blood 2007; 109(10): 4582-4585. (More)
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Review: T-cell therapies following HCT
This review focuses on T-cell strategies currently available to treat disease while minimizing toxicities in patients who have undergone hematopoietic cell transplantation (HCT). Clinical applications using cytotoxic T cells after HCT are discussed, including unmanipulated donor T cells, allodepleted T cells, donor T cells inculcated with a suicide gene, ex vivo expanded T cells, cytokine-induced killer cells, antigen-specific cytotoxic T-lymphocyte (CTL) clones, Epstein-Barr virus-specific CTLs, and tumor-infiltrating lymphocytes.
Kennedy-Nasser AA, et al. Bone Marrow Transplant 2007; E pub ahead of print, May 14. (More)
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Review: Allogeneic HCT for aplastic anemia
A review discussing the two treatment strategies for patients with severe aplastic anemia (SAA): immunosuppressive therapy or hematopoietic cell transplantation (HCT). The salient features of immunosuppressive therapy and allogeneic HCT are discussed, including patient exclusions, relapse risk, relapse pattern, and early and late toxicities The authors provide recommendations for upfront treatment choices for several clinical scenarios.
Armand P, et al. Biol Blood Marrow Transplant 2007; 13(5): 505-516. (More)
Two recent clinical reports on treating SAA:
Maury S, et al. Haematologica 2007; 92(5): 589-596. (More)
Kim S-Y, et al. Biol Blood Marrow Transplant 2007; 13(7): 863-870. (More)
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Other journal articles of note:
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HCT and radiation incidents
The NMDP and ASBMT have created a Web site with guidelines and protocols to assist transplant physicians with comprehensive evaluation and treatment of victims of radiation exposure. Visit the Radiation Injury Treatment Network (RITN) Web site. |
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