| Vol. 7, No. 4: July/August 2007 |
Non-myeloablative cord blood transplants in adults
A report on 110 adult patients (median age 51 years) who underwent non-myeloablative transplantation using one or two units of umbilical cord blood (UCB). Seventeen patients had a matching UCB with cell dose >3.0 x 107 nucleated cells/kg and received one UCB unit, 93 patients received a second partially HLA matched UCB unit. Median time to neutrophil recovery was 12 days, and three-year survival and event-free survival were 45% and 38%, respectively. The authors conclude the use of UCB after a non-myeloablative conditioning is an acceptable strategy for extending the availability of transplant therapy, particularly for older patients.
Brunstein CG, et al. Blood 2007; E pub ahead of print, June 14. (More)
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Cord blood transplants in Fanconi anemia patients
A retrospective study of cord blood transplantation in 93 Fanconi anemia patients with a median age of 8.6 years. The median number of nucleated cells infused by recipient weight was 4.9 x 107/kg. Cumulative incidence of grade II-IV acute and of chronic GVHD was 32% and 16%, respectively. Overall survival was 40%, and in a multivariate analysis, favorable outcome was associated with use of Fludarabine in the conditioning regimen, nucleated cell dose ≥4.9 x 107/kg, and negative cytomegalovirus in the recipient. The authors note that easily modifiable factors such as graft selection and choice of conditioning regimen can considerably improve survival in Fanconi anemia patients receiving cord blood transplants.
Gluckman E, et al. Biol Blood Marrow Transplant 2007; 13(9): 1073-1082. (More)
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Improved transplant outcome in young adults with AML
The overall survival of de novo acute myeloid leukemia (AML) patients in first complete remission undergoing allogeneic bone marrow transplantation has almost doubled in the past two decades, according to results of a study published in Bone Marrow Transplantation. The study examined outcomes of 170 patients with a median age of 29 years (range 1-47) who underwent an allogeneic bone marrow transplantation, 80 patients before 1990 and 90 patients after 1990. At a median follow-up of 13 years, transplant-related mortality was 30% before and 7% after 1990 (p<0.001), and actuarial 10-year survival was 42% before and 79% after 1990 (p<0.00001).
Vicente D, et al. Bone Marrow Transplant 2007; 40(4): 349-354. (More)
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Prior therapy does not affect transplant outcomes in MDS/AML
Patients transplanted for secondary myelodysplastic syndrome (MDS) or MDS transformed to acute myeloid leukemia (tAML) had similar outcomes to patients transplanted for de novo MDS/tAML, according to a study published in Blood. The study examined outcomes of 257 MDS/tAML patients with a median age of 43 years (range 3-72) who were compared with results of 339 patients who received transplants for de novo MDS/tAML. A multivariate analysis did not detect significant differences in outcome between the two groups. Relapse incidence was significantly lower (p=0.003) and relapse-free survival significantly higher (p=0.02) with unrelated donor transplants.
Chang CK, et al. Blood 2007; 110(4): 1379-1387. (More)
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Autologous and unrelated donor transplant outcomes similar in MDS/AML
A study comparing the outcome of 593 patients with myelodysplasia (MDS) and secondary acute myeloid leukemia (sAML) undergoing either autologous transplantation or allogeneic transplantation from a matched unrelated donor. In the allogeneic group, 167 patients were transplanted without prior chemotherapy and 136 were transplanted in first complete remission (CR1). All 290 patients in the autologous group were transplanted in CR1. Three-year overall survival was best in the allogeneic CR1 group (50%), followed by the autologous CR1 patients (41%) and the unrelated donor patients transplanted without prior chemotherapy (40%). The authors conclude that both autologous and matched unrelated donor transplantation offer the possibility of long-term survival to patients with MDS/sAML.
Al-Ali HK, et al. Leukemia 2007; E pub ahead of print, July 5. (More)
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Mesenchymal stem cells can enhance engraftment
Infusing mesenchymal stem cells (MSCs) at the time of transplant can result in 100% donor chimerism and fast neutrophil and platelet engraftment, according to a study published in Leukemia. The study examined seven patients, three of whom had prior graft failure, receiving MSCs together with allogeneic grafts. The MSC donors were HLA-identical siblings (n=3) or haploidentical (n=4), and the conditioning was myeloablative in four patients and reduced-intensity in three. Both neutrophil engraftment (>0.5 x 109/L) and platelet engraftment (>30 x 109/L) were reached at a median of 12 days. One patient died of aspergillosis; six patients are alive and well.
Le Blanc K, et al. Leukemia 2007; 21(8):1733-1738. (More)
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Daclizumab for GVHD associated with increased risk of infection
A study of the long-term effects of daclizumab has concluded that although it is active in steroid-refractory GVHD, it is also associated with significant morbidity and mortality due to infectious complications. The retrospective study examined 57 patients who underwent allogeneic stem cell transplantation between 1993-2000 and were treated with daclizumab for steroid-refractory acute GVHD, receiving a mean number of five doses (range 1-22). GVHD was assessed at baseline, day 15, 29, and 43. although 54% of patients had an improvement in their overall GVHD score by day 43, opportunistic infections developed in 95% of patients and 43 patients (75%) died following treatment with daclizumab. In 79% of the cases, death was due to active GVHD and infection.
Perales M-A, et al. Bone Marrow Transplant 2007; E pub ahead of print, July 9. (More)
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Transplantation in multiple myeloma: Auto or allo? Single or tandem? Ablative or non-ablative?
Three recent journal articles review treatment advances in multiple myeloma and outline optimal treatment strategies:
- A review by S. Pant et al focuses on newer and better induction regimens, analysis of results with autologous and allogeneic transplantation, and the development of risk-adapted stratification. Also reviewed are quality of life issues, reduced-intensity allogeneic transplantation, and sequential autologous and non-ablative allogeneic transplantation.
- A review by J-L Harousseau et al examines the role of allogeneic vs. autologous transplants in the management of multiple myeloma. A focus of the review is a recently published Italian study showing improved event-free survival in patients undergoing autologous transplantation to reduce tumor mass followed by reduced-intensity allogeneic transplantation.
- A review by N Kröger focuses on how to harness the graft-versus-myeloma effect and target molecular remission after allogeneic stem cell transplantation.
Pant S, et al. Biol Blood Marrow Transplant 2007; 13(8): 877-885. (More)
Harousseau J-L, et al. Bone Marrow Transplant 2007; E pub ahead of print, August 6. (More)
Kröger N. Leukemia 2007; E pub ahead of print, June 14. (More)
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Other journal articles of note:
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NMDP symposium at ASH
Save the date: The NMDP symposium The Future of Clinical Research in HCT: Reports from the 2007 State of the Science Symposium will take place December 7, 7-11 a.m. at the Georgia World Congress Center in Atlanta. |
RITN Seminar Sept. 25
The Radiation Injury Treatment Network (RITN) is sponsoring an all-day seminar on the medical challenges that would arise due to an ionizing radiation event. The seminar is September 25, in Bethesda, Md.
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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