| Vol. 7, No. 5: September/October 2007 |
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High-resolution HLA matching improves success of unrelated transplant
High-resolution donor-recipient matching at HLA-A, -B, -C, and -DRB1 (8/8 match) is associated with higher rates of survival, according to a large-scale National Marrow Donor Program study published in Blood. This study examined 3,857 unrelated donor transplants from 1988-2003 facilitated by the NMDP. Low- to intermediate-resolution HLA typing did not provide adequate information for the selection of an unrelated donor. The study showed that if a fully allele-matched 8/8 donor is not available, then single mismatches at HLA-B or -C appear to be better tolerated than single HLA-A or -DRB1 mismatches. Mismatching at HLA-DP or -DQ alleles had no significant effect on survival. The researchers noted that although HLA matching is important for improving the success of unrelated donor transplantation, patient factors such as patient age, CMV status, disease diagnosis, disease stage and patient race remain the most critical factors of survival, with disease stage being the only patient factor that physicians can control by transplanting patients earlier in the course of their disease.
Lee SJ, et al. Blood 2007; E pub ahead of print, Sept. 4. (More)
Related article: HLA-DPB1 mismatch increases acute GVHD, lowers relapse. (More)
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Reduced-intensity HCT for MDS provides durable disease control
There is no significant difference in survival between related and unrelated donor transplants using reduced-intensity conditioning in high-risk myelodysplastic syndrome patients, according to a study published in Bone Marrow Transplantation. Patients in this study received fludarabine and melphalan followed by a stem cell graft from an HLA-identical sibling (n=19) or unrelated donor (n=24). Median age was 58 years (range 30-71) and all but two patients were IPSS category intermediate or high-risk. Two-year overall survival was 53.5%, disease-free survival was 51.2%, and there was no significant survival difference between related and unrelated donor recipients, although relapse rate was significantly higher in the related donor cohort (38.5%) compared to the unrelated donor cohort (7%) (p=0.02).
Nakamura R, et al. Bone Marrow Transplant 2007; 40(9): 843�850. (More)
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Lower relapse in unrelated vs. related marrow HCT for pediatric ALL
A single-center study of related (n=37) and unrelated (n=36) donor bone marrow transplantation in pediatric patients with acute lymphoblastic leukemia (ALL). Three-year cumulative relapse rates for the related and unrelated donor groups were 55.6% and 22.0%, respectively (p=0.03), which the researchers attributed to a stronger graft-versus-leukemia effect from the unrelated grafts. Three-year overall survival was 62.3% for unrelated and 49.1% for related donor cohorts (p=0.5).
Gassas A, et al. Bone Marrow Transplant 2007; E pub ahead of print, Sept. 17. (More) |
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Report: 2007 State of the Science Symposium
A report on the June 2007 Blood and Marrow Transplant Clinical Trials Network (BMT CTN) State of the Science Symposium that identified the most compelling clinical research opportunities that exist in blood and marrow transplantation. The report summarizes discussions at the symposium and identifies eleven high-priority clinical trials that participants in the BMT CTN plan to focus on in the next several years.
Ferrara JLM, et al. Biol Blood Marrow Transplant 2007; 13(11): 1268-1285. (More)
Related conference: NMDP Symposium at ASH. (More)
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Strategies to improve non-myeloablative transplant outcomes
A retrospective study of 834 consecutive non-myeloablative related (n=498) or unrelated (n=336) donor transplants between 1997-2006 at 15 transplant centers. Median age of patients was 55 years (range 5-74). Patients were conditioned with 2 Gy total body irradiation alone (n=171) or combined with fludarabine (n=663). Patients with the lowest relapse rates per patient year (0.00-0.24) were those with chronic lymphocytic leukemia and multiple myeloma in complete remission, low-grade or mantle cell non-Hodgkin lymphoma (NHL), and high-grade NHL in complete remission. Patients with advanced myeloid and lymphoid malignancies had the highest remission rates (>0.52). The researchers conclude that when using non-myeloablative conditioning regimens, transplantation should be considered earlier in the disease course when tumor burden is lower and that patients with advanced myeloid and lymphoid malignancies might benefit from cytoreductive treatment before transplantation.
Kahl C, et al. Blood 2007; 110(7): 2744-2748. (More) |
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Similar outcomes of cryopreserved, fresh allogeneic PBSC grafts
A single-center comparison of 105 related-donor transplants using cryopreserved peripheral blood stem cells (PBSC) with 106 historic unfrozen controls found no significant difference in transplant outcomes, according to a study in Biology of Blood and Marrow Transplantation. Neutrophil and platelet engraftment, lymphocyte recovery, acute and chronic GVHD, disease recurrence, non-relapse mortality, and overall survival did not differ significantly depending on whether cryopreserved or fresh PBSC were used. The researchers conclude that it is "therefore reasonable to consider the option of cryopreserved allografts."
Kim DH, et al. Biol Blood Marrow Transplant 2007; 13(10): 1233-1243. (More) |
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Review: Second malignancies after allo-HCT
As the number of hematopoietic cell transplant (HCT) recipients surviving long-term grows, so does the recognition that these patients have a higher risk of developing second malignancies than the general population. This review discusses post-transplant lymphoproliferative disorder, the most prevalent second malignancy after allogeneic transplantation, and second solid malignancies, which can occur after both auto- and allo-HCT. The authors make recommendations on the systematic, prospective monitoring, and vigilant screening processes that can increase the long-term survival of transplant recipients.
Lowe T, et al. Biol Blood Marrow Transplant 2007; 13(10): 1121-1134. (More) |
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Review: Transplantation for sickle cell disease
Hematopoietic cell transplantation (HCT) is the only curative intervention that can restore normal hematopoiesis in sickle cell disease. However, the decision whether to transplant is made difficult because sickle cell disease is typically non-fatal in children with adequate supportive care. This review outlines advances in selecting donors, supportive care, and reduced-toxicity conditioning regimens, and concludes that HCT should be the preferred treatment option, especially in young sickle cell patients predicted to experience early mortality or a reduced quality of life.
Shenoy S, et al. Bone Marrow Transplant 2007; 40(9): 813�821. (More)
Related article: Related donor transplantation for sickle cell disease. (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 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.
More information |
Selecting donors and CBUs
Save the date: February 15, 2008. The NMDP session at the 2008 BMT Tandem Meetings is entitled Selecting donors and cord blood units: Evidence-based decisions.
San Diego, Calif., Feb. 13-17.
More information |
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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