| Vol. 7, No. 6: November/December 2007 |
Matched sibling HCT in CR1 best for adults with ALL
The final report of an international collaboration that prospectively evaluated allogeneic transplantation in adults with acute lymphoblastic leukemia (ALL) and compared standard chemotherapy with autologous transplantation. Results of the 1,913 patients enrolled in the MRC UKALL XII/ ECOG E2993 trial showed that patients randomized to chemotherapy had a significantly higher five-year overall survival (OS) than those randomized to autologous transplant (46% vs. 37%, respectively), but that the highest five-year OS (53%) was achieved in Ph- ALL patients who underwent matched sibling transplantation. The researchers concluded that matched related transplants for ALL in first complete remission "provide the most potent anti-leukemic therapy and considerable survival benefit for standard-risk patients."
Goldstone AH, et al. Blood 2007; E pub ahead of print, Nov. 29. (More)
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Similar survival with autologous, unrelated donor transplants for ALL in CR1
A study of 260 adult acute lymphoblastic leukemia (ALL) patients in first (CR1) or second (CR2) complete remission undergoing autologous transplant (n=101) or unrelated donor transplant (n=159). Patient data sets came from the National Marrow Donor Program (unrelated donor transplants) and the Center for International Blood and Marrow Transplant Research (autologous transplants). Relapse was higher in autologous transplants, and one-year treatment-related mortality was higher in unrelated donor transplants. Five-year leukemia-free survival in CR1 patients was similar for autologous transplantation (37%) and unrelated donor transplantation (39%). A non-significant trend was found favoring unrelated donor transplantation for patients in CR2.
Bishop MR, et al. Bone Marrow Transplant 2007; E pub ahead of print, Dec. 17. (More)
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PBSC vs. BM unrelated transplantation: Higher GVHD with PBSC, similar survival
This study compared outcomes of 331 unrelated donor peripheral blood stem cell (PBSC) and 586 bone marrow (BM) transplants in adults with leukemia and myelodysplastic syndrome (MDS). At a median of three years, grades II-IV acute graft-versus-host disease (GVHD) were significantly higher in PBSC recipients (58%) than in BM recipients (45%) (p<0.001). Incidence of chronic GVHD was also significantly higher in the PBSC group (56% vs. 42%; p<0.001). However, three-year treatment-related mortality, leukemia recurrence, leukemia-free survival, and overall survival were similar in the PBSC and BM groups. The researchers state that these results are in contrast to the survival advantage seen in patients with advanced leukemia undergoing transplant using PBSC grafts from HLA-matched sibling donors.
Eapen M, et al. Biol Blood Marrow Transplant 2007; 13(12): 1461-1468. (More)
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Allo-HCT better than immunosuppressive therapy as second-line treatment in pediatric SAA
Children with severe aplastic anemia (SAA) who fail to respond to an initial course of immunosuppressive therapy (IST) have significantly higher survival if they then undergo allogeneic transplantation rather than receive a second course of IST. Results from a prospective multicenter study in Japan show that five-year failure-free survival (survival with response) was 83.9% in 31 transplanted patients and 9.5% in 21 patients receiving a second course of IST (p<0.0001). Graft sources were HLA-matched unrelated donors (n=25), HLA-mismatched related donors (n=4) and one-antigen mismatched umbilical cord blood units (n=2).
Kosaka Y, et al. Blood 2007; E pub ahead of print, Nov. 7. (More)
Related article: Significant improvement in outcome of unrelated HCT for SAA. (More) |
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In treating acute GVHD, etanercept with steroids better than steroids alone
This study compared 61 transplant recipients with acute GVHD who received steroids plus etanercept to 99 controls receiving steroids alone. The two groups were matched with respect to age, conditioning, donor, degree of HLA match, and severity of GVHD at onset. The 61 patients treated with etanercept and steroids had a significantly higher rate of complete responses than patients treated with steroids alone (69% vs. 33%, respectively; p<0.0001). Adding etanercept significantly improved complete response rates in transplant recipients of both related donors (79% vs. 39%, p=0.001) and unrelated donors (53% vs. 26%, p=0.0005).
Levine JE, et al. Blood 2007; E pub ahead of print, Nov. 27. (More)
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Comparable outcomes after related and unrelated non-myeloablative transplants
A retrospective study of non-myeloablative transplantation for hematological malignancies at the Fred Hutchinson Cancer Research Center from 1997-2006 found no statistically significant difference between unrelated (n=184; 67% >50 yrs.) and related (n=221; 66% > 50 yrs.) transplant recipients in risk of non-relapse mortality, relapse, or overall mortality. The incidence of severe acute and extensive chronic GVHD also was not significantly different between the related and unrelated donor groups.
Mielcarek M, et al. Biol Blood Marrow Transplant 2007; 13(12): 1499-1507. (More) |
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Non-myeloablative HCT in relapsed, refractory, and transformed indolent NHL
A multicenter study of 62 patients with relapsed, refractory, or transformed indolent non-Hodgkin's lymphoma (NHL) treated with non-myeloablative allogeneic hematopoietic cell transplantation (HCT) using related (n=34) or unrelated (n=28) donors. Median age was 54 years, and patients had received a median of six lines of prior treatment. Three-year overall survival was 52% for patients with indolent disease, and 18% for patients with transformed disease. The researchers conclude that non-myeloablative transplantation "can produce durable disease-free survival in patients with relapsed or refractory indolent NHL, even in this relatively elderly and heavily pretreated cohort."
Rezvani AR, et al. J Clin Oncol 2007; E pub ahead of print, Dec. 3. (More) |
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Review: Allogeneic HCT using mismatched/haploidentical donors
Because virtually every patient needing a transplant has at least one HLA partially matched parent, sibling or child, haploidentical transplantation is often considered when a patient cannot find an HLA-matched related or unrelated donor or cord blood unit. However, haploidentical transplants can have higher rates of GVHD, infectious complications, and treatment-related morbidity and mortality. This review discusses the recent advances that have improved outcomes in haploidentical stem cell transplantation, including effective T-cell depletion, using "megadoses" of stem cells, earlier detection of severe infections, better antimicrobial therapy and reduced-intensity conditioning.
Koh L-P, et al. Biol Blood Marrow Transplant 2007; 13(11): 1249-1267. (More) |
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Review: HCT for primary immunodeficiency disease
A review of hematopoietic stem cell transplantation for primary cellular immunodeficiency syndromes diagnosed in children, including SCID, Wiskott-Aldrich syndrome, familial hemophagocytic lymphohistiocytosis, Chediak-Higashi syndrome, severe congenital neutropenia, and chronic granulomatous disease. Factors affecting transplant outcomes are discussed, including stem cell sources, conditioning regimens, infections, GVHD prophylaxis, and newborn screening.
Dvorak CC, et al. Bone Marrow Transplant 2007; E pub ahead of print, Oct. 29. (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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New Quick-Reference Guidelines
Developed by the NMDP in consultation with several leading transplant organizations, these new guidelines contain:
- NMDP/ASBMT referral guidelines
- Post-transplant screening and preventive practices
- Screening for chronic GVHD, including photo atlas
Order online |
Outcomes in unrelated vs. related transplantation: Applying new data for referral and decision-making
Are there differences in outcomes between related and unrelated donors? Dr. Dennis Confer, NMDP Chief Medical Officer, answers this question and more in a live CME Webinar on Jan. 30, 2008, 11:30 a.m. - 12:30 p.m. CST.
Register online |
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 | |
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