| Vol. 8, No. 2: March/April 2008 |
Degree of match, timing matter in unrelated HCT for pediatric SAA
A report from the Center for International Blood and Marrow Transplant Research (CIBMTR) on 195 children with acquired severe aplastic anemia (SAA) who underwent unrelated donor hematopoietic cell transplantation (HCT) between 1989 and 2003. Five-year probabilities of overall survival were 57% for 8/8 matched transplants and 39% for mismatched transplants (p=0.008). Higher mortality rates were observed in recipients with poor performance scores, after mismatched transplants, and when the interval between diagnosis and transplant was >4 years. The authors conclude that unrelated HCT is an acceptable alternative for children with SAA who fail immunosuppressive therapy and lack an HLA-matched sibling donor. The authors also conclude that early referral for transplantation leads to better outcomes.
Perez-Albuerne ED, et al. Br J Haematol 2008; 141(2): 216-223. (More)
|
 |
The importance of histology in reduced-intensity HCT for lymphomas
A single-center retrospective analysis of 36 patients transplanted for advanced Hodgkin disease and 51 transplanted for non-Hodgkin lymphoma (NHL) between 2000 and 2006. All 87 patients were conditioned with fludarabine and low-dose I.V. busulfan, and 59 (68%) had undergone prior autologous transplantation. The one-year cumulative incidence of non-relapse mortality was 13%. Three-year overall survival was 56% for patients with Hodgkin disease, 81% for indolent NHL, 42% for aggressive NHL, and 40% for mantle cell lymphoma. A multivariate analysis identified indolent NHL as a favorable factor for overall survival and progression-free survival. Advanced age and elevated pre-transplantation lactate dehydrogenase (LDH) were identified as adverse factors. The authors conclude that reduced-intensity transplantation earlier in the disease course may be warranted for patients with relapsed indolent NHL.
Armand P, et al. Biol Blood Marrow Transplant 2008; 14(4): 418-425. (More)
|
| |
Non-myeloablative, myeloablative outcomes similar in HCT for lymphoma
A report on 141 consecutive patients at a single institution transplanted between 1997 and 2004 for non-Hodgkin and Hodgkin lymphoma using myeloablative (MA) or non-myeloablative/reduced intensity (NMA) conditioning. NMA patients had more advanced disease and 30 (39%) NMA patients had previously received one or more autologous transplants. Although patients in the MA group had significantly higher one-year treatment-related mortality than NMA patients (43% vs. 17%, respectively; p<0.01), they had a lower risk of relapse at three years (11% vs. 36%, respectively; p<0.01). There were no significant differences between the MA and NMA groups in four-year overall survival (46% vs. 49%, respectively; p=0.34).
Tomblyn M, et al. Biol Blood Marrow Transplant 2008; 14(5): 538-545. (More)
|
| |
HCT for aggressive T-cell lymphomas in adults
A study of 77 adult patients transplanted for aggressive T-cell lymphomas and reported to the French bone marrow registry. Fifty-seven patients (74%) received myeloablative conditioning and 31 patients (40%) were in complete remission at time of transplant. Five-year overall survival (OS) was 57%, and event-free survival was 53%. Five-year OS was significantly higher in patients transplanted in complete remission or partial response (69%) compared to patients transplanted with stable or progressive disease or in relapse (29%) (p<0.0003). Patients with two or fewer lines of chemotherapy also had significantly higher OS at five years than patients having more than two lines of chemotherapy (73% vs. 39%, respectively; p=0.003). The authors conclude that adult patients with aggressive T-cell lymphomas may benefit from HCT at an early stage in the chemosensitive disease course.
Le Gouill S, et al. J Clin Oncol 2008; E pub ahead of print, April 7. (More)
|
| |
No significant late cognitive and academic sequelae after HCT in children
Hematopoietic cell transplantation "entails minimal risk of late cognitive and academic sequelae," according to a study of pediatric patients evaluated before admission and at 1, 3, and 5 years post-transplant using three age-appropriate neurocognitive and academic tests. Fifty-nine percent (158 of 268) of the patients were evaluable at 1-year post-transplant. The researchers reported no significant post-transplant changes in academic achievement and global intelligence quotient in the cohort as a whole. However, socioeconomic status (SES) was a significant determinant of all cognitive and academic outcomes, with lower SES groups having a significantly higher risk for neurocognitive sequelae compared to high SES groups.
Phipps S, et al. J Clin Oncol 2008; 26(12): 2027-2033. (More)
|
| |
Contingency planning for radiological and nuclear events
Because myelosuppression is a common complication of radiation exposure, hematologists and oncologists will likely be called upon to manage radiation victims in the aftermath of a large event such as a nuclear detonation. In a disaster response, there may also be a countrywide call for surge capacity that involves hematologists/oncologists. This article describes how the Radiation Injury Treatment Network (RITN) has assembled transplant centers, donor centers and umbilical cord blood banks to develop treatment guidelines, educate healthcare professionals, coordinate situation response and provide comprehensive evaluation and care for radiation injury victims.
Weinstock DM, et al. Blood 2008; E pub ahead of print, Feb. 20. (More) |
| |
Two Reviews: Applying transplant for adults with AML
Two reviews on hematopoietic cell transplantation for adults with acute myelogenous leukemia (AML), currently the leading indication for allogeneic transplantation worldwide.
Hamadani M, et al. This review focuses on the appropriate role and timing of allogeneic and autologous transplantation in AML through a critical analysis of the literature. The review discusses recent advances in allogeneic transplantation for adults with AML, and provides evidence-based recommendations for timing of a donor search and application of allogeneic transplantation for patients in first and second complete remission (CR).
Craddock CF. This review focuses on a discussion of advances in treating AML, including the role and timing of myeloablative or reduced-intensity conditioning regimens. The author summarizes the application of allogeneic transplantation for AML patients in first and second CR, and in advanced-phase disease. (Editor's note: All 10 articles in the issue of Bone Marrow Transplantation in which this review appears are on transplantation for acute leukemia.)
Hamadani M, et al. Biol Blood Marrow Transplant 2008; 14(5): 556-567. (More)
Craddock CF, et al. Bone Marrow Transplant 2008; 41(5): 415-423. (More) |
| |
Review: HCT in Hurler syndrome
Hematopoietic cell transplantation (HCT) is the only treatment that can prevent the progression of central nervous system disease in Hurler syndrome patients. Topics covered in this review include the clinical outcome of transplanted Hurler syndrome patients, limitations of HCT in Hurler syndrome, and clinical factors believed to contribute to the variable outcome of HCT for this disease. The review focuses on the long-term outcome and complications of transplanted Hurler syndrome patients.
Aldenhoven M, et al. Biol Blood Marrow Transplant 2008; 14(5): 485-498. (More) |
| |
Other journal articles of note:
|
| |
Advances in Transplantation is an electronic newsletter published six times a year by the Medical Education Team of the National Marrow Donor Program (NMDP).
This newsletter is sent only to those
individuals who have requested it.
To unsubscribe or change your subscription options,
see link at the bottom of this newsletter.
E-mail your comments or suggestions | |
|
New clinical decision-making resources for unrelated transplantation
Two free NMDP educational resources discussing factors that have led to improved outcomes for unrelated donor transplantation, and how this new information ultimately affects clinical decision-making:
|
Slides available: Transplant State of the Science
View slides from the NMDP-sponsored symposium reporting on the 2007 State of the Science Symposium. This NMDP symposium was held prior to the annual meeting of the American Society of Hematology.
View slides |
New Guidelines for Transplant Consultation and Post-Transplant Care
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 | |
| THANK YOU FOR SIGNING UP! |
Thank you for subscribing to Advances in Transplantation.
To unsubscribe or change your subscription options, see link at the bottom of this newsletter. | | |
