| Vol. 8, No. 3: May/June 2008
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Allo-HCT in children with isolated CNS relapsed ALL
This study compared allogeneic transplantation outcomes in 116 children with relapsed acute lymphoblastic leukemia (ALL) involving the central nervous system (CNS) alone (n=14), the bone marrow (BM) alone (n=85), or both BM and CNS (n=17). At two years, no patients with isolated CNS relapse had died compared to 19% and 29% in the BM and BM+CNS groups, respectively (p=0.03). At five years post-transplant, leukemia-free survival in the isolated CNS patients, BM patients and BM+CNS patients was 91%, 35%, and 46%, respectively (p<0.01). The authors conclude that the use of allogeneic transplantation is warranted in children with poor-prognosis isolated CNS relapse.
Harker-Murray PD, et al. Biol Blood Marrow Transplant 2008; 14(6): 685-692. (More)
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Mesenchymal stem cells can effectively treat steroid-resistant acute GVHD
Mesenchymal stem cells (MSCs) can effectively treat allogeneic transplant recipients who have developed steroid-resistant severe acute GVHD, according to a study published in The Lancet. Patients in this study of 55 patients had a median age of 22 years (range 0.5-64) and received a median dose of 1.4 x 106 (range 0.4-9 x 106) MSCs per kg recipient weight. MSCs were obtained from HLA-identical sibling donors (n=5), haploidentical donors (n=18), and HLA-mismatched unrelated donors (n=69). Of the 55 patients, 30 (55%) achieved complete responses to MSC infusions, and eight more patients achieved a partial response for an overall response rate of 69%.
Le Blanc K, et al. Lancet 2008; 371(9624): 1579-1586. (More)
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Clinical and ethical issues of growth factors in normal donors
A report of a conference addressing the medical and ethical issues raised by asking healthy donors to accept a small, but not zero, physical risk when taking growth factors prior to hematopoietic cell donations. The focus of the conference was on G-CSF used prior to the collection of peripheral blood stem cells for use in allogeneic transplantation, but other growth factors discussed include erythropoietin, thrombopoietin, and AMD3100. The risks of growth factor-stimulated donations are evaluated in the context of the risks currently experienced by volunteer donors of whole blood, platelets, and marrow.
McCullough J, et al. Transfusion 2008; E-pub ahead of print, June 19. (More)
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Non-myeloablative or myeloablative HCT for follicular lymphoma
Non-myeloablative and myeloablative conditioning regimens yield comparable survival in patients transplanted for follicular lymphoma (FL), according to two recently published studies. In a study of 47 relapsed FL patients receiving non-myeloablative conditioning, the overall survival was 85% at a median follow-up of 60 months (range, 19-94). In another study of 37 patients with clinically high-risk FL undergoing myeloablative transplantation, at a median follow-up of 63.5 months the 5-year overall survival was 79.1%.
Khouri IF, et al. Blood 2008; 111(12): 5530-5536. (More)
Kuruvilla J, et al. Biol Blood Marrow Transplant 2008; 14(7): 775-782. (More)
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An etoposide-containing regimen in adult patients transplanted for ALL
A retrospective analysis of 37 adult patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic transplantation conditioned with etoposide phosphate (30 mg/kg), cyclophosphamide (120 mg/kg), and fractionated total-body irradiation (12 Gy). Ten patients were Philadelphia chromosome-positive (Ph+) and 35 patients were in complete remission at time of transplantation. At median follow-up of 35.1 months, 32 patients were alive, including all 10 Ph+ patients. Three-year overall survival, relapse rate, and transplant-related mortality were 89.2%, 8.1%, and 5.4%, respectively.
Shigematsu A, et al. Biol Blood Marrow Transplant 2008; 14(5): 568-575. (More)
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Allo-HCT for adults with Ph+ ALL in the era of tyrosine kinase inhibitors
This review describes the use of imatinib and other tyrosine kinase inhibitors in patients with Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL). By incorporating imatinib during the induction/consolidation phase in Ph+ ALL patients, physicians can increase the number of Ph+ ALL patients achieving complete remission prior to allogeneic transplantation. The authors also note that imatinib and other tyrosine kinase inhibitors combined with glucocorticoids and/or conventional chemotherapy can improve outcomes in Ph+ ALL patients ineligible for allogeneic transplantation.
Mourad YRA, et al. Biol Blood Marrow Transplant 2008; E-pub ahead of print, June 4. (More)
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ASH 50th anniversary review: Myelodysplastic syndromes
A review of myelodysplastic syndromes (MDS) discussing the molecular basis of MDS, clinical and laboratory features, classification schemes, and the clinical management of MDS patients. Clinical management options discussed include transfusions, hematopoietic growth factors, transcriptional modifying agents, immunomodulatory agents, chemotherapy, and allogeneic blood or marrow cell transplantation.
Nimer SD. Blood 2008; 111(10): 4841-4851. (More)
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Review: Selection of cord blood for transplantation
This review examines the clinical factors involved in selecting one or more optimal cord blood units for transplantation, particularly that a high cell dose at the time of transplant is critical for reliable engraftment and is the only factor that has been consistently associated with improved outcome. The review also explores other factors, including NIMA (non-inherited maternal) and NIPA (non-inherited paternal) alleles, and ABO mismatches. The authors also provide their institution�s algorithm for cord blood selection.
Wall DA, et al. Bone Marrow Transplant 2008; E-pub ahead of print, May 12. (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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Live CME Webinar: MDS Treatment Advances
Earn CME credit by learning about the latest advances in both drug and transplant therapies for myelodysplastic syndrome (MDS).
Monday, July 21, 2008
11:15 a.m.-12:30 p.m. CDT
Register online
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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:
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Allogeneic Transplantation: Applying New Research for Improved Outcomes
Discover the latest clinical advances in allogeneic transplantation that have expanded patient eligibility, improved outcomes, and stimulated a dramatic growth in transplantation.
Save the date:
NMDP ASH Symposium
Friday, Dec. 5, 2008, 7:00 a.m.
San Francisco, California
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