| Vol. 8, No. 4: July/August 2008
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Unrelated donor transplants in adults with Ph- ALL in CR1
A retrospective study of 169 patients with Philadelphia-negative acute lymphoblastic leukemia (ALL) in first complete remission (CR1) transplanted between 1995 and 2004 and reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). More than 90% of patients were at high risk. Five-year treatment-related mortality, relapse, and overall survival were 42%, 20%, and 39%, respectively. The researchers discuss the multivariate analysis and also compare these outcomes to historical studies using chemotherapy and sibling donors. An accompanying editorial by Dr. Jacob Rowe notes that "overall survival is significantly better than what one would expect from high-risk ALL patients who would be treated without transplantation."
Marks DI, et al. Blood 2008; 112(2): 426-434. (More)
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Effect of prior imatinib therapy on the outcome of HCT for CML
Imatinib mesylate (IM) is the preferred first-line therapy for chronic myelogenous leukemia (CML), but many CML patients will eventually undergo hematopoietic cell transplantation (HCT) due to IM resistance or non-response. To determine whether IM affects HCT outcomes, researchers analyzed transplants reported to the CIBMTR of CML patients transplanted with (n=409) or without (n=900) prior IM therapy. A matched-pairs analysis revealed that patients in first chronic phase who received IM prior to HCT have better survival than those who did not receive IM before HCT. In patients with advanced CML, there were no differences in transplant-related mortality, relapse, leukemia-free survival, or survival. The researchers conclude that their results "should be reassuring to patients receiving IM before HCT."
Lee SJ, et al. Blood 2008; E-pub ahead of print, July 29. (More)
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Novel reduced-toxicity conditioning for advanced hematologic malignancies
A report of 133 patients with a median age of 55 years (range 23-73) with advanced hematologic malignancies transplanted using a reduced-toxicity conditioning regimen of fludarabine, BCNU, and melphalan. At a median follow-up of 58 months, 3-year overall survival (OS) was 53% and event-free survival (EFS) was 46%. In univariate and multivariate analyses, no significant differences in OS and EFS were found regarding disease status (early vs. advanced), patient age (<55 vs. >55 years), or donor type (related vs. unrelated). Non-relapse mortality after 100 days and 1 year was 16% and 26%, respectively, which the researchers characterized as "low" for this high-risk patient cohort, and feasible for older patients or those with a higher degree of comorbidities.
Marks R, et al. Blood 2008; 112(2): 415-425. (More)
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Factors influencing cord blood transplant outcomes for inherited metabolic disorders
A study of 159 pediatric patients with inherited metabolic disorders transplanted with unrelated donor cord blood using a myeloablative conditioning regimen. Median age was 1.5 years, median weight was 12 kg, and median infused cell dose was 7.57 x 107/kg recipient weight. High donor-chimerism (>90%) was achieved in 97% of recipients and grade III/IV acute GVHD occurred in 10.3%. Overall survival (OS) in all patients at 1 and 5 years post-transplant was 72% and 58%, respectively. In patients with high performance scores (Lansky 80-100), 1- and 5-year OS was 85% and 76%, respectively.
Prasad VK, et al. Blood 2008; E-pub ahead of print, June 27. (More)
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COBLT results: Cord blood transplantation in pediatric patients with hematologic malignancies
A report of the first prospective, multi-center national trial of unrelated donor cord blood transplants. The report summarizes the outcomes of 191 children with hematologic malignancies receiving cord blood transplants between 1999 and 2003 as part of the Cord Blood Transplantation Study (COBLT). Median age of patients was 7.7 years (range 0.9-17.9), and median weight was 25.9 kg (range 7.5, 118.4). Median total infused nucleated cell dose was 3.9 x 107/kg (range 0.8-22.8). Patients received identical cytoreduction, GVHD prophylaxis, and supportive care. Median times to neutrophil and platelet engraftment were 27 and 174 days, respectively, and 6-month and 2-year survival were 67.4% and 49.5%, respectively.
Kurtzberg J, et al. Blood 2008; E-pub ahead of print, Aug. 21. (More)
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Assessing donor options for African Americans needing unrelated donor HCT
Given the high frequency of rare and uncommon polymorphisms in the African-American population plus donor availability rates, identifying an HLA-matched unrelated donor for this population requires innovative donor search strategies, according to an analysis by the University of Chicago. The report summarizes results of 51 adult donor searches of the NMDP Registry between 2002 and 2007, and a current retrospective analysis of potential cord blood units in the NMDP Registry. The retrospective search of the NMDP Registry for unrelated cord blood units yielded a median of 14 potentially matched cord blood units (4/6 or higher) for 98% of the patients. The authors conclude that "the wide availability and speedy acquisition of unrelated umbilical cord blood units creates an attractive resource for patients without an appropriate unrelated donor."
Dew A, et al. Biol Blood Marrow Transplant 2008; 14(8): 938-941. (More)
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WHO classification and WPSS predict outcome in transplanted MDS patients
The World Health Organization (WHO) classification of myelodysplastic syndrome (MDS) combined with the WHO Prognostic Scoring System (WPSS) can predict MDS transplant outcomes, according to a study in Blood. In a multivariate analysis of 365 patients with MDS or AML transformed from MDS transplanted at 41 Italian transplant centers from 1990-2006, the WHO classification showed a significant effect on overall survival (OS) (p=0.017) and probability of relapse (p=0.01). In addition, transfusion dependence, one of the factors in the WPSS, was significantly associated with a reduced OS (p=0.01) and increased transplant-related mortality (p=0.037).
Alessandrino EP, et al. Blood 2008; 112(3): 895-902. (More)
Related article: A flow cytometric scoring systems in MDS. (More)
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Impact of HLA-DPB1 allelic and single amino acid mismatches on HCT
A study of HLA matching in unrelated donor transplant outcomes has demonstrated a significant association between HLA-DPB1 allele mismatches and increased incidence of acute GVHD and lower overall survival. This study of 161 unrelated donor transplant recipients also showed that a mismatch at amino acid position 69 significantly increased the risk for transplant-related mortality. Risk factors for acute GVHD also included mismatches at positions 8, 9, 35, 76 and 84. The authors note that their study is the first to demonstrate an in vivo effect of single amino acid mismatches on hematopoietic cell transplant outcomes.
Ludajic K, et al. Br J Haematol 2008; 142(3): 436-443. (More)
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Review: Hematopoietic cell transplantation for NHL
This review assesses the progress over the past 25 years for hematopoietic cell transplantation (HCT) to treat non-Hodgkin's lymphoma (NHL). The author describes current outcomes by type of lymphoma, and the role for reduced-intensity allogeneic transplantation. Ongoing research studies and needed research are also discussed.
Appelbaum FR. J Clin Oncol 2008; 26(18): 2927-2929. (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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Online CME Webinar: MDS Treatment Advances
Learn the latest advances in both drug and transplant therapies for myelodysplastic syndrome (MDS).
Presented by Drs. Corey Cutler and Richard Stone of the Dana-Farber Cancer Institute.
Register for CME program
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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.
NMDP ASH Symposium: Friday, Dec. 5, 2008, 7:00 a.m.
San Francisco, California
More information
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