| Vol. 8, No. 5: September/October 2008 |
Cord blood transplants co-infused with peripheral blood stem cells
Adults with high-risk disease transplanted with cord blood co-infused with third-party stem cells had a 5-year overall survival (OS) of 56%, according to a study to appear in Bone Marrow Transplantation. The 55 adults in the study had a median age of 34 years and received a median cord blood cell dose of 2.39 x 107 cells/kg, just under the consensus minimum cell dose of 2.5 x 107 cells/kg. Grafts were supplemented with mobilized hematopoietic stem cells from haploidentical donors (n=38) or related or unrelated donors (n=17). Patients <40 years had a 5-year OS and disease-free survival of 63% and 54%, respectively. The researchers state that their technique will permit lower-dose single cord blood units to be a first option for adult patients lacking an adult donor.
Bautista G, et al. Bone Marrow Transplant 2008; E-pub ahead of print, Oct. 13. (More)
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Comparing cord blood to mismatched unrelated donors
Despite more than 12 million volunteers listed on worldwide registries, some patients with rare HLA types may still not find a suitably matched donor. Although some receive haploidentical transplants, often the choice is between a mismatched unrelated donor and a cord blood graft. Results from a study comparing 27 cord blood transplants with 14 mismatched unrelated donor transplants show that cord blood may be the better choice. The study found that 3-year overall survival in cord blood recipients was 66% compared to 14% in the mismatched unrelated donor group (p=0.006).
Ringdén O, et al. Bone Marrow Transplant 2008; E-pub ahead of print, Sept. 1. (More)
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Related, unrelated HCT comparable for older adult AML
A multi-center study of 368 transplants found no significant difference in survival after unrelated and related donor transplants in adults >50 transplanted for acute myeloid leukemia (AML). Patients with normal cytogenetics in first complete remission (CR1) had 2-year event-free survival (EFS) of 64% (matched sibling donor) and 53% (unrelated donor). A multivariate analysis showed that both disease status and cytogenetic risk were highly significantly predictors of EFS and overall survival (p<0.001). Delaying transplant reduced survival: patients with normal cytogenetics beyond CR1 had 2-year EFS of 24% (matched sibling) and 33% (unrelated).
Schetelig J, et al. J Clin Oncol 2008; E-pub ahead of print, Sept. 2. (More)
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Comparable outcomes in related, alternative donor HCT for pediatric ALL
A study of 83 children with acute lymphoblastic leukemia (ALL) undergoing myeloablative hematopoietic cell transplantation (HCT) in first or second complete remission. Forty-one patients had matched sibling donors and 42 had alternate donors (31 matched unrelated, 9 mismatched, and 2 mismatched related donors). Conditioning was similar in the two groups, but the alternate donor group also received alemtuzumab. Three-year disease-free survival in the matched sibling group was 72% vs. 62% in the alternate donor group (p=0.232). The researchers conclude that myeloablative transplantation using alemtuzumab with alternative donors can result in survival comparable to transplant using matched sibling donors.
Kennedy-Nasser AA, et al. Biol Blood Marrow Transplant November 2008; 14(11): 1245-1252. (More)
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Sirolimus for GVHD associated with VOD after myeloablative transplantation
Sirolimus can effectively treat GVHD, but according to a new report it may also raise the incidence of veno-occlusive disease (VOD) when combined with other drugs used in transplantation. In a retrospective study of 488 myeloablative transplants, researchers found that sirolimus used with cyclophosphamide and total body irradiation significantly raises the incidence of VOD (OR 2.35, p=0.005). The incidence of VOD was also significantly increased when sirolimus was used with methotrexate (OR 3.23, p<0.001) and when used with busulfan-based conditioning (OR 8.8, P=0.008). However, sirolimus without methotrexate was not associated with an increased risk of VOD (OR 1.55, p=0.33).
Cutler C, et al. Blood 2008; E-pub ahead of print, Sept. 5. (More)
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Lower infection-related mortality after non-myeloablative HCT than after myeloablative HCT
In a retrospective single-center study of 141 consecutive transplants, there were fewer early post-transplant infections in lymphoma patients undergoing non-myeloablative transplantation (n=76) compared to patients transplanted after myeloablative conditioning (n=65). Before neutrophil engraftment, the non-myeloablative group had a 53% lower rate of bacterial infection (RR=0.47; p=0.06). After engraftment, the density of bacterial infections was similar in the two groups. The 1-year infection-related mortality was significantly lower in the non-myeloablative group than in the myeloablative group (9% vs. 22%, respectively; p=0.03).
Bachanova V, et al. Bone Marrow Transplant 2008; E-pub ahead of print, Sept. 22. (More)
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Non-myeloablative HCT can be effective in refractory CLL
This is a 5-year follow-up to an earlier 2-year report on non-myeloablative hematopoietic cell transplantation (HCT) in adults with fludarabine-refractory chronic lymphocytic leukemia (CLL). The 82 patients in this update had a median age of 56 years (range 42-72), and were transplanted using related (n=52) or unrelated (n=30) donors. At a median of 5 years post-transplant, overall survival was 50%. As noted in an accompanying editorial by Dr. J.G. Gribben, this 5-year median survival is notably better than the median survival time of less than 1 year experienced by fludarabine-refractory CLL patients not undergoing HCT.
Sorror ML, et al. J Clin Oncol 2008; 26(30): 4912-4920. (More)
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Review: Donor lymphocyte infusions
A review of the use of donor lymphocyte infusion (DLI) in allogeneic transplant recipients to: enhance the graft-versus-tumor effect, treat tumor recurrence, prevent disease relapse, or convert recipients from mixed- to full-donor chimerism. The authors make a distinction between therapeutic DLI and pre-emptive DLI, and review the medical literature on the use of DLI in specific diseases.
Tomblyn M, et al. Bone Marrow Transplant 2008; E-pub ahead of print, Aug. 18. (More)
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Review: Allogeneic HCT for Hodgkin lymphoma
This review examines recent data on using reduced-intensity allogeneic transplantation to treat the subset of Hodgkin lymphoma (HL) patients not cured by conventional therapy or who relapse after autologous transplantation. The authors evaluate the clinical evidence for a graft-versus-tumor response in HL and discuss prognostic factors to identify HL patients who could benefit most from allogeneic transplantation.
Peggs KS, et al. Br J Haematol 2008; 143(4): 468-480. (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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BBMT supplement marks 20th anniversary of NMDP
Order a free printed copy of the September supplement to BBMT, which highlights major advances and trends in unrelated transplants through the work of the NMDP.
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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
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ASH Annual Meeting
San Francisco, Calif.
December 6-8
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