| Vol. 8, No. 6: November/December 2008 |
Unrelated donor HCT: Factors associated with a better HLA match
This study of 7,486 marrow and peripheral blood stem cell transplants facilitated by the NMDP from 2000-2005 found that patients with intermediate- and late-stage disease had a significantly higher likelihood of using a partially matched or mismatched donor. Non-Caucasian patients were also more likely to have a less-matched donor than Caucasian patients. Over the years of the study, there was a progressive increase in well-matched donors and a decrease in mismatched donors. The researchers conclude that initiating a search early in the disease process will improve the likelihood of identifying the best available donor, especially for non-Caucasian patients.
Dehn J, et al. Biol Blood Marrow Transplant 2008; 14(12): 1334-1340. (More)
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Risk factors for outcomes after cord blood transplantation in adults with lymphoid malignancies
A study of 104 adult patients (median age 41 years, range 16-65) with lymphoid malignancies who underwent unrelated donor cord blood transplantation with one (n=78) or two (n=26) cord blood units. Eighty-seven percent of patients had advanced disease at time of transplant, and 60% had had a failed prior autologous transplant. One-year progression-free survival was 40%, and patients with chemosensitive disease had significantly improved survival (49% vs. 34%; p=0.03). Multivariate analyses revealed that chemosensitive disease, higher cell dose, and use of low-dose total-body irradiation were factors significantly associated with better transplant outcomes.
Rodrigues CA, et al. J Clin Oncol 2008; E-pub ahead of print, Dec. 8. (More)
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Risk factors for acute GVHD after cord blood transplant
A single-center study of 265 consecutive patients analyzing risk factors for acute GVHD in unrelated donor transplants using one (n=80) or two (n=185) cord blood units. A multiple regression analysis revealed three significant risk factors for developing grade II-IV acute GVHD: non-myeloablative conditioning, conditioning regimen without antithymocyte globulin, and use of two cord blood units. Despite a significantly higher incidence of grade II-IV acute GVHD in double cord recipients, 1-year transplant-related mortality was significantly lower in these recipients than in single cord recipients (24% vs. 39%, respectively; p=0.02).
MacMillan ML, et al. Blood 2008; E-pub ahead of print, Nov. 7. (More)
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Unrelated cord blood transplantation in adult AML
In this single-center study at the University of Tokyo, 77 adult patients with acute myelogenous leukemia (AML) received myeloablative transplants using single HLA-mismatched cord blood units. Median age of patients was 45 years (range 18-55), and median nucleated cell dose was 2.44 x 107/kg. Cumulative incidence of grade III-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD was 25.1% and 28.6%, respectively. Five-year transplant-related mortality and event-free survival was 9.7% and 62.8%, respectively.
Ooi J, et al. Biol Blood Marrow Transplant 2008; 14(12): 1341-1347. (More)
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In high-risk lymphoma, favorable outcomes using reduced-intensity transplantation
In a study of 48 lymphoma patients who had failed a median of five lines of prior therapy, researchers report "encouraging survival rates" using reduced-intensity transplants to treat this high-risk group. Patients had relapsed/refractory diffuse large B-cell lymphoma -- de novo disease (n=30) and transformed follicular lymphoma (n=18) -- and had a median age of 46 (range 23-64) years. Unrelated donors were used in 18 transplants, and sibling donors in 30. All patients successfully engrafted, and at a median follow-up of 52 months, rates of grade II-IV acute GVHD and extensive chronic GVHD were 17% and 13%, respectively. Four-year progression-free survival and overall survival rates were 48% and 47%, respectively.
Thomson KJ, et al. J Clin Oncol 2008; E-pub ahead of print, Dec. 8. (More)
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Improved transplant outcomes using sirolimus for GVHD prophylaxis
A study of 190 adult lymphoma patients comparing transplant outcomes of patients receiving sirolimus for GVHD prophylaxis (n=142) with patients transplanted using a calcineurin inhibitor and methotrexate, but without sirolimus (n=48). Both myeloablative and reduced-intensity conditioning regimens were used. Three-year overall survival was 63% in the sirolimus group compared with 41% in the no-sirolimus group (p=0.007). Sirolimus patients had a similar incidence of non-relapse mortality, but had a decreased incidence of disease progression compared with non-sirolimus patients (3-year cumulative incidence, 42% vs. 74%, respectively; p<0.001).
Armand P, et al. J Clin Oncol 2008; 26(35): 5767-5774. (More)
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Risk factors for solid cancers after allogeneic transplantation
The latest update to an ongoing large-scale, long-term study examining risk factors for solid cancers in patients following allogeneic bone marrow transplantation. Researchers analyzed 28,874 transplants between 1964 and 1994 reported to the Center for International Blood and Marrow Transplant Research (n=23,542), or between 1969 and 1996 at the Fred Hutchinson Cancer Research Center (n=5,332). Overall, new solid cancers appeared at twice the rate expected based on general population rates (Observed/Expected ratio: 2.1). Multivariate analyses revealed three significant risk factors for developing second solid cancers: Total-body irradiation (Relative Risk: 1.75), limited field irradiation (RR: 2.95), and moderate to severe chronic GVHD (RR=1.55). The researchers state that their results indicate the need for lifelong surveillance of transplant recipients.
Rizzo JD, et al. Blood 2008; E-pub ahead of print, Oct. 29. (More)
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Review: Graft-versus-leukemia effects and donor lymphocyte infusions
This ASH 50th Anniversary Review outlines the underlying physiology of the graft-versus-leukemia (GVL) effect in allogeneic transplantation and how its strength varies by disease, disease stage, donor histocompatibility, degree of chimerism, and additional treatment. Also reviewed are efforts to use donor lymphocyte infusions (DLI) to bring about a GVL effect without producing graft-versus-host disease. The strength of the GVL effect in CML, CLL, AML/MDS, multiple myeloma, and solid tumors is also discussed, as are the clinical results of using DLI in these diseases.
Kolb H-J. Blood 2008; 112(12): 4371-4383. (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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Supported by an unrestricted educational grant from Otsuka America Pharmaceutical, Inc., provided to the National Marrow Donor Program through The Marrow Foundation, the funding partner of the NMDP.
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Slides from NMDP symposium at ASH available online
This year�s NMDP-sponsored symposium, Allogeneic transplantation: Applying new research for improved outcomes, was standing-room only. Online access to slides presented at the symposium is now available.
View Symposium slides
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Access the latest data and tools on transplantation
Visit the NMDP booth at the BMT Tandem Meetings and get a 2GB USB drive that will plug you in to the latest transplant tools and data, including:
- Improved transplant outcomes
- Post-transplant guidelines
- Free patient materials
- Medical education programs
BMT Tandem Meetings
Tampa, Fla.
February 11-15, 2009
Meeting agenda
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Optimizing cord blood transplantation
Save the date: Plan to attend the NMDP Session at the BMT Tandem Meetings, where three leaders in the field will speak on optimizing cord blood transplantation from the perspectives of:
- A transplant center
- A registry
- A cord blood bank
Saturday, Feb. 14, 10:30 a.m.
Tampa Convention Center
Tampa, Fla.
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New related donor cord blood program
Learn about a new program allowing families to store the umbilical cord blood of a new baby to treat a biological sibling or parent with a diagnosed disease. Eligible families can access this program at no cost.
More information
Order brochure
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The NMDP and 20 years of advances in unrelated transplant
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.
Order supplement
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