| Vol. 9, No. 1: January/February 2009 |
ASBMT evidence-based review: The role of HCT in MDS
A systematic evidence-based review by the American Society for Blood and Marrow Transplantation (ASBMT) of hematopoietic cell transplantation in adults with myelodysplastic syndromes (MDS). The report includes a summary of treatment recommendations for MDS unanimously agreed upon by a panel of MDS experts. Topics covered include the role of risk-group stratification, pre-transplantation induction chemotherapy, the selection of patients for transplant and non-transplant options, the appropriate timing and use of alternative donors, and the role of hypomethylating and immunomodulatory treatment regimens.
Oliansky DM, et al. Biol Blood Marrow Transplant 2009; 15(2): 137-172. (More)
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Transplant better than chemotherapy in high-risk AML patients in CR1
A study of high-risk acute myeloid leukemia (AML) found that patients undergoing allogeneic transplantation had significantly higher overall survival than a cohort receiving consolidation chemotherapy. The study examined 77 high-risk AML patients in first complete remission (CR1) transplanted with a related or unrelated donor between 1996 and 2004. Two-year overall survival was significantly higher in the transplant group than in the chemotherapy group (52% vs. 24%, respectively; p=0.005). Transplanted patients had a significantly lower relapse incidence (39%) than patients who received chemotherapy (77%) (p=0.0005).
Basara N, et al. Leukemia 2009; E-pub ahead of print, Jan. 8. (More)
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Minimal residual disease a strong predictor of outcomes in pediatric ALL
Minimal residual disease (MRD) quantified pre-transplant using real-time polymerase chain reaction can predict outcome in children with relapsed acute lymphoblastic leukemia (ALL). In this study of 91 children transplanted with relapsed ALL, patients with no detectible or very low MRD had significantly higher event-free survival than patients with intermediate or high MRD: 60% vs. 27%, respectively; p=0.004. Cumulative incidence of relapse was also significantly lower in the no or low MRD group (13%) compared to the intermediate/high MRD group (57%) (p<0.001).
Bader P, et al. J Clin Oncol 2009; 27(3): 377-384. (More)
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Long-term control of HIV by HCT using a donor selected for an allele deletion
A case study of a hematopoietic cell transplant resulting in long-term control of HIV infection in a 40-year-old HIV+ patient with acute myeloid leukemia. The graft used came from a donor specifically selected for having a 32-bp deletion in the CCR5 allele, which is known to provide resistance against HIV-1 acquisition. The researchers tested 61 HLA-matched donors before finding one with the CCR5 deletion. The patient has discontinued antiretroviral therapy and has had no detectable proviral HIV DNA in tissue specimens at 20 months post-transplant.
Hütter G, et al. N Engl J Med 2009; 360(7): 692-698. (More)
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Unrelated transplant outcomes approach related outcomes in first chronic phase CML
A large-scale study of 4,566 patients with chronic myeloid leukemia (CML) in first chronic phase reported to the CIBMTR that compared transplant outcomes of HLA-A, -B, -C, and DRB1 allele-matched (8/8) related or unrelated donors and 7/8 matched unrelated donors transplanted between 1988-2003. Unrelated donor transplants were facilitated by the NMDP. Five-year overall survival after 8/8 unrelated and 8/8 related transplant was 55% and 63%, respectively (p<0.001). The authors note that because of the large number of patients studied, the differences in unrelated and related transplant outcomes reach statistical significance, but in absolute terms the differences are modest.
Arora M, et al. J Clin Oncol 2009; E-pub ahead of print, Feb. 17. (More)
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Myeloablative vs. autologous transplant in adults with ALL in CR1
This prospective sibling donor versus no-donor comparison demonstrates that adult patients with standard-risk acute lymphoblastic leukemia (ALL) in first complete remission (CR1) have significantly better outcomes after allogeneic transplantation than after autologous transplantation and other treatments. In this study, 91 patients underwent transplantation with a sibling donor and were compared to 161 patients without a sibling donor, the majority of whom underwent autologous transplantation (n=123) or allogeneic transplantation with an unrelated donor (n=29). Five-year disease-free survival was significantly better in the allogeneic transplantation than in the no sibling donor group: 60% vs. 42%, respectively (p<0.01).
Cornelissen JJ, et al. Blood 2009; 113(6): 1375-1382. (More)
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Review: G-CSF for myeloid malignancies
G-CSF is often given to speed neutrophil recovery after allogeneic blood or marrow transplantation, where it can reduce the frequency and duration of febrile neutropenia and infections. However, post-transplant G-CSF has never been conclusively proven to produce a survival benefit in recipients. This review focuses on the conflicting evidence used to appraise the utility of post-transplant G-CSF administration.
Battiwalla M, et al. Bone Marrow Transplant 2009; E-pub ahead of print, Feb. 2. (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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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 with a diagnosed disease. There is no charge to eligible families to have the cord blood collected and stored.
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Clinical decision-making resource for unrelated transplantation
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The NMDP and 20 years of advances in unrelated transplant
Order a free printed copy of the September 2008 supplement to BBMT, which highlights major advances and trends in unrelated transplants through the work of the NMDP.
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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
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