| Vol. 9, No. 2: March/April 2009 |
Rituximab prior to HCT may improve survival in B cell lymphoma
A retrospective study of 435 B cell lymphoma patients transplanted between 1999-2004 and reported to the CIBMTR (Center for International Blood and Marrow Transplant Research). Patients received rituximab within 6 months prior to transplant (n=179) or not (n=256). The rituximab cohort had a significantly lower incidence of treatment-related mortality, lower grade II-IV acute GVHD, and lower grade III-IV acute GVHD. There was no difference in the risk of chronic GVHD. Progression-free survival (RR=0.68; p=0.01) and overall survival (RR=0.63; p=0.004) were significantly better in the rituximab cohort.
Ratanatharathorn V, et al. Br J Haematol 2009; E-pub ahead of print, March 26. (More)
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Allo-HCT better than chemotherapy in Ph+ ALL
A report from the UKALLXII/ECOG 2993 prospective study evaluating the outcomes of allogeneic HCT (related or unrelated donor) with chemotherapy in Ph+ acute lymphoblastic leukemia patients below the age of 55 achieving complete remission. Five-year overall survival (OS) in the 267 patients studied was comparable following sibling transplant and unrelated donor transplant (44% vs. 36%, respectively; p=ns). Five-year OS was 19% following chemotherapy alone, which was significantly lower than both types of allogeneic transplantation (p=0.0002).
Fielding AK, et al. Blood 2009; E-pub ahead of print, Feb. 24. (More)
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Cost comparison in HCT: Matched related donor vs. cord blood
A study comparing the costs of HCT within the first 100 days in recipients of matched related (MR) and umbilical cord blood (CB) transplants using myeloablative and non-myeloablative regimens. The median cost per day survived (excluding costs of graft acquisition) was highest with myeloablative CB ($2,082), followed by non-myeloablative CB ($1,156), MR myeloablative ($1,016), and MR non-myeloablative ($612). The researchers conclude that the higher cost of CB transplantation is primarily driven by severe post-transplant complications, graft failure, and prolonged inpatient stay, and note that strategies to enhance engraftment will likely decrease costs.
Majhail NS, et al. Biol Blood Marrow Transplant 2009; 15(5): 564-573. (More)
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Conditioning, time to transplant affect CBT outcomes in Hurler syndrome
A study of 93 Hurler syndrome patients undergoing cord blood transplantation that resulted in 3-year event-free survival (EFS) and overall survival of 70% and 77%, respectively. In a multivariate analyses, use of a Bu/Cy conditioning regimen and a shorter interval from diagnosis to transplant were predictors for improved EFS (82% for patients transplanted within 4.6 months after diagnosis compared to 57% for the rest). The researchers concluded that cord blood transplantation "should be considered expediently for children with Hurler syndrome."
Boelens JJ, et al. Biol Blood Marrow Transplant 2009; 15(5): 618-625. (More)
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Mobilized PBSC donation: procedure generally safe, complete recovery universal
A report on 2,408 unrelated peripheral blood stem cell (PBSC) donors prospectively evaluated by the National Marrow Donor Program between 1999 and 2004. Six percent of donors experienced grade III-IV CALGB toxicities and 0.6% experienced toxicities that were considered serious and unexpected. The study found that complete recovery is universal, however, and identified no late adverse events attributable to donation. The researchers conclude that "PBSC collection in unrelated donors is generally safe, but nearly all donors will experience bone pain, 1 in 4 will have significant headache, nausea, or citrate toxicity, and a small percentage will experience serious short-term adverse events."
Pulsipher MA, et al. Blood 2009; 113(15): 3604-3611. (More)
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Long-term survival after unrelated donor HCT for NHL
An analysis of 283 patients undergoing unrelated donor myeloablative HCT for non-Hodgkin lymphoma (NHL) facilitated by the Center for International Blood and Marrow Transplant Research/National Marrow Donor Program (CIBMTR/NMDP) between 1991 and 2004. The estimated 5-year survival was 24%. Follicular lymphoma and peripheral T cell lymphoma had improved survival compared to aggressive B cell lymphomas. Risk of disease recurrence was increased 5-fold (RR=5.74, p=0.002) for those undergoing transplant with refractory disease. The researchers conclude that unrelated donor transplant can be a treatment option for patients with high-risk, recurrent, or refractory lymphoma, particularly for those with good performance status and chemosensitive disease.
van Besien K, et al. Biol Blood Marrow Transplant 2009; 15(5): 554-563. (More)
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Review: Quality of life after allo-HCT
A review summarizing longitudinal studies of quality of life (QOL) after allogeneic hematopoietic cell transplantation (HCT). The reviewers note that early moderate impairments largely return to pre-transplant levels by day 100, and that a majority of studies suggest that more than 60% of patients report good to excellent QOL 1-4 years post-transplant. The review examines levels of physical, emotional, social, and role functioning after allo-HCT, and compares QOL after allo-HCT to QOL after auto-HCT and standard-dose chemotherapy, and to matched non-cancer controls.
Pidala J, et al. Blood 2009; E-pub ahead of print, March 31. (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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NMDP Registry renamed
Be The Match RegistrySM
The NMDP Registry has been renamed the Be The Match Registry. More than just a new name, it is a new approach to engaging the public to join the registry and donate cord blood to serve all patients in need of a transplant.
Learn more
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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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Clinical decision-making resource for unrelated transplantation
Get this free NMDP resource discussing factors that have led to improved outcomes for unrelated donor transplantation, and how this new information ultimately affects clinical decision-making.
Download Clinical Fact Sheet
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