Vol. 9, No. 3: May/June 2009
|
Allo-HCT has significant survival benefit for intermediate- and poor-risk CR1 AML patients
A meta-analysis of prospective trials comparing allogeneic hematopoietic cell transplantation (HCT) to non-transplant therapies for acute myeloid leukemia (AML) in first complete remission (CR1). Overall, 24 trials and 6,007 patients were analyzed, including 3,638 patients classified by cytogenetic risk (547 good, 2,499 intermediate, and 592 poor). The study found a significant overall survival and relapse-free survival benefit of allogeneic HCT for poor-risk and intermediate-risk AML, but not for good-risk AML. The authors conclude that poor- and intermediate-risk AML patients in CR1 should preferably undergo allogeneic HCT rather than autologous transplantation or consolidation chemotherapy.
Koreth J, et al. JAMA 2009; 301(22): 2349-2361. (More)
|
|
5-azacitidine in patients with MDS prior to transplant
A study of 30 myelodysplastic syndrome (MDS) patients receiving pre-transplant 5-azacitidine compared to 24 MDS patients who did not found no significant differences in outcomes. The 1-year estimates of overall survival, relapse-free survival and cumulative incidence of relapse were 47%, 41%, and 20% for 5-azacitidine patients and 60%, 51%, and 32%, respectively, for non-5-azacitidine patients. The authors conclude that 5-azacitidine does not appear to affect transplant outcomes, and may stabilize the disease to allow time for patients to reach transplant.
Field T, et al. Bone Marrow Transplant 2009; E-pub ahead of print, June 22. (More)
|
|
|
Acute GVHD responds to third-party mesenchymal stem cells and steroids
This study of 31 adult patients with grades II-IV GVHD resulted in a 77% complete response rate to treatment with corticosteroids and a laboratory preparation of unrelated, culture-expanded human mesenchymal stem cells (MSCs). Twenty-one patients had grade II, 8 had grade III, and 3 had grade IV acute GVHD. Ninety-four percent of patients had an initial response to treatment (77.4% complete response and 16.1% partial response). The researchers conclude that third-party human MSCs are safe and may effectively treat acute GVHD, but a randomized trial is warranted "to fully investigate these encouraging results."
Kebriaei P, et al. Biol Blood Marrow Transplant 2009; 15(7): 804-811. (More)
|
|
|
Transplantation for recurrent and refractory Hodgkin's lymphoma in pediatric patients
A study of 91 children and adolescents with relapsed or refractory Hodgkin's lymphoma (HL) has shown that allogeneic transplantation can benefit these patients. This study of the European registry of pediatric HL transplants from 1987-2005 found 2- and 5-year overall survival (OS) of 54% and 45%, respectively. Patients with good performance status and treatment-sensitive disease transplanted since 2001 had a 3-year OS of 83% and progression-free survival of 60%.
Claviez A, et al. Blood 2009; E-pub ahead of print, June 4. (More)
|
|
|
Reduced-intensity HCT in pediatric patients ineligible for myeloablative therapy
A Pediatric Blood and Marrow Transplant Consortium study of 47 high-risk pediatric patients with hematological malignancies ineligible for myeloablative transplantation. Patients were conditioned with IV busulfan, fludarabine and ATG, and received marrow (n=18), peripheral blood stem sells (n=17) or single cord blood units (n=12). At a median follow-up of 24 months, 2-year event-free survival, overall survival, transplant-related mortality (TRM), and relapse were 40%, 45%, 11%, and 43%, respectively. The researchers conclude that reduced-intensity transplantation "offers a distinct advantage of low TRM to patients relapsing after a first myeloablative regimen who obtain a second remission."
Pulsipher MA, et al. Blood 2009; E-pub ahead of print June 15. (More)
|
|
|
Reduced-intensity conditioning with TLI and ATG results in low risk of GVHD, sustained remission
A study of 111 reduced-intensity transplants after a conditioning regimen of total lymphoid irradiation (TLI) and anti-thymocyte globulin (ATG), a regimen that favors regulatory natural killer T-cells in the host. The 3-year overall and event-free survival was 60% and 40%, respectively. Cumulative incidence of grade II-IV acute GVHD was 2% and 10% in patients transplanted with related and unrelated donors, respectively. Non-relapse mortality at 1 year was less than 4%. Cumulative incidence of chronic GVHD was 27%. The researchers conclude that because this approach resulted in a high sustained remission among patients with active disease, it suggests retained graft-versus-tumor reactions.
Kohrt HE, et al. Blood 2009; E-pub ahead of print, May 7. (More)
|
|
|
Review: Natural killer cells in allo-HCT
This review describes the role of alloreactive natural killer (NK) cells in hematopoietic cell transplantation, which can have favorable effects on relapse and survival, but also adverse outcomes related to relapse, infection and GVHD. The authors present a brief update of NK cell biology, and then summarize the current understanding of the role of NK cells in mediating and modulating engraftment, as well as the graft-versus-host and graft-versus-tumor responses.
Gill S, et al. Biol Blood Marrow Transplant 2009; 15(7): 765-776. (More)
|
|
|
Other journal articles of note:
|
|
|
Advances in Transplantation is an electronic newsletter published six times a year by the Medical Education Team of the National Marrow Donor Program (NMDP).
This newsletter is sent only to those
individuals who have requested it.
To unsubscribe or change your subscription options,
see link at the bottom of this newsletter.
E-mail your comments or suggestions
|
|
|
Supported by an unrestricted educational grant from Otsuka America Pharmaceutical, Inc., provided to the National Marrow Donor Program through the Be The Match FoundationSM, the funding partner of the NMDP.
|
|
NMDP marks 3,000th cord blood transplant
The NMDP has now facilitated more than 3,000 cord blood transplants, double the number just two years ago. The NMDP has more than 100,000 cord blood units listed on its Be The Match Registry®.
Learn more
|
Save the Date: NMDP Symposium at ASH
Plan to attend the NMDP symposium prior to the ASH annual meeting: Navigating the Therapeutic Pathways for AML and MDS.
December 4, 7:00-11:00 a.m.
New Orleans Convention Center
Learn more
|
|
| THANK YOU FOR SIGNING UP!
|
Thank you for subscribing to Advances in Transplantation.
To unsubscribe or change your subscription options, see link at the bottom of this newsletter.
|
|
|
