Vol. 9, No. 5: September/October 2009
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Evidence-based guidelines for preventing post-transplant infectious complications
An update of guidelines published in 2000 for preventing infections among hematopoietic cell transplantation (HCT) recipients developed by an international group of experts in infectious diseases, HCT, and public health. The guidelines are evidence-based, consensus recommendations on preventing and controlling bacterial, viral, and fungal infections. They also include recommendations on graft safety, rare infections, infection control and prevention in health care facilities, safe living after transplantation, and vaccinations.
Tomblyn M, et al. Biol Blood Marrow Transplant 2009; 15(10): 1143-1238. (More)
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Race, socioeconomic status affect HCT outcomes
Low socioeconomic status (SES), regardless of race, has a negative impact on HCT outcomes, according to a study of 6,207 unrelated transplants between 1995-2004 reported to the Center for International Blood and Marrow Transplant Research. Patient income was estimated from residential ZIP code. The study also showed that African Americans (but not Asian or Hispanic) had worse overall survival (relative-risk: 1.47; p<0.001) compared to Whites. The authors remark that inferior outcomes among African Americans are not fully explained by transplant-related factors or SES, and that other factors such as genetic polymorphisms may also be important.
Baker KS, et al. Biol Blood Marrow Transplant 2009; E-pub ahead of print Sept. 14. (More)
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Overall good QOL of adult survivors of childhood HCT
The majority of adult survivors of a childhood hematopoietic cell transplant (HCT) function as well as non-transplant controls on many quality of life (QOL) measures, according to a new study. The study measured the physical function, psychological function and cognitive symptoms of 214 transplant recipients (median age at transplant was 11.9 years). Of note, transplant recipients were more likely than controls to report continuing difficulties in physical functioning and depression. The authors state that QOL for future patients could be improved by better and more detailed informed consent, and by developing survivorship programs with rehabilitation and education interventions.
Sanders JE, et al. Bone Marrow Transplant 2009; E-pub ahead of print Aug. 31. (More)
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Comparing allogeneic and autologous HCT in pediatric NHL
A study comparing autologous and allogeneic transplantation in 182 children with refractory or recurrent pediatric non-Hodgkin lymphoma (NHL) found no significant differences in outcomes based on transplant type, except in lymphoblastic lymphoma. After adjusting for disease status, five-year event-free survival (EFS) was similar after allogeneic and autologous transplant for diffuse large B cell (50% vs. 52%), Burkitt (31% vs. 27%), and anaplastic large cell lymphoma (46% vs. 35%). However, EFS was significantly higher for lymphoblastic lymphoma after allogeneic transplant: 40% vs. 4%; p<0.01).
Gross TG, et al. Biol Blood Marrow Transplant 2009; E-pub ahead of print Oct. 1. (More)
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Private umbilical cord banking not cost-effective
Private umbilical cord blood banking results in an additional $1.3 million per life-year gained, according to a new study, and is only cost-effective when, because of family medical history, the likelihood of a child needing a transplant is greater than 1 in 110 (>0.9%). The researchers made their calculations using long-term, large-scale population data predicting a 0.04% lifetime chance of requiring an autologous transplant and a 0.07% chance of a sibling requiring an allogeneic transplant.
Kaimal AJ, et al. Obstetrics & Gynecology 2009; 114(4): 848-855. (More)
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HCT comorbidity index predicts outcomes in high-risk MDS, AML
A retrospective study of 128 consecutive adults transplanted using an alemtuzumab-based reduced-intensity conditioning regimen shows that a transplant-specific comorbidity index (HCT-CI) can effectively identify patients with a high risk of inferior transplant outcomes. Patients had a median age of 53 years (range 21-72) and had high-risk myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML). Survival was significantly different based on HCT-CI score, with three-year disease-free and overall survival of 58 and 69% (score 0), 39 and 39% (score 1-2) and 24 and 32% (score greater than or equal to 3), respectively.
Lim ZY, et al. Bone Marrow Transplant 2009; E-pub ahead of print Sept. 21. (More)
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ATG with cyclosporine, methotrexate can decrease GVHD
A prospective, randomized trial of 201 transplant recipients has shown that adding rabbit antithymocyte globulin (ATG) to a GVHD prophylaxis of cyclosporine and methotrexate can significantly reduce the incidence of acute and chronic GVHD. The decreased GVHD did not increase relapse or non-relapse mortality, and did not compromise overall survival. Cumulative incidence of grade II-IV acute GVHD was 33% in the ATG group versus 51% in the non-ATG group (p=0.011). Two-year cumulative incidence of extensive chronic GVHD was 12.2% versus 42.6% in the ATG and non-ATG groups, respectively (p<0.0001).
Finke J, et al. Lancet Oncol 2009; 10(9): 855-864. (More)
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Reduced-intensity allo-HCT in adults with myelofibrosis
A multi-center study of 103 adults with myelofibrosis transplanted between 2002-2007 using a reduced-intensity conditioning regimen resulted in a five-year event-free and overall survival of 51% and 67%, respectively. Patients were a median age of 55 years (range 32-68) and received a busulfan- and fludarabine-based reduced-intensity regimen. Transplants used related (n=33) or unrelated donor (n=70) grafts. Grade II-IV acute GVHD and chronic GVHD occurred in 27% and 43% of patients, respectively. One-year non-relapse mortality was 16% and was significantly lower for patients with a completely matched donor: 12% vs. 38% (p=0.003).
Kroger N, et al. Blood 2009; E-pub ahead of print Oct. 7. (More)
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Severe sickle cell disease: pathophysiology and therapy
A review of the current knowledge of the pathophysiology of sickle cell disease and an analysis of the medical and psychosocial cost of supporting patients with this chronic illness. The authors outline how advances in allogeneic transplantation and post-transplant care have led to increased use of this treatment modality in both children and adults with sickle cell disease. The authors conclude that better methods to predict the course of sickle cell disease will likely improve outcomes by optimizing transplant timing.
Buchanan G, et al. Biol Blood Marrow Transplant 2009; E-pub ahead of print Oct. 12. (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 Be The Match FoundationSM, the funding partner of the NMDP.
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Updated 2009 Clinical Guidelines
The NMDP has updated its Quick Reference Guidelines, which are now available online:
Or pick up printed copies at NMDP booth #142 Dec. 5-7 at the ASH Annual Meeting.
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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
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New CME programs on HCT
The NMDP is offering three new CME programs on:
- Comparing related, unrelated outcomes
- Factors that influence outcomes, graft choices
- Advances in HLA matching
Learn more | |
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