In this installment of the “How I Treat” series in the journal Blood, the author outlines a treatment algorithm for patients presenting with chronic myeloid leukemia (CML) in blast crisis. Dr. Hehlmann recommends patients in blast crisis “be treated with a tyrosine kinase inhibitor according to mutation profile, with or without chemotherapy, with the goal of achieving a second chronic phase and proceeding to allogeneic stem cell transplantation as quickly as possible.”
Outcomes comparable in related, unrelated HCT in pediatric ALL
A study comparing 94 HLA-matched sibling hematopoietic cell transplant (HCT) outcomes with 168 unrelated marrow and 86 cord blood transplant outcomes in high-risk pediatric acute lymphoblastic leukemia (ALL) has found comparable leukemia-free survival (LFS) among the groups. HCT recipients were between 1-15 years old, and had ALL in second complete remission (CR). Three-year LFS was 50%, 44%, 44%, and 43% after matched sibling, matched unrelated marrow, mismatched unrelated marrow, and cord blood transplant, respectively (p>0.05).
Late effects in HCT recipients with severe aplastic anemia
A study of late effects in 1,718 patients with acquired severe aplastic anemia (SAA) transplanted between 1995-2006. Median age at time of transplant was 20 years (range <1-67 years), and outcomes were reported to CIBMTR (Center for International Blood and Marrow Transplant Research). Probability of experiencing late effects (e.g., solid tumors, hypothyroidism, cirrhosis) varied by type of donor. Of one-year survivors of matched sibling transplantation, 6% had one late effect and 1% had multiple late effects. For one-year survivors of unrelated donor transplantation, 13% had one late effect and 2% had multiple late effects. The authors recommend that patients transplanted for SAA be counseled about the probability of experiencing late effects and receive lifelong monitoring.
Mismatched HCT for malignant diseases associated with graft failure
This study of 663 patients undergoing unrelated donor HCT for non-malignant diseases (NMD) found a significant association between HLA-mismatch and graft failure. Transplants took place between 1995-2007 and were reported to the NMDP and CIBMTR (Center for International Blood and Marrow Transplant Research). Compared to 8/8 matched transplants, the adjusted odds ratio for graft failure of 7/8 and 6/8 (allele and/or antigen) mismatched pairs was 2.81 (1.74-4.54; p<0.0001) and 2.22 (1.26-3.97; p=0.006), respectively. The authors concluded that “patients with NMD should receive transplants from allele matched (8/8) donors if possible.”
A 2012 update to the guidelines for training HCT physicians first developed and published by the American Society for Blood and Marrow Transplantation (ASBMT) in 2001. The ASBMT guidelines provide a framework for use by HCT educators and directors in developing HCT training programs to ensure that HCT physicians in training develop the skill set needed to deliver the highest quality of care. The guidelines include descriptions of key educational goals, the mentoring process, and specific core competencies to be mastered.
New webinar: Updated guidelines for post-transplant care
View a free webinar on the 2012 publication, Recommended screening and preventive practices for long-term survivors after HCT. This 45-minute presentation (slides and audio) by lead author Navneet Majhail, M.D., covers key updates of the guidelines on long term follow-up care of HCT recipients, and provides ideas for implementing the guidelines into clinical practice. Access webinar »
Test Your Knowledge
Which age group received the most transplants from the NMDP in 2011?
In addition to inclusion in the mobile app, patient versions of the transplant care guidelines are also available in three new, easy-to-understand brochures. These preventive care guidelines help transplant recipients prepare for follow-up care appointments, and include customized lists of tests and evaluations for 6-month, 12-month, and 2+year annual check-ups Order now »
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