A randomized, multi-center trial of 201 myeloablative hematopoietic cell transplants (HCT) in adults has identified several prognostic factors predicting outcomes, including the result that selecting donors <40 years leads to significantly improved overall survival. Patients in the study had a median age of 40 years (range, 18-60), and a median follow-up time of three years. In multiple regression analyses, donor age ≥40 years adversely affected the risk of developing grade III-IV acute GVHD (HR = 2.57; 95% CI, 1.27-5.21; p=0.009), extensive chronic GVHD (HR = 2.06; 95% CI, 1.12-3.79; p=0.021), and overall survival (HR = 1.66; 95% CI, 1.10-2.51; p=0.016).
Stephen Spellman, MBS, Director, Immunobiology and Observational Research, CIBMTR, provides additional insight on the above article. Read commentary »
Revised IPSS for MDS
This publication reports on a Revised-International Prognostic Scoring System (IPSS-R) to evaluate the prognosis of adult patients with myelodysplastic syndromes (MDS). Based on the original IPSS developed in 1997, the IPSS-R was developed by analyzing transplant outcomes of 7,012 MDS patients in 11 countries. New components of the IPSS-R include the depth of cytopenias, splitting the low marrow blast percentage value, and five instead of three cytogenetic prognostic subgroups (with new classifications for several less common cytogenetic subsets). In addition, the new IPSS-R increases the number of major prognostic categories from four to five.
Two karyotypes predict HCT outcomes in high-risk AML
A retrospective cohort analysis of 236 adults (median age 55 years, range 22-77) with high-risk acute myeloid leukemia (AML) who underwent allogeneic HCT between 2005-2008 has shown that the presence or absence of just two complex karyotypes, abnl(17p) and −5/5q−, is highly predictive of transplant outcomes. Two-year event-free survival (EFS) of patients with abnl(17p) was 11%, and patients with −5/5q− but no abnl(17p) had two-year EFS of 29%. Patients with adverse-risk AML but neither of these two marker lesions had a two-year EFS of 49%.The authors of a Commentary accompanying the article note that “this new cytogenetic observation may have simplified the process of identifying the most high-risk AML patients.”
This review highlights long-term and late effects of hematopoietic cell transplantation (HCT), including strategies to manage or prevent transplant complications. The authors note that many HCT complications are also complications of solid-tumor treatments, such as infections, second cancers, bone loss, and dysfunctions of the cardiovascular, pulmonary, renal, and endocrine systems. Thus, while many physicians would be aware of these complications, the authors note that many other complications are unique to HCT and require specialized treatment. The authors recommend annual comprehensive physical examinations for HCT recipients to maximize early detection and prevention of life-threatening complications.
This review examines the role of autologous and allogeneic transplantation in patients with Waldenström macroglobulinemia, which has a response rate to first-line chemotherapy of approximately 90%. The authors note that a favorable genetic profile and the indolent nature of Waldenström macroglobulinemia make patients with this disease ideal candidates for autologous transplant. However, the authors’ review of the literature led them to conclude that autologous transplant is underutilized in the management of this disease. The authors further note that allogeneic transplant in Waldenström macroglobulinemia “should be considered investigational and used only in the context of a clinical trial or when other chemotherapeutic options have been exhausted.”
If you have a challenging case involving an older patient with AML or MDS, submit it to the panel of experts speaking at the NMDP Friday Symposium preceding the ASH Annual Meeting in Atlanta, Ga. If selected, your case will be discussed at the symposium titled Treatment of AML and MDS in Older Patients: A Case-Based Approach, from 7-11:00 a.m. on December 7.
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