Marrow, PBSC have comparable survival; more cGVHD with PBSC
A phase III, multi-center, randomized trial comparing peripheral blood stem cells (PBSC) and bone marrow transplant outcomes has found comparable 2-year survival: 51% vs. 46%, respectively (p=0.29). However, chronic graft-versus-host disease (cGVHD) developed more often and was more severe in patients who received PBSC compared with those receiving marrow. Two-year cGVHD incidence was 53% (PBSC) vs. 41% (marrow) (p=0.01). This study of unrelated donor transplants was conducted by the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) and examined 551 patients transplanted between 2004-2009.
Comparing unrelated marrow and PBSC donor experiences
This prospective study compared 2,726 marrow and 6,768 peripheral blood stem cell (PBSC) donations facilitated by the NMDP between 2004-2009. Donor pain levels and adverse events were measured at baseline, during growth factor administration, on donation day, within 48 hours of donation, and weekly, until donors reported a full recovery. Peak levels of pain and adverse events were comparable between the two donation procedures for most donors. However, marrow donors recovered more slowly, with 3% still not fully recovered by 24 weeks, compared to a 100% recovery rate of PBSC donors. Other factors associated with increased adverse events included obesity, increasing age, and female sex.
Improved survival in unrelated donor HCT for pediatric ALL
In a single-center study of 356 allogeneic transplants in pediatric acute lymphoblastic leukemia (ALL) performed between 1988-2007, overall survival (OS) significantly improved after the introduction of high-resolution HLA matching in 2002. In this study from the Bristol Royal Hospital for Children, unrelated donor transplants performed between 2002-2007 using high-resolution HLA matching (HLA-A, -B, -C, -DRB1, -DQB1) yielded significantly higher OS than low- or intermediate transplants from 1988-2001: 78.8% vs. 47.4%, p=0.026. Since 2002, matched unrelated and matched sibling donor transplants at the center had comparable two-year OS: 78.8% vs. 80.8%.
Improved outcomes in HCT for Wiskott-Aldrich syndrome
A single-center study of 47 patients transplanted for Wiskott-Aldrich syndrome has shown that survival has significantly improved over time in this disease. Five-year overall survival (OS) in patients transplanted between 2001-2009 was significantly higher than those transplanted between 1990-2000: 90.8% vs. 62.5%, respectively (p=0.03). Day 100 transplant-related mortality was significantly lower in the 2001-2009 group than in the 1990-2000 group: 0% vs. 19%, respectively (p=0.03). The authors note that likely reasons for the improved survival include use of high-resolution HLA typing, early detection of viral reactivation, and new immunosuppressive agents available for treatment of GVHD.
Review: Approach to diagnosing and treating oral GVHD
A review article describing a comprehensive and multidisciplinary approach to the diagnosis and clinical management of patients with chronic GVHD of the oral cavity. The authors focus on differential diagnoses, symptom control, and screening for secondary complications, with the ultimate goal of early detection and more effective treatment. Topics covered include mucosal disease, salivary gland disease, sclerotic disease, secondary candidiasis, and dental caries.
You are invited to attend Treatment of AML and MDS in Older Patients: A Case Based Approach, the NMDP satellite breakfast symposium preceding the 54th Annual Meeting of the American Society of Hematology (ASH). Speakers:
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