Microtransplantation as a novel post-remission therapy in AML
This article reported on a novel “microtransplantation” technique using growth factor-mobilized haploidentical stem cells infused after three consecutive cycles of high-dose cytarabine consolidation therapy in 101 patients with acute myeloid leukemia (AML) in first complete remission. The cytarabine conditioning used was not fully immunosuppressive and patients did not receive GVHD prophylaxis. In a low-risk patient group, six-year leukemia-free survival (LFS) and overall survival (OS) were 84.4% and 89.5%, respectively. No patients developed GVHD. In an accompanying editorial, Dr. Thomas Spitzer writes that “these intriguing results suggest a possible role for adoptive cellular therapy from haploidentical donors as an adjunct to consolidation chemotherapy for acute myeloid leukemia.”
Secondary malignancy rates similar after myeloablative, reduced-intensity HCT
A single-center study of 931 consecutive patients undergoing hematopoietic cell transplantation (HCT) has shown that the risk of secondary malignancies following reduced-intensity or reduced toxicity conditioning HCT is not reduced compared to myeloablative conditioning HCT. Over a 13-year period, 17 patients developed secondary malignancies, diagnosed at a median of 3.6 years (range, 0.6-11.5 years) after HCT. The cumulative incidence of secondary malignancies was 1.7%, 7.4%, and 5.7% after myeloablative, reduced-intensity, and reduced-toxicity HCT, respectively (p=0.02). The authors conclude that patients and physicians need to be aware of this association and that life-long cancer screening is appropriate for all HCT recipients.
Single, double cord blood grafts comparable in adults transplanted for acute leukemia
A study of adults with acute leukemia transplanted with one (n=106) or two umbilical cord blood (UCB) units (n=303) has found comparable outcomes in the two patient cohorts. All UCB units for single transplants contained ≥2.5 x 107 total nucleated cells/kg. Neutrophil recovery (odds ratio 0.83, p=0.59), transplant-related mortality (hazard ratio (HR) 0.91, p=0.63), relapse (HR 0.90, p=0.64), and overall mortality (HR 0.93, p=0.62) were comparable after single and double UCB transplants. The researchers conclude that double UCB transplantation for adults with acute leukemia is indicated when an adequately dosed single UCB unit is not available.
Review: HCT and cellular therapy for sickle cell disease
A review of allogeneic transplantation and autologous stem cell therapy as treatment for sickle cell disease (SCD). Issues discussed include patient selection and eligibility, allogeneic graft sources, graft manipulation, mixed donor chimerism, intensity of conditioning regimens, and novel techniques using autologous “gene correction” stem cells. Although most transplants to date have used HLA-matched sibling donors, other transplant strategies being explored (and discussed in this review) include using matched unrelated adult donors, umbilical cord blood donors, and haploidentical familial donors.
New CME: Screening and preventive practices for HCT survivors
Earn 0.75 CME credits for viewing a 38-minute online course on new post-transplant care guidelines. Hear a dialogue between two authors of the guidelines publication discussing how to screen HCT recipients. Target audience: All primary care physicians, internists, Hematologists/Oncologists, and advanced health care professionals caring for HCT recipients.
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