Myeloablative HCT improves survival in younger adults with ALL in first remission
A meta-analysis combining data from 13 studies including 2,962 adults has shown that allogeneic, but not autologous, hematopoietic cell transplantation (HCT) improves survival in younger adults with acute lymphoblastic leukemia (ALL) in first complete remission. The meta-analysis, which excluded Philadelphia chromosome-positive patients, also found no beneficial effect of autologous HCT compared to chemotherapy. Patients <35 years of age undergoing myeloablative HCT with a matched sibling donor had a survival benefit (Odds ratio [OR] = 0.79; 95% CI, 0.70-0.90, p=0.0003) compared to those without a sibling donor available. Individuals ≥35 years of age did not experience this survival benefit (OR = 1.01; 95% CI, 0.85-1.19, p=0.9), which the authors attributed to the higher absolute risk of non-relapse mortality in older patients.
Review: Cord blood transplant supported by third-party donor cells
This article reviews umbilical cord blood transplantation (CBT) supported by co-infusion of adult CD34+ stem cells from mismatched unrelated donors. Through the transient engraftment of the CD34+ cells, CBT recipients experience immune system support until the donated cord blood cells engraft. The authors also discuss the biological characteristics of umbilical cord blood that affect hematopoietic recovery in CBT recipients, including fetal immune system tolerance to foreign antigens, which contributes to a low incidence of GVHD, and the presence of sensitized maternal microchimeric cells, which can induce a graft-versus-leukemia effect.
A summary of the updated screening and preventive practices guidelines for HCT recipients focusing on ways that health care providers can effectively integrate the guidelines into clinical practice. Barriers to successful long-term follow-up of HCT recipients are identified, and the authors recommend methods that health care providers — at transplant centers and in community clinics — can adopt to ensure that HCT recipients receive early detection and timely treatment of late complications such as secondary cancers, late infections, and organ toxicity.
This review summarizes the mechanisms of action of sirolimus in preventing and treating graft-versus-host disease (GVHD). The authors discuss the immunosuppressive, antitumor, and antiviral properties of sirolimus, and analyze its potential advantages over other immunosuppressors. Topics include sirolimus in combination with tacrolimus in GVHD prophylaxis, sirolimus as primary therapy for acute GVHD, and sirolimus as a treatment for steroid-refractory acute and chronic GVHD.
New autoimmune diseases after cord blood transplantation
An analysis of 726 cord blood transplants reported to the European cord blood transplant database has found that the cumulative incidence of autoimmune disease developing post-transplant in these patients was 5.0% at 1 year and 6.6% at 5 years. The most commonly occurring diseases were organ-specific autoimmune diseases such as cytopenias, followed by autoimmune diseases of the thyroid. A multivariate analysis revealed that transplantation for a non-malignant disease was the main risk factor for developing an autoimmune disease (p=0.0001).
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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