Risk-stratified adoptive cellular therapy after HCT for CLL
This study examined outcomes of 50 consecutive patients with chronic lymphocytic leukemia (CLL) transplanted after reduced-intensity conditioning followed by pre-emptive donor lymphocyte infusions (DLI) with the intention of reducing the risk of GVHD. At a median follow-up of 4.3 years, 4-year overall and progression-free survival was 75% and 65%, respectively. DLI was associated with a 29% cumulative incidence of severe GVHD and mortality of 6.4%.The authors conclude that “directed delivery of allogeneic cellular therapy has the potential to induce durable remissions in high-risk CLL without incurring excessive GVHD.”
This study examined 202 adults with chemotherapy-unresponsive mantle cell lymphoma (MCL) who underwent allogeneic HCT between 1998 and 2010 and whose outcomes were reported to CIBMTR (Center for International Blood and Marrow Transplant Research). Patients received either myeloablative (n=74) or reduced intensity/non-myeloablative conditioning (n=128). Univariate analyses found that intensity of the conditioning regimen had no significant effect on three-year non-relapse mortality, relapse/progression, progression-free survival, and overall survival. Three-year overall survival using myeloablative and reduced intensity/non-myeloablative conditioning was 25% and 30%, respectively (p=0.45). The authors conclude that “despite a refractory disease state, approximately a fourth of MCL patients can attain durable remissions after allo-HCT.”
A first salvage therapy combining azacitidine (AZA) with donor lymphocyte infusions (DLI) in relapsed transplant recipients has a 30% response rate, according to results of a recent study. This multicenter study of patients with acute myeloid leukemia (AML; n=28) and myelodysplastic syndromes (MDS; n=2) had a treatment schedule of up to eight cycles of AZA followed by DLI after every second AZA cycle. A median of three AZA courses were administered, and 22 patients (73%) received DLI. Overall response rate was 30%: seven complete remissions (23%) and two partial remissions (7%). The authors conclude that AZA and DLI can induce long-term remissions and can be a suitable salvage therapy for patients with AML or MDS relapsing after allogeneic HCT.
Previous studies have shown the prognostic value of the hematopoietic cell transplantation-comorbidity index (HCT-CI), which measures the prevalence and severity of organ impairments in patients considering HCT. To ensure consistent HCT-CI scores among different evaluators, a web-based training program has been developed that utilizes consistent guidelines and systematic scoring methods. In a test of the training program, 88 randomly selected HCT recipient records at a single institution were confidentially re-scored by evaluators using the web-based program. The inter-evaluator agreement on HCT-CI scores was high, with weighted kappa values of 0.89-0.97.
On January 30, the Worldwide Network for Blood and Marrow Transplantation (WBMT) announced the landmark achievement of the 1 millionth blood stem cell transplant worldwide. The total includes all peripheral blood, marrow, and cord blood transplants, both autologous and allogeneic, performed worldwide since 1957.
“One million transplants is a milestone that may surprise many people, because blood stem cell transplants were viewed as a rare procedure until the last decade or so,” said Dietger Niederwieser, M.D., president of the WBMT and professor of medicine at the University Hospital of Leipzig, Germany.
Earn 0.75 CME credits through an online activity on post-transplant care jointly sponsored by Medscape Education Oncology and the National Marrow Donor Program® (NMDP). Review risk factors associated with exposures and late effects, guidelines for head-to-toe assessment, and screening and vaccination schedules. Take CME »
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