In this commentary in Blood, Drs. Stephen Forman and Jacob Rowe note that although allogeneic HCT in patients with relapsed acute leukemia in second remission (CR2) can be effective, most patients are not actually able to achieve CR2. The result, the authors note, is that “the long-term outcomes of such a strategy are poor: the 5-year overall survival from first relapse for patients with acute leukemia is only approximately 10%.” More effective minimal residual disease detection during first remission may be a useful bridging treatment between relapse and transplantation, according to the authors, especially if it leads to earlier reinduction therapy in appropriate patients who can then undergo HCT before overt relapse.
Allogeneic HCT in AML patients in second remission
This In this study of patients with acute myeloid leukemia (AML), 1,271 of 3,919 patients age 16 to 49 years who did not receive a transplant in first complete remission (CR1) relapsed. The percentage of these relapsed patients able to achieve CR2 was 55%, which varied by risk group: favorable (82%), intermediate (54%), adverse (27%), and unknown (53%). Five-year survivals of these patients were 32%, 17%, 7%, and 23%, respectively. Of these relapsed patients, 19% are alive beyond 5 years. The authors conclude that “successful salvage treatment of patients who do not undergo transplantation in CR1 and relapse can be achieved in 19% of patients, which is improved by a transplant except in favorable risk disease.”
A report on the outcomes of allogeneic HCT in 143 patients with neuroblastoma reported to CIBMTR (Center for International Blood and Marrow Transplant Research) in 1990-2007. Outcomes were analyzed as a whole, and separately based on whether patients had undergone prior autologous HCT (n=97) or not (n=46). One-year and five-year overall survival were 50% and 7% for patients with prior autologous HCT and 59% and 29% for those without prior autologous HCT, respectively. The authors note that although their retrospective study could not determine why either strategy was chosen for patients, they conclude that allogeneic HCT has a better chance to cure neuroblastoma patients who have not had a prior autologous transplant.
Graft-versus-tumor effects in advanced malignancies
A study of a minimal-intensity pre-transplant conditioning regimen consisting of low-dose total body irradiation with or without fludarabine has shown that it can induce strong graft-versus-tumor (GVT) effects leading to lasting remissions in 45% to 75% of patients. The researchers note that this very low intensity regimen “allows the purest assessment of GVT effects apart from conditioning and GVHD not augmented by regimen-related toxicities.” Five-year survival in 1,092 patients transplanted for advanced hematologic malignancies ranged from 25% to 60%, with GVT effects seen across all disease stages, except for advanced ALL.
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 »
Resources For Your Patients
Online patient community
Are you looking for ways to help your patients connect with others like them? Invite them to visit the Be The Match Patients Connect Facebook Page to connect with a community of more than 2,000 transplant patients, caregivers, and families. Visit now »
Visit Us Online
Access outcomes data slides, CME, clinical references, patient education and more.
Advances in Transplantation is an electronic newsletter published monthly by the National Marrow Donor Program (NMDP). This newsletter is sent only to those individuals who have requested to receive clinical education updates from NMDP.
If this e-mail message was forwarded to you and you'd like Advances in Transplantation delivered directly to you, please subscribe.
If you are a member of the NMDP Be The Match Registry®, unsubscribing to the Advances in Transplantation e-newsletter does not change your status on the registry. The NMDP may still contact you by e-mail, postal mail or telephone if a patient needs you or to request that you update your address.