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Advances in Transplantation
Featured Articles

The myth of CR2 in adult acute leukemia

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.

Forman SJ, et al. Blood

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.”

Burnett AK, et al. J Clin Oncol

Two editorials discussing these results: 1. Dr. Richard Stone, 2. Dr. Charles Schiffer.

Allogeneic HCT for neuroblastoma

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.

Hale GA, et al. Bone Marrow 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.

Storb R, et al. J Clin Oncol

Accompanying audio editorial by Dr. Jane F. Apperley

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Matched related HCT for SCD

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