Survival for patients undergoing allogeneic hematopoietic cell transplantation (HCT) has significantly improved over time, according to a study of 38,060 patients with hematologic malignancies transplanted between 1994 and 2005 and reported to CIBMTR (Center for International Blood and Marrow Transplant Research). The authors note that despite a median age increase from 33 to 40 years during the 12-year period, one-year survival improved significantly in patients undergoing unrelated donor HCT: 48% to 63%; p=0.003. Survival in patients undergoing sibling HCT also improved, but the difference was not statistically significant. Survival at 100 days post-transplant was significantly improved for patients with acute myeloid leukemia in first complete remission after myeloablative sibling HCT (85% to 94%) and unrelated donor HCT (63% to 86%); p<0.001. Similar improvements were seen for acute lymphoblastic leukemia and myelodysplastic syndromes.
Review: Allogeneic HCT for diffuse large B cell lymphoma
In this review article, the authors note that despite overall improvements in outcomes of patients with diffuse large B cell lymphoma (DLBCL), approximately 30-40% will develop relapsed or refractory disease. They outline a new algorithm intended to discriminate which relapsed and refractory DLBCL patients are most likely to benefit from autologous HCT versus allogeneic HCT, and which allogeneic HCT candidates would benefit most from reduced-intensity conditioning and which should receive myeloablative conditioning. They conclude that a prospective registry-based study is needed to define the optimal position of allogeneic HCT in the overall treatment strategy for DLBCL.
Although first used only to treat children - due to the low cell dose infused - umbilical cord blood (UCB) has been proven effective in treating adults when cord blood units of sufficient cell dose and HLA match are used. In this review article, the authors highlight the improving results in UCB transplantation in adults, and discuss the use of double UCB units, improved supportive care techniques, and ongoing efforts to expand UCB cells to reduce the time to stem cell engraftment.
In this installment of the “How I Treat” series in the journal Blood, Dr. Nicola Gökbuget outlines how improved supportive care, targeted therapies, moderately intensified consolidation, and reduced-intensity hematopoietic cell transplantation have improved outcomes somewhat for older patients with acute lymphoblastic leukemia (ALL). But she also notes that older patients with ALL still have a significantly lower complete remission rate, higher early mortality, higher relapse rate, and poorer survival compared to younger patients. She recommends that physicians differentiate between fit and unfit older patients in order to offer both groups optimal treatment regarding toxicity and mortality risks, quality of life, and long-term outcome.
Earn up to 2.25 CME credits through an online activity on the latest approaches to the treatment of older patients with AML and MDS. Join Drs. Appelbaum, Roboz, Steensma, and Forman as they review the latest research and present case studies. Take CME »
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Other Noteworthy Articles
Review: Monoclonal antibodies in HCT conditioning regimens
This clinical fact sheet provides an overview of recent trends in allogeneic transplantation in MDS and how the latest research affects clinical decision-making. Access »
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