Review: HCT for MDS in older patients in context of CMS
The Centers for Medicare and Medicaid Services (CMS) announced in 2010 that Medicare would begin to cover allogeneic hematopoietic cell transplantation (HCT) for patients with MDS if they were enrolled in a clinical study meeting CMS criteria. This review outlines these CMS criteria and suggests that incorporating the existing Stem Cell Transplant Outcome Database may allow such a clinical trial to be activated quickly and in the most cost-efficient way.
Dr. Willis Navarro, NMDP Medical Director of Transplant Services, provides insight to future directions on above article, Review: HCT for MDS in older patients in context of CMS. Read commentary.
Pregnancy after HCT: A report from CIBMTR
Fertility can be preserved in some hematopoietic cell transplant (HCT) patients, including those very young at the time of transplant and those receiving myeloablative conditioning, according to a study of transplants between 2001-2007 reported to CIBMTR (Center for International Blood and Marrow Transplant Research). Of the 178 post-HCT pregnancies, 83 were in female HCT recipients and 95 were in female partners of male HCT recipients. Age at HCT was <20 years for 50% of women and 19% of men. The researchers recommend that HCT patients “should be counseled both before and after HCT about potential loss of fertility, methods for preserving fertility, and planning for future pregnancy.”
This study of 252 pediatric patients confirms that the hematopoietic cell transplantation (HCT) comorbidity index (HCT-CI) can predict transplant outcomes in children as well as adults. One-year cumulative incidence of non-relapse mortality (NRM) increased with increasing HCT-CI score, and overall survival (OS) decreased with increasing HCT-CI score (p<0.01). The researchers conclude that the HCT-CI score can be “a useful tool to assess risk, guide counseling in the pre-transplant setting and devise innovative therapies for the highest risk groups.”
Reduced transplant-related mortality over time in AML
A study of 5,972 patients undergoing hematopoietic cell transplantation (HCT) between 1985-2004 has shown significant improvements over time in transplant-related mortality (TRM). Patients were <50 years and underwent related or unrelated donor myeloablative HCT for acute myeloid leukemia (AML) in first (CR1) or second complete remission (CR2). Researchers studied data reported to CIBMTR (Center for International Blood and Marrow Transplant Research). In a univariate analysis of related HCT, three-year TRM in CR1 patients declined from 29% in 1985-1989 to 15% in 2000-2004 (p<0.001). In unrelated HCT, three-year TRM in CR1 patients declined from 39% in 1990-1994 to 31% in 2000-2004 (p=0.001).
Unrelated donor HCT for AML in CR1: 78% survival at three years
In this study of 44 patients undergoing hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) in first remission (CR1), three-year event-free survival (EFS) and overall survival (OS) were 70% and 78%, respectively. Patients were conditioned with a myeloablative, but reduced-toxicity regimen of i.v. busulfan, fludarabine, and antithymocyte globulin. Patients were a median of 48 years and 59% had high-risk cytogenetics. The 100-day and 3-year cumulative incidence of transplant-related mortality was 5% and 15%, respectively. Three-year EFS and OS were similar in patients > 55 years compared to those ≤55 years: 80% vs. 67% (p=0.47) and 80% vs. 78% (p=0.81), respectively. Three-year EFS and OS in patients with and without poor risk cytogenetics were also similar: 63% vs. 82%, p=0.43; and 78% vs. 82%, p=0.89, respectively.
BMT CTN announces guidance for cell therapy trials
The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) has published guidelines for investigators interested in using BMT CTN infrastructural support to conduct phase II trials on novel cell therapies. Eligible cell therapies are those designed to improve the outcome of transplant by reconstituting anti-tumor or anti-infectious immunity or modulating allo-reactivity, or to use transplant as a means of genetic correction for inherited diseases. The guidelines outline the process by which studies can be submitted, reviewed, and implemented by BMT CTN.
You can now instantly access our Transplant Clinical Guidelines through a free mobile app. The app contains clinical decision-making information from the NMDP/ASBMT Timing for Transplant Consultation Guidelines and Post-Transplant Care Guidelines. The app is now available on iPhone®, iPad™, and Android devices (coming soon to Blackberry and mobile web). Download free app
New research at ASH shows continued improvement in HCT outcomes
Read a special edition of Advances in Transplantation summarizing the latest research in hematopoietic cell transplantation presented at the American Society of Hematology (ASH) Annual Meeting. Research highlights include:
• HCT outcomes improving over time • Related, unrelated donor HCT comparable in children with ALL • Azacitidine may prevent or delay relapse after HCT
Supported by an unrestricted educational grant from Otsuka America Pharmaceutical, Inc., provided to the National Marrow Donor Program through the Be The Match Foundation®, the funding partner of the NMDP.
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