Allogeneic HCT in NHL patients relapsing after autologous transplant
Patients with diffuse large B-cell non-Hodgkin lymphoma undergoing allogeneic HCT after relapsing following an autologous transplant have a 3-year overall survival of 53.8%, according to a study of 101 such patients identified in the European Group for Blood and Marrow Transplantation database. Patients were a median age of 47 years (range 18-66), and underwent myeloablative transplantation (n=37) or reduced-intensity transplantation (n=64). Three-year progression-free survival (PFS) was 41.7%. Time to relapse after autologous transplant of <12 months was significantly associated with lower PFS (p=0.03). There were no significant differences in outcomes in transplants using HLA-identical sibling donors and matched unrelated donors.
ASBMT statement: Generic immunosuppressants in HCT
A report from an ASBMT (American Society for Blood and Marrow Transplantation) Task Force that examined issues of drug bioequivalence, drug safety, and pharmacoeconomics of generic immunosuppressants used in hematopoietic cell transplantation (HCT). The consensus report include recommendations on patient education, consistent use of one drug formulation, enhanced monitoring after formulation changes, clinical trials examining equivalence, and analyses of true costs.
Donor lymphocyte infusions in patients transplanted for Hodgkin lymphoma
A study of 76 consecutive patients with a median age of 31 years (range 13-59) with multiply relapsed or refractory Hodgkin lymphoma who underwent in vivo T-cell depleted allogeneic transplantation using reduced-intensity conditioning. Recipients relapsing post-transplant (n=24) or patients with mixed chimerism (n=22) received donor lymphocyte infusions (DLI) in a dose-escalating fashion. DLI were not given to 30 patients with active GVHD or improving chimerism. Nineteen (86%) of the 22 patients with mixed chimerism converted to full donor status. Nineteen (79%) of 24 relapsed patients responded (14 complete responses, five partial responses). The authors concluded that DLI induces a potent graft-versus-lymphoma effect and that “preemptive DLI based on mixed chimerism may reduce relapse risk.”
Radioimmunotherapy prior to reduced-intensity HCT in advanced follicular lymphoma
A single-center study of 12 patients with relapsed, refractory or transformed follicular lymphoma (FL) receiving radioimmunotherapy (yttrium-90) to reduce tumor load prior to reduced-intensity transplantation. Median age of patients was 55 years (range 40-66), with a median of 5 (range 2-10) lines of prior therapy. Cumulative incidence of grade IIIV acute GVHD at 100 days was 17%. Cumulative incidence of chronic GVHD at 12 months was 63% (7 of 11 evaluable patients), however only one of these patients had severe chronic GVHD. Two-year overall survival and progression-free survival were 83% and 74%, respectively. The authors conclude that radioimmunotherapy treatment “is associated with favorable outcomes including acceptable rates of GVHD and relapse in advanced FL patients, and warrants prospective studies.”
Review: Selection and acquisition of unrelated cord blood grafts
This review outlines a framework for the search and selection of cord blood grafts, with recommendations on who should be considered for a cord blood search, how to access worldwide cord blood bank inventories, and how to balance total nucleated cell dose and human leukocyte antigen match in cord blood unit (CBU) selection. Also discussed are aspects of CBU quality that transplant centers must consider, such as processing methods, unit age, availability of attached segments, and infectious disease and hemoglobinopathy screening results. The authors integrate these factors into a proposed CBU selection algorithm that includes how to select double-unit grafts.
Clinical guidelines app: Mobile web version now available
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 via mobile web, iPhone®, iPad™, and Android (coming soon to Blackberry). Download free app
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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