Improved HCT outcome over time in children with very high-risk leukemia
Hematopoietic cell transplant (HCT) outcomes in children with very high-risk leukemia have significantly improved over time, regardless of donor source (matched sibling, matched unrelated, or haploidentical), according to a single-center study of 190 patients. Five-year overall survival (OS) for 37 patients with acute lymphoblastic leukemia (ALL) transplanted in 2000-2007 was 65%, compared to 28% for 57 ALL patients transplanted in 1991-1999 (p=0.004). Five-year OS in 46 patients with acute myeloid leukemia (AML) transplanted in 2002-2008 was 74% compared to 34% in 50 patients with AML transplanted in 1997-2002 (p<0.001). Patients transplanted in recent time periods had significantly improved OS regardless of donor type: sibling, 70% vs. 24% (p<0.001); unrelated, 61% vs. 37% (p=0.014); and haploidentical, 88% vs. 19% (p<0.001).
Most neurocognitive functions improve after transplant
A study of 92 adult transplant recipients tested on information processing speed, verbal memory, executive function, and motor dexterity and speed has shown that post-transplant neurocognitive function improves in the first five years post-transplant. The 92 recipients were tested at 80 days post-transplant and again at 1 and 5 years post transplant. A case-matched control group (n=66) was tested at the 5 year time point. Recipients recovered significant cognitive function from the 80 days time point to 5 years in all tests (p<0.0001), except verbal recall (p>0.06). Verbal fluency and executive function improved between 1 and 5 years post-transplant, but motor dexterity did not. Because mild deficits in fine motor skills and verbal memory remained in 40% of recipients, the authors concluded that “risk factors, mechanisms and rehabilitation strategies need to be identified for these residual deficits.”
Review: Secondary cancers after allo-HCT in adults
A review of the epidemiology, risk factors and screening recommendations for secondary cancers that can arise after allogeneic transplantation in adults. The author discusses the incidence and causes of the most common secondary cancers such as post-transplant lymphoproliferative disorders, new solid cancers, and donor-derived hematological malignancies, and recommends that transplant physicians construct a patient-specific risk profile based on known exposures and risk-factors.
A review of hematopoietic cell transplantation (HCT) in Waldenström macroglobulinemia (WM) focusing on improving transplant outcomes by identifying patients expected to have poor survival with chemotherapy. The authors recommend that newly diagnosed patients undergo risk stratification based on the International Prognostic Scoring System for WM (IPSSWM). Also discussed is the therapeutic role of HCT and a suggested treatment algorithm for selecting an HCT strategy. The authors conclude that the “risk of allogeneic HCT complications is justified in HCT-eligible patients whose expected survival is <5 years.”
Review: Growth in allo-HCT drives need for more physicians
This review discusses the effects of a shortage of transplant physicians and transplant center capacity in the U.S. caused by a projected doubling of unrelated donor transplants from 5,000/year in 2010 to 10,000/year in 2015. The authors report on a survey of U.S. transplant centers in the NMDP Network that describes current transplant activity and capacity of U.S. centers. The data show that from 2005 to 2009, the number of related transplants increased by 15% and unrelated donor transplants increased by 45%. The survey also found that the majority of transplant centers accommodated these increases using existing physicians and bed capacity, which the authors say has the potential to compromise quality of care and outcomes for transplant recipients. The authors conclude that these data will be helpful for policy makers and transplant center administrators as they evaluate capacity and personnel shortages to accommodate the projected growth rate of unrelated donor transplantation.
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 available via Blackberry®, iPhone®, iPad™, Android™, and mobile web. Download free app
NMDP Session from the BMT Tandem Meetings
A recording of the NMDP Session, Cord Blood Unit Access and Selection: 2010 and Beyond, is now available online. This session, presented at the 2011 BMT Tandem Meetings, addresses current topics in cord blood transplantation, including:
• Implications of Cord Blood Licensure for Transplant Programs • Best Practices and Emerging Trends in Cord Blood Unit Selection • Applying Cord Blood Match Rates to Search Algorithms
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.
National Marrow Donor Program, 3001 Broadway St. N.E., Minneapolis, MN 55413-1753
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