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  Your Concise Update on Transplant Research
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  National Marrow Donor Program   Advances in Transplatation  
Vol. 11 | No. 8
August 2011
 Post-Transplant Spotlight  
Planning for post-transplant care
Clinical Challenge
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What % of NMDP transplants use PBSC?
Reduced-intensity HCT in pediatric patients
Cord blood Apgar score predicts engraftment
TBI a risk factor for sclerotic-type chronic GVHD
HCT for childhood ALL in third remission
CMV-versus-leukemia effect in AML
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Transplant Outcomes
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Mobilization therapy found to be safe for stem cell donors
A study of 22 peripheral blood stem cell (PBSC) donors receiving G-CSF has determined that G-CSF does not cause chromosome loss or gain in donors, a result the lead author notes is “contrary to the previously published data.” Researchers at the University of Minnesota used fluorescence-in-situ-hybridization (FISH) to examine peripheral blood lymphocytes of the PBSC donors, and compared their specimens to 22 matched controls. Lymphocyte specimens were collected and examined by FISH at five time points over a 12 month period, and were evaluated for aneuploidy at nine loci mapped to chromosomes 7, 8, 9, 17, 21 and 22. The FISH analysis found no instances of G-CSF-induced chromosomal instability or replication asynchrony.
Hirsch B, et al. Blood, 2011; published online June 30.
Expert Commentary
Dr. Bronwen Shaw of the Royal Marsden Hospital and the Anthony Nolan Trust, London, provides insight on the above article. Read commentary.
Long-term study of HCT in pediatric aplastic anemia
A long-term study of 152 pediatric patients transplanted for aplastic anemia (AA) shows an estimated 30-year survival of 82% for acquired AA patients and 58% for Fanconi anemia (FA) patients (p=0.01). In this single-institution study, median follow-up was 21.8 years, and a multivariate analysis identified FA (p=0.03) and chronic GVHD (p=0.02) as risk factors for lowered survival. Late effects included malignancies in 13% of survivors: FA (n=2) and acquired AA (n=18), with four total deaths due to malignancies. The authors conclude that “the majority of long-term survivors after transplantation for AA during childhood can have a normal productive life.”
Sanders JE, et al. Blood, 2011; 118(5): 1421-1428.
Long-term outcomes of pediatric HCT vs. conventional therapy
A long-term study has found that children treated with hematopoietic cell transplantation (HCT) have a higher risk for several adverse health conditions compared to both childhood cancer survivors treated conventionally and to sibling controls. The researchers analyzed data from multi-institutional outcomes databases and health surveys sent to HCT (n=145) and cancer survivors (n=7207), and sibling controls (n=4020). Compared to cancer survivors treated conventionally, HCT survivors had significantly higher risks of severe or life-threatening conditions (Relative Risk [RR]=3.9, p<0.01), multiple adverse health conditions (RR=2.6, p<0.01), functional impairment (RR=3.5, p<0.01), and activity limitation (RR=5.8, p<0.01). The authors conclude that childhood HCT survivors remain a high-risk population requiring close monitoring.
Armenian SH, et al. Blood, 2011; 118(5): 1413-1420.
Commentary in Blood on both of these long-term health studies: Survivors after blood wars.
Pre-HCT radioimmunotherapy in high-risk B-cell NHL
A non-myeloablative conditioning regimen incorporating 90Y-ibritumomab tiuxetan-based radioimmunotherapy can lead to a 30-month post-transplant survival of 54%, according to a study of 40 patients with chemoresistant, bulky, or aggressive B-cell non-Hodgkin lymphoma. Median age of patients was 58 years (range 29-69), and median prior regimens was 6 (range 3-12). Estimated 30-month survival, progression-free survival, and non-relapse mortality were 54.1%, 31.1%, and 15.9%, respectively. The authors conclude that 90Y-ibritumomab tiuxetan-based radioimmunotherapy, combined with fludarabine and total body irradiation, can facilitate early cytoreduction and “is safe and yields early responses and prolonged disease control in some of the highest-risk B-NHL patients.”
Gopal AK, et al. Blood, 2011; 118(4): 1132-1139.
Blood “How I Treat” series: Thalassemia
A review article on diagnosing and managing the thalassemias, including β thalassemia intermedia and β thalassemia major. Topics discussed include: improved diagnostic tools such as fetal DNA samples to detect single point mutations, dealing with clinical manifestations and long-term complications, disease management such as transfusion therapy and oral iron chelators, and the role of hematopoietic cell transplantation, including cord blood transplantation.
Rachmilewitz EA, et al. Blood, 2011; published online August 2.
CME: Management of Advanced Non-Hodgkin Lymphomas
A new NMDP-sponsored CME series is now available: Management of Advanced Non-Hodgkin Lymphomas. This four-part series reviews treatment options for follicular, mantle cell, diffuse large B-cell, and T-cell lymphomas. Learn about first- and second-line treatment options for relapsed/refractory patients, including novel agents, and both allogeneic and autologous transplantation. Access NHL CME program
Otsuka America Pharmaceutical, Inc
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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