Medical Education

  Your Concise Update on Transplant Research
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  National Marrow Donor Program   Advances in Transplatation  
Vol. 11 | No. 9
September 2011
 Post-Transplant Spotlight  
Planning for post-transplant care
How would you treat
A 56-year-old woman develops chronic GVHD 6 months post-transplant…
NCI, NHLBI Report: Late effects after pediatric HCT
T cell-depleted unrelated HCT
Review: Bronchiolitis obliterans after HCT
Double-unit CBT vs. marrow, PBSC transplant
Physicians' Resource Center
Patient Resources
Transplant Outcomes
Clinical Guidelines
Mobile App
Comprehensive chronic GVHD assessment
In this “How I Treat” series from Blood, the author outlines “a streamlined and reliable method” for conducting a thorough assessment of chronic GVHD using the criteria developed by the National Institutes of Health Chronic GVHD Consensus Project. The author notes that periodic, complete, and accurate chronic GVHD assessment using NIH guidelines is crucial to ensuring that the disease is properly diagnosed and promptly treated before it progresses and becomes more difficult to treat.
Carpenter PA. Blood 2011; 118(10): 2679-2687.
Low chronic GVHD, relapse in T cell-depleted HCT for AML
A multi-center trial of T cell-depleted hematopoietic cell transplantation (HCT) in AML patients in first complete remission has resulted in a 1-year disease-free survival of 72.8% and a 3-year relapse rate of 17.4%. The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) study examined 44 patients with a median age of 48.5 years (range 21-59) who underwent peripheral blood stem cell transplantation for acute myelogenous leukemia in first (n=37) or second (n=7) complete remission. Because grafts were depleted of T cells, no GVHD prophylaxis was given. The 2-year incidence of grade II-IV acute GVHD was 22.7%, and the incidence of extensive chronic GVHD was 6.8%.
Devine SM, et al. Biol Blood Marrow Transplant 2011; 17(9): 1343-1351.
Treatment options for transformed lymphoma
This review is a detailed discussion on treatment options for transformed non-Hodgkin lymphoma arising from follicular lymphoma. The authors discuss the biological mechanism of transformation, the prognostic implications of early versus late transformation, emerging novel therapies, clinical outcomes using standard chemotherapy and radioimmunotherapy, and the role of autologous stem cell transplantation as a salvage regimen. The authors also discuss improvements in supportive care and other advances in the last decade that have significantly improved transplant outcomes, and discuss the optimal timing of transplantation to further improve outcomes.
Reddy N, et al. Biol Blood Marrow Transplant 2011; 17(9): 1265-1272.
Azacitidine to treat imminent relapse in transplanted MDS/AML patients
In this study of 59 patients transplanted for CD34+ myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML), 20 patients experienced minimal residual disease (MRD) defined as a CD34+ donor chimerism of <80%. At a median of 169 days post-transplant, all 20 MRD patients received four cycles of pre-emptive azacitidine to prevent imminent relapse. Sixteen of the 20 patients (80%) responded with either increasing CD34+ donor chimerism to ≥80% (n=10) or stabilization (n=6) without relapsing. The authors conclude that “pre-emptive azacitidine treatment can substantially prevent or delay hematologic relapse” in patients transplanted for MDS and AML who experience MRD.
Platzbecker U, et al. Leukemia 2011; published online September 2.
Trends in HCT for multiple myeloma
This multi-center study of 1207 patients transplanted for multiple myeloma analyzed outcomes submitted to CIBMTR (Center for International Blood and Marrow Transplant Research) over three time periods: 1989-1994 (n=343), 1995-2000 (n=376), and 2001-2005 (n=488). Patients transplanted in 2001-2005 were significantly older (with 53% being >50 years old), and this cohort had more patients who had received prior autologous transplants. One-year overall survival (OS) increased over time due to decreases in treatment-related mortality. However, 5-year relapse rates increased from 39% in 1989-1994 to 58% in the 2001-2005 time period. In the 2001-2005 cohort, projected 5-year progression-free survival and OS are 14% and 29%, respectively.
Kumar S, et al. Blood 2011; 118(7): 1979-1988.
Special edition: Non-Hodgkin Lymphoma Advances in Transplantation
Access a special edition of Advances in Transplantation that summarizes the latest research in transplant therapy for non-Hodgkin lymphoma. This issue contains research results published in medical journals and presented at major medical meetings in the past year. Access NHL Special Edition
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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