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.
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%.
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.
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.
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.
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
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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