Better outcomes with reduced-intensity HCT than with chemotherapy in older AML patients
A study of patients age 60-70 years with acute myelogenous leukemia (AML) in first remission has shown that reduced-intensity hematopoietic cell transplantation (HCT) yields lower relapse and higher leukemia-free survival than chemotherapy. HCT recipients (n=94) were compared to chemotherapy recipients (n=96) and had significantly lower risk of relapse at 3 years (32% vs. 81%, respectively; p<0.001), higher 3-year non-relapse mortality (36% vs. 4%, respectively; p<0.001), and longer 3-year leukemia-free survival (32% vs. 15%, respectively; p=0.001). Three-year overall survival was not statistically different in the two groups. In an accompanying editorial, Dr. Richard Champlin concludes that reduced-intensity HCT “should be considered an effective treatment option and an established standard of care for older patients with AML.”
Preemptive immunotherapy to prevent post-transplant relapse in pediatric AML
Pediatric HCT patients who face higher relapse risk due to mixed chimerism (MC) after transplant may be helped by preemptive immunotherapy, according to results of a recent study. In this study of 71 children transplanted for AML, 20 showed signs of MC, and 13 patients were immediately taken off immunosuppressive drugs and/or received donor leukocyte infusions. Six of the 13 MC patients achieved continuous complete chimerism and long-term remission, leading to a 46% event-free survival. The researchers concluded that MC is a prognostic factor for impending relapse, and that “preemptive immunotherapy may improve the outcome in defined high-risk patients after transplantation.”
HCT for patients with T315I BCR-ABL mutated leukemias
When patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) or chronic myeloid leukemia (CML) become resistant to tyrosine kinase inhibitors due to a T315I mutation, their prognosis is very poor. In a study of 64 such patients with CML or ALL who underwent allogeneic HCT, 2-year overall survival (OS) was 59%, 67%, and 30% for CML patients in chronic phase, accelerated phase, and blastic phase, respectively. Two-year OS for Ph+ ALL patients was 25%. The researchers conclude that “allogeneic stem cell transplantation represents a valuable therapeutic tool for eligible patients with BCR-ABL T315I mutation, a tool that may or may not be replaced by third-generation tyrosine kinase inhibitors.”
This report from the National Cancer Institute, the Pediatric Blood and Marrow Transplant Consortium, and the National Heart, Lung, and Blood Institute outlines the late effects of hematopoietic cell transplantation (HCT) on the pediatric endocrine system. The report focuses on the organs most affected by HCT (thyroid gland, pituitary gland, and gonads), but also discusses how HCT can disrupt hormones affecting the development and stability of the skeletal system. Also discussed are methods to reduce pubertal or gonadal failure, which still remain high, and ways to preserve fertility, which still remain limited except in post-pubertal males.
NMDP and ASBMT release 2012 transplant referral guidelines
Get the updated 2012 NMDP/ASBMT Recommended Timing for Transplant Consultation, which specifies prognostic factors for patients at risk of disease progression and, therefore, which patients should be evaluated for transplantation. Access print guidelines >> Also available in a free mobile app, which has been newly updated to include transplant outcomes data.
NMDP marks 25th anniversary and 50,000th marrow transplant
Twenty-five years ago, the NMDP facilitated its first marrow transplant between an unrelated donor and patient. And in November, the NMDP facilitated its 50,000th transplant. Learn more about these two important milestones, including how they were commemorated in December at the 2011 ASH Annual Meeting.
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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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