A multi-center study of 1,041 children with acute lymphoblastic leukemia (ALL) who failed induction chemotherapy has revealed which patients would benefit from continued chemotherapy and which would benefit from hematopoietic cell transplantation (HCT). At a median follow-up of 8.3 years (range, 1.5-22.1), the estimated 10-year survival was 72% in patients <6 years with precursor B-cell leukemia and no adverse genetic features treated with chemotherapy only. T-cell leukemia patients receiving allogeneic transplants trended toward improved 10-year survival (40% related donor HCT, 45% unrelated donor HCT) compared to chemotherapy-only patients (26%) (p=0.06).
This retrospective study analyzed outcomes of 102 adults and 11 children with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) who underwent HCT between 1990-2009 while in CR1 (n=71), CR2 (n=11), or with active disease (n=31). Sixty-seven patients received a tyrosine kinase inhibitor (TKI) before HCT, and 32 received post-transplant TKI maintenance. Univariate and multivariate analyses revealed that neither pre- nor post-transplant TKI use had any significant impact on transplant outcomes. At a median follow-up of 5 years, overall survival was significantly higher for patients transplanted in CR1 compared with those transplanted in advanced disease: 43% vs. 16%, respectively; (p=0.002).
Reduced-intensity vs. non-myeloablative HCT in older CML patients
Reduced-intensity conditioning (RIC) is superior to non-myeloablative (NMA) conditioning in chronic myelogenous leukemia (CML) patients 40 years and older, according to a study of 306 transplants between 2001-2007 reported to the CIBMTR (Center for International Blood and Marrow Transplant Research). A majority (74%) of patients received pre-transplant imatinib therapy. Three-year overall survival was similar across three age groups (40-49, 50-59, and ≥60 years): 54%, 52%, and 41%, respectively; p=0.26. A multivariate analysis revealed significantly superior 3-year disease-free survival for RIC compared to NMA [Relative risk of death: 0.45; 95% CI: 0.33-0.61, p<0.0001].
HCT for SCID: mismatched related donor grafts or unrelated cord blood?
A retrospective study of 249 pediatric patients transplanted for SCID or Omenn syndrome has shown comparable outcomes when using umbilical cord blood or mismatched related donors as the graft source. There was a trend toward a greater incidence of grades II-IV acute GVHD in cord blood recipients, but this was not significant (p=0.06). Cord blood recipients had significantly higher incidence of chronic GVHD compared to the related donor cohort: 22% vs. 10%, respectively; (p=0.03). Estimated 5-year overall survival was 62% in the related donor cohort and 57% in the cord blood cohort (p=0.68).
Review: Predicting transplant-related toxicity, improving outcomes in older patients
This review article discusses how to use geriatric assessments and patient-reported outcome tools currently being used in other areas of oncology to improve hematopoietic cell transplant outcomes in older patients. The authors show how these techniques could be used in risk stratification of HCT patients, interventional studies, and predictive models incorporating genetic and biomarker data.
Now available: Four new programs based on the NMDP Symposium, Recent Advances in Hematopoietic Cell Transplantation: Evidence-Based Decision-Making, presented prior to the Annual Meeting of the American Society of Hematology in December 2011. Available as recorded or slide-only presentations. Access now »
Visit NMDP at ONS
Explore free patient and clinical transplant resources at NMDP booth #935 at the upcoming Oncology Nursing Society (ONS) 37th Annual Congress. For an in-depth look at a resource designed to help patients and caregivers learn about transplant, visit poster #303 on May 3 at ONS.
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Permissive T-cell-epitope matches at HLA-DPB1 in HCT
Access clinical resources, education and the latest research to help guide decision-making when considering transplant as a treatment for patients with non-Hodgkin lymphomas (NHL). Access resources »
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