This review discusses the role of hematopoietic cell transplantation (HCT) in patients with myelodysplastic syndromes (MDS), which is diagnosed at a median age of approximately 75 years. The author focuses on how donor selection, transplant timing, patient age, comorbidities, and iron overload affect transplant outcome. Also discussed are the role of cytogenetics and molecular genetics, reduced-intensity conditioning, and cytoreductive pre-transplant therapy on HCT outcome.
Acute GVHD biomarkers can predict treatment outcomes
Biomarkers for acute GVHD can be used for early identification of patients at high or low risk for treatment non-responsiveness or death, according to new research. Investigators in this prospective study measured six previously validated diagnostic biomarkers of GVHD in 112 transplant recipients on day of transplant and on days 14 and 28 post-transplant. By measuring concentrations of all six biomarkers, the researchers could predict day 28 post-therapy non-response, as well as mortality at day 180 after GVHD onset. The authors conclude that biomarkers “may provide opportunities for early intervention and improved survival after hematopoietic cell transplantation.”
Double cord blood, peripheral blood HCT have comparable outcomes
This study compared HCT outcomes in adults with acute leukemias receiving two 4-6/6 HLA-matched umbilical cord blood units (dUCB, n=160) to outcomes using peripheral blood progenitor cells (PBPC) from 7/8 (n=111) or 8/8 (n=313) HLA-matched unrelated donors. All transplants used reduced-intensity conditioning (RIC), and of the 160 dUCB recipients, 120 were conditioned with total body irradiation, cyclophosphamide, and fludarabine (dUCB-TCF). Two-year survival was comparable in dUCB-TCF, 7/8 PBPC and 8/8 PBPC transplants: 38%, 37% and 44%, respectively (p>0.05). The authors conclude that “these data support use of dUCB-TCF transplantation in adults with acute leukemia who may benefit from RIC transplantation urgently or lack a 7-8/8 unrelated donor.”
This review notes that while autologous transplantation has been an established treatment for many lymphomas, the number of allogeneic hematopoietic cell transplants (HCT) for lymphoma has steadily increased over the last decade. The authors note that allogeneic HCT is now most often used to treat relapse after autologous transplantation, but is also being increasingly used in earlier disease phases in selected patient populations. The popularity of allogeneic HCT will likely increase, the authors note, if rates of non-relapse mortality after allogeneic HCT continue to decline.
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 »
Test Your Knowledge
How many patients were approved for financial assistance from the NMDP in 2011?
Advances in Transplantation is an electronic newsletter published monthly by the National Marrow Donor Program (NMDP). This newsletter is sent only to those individuals who have requested to receive clinical education updates from NMDP.
If this e-mail message was forwarded to you and you'd like Advances in Transplantation delivered directly to you, please subscribe.
If you are a member of the NMDP Be The Match Registry®, unsubscribing to the Advances in Transplantation e-newsletter does not change your status on the registry. The NMDP may still contact you by e-mail, postal mail or telephone if a patient needs you or to request that you update your address.