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Yusuf RA, Preussler JM, Meyer CL, Schoeppner K, Sees Coles JA, Ruffin A, McCann M, Devine SM, Auletta JJ. Reducing barriers of access and care related to hematopoietic cell transplantation and cellular therapy: The mission-driven role of the national marrow donor program. Best Pract Res Clin Haematol 2023; 36:101480. [PMID: 37353289 DOI: 10.1016/j.beha.2023.101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/25/2023]
Abstract
The treatment of malignant and nonmalignant hematologic disorders continues to benefit from significant scientific advancement and progress in the use of hematopoietic cell transplantation and cellular therapies. However, barriers associated with receiving these lifesaving treatments and care remain, which necessitate innovative approaches to overcome, so all persons in need can receive these therapies. This article reviews barriers to receiving hematopoietic cell transplantation and cellular therapies, and highlights novel approaches taken by the National Marrow Donor Program in reducing barriers for all patients in need.
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Affiliation(s)
- Rafeek A Yusuf
- National Marrow Donor Program, Minneapolis, MN, USA; Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA.
| | - Jaime M Preussler
- National Marrow Donor Program, Minneapolis, MN, USA; Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA.
| | - Christa L Meyer
- National Marrow Donor Program, Minneapolis, MN, USA; Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA.
| | | | | | - Amber Ruffin
- National Marrow Donor Program, Minneapolis, MN, USA.
| | - Meggan McCann
- National Marrow Donor Program, Minneapolis, MN, USA.
| | - Steven M Devine
- National Marrow Donor Program, Minneapolis, MN, USA; Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA.
| | - Jeffery J Auletta
- National Marrow Donor Program, Minneapolis, MN, USA; Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA.
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Suárez-González J, Martínez-Laperche C, Kwon M, Balsalobre P, Carbonell D, Chicano M, Rodríguez-Macías G, Serrano D, Gayoso J, Díez-Martín JL, Buño I. Donor Cell-Derived Hematologic Neoplasms after Hematopoietic Stem Cell Transplantation: A Systematic Review. Biol Blood Marrow Transplant 2018; 24:1505-1513. [PMID: 29410295 DOI: 10.1016/j.bbmt.2018.01.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/25/2018] [Indexed: 02/07/2023]
Abstract
Development of de novo hematologic malignancies in donor cells after allogeneic stem cell transplantation (allo-SCT) provides a useful in vivo model to study the process of leukemogenesis. A systematic analysis of the cases reported in the literature was performed to identify risk factors and mechanisms involved in the pathogenesis of donor cell-derived hematologic neoplasms (DCHN) and leukemogenic transformation. Relevant data were extracted from 137 cases. Cases of DCHN show a wide heterogeneity with regard to recipient/donor age, sex mismatch, and conditioning regimen. Some characteristics, such as the type of primary disease, the type of hematologic malignancy of the DCHN, and the stem cell source used in the transplant procedure, differ from those expected. Mechanisms involved in the pathogenesis of DCHN are complex, and several hypotheses have been proposed, such as pre-existing hematologic neoplasms or premalignant clones in the donor, decreased immune surveillance, and damage to bone marrow microenvironment in the recipient. Most likely several if not all these mechanisms play a role in DCHN development. Novel approaches, such as next-generation sequencing to study consecutive samples after allo-SCT in these patients, appear to be promising to decipher the mechanisms of leukemogenesis.
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Affiliation(s)
- Julia Suárez-González
- Genomics Unit, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Carolina Martínez-Laperche
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.
| | - Mi Kwon
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Pascual Balsalobre
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Diego Carbonell
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain
| | - María Chicano
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - David Serrano
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jorge Gayoso
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain
| | - José Luis Díez-Martín
- Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ismael Buño
- Genomics Unit, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Translational Oncology, Gregorio Marañón Health Research Institute, Madrid, Spain; Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain
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Second allo-SCT in patients with lymphoma relapse after a first allogeneic transplantation. A retrospective study of the EBMT Lymphoma Working Party. Bone Marrow Transplant 2015; 50:790-4. [PMID: 25751644 DOI: 10.1038/bmt.2015.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/04/2014] [Accepted: 12/22/2014] [Indexed: 11/08/2022]
Abstract
The aim of this registry-based retrospective study was to analyze the outcome of second allogeneic hematopoietic SCT (alloHSCT_2) performed in patients with lymphoma who had relapsed after a first allogeneic transplant (alloHSCT_1). Patients ⩾18 years who had received an alloHSCT_2 for lymphoma relapse between 2000 and 2011 were eligible. One hundred and forty patients were identified. The diagnosis was Hodgkin lymphoma (HL) in 31%, diffuse large B-cell lymphoma in 14%, T-cell lymphoma in 12%, indolent lymphoma in 19%, mantle cell lymphoma in 16% and other lymphomas in 8% of the patients. The median interval from alloHSCT_1 to alloHSCT_2 was 19 (range 4-116) months. Disease status at alloHSCT_2 was chemosensitive in 46%, refractory in 43% and unknown in 11% of the patients. Three-year PFS, OS, relapse incidence and nonrelapse mortality were 19%, 29%, 58% and 23%, respectively. PFS and OS were significantly affected by refractory disease at alloHSCT_2 and a short interval between alloHSCT_1 and alloHSCT_2. Long-term PFS was observed across all lymphoma subsets except for aggressive B-cell lymphoma. In conclusion, alloHSCT_2 is feasible and can result in long-term disease control in patients with lymphoma recurrence after alloHSCT_1, in particular if relapse occurs late and is chemosensitive.
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Estcourt LJ. Why has demand for platelet components increased? A review. Transfus Med 2014; 24:260-8. [DOI: 10.1111/tme.12155] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/24/2014] [Accepted: 09/06/2014] [Indexed: 01/16/2023]
Affiliation(s)
- L. J. Estcourt
- NHS Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
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Urbano-Ispizua A, Baldomero H, Gratwohl A. Hematopoietic stem cell transplantation in Europe. Differences between Eastern and Western countries. Hematology 2013; 17 Suppl 1:S192-4. [DOI: 10.1179/102453312x13336169157095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Alvaro Urbano-Ispizua
- Institute of Hematology and OncologyHospital Clinic Barcelona, University of Barcelona, José Carreras Institute of Research, Barcelona, Spain
| | - Helen Baldomero
- Institute of Hematology and OncologyHospital Clinic Barcelona, University of Barcelona, José Carreras Institute of Research, Barcelona, Spain
| | - Alois Gratwohl
- European Group for Blood and Marrow Transplantation Activity Survey OfficeUniversity Hospital, Basel, Switzerland
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Peinemann F, Smith LA, Bartel C. Autologous hematopoietic stem cell transplantation following high dose chemotherapy for non-rhabdomyosarcoma soft tissue sarcomas. Cochrane Database Syst Rev 2013; 2013:CD008216. [PMID: 23925699 PMCID: PMC6457767 DOI: 10.1002/14651858.cd008216.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a highly heterogeneous group of rare malignant solid tumors. Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) comprise all STS except rhabdomyosarcoma. In patients with advanced local or metastatic disease, autologous hematopoietic stem cell transplantation (HSCT) applied after high-dose chemotherapy (HDCT) is a planned rescue therapy for HDCT-related severe hematologic toxicity. The rationale for this update is to determine whether any randomized controlled trials (RCTs) have been conducted and to clarify whether HDCT followed by autologous HSCT has a survival advantage. OBJECTIVES To assess the effectiveness and safety of HDCT followed by autologous HSCT for all stages of non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) in children and adults. SEARCH METHODS For this update we modified the search strategy to improve the precision and reduce the number of irrelevant hits. All studies included in the original review were considered for re-evaluation in the update. We searched the electronic databases CENTRAL (2012, Issue 11) in The Cochrane Library , MEDLINE and EMBASE (05 December 2012) from their inception using the newly developed search strategy. Online trials registers and reference lists of systematic reviews were searched. SELECTION CRITERIA Terms representing STS and autologous HSCT were required in the title or abstract. In studies with aggregated data, participants with NRSTS and autologous HSCT had to constitute at least 80% of the data. Single-arm studies were included in addition to studies with a control arm because the number of comparative studies was expected to be very low. DATA COLLECTION AND ANALYSIS Two review authors independently extracted study data. Some studies identified in the original review were re-examined and found not to meet the inclusion criteria and were excluded in this update. For studies with no comparator group, we synthesized the results for studies reporting aggregate data and conducted a pooled analysis of individual participant data using the Kaplan-Meyer method. The primary outcomes were overall survival (OS) and treatment-related mortality (TRM). MAIN RESULTS The selection process was carried out from the start of the search dates for the update. We included 57 studies, from 260 full text articles screened, reporting on 275 participants that were allocated to HDCT followed by autologous HSCT. All studies were not comparable due to various subtypes. We identified a single comparative study, an RCT comparing HDCT followed by autologous HSCT versus standard chemotherapy (SDCT). The overall survival (OS) at three years was 32.7% versus 49.4% with a hazard ratio (HR) of 1.26 (95% confidence interval (CI) 0.70 to 2.29, P value 0.44) and thus not significantly different between the treatment groups. In a subgroup of patients that had a complete response before treatment, OS was higher in both treatment groups and OS at three years was 42.8% versus 83.9% with a HR of 2.92 (95% CI 1.1 to 7.6, P value 0.028) and thus was statistically significantly better in the SDCT group. We did not identify any other comparative studies. We included six single-arm studies reporting aggregate data of cases; three reported the OS at two years as 20%, 48%, and 51.4%. One other study reported the OS at three years as 40% and one further study reported a median OS of 13 months (range 3 to 19 months). In two of the single-arm studies with aggregate data, subgroup analysis showed a better OS in patients with versus without a complete response before treatment. In a survival analysis of pooled individual data of 80 participants, OS at two years was estimated as 50.6% (95% CI 38.7 to 62.5) and at three years as 36.7% (95% CI 24.4 to 49.0). Data on TRM, secondary neoplasia and severe toxicity grade 3 to 4 after transplantation were sparse. The one included RCT had a low risk of bias and the remaining 56 studies had a high risk of bias. AUTHORS' CONCLUSIONS A single RCT with a low risk of bias shows that OS after HDCT followed by autologous HSCT is not statistically significantly different from standard-dose chemotherapy. Therefore, HDCT followed by autologous HSCT for patients with NRSTS may not improve the survival of patients and should only be used within controlled trials if ever considered.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Str. 62CologneGermany50937
| | - Lesley A Smith
- Oxford Brookes UniversityDepartment of Psychology, Social Work and Public HealthJack Straws LaneMarstonOxfordUKOX3 0FL
| | - Carmen Bartel
- Institute for Quality and Efficiency in Health Care (IQWiG)Dep. Quality of Health CareIm Mediapark 8CologneGermany50670
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Practice variation in physician referral for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2012; 48:63-7. [PMID: 22705801 DOI: 10.1038/bmt.2012.95] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hematological malignancy patients not referred by their primary hematologist/medical oncologist suffer disparate access to allogeneic hematopoietic cell transplantation (HCT). However, investigation into physician, system and patient factors relevant to this decision making is lacking. We surveyed a national randomized sample of practicing hematologists/medical oncologists identified through the AMA (American Medical Association) masterfile. A modified Dillman approach was utilized to encourage survey response. From 1200 surveyed, a total of 113 physicians responded. In all, 68% were male, 62% identified as White/non-Hispanic, 79% practiced in non-academic settings and 80% reported spending 75-100% of their professional effort in clinical care. Using clinical vignettes, we detected significantly increased odds for HCT non-referral according to age (age 60 vs 30, odds ratio (OR) 8.3, 95% confidence interval (CI): 5.9-11.7, P<0.0001), insurance coverage (no coverage vs coverage, OR 6.9, 95% CI: 5.2-9.1, P<0.0001) and race (African-American vs Caucasian, OR 2.4, 95% CI: 1.9-2.9, P<0.0001). Physician (perception of HCT risks), system (insurance coverage) and patient (age, social support and co-morbid illness) factors were strongly endorsed by respondents as important determinants of their HCT referral practices. These data speak to important factors relevant to HCT referral practices, and highlight several opportunities for education and intervention to reduce current disparities.
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Ahmed SOA, Ghavamzadeh A, Zaidi SZ, Baldomero H, Pasquini MC, Hussain F, Alimoghaddam K, Almohareb F, Ayas M, Hamidieh A, Mahmoud HK, Elhaddad A, Ben Othman T, Abdelkefi A, Sarhan M, Abdel-Rahman F, Adil S, Alkindi S, Bazarbachi A, Benchekroun S, Niederwieser D, Horowitz M, Gratwohl A, El Solh H, Aljurf M. Trends of hematopoietic stem cell transplantation in the Eastern Mediterranean region, 1984-2007. Biol Blood Marrow Transplant 2011; 17:1352-61. [PMID: 21440654 PMCID: PMC3371191 DOI: 10.1016/j.bbmt.2011.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 01/14/2011] [Indexed: 12/01/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) activity was surveyed in the 9 countries in the World Health Organization Eastern Mediterranean region that reported transplantation activity. Between the years of 1984 and 2007, 7933 transplantations were performed. The number of HSCTs per year has continued to increase, with a plateau in allogeneic HSCT (allo-HSCT) between 2005 and 2007. Overall, a greater proportion of transplantations were allo-HSCT (n = 5761, 77%) compared with autologous HSCT (ASCT) (n = 2172, 23%). Of 5761 allo-HSCT, acute leukemia constituted the main indication (n = 2124, 37%). There was a significant proportion of allo-HSCT for bone marrow failures (n = 1001, 17%) and hemoglobinopathies (n = 885, 15%). The rate of unrelated donor transplantations remained low, with only 2 matched unrelated donor allo-HSCTs reported. One hundred umbilical cord blood transplantations were reported (0.017% of allo-HSCT). Peripheral blood stem cells were the main source of graft in allo-HSCT, and peripheral blood stem cells increasingly constitute the main source of hematopoietic stem cells overall. Reduced-intensity conditioning was utilized in 5.7% of allografts over the surveyed period. ASCT numbers continue to increase. There has been a shift in the indication for ASCT from acute leukemia to lymphoproliferative disorders (45%), followed by myeloma (26%). The survey reflects transplantation activity according to the unique health settings of this region. Notable differences in transplantation practices as reported to the European Group for Blood and Marrow Transplantation over recent years are highlighted.
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Affiliation(s)
- Syed O A Ahmed
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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9
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Peinemann F, Smith LA, Kromp M, Bartel C, Kröger N, Kulig M. Autologous hematopoietic stem cell transplantation following high-dose chemotherapy for non-rhabdomyosarcoma soft tissue sarcomas. Cochrane Database Syst Rev 2011:CD008216. [PMID: 21328307 DOI: 10.1002/14651858.cd008216.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a highly heterogeneous group of rare malignant solid tumors. Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) comprise all STS except rhabdomyosarcoma. In patients with advanced local or metastatic disease, autologous hematopoietic stem cell transplantation (HSCT) applied after high-dose chemotherapy (HDCT) is a planned rescue therapy for HDCT-related severe hematologic toxicity. OBJECTIVES To assess the effectiveness and safety of HDCT followed by autologous HSCT for all stages of soft tissue sarcomas in children and adults. SEARCH STRATEGY We searched the electronic databases CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE and EMBASE (February 2010). Online trial registers, congress abstracts and reference lists of reviews were searched and expert panels and authors were contacted. SELECTION CRITERIA Terms representing STS and autologous HSCT were required in the title, abstract or keywords. In studies with aggregated data, participants with NRSTS and autologous HSCT had to constitute at least 80% of the data. Comparative non-randomized studies were included because randomized controlled trials (RCTs) were not expected. Case series and case reports were considered for an additional descriptive analysis. DATA COLLECTION AND ANALYSIS Study data were recorded by two review authors independently. For studies with no comparator group, we synthesised results for studies reporting aggregate data and conducted a pooled analysis of individual participant data using the Kaplan-Meyer method. The primary outcomes were overall survival (OS) and treatment-related mortality (TRM). MAIN RESULTS We included 54 studies, from 467 full texts articles screened (11.5%), reporting on 177 participants that received HSCT and 69 participants that received standard care. Only one study reported comparative data. In the one comparative study, OS at two years after HSCT was estimated as statistically significantly higher (62.3%) compared with participants that received standard care (23.2%). In a single-arm study, the OS two years after HSCT was reported as 20%. In a pooled analysis of the individual data of 54 participants, OS at two years was estimated as 49% (95% CI 34% to 64%). Data on TRM, secondary neoplasia and severe toxicity grade 3 to 4 after transplantation were sparse. All 54 studies had a high risk of bias. AUTHORS' CONCLUSIONS Due to a lack of comparative studies, it is unclear whether participants with NRSTS have improved survival from autologous HSCT following HDCT. Owing to this current gap in knowledge, at present HDCT and autologous HSCT for NRSTS should only be used within controlled trials.
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Affiliation(s)
- Frank Peinemann
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care (IQWiG), Dillenburger Str. 27, Cologne, Germany, 51105
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Gratwohl A, Baldomero H, Schwendener A, Gratwohl M, Apperley J, Frauendorfer K, Niederwieser D. The EBMT activity survey 2008: impact of team size, team density and new trends. Bone Marrow Transplant 2010; 46:174-91. [DOI: 10.1038/bmt.2010.69] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hematopoietic SCT activity in Asia: a report from the Asia-Pacific Blood and Marrow Transplantation Group. Bone Marrow Transplant 2010; 45:1682-91. [DOI: 10.1038/bmt.2010.34] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Bacher U, Haferlach C, Kröger N, Schnittger S, Kern W, Wiedemann B, Zander AR, Haferlach T. Diagnostic tools in the indications for allogeneic stem cell transplantation in myelodysplastic syndromes. Biol Blood Marrow Transplant 2009; 16:1-11. [PMID: 20053328 DOI: 10.1016/j.bbmt.2009.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 08/10/2009] [Indexed: 11/18/2022]
Abstract
The rates of allogeneic stem cell transplantation (SCT) to treat the myelodysplastic syndromes (MDS) is continually increasing. However, given the growing arsenal of therapeutic options in parallel to deeper insight into the heterogeneity of this disorder, determining the indications for SCT in MDS remains a difficult task. The International Prognostic Scoring System (IPSS) serves as a guideline for therapeutic decisions, but many aspects (eg, interpretation of rare cytogenetic abnormalities, combinations of chromosomal alterations and/or molecular markers, variant clinical courses within distinct biological subgroups) remain the subject of continuous investigation. In an effort to achieve a more well-differentiated risk categorization, attempts have been made to perform a more detailed cytogenetic categorization, and the use of various fluorescein in situ hybridization (FISH) techniques has improved the description of aberrations. Multicenter initiatives have standardized multiparameter flow cytometry techniques for diagnosis of MDS. In advanced MDS, screening for molecular mutations can identify cases with a high transformation risk. Finally, the new World Health Organization classification system provides a more homogenous morphological categorization of MDS compared with the former French-American-British system. Consequently, in the near future, risk stratification in MDS might incorporate additional diagnostic tools and categorization systems aimed at improving the timing and indication for SCT in this complex disorder.
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Affiliation(s)
- Ulrike Bacher
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
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13
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Ocheni S, Iwanski GB, Schafhausen P, Zander AR, Ayuk F, Klyuchnikov E, Zabelina T, Fiedler W, Schnittger S, Hochhaus A, Brümmendorf TH, Kröger N, Bacher U. Characterisation of extramedullary relapse in patients with chronic myeloid leukemia in advanced disease after allogeneic stem cell transplantation. Leuk Lymphoma 2009; 50:551-8. [PMID: 19373652 DOI: 10.1080/10428190902755513] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recently, higher extramedullary relapse rates following allogeneic stem cell transplantation (SCT) in myeloid malignancies were reported e.g. because of selection of poor-risk patients. We analysed five consecutive patients with post-transplant extramedullary relapse of chronic myeloid leukemia (CML) out of a total of 24 patients (21%) undergoing allo-SCT. All five patients with extramedullary relapse had clonal evolution and a history of blast phase (BP). In particular, 56% of the patients in BP had extramedullary relapse with no extramedullary relapse in patients with chronic/accelerated phase. Most frequent manifestation sites were the skeletal system, the muscles/subcutaneous tissue and the central nervous system. In one case chloroma was mimicking myositis of the lower limbs. Combined approaches were performed including irradiation (n = 4), chemotherapy (n = 2), IM (n = 2), dasatinib (n = 4), nilotinib (n = 1), a novel aurora-kinase-inhibitor (n = 1), donor lymphocytes (n = 2) or a second allo-SCT (n = 2). Transient response was achieved in one case, stable partial remissions in two cases, whereas two cases were refractory. Research should focus on prospective studies aiming to improve treatment of extramedullary relapse in stem cell recipients with CML with a special focus on the role of second generation tyrosine kinase inhibitors.
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Affiliation(s)
- Sunday Ocheni
- Clinic for Stem Cell Transplantation, University Cancer Centre Hamburg, Hamburg, Germany
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Baumann FT, Kraut L, Schüle K, Bloch W, Fauser AA. A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation. Bone Marrow Transplant 2009; 45:355-62. [PMID: 19597418 DOI: 10.1038/bmt.2009.163] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A haematopoietic SCT (HSCT) can cause severe side effects, which may have a profound impact on a patient's life both physically and psychologically. Some studies have shown that physical activity has positive effects for inpatients after an HSCT. Therefore, the question arises whether a controlled exercise programme right from the beginning of the conditioning phase could help contribute to a patient's physical and psychological recovery. To evaluate the different effects of specific, moderate physical activities on the physical and psychological condition of HSCT patients we performed a controlled randomized study with 64 inpatients undergoing an allogeneic or autologous HSCT. The patients were randomly assigned to two groups. Although the training group took part in a specific programme of exercise therapy twice a day throughout the entire hospitalization phase, patients in the control group were offered the hospital's standard mobilization programme. The results of this study showed significant differences in favour of the training group regarding strength, endurance, lung function and quality of life. However, further studies are needed to confirm these results.
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Affiliation(s)
- F T Baumann
- Institute for Rehabilitation and Sport for the Disabled, German Sport University, Cologne, Germany
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15
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Suttorp M. Innovative approaches of targeted therapy for CML of childhood in combination with paediatric haematopoietic SCT. Bone Marrow Transplant 2009; 42 Suppl 2:S40-6. [PMID: 18978743 DOI: 10.1038/bmt.2008.282] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Allogeneic haematopoietic SCT (HSCT) induces CRs in most patients with CML. With the excellent short-term treatment results induced by imatinib (IMA), attitudes have changed and only a minority of children are now transplanted upfront. This review addresses the role of IMA in children with CML, focusing on the starting dose of IMA, possible adverse effects, timing of HSCT in children, duration of IMA treatment and monitoring of treatment efficacy to unravel failure of early treatment of IMA as well as treatment of CML relapse after HSCT. As the paediatric experience with IMA is still very limited, many answers and algorithms are adapted from CML in adults. Basically, HSCT should be postponed to achieve an optimal tumour cell reduction by IMA treatment. Children with a low-risk EBMT score should undergo HSCT within 2 years after diagnosis to avoid prolonged exposure and unknown late effects of IMA. Without a perfectly HLA-matched donor, HSCT may be postponed until CML becomes refractory to IMA. As realized in the presently activated international trial CML-paed II, this approach represents a risk-adapted therapy with the benefit of being tailored to the needs and profile of an individual patient.
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Affiliation(s)
- M Suttorp
- Department of Paediatrics, University Hospital, Dresden, Germany.
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Kanold J, Paillard C, Tchirkov A, Merlin E, Marabelle A, Lutz P, Rousseau R, Baldomero H, Deméocq F. Allogeneic or haploidentical HSCT for refractory or relapsed solid tumors in children: toward a neuroblastoma model. Bone Marrow Transplant 2008; 42 Suppl 2:S25-30. [DOI: 10.1038/bmt.2008.279] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Turkish Transplant Registry: a comparative analysis of national activity with the EBMT European Activity Survey. Bone Marrow Transplant 2008; 42 Suppl 1:S142-S145. [DOI: 10.1038/bmt.2008.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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B-cell concentration in the apheretic product predicts acute graft-versus-host disease and treatment-related mortality of allogeneic peripheral blood stem cell transplantation. Transplantation 2008; 85:386-90. [PMID: 18322430 DOI: 10.1097/tp.0b013e3181622e36] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The influence of the graft composition on the clinical outcome after allogeneic peripheral blood stem cell (PBSC) transplantation is not well established. METHODS The cellular composition of the apheretic products obtained from 63 human leukocyte antigen-identical siblings was prospectively correlated with the outcome of patients with hematological malignancies undergoing an allogeneic PBSC transplant after myeloablative conditioning. The concentration of nuclear, mononuclear, CD34+, T-cell subsets, B cells, and natural killer cells in the graft has been analyzed. RESULTS In univariate analysis, acute graft-versus-host disease (GVHD) correlated with the disease (P=0.002), with the phase of disease at transplant (P=0.01), and with the number of CD20+ cells infused (P=0.05). In multivariate analysis, a dose of CD20+ cells in the graft higher than the median dose remained the only factor negatively affecting the incidence of acute GVHD (P=0.01; 95% confidence interval [CI]: 0.12-0.78). In univariate analysis, treatment-related mortality (TRM) correlated with the disease (P=0.04) and was negatively affected by a dose of infused B cells greater than the median value (28% versus 50%; P=0.02). In multivariate analysis, TRM was close to statistical correlation with the dose of CD20+ cells (P=0.06; 95% CI: 0.02-1.05). No other clinical parameter was influenced by the composition of the graft. CONCLUSIONS Our results suggest that the concentration of B cells in the apheretic product may predict the incidence of acute GVHD and TRM in patients undergoing an allogeneic PBSC transplantation and open the way to the new preventive and therapeutic strategies for the management of GVHD.
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19
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Matthes-Martin S, Pötschger U, Bergmann K, Frommlet F, Brannath W, Bauer P, Klingebiel T. Risk-Adjusted Outcome Measurement in Pediatric Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2008; 14:335-43. [DOI: 10.1016/j.bbmt.2007.12.487] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 12/13/2007] [Indexed: 11/26/2022]
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20
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Pedrazzoli P, Rosti G, Secondino S, Carminati O, Demirer T. High-dose chemotherapy with autologous hematopoietic stem cell support for solid tumors in adults. Semin Hematol 2008; 44:286-95. [PMID: 17961729 DOI: 10.1053/j.seminhematol.2007.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Supported by experimental evidence and convincing results of early phase II studies, since the 1980s high-dose chemotherapy (HDC) with autologous hematopoietic stem cell support (AHSCT) has been uncritically adopted by many oncologists as a potentially curative option for several solid tumors. As a result, the number (and size) of randomized trials comparing this approach with conventional chemotherapy initiated (and often abandoned before completion) in this setting was limited and the benefit of a greater escalation of dose of chemotherapy with stem cell transplantation in solid tumors remains, with the possible exception of breast carcinoma (BC) and germ cell tumors (GCT), largely unsettled. In this article, we review and comment on the data from studies to date of HDC for solid tumors in adults.
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Affiliation(s)
- Paolo Pedrazzoli
- Divisione di Oncologia Medica Falck, Ospedale Niguarda Ca' Granda, Milano, Italy, and Department of Hematology, Ankara University Medical School, Turkey
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21
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Hows JM, Passweg JR, Tichelli A, Locasciulli A, Szydlo R, Bacigalupo A, Jacobson N, Ljungman P, Cornish J, Nunn A, Bradley B, Socié G. Comparison of long-term outcomes after allogeneic hematopoietic stem cell transplantation from matched sibling and unrelated donors. Bone Marrow Transplant 2006; 38:799-805. [PMID: 17075568 DOI: 10.1038/sj.bmt.1705531] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term survivors of hematopoietic stem cell transplants remain at risk of potentially fatal complications that detract from life quality. Long-term morbidity and mortality were compared between matched recipient cohorts surviving 2 or more years and defined by donor type, HLA matched sibling donor (MSD) or volunteer unrelated donor (URD). Patients were previously entered into the prospective multicenter International Unrelated Search and Transplant Study. Thirty-nine centers provided data on 108 URD and 355 MSD recipients surviving more than 2 years. Long-term survival, performance status, chronic GvHD (c-GvHD), secondary malignancy, endocrine dysfunction, cataracts, bone necrosis and dental pathology were compared between cohorts. Twelve year survival was 77+/-5% for the MSD and 67+/-11% for the URD cohort (P=0.1). Late death occurred in 105 of 463 recipients alive at 2 years, 73 after 355 (21%) MSD and 32 after 108 (30%) URD transplants, P=0.10. Of 105 deaths, the cause was relapse in 60 and unrelated to relapse in 45 cases. Cumulative incidence of extensive c-GvHD (P=0.002), cataracts (P=0.02) and bone necrosis (P=0.02) was higher after URD transplants. No long-term difference in endocrine dysfunction, secondary malignancy and major dental pathology was detected. This landmark study will assist physicians counseling patients pre-transplant and with their long-term care post transplant.
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Affiliation(s)
- J M Hows
- Department of Biomedical Sciences, Faculty of Applied Sciences, University of the West of England, Bristol, UK.
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22
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Abstract
Along with improved supportive care and thus reduced treatment-related mortality, an increasing number of elderly patients (> 60 years) with haematological malignancies are now considered for high-dose therapy (HDT) supported by autologous stem cell transplantation (ASCT). ASCT is feasible in selected elderly patients with multiple myeloma and those with non-Hodgkin's lymphoma. As elderly patients have generally been excluded from randomized studies evaluating efficacy of ASCT in comparison with non-transplant approaches, limited data are available on the efficacy of ASCT in this patient population. Recent developments in supportive care including amifostine and palifermin may increase feasibility of ASCT in elderly patients. Prospective studies are needed to evaluate feasibility and efficacy of ASCT in patients over 60 years of age. Also, further studies are needed in order to decrease toxicity of high-dose regimens in this patient group where co-morbid conditions may modify the toxicity of HDT in a clinically significant manner.
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Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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23
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Ravagnani F, Coluccia P, Notti P, Arienti F, Bompadre A, Avella M, Bozzi F, Barzanò E, Podda M, Pupa S, Luksch R. Peripheral blood stem cell collection in pediatric patients: feasibility of leukapheresis under anesthesia in uncompliant small children with solid tumors. J Clin Apher 2006; 21:85-91. [PMID: 16035098 DOI: 10.1002/jca.20058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Leukapheresis demands patient's compliance and adequate vascular accesses, which can require invasive methods in very small children whose treatment protocol includes hemopoietic stem cell collection for myeloablative chemotherapy and stem cell rescue. Since 1998, at the Istituto Nazionale Tumori of Milan, in selected uncompliant small children, the placement of peripheral vascular accesses and leukapheresis have been performed at the same time under general anesthesia. Peripheral venous cannulas were positioned for blood collection, while blood was returned through either peripheral cannulas or mono-lumen central catheters previously installed for chemotherapy. A continuous-flow cell separator was used for leukapheresis. Between 1998 and 2003, 47 children with solid tumors underwent anesthesia for a total of 54 leukaphereses. The patients' age ranged from 12.7 to 93 months (median 30.3) and their weight ranged from 7 to 20 kg (median 14.1). Neither metabolic nor anesthesiological complications were recorded. In 89% of cases, the CD 34(+) cell target was achieved at a single harvest; the median number of CD 34(+) cells was 10.8 x 10(6)/kg/leukapheresis (range 1-117) and the median collection efficiency was 63.4% (range 25-100.6). Leukapheresis under anesthesia is feasible and safe in very low-weight children whose compliance is lacking due to age and disease.
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Affiliation(s)
- Fernando Ravagnani
- Immunohematology and Transfusion Medicine Service, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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24
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Quittet P, Ceballos P, Lopez E, Lu ZY, Latry P, Becht C, Legouffe E, Fegueux N, Exbrayat C, Pouessel D, Rouillé V, Daures JP, Klein B, Rossi JF. Low doses of GM-CSF (molgramostim) and G-CSF (filgrastim) after cyclophosphamide (4 g/m2) enhance the peripheral blood progenitor cell harvest: results of two randomized studies including 120 patients. Bone Marrow Transplant 2006; 38:275-84. [PMID: 16883311 PMCID: PMC2100150 DOI: 10.1038/sj.bmt.1705441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The use of a combination of G-CSF and GM-CSF versus G-CSF alone, after cyclophosphamide (4 g/m2) was compared in two randomized phase III studies, including 120 patients. In study A, 60 patients received 5 x 2 microg/kg/day of G-CSF and GM-CSF compared to 5 mug/kg/day of G-CSF. In study B, 60 patients received 2.5 x 2 microg/kg/day G-CSF and GM-CSF compared to G-CSF alone (5 microg/kg/day). With the aim to collect at least 5 x 10(6)/kg CD34 cells in a maximum of three large volume leukapherises (LK), 123 LK were performed in study A, showing a significantly higher number of patients reaching 10 x 10(6)/kg CD34 cells (21/29 in G+GM-CSF arm vs 11/27 in G-CSF arm, P=0.00006). In study B, 109 LK were performed, with similar results (10/27 vs 15/26, P=0.003). In both the study, the total harvest of CD34 cells/kg was twofold higher in G-CSF plus GM-CSF group (18.3 x 10(6) in study A and 15.85 x 10(6) in study B) than in G-CSF group (9 x 10(6) in study A and 8.1 x 10(6) in study B), a significant difference only seen in multiple myeloma, with no significant difference in terms of mobilized myeloma cells between G-CSF and GM-CSF groups.
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Affiliation(s)
- Philippe Quittet
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Patrice Ceballos
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Ernesto Lopez
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Zhao-Yang Lu
- Unité de Thérapie Cellulaire
CHRU Montpellier Hôpital Saint-Eloi34295 Montpellier,FR
| | - Pascal Latry
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Catherine Becht
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Eric Legouffe
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Nathalie Fegueux
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Carole Exbrayat
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Damien Pouessel
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Valérie Rouillé
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
| | - Jean-Pierre Daures
- Laboratoire de biostatistique
Institut Universitaire de Recherche CliniqueUniversité Montpellier I34093 Montpellier cedex 5,FR
| | - Bernard Klein
- Unité de Thérapie Cellulaire
CHRU Montpellier Hôpital Saint-Eloi34295 Montpellier,FR
| | - Jean-François Rossi
- Service d'hématologie et oncologie médicale
CHRU Montpellier Hôpital LapeyronieUniversité Montpellier I34295 Montpellier,FR
- * Correspondence should be adressed to: Jean-François Rossi
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25
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Kuittinen T, Jantunen E, Vanninen E, Mussalo H, Vuolteenaho O, Ala-Kopsala M, Nousiainen T, Hartikainen J. Cardiac effects within 3 months of BEAC high-dose therapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation. Eur J Haematol 2006; 77:120-7. [PMID: 16856907 DOI: 10.1111/j.1600-0609.2006.00687.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Limited data are available on the cardiac effects of high-dose cyclophosphamide (CY) in patients with non-Hodgkin's lymphoma (NHL). We prospectively assessed the cardiac effects of high-dose CY in 30 adult NHL patients receiving CY 6 g/m(2) as part of BEAC high-dose therapy (HDT). METHODS Radionuclide ventriculography (RVG) and plasma natriuretic peptide (NT-proANP, NT-proBNP) measurements were performed simultaneously prior to BEAC at baseline (d - 7), 12 days (d + 12) and 3 months (m + 3) after stem cell infusion (D0). In addition to these time points, natriuretic peptides were measured 2 days before (d - 2) and 1 week (d + 7) after stem cell infusion. RESULTS Left ventricular ejection fraction (LVEF) decreased from d - 7 (53% +/- 2%) to d + 12 (49% +/- 2%, P = 0.009). However, no significant change in cardiac diastolic function was observed. The LVEF returned towards baseline by m + 3. Plasma NT-proANP and NT-proBNP increased significantly from baseline (445 +/- 65 pmol/L and 129 +/- 33 pmol/L) to d - 2 (1,127 +/- 142 pmol/L, P < 0.001 and 624 +/- 148 pmol/L, P < 0.001, respectively). Thereafter, they started to decrease, but on d + 7 NT-proANP (404 +/- 157 pmol/L, P = 0.048) and NT-proBNP (648 +/- 125 pmol/L, P = 0.015) were still significantly higher than at baseline. On d + 12 and m + 3 they no longer differed from baseline. CONCLUSIONS Our findings suggest that high-dose CY results in acute, subclinical systolic dysfunction in NHL patients previously treated with anthracyclines. Natriuretic peptides seem to be more sensitive than LVEF to reflect this transient cardiac effect. Serial measurements of natriuretic peptides might be a useful tool to assess cardiac effects of high-dose CY.
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Affiliation(s)
- T Kuittinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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26
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Kuthiala SS, Lyman GH, Ballester OF. Randomized clinical trials for hematopoietic stem cell transplantation: lessons to be learned from the European experience. Bone Marrow Transplant 2006; 37:219-21. [PMID: 16299544 DOI: 10.1038/sj.bmt.1705230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We evaluated the number and characteristics of randomized controlled trials (RCTs) addressing hematopoietic stem cell transplantation (HSCT) for patients with hematological malignancies, comparing the productivity of US and Europe. A MEDLINE search was conducted to identify all published RCTs for the management of adult patients with hematological malignancies from January 1992 to December 2003. Eighty-three of the 306 trials identified included HSCT as one of the treatment arms. The US produced 25, Europe 54, and all other countries four. Four European countries, France, Italy, Germany, and UK (FIGU), produced 32 out of the 54 European studies. Significant differences emerged when focus of the study and accrual numbers were analyzed. Trials comparing HSCT to standard dose therapy represented 34.9% of the 83 trials and 59.4% of FIGU trials, but only 4% of US studies (P = 0.001). US trials accrued a mean of 110.2 patients per study, as compared to 222.6 in FIGU studies (P = 0.006) and 205.3 when all non-US countries are considered (P = 0.01). Our conclusions are that US transplant RCT have focused on issues other than the comparison of HSCT to standard therapies. There is serious paucity of US trials defining the role of HSCT in the management of hematological malignancies.
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Affiliation(s)
- S S Kuthiala
- Section of Hematology/Oncology, Medical College of Georgia, Augusta, GA 30912, USA.
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27
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Bonanomi S, Gaiero A, Masera N, Rovelli A, Uderzo C, Fichera G, Mulas R, Zecca S, Pozzi L, Cohen A. Distinctive characteristics of diabetes mellitus after hematopoietic cell transplantation during childhood. Pediatr Transplant 2006; 10:461-5. [PMID: 16712604 DOI: 10.1111/j.1399-3046.2006.00498.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report on six patients who developed diabetes mellitus after hematopoietic cell transplantation (HCT). The prevalence in our cohort of long-term survivors after HCT performed below 18 yr of age was 3%. The median age at onset of diabetes was 22.4 yr (range 11.3-34.4). The median period between HCT and diabetes was 10.1 yr (range 5.6-22.1). Five out of the six patients received total irradiation therapy and five had other endocrinological abnormalities. The onset of diabetes in all patients was insidious and none had diabetic ketoacidosis. Body mass indexes at diabetes onset were within normal levels. The clinical and laboratory features that characterized our patients with diabetes after HCT make it difficult to classify them as having type-1 or type-2 diabetes. The relatively high prevalence of diabetes and its insidious onset in this group of patients, advocate clinicians to evaluate carefully even slight variations in fasting blood glucose, usually included in the routine biochemistry follow-up. These data also suggest that HbA1c and oral glucose-tolerance test should be added to the follow-up program of late complications if fasting blood glucose levels are slightly increased.
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Affiliation(s)
- Sonia Bonanomi
- Department of Pediatrics, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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28
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Park SH, Choi SM, Lee DG, Choi JH, Yoo JH, Lee JW, Min WS, Shin WS, Kim CC. Current trends of infectious complications following hematopoietic stem cell transplantation in a single center. J Korean Med Sci 2006; 21:199-207. [PMID: 16614501 PMCID: PMC2733991 DOI: 10.3346/jkms.2006.21.2.199] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study was to analyze the infectious complications after hematopoietic stem cell transplantation (HSCT) according to the recent changes of HSCT. Medical records of 379 adult patients who underwent HSCT consecutively at Catholic HSCT Center from January 2001 to December 2002 were reviewed retrospectively. Allogeneic HSCT accounted for 75.7% (287/379) and autologous HSCT for 24.3% (92/379). During pre-engraftment period, bacterial infection was predominant, and E. coli was still the most common organism. After engraftment, viral infection was predominant. The incidence of invasive fungal infection showed bimodal distribution with peak correlated with neutropenia and graft-versus-host disease (GVHD). The overall mortality and infection-related mortality rates according to 3 periods were as follows; during pre-engraftment, 3.16% (12/379) and 1.8% (7/379); during midrecovery period, 7.9% (29/367) and 4.1% (15/367); during late-recovery period, 26.9% (91/338), and 15.9% (54/338). Risk factors for infection-related mortality were as follows; during pre-engraftment period, fungal infection and septic shock; during the mid-recovery period, hemorrhagic cystitis and delayed engraftment; during the late-recovery period, fungal infection, chronic GVHD, and relapse. In conclusion, infection was still one of the main complications after HSCT and highly contributes to mortality. The early diagnosis and the effective vaccination strategy are needed for control of infections.
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Affiliation(s)
- Sun Hee Park
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Su-Mi Choi
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Dong-Gun Lee
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jung-Hyun Choi
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jin-Hong Yoo
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jong-Wook Lee
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Woo-Sung Min
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Wan-Shik Shin
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Chun-Choo Kim
- Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
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29
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Fillitz M, Karlic H, Tüchler H, Zeibig J, Spiegel W, Wihlidal P, Varga F, Pittermann E, Pfeilstöcker M. Does mRNA level of microsomal carnitine palmitoyltransferase predict yield of peripheral blood stem cell apheresis? Ann Hematol 2006; 85:386-93. [PMID: 16557380 DOI: 10.1007/s00277-005-0074-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Accepted: 12/22/2005] [Indexed: 11/30/2022]
Abstract
Transplantation of autologous hematopoietic stem cells is a well established therapeutic procedure. Despite advances in efficacy of the stem cell mobilization and apheresis process until now a predictive factor for the expected stem cell yield before initiation of mobilization therapy could not be identified. The main objective of our study was to evaluate alterations in enzymes involved in fatty acid metabolism on the level of gene expression in mononuclear cells, as changes in relative mRNA levels of these enzymes could represent the hematopoietic regenerative potential. Data of 23 consecutive patients with different lymphoid malignancies undergoing stem cell mobilization were analyzed. Our results show that mRNA levels of microsomal carnitine palmitoyltransferase in peripheral blood mononuclear cells quantified before application of mobilization therapy correlate positively with the amount of CD34 positive cells in peripheral blood before first apheresis, in the first apheresis product and in the total harvest outcome. The association of enzymes involved in fatty acid metabolism with hematoopoiesis was further confirmed in healthy subjects on altitude-adaptation training and in proliferating or differentiating HL60 cells. This gives evidence for a possible predictive value of such analyzes though further data of a larger sample are to be collected to confirm our observations.
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Affiliation(s)
- Michael Fillitz
- 3rd Department of Medicine, Hanusch Hospital, H. Collinstrasse 30, 1140 Vienna, Austria
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30
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Jantunen E, Itälä M, Lehtinen T, Kuittinen O, Koivunen E, Leppä S, Juvonen E, Koistinen P, Wiklund T, Nousiainen T, Remes K, Volin L. Early treatment-related mortality in adult autologous stem cell transplant recipients: a nation-wide survey of 1482 transplanted patients. Eur J Haematol 2006; 76:245-50. [PMID: 16412136 DOI: 10.1111/j.1600-0609.2005.00605.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate early (<100 d) treatment-related mortality (TRM) in autologous stem cell transplant (ASCT) recipients. PATIENTS Altogether 1482 adult patients received ASCT in six Finnish centres 1990-2003. The most common diagnoses were non-Hodgkin's lymphoma (NHL) (n = 542), multiple myeloma (MM) (n = 528), breast cancer (BC) (n = 132), Hodgkin's lymphoma (n = 86) and chronic lymphocytic leukaemia (CLL) (n = 63). RESULTS Forty-two patients (2.8%) died from treatment-related reasons <100 d from ASCT. The median time to death was 38 d from ASCT (0-99). The risk of TRM varied according to the diagnoses. The highest risk was observed in patients with AL amyloidosis (24%) followed by NHL (4.4%) and MM (1.9%). No early TRM was observed in patients transplanted for BC or CLL. Infections were the cause of death in 16 patients (fungal 7, bacterial 6, viral 3). Organ toxicity was responsible for early death in 26 patients (heart 9, lungs 7, other 10). CONCLUSIONS This nation-wide survey indicated a low early TRM in ASCT recipients in general, but higher risks in patients with AL amyloidosis or NHL. In addition to patient selection, also optimization of transplant procedure may be needed in these patient groups to reduce early TRM.
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Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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31
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Breems DA, Löwenberg B. Autologous stem cell transplantation in the treatment of adults with acute myeloid leukaemia. Br J Haematol 2005; 130:825-33. [PMID: 16156852 DOI: 10.1111/j.1365-2141.2005.05628.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Most adult patients under 60 years with acute myeloid leukaemia (AML) who achieve a complete remission after induction chemotherapy will relapse if they do not receive further therapy. Consolidation treatment with autologous stem cell transplantation (SCT) is one option that has been studied extensively. High-dose cytotoxic therapy followed by autologous SCT or intensive cycles of chemotherapy furnish overall approximately similar probabilities of survival when applied in first remission. Here, we present a concise update regarding the place of autologous SCT in the treatment of AML. Particular issues discussed are the value of autologous SCT in different prognostic subsets of AML and the value of autologous mobilised peripheral blood stem cell transplants, which offer a much faster haematopoietic recovery.
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Affiliation(s)
- Dimitri A Breems
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Kuittinen T, Husso-Saastamoinen M, Sipola P, Vuolteenaho O, Ala-Kopsala M, Nousiainen T, Jantunen E, Hartikainen J. Very acute cardiac toxicity during BEAC chemotherapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation. Bone Marrow Transplant 2005; 36:1077-82. [PMID: 16247436 DOI: 10.1038/sj.bmt.1705175] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiotoxicity is potentially the most threatening nonhaematological side effect of high-dose CY. We prospectively evaluated the very acute cardiac effects of high-dose CY in 17 adult non-Hodgkin's lymphoma (NHL) patients receiving CY 1500 mg/m2/day as a part of BEAC high-dose therapy (HDT). Magnetic resonance imaging (MRI) and plasma natriuretic peptide (NT-proBNP, NT-proANP) measurements were performed prior to HDT (d-7) and just after completing HDT (d-2). After the high-dose CY left atrial end-systolic area increased from 15.2+/-1.2 to 18.5+/-1.4 cm2 (P=0.001), left ventricular end-diastolic volume from 136.1+/-12.3 to 156.6+/-11.1 cm3 (P=0.04) and left ventricular end-systolic volume from 67.4+/-7.8 to 75.3+/-7.1 cm3 (P=0.018). However, no significant change in left ventricular ejection fraction (LVEF) was observed. At the same time, plasma levels of NT-proBNP increased from 134.9+/-53.3 to 547.1+/-168.4 pmol/l (P=0.003) and NT-proANP from 481.1+/-105.5 to 1056.6+/-193.1 pmol/l (P=0.001), respectively. To conclude, high-dose CY results in very acute cardiac toxicity characterised by enlargement of the heart chambers in NHL patients previously treated with anthracyclines. This toxicity can be detected with increased concentrations of circulating natriuretic peptides but not with LVEF measurement.
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Affiliation(s)
- T Kuittinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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Cesaro S, Oneto R, Messina C, Gibson BE, Buzyn A, Steward C, Gluckman E, Bredius R, Breddius R, Boogaerts M, Vermylen C, Veys P, Marsh J, Badell I, Michel G, Güngör T, Niethammer D, Bordigoni P, Oswald C, Favre C, Passweg J, Dini G. Haematopoietic stem cell transplantation for Shwachman-Diamond disease: a study from the European Group for blood and marrow transplantation. Br J Haematol 2005; 131:231-6. [PMID: 16197455 DOI: 10.1111/j.1365-2141.2005.05758.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This report assessed the results of allogeneic stem cell transplantation (allo-SCT) in 26 patients with Shwachman-Diamond disease (SDS) and severe bone marrow abnormalities. The conditioning regimen was based on busulphan (54%), total body irradiation (23%), fludarabine (15%) or other chemotherapy combinations (8%). Standard prevention of graft versus host disease (GVHD) with cyclosporin +/- methotrexate was adopted in 54% of the patients whilst in vivo or in vitro T-cell depletion was used in 17 and four patients respectively. Neutrophil and platelet engraftment were achieved in 21 (81%) and 17 (65%) of 26 patients after a median time of 18 days and 29 days respectively. The incidence of grade III and IV acute GVHD was 24% and of chronic GVHD 29%. Nine patients died after a median time of 70 d, post-SCT. After a median follow-up of 1.1 years, the transplant-related mortality was 35.5% (95% CI 17-54) whilst the overall survival was 64.5% (95% CI 45.7-83.2). Allo-SCT was found to be successful in more than half of SDS patients with severe bone marrow dysfunction. Further improvements would be anticipated by a better definition of the optimum time in the course of disease to transplant and by the adoption of less toxic conditioning regimens.
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Affiliation(s)
- Simone Cesaro
- Department of Pediatrics, Clinic of Paediatric Haematology Oncology, University of Padova, Italy.
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Kuittinen T, Wiklund T, Remes K, Elonen E, Lehtinen T, Kuittinen O, Leppä S, Putkonen M, Räty R, Turpeenniemi-Hujanen T, Nousiainen T, Jantunen E. Outcome of progressive disease after autologous stem cell transplantation in patients with non-Hodgkin's lymphoma: a nation-wide survey. Eur J Haematol 2005; 75:199-205. [PMID: 16104875 DOI: 10.1111/j.1600-0609.2005.00481.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyse outcome and prognostic factors in non-Hodgkin's lymphoma (NHL) patients who progress after autologous stem cell transplantation (ASCT). PATIENTS Altogether 115 consecutive NHL patients transplanted in 1991-2000 were studied. Histology included diffuse large B cell (n = 52), follicular (n = 26), mantle cell (n = 15), T cell (n = 16) and other subtypes (n = 6). The median time from ASCT to the progression was 7 months. Ninety-six patients (83%) received salvage treatment. RESULTS Twenty-four patients (25%) achieved complete remission and 30 (31%) partial remission. The median overall survival was 8 months (range 0-98+) and the projected 4-year survival 21%. In multivariate analysis factors predicting treatment response after the progression included the use of rituximab (P = 0.036), histology other than diffuse large B cell (P = 0.001) and International Prognostic Index < or =2 at progression (P < 0.001). Normal lactate dehydrogenase (LDH) at progression (P = 0.002), response to salvage treatment (P < 0.001) and time from ASCT to progression > or =7 months (P = 0.022) were predictors for overall survival. CONCLUSIONS Although the prognosis of patients who progress after ASCT is generally poor, many patients will respond to current therapies, and some may experience prolonged survival. Normal LDH at time of disease progression and longer time to progression after ASCT were the most powerful predictors for a promising outcome.
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Affiliation(s)
- T Kuittinen
- Department of Medicine, Kuopio University Hospital, Finland.
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Abstract
Allogeneic haemopoietic stem-cell transplantation (HSCT) can induce long-lasting complete molecular remissions in most patients with chronic myeloid leukemia (CML) for more than 20 years. No other intervention for this disease has such a track record, and early HSCT, despite its associated morbidity and mortality, has become standard care for patients with a compatible donor. This situation has changed with the introduction of the specific tyrosine kinase inhibitor imatinib. The excellent short-term results of imatinib have changed attitudes, and the number of transplantations for CML have declined rapidly since 1999. In this debate, Alois Gratwohl and Gianantonio Rosti present opposing arguments as to whether there is still a role for early HSCT in CML.
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Affiliation(s)
- Alois Gratwohl
- Haematology and Stem Cell Transplant Team, University Hospital, CH-4031 Basel, Switzerland.
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Gratwohl A, Baldomero H, Schmid O, Horisberger B, Bargetzi M, Urbano-Ispizua A. Change in stem cell source for hematopoietic stem cell transplantation (HSCT) in Europe: a report of the EBMT activity survey 2003. Bone Marrow Transplant 2005; 36:575-90. [PMID: 16086045 DOI: 10.1038/sj.bmt.1705104] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This EBMT activity survey presents the status of hematopoietic stem cell transplantation (HSCT) in Europe 2003 and focuses on changes in stem cell source over the last decade. There were 21 028 first HSCT, 7091 allogeneic (34%), 13 937 autologous (66%) and 4179 additional re- or multiple transplants reported from 597 centers in 42 European countries in the year 2003. Main indications were leukemias (6613 (31%; 78% allogeneic)); lymphomas (11 571 (55%; 93% autologous)); solid tumors (1792 (9%; 92% autologous)) and nonmalignant disorders (898 (5%; 93% allogeneic)). In 1991, the vast majority of autologous and all allogeneic HSCT were still bone marrow (BM) transplants. Stem cell source changed rapidly to peripheral blood (PB) for autologous HSCT between 1992 and 1996. In 2003, 97% of autologous HSCT were PB derived. The change to PB for allogeneic HSCT followed 3 years later and occurred at a lower rate. In 2003, 65% of all allogeneic HSCT were PB derived. The change in stem cell source was not homogeneous. It was associated with donor type, main diagnosis, disease stage and it differed between European countries. In 2003, bone marrow remains a significant source of stem cells in some European countries for autologous HSCT and for nonmalignant disorders in allogeneic HSCT.
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Affiliation(s)
- A Gratwohl
- Hematology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
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Childs R, Srinivasan R. High-dose chemotherapy and allogeneic immunotherapy. Lancet 2005; 366:273-5. [PMID: 16039317 DOI: 10.1016/s0140-6736(05)66963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Richard Childs
- Hematology Branch, National Institutes of Health, Bethesda, MD 20892, USA.
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Abstract
Allogeneic stem cell transplantation (HSCT) requires the harvest of an adequate number of stem cells (SC) from a histocompatible donor and their infusion into a patient following a conditioning regimen. During the past 35 years, the role of HSCT has changed from an experimental procedure for terminally ill patients to a curative treatment. In 2003, 1170 procedures were registered in Italy (Italian Group for Blood and Marrow Transplantation). The main reported indications were as follows: leukemia, lymphoproliferative diseases, myelodysplasia, and nonmalignant diseases such as thalassemia and severe aplastic anemia. Important changes have been observed in the last 5 years: the shift from bone marrow to peripheral blood as the SC source, the increasing number of alternative donors such as unrelated, partially matched family donors and cord blood SC, and the new extra-hematological indications including solid tumors. Moreover, the development of nonmyeloablative conditioning regimens have allowed physicians to perform HSCT in patients with advanced age or important comorbidities. In contrast, the availability of the Tyrosine kinase inhibitor (STI-571) for treatment of patients affected by chronic myelogenous leukemia, which was formerly the main indication for HSCT, has produced a dramatic decrease in the number of transplantations in this setting. HSCT performed in the early phases of disease and in young patients offers more than a 50% cure rate. The transplant-related mortality still represents the greatest obstacle, ranging from 20%-30%, despite the less toxic conditioning regimens, high-resolution HLA typing, and better supportive care. GvHD and infections remain the main causes of morbidity. As regards relapses, they correlate with disease status at the time of transplantation. Promising results have been recently obtained with haploidentical and with cord blood SC transplantation also in adult patients.
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Affiliation(s)
- A Bosi
- BMT Unit, Department of Hematology, University of Florence, Florence, Italy
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