Encouraging progression-free survival in HCT for older NHL patients
This CIBMTR (Center for International Blood and Marrow Transplant Research) study analyzed outcomes of 1,248 patients age ≥40 years undergoing reduced-intensity or non-myeloablative hematopoietic cell transplantation (HCT) for aggressive (n=668) or indolent (n=580) non-Hodgkin lymphoma (NHL). One-year relapse, acute and chronic GVHD, and non-relapse mortality (NRM) were comparable among the three age cohorts studied: 40-54 years, 55-64 years, and ≥65 years. Three-year overall survival (OS) was significantly lower in the older cohorts (54%, 40%, and 39%, respectively; p<0.0001). Age ≥55 years, HLA mismatch, and Karnofsky Performance Status <80 adversely affected NRM, progression-free survival, and OS. The authors concluded that “even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.”
In this review, the authors note that the optimal time to address fertility issues in patients considering HCT is before the onset of therapy for the underlying disease, and that a referral to a reproductive specialist should be made for patients interested in fertility preservation. Also discussed are common barriers to fertility preservation in HCT patients, including the perception of a lack of time to preserve fertility in urgent transplant cases, inadequate access to reproductive specialists, and costs and lack of insurance coverage for fertility preservation.
HCT outcomes improving over time in teens and young adults with ALL
Survival in adolescents and young adults (AYAs, ages 15-40 years) undergoing myeloablative HCT for acute lymphoblastic leukemia (ALL) has improved over time, according to study data from 2,668 transplant recipients reported to the CIBMTR. The study analyzed transplant outcomes in 981 children, 1,218 AYAs, and 469 older adults during three time periods: 1990-1995, 1996-2001, and 2002-2007. Survival improved significantly over time in AYAs, which paralleled the improved survival seen in children, but overall survival did not change over time for older adults. The researchers noted that “survival improvements were primarily related to lower rates of early treatment-related mortality in the most recent era.”
This World Marrow Donor Association (WMDA) report outlines the clinical and regulatory issues affecting unrelated adult donor and recipient safety, and practical methods for assessing the health of unrelated adult donors at each stage of the donation process. The authors announce the formation of a donor medical suitability working group, through which donor centers and registries can request a consensus opinion on unique or challenging situations regarding the safety of stem cell donation.
In this study of 242 consecutive patients undergoing hematopoietic cell transplantation (HCT) for progressive myelodysplastic syndrome (MDS), outcomes were compared between patients receiving rabbit antithymocyte globulin (ATG; n=93) and those who did not (n=149). Three-year overall and event-free survival, relapse, non-relapse mortality, and chronic GVHD were not significantly different between the two cohorts. Grade II-IV acute GVHD occurred more frequently in the no-ATG group than in the ATG group: 55% vs. 27%, respectively (p<0.0001). In an accompanying editorial, Dr. Andrea Bacigalupo concludes that this study “adds further evidence to the fact that ATG protects against GVHD without a detrimental effect on relapse and survival.”
Articles in this special issue of our post-transplant Living Now newsletter discuss how transplant affects caregivers, how caregivers can take care of themselves, getting help from others, and dealing with emotional issues.
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.