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Reduced intensity transplantation

Henrik Hasle, Gertjan J L Kaspers
Over the last four decades the survival of paediatric patients with acute myeloid leukaemia has gradually increased to 70% in high-income countries. The therapy is very intensive and associated with many acute and long-term side effects. The early death rate has been reduced to 1-4%. The acute toxicity is a limiting factor for improving survival in low-income countries. Transplant is associated with more endocrinological late effects while cardiotoxicity is more common after relapse. Reducing the physical costs of therapy without jeopardizing survival may be accomplished by optimal supportive care, less cardiotoxic anthracyclines, less consolidation courses and strict indications for stem cell transplantation...
October 21, 2016: British Journal of Haematology
Hannah K Choe, Usama Gergis, Sebastian A Mayer, Himanshu Nagar, Adrienne A Phillips, Tsiporah B Shore, Michael J Smith, Koen van Besien
BACKGROUND: Preliminary evidence indicates that the addition of low dose TBI (2-4 Gy) to reduced intensity conditioning may reduce the rate of relapse in allogeneic stem cell transplants. In very high risk patients receiving combination haploidentical-single unit cord blood transplants, we have added 4 Gy TBI to the widely used fludarabine, melphalan conditioning regimen, in hopes of reducing relapse and decreasing graft rejection. METHODS: We retrospectively reviewed the posttransplant outcomes of patients who underwent haplo-cord SCT between May 2013 and March 2015 and who received fludarabine 30mg/m2 D-7 to -3, melphalan 140mg/m2 D-2, and 2 Gy TBI D-4 and -3...
October 19, 2016: Transplantation
Galen E Switzer, Jessica Bruce, Deidre M Kiefer, Hati Kobusingye, Rebecca Drexler, RaeAnne M Besser, Dennis L Confer, Mary M Horowitz, Roberta J King, Bronwen E Shaw, Marcie Riches, Brandon Hayes-Lattin, Michael Linenberger, Brian Bolwell, Scott D Rowley, Mark R Litzow, Michael A Pulsipher
The increasing number of older adults with blood-related disorders and the introduction of reduced intensity conditioning regimens has led to increases in hematopoietic stem cell (HSC) transplantation among older adults and a corresponding increase in the age of siblings who donate HSCs to these patients. Data regarding the donation-related experiences of older donors is lacking. The Related Donor Safety Study (RDSafe) aimed to examine/compare health-related quality of life (HRQoL) of older versus younger HSC donors...
October 14, 2016: Biology of Blood and Marrow Transplantation
Aline Clavert, Zinaida Peric, Eolia Brissot, Florent Malard, Thierry Guillaume, Jacques Delaunay, Viviane Dubruille, Steven Le Gouill, Beatrice Mahe, Thomas Gastinne, Nicolas Blin, Jean-Luc Harousseau, Philippe Moreau, Noel Milpied, Mohamad Mohty, Patrice Chevallier
Late complications (LC) and quality of life (QOL) were analyzed in 110 adult patients who underwent reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT) and were alive for more than two years after allo-SCT. Overall survival of these patients was 93% (95%CI, 88-99%) and 81% (95%CI, 71-94%) at 5 and ten years, respectively. The primary cause of death was a recurrence of primary malignancy. With a median follow-up of 4.6 years (range, 2-12.1), chronic graft versus host disease (cGVHD) was the most prevalent late effect with a cumulative incidence (CI) of 66% (95%CI, 57-74) at ten years...
October 14, 2016: Biology of Blood and Marrow Transplantation
Patrice Chevallier, Myriam Labopin, Regis Peffault de La Tour, Bruno Lioure, Claude-Eric Bulabois, Anne Huynh, Didier Blaise, Pascal Turlure, Etienne Daguindau, Natacha Maillard, Ibrahim Yakoub-Agha, Gaelle Guillerm, Jeremy Delage, Nathalie Contentin, Jacques-Olivier Bay, Florence Beckerich, Jean-Henri Bourhis, Marie Detrait, Stéphane Vigouroux, Sylvie François, Faezeh Legrand, Thierry Guillaume, Mohamad Mohty
We have retrospectively compared survivals between acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) patients who received either a clofarabine/busulfan (CloB2A2) or a fludarabine/busulfan (FB2A2) RIC regimen for allogeneic stem cell transplantation. Between 2009 and 2014, 355 allotransplanted cases were identified from the SFGM-TC registry as having received either the FB2A2 (n = 316, 56% males, median age: 59.2 years, AML 78.5%, first complete remission [CR1] 72%, median follow-up: 20 months) or the CloB2A2 (n = 39, 62% males, median age: 60...
October 17, 2016: Cancer Medicine
F C A Odongo, L S Azevedo, E D Neto, H Yeh-Li, H Caiaffa, L C Pierrotti
BACKGROUND: Influenza virus infection can cause severe illness in certain high-risk groups. Solid organ and hematopoietic stem cell transplant recipients have been shown to present a greater risk for severe influenza and complications than the general population. METHODS: Retrospective descriptive cohort study of the features and outcomes of influenza infection in renal transplant recipients from July 2009 to May 2014. RESULTS: Thirty-one patients were diagnosed with influenza A infection within the specified period...
September 2016: Transplantation Proceedings
Mohamed A Kharfan-Dabaja, Jessica El-Asmar, Farrukh T Awan, Mehdi Hamadani, Ernesto Ayala
Novel therapies targeting various kinases downstream of the B-cell receptor have emerged along with monoclonal antibodies and BCL-2 antagonists, and are changing the therapeutic landscape of chronic lymphocytic leukemia. However, cure remains unattainable unless eligible patients are offered an allogeneic hematopoietic cell transplant. Access to allogeneic hematopoietic cell transplantation has expanded considerably with availability of reduced intensity conditioning regimens which is capable offering durable remissions even in poor-risk disease...
March 2016: Best Practice & Research. Clinical Haematology
Takayoshi Tachibana, Kenji Matsumoto, Masatsugu Tanaka, Maki Hagihara, Kenji Motohashi, Wataru Yamamoto, Eriko Ogusa, Satoshi Koyama, Ayumi Numata, Naoto Tomita, Jun Taguchi, Shin Fujisawa, Heiwa Kanamori, Hideaki Nakajima
The prognosis for disease relapse after first hematopoietic cell transplantation (HCT1) is poor. Here, we present a retrospective multicenter study to evaluate the clinical outcome and the prognostic factors for second hematopoietic cell transplantation (HCT2). The cohort in this study comprised 60 patients diagnosed with acute leukemia, who underwent HCT2 due to hematological relapse after HCT1. The overall survival (OS) at two years, non-relapse mortality (NRM), and relapse mortality (RM) were 30.3%, 40.9%, and 28...
October 14, 2016: Leukemia & Lymphoma
Maxi Wass, Friederike Hitz, Judith Schaffrath, Carsten Müller-Tidow, Lutz P Müller
Age is a dominant predictor of outcome in acute myeloid leukemia (AML). However, it is not clear to which extent comorbidities contribute to this effect. The objective of this study was to determine the impact of pretreatment comorbidities on survival of AML patients. In a single-center retrospective study 194 adult AML patients were included. The Hematopoietic cell transplantation comorbidity index (HCT-CI), the Adult Comorbidity Evaluation-27 (ACE-27) score and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) as well as data on demographics, cytogenetics, treatment and outcome were evaluated at the time of initial diagnosis by univariate and multivariate analysis...
2016: PloS One
A Nazha, L Rybicki, D Abounader, B Bolwell, R Dean, A T Gerds, D Jagadeesh, B K Hamilton, B T Hill, M Kalaycio, H Liu, B Pohlman, R Sobecks, M A Sekeres, N S Majhail
No abstract text is available yet for this article.
October 10, 2016: Bone Marrow Transplantation
Silke Heidenreich, Dimitris Ziagkos, Liesbeth C de Wreede, Anja van Biezen, Jürgen Finke, Uwe Platzbecker, Dietger Niederwieser, Hermann Einsele, Wolfgang Bethge, Michael Schleuning, Dietrich W Beelen, Johanna Tischer, Arnon Nagler, Bertram Glass, Johan Maertens, Lucrecia Yáñez, Yves Beguin, Heinz Sill, Christof Scheid, Matthias Stelljes, Arnold Ganser, Pierre Zachée, Dominik Selleslag, Theo de Witte, Marie Robin, Nicolaus Kröger
In this retrospective analysis we evaluated the outcome of 313 patients aged 70 years or older in the registry of the European Society for Blood and Marrow Transplantation (EBMT) with MDS (n=221) and secondary acute myeloid leukemia (sAML) (n= 92) who underwent allogeneic hematopoietic stem cell transplantation (HSCT) from related (n=79) or unrelated donors (n=234). Median age at HSCT was 72 years (70-78 years). Conditioning regimen was non-myeloablative (NMA, n=54), reduced-intensity (RIC, n=207) or standard-intensity (MAC, n=52)...
October 5, 2016: Biology of Blood and Marrow Transplantation
Ashley Rosko, Hai-Lin Wang, Marcos de Lima, Brenda Sandmaier, H Jean Khoury, Andrew Artz, Johnathan Brammer, Christopher Bredeson, Sherif Farag, Mohamed Kharfan-Dabaja, Hillard M Lazarus, David I Marks, Rodrigo Martino Bufarull, Joseph McGuirk, Mohamed Mohty, Taiga Nishihori, Ian Nivison-Smith, Armin Rashidi, Olle Ringden, Matthew Seftel, Daniel Weisdorf, Veronika Bachanova, Wael Saber
: Older adults with B-cell acute lymphoblastic leukemia (B-ALL) have poor survival. We examined the effectiveness of reduced intensity conditioning (RIC) hematopoietic cell transplant (HCT) in adults with B-ALL age 55 years and older and explored prognostic factors associated with long-term outcomes. METHODS: Using CIBMTR registry data, we evaluated 273 patients (median age 61, range 55-72) with B-ALL with disease status in CR1 (71%), >CR2 (17%) and Primary Induction Failure (PIF)/Relapse (11%), who underwent RIC HCT between 2001-2012 using mostly unrelated donor (59%) or HLA-matched sibling (32%)...
October 6, 2016: American Journal of Hematology
Alex F Herrera, Haesook T Kim, Katherine A Kong, Malek Faham, Heather Sun, Aliyah R Sohani, Edwin P Alyea, Victoria E Carlton, Yi-Bin Chen, Corey S Cutler, Vincent T Ho, John Koreth, Chitra Kotwaliwale, Sarah Nikiforow, Jerome Ritz, Scott J Rodig, Robert J Soiffer, Joseph H Antin, Philippe Armand
Next-generation sequencing (NGS)-based circulating tumour DNA (ctDNA) detection is a promising monitoring tool for lymphoid malignancies. We evaluated whether the presence of ctDNA was associated with outcome after allogeneic haematopoietic stem cell transplantation (HSCT) in lymphoma patients. We studied 88 patients drawn from a phase 3 clinical trial of reduced-intensity conditioning HSCT in lymphoma. Conventional restaging and collection of peripheral blood samples occurred at pre-specified time points before and after HSCT and were assayed for ctDNA by sequencing of the immunoglobulin or T-cell receptor genes...
October 6, 2016: British Journal of Haematology
Zhi Guo, Hong-Yan Gao, Tian-Yan Zhang, Xiao-Dong Liu, Kai Yang, Jing-Xing Lou, Xue-Peng He, Yuan Zhang, Peng Chen, Hui-Ren Chen
The study was aimed to explore the efficacy and safety of allo-HSCT with high-dose cyclophosphamide-induced immune tolerance for SAA. In the present study, 20 cases (12 male, 8 female; average age = 17.8 years) received reduced-intensity conditioning allo-HSCT from August 2012 to August 2014 in the Beijing Military Region General Hospital. All were HLA mismatched and received CSA; 11 received ATG-intensive immune therapy. Donors underwent mobilization with cell colony-stimulating factor. The modified preconditioning regimen included reduced-strength fludarabine combined with Busulfex and cytarabine, cyclophosphamide...
October 5, 2016: International Journal of Hematology
Alicia I Fayad, Daniel G Buamscha, Agustín Ciapponi
BACKGROUND: Acute kidney injury (AKI) is a common condition among patients in intensive care units (ICU), and is associated with substantial morbidity and mortality. Continuous renal replacement therapy (CRRT) is a blood purification technique used to treat the most severe forms of AKI but its effectiveness remains unclear. OBJECTIVES: To assess the effects of different intensities (intensive and less intensive) of CRRT on mortality and recovery of kidney function in critically ill AKI patients...
October 4, 2016: Cochrane Database of Systematic Reviews
D E Gladstone, M Petri, J Bolanos-Meade, A E Dezern, R J Jones, D Fine, R A Brodsky
Systemic lupus erythematosus (SLE), a disorder of the immune system, is potentially curable by allogeneic bone marrow transplantation (alloBMT). Until recently, alloBMT was limited by donor availability and toxicity. Reduced intensity conditioning (RIC) combined with post-transplantation cyclophosphamide (PTCy) has improved the availability and safety of alloBMT permitting its exploration in severe-refractory autoimmune illnesses. We report the six-year follow-up of a young female whose refractory SLE-associated nephrosis resolved after RIC alloBMT with PTCy...
September 29, 2016: Lupus
Toshihiro Miyamoto, Shuichiro Takashima, Koji Kato, Ken Takase, Goichi Yoshimoto, Shuro Yoshida, Hideho Henzan, Koichi Osaki, Tomohiko Kamimura, Hiromi Iwasaki, Tetsuya Eto, Takanori Teshima, Koji Nagafuji, Koichi Akashi
Umbilical cord blood transplantation with a reduced-intensity conditioning regimen (RIC-UCBT) is used increasingly in patients who have comorbid organ functions and lack human leukocyte antigen-identical donors. We compared the outcomes in 35 patients who received mycophenolate mofetil plus cyclosporine (MMF/CSP, n = 17) or MMF plus tacrolimus (MMF/TAC, n = 18) for graft-versus-host disease (GVHD) prophylaxis after RIC-UCBT. Cumulative incidence of neutrophil engraftment was 94 and 89 % in MMF/CSP and MMF/TAC groups, respectively (p = 0...
September 29, 2016: International Journal of Hematology
Juan Wang, Dan Chen, Da-Bing Li, Xin Yu, Guo-Bing Shi
BACKGROUND: Previous study indicated that high-dose statin treatment might increase the risk of hemorrhagic stroke and adverse reactions. We aim to compare the efficacy and safety of intensive-dose and standard-dose statin treatment for preventing stroke in high-risk patients. METHODS: A thorough search was performed of multiple databases for publications from 1990 to June 2015. We selected the randomized clinical trials comparing standard-dose statin with placebo and intensive-dose statin with standard-dose statin or placebo for the prevention of stroke events in patients...
September 2016: Medicine (Baltimore)
Alessandro Busca, Anna Candoni, Ernesta Audisio, Roberto Passera, Benedetto Bruno, Federico Monaco, Nicola Mordini, Adriana Vacca, Mario Delia, Franco Aversa, Livio Pagano
Patients with acute myeloid leukemia (AML) during induction chemotherapy and those who receive allogeneic hematopoietic stem cell transplantation (HSCT) are at higher risk of invasive fungal infections (IFI). In the present study, we investigated whether the risk of IFI in AML patients receiving HSCT might be affected by the antifungal prophylaxis with posaconazole administered during the induction/salvage chemotherapy treatment. Between August 2001 and April 2015, 130 patients with AML received itraconazole/fluconazole (group A) and 99 received posaconazole (group B) as antifungal prophylaxis after induction/salvage chemotherapy at 7 Italian centers and all patients received fluconazole as antifungal prophylaxis after HSCT...
September 22, 2016: Biology of Blood and Marrow Transplantation
Mohamed A Kharfan-Dabaja, Ambuj Kumar, Mehdi Hamadani, Stephan Stilgenbauer, Paolo Ghia, Claudio Anasetti, Peter Dreger, Emili Montserrat, Miguel-Angel Perales, Edwin P Alyea, Farrukh T Awan, Ernesto Ayala, Jacqueline C Barrientos, Jennifer R Brown, Januario Castro, Richard R Furman, John Gribben, Brian T Hill, Mohamad Mohty, Carol Moreno, Susan O'Brien, Steven Z Pavletic, Javier Pinilla-Ibarz, Nishitha M Reddy, Mohamed Sorror, Christopher Bredeson, Paul Carpenter, Bipin N Savani
We sought to establish clinical practice recommendations to redefine the role of allogeneic hematopoietic cell transplantation (allo-HCT) for patients with chronic lymphocytic leukemia (CLL) in an era of highly active targeted therapies. We performed a systematic review to identify prospective randomized controlled trials comparing allo-HCT against novel therapies for treatment of CLL at various disease stages. In the absence of such data, we invited physicians with expertise in allo-HCT and/or CLL to participate in developing these recommendations...
September 19, 2016: Biology of Blood and Marrow Transplantation
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