scholarly journals Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia

2010 ◽  
Vol 28 (3) ◽  
pp. 405-411 ◽  
Author(s):  
ZiYi Lim ◽  
Ronald Brand ◽  
Rodrigo Martino ◽  
Anja van Biezen ◽  
Jürgen Finke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Advanced Disease ◽  
Disease Stage ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Advanced Disease Stage ◽  
Recipient Age

Purpose This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients. Patients and Methods We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC). Results The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P < .01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P < .01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P < .01) was the major independent variable associated with an inferior 4-year overall survival. Conclusion Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.

Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Myelodysplastic Syndromes 50 Years or Older. A Retrospective Survey from the EBMT.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 520-520 ◽  
Author(s):  
ZiYi Lim ◽  
Ronald Brand ◽  
Anja van Biezen ◽  
Jurgen Finke ◽  
Dietger W. Niederwieser ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Advanced Disease ◽  
Disease Stage ◽  
Hematopoietic Stem ◽  
Donor Type ◽  
Advanced Disease Stage

Abstract Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for patients with MDS. However, the advanced age of the majority of patients with MDS poses a significant barrier to the success of transplantation. Many of these patients have co-morbidities, or lack a suitable sibling matched donor. While reduced intensity conditioning (RIC) has expanded the scope of allografting to older patients, it remains unclear as to whether it confers an improvement in overall survival in this patient sub-group. Here we report on the results of a retrospective multi-centre analysis of 1385 patients aged 50 years or older with MDS transplanted since 1993. The main variables analysed in this study were donor status (sibling vs unrelated matched), age group (50–60 years vs >60years), disease stage at time of transplantation (early:<5% blasts vs advanced:>5% blasts), type of conditioning regimen (RIC vs standard myeloablative conditioning, SMC), period of transplantation (1993–96, 1997–2000–2001-). There were 1000 matched sibling (72%) and 385 matched unrelated donor transplants (28%). The median age of the cohort was 56 years (range:50–74 years), with 1053 patients (76%) aged 50–60 years and 332 patients (24%) above 60 years. 604 patients(44%) received SMC and 781 patients (56%) received RIC. 189 patients (14%) had RA/RARS, 388 patients (28%) had RAEB, 233 patients(17%) had RAEB-t and 393 patients secondary AML (28%). FAB classification was unavailable for 182 patients (13%). Patients receiving RIC were older (age>60 years: 30% RIC vs 14% SMC, p<0.001), but SMC had a more advanced disease stage at transplant (42% RIC vs 51% SMC). There was no difference in donor type between RIC and SMC (MUD: 28% RIC vs 28% SMC) The estimated cumulative incidence (competing risk model) at 4-years post transplant for TRM decreased from 47%(1993–1996), via 40%(1997–2000) to 35%(2001-); for Relapse Incidence these figures are 29%, 33% and 40% respectively. On multivariate analysis, age >60 years(HR:1.28, 95%CI [1.0–1.6], p=0.04), use of RIC (HR:1.50 95%CI [1.2–1.9], p<0.001) and advanced disease stage at transplantation (HR:1.51, 95%CI [1.2–2.0], p=0.002) were associated with an increased relapse rate; the use of RIC with a lower TRM (HR:0.71, 95%CI [0.57–0.88], p<0.01) and advanced disease stage at transplantation with a higher TRM (HR: 1.4, 95%CI [1.1–1.8], p<0.01) In contrast, donor type did not significantly influence either the 4-year TRM or relapse rates(HR’s 1.12 and 0.94 respectively, both p>0.30). Advanced disease stage at transplantation was the only independent variable associated with an inferior 4-year overall survival(OS)(HR: 1.47, 95%CI [1.2–1.8], p<0.001). In conclusion, disease stage at time of transplantation has an important prognostic impact on outcomes. The use of RIC is associated with higher relapse but lower TRM and comparable OS with SMC in this cohort. While patients aged >60 years had an increased relapse rate, there was no significant difference in OS compared with those aged 50–60 years. The choice of donor did not significantly influence outcomes. Long-term survival can be achieved in a sub-group of older MDS patients, but prospective studies are warranted to improve patient selection and to identify optimal treatment strategies.

scholarly journals Indication and benefit of upfront hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma in the era of ALL-type induction therapies

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mari Morita-Fujita ◽  
◽  
Yasuyuki Arai ◽  
Satoshi Yoshioka ◽  
Takayuki Ishikawa ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Advanced Disease ◽  
Lymphoblastic Lymphoma ◽  
Disease Stage ◽  
Hematopoietic Stem

AbstractSince the introduction of leukemia-type induction therapies for T-cell lymphoblastic lymphoma (T-LBL), improvements in the long-term outcomes of T-LBL have been reported. However, indications for and the appropriate timing of hematopoietic stem cell transplantation (HSCT) have not yet been established. Therefore, we performed a multicenter retrospective cohort study of patients with T-LBL treated using leukemia-type initial therapies to compare the outcomes after HSCT at different disease stages. We enrolled 21 patients with T-LBL from a total of 11 centers, and all patients received hyper-CVAD as a leukemia-type initial regimen. HSCT was performed during the CR1/PR1 (standard disease) stage in 11 patients, while it was completed at a later or non-remission (advanced disease) stage in 10 patients. Following HSCT, the overall survival rate was significantly greater in standard disease than in advanced-disease patients (79.5% vs. 30.0% at 5 years; hazard ratio (HR) 5.97; p = 0.03), with trend to the lower incidence of relapse in the former group (27.3% vs. 60.0% at 5 years; HR 2.29; p = 0.19). A prognostic difference was not detected between cases treated with allogeneic and autologous HSCTs. Our study suggests that frontline HSCT may be a feasible treatment option for T-LBL, even in the era of leukemia-type initial therapy.

Impact of Conditionning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation for Children with Acute Myeloid Leukemia in First Complete Remission: Total-Body Irradiation and Cyclophosphamide Versus Busulfan and Cyclophosphamide - A Report from The Societe Francaise de Greffe de Moelle et de Therapie Cellulaire.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 617-617 ◽  
Author(s):  
Jean-Hugues Dalle ◽  
Luc Caty ◽  
Regis Peffault ◽  
Alexandra Salmon ◽  
Valerie Mialou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Cumulative Incidence ◽  
Conditioning Regimen ◽  
Unrelated Donor ◽  
Matched Unrelated Donor ◽  
Hematopoietic Stem

Abstract Goal: Compare results after allogeneic HSCT for AML in CR1 in pediatric population after myeloablative conditioning regimen either based on TBI or busulfan. Patients and Methods: Retrospective analysis from French registry including all consecutive patients under 18 years of age (n=131) from Dec’1979 and Oct’2004 transplanted for AML in CR1 with either sibling (n=104) or matched unrelated donor and given either multi-fractionated TBI 12Gy and cyclophosphamide 120mg/kg (TBI-Cy) or Busulfan 16mg/kg and Cyclophosphamide 200mg/kg (BuCy200). Results were analysed according to EBMT statistical analysis guidelines i.e. OS and EFS were analyzed by KM method and Log-rank test for comparison where TRM and relapse incidence were analyzed by cumulative incidence method and Gray test for comparison. Multivariate analyses were performed using proportional hazard model for the distribution of competitive risks defined by Fine and Gray. Results: 131 patients (female: 51.5%) were included. Median age at initial diagnosis was 11y (0.5 to 17.8). Median time from diagnosis to transplantation was 4.2 months. Eighty-three patients received BuCy200 and 48 patients were transplanted after TBI-Cy. Patient subgroups were comparable for age, gender, sex mismatch, source of graft (BMT vs PBSC), donor type (geno-identical vs 10/10 matched unrelated donor vs other), cytogenetical analysis and WBC at initial diagnosis, and for donor-recipient CMV status (−/+ vs others). Both 5 year-overall and event-free survival rates appeared significantly better in BuCy200 group than in TBI-Cy group with 73.3% vs 56.1% (p=0.02) and 67+/−7% vs 38+/−9% (p=0.002), respectively. TRM incidence at day 365 was dramatically better in BuCy200 group than in TBI-Cy group with 4,7% vs 26.1% of TRM rate (p=0.002), respectively. Even though there were no statistical significant differences for both acute and chronic GVHD cumulative incidences whatever given conditioning regimen, there was a trend for obtaining lesser GVHD in BuCy200 group: day 100 grade II-IV aGVHD cumulative incidence was 13% vs 37% and 2 year extensive cGVHD was 9 vs 19% for BuCy200 and TBI-Cy group, respectively. At 5 years, there was a trend for less relapse in BuCy200 group than in TBI-Cy 16+/−3% vs 32+/−6% (p=0.09), respectively. Conclusion: This study demonstrates the superiority of BuCy200 on TBI-Cy conditioning regimen for paediatric patients presenting with AML in CR1 and undergoing allogeneic hematopoietic stem cell transplantation from either matched related or unrelated donor. These results, obtained from a larger cohort, confirm and update those published by our group in 1994. Figure 1: Overall survival Figure 1:. Overall survival

scholarly journals Implementation of allogeneic hematopoietic stem cell transplantation from unrelated donors from Russian and foreign registries

2020 ◽  
Vol 65 (3) ◽  
pp. 299-311
Author(s):  
V. A. Vasilyeva ◽  
L. A. Kuzmina ◽  
E. N. Parovichnikova ◽  
M. Yu. Drokov ◽  
A. A. Dmitrova ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Russian Federation ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
The Past ◽  
Unrelated Donors ◽  
The Russian Federation

Introduction. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a standard treatment for many patients with hematological malignancies. Over the past 20 years, an increase in transplantation activity has been noted throughout the world. About 50 % of all allo-HSCT are transplanted from unrelated donors. Aim: to present the dynamics and stages of the development of unrelated donation using the example of one transplant center.Materials and methods. This study analyzed Allo-HSCT performed from 2009 to March 2019 at the National Research Center for Hematology (NRCH). The work of the unrelated donor recruiting group and the tissue typing laboratory was analyzed for this period. 107 patient requests for unrelated donor search were dissected to identify search failures. The parameters of 206 unrelated donors were estimated depending on the register (Russian Federation/foreign). Results. The number of allo-HSCTs did not exceed more than 20 per year, in 2009–2011. Since 2012, the number of alloHSCT signifi cantly increased when the possibility for searching for unrelated donors abroad as well as in the Russian Federation (RF) databases appeared. During this time an increase by more than 50 % was noted in the number of allo-HSCTs. Allo-HSCs from unrelated donors of the Russian Federation make up 30–40 % of all unrelated allo-HSCs. 16 % of potential donors of hematopoietic stem cells included in the NRCH registry are donors of the human blood components. Despite the increasing number of unrelated donors in international and RF databases, 12 % of patients did not fi nd a compatible donor in any of the registers, due to a rare combination of HLA genes. It was revealed that among donors from the RF from whom alloHSCT was performed, there was not a signifi cant prevalence of men, compared to the foreign registry, 50.7 % and 66.7 %, respectively, despite the preference of donor-male by doctors. The 5-year overall survival in patients with acute leukemia in the fi rst complete remission, depending on the performance of allo-HSCT from a donor from the RF or foreign registers, are comparable, 40 % and 39.5 %, respectively.Conclusion. The number of allo-HSCT has increased 5 times over the past 10 years largely due to the development of unrelated donation: 30–40 % of allo-HSC transplants received from unrelated donors were performed from donors from the United database of the Russian Federation. The 5-year overall survival of these patients is comparable with the results of the overall survival patients who received transplants from donors from foreign registers.

scholarly journals Donor and Recipient Individual Factors As Predictive Markers of Overall Survival After Allogeneic Hematopoietic Stem Cell Transplantation; Dream or Reality

2021 ◽  
Author(s):  
Pooya Eslampour ◽  
Sayeh Parkhideh ◽  
Mahshid Mehdizadeh ◽  
Samira Karami ◽  
Elham Roshandel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Underlying Disease ◽  
Individual Factors ◽  
Hematopoietic Stem ◽  
Gender Status ◽  
Recipient Age

Low overall survival (OS) still is a major concern of allogeneic hematopoietic stem cell transplantation (allo-HSCT), which is affected by many individual and environmental factors. In this study, we retrospectively evaluated the association of donor and recipient individual factors with the overall survival of 206 patients who underwent allo-HSCT. Donor and recipient prognostic factors consisted of donor and recipient age, donor-recipient gender status, recipient body mass index (BMI), underlying disease, recipient cytomegalovirus (CMV) serostatus, and time from diagnosis to transplant (DTT) were included in the overall survival analysis. In univariable analysis, recipient age, donor-recipient gender status, underlying disease, recipient CMV serostatus, and DTT were significantly associated with the OS. The hazard of death in patients with DTT less than 14 months was 38% lower than those with a DTT higher than 14 months (P=0.06). Multivariate analysis showed that patients with aplastic anemia (HR=3.58; P=0.11) and Hodgkin’s disease (HR=3.89; P=0.11) have a much lower survival than unclassified diseases. Moreover, patients with acute myeloid leukemia and acute lymphoblastic leukemia showed better outcomes compared to the unclassified group. The donor and patient characteristics such as age, CMV serostatus, underlying disease, and time from diagnosis to transplantation could influence the overall survival of patients after allo-HSCT.

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