Are predictive factors clinically useful in bone marrow transplantation?

Bolwell, Brian J.

doi:10.1038/sj.bmt.1704267

Cited by 28 publications

(22 citation statements)

References 56 publications

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“…Up to now, no studies have found an association of the risk of leukaemic relapse post-transplant with age. 44 In contrast, in this study, we report a better DFS in the older children that received a higher dose of TBI (Table 5). No significant difference in occurrence of relapse was found between children receiving 8 vs 2 Â 6 Gy, possibly due to low numbers.…”

Section: Discussioncontrasting

confidence: 54%

HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

Willemze

Geskus

Noordijk

et al. 2007

Bone Marrow Transplant

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To examine relapse, survival and transplant-related complications in relationship to disease-and pre-treatment-related characteristics, we evaluated 132 children, who consecutively received an allogeneic HLA-identical SCT for acute leukaemia in our centre: ALL in first remission (n ¼ 24), ALL in second remission (n ¼ 53) and AML in first remission (n ¼ 55). The source of the stem cells was bone marrow in all but three cases. Most patients (89%) were pre-treated with cyclophosphamide and an age-related dose of TBI. Initially, GVHD prophylaxis consisted of long-course MTX only (n ¼ 24), later shortcourse MTX and CsA (n ¼ 102) was given. All patients were nursed in strictly protective isolation and received total gut decontamination to suppress their potentially pathogenic enteric microflora. The 5-year probability of overall survival was 63, 53 and 74% for ALL1, ALL2 and AML1, respectively (median follow-up: 10.6 years). The overall transplant-related mortality was 6%. The incidence of acute GVHD was 17%; 6% was grades II-IV. A higher total biologically effective TBI dose (BED) resulted in a decreased relapse frequency (P ¼ 0.034) and increased overall survival. AML patients with acute GVHD got no relapse (P ¼ 0.02); this was not the case in ALL patients. Fractionated TBI regimens with higher BED should be evaluated in prospective studies.

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Section: Discussioncontrasting

confidence: 54%

HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

Willemze

Geskus

Noordijk

et al. 2007

Bone Marrow Transplant

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“…These variables influence survival following RIST 7,23 as well as CST. [24][25][26] Furthermore, there was a wide difference in GVHD prophylaxis between CST and RIST. Most RIST recipients received cyclosporin alone.…”

Section: Discussionmentioning

confidence: 99%

Comparison between reduced intensity and conventional myeloablative allogeneic stem-cell transplantation in patients with hematologic malignancies aged between 50 and 59 years

Kojima¹,

Kami²,

Kanda

et al. 2005

Bone Marrow Transplant

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Summary:To evaluate the efficacy of reduced-intensity stem-cell transplantation (RIST), we retrospectively compared outcomes of 207 consecutive Japanese patients aged between 50 and 59 years with hematologic malignancies who received RIST (n ¼ 70) and conventional stem-cell transplantation (CST) (n ¼ 137). CST recipients received total body irradiation (TBI)-based or busulfan/cyclophosphamide-based regimens. RIST regimens were purine analog-based (n ¼ 67), 2 Gy TBI-based (n ¼ 2), and others (n ¼ 1). Most CST recipients (129/137) received calcineurin inhibitors and methotrexate as graft-versus-host (GVHD) prophylaxis, while 32 RIST recipients received cyclosporin. In all, 23 CST and five RIST recipients died without disease progression within 100 days of transplant. Grade II to IV acute GVHD occurred in 56 CST and 38 RIST recipients. There was no significant difference in overall survival (OS) and progression-free survival between CST and RIST. On multivariate analysis on OS, five variables were significant: preparative regimens (CST vs RIST) (hazard ratio ¼ 1.92, 95% confidence interval, 1.25-2.97; P ¼ 0.003), performance status (2-4 vs 0-1) (2.50, 1.51-4.16; Po0.001), risk of underlying diseases (1.85, 1.21-2.83; P ¼ 0.004), acute GVHD (2.57, 1.72-3.84; Po0.001), and CML (0.38, 0.21-0.69; P ¼ 0.002). We should be careful in interpreting results of this smallsized retrospective study; however, reduced regimenrelated toxicity might contribute to better survival in RIST. The low relapse rates following RIST suggest a strong antitumor activity through allogeneic immunity. Bone Marrow Transplantation (2005) 36, 667-674. doi:10.1038/sj.bmt.1705122; published online 22 August 2005 Keywords: allogeneic hematopoietic stem-cell transplantation; regimen-related toxicity; graft-versus-host disease; nonrelapse mortality; graft-versus-leukemia effect Allogeneic hematopoietic stem-cell transplantation (autologous stem-cell transplantation (allo-SCT)) is a therapeutic option for advanced hematologic malignancies. A small but significant proportion of these patients can be cured with allo-SCT. 1 Conditioning regimens have been developed to maximize dose intensity, escalating the dose-limiting toxicity in nonhematopoietic tissues. 2 Conventional stem-cell transplantation (CST) using a myeloablative preparative regimen is associated with severe regimen-related toxicities (RRT), resulting in high nonrelapse mortality (NRM) especially for old patients. 3 NRM tends to be higher in patients with refractory or advanced diseases, who have been treated heavily, compared with those who have achieved remission. 3 Considering that highdose chemotherapy followed by allo-SCT is ineffective for these patients, 4 and that intensification of preparative regimens usually leads to severe RRT and high NRM, 5 it remains unknown whether myeloablative preparative regimens are beneficial to improve survival of patients with advanced chemorefractory leukemia.A new strategy for transplantation using a reducedintensity stem-cell transplantation (RIST) or...

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“…However, age per se is a poor predictor of HCT outcomes, 11 probably due to a lack of data on organ malfunctions in most previous reports. In addition, protocol exclusion criteria bias any assessment of the influence of aging, and recent reports failed to show any impacts of chronological age on allogeneic HCT (allo-HCT) outcomes.…”

Section: Introductionmentioning

confidence: 94%

Comorbidities and Hematopoietic Cell Transplantation Outcomes

Sorror

2010

Hematology

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Conventional allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment option for various hematological diseases due, in part to high-dose conditioning and, in part, to graft-versus-tumor effects. Reduced-intensity or non-myeloablative conditioning regimens have relied mostly on graft-versus-tumor effects for disease control, and their advent has allowed relatively older and medically infirm patients to be offered allo-HCT. However, both HCT modalities have been associated with organ toxicities and graft-versus-host disease, resulting in substantial non-relapse mortality. It has become increasingly important to optimize pre-transplant risk assessment in order to improve HCT decision making and clinical trial assignments. Single-organ comorbidity involving liver, lung, heart, or kidney before HCT has been traditionally found to cause organ toxicity after HCT. Recent efforts have resulted in the advent of a weighted scoring system that could sensitively capture multiple-organ comorbidities prior to HCT. The HCT-comorbidity index (HCT-CI) has provided better prediction of HCT-related morbidity and mortality than other non-HCT-specific indices. Subsequent studies, with the exception of a few studies with modest numbers of patients, have confirmed the prognostic importance of the HCT-CI. Further, the HCT-CI has been consolidated with various disease-specific and patient-specific risk factors to refine assignments of patients to the appropriate HCT setting. Ongoing studies are addressing prospective validation of the HCT-CI, furthering our understanding of biological aging, and enhancing the applicability of the HCT-CI comorbidity coding. Future knowledge of the impacts of multiple comorbidities on post-HCT toxicities might guide new prophylactic and therapeutic interventions to lessen the procedure's mortality.

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Are predictive factors clinically useful in bone marrow transplantation?

Cited by 28 publications

References 56 publications

HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

Comparison between reduced intensity and conventional myeloablative allogeneic stem-cell transplantation in patients with hematologic malignancies aged between 50 and 59 years

Comorbidities and Hematopoietic Cell Transplantation Outcomes

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