Treatment of secondary myelodysplastic syndrome after heart transplantation with chemotherapy and nonmyeloablative stem-cell transplantation1

Kobbe, Guido; Germing, Ulrich; Aivado, Manuel; Zohren, Fabian; Schubert, Dominik; Strupp, Corinna; Pape, H.; Tenderich, Gero; Körfer, Reiner; Storb, Rainer; Haas, Rainer; Schneider, Peter

doi:10.1097/00007890-200210270-00027

Cited by 13 publications

(13 citation statements)

References 10 publications

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“…Over the last 20 years, several case reports have detailed encouraging results of alloSCT in solid organ transplant recipients . In a summary of published cases by Chiang and Lazarus , 8/10 recipients of alloSCT after SOT were alive at the last follow‐up.…”

Section: Introductionmentioning

confidence: 99%

Allogeneic Hematopoietic Stem Cell Transplantation in Solid Organ Transplant Recipients: A Retrospective, Multicenter Study of the EBMT

Basak

Wiktor-Jedrzejczak

Labopin

et al. 2015

American Journal of Transplantation

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We conducted a questionnaire survey of the 565 European Society for Blood and Marrow Transplantation centers to analyze the outcome of allogeneic hematopoietic stem cell transplantation (alloSCT) in recipients of solid organ transplantation (SOT). We investigated 28 patients with malignant (N = 22) or nonmalignant diseases (N = 6), who underwent 31 alloSCT procedures: 12 after kidney, 13 after liver and 3 after heart transplantation. The incidence of solid organ graft failure at 60 months after first alloSCT was 33% (95% confidence interval [CI], 16–51%) for all patients, 15% (95% CI, 2–40%) for liver recipients and 50% (95% CI, 19–75%) for kidney recipients (p = 0.06). The relapse rate after alloSCT (22%) was low following transplantation for malignant disorders, despite advanced stages of malignancy. Overall survival at 60 months after first alloSCT was 40% (95% CI, 19–60%) for all patients, 51% (95% CI, 16–86%) for liver recipients and 42% (95% CI, 14–70%) for kidney recipients (p = 0.39). In summary, we show that selected SOT recipients suffering from hematologic disorders may benefit from alloSCT and experience enhanced long‐term survival without loss of organ function.

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Section: Introductionmentioning

confidence: 99%

Allogeneic Hematopoietic Stem Cell Transplantation in Solid Organ Transplant Recipients: A Retrospective, Multicenter Study of the EBMT

Basak

Wiktor-Jedrzejczak

Labopin

et al. 2015

American Journal of Transplantation

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“…Two patients survived at a follow-up of 7-22 months after receiving myeloablative conditioning regimen. Kobbe et al 18 reported successful use of non-myeloablative conditioning regimen followed by matching-related HSCT for a patient with MDS following heart transplantation. The use of allogeneic HSCT for PTLD has not been previously described…”

Section: Discussionmentioning

confidence: 99%

Hematopoietic stem-cell transplantation following solid-organ transplantation in children

Schechter

Gassas

Weitzman

et al. 2011

Bone Marrow Transplant

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Reports of hematopoietic stem-cell transplantation (HSCT) following solid-organ transplantation have been described in adults mainly as case reports. These reports demonstrate feasibility but likely do not reflect true outcomes due to a positive reporting bias. We report herein the outcomes of all our pediatric recipients of allogeneic HSCT following previous solid-organ transplantation between 2000 and 2009. Four children were identified. Two patients underwent heart transplantation followed by cord-blood allogeneic HSCT for T-cell lymphoma/post transplant lymphoproliferative disease (PTLD) and two patients underwent liver transplantation followed by living-donor allogeneic HSCT for severe aplastic anemia (SAA). The mean time between transplants was 4.2 years (range 1.5-6 years). All patients engrafted; however, all patients died from 37 days to 1 year after HSCT. Causes of death included infections (n ¼ 2), multi-organ failure (n ¼ 1) and solid-organ graft rejection (n ¼ 1). Though three patients survived beyond day þ 100, multiple complications were observed including EBV re-activation followed by EBV-positive PTLD (n ¼ 1) and five episodes of severe infections. The patients transplanted for lymphoma did not have evidence of recurrence at last follow-up. Although feasibilty has been shown with this cohort, we conclude that allogeneic HSCT in immunosuppressed patients following solid-organ transplantation remains a very high risk procedure that results in severe morbidity and mortality in children.

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“…He is now more than 4.5 yr after HCT from an HLA‐matched, ABO incompatible brother and has remained in complete remission of his leukemia. Another 60‐yr‐old man had developed MDS‐refractory anemia with excess blasts 10 yr after orthotopic heart transplantation (31). He received remission induction with chemotherapy followed by HCT from an HLA‐matched ABO incompatible sister.…”

Section: Hematological Malignanciesmentioning

confidence: 99%

Non‐myeloablative allogeneic transplantation – State‐of‐the‐art

Storb

2004

Pediatric Transplantation

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Work by several groups of investigators has brought about changes in the way hematopoietic cell allografts are being done to treat patients with hematologic diseases. Less intensive conditioning regimens have been introduced, and in the case of patients with hematologic malignancies, the burden of eradicating malignant cells has shifted from high-dose chemoradiation treatment toward using the hematopoietic cell donor's T lymphocytes for that purpose by invoking allogeneic graft-versus-tumor effects. While the majority of the transplant regimens used in these efforts are still fairly intense and toxic, a radical departure from conventional transplantation focuses on the almost exclusive use of immunosuppressive agents with little toxicity to establish the allografts. The success of the procedure for patients with hematologic malignancies rests on replacing the host's hematopoietic cells by the allograft. For non-malignant diseases, the procedure can be used to establish a stable state of mixed donor/host hematopoietic chimerism, which, in itself, may be sufficient to cure disease manifestations.

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Treatment of secondary myelodysplastic syndrome after heart transplantation with chemotherapy and nonmyeloablative stem-cell transplantation1

Abstract: Allogeneic blood stem-cell transplantation using minimal conditioning is a new, promising treatment option for patients with hematologic malignancies after solid-organ transplantation.

Cited by 13 publications

References 10 publications

Allogeneic Hematopoietic Stem Cell Transplantation in Solid Organ Transplant Recipients: A Retrospective, Multicenter Study of the EBMT

Allogeneic Hematopoietic Stem Cell Transplantation in Solid Organ Transplant Recipients: A Retrospective, Multicenter Study of the EBMT

Hematopoietic stem-cell transplantation following solid-organ transplantation in children

Non‐myeloablative allogeneic transplantation – State‐of‐the‐art

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