Bone Marrow Transplantation (2013) 48, & 2013 Macmillan Publishers Limited All rights reserved /13

Size: px
Start display at page:

Download "Bone Marrow Transplantation (2013) 48, & 2013 Macmillan Publishers Limited All rights reserved /13"

Transcription

1 Bone Marrow Transplantation (2013) 48, & 2013 Macmillan Publishers Limited All rights reserved /13 ORIGINAL ARTICLE The impact of center experience on results of reduced intensity: allogeneic hematopoietic SCT for AML. An analysis from the Acute Leukemia Working Party of the EBMT S Giebel 1, M Labopin 2, M Mohty 3, GJ Mufti 4, D Niederwieser 5, JJ Cornelissen 6, JJWM Janssen 7, N Milpied 8, L Vindelov 9, E Petersen 10, R Arnold 11, A Bacigalupo 12, D Blaise 13, C Craddock 14, A Nagler 15, F Frassoni 12, M Sadus-Wojciechowska 1 and V Rocha 16 Allogeneic hematopoietic SCT with reduced-intensity conditioning (RIC-HSCT) is increasingly adopted for the treatment of older adults with AML. Our goal was to verify for the first time, if center experience influences outcome of RIC-HSCT. Results of 1413 transplantations from HLA-matched related or unrelated donors for adult patients with AML in first CR were analyzed according to the level of center activity. Transplants were performed in 203 European centers between 2001 and The 2-year probability of leukemia-free survival (LFS) after RIC-HSCT performed in centers with the lowest activity (p15 procedures/7 years) was 43±3% compared with 55±2% in the remainder (Po01). The incidence of non-relapse mortality (NRM) was 24±3% and 15±1% (P ¼ 04), whilst relapse rate was 33±3% and 31±1% (P ¼ 3), respectively. In a multivariate model, adjusted for other prognostic factors, low RIC-HSCT activity was associated with decreased chance of LFS (hazard ratio (HR) ¼ 4; Po01) and increased risk of NRM (HR ¼ 1.47, P ¼ 4) and relapse (HR ¼ 1.41, P ¼ 1). Center experience is a very important predictor of outcome and should be considered in future analyses evaluating the results of RIC-HSCT. The reasons why centers with low RIC-HSCT activity have worse outcomes should be further investigated. Bone Marrow Transplantation (2013) 48, ; doi:1038/bmt ; published online 9 July 2012 Keywords: reduced-intensity conditioning; hematopoietic SCT; acute myeloid leukemia; center experience INTRODUCTION The outcome of allogeneic hematopoietic SCT (allo-hsct) depends on many variables related to the disease, patient, donor and procedure characteristics. However, even if all known risk factors are taken into account, transplant outcome remains highly variable, implying a role for other external factors such as the center experience, socio-economic status of a country or implementation of an international system accreditation of a transplant center. 1 4 The introduction of allo-hsct with reduced-intensity conditioning (RIC-HSCT) has allowed application of transplantation procedures to patients with advanced age and significant comorbidities. 5 8 This option appears particularly important for diseases with prevalence in the elderly, like AML Although the proportion of RIC-HSCT among allo-hsct is continuously growing, 12,13 no randomized trials have been conducted to establish evidence-based standards of care. A large heterogeneity of the procedure exists with regard to the indications, conditioning regimens and protocols of immunosuppression. 14 Furthermore, the procedure requires careful monitoring of the disease status and engraftment, which may be achieved with various laboratory techniques. Long-term post-transplant care is essential as life-threatening immune-dependent complications may occur late after RIC-HSCT. Taking into account the complexity and the heterogeneity of the procedure we evaluated whether transplant center experience affects outcome of RIC-HSCT. PATIENTS AND METHODS Study design and data collection This was a retrospective multicenter analysis. Data were provided by the registry of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Centers participating in the European Group for Blood and Marrow Transplantation are annually requested to report all consecutive SCTs and follow-up. The validation and quality control program includes verification of the computer print-out of the entered data, cross-checking with the national registries, and annual on-site visits of selected teams. 1 Department of Bone Marrow Transplantation, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland; 2 Acute Leukemia Working Party of the EBMT, Faculté de Médicine Saint-Antoine 27, Paris, France; 3 Department D Hematologie, CHU Nantes, Nantes, France; 4 Department of Haematological Medicine, GKT School of Medicine, King s Denmark Hill Campus, London, UK; 5 Division of Hematology, Oncology and Hemostasiology, University Hospital Leipzig, Leipzig, Germany; 6 Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands; 7 Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands; 8 CHU Bordeaux, Hôpital Haut-leveque, Pessac, France; 9 BMT Unit Department of Hematology, Rigshospitalet, Copenhagen, Denmark; 10 Department of Hematology, University Medical Centre, Utrecht, The Netherlands; 11 Medizinische Klinik m. S. Hämatologie/Onkologie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; 12 Department of Hematology II, Ospedale San Martino, Genova, Italy; 13 Unité de transplantation et de thérapie cellulaire, Inserm UMR 891, Institut Paoli Calmettes, Marseille, France; 14 Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK; 15 Chaim Sheba Medical Center, Tel-Hashomer, Israel and 16 Hopital St Louis, Paris, France. Correspondence: Dr S Giebel, Department of Bone Marrow Transplantation, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, Gliwice, Poland. sgiebel@io.gliwice.pl Received 27 February 2012; revised 3 May 2012; accepted 16 May 2012; published online 9 July 2012

2 Criteria of selection Inclusion criteria were as follows: (1) patients with AML in first CR1, excluding AML secondary to myelodysplastic syndrome (2) age X18 years, (3) HSCT from HLA-identical sibling (that is, compatible for HLA-A, -B and -DRB1, as analyzed using either serological or molecular techniques) or from HLA-matched unrelated donor (82% of patients/donors of were reported to be compatible for HLA-A, -B, -C, -DRB1 and -DQB1 that is, 10 out of 10 loci; 10% were matched for 8/8 loci; 8% were matched for 6/6 loci), (4) transplants performed between 2001 and 2007 in centers reporting to the European Group for Blood and Marrow Transplantation (5) BM or peripheral blood used as a source of stem cells, (6) RIC that is, regimen based on BU administered at the total dose of p8 mg/kg or TBI applied at p6 Gy. Patients, donors and HSCT procedure Altogether 1413 patients, including 710 men, treated in 203 transplant centers were analyzed. Median age was 55 years (range, years). Data on cytogenetics were available for 614 (43.5%) cases, among which 5.4% were classified as favorable, 76.2% intermediate and 18.4% unfavorable. Transplantations were performed from HLA-identical sibling in 1058 patients (74.9%) and from unrelated volunteer in 355 cases (25.1%) using either peripheral blood (9%) or BM (9.3%) as a source of stem cells. TBI was used for conditioning in 386 patients (27.3%). The reasons for choosing RIC were known in 427 cases and included advanced recipient age (44.7%), the presence of comorbidities (18.7%) and ongoing study protocol (36.5%). Detailed patient and procedure characteristics are listed in Table 1. Statistical analysis The probabilities of leukemia-free survival (LFS), relapse incidence (RI), and non-relapse mortality (NRM) were the primary study end-points. The LFS was defined as time interval from RIC-HSCT to either relapse or death in remission, and was calculated using the Kaplan Meier estimate. The RI and NRM were calculated using cumulative incidence curves in a competing risks setting, death in remission being treated as an event competing with relapse. 15,16 Univariate analyses were done with the use of the log-rank test for LFS and Gray s test for RI and NRM. The number of RIC-HSCT for any indication and the total number of allo-hsct performed in the study period were used as independent variables to test the impact of center experience on outcomes. All centers were first categorized using the quintiles with increasing number of transplantation procedures. If the relative event rates in two or more adjacent categories were not substantially different, the categories were merged. Multivariate analysis was performed with the use of the Cox proportional hazard model, adjusted for potential recipient-, donor- and procedure-related risk factors, including the Human Development Index of a country where the transplantation was performed and the year of first RIC-HSCT preformed in a center. The median follow-up for survivors was 35 months ( 103 months). All P-values are two-sided with type 1 error rate fixed at 5. RESULTS Leukemia-free survival The probability of LFS in the whole group was 52% (s.e., ±1%) at 2 years. For five consecutive groups of centers with increasing number of RIC-HSCT performed between 2001 and 2007 the LFS rates were 43±3, 53±3, 54±3, 53±3 and 60±1% (Table 2). When 100 centers belonging to the first quintile (p15 RIC-HSCT in 7-year period) were compared with 103 remaining ones the difference was statistically significant (43±3 versus 53±2%, Po01) (Table 2, Figure 1). In contrast, no significant differences were found between centers belonging to the 2nd, 3rd, 4th, and 5th quintile. In a subgroup analysis the negative effect of low RIC-HSCT activity on LFS was particularly pronounced among patients aged 55 years or more (34±5% for the 1st quintile compared with 53±2% for 2nd 5th quintile, P ¼ 01) with only a tendency among younger patients (50±4 versus 57±2%, P ¼ 6). The effect could be demonstrated for transplantations from sibling (43±4 versus 57±2%, Po01) but not from unrelated donors (40±9 versus 49±3%, P ¼ 3). Table 1. Patients and donors (transplantation procedure) All centers N 1413 Median patient age, range (years) 55 (18 77) Median year of transplantation, range 2005 ( ) Karyotype risk group Favorable 33 (5%) Intermediate 468 (77%) Unfavorable 113 (18%) Unknown 799 Median interval from diagnosis to CR1, 47 (10 256) range (days) Median interval from diagnosis to 161 (28 997) transplantation, range (days) Donor/recipient gender Female/male 252 (18%) Other combinations 1137 (82%) Unknown 24 Donor CMV serological status Positive 579 (58%) Negative 416 (42%) Unknown 418 Recipient CMV serological status Positive 682 (68%) Negative 322 (32%) Unknown 409 Donor type HLA-identical sibling 1058 (75%) HLA-matched unrelated 355 (25%) Type of conditioning Chemotherapy-based 1013 (72%) TBI-based 386 (28%) Unknown 14 Source of stem cells BM 131 (9%) Peripheral blood 1282 (91%) Reasons of reduced-intensity conditioning Advanced age 191 (45%) Comorbidities 80 (19%) Study protocol 156 (36%) Unknown 986 In a multivariate model, the lowest activity with regard to RIC-HSCT was associated with decreased chance of LFS (hazard ratio, (HR) ¼ 4, 95% confidence interval ¼ 2, Po01) (Table 2). Other factors associated with impaired outcome were transplantation from unrelated donor (P ¼ 4), the use of TBI-based conditioning (P ¼ 4) and recipient age 455 years (P ¼ 5). The chance of LFS was improved with increasing values of the Human Development Index, analyzed as a continuous variable (P ¼ 05). The effect of center experience was also analyzed according to the total number of allo-hsct performed in a study period. In this case, after categorization by quintiles, no clear cutoff point could be determined with the probabilities of LFS at 2 years for the consecutive groups of centers being 45±3, 51±3, 55±3, 57±3 and 46±4%. Relapse incidence The cumulative incidence of relapse in the whole study population was 31±1% at 2 years. For the five quintiles with increasing 239 & 2013 Macmillan Publishers Limited Bone Marrow Transplantation (2013)

3 240 Table 2. Results of the univariate and multivariate analysis of center experience and other factors affecting outcome of reduced-intensity conditioning-hematopoietic SCT for adults with AML in first CR Factor Univariate analysis Leukemia-free survival Relapse incidence Non-relapse mortality % at 2 years (±s.e.) P % at 2 years (±s.e.) P % at 2 years (±s.e.) P Number of RIC-HSCT/center ( ) 1 3 p15 43±3 33±3 24± ±3 33±3 13± ±4 34±3 13± ±3 30±3 17± ±3 25±3 15±2 Number of RIC-HSCT ( ) o p15 43±3 33±3 24± ±2 31±1 15±1 Factor Multivariate analysis Leukemia-free survival Relapse incidence Non-relapse mortality HR (95%CI) P HR (95%CI) P HR (95%CI) P Donor type (URD versus sibling) 2 (7 4) (4 1.51) (4 1.6) 8 Conditioning (TBI versus Cht.) 2 (8 9) 4 9 (3 5) (5 1.23) 02 Year of HSCT (X2005 versus o2005) 7 ( 1.26) 6 7 (1 7) 9 8 (3 1.31) 8 Patient age (455 versus p55 years) 4 (1 1) 5 6 (6 1.31) (6 1.72) 9 Interval dgn HSCT (4160 versus p160 days) 9 (5 5) 6 1 (2 1.24) (4 1.68) 2 Source of stem cells (PB versus BM) 1.26 (6 1.64) 2 (6 4) (5 2.63) 6 Donor/recipient gender (F/M versus others) 3 (8 2) (4 1.54) (3 1.66) 5 Human development index (continues) 6 (0 7) 05 5 (1 2.65) 2 (0 1.11) 6 Year of RIC-HSCT (X2001 versus o2001) 1.11 (1 1.37) 9 (9 1.16) 9 8 ( 1.37) No. RIC-HSCT/center (p15 versus 415) 4 (2 versus ) o (8 1.85) (2 2.08) 4 Abbreviations: Cht. ¼ chemotherapy-based conditioning; CI ¼ confidence interval; dgn. ¼ diagnosis; F ¼ female; HR ¼ hazard ratio; M ¼ male; PB¼ peripheral blood; RIC-HSCT¼reduced-intensity conditioning-hematopoietic stem cell transplantation; URD ¼ unrelated donor. For subsequent quintiles with increasing RIC-HSCT activity the number of patients included in the analysis was as follows: 287, 316, 253, 295 and 262, while the number of transplant centers was: 100, 43, 24, 23 and 13. Additional multivariate analysis was performed including donor and recipient CMV serological status in the model. It was restricted to 995 cases with the available data. The CMV status did not influence outcome significantly. The number of RIC-HSCT/center (p15 versus 415 in a study period) had significant impact on leukemia-free survival (HR ¼ 2, 95%CI, 7 1; Po01) and relapse incidence (HR ¼ 1.59, 95%CI, ; P ¼ 05), while not on non-relapse mortality (HR ¼ 1.35, 95%CI, ; P ¼ ). activity regarding RIC-HSCT, the RI was 33±3%, 33±3%, 34±3%, 30±3% and 25±3%, respectively (Table 2). In a univariate analysis, no significant difference could be demonstrated between centers with the lowest activity and the remaining ones (33±3% versus 31±1%, P ¼ 3). However, in a multivariate model adjusted for other potential risk factors, transplants performed in centers with the lowest activity were associated with increased risk of relapse (HR ¼ 1.37, 95% confidence interval ¼ , P ¼ 1) (Table 2). The only other variable affecting the risk of relapse was the use of BM as a source of stem cells (P ¼ 02). The number of allo-hsct performed between 2001 and 2007 had no significant influence on the RI with the probabilities of 34±3, 33±3, 29±3, 27±3 and 32±3% for the consecutive groups of centers with increasing number of transplantations. Non-relapse mortality In the whole study cohort the cumulative incidence of NRM was 16±1% at 2 years. For the five consecutive groups of centers with increasing number of RIC-HSCT performed between 2001 and 2007 the probability of NRM was 24±3, 13±2, 13±2, 17±1 and 15±1% (Table 2). The cumulative incidence of NRM was significantly higher in centers with the lowest activity compared with the remaining ones (24±3% versus 15±1%, P ¼ 04) (Table 2, Figure 1). In a multivariate model, the lowest activity with regard to RIC-HSCT was associated with increased risk of NRM (HR ¼ 1.47, 95% confidence interval ¼ , P ¼ 4), together with TBI-based conditioning (P ¼ 02) (Table 2). The most frequent reason of NRM was GVHD, which attributed to 43% of transplantation-related deaths in centers with the lowest RIC-HSCT activity and 39% in the remaining ones (P ¼ 6). The incidence of grade II IV acute GVHD (22% versus 20%, P ¼ ) and grade III IV acute GVHD (10% versus 7%, P ¼ 9), as well as the probability of chronic GVHD (46±4 versus 51±2%, P ¼ ) did not differ in the two respective cohorts. Infections as a cause of NRM were reported in 34% and 36% (P ¼ 6), respectively. Other causes, including interstitial pneumonitis, hemorrhage, cardiac toxicity and second malignancy were rare, not exceeding 5%. The incidence of primary graft failure was 2% in both the groups while the incidence of secondary graft failure was 1% in centers with the lowest activity and % in the remaining ones (P ¼ 9). In the analysis according to the total number of allo-hsct, the cumulative incidence of NRM for the 1st 5th quintile was 21±3, 15±2, 16±2, 16±2 and 14±2%. DISCUSSION Results of allo-hsct vary among centers. The existence of center effects with regard to LFS and NRM has been reported by Frassoni Bone Marrow Transplantation (2013) & 2013 Macmillan Publishers Limited

4 Probablllty Probablllty Probablllty Leukemia-free survival P <01 Non-relapse mortality P =04 Relapse incidence P =3 Figure 1. Results of reduced-intensity conditioning hematopoietic SCT for adults with AML in first CR, according to the center experience. et al. 1 However, in this analysis the authors failed to determine the reasons why results obtained in participating centers differed. Considerations included the possible impact of variations regarding patients selection and details of the transplantation procedure. Subsequent studies confirmed that such variations exist and may affect outcomes. Based on internet questionnaires, Lee et al. 17 clearly showed that in the field of HSCT clinical practice varied strongly among centers and individual physicians, with regard to both indications for allo-hsct and the choice of conditioning intensity. In another study the same group of authors demonstrated great heterogeneity related to post-transplant monitoring and supportive care, including the use of hematopoietic growth factors, empiric antibiotic therapy and protective isolation procedures. 18 Loberiza et al. 19 highlighted the importance of organizational aspects such as the number of patients-per-physician, availability of physicians after office hours and the presence of students/residents without fellows, showing not only differences among centers but also their impact on the outcome of HLA-identical sibling HSCT. With regard to the effect of center experience, Horowitz et al. 2 found increased NRM and decreased LFS for 21 centers performing p5 procedures per year compared with the remaining 65 teams, with borderline significance in a univariate analysis. On the other hand, in a French study including 35 transplant centers, the allo-hsct activity did not influence outcome. 20 Finally, in a Japanese population the center experience influenced survival after HSCT from sibling but not from unrelated donors. 21 The role of center experience has not been previously evaluated in patients undergoing a RIC allograft. In the present study, we assumed that results of this relatively newly introduced procedure may be particularly susceptible to individual team and physician s decisions. In the absence of generally accepted standards those decisions may be in major part based on center experience. In a relatively homogenous setting of patients with AML in CR1, treated in 203 centers, we clearly demonstrated that the number of RIC-HSCT procedures performed for any indication in a study period was the most important predictor of outcome. In particular, we found that very low activity, which in our study meant 15 or less RIC-HSCT within 7 years, was associated with significantly decreased probability of LFS, resulting mainly from increased risk of NRM and to a lesser extent the risk of relapse. The precise reasons of the above effects are difficult to identify in a retrospective analysis. With regard to relapse, the risk may depend on the disease characteristics, including cytogenetic features, the quality of CR, as well as precise monitoring of engraftment and residual disease after transplantation driving appropriate immunomodulation. The risk of NRM is mainly dependent on the recipient/donor characteristics, as well as the quality of post-transplant care. Some of these potential prognostic factors could be included in multivariate models, which proved the effect of center experience to be independent. The model was also adjusted for the socio-economic status of a country where the transplantation was performed, using the Human Development Index as a measure. In line with our previous findings, we confirmed the importance of the socio-economic status, which effect was independent on the center experience. 3 To better understand the reasons why the outcome differed between centers with very low activity and the remainder, and in particular to check if the patients preselection could be the cause, we performed additional post-hoc analysis comparing transplant characteristics in centers belonging to the 1st and 2nd 5th quintile according to the RIC-HSCT activity. With the cutoff point of 15 RIC-HSCT procedures in 7 years (that is, 2.1/year) established empirically based on results of a univariate analysis, we found that the interval from diagnosis to transplantation was significantly longer for centers with low activity (median 169 days, range ) compared with the remainders (median 157 days, range ; P ¼ 02), while the interval from diagnosis to CR1 was equal: 47 days (range ) and 47 days (range ), respectively (P ¼ 3). No significant differences could be demonstrated for the recipient age (median 55 years in both cohorts), proportion of patients with adverse karyotype (20% versus 18%, respectively, P ¼ 6), as well as reasons for choosing RIC, which were advanced age (46 versus 45%, respectively), the presence of comorbidities (25% versus 17%, respectively), or ongoing study protocol (29% versus 38%, respectively). Importantly, the use of unrelated donors was less frequent in centers with low activity compared with the others (11% versus 29%, 241 & 2013 Macmillan Publishers Limited Bone Marrow Transplantation (2013)

5 242 Po001). The above data do not support the hypothesis that adverse patient, disease or transplant characteristics are the cause of inferior outcome in less experienced centers. It must be stressed, however, that the karyotype, being a major determinant of treatment outcome, was known in less than half of patients included in our analysis. With regard to the transplantation procedure we found significant differences including lower proportion of TBI-based conditioning (20% versus 29%, P ¼ 02) and BM as a source of stem cells (6% versus 10%, P ¼ 2) in centers with the lowest activity compared with the remainder. As both factors were found to negatively influence LFS in the Cox model, the above differences cannot explain the effect of center experience. Finally, we performed additional analysis including patients with age 55 years or more, in whom the age itself could be sufficient indication for reduction in the intensity of conditioning. In this cohort low RIC-HSCT activity was associated with 19% decrease of the 2-year probability of LFS. Altogether it appears that the effect of center experience on outcome is not a consequence of patients preselection. In contrast, it can be speculated that the differences in outcome are probably related to procedural details and individual physician decisions, which cannot be identified in a retrospective registry study. It must be considered, however, that the attitudes toward RIC-HSCT vary markedly in the transplantation community and in two-thirds of patients in our setting the reason for choosing RIC was not known. It is likely that the patient characteristics would differ in centers that apply this type of transplantation as the main policy compared with centers that use this treatment in few exceptional cases only. Hence, there may be confounding factors that are difficult to identify in a retrospective analysis. In addition to the RIC-HSCT activity we also evaluated the potential influence of the total number of allo-hsct performed in a study period. This factor, however, could not be clearly correlated with outcome. RIC-HSCT is associated with some specific requirements. In particular, detailed monitoring of chimerism with appropriate adjustment of immunosuppressive treatment is essential to prevent relapse. As well, the pattern of complications differs for RIC and myeloablative procedures. Therefore it may be that general experience with allo-hsct cannot be easily transposed to the field of non-myeloablative transplants. The cutoff point predictive for results of RIC-HSCT in our study was 2.1 per year. Hence, it seems that the number of procedures required to reach satisfactory results is relatively low. This should encourage the least experienced teams to increase their activity. Collaboration with centers with well-established RIC-HSCT program, including harmonization of treatment protocols, continued consultancy and education are potential tools to improve the outcome. Finally, we postulate that the effect of center experience, as a very important predictor of outcome should be considered for future analyses evaluating the results of RIC-HSCT. Further investigation is required to determine if the impact of center experience is restricted to patients with AML. CONFLICT OF INTEREST The authors declare no conflict of interest. REFERENCES 1 Frassoni F, Labopin M, Powles R, Mary JY, Arcese W, Bacigalupo A et al. Effect of centre on outcome of bone-marrow transplantation for acute myeloid leukaemia. Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation. Lancet 2000; 355: Horowitz MM, Przepiorka D, Champlin RE, Gale RP, Gratwohl A, Herzig RH et al. Should HLA-identical sibling bone marrow transplants for leukemia be restricted to large centers? Blood 1992; 79: Giebel S, Labopin M, Ehninger G, Beelen D, Blaise D, Ganser A et al. Association of Human Development Index with rates and outcomes of hematopoietic stem cell transplantation for patients with acute leukemia. Blood 2010; 116: Gratwohl A, Brand R, Niederwieser D, Baldomero H, Chabannon C, Cornelissen J et al. Introduction of a quality management system and outcome after hematopoietic stem-cell transplantation. J Clin Oncol 2011; 29: Giralt S, Estey E, Albitar M, van Besien K, Rondón G, Anderlini P et al. Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloablative therapy. Blood 1997; 89: Slavin S, Nagler A, Naparstek E, Kapelushnik Y, Aker M, Cividalli G et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases. Blood 1998; 91: Appelbaum FR. Hematopoietic-cell transplantation at 50. N Engl J Med 2007; 357: Ljungman P, Urbano-Ispizua A, Cavazzana-Calvo M, Demirer T, Dini G, Einsele H et al. Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: definitions and current practice in Europe. Bone Marrow Transplant 2006; 37: Mohty M, de Lavallade H, Ladaique P, Faucher C, Vey N, Coso D et al. The role of reduced intensity conditioning allogeneic stem cell transplantation in patients with acute myeloid leukemia: a donor vs no donor comparison. Leukemia 2005; 19: Aoudjhane M, Labopin M, Gorin NC, Shimoni A, Ruutu T, Kolb HJ et al. Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic haematopoietic stem cell transplantation for patients older than 50 years of age with acute myeloblastic leukaemia: a retrospective survey from the Acute Leukemia Working Party (ALWP) of the European Group for Blood and Marrow Transplantation (EBMT). Leukemia 2005; 19: Forman SJ. What is the role of reduced-intensity transplantation in the treatment of older patients with AML? Hematology Am Soc Hematol Educ Program Gratwohl A, Baldomero H, Passweg J, Urbano-Ispizua A. European Group for Blood and Marrow Transplantation (EBMT). Accreditation Committee. Increasing use of reduced intensity conditioning transplants: report of the 2001 EBMT activity survey. Bone Marrow Transplant 2002; 30: Gratwohl A, Baldomero H, Schwendener A, Rocha V, Apperley J, Frauendorfer K. The EBMT activity survey 2007 with focus on allogeneic HSCT for AML and novel cellular therapies. Bone Marrow Transplant 2009; 43: Blaise D, Vey N, Faucher C, Mohty M. Current status of reduced-intensity-conditioning allogeneic stem cell transplantation for acute myeloid leukemia. Haematologica 2007; 92: Gooley TA, Leisenring W, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 1999; 18: Fine JP, Gray RJ. A proportional hazards model for subdistribution of a competing risk. J Am Stat Assoc 1999; 94: Lee SJ, Joffe S, Artz AS, Champlin RE, Davies SM, Jagasia M et al. Individual physician practice variation in hematopoietic cell transplantation. J Clin Oncol 2008; 26: Lee SJ, Astigarraga CC, Eapen M, Artz AS, Davies SM, Champlin R et al. Variation in supportive care practices in hematopoietic cell transplantation. Biol Blood Marrow Transplant 2008; 14: Loberiza Jr FR, Zhang MJ, Lee SJ, Klein JP, LeMaistre CF, Serna DS et al. Association of transplant center and physician factors on mortality after hematopoietic stem cell transplantation in the United States. Blood 2005; 105: Mesnil F, Jouet JP, Tuppin P, Vernant JP, Golmard JL. Evaluation of centre and period effects in allogeneic haematopoietic stem cell transplantation in France. Bone Marrow Transplant 2004; 34: Matsuo K, Hamajima N, Morishima Y, Harada M. Hospital capacity and posttransplant survival after allogeneic bone marrow transplantation: analysis of data from the Japan Society for Hematopoietic Cell Transplantation. Bone Marrow Transplant 2000; 26: Bone Marrow Transplantation (2013) & 2013 Macmillan Publishers Limited

Myeloablative and Reduced Intensity Conditioning for HSCT Annalisa Ruggeri, MD, Hôpital Saint Antoine Eurocord- Hôpital Saint Louis, Paris

Myeloablative and Reduced Intensity Conditioning for HSCT Annalisa Ruggeri, MD, Hôpital Saint Antoine Eurocord- Hôpital Saint Louis, Paris Myeloablative and Reduced Intensity Conditioning for HSCT Annalisa Ruggeri, MD, Hôpital Saint Antoine Eurocord- Hôpital Saint Louis, Paris 18th ESH - EBMT Training Course on HSCT 8-10 May 2014, Vienna,

More information

Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany;

Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Mobilized Peripheral Blood Stem Cells Compared with Bone Marrow as the Stem Cell Source for Unrelated Donor Allogeneic Transplantation with Reduced-Intensity Conditioning in Patients with Acute Myeloid

More information

Increasing numbers of patients are receiving reduced intensity conditioning regimen

Increasing numbers of patients are receiving reduced intensity conditioning regimen ARTICLE Stem Cell Transplantation EUROPEAN HEMATOLOGY ASSOCIATION Haematologica 2016 Volume 101(2):256-262 Correspondence: Bipin.Savani@Vanderbilt.Edu Received: 22/08/2015. Accepted: 10/11/2015. Pre-published:

More information

Leukemia (2012), 1 7 & 2012 Macmillan Publishers Limited All rights reserved /12

Leukemia (2012), 1 7 & 2012 Macmillan Publishers Limited All rights reserved /12 Leukemia (2012), 1 7 & 2012 Macmillan Publishers Limited All rights reserved 0887-6924/12 www.nature.com/leu ORIGINAL ARTICLE Impact of graft-versus-host disease after reduced-intensity conditioning allogeneic

More information

Reduced-intensity Conditioning Transplantation

Reduced-intensity Conditioning Transplantation Reduced-intensity Conditioning Transplantation Current Role and Future Prospect He Huang M.D., Ph.D. Bone Marrow Transplantation Center The First Affiliated Hospital Zhejiang University School of Medicine,

More information

3,4, Xiao-jun Huang 5, Fabio Ciceri 6, and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy

3,4, Xiao-jun Huang 5, Fabio Ciceri 6, and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy Donor age determines outcome in acute leukemia patients over 40 undergoing haploidentical hematopoietic cell transplantation Jonathan Canaani 1,Bipin N Savani 2 M, yriam Labopin 3,4, Xiao-jun Huang 5,

More information

J Clin Oncol 24: by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 24: by American Society of Clinical Oncology INTRODUCTION VOLUME 24 NUMBER 24 AUGUST 20 2006 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Results of Genoidentical Hemopoietic Stem Cell Transplantation With Reduced Intensity Conditioning for Acute

More information

AIH, Marseille 30/09/06

AIH, Marseille 30/09/06 ALLOGENEIC STEM CELL TRANSPLANTATION FOR MYELOID MALIGNANCIES Transplant and Cellular Therapy Unit Institut Paoli Calmettes Inserm U599 Université de la Méditerranée ée Marseille, France AIH, Marseille

More information

KEY WORDS: Allogeneic, Hematopoietic cell transplantation, Graft-versus-host disease, Immunosuppressants, Cyclosporine, Tacrolimus

KEY WORDS: Allogeneic, Hematopoietic cell transplantation, Graft-versus-host disease, Immunosuppressants, Cyclosporine, Tacrolimus A Retrospective Comparison of Tacrolimus versus Cyclosporine with Methotrexate for Immunosuppression after Allogeneic Hematopoietic Cell Transplantation with Mobilized Blood Cells Yoshihiro Inamoto, 1

More information

Study design. Treatment modalities

Study design. Treatment modalities (2005) 19, 916 920 & 2005 Nature Publishing Group All rights reserved 0887-6924/05 $30.00 www.nature.com/leu The role of reduced intensity conditioning allogeneic stem cell transplantation in patients

More information

Abstract 1 INTRODUCTION RESEARCH ARTICLE

Abstract 1 INTRODUCTION RESEARCH ARTICLE Received: 24 January 207 Revised: 9 March 207 Accepted: 20 March 207 DOI: 0.002/ajh.24737 RESEARCH ARTICLE Long term impact of hyperleukocytosis in newly diagnosed acute myeloid leukemia patients undergoing

More information

Current Status of Haploidentical Hematopoietic Stem Cell Transplantation

Current Status of Haploidentical Hematopoietic Stem Cell Transplantation Current Status of Haploidentical Hematopoietic Stem Cell Transplantation Annalisa Ruggeri, MD, PhD Hematology and BMT Unit Hôpital Saint Antoine, Paris, France #EBMTITC16 www.ebmt.org Hematopoietic SCT

More information

Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study

Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study Ruggeri et al. Journal of Hematology & Oncology (2016) 9:89 DOI 10.1186/s13045-016-0321-y RESEARCH Open Access Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first

More information

ALLOGENEIC STEM CELL TRANSPLANTATION FOR ACUTE MYELOBLASTIC LEUKEMIAS

ALLOGENEIC STEM CELL TRANSPLANTATION FOR ACUTE MYELOBLASTIC LEUKEMIAS ALLOGENEIC STEM CELL TRANSPLANTATION FOR ACUTE MYELOBLASTIC LEUKEMIAS Didier Blaise, MD Transplant and Cellular Therapy Unit (U2T) Department of Hematology Centre de Recherche en Cancérologie, Inserm U891

More information

options in Myeloablative HSCT

options in Myeloablative HSCT Should Busilvex we use AlloSCT in AML options in Myeloablative HSCT Reduced Intensity or Myeloablative preparative protocols? Moderator: Andrea Bacigalupo Reduced Intensity: Arnon Nagler Myeloablative:

More information

Reduced-Intensity Allogeneic Bone Marrow Transplantation

Reduced-Intensity Allogeneic Bone Marrow Transplantation Reduced-Intensity Allogeneic Bone Marrow Transplantation Session Chair: Claudio Anasetti, MD Speakers: Brenda M. Sandmaier, MD; Issa F. Khouri, MD; and Franco Locatelli, MD Outcomes with Myeloid Malignancies

More information

Feasibility and Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in 30 Patients with Poor Risk Acute Myeloid Leukemia Older than 60 Years

Feasibility and Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in 30 Patients with Poor Risk Acute Myeloid Leukemia Older than 60 Years The Open Leukemia Journal, 2010, 3, 55-59 55 Open Access Feasibility and Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in 30 Patients with Poor Risk Acute Myeloid Leukemia Older than Years

More information

Reduced intensity conditioning regimens

Reduced intensity conditioning regimens Reduced intensity conditioning regimens (2002) 30, 63 68 2002 Nature Publishing Group All rights reserved 0268 3369/02 $25.00 www.nature.com/bmt Low transplant-related mortality after second allogeneic

More information

KEY WORDS: Acute myeloid leukemia, FLT3-ITD, NPM1, CEBPA, Reduced conditioning, Allogeneic stem cell transplantation

KEY WORDS: Acute myeloid leukemia, FLT3-ITD, NPM1, CEBPA, Reduced conditioning, Allogeneic stem cell transplantation Potent Graft-versus-Leukemia Effect after Reduced-Intensity Allogeneic SCT for Intermediate-Risk AML with FLT3-ITD or Wild-Type NPM1 and CEBPA without FLT3-ITD Ga elle Laboure, 1 Stephanie Dulucq, 2 Myriam

More information

EBMT2008_22_44:EBMT :29 Pagina 454 CHAPTER 30. HSCT for Hodgkin s lymphoma in adults. A. Sureda

EBMT2008_22_44:EBMT :29 Pagina 454 CHAPTER 30. HSCT for Hodgkin s lymphoma in adults. A. Sureda EBMT2008_22_44:EBMT2008 6-11-2008 9:29 Pagina 454 * CHAPTER 30 HSCT for Hodgkin s lymphoma in adults A. Sureda EBMT2008_22_44:EBMT2008 6-11-2008 9:29 Pagina 455 CHAPTER 30 HL in adults 1. Introduction

More information

Cover Page. The handle holds various files of this Leiden University dissertation.

Cover Page. The handle   holds various files of this Leiden University dissertation. Cover Page The handle http://hdl.handle.net/1887/20898 holds various files of this Leiden University dissertation. Author: Jöris, Monique Maria Title: Challenges in unrelated hematopoietic stem cell transplantation.

More information

Long-Term Outcome of Autologous Hematopoietic Stem Cell Transplantation (AHSCT) for Acute Myeloid Leukemia (AML)- Single Center Retrospective Analysis

Long-Term Outcome of Autologous Hematopoietic Stem Cell Transplantation (AHSCT) for Acute Myeloid Leukemia (AML)- Single Center Retrospective Analysis Pathol. Oncol. Res. (2018) 24:469 475 DOI 10.1007/s12253-017-0266-7 ORIGINAL ARTICLE Long-Term Outcome of Autologous Hematopoietic Stem Cell Transplantation (AHSCT) for Acute Myeloid Leukemia (AML)- Single

More information

Stem cell transplantation for patients with AML in Republic of Macedonia: - 15 years of experience -

Stem cell transplantation for patients with AML in Republic of Macedonia: - 15 years of experience - Stem cell transplantation for patients with AML in Republic of Macedonia: - 15 years of experience - R E S E A R C H A S S O C I A T E P R O F. D - R Z L A T E S T O J A N O S K I Definition Acute myeloid

More information

Workshop I: Patient Selection Current indication for HCT in adults. Shinichiro Okamoto MD, PhD Keio University, Tokyo, Japan

Workshop I: Patient Selection Current indication for HCT in adults. Shinichiro Okamoto MD, PhD Keio University, Tokyo, Japan Workshop I: Patient Selection Current indication for HCT in adults Shinichiro Okamoto MD, PhD Keio University, Tokyo, Japan Factors to Take into Account with Recommending HCT Patient & disease factors

More information

MUD HSCT as first line Treatment in Idiopathic SAA. Dr Sujith Samarasinghe Great Ormond Street Hospital for Children, London, UK

MUD HSCT as first line Treatment in Idiopathic SAA. Dr Sujith Samarasinghe Great Ormond Street Hospital for Children, London, UK MUD HSCT as first line Treatment in Idiopathic SAA Dr Sujith Samarasinghe Great Ormond Street Hospital for Children, London, UK No Financial Disclosures Guidelines for management of aplastic anaemia British

More information

KEY WORDS: CRp, Platelet recovery, AML, MDS, Transplant

KEY WORDS: CRp, Platelet recovery, AML, MDS, Transplant Platelet Recovery Before Allogeneic Stem Cell Transplantation Predicts Posttransplantation Outcomes in Patients with Acute Myelogenous Leukemia and Myelodysplastic Syndrome Gheath Alatrash, Matteo Pelosini,

More information

Bone Marrow Transplantation in Myelodysplastic Syndromes. An overview for the Myelodysplasia Support Group of Ottawa

Bone Marrow Transplantation in Myelodysplastic Syndromes. An overview for the Myelodysplasia Support Group of Ottawa Bone Marrow Transplantation in Myelodysplastic Syndromes An overview for the Myelodysplasia Support Group of Ottawa Objectives Provide brief review of marrow failure Re emphasize the importance of predictions

More information

Cord Blood Transplant. E. Gluckman Eurocord ESH-EBMT training course Vienna 2014

Cord Blood Transplant. E. Gluckman Eurocord ESH-EBMT training course Vienna 2014 Cord Blood Transplant E. Gluckman Eurocord ESH-EBMT training course Vienna 2014 Background Since 1988, umbilical cord blood (CB) has been successfully used to treat children and adults needing stem cell

More information

The National Marrow Donor Program. Graft Sources for Hematopoietic Cell Transplantation. Simon Bostic, URD Transplant Recipient

The National Marrow Donor Program. Graft Sources for Hematopoietic Cell Transplantation. Simon Bostic, URD Transplant Recipient 1988 199 1992 1994 1996 1998 2 22 24 26 28 21 212 214 216 218 Adult Donors Cord Blood Units The National Donor Program Graft Sources for Hematopoietic Cell Transplantation Dennis L. Confer, MD Chief Medical

More information

4nd Patient and Family Day

4nd Patient and Family Day 4nd Patient and Family Day EBMT Slide template Barcelona 7 February 2008 EBMT 2010 Vienna, Austria ; www.ebmt.org History of Stem Cell Transplantation Appelbaum et al, NEJM 2006 What is EBMT? Scientific,

More information

Published Ahead of Print on May 10, 2018, as doi: /haematol Copyright 2018 Ferrata Storti Foundation.

Published Ahead of Print on May 10, 2018, as doi: /haematol Copyright 2018 Ferrata Storti Foundation. Published Ahead of Print on May 10, 2018, as doi:10.3324/haematol.2018.189258. Copyright 2018 Ferrata Storti Foundation. Outcomes of hematopoietic stem cell transplantation from unmanipulated haploidentical

More information

Donatore HLA identico di anni o MUD giovane?

Donatore HLA identico di anni o MUD giovane? Donatore HLA identico di 60-70 anni o MUD giovane? Stella Santarone Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie Pescara AGENDA 1. Stem Cell Donation: fatalities and severe events

More information

A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemia

A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemia Piemontese et al. Journal of Hematology & Oncology (2017) 10:24 DOI 10.1186/s13045-017-0394-2 RESEARCH A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated

More information

ARTICLES. Introduction. Methods. Study design This was a prospective multicenter study. The study protocol was

ARTICLES. Introduction. Methods. Study design This was a prospective multicenter study. The study protocol was Stem Cell Transplantation ARTICLES Low non-relapse mortality and long-term preserved quality of life in older patients undergoing matched related donor allogeneic stem cell transplantation: a prospective

More information

Distinct factors determine the kinetics of disease relapse in adults transplanted for acute myeloid leukaemia

Distinct factors determine the kinetics of disease relapse in adults transplanted for acute myeloid leukaemia Original Article doi: 10.1111/joim.12720 Distinct factors determine the kinetics of disease relapse in adults transplanted for acute myeloid leukaemia C. Craddock 1, J. Versluis 2, M. Labopin 3, G. Socie

More information

Late complications after hematopoietic stem cell transplant in adult patients

Late complications after hematopoietic stem cell transplant in adult patients Late complications after hematopoietic stem cell transplant in adult patients Gérard Socié, MD, PhD Hematology/Transplantation, Hospital Saint Louis, Paris, France Synopsis H S C T Allogeneic HSCT activity

More information

HCT for Myelofibrosis

HCT for Myelofibrosis Allogeneic HSCT for MDS and Myelofibrosis Sunil Abhyankar, MD Professor Medicine, Medical Director, Pheresis and Cell Processing University of Kansas Hospital BMT Program April 27 th, 213 HCT for Myelofibrosis

More information

Disease relapse is the most common cause of treatment failure

Disease relapse is the most common cause of treatment failure Stem Cell Transplantation Clinical activity of azacitidine in patients who relapse after allogeneic stem cell transplantation for acute myeloid leukemia Charles Craddock, 1 Myriam Labopin, 2 Marie Robin,

More information

Validation of the acute leukemia-ebmt score for prediction of mortality following allogeneic stem cell transplantation in a multi-center GITMO cohort

Validation of the acute leukemia-ebmt score for prediction of mortality following allogeneic stem cell transplantation in a multi-center GITMO cohort Received: 16 December 2016 Revised: 22 January 2017 Accepted: 3 February 2017 DOI: 10.1002/ajh.24677 RESEARCH ARTICLE Validation of the acute leukemia-ebmt score for prediction of mortality following allogeneic

More information

What s new in Blood and Marrow Transplant? Saar Gill, MD PhD Jan 22, 2016

What s new in Blood and Marrow Transplant? Saar Gill, MD PhD Jan 22, 2016 What s new in Blood and Marrow Transplant? Saar Gill, MD PhD Jan 22, 2016 Division of Hematology-Oncology University of Pennsylvania Perelman School of Medicine 1 Who should be transplanted and how? Updates

More information

Donor Lymphocyte Infusion for Malignancies Treated with an Allogeneic Hematopoietic Stem-Cell Transplant

Donor Lymphocyte Infusion for Malignancies Treated with an Allogeneic Hematopoietic Stem-Cell Transplant Last Review Status/Date: September 2014 Page: 1 of 8 Malignancies Treated with an Allogeneic Description Donor lymphocyte infusion (DLI), also called donor leukocyte or buffy-coat infusion is a type of

More information

Haematopoietic stem cell transplantation (SCT)

Haematopoietic stem cell transplantation (SCT) HAEMATOPOIETIC TEM CELL TRANPLANTATION FOR CHILREN IN BELGIUM Marie-Françoise resse 1 & Yves Beguin 2 1 epartment of Paediatrics, ivision of Hemato-Oncology, UHOPL, University of Liege, Liège, Belgium;

More information

A.M.W. van Marion. H.M. Lokhorst. N.W.C.J. van de Donk. J.G. van den Tweel. Histopathology 2002, 41 (suppl 2):77-92 (modified)

A.M.W. van Marion. H.M. Lokhorst. N.W.C.J. van de Donk. J.G. van den Tweel. Histopathology 2002, 41 (suppl 2):77-92 (modified) chapter 4 The significance of monoclonal plasma cells in the bone marrow biopsies of patients with multiple myeloma following allogeneic or autologous stem cell transplantation A.M.W. van Marion H.M. Lokhorst

More information

Clinical Study Steroid-Refractory Acute GVHD: Predictors and Outcomes

Clinical Study Steroid-Refractory Acute GVHD: Predictors and Outcomes Advances in Hematology Volume 2011, Article ID 601953, 8 pages doi:10.1155/2011/601953 Clinical Study Steroid-Refractory Acute GVHD: Predictors and Outcomes Jason R. Westin, 1 Rima M. Saliba, 1 Marcos

More information

Il Trapianto da donatore MUD. Alessandro Rambaldi

Il Trapianto da donatore MUD. Alessandro Rambaldi Il Trapianto da donatore MUD Alessandro Rambaldi Overview Comparison of outcomes of allo- HSCT from matched related and unrelated donors. We need evidence based results! Is the Dme needed to find an unrelated

More information

KEY WORDS Leukemia Myelodysplastic syndrome Transplant Aging

KEY WORDS Leukemia Myelodysplastic syndrome Transplant Aging Biology of Blood and Marrow Transplantation 13:454-462 (2007) 2007 American Society for Blood and Marrow Transplantation 1083-8791/07/1304-0001$32.00/0 doi:10.1016/j.bbmt.2006.11.024 Allogeneic Hematopoietic

More information

Effect of Conditioning Regimen Intensity on Acute Myeloid Leukemia Outcomes after Umbilical Cord Blood Transplantation

Effect of Conditioning Regimen Intensity on Acute Myeloid Leukemia Outcomes after Umbilical Cord Blood Transplantation Effect of Conditioning Regimen Intensity on Acute Myeloid Leukemia Outcomes after Umbilical Cord Blood Transplantation Betul Oran, 1,2 John E. Wagner, 1,3 Todd E. DeFor, 1 Daniel J. Weisdorf, 1,2 Claudio

More information

Le infezioni fungine nel trapianto di cellule staminali emopoietiche. Claudio Viscoli Professor of Infectious Disease University of Genova, Italy

Le infezioni fungine nel trapianto di cellule staminali emopoietiche. Claudio Viscoli Professor of Infectious Disease University of Genova, Italy Le infezioni fungine nel trapianto di cellule staminali emopoietiche Claudio Viscoli Professor of Infectious Disease University of Genova, Italy Potential conflicts of interest Received grants as speaker/moderator

More information

Sylwia Mizia, 1 Dorota Dera-Joachimiak, 1 Malgorzata Polak, 1 Katarzyna Koscinska, 1 Mariola Sedzimirska, 1 and Andrzej Lange 1, 2. 1.

Sylwia Mizia, 1 Dorota Dera-Joachimiak, 1 Malgorzata Polak, 1 Katarzyna Koscinska, 1 Mariola Sedzimirska, 1 and Andrzej Lange 1, 2. 1. Bone Marrow Research Volume 2012, Article ID 873695, 5 pages doi:10.1155/2012/873695 Clinical Study Both Optimal Matching and Procedure Duration Influence Survival of Patients after Unrelated Donor Hematopoietic

More information

MUD SCT. Pimjai Niparuck Division of Hematology, Department of Medicine Ramathibodi Hospital, Mahidol University

MUD SCT. Pimjai Niparuck Division of Hematology, Department of Medicine Ramathibodi Hospital, Mahidol University MUD SCT Pimjai Niparuck Division of Hematology, Department of Medicine Ramathibodi Hospital, Mahidol University Outlines Optimal match criteria for unrelated adult donors Role of ATG in MUD-SCT Post-transplant

More information

Indication for unrelated allo-sct in 1st CR AML

Indication for unrelated allo-sct in 1st CR AML Indication for unrelated allo-sct in 1st CR AML It is time to say! Decision of allo-sct: factors to be considered Cytogenetic risk status Molecular genetics FLT3; NPM1, CEBPA. Response to induction Refractoriness

More information

Should patients with higher risk MDS (or AML in «early relapse») proceed directly to allo SCT without prior chemotherapy?

Should patients with higher risk MDS (or AML in «early relapse») proceed directly to allo SCT without prior chemotherapy? Should patients with higher risk MDS (or AML in «early relapse») proceed directly to allo SCT without prior chemotherapy? Pierre Fenaux Cohem 2012 Barcelona Should patients with higher risk MDS (or AML

More information

Comparison of Reduced-Intensity and Conventional Myeloablative Regimens for Allogeneic Transplantation in Non-Hodgkin s Lymphoma

Comparison of Reduced-Intensity and Conventional Myeloablative Regimens for Allogeneic Transplantation in Non-Hodgkin s Lymphoma Biology of Blood and Marrow Transplantation 12:1326-1334 (2006) 2006 American Society for Blood and Marrow Transplantation 1083-8791/06/1212-0001$32.00/0 doi:10.1016/j.bbmt.2006.08.035 Comparison of Reduced-Intensity

More information

MUD SCT for Paediatric AML?

MUD SCT for Paediatric AML? 7 th South African Symposium on Haematopoietic Stem Cell Transplantation MUD SCT for Paediatric AML? Alan Davidson Haematology / Oncology Service Red Cross Children s Hospital THE SCENARIO A 10 year old

More information

Bone Marrow Transplantation and the Potential Role of Iomab-B

Bone Marrow Transplantation and the Potential Role of Iomab-B Bone Marrow Transplantation and the Potential Role of Iomab-B Hillard M. Lazarus, MD, FACP Professor of Medicine, Director of Novel Cell Therapy Case Western Reserve University 1 Hematopoietic Cell Transplantation

More information

Monosomal Karyotype Provides Better Prognostic Prediction after Allogeneic Stem Cell Transplantation in Patients with Acute Myelogenous Leukemia

Monosomal Karyotype Provides Better Prognostic Prediction after Allogeneic Stem Cell Transplantation in Patients with Acute Myelogenous Leukemia Monosomal Karyotype Provides Better Prognostic Prediction after Allogeneic Stem Cell Transplantation in Patients with Acute Myelogenous Leukemia Betul Oran, 1 Michelle Dolan, 2 Qing Cao, 1 Claudio Brunstein,

More information

Mantle cell lymphoma Allo stem cell transplantation in relapsed and refractory patients

Mantle cell lymphoma Allo stem cell transplantation in relapsed and refractory patients Mantle cell lymphoma Allo stem cell transplantation in relapsed and refractory patients Olivier Hermine MD, PhD Department of Hematology INSERM and CNRS, Imagine Institute Necker Hospital Paris, France

More information

Introduction to Clinical Hematopoietic Cell Transplantation (HCT) George Chen, MD Thursday, May 03, 2018

Introduction to Clinical Hematopoietic Cell Transplantation (HCT) George Chen, MD Thursday, May 03, 2018 Introduction to Clinical Hematopoietic Cell Transplantation (HCT) George Chen, MD Thursday, May 03, 2018 The transfer of hematopoietic progenitor and stem cells for therapeutic purposes Hematopoietic Cell

More information

Outcome of acute leukemia patients with central nervous system (CNS) involvement treated with total body or CNS irradiation before transplantation

Outcome of acute leukemia patients with central nervous system (CNS) involvement treated with total body or CNS irradiation before transplantation Original Article Page 1 of 9 Outcome of acute leukemia patients with central nervous system (CNS) involvement treated with total body or CNS irradiation before transplantation Wen-Han Kuo 1, Yu-Hsuan Chen

More information

Research Article Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic Stem Cell Transplantation

Research Article Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic Stem Cell Transplantation Bone Marrow Research Volume 23, Article ID 565824, 7 pages http://dx.doi.org/.55/23/565824 Research Article Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic

More information

Introduction to Hematopoietic Stem Cell Transplantation

Introduction to Hematopoietic Stem Cell Transplantation Faculty Disclosures Introduction to Hematopoietic Stem Cell Transplantation Nothing to disclose Jeanne McCarthy-Kaiser, PharmD, BCOP Clinical Pharmacist, Autologous Stem Cell Transplant/Long- Term Follow-Up

More information

Listen to the podcast by Dr Schiffer at J Clin Oncol 30: by American Society of Clinical Oncology INTRODUCTION

Listen to the podcast by Dr Schiffer at  J Clin Oncol 30: by American Society of Clinical Oncology INTRODUCTION VOLUME 30 NUMBER 7 MARCH 1 2012 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Impact of FLT3 Internal Tandem Duplication on the Outcome of Related and Unrelated Hematopoietic Transplantation

More information

Reduced intensity conditioning for allogeneic haematopoietic stem cell transplantation (HSCT)

Reduced intensity conditioning for allogeneic haematopoietic stem cell transplantation (HSCT) 1 Reduced intensity conditioning for allogeneic haematopoietic stem cell transplantation (HSCT) S. Servais, Y. Beguin, F. Baron Reduced intensity conditioning (RIC) regimens have allowed performing allogeneic

More information

Effect of Conditioning Regimen Intensity on CMV Infection in Allogeneic Hematopoietic Cell Transplantation

Effect of Conditioning Regimen Intensity on CMV Infection in Allogeneic Hematopoietic Cell Transplantation Version 3-30-2009 Effect of Conditioning Regimen Intensity on CMV Infection in Allogeneic Hematopoietic Cell Transplantation Authors: Hirohisa Nakamae, 1 Katharine A. Kirby, 1 Brenda M. Sandmaier, 1,2

More information

Dr Claire Burney, Lymphoma Clinical Fellow, Bristol Haematology and Oncology Centre, UK

Dr Claire Burney, Lymphoma Clinical Fellow, Bristol Haematology and Oncology Centre, UK EMBT LWP 2017-R-05 Research Protocol: Outcomes of patients treated with Ibrutinib post autologous stem cell transplant for mantle cell lymphoma. A retrospective analysis of the LWP-EBMT registry. Principle

More information

Dose intensity and the toxicity and efficacy of allogeneic hematopoietic cell transplantation

Dose intensity and the toxicity and efficacy of allogeneic hematopoietic cell transplantation (2005) 19, 171 175 & 2005 Nature Publishing Group All rights reserved 0887-6924/05 $30.00 www.nature.com/leu KEYNOTE ADDRESS Dose intensity and the toxicity and efficacy of allogeneic hematopoietic cell

More information

AML:Transplant or ChemoTherapy?

AML:Transplant or ChemoTherapy? AML:Transplant or ChemoTherapy? 1960 s: Importance of HLA type in Animal Models Survival of Dogs Given 1000 RAD TBI and a Marrow Infusion from a Littermate Matched or Mismatched for Dog Leucocyte Antigens

More information

Protocol. Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia

Protocol. Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia Hematopoietic Stem-Cell Transplantation for Acute Myeloid (80126) Medical Benefit Effective Date: 07/01/14 Next Review Date: 05/15 Preauthorization Yes Review Dates: 04/07, 05/08, 05/09, 05/10, 05/11,

More information

Autologous versus Allogeneic Unrelated Donor Transplantation for Acute Lymphoblastic Leukemia: Comparative Toxicity and Outcomes

Autologous versus Allogeneic Unrelated Donor Transplantation for Acute Lymphoblastic Leukemia: Comparative Toxicity and Outcomes Biology of Blood and Marrow Transplantation 8:213-220 (2002) 2002 American Society for Blood and Marrow Transplantation ASBMT Autologous versus Allogeneic Unrelated Donor Transplantation for Acute Lymphoblastic

More information

Telephone: ; Fax: ; E mail:

Telephone: ; Fax: ; E mail: MINUTES AND OVERVIEW PLAN CIBMTR WORKING COMMITTEE FOR GRAFT SOURCES & MANIPULATION Grapevine, TX Thursday, February 27, 2014, 2:45 4:45 pm Co Chair: Co Chair: Co Chair: Statisticians: Scientific Director:

More information

Allogeneic hematopoietic stem cell transplantation from family members other than HLA-identical siblings over the last decade ( )

Allogeneic hematopoietic stem cell transplantation from family members other than HLA-identical siblings over the last decade ( ) TRANSPLANTATION Allogeneic hematopoietic stem cell transplantation from family members other than -identical siblings over the last decade (1991-2000) Yoshinobu Kanda, Shigeru Chiba, Hisamaru Hirai, Hisashi

More information

Experimental Hematology 31 (2003)

Experimental Hematology 31 (2003) Experimental Hematology 31 (2003) 1182 1186 Busulfan-cyclophosphamide versus total body irradiation cyclophosphamide as preparative regimen before allogeneic hematopoietic stem cell transplantation for

More information

Hematology and Oncology, The Cleveland Clinic, Cleveland, Ohio; 3 Department of Biostatistics, The Ohio State University Hospitals, Columbus, Ohio

Hematology and Oncology, The Cleveland Clinic, Cleveland, Ohio; 3 Department of Biostatistics, The Ohio State University Hospitals, Columbus, Ohio Biology of Blood and Marrow Transplantation 12:61-67 (2006) 2006 American Society for Blood and Marrow Transplantation 1083-8791/06/1201-0004$32.00/0 doi:10.1016/j.bbmt.2005.06.004 High Disease Burden

More information

Medical Benefit Effective Date: 07/01/12 Next Review Date: 03/13 Preauthorization* Yes Review Dates: 04/07, 05/08, 03/10, 03/11, 03/12

Medical Benefit Effective Date: 07/01/12 Next Review Date: 03/13 Preauthorization* Yes Review Dates: 04/07, 05/08, 03/10, 03/11, 03/12 Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous (80130) Medical Benefit Effective Date: 07/01/12 Next Review Date: 03/13 Preauthorization* Yes Review Dates: 04/07, 05/08, 03/10, 03/11,

More information

VC 2007 Wiley-Liss, Inc.

VC 2007 Wiley-Liss, Inc. Reduced intensity compared with high dose conditioning for allotransplantation in acute myeloid leukemia and myelodysplastic syndrome: A comparative clinical analysis Catherine M. Flynn, 1,3 Betsy Hirsch,

More information

Biol Blood Marrow Transplant 17: (2011) Ó 2011 American Society for Blood and Marrow Transplantation

Biol Blood Marrow Transplant 17: (2011) Ó 2011 American Society for Blood and Marrow Transplantation Outcomes of Patients with Myeloid Malignancies Treated with Allogeneic Hematopoietic Stem Cell Transplantation from Matched Unrelated Donors Compared with One Human Leukocyte Antigen Mismatched Related

More information

Factors Influencing Haematopoietic Progenitor cell transplant outcome Optimising donor selection

Factors Influencing Haematopoietic Progenitor cell transplant outcome Optimising donor selection Factors Influencing Haematopoietic Progenitor cell transplant outcome Optimising donor selection Alison Logan Transplantation Laboratory Manchester Royal Infirmary Haematopoietic progenitor cell transplants

More information

Therapeutic Advances in Treatment of Aplastic Anemia. Seiji Kojima MD. PhD.

Therapeutic Advances in Treatment of Aplastic Anemia. Seiji Kojima MD. PhD. Therapeutic Advances in Treatment of Aplastic Anemia Seiji Kojima MD. PhD. Department of Pediatrics Nagoya University Graduate School of Medicine Chairman of the Severe Aplastic Anemia Working Party Asia-Pacific

More information

Matched and mismatched unrelated donor transplantation: is the outcome the same as for matched sibling donor transplantation?

Matched and mismatched unrelated donor transplantation: is the outcome the same as for matched sibling donor transplantation? HEMATOPOIETIC STEM CELL TRANSPLANTATION I: EXPLOITING ALTERNATIVE DONORS Matched and mismatched unrelated donor transplantation: is the outcome the same as for matched sibling donor transplantation? Andrea

More information

Haploidentical Transplantation: The Answer to our Donor Problems? Mary M. Horowitz, MD, MS CIBMTR, Medical College of Wisconsin January 2017

Haploidentical Transplantation: The Answer to our Donor Problems? Mary M. Horowitz, MD, MS CIBMTR, Medical College of Wisconsin January 2017 Haploidentical Transplantation: The Answer to our Donor Problems? Mary M. Horowitz, MD, MS CIBMTR, Medical College of Wisconsin January 2017 Allogeneic Transplant Recipients in the US, by Donor Type 9000

More information

An Introduction to Bone Marrow Transplant

An Introduction to Bone Marrow Transplant Introduction to Blood Cancers An Introduction to Bone Marrow Transplant Rushang Patel, MD, PhD, FACP Florida Hospital Medical Group S My RBC Plt Gran Polycythemia Vera Essential Thrombocythemia AML, CML,

More information

Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS

Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS (12) 47, 3 211 & 12 Macmillan Publishers Limited All rights reserved 268-3369/12 www.nature.com/bmt ORIGINAL ARTICLE Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative

More information

CONSIDERATIONS IN DESIGNING ACUTE GVHD PREVENTION TRIALS: Patient Selection, Concomitant Treatments, Selecting and Assessing Endpoints

CONSIDERATIONS IN DESIGNING ACUTE GVHD PREVENTION TRIALS: Patient Selection, Concomitant Treatments, Selecting and Assessing Endpoints CONSIDERATIONS IN DESIGNING ACUTE GVHD PREVENTION TRIALS: Patient Selection, Concomitant Treatments, Selecting and Assessing Endpoints CENTER FOR INTERNATIONAL BLOOD AND MARROW TRANSPLANT RESEARCH Potential

More information

KEY WORDS: Total body irradiation, acute myelogenous leukemia, relapse

KEY WORDS: Total body irradiation, acute myelogenous leukemia, relapse The Addition of 400 cgy Total Body Irradiation to a Regimen Incorporating Once-Daily Intravenous Busulfan, Fludarabine, and Antithymocyte Globulin Reduces Relapse Without Affecting Nonrelapse Mortality

More information

PERFORMANCE AFTER HSCT Mutlu arat, md ıstanbul bilim un., dept. hematology ıstanbul, turkey

PERFORMANCE AFTER HSCT Mutlu arat, md ıstanbul bilim un., dept. hematology ıstanbul, turkey PERFORMANCE AFTER HSCT Mutlu arat, md ıstanbul bilim un., dept. hematology ıstanbul, turkey Joint Educational Meeting of the EBMT Severe Aplastic Anaemia, Late Effects and Autoimmune Diseases Working Parties

More information

Haploidentical Transplantation today: and the alternatives

Haploidentical Transplantation today: and the alternatives Haploidentical Transplantation today: and the alternatives Daniel Weisdorf MD University of Minnesota February, 2013 No matched sib: where to look? URD donor requires close HLA matching and 3-12 weeks

More information

Published Ahead of Print on September 20, 2013, as doi: /haematol Copyright 2013 Ferrata Storti Foundation.

Published Ahead of Print on September 20, 2013, as doi: /haematol Copyright 2013 Ferrata Storti Foundation. Published Ahead of Print on September 20, 2013, as doi:10.3324/haematol.2013.094193. Copyright 2013 Ferrata Storti Foundation. Unrelated umbilical cord blood transplant for adult acute lymphoblastic leukemia

More information

Late effects after HSCT

Late effects after HSCT Late effects after HSCT Yves Chalandon Hematology Division, University Hospital of Geneva (HUG) Switzerland Hôpitaux Universitaires de Genève Company name Disclosures of: Yves Chalandon Research support

More information

Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation in Adults With Acute Myeloid Leukemia

Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation in Adults With Acute Myeloid Leukemia Reduced-intensity conditioning regimens decrease treatment-related toxicity and can be used in older AML patients and in younger AML patients with medical comorbidities. Gene Elling. St. Barts. Photograph.

More information

Santoro et al. Journal of Hematology & Oncology (2018) 11:55 https://doi.org/ /s

Santoro et al. Journal of Hematology & Oncology (2018) 11:55 https://doi.org/ /s Santoro et al. Journal of Hematology & Oncology (2018) 11:55 https://doi.org/10.1186/s13045-018-0598-0 RESEARCH Unmanipulated haploidentical in comparison with matched unrelated donor stem cell transplantation

More information

BACKGROUND AND RATIONALE

BACKGROUND AND RATIONALE SYNOPSIS Observational study on the use of B cell receptor kinase inhibitors and BCL2 antagonists prior to allogeneic hematopoietic stem cell transplantation for B cell malignancies: A joint project of

More information

Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia following allogeneic stem cell transplantation

Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia following allogeneic stem cell transplantation https://helda.helsinki.fi Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia following allogeneic stem cell transplantation Schmid, Christoph 2018-02 Schmid, C, de Wreede,

More information

Reduced-Intensity Conditioning before Allogeneic Hematopoietic Stem Cell Transplantation in Patients Over 60 Years: A Report from the SFGM-TC

Reduced-Intensity Conditioning before Allogeneic Hematopoietic Stem Cell Transplantation in Patients Over 60 Years: A Report from the SFGM-TC Reduced-Intensity Conditioning before Allogeneic Hematopoietic Stem Cell Transplantation in Patients Over 60 Years: A Report from the SFGM-TC Patrice Chevallier, 1 Richard M. Szydlo, 2 Didier Blaise, 3

More information

Does anti-thymocyte globulin have a place in busulfan/fludarabine

Does anti-thymocyte globulin have a place in busulfan/fludarabine ORIGINAL ARTICLE Korean J Intern Med 2016;31:750-761 Does anti-thymocyte globulin have a place in busulfan/fludarabine conditioning for matched related donor hematopoietic stem cell transplantation? Young

More information

Disclosures of: Emanuele Angelucci

Disclosures of: Emanuele Angelucci Company name Novartis Disclosures of: Emanuele Angelucci Research support Employee Consultant Stockholder Speakers bureau Advisory board Chair of TELESTO pro Other EBMT 2012 Educational Session Haemoglobinopathy

More information

Relapse Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

Relapse Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant (2004) 34, 721 727 & 2004 Nature Publishing Group All rights reserved 0268-3369/04 $30.00 www.nature.com/bmt Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling

More information

Myeloperoxidase Expression in Acute Myeloid Leukemia Helps Identifying Patients to Benefit from Transplant

Myeloperoxidase Expression in Acute Myeloid Leukemia Helps Identifying Patients to Benefit from Transplant Original Article http://dx.doi.org/1349/ymj.212.53.3.53 pissn: 513-5796, eissn: 1976-2437 Yonsei Med J 53(3):53-536, 212 Myeloperoxidase Expression in Acute Myeloid Leukemia Helps Identifying Patients

More information

Trends in Hematopoietic Cell Transplantation. AAMAC Patient Education Day Oct 2014

Trends in Hematopoietic Cell Transplantation. AAMAC Patient Education Day Oct 2014 Trends in Hematopoietic Cell Transplantation AAMAC Patient Education Day Oct 2014 Objectives Review the principles behind allogeneic stem cell transplantation Outline the process of transplant, some of

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem_cell_transplantation_for_waldenstrom_macroglobulinemia

More information

Rob Wynn RMCH & University of Manchester, UK. HCT in Children

Rob Wynn RMCH & University of Manchester, UK. HCT in Children Rob Wynn RMCH & University of Manchester, UK HCT in Children Summary Indications for HCT in children Donor selection for Paediatric HCT Using cords Achieving engraftment in HCT Conditioning Immune action

More information