Allogeneic hematopoietic stem cell transplantation in Fanconi anemia: the European Group for Blood and Marrow Transplantation experience.
Peffault de Latour R, Porcher R, Dalle JH, Aljurf M, Korthof ET, Svahn J, Willemze R, Barrenetxea C, Mialou V, Soulier J, Ayas M, Oneto R, Bacigalupo A, Marsh JC, Peters C, Socie G, Dufour C; FA Committee of the Severe Aplastic Anemia Working Party and the Pediatric Working Party of the European Group for Blood and Marrow Transplantation. Blood. 2013 Dec 19;122(26):4279-86. doi: 10.1182/blood-2013-01-479733. Epub 2013 Oct 21.
795 patients with Fanconi anemia (FA) who underwent first hematopoietic stem cell transplantation (HSCT) between May 1972 and January 2010 were analyzed. With a 6-year median follow-up, overall survival was 49% at 20 years. Better outcome was observed for patients transplanted before the age of 10 years, before clonal evolution, from a matched family donor, after a conditioning regimen without irradiation, the latter including fludarabine. Age more than 10 years at time of HSCT, clonal evolution as an indication for transplantation, peripheral blood as source of stem cells, and chronic graft-versus-host disease were found to be independently associated with the risk for secondary malignancy. Changes in transplant protocols have significantly improved the outcome of patients with FA, who should be transplanted at a young age, with bone marrow as the source of stem cells.
Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation.
Baron F, Labopin M, Blaise D, Lopez-Corral L, Vigouroux S, Craddock C, Attal M, Jindra P, Goker H, Socié G, Chevallier P, Browne P, Sandstedt A, Duarte RF, Nagler A, Mohty M.
Bone Marrow Transplant. 2014 Jan 13. doi: 10.1038/bmt.2013.204. [Epub ahead of print]
The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. These data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.
Prophylaxis and treatment of GVHD: EBMT-ELN working group recommendations for a standardized practice.
Ruutu T, Gratwohl A, de Witte T, Afanasyev B, Apperley J, Bacigalupo A, Dazzi F, Dreger P, Duarte R, Finke J, Garderet L, Greinix H, Holler E, Kröger N, Lawitschka A, Mohty M, Nagler A, Passweg J, Ringdén O, Socié G, Sierra J, Sureda A, Wiktor-Jedrzejczak W, Madrigal A, Niederwieser D.
Bone Marrow Transplant. 2013 Jul 29. doi: 10.1038/bmt.2013.107. [Epub ahead of print]
GVHD remains the major impediment to broader application of allogeneic haematopoietic SCT. It can be prevented completely, but at the expense of other complications, rejection, relapse or delayed immune reconstitution. No optimal prevention or treatment method has been defined. This is reflected by enormous heterogeneity in approaches in Europe. An European Group for Blood and Marrow Transplantation and the European LeukemiaNet working group has developed in a Delphi-like approach recommendations for prophylaxis and treatment of GVHD in the most common allogeneic transplant setting, transplantation from an HLA-identical sibling or unrelated donor for standard risk malignant disease. The working group proposes these guidelines to be adopted as routine standard in transplantation centres and to be used as comparator in systematic studies evaluating the advantages and disadvantages of practices differing from these recommendations.
Reduced intensity-conditioned allogeneic stem cell transplantation for multiple myeloma relapsing or progressing after autologous transplantation: a study by the European Group for Blood and Marrow Transplantation
HW Auner, R Szydlo, A van Biezen, S Iacobelli, G Gahrton, N Milpied, L Volin, J Janssen, S Nguyen Quoc, M Michallet, H Schoemans, J el Cheikh, E Petersen, F Guilhot, S Schönland, L Ahlberg, C Morris, L Garderet, T de Witte and N Kröger, on behalf of the Plasma Cell Dyscrasia Sub-committee of the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation (EBMT).
413 multiple myeloma (MM) patients who received a related or unrelated reduced intensity conditioning (RIC) allo-SCT for the treatment of relapse/progression after prior autologous stem cell transplantation (ASCT) were analyzed in terms of long-term outcome and prognostic factors. Median overall survival (OS) and progression free survival (PFS) from the time of RIC allo-SCT for the entire population were 24.7 and 9.6 months, respectively. Cumulative non-relapse mortality (NRM) at 1 year was 21.5%. In multivariate analysis, CMV seronegativity of both patient and donor was associated with significantly better PFS, OS and NRM. Patient–donor gender mismatch was associated with better PFS, fewer than two prior auto-SCT was associated with better OS, and shorter time from the first auto-SCT to the RIC allo-SCT was associated with lower NRM. The results of this study identify patient and donor CMV seronegativity as the key prognostic factor for outcome after RIC allo-SCT for MM relapsing or progressing after prior auto-SCT.
Bone Marrow Transplantation (2013) 48, 1395–1400; doi:10.1038/bmt.2013.73; published online 27 May 2013