EBMT NEWSLETTER | January 2016 | Volume 50 - Issue 1

Important dates

EBMT Publications

High-dose chemotherapy and autologous hematopoietic stem cell transplantation as adjuvant treatment in high-risk breast cancer: data from the EBMT registry.
Martino M, Lanza F, Pavesi L, Öztürk M, Blaise D, Núñez RL, Schouten HC, Bosi A, De Giorgi U, Generali D, Rosti G, Necchi A, Ravelli A, Bengala C, Badoglio M, Pedrazzoli P, Bregni M; European Group for Blood and Marrow Transplantation (EBMT), Solid Tumor Working Party. Biol Blood Marrow Transplant. 2015 Dec 23. pii: S1083-8791(15)01878-9. doi: 10.1016/j.bbmt.2015.12.011. [Epub ahead of print] PMID: 26723932

The efficacy of high-dose chemotherapy and autologous stem cell transplantation for breast cancer has been an area of intense controversy among the medical oncology community. The purpose of the present study was to analyze the EBMT registry data on primary, operable, non-metastatic breast cancer patients with four or more involved nodes at surgery who received high-dose therapy and autologous stem cell transplantation between 1995 and 2005 in Europe. All patients received surgery before transplant and 55 patients received neo-adjuvant treatment before surgery. 57.3% of patients were premenopausal at treatment; 56.5% had endocrine-responsive tumors; 19.5% had a human epidermal growth factor receptor 2 negative tumor and 72.4 % had > 10 positive lymph nodes at surgery. Seventy nine percent received a single HDC procedure. Overall transplant-related mortality was 1.9%, being 0.9% between 2001-2005, whereas secondary tumor-related mortality was 0.9%. With a median follow-up of 120 months, overall survival (OS) and disease-free survival at 5 and 10 years in the whole population were 75/64 and 58/44%, respectively. Human epidermal growth factor receptor 2 status did not affect survival probability. The conclusion of this study was that autologous stem cell transplantation should be considered in patients with high-risk breast cancer in the context of prospective clinical trials because of the impressive long-term survival rates in patients with high-risk BC.
Autologous stem cell transplantation for relapsed/refractory diffuse large B-cell lymphoma: efficacy in the rituximab era and comparison to first allogeneic transplants. A report from the EBMT Lymphoma Working Party.
Robinson SP, Boumendil A, Finel H, Blaise D, Poiré X, Nicolas-Virelizier E, Or R, Malladi R, Corby A, Fornecker L, Caballero D, Pohlreich D, Nagler A, Thieblemont C, Finke J, Bachy E, Vincent L, Schroyens W, Schouten H, Dreger P. Bone Marrow Transplant. 2015 Nov 30. doi: 10.1038/bmt.2015.286. [Epub ahead of print]. PMID: 26618550
With the advent of more effective first line therapies, the role of autologous stem cell transplantation in patients with relapsed / refractory diffuse large B cell lymphomas has been challenged. In this retrospective study of the Lymphoma Working Party of the EBMT, autologous stem cell transplantation was compared to allogeneic stem cell transplant (myeloblative conditioning and reduced intensity conditioning) both as first transplant in a total of 4210 patients diagnosed of diffuse large B cell lymphoma between 2002 and 2010. The 4-year non-relapse mortality rates were 7%, 20% and 27% for autologous, reduced intensity and myeloblative stem cell transplantation, respectively. The 4-year relapse incidence was 45%, 40% and 38%, respectively. The 4-year progression free survival was 48%, 52% and 35% for the three groups of patients and finally, 4-year overall survival was 60%, 52% and 38%, respectively. After adjustment for confounding factors non-relapse mortality was found to be significantly worse for patients undergoing allogeneic stem cell transplantation whilst there was no difference in the relapse incidence amongst the three groups of patients. In view of these data, the authors conclude that autologous stem cell transplantation is an effective treatment for patients with relapsed diffuse large B cell lymphoma in the rituximab era and remains the standard of care at least in those patients with chemosensitive disease after salvage therapy.
European Group for Blood and Marrow Transplantation Centers with FACT-JACIE Accreditation Have Significantly Better Compliance with Related Donor Care Standards.
Anthias C, O'Donnell PV, Kiefer DM, Yared J, Norkin M, Anderlini P, Savani BN, Diaz MA, Bitan M, Halter JP, Logan BR, Switzer GE, Pulsipher MA, Confer DL, Shaw BE. Biol Blood Marrow Transplant. 2015 Nov 18. pii: S1083-8791(15)00736-3. doi: 10.1016/j.bbmt.2015.11.009. [Epub ahead of print]. PMID: 26597079
Current data suggest that the incidence of donation-associated adverse events is higher in related than in unrelated donors. Specific requirements to safeguard related donors health were introduced to Foundation for the Accreditation of Cellular Therapy/The Joint Accreditation Committee ISCT and EBMT (FACT-JACIE) Standards, but the impact of accreditation on related donor care has not been adequately evaluated yet. A survey of transplant program directors of European Group for Blood and Marrow Transplantation member centers was conducted by the Donor Health and Safety Working Committee of the Center for International Blood and Marrow Transplant Research to test the hypothesis that related donors care in FACT-JACIE accredited centers is more closely aligned with international consensus donor care recommendations than related donors care delivered in centers without accreditation and the results of this survey are extensively discussed in this manuscript. Responses were received from 39% of 304 centers. The results of this survey indicate that practice in accredited centers was much closer to recommended standards as compared with nonaccredited centers: a higher percentage of accredited centers use eligibility criteria to assess related donors (93% versus 78%; P = .02), and a lower percentage have a single physician simultaneously responsible for the related donor and their recipient (14% versus 35%; P = .008). In contrast, where regulatory standards do not exist, both accredited and nonaccredited centers fell short of accepted best practice. These results raise concerns that despite improvements in care, current practice can place undue pressure on donors and may increase the risk of donation-associated adverse events. Measures to address these issues through enhancement of regulatory standards as well as national initiatives to standardize related donor care are recommended by the authors. 
Outcome of allogeneic hematopoietic stem-cell transplantation for adult patients with AML and 11q23/MLL rearrangement (MLL-r AML).
Pigneux A, Labopin M, Maertens J, Cordonnier C, Volin L, Socié G, Blaise D, Craddock C, Milpied N, Bacher U, Malard F, Esteve J, Nagler A, Mohty M. Leukemia. 2015 Dec;29(12):2375-81. doi: 10.1038/leu.2015.143. Epub 2015 Jun 17. PMID: 26082270
This retrospective analysis of the Acute Leukemia Working Party of the EBMT presents the outcome of a group of 159 adult patients with 11q23/MLL [mostly corresponding to t(9;11), t(11;19), t(6;11) and t(10;11) translocations] rearranged acute myeloid leukemia in first or second complete remission  treated with an allogeneic stem cell transplantation between 2000 and 2010.  Two-year overall survival, leukemia-free survival, relapse incidence and non-relapse mortality were 56±4%, 51±4%, 31±3% and 17±4%, respectively. The outcome differed according to 11q23/MLL rearrangement, being more favorable in patients with t(9;11) and t(11;19) compared with t(10;11) and t(6;11). Multivariate analysis for overall survival identified t(6;11), t(10;11), age>40 years and being allografted in second complete remission as unfavorable features, whereas t(6;11), t(10;11), a second complete remission and the use of reduced-intensity conditioning regimen affected poorly the leukemia-free survival. This study confirms the potential role of allogeneic stem cell transplantation for adult patients with 11q23/MLL rearranged acute myeloid leukemia in first complete remission and also highlights the capacity of the registry of the EBMT to give additional insight in infrequent and rare diseases.

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BMT Journal featured articles

Bone Marrow Transplantation publishes high quality, peer reviewed original research and reviews that address all aspects of basic biology and clinical use of haemopoietic cell transplantation.

The journal also covers all aspects of the research and treatment of transplant-related complications and consequences including quality of life and psychological issues. Basic research studies on topics of relevance are also covered.
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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 EBMT
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Hematopoietic SCT in Europe 2013: recent trends in the use of alternative donors showing more haploidentical donors but fewer cord blood transplants
J R Passweg, H Baldomero et al
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