EBMT NEWSLETTER | September 2014 | Volume 43 - Issue 1

Important dates
Donor cytomegalovirus status influences the outcome of allogeneic stem cell transplant: a study by the European group for blood and marrow transplantation.
Ljungman P, Brand R, Hoek J, de la Camara R, Cordonnier C, Einsele H, Styczynski J, Ward KN, Cesaro S; Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation.
Clin Infect Dis. 2014 Aug 15
This retrospective analysis of the infectious Diseases Working Party of the EBMT further explores the impact of CMV serostatus in the allogeneic stem cell transplantation setting. After analyzing 49542 allogeneic stem cell transplantation recipients (29349 of them, seropositive and 20193, seronegative), the use of CMV seropositive donors in CMV seronegative patients was associated to a poorer overall survival in the unrelated donor setting. This impact was not seen in patients receiving HLA-matched sibling grafts. In CMV seropositive patients, the use of seropositive unrelated donor grafts was associated with an improved overall survival in comparison with seronegative donors when using a myeloablative conditioning protocol. This difference was not seen in patients being treated with a reduced intensity conditioning regimens and did not apply to patients being allografted from HLA-identical sibling donors, either. Interestingly, these associations were also seen when restricting the analysis to patients being allografted from 2000 onward.

Impact of the International Prognostic Scoring System cytogenetic risk groups on the outcome of patients with primary myelodysplastic syndromes undergoing allogeneic stem cell transplantation from Human Leukocyte Antigen-identical siblings: a retrospective analysis of the European Society for Blood and Marrow Transplantation-Chronic Malignancies Working Party.
Onida F, Brand R, van Biezen A, Schaap M, Borne PA, Maertens J, Beelen DW, Carreras E, Alessandrino EP, Volin L, Kuball JH, Figuera A, Sierra J, Finke J, Kröger N, De Witte T.
Haematologica. 2014 Aug 1

In this large series of patients with primary myelodisplastic syndrome (MDS) who underwent allograft from HLA-identical siblings between 1981 and 2006 and were reported to the EBMT Database, poor-risk cytogenetics as defined by the International Prognostic Score System (IPSS) is associated with a relatively poor survival after allogeneic stem cell transplantation (allo-SCT) except in patients who are transplanted in RA/RARS before progression. The outcome in patients with poor-risk cytogenetics appears not to benefit from intensive chemotherapy prior to allo-SCT, even if the patients have been transplanted in first complete remission. As a direct implication for clinical practice, patients with RA/RARS harbouring poor-risk cytogenetic aberrations for whom a suitable HLA-identical sibling is identified should be encouraged to undergo allo-SCT before progression into a more advanced stage of disease. On the other hand, front line allo-SCT from HLA-identical sibling may be recommended in MDS patients with marrow blasts ≥5% and poor-risk cytogenetics.

Outcome of Aplastic Anemia in adolescence. A survey of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation.
Dufour C, Pillon M, Passweg J, Socie' G, Bacigalupo A, Franceschetto G, Carraro E, Oneto R, Risitano AM, Peffault de Latour R, Tichelli A, Rovo A, Peters C, Hoechsmann B, Samarasinghe S, Kulasekararaj AG, Schrezenmeier H, Aljurf M, Marsh J.
Haematologica. 2014 Aug 1
This is the first report investigating the outcome of aplastic anemia (AA) in the specific age group of the adolescence. This study demonstrates that AA in adolescents has a very good outcome. If a matched family donor (MFD) is available, allogeneic stem cell transplantation (allo-SCT) either performed in an adult or pediatric center using bone marrow cells and done within two months of diagnosis, is the first choice treatment. If a MFD is not available, immunosuppressant therapy (ST)  using the combination of ATG and CSA still remains at present an acceptable second therapeutic choice. This is largely because, if IST fails, allo-SCT represents a very good rescue alternative both in terms of overall survival and event-free survival. Previous IST increases the risk of post-therapy tumors and this has to be considered for monitoring during long term follow up. All these observations point to the need of an early referral of AA patients, irrespectively from the age, to specialist centers for appropriate diagnosis definition and correct therapeutic decision.

Long-Term Outcome of Allogeneic Hematopoietic Cell Transplantation for Patients With Mycosis Fungoides and Sézary Syndrome: A European Society for Blood and Marrow Transplantation Lymphoma Working Party Extended Analysis.
Duarte RF, Boumendil A, Onida F, Gabriel I, Arranz R, Arcese W, Poiré X, Kobbe G, Narni F, Cortelezzi A, Olavarría E, Schmitz N, Sureda A, Dreger P.
J Clin Oncol. 2014 Aug 25
This analysis focuses on non-relapse mortality (NRM), cumulative incidence of relapse/progression, progression-free survival (PFS), overall survival (OS), and the impact of disease and transplant factors on the long-term outcome of a group of 60 patients with advanced-stage (TNM stages IIB and higher) mycosis fungoides (MF) and Sézary syndrome (SS) treated with an allogeneic stem cell transplantation (allo-SCT). These results, from the largest series on this topic published to date, provide a clearer picture of the value of allo-SCT as a therapeutic strategy for high-risk patients with advanced-stage MF/SS. They further support the existence of a clinically relevant and persistent graft-versus- MF/SS effect, as suggested by the efficacy of reduced intensity conditioning and donor lymphocyte infusions, and by the low rate of late relapse/progression after the procedure.
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