scholarly journals Costs of Allogeneic Hematopoietic Cell Transplantation with High-Dose Regimens

2008 ◽  
Vol 14 (2) ◽  
pp. 197-207 ◽  
Author(s):  
Akiko M. Saito ◽  
Corey Cutler ◽  
David Zahrieh ◽  
Robert J. Soiffer ◽  
Vincent T. Ho ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
High Dose

High dose valacyclovir for cytomegalovirus prophylaxis following allogeneic hematopoietic cell transplantation

2021 ◽  
pp. 107815522110604
Author(s):  
Kelly G Hawks ◽  
Amanda Fegley ◽  
Roy T Sabo ◽  
Catherine H Roberts ◽  
Amir A Toor
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
High Dose ◽  
Cmv Infection ◽  
Allogeneic Hct ◽  
Clinically Significant ◽  
Cmv Disease ◽  
Cmv Prophylaxis

Introduction Cytomegalovirus (CMV) is one of the most common and clinically significant viral infections following allogeneic hematopoietic cell transplantation (HCT). Currently available options for CMV prophylaxis and treatment present challenges related to side effects and cost. Methods In this retrospective medical record review, the incidence of clinically significant CMV infection (CMV disease or reactivation requiring preemptive treatment) following allogeneic HCT was compared in patients receiving valacyclovir 1 g three times daily versus acyclovir 400 mg every 12 h for viral prophylaxis. Results Forty-five patients who received valacyclovir were matched based on propensity scoring to 35 patients who received acyclovir. All patients received reduced-intensity conditioning regimens containing anti-thymocyte globulin. Clinically significant CMV infection by day + 180 was lower in the valacyclovir group compared to the acyclovir group (18% vs. 57%, p = 0.0004). Patients receiving valacyclovir prophylaxis also had less severe infection evidenced by a reduction in CMV disease, lower peak CMV titers, delayed CMV reactivation, and less secondary neutropenia. Conclusion Prospective evaluation of valacyclovir 1 g three times daily for viral prophylaxis following allogeneic HCT is warranted. Due to valacyclovir's favorable toxicity profile and affordable cost, it has the potential to benefit patients on a broad scale as an option for CMV prophylaxis.

Allogeneic Hematopoietic Cell Transplantation (allo-HCT) Can Induce Durable Remission in Heavily Pretreated Relapsed Hodgkin Lymphoma. (HL).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1192-1192
Author(s):  
Robert Chen ◽  
Joycelynne Palmer ◽  
Leslie Popplewell ◽  
Jessica Shen ◽  
Eileen Smith ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Conflicts Of Interest ◽  
Conditioning Regimen ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
High Dose ◽  
Unrelated Donor ◽  
Heavily Pretreated

Abstract Abstract 1192 Poster Board I-214 Background: Even though Hodgkin lymphoma (HL) is a curable disease, about, 20-30% patients are either refractory to induction chemotherapy or relapse post treatment. High dose chemotherapy and autologous HCT has been shown to be an effective salvage therapy for patients with relapsed HL. However, relapse continues to occur after auto-HCT, especially in patients with chemoresistant or poor-risk features at relapse. The prognosis of these patients is poor with limited options of treatment. Although allo-HCT offers both cytoreduction and potential graft-versus-tumor effect, its use in relapsed HL has been limited by non-relapse mortality (NRM) and patient co-morbidities induced by numerous prior treatments. To examine the potential impact of allo-HCT on survival and disease outcomes, we performed retrospective analysis of allo-HCT in relapsed/refractory HL to determine if allo-HCT can induce long-term remission in heavily pretreated relapsed HL. Results: Between January 2003 and December 2008, 29 patients with relapsed HL underwent allo-HCT at City of Hope National Medical Center. The median age was 37 (range: 14-63). 20 (69%) patients were chemosensitive at time of allo-HCT. 17 (59%) patients had prior auto-HCT. 16 (55%) patients received matched siblings and 13 (45%) received unrelated donor cells. 20 (69%) patients had prior radiation treatments. The median number of prior regimens was 5 (range: 2-8). 23 (79%) patients underwent a non-myeloablative conditioning regimen while 6 (21%) patients had a myeloablative regimen. 14 (48%) patients received Tacrolimus/Sirolimus as graft versus host disease prophylaxis and 15 (52%) patients received a combination of Cellcept/CsA, Cellcept/CsA/MTX, Tacrolimus/MTX, or Tacrolimus/Sirolimus/MTX. With a median follow up of 31.9 months (range: 9.7-69.1) for surviving patients, the results show: Conclusion: Allogeneic hematopoietic cell transplantation in heavily pretreated relapsed Hodgkin's lymphoma is feasible, tolerable, and can induce durable clinical remissions. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Quality of life after allogeneic hematopoietic cell transplantation

Blood ◽  
2009 ◽  
Vol 114 (1) ◽  
pp. 7-19 ◽  
Author(s):  
Joseph Pidala ◽  
Claudio Anasetti ◽  
Heather Jim
Keyword(s):  
Quality Of Life ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Standard Dose ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Effective Control ◽  
High Dose ◽  
Allogeneic Hct

Abstract High-dose therapy with allogeneic hematopoietic cell transplantation (HCT) offers effective control and potential cure of hematopoietic malignancies, but with the cost of associated morbidity that includes adverse effects on quality of life (QOL). A growing body of literature has characterized this impact. Longitudinal studies suggest early moderate impairments that largely return to pretransplantation levels by day 100; the majority of studies suggest that greater than 60% of patients report good to excellent QOL in years 1 to 4 after HCT. Comparisons of allogeneic HCT with autologous HCT and standard-dose chemotherapy suggest impairments in QOL and a different trajectory of recovery in allogeneic HCT, but these conclusions are limited by confounding variables. Cross-sectional studies suggest larger and more persistent decrements in QOL in comparison with matched noncancer controls and population normative data. Acute and chronic graft-versus-host disease (GVHD) are significant threats to QOL. Behavioral interventions show promise to maintain or improve quality of life after allogeneic HCT. The review concludes with recommendations to investigators and clinicians as the state of this research advances.

scholarly journals Comorbidity-Age Index: A Clinical Measure of Biologic Age Before Allogeneic Hematopoietic Cell Transplantation

2014 ◽  
Vol 32 (29) ◽  
pp. 3249-3256 ◽  
Author(s):  
Mohamed L. Sorror ◽  
Rainer F. Storb ◽  
Brenda M. Sandmaier ◽  
Richard T. Maziarz ◽  
Michael A. Pulsipher ◽  
...  
Keyword(s):  
Decision Making ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
High Dose ◽  
Training Set ◽  
Poor Prognostic Factor ◽  
Mortality Risks ◽  
Validation Set

Purpose Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cell transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown. Patients and Methods Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age intervals and a validation set to assess the performance of prognostic models. Results In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P = .29), 1.48 (P = .04), 1.75 (P = .004), and 1.84 (P = .005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P < .001) and survival (0.682 v 0.560; P < .001) compared with age, respectively. Patients with comorbidity/age scores of 0 to 2 had comparable mortality risks regardless of conditioning regimens. Patients with scores of 3 to 4 and ≥ 5 had statistically significant higher mortality risks after high-dose versus nonmyeloablative regimens. Conclusion Age is a poor prognostic factor. The proposed composite measure allows integration of both comorbidities and age into clinical decision making and comparative-effectiveness research of HCT.

Outcome of Allogeneic Hematopoietic Cell Transplantation in AML or MDS with a HLA-Mismatched Unrelated Donor: A Single Center Analysis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5940-5940
Author(s):  
Jörg Schmohl ◽  
Christiane Dorn ◽  
Sebastian P. Haen ◽  
Christoph Faul ◽  
Lothar Kanz ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cell Transplantation ◽  
Cumulative Incidence ◽  
Acute Gvhd ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
High Dose ◽  
Single Center ◽  
Mismatched Donor

Abstract Introduction: In acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), allogeneic hematopoietic cell transplantation (HCT) can constitute a curative treatment option. Best results are reported using 10/10 HLA-matched donors, and several reports indicated inferior outcomes because of increased graft versus host disease (GVHD) and non-relapse mortality (NRM) if a HLA-mismatched donor is used. Methods: Here we present a single center analyses evaluating all patients (pts) with AML or MDS receiving allogeneic HCT with a mismatch unrelated donors (MMUD) between 2004 and 2014. Results:137 pts were evaluated. Median age was 51 years (range 18-76). For myeloablative conditioning (n=52) the following regimens were used: 12 Gy total body irradiation (TBI) and high-dose cyclophosphamide (n=40), or high-dose busulfan and cyclophosphamide (n=8); for reduced intensity conditioning (n=83) fludarabine with either busulfan (n=27), melphalan (n=6), treosulfan (n=7), cyclophosphamide (=15) or TBI (n=19) was used. Stem cell sources were either peripheral blood (n=134) or bone marrow (n=3). The donor/recipient match was a 9/10 alleleic mismatch in 41% and a 9/10 antigen-mismatch in 59% of cases. All but 21 patients received antithymocyte globuline prior to transplantation for GVHD prophylaxis. Post-transplant immunosuppression consisted of a combination of calcineurine inhibitors with either methotrexate (n=65) or mycophenolate mofetil (n=28). Kaplan-Meier estimated overall survival (OS) for all patients at 1 year was 70% and at 3 years 23%. Cumulative incidence of relapse was 32%. Median follow up of patients alive was 40 months (4-122 month). Engraftment with >500 neutrophils and >25.000 platelets was observed at a median of 20 and 20 days after HCT, respectively. Cumulative incidence of NRM until day 100, 1 year and 3 years was 16%, 27% and 28%, respectively. OS and NRM were not different in pts with allelic or antigen-mismatched donors (OS at 1 year/3 years: 65%/48% versus 48%/33% (p=0,2411), NRM at day 100, 1 year and 3 years: 21%, 24% and 33% versus 20%, 27% and 37% (p=0,6210) ). Acute GvHD mostly occurred at lower grades (grade I 34%, grade II 16%, ≥ grade III 10%). Risk of acute GVHD for patients with an antigen-mismatched donor was not different compared to those with an allelic-mismatched donors (51% versus 42%, p=0,4086). Conclusion: Stem cell treatment with mismatched donors in allogeneic HCT is a valuable and safe option for pts with missing matched stem cell source. Due to optimized pre- and-posttransplant treatment, satisfactory long term survival can be achieved. Disclosures No relevant conflicts of interest to declare.

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