scholarly journals Decision analysis for donor selection in stem cell transplantation—HLA-8/8 allele-matched unrelated donor vs HLA-1 AG mismatched related donor

2014 ◽  
Vol 4 (12) ◽  
pp. e263-e263 ◽  
Author(s):  
J Kanda ◽  
◽  
S Fuji ◽  
S Kato ◽  
A Takami ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Decision Analysis ◽  
Cell Transplantation ◽  
Donor Selection ◽  
Unrelated Donor ◽  
Matched Unrelated Donor ◽  
Related Donor

scholarly journals Association between preconditioning absolute lymphocyte count and transplant outcomes in patients undergoing matched unrelated donor allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning and anti-thymocyte globulin

2021 ◽  
Vol 12 ◽  
pp. 204062072110637
Author(s):  
Jeongmin Seo ◽  
Dong-Yeop Shin ◽  
Youngil Koh ◽  
Inho Kim ◽  
Sung-Soo Yoon ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Cell Depletion ◽  
Unrelated Donor ◽  
Reduced Intensity Conditioning ◽  
Matched Unrelated Donor ◽  
T Cell Depletion ◽  
Reduced Intensity

Background: Allogeneic stem cell transplantation (alloSCT) offers cure chance for various hematologic malignancies, but graft- versus-host disease (GVHD) remains a major impediment. Anti-thymocyte globulin (ATG) is used for prophylactic T-cell depletion and GVHD prevention, but there are no clear guidelines for the optimal dosing of ATG. It is suspected that for patients with low absolute lymphocyte counts (ALCs), current weight-based dosing of ATG can be excessive, which can result in profound T-cell depletion and poor transplant outcome. Methods: The objective of the study is to evaluate the association of low preconditioning ALC with outcomes in patients undergoing matched unrelated donor (MUD) alloSCT with reduced-intensity conditioning (RIC) and ATG. We conducted a single-center retrospective longitudinal cohort study of acute leukemia and myelodysplastic syndrome patients over 18 years old undergoing alloSCT. In total, 64 patients were included and dichotomized into lower ALC and higher ALC groups with the cutoff of 500/μl on D-7. Results: Patients with preconditioning ALC <500/μl were associated with shorter overall survival (OS) and higher infectious mortality. The incidence of acute GVHD and moderate-severe chronic GVHD as well as relapse rates did not differ according to preconditioning ALC. In multivariate analyses, low preconditioning ALC was recognized as an independent adverse prognostic factor for OS. Conclusion: Patients with lower ALC are exposed to excessive dose of ATG, leading to profound T-cell depletion that results in higher infectious mortality and shorter OS. Our results call for the implementation of more creative dosing regimens for patients with low preconditioning ALC.

scholarly journals BK virus‐induced nephritis and cystitis after matched unrelated donor stem cell transplantation: A case report

2020 ◽  
Vol 8 (12) ◽  
pp. 2839-2842
Author(s):  
Nadine Gelbrich ◽  
Matthias B. Stope ◽  
Sander Bekeschus ◽  
Martin Weigel ◽  
Martin Burchardt ◽  
...  
Keyword(s):  
Stem Cell ◽  
Case Report ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Bk Virus ◽  
Unrelated Donor ◽  
Matched Unrelated Donor

Poor Performance Status, Chemorefractory Disease At Transplantation, and Umbilical Cord Blood As Donor Source Were Adverse Prognostic Factors for Overall Survival After Allogeneic Stem Cell Transplantation for Follicular Lymphoma: Retrospective Study of the Japan Society of Hematopoietic Stem Cell Transplantation (JSHCT) Lymphoma Working Group

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3093-3093
Author(s):  
Koji Izutsu ◽  
Ritsuro Suzuki ◽  
Shinichi Kako ◽  
Rika Sakai ◽  
Takehiko Mori ◽  
...  
Keyword(s):  
Stem Cell ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Related Donor

Abstract Abstract 3093 Allogeneic hematopoietic stem cell transplantation (allo SCT) is potentially curative treatment for relapsed follicular lymphoma (FL) that remains non-curative disease even with modern immunochemotherapy. Number of potential candidate of allo SCT for FL has been increasing with the development of reduced intensity conditioning (RIC) regimens and increased donor availability due to use of hematopoietic stem cell from unrelated donor including cord blood (CB). However, short-term and long-term transplantation-related complications are still major obstacles in applying this treatment. Recently, EBMT and CIBMTR reported a prognostic score of allo SCT for FL (Ann Oncol 2011;22 :Suppl 4, iv94). However, this score awaits validation. To elucidate prognostic factors for OS after allo SCT for FL, we conducted a retrospective study using the national registry data of the Japan Society of Hematopoietic Cell Transplantation (JSHCT). In total, 472 cases of allo SCT for FL performed from 2000 to 2008 were identified. 220 (46.6%) were male and the median age at allo SCT was 50 yo (range: 27–75). Forty six (9.7%) patients were 60 yo or older. Eighty two (17.3%) patients had previous history of autologous transplantation (ASCT). Stem cell source was BM or PB from related donor in 215 (45.5%), unrelated donor BM in 180 (38.1%), and unrelated donor umbilical cord blood (CB) in 77 (16.3%). Conditioning regimen was myeloablative (MAC) in 20.7% and reduced intensity (RIC) in 79.3%, respectively. Patients undergoing MAC were younger than those with RIC (45 vs 50 yo, P<0.01). T-cell depletion with ATG or ALG was performed in 7.5%. ECOG performance status (PS) at allo SCT was ≥ 2 in 10.7%. 71.5% had chemosensitive disease at allo SCT and disease status was CR in 38.9%. With a median follow up of 47.3 mo (range: 0.9–122) among survivors, overall survival rate at 4years after allo SCT (4y OS) was 52.6%. Patients who had CB transplantation had worse OS than those transplanted from related donor or unrelated BM (30.0%, 58.5%, 54.6%, P =1.35e-6, logrank). Additionally, in univariate analysis, PS ≥2, chemoresistant disease at allo SCT, older age, male sex were adverse prognostic factors for OS, while previous history of ASCT, time from diagnosis to allo SCT (<3y vs ≥3y), disease status at allo SCT (CR vs non CR), conditioning regimen (MAC vs RIC), and year of allo SCT (2000–2 vs 2003–5 vs 2006–8) were not. 4y OS of patients undergoing MAC and RIC were 46.2% and 54.0% (P =0.28), respectively. In multivariate analysis with proportional hazard modeling, PS ≥2 (HR 3.2, P =0.00015), chemorefractory disease (HR 2.7, P =0.039), and use of CB (HR 3.8, P =0.039) were independent adverse predictors of OS. Although risk factors that are incorporated in the proposed EBMT/CIBMTR risk score other than PS were not predictive of OS in the present analysis, we applied this score to the population of the present study. In the entire population, 4y OS were 61.0% and 38.5% (P =9.5e-08) in patients with the score <3 (n=294) and ≥3 (n=77), respectively. This score was predictive of OS in patients who underwent transplantation from related donor (65.4% vs 36.7%, P =3.77e-08) and from unrelated BM (59.0% vs 41.7%, P =0.0217). In conclusion, this retrospective study of JSHCT registry data showed that allo SCT for FL is a reasonable option for patients with relapsed FL when suitable donor is available. Poor PS, chemorefractory disease, and CB as donor source were adverse prognostic factors for OS. Disclosures: No relevant conflicts of interest to declare.

Clinical Outcomes of Haploidentical Donor Compared with Unrelated and HLA-Matched Related Donor Hematopoietic Stem Cell Transplantation for Hematologic Malignancies

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4159-4159
Author(s):  
Yi Luo ◽  
Yamin Tan ◽  
Xiaoyu Lai ◽  
Weiyan Zheng ◽  
Jimin Shi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conditioning Regimen ◽  
Hematologic Malignancies ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Haploidentical Transplantation ◽  
Related Donor ◽  
Matched Donor

Abstract Abstract 4159 Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapeutic option for hematologic malignancies. In clinical trials, a HLA-matched donor can only be found for about 50% to 60% of patients referred for HSCT which greatly limit the application of this important procedure. Haploidentical HSCT would increase the availability of donors for nearly 100% of patients. However, haploidentical HSCT may be associated with high risks of complications, such as graft rejection, severe GVHD and infection etc. Although great progress have been achieved in haploidentical HSCT based on advanced technologies and novel drugs, no study has simultaneously compared the outcomes of haploidentical, unrelated and HLA-matched related donor HSCT. Materials and Methods: In this study, 225 patients with hematologic malignancies received allo-HSCT from diffent donor sources in our center (69 with haploidentical donors, 62 with HLA-matched related donors and 94 with unrelated donors). The clinical outcomes of haploidentical HSCT cohort, unrelated donor HSCT cohort and HLA-matched related donor HSCT cohort were compared. In HLA-matched sibling and unrelated donor transplantation cohorts, patients received a same conditioning regimen consisting of intravenous busulfan 3.2 mg/kg/d on days –7 to –4, intravenous cyclophosphamide 60 mg/kg/d on days –3 to –2, and 250 mg/m2 of Me-CCNU orally on day -1. For haploidentical HSCT, conditioning regimen consisted of Ara-C (4 g/m2/d) on day -10 and -9, Bu (9.6mg/kg) on day -8, -7 and -6, Cy (1.8 g/m2/d) on day -5 and -4, Me-CCNU (250 mg/kg) on day -3, and ATG (2.5 mg/kg/d) on day -5 to -2. GVHD prophylaxis consisted of cyclosporine A (CsA), mycophenolate mofetil (MMF), and short-term methotrexate while ATG (1.5 mg/kg/d) for three or four days, were added in HLA-matched or mismatched unrelated HSCT. Results: The patients receiving haploidentical HSCT experienced grades III-IV aGVHD more frequently than those receiving unrelated donor HSCT and related matched donor HSCT (24.4% vs 12% vs 2.6% respectively, p<0.05). However the incidence of cGVHD was comparable (17.8% in the haploidentical cohort vs 37.3% in the unrelated donor cohort vs 25.6% in the related matched donor cohort, p>0.05). The transplantation-related mortality (TRM) at d100 were 17.4%, 8.5% and 1.6% in the haploidentical, unrelated and related matched transplantation cohorts respectively (p<0.05). The 3-year relapse incidence were 10.1%, 15.9%, 17.7% in the haploidentical, unrelated and relate matched transplantation cohorts respectively (p>0.05). The 3- year overall survival (OS) was comparable in three cohorts (64.2±6.4% in the haploidentical cohort vs 67.5±5.3% in the unrelated donor cohort vs 77.5±5.8% in the related matched cohort, p>0.05). Conclusion: Although a higher incidence of aGVHD and TRM was observed in the haploidentical transplantation cohort, the incidences of cGVHD and relapse were comparable in the haploidentical, unrelated and related matched transplantation cohorts. Ultimately the patients receiving haploidentical transplantation achieved comparable OS with those receiving unrelated donor transplantation. An HLA-matched HSCT is commonly the preferred transplantation and donors from HLA-matched related siblings are usually the first choice. Haploidentical stem cell transplantation is relatively safe and efficient for patients who do not have HLA matched donors. Disclosures: No relevant conflicts of interest to declare.

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