Below you will be able read over the summaries of three recent papers that were published in peer-reviewed journals.
Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors.
Styczyński J, Tridello G, Koster L, Iacobelli S, van Biezen A, van der Werf S, Mikulska M, Gil L, Cordonnier C, Ljungman P, Averbuch D, Cesaro S, de la Camara R, Baldomero H, Bader P, Basak G, Bonini C, Duarte R, Dufour C, Kuball J, Lankester A, Montoto S, Nagler A, Snowden J, Kröger N, Mohty M, Gratwohl A; Infectious Diseases Working Party EBMT.
Bone Marrow Transplant. 2019 Aug 27. doi: 10.1038/s41409-019-0624-z. [Epub ahead of print]
In this important megafile study of EBMT registry, incidence and causes of death after autologous and allogeneic hematopoietic stem cell transplantation were analyzed from 1980 to 2015. Mortality from all causes decreased over the years in autologous and allogeneic stem cell transplantation. Interestingly death caused by Infection, GvHD and toxicity decreased while the death caused by relapse increased. Regarding infection especially death caused by bacterial and fungal infection decreased over time suggesting a better and improved management of these patients in the centers especially in the early and intermediate post –transplant phase. The study nicely showed that especially death due to bacterial and fungal infections is reduced over time most likely because a better management of these complication in the centers, highlighting the importance of continuous education and keeping a high quality standard such as JACIE in transplant centers.
Haploidentical vs. unrelated allogeneic stem cell transplantation for acute lymphoblastic leukemia in first complete remission: on behalf of the ALWP of the EBMT.
Shem-Tov N, Peczynski C, Labopin M, Itälä-Remes M, Blaise D, Labussière-Wallet H, Socié G, Kröger N, Mielke S, Afanasyev B, Chevallier P, Tischer J, Helbig G, Jindra P, Peric Z, Giebel S, Mohty M, Nagler A
Leukemia. 2019 Aug 19. doi: 10.1038/s41375-019-0544-3. [Epub ahead of print]
The introduction of T-cell repleted methods to perform haplo-identical stem cell transplantation has led to an increase use of Haplo-identical stem cell transplantation worldwide. Beside the ATG approach, in Western countries and North Amerika the use of post-transplant Cyclophosphamide (PTCy) is mainly used as GvHD Prophylaxis. In this interesting retrospective study Haplo-identical stem cell transplantation was compared to matched or mismatched unrelated stem cell transplantation in Acute lymphoblastic Leukemia (ALL) patient in 1. CR. Even if the number of included Haplo-identical donor was relative low (n=136) no difference between Haplo-identical and matched and mismatched unrelated donor transplantation in all relevant outcome parameter.
This studies shows that Haplo-identical stem cell transplantation is also becoming a reasonable donor option in patients with ALL with similar results in comparison to unrelated donor cell transplantation and should be further evaluated in a prospective well designed study.
Trends in the use of hematopoietic stem cell transplantation for adults with acute lymphoblastic leukemia in Europe: a report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT).
Giebel S, Boumendil A, Labopin M, Seesaghur A, Baron F, Ciceri F, Esteve J, Gorin NC, Savani B, Schmid C, Wetten S, Mohty M, Nagler A
Ann Hematol. 2019 Oct;98(10):2389-2398. doi: 10.1007/s00277-019-03771-2. Epub 2019 Aug 7.
In this study the strength of a real world registry is clearly shown by analyzing the use of hematopoietic stem cell transplantation in patients with Acute Lymphoblastic Leukemia which is regarding allogeneic stem cell transplantation still the second most frequent indication after AML. Over the time (2001-2015) the number of allogeneic stem cell procedures is steadily increasing while the numbers of autologous stem cell transplantation is decreasing over time. The increase of allogeneic stem cell transplantation is mainly due to an increase use of unrelated donors, use of reduced intensity conditioning and a broader use in older patients. However, the introduction of new non-transplant possibilities such as CAR T Cells, monoclonal and bi- specific antibodies or TKIs might change the use of allogeneic stem cell transplantation in the future. Beside replacing allogeneic stem cell transplantation, these new possibilities can be also used as part of an entire transplant procedure with higher cure rate if given prior or after stem cell transplantation.