Determinants of survival in myelofibrosis patients undergoing allogeneic hematopoietic cell transplantation.
Hernández-Boluda JC, Pereira A, Kröger N, Beelen D, Robin M, Bornhäuser M, Angelucci E, Vitek A, Blau IW, Niittyvuopio R, Finke J, Cornelissen JJ, Passweg J, Dreger P, Petersen E, Kanz L, Sanz J, Zuckerman T, Zinger N, Iacobelli S, Hayden P, Czerw T, McLornan D, Yakoub-Agha I.Hernández-Boluda JC, et al.
Leukemia. 2020 Apr 14. doi: 10.1038/s41375-020-0815-z. Online ahead of print
In this large Registry study of CMWP outcome of 2916 myelofibrosis patients who underwent first allo-HCT from an HLA-identical sibling or unrelated donor between 2000 and 2016 were reported. Factors independently associated with increased mortality were age ≥ 60 years and Karnofsky Performance Status <90% at transplant, and occurrence of graft failure, grades III–IV acute graft-vs.-host disease (aGVHD), and disease progression/relapse during follow-up. The opposing effects of chronic graft-vs.-host disease (GVHD) on non-relapse mortality and relapse incidence resulted in a neutral influence on survival. Graft failure increased in unrelated donor recipients and decreased with myeloablative conditioning (MAC) and negative donor/recipient cytomegalovirus serostatus. Risk of grades III–IV aGVHD was higher with unrelated donors and decreased with MAC. Relapse incidence tended to be higher in patients with intermediate-2/high-risk DIPSS categories and to decrease in CALR-mutated patients. Acute and chronic GVHD reduced the subsequent risk of relapse.
Outcome of Patients With Fanconi Anemia Developing Myelodysplasia and Acute Leukemia Who Received Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis on Behalf of EBMT Group
Giardino S, de Latour RP, Aljurf M, Eikema DJ, Bosman P, Bertrand Y, Tbakhi A, Holter W, Bornhäuser M, Rössig C, Burkhardt B, Zecca M, Afanasyev B, Michel G, Ganser A, Alseraihy A, Ayas M, Uckan-Cetinkaya D, Bruno B, Patrick K, Bader P, Itälä-Remes M, Rocha V, Jubert C, Diaz MA, Shaw PJ, Junior LGD, Locatelli F, Kröger N, Faraci M, Pierri F, Lanino E, Miano M, Risitano A, Robin M, Dufour C; Severe Aplastic Anemia and Chronic Malignancies Working Parties of European Blood and Marrow Transplantation group.Giardino S, et al.
Am J Hematol. 2020 Apr 8. doi: 10.1002/ajh.25810. Online ahead of print.
In this important and clinical relevant study of the Aplastic Anemia WP and CMWP outcome of 74 FA patients with a diagnosis of myelodysplastic syndrome (n = 35), acute leukemia (n = 35) or with cytogenetic abnormalities (n = 4), who underwent allo-HSCT from 1999 to 2016 were reported. The 5-year OS and EFS were 42% (30-53%) and 39% (27-51%), respectively. Patients transplanted in CR showed better OS compared with those transplanted in presence of an active malignant disease (OS:71%[48-95] vs 37% [24-50],P = .04), Non-relapse-related mortality and incidence of relapse at 5-years were 40% (29-52%) and 21% (11-30%) This analysis confirms the poor outcome of transformed FA patients and identifies the importance of achieving CR pre-HSCT, suggesting that, in a newly diagnosed transformed FA patient, a cytoreductive approach pre-HSCT should be considered if a donor have been secured.
Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT.
Sanz J, Galimard JE, Labopin M, Afanasyev B, Angelucci E, Ciceri F, Blaise D, Cornelissen JJ, Meijer E, Diez-Martin JL, Koc Y, Rovira M, Castagna L, Savani B, Ruggeri A, Nagler A, Mohty M; Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT).Sanz J, et al.
J Hematol Oncol. 2020 May 6;13(1):46. doi: 10.1186/s13045-020-00882-6
In this large retrospective EBMT registry study from Acute Leukemia Working Party the increasing use of post transplant cyclophosphamide was compared in MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017. Haplo-SCT carried a significantly increased risk of acute grade II-IV GVHD (HR 1.6; 95% CI 1.1-2.4) and NRM (HR 2.6; 95% CI 1.5-4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8-1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8-1.3). The authors conclude that Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.
BK Virus Infection in Allogeneic Hematopoietic Cell Transplantation: An Update on Pathogenesis, Immune Responses, Diagnosis and Treatments.
Saade A, Styczynski J, Cesaro S; Infectious Disease Working party of EBMT.Saade A, et al.
J Infect. 2020 Jun 8:S0163-4453(20)30390-X. doi: 10.1016/j.jinf.2020.06.009. Online ahead of print
BK polyomavirus (BKPyV) infection is causing significant morbidity after allogeneic stem cell transplantation. In this valuable article by the Infectious Disease Working Party the current knowledge on BKPyV, from the virus constitution to the pathophysiology and immune-related mechanisms is summarized. The authors focused on BKPyV-induced HC in HCT to discuss the benefit of monitoring BKPyV viruria and viremia in the management of patients. They also addressed currently used therapeutics, along with future promising therapies to propose clinical and practical guidelines and further interesting research areas.
Changes in Patients Population and Characteristics of Hematopoietic Stem Cell Transplantation for Relapsed/Refractory Hodgkin Lymphoma: An Analysis of the Lymphoma Working Party of the EBMT
Sureda A, Genadieva Stavrik S, Boumendil A, Finel H, Khvedelidze I, Dietricht S, Dreger P, Hermine O, Kyriakou C, Robinson S, Schmitz N, Schouten HC, Tanase A, Montoto S.Sureda A, et al.
Bone Marrow Transplant. 2020 May 15. doi: 10.1038/s41409-020-0929-y. Online ahead of print.
In this large and important registry study of the Lymphoma Working Party a total of 13,639 adult patients receiving an auto-HCT or allo-HCT for relapsed/refractory Hodgkin lymphoma who were reported to EBMT over a 25-year period were reviewed. Regarding auto-HCT, recipients are younger, interval between diagnosis and transplant shorter, peripheral blood has become the universal stem cell source and the use of total body irradiation is almost non-existent in recent years. Allo-HCT is currently mostly used as a second transplant; recipients are younger, fitter and less frequently, chemo refractory. Reduced intensity conditioning protocols have vastly replaced myeloablative protocols. Both in auto-HCT and allo-HCT, NRM, PFS and OS have significantly improved but relapse remains the main cause of treatment failure. A better selection of patients and improvements in the supportive care has resulted in a reduction in the NRM. Relapse after HCT remains unchanged and further research is needed.