Blood and Marrow Transplant Clinical Trials Network Study 1102 heralds a new era in hematopoietic cell transplantation in high‐risk myelodysplastic syndromes: Challenges and opportunities in implementation

Warlick, Erica D.; Üstün, Celalettin; Andreescu, Astrid C. M.; Bonagura, Anthony; Brunner, Andrew M.; Chandra, Abhinav; Foran, James M.; Juckett, Mark; Kindwall‐Keller, Tamila L.; Klimek, Virginia M.; Pease, Daniel F.; Steensma, David P.; Waldman, Bryce; Horowitz, Mary M.; Burns, Linda J.; Khera, Nandita

doi:10.1002/cncr.33826

Cited by 6 publications

(1 citation statement)

References 40 publications

(41 reference statements)

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“…Unfortunately, while currently available treatments may provide symptomatic improvement, and some are associated with improvements in survival, none are curative without allogeneic transplant [4][5][6]. DNA methyltransferase inhibitors (DNMTIs, also termed hypomethylating agents or HMAs) have been shown to prolong survival in MDS compared to other therapeutics including chemotherapy and best supportive care [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Evaluating complete remission with partial hematologic recovery (CRh) as a response criterion in myelodysplastic syndromes (MDS)

et al. 2022

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Myelodysplastic syndromes (MDS) treated with DNMTI therapy have responses according to the 2006 IWG response criteria. CR responses have had the strongest association with OS. Recently, CR with partial hematologic recovery (CRh; i.e. blasts <5%, ANC > 500, platelets > 50) has been evaluated in AML, but its relevance is unknown in MDS. We identified adult patients with MDS treated with DNMTIs. We assessed best overall response to therapy according to IWG 2006 criteria, and subsequently identified patients meeting CRh criteria from the subgroup with SD or mCR. We evaluated duration of therapy and overall survival according to response. We identified 311 patients with MDS who received treatment between 2007 and 2018. The median age at the time of therapy was 69 years (range 23–91). Median follow up was 60 months. According to IWG 2006, responses included CR (n = 43, 14%), PR (n = 2, 1%), mCR (n = 57, 18%), SD (n = 149, 48%) and PD (n = 60, 19%). 79 patients (25%) achieved HI. A total of 62 patients (20%) met CRh criteria leading to reclassification of mCR (now n = 26, 8%) or SD (now n = 118, 38%). Patients achieving CR had similar time on therapy (median 8.1mo) compared to CRh (median 6mo, HR 1.4, 95% CI 0.9–2.0), and longer than other responses (p < 0.001). OS varied according to response; median OS was similar between CR (23.3mo) and CRh (25mo, HR 1.28 [0.79–2.08]), which was longer than those with mCR (17.2mo, HR 1.71 [0.96–3.05]), SD (16.3mo, HR 1.61 [1.04–2.48]), and PD (8.7mo, HR 3.04 [1.91–4.83]) (p < 0.001). OS associations with CR/CRh were confirmed in multivariable analysis accounting for allogeneic transplant. MDS patients who achieve a CRh response had similar survival and duration on therapy as patients who achieve CR response and superior to other IWG responses. These data support further evaluation of CRh into future response criteria and clinical trials.

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Section: Introductionmentioning

confidence: 99%

Evaluating complete remission with partial hematologic recovery (CRh) as a response criterion in myelodysplastic syndromes (MDS)

et al. 2022

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Use of Hematopoietic Cell Transplant for Hematologic Cancers by Race, Ethnicity, and Age

Hahn,

Herr,

Brazauskas

et al. 2024

JAMA Netw Open

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ImportanceUtilization of hematopoietic cell transplantation (HCT) for hematologic cancers previously demonstrated race, ethnicity, and age-based disparities.ObjectiveTo evaluate utilization over time by race, ethnicity, and age to determine if disparities persist in light of recent significant increases in HCT volume.Design, Setting, and ParticipantsThis US population-based retrospective cohort study includes patients who received transplants from January 2009 to December 2018. Data collection and cleaning occurred from February 2019 to November 2021, and data analysis occurred from January 2022 to October 2023. Method 1 restricted the analysis to Surveillance, Epidemiology and End Results (SEER) reporting areas for cases and transplants. Method 2 applied SEER age-, race-, and ethnicity-specific incidence rates to corresponding US census population and included all transplants reported to the Center for International Blood and Marrow Transplant Research. Race and ethnicity groups were hierarchically defined as Hispanic (any race), non-Hispanic White, non-Hispanic Black, and non-Hispanic Other (Asian and American Indian).ExposureReceipt of HCT.Main Outcomes and MeasuresUtilization rate of autologous or allogeneic HCT for patients with hematologic cancers by age, race, and ethnicity.ResultsFrom 2009 to 2018, 136 280 HCTs were analyzed for 6 hematologic cancers comprising 16.7% pediatric/adolescent/young adults (0-39 years), 83.3% adults (40-84 years), 58% male, 10.3% Hispanic, 11.4% non-Hispanic Black, 3.8% non-Hispanic Other, and 74.5% non-Hispanic White patients, with 49 385 allogeneic and 86 895 autologous HCTs performed. HCT utilization increased over time for all disease, age, race, and ethnic groups. From 2017 to 2018, adult (40-84 years) allogeneic transplant utilization for acute myeloid leukemia and myelodysplastic syndrome (MDS) was similar for Hispanic and non-Hispanic White or Other patients but was lower for non-Hispanic Black patients (acute myeloid leukemia: 19% vs 13%; MDS: 9%-10% vs 5%). Similarly, autologous transplant utilization for lymphoma was similar for all race and ethnicity groups; however, autologous transplant for multiple myeloma was highest for non-Hispanic White patients and lower for all other groups (31% vs 26%-27%). In patients aged 0 to 39 years, utilization of allogeneic transplant for acute lymphoblastic leukemia was highest in Hispanic patients, followed by non-Hispanic White, Black, and Other races (acute lymphoblastic leukemia: 19%, 18%, 17%, and 16%, respectively).Conclusions and RelevanceIn this cohort study of autologous and allogeneic transplant utilization for hematologic cancers, disparities persisted for non-Hispanic Black patients. Hispanic, non-Hispanic Other, and younger age groups had increased utilization over time that was on par with non-Hispanic White patients in the most recent cohort.

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Transplantation and Cellular Therapy for Older Adults—The MSK Approach

Lin,

Dahi,

Korc-Grodzicki

et al. 2024

Curr Hematol Malig Rep

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Blood and Marrow Transplant Clinical Trials Network Study 1102 heralds a new era in hematopoietic cell transplantation in high‐risk myelodysplastic syndromes: Challenges and opportunities in implementation

Cited by 6 publications

References 40 publications

Evaluating complete remission with partial hematologic recovery (CRh) as a response criterion in myelodysplastic syndromes (MDS)

Evaluating complete remission with partial hematologic recovery (CRh) as a response criterion in myelodysplastic syndromes (MDS)

Use of Hematopoietic Cell Transplant for Hematologic Cancers by Race, Ethnicity, and Age

Transplantation and Cellular Therapy for Older Adults—The MSK Approach

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