Differences between the different conditioning regimens for allogeneic stem cell transplantation

Schattenberg, A.V.M.B.; Levenga, Tjakiena H

doi:10.1097/01.cco.0000245318.90015.72

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…Here, prompt hematopoietic recovery occurs (<28 days) without stem cell support. [2] RIC regimens do not fit the criteria for MA or NMA regimens: they cause cytopenia of variable duration, and should be given with stem cell support, although cytopenia may not be irreversible. [3]…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury and mortality in hematopoietic stem cell transplantation: A single-center experience

Sehgal¹,

George²,

John³

et al. 2017

Indian J Nephrol

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Hematopoietic stem cell transplant (HSCT) is a life-saving procedure for patients with several malignant and nonmalignant hematological disorders. Acute kidney injury (AKI) is a common complication after HSCT. The aim of the study was to identify the incidence and outcomes of AKI associated with HSCT in our center. Sixty-six HSCT recipients from October 2008 to March 2014 at Christian Medical College, Ludhiana, were followed up till July 31, 2014. RIFLE criteria utilizing serum creatinine was used to diagnose and stage AKI. Mortality and AKI were the primary outcomes studied. The risk of AKI in relation to conditioning regimen, type of HSCT (allogeneic and autologous), co-morbidities, graft versus host disease, drug toxicity, and veno-occlusive disease were analyzed. Sixty-five patients were included in the study. Male: Female ratio was 3.6:1 with a median age of 17 years (1.5–62). Forty-nine (75.4%) patients had AKI over 3 months, R 17 (26.2%), I 19 (29.2%), and F 13 (20%). AKI occurred at a mean of 19.4 ± 29.2 days after the HSCT. AKI was more commonly observed in patients undergoing allogeneic versus autologous HSCT (85.2% in allogeneic vs. 27.8% in autologous, P = 0.005). Mortality was seen in 20 patients (30.8%) in 3 months. AKI in the first 2 weeks (P < 0.016) was a significant risk factor for mortality. Incidence of AKI in HSCT is high and accounts for significant mortality and morbidity. RIFLE classification of AKI has prognostic significance among HSCT patients with an incremental trend in mortality.

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Section: Introductionmentioning

confidence: 99%

Acute kidney injury and mortality in hematopoietic stem cell transplantation: A single-center experience

Sehgal¹,

George²,

John³

et al. 2017

Indian J Nephrol

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“…Despite rapid advances in hematopoietic cell transplant (HCT) techniques, the procedure continues to be associated with a high morbidity and mortality with transplant related mortality (TRM) ranging from 15% to as high as 50% 1-3. In those who survive the acute toxicity, disease relapse remains a major cause of death 3.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In those who survive the acute toxicity, disease relapse remains a major cause of death 3. High doses of ionizing radiation and alkylating agents such as cyclophosphamide and mephalan, induce significant DNA damage 4 and are commonly used during HCT 3. Single nucleotide polymorphisms (SNPs) in DNA repair genes may potentially influence the effectiveness of various chemotherapeutic regimens used in HCT and have been associated with treatment outcomes and overall survival in patients undergoing chemotherapy for a variety of hematological malignancies 5,6.…”

Section: Introductionmentioning

confidence: 99%

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Association between Genetic Variants in the Base Excision Repair Pathway and Outcomes after Hematopoietic Cell Transplantations

Thyagarajan

Lindgren

Basu

et al. 2010

Biology of Blood and Marrow Transplantation

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Purpose Alkylating agents with or without ionizing radiation are frequently used in pre-transplant conditioning regimens. Damage induced by these agents is commonly repaired by the base excision repair (BER) pathway. Hence, we hypothesized that genetic polymorphisms in the BER pathway will be associated with post hematopoietic cell transplant (HCT) outcomes. Patients and Methods We evaluated the association between single nucleotide polymorphisms (SNPs) (n= 179) in the BER pathway with transplant related mortality at one year (TRM) and disease relapse in a cohort of 470 recipients who underwent allogeneic HCT for treatment of hematologic malignancies at the University of Minnesota. Results After adjustment for age at transplant, donor type, race, and conditioning regimen, four SNPs in OGGI, LIG3 and MUTYH genes (rs159153, rs3135974, rs3219463, rs3219476) were associated with increased risk of TRM whereas two SNPs in TDG gene (rs167715, rs2374327) were associated with decreased risk of TRM at one year (p≤0.01). Patients with increasing numbers of deleterious alleles in the BER pathway showed a higher cumulative incidence of TRM at one year (51% for ≥ 4 deleterious alleles vs. 14% for ≤ 1 deleterious allele; p<0.001). One SNP, rs3135974, in LIG3 gene was associated with decreased risk of disease relapse (p<0.001) post HCT. Conclusions These findings suggest that SNPs in the BER pathway can be used as genetic biomarkers to predict individuals at high risk for TRM and disease relapse. Modulation of pre-transplant conditioning may alter risk in these patients.

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“…On the other hand, non-myeloablative HCT depends more on donor cellular immune effects and less on the cytotoxic effects of the preparative regimen to control the underlying disease. 1,2 It ultimately uses a lower dose conditioning regimen and can thus be offered to older patients, to those debilitated by additional comorbidities, or to high-risk, heavily pretreated patients, who would not tolerate myeloablative HCT, resulting in a consequent decrease in regimen-related toxicity and treatment-related mortality. [3][4][5] Acute kidney injury (AKI) is highly prevalent whether the patients undergo myeloablative or non-myeloablative regimens; however, the pathogenesis and risk factors leading to AKI can differ between the two.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in HCT: an update

Lopes

Jorge

Neves

2016

Bone Marrow Transplant

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Acute kidney injury (AKI) is highly prevalent whether the patients undergo myeloablative or non-myeloablative hematopoietic cell transplantation (HCT); however, the pathogenesis and risk factors leading to AKI can differ between the two. The prognosis of AKI in patients receiving HCT is poor. In fact, AKI following HCT is associated not only with increased short-and long-term mortality, but also with progression to chronic kidney disease. Herein, the authors provide a comprehensive and up-to-date review of the definition and diagnosis, as well as of the incidence, pathogenesis and outcome of AKI in patients undergoing HCT, centering on the differences between myeloablative and non-myeloablative regimens. INTRODUCTIONHematopoietic cell transplantation (HCT) is currently used to treat numerous malignant (for example, multiple myeloma, leukemias and lymphomas) and non-malignant hematological disorders (for example, aplastic anemia, b-thalassemia, immunodeficiency disorders and inborn errors of metabolism), as well as solid tumors (for example, breast cancer and neuroblastoma), which are in other instances incurable.The two major HCT procedures, taking into consideration the conditioning regimen used, are myeloablative autologous and allogeneic HCT and non-myeloablative allogeneic HCT. On the one hand, myeloablative HCT utilizes the maximally tolerated dose of TBI with or without chemotherapy, or with chemotherapy alone. On the other hand, non-myeloablative HCT depends more on donor cellular immune effects and less on the cytotoxic effects of the preparative regimen to control the underlying disease. 1,2 It ultimately uses a lower dose conditioning regimen and can thus be offered to older patients, to those debilitated by additional comorbidities, or to high-risk, heavily pretreated patients, who would not tolerate myeloablative HCT, resulting in a consequent decrease in regimen-related toxicity and treatment-related mortality. [3][4][5] Acute kidney injury (AKI) is highly prevalent whether the patients undergo myeloablative or non-myeloablative regimens; however, the pathogenesis and risk factors leading to AKI can differ between the two. In fact, AKI in patients receiving HCT is associated not only with increased short-and long-term mortality as compared with patients with no AKI, but also with a higher rate of progression to chronic kidney disease (CKD). Herein, the authors provide a comprehensive and up-to-date review of the definition and diagnosis of AKI as well as of the incidence, risk factors, pathogenesis and outcome of AKI in patients undergoing HCT, centering on the differences between myeloablative and nonmyeloablative regimens.

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Differences between the different conditioning regimens for allogeneic stem cell transplantation

Cited by 11 publications

References 11 publications

Acute kidney injury and mortality in hematopoietic stem cell transplantation: A single-center experience

Acute kidney injury and mortality in hematopoietic stem cell transplantation: A single-center experience

Association between Genetic Variants in the Base Excision Repair Pathway and Outcomes after Hematopoietic Cell Transplantations

Acute kidney injury in HCT: an update

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