Nonmyeloablative allogeneic hematopoietic cell transplantation

Storb, Rainer; Sandmaier, Brenda M.

doi:10.3324/haematol.2015.132860

Cited by 49 publications

(47 citation statements)

References 62 publications

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“…[30] Strategies to overcome increased risk of relapse, particularly those that can enhance GVL, are needed in elderly patients who are usually only candidates for RIC. Donor lymphocyte infusions (DLI) can be used successfully as a prophylactic measure [31] or at time of relapse [32], however the increased risk of GVHD and DLI availability are limiting factors for wide utilization of this strategy.…”

Section: Discussionmentioning

confidence: 99%

“…[10] In order to better select patients for alloHCT, clinical risk tools including the HCT-specific comorbidity index (HCT-CI) [11] and frailty index [12] can help clinicians assess patient-specific factors that influence TRM and OS after alloHCT. Additionally, a disease-specific predictive tool, the disease risk index (DRI), [13] was developed and later revised to improve the ability to estimate OS after alloHCT across various hematologic malignancies regardless of age, conditioning regimen, graft source, or donor type.…”

Section: Introductionmentioning

confidence: 99%

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Allogeneic Hematopoietic Cell Transplantation for Older Patients: Prognosis Determined by Disease Risk Index

Cao

Lazaryan

et al. 2017

Biology of Blood and Marrow Transplantation

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The treatment of elderly patients with advanced hematological malignancies has expanded to include reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT) as a potentially curative option. We studied the association between disease risk index (DRI) and clinical outcomes of 196 elderly patients (median age: 64.8 [60-75] years) with hematological malignancies receiving RIC alloHCT (2000-2014). Donors were adult related and unrelated (RD, URD; n = 100, 51.1%) or umbilical cord blood (UCB) (n = 96, 48.9%). DRI classified 12 patients (6.1%) as low risk (LR), 146 patients (74.5%) as intermediate risk (IR) and 38 patients (19.4%) as high-risk (HR). Two-year overall survival (OS) was 47% (52% for LR/IR vs. 29% for HR; p<0.01) and two-year disease-free survival (DFS) was 39% (44% for LR/IR vs. 21% for HR; p<0.01). Relapse incidence was 30% (26% for LR/IR vs. 44% for HR; p<0.01). Treatment-related mortality (TRM) was 29% at 2 years; this was similar for all DRI groups. In multiple regression analysis, HR DRI was associated with increased risk of relapse (HR=2.07; 95% CI 1.34-3.33; p=0.02) and treatment failure (HR=2.07; 95% CI 1.35-3.18; p<0.01), and decreased OS (HR=2.11; 95% CI 1.34-3.33; p<0.01). In elderly patients, DRI is a significant prognostic factor for post-transplant relapse, treatment failure, and mortality. Due to increased risk of relapse leading to poor survival in HR DRI, participation in clinical trials offering relapse prevention strategies after RIC alloHCT should be encouraged when available.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Allogeneic Hematopoietic Cell Transplantation for Older Patients: Prognosis Determined by Disease Risk Index

Cao

Lazaryan

et al. 2017

Biology of Blood and Marrow Transplantation

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“…RIC potentially extends the curative graft-versus-leukemia effect to patients of older age or to young patients with significant comorbidities. [179][180][181][182] Conditioning intensity varies. For instance, busulfan/fludarabine is more dose-intense than fludarabine/low-dose total-body irradiation.…”

Section: -5977174177mentioning

confidence: 99%

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Döhner

Estey

Grimwade

et al. 2017

Blood

4,790

5,387

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The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease

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“…4,5 Therefore, further researches are needed to explore new methods for decreasing the rate of relapse and improving the survival of patients with r/r ALL who undergo RIC allo-HSCT, and such methods may be realized by improving the graftversus-leukemia (GVL) effect. 6 High complication remission (CR) rates and curative effects have been achieved in patients with r/r ALL using CD19-directed chimeric antigen receptor-modified T (CAR-T) cells. 7,8 However, these cells are difficult to collect in sufficient numbers for patients who have an extremely high leukemia burden.…”

Section: Introductionmentioning

confidence: 99%

Donor-derived CAR-T Cells Serve as a Reduced-intensity Conditioning Regimen for Haploidentical Stem Cell Transplantation in Treatment of Relapsed/Refractory Acute Lymphoblastic Leukemia: Case Report and Review of the Literature

Zhang

Kong

et al. 2018

Journal of Immunotherapy

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Nonmyeloablative allogeneic hematopoietic cell transplantation

Cited by 49 publications

References 62 publications

Allogeneic Hematopoietic Cell Transplantation for Older Patients: Prognosis Determined by Disease Risk Index

Allogeneic Hematopoietic Cell Transplantation for Older Patients: Prognosis Determined by Disease Risk Index

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Donor-derived CAR-T Cells Serve as a Reduced-intensity Conditioning Regimen for Haploidentical Stem Cell Transplantation in Treatment of Relapsed/Refractory Acute Lymphoblastic Leukemia: Case Report and Review of the Literature

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