By Mary J. Laughlin, Hillard M. Lazarus
The world over famous physicians and researchers evaluate either the fundamentals of allogeneic stem mobilephone transplantation and up to date advances within the box, relatively as they relate to antitumor results and graft-versus-host affliction in addition they supply exact decision-tree analyses to steer clinicians in picking out and dealing with their allogeneic transplant sufferers. The suggestions mentioned hide numerous components, starting from stem mobile mobilization in general donors, to symptoms for allogeneic transplantation except hematologic malignancies, to using nonmyeloablative conditioning regimens. The authors additionally discover new advancements within the optimum choice of unrelated allogeneic grafts (e.g., matched unrelated donor, partly mismatched loved one, or umbilical wire blood), the use allogeneic peripheral blood stem telephone vs marrow-derived grafts for transplantation, and the kinetics of immune reconstitution after transplantation.
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Additional resources for Allogeneic Stem Cell Transplantation (Current Clinical Oncology)
Reinforces the observation that a significant survival advantage is gained in high-risk younger patients undergoing allogeneic SCT (20). Presumably, the lower mortality and morbidity sustained by younger patients undergoing SCT highlights the advantage of this method over chemotherapy. In addition, review of a number of smaller phase II trials in high-risk adult ALL who have undergone ASCT in CR1 suggest a higher DFS when compared with conventional chemotherapy (21–27). High risk in these studies was defined as patients having at least one or more of the following: age greater than 30 yr, WBC greater than 30 × 109/L at presentation, extramedullary disease, unfavorable cytogenetic abnormalities, and requiring more than 4 wk to achieve a CR.
Thirty-four patients received intensive chemotherapy prior to the conditioning for BMT. The 2-yr DFS was 60% for the 16 patients transplanted in CR. The results were significantly less favorable for those with more advanced disease who only partially responded prior to intensive chemotherapy (2-yr DFS: 18%), while none of those who either relapsed or were resistant to chemotherapy became long-term survivors after BMT. Forty-four patients had not received any prior intensive chemotherapy. The DFS at 2 yr after BMT was 58 ± 19% when a patient was transplanted for refractory anemia with ringed sideroblasts (RARS), 74 ± 14% for refractory anemia with excess blasts (RAEB), 50 ± 16% for RAEB in transformation (RAEB-T), and 18 ± 11% for secondary AML.
Of adverse features 0 1 2 3 4 No. of patients Age <60 yr WBC <30,000/µL No medstinal mass Laboratory a features Estimated survival at 3 yr 22 83 146 89 13 0 1 12 25 13 0 16 25 68 13 0 63 145 89 13 0 3 110 85 13 91% (66–98%) 64% (51–75%) 49% (36–61%) 21% (12–35%) 0 a Adverse laboratory features include the presence of the Ph or BCR/ABL+ PCR analysis, L3 morphology, or precursor B lineage disease. 1. Prognostic Role of MRD Monitoring In addition to the adverse prognostic factors listed in Table 1, the detection of MRD using qualitative or semiquantitative polymerase chain reaction (PCR) or flow cytometric techniques is also beginning to provide important prognostic information.
Allogeneic Stem Cell Transplantation (Current Clinical Oncology) by Mary J. Laughlin, Hillard M. Lazarus