17 research outputs found
Prognostic Factors Affecting Outcome after Allogeneic Transplantation for Hematological Malignancies from Unrelated Donors: Results from a Randomized Trial
Several prognostic factors for the outcome after allogeneic hematopoietic stem-cell transplant (HSCT) from matched unrelated donors have been postulated from registry data; however, data from randomized trials are lacking. We present analyses on the effects of patient-related, donor-related, and treatment-related prognostic factors on acute GVHD (aGVHD), chronic GVHD (cGVHD), relapse, nonrelapse mortality (NRM), disease-free survival (DFS), and overall survival (OS) in a randomized, multicenter, open-label, phase III trial comparing standard graft-versus-host-disease (GVHD) prophylaxis with and without pretransplantation ATG-Fresenius (ATG-F) in 201 adult patients receiving myeloablative conditioning before HSCT from HLA-A, HLA-B antigen, HLA-DRB1, HLA-DQB1 allele matched unrelated donors. High-resolution testing (allele) of HLA-A, HLA-B, and HLA-C were obtained after study closure, and the impact of an HLA 10/10 4-digit mismatch on outcome and on the treatment effect of ATG-F versus control investigated. Advanced disease was a negative factor for relapse, DFS, and OS. Donor age â„40 adversely affected the risk of aGVHD III-IV, extensive cGVHD, and OS. Younger donors are to be preferred in unrelated donor transplantation. Advanced disease patients need special precautions to improve outcome. The degree of mismatch had no major influence on the positive effect of ATG-F on the reduction of aGVHD and cGVHD
Different Panel of Gene Variants Influence Outcome of Transplant From Sibling Donors Compared to HLA-Identical Unrelated Donors
Randomized Trial on GvHD Prophylaxis with or without Anti-Human T-Lymphocyte Immunoglobulin ATG-Fresenius (ATG-F) in Allogeneic Hematopoietic Cell Transplantation from Matched Unrelated Donors: Final Long-Term Results after 8.6 Years Median Follow-up
Cytomegalovirus Reduces the Relapse Risk for Acute Leukemia After Transplant: There Is a Virus-Versus-Leukemia Effect.
Relevance of C1 and C2 Epitopes for Hemopoietic Stem Cell Transplantation: Role for Sequential Acquisition of HLA-C-Specific Inhibitory Killer Ig-Like Receptor
Time-dependent prediction of mortality and cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation using machine learning
Allogeneic hematopoietic cell transplantation (HCT) effectively treats high-risk hematologic diseases but can entail HCT-specific complications, which may be minimized
by appropriate patient management, supported by accurate, individual risk estimation. However, almost all HCT risk scores are limited to a single risk assessment
before HCT without incorporation of additional data. We developed machine learning models that integrate both baseline patient data and time-dependent laboratory
measurements to individually predict mortality and cytomegalovirus (CMV) reactivation after HCT at multiple time points per patient. These gradient boosting machine
models provide well-calibrated, time-dependent risk predictions and achieved areas
under the receiver-operating characteristic of 0.92 and 0.83 and areas under the
precisionârecall curve of 0.58 and 0.62 for prediction of mortality and CMV reactivation, respectively, in a 21-day time window. Both models were successfully validated
in a prospective, non-interventional study and performed on par with expert hematologists in a pilot comparison
Allogeneic haematopoietic cell transplantation offers the chance of cure for patients with transformed follicular lymphoma
Purpose In patients with follicular lymphoma, secondary transformation to aggressive lymphoma (tFL) implies a poor prognosis. In principle, allogeneic haematopoietic cell transplantation (allo-HCT) offers a chance of cure for tFL but is rarely practiced. Aim of this retrospective multicenter study was to define the actual significance of allo-HCT in treatment of tFL. Methods The database of the German Registry for Stem Cell Transplantation (DRST) was screened for patients who underwent allo-HCT for tFL 1998-2008. Confirmation of tFL-diagnosis by local and/or pathologists of the National NHL Board was mandatory for enrolment. Gaps in reported EBMT Minimum Essential Data datasets (MED-A) were filled by local DRST data managers. Relevant HCT outcome variables were evaluated by uni- and multivariate statistical analysis. Results Median age of enrolled 33 patients was 51 years with a post allo-HCT median follow-up of 7.1 years of surviving patients. At time of HCT 24/33 patients had chemosensitive disease. In 24/33 patients reduced intensity conditioning (RIC) was used. Estimated 1, 2, 5-year overall survival (OS) and event-free survival rates were 49/39/33, and 33/30/24%. Cumulative 100 days non-relapse mortality was 25%. Chemosensitive disease, RIC, and limited chronic GvHD were identified as independent prognostic factors for OS. Conclusions Allo-HCT offers the chance of cure for tFL
Chronic Graft-Versus-Host Disease: Lessons From a Randomized Trial on GvHD Prophylaxis with or without Anti-T-Cell Globulin ATG-Fresenius (ATG-F) In Allogeneic Hematopoietic Cell Transplantation (HSCT) From Matched Unrelated Donors
Spenderauswahl, allogene Stammzelltransplantation
Die allogene Stammzelltransplantation besitzt fĂŒr viele schwere, maligne und nicht-malĂgne hĂ€matologische Erkrankungen ein hohes kuratives Potenzial. Ein kritisches Element der Stammzelltransplantation ist die Auswahl geeigneter Spender. Ziel dieser Leitlinie ist es, den klinisch tĂ€tigen HĂ€matologen/Internistischen Onkologen einen hierarchischen Algorithmus fĂŒr die Spenderauswahl an die Hand zu geben. ZusĂ€tzlich wird die Wertigkeit von alternativen Transplantatquellen (Nabelschnurblut, haploidente Spender) dargestellt. Dabei werden SpenderverfĂŒgbarkeit und individuelles Erkrankungsrisiko in Beziehung gesetzt. Die vorliegende Leitlinie stellt eine Zusammenfassung des aktuellen Konsensus der Deutschen Gesellschaft fĂŒr Immungenetik (DGI) und der Deutschen Arbeitsgemeinschaft fĂŒr Knochenmark- und Blutstammzelltransplantation (DAG-KBT) als Fachgremium der DGHO dar