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Maastricht, Netherlands

Sharma M.,Thomas Jefferson University | Zhang M.-J.,Medical College of Wisconsin | Zhong X.,Medical College of Wisconsin | Abidi M.H.,Barbara Ann Karmanos Cancer Institute | And 35 more authors.
Biology of Blood and Marrow Transplantation | Year: 2014

Autologous hematopoietic cell transplantation (AHCT) for plasma cell myeloma is performed less often in people >70 years old than in people ≤70 years old. We analyzed 11,430 AHCT recipients for plasma cell myeloma prospectively reported to the Center for International Blood and Marrow Transplant Research between 2008 and 2011, representing the majority of US AHCT activity during this period. Survival (OS) was compared in 3 cohorts: ages 18 to 59 years (n= 5818), 60 to 69 years (n= 4666), and >70 years (n= 946). Median OS was not reached for any cohort. In multivariate analysis, increasing age was associated with mortality (P= .0006). Myeloma-specific mortality was similar among cohorts at 12%, indicating an age-related effect on nonmyeloma mortality. Analyses were performed in a representative subgroup comparing relapse rate, progression-free survival (PFS), and nonrelapse mortality (NRM). One-year NRM was 0% for age >70 years and 2% for other ages (P= not significant). The three-year relapse rate was 56% in age 18 to 59 years, 61% in age 60 to 69 years, and 63% age >70 (P= not significant). Three-year PFS was similar at 42% in age 18 to 59 years, 38% in age 60 to 69 years, and 33% in age >70 years (P= not significant). Postrelapse survival was significantly worse for the older cohort (P= .03). Older subjects selected for AHCT derived similar antimyeloma benefit without worse NRM, relapse rate, or PFS. © 2014 American Society for Blood and Marrow Transplantation. Source

Gupta V.,University of Toronto | Malone A.K.,Mount Sinai Medical Center | Hari P.N.,Medical College of Wisconsin | Ahn K.W.,Medical College of Wisconsin | And 33 more authors.
Biology of Blood and Marrow Transplantation | Year: 2014

We evaluated outcomes and associated prognostic factors in 233 patients undergoing allogeneic hematopoietic cell transplantation (HCT) for primary myelofibrosis (MF) using reduced-intensity conditioning (RIC). The median age at RIC HCT was 55 yr. Donors were a matched sibling donor (MSD) in 34% of RIC HCTs, an HLA well-matched unrelated donor (URD) in 45%, and a partially matched/mismatched URD in 21%. Risk stratification according to the Dynamic International Prognostic Scoring System (DIPSS) was 12% low, 49% intermediate-1, 37% intermediate-2, and 1% high. The probability of survival at 5 yr was 47% (95% confidence interval [CI], 40% to 53%). In a multivariate analysis, donor type was the sole independent factor associated with survival. Adjusted probabilities of survival at 5-yr were 56% (95% CI, 44% to 67%) for MSD, 48% (95% CI, 37% to 58%) for well-matched URD, and 34% (95% CI, 21% to 47%) for partially matched/mismatched URD (P=002). The relative risk (RR) for NRM was 3.92 (P= .006) for well-matched URD and 9.37 (P < .0001) for partially matched/mismatched URD. Trends toward increased NRM (RR, 1.7; P= .07) and inferior survival (RR, 1.37; P= .10) were observed in DIPSS intermediate-2/high-risk patients compared with DIPSS low/intermediate-1 risk patients. Our data indicate that RIC HCT is a potentially curative option for patients with MF, and that donor type is the most important factor influencing survival in these patients. © 2014 American Society for Blood and Marrow Transplantation. Source

Copelan E.A.,Levine Cancer Institute | Hamilton B.K.,Cleveland Clinic | Avalos B.,Levine Cancer Institute | Ahn K.W.,Center for International Blood and Marrow Transplant Research | And 33 more authors.
Blood | Year: 2013

Cyclophosphamide combined with total body irradiation (Cy/TBI) or busulfan (BuCy) are the most widely used myeloablative conditioning regimens for allotransplants. Recent data regarding their comparative effectiveness are lacking. We analyzed data from the Center for International Blood and Marrow Transplant Research for 1230 subjects receiving a first hematopoietic cell transplant from a human leukocyte antigen-matched sibling or from an unrelated donor during the years 2000 to 2006 for acute myeloid leukemia (AML) in first complete remission (CR) after conditioning with Cy/TBI or oral or intravenous (4) BuCy. Multivariate analysis showed significantly less nonrelapse mortality (relative risk [RR]= 0.58; 95% confidence interval [CI]: 0.39-0.86; P = .007), and relapse after, but not before, 1 year posttransplant (RR=0.23; 95% CI: 0.08-0.65; P=.006), and better leukemia-free survival (RR=0.70; 95% CI: 0.55-0.88; P = .003) and survival (RR = 0.68; 95% CI: 0.52-0.88; P = .003) in persons receiving 4, but not oral, Bu compared with TBI. In combination with Cy, 4 Bu is associated with superior outcomes compared with TBI in patients with AML in first CR. © 2013 by The American Society of Hematology. Source

Jacobsohn D.A.,Center for Cancer and Blood Disorders | Arora M.,University of Minnesota | Klein J.P.,Medical College of Wisconsin | Hassebroek A.,Center for International Blood and Marrow Transplant Research | And 21 more authors.
Blood | Year: 2011

There is a paucity of information regarding the factors that affect nonrelapse mortality (NRM) and overall survival among children that develop chronic graftversus- host disease (cGVHD). We performed multivariate analyses using data from the Center for International Blood and Marrow Transplant Research to identify risk factors for NRM and survival in 1117 pediatric subjects with leukemia or myelodysplastic syndrome, transplanted from related donors, unrelated donors (URD), or unrelated cord blood between 1995 and 2004. We identified 4 variables associated with higher NRM: HLA partially matched or mismatched URD, peripheral blood cell graft, Karnofsky/ Lansky score < 80 at cGVHD diagnosis, and platelets < 100 × 10 9/L at cGVHD diagnosis. Factors associated with significantly worse survival were: age> 10 years, transplantation from HLA partially matched or mismatched URD, advanced disease at transplantation, Karnofsky/ Lansky < 80; and platelets < 100 × 10 9/L. Cumulative incidence of discontinuation of systemic immune suppression at 1, 3, and 5 years after diagnosis of cGVHD were 22% (20%-25%), 34% (31%-37%), and 37% (34%-40%), respectively. This is the largest study elucidating variables affecting outcome after diagnosis of cGVHD in pediatric allograft recipients. These variables may be useful for risk stratification, development of future clinical trials, and family counseling in children with cGVHD. Source

Hamadani M.,West Virginia University | Saber W.,Medical College of Wisconsin | Ahn K.W.,Medical College of Wisconsin | Carreras J.,Medical College of Wisconsin | And 18 more authors.
Biology of Blood and Marrow Transplantation | Year: 2013

Patients with chemorefractory mantle cell lymphoma (MCL) have a poor prognosis. We used the Center for International Blood and Marrow Transplant Research database to study the outcome of 202 patients with refractory MCL who underwent allogeneic hematopoietic cell transplantation (allo-HCT) using either myeloablative (MA) or reduced-intensity/nonmyeloablative conditioning (RIC/NST), during 1998-2010. We analyzed nonrelapse mortality (NRM), progression/relapse, progression-free survival (PFS), and overall survival (OS). Seventy-four patients (median age, 54 years) received MA, and 128 patients (median age, 59 years) received RIC/NST. Median follow-up after allo-HCT was 35 months in the MA group and 43 months in the RIC/NST group. At 3 years post-transplantation, no significant between-group differences were seen in terms of NRM (47% in MA versus 43% in RIC/NST; P = .68), relapse/progression (33% versus 32%; P = .89), PFS (20% versus 25%; P = .53), or OS (25% versus 30%; P = .45). Multivariate analysis also revealed no significant between-group differences in NRM, relapse, PFS, or OS; however, receipt of a bone marrow or T cell-depleted allograft was associated with an increased risk of NRM and inferior PFS and OS. Our data suggest that despite a refractory disease state, approximately 25% of patients with MCL can attain durable remission after allo-HCT, and conditioning regimen intensity does not influence outcome of allo-HCT. © 2013 American Society for Blood and Marrow Transplantation. Source

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