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Majhail N.S.,Center for International Blood and Marrow Transplant Research | Douglas Rizzo J.,Medical College of Wisconsin
Bone Marrow Transplantation | Year: 2013

Advances in hematopoietic cell transplantation (HCT) have led to an increasing number of transplant survivors. However, long-term survival is challenged by late relapse, late complications and late non-relapse mortality, and HCT survivors need continued lifelong surveillance for screening, early detection and timely treatment of late complications such as secondary cancers, late infections and organ toxicity. Guidelines for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT were updated and published in 2012. However, several barriers to the care of HCT survivors and routine utilization of these guidelines in clinical practice exist. Examples include paucity of and challenges to conducting prospective randomized trials for screening and prevention of late complications, lack of resources to manage late effects at the level of transplant centers and community health care providers, and inadequate tools to facilitate care and followup of HCT survivors. We summarize the long-term followup guidelines in this review, discuss ways that providers can integrate and utilize them for the care of their patients, and identify areas for research that can inform and increase the utilization of screening and prevention guidelines in clinical practice. © 2013 Macmillan Publishers Limited. Source

Spellman S.R.,Center for International Blood and Marrow Transplant Research | Eapen M.,Medical College of Wisconsin | Logan B.R.,Medical College of Wisconsin | Mueller C.,German National Bone Marrow Registry | And 6 more authors.
Blood | Year: 2012

Selection of a suitable graft for allogeneic hematopoietic stem cell transplantation involves consideration of both donor and recipient characteristics. Of primary importance is sufficient donor-recipient HLA matching to ensure engraftment and acceptable rates of GVHD. In this Perspective, the National Marrow Donor Program and the Center for International Blood and Marrow Transplant Research provide guidelines, based on large studies correlating graft characteristics with clinical transplantation outcomes, on appropriate typing strategies and matching criteria for unrelated adult donor and cord blood graft selection. © 2012 by The American Society of Hematology. Source

Majhail N.S.,University of Minnesota | Majhail N.S.,Center for International Blood and Marrow Transplant Research
British Journal of Haematology | Year: 2011

Secondary cancers that arise in allogeneic haematopoietic-cell transplant recipients, possibly as a result of treatment exposures, are a relatively rare complication of transplantation. However, they can be associated with significant morbidity and mortality. Secondary cancers include post-transplant lymphoproliferative disorders, new solid cancers and donor-derived haematological malignancies. This review describes the epidemiology, risk factors and screening recommendations for secondary cancers among adult allogeneic haematopoietic-cell transplant recipients. Constructing a patient-specific risk profile based on known exposures and risk-factors is the key to developing appropriate screening and preventative strategies for secondary cancers after allogeneic transplantation. © 2011 Blackwell Publishing Ltd. Source

Majhail N.S.,Center for International Blood and Marrow Transplant Research | Mau L.W.,Chronic Disease Research Group | Denzen E.M.,National Marrow Donor Program | Arneson T.J.,Chronic Disease Research Group
Bone Marrow Transplantation | Year: 2013

There is a lack of multi-center cost-identification studies for hematopoietic cell transplantation (HCT). We used a single longitudinal administrative claims database representing a national, commercially insured population to evaluate the feasibility of identifying HCT recipients and to establish a cohort of autologous and allogeneic HCT recipients to study inpatient and outpatient direct medical costs from transplant hospitalization through first 100 days post-transplantation. Using ICD-9 procedure and diagnosis codes, we identified 3365 patients who had received their first transplant in the United States between 2007 and 2009 (autologous, 1678, allogeneic, 1320, graft source not specified, 367). The median 100-day total costs for autologous HCT were 99 899 (interquartile range (IQR), 73 914-140 555), and for allogeneic HCT were 203 026 (IQR, 141 742-316 426). The majority of costs (>75%) occurred during the initial transplant hospitalization for both autologous and allogeneic HCT recipients. Costs were greater among pediatric (≤20 years) compared with adult (>20 years) recipients and this difference was more pronounced with allogeneic HCT. Using a claims database representing a national HCT population, we highlight the high costs associated with autologous and allogeneic HCT. Our study lays the foundation for using claims data for future research on economic aspects of HCT. © 2013 Macmillan Publishers Limited All rights reserved. Source

Spellman S.,Scientific Services | Bray R.,Emory University | Rosen-Bronson S.,Georgetown University | Haagenson M.,Center for International Blood and Marrow Transplant Research | And 4 more authors.
Blood | Year: 2010

Donor-directed human leukocyte antigen (HLA)-specific allo-antibodies (DSAs) cause graft failure in animal models of hematopoietic stem cell transplantation (HCT). Archived pretransplantation sera from graft failure patients (n = 37) and a matched case-control cohort (n = 78) were tested to evaluate the role of DSAs in unrelated donor HCT. Controls were matched for disease, disease status, graft type, patient age, and transplantation year. Patients had acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, or myelodysplastic syndrome; 98% received myeloablative conditioning regimens 100% received T-replete grafts, 97% received marrow, 95% HLA-mismatched, and 97% received calcineurin-based graft-versus-host disease prophylaxis. Among the 37 failed transplantations, 9 (24%) recipients possessed DSAs against HLA-A, B, and/or DP, compared with only 1 (1%) of 78 controls. Therefore, the presence of DSAs was significantly associated with graft failure (odds ratio = 22.84; 95% confidence interval, 3.57-∞; P < .001). These results indicate that the presence of pre-transplantation DSAs in recipients of unrelated donor HCT is associated with failed engraftment and should be considered in HCT donor selection. © 2010 by The American Society of Hematology. Source

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