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Tanaka M.,Kanagawa Cancer Center | Miyamura K.,Red Cross | Terakura S.,Nagoya University | Imai K.,Sapporo Hokuyu Hospital | And 11 more authors.
Biology of Blood and Marrow Transplantation | Year: 2015

We retrospectively compared the transplantation outcomes for patients 50 years or older who received umbilical cord blood transplantation (UCBT) with those who received unrelated bone marrow transplantation (UBMT) for hematologic malignancies. A total of 1377 patients who underwent transplantation between 2000 and 2009 were included: 516 received 8/8 HLA allele-matched UBMT, 295 received 7/8 HLA allele-matched UBMT, and 566 received 4/6 to 6/6 HLA-matched UCBT. Adjusted overall survival (OS) was significantly lower in those who underwent UCBT than those who underwent 8/8 HLA-matched UBMT but was similar to that of 7/8 HLA-matched UBMT (the 2-year OS after 8/8 HLA-matched UBMT, 7/8 HLA-matched UBMT, and UCBT were 49% [95% confidence interval (CI), 45% to 55%], 38% [95% CI, 32% to 45%], and 39% [95% CI, 34% to 43%], respectively). However, adjusted OS was similar between 8/8 HLA-matched UBMT and UCBT receiving ≥.84× 105 CD34+ cells/kg among those with acute myeloid leukemia and those with acute lymphoblastic leukemia (the 2-year OS was 49% [95% CI, 43% to 55%], and 49% [95% CI, 41% to 58%], respectively). These data suggest that UCB is a reasonable alternative donor/stem cell source for elderly patients with similar outcomes compared with UBM from 8/8 HLA-matched unrelated donors when the graft containing ≥.84× 105 CD34+ cells/kg is available. © 2015 American Society for Blood and Marrow Transplantation. Source

Aoki J.,Kanagawa Cancer Center | Kanamori H.,Kanagawa Cancer Center | Tanaka M.,Kanagawa Cancer Center | Fukuda T.,National Cancer Center Hospital | And 14 more authors.
American Journal of Hematology | Year: 2016

Previous studies have repeatedly reported that increasing age is a significant risk factor for worse outcomes after allogeneic hematopoietic stem cell transplantation (allo-HSCT) among patients with acute myeloid leukemia (AML). However, more recent studies reported conflicting results regarding the association between age and outcomes in elderly patients. Therefore, we conducted a large-scale, nationwide retrospective study to examine the impact of age on outcomes of allo-HSCT with reduced intensity conditioning (RIC) for AML patients who were older than 50 years. Of the 757 patients, 89 patients (11.8%) were 50-54, 249 patients (32.9%) were 55-59, 301 patients (39.8%) were 60-64 and 118 patients (15.6%) were ≥65 years old. The 3-year overall survival (OS) (47.8, 45.2, 37.9, and 36.6% for patients aged 50-54, 55-59, 60-64, and ≥65 years, respectively, P=0.24) and nonrelapse mortality (NRM) (24.0, 22.8, 29.2, and 27.6% for patients aged 50-54, 55-59, 60-64, and ≥65 years, respectively, P=0.49) were not significantly different among the four age groups. Multivariate analysis revealed that increased age had no significant effect on OS or NRM after adjusting for covariates. These results suggested that advanced patient age is not a contraindication for RIC allo-HSCT in elderly AML patients. © 2016 Wiley Periodicals, Inc. Source

Kurokawa Y.,Osaka University | Shibata T.,Clinical Data | Sasako M.,Hyogo College of Medicine | Sano T.,Cancer Institute Hospital | And 3 more authors.
Gastric Cancer | Year: 2014

Background: Neoadjuvant chemotherapy may improve outcomes in gastric cancer. Tumor responses can be evaluated with RECIST, Japanese Classification of Gastric Carcinoma (JCGC), and histological criteria. These approaches have not yet been compared. Methods: We analyzed two phase II trials of neoadjuvant chemotherapy using S-1 plus cisplatin. JCOG0210 included patients with linitis plastica and large ulcero-invasive tumors, whereas JCOG0405 comprised those with para-aortic or bulky lymph node metastases. Radiologic evaluations were conducted using RECIST in JCOG0405 and JCGC criteria in JCOG0210, because the latter included many patients without measurable lesions. A histological responder was defined as a patient in whom one third or more of the tumor was affected. The hazard ratios (HR) for death between responders and non-responders and response rate differences between short- and long-term survivors were estimated. Results: In JCOG0210 (n = 49), HR was 0.54 in JCGC responders (P = 0.059) and 0.40 in histological responders (P = 0.005). The difference in response rates between short- and long-term survivors using histological criteria (34 %, P = 0.023) was greater than that using JCGC criteria (24 %, P = 0.15). In JCOG0405 (n = 51), HR was 0.67 in RECIST responders (P = 0.35) and 0.39 in histological responders (P = 0.030). In short- and long-term survivors, respectively, RECIST response rates were 62 and 67 % (P = 0.77), whereas histological response rates were 33 and 63 % (P = 0.048). Conclusions: Histological criteria showed higher response assessment validity than RECIST or JCGC criteria and yielded the best surrogate endpoint for overall survival. © 2013 The International Gastric Cancer Association and The Japanese Gastric Cancer Association. Source

Nakasone H.,Stanford University | Nakasone H.,Jichi Medical University | Onizuka M.,Tokai University | Suzuki N.,Sapporo Medical University | And 12 more authors.
Bone Marrow Transplantation | Year: 2013

Cryptogenic organizing pneumonia (COP), previously known as bronchiolitis obliterans organizing pneumonia (BOOP), is a significant complication after allogeneic hematopoietic SCT (HCT). However, the pathogenesis of this complication has not yet been elucidated. Therefore, we identified the pre-transplant risk factors for the development of COP/BOOP using the Japan transplant registry database between 2005 and 2009. Among 9550 eligible recipients, 193 experienced COP/BOOP (2%). HLA disparity (odds ratio (OR) 1.51, P=0.05), female-to-male HCT (OR 1.53, P=0.023), and PBSC transplant (OR 1.84, P=0.0076) were significantly associated with an increased risk of COP/BOOP. On the other hand, BU-based myeloablative conditioning (OR 0.52, P=0.033), or fludarabine-based reduced-intensity conditioning (OR 0.50, P=0.0011) in comparison with a TBI-based regimen and in vivo T-cell depletion (OR 0.46, P=0.055) were associated with a lower risk. Of the 193 patients with COP/BOOP, 77 died, including non-relapse death in 46 (59%). Pulmonary failure and fatal infection accounted for 41% (n=19) and 26% (n=12) of the non-relapse death. Allogeneic immunity and conditioning toxicity could be associated with COP/BOOP. Prospective studies are required to elucidate the true risk factors for COP/BOOP and to develop a prophylactic approach. © 2013 Macmillan Publishers Limited All rights reserved. Source

Kato M.,University of Tokyo | Kato M.,Saitama Childrens Medical Center | Takahashi Y.,Nagoya University | Tomizawa D.,Tokyo Medical and Dental University | And 14 more authors.
Biology of Blood and Marrow Transplantation | Year: 2013

Recent reports revealed that intravenous (iv) busulfan (BU) may not only reduce early nonrelapse mortality (NRM) but also improve overall survival (OS) probability in adults. Therefore, we retrospectively compared outcomes for 460 children with acute leukemia who underwent hematopoietic stem cell transplantation with either iv-BU (n=198) or oral busulfan (oral-BU) (n=262) myeloablative conditioning. OS at 3years was 53.4%±3.7% with iv-BU and 55.1%±3.1% with oral-BU; the difference was not statistically significant (P= 77). OS at 3years in 241 acute lymphoblastic leukemia and 219 acute myeloid leukemia patients was 56.4%±5.5% with iv-BU and 54.6%±4.1 with oral-BU (P= 51) and 51.0%±5.0% with iv-BU and 55.8%±4.8% with oral-BU (P= 83), respectively. Cumulative incidence of relapse at 3years with iv-BU was similar to that with oral-BU (39.0%±3.6% and 36.4%±3.1%, respectively; P= 67). Cumulative incidence of NRM at 3years was 16.6%±2.7% with iv-BU and 18.3%±2.5% with oral-BU (P= 51). Furthermore, multivariate analysis showed no significant survival advantage with iv-BU. In conclusion, iv-BU failed to show a significant survival advantage in children with acute leukemia. © 2013 American Society for Blood and Marrow Transplantation. Source

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