Twenty Years of Unrelated Donor Bone Marrow Transplantation for Pediatric Acute Leukemia Facilitated by the National Marrow Donor Program

Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota 55455, USA.
Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation (Impact Factor: 3.35). 10/2008; 14(9 Suppl):16-22. DOI: 10.1016/j.bbmt.2008.05.019
Source: PubMed

ABSTRACT The National Marrow Donor Program (NMDP) has facilitated unrelated donor hematopoietic cell transplants for more than 20 years. In this time period, there have been many changes in clinical practice, including improvements in HLA typing and supportive care, and changes in the source of stem cells. Availability of banked unrelated donor cord blood (incorporated into the NMDP registry in 2000) as a source of stem cells has become an important option for children with leukemia, offering the advantages of immediate availability for children with high-risk disease, the need for a lesser degree of HLA match, and expanding access for those with infrequent HLA haplotypes. Overall survival (OS) in children with acute leukemia transplanted with unrelated donor bone marrow (BM) is markedly better in more recent years, largely attributable to less treatment-related mortality (TRM). Within this cohort, 2-year survival was markedly better for patients with acute lymphoblastic leukemia (ALL) in first complete response (CR1) (74%) versus second complete response (CR2) (62%) or more advanced disease (33%). Similar findings are observed with patients with AML, suggesting earlier referral to bone marrow transplant (BMT) is optimal for survival. Notably, this improvement over time was not observed in unmodified peripheral blood stem cell (PBSC) recipients, suggesting unmodified PBSC may not be the optimal stem cell source for children.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The two mile long Main Drive Line (MDL) distributes 476 MHz at each of the 31 sectors along its length. Each of the 31 sectors has a six times multiplier which drives the 2856 MHz phase reference system for that sector. This system is used to set and maintain phase of the accelerator structures over time. During previous runs significant down time resulted from sector phasing which was required after multiplier replacement. A system was designed to calibrate the phase of the 476 MHz input to the phase of the 2856 MHz output of the multiplier units. This enabled multipliers to be replaced without rephasing sectors
    Particle Accelerator Conference, 1997. Proceedings of the 1997; 06/1997
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The RHIC Real Time Data Link (RTDL) System distributes to all locations around the RHIC ring machine parameters of general interest to accelerator systems and users. The system, along with supporting host interface, is centrally located. The RTDL System is comprised of two module types: the Encoder Module (V105) and the Input Module (V106). There is only one V105 module, but many (up to 128) Input Modules. Multiple buffered outputs are provided for use locally or for retransmission to other RHIC equipment locations. Machine parameters are generated from the V115 Waveform Generator Module (WFG) or from machine hardware and coupled directly through a fiber optic serial link to one of the V106 input channels
    Particle Accelerator Conference, 1997. Proceedings of the 1997; 06/1997
  • [Show abstract] [Hide abstract]
    ABSTRACT: The problem of closed-loop system identification given noisy input-output measurements is considered. The closed-loop system operates under an external cyclostationary input which is not measured. Noisy measurements of the (direct) input and output of the plant are assumed to be available. The various disturbances affecting the system are either stationary or cyclostationary with cycle frequencies different from the input cycle frequencies. The closed-loop system must be stable but it is allowed to be unstable in open-loop. A frequency-domain parametric solution is proposed and analyzed using an equation error formulation, and cyclic spectrum and cross-spectrum of the input-output measurements. The parameter estimator is shown to be consistent. A simulation example using an unstable open-loop system is presented to illustrate the proposed approach.
    Signals, Systems & Computers, 1997. Conference Record of the Thirty-First Asilomar Conference on; 12/1997