Donor-Derived Second Hematologic Malignancies after Cord Blood Transplantation

Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation (Impact Factor: 3.4). 02/2010; 16(7):1025-31. DOI: 10.1016/j.bbmt.2010.02.014
Source: PubMed

ABSTRACT Double umbilical cord blood transplantation (UCBT) with a reduced-intensity conditioning regimen is an effective strategy for adult patients without a matched donor. The risk of second malignancies in these patients has not yet been established, however. In the present study, 98 adults with a hematologic malignancy underwent double UCBT. Seventy patients received a reduced-intensity conditioning regimen of fludarabine 30 mg/m(2)/day for 6 days, melphalan 100 mg/m(2)/day for 1 day, and rabbit antithymocyte globulin 1.5 mg/kg/day for 4 days, and 28 patients received a myeloablative total body radiation-containing conditioning regimen. Sixty-three patients received sirolimus-based graft-versus-host disease (GVHD) prophylaxis, and 35 patients received non-sirolimus-based GVHD prophylaxis. The median patient age was 48 years (range, 19-67 years). Eighteen patients developed a second malignancy at a median of 134 days after transplantation. Sixteen patients had lymphoma, and 2 patients had myelodysplasic syndrome/myeloproliferative disorder (MDS/MPD). Sixteen of these second malignancies (both cases of MDS/MPD and 14 of the lymphomas) were donor-derived; the origins of the others were not determined. GVHD prophylaxis, HLA matching, primary disease, age, total nucleated cell dose, and CD34(+) cell dose were not associated with a higher rate of second malignancy. Second myelogenous malignancies of donor origin occur after double UCBT, suggesting that a search for donor origin should be performed in all patients with suspected relapse.

Download full-text


Available from: Joseph Antin, May 02, 2014
13 Reads
  • Source
    • "HLA compatibility was thought to be another key factor in CBT outcome, as with other stem cell sources. Several studies have shown that HLA mismatch at HLA-A, -B antigens and - DRB1 alleles leads to delayed engraftment, increased severity of acute GVHD, increased TRM and decreased survival (Rubinstein et al., 1998; Gluckman et al., 2004; Barker et al., 2010; Delaney & Ballen, 2010). Although increasing the number of HLA mismatching might be associated with decreased relapse risk in patients with leukemia, suggested GVL effect increased in HLA-mismatched CBT, HLA-mismatch does not offer any benefit in DFS (Barker et al., 2010). "
    Acute Leukemia - The Scientist's Perspective and Challenge, 12/2011; , ISBN: 978-953-307-553-2
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Erişkinlerden farklı olarak çocuklarda hematopo-etik kök hücre transplantasyonu malign hasta-lıklar yanında birçok malign olmayan doğuştan kazanılmış hastalıkta tedavi edici bir yöntem ola-rak kullanılmaktadır. Çocuklarda 1968 yılında ilk başarılı allojenik HKHT bildirilmesinden sonra HLA gruplarının tanımlanması ve HLA uyumlu vericilerden nakillerin başlaması başarı oranını artırmıştır. Akraba dışı vericiler ve kordon kanla-rından yapılan nakillerin artması ile HKHT tüm dünyada yaygınlaşmıştır. Günümüzde çocukluk yaş grubunda hematolojik malignansiler, immun yetmezlikler, hemoglobinopatiler, kemik iliği yet-mezlikleri ve konjenital metabolik hastalıklarda hayat kurtarıcı bir tedavi yöntemi olarak kabul edilmektedir. Bu yazıda çocuklarda hematopoetik kök hücre transplantasyon endikasyonları ve transplantas-yon sonrası izlemde karşılaşılan sorunlar litera-tür gözden geçirilerek bir derleme halinde sunul-muştur. Anahtar kelimeler: Hematopetik kök hücre transplantasyonu, çocukluk çağı Hematopoetic stem cell transplantation in childhood Hematopoetic stem cell transplantation has been established as a curative therapy method in vari-ous malign and non-malign disorders in childho-od. The first successful bone marrow transplants were done in children with severe combined im-munodeficiency and Wiskott-Aldrich diseases in 1968. After the discovery of the human leukocy-te antigens (HLAs) matching between patient and donor became possible leading to increased transplantation success. After that, the number of bone marrow transplants performed worldwi-de increased substantially. The use of unrelated donors and umbilical cord blood (UCB) grafts has increased the possibilities of finding a suitable donor. Now, almost more than 20.000 transplants are performed yearly with more than modality for many diseases in children, including hematologic malignancies, immundeficiencies, hemoglobino-pathies, bone marrow failure syndromes and con-genital metabolic disorders.
  • [Show abstract] [Hide abstract]
    ABSTRACT: While it is often desirable to select planar antennas and circuitry for their advantages in terms of cost, low-profile, and compatibility with microwave integrated circuits, there are still many applications where it is necessary to combine such components with rectangular waveguides. This is especially true at millimeter wave frequencies, where waveguide circuitry must often be connected to planar antennas, or planar circuitry must be combined with waveguide feeds. Traditional waveguide-to-microstrip transitions have used either wire probe coupling, machined matching step sections, or fin-line type transitions, but each of these suffers from several disadvantages in terms of manufacturing or fabrication complexity, cost, or an inconvenient physical configuration. This paper describes and discusses several broadwall and endwall waveguide-to-microstrip transitions that rely on aperture coupling techniques, and are thus well-suited for low-cost high-volume production for commercial millimeter wave applications. Five different waveguide-to-microstrip transitions have been analyzed using a full-wave moment method procedure, with experimental results for the more interesting designs
    Antennas and Propagation Society International Symposium, 1996. AP-S. Digest; 08/1996
Show more