Bone Marrow Transplant Update - Spring 2010
Tandem transplants – New idea under investigation in patients with multiple myeloma and occasionally in patients with very advanced non-Hodgkin’s lymphoma
Mini-transplant plus Gleevec improves outcomes for Ph+ ALL patients
Life-saving protocols for your patients with hematologic malignancies
New patient housing facility at SCCA
Transplant program at SCCA ranks first in one-year survival rates
Tandem Transplants – New Idea Under Investigations
In patients with multiple myeloma and those with very advanced non-Hodgkin’s lymphoma, Seattle Cancer Care Alliance oncologists and transplant physicians are studying tandem transplants: using autologous transplantation following high-dose chemotherapy or radiation therapy to reduce tumor burden before doing a “mini” allogeneic transplant from a related or unrelated donor. The idea behind this approach is that donor immune cells will have a greater chance of eradicating the remaining tumor cells since there are less of them. See descriptions of current tandem transplants on page 3 for Study Numbers 1409 and 2070.
Dr. George Georges, principal investigator for SCCA Trial #1581, has been treating Ph+ acute lymphocytic leukemia patients with allogeneic nonmyeloablative hematopoietic cell transplantation followed by maintenance therapy with a tyrosine kinase inhibitor, with very positive results.
“In 1990, only about 10 percent or less of older patients with this disease survived long term. Now, with imatinib given after allografting, we have a cohort of patients with 73 percent long-term disease-free survival,” Georges says.
Two weeks after nonmyeloablative transplant, patients begin taking imatinib or one of the other currently available tyrosine kinase inhibitors. Georges and his team have seen the best results in patients who receive their transplant while in first remission and who have no evidence of minimal residual disease at the time of transplant. Those with more advanced disease or who are in second remission do not do as well.Ph+ ALL is a very lethal disease and older patients cannot tolerate a full myeloablative transplant. The mini transplant allows for the opportunity for long-term survival, if it is followed -up with one to three years of imatinib treatment. Risks associated with the treatment are infections as a result of graft-versus-host disease.
For more information about this trial and whether your patient will qualify, please contact George Georges, MD at (206) 667-6886 or firstname.lastname@example.org.
SCCA House is an 80-unit patient housing facility for general oncology and pre- and post-stem cell transplant patients. The carefully monitored clean environment is designed for immunosuppressed patients. The private suites come in three sizes to accommodate two, three, or five people and include many special features and amenities, including kitchenettes.
“This beautiful new facility will help meet a significant demand for lodging for patients and their caregivers during various forms of cancer treatment, which can last as long as several weeks,” said Norm Hubbard, SCCA executive vice president.
For more details about SCCA House or to make reservations, call (206) 204-3700 or visit the web at www.seattlecca.org.
Protocol 1409: A Phase I/II study of autologous stem cell transplantation followed by non-myeloablative allogeneic stem cell transplantation for patients with relapsed or refractory lymphoma; a multi-center trial. PI: David Maloney, MD.
Myelodysplastic syndrome or myeloproliferative disorders
Protocol 2056: Low-dose TBI dose escalation to decrease risks of progression and graft rejection after hematopoietic cell transplantation with nonmyeloablative conditioning as treatment for untreated myelodysplastic syndrome or myeloproliferative disorders; a multi-center trial. PI: Brenda Sandmaier, MD.
High-Risk Multiple Myeloma
Protocol 2070: Tandem autologous HCT / non-myeloablative allogeneic HCT from HLA-matched related and unrelated donors followed by Bortezomib maintenance therapy for patients with high-risk multiple myeloma. Principal Investigator: Marco Mielcarek, MD.
Chronic Lymphocytic Leukemia
Protocol 1711: Allogeneic hematopoietic stem cell transplantation with non-myeloablative conditioning for patients with chronic lymphocytic leukemia—a multi-center trial. PI: David Maloney, MD.
Protocol 1840: Non-myeloablative conditioning followed by unrelated donor hematopoietic cell transplantation for patients with Fludarabine-refractory chronic lymphocytic leukemia: A multi-center trial. PI: David Maloney, MD, PhD.
Protocol 1813: A multi-center Phase III study comparing non-myeloablative conditioning with TBI versus Fludarabine/TBI for HLA-matched related hematopoietic cell transplantation for treatment of hematologic malignancies. PI: Brenda Sandmaier, MD.
Protocol 1898: A multi-center study of non-myeloablative conditioning with TBI or Fludarabine/TBI for HLA-matched related hematopoietic cell transplantation for treatment of hematologic malignancies with post grafting immunosuppression with Tacrolimus and Mycophenolate Mofetil. PI: David Maloney, MD, PhD.
Protocol 1938: A randomized phase II study to determine the most promising postgrafting immunosuppression for prevention of acute GVHD after unrelated donor G-CSF mobilized peripheral blood mononuclear cell (G-PBMC) transplantation using non-myeloablative conditioning for patients with hematologic malignancies a multi-center trial. PI: Brenda Sandmaier, MD.
Protocol 1959: Campath® (Alemtuzumab) dose escalation, low-dose TBI and Fludarabine followed by HLA Class II mismatched donor stem cell transplantation for patients with hematologic malignancies: a multi-center Trial. PI: Brenda Sandmaier, MD.
Protocol 2230: A Phase I/II study evaluating the safety and efficacy of adding a single prophylactic donor lymphocyte infusion (DLI) of natural killer cells early after non-myeloablative, HLA-haploidentical hematopoietic cell transplantation. PI: Monica Thakar, MD.
Read more about these clinical trials online at http://www.fhcrc.org/patient/treatment/trials/index.php
Fred Hutchinson Transplant Program at Seattle Cancer Care Alliance (SCCA) was one of only two bone marrow transplant programs nationwide that consistently outperformed the expected one-year survival rate for unrelated donor transplants, according to an independent report that assessed 122 transplant centers over a five-year period. The Center for International Blood and Marrow Transplant Registry (CIBMTR) examined the survival rates of 8,847 transplants performed to treat blood cancers between 002 through 2007 at U.S. centers in the National Marrow Donor Program (NMDP) network. The Fred utchinson Bone Marrow Transplant Program at SCCA “over performed” in terms of expected one-year survival rates after transplant. Only one other transplant center in the nation matched that record.
Talk to a Transplant Doctor For a transplant consultation, call (800) 804-8824 Monday through Friday, 8:30 a.m. to 5:00 p.m. Pacific time.
The SCCA Adult Bone Marrow Transplant News is a publication presenting the latest information on bone marrow transplant research at SCCA, providing up-to-date information for all health care professionals caring for transplant patients.
Read about important outcomes research at the Fred Hutch that may benefit your patients.
Each issue of Clinical Trials Monthly highlights several of the more than 200 clinical trials that are currently recruiting patients at SCCA.
Each quarterly Leading Edge newsletter will highlight a new topic to give you the latest news on leading-edge therapies that SCCA physicians are offering.