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Bone Marrow Transplant Update - Spring 2009

Fred Hutchinson Transplant Program at SCCA

SCCA Transplant Program Ranks First in One-Year Survival Rates
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.

Mini-Transplants for Older Patients

Non-myeloablative conditioning regimens are well tolerated in patients who are ineligible for conventional conditioning prior to bone marrow transplantation due to advanced age or co-morbidities.  Thanks to these “mini-transplants,” there is no absolute upper age limit for transplantation.

Life-Saving Protocols for Your Patients with Hematologic Malignancies
Ongoing clinical trials at SCCA may provide your patients with the treatment they need to survive their disease. See this quick list of trials for multiple myeloma, chronic lymphocytic leukemia, and other hematologic malignancies.

Aplastic Anemia Treatment Improves Transplant Science
Ongoing clinical trials for aplastic anemia patients at SCCA teach physicians about transplant issues in malignant diseases. Promising treatment protocols at SCCA may improve outcomes even more.

Transplantation Consultation
If you are considering referring a patient for a bone marrow or stem cell transplant and want to discuss treatment options with a physician, please call our intake office and ask to speak to the clinical coordinator. The clinical coordinator is a physician transplant specialist from the Fred Hutchinson Cancer Research Center. Call (206) 288-SCCA (7222) or (800) 804-8824.

Transplant Program at SCCA Ranks First in One-Year Survival Rates CIBMTR Report Assessed 122 Transplant Centers Over Five Years

Fred Hutchinson Transplant Program at Seattle Cancer Care Alliance (SCCA) was one of only two hematopoietic cell 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 at U.S. centers in the National Marrow Donor Program (NMDP) network. 
  • The survival data was collected for the years 2002 through 2006 and patient outcomes were measured at the end of 2007. 
  • In each of five years, Fred Hutchinson 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. 
  • The data was adjusted for several risk factors that could influence patient outcomes such as type of disease, its stage, patient age, and degree of donor cell match.

Mini-Transplants for Older Patients

 

Non-myeloablative regimens expand eligibility for those with co-morbidities

Hematopoietic cell transplants that use non-myeloablative conditioning regimens are well tolerated by most patients who are ineligible for conventional high-dose conditioning prior to transplantation due to advanced age or co-morbidities.

Thanks to these “mini-transplants,” there is no absolute upper age limit for transplantation. Patients in their 60s, 70s, and 80s (as well as younger patients) now undergo non-myeloablative transplants at the Hutchinson Center Transplant Program at SCCA. A majority (60 percent) never have to be hospitalized during their transplant process and complete their conditioning, stem cell infusion, and recovery entirely in outpatient settings.

Graft-Versus-TUMOR Effect
Mini-transplants, also called mixed chimeric transplants, “do not rely on high-dose cytotoxic therapy,” says Rainer Storb, MD, Head of the Transplantation Biology Program at Fred Hutchinson Cancer Research Center, “but rather rely on graft-versus-tumor effects for killing the patient’s cancer cells.” The low-dose conditioning regimen is administered to weaken the patient’s immune system so it accepts the donor’s stem cells.

Ideally, the transplanted cells engraft and a new immune system develops alongside the patient’s remaining immune system. For a time, the patient has two immune systems (mixed chimerism) before the patient’s system eventually disappears.

Mini-Transplants for Older Patients

Our researchers are conducting a series of clinical trials on non-myeloablative (mini) transplants in older patients who have related or unrelated HLA-matched donors and acute myelogenous leukemia, adult high-risk acute lymphocytic leukemia, refractory chronic lymphocytic leukemia, advanced non-Hodgkin’s lymphoma, advanced Hodgkin’s lymphoma, multiple myeloma, or various myelodysplastic syndromes. Advanced age alone does not disqualify patients from participating in these trials.

Life-Saving Protocols for Your Patients with Hematologic Malignancies

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. PI: 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.

For Hematologic Malignancies
• 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.

Transplantation Consultation

If you are considering referring a patient for a bone marrow or stem cell transplant, and want to discuss treatment options with a physician, please call our intake office and ask to speak to the clinical coordinator. The clinical coordinator is a physician transplant specialist from the Fred Hutchinson Cancer Research Center. Call (206) 288-SCCA (7222) or (800) 804-8824.

Aplastic Anemia Transplant Research at the Hutchinson Center

“Aplastic anemia represents a non-malignant, but nevertheless highly fatal disease for which transplantation has been uniquely successful,” Storb says. “Transplantation for aplastic anemia has taught us a lot about transplantation for malignant diseases since transplantation-related issues can be looked at in ‘pure’ form without the constant threat of recurrent malignant disease which otherwise tends to muddle the statistical analyses.”

Current survival for aplastic anemia patients who receive a transplant is around 90 percent, according to Storb, who is principal investigator for a clinical trial for patients with severe aplastic anemia. Protocol 2054 relies on existing transplant strategies but limits the number of transplanted cells. The purpose is to determine whether limiting the number of cells will decrease mortality (now around 10 percent) by reducing infections and reducing chronic graft-versus-host diseases, which now affect about 25 percent of patients.

Currently enrolling patients, Protocol 2054 uses Cyclophosphamide and Antithymocyte Globulin conditioning regimen for marrow transplantation from HLA-matched family members for severe aplastic anemia and looks at the effect of marrow cell dose on chronic Graft-vs.-Host Disease. This is a multi-center trial.


Adult Bone Marrow Transplant News

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.

Pediatric Bone Marrow Transplant News

Read about important outcomes research at the Hutchinson Center that may benefit your patients.

Clinical Trials Monthly

Each issue of Clinical Trials Monthly highlights several of the more than 200 clinical trials that are currently recruiting patients at SCCA.

The Leading Edge Newsletter

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.