ASH News Daily 2012 - Saturday, December 8, 2012 - (Page A-18)
Page A–18
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TRANSPLANTATION
Allogeneic Transplantation Opens Its Door to Everyone
BY JENNA D. GOLDBERG, MD
or many years, patients were
denied allogeneic hematopoietic
stem cell transplants because
a suitable donor could not be
found for them. This problem disproportionally
F
affected
minorities,
who are underrepresented in volunteer
donor pools. However, significant
strides have been made toward
offering an allogeneic transplant to
all patients who may benefit from
one. Today, an Education Program
session, “Hematopoietic Stem Cell
Transplantation I: Exploiting Alternative
Donors,” will detail recent
advances in alternative donor transplantation.
While there may still be
an occasional patient who is unable
to be paired with a donor, the speakers
in today’s session will explain
why donor selection should not be a
barrier to allogeneic transplantation
in the vast majority of cases.
The opening talk in this session
will be given by Elizabeth Shpall,
MD, from The University of Texas
MD Anderson Cancer Center. She
will review the rapidly advancing
field of umbilical cord blood transplantation.
After the first cord blood
transplant was performed in 1989,
the use of cord blood units has considerably
increased. The ability to
perform cord blood transplantation
on adults has dramatically improved
due to the use of double cord blood
transplantation to overcome the difficulty
in finding large enough units
for many adults. Other strategies
that are being studied to improve
engraftment following cord blood
transplantation include the transplantation
of ex-vivo expanded cord
blood units, direct intra-bone marrow
injection, co-infusion with a
haploidentical T-cell-depleted graft,
and the use of agents to enhance the
homing of cord blood to the bone
marrow.
Andrea Bacigalupo, MD, of Ospedale
San Martino, Italy, will discuss
recent developments in the field of
matched and mismatched unrelated
donor transplantation.
Allele-level
HLA matching, tailored conditioning
regimens, better graft-versus-host
disease (GVHD) prophylaxis, and
improved supportive care have all
positively impacted outcomes following
unrelated donor transplantation.
Dr. Bacigalupo will highlight
some of these key advances. For example,
he will address the role of Tcell
antibodies for the prevention of
GVHD. The preferred donor choice
may be disease-dependent. While
most disease-specific studies have
continued to demonstrate a slight
advantage toward a matched related
donor compared with an unrelated
donor, one recent study, completed
by the European Blood and Marrow
Transplant Group and not yet published,
demonstrated that a patient
over the age of 50 with myelodysplastic
syndromes may benefit from
a young unrelated donor compared
with an older matched related donor.1
While Dr. Bacigalupo currently
recommends matched related donor
transplantation in most situations
when available, he believes future
research may dictate the use of unrelated
donors in specific situations.
Finally, Ephraim J. Fuchs, MD, of
John Hopkins University School of
Medicine will close the session by
reviewing the field of haploidentical
transplantation. Haploidentical
donors can be found quickly for
nearly all patients because all biological
parents, children, and half of siblings
will be haploidentical. At Johns
Hopkins, more than 95 percent of
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Personal
«« From Page A-16
Within a month, her CBC and copper
levels returned to normal, but
her neurologic symptoms worsened
rapidly. She was now ataxic and had
to stop working. Interestingly, her
zinc level remained elevated so she
was advised to continue copper replacement.
The search began for an
explanation. Why did her zinc levels
remain elevated? How could we
explain her gait abnormality?
A neurologist
was
consulted.
For more information see www.ehaweb.org
or contact the EHA Executive Office at training@ehaweb.org
TRTH is being made possible by a generous unrestricted
educational grant from the Wallace H. Coulter Foundation.
An MRI showed a myelopathy
confined to the cervical cord. We
learned that zinc and copper are absorbed
via common pathways and
that too much of one could lead to
a deficiency of the other. But that
did not explain why her zinc levels
stayed up. A search began for
alternate sources of zinc, and fortunately,
for this I had plenty of help.
Flo’s friends contacted local health
authorities. Zinc levels in the water
supply were checked. A zinc expert
with a PhD was brought in from
New Jersey. “Think zinc” computer
printouts began to appear taped to
the windows of neighboring busi-
patients have had at least one HLAhaploidentical,
first-degree relative
identified. Early trials of haploidentical
transplantation revealed a high
rate of GVHD and rejection related
to HLA mismatching. However,
strategies to reduce T cells from the
donor graft have demonstrated improved
outcomes. Dr. Fuchs and his
colleagues have pioneered administration
of high-dose post-transplantation
cyclophosphamide to deplete
alloreactive T cells from the host and
donor. With this strategy, lower rates
of GVHD and non-engraftment have
been demonstrated.
Future studies will compare strategies
of alternative donor transplantation
with each other and will compare
alternative donor
transplantation
with matched sibling transplantation.
To learn more about where we stand
right now in allogeneic transplantation
for the 70 percent of patients who
lack a matched sibling donor, attend
this Education session today at either
7:30 or 9:30 a.m. in Room A103, Level
1, Building A in the Georgia World
Congress Center.
1
Further details about this unpublished
study are available in Dr. Bacigalupo’s article
in Hematology 2012 (the ASH Education Program).
Dr. Goldberg indicated no relevant
conflicts of interest.
nesses. Yet a year later, Flo continued
on copper replacement because
her zinc levels would not drop. She
had to stop working, but her network
of friends did not.
A breakthrough finally came
from Flo’s sister, Lola, who was living
in Las Vegas. While Lola surfed
the Internet for zinc-related health
problems one evening, a side-bar
ad popped up on her screen. The
ad announced a class-action lawsuit
for people harmed from zinc contained
in denture adhesive paste!
Sure enough, for 18 years, Flo had
been using one of the popular denture
adhesives named in the suit.
She immediately stopped using it,
and her zinc levels promptly returned
to normal. Mystery solved?
Today, she is off copper and her
neurologic symptoms have slowly
improved. She is as spunky as ever,
walking with a cane, but she is unable
to work. Her story illustrates
how modern information technology
together with traditional values
of friendship, persistence, and compassion
can help to clarify difficult
problems in hematology care.”
Read more of these personal and
patient stories in future issues.
ASH NEWS DAILY
Saturday, December 8, 2012
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ASH News Daily 2012 - Saturday, December 8, 2012
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