ASH News Daily 2012 - Saturday, December 8, 2012 - (Page A-18)

Page A–18 ® 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 EHA-ASH TRANSLATIONAL RESEARCH TRAINING IN HEMATOLOGY ADVANCE YOUR CAREER IN TRANSLATIONAL RESEARCH TRTH is an intensive training and mentoring experience intended to advance the careers of young and gifted researchers and scientists. Established by the European Hematology Association and the American Society of Hematology, TRTH is a highly selective international program focused on translational laboratory research with international experts in hematology. Interested in refining your skills and taking your career to the next level? Apply for TRTH! Participants work closely with faculty on topics such as biostatistics and biomarkers, genetics and molecular biology, ethics, phase 1 clinical study design and professional networking. 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

Table of Contents for the Digital Edition of ASH News Daily 2012 - Saturday, December 8, 2012

ASH News Daily 2012 - Saturday, December 8, 2012

https://www.nxtbookmedia.com