Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for patients with a hematologic disease. Although the clinical outcomes after allo-HCT have significantly ...improved during the last few decades, graft-versus-host disease (GVHD) is still a major cause of post-HCT morbidity and mortality. Systemic glucocorticoids (GC) remain an integral part of treatment in patients with GVHD including both acute and chronic GVHD. Although it is well-known that usage of systemic GC is associated with various side effects, the short- and long-term effects of GCs in the HCT setting are not well-characterized due to limited published data. In order to clarify this issue, we summarize the information on side effects associated with GCs, focusing specifically on the sequelae of these agents in the early post-HCT period. In instances where limited data are available, we included data from other fields such as autoimmune diseases, given the potential parallels between autoimmune conditions and GVHD.
Abstract Over the past decade, transplantation of peripheral blood hematopoietic cells has increased and is now the predominant graft source for related or unrelated adult allogeneic hematopoietic ...stem cell transplantation. At the same time, increasing numbers of patients are receiving reduced intensity conditioning prior to hematopoietic stem cell infusion. In prior work utilizing smaller patient numbers and limited data, reduced intensity conditioning peripheral blood stem cell transplantation was shown to be non-inferior to reduced intensity conditioning bone marrow transplantation for acute leukemia. A recent, large registry analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation showed peripheral blood grafts result in superior outcomes compared to bone marrow after reduced intensity conditioning regimens for acute leukemia. The T-cell replete peripheral blood stem cell allografts are associated with significant graft-versus-leukemia benefits that are important drivers of improved leukemia free survival and overall survival. However, an increased risk of chronic graft-versus-host disease after peripheral blood grafts is concerning and long term follow-up comparing peripheral versus bone marrow grafts after reduced intensity conditioning regimen is needed. Further assessment of the long standing risks should be undertaken in an effort to better understand whether the risk of chronic graft-versus-host disease among peripheral blood graft recipients translates into continued graft-versus-leukemia effects and long-term remissions and cures, or, results in late morbidity and mortality.
Cancer care advances have led to increased numbers of cancer survivors and to improved understanding of late effects of cancers and their therapies and survivorship issues. Long-term follow-up of ...cancer patients is crucial in preventing and managing many of the late effects of cancers and their therapies. However, the literature has highlighted the high rates of loss to follow–up (loss to FU) after cancer treatment, particularly in patients with hematologic malignancies. In this review, we performed a systematic search of published literature on issues pertaining to loss to FU in survivors of hematologic malignancies, highlighting the predictors of increased or decreased rates of loss to FU. We found that the literature on survivors of adulthood cancers is very limited, in contrast to articles discussing young adult survivors of childhood cancers. Predictors and barriers of loss to FU were found to be variable in different studies; however, they shared some common themes, including disease-related, logistic, financial and educational factors. Furthermore, we discuss the potential interventions to mitigate the loss to FU, along with discussing research priorities in this area.
The ideal stem cell graft source remains unknown in haploidentical haematopietic cell transplantation (haplo-HCT) with posttransplantation cyclophosphamide (PTCy). This study compared outcomes of ...bone marrow (BM) versus peripheral blood (PB) stem cell graft for haplo-HCT in acute lymphoblastic leukemia (ALL). A total of 314 patients with ALL (BM-157; PB-157) were included in this study. The cumulative incidence of engraftment at day 30 was higher in the PB group compared with BM (93% vs. 88%, p < 0.01). The incidences of acute graft-versus-host disease (GVHD) and chronic GVHD were not significantly different between the study cohorts. In the multivariate analysis, there were tendencies toward a higher incidence of grade II-IV acute GVHD (hazard ratio (HR) = 1.52, p = 0.07), chronic GVHD (HR = 1.58, p = 0.05), and nonrelapse mortality (NRM) (HR = 1.66, p = 0.06) in patients receiving PB versus BM graft, respectively. The use of PB grafts was associated with lower leukemia-free survival (LFS) (HR = 1.43, p = 0.05), overall survival (OS) (HR = 1.59, p = 0.02), and GVHD-free, relapse-free survival (GRFS) (HR = 1.42, p = 0.03) compared with BM grafts. There was no difference in relapse incidence (HR = 1.23, p = 0.41) between the study groups. In conclusion, use of BM graft results in better survival after haplo-HCT with PTCy in patients with ALL, compared with PB stem cell graft.
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