Phase I Trial of Post Allogeneic Stem Cell Transplant Maintenance Lenalidomide in Patients with High Risk Acute Myeloid Leukemia or Myelodysplastic Syndrome
Background: Patients (pts) with High-risk Acute Myeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS) often proceed to allogeneic hematopoietic stem cell transplant (alloHSCT) due to poorer outcomes. This is the only chance of cure; however, relapse rates after alloHSCT remain high and range between 25-50%. Maintenance approaches post-HSCT, such as hypomethylating agents or tyrosine kinase inhibitors, have been used to decrease the relapse rate with mixed results. Lenalidomide is known to augment T/NK cell activity/proliferation which lead us to hypothesize that it will enhance the Graft-versus-Leukemia (GvL) effect without increasing the incidence of acute Graft-versus-Host (GvH).
Background: Studies of bone marrow cell clonal alterations in patients with Fanconi anemia (FA), a cancer-prone inherited bone marrow failure (BMF) syndrome, have focused on their role in progression from BMF to myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). The role of such alterations on patient outcomes after hematopoietic cell transplantation (HCT) is unknown.
Background: Azacitidine (Aza) and donor lymphocyte infusions (DLI) confer survival advantage with improved tolerability for patients with relapsed acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) following allogenic stem cell transplantation (SCT).
Background: We tried to clarify the clinical significance of Wilms tumor gene-1 expression in peripheral blood cells (PB-WT1) for early detection of relapse in patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Myelodysplastic syndrome (MDS) is an aging-associated group of clonal disorders characterized by ineffective hematopoiesis, leading to cytopenias and an increased risk of developing acute myeloid leukemia (AML). MDS arises from abnormal hematopoietic stem cells (HSCs). The only potentially curative therapy available for MDS patients is hematopoietic cell transplantation (HCT), but relapse is common, likely due to the inability of current therapies to effectively eliminate disease-initiating MDS HSCs.
Background: Allogeneic hematopoietic stem cell transplantation (HCT) is a highly effective therapy for acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS), but can be associated with significant morbidity and mortality. Low pre-HCT diffusing capacity for carbon monoxide (DLCO) is a risk factor for death post-HCT. We sought to identify additional patient- or HCT-related variables that might modulate this risk.
Background: Outcomes of allogeneic stem cell transplantation (AHSCT) vary based on both disease and patient characteristics. Our group developed a model to predict survival in patients with AML/MDS using 3 factors, 2 disease-related (cytogenetics, disease status at transplant) and 1 patient-related (HCT-CI) (Bachegowda et al.Blood.2017). This model effectively stratified patients into 3 risk groups with very different survival. Here we aim to validate this model in a large cohort of AML/MDS patients receiving AHSCT with different donors.
Background: Melphalan exposure as measured by area under the curve (AUC) has a 5-fold variability between pts, with higher AUCs associated with improved outcomes but increased toxicity (Shaw BBMT 2012). Evomela ® (propylene glycol free melphalan, PGF-MEL) is an intravenous formulation with improved stability and possibly less toxicity related to the solubilizing agent. We aimed to determine the pharmacokinetics (PK) and relationship between exposure and toxicities with this formulation in order to optimiz e dosing.
AbstractIn contrast to the evidence regarding azacitidine (Aza), there is limited knowledge about the combination of decitabine (DAC) and donor lymphocyte infusions as salvage therapy for relapse after allogeneic stem cell transplantation (allo-SCT) so far. We retrospectively analyzed data of 36 patients with hematological (n = 35) or molecular relapse (n = 1) of acute myeloid leukemia (AML,n = 29) or myelodysplastic syndrome (MDS,n = 7) collected from 6 German transplant centers. Patients were treated with a median of 2 cycles DAC (range, 1 to 11). DAC was the first ...
Allogeneic hematopoietic stem cell transplantation (HCT) remains the best established curative treatment for high-risk hematologic malignancies. Common indications for HCT, such as acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), are largely diseases of older age and have poor outcomes after nontransplant therapy [1,2]. The feasibility of HCT after reduced-intensity conditioning (RIC) from HLA-matched related (MRD) or unrelated donor (MUD) has been well established, permitting overall survival (OS) of around 30% to 50% [3,4].
Haplo/cord transplantation combines an umbilical cord blood (UCB) graft with CD34-selected haploidentical cells and results in rapid hematopoietic recovery followed by durable UCB engraftment. We compared outcomes of transplants in older patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS) who received either HLA-matched unrelated donor cells (MUD) or haplo/cord grafts. Between 2007 and 2013, 109 adults ages 50 and older underwent similar reduced intensity conditioning (RIC) with fludarabine and melphalan and antibody-mediated T-cell depletion for AML (n=83) or high risk MDS (n=26) follow...