Allogeneic stem cell transplants in recent years have greatly improved in effectiveness. Overall survival increased highly significantly (41%) and the risk of severe graft versus host complications decreased by 67%. Article posted November 27, 2010

November 27, 2010. Source: N Engl J Med. 2010, 363:2091-2101, 2158-2159.

The effect of allogeneic hematopoietic stem cell transplantation (stem cell transplants using stem cells from donors) have improved significantly over the past ten years. Long-term survival was significantly improved (41%) and the risk of complications is significantly decreased (67%), according to a study published in the New England Journal of Medicine last week.

Patients who underwent a transplant in the period 2003 to 2007 gave a significant decrease in mortality seen and was not preceded by relapse compared with patients who had a transplant done in the peridoe from 1993 to 1997. This was determined by a measurement on day 200 (60%) and overall improvement (52%), and decreases were seen in the rate of relapse or progression of a malignant disease (21%) and total mortality ( 41%). The results were similar when the analysis was limited to patients who received myeloablative conditioning therapy, the researchers write.
There was also a significant reduction in the risk of severe graft versus host complications (GVHD). Patients in the 2003-2007 group had a 67% decrease in the probability of developing grade 3 or 4 GVDH.

Because the study retropostpectieve study and no randomized study with a control group given the evidence wetenschappeljk not hard to call, and more research is needed. It can be
coupled with a number of changes in clinical practice that have occurred between the two periods .. Moreover, the positive difference so evident that researchers are able to stand behind their conclusions. One explanation for this improvement can be explained as follows according to the researchers:


The main conclusion of this study is that changes in the practice of allogeneic blood and marrow transplantation have resulted in a reduction in overall mortality in the year 2000, compared to the year 1990, notes the author of an accompanying editorial, John H. Kerstens, MD.

Study Details

In the study, Dr.. McDonald and colleagues sought to determining whethere Advances in care have improved outcomes in transplantation. They Evaluated overall mortality, mortality not preceded
by relapse, recurrent malignant conditions, and the frequency and severity of Major Complications of transplantation (GVHD and hepatic, renal, pulmonary, and infectious Complications) in
Two time periods.

The first group was comprised of 1418 Patients who Received Their first allogeneic transplants at the Fred Hutchinson Cancer Center from 1993 to 1997, the second group was comprised
of 1148 Patients who Received Their first transplant from 2003 to 2007. The adjusted average time to engraftment was 1.83 days less in the 2003-2007 Group Than in the 1993-1997 group
(P <.001). It was 1.62 days less among patiënten who had gone under and engraftment Were receiving myeloablative therapy (P <.001).

In a subanalysis of Patients with low Rans Fun Plant Assessment of Mortality (PAM) scores (<18), the hazard ratio for death by day 200 that was not preceded by relapse in the 2 groups
was 0.41 and for overall mortality was 0.77. For Those with high PAM scores, the hazard ratios Were 0.36 and 0.5, respectively.
Lower Rate of Complications Associated With Mortality

The odds of Jaundice Were Reduced significantly, by More Than 70% in the 2003-2007 group. Stage 3 or 4 hepatic GVHD occurred in 11.9% of patients in the 1993-1997 group,
compared with 2.1% in the 2003-2007 group. There Were Also 78 cases of stage 4 liver GVHD in the 1993-1997 group and only 2 cases in the 2003-2007 group. The odds of acute kidney
Were injury significantly lower in the 2003-2007 Than in the 1993-1997 group, and "the hazard of respiratory failure" was 36% lower. From 1993-1997 to 2003-2007, the risk of Developing
bacteremia with a gram-negative organism Decreased by 39%, the risk for invasive mold infection Decreased by 51%, and the hazard of invasive candida infection Decreased by 88%.

The rate of cytomegalovirus (CMV) Reactivation remained stable in the two groups, but the hazard of early CMV disease Declined by 48% in the 2003-2007 group When All CMV sero-positive
patiënten Were included, and by 47% When only CMV sero-positive patients receiving myeloablative therapy Were included. Although theses data Clearly show improvements in outcomes over
time, the authors conclude the, They Also highlight areas or transplantation biology and patient care in Which Research is Needed to Achieve Further progress - specifically,
GVHD, graft vs. tumor effects, immune tolerance logic, and the management of infection and recurrent malignant conditions.

The study was supported by the National Institutes of Health. Several of the authors have disclosed relevant financial relationships, as noted in the paper. Dr. Kersey HAS
disclosed no relevant financial relationships.

N Engl J Med. 2010, 363:2091-2101, 2158-2159.