Recent Trends in Allogeneic Hematopoietic Stem Cell Transplantation: CIBMTR Data

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Recent Trends in Allogeneic Hematopoietic Stem
Cell Transplantation CIBMTR Data

• Ravi Vij MD
• Assistant professor
• Section of BMT and Leukemia
• Washington University School of Medicine

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ANNUAL NUMBERS OF BLOOD AND MARROW TRANSPLANTS
WORLDWIDE1970-2002
Autologous
NUMBER OF TRANSPLANTS
Allogeneic
1970
1975
1980
1985
1990
1995
2000
YEAR
1
3
Indications for Hematopoietic Stem Cell
Transplantation in North America2003
Allogeneic (Total N7,300) Autologous (Total
N9,600)
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Allogeneic Transplants in Patients
gt20y,Registered with the CIBMTR, 1989-2004- By
Donor Type -
Data incomplete
Slide 9
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Allogeneic Stem Cell Sourcesby Recipient
Age1997-2004
Bone Marrow (BM) Peripheral Blood (PB) Cord
Blood (CB)
Age 20 yrs Age gt20 yrs
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Cord Blood Transplants,Registered with the
CIBMTR, 1997-2004
Data incomplete
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Trends in Allogeneic TransplantsRecipient
Age1987-2004
20 yrs 21-40 yrs 41-50 yrs 51-60 yrs gt60 yrs
Transplants for AML, ALL, CML
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Allogeneic Transplants,Registered with the
CIBMTR,1998-2004
Data incomplete
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100-day Mortality after HLA-identical Sibling
Myeloablative Transplants,2002-2003
1st Complete Remission 2nd Complete Remission
Not in Remission Chronic Phase Accelerated
Phase Blast Phase
AML ALL CML MDS Aplastic Immune Anemia Defic
iency
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100-day Mortality after Unrelated Donor
Transplants, 2002-2003
AML ALL CML MDS Aplastic Immune Anemia Defic
iency
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Causes of Death after Transplants Done in
1998-2002
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Indications for Allogeneic Hematopoietic Stem
Cell Transplants, 2003 Worldwide
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Probability of Survival after HLA-identical
Sibling Transplants with Myeloablative
Conditioning for AML, Age ³20 Years, 1998-2004-
by Disease Status -
Early (N2,369)
Probability,
Intermediate (N611)
Advanced (N1,113)
P lt 0.001
0
2
6
1
3
4
5
Years
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Probability of Survival after HLA-identical
Sibling Transplants for AML, Age gt50 Years,
1998-2004- by Disease Status and Conditioning
Regimen Intensity -
Early, Myeloablative (N467)
Probability,
Early, RIC (N278)
Intermediate, Myeloablative (N133)
Intermediate, RIC (N113)
P 0.54
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
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Probability of Survival after HLA-identical
Sibling Transplants for ALL, Age ³20 Years,
1998-2004- by Disease Status -
Probability,
Early (N879)
Intermediate (N323)
Advanced (N360)
P lt 0.001
0
2
6
1
3
4
5
Years
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Probability of Survival after Transplants for CML
in Chronic Phase, 1998-2004- by Donor Type and
Disease Duration -
HLA-identical sibling, lt1y (N2,813)
HLA-identical sibling, ³1y (N1,218)
Probability,
Unrelated, lt1y (N1,099)
Unrelated, ³1y (N1,281)
P lt 0.001
0
2
6
1
3
4
5
Years
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Probability of Survival after Autologous and
HLA-identical Sibling Transplants for CLL,
1998-2004
Auto (N342)
RIC (N317)
Probability,
Myeloablative conditioning (N290)
P lt 0.001
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
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Probability of Survival after Allotransplants
for Early MDS, Age gt50 Years, 1998-2004- by
Conditioning Regimen and Donor Type -
Myeloablative, HLA-id sib (N89)
Probability,
RIC, unrelated (N33)
Myeloablative, unrelated (N50)
RIC, HLA-id sib (N78)
P 0.97
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
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Probability of Survival after Allotransplants for
Advanced MDS, Age gt50 Years, 1998-2004- by
Conditioning Regimen and Donor Type -
Myeloablative, HLA-id sib (N249)
Myeloablative, unrelated (N163)
Probability,
RIC, HLA-id sib (N135)
RIC, unrelated (N93)
P lt 0.001
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
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Probability of Survival after Transplants for
Severe Aplastic Anemia, 1998-2004- by Donor Type
and Age -
HLA-id sib, 20y (N915)
HLA-id sib, gt20y (N822)
Unrelated, 20y (N388)
Probability,
Unrelated, gt20y (N212)
P lt 0.001
0
2
6
1
3
4
5
Years
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Probability of Survival after HLA-identical
Sibling Transplants for Follicular Lymphoma,
1998-2004- by Disease Status and Conditioning
Regimen -
Chemo-sensitive, RIC (N195)
Chemo-sensitive, Myeloablative (N267)
Probability,
Chemo-resistant, RIC (N37)
Chemo-resistant, Myeloablative (N60)
P 0.0258
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
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Probability of Survival after HLA-identical
Sibling Transplants for Diffuse Large Cell
Lymphoma, 1998-2004- by Disease Status and
Conditioning Regimen -
Chemo-sensitive, RIC (N56)
Chemo-sensitive, Myeloablative (N214)
Chemo-resistant, Myeloablative (N75)
Chemo-resistant, RIC (N26)
Probability,
P 0.011
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
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Probability of Survival after Transplants for
Mantle Cell Lymphoma, 1998-2004- by Donor Type
and Conditioning Regimen -
Auto (N1,202)
Probability,
HLA-id sib, RIC (N111)
HLA-id sib, Myeloablative (N205)
unrelated, RIC (N60)
Unrelated, Myeloablative (N46)
P lt 0.001
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
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Probability of Survival after Allotransplants
for Hodgkin Disease, 1998-2004- by Donor Type
and Conditioning Regimen -
HLA-id sib, RIC (N79)
Unrelated, Myeloablative (N33)
Probability,
HLA-id sib, Myeloablative (N129)
Unrelated, RIC (N30)
P 0.39
0
2
6
1
3
4
5
RIC Reduced Intensity Conditioning
Years
Slide 45
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Probability of Survival after Hematopoietic Stem
Cell Transplants for Multiple Myeloma,
1998-2004- by Donor Type -
Auto (N12,565)
Probability,
HLA-id sib (N763)
Unrelated (N103)
0
2
6
1
3
4
5
Years
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Indications for Allogeneic Transplantation

• High risk AML in CR1 and all AML patients in
  CR2/relapse
• High risk ALL in CR1 and all ALL patients in CR2
• CML resistant or refractory to bcr-abl inhibitors
• Young patients with MDS
• Aplastic Anemia
• Young patients with low grade lymphoma/CLL
  failing initial therapies.
• Aggressive NHL that is refractory to or relapses
  soon after initial therapy

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Indications for Reduced Intensity Transplantation

• Low grade lymphoproliferative disorders
• Older patients with myeloid neoplasms
• 2nd transplant after prior autologous or
  allogeneic transplant
• ?As part of tandem auto-allogeneic approach for
  myeloma and aggressive lymphoid neoplasms.