1998 European Group for Blood and Marrow Transplantation
The 24th annual meeting of the European Group for Blood and Marrow Transplantation - March 22-26, 1998
by Jennifer Treleaven, MD
As always, there was a wide variety of presentations pertaining to all aspects of stem cell
transplantation, including both clinical and laboratory issues.
Stem cell transplantation is now applicable to a wider patient population than has been
the case previously. Older subjects can benefit, and the disease categories for which a
stem cell transplant procedure is recognized as an appropriate therapeutic approach are
expanding. These have come to include, among many others, breast cancer, chronic
lymphocytic leukaemia and multiple myeloma. The source from which stem cells may be
recovered has also expanded to include cord blood in addition to bone marrow and
peripheral blood.
Of particular interest were the abstracts describing the preparation of cord blood for
transplantation (Torretta et al in Pavia, Italy, Richter et al from Mannheim in Germany,
and Marchand et al from Besancon in France). Clinical papers came from Gluckman et al
on behalf of Eurocord concerning results in children suffering from b thalassemia major.
They described 7 children transplanted after Bu/Cy conditioning, with a mean of 3.3
x107/kg nucleated cells. All of the patients are alive, although engraftment occurred in
only 4 out of 7 patients. One rejected the transplant and 3 are currently transfusion
independent. The other 4 are alive with thalassemia. The authors suggest that more
immunosuppressive conditioning regimens and GvHD prophylaxis may be appropriate
although the incidence of GvHD between HLA matched siblings seems small, and that the
body weight of recipients should be small to maximize the number of nucleated cells/kg
body weight received.
Ortega et al from Barcelona in Spain presented 10 paediatric patients with an assortment
of haematological problems, for whom the cord blood donor was an HLA identical sibling
in 2 cases and an unrelated donor in 8 cases, not always matched at 6/6 alleles. They
observed sustained engraftment in 90% of patients and autologous reconstitution in 1
patient. 6 patients were alive and well after 5-39 months.
Both of these papers indicate that cord blood-derived stem cells offer a viable alternative
to blood or bone marrow-derived stem cells in matched, matched but unrelated and
mismatched unrelated settings, provided that sufficient cells can be obtained from the
cord to sustain engraftment. The future will surely afford further experience using these
procedures and in optimizing conditioning and immunosuppressing regimens, as well as
making cord blood transplants available to a wider patient population.
Multiple myeloma and chronic lymphocytic leukaemia are usually associated with the older
age groups but occur in patients of under 50 years of age in a significant proportion of
cases. Although responsive to autologous transplantation, they commonly relapse and
may be considered largely incurable using these procedures. Allogeneic transplantation
using either bone marrow or peripheral blood stem cells to rescue the patient has been
attempted by a number of institutions. For myeloma, Majolino et al from Torino, Italy
presented data on 10 patients who underwent allografting with PBSC and achieved a CR in
71%. 8 are currently still alive, and 6 are in CR 7-28 months from transplant. Gahrton et
al, representing the EBMT Myeloma Subcommittee, carried out a multivariate analysis for
factors associated with improved survival with allo-BMT and showed that the favorable
ones are age less than 50 years, female sex, b-2 microglobulin less than 1mg/ml in
serum and only one line of treatment administered prior to BMT. Relapse was more
common in the autologous group, and transplant-related mortality higher in the
allogeneic group. Long-term survival appeared to be similar in the 2 groups, and donor
lymphocyte infusions appeared to produce some responses in patients relapsing after
allo-BMT.
As far as chronic lymphocytic leukaemia is concerned, a number of centers, including the
EBMT Subcommittee CLL working Party led by Michallet, the Royal Marsden Hospital UK,
and the Hospital Clinic, Barcelona, Spain, reported outcomes after allo-BMT. They all
found a higher transplant-related mortality with allo-BMT but noted promising long-term
disease-free survivals. The Royal Marsden group noted that aggressive antimicrobial
prophylaxis is crucial to prevent opportunistic infections, and that there is evidence for an
allogeneic graft-versus-leukemia effect.
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