Autologous stem cell transplantation (ASCT) is known to be superior to conventional chemotherapies and has been established as a standard of care for young patients with multiple myeloma. In the 2000s, novel agents such as thalidomide, bortezomib, and lenalidomide became clinically available, and several clinical trials using these drugs as induction therapy, conditioning regimen, and post-transplant consolidation and maintenance therapy have been reported, leading to an increasing improvement in the treatment results compared to the conventional therapies. Future changes in the therapeutic strategies using the novel agents will increase the CR rate and prolong PFS and OS. The 2nd generation drugs including carfilzomib and pomalidomide, as well as antibody drugs such as elotuzumab and daratumumab, are now under development. These drugs are expected to further improve the treatment results.
Physical rehabilitation for allogeneic hematopoietic stem cell transplantation (HSCT) recipients has been recommended after its effectiveness in maintaining and improving motor function as well as quality of life was reported in Europe and the United States. In this study, we conducted a nationwide survey to investigate current issues in rehabilitation for allogeneic HSCT recipients in Japan and to aid in the design of rehabilitation programs hereafter. The survey was conducted in August 2010 by mailing questionnaires to 128 institutions where at least 5 allogeneic HSCTs were performed annually, excluding pediatric recipients. Of 80 responses received, 77 were selected for analysis after screening out invalid responses (valid response rate: 60.2%). The results obtained were as follows: 27 institutions (35.1%) provided physical rehabilitation services to all allogeneic HSCT recipients; 13 (16.9%) only provided them to those recipients with low performance status (PS) scores; and 37 (48.1%) did not provide any physical rehabilitation services. The most common reason given for not providing rehabilitation services was “insufficient physical therapists” (15 institutions; 40.5%). These findings provide evidence that the provisions for rehabilitation intervention for allogeneic HSCT recipients are by no means adequate in Japan, and that implementation of standard physical rehabilitation programs using evidence-based guidelines is urgently required.
The number of long-term survivors of allogeneic hematopoietic cell transplantation (allo-HCT) has continued to increase along with improved overall survival following allo-HCT. Although pediatric allo-HCT recipients need to be protected from vaccine-preventable diseases, the data on safety and efficacy of vaccines in them are limited. Therefore, we retrospectively evaluated the safety and efficacy of live attenuated vaccines in pediatric allo-HCT recipients who were treated at our hospital. This study targeted allo-HCT recipients whose antibody values were available after vaccination. The numbers of recipients vaccinated were 43 for measles, 37 for rubella, 29 for varicella, and 24 for mumps. The seropositivity percentages were 62.8% for measles, 67.8% for rubella, 58.6% for varicella, and 12.5% for mumps. No severe adverse event requiring treatment occurred. This study showed that overall vaccination in allo-HCT recipients is safe for all four vaccines and effective except against mumps.
We here report a rare case of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for an acute myeloid leukemia (AML) patient with the Rh-variant D-- phenotype. People whose red blood cells (RBCs) have a rare deleted Rh phenotype (D--) readily produce anti-Rh17 alloantibodies (an antibody to the RhCc/Ee protein). This causes clinical complications resulting from RBC destruction due to the interaction of alloantibodies with RBCs carrying the corresponding antigen. Consequently, patients with such variants who have formed alloantibodies pose a challenge for transfusions given the scarcity of compatible donors. In fact, in Japan, only 1 in 200,000 individuals are eligible donors. A 26-year-old male AML patient underwent allo-PBSCT from an HLA-matched sibling donor. He had the rare D-- phenotype and developed anti-Rh17 alloantibodies before allo-PBSCT. Given the scarcity of compatible blood donors for transfusions, the patient required autologous blood donations in preparation for allo-PBSCT. RBC engraftment was prompt during allo-PBSCT; thus, no unscheduled RBC blood transfusion was required. Five months later, his blood type changed to that of his sibling donor, and no irregular antibodies to RBCs were detected.
Some studies have reported the graft versus tumor (GVT) effect against neuroblastoma, but it remains unclear whether this effect is associated with long-term survival in neuroblastoma. Here, we describe a 13-year-old boy who has survived for 7 years following allogeneic hematopoietic stem cell transplantation (HSCT) for refractory neuroblastoma. The patient received conventional therapy, but there were residual tumor cells in bone marrow. Hence, he received allogeneic HSCT. Although he did not achieve complete remission just after HSCT, tumor markers were reduced during severe chronic graft versus host disease (cGVHD). This indicates the possibility that the GVT effect against neuroblastoma is associated with cGVHD and it can improve long-term outcome.
The Japan Society of Hematopoietic Cell Transplantation (JSHCT) has been collaborating with the Korean Society of Blood and Marrow Transplantation (KSBMT) since 2008, aiming at promoting the next generation of transplant physicians and facilitating scientific research. As a part of this collaborative activity, more than ten transplant physicians from JSHCT participated in the 18th annual winter meeting of KSBMT this year. I will herein report briefly about the meeting.