Allogeneic hematopoietic stem-cell transplantation is an effective therapeutic option for adults suffering from conditions such as acute myeloid leukemia, acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome. However, post-transplant relapse is still a challenge to be overcome. An intensified conditioning regimen with high-dose cytarabine (HDCA) added to cyclophosphamide/total-body irradiation (CY/TBI) has been developed to reduce post-transplant relapse. However, its additional effects have not yet been completely elucidated. Therefore, we conducted a cohort study to compare the prognosis of HDCA/CY/TBI and CY/TBI for myeloid malignancy and ALL. The superiority of HDCA/CY/TBI over CY/TBI was documented in cord blood transplantation, but not in bone marrow transplantation or peripheral blood stem cell transplantation. A large-scale prospective study is warranted for establishing the efficiency of the HDCA/CY/TBI conditioning regimen.
We retrospectively analyzed the outcomes of 14 patients with chronic myeloid leukemia (CML) who underwent allogeneic hematopoietic stem cell transplantation in the tyrosine kinase inhibitor (TKI) era. The median age of the patients was 42 years (range, 20-66 years). Disease status at transplantation was as follows: first chronic phase (CP1; n=3), second chronic phase (CP2; n=8), and accelerated phase/blast phase (AP/BP; n=3). Sources of stem cells were as follows: related bone marrow (BM; n=2), related peripheral blood stem cells (n=1), unrelated BM (n=4), and cord blood (n=7). The 3-year overall survival (OS) rate was 71%. According to the disease status at the time of transplantation, the 3-year OS rate was 67% in CP1, 75% in CP2, and 67% in AP/BP (P=0.925). The six patients newly diagnosed with BP CML achieved CP2, and the 3-year OS rate was 83%. In the TKI era, patients newly diagnosed with BP CML are expected to demonstrate improved prognosis.
We investigated the practice of physical therapy for patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Japan. In June 2014, questionnaires were sent to physical therapists in 65 hospitals to survey the standard practice of physical therapy for patients who underwent allo-HSCT. The questionnaires consisted of 22 items, including the patient’s condition which made it difficult to decide whether to apply physical therapy and how the therapists managed this decision, and how they learned about physical therapy in allo-HSCT and the anxiety they felt regarding their knowledge in this area. The response rate was 75% (49 hospitals). Twenty-one items, including fever, nausea, and vomiting, were suggested as patient conditions that often required difficult decisions for physical therapists to practice physical therapy, and some hospitals established rules for these conditions. In addition, many physical therapists felt anxious about their knowledge regarding physical therapy in allo-HSCT. These findings suggest that we should develop standard guidelines for effectively performing physical therapy in patients who have undergone allo-HSCT.
In 1963, we had our first 5-year survivor with adult acute leukemia in Osaka, which initiated the hope to cure leukemia. Intensive chemotherapy followed by bone marrow transplantation was further propelled by medical developments such as the bio-clean room, fraction transfusions, antiviral and antifungal drugs, immunosuppressants, and colony-stimulating factors. This was supported by the initiation of the Japan marrow donor program along with cord blood banking, as well as the enactment of the law for the adequate procurement of hematopoietic stem cells. All of these movements were supported by the goodwill and cooperation of many individuals.