Objective: The objective of this study was to analyze factors associated with outcomes of allogeneic hematopoietic cell transplantation (HCT), and cytogenetic and disease risks at HCT among patients with minimally differentiated acute myeloid leukemia (AML) to identify the potential clinical efficacy of allogeneic HCT. Patients and Methods: We retrospectively analyzed 398 patients who received allogeneic HCT for minimally differentiated AML between 2000 and 2015. Results: According to cytogenetic and disease risks at HCT, we divided patients into four groups: 1) intermediate risk and complete remission (CR) (n=183) or 2) non-CR (n=90), and 3) poor risk and CR (n=66) or 4) non-CR (n=59). Median follow-up times for survivors were 8-42 months. Three-year overall survival (OS) in the four groups were 1) 59.7%, 2) 30.9%, 3) 58.7%, and 4) 9.7%, respectively. Multivariate Cox regression analysis showed that a poor risk, Eastern Cooperative Oncology Group performance status≧1, and non-CR at HCT were independent predictors of poorer OS. Conclusion: Our data suggest that allogeneic HCT can be considered for patients with minimally differentiated AML. Prospective trials of allogeneic HCT are needed to improve the safety and efficacy of allografting in patients with minimally differentiated AML.
There is an urgent need to achieve more efficient and rapid donor coordination process in the Japan Marrow Donor Program (JMDP). We conducted a questionnaire survey to evaluate the relationship between stem cell donation and the psychosocial background of unrelated donors registered to JMDP. Unrelated donors who donated stem cells or who terminated coordination of JMDP for reasons not including health conditions or patient-related factors were enrolled in April and May 2017. Of 870 donors (non-donation group, 738 donors; donation group, 132 donors) who were mailed questionnaires, 385 donors (non-donation, 315; donation, 70) responded. Multivariate logistic regression showed that high cooperativity (scored on a five-point scale), low anxiety regarding donation, and low difficulty controlling work/family issues were significantly associated with successful donation. Donors who had donated blood frequently (>10 times) showed an odds ratio of 2.5 for stem cell donation, by univariate analysis. In the non-donation group, the reasons for not donating were “Donation may affect my work/I could not arrange my work schedule” in 43% of donors, “My family disagreed” in 21%, “May affect family life” in 15%, and “concern/fear about the risk of donation” in 11%. Using factors we found to be associated with donation (cooperativity, anxiety, and control of work/family issues), a large-scale survey is warranted to put up concrete measures.
The purpose of this study was to investigate changes in skeletal muscle cross-sectional area after allogeneic hematopoietic stem cell transplantation. The study included 15 patients who underwent computed tomography before and after stem cell transplantation. The gluteus maximus, gluteus medius, rectus femoris, rectus abdominis, abdominis lateralis, and paraspinal muscles were analyzed. After transplantation, the gluteus maximus, gluteus medius, and rectus femoris muscles showed significantly reduced cross-sectional area and demonstrated fatty degeneration. Although no fatty degeneration was observed, cross-sectional area was reduced in the paraspinal muscles. Changes in skeletal muscle early after allogeneic hematopoietic stem cell transplantation differed among muscle types. Our findings suggested that paraspinal muscle groups, although classified as antigravity muscles, also exhibit atrophy similar to that in lower limb skeletal muscles.
Complications associated with allogenic hematopoietic stem cell transplantation include oral mucosal disorder and severe sepsis resulting from myelosuppression. The present study investigated factors that could potentially suppress severe oral mucosal disorder during allogeneic hematopoietic stem cell transplantation. A survey was conducted of patients who received allogenic hematopoietic stem cell transplantation between April 2011 and March 2015. Survey items included age, sex, stem cell source, Hematopoietic Cell Transplantation-specific Comorbidity Index score, human leukocyte antigen compliance, the intensity conditioning regimen, total body irradiation dose, methotrexate administration, oral management (2013.4-), myelosuppression of hematopoietic stem cell transplantation, and professional mechanical tooth cleaning (PMTC) before hematopoietic stem cell transplantation. Age (P=0.0560) was associated with the severity of oral mucosal disorder (P<0.2), and PMTC before hematopoietic stem cell transplantation (P=0.0021) was selected. In logistic regression analysis, PMTC before hematopoietic stem cell transplantation was significantly associated with reduced severe oral mucosal disorder (odds ratio 0.3692; P=0.0017). We examined the cases without PMTC or PMTC after August 2012 when there was myelosuppression before July 2017 and found significant oral mucosal disorder in the group treated with PMTC had been reduced (P=0.0024). PMTC is an important supportive therapy to suppress the severe oral mucosal disorder suggested that it should be performed for all patients before undergoing allogenic hematopoietic stem cell transplantation.
A hematopoietic cell transplant coordinator (HCTC) is responsible for the coordination between recipients and donors in transplant centers. In July 2015, we established an HCTC-led coordination system, replacing the previously physician-led coordination system. In the present study, we retrospectively analyzed the coordination period during the search for unrelated donors through the Japan Marrow Donor Program (JMDP) prior to and after introducing the HCTC-led coordination system at our institution. A total of 72 recipients were enrolled in this study: 41 (prior to) and 31 (after introducing the system). Following the introduction of the HCTC-led coordination system, the median time between registration for the initiation of a JMDP donor search and actual transplant was significantly shortened by 34 days (from 154 to 120 days, P=0.0003). Similarly, the median time between the registration for the initiation of a JMDP donor search and selection of the donor, and the median time between the selection of the donor and actual transplant were significantly shortened from 72 to 58 days (P=0.03) and from 73 to 61 days (P=0.0006), respectively. Our findings suggested that the introduction of an HCTC-led coordination system in transplant centers may markedly shorten the search time for an unrelated donor through the JMDP.
This study illustrated the narrative personal stories of three sibling donors of hematopoietic stem-cell transplantation (HSCT). We recapitulated data from semi-structured interviews conducted by using the life-story method, and we analyzed psychological influences which the sibling donors had on their families in terms of the family system theory. Donor A (30s, male) donated to his sister with acute leukemia. Through the process of transplantation, donor A and his sister became aware of the power balance between them, which influenced to their parent`s emotional attitude. Donor B (40s, male) donated to his brother with acute leukemia. The awareness of blood ties in turn raised his anxiety of the risk of leukemia in Donor B and his children. Donor C (60s, female), the youngest of 4 sisters, donated to her sister with malignant lymphoma. The strength of the emotional bond among the 4 sisters was maintained and reinforced even after the death of the patient. Collectively, these analyses suggest that sibling donor HSCT has an influence on the whole family relationships as well as those among the involved siblings, which warrants the need for sustainable family support before and after HSCT.