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2 results on '"Couriel, Daniel R"'

1. Increasing Incidence of Chronic Graft-versus-Host Disease in Allogeneic Transplantation – A Report from CIBMTR

Author

Arai, Sally, Arora, Mukta, Wang, Tao, Spellman, Stephen R., He, Wensheng, Couriel, Daniel R., Urbano-Ispizua, Alvaro, Cutler, Corey S., Bacigalupo, Andrea A., Battiwalla, Minoo, Flowers, Mary E., Juckett, Mark B., Lee, Stephanie J., Loren, Alison W., Klumpp, Thomas R., Prockup, Susan E., Ringdén, Olle T.H., Savani, Bipin N., Socié, Gérard, Schultz, Kirk R., Spitzer, Thomas, Teshima, Takanori, Bredeson, Christopher N., Jacobsohn, David A., Hayashi, Robert J., Drobyski, William R., Frangoul, Haydar A., Akpek, Görgün, Ho, Vincent T., Lewis, Victor A., Gale, Robert Peter, DSc(hon), Koreth, John, Chao, Nelson J., Aljurf, Mahmoud D., Cooper, Brenda W., Laughlin, Mary J., Hsu, Jack W., Hematti, Peiman, Verdonck, Leo F., Solh, Melhelm M., Norkin, Maxim, Reddy, Vijay, Martino, Rodrigo, Gadalla, Shahinaz, Goldberg, Jenna D., McCarthy, Philip L., Pérez-Simón, José A., Khera, Nandita, Lewis, Ian D., Atsuta, Yoshiko, Olsson, Richard F., Saber, Wael, Waller, Edmund K., Blaise, Didier, Pidala, Joseph A., Martin, Paul J., Satwani, Prakash, Bornhäuser, Martin, Inamoto, Yoshihiro, Weisdorf, Daniel J., Horowitz, Mary M., and Pavletic, Steven Z.

Subjects
Adult, Male, Adolescent, International Cooperation, Hematopoietic Stem Cell Transplantation, Infant, Newborn, Graft vs Host Disease, Infant, Middle Aged, Myeloablative Agonists, Survival Analysis, Article, Leukemia, Myeloid, Acute, immune system diseases, hemic and lymphatic diseases, Child, Preschool, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Myelodysplastic Syndromes, Chronic Disease, Odds Ratio, Humans, Transplantation, Homologous, Female, Child, Bone Marrow Transplantation
Abstract

Although transplant practices have changed over the last decades, no information is available on trends in incidence and outcome of chronic graft-versus-host disease (cGVHD) over time. This study used the central database of the Center for International Blood and Marrow Transplant Research (CIBMTR) to describe time trends for cGVHD incidence, nonrelapse mortality, and risk factors for cGVHD. The 12-year period was divided into 3 intervals, 1995 to 1999, 2000 to 2003, and 2004 to 2007, and included 26,563 patients with acute leukemia, chronic myeloid leukemia, and myelodysplastic syndrome. Multivariate analysis showed an increased incidence of cGVHD in more recent years (odds ratio = 1.19, P.0001), and this trend was still seen when adjusting for donor type, graft type, or conditioning intensity. In patients with cGVHD, nonrelapse mortality has decreased over time, but at 5 years there were no significant differences among different time periods. Risk factors for cGVHD were in line with previous studies. This is the first comprehensive characterization of the trends in cGVHD incidence and underscores the mounting need for addressing this major late complication of transplantation in future research.

Published
2014

2. Double Umbilical Cord Blood Transplantation after Novel Myeloablative Conditioning Using FluBu4/TLI

Author

Abedin, Sameem, Levine, John E., Choi, Sung, Yanik, Gregory, and Couriel, Daniel R.

Subjects
Adult, Male, Time Factors, Transplantation Conditioning, Adolescent, Graft vs Host Disease, Pilot Projects, Article, Disease-Free Survival, Neoplasms, Humans, Child, Busulfan, Aged, Incidence, Graft Survival, Infant, Newborn, Infant, Middle Aged, Myeloablative Agonists, Hematologic Diseases, Survival Rate, Child, Preschool, Acute Disease, Chronic Disease, Female, Cord Blood Stem Cell Transplantation, Vidarabine, Whole-Body Irradiation, Follow-Up Studies
Abstract

We conducted a pilot study evaluating double umbilical cord blood transplantation (dCBT) after myeloablative conditioning with fludarabine and busulfan 3.2 mg/kg i.v. × 4, followed by total lymphoid irradiation at 400 cGy (FluBu4/TLI) for any indicated hematological disorder for patients without a suitable donor. Twenty patients with predominantly high-risk disease underwent dCBT according to protocol. The regimen was well tolerated, with mucositis as the primary observed toxicity (n = 19). The cumulative incidence of neutrophil engraftment was 89% (95% confidence interval [CI], 64% to 97%), with a median time to recovery of 16 days (range, 12 to 31 days). All evaluable patients with neutrophil engraftment achieved complete donor chimerism by day 40. The cumulative incidence of grades III and IV acute graft-versus-host disease (GVHD) at day 100 was 10% (95% CI, 2% to 27%), and the cumulative incidence of chronic GVHD was 35% (95% CI, 16% to 55%) by the end of the study. At 1 year, the cumulative incidence of treatment-related mortality (TRM) was 35% (95% CI, 16% to 55%). The leading cause of nonrelapse mortality was acute GVHD (n = 4), followed by graft failure (n = 2) and chronic GVHD (n = 1). TRM was significantly associated with a pretransplantation hematopoietic cell transplantation-specific comorbidity index score ≥ 3 (P = .005). At 1 year, disease relapse occurred in 6 patients and overall survival was 40% (95% CI, 19% to 60%). We conclude that FluBu4/TLI is an adequate preparative regiment before dCBT, providing high engraftment rates and relatively early neutrophil recovery. The best survival outcomes were seen in patients without significant comorbidities before transplantation, and outcomes are comparable to previously published dCBT studies.

Published
2014

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