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Dr. Yvette Kasamon: New hope for bone marrow transplantation

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Dr. Yvette Kasamon: New hope for bone marrow transplantation

 

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CLEMENTINE:

Hello! You’re on MD-FM INSIGHT, the first medical web radio. Today we’ll be devoting our "Question & Answer" program to reduced intensity HLA-haplo-identical bone marrow transplantation.

At the 2013 annual meeting of the American Society of Hematology, which took place last December in New Orleans, we interviewed Dr. Yvette Kasamon, associate professor of oncology at the John Hopkins University in Baltimore, Maryland. She presented the results of a study evaluating the impact of older age on outcomes in non-myeloablative haplo-identical transplantation with post-transplantation cyclophosphamide.

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CLEMENTINE:

Hello Dr. Kasamon, first of all –can you tell us what is the main issue with bone marrow transplantation, why are we investigating the use of reduced intensity transplantation?

 

KASAMON:

“In general, in order to have a bone marrow transplant, you need to have had a fully matched donor but many patients are not able to find such a donor or it takes too long for such an unrelated donor transplant to be arranged --on average about 4 months. And so, the number of patients who are in need of transplant but who, for logistical reasons, cannot get one is a large barrier, and it is of upmost importance that we break that barrier so that we’re able to then offer a bone marrow transplant, which maybe the only curative option for these patients with advanced blood cancers.”

 

CLEMENTINE:

Ok so the reduced intensity approach enables to break that barrier… And in the specific context of HLA-haplo-identical transplantation, what is the role of post-transplantation cyclo-phosphamide?

 

KASAMON:

“The use of the post-transplantation cyclophosphamide significantly decreases the risk of graft vs. host disease, and also decreases the risk of graft failure. So, traditionally, historically, the more HLA mismatches, the worse people did in term of graft vs. host disease, graft failure and overall transplant-related deaths. However, with the use of this post transplant cyclophosphamide, it appears to level the playing field: if you look after half-matched transplants with the cyclophosphamide, the risks of significant complications like graft vs. host disease; for instance, were about as similar as one might see with a fully matched donor.”

 

CLEMENTINE:

So does this approach improve survival?

 

KASAMON:

“Well whether or not this particular approach improves survival is unclear. I happen to believe “certainly” that if you are doing a reduced intensity half-matched transplant, there are no comparative studies but: it does look like the cyclophosphamide after the transplant would likely improve survival, because graft vs. host disease is no longer the major barrier to a successful outcome with these transplants, it’s relapse.”

 

CLEMENTINE:

Ok, and so in terms of relapse … Isn’t mylo-ablative transplantation better than reduced intensity transplantation?

 

KASAMON:

“Yes there may be an increased risk of relapse with the reduced intensity transplants, because it’s less chemotherapy but there is also less risk of death from the transplant itself and so it may be, at the end of the day, that they look to be about the same…. So I think the take home point is not whether if reduced intensity transplant per se and our approach per se will improve survival or decrease relapse, it’s that this form of alternative donor transplant now affords the opportunity for patients who desperately need a transplant to actually have one and that having a perfect match is no longer a requirement for successful outcomes with an allogenic bone marrow transplant.”

 

CLEMENTINE:

And do you consider that your study completely validates these techniques?

 

KASAMON:

“Well so in terms of giving the post transplantation cyclophosphamide, and that general approach, I think the answer is: yes. But, what we don’t know is: are cord transplants better than reduced intensity transplants with post transplantation cyclophosphamide? It’s very difficult to do those studies, however there’s a randomized phase III study ongoing now through the bone marrow transplant clinical trial network, which is addressing just that question.”

 

CLEMENTINE:

So, all in all, what is your take home message?

 

KASAMON:

“The take home message is that with the recent advances in alternative donor transplant, be it cord, be it haplo-, these advances now significantly increase the availability of allogenic bone marrow transplants to patients who otherwise would not be able to get one. And the problem now with the haploidentical transplants, the way we do them, it’s no longer graft vs. host disease, it’s no longer graft failure --it’s relapse. And so the focus now is to look at strategies to reduce the risk of relapse in the nonmyeloablative setting.”

 

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Clementine:

This show is over. By visiting the MD-FM website, you can check out the themes of the programs we will be offering you regularly.

See you soon on MD-FM.

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