Univ. Prof. Dietger Niederwieser José Carreras Transplantationseinheit Hämatologie und intern. Onkologie Leipzig.

Präsentation zum Thema: "Univ. Prof. Dietger Niederwieser José Carreras Transplantationseinheit Hämatologie und intern. Onkologie Leipzig."—  Präsentation transkript:

1 Univ. Prof. Dietger Niederwieser José Carreras Transplantationseinheit Hämatologie und intern. Onkologie Leipzig

2 East German study group (OSHO): OS of AML patients according to age p=0.0005 0.62±0.16 0.17±0.41 Time from diagnosis (years) Proportion of patients alive  60 years >60 years 01230123 1 0.8 0.6 0.4 0.2 0

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22 HSCT - rates in Europe 2000 Total transplants (1st.) per 10 million 0 or no report 1 - 50 51 - 200 201 - 400 > 400

23 EBMT SURVEY ON BMT IN 2000 Donor type and source BM PBPC Total Allogeneic total2989 3415 6404 HLA-id1700 2255 3955 HLA-nid 84 353 437 twin 14 44 58 unrel1191 763 1954 Autologous 566 12166 12732 Preliminary data 9.2001

24 EBMT SURVEY ON BMT IN 2000 Main Indications Allo AutoTotal Leukemias465317646417 Lymphomas 82084989318 SAA 287 1 288 Solid tumors 10422862390 Non malignant disorders 413 99 512 Others 127 84 211 Total6404 12732 19136 Preliminary data 9.2001

25 0 10 20 30 40 50 60 70 80 90 100 19901991199219931994199519961997 % BM allo PBPC allo BM auto PBPC auto Changes in stem cell source 1990-1997 7 / 98

26 Stem Cell Transplantation In DLA-identical Littermate Dogs With Minimal Conditioning (R. Storb, Blood, 89:3048-3054)

27 Induction of chimerism for the treatment of hematological malignancies using unrelated donors University Leipzig, Germany FHCRC, Seattle, USA Stanford University, USA

28 Treatment Protocol: HLA-Matched Related Grafts Fludarabine: 30 mg/m 2 /day (110 / 212 pts) PBSC HSCT: CD34 + : 8.0 x 10 6 /kg (1.0-42.6) CD3 + : 3.6 x 10 8 /kg (0.3-68.0) MMF 15 mg/kg po bid CSP 6.25 mg/kg po bid 2 GyTBI HSCT Chimerism Analyses -3560283584-4-2 FLU CSP 6.25 mg/kg po bid 180

29 Neutrophils Platelets Hematologic Changes Following Autologous and Allogeneic Transplantation Allo Auto ASH Plenary 2001

30 RESULTS Full Chimerism can be induced with minimal conditioning also using unrelated donors. 6 out of 52 patients rejected. 25 / 52 patients (48%) are alive after a median observation time of 210 days (range 13-655). The TRM is low with 25% despite high age and contraindication for conventional SCT. Graft-versus-Host-Disease grade II-IV occurred in 33 / 46 evaluable patients (71,7%) and was lethal in 6 patients (13%).

31 3624120 1,0 0,8 0,6 0,4 0,2 0 LFS 0,64  0,11 0,32  0,11 0,06  0,05 TRM Rezidiv Monate Wahrscheinlichkeit HSCT after 200 cGy±Fludarabine in patients mit de novo or secundary AML ( n = 22 )

32 Marc Frederick freut sich: Fett ist die ideale Quelle für Stammzellen, denn es gibt eine Menge davon. „Wer es also zukünftig nicht schafft, die überflüssigen Pfunde auf herkömmliche Weise loszuwerden, kann es ja mit einer Stammzellspende versuchen.

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34 Fred Hutchinson Cancer Research Center Rainer StorbChris Flowers Marie-Térèse LittleLyle Feinstein Brenda SandmaierAnn Woolfrey David Maloney Mary Flowers Mike MarisBill Bensinger Jerry RadichTed Gooley Art MolinaBeverly Torok-Storb Seattle VA Hospital Tom Chauncey Stanford University Judy Shizuru Karl Blume University of Colorado Peter McSweeney City of Hope Firoozeh Sahebi Ashwin Kashyap Stephen Forman University of Leipzig U. Hegenbart W. Pönisch; Uharek F. Kamprath; Th. Lange AND THE TRANSPLANT TEAMS