Pre-transplant conditioning can significantly influence post-transplant outcomes. A strong anti-tumor effect achieved by myeloablative conditioning (MAC) is frequently counterbalanced by higher morbidity and non-relapse mortality, particularly in older adults. On the other hand, reduced intensity conditioning (RIC) is associated with lower post-transplant mortality, but may not be sufficient enough to prevent relapse, particularly in patients with persistent and aggressive malignances.
According to the American Cancer Society, it was estimated in 2011 there were 44,600 cases of leukemia, 66,360 cases of non-Hodgkin lymphoma, 8,830 cases of Hodgkin lymphoma, and 20,520 cases of myeloma diagnosed for the first time. In addition, the Leukemia and Lymphoma Society estimates that one person is diagnosed with a blood cancer approximately every four minutes in the U.S. The outcome for patients with hematologic malignancies has dramatically changed with the use of novel therapies.
The treatment of acute myelogenous leukemia (AML) has 2 steps: the first step involves therapy to get it into remission, and the second step involves therapy to prevent it from coming back. Over several decades our approach to the first step has largely remained the same, but our approach to the second step has evolved significantly. The fundamental clinical decision for the second step has become: is the prospect for durable control better with posttransplantation chemotherapy or with hematopoietic cell transplantation?
Heterogeneous in nature the management of leukemia, lymphoma and multiple myeloma all present complex clinical problems, requiring an ever evolving multidisciplinary approach to diagnosis and treatment. Recognizing that patient quality of life and survival are significantly improved when these cancers are detected early and treated appropriately.
This Grand Rounds in Hematology monograph, Improving the Treatment of Hematologic Malignancies:
Chronic Lymphocytic Leukemia, is based on our selection of key abstracts from the ASH meeting in December 2006 and related publications in the following areas of chronic lymphocytic leukemia (CLL): new advances in prognosis, approaches to frontline therapy including the use of chemoimmunotherapies, management of the relapsed refractory patient, and, finally, novel drugs for the treatment of CLL.
The American Society for Blood and Marrow Transplantation (ASBMT) has supported the conduct of a series of evidence-based reviews exploring the role of hematopoietic cell transplantation (HCT) in various hematologic disorders over the past several years. This abridged report summarizes the major findings of two recent reviews addressing the role of HCT in the management of acute lymphoblastic leukemia, one review in children, the other in adults.