Quiz: Transplant Considerations for Patients With Hematologic Cancers

What are appropriate sources of stem cells for HCT in patients without an HLA-matched, related donor? Is post-transplant cyclophosphamide–based haploidentical donor transplantation appropriate for racial and ethnic minority patients with hematologic cancers? Test your knowledge with this multiquestion quiz.

Question 1

Answer

D.HLA-unmatched, intensive myeloablation

Allogeneic hematopoietic cell transplantation is standard treatment for patients with advanced hematologic cancers. According to a recent study by researchers at the University of Texas Health Sciences Center in Houston and the Blood and Marrow Transplant Program at Northside Hospital in Atlanta, Georgia, for patients without HLA-matched related donors, there are three alternative sources of stem cells for transplantation: (1) matched, unrelated donor, (2) umbilical cord blood, and (3) haploidentical donor.

Question 2

Answer

A.True

The probability of finding an 8-of-8 HLA-matched unrelated donor differs markedly among different ethnic and racial patient populations with hematologic cancer, from 75% for white patients with European-ancestry to ≤ 20% among African Americans. Increasingly, therefore, PTCy-based HIDT is attempted with minority patients.

Question 3

Answer

C.PTCy-based HIDT

According to a recent single-institution cohort study of 203 patients, PTCy-based HIDT is associated with superior outcomes for black patients with hematologic cancers than for white patients because of a reduced risk of relapse. In multivariate analysis, African-American patients who underwent PTCy-based HIDT had superior overall survival, disease-free survival, and relapse rates compared with white patients. However, the 3-year non-relapse mortality rates were similar between black and white patients. Registry data analyses suggest that survival rates are inferior among African-American patients following unrelated-donor and cord-blood transplantation.

Question 4

Answer

C.Mild chronic GVHD

In a recent single-institution cohort study, the incidences of acute GVHD and moderate-to-severe chronic GVHD were similar between African-American and white patients, but the incidence of mild chronic GVHD was higher among African Americans. Mild chronic GVHD is known to be associated with reduced relapse risk and improved survival in hematologic cancer patients following cell transplantation, the study authors noted.

Question 5

Answer

D.None of the above

To address the high rates of haploidentical graft rejection and severe GVHD following cell transplantation in hematologic cancer settings, researchers developed T-cell depletion and myeloablative regimens-and more recently, PTCy with or without myeloablation. To date, however, none has emerged as the superior or optimal regimen and there have been no prospective head-to-head comparisons of conditioning regimen intensities for patients undergoing HIDT. There is some evidence that myeloablative regimens, when an option, might reduce relapse risk.