Sektion StammzelltransplantationAbteilung Innere Medizin VUniversitätsklinikum Heidelberg

AllogeneStammzelltransplantation:Jahresbericht 2011

27.02.2012

Zahlen

Keine Ind. Tod vor TPL Suche

Neuvorstellungen: 183

27.2.2012

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Erwachsene Kinder

HD: allogene Transplantationszahlen

114

27.2.2012

• Allogene Tpl: n = 6

• Spender: MD (n = 3)MSD (n = 2)MMUD (n = 1)

• Diagnosen: JMML (n = 1)SCID (n = 2)ALL, CR1 (n = 1)b-Thalassämie (n = 2)

Allogene Transplantation Kinderklinik

27.2.2012

Allogene Transplantation Kinderklinik

– Art des Transplantats: PBMC (n = 3)KM (n = 3)

– Konditionierung: myeloablativ (n = 6)

– Primäres Engraftment: (n = 6)

– Remissionsstatus: CR (n = 5). TRM (n = 1)

HSCT in Deutschland

2010: HD mit 108 alloHSCT an 6. Stelle in Deutschland

Spender: verwandt vs. unverwandt

2010: 71% unverwandte Spender in Deutschland

HD: Spender 2005-2011

27.2.2012

0102030405060708090

2005 2006 2007 2008 2009 2010 2011

Unverwandt Verwandt

HD: Indikationen 2005-2011

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2005

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AML/MDS

ALL

Lymph./CLL

Myelom/Amyl

MPS/CML

Sonst. Npl.

Sonstige

27.2.2012

Ergebnisse

HD: Gesamtüberleben (Erwachsene)

0 12 24 36 48 60 72 840

20

40

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100

2005-2010 (476)2011 (112)

Monate

% Ü

berle

ben

Non-Relapse Mortality (Erwachsene)

0 12 24 36 48 60 72 840

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1-y: 15% vs 15%, p=0.57

2005-2010 (476)2011 (112)

5-y: 22%

Monate

% N

RM

Ursachen NRM in 2011 im Einzelnen(der vor 2011 Transplantierten)

• Akute GVHD: 2 (Mo +4, Mo +13)

• Chronische GVHD: 2 (Mo +20, Mo +36)

• Infektion: 1 (Mo +72)

• Zweitmalignom: 2 (Mo +46 (Colon-Npl), Mo +123 (Ösophagus-Npl.))

Ursachen NRM im Einzelnen(der in 2011 Transplantierten)

• Tod in primärer Aplasie: 5 (d +3, d +6, d +12, d +26, d +39)

• Akute GVHD: 4 (d +67, d +96, d +97, d +99)

• Pneumonie: 3 (d +69, d +147, d +201)

• Andere: 1 (d +107)

20.1.2011

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Gesamt Refraktär

HD: Transplantationszahlen AML+MDSMedianes Alter in JahrenFälle pro Jahr

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2005 2006 2007 2008 2009 2010

HD: Gesamtüberleben AML/MDSEffekt Kalenderjahr

0 12 24 36 48 60 720

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2005-2006 (n=60)

2007-2008 (n=69)

2009-2010 (n=86)

Monate

% Ü

berle

ben

HD: Gesamtüberleben AML/MDSEffekt Alter

0 12 24 36 48 60 720

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18-49 (n=94)

50-59 (n=52)

60-70 (n=69)

Monate

% Ü

berle

ben

0 12 24 36 48 60 720

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Inland (249)Ausland (62)

HR 0.94 (0.59-1.51); p 0.797

Months from SCT

% S

urvi

val

Heidelberg: OS by UD source (2005-2010; n = 311)

0 12 24 36 48 60 720

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Inland (249)Ausland (62)

HR 0.91 (0.44-1.88); p 0.795

Months from SCT

% N

RM

Heidelberg: NRM by UD source (2005-2010; n = 311)

Studien

NCT Clinical Cancer ProgramHematopoietic MalignanciesSignificant Accomplishments & Highlights

Development of CK18F as GVHD biomarker• 2006: Identification of apoptosis marker CK18F as potential GVHD activity

• 2007: Retrospective assessment of clinical applicability (Luft et al, Blood 2007)

• 2009: Initiation of clinical study for clinical validation and launch of interdisciplinary project to delineate steroid-refractory GVHD (with grant support by Helmholtz Alliance forImmunotherapy, HAIT; Chair: Peter Krammer)

• 2011: Reaching accrual target of clinical study (145 patients).

• 2011: Characterization of endothelial vulnerability as basis of GVHD refractoriness

• 2011: Impact of statins on GVHD refractoriness• 2011 Start LEBENS-Studie

active caspases

VEVD237 DALD396

CK18 neo-epitope for the M30 mAb

apoptosis-inducing stimuli

CCP Hematology

AG GVHD

• Thomas Luft

• Michael Hess

• Sascha Dietrich

• Sandra Sauer

• AM Geueke

• Thomas Schmitt

• Michael Schmitt

• Mindaugas Andrulis

• Steroid-refraktäreGVHD

• Endothel und GVHD

• Statine

• CK18F-Studie

• LEBENS-Studie (in Koop. mit Abt. Präventive Onkologie / NCT)

Mitglieder Projekte

Phase-II-Studie auto-allo vs auto-auto in derPrimärtherapie der multiplen Myloms: Design

02/2012:140/220 Patienten rekrutiert

Auto-allo vs auto-auto 1st-line bei MM: Patienten Heidelberg 02/2012

21

16

7 6

1 dead (PD)4 too early

1 dead(PD)

2 dead(PD)

REFERRAL

Donor search

indication (=EBMT risk or Richter’s)

?

B

Observe;any treat.

OS

donor 9/10

no donor 9/10

Observe OS

OS

no

yes

SEARCH

Observe OS

refusal

Retrospective donor vs no-donor study (by EBMT indication; Heidelberg 6/2005-7/2011)

3 months

Allo-SCT;other treat.

REFERRAL

Donor search

indication (=EBMT risk or Richter’s)

?

B

Observe;any treat.

OS

donor 9/10

no donor 9/10

Observe OS

OS

no

yes

SEARCH

Observe OS

refusal

11 died w/i3 months

Heidelberg donor vs no-donor CLL study Patient flow

117

19

98

8

65

14

Allo-SCT 51other treat 14

More at EBMT 2012!(Herth et al, Tue April 3, 14:00)

Networking

Publikationen

Publikationen (peer-reviewed) 2011

Turk J Hematol0.6

F. McClanahan, P. Dreger

Current strategies for the diagnosis and management of CLL, with a focus on poor-risk CLL (Review)

CLL

JCO 18.970

B. Björkstrand, U. Hegenbart,H. Goldschnmidt et al.

Tandem Autologous / RIC Allogeneic SCT vs AutologousTransplantation in Myeloma: Long-Term Follow-Up

PCD

Leukemia8.966

W. Wiktor-Jedrzejczak, P. Dreger et al.

HSCT in T-PLL: a retrospective study from the EBMT and the Royal Marsden Consortium

T-PLL

Blood Reviews6.797

S. Böttcher, P. Dreger et al.

Allo-SCT for CLL: Lessons to be learned from minima l residual disease studies (Review)

CLL

CCR7.338

S. Dietrich, T. Luft et al.

Leflunomide Overcomes CD40L/IL-4-Mediated Resistance t o Fludarabine-Induced Apoptosis …of CLL Cells

CLL

BMT3.660

T. Schmitt et al.Pentostatin for Treatment of Steroid-Refractory Acute G VHD: A Retrospective Single Center Analysis.

GVHD

BMT3.660

S, Schönland, U. Hegenbart et al.

Current status of hematopoietic cell transplantatio n in the treatment of systemic amyloid light-chain amyloidosi s (Review)

PCD

BBMT3.275

S. Dietrich et al.Blastic plasmacytoid dendritic cell neoplasia in elderly patients: Results of a treatment algorithm employing allo-SCT …

BPDC

Cancer5.131

S. Dietrich et al.Patterns and outcome of relapse after autologous stem ce lltransplantation for mantle cell lymphoma

Lymphoma

Ann Oncol 6.452

P. DregerAlloSCT in non-Hodgkin lymphoma (Review)Lymphoma

Blood10.588

J. Wiskemann et al.Effects of a partly self-administered exercise program p rior to, during and after allogeneic SCT: a randomized controlle dtrial

Supportiv

Blood10.588

T. Luft et al.Steroid-refractory GVHD: T-cell attack within a vulnera bleendothelial system

GVHD

Journals - IFAuthorPublications in 2011Topic

Oral presentations at major meetings 2011

EBMTP. DregerAlloSCT in CLLCLL

ICML, iwCLLS. Dietrich, P. DregerAuto vs FCR (CLL3 vs CLL8)CLL

ASH, DGHOT. LuftRole of endothelium in refractory GVHDGVHD

ICMLP. DregerAlloSCT in NHLLymphoma

MeetingsPresenterInvitated talks at major meetings 2011Topic

ASH I. El-Najjar, P. DregerTBI for 1st ASCT in FL (EBMT)Lymphoma

EBMTP. Dreger, T. ZenzImpact of TP53 lesions on allo-SCT (CLL3X)CLL

EBMT, DGHOS. JungTox of Aplasia Conditioning AML

EBMTS. Dietrich, M. AndrulisEndothelial TM expression in refractory GVHDGVHD

MeetingsPresentersOral presentations in 2011Topic

Veranstaltungen

NCT Clinical Cancer ProgramHematopoietic MalignanciesOverview

Integration into NCT• Covers all hemato-oncological patient-related care, Tumor Boards, and research within NCT

• Bridge for translational activities via� Clinical Cooperation Unit Molecular Hematology� SFB 873 / SFB-TR 79� Other grant-supported cooperations with DKFZ (Myeloma radiodiagnostics, HAIT) and NCT

departments (Physical exercise and SCT)

Clinical Activities & Competences• Section Stem Cell Transplantation (2010: 199 autologous, 108 allogeneic)

• Section Multiple Myeloma• Coordination of Center for Amyloidosis at UKHD

• Lymphoma / CLL and AML / MDS

• Clinical care accomplishment 2010: >7300 CMI points

Patient Numbers in 2009• Lymphoma + Myeloma / Leukemia (newly diagnosed): 493 / 77

• Lymphoma + Myeloma / Leukemia (treated): 1162 / 552• Trial enrollment: 203 of 570 newly diagnosed patients (36%)

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Auto Allo

CCP Hematology

CLL-Studientreffen 23.-24.9.2011 in Heidelberg

Leiter: Prof. Dr. Michael Hallek, Köln

CLL-Studientreffen 23.-24.9.2011 in Heidelberg

Gratwanderung?

Leben nach einer Stammzelltransplantation

Patiententag 05.11.2011

in Heidelberg

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