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Sektion StammzelltransplantationAbteilung Innere Medizin VUniversitätsklinikum Heidelberg
AllogeneStammzelltransplantation:Jahresbericht 2011
27.02.2012
Zahlen
Keine Ind. Tod vor TPL Suche
Neuvorstellungen: 183
27.2.2012
0
20
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80
100
120
1997
1998
1999
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2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
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
0
10
20
30
40
50
2005
2006
2007
2008
2009
2010
2011
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
60
80
100
2005-2010 (476)2011 (112)
Monate
% Ü
berle
ben
Non-Relapse Mortality (Erwachsene)
0 12 24 36 48 60 72 840
20
40
60
80
100
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
0
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2005 2006 2007 2008 2009 2010
Gesamt Refraktär
HD: Transplantationszahlen AML+MDSMedianes Alter in JahrenFälle pro Jahr
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010
HD: Gesamtüberleben AML/MDSEffekt Kalenderjahr
0 12 24 36 48 60 720
20
40
60
80
100
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
20
40
60
80
100
18-49 (n=94)
50-59 (n=52)
60-70 (n=69)
Monate
% Ü
berle
ben
0 12 24 36 48 60 720
20
40
60
80
100
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
20
40
60
80
100
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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