A Psychosocial Assessment of Patients before and after Autologous Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3152-3152
Author(s):  
Brian J. Bolwell ◽  
Linda McLellan ◽  
Larry Foster ◽  
Jane Dabney ◽  
Erin Welsh ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Autologous Transplantation ◽  
Well Being ◽  
Autologous Stem Cell Transplant ◽  
Psychosocial Assessment ◽  
Cell Transplant ◽  
Post Transplant ◽  
Allogeneic Bmt ◽  
Significant Difference

Abstract There are relatively few reports in the medical literature describing psychosocial assessment of bone marrow transplant patients; what data exists primarily focuses on allogeneic transplant recipients. We have begun to prospectively assess psychosocial parameters of patients undergoing autologous transplantation using the Functional Assessment of Cancer Therapy-BMT (FACT-BMT) tool. The general questions consist of four subscales developed and normed in cancer patients that measure; physical well-being; social/family well-being; emotional well-being; functional well-being; and a specific module to address BMT-specific concerns. Each subscale is positively scored, with higher scores indicating better functioning. A baseline survey is collected by the social worker pre-transplant and a follow-up survey is administered and collected approximately 6 weeks post-transplant by the Transplant Coordinator. 56 consecutive patients undergoing autologous stem cell transplant have FACT-BMT data both pre-transplant and approximately one month post-discharge. Median age was 50. 52% are male; underlying diagnoses include NHL (45%), Hodgkin’s disease (32%), myeloma (16%), AML (5%), testicular cancer (2%). 93% had chemosensitive disease at the time of transplant. All patients received peripheral blood progenitor cells (PBPCs), and all received a chemotherapy-only preparative regimen. All patients were hospitalized for approximately three weeks for the transplant. For most of the variables measured by the FACT-BMT tool, there was no significant difference in pre-transplant and post-transplant scores. The one variable that did change was emotional well-being: patients scored statistically significantly higher post-transplant as compared to the pre-transplant score (p<0.001). We also have collected baseline FACT-BMT data on 42 consecutive allogeneic BMT recipients, as well as 12 recipients of non-myeloablative allogeneic BMT transplants. There is no significant difference in any pre-transplant variables measured by the FACT-BMT score between autologous recipients, ablative allogeneic recipients, and non-myeloablative allogeneic recipients. We conclude that patients undergoing an autologous stem cell transplant have a higher sense of emotional well-being after engraftment and hospital discharge. Presumably this reflects positive feelings about accomplishing this intensive treatment for their underlying malignancy, and suggests that emotional and physical recovery after auto-BMT is reasonably rapid. A larger dataset will hopefully allow a more detailed comparison of allo and auto BMT recipients.

Second Autologous Stem Cell Transplant (ASCT) as Salvage Therapy for Relapsed Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1170-1170
Author(s):  
Rebecca L. Olin ◽  
David L. Porter ◽  
Selina M. Luger ◽  
Stephen J. Schuster ◽  
Donald Tsai ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Treatment Options ◽  
Univariate Analysis ◽  
Complete Response ◽  
Autologous Stem Cell Transplant ◽  
Response To Therapy ◽  
Cell Transplant ◽  
Significant Difference

Abstract Introduction: Autologous stem cell transplant (ASCT) as part of initial therapy has been shown to prolong survival of patients with multiple myeloma, with some achieving durable complete remission. However, the majority of patients ultimately relapse after ASCT and require salvage treatment. Options for the treatment of such patients have increased significantly over recent years, including not only novel chemotherapeutic and biological agents but also additional ASCTs. We performed a retrospective analysis of our experience with salvage ASCT for multiple myeloma to determine which clinical variables influence outcome. Methods: Between October 1992 and February 2005, we performed 342 ASCTs for multiple myeloma. Twenty-six of these were salvage transplants for relapsed disease after prior ASCT, and all were included in the analysis. Patients who received two planned (tandem) ASCTs were not included. Results: The median age at diagnosis was 47 (range 25–66), and median ISS and DS stages at diagnosis were 1 and 2, respectively. The initial ASCT was melphalan-based in 21/26; six (23%) achieved a complete response (CR) to the initial transplant, and fifteen (58%) achieved a partial response (PR). The median event-free survival (EFS) after the initial transplant was 19.5 months (range 2–60). The median time between initial and salvage ASCT was 2.6 years (range 0.3–7.6). Twenty-two patients (85%) received non-transplant therapy between ASCTs, and the median number of lines of therapy prior to salvage ASCT was 3. At the time of salvage ASCT, the median age was 52.5 (range 28–69). Fourteen patients received melphalan alone, eight received melphalan/TBI, and four received other regimens. Eleven patients (42%) achieved a response to therapy (1 CR, 10 PR). One patient (4%) died of transplant-related toxicity. The median follow-up after salvage ASCT is 12 months (range 0.2–58). Median EFS is 9 months, and median overall survival (OS) is 36 months. The 2-year EFS is 14%, and 2-year OS is 52%. On univariate analysis, both response to and EFS after initial transplant significantly predict improved EFS after salvage transplant (p=0.0008 and p=0.0065 respectively). Both also predict improved OS (p=0.03 and 0.0005 respectively). A greater than 12 month interval between first and second transplant also correlated with OS (p=0.04). There was no significant difference in EFS or OS by preparative regimen. Interestingly, type of response to the salvage transplant (CR/PR or less than PR) did not predict improved EFS or OS. Conclusion: This study suggests that salvage ASCT after relapse from initial ASCT is a feasible therapy for patients with heavily treated multiple myeloma, particularly those with a prolonged response to the first transplant.

Outcomes and Treatments of Relapsed AL Amyloidosis Following Stem Cell Transplant

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1858-1858 ◽  
Author(s):  
Rahma Warsame ◽  
Soo-Mee Bang ◽  
Shaji K. Kumar ◽  
Martha Q Lacy ◽  
Francis K Buadi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Plasma Cells ◽  
Conflicts Of Interest ◽  
Treatment Options ◽  
Autologous Stem Cell Transplant ◽  
Al Amyloidosis ◽  
Cell Transplant ◽  
Post Transplant

Abstract Abstract 1858 Systemic light chain amyloidosis (AL amyloidosis) is a condition where clonal plasma cells produce misfolded insoluble immunoglobulin light chains that deposit in various organs causing progressive organ dysfunction. Chemotherapy and autologous stem cell transplant (ASCT) when eligible is the standard treatment options for patients with AL amyloidosis. There are several studies who report long term outcomes of patient post ASCT. However, there is a paucity of literature describing the outcomes of patients who have received ASCT but have relapsed. We performed a retrospective study to assess the outcomes and treatment regimens employed following relapse after ASCT. Between 1996 and 2009, 410 patients received ASCT at the Mayo Clinic as first line therapy. Of those 410 patients 42 patients died within 3 months of transplant, 64 patients died without documented relapse, 158 patients were alive without documented progression, and 146 patients had documented progression. Those 146 patients are the subject of our study. The median time to hematologic relapse was 2 years (range: 0.2–15.5 years). At relapse, 59 patients were treated with IMiD based therapy, 36 with alkylator based therapy, 24 with bortezomib, 15 with steroids, and 5 with second ASCT. The respective hematologic response rates were 58%, 33%, 50%, 53%, and 60%. The remaining six patients were not evaluable for response for one other following reasons: organ transplants; no further therapy; inevaluable disease. With a median post relapse follow up of 3.6 years, the median overall survival (OS) from the first post ASCT relapse was 4.6 years. The median post transplant follow up was 6.1 years, the median OS for these patients was 7.3 years from the time of transplant. These data provide novel information about outcomes after SCT relapse, which should be useful not only for patients and doctors but also for investigators designing studies for salvage therapies post-transplant. Disclosures: No relevant conflicts of interest to declare.

Secondary neutropenia (SN) after autologous hematopoietic stem cell transplantation (AHSCT) in patients (pts) with lymphoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6552-6552
Author(s):  
Sunita Nathan ◽  
John Joseph Maciejewski ◽  
Elizabeth Shima Rich ◽  
Parameswaran Venugopal ◽  
Kent W. Christopherson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Conditioning Regimen ◽  
Stage Iv ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Cd34 Cells ◽  
Transplant Complications

6552 Background: Plerixafor for mobilization of autologous stem cells (ASC) has increased the yield of transplanted ASC and is evolving as an important option for mobilization. A prior study reported a 10% incidence of SN after AHSCT (BMT 2009 Aug; 44(3): 175-83). Incidence and outcome of SN in the setting of Plerixafor/G-CSF (P/G), is unknown. We report the incidence and possible etiology for the development of SN in pts undergoing AHSCT for lymphoma at our institution. Methods: Data from 80 consecutive AHSCT pts over a 2 year period were reviewed. All pts were mobilized using P/G. Demographics, AHSCT indication, prior therapies (Rx), conditioning regimen (CR), engraftment and post-transplant complications were identified and collected. SN was defined as ANC <1000 after initial engraftment. Results: 80 pts underwent an AHSCT for lymphoma from 2009-11. 70 pts had evaluable data. 37 (52.86%) pts (average age 55.4 yrs) were male and 33 (47.14%) pts (average age 48.3 yrs) female. 25 (35.7%) pts had ≥2 comorbidities. Indications included relapsed/ refractory B-NHL, T-NHL and HL. 47 (67%) pts had Stage IV ds, 48.9% with BM involvement. 17 (24.3%) pts had >2 Rx, 18 (25.7%) with loco-regional XRT and 3 (4.3%) with RIT. CR included BEAM, BEC and Benda-EAM +/- Rituxan. # of CD34+ cells given ranged; 1.77-19.99 x 10^6/kg. Neutrophil engraftment occurred at a median of 11 days. 26 (37.14%) pts developed SN possibly from PCP prophylactic antibiotics and infections. Prior BM involvement, Rx or XRT had no role. 5 (45.4%) pts with Benda-EAM CR had SN. Associated morbidity/mortality were not noted. Conclusions: We conclude that secondary neutropenia is common after autologous stem cell transplant using the Plerixafor/GCSF combination for mobilization and is higher than reported in the literature (37% vs 10%). Patients who received this combination for mobilization should be followed up closely in the post-transplant period for secondary neutropenia. About half the patients who received the Benda-EAM conditioning regimen developed secondary neutropenia warranting its use with caution outside of a clinical trial.

Effects of G-CSF vs. No G-CSF on Outcomes Post-Autologous Stem Cell Transplant - A Two-Centre Retrospective Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5133-5133
Author(s):  
Debra J. Bergstrom ◽  
Wanda S. Hasegawa ◽  
Peter Duggan
Keyword(s):  
Stem Cell ◽  
Febrile Neutropenia ◽  
Hospital Discharge ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Post Transplant ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Neutrophil Engraftment

Abstract INTRODUCTION In management of patients post-autologous stem cell transplant (ASCT), there continues to be controversy regarding the benefit of granulocyte-colony stimulating factor (GCSF) given post-autologous stem cell transplantation on length of time to engraftment and rates of febrile neutropenia. We conducted a chart review on all patients who received autologous stem cell transplants with follow-up at two tertiary care centres, the Health Sciences Centre in St. John’s, Newfoundland, and Victoria General Hospital in Halifax, Nova Scotia from February 2001 to February 2006. METHODS Comparison was made between two groups, either receiving (Group A) or not receiving (Group B) planned GCSF (starting 5 days post ASCT) for engraftment purposes. Patients who were not intended to receive GCSF but later received it due to delayed engraftment or febrile neutropenia remained in the non-intervention arm for analysis. Patients were excluded who had CD34+ infusion doses of < 2.5 cells x 106/kg body weight as all these patients received planned GCSF to promote engraftment at both centers. Also, we excluded patients who were transferred from the treatment center (Halifax or St. John’s) to their referring center for post transplant care prior to engraftment as follow up data would not be available for these cases. Primary outcomes included time to neutrophil engraftment and days to hospital discharge. Secondary outcomes included episodes of febrile neutropenia, number of packed red cell and platelet transfusions, days to platelet engraftment and transplant related mortality. Comparison between groups of episodes of febrile neutropenia was performed using Fisher’s exact test and all other variables were analyzed using the unpaired t-test. RESULTS 215 patients were included, having received autologous stem cell transplants at the above centres from February 2001 to February 2006. There were no significant differences between the two groups in age, sex, or diagnoses. More patients in Group B received etoposide/melphalan conditioning whereas there were more treated with BEAM in group A. Mobilizing regimens also differed significantly, with more patients in the group B receiving GCSF alone. Median time to neutrophil engraftment differed between group A and group B (11 vs. 14 days respectively, p<0.0001). There was a higher incidence of febrile neutropenia in patients in group B (89%) compared with group A (76%, p<0.01). However, there was no significant difference between days to hospital discharge, platelet and packed red cell transfusions, or transplant related mortality. One distinct weakness of the study was in evaluating the duration of hospital stay as this was determined by date of final discharge post transplant and did not take into account delayed admissions or periods of discharge between recurrent admissions for transplant-related issues. CONCLUSION We observed a significant difference between the rate of febrile neutropenia and duration to neutrophil engraftment in those routinely receiving GCSF as part of post-transplant care vs. those who receive it either not at all or only for delayed engraftment. However, the clinical significance of these findings is unclear, particularly as the time to hospital discharge and the transfusion requirement was the same between the groups. Nonetheless, these results indicate a need for further study in this area, and suggest that more dedicated research into cost-effectiveness of the intervention may be useful.

scholarly journals Measles, Mumps & Rubella Titers Post Autologous Stem Cell Transplant in Multiple Myeloma Patients Induced with Modern Therapy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 43-43
Author(s):  
Mariano Arribas ◽  
Gregory J Ahmann ◽  
Skye Buckner-Petty ◽  
Esteban Braggio ◽  
Elitza S Theel ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Board Of Directors ◽  
Stem Cell Transplant ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Advisory Committees ◽  
Post Transplant ◽  
Number Of Patients ◽  
Antibody Titers

Multiple Myeloma (MM) is a hematological malignancy resulting in abnormal plasma cells proliferating in the bone marrow. One of the most common treatment strategies for newly diagnosed MM is the combination of induction therapy followed by autologous stem cell transplant (ASCT). Due to the underlying disease and/or the effect of the treatment regimens administered, immunosuppression is a common clinical consequence. It has been shown that ASCT recipients, treated with traditional compounds, have a reduction in the levels of antibody titers to vaccine-preventable diseases such as measles, mumps and rubella (MMR), between one and four years post-transplant. Therefore, re-vaccination is recommended at least two years after ASCT. Therapeutic options have expanded in the past decade, with the introduction of novel agents that have significantly improved MM patient outcomes; however, this may also arguably have new and different implications on a patient's immune system. In this study we sought to analyze the presence of IgG antibodies against MMR in 110 patients with MM post-ASCT. All patients received ASCT between 2014 and 2019 at Mayo Clinic Arizona. Plasma samples were collected approximately 100 days after ASCT (median 92 days) and the antibody titers were tested using the Bio-Rad MMR IgG multiplex flow immunoassay. Sample antibody index values were compared with the assay-specific calibration to determine positivity. For a control population, we utilized the results of fully vaccinated and presumptively immune healthcare workers (HCWs) that were evaluated for the presence of antibodies to measles (n=199), mumps (n=197) and rubella (n=209), using the same method, instrument and laboratory. Overall, 70% of the MM patients were positive for antibodies against measles, compared with 77.4% of HCWs. For mumps, the MM cohort had a positivity of 49.1% versus 84.8% of HCWs. Finally, rubella antibodies were found in 64.5% and 83.7% of MM and HWCs, respectively. Next, we performed testing on serial samples collected from 45 MM patients, comparing the presence of MMR antibodies pre-ASCT (median 130 days) and post-ASCT. The number of patients with positive titers detected pre- and post-transplant was unchanged for each of the three viruses. In summary, our findings do not indicate a significant reduction in relative MMR antibody levels in ASCT recipients. This suggests that earlier re-vaccination is not required post-ASCT in the era of novel MM compounds. However, further validation studies in larger cohorts are necessary prior to considering a change in current vaccination guidelines. Disclosures Braggio: DASA: Consultancy; Bayer: Other: Stock Owner; Acerta Pharma: Research Funding. Fonseca:Janssen: Consultancy; Takeda: Consultancy; Novartis: Consultancy; Bayer: Consultancy; Sanofi: Consultancy; Merck: Consultancy; Pharmacyclics: Consultancy; Amgen: Consultancy; BMS: Consultancy; Celgene: Consultancy; Juno: Consultancy; Kite: Consultancy; Aduro: Consultancy; OncoTracker: Consultancy, Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Consultancy; GSK: Consultancy; AbbVie: Consultancy; Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees.

Effect of lenalidomide use as part of induction chemotherapy on the risk of peri-transplant venous thromboembolic events (VTE) in patients undergoing autologous stem cell transplant for multiple myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19524-e19524
Author(s):  
Naresh Bumma ◽  
Monica Peravali ◽  
Ghayathri Jeyakumar ◽  
Seongho Kim ◽  
Asif Alavi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Retrospective Chart Review ◽  
Autologous Stem Cell Transplant ◽  
Induction Treatment ◽  
Cell Transplant ◽  
Vte Prophylaxis ◽  
Significant Difference ◽  
Venous Thromboembolic Events

e19524 Background: Lenalidomide (len) is approved for treatment in Multiple Myeloma (MM) Use of len has been associated with an increase in venous thrombotic events (VTE) and aspirin prophylaxis is recommended for pts who are on active treatment with len. Autologous stem cell transplant (ASCT) is used during the treatmentof MM after initial induction therapy. The use of intravenous catheters and hospitalization increase the risk of VTE in peri-transplant period. We evaluated the incidence of VTE in peri-transplant period to determine if len use increased the risk of VTE. Methods: We performed a retrospective chart review of pts with MM who underwent first ASCT at our institution between 1/2011-1/2015.Data was collected on pt. demographics, len use, VTE prophylaxis, VTE incidence and VTE treatment. Chemical anticoagulation during the peri-transplant period was based on physician preference and chemical anticoagulation was stopped once platelet counts dropped below 50,000/ uL. All pts were encouraged to ambulate daily for mechanical prophylaxis. Associations with incidence of VTE were conducted by univariable and multivariable logistic regression analyses. Results: A total of 303 pts met the study criteria. 204 pts received Len as part of induction treatment while 99 did not. There was no significant difference in demographics of the 2 groups. 87% pts in the Len group and 81% in the non-Len group did not receive any chemical prophylaxis, respectively during hospitalization. 15 pts developed DVT within 100 days of transplant: 10 in len group and 5 in non-len group (p > 0.99). 14 of the 15 were catheter associated. Median time to DVT was 10.5 days post-transplant. Caucasians had a higher risk of DVT; adjusted OR 0.315 (95%CI 0.03-0.99; p = 0.046). Incidence of VTE was not affected by prophylaxis, or response to induction. Conclusions: Despite the fact that during the peri-transplant period most of the patients were not on prophylactic chemical anticoagulation due to chemotherapy associated thrombocytopenia len use during the induction treatment did not increase the risk of peri-transplant VTE.

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