Risk Factors for 30-Day Hospital Readmission Following Myeloablative Allogeneic Stem Cell Transplantation.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1532-1532
Author(s):  
Nelli Bejanyan ◽  
Aleksandr Lazaryan ◽  
Lisa Rybicki ◽  
Shawnda Tench ◽  
Steven Andresen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Hospital Readmission ◽  
Unrelated Donor ◽  
Day Hospital ◽  
Stem Cell Source ◽  
Cell Source ◽  
Preparative Regimen

Abstract Abstract 1532 Introduction: Patient readmission within 30 days from discharge has been perceived by Centers for Medicare and Medical Services as an indicator of poor health-care quality for specific high-cost medical conditions. Patients who undergo allogeneic hematopoietic stem cell transplantation (AlloHSCT) were previously found to have higher rates of readmission as compared to those with autologous HSCT. The purpose of this exploratory retrospective study was to identify the reasons and risk factors for 30-days readmission among the recipients of myeloablative AlloHSCT. Methods: 618 adults were at risk for 30-day readmission following AlloHSCT from 1990 to 2009 at our single academic institution. Recursive partitioning analysis was used to identify the most optimal grouping of various preparative regimens relative to readmission. Univariate and multivariable risk factors for readmission were identified with logistic regression analysis. Impact of 30-day readmission on overall mortality was estimated by Cox proportional hazards analysis. Results: 242 (39%) of 618 patients (median age=42 years [range, 18–66]; 54% males; 89% Caucasians) were readmitted after a median of 10 days (range, 1–30) from discharge. Median duration of readmission was 8 days (range, 0–103). Infections (n=68), fever without identified source of infection (n=63), gastrointestinal complications (n=44), GVHD (n=38), and other reasons (n=29) accounted for 28%, 26%, 18%, 16%, and 12% of readmissions, respectively. 30% of readmitted patients had lymphoid and 67% had myeloid malignancy; 90% received ≥1 prior chemotherapy; 26% had TBI-containing preparative regimen; bone marrow was the most common (84%) source of stem cells; 46% had unrelated donor AlloHCST. During their index admission, 65% of subsequently readmitted patients were hospitalized for more than 29 days; 52% of patients recovered their ANC > 500/mL within 15 days; 41% had infection; 16% had grade II-IV GVHD. In univariate analysis, greater risk for readmission was associated with lymphoid malignancy (vs. myeloid, p=0.03), more previous chemotherapy regimens (p=0.01), TBI-containing preparative regimen (p<0.001), peripheral stem cell source (vs. bone marrow, p=0.01), unrelated donor (p<0.001), and infection during admission for AlloHSCT (p<0.001). In multivariable analysis, TBI-based preparative regimen (HR=2.6; 95% CI, 1.6–4.2), infection during admission for AlloHSCT (HR=2.3; 95% CI, 1.6–3.3), and peripheral stem cell source (vs. bone marrow, HR=1.9; 95% CI, 1.03–3.4) predicted 30-day readmission. 30-day readmission was an independent predictor of all-cause mortality (HRAdj=1.8; 95% CI, 1.5–2.2). Conclusion: 30-day hospital readmissions following myeloablative AlloHSCT portended poor survival. Our data emphasize the importance of risk-standardized approach to 30-day hospital readmission if it is used as a quality-of-care metric for bone marrow transplantation. Further studies will be necessary to validate our findings. Disclosures: No relevant conflicts of interest to declare.

Length of Stay and Hospital Costs for Patients Undergoing Allogeneic Stem-Cell Transplantation

2020 ◽  
pp. OP.20.00170
Author(s):  
Amandeep Godara ◽  
Nauman S. Siddiqui ◽  
Satish Munigala ◽  
Rishi Dhawan ◽  
Ankit J. Kansagra ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Length Of Stay ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Peripheral Blood ◽  
Hospital Costs ◽  
Stem Cell Source ◽  
Cell Source ◽  
Transplant Complications

PURPOSE: Patients who undergo allogeneic hematopoietic stem-cell transplantation (allo-HSCT) usually require a prolonged hospital stay that varies greatly across patients. Limited information exists on the factors associated with hospital length of stay (LOS) after allo-HSCT and the impact on transplant-related costs. The objective of this study was to determine predictors for longer LOS for allo-HSCT and to assess their impact on the cost of transplant stay. METHODS: Using the National Inpatient Sample database, adult patients hospitalized for allo-HSCT were identified using International Classification of Diseases, Ninth Revision, primary and secondary procedure codes. RESULTS: Between 2002 and 2015, 68,296 hospitalizations for allo-HSCT were identified. Peripheral blood was the most common stem-cell source (80%) followed by bone marrow (15%) and cord blood (5%). Median LOS was 25.8 days (interquartile range [IQR], 21-34.0 days), and the overall inpatient mortality rate was 8%. Stem-cell source was a significant predictor for longer LOS, being significantly longer for cord blood (median, 36.9 days; IQR, 26.7-49.9 days) compared with bone marrow (median, 27.2 days; IQR, 21.5-35.2 days) and peripheral blood (median 25.4 days; IQR, 20.8-32.7 days). Other predictors for longer LOS were patient characteristics such as age and race, transplant/post-transplant characteristics, and complications such as total body irradiation use, acute graft-versus-host disease, and infections. Longer LOS was also found to be associated with higher hospital costs. CONCLUSION: In patients who undergo allo-HSCT, LOS can be predicted using patient- and transplant-related characteristics as well as post-transplant complications. LOS is also a driver for increased cost, and further efforts are needed to mitigate transplant complications and resource utilization.

Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in the Treatment of Acute Lymphocytic Leukemia (ALL) in 126 Adults: Impact of Donor Source on Leukemia Free Survival (LFS).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2064-2064 ◽  
Author(s):  
Priya Kumar ◽  
Todd E. Defor ◽  
Claudio Brunstein ◽  
Juliet Barker ◽  
John E. Wagner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Growth Factor ◽  
Disease Status ◽  
Lymphocytic Leukemia ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Stem Cell Source ◽  
Cell Source ◽  
Donor Source

Abstract White blood cell (WBC) count and specific cytogenetic abnormalities at diagnosis, patient age and disease status at HSCT have previously been identified as risk factors associated with LFS in patients with ALL. As the use of umbilical cord blood (UCB) is relatively new, particularly for adults, we sought to evaluate the relative impact of donor source. In this single center study, 126 adults aged 18–61 (median 31) years (yrs) underwent myeloablative conditioning (cyclophosphamide 120 mg/kg and total body irradiation 1320–1375 cGy based regimen in 92%) followed by allogeneic HSCT. Stem cell source was an HLA matched related donor (MRD) in 85, HLA matched unrelated donor (URD:M) in 15, HLA mismatched unrelated donor (URD:MM) in 14 and HLA 0–2 (A, B, DRB1) mismatched UCB in 12. At the time of HSCT, 64 patients were in CR1, 51 in CR2, and 11 patients in ≥ CR3; 20 pts had T-lineage disease; 38 pts (30%) had either t(9;22)(n=28), t(4;11) or t(1,19) (n=10) with the remainder (70%) having normal cytogenetics. WBC ≥ 30 x 109/l at diagnosis was documented in 50%. Demographics, disease characteristics at initial diagnosis and transplant variables were similar in all 4 groups except: year of transplant after 1996 and use of growth factor for all UCB recipients. Outcomes by donor source: MRD URD:M URD:MM UCB P N 85 15 14 12 Median follow up in yrs 9.3 3.5 7.2 1.2 OS 1 yr % (95% CI) 41 (31–52) 33 (9–57) 14 (0–33) 75 (51–100) 0.02 LFS 1 yr % (95% CI) 35 (25–45) 27 (4–49) 14 (0–33) 67 (40–93) 0.03 Relapse 1 yr % (95% CI) 21 (12–30) 20 (0–40) 0 8 (0–23) 0.22 TRM 1 yr % (95% CI) 44 (33–55) 53 (27–79) 86 (57–100) 25 (1–49) <0.01 As a consequence of low TRM, OS and LFS were superior after UCB transplants. In multiple regression analysis, 5 independent risk factors were significantly associated with poorer OS: use of URD:M (RR 3.8, 95% CI 1.1–13.8, p= 0.04) and URD:MM (RR 4.9, 95% CI, 1.3–19.1, p= 0.02), ≥ CR3 at HSCT (RR 3.0, 95% CI, 1.1–8.8, p= 0.04), WBC >30 x 109/l (RR 2.4, 95% CI, 1.4–4.1, p<0.01), cytomegalovirus (CMV) seropositive recipient and donor (RR 4.0, 95% CI, 2.0–7.9, p<0.01), and ≥ 2 induction regimens to achieve initial CR (RR 2.7, 95% CI, 1.2–5.9, p= 0.01). Patients who developed grade II–IV acute graft versus host disease (GVHD) had significantly lower mortality rates (RR 0.4, 95% CI, 0.2–0.7, p<0.01). There was no impact on OS by year of transplant or use of growth factor. Variables associated with poor LFS were identical to those for OS, and GVHD was again associated with improved LFS. These results support the use of UCB as an alternative stem cell source for adults with ALL with results comparable to outcomes observed with MRDs. In addition, GVHD is associated with improved LFS suggesting a significant graft versus leukemia effect with all donor graft sources.

Fewer Relapses Following Unrelated Donor Cord Blood (UDCB) Compared to Related or Unrelated Bone Marrow (BM) or Peripheral Blood Cell (PBSC) Transplant in the Treatment of Childhood Relapsed and Very High Risk Acute Lymphoblastic Leukemia (ALL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3153-3153
Author(s):  
Donna A. Wall ◽  
Ka Wah Chan ◽  
Bess Bowen ◽  
Lorraine Alexander ◽  
Michael Grimley
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Cord Blood ◽  
Hematopoietic Progenitor Cell ◽  
Unrelated Donor ◽  
Stem Cell Source ◽  
High Risk Disease ◽  
Cell Source ◽  
Preparative Regimen ◽  
First Remission

Abstract With aggressive primary therapy for ALL children who relapse are presenting to transplant after having received more intensive frontline and salvage therapy - resulting in transplant candidates with more resistant disease and at a higher risk for transplant related morbidity/mortality (TRM). Thus the the current generation of children presenting for allogeneic transplant are much more difficult to treat. With the addition of unrelated donor cord blood as an alternative hematopoietic progenitor cell source there is now an unrelated donor product available for a majority of children in a timely fashion. For the last 5 years we have treated all children with ALL coming to transplant with a standard preparative regimen which has minimally changed over that time period. Over the past year all children have received identical immunosuppression regardless of stem cell source. This allows us to analyze the impact of allogeneic stem cell source on the outcome of transplant - the graft-vs.-leukemia effect of the various HSCT sources. Between 3/2001 and 7/2006 a total of 54 transplants (txp) were performed at Texas Transplant Institute for treatment of childhood ALL (median age 8 yr, range 0–17 yrs). There were 13 txp for standard risk disease (CR1: Ph+, requiring more than 28 d to achieve CR1, severe hypodiploidy; CR2 with first remission >36 mo) − 7 CB and 6 BM/PBSC. There were 41 txp for high risk disease (CR2 with first remission <36 mo, >CR2 or not in remission at time of txp) − 31 CB and 10 BM/PBSC. All received TBI (1200 cGy in 6 fractions), cyclophosphamide 120 mg/kg, and either thio-tepa 10mg/kg or VP16 1500 mg/m2, or an additional 150 cGy TBI. There was no adjustment in the preparative regimen for the donor source. The first 26 CB transplants (UDCBT) received ATG 30 mg/kg x 3 days prior to txp, the subsequent patients did not receive ATG. There were 38 UDCBT, 14 matched sibling donor and one each of unrelated donor and partial matched family member (6 PBSC, 8 BM). GVHD prophylaxis was a calcineurin inhibitor combined with steroid or mini-methotrexate and/or sirolimus. The time to ANC>500 and platelet recovery was prolonged in the UDCBT group compared to BM/PBSC (19 vs. 14.5 d for ANC, 57 vs. 23 d for platelet >20,000). There were two graft failures in the UDCBT group - both CR1 patients and both salvaged with a second UDCBT. With median f/u of 270 and 350 days for CB and BM/PBSC respectively there was a significant difference in the risk for relapse (5/37 vs. 9/16; p<0.03), TRM (8/37 – 1 GVHD, 3 MOSF, 2 bacterial, 1 leukoencephalopathy, 1 pulmonary vs. 2/16 -fungus, LPD; p= 0.7). KM survival analysis is shown below: Relapses/N 1 yr DFS 2 yr DFS Standard UDCBT 0/7 86% 86% Standard BM/PBSC 3/6 60% 30% HR UDCBT 5/31 62% 56% HR BM/PBSC 6/10 60% 50% Importantly there have continued to be late deaths in the BM/PBSC group due to relapse with the CB curves remaining stable after 18 months post txp. Despite 80% of the CBT being performed for children with high risk disease there were fewer relapses in the UDCBT cohort suggesting a robust allogeneic effect against ALL in the setting of UDCBT.

Bacterial, Viral and Fungal Infections in Patients after Allogeneic Stem Cell or Bone Marrow Transplantation - A Comparison between Patients with Related and Patients with HLA-Matched Non-Related Stem Cell Donors.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4978-4978
Author(s):  
Christina T. Rieger ◽  
Johanna Tischer ◽  
Helmut Ostermann
Keyword(s):  
Bone Marrow ◽  
Candida Albicans ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
Fungal Infections ◽  
Stem Cell Source ◽  
Cell Source ◽  
Group A ◽  
Group B

Abstract Bacterial, viral and fungal pathogens frequently cause severe, life-threatening infections in immunocompromised patients after allogeneic stem cell transplantation (SCT). We investigated whether patients with related stem cell donors (group A) developed infections less frequently than patients with HLA-matched, non-related donors (group B). Fifty-nine consecutive patients treated at our transplantation unit between April 2004 and January 2005 were included into the analysis. We documented demographic and clinical characteristics at baseline, treatment, clinical course, microbiological examinations, clinical and radiological signs of infection and mortality. Of the total 59 patients analyzed, 22 received stem cells from related and 37 from HLA-matched non-related donors. Both groups were well balanced regarding age and weight. 50% of the patients in group A and 60% in group B were male. Most frequent diagnoses were acute myeloid leukemia (30 of 59 patients [50.8%]; group A: 68.2%; group B: 40.5%), multiple myeloma (15.2%), acute lymphoblastic leukemia (11.9%) and chronic myeloid leukemia (10.2%). Bone marrow was more often the stem cell source in group A (45.5%/ 10 patients) than in group B (10.8%/ 4 patients), peripheral stem cell transplantation respectively was predominant in the unrelated group (86.5%/ 32 patients) versus the family donor group (54.5%/ 12 patients), cord blood was used as unrelated stem cell source in1 patient (2.7%). Clinically documented infections occurred in 6% in group A and in 14% in group B. Pulmonary infiltrates were observed more frequently in group A (11 patients/ 50%) than in group B (16 patients/ 43.2%). The predominant findings were atypical infiltrates (total 16 patients), followed by signs of fungal (total 7 patients) and bacterial pulmonary infiltration (total 4 patients). Microbiologically documented infections were detected in all patients. The average number of pathogens was equal in both groups. Detected pathogens were HHV-6 (48 patients), coagulase-negative Staphylocci (17 patients), EBV (14 patients) and CMV (11 patients). Three fungal infections were detected by microbiological approaches in group A (2 × Candida albicans, 1 × Pitysporum ovale) compared to nine fungal infections in group B (5 × Candida albicans, 1 × Candida glabrata, 1 × Candida parapsilosis, 2 × Geotrichum capitatum). Two years after transplantation, 55.9% of patients were alive (group A: 68.2%; group B: 48.6%). Patients with AML had a two-year survival of 50% (group A: 53.3%; group B: 46.7%). In our study, we observed no clear relation between frequency of infection and donor type, yet there was a trend towards more invasive fungal infections in the unrelated group (13% group A vs. 24% group B).

Immune Reconstitution In Anti-Thymocyte Globulin Conditioned Unrelated Donor Stem Cell Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2071-2071 ◽  
Author(s):  
David Jared Kobulnicky ◽  
Roy T Sabo ◽  
Allison F Scalora ◽  
David Portier ◽  
Devon Fletcher ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Immune Reconstitution ◽  
Unrelated Donor ◽  
Cell Recovery ◽  
Ebv Reactivation ◽  
Stem Cell Source ◽  
Cell Source

Abstract Anti-thymocyte globulin (ATG) is widely used for in vivo T cell depletion and immunomodulation in unrelated donor (URD) stem cell transplantation (SCT) to reduce the risk of graft vs. host disease (GVHD). However, despite the reduction in GVHD risk, outcomes are generally not superior to matched related donor (MRD) SCT conditioned without ATG. This is primarily because of defective immune reconstitution and high rates of opportunistic infections in ATG recipients. We have previously reported equivalent outcomes in URD SCT recipients conditioned with ATG when compared to MRD recipients. We now report immune reconstitution in an expanded cohort of these patients. Patients with AML, ALL, MDS, MPD (n=142) transplanted between 2004 and 2011 were included in this retrospective review. Seventy eight received either bone marrow or peripheral blood stem cell (PBSC) grafts from URD and received either 10 or 7.5 mg/kg rabbit ATG (Thymoglobulin, Sanofi-Aventis) during conditioning, those with MRD did not. Conditioning was myeloablative in all patients. Lymphoid recovery was equivalent in the two cohorts during the first year following SCT except in the first month (Figure), when URD recipients had lower absolute lymphocyte count (μ-URD=0.6x103/ μ L, μ-MRD=1.1; repeated measures mixed model p=0.022). Age, CD3/34 cell dose infused, stem cell source and conditioning intensity were not associated with ALC recovery post transplant. In a subset of patients lymphocyte subset enumeration was performed following withdrawal of immunosuppression, at an average 237 days post-SCT. ATG recipients had significantly lower mean CD4+ counts (μ-URD=267 (n=30), μ-MRD =434/ μ L (n=27); ANCOVA p = 0.003), however no significant differences were observed in CD3+, CD8+, CD19+ or CD56+ cell recovery. ATG recipients were significantly more likely to have complete donor T cell chimerism at 1 (OR = 12.5, CI= 2.4, 66.0, p = 0.001) and 2 months post-SCT (OR = 6.5 , CI=1.5, 27.4, p = 0.013), however by 9 months following SCT this trend had reversed with a greater likelihood of mixed T cell chimerism (OR > 100; p = 0.017), suggesting re-emergence of recipient derived T cell clones. Consequently, donor lymphocyte infusions were given significantly more often to ATG recipients (12/78) than to non-recipients (2/64) (OR = 5.64, CI = 1.21, 26.20, p=0.027). High grade CMV viremia (1000 copies/ μL) was significantly more likely in CMV sero-positive ATG recipients (n=18/55) than in non-recipients (n=7/48) (OR = 2.8, CI 1.1, 7.6, p = 0.032). Reduced intensity conditioning and PBSC were associated with higher CMV reactivation in ATG recipients and there was a lower likelihood of survival in these individuals than in those who did not receive ATG (HR: 0.53, CI: 0.31, 0.92; p = 0.024). EBV reactivation was observed more often in susceptible ATG recipients (n=22/58) than in non-recipients (n=5/43), (OR=4.6, CI=1.6, 13.6, p= 0.003). The median peak EBV viral load in ATG recipients (u=1545 copies/ μL, IQR: 288, 2,302) was significantly higher than in non-recipients (u=120 IQR: 57, 169, p = 0.005). PBSC stem cell source (p = 0.049) and HLA mismatch (p =< 0.001) were associated with EBV reactivation in ATG recipients but not in non-recipients. ATG recipients were also more likely to experience a fungal infection (OR=2.8, CI=1.1, 6.7, p=0.023). 1-month ALC was predictive of disease free survival whereby it had a significant negative effect on relapse (HR = 0.33; 95% CI: 0.16, 0.66; p = 0.002). As 1-month ALC increased by one-tenth, the odds of relapse decreased by over 3% and survival increased by 3%. In conclusion, high doses of ATG used during conditioning are associated with an early retardation of lymphoid recovery post-SCT, and with late mixed T cell chimerism accompanied by a delay in CD4+ T cell recovery. This is associated with a higher rate of viral reactivation in PBSC recipients and of fungal infections in general. Lower doses of ATG should be used in SCT and in ATG conditioned SCT, early intervention with DLI, particularly CD8+ cell depleted DLI as reported by others, may help restore T cell repertoire and improve SCT outcomes and survival. Disclosures: Toor: Sanofi Avnetis: Research Funding.

scholarly journals What Is the Most Appropriate Source for Hematopoietic Stem Cell Transplantation? Peripheral Stem Cell/Bone Marrow/Cord Blood

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Itır Sirinoglu Demiriz ◽  
Emre Tekgunduz ◽  
Fevzi Altuntas
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Hematopoietic Stem ◽  
Stem Cell Source ◽  
Cell Source ◽  
Selection Of

The introduction of peripheral stem cell (PSC) and cord blood (CB) as an alternative to bone marrow (BM) recently has caused important changes on hematopoietic stem cell transplantation (HSCT) practice. According to the CIBMTR data, there has been a significant decrease in the use of bone marrow and increase in the use of PSC and CB as the stem cell source for HSCT performed during 1997–2006 period for patients under the age of 20. On the other hand, the stem cell source in 70% of the HSCT procedures performed for patients over the age of 20 was PSC and the second most preferred stem cell source was bone marrow. CB usage is very limited for the adult population. Primary disease, stage, age, time and urgency of transplantation, HLA match between the patient and the donor, stem cell quantity, and the experience of the transplantation center are some of the associated factors for the selection of the appropriate stem cell source. Unfortunately, there is no prospective randomized study aimed to facilitate the selection of the correct source between CB, PSC, and BM. In this paper, we would like to emphasize the data on stem cell selection in light of the current knowledge for patient populations according to their age and primary disease.

Related Vs Unrelated Donors After Auto-Allo Tandem Stem Cell Transplantation for Newly Diagnosed Patients with Multiple Myeloma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1201-1201
Author(s):  
Nicolaus Kröger ◽  
Tatjana Zabelina ◽  
Marion Heinzelmann ◽  
Georgia Schilling ◽  
Christine Wolschke ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Unrelated Donor ◽  
Newly Diagnosed ◽  
Stem Cell Source ◽  
Cell Source ◽  
Unrelated Donors

Abstract Abstract 1201 Poster Board I-223 Introduction: Autologous stem cell transplantation followed by a dose-reduced conditioning and allogeneic stem cell transplantation from HLA-identical siblings has become a treatment option for patients with multiple myeloma. However, only a minority of the patients with multiple myeloma has an HLA-identical sibling and the experience using unrelated donor in this setting is limited. Patients and Methods: From 1997 to 2007, 73 patients (male:45; female:28) with multiple myeloma stage II/III and a median age of 49 years (r, 29-64) were included in a prospective trial to determine the efficacy of a tandem auto-allogeneic stem cell transplantation SCT) from HLA-identical sibling (n=24) or unrelated donors (n=45). Unrelated donor were either fully HLA matched (n=29) or had one mismatch (n=16).Deletion 13q14 could be analyses in 64 pts was found to be positive in 66% of the pts. Del13q14 was more present in patient with unrelated (n=42) than with related (n=22) donors. Stem cell source was PBSC (n=69) or bone marrow (n=4). Induction-chemotherapy consisted of a median of 4 cycles anthracycline-based therapy in 60 pts, or of thalidomide- (n=3) or bortezomib- (n=8) based regimen. 6 pts did not respond to induction therapy and received salvage chemotherapy before autologous SCT. Conditioning prior auto SCT consisted of melphalan 200mg/m2. After a median of 110 days (range 39-228) patients received a reduced intensity regimen with melphalan (140 mg/m2)/fludarabine regimen followed by allogeneic SCT from related (n=24) or unrelated (n=45) donors. GvHD prophylaxis consisted of anti-lymphocyte globulin (ATG-Fresenius®), cyclopsorin A and short course of MTX. Results: No primary or secondary graft failure was observed and leukocyte engraftment was achieved after a median of 15 days (range, 9-27), respectively. Acute graft-versus-host disease (GvHD) grade II to IV occurred in 38% and chronic GvHD in 22% of the patients. Limited GvHD was seen in 16 % and extensive GvHD was seen in 6 % of the patients. There was no difference regarding incidence of GvHD between HLA-identical sibling and unrelated donors. Overall response rate at day 100 was 94% including 55% complete remission (CR) and did not differ between related and unrelated SCT. Cumulative incidence (CI) of non-relapse mortality at one year was 20% (95% CI:11-29%) and did not differ between MUD and MRD (21 vs 17%, p 0.35). The cumulative incidence of relapse at 3 and 5 years was 30% (95% CI:19-41%) and 42% (95% CI: 29-55%), respectively with no difference between related and unrelated SCT at 5 years: 36 vs 44%(p= 0.6). The only significant factor for higher relapse incidence at 5 years was the presence of del13q14 (60 vs 20%, p= 0.007). After a median follow up of 40 months (r., 26-100), the estimated 5-year progression-free (PFS) and overall survival (OS) rates were 31% (95%CI: 19-43%) and 54% (95% CI: 42-64%), respectively, with no difference between related and unrelated SCT. Due to the higher relapse incidence only presence of del13q resulted in a significant worse 5- year OS and DFS (45 vs 77%, p=0.02 and 18 vs 57%, p=0.04). Conclusions: Unrelated donors as stem cell source for auto-allogeneic tandem stem cell transplantation for newly diagnosed myeloma patients resulted in similar NRM, relapse-incidence, DFS and OS than HLA-identical sibling transplantation and can therefore be used as alternative stem cell source. Outcome after transplantation is better for patients lacking del 13q14. Disclosures: No relevant conflicts of interest to declare.

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