Validation of Proposed European Leukemia Net Recommendations for Standardized Reporting and Classification of Cytogenetic Risk in AML Patients Treated with Stem Cell Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4894-4894
Author(s):  
Claudia Ulrike Walter ◽  
Fahed Almhareb ◽  
Naeem A. Chaudhri ◽  
Wahiba Chebbo ◽  
Shad Ahmed ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Risk Stratification ◽  
Risk Group ◽  
Intermediate Risk ◽  
Event Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
First Remission

Abstract Abstract 4894 Background: Pretreatment karyotypes of leukemic cells provide the core for risk-stratification schemes in acute myeloid leukemia (AML) and cytogenetic abnormalities are well established as the strongest prognostic factor for response to therapy and for survival in AML patients. Several cytogenetic risk classifications have been built to stratify AML patients. Only the recent European Leukemia Net (ELN) recommendations by an international panel proposed a new standardized cytogenetic reporting system for AML. More importantly, few studies attempted so far to validate the ELN requirements for risk assessment in AML patients treated with allogeneic hematopoietic stem cell transplantation (HSCT). We investigated whether our series of adult AML patients treated with HSCT could validate the ELN classification criteria. We also assessed the prognostic value of this new risk stratification scheme. Methods: ELN cytogenetic reporting criteria were applied to a series of 110 adult AML patients from a single institution in the Middle East for whom complete cytogenetic data from pretreatment leukemic marrow were available and patients were assigned to the proposed cytogenetic risk subgroups, accordingly. We compared outcome for the different prognostic subgroups. Parameters analyzed were overall survival (OS) and event-free survival (EFS). Our AML group included 62 (56%) patients treated in their first remission (CR1), while most non-CR1 AML patients were treated with HSCT in CR2. The median age of all patients was 25 years (range: 14–57). Results: The patient group included 32 (29%) patients with favorable risk, 60 (55%) in the intermediate-risk group, and 18 (16%) in the adverse-risk group. When all the three groups were considered, there was significant difference in overall survival (OS) (P=0.007) and event-free survival (EFS) (P=0.007). However, there was no significant difference between our favorable-risk group and the intermediate-risk group. This is most likely due to selection bias in the favorable group (e.g. CD56 expression and other unfavorable markers). The adverse-risk group had significantly (P=0.002) shorter survival with median survival of 7.5 months vs. the intermediate-risk group where median survival has not been reached with an average follow-up of 46 months. When we attempted to consider only patients treated with HSCT in the first remission, there were too few patients in the intermediate-risk group (7 patients) for statistical evaluation. Conclusions: The ELN criteria proofed valuable in risk-stratifying our set of adult AML patients who were treated with HSCT and represent a Middle Eastern population. Our series clearly validated the ELN classification. The ELN classification needs further validation in patients treated with HSCT in first remission. Disclosures: No relevant conflicts of interest to declare.

Application of Risk-Adapted Therapy for Acute Myeloid Leukemia to a Population. Effects of Stem Cell Transplantation on Outcome.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4449-4449
Author(s):  
Anders Wahlin ◽  
Mats L. Brune ◽  
Rolf Billstrom
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
Relapse Free Survival ◽  
Free Survival ◽  
First Remission

Abstract We introduced a risk-adapted treatment program for non-APL AML in four Swedish health regions. The aim was to optimise treatment results by the use of risk group stratification, mainly based on cytogenetic findings at diagnosis. All patients received induction therapy with idarubicin-cytarabine 3+7 and consolidation cycles containing high-dose cytarabine. Stem cell transplantation was done in CR1 in selected patients, sparing patients with low/intermediate risk of relapse the risks associated with transplantation. 279 patients, 77% of all AML patients 18–60 years (median 51 yrs), in the population were included in the program. Cytogenetics was performed in 98%. Excluding APL, 19 patients had low-risk. The intermediate-risk group consisted of 165 patients, 96 with a normal karyotype. 95 patients were allocated to the high-risk group. 6% died < 30 days after diagnosis. CR rate was 80%. 111 transplants, 78 allogeneic/URD and 33 autologous, were performed in CR1. 40% of all patients were alive after five years. Median overall survival time was 887 days in low-risk, 611 days in intermediate risk, 345 days in high-risk patients. Relapse-free survival times were also significantly (p<0.001) different between the three risk groups. 43% of responding patients were alive in first remission after four years. 4-year relapse-free survival was significantly better for both intermediate risk (67%) and high-risk (41%) with allogeneic/URD transplantation than with autologous transplant or chemotherapy alone. Relapse was observed more often among patients treated with chemotherapy alone (42%, p=0.03) or with autologous transplants (42%, p=0.09) than among patients receiving allogeneic/URD transplants in CR1, 22%. Our results do not support the use of autologous transplantation in AML in first remission.

The t(9;11) Confers Good Prognosis in AML Patients Treated with Stem Cell Transplantation As Compared to Non-t(9;11) and Other Adverse-Risk Abnormalities

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2527-2527
Author(s):  
Claudia Ulrike Walter ◽  
Fahed Almhareb ◽  
Naeem A. Chaudhri ◽  
Abu Jafar Saleh ◽  
Wahiba Chebbo ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Risk Group ◽  
Intermediate Risk ◽  
Hematopoietic Stem ◽  
Mll Gene ◽  
Significant Difference ◽  
First Remission ◽  
11Q23 Abnormalities

Abstract Abstract 2527 Background: In contrast to most translocations affecting the MLL gene, the t(9;11) is not associated with a markedly poor prognosis. Several studies revealed a very favorable outcome in the pediatric patient group. In adult AML, the t(9;11) has also been associated with superior survival, at least compared to other 11q23 abnormalities. Therefore, 11q23 rearrangements in adult AML are now often dichotomized into t(9;11) and non-t(9;11), with the former being included in the intermediate-risk group and the latter in the adverse-risk group. The proposed European Leukemia Net (ELN) cytogenetic reporting criteria reflect this division. We investigated whether the outcome of AML patients treated with allogeneic hematopoietic stem cell transplantation (HSCT) with t(9;11) remains significantly different from the rest of the adverse-risk cytogenetic group. Methods: Conventional cytogenetics and FISH data from diagnostic bone marrow of 110 adult AML patients treated with HSCT was reviewed and patients classified according to the recommendations of the European Leukemia Net and included 32 with favorable risk, 60 in the intermediate-risk group, and 18 in the adverse-risk group. FISH confirmed MLL rearrangement in cases with apparent 11q23 abnormalities. We compared outcome of patients with t(9;11) to the group of patients with adverse-risk cytogenetics that included all MLL-positive non-t(9;11) among other cytogenetic abnormalities classified adverse-risk. Our study included 62 (56%) patients treated in first remission (CR1), while most non-CR1 AML patients were treated with HSCT in CR2. Patients were between 14 and 57 years, with median age of 25 years. Results: Of the 110 AML patients, 9 (8%) had MLL gene rearrangement. Of these patients only 5 (4.5% of all patients) had t(9;11). When all patients with MLL rearrangement were considered, there was no significant difference between this group and the patients with adverse-risk cytogenetics in overall survival (OS) or event-free survival (EFS). In contrast, when only patients with the t(9;11) were considered, the t(9;11) patients had significantly longer OS (P=0.02) and EFS (P=0.03) as compared with patients with adverse cytogenetics including all non-t(9;11) MLL-rearranged cases. The outcome of MLL-positive non-t(9;11) patients was similar to the group with adverse-risk cytogenetics. MLL rearrangements in the non-t(9;11) group included t(4;11)(q21;q23), t(6;11)(q27;q23) and a variant t(6;11;7)(q27;q23;q11.2), as well as t(11;17)(q23;q25). The survival for patients with t(9;11) remained significantly longer even when only patients treated with HSCT in first remission were considered, although numbers were small. All five patients with t(9;11) were treated with HSCT in CR1. Conclusions: The data supports the conclusion that MLL-positive t(9;11) AML patients should be classified differently from the rest of the MLL-rearranged cases and should be considered as part of the intermediate-risk group. This classification separating the t(9;11) cases from the rest of the MLL-positive cases should be maintained even when patients are treated with allogeneic HSCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Impact of Cytogenetics on the Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Relapsed/Refractory Acute Myeloid Leukemia: A Survey from the Acute Leukemia Working Party (ALWP) of EBMT

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4639-4639
Author(s):  
Monica Poiani ◽  
Myriam Labopin ◽  
Dietrich W. Beelen ◽  
Johanna Tischer ◽  
Jürgen Finke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Prognostic Factor ◽  
Stem Cell Transplantation ◽  
Research Funding ◽  
Risk Group ◽  
Chronic Gvhd ◽  
Risk Groups ◽  
Intermediate Risk ◽  
Free Survival

Abstract Introduction: Diagnostic karyotype is one of the most important determinants of initial response to treatment, remission duration and overall survival in Acute Myelogenous Leukemia (AML). Moreover, risk stratification of AML based on cytogenetic abnormalities is a key parameter for the success rate and outcome of allogeneic stem cell transplantation (allo-SCT) in AML. However, while the prognostic significance of chromosomal abnormalities is well established during frontline therapy, its influence at time of salvage therapy in Primary Refractory (Ref) and Relapsed (Rel) AML and the role of allo-SCT in this subset, remains uncertain. Patients and methods: This was a survey from the EBMT registry which included adult AML patients undergoing allo-SCT for Ref/Rel AML from HLA-matched related or 9/10 - 10/10 unrelated donor (UD) between 2000 and 2017. Patients were stratified according to cytogenetic risk as defined by Grimwade et al. (Blood 2010). Primary endpoint was Leukemia-Free Survival (LFS). Secondary endpoints were relapse cumulative incidence (RI), non-relapse mortality (NRM), overall survival (OS), acute and chronic GVHD and GVHD-relapse-free Survival (GRFS). Results: 2089 patients with Ref AML (n=972) and Rel AML (n=1117) were analyzed: 154 patients had a favorable risk, 1283 were in intermediate risk and 652 had an adverse cytogenetic risk. Median follow-up was 49 months. Patients and transplant characteristics are summarized in table 1. Patients in the favorable risk group were younger and transplanted more frequently in first or second relapse. Patients in the adverse risk group received more frequently transplants from 9/10 UD. FLT3-ITD mutation was present in 18%, 43% and 16% of the favorable, intermediate and adverse risk groups, respectively (p<10-3). The 3 groups were not significantly different in terms of Karnosfky score, patient and CMV serology status and conditioning intensity (myeloablative or reduced). Outcome correlated with cytogenetic category, with a percentage of complete remission within 100 days after transplant of 79%, 69% and 61% (p<10-3), RI at 2 years were 42%, 51% and 61% (p<10-5), LFS and OS rates were 34%, 27%, 18% and 41%, 33%, 22% in favorable, intermediate and adverse risk group (p<10-5 for both LFS and OS), respectively. Non-relapse mortality, on the contrary, did not differ among the three groups (24%, 21% and 21%, respectively; p=NS). We performed a multivariate analysis adjusting for all factors differing between risk groups and factors known as influencing outcome of AML patients after allograft. Compared to the favorable risk group, intermediate risk group was associated with a higher RI (HR=1.58; 95% CI: 1.17-2.14; p=0.003), lower LFS (HR=1.39; 95% CI: 1.09-1.77; p=0.008), lower OS (HR=1;47; 95% CI: 1.14-1.90; p=0.003) and lower GRFS (HR=1;29; 95% CI: 1.03-1.61; p=0.03). The adverse risk group was associated with a higher RI (HR=2.27; 95% CI: 1.65-3.10; p<10-5), lower LFS (HR=1.86; 95% CI: 1.44-2.40; p<10-5), lower OS (HR=1.89; 95% CI: 1.44-2.47; p<10-5) and lower GRFS (HR=1.62; 95% CI: 1.28-2.06; p<10-4; Figure1). In a subgroup analysis of patients in intermediate or adverse risk groups with available information on FLT3-ITD status, adverse cytogenetics remained an important prognostic factor for RI (HR=1.55; 95% CI: 1.22-1.97; p=0.0004), LFS (HR=1.37; 95% CI: 1.12-1.68; p=0.002), OS (HR=1.38; 95% CI: 1.11-1.70; p=0.003) and GRFS (HR=1.31; 95% CI: 1.08-1.59; p=0.006) compared to the intermediate risk group. Other poor prognostic factors in this population were presence of FLT3-ITD mutation, Rel vs Ref status at transplant, Karnofsky score <80%, use of bone marrow as stem cell source and patient CMV serology positivity. In vivo T cell depletion was associated with a lower risk of acute and chronic GVHD and a better GRFS. Conclusion: In Rel and Ref AML karyotype remains an important prognostic factor for those patients undergoing allo-SCT in active disease phase, allowing to separate patients into different risk groups. Moreover, FLT3-ITD mutation remains a negative prognostic factor in this population. Disclosures Beelen: Medac: Consultancy, Other: Travel Support. Tischer:Jazz Pharmaceuticals: Other: Jazz Advisory Board. Finke:Novartis: Consultancy, Honoraria, Other: travel grants, Research Funding; Medac: Consultancy, Honoraria, Other: travel grants, Research Funding; Neovii: Consultancy, Honoraria, Other: travel grants, Research Funding; Riemser: Consultancy, Honoraria, Research Funding. Ganser:Novartis: Membership on an entity's Board of Directors or advisory committees. Mohty:MaaT Pharma: Consultancy, Honoraria.

IL10-592 CC Genotype In the Donor Is Associated with a Significant Decrease of Relapse Rate and a Significant Increase of Event-Free Survival and Overall Survival After Allogeneic Hematopoietic Stem Cell Transplantation In Children with Hematological Malignancies

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4459-4459
Author(s):  
Bernd Gruhn ◽  
Janine Voigt ◽  
Nadine Pfaffendorf-Regler ◽  
Ilona Wolff ◽  
Felix Zintl ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Relapse Rate ◽  
Myeloid Leukemia ◽  
Event Free Survival ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
Il10 Gene

Abstract Abstract 4459 IL10 is a pivotal immunomodulatory cytokine and is usually regarded as a suppressor of the immune responses. However, IL10 has been shown to have some immunostimulatory effects. The IL10-592 CC genotype is associated wit higher production of IL10. Because IL10 may promote the development of alloimmunity we hypothesized that the IL10-592 CC genotype in the donor reduces the risk of relapse after hematopoietic stem cell transplantation (HSCT). A cohort of 211 children (median age, 12 years) with acute lymphoblastic leukemia (n=100), acute myeloid leukemia (n=62), myelodysplastic syndrome (n=30) or chronic myeloid leukemia (n=19) who underwent allogeneic bone marrow (n=153) or peripheral blood stem cell transplantation (n=58; T-cell depleted: n=26) in a single center and/or their respective donors was genotyped of IL10 gene for rs1800872 using TaqMan real-time polymerase chain reaction. The donor was HLA-matched unrelated in 48% of transplants and HLA-identical related in 42% of transplants. Conditioning regimen was myeloablative in all cases. Two forms of post-transplant immunosuppression predominated, cyclosporine A and methotrexate in 69% of transplants and cyclosporine A alone in 17% of transplants. Cell samples from the donor were available in 174 cases and from the patient in 197 cases. The IL10-592 CC genotype was present in 82 of the 174 donors (47.1%) and in 104 of the 197 patients (52.8%). Interestingly, we found a significantly reduced incidence of relapse in patients who were transplanted from a donor with the IL10-592 CC genotype (15.9% versus 30.4%; p=0.016). In addition, we observed a significant increase of event-free survival (52.4% versus 33.7%; p=0.019) and a significant increase of overall survival (54.9% versus 37.0%; p=0.040) if the IL10-592 CC genotype was present in the donor. The occurrence of the IL10-592 CC genotype, in either donors or recipients, had no significant impact on treatment related mortality, acute and chronic graft-versus host disease. In conclusion, IL10-592 CC genotype in the donor is associated with a significant decrease of relapse rate and a significant increase of event-free survival and overall survival after HSCT in children with hematological malignancies. This is the first study to describe an association of IL10 gene polymorphism with relapse rate after HSCT. Selecting a donor with the IL10-592 CC genotype could be a useful therapeutic strategy for improving the final outcome after allogeneic HSCT. Disclosures: No relevant conflicts of interest to declare.

Revised Neuroblastoma Risk Classification System: A Report From the Children's Oncology Group

2021 ◽  
pp. JCO.21.00278
Author(s):  
Meredith S. Irwin ◽  
Arlene Naranjo ◽  
Fan F. Zhang ◽  
Susan L. Cohn ◽  
Wendy B. London ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Risk Group ◽  
Staging System ◽  
Risk Classification ◽  
Intermediate Risk ◽  
Oncology Group ◽  
Event Free Survival ◽  
Free Survival ◽  
Pathology Classification

PURPOSE Treatment planning for children with neuroblastoma requires accurate assessment of prognosis. The most recent Children's Oncology Group (COG) risk classification system used tumor stage as defined by the International Neuroblastoma Staging System. Here, we validate a revised classifier using the International Neuroblastoma Risk Group Staging System (INRGSS) and incorporate segmental chromosome aberrations (SCA) as an additional genomic biomarker. METHODS Newly diagnosed patients enrolled on the COG neuroblastoma biology study ANBL00B1 between 2007 and 2017 with known age, International Neuroblastoma Staging System, and INRGSS stage were identified (N = 4,832). Tumor MYCN status, ploidy, SCA status (1p and 11q), and International Neuroblastoma Pathology Classification histology were determined centrally. Survival analyses were performed for combinations of prognostic factors used in COG risk classification according to the prior version 1, and to validate a revised algorithm (version 2). RESULTS Most patients with locoregional tumors had excellent outcomes except for those with image-defined risk factors (INRGSS L2) with MYCN amplification (5-year event-free survival and overall survival: 76.3% ± 5.8% and 79.9% ± 5.5%, respectively) or patients age ≥ 18 months with L2 MYCN nonamplified tumors with unfavorable International Neuroblastoma Pathology Classification histology (72.7% ± 5.4% and 82.4% ± 4.6%), which includes the majority of L2 patients with SCA. For patients with stage M (metastatic) and MS (metastatic, special) disease, genomic biomarkers affected risk group assignment for those < 12 months ( MYCN) or 12-18 months ( MYCN, histology, ploidy, and SCA) of age. In a retrospective analysis of patient outcome, the 5-year event-free survival and overall survival using COG version 1 were low-risk: 89.4% ± 1.1% and 97.9% ± 0.5%; intermediate-risk: 86.1% ± 1.3% and 94.9% ± 0.8%; high-risk: 50.8% ± 1.4% and 61.9% ± 1.3%; and using COG version 2 were low-risk: 90.7% ± 1.1% and 97.9% ± 0.5%; intermediate-risk: 85.1% ± 1.4% and 95.8% ± 0.8%; high-risk: 51.2% ± 1.4% and 62.5% ± 1.3%, respectively. CONCLUSION A revised 2021 COG neuroblastoma risk classifier (version 2) that uses the INRGSS and incorporates SCAs has been adopted to prospectively define COG clinical trial eligibility and treatment assignment.

Bortezomib-Based Regimens As Consolidation Therapy after Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma: A Single Center Experience from Oran (Algeria)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5121-5121 ◽  
Author(s):  
Souad Talhi ◽  
Soufi Osmani ◽  
Mohamed Brahimi ◽  
Kamila Amani ◽  
Hafida Ouldjeriouat ◽  
...  
Keyword(s):  
Stem Cells ◽  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Progression Free Survival ◽  
Consolidation Therapy ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
Significant Difference

Abstract INTRODUCTION: Autologous stem cell transplant (ASCT) is the standard of care in transplant-eligible multiple myeloma (MM) patients and is associated witha significant improvement in progression-free survival (PFS), complete remission rates (CR), and overall survival (OS). However, the majority ofpatientsrelapse. This study compares the efficacy of autologous hematopoietic stem cells followed by consolidation bybortezomibbased regimens to the no consolidation therapy in adult patients. PATIENTS AND METHODS: This is a retrospective study over a period of 7 years (2009-2015). All patients less than 65 years with a newly MM diagnosis were included. The protocol used in induction was VD (n=47) treatment whichconsisted of four 3-week cycles of 1.3 mg/m2 bortezomib administered subcutaneously (SC) on days 1, 4, 8, and 11 and 40 mg dexamethasone on days 1Ð4 and 9Ð12. Therapy with VTD was composed of four 3-week cycles of SC bortezomib and dexamethasone at the same doses and schedules as for the VD regimen plus 100 mg/day thalidomide administered orally. Therapy with VCD was composed of four 3-week cycles of SC bortezomib and dexamethasone at the same doses and schedules as for the VD regimen plus 500 mg/m2 cyclophosphamide administered orally on days 1, 8, and 15. Recommended concomitant medications included bisphosphonates, antibiotics, and antiviral prophylaxis. Acetyl salicylic acid was systematically used in the VTD arm. Stem cells were mobilized with 15 or 10 microg/kg G-CSF alone. Leukapheresis to harvest stem cells was performed on day -2 and -1. The grafts were kept in a conventional blood bank refrigerator at 4¡C until reinfusion on day 0. The target yield was 2 x106 CD34+ cells/kg. Following induction therapy, all patients had to proceed to ASCT. The conditioning regimen consisted of melphalan 200 mg/m2 in all patients.The consolidation regimen consisted of two cycles of VD or VCD or VTD after autologous stem- cell transplantation. In our study patients were divided into two groups: Group1 (ASCT plus consolidation) and Group 2 (ASCT alone). The therapeutic evaluation focused on the overall response (CR + VGPR) and progression free survival (PFS) and overall survival (OS) calculated by the Kaplan-Meier method. RESULTS: Over a period of 7 years, 153 patients were collected divided in two group: G1 (n=71) and G2 (n=82). Baseline characteristics are summarized in Table 1. No significant difference was observed between the 2 groups. In terms of CR, 58% of the patients in the G1 achieved a CR after consolidation vs 33% in the G2 after ASCT alone (p=0.007). In terms of VGPR, 31% of the patients in the G1 achieved a least a VGPR vs 17% in the G2 (p=0.04). The relapse rate was significantly lower in the G1 (10%) than the G2 (39%), (p=0.0001). The median follow-up period was 23,4 months. PFS was significantly higher in the G1, median no reached vs 37 months in the G2 (p=0.02) but no significant difference was observed in terms of OS rate between the 2 groups, 91% (G1) versus 82% (G2) at 27 months (p=0.7). CONCLUSION: We conclude thatbortezomib-based regimens as consolidation therapy after ASCT in patients with MM was effective in the improvement of PFS and response rate. Table Patients characteristics. Table. Patients characteristics. Disclosures No relevant conflicts of interest to declare.

scholarly journals Randomized Comparison of Gemcitabine, Dexamethasone, and Cisplatin Versus Dexamethasone, Cytarabine, and Cisplatin Chemotherapy Before Autologous Stem-Cell Transplantation for Relapsed and Refractory Aggressive Lymphomas: NCIC-CTG LY.12

2014 ◽  
Vol 32 (31) ◽  
pp. 3490-3496 ◽  
Author(s):  
Michael Crump ◽  
John Kuruvilla ◽  
Stephen Couban ◽  
David A. MacDonald ◽  
Vishal Kukreti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Response Rate ◽  
Aggressive Lymphoma ◽  
Event Free Survival ◽  
Free Survival

Purpose For patients with relapsed or refractory aggressive lymphoma, we hypothesized that gemcitabine-based therapy before autologous stem-cell transplantation (ASCT) is as effective as and less toxic than standard treatment. Patients and Methods We randomly assigned 619 patients with relapsed/refractory aggressive lymphoma to treatment with gemcitabine, dexamethasone, and cisplatin (GDP) or to dexamethasone, cytarabine, and cisplatin (DHAP). Patients with B-cell lymphoma also received rituximab. Responding patients proceeded to stem-cell collection and ASCT. Coprimary end points were response rate after two treatment cycles and transplantation rate. The noninferiority margin for the response rate to GDP relative to DHAP was set at 10%. Secondary end points included event-free and overall survival, treatment toxicity, and quality of life. Results For the intention-to-treat population, the response rate with GDP was 45.2%; with DHAP the response rate was 44.0% (95% CI for difference, −9.0% to 6.7%), meeting protocol-defined criteria for noninferiority of GDP (P = .005). Similar results were obtained in a per-protocol analysis. The transplantation rates were 52.1% with GDP and 49.3% with DHAP (P = .44). At a median follow-up of 53 months, no differences were detected in event-free survival (HR, 0.99; stratified log-rank P = .95) or overall survival (HR, 1.03; P = .78) between GDP and DHAP. Treatment with GDP was associated with less toxicity (P < .001) and need for hospitalization (P < .001), and preserved quality of life (P = .04). Conclusion For patients with relapsed or refractory aggressive lymphoma, in comparison with DHAP, treatment with GDP is associated with a noninferior response rate, similar transplantation rate, event-free survival, and overall survival, less toxicity and hospitalization, and superior quality of life.

Faisability and Results of Autologous Stem Cell Transplantation In Lymphoma Patients Over 65 Years Old.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4593-4593
Author(s):  
Adrian Tempescul ◽  
Jean-Christophe Ianotto ◽  
Jean-Richard Eveillard ◽  
Gaelle Guillerm ◽  
Fontanet Delices Bijou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Elderly Patients ◽  
Disease Free Survival ◽  
Free Survival ◽  
Younger Patients ◽  
Significant Difference ◽  
Two Populations ◽  
Disease Free

Abstract Abstract 4593 Introduction: The incidence of lymphoma is increasing in the western population. Autologous stem cell transplantation (ASCT) is the standard consolidation procedure in patients with lymphoma expressing bad features at the time of diagnosis or in patients relapsing after a first line of chemotherapy (or radiotherapy). It has already been proven that ASCT improves the overall survival and the disease free survival in younger patients. No data are available for the feasibility and the results of ABSCT in elderly patients (OMS defines elderly as age superior to 65 years). Purpose: We performed a retrospective study in our centre, comparing the feasibility and the results of ABSCT in elderly patients with lymphoma compare to patients younger than 65 years old. Patients and Methods: We identified 147 patients who underwent ASCT transplantation in Brest Transplantation Centre. Ninety-four patients were younger than 65 (mean51.44years) and 53 patients were older (mean 67.86 years). Results: Transplantation related mortality (TRM) (up to 100 days post ASCT) was similar for the two populations. There was no statistically significant difference between the two populations regarding the number of units of RBC and platelets transfused, the number of CD 34 reinjected and infectious complications. There was a statistically significant difference between the two populations regarding the duration of aplasia: 11.21 days in younger patients and 11.89 days in elderly population. There was no statistically significant difference between the two populations regarding the overall survival (OS) and the disease free survival (DFS). Conclusion: Our retrospective, monocentric, comparative study showed that ACST could be performed in selected elderly patients (over 65 years old) with no significant difference regarding TRM, DFS and OS but a little bit longer period of aplasia: 11.21 days for young patients and 11.89 in elderly (p-0.0005). Disclosures: No relevant conflicts of interest to declare.

Prognostic Value of Pre-Transplant PET Scan in Patients with Diffuse Large B-Cell (DLBCL) Lymphoma Undergoing Autologous Stem Cell Transplantation (ASCT)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5495-5495
Author(s):  
Allison M Winter ◽  
Lisa A. Rybicki ◽  
Shetal Shah ◽  
Deepa Jagadeesh ◽  
Aaron T. Gerds ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Fdg Pet ◽  
Rank Test ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Deauville Score ◽  
Significant Difference ◽  
Baseline Characteristics

Abstract Background: Recent data have shown that pre-transplant FDG-PET is prognostic in DLBCL patients undergoing autologous stem cell transplantation (ASCT). We retrospectively analyzed data on patients with DLBCL treated with ASCT to assess the impact of pre-transplant FDG-PET on relapse-free survival (RFS) and overall survival (OS). Methods: We reviewed medical records of 32 patients with DLBCL who underwent ASCT using high dose busulfan, cyclophosphamide, and etoposide (Bu/Cy/VP) at Cleveland Clinic from June 2008 to December 2012 and had both a relapse FDG-PET as well as a pre-transplant FDG-PET available for review. All images were interpreted by a staff nuclear medicine radiologist blinded to the outcomes. Visual analysis was performed using the Deauville five-point scale and semiquantitative analysis was done by measuring the maximum standardized uptake value (SUVmax). ΔSUVmax was calculated by determining the difference between the SUVmax at the time of relapse and the SUVmax immediately prior to transplant. Patients were grouped into pre-transplant Deauville score 1-3 or 4-5. Baseline characteristics were compared between groups using the Chi-square test or Wilcoxon rank test. Cox proportional hazards analysis was used to identify prognostic factors. Outcomes were calculated from the date of ASCT. Overall survival (OS) and relapse-free survival (RFS) were estimated using the Kaplan-Meier method and compared using the log-rank test Results: The median age of the patients at transplant was 57 and 69% were male. There was no significant difference in baseline characteristics of patients who had a Deauville score 1-3 compared to patients who had a Deauville score 4-5 including mean age, gender, race, Karnofsky performance status, number of prior chemotherapy regimens, prior radiation therapy, and IPI at diagnosis and transplant. There was a trend towards significance in the median SUVmax at relapse in the Deauville 1-3 group compared to the Deauville 4-5 group (11.1 vs. 18.1, p=0.08) and a significant difference in the median pre-transplant SUVmax (2.3 vs. 8.1, p<0.001). Deauville score 4-5 was the only baseline variable that was prognostic for both RFS (HR=4.2, CI 1.6-11.5, p=0.004) and OS (HR=5.5, CI 1.6-18.9, p=0.006). The 3-year RFS for patients in the Deauville 1-3 group was 64% compared to 12% in the Deauville 4-5 group (p=0.002) and the 3-year OS for patients in the Deauville 1-3 group was 84% compared to 30%, respectively (p=0.002 [Figure 1]). The median ΔSUVmax was 74%. There was no difference in RFS or OS in patients who had a ΔSUVmax above or below this median. However, a high pre-transplant SUVmax(>6 vs. <6) was associated with significantly inferior RFS (p=0.03 [Figure 2]). Conclusions: Pre-transplant FDG-PET Deauville score is prognostic of RFS and OS in patients with DLBCL undergoing ASCT. High SUVmax(>6) prior to transplant is predictive of poor RFS. Pre-transplant PET is a powerful tool for identifying DLBCL patients at high risk for treatment failure with ASCT and could be used to risk-stratify patients in prospective clinical trials of novel transplant strategies. Figure 1. OS of DLBCL patients undergoing ASCT based on pre-transplant Deauville score. Figure 1. OS of DLBCL patients undergoing ASCT based on pre-transplant Deauville score. Figure 2. RFS of DLBCL patients undergoing ASCT based on pre-transplant SUVmax. Figure 2. RFS of DLBCL patients undergoing ASCT based on pre-transplant SUVmax. Disclosures Smith: celegene, spectrum, genentech: Honoraria. Majhail:Gamida Cell Ltd.: Consultancy; Anthem Inc.: Consultancy.

Sign in / Sign up

Export Citation Format

Share Document