Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Myelodysplastic Syndrome: Impact of Age and Conditioning

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5939-5939
Author(s):  
Jörg Schmohl ◽  
Spanier Lena ◽  
Christiane Dorn ◽  
Christoph Faul ◽  
Wichard Vogel ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Conflicts Of Interest ◽  
Chronic Gvhd ◽  
Progression Free Survival ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
Allogeneic Hct ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Introduction: Myelodysplastic syndromes (MDS) are one of the main indications for allogeneic hematopoetic cell transplantation (HCT). With the introduction of reduced intensity conditioning regimens (RIC) this curative therapy is increasingly used in elderly (≥60 years) or comorbid patients (pts). Methods: Here we retrospectively analyzed data obtained in 81 consecutive adult MDS patients (f=32, m=49) that underwent allogeneic HCT using either myeloablative (MAC) regimens (Busulfan (Bu)/Cyclophosphamid (Cy) (n=13), Cy (n=1); Cy/Total Body Irradiation (TBI) 12Gray (n=6)) or RIC (FLAMSA/Fludarabin (Flu)/Bu (n=3); Flu/Bu (n=28); Flu/TBI (n=5); Flu/Thiotepa/Melphalan (Mel) (n=2); Flu/Treosulfan (n=12), FLAMSA/Bu/Cy (n=1), Flu/Cy/TBI (n=2), Flu/Mel (n=2)). For graft versus host disease (GVHD) prophylaxis, calcineurin inhibitor combined with mycophenolate mofetil (n=24) or methotrexate (n=41) and anti-thymocyte globulin (n=60) were used. Results: Median age at first diagnosis of patients was 53 years (range 21-72). Pts were grouped in 2 age categories: pts <60 years (group A, n=57) and >60 years (group B, n=24). Pts suffered from MDS/CMML 5q, n=2; CMML I, n=3; CMML II, n=2; RAEB I, n=21; RAEB II, n=21; RCMD, n=27; RCUD, n=2. Median IPSS score in group A and B was 1.4. 32% of group A and 35% of group B had an IPSS Score below 2. Mean HTC-CI in group A was 1.4, in group B 1.7. Grafts either from matched related (A, n=18, B, n=2), matched unrelated (MUD; A, n=25, B, n=13) or mismatched unrelated (MMUD; A, n=7, B, n=9) donors were used. Conditioning in group A was MAC (n=20) or RIC (n=31) whereas all patients in B received RIC. No significant age-associated influence was observed with regard to median survival (A, 44 months; B, 26 months; p=0.7) or estimated 3 year overall survival (OS) (A, 33%; B, 19%; p=0.3). Median observation time of patient alive was 40 months (range 3-168 month). Cumulative incidences of non-relapse mortality adjusted for relapse as competing risk showed no significant difference for group A and B. Progression free survival was not significantly different between the groups (A, 20 months; B 12 months; p=0.25). Kaplan-Mayer Analysis showed no difference in OS between risk groups; however, progression free survival was significantly lower in the group with IPSS >2 (7 vs 22 months, p=0.02). Within 100 days, neither in A nor B non-relapse mortality (NRM) was documented. The use of a MMUD appeared to have a negative but not significant influence in older pts on OS (3-year OS in A: MUD 75% vs. MMUD 25%, p=1.00; B: MUD 100% vs MMUD 0%, p=0.2). Incidence of GvHD ≥II was in 14% vs. 6% in A and B. Incidence of chronic GVHD was 42% in A (limited=12, extensive=12) and 37% in B (limited=4, extensive=5). Conclusion: RIC represents a promising treatment option in elderly MDS pts and allows for allogeneic HCT even in comorbid pts. Age had no negative impact on survival. Interestingly, IPSS score has an influence on progression free survival in patients. Disclosures No relevant conflicts of interest to declare.

The Effect of Costimulatory Moleculars on Graft-Versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4875-4875
Author(s):  
Zhenhua Qiao ◽  
Fang Ye ◽  
Lei Zu
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Hematopoietic Stem ◽  
Graft Versus Host ◽  
Group A ◽  
Group B

Abstract Objective: To explore the effect of costimulatory molecular and CD25 expressed on peripheral CD4+ T lymphocytes on graft-versus-host disease(GVHD) after allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods: 1. The 21 patients who suffered of hematology diseases or malignant solid tumors and were underwent allo-HSCT and 10 normal individuals were enrolled in the study.2. For the sake of difference conditioning regimens we divided the 21 patients into two groups: patients undergoing non-myeloablative stem cell transplantation(NST) belonged to group A, others undergoing traditional myeloablative stem cell transplantation belonged to group B; we divided them into five groups for with GVHD or without GVHD and types of GVHD: group 1(group A with acute GVHD), group 2(group A with chronic GVHD), group 3(group B with acute GVHD), group 4(group B without GVHD), group 5(group A without GVHD).3. The levels of CD28, CD80, CD152 and CD25 expressions on peripheral CD4+ T lymphocytes were detected by three colors flow cytometry (FCM)in different time(before allo-HSCT,7days,14days,21days,30days after allo-HSCT, the time of GVHD and the time after GVHD treated).4.STR-PCR for detecting micro-satellites chimeras forming. Results: 1. All 21 patients achieved engraftment. By STR-PCR assay,12 cases formed complete chimeras(CC) and 9 cases formed mixed chimeras(MC). In group A,3 cases developed acute GVHD and 4 cases developed chronic GVHD; in group B,4 cases developed aGVHD. The incidence of GVHD and infection rates between group A and B has no difference(X2=3.711, P=0.144).2. Among these 21 cases,5 cases died:2 cases died of multiple organs function failure due to primary disease relapse,1 case died of bleeding in brain and 2 cases died of liver function failure for the sake of complicated with acute GVHD; others survive with disease free till present.3. The results of multivariate logistic regression models and Kaplan-Meier survival curves analyses showed: age, sex, infection, HLA-type, blood type, conditioning regiment and the times of absolute neutrophil counts and platelets recovering to normal, had no association with the incidence of GVHD;A multivariate COX survival function model analysis showed CD4CD152 and CD4CD25 are independent prognostic factors for GVHD(X2=13.128, P<0.0001).4. Patients with GVHD demonstrated higher CD4+CD28+ and CD4+CD80+ T cell levels than those without GVHD(P<0.01);patients with aGVHD demonstrated higher than those with cGVHD(P<0.05) and without GVHD(P<0.05); Patients with GVHD demonstrated lower CD4+CD152+ and CD4+CD25+ T cell levels than those without GVHD(P<0.01); the same result occurs between aGVHD and cGVHD and without GVHD. After effective treatment, unnormal CD4+CD28+, CD4+CD80+, CD4+CD152+ and CD4+CD25+ T cell levels recovered to the levels before transplantation. Conclusions: The incidences of GVHD between NST and traditional myeloablative stem cell transplantation had no difference. B7-CD28/CD152 costimulatory pathway plays a critical role in developing of GVHD. Peripheral CD4+CD28+, CD4+CD80+, CD4+CD152+ and CD4+CD25+ T cell levels were relative to recipient GVHD, especially CD4+CD152+ and CD4+CD25+ T cell levels. Down-grade CD4+CD28+ and CD4+CD80+ T cell levels and up-grade CD4+CD152+ and CD4+CD25+T cell levels could reduce the incidence of GVHD.

The Therapeutic Effect of Lenalidomide Is Enhanced After Allogeneic Stem Cell Transplantation: Results of a Case-Control Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1996-1996
Author(s):  
Vittorio Montefusco ◽  
Francesco Spina ◽  
Elena Zamagni ◽  
Giorgia Saporiti ◽  
Francesca Patriarca ◽  
...  
Keyword(s):  
Stem Cell ◽  
Retrospective Study ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conflicts Of Interest ◽  
Late Onset ◽  
Chronic Gvhd ◽  
Progression Free Survival ◽  
Hematopoietic Stem ◽  
Matching Criteria

Abstract Abstract 1996 Introduction. Lenalidomide (Len) is a highly effective drug against multiple myeloma (MM). It acts through several mechanisms, such as a direct cytotoxic effect, anti-angiogenesis, microenvironment modifications, and immunomodulation. The latter property is particularly interesting in the allogeneic hematopoietic stem cell transplantation (Allo-HSCT) setting, since Len may interact favourably with the graft-versus-myeloma (GVM) effect. Preliminary results from retrospective studies on heterogeneous patient populations have suggested that Len is more effective when given after Allo-HSCT. In order to verify this observation, we have conducted a case-matched analysis comparing Len after autologous stem cell transplantation (Auto-HSCT) vs. Len after Allo-HSCT. The hypothesis is that Len may be more potent when administered after Allo-HSCT. Methods and results. In this retrospective study the matching criteria was represented by the number of treatment lines received before Len. In an attempt to uniform the treatment regimens, an intra-centre matching was recommended. To April 2011 we collected data from 39 patients in each group. Baseline characteristics between Auto and Allo patients were similar, except for age at diagnosis (53 years, range 39–70, in Auto patients; 47 years, range 29 – 61, in Allo patients). The median number of previous lines of treatment was 3 (range 1–6 ) for both groups. Twenty-one out 39 (54%) Allo patients received Allo-HSCT as second or subsequent line of therapy. Thirty-two (82%) Auto and 35 (90%) Allo patients received bortezomib in previous lines. Similarly, 34 (87%) Auto and 12 (54%) Allo patients were previously treated with thalidomide. Len was always combined with dexamethasone. Median time between Auto-HSCT and Len start was 38 months (range 7–159), and for Allo-HSCT 29 months (range 4–215). Best responses were for Auto and Allo patients as follows: 5 vs. 4 CR, 6 vs. 8 VGPR, 11 vs. 12 PR, 6 vs. 8 SD, 11 vs. 7 PD. Time from Len start to the best response was 4 months for both groups. With a median follow-up of 11.5 months (range 1–39), 1 year and 2 year progression-free survival were 41% and 6% for Auto patients, and 52% and 44% for Allo patients (p=0.03), respectively. Two years overall survival was 48% for Auto and 75% for Allo patients (p=0.03). Similar results were observed regardless of previous thalidomide treatment. No unexpected toxicities were reported. Two (10%) patients had worsening of a pre-existent extensive chronic GVHD. Discussion and Conclusion. The comparison between Auto and Allo patients has shown a benefit in terms of PFS and OS in favor of Len administered after AlloHSCT. This observation supports the hypothesis that Len is synergistic with the GVM effect. Since Len has a potent immunomodulatory effect, this can raise concerns about its use after AlloHSCT. A Dutch prospective study showed that the early administration of Len 10 mg daily after non-myeloablative Allo-HSCT induces late onset acute GVHD in a substantial proportion of patients, causing the premature discontinuation of the study. On the contrary, our retrospective study has shown that a later administration is feasible and safe, without an excess of GVHD, suggesting that a more mature immune system can better tolerate Len. Moreover, since in all cases dexamethasone was given in combination with Len, its immunosuppressive effect may have harnessed the Len-induced immune activation. In conclusion our study suggests that Len is particularly active after AlloHSCT, still retaining a favorable toxicity profile. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Haploidentical Stem Cell Transplantation after Myeloabaltive Conditioning Is a Valid and Safe Option for Young Patients with Refractory or Relapsed Aggressive Non-Hodgkin Lymphoma: A Study Compared with HLA-Matched Transplant

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5849-5849
Author(s):  
Haiwen Huang ◽  
Xiaofang Xiao ◽  
Jia Chen ◽  
Zhengming Jin ◽  
Xiaowen Tang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Young Patients ◽  
Progression Free Survival ◽  
Hematopoietic Stem ◽  
Free Survival

Abstract Purpose: The role of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) therapy for refractory or relapsed (R/R) aggressive non-Hodgkin lymphoma (NHL) patients was still unknown. In this study, we aimed to explore the clinical outcome of R/R aggressive NHL patients received haplo-HSCT treatment. Patients and Methods: 23 R/R aggressive NHL patients who had undergone haplo-HSCT in our center between February 2006 and October 2015 were retrospectively analyzed, and 25 R/R aggressive NHL patients who received HLA-matched HSCT at the same period were also involved in this study. All patients received myeloablative conditioning (MAC) regimen, and antithymocyte globulin, cyclosporine A, mycophenolate mofetil and short course of methotrexate were used as graft-versus-host disease (GVHD) prophylaxis. 12 patients had experienced autologous HSCT prior to allo-HSCT. Results: The median age of the total 48 patients was 33 (16-58) years old, and there were 33 males and 15 females in the total cohorts. The diagonosis were as following: 16 (33%) diffuse large B cell lymphoma and 22 (46%) peripheral T cell lymphoma. There were no difference in sex, age at transplantation, histologic diagnosis, aaIPI score, previous ASCT and conditioning regime between HLA-matched HSCT and Haplo-hsct groups. 44 patients had achieved engrafment, and the median times to neutrophil and platelet recovery were 12 and 15 days, respectively. Incidences of grade 3-4 acute GVHD were 18.3% in haplo-HSCT group and 16.7% in HLA-matched HSCT groups(p=0.87), while 2 years cumulative incidences of chronic GVHD in these two groups were 43.5% and 36.7% (P=0.68). For 16 patients who had chemoresistant disease at transplantation in haplo-HSCT group, four patients achieved complete remission, and ten patients achieved partial remission, while the other two patients experienced disease progression at 21 days and 37 days, respectively. With a median follow-up of 25 months, 12 patients experienced disease recurrence or progression in haplo-HSCT. And four patients died of transplantation related mortality: infection (n=2); acute GVHD (n=1) and multi-organ failure (n=1). There were no differences in overall survival (OS) rate at 2 years (52.8% vs 57.0%, P=0.85) and 2 years progress free survival (PFS) rate (52.7% vs 56.9%, p=0.73) between the haplo-SCT and HLA-matched SCT groups. Multivariate analyses suggested that old age (>45 years)(p=0.02), primarychemorefractory (p=0.04)and occurrence of grade3-4 aGVHD (p=0.01) may contribute to poor prognosis. Conclusion: Haploidentical hematopoietic stem cell transplantation withmyeloablative conditioning regimenachieved satisfactory outcome with acceptable side-effects. This approachcan be a feasible and acceptabletherapy for young patients withR/R NHLwho have no access to a HLA-matched donor. Figure Comparison of outcomes after haplo-SCT and HLA-matched SCT. (a) Overall survival, (b) Progression-free survival, (c) Cumulative incidences of grade3-4 acute GVHD, (d) cumulative incidences of chronic GVHD, (e) cumulative incidences of relapse, (f) cumulative incidences of non-relapse mortality. Figure. Comparison of outcomes after haplo-SCT and HLA-matched SCT. (a) Overall survival, (b) Progression-free survival, (c) Cumulative incidences of grade3-4 acute GVHD, (d) cumulative incidences of chronic GVHD, (e) cumulative incidences of relapse, (f) cumulative incidences of non-relapse mortality. Disclosures No relevant conflicts of interest to declare.

Salvage Autologous or Allogeneic Stem Cell Transplantation After the Failure of First Autograft in Patients with Multiple Myeloma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1186-1186
Author(s):  
Qaiser Bashir ◽  
Peter Thall ◽  
Chitra Hosing ◽  
Floralyn L Mendoza ◽  
Eric Han ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conflicts Of Interest ◽  
Treatment Options ◽  
Chronic Gvhd ◽  
Progression Free Survival ◽  
Hematopoietic Stem ◽  
Related Donor

Abstract Abstract 1186 Poster Board I-208 Background: Almost all patients with multiple myeloma (MM) who receive autologous hematopoietic stem cell transplantation (auto HCT) eventually relapse. The treatment options for these patients include novel agents or second (salvage) auto or allogeneic (allo) HCT. Use of reduced intensity conditioning (RIC) has significantly reduced the transplant-related mortality (TRM) with allo HCT. We evaluated the outcomes of patients who received salvage auto or allo HCT for relapsed MM. Methods: Sixty-two patients (24 females and 38 males), with a median age of 55 years (range: 37-73) received a salvage auto HCT between January 1992 and December 2008, whereas 44 patients (19 females and 25 males), with a median age of 51 years (range 32-65) received salvage allo HCT (12 unrelated and 32 related donor) between October 1988 and December 2006. Among 12 patients with unrelated allo HCT, ten were matched at 10/10 HLA loci, while two patients were mismatched at 1 or 2 loci, respectively. Among 32 patients with related donor allo HCT, 29 matched at 10/10 loci, while 3 patients had one or two antigen mismatches. In the allo HCT group eight patients received myeloablative regimens (MA), while thirty six patients received RIC regimens. MA regimens were fludarabine + melphalan 180 mg/m2 in 4 patients, busulfan + cyclophosphamide in 2 patients, busulfan + melphalan in one patient and TBI-based in another patient. RIC regimens were fludarabine + melphalan ≤140 mg/m2 in 34 patients and cyclophosphamide + fludarabine in 2 patients. Results: Median follow-up for both auto and allo HCT patients was 24 months. Median prior treatment regimens in auto and allo HCT patients were 4 (2-16) and 5 (2-10), respectively. Overall response rates in evaluable patients in auto HCT and allo HCT were 63% and 75%, respectively. Cumulative incidence of grade II-IV acute GVHD was 27% and limited or extensive chronic GVHD was 43% in allo HCT group. One-hundred day TRM in auto HCT and allo HCT groups was 3% and 9%, respectively. Most common causes of nonrelapse mortality were infections (12%) in auto, and acute or chronic GVHD (24%) in allo HCT group. Median progression free survival (PFS) and overall survival (OS) for auto HCT were 15.5 and 43.3 months, and for allo HCT were 6.9 and 14 months, respectively. Patients receiving MA regimens had significantly shorter PFS and OS than patients receiving RIC regimens. Conclusions: Both second auto and allo HCT are feasible for salvage therapy in patients with advanced MM, who had relapsed after an auto HCT. Disease progression remains the major cause of treatment failure. RIC regimens have improved the outcome of allo HCT. Disclosures: No relevant conflicts of interest to declare.

Allogeneic Hematopoietic Stem Cell Transplantation (HCT) Compared to Chemotherapy Only in Acute Myeloid Leukemia (AML) Patients 60 Years and Older: A Center for International Blood and Marrow Transplantation Research (CIBMTR)/ Cancer and Leukemia Group B (CALGB) Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 657-657 ◽  
Author(s):  
Sherif Farag ◽  
Kati Maharry ◽  
Waleska S. Perez ◽  
Mei-Jie Zhang ◽  
John F. DiPersio ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Hematopoietic Stem ◽  
Long Term Outcome ◽  
Free Survival ◽  
Prognostic Features ◽  
Allogeneic Hct ◽  
Significant Difference ◽  
Chemotherapy Patients ◽  
Reduced Intensity

Abstract Abstract 657 The outcome of patients aged 60 years or older with AML treated with conventional cytotoxic chemotherapy remains extremely poor with few long-term survivors, irrespective of the type of induction or post-remission treatment intensity or duration. In younger patients, allogeneic HCT performed in first complete remission (CR1) appears to offer a potential advantage in terms of progression-free survival and possibly overall survival (OS) in patients with adverse prognostic features, due at least in part to a graft-versus-leukemia (GvL) effect. Preliminary results of reduced-intensity (RIC) allogeneic HCT performed in older AML patients in CR1 suggest that this approach may improve long-term outcome. However, as patients undergoing allogeneic HCT are likely to be highly selected, it remains uncertain if such an approach will truly improve outcome compared to chemotherapy alone. To investigate this possibility, we compared the outcome of 100 AML patients aged 60-70 years who received RIC allogeneic HSCT in CR1 and were reported to the CIBMTR to that of 96 AML patients treated with only standard induction (daunorubicin and cytarabine ± etoposide) and post-remission chemotherapy on CALGB protocols 9720 and 10201 between January 1998 and October 2006. Patients with therapy-related AML or following an antecedent hematologic disorder were included, along with de novo patients. In the chemotherapy-treated group, only patients who remained in CR1 for at least 4 months were included in order to reduce selection bias. Patients in the HCT cohort were younger than those in the chemotherapy-treated cohort (P<.001; median age 63 v 65 years). There was no significant difference in the distribution of sex, therapy-related leukemia, white blood cell count, FAB classification, or the proportion with normal cytogenetics at diagnosis between the two groups. The time from diagnosis to achievement of CR1 was longer for HCT patients compared to chemotherapy-treated patients (P=.007; median 46 v 38 days). HCT donors were HLA-identical siblings (n=48, 48%) and closely matched unrelated donors (n=52, 52%) and all HCT utilized reduced intensity conditioning plus pharmacologic GVHD prophylaxis. The median follow-up of chemotherapy-treated patients was longer than that of HSCT patients (51 v 30 months). Overall, allogeneic HCT tended to be associated with longer leukemia-free survival (LFS) compared to chemotherapy. The 3-year LFS from CR1 for HCT patients was 34% (95% confidence interval [CI], 24%-44%) compared to 17% (95% CI, 10%-25%) for chemotherapy-treated patients (P=.06). This was largely due to a higher relapse rate (RR); 86% of the chemotherapy patients relapsed compared to only 29% who received HCT (P<.001). However, the non-relapse mortality rate was significantly higher among patients receiving HCT compared to chemotherapy-treated patients (P<.001; 39% v 17%). Survival from CR1 did not differ between the groups (P=.47), with 3 year estimates of 35% (95% CI, 25%-46%) for HSCT patients compared to 25% (95% CI, 17%-34%) for chemotherapy patients. Our results indicate that RIC allogeneic HCT in CR1 in older AML patients is associated with a longer LFS, largely due to a reduction in the RR. Strategies aimed at reducing non-relapse mortality associated with allogeneic HCT, including better graft-versus-host disease prophylaxis and treatment, may lead to a significant improvement in OS for older AML patients. Disclosures: No relevant conflicts of interest to declare.

First and Second High Dose Treatment Supported by Autologous Hematopoetic Cell Transplantation Rescue in Multiple Myeloma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4528-4528
Author(s):  
Sinem Civriz Bozdag ◽  
Pervin Topcuoglu ◽  
Meral Beksac ◽  
Osman Ilhan ◽  
Muhit Ozcan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cell Transplantation ◽  
Median Time ◽  
Conflicts Of Interest ◽  
Early Period ◽  
Progression Free Survival ◽  
Response Rates ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Free Survival

Abstract Abstract 4528 Purpose: We aimed to evaluate the outcome of multiple myeloma patients underwent double autologus hematopoietic cell transplantation in our center. Patient&Method: We retrospectively analyzed 31 multiple myeloma patients (22F;9M) receiving two times high dose therapy supported by auto-HCT in Adult BMT Unit of Ankara University between 2005–2010. Median age was 52 years (34–66ys) prior to first auto-HCT. We evaluated the response rates of progression free survival (PFS) of both transplantation, respectively and also overall survival (OS) from the diagnosis. Results: The median time from diagnosis to the first transplantation was 11 months (5–68ms). The response rates were 87% before the first auto-HSCT [2 Complete response (CR),4 near-CR, 7 very good partial remission (VGPR), 14 PR) but four patients (11%) had refractory disease. The response of first auto-HCT was complete remission or partial response in 50% of the pts and 36% for stable disease. Only 4 pts was progressed at early period of 1st auto-HCT. The median time from the 1st to 2nd auto-HSCT was 16 months (3–64 ms). Seventy-seven percent patients sue to progressive disease responded completely or partially to one or two step treatment regimens before the second auto-HSCT. When evaluated the responses after the second auto-HCT, 14 (46%) patients were in CR or near-CR, 12 (38%) for stabile disease and 5 for refractory. PFS was estimated similar after both first and second auto-HCT (median 9 months vs 10 months, p=0.3) (Graphic 1). Five- year OS from the diagnosis was 75±10%. Conclusion: PFS of the myeloma pts was estimated similar median time after 1st&2nd auto-HSCT. Collection of adequate hematopoietic stem cells enough for more than one auto-HCT in myeloma patients can be appropriate. Although the majority of responses after the first AHSCT were partial responses, complete or near complete responses were dominant after the second AHSCT.Improvement in responses and the similarity of progression free survival can be explained by the contribution of the new antimyelom treatment options Disclosures: No relevant conflicts of interest to declare.

scholarly journals Maintenance Sorafenib Is Superior to Prophylactic DLI in Improving the Prognosis of FLT3-ITD-Positive AML after Allogeneic HSCT

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2668-2668 ◽  
Author(s):  
Jimin Shi ◽  
Liqin Cao ◽  
Yi Luo ◽  
Yanmin Zhao ◽  
Yamin Tan ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Donor Lymphocyte Infusion ◽  
Hematopoietic Stem ◽  
Improved Outcomes ◽  
Sorafenib Group ◽  
Significant Difference ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Group D

Background: Compared with traditional chemotherapy, allogeneic hematopoietic stem cell transplantation (allo-HSCT) can improve the prognosis of patients with FLT3-ITD positivity. Relapse after transplantation is still an important factor affecting survival. Prophylactic donor lymphocyte infusion (DLI) and maintenance sorafenib are two methods for preventing relapse after allo-HSCT in FLT3-ITD-positive acute myeloid leukemia (AML) patients, and their roles in these patients after allo-HSCT need to be further studied. Methods: From January 2014 to December 2018, 69 FLT3-ITD-positive patients who received allo-HSCT at our center were included in this retrospective study. All patients were divided into four groups according to the different treatments received: group A (23 patients who received maintenance sorafenib), group B (12 patients who received prophylactic DLI), group C (33 patients who received neither prophylactic DLI nor maintenance sorafenib), and group D (1 patient who received a combination of prophylactic DLI with maintenance sorafenib), because there was only one patient in group D, it was not included in the analysis. Results: For all patients, the 2-year estimated overall survival (OS) and leukemia-free survival (LFS) were 79.9% and 78.3%, respectively, and the 2-year cumulative incidence of relapse (CIR) was 17.2%. The 2-year estimated OS, LFS and CIR in group A, group B and group C were 95.7%vs75%vs66.8%, 95.7%vs74.1%vs70.2% and 4.3%vs6.7%vs26.1%, respectively. Group A was the best one in OS, LFS and CIR. Between the group A and group C, there were significant difference in OS(P=0.03) and LFS(P=0.04), but not in CIR(P=0.06).The OS in group A was significantly higher than group B(P=0.047), but the difference was not statistically in LFS and CIR (P=0.14 and P=0.21). Conclusion: Maintenance sorafenib after allo-HSCT was associated with improved outcomes for FLT3-ITD positive AML patients and was superior to prophylactic DLI in promoting FLT3-ITD-positive patients obtain a better survival after allo-HSCT. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Comparison of the DONOR Lymphocyte Infusion and Second Allogeneic STEM-CELL Transplantation in the Treatment of First Hematological Relapse after Allogeneic STEM-CELL Transplantation in Adults with ACUTE Leukemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5698-5698
Author(s):  
Haluk Demiroglu ◽  
Elifcan Aladag ◽  
Nelson J. Chao ◽  
Yahya Buyukasik ◽  
Hakan Goker
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Conflicts Of Interest ◽  
Chronic Gvhd ◽  
Donor Lymphocyte Infusion ◽  
Hematopoietic Stem ◽  
Significant Difference

Purpose: Relapse after allogeneic hematopoietic bone marrow transplantation (AHSCT) in acute leukemia is a poor prognosis indicator. Although there is no definite opinion about the optimal treatment chemotherapy, second allogeneic hematopoietic stem cell transplantation (AHSCT2) or donor lymphocyte infusion (DLI) are among the treatment options. Relapse after allogeneic transplantation remains unfortunately quite common and we frequently face difficult management decisions. The decision to offer either option is based on several factors, including donor availability, remission status, presence of disabling comorbidities, and center or physician preference. The aim of this study was to investigate the effect of AHBMT2 or DLI on survival in relapsed transplant patients suffers from acute leukemia. Method:We here in report a retrospective analysis of single-center experience with AHBMT2 and DLI to treat patients relapsing from acute leukemia after a first AHBMT from 2003 to 2018.We enrolled the study 20 patients who underwent DLI and 6 patients who underwent AHBMT2. Result:There was no significant difference in OS between the groups afterward intervention (p:0,9) The 2-year survival rate was 33% in the AHBMT2 group and 43% in the DLI group. After intervention, chronic GVHD was observed only in DLI group. Conclusion: DLI can be considered after relapse as a safer and less toxic method than AHBMT2. Disclosures No relevant conflicts of interest to declare.

Impact of KIR B/X Genotype and Missing KIR Ligands in HLA-Matched Unrelated Donor HSCT

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4488-4488
Author(s):  
Weiyang Li ◽  
Jun He ◽  
Xiaojing Bao ◽  
Lina Zhou ◽  
Wu Depei ◽  
...  
Keyword(s):  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Unrelated Donor ◽  
Prognostic Impact ◽  
Matched Unrelated Donor ◽  
Hematopoietic Stem ◽  
Platelet Recovery ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Abstract 4488 Objective To study the prognostic impact of missing ligands for inhibitory killer immunoglobulin-like receptor(KIR) and donor KIR B/X genotype in HLA-matched hematopoietic stem cell transplantation(HSCT) using unrelated donor. Methods HLA genotype of 51 patients (ALL 22 cases,AML 13 cases,CML 14 cases,MDS 1 case and HAL 1 case) and their matched unrelated donors was determined by polymerase chain reaction sequence oligonucleotide probes(PCR- SSOP) and sequence specific primers (PCR-SSP).The KIR genotype was determined by PCR-SSP. Results Patients were divided into two groups. Group A consisted of 16 patients with donor KIR B/X genotype and missing HLA class I ligands for donor inhibitory KIR, and group B consisted of 35 patients without KIR B/X or missing KIR ligands.The 3-year overall survival(OS) rate for group A was 93.8%, and the OS rate for group B was 61.7% (P=0.058).The 3-year continuous complete remission(CCR) rate for the two groups was 83.3% and 57.2%,respectively(P=0.098).There was no significant difference in neutrophil and platelet recovery,≥ III° acute GVHD(6.3% vs 20.0%,P>0.05) and extensive chronic GVHD (25.0% vs 17.1%,P>0.05) between the two groups. Conclusions In HLA-matched unrelated donor HSCT,donor KIR B/X genotype and missing KIR ligands may be associated with decreased severely acute GVHD,improved CCR and OS. Disclosures: No relevant conflicts of interest to declare.

The Efficacy and Safety of Recombinant Human Thrombopoietin in Patients with Hematological Malgnancies After Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4565-4565
Author(s):  
Miao Miao ◽  
Wu Depei ◽  
Aining Sun ◽  
Ying Wang ◽  
Lingzhi Yan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Platelet Transfusion ◽  
Severe Thrombocytopenia ◽  
Hematopoietic Stem ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Recombinant Human Thrombopoietin

Abstract Abstract 4565 OBJECTIVE: To evaluate the efficacy and sefety of recombinant human thrombopoietin(rhTPO) prior to engraftment in adults with hematological malignancie who received allogeneic haematopoietil stem cell transplantation(Allo-HSCT). METHODS: This sutdy was a randomized, controlled clinical trial,38 patients were hematological malignancie, inclulding acute and chrinic myeloid leukemia, acute lymphoblastic leukemia, lymphoma.They received Allo-HSCT and were randomly divided into groups(group A 19 cases, group B 19 cases).The group A was no-rhTPO as control, the group B were received rhTPO 15000U/d from +1 day, and continued until the untransfused platelet count was >70×109/L for two consecutived days. Patients received platelete transfusion when they developed severe thrombocytopenia<20×109/L. Efficacy and sefety of rhTPO on the outcome of Allo-HSCT were evaluated. RESULTS: In both group A and B, platelet decrease after Allo-HSCT had no sognificant difference. The platelet engraftment duration of group A and B was 15.68±1.36(range 11–31) days and 13.47±0.72(range 9–21) days, respectively. The amount of platelet transfusion of group A and B was 4±0.55(range 20–130) units and 2.89±0.36(range 0–50) units, respectively. The effects of rhTPO on neutrophil engraftment, hepatic function, renal function, alloergic reations and acute GVHD were not found. CONCLUSION: The platelet engraftment duration of group B was shorter than that of group A(t=27.2, p<0.001), the amount of need platelet transfusion was significently less than those in the group A.There was a statistically significant difference in platelet engraftment and platelet transfusion needed(t=2.523, p<0.05). Administration of rhTPO prior to platelet engraftment after Allo-HSCT seem to be efficacy and safe. Disclosures: No relevant conflicts of interest to declare.

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