Allogeneic hematopoietic cell transplant for multiple myeloma: Comparative results of planned therapy versus salvage therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7035-7035
Author(s):  
L. Shune ◽  
D. J. Weisdorf ◽  
B. McClune ◽  
L. Ma ◽  
L. J. Burns ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Salvage Therapy ◽  
Therapy Group ◽  
Hematopoietic Cell ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hct ◽  
Autologous Hct ◽  
Related Mortality

7035 Background: Despite advances in therapy for multiple myeloma, the disease remains incurable using chemotherapy or immune-modulating agents alone. Several newer hematopoietic cell transplant (HCT) strategies including tandem HCT, and non- myeloablative (NMA) regimens have reported encouraging results. However, the appropriate timing for utilizing these strategies is not clear. Methods: We report outcomes in 51 patients with multiple myeloma who received an allogeneic HCT; either as salvage therapy (after failing a prior autologous HCT), n= 15 or as planned therapy, n= 36, between the years 1996 and 2008 at University of Minnesota. Results: Patients in salvage therapy group were significantly older than in planned therapy group (median age 58 versus 49 years) and had a longer interval from diagnosis to transplant (median 47 versus 10 months). Forty four patients received a HCT from a HLA-identical sibling. Five received umbilical cord blood (four in salvage therapy, one in planned therapy group) and two received unrelated donor HCT (one in each group). Thirteen patients in planned therapy group underwent a tandem transplant (planned autologous followed by NMA sibling HCT). All patients in salvage therapy group, and 50% in planned therapy group received NMA HCT. Patients in salvage therapy group were more heavily pre-treated, all having failed a prior autologous HCT. Complete response was seen in 34% versus 47% of recipients in the two groups, respectively. After a median follow-up of 24 and 41 months, similar relapse was seen, but transplant related mortality (TRM) was significantly higher in salvage therapy group, leading to significantly lower two year survival and disease free survival (DFS) in salvage group. Conclusions: Good overall survival and low transplant related mortality was seen in patients undergoing a planned allogeneic transplant. In heavily pre-treated patients, receiving allogeneic HCT as salvage therapy, despite lower relapse, the high TRM led to lower survival. [Table: see text] No significant financial relationships to disclose.

scholarly journals Measles Reactivity in Windsor Patients Post Autologous Versus Allogeneic Hematopoietic Cell Transplantation: A Retrospective Review

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 30-30
Author(s):  
Kayla Negus ◽  
Mohammad Jarrar ◽  
Indryas L. Woldie ◽  
Sindu M. Kanjeekal ◽  
Kit McCann ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Hematopoietic Cell Transplantation ◽  
Cellular Therapy ◽  
Immune Status ◽  
The United States ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Post Transplant ◽  
Allogeneic Hct ◽  
Autologous Hct

Background As the antivaccine movement has increased, vaccine preventable illnesses have also increased. The resurgence of measles globally has been noted, specifically the United States received 1200 new cases of measles in 2019, which is the highest number of cases since 1994. Measles is a highly contagious pathogen; the virus has an attack rate of up to 90% in susceptible individuals. Standard of care for patients post hematopoietic cell transplant (HCT) includes repeating all childhood vaccinations. However, compliance with recommendations is unknown. No previous reports have been created measuring the difference in measles, mumps, and rubella (MMR) reactivity between autologous and allogeneic HCT patients post treatment. Methods A retrospective chart review investigated HCT patients between 2000-2019 from the Windsor Regional Hospital (WRH) cancer centre. Patients were excluded from data collection if they were deceased before an MMR reactivity test could be done or if they were lost to follow up. A total of 83% of autologous HCT (N=57) and 66% of allogeneic HCT (N=47) patients had serology tested to measure MMR reactivity post-transplant prior to live vaccinations. MMR titres were drawn from autologous patients a median of 395 days after HCT and a median of 907 days after HCT for allogeneic patients. Results Overall, allogeneic HCT patients had more reactivity than autologous HCT patients as seen in Table 1. Conclusion All patients not reactive to measles need to be re-vaccinated 24 months after treatment according to 2019 American Society for Transplantation and Cellular Therapy guidelines. Our patients are treated in a variety of transplant centers in Ontario, Canada as well as Detroit, Michigan; which is of concern because measles cases have been reported in Detroit. The majority (66%) of allogeneic HCT patients had a myeloid malignancy, while 70% of autologous patients has a diagnosis of multiple myeloma. As evidenced by the poor MMR response, less robust immune systems may be accounted for by multiple myeloma patients. This does emphasize the need for MMR vaccinations post HCT for multiple myeloma patients and raises the question regarding immunization for at risk non-transplant eligible patients. We suggest that it may be reasonable to assess MMR immune status in all myeloma patients to determine if this is a transplant effect or an effect of the underlying immune status of the myeloma patient. This study does emphasize the need to assess MMR status post transplant in all myeloma patients, as the vast majority in our study did not demonstrate immunity post stem cell transplant. Figure Disclosures Hamm: Amgen: Consultancy.

Significant Improvement In Day 100 and 1-Year Overall Survival In Patients Who Underwent Myeloablative Allogeneic Hematopoietic Cell Transplant In the US or Canada Between 1994 and 2005

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3509-3509
Author(s):  
Theresa Hahn ◽  
Philip L. McCarthy ◽  
Anna Hassebroek ◽  
John P. Klein ◽  
J. Douglas Rizzo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Disease Status ◽  
Mortality Rates ◽  
Hematopoietic Cell ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Allogeneic Hct ◽  
Matched Sibling ◽  
Over Time ◽  
Related Mortality

Abstract Abstract 3509 Allogeneic hematopoietic cell transplantation (alloHCT) has become standard therapy for hematologic disorders and malignancies. We assessed whether overall survival (OS) at 100 days, which represents early transplant-related mortality (TRM), and at one year, which represents disease-related mortality and later TRM, had changed over time. The study population was derived from patients undergoing 38,060 first alloHCTs between 1994–2005 in US and Canadian centers and reported to the CIBMTR. Donor lymphocyte infusions were excluded. Statistical significance was measured using Ptrend over 6 time cohorts to test whether the OS estimates were stable (slope = 0), increasing (slope>0) or decreasing (slope<0) over time. The Day 100 and 1 year OS estimates are shown in the Table. Disease and disease status subgroups were defined a priori, and the OS estimates are not adjusted for any covariates such as age, Karnofsky status, etc. Marked improvements in 100-day survival were seen for all disease and disease status groups examined. Day 100 mortality rates in HLA-matched sibling alloHCT recipients during the most recent period (2004-5) were as low as 2% for CML treated in CP1, 6–8% for AML in CR1 and ALL in CR2, and a modest 12% for MDS. Even in alloHCT recipients with unrelated donors treated in 2004-5, the Day 100 mortality rates ranged from 9–22%, a significant decrease from historical mortality rates of 29–37%. Significant improvements in 1-year OS were noted for all groups undergoing unrelated-donor alloHCT; however, among those undergoing HLA-matched sibling alloHCT, significant improvements in 1-year OS were only seen in patients with CML in CP1 or MDS. OS has improved for many patients undergoing myeloablative alloHCT, which likely reflects improvement in supportive care and better patient/donor selection. Day 100 OS has significantly improved in all patients who received a myeloablative HLA-matched related or unrelated donor alloHCT. Significant improvement in 1-year OS was also experienced by most patients. Table: Overall survival (95% CI) estimates over time HLA-Matched Sibling Myeloablative Allogeneic HCT 1994-5 1996-7 1998-9 2000-1 2002-3 2004-5 Ptrend AML in CR1     N 370 370 383 376 384 440 <0.001     @100 days 85 (81–88) 87 (84–90) 90 (86–93) 88 (84–91) 92 (89–94) 94 (91–96) 0.1662     @1 year 69 (65–74) 70 (66–75) 72 (67–76) 67 (62–72) 74 (69–78) 75 (71–80) ALL in CR2+     N 179 186 149 159 156 163 0.0018     @100 days 77 (70–83) 82 (76–87) 88 (82–93) 85 (79–90) 85 (79–90) 92 (87–96) 0.2937     @1 year 62 (55–69) 63 (56–70) 69 (61–77) 59 (51–67) 64 (56–71) 70 (62–77) CML in CP1     N 483 540 492 317 155 125 <0.001     @100 days 84 (81–87) 88 (85–90) 89 (87–92) 91 (87–94) 99 (96–100) 98 (94–100) <0.001     @1 year 71 (66–75) 72 (68–76) 80 (76–83) 82 (77–86) 89 (83–93) 92 (86–96) MDS     N 225 290 273 235 239 227 <0.001     @100 days 71 (65–77) 75 (70–80) 76 (71–81) 82 (77–87) 85 (80–89) 88 (84–92) 0.0488     @1 year 54 (48–61) 51 (45–57) 57 (51–63) 58 (51–65) 61 (55–68) 64 (58–71) Unrelated Donor Myeloablative Allogeneic HCT 1994-5 1996-7 1998-9 2000-1 2002-3 2004-5 Ptrend AML in CR1     N 52 75 88 135 182 336 <0.001     @100 days 63 (50–76) 64 (53–74) 69 (59–78) 75 (68–82) 82 (76–87) 86 (82–90) 0.0427     @1 year 48 (35–62) 35 (25–47) 48 (37–59) 51 (42–60) 54 (46–61) 56 (50–62) ALL in CR2+     N 129 151 132 116 164 197 <0.001     @100 days 66 (58–74) 70 (62–77) 71 (62–78) 75 (67–82) 78 (71–84) 91 (87–95) <0.001     @1 year 43 (34–51) 45 (37–53) 49 (40–58) 40 (31–50) 54 (46–62) 67 (60–74) CML in CP1     N 211 250 292 152 87 118 0.0006     @100 days 71 (65–77) 70 (64–75) 74 (69–79) 75 (68–81) 80 (71–88) 87 (81–93) 0.0057     @1 year 51 (44–57) 54 (48–61) 59 (53–64) 60 (52–68) 65 (54–75) 71 (62–80) MDS     N 104 138 135 140 161 234 <0.001     @100 days 64 (54–73) 62 (54–70) 59 (51–67) 67 (59–75) 74 (67–81) 78 (72–83) <0.001     @1 year 41 (31–50) 44 (35–52) 35 (27–43) 45 (37–54) 52 (44–60) 57 (50–63) Disclosures: No relevant conflicts of interest to declare.

scholarly journals Utilization and Outcomes of Autologous Hematopoietic Cell Transplant in Elderly Multiple Myeloma Patients Aged 75 Years and Older in the US

2021 ◽  
Vol 27 (3) ◽  
pp. S47
Author(s):  
Pashna N. Munshi ◽  
David H. Vesole ◽  
Andrew St. Martin ◽  
Omar Davila ◽  
Parameswaran Hari ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
The Us

scholarly journals 1001. Feasibility and Outcomes of a Pre-Transplant Antibiotic Allergy Evaluation Program for Allogeneic Hematopoietic Cell Transplant (HCT) Candidates

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S351-S352
Author(s):  
Catherine Liu ◽  
Elizabeth M Krantz ◽  
Erica J Stohs ◽  
Hannah Imlay ◽  
Lahari Rampur ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Hematopoietic Cell ◽  
Antibiotic Prescribing ◽  
Cell Transplant ◽  
Infection Prophylaxis ◽  
Hematopoietic Cell Transplant ◽  
Pneumocystis Jiroveci ◽  
Evaluation Program ◽  
Allogeneic Hct ◽  
Antibiotic Allergy

Abstract Background Antibiotic allergies impact the management of hematopoietic cell transplant (HCT) patients who are often prescribed antibiotics for infection prophylaxis and treatment. We evaluated the feasibility and outcomes of an antibiotic allergy evaluation program prior to allogeneic HCT. Methods In August 2017, we implemented a program to expedite allergy clinic referrals for adult allogeneic HCT candidates who reported an antibiotic allergy at their initial pre-transplant evaluation visit (PTEV). Allergy labels and clinical data including outcomes of allergy evaluation were prospectively collected for patients with PTEVs between 8/10/17 and November 15/18. The use of selected antibiotics was collected in the 100 days following HCT among patients with a reported β-lactam allergy (BLA). Choice of prophylactic agent for Pneumocystis jiroveci among patients with reported sulfa allergies was assessed among HCT recipients after engraftment. Results Of 276 allogeneic HCT candidates, 109 (39.5%) reported >= 1 antibiotic allergy (Table 1). Of the 109, 69 (63%) were referred for allergy evaluation; 83% (57/69) of those referred were evaluated at a median of 14 days after PTEV, and a median of 18 days before transplant. Among evaluated patients, 45 (79%) had >= 1 antibiotic allergy de-labeled including 74% (28/38) of those with BLA (Figure 1). Of the 10 patients whose BLAs could not be delabeled, 1 had a possible immediate IgE-mediated reaction, 5 had a delayed type IV hypersensitivity, and 4 had other reactions or required additional testing. Post-transplant antibiotic use among evaluated vs. nonevaluated patients reporting BLA is shown in Figure 2. Among 31 patients with reported sulfa allergies who underwent HCT, those who were evaluated received TMP-SMX rather than alternative prophylaxis more often (48%; 11/23) than those who were not evaluated (25%; 2/8). 10 (43%) of 23 evaluated patients were delabeled; 7 of 10 delabeled patients received TMP-SMX. Conclusion Antibiotic allergies are frequently reported among HCT candidates. Pre-transplant antibiotic allergy evaluation was feasible, led to de-labeling of the majority of reported allergies, and may alter antibiotic prescribing and increase the use of preferred agents following transplant. Disclosures All authors: No reported disclosures.

Infectious Causes of Acute Gastroenteritis in US Children Undergoing Allogeneic Hematopoietic Cell Transplant: A Longitudinal, Multicenter Study

2019 ◽  
Vol 9 (4) ◽  
pp. 421-427 ◽  
Author(s):  
Jennifer E Schuster ◽  
Samantha H Johnston ◽  
Bhinnata Piya ◽  
Daniel E Dulek ◽  
Mary E Wikswo ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Hematopoietic Cell ◽  
Mortality Data ◽  
Molecular Testing ◽  
Case Report Form ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Prospective Longitudinal Study ◽  
Allogeneic Hct ◽  
Prospective Longitudinal

Abstract Background Acute gastroenteritis (AGE) in hematopoietic cell transplant (HCT) patients causes significant morbidity and mortality. Data regarding the longitudinal assessment of infectious pathogens during symptomatic AGE and asymptomatic periods, particularly in children, are limited. We investigated the prevalence of AGE-associated infectious pathogens in children undergoing allogeneic HCT. Methods From March 2015 through May 2016, 31 pediatric patients at 4 US children’s hospitals were enrolled and had stool collected weekly from pre-HCT through 100 days post-HCT for infectious AGE pathogens by molecular testing. Demographics, clinical symptoms, antimicrobials, vaccination history, and outcomes were manually abstracted from the medical record into a standardized case report form. Results We identified a pathogen in 18% (38/206) of samples, with many detections occurring during asymptomatic periods. Clostridioides difficile was the most commonly detected pathogen in 39% (15/38) of positive specimens, although only 20% (3/15) of C. difficile–positive specimens were obtained from children with diarrhea. Detection of sapovirus, in 21% (8/38) of pathogen-positive specimens, was commonly associated with AGE, with 87.5% of specimens obtained during symptomatic periods. Norovirus was not detected, and rotavirus was detected infrequently. Prolonged shedding of infectious pathogens was rare. Conclusions This multicenter, prospective, longitudinal study suggests that the epidemiology of AGE pathogens identified from allogeneic HCT patients may be changing. Previously reported viruses, such as rotavirus and norovirus, may be less common due to widespread vaccination and institution of infection control precautions, and emerging viruses such as sapoviruses may be increasingly recognized due to the use of molecular diagnostics.

scholarly journals 1756. Role of Human bocavirus Respiratory Tract Infection in Hematopoietic Cell Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S645-S645
Author(s):  
Chikara Ogimi ◽  
Emily T Martin ◽  
Hu Xie ◽  
Angela P Campbell ◽  
Alpana Waghmare ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Retrospective Review ◽  
Respiratory Symptoms ◽  
Hematopoietic Cell ◽  
Human Bocavirus ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hct

Abstract Background Limited data exist regarding the impact of human bocavirus (BoV) in hematopoietic cell transplant (HCT) recipients. We examined incidence and disease spectrum of BoV respiratory tract infection (RTI) in HCT recipients. Methods In a longitudinal surveillance study of viral RTIs among allogeneic HCT recipients, pre-HCT and weekly post-HCT nasal washes and symptom surveys were collected through day 100, then every 3 months, and whenever respiratory symptoms occurred through 1-year post-HCT. Samples were tested by multiplex semi-quantitative PCR for RSV, parainfluenza virus 1–4, influenza A/B, adenovirus, human metapneumovirus, rhinovirus, coronavirus, and BoV. Plasma samples from BoV+ subjects were analyzed by PCR. In addition, we conducted a retrospective review of HCT recipients with BoV detected in bronchoalveolar lavage or lung biopsy. Results Among 469 patients in the prospective cohort, 21 distinct BoV RTIs (3 pre-HCT and 18 post-HCT) were observed by 1-year post-HCT in 19 patients (median 42 years old, range 0–67) without apparent seasonality. BoV was more frequently detected in the latter half of the first 100 days post-HCT (Figure 1). The frequencies of respiratory symptoms in patients with BoV detected did not appear to be higher than those without any virus detected, with the exception of watery eyes (P < 0.01) (Figure 2). Univariable models among patients with BoV RTI post-HCT showed higher peak viral load in nasal samples (P = 0.04) and presence of respiratory copathogens (P = 0.03) were associated with presence of respiratory symptoms; however, BoV detection in plasma was not (P = 0.8). Retrospective review identified 6 allogeneic HCT recipients (range 1–64 years old) with BoV detected in lower respiratory tract specimens [incidence rate of 0.4% (9/2,385) per sample tested]. Although all 6 cases presented with hypoxemia, 4 had significant respiratory copathogens or concomitant conditions that contributed to respiratory compromise. No death was attributed mainly to BoV lower RTI. Conclusion BoV is infrequently detected in respiratory tract in HCT recipients. Our studies did not demonstrate convincing evidence that BoV is a significant pathogen in either upper or lower respiratory tracts. Watery eyes were associated with BoV detection. Disclosures All authors: No reported disclosures.

scholarly journals Results of autologous and allogeneic hematopoietic cell transplant therapy for multiple myeloma

2005 ◽  
Vol 35 (12) ◽  
pp. 1133-1140 ◽  
Author(s):  
M Arora ◽  
P B McGlave ◽  
L J Burns ◽  
J S Miller ◽  
J N Barke ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hematopoietic Cell Transplant
Sign in / Sign up

Export Citation Format

Share Document