A validated symptomatic BKV risk assessment score in patient post allogeneic stem cell transplant.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18536-e18536
Author(s):  
Ala Abudayyeh ◽  
Heather Y. Lin ◽  
Maen Abdelrahim ◽  
Gabriela Rondon ◽  
Borje Andersson ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Cumulative Incidence ◽  
Stem Cell Transplant ◽  
Conditioning Regimen ◽  
Large Cohort ◽  
Grading System ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Cell Immunity

e18536 Background: BKV, Polyomavirus hominis 1, is a member of the family Polyomaviridae, is a non-enveloped virion; in the 1980s, it emerged as an important pathogen in SCT recipients. In the absence of sufficient T-cell immunity, BKV reactivation can progress, leading to prolonged hospital stays and increased mortality secondary to late hemorrhagic cystitis, ureteral stenosis, and nephropathy. In our recently completed retrospective study of 2477 SCT patients, 38.1% had developed renal impairment, and BKV viruria was present in 25%. In addition, BKV was found to be an independent predictor of chronic kidney disease and shorter survival. Using the large cohort (2477) patients studied earlier (2004-2012) we have derived a grading system to identify patients with risk of symptomatic BKV. We hypothesize that the current grading system will identify the patients at risk of symptomatic BKV at day 30 post allogeneic stem cell transplant. Methods: We performed a retrospective chart review of all patients who underwent allogeneic SCT from 2012-2016. The data was extracted from the secured database at MD Anderson cancer Center. Using the three variables that were significant predictor for symptomatic BKV derived from our initial study (conditioning regimen, HLA donor status, & underlying cancer diagnosis) we performed the analysis. Predicted cumulative incidence rate of BK infection at 30 days after transplant in 1308 patients were calculated in the presence of death as a competing risk using the “BASELINE” statement in PHREG procedure in SAS. Patients were classified into low, moderate and high risk according to the distribution of the predicted cumulative incidence of BK infection 30 days after transplant. Results: We have shown that the grading system derived from allogeneic SCT population predicted accurately the high, moderate & low risk population for developing symptomatic BKV. Conclusions: We have created and validated a grading system for symptomatic BKV in a large cohort of (1308 patients) to predict risk at day 30 post allogeneic SCT. Using this grading system we would hope to identify high risk patients for BKV and intervene early with novel therapies prior to complications associated.

scholarly journals Busulfan and Fludarabine As Conditioning Regimen for Unrelated Allogeneic Stem Cell Transplant: A Single-Center Experience

2016 ◽  
Vol 22 (3) ◽  
pp. S358
Author(s):  
Grerk Sutamtewagul ◽  
Kamal Kant Singh Abbi ◽  
Umar Farooq ◽  
Sarah L. Mott ◽  
Lindsay Dozeman ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Conditioning Regimen ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Single Center ◽  
Single Center Experience

scholarly journals Thrombotic Microangiopathy after Pediatric Allogeneic Stem Cell Transplant: Potential Early Markers to Predict Individuals at High-Risk

2019 ◽  
Vol 25 (3) ◽  
pp. S45-S46
Author(s):  
Christopher E Dandoy ◽  
Audrey Stegman ◽  
Abigail R Pate ◽  
Ava Stendahl ◽  
Priscila Badia Alonso ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Thrombotic Microangiopathy ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Early Markers

Comorbidity and Outcomes for Patients Over Age 65 Years Treated with Allogeneic Stem Cell Transplantation for Acute Myelogenous Leukemia and Myelodysplastic Syndrome

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2032-2032 ◽  
Author(s):  
Henry J. Conter ◽  
Nhu-Nhu Nguyen ◽  
Gabriela Rondon ◽  
Julianne Chen ◽  
Elizabeth J Shpall ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Cumulative Incidence ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
High Risk Patients ◽  
Risk Patients ◽  
Acute Myelogenous ◽  
Related Mortality

Abstract Abstract 2032 Background: Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) preferentially afflict patients 65 years of age and older. Patients in this age group are likely to have underlying comorbid conditions. These comorbidities affect treatment planning decisions and clinical outcomes. Here we report comorbidity-stratified outcomes of patients older than 64 treated at MD Anderson Cancer Center from 1996 until 2011, inclusive, treated with allogeneic stem cell transplant (ASCT). Methods: 182 patients older than 64 received an ASCT for AML (n=143) or MDS (n=39). Patient charts were reviewed and comorbidity data abstracted using a standardized form. Burden of comorbidity was assessed using the Hematopoetic Stem Cell Transplant-Specific Comorbidity Index (HSCT-CI). Low-risk, intermediate-risk, and high-risk patients were categorised at 0, 1–2, and >=3 points as per the HSCT-CI. 157 patients were evaluable for pre-transplant comorbidity. Outcomes of interest were cumulative incidence of transplant-related mortality (TRM), cumulative incidence of relapse-related mortality (RRM), incidence of acute and chronic graft-versus-host disease (GVHD), and overall survival (OS). These were estimated from the date of transplantation. Results: The median age of transplanted patients was 67 (range 65–79), and 37 patients age 70 and older were treated. The majority of patients were intermediate-risk and high-risk patients (table), 9 patients had HSCT-CI scores of >=5. Median follow-up for alive patients was 12.6 months (n=63; range 0–118). Cumulative incidence of TRM was 6% at 100 days, 14% at 1 year, 23% at 2 years, and 36% at 5 years (figure). Cumulative incidence of RRM was 36% at 1 year, 42% at 2 years, and 47% at 5 years. HSCT-CI did not independently predict for either TRM or RRM (log-rank test p=0.95). The incidence of grade III and IV acute GVHD was 10% of all patients. The cumulative incidence of chronic GVHD was 25% at 1 year, 27% at 2 years, and 30% at 5 years, with no association between GVHD and HSCT-CI comorbidity. Conclusion: ASCT is a curative option for selected patients over age 64. HSCT-CI did not predict TRM or survival on this cohort of high-risk patients. Disease relapse was of greater concern than TRM, and so novel approaches to relapse prevention are needed. Disclosures: No relevant conflicts of interest to declare.

IL28B genetic variation and cytomegalovirus‐specific T‐cell immunity in allogeneic stem cell transplant recipients

2016 ◽  
Vol 89 (4) ◽  
pp. 685-695 ◽  
Author(s):  
Isabel Corrales ◽  
Carlos Solano ◽  
Paula Amat ◽  
Estela Giménez ◽  
Rafael de la Cámara ◽  
...  
Keyword(s):  
Genetic Variation ◽  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplant ◽  
T Cell Immunity ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Transplant Recipients ◽  
Cell Immunity

scholarly journals Risk Factors for Relapse Following Allogeneic Transplant for Acute Myeloid Leukemia in the UCLA Patient Population

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5855-5855
Author(s):  
Harsh Patel ◽  
Alfonso Molina ◽  
Mina Nikanjam ◽  
Gary J. Schiller
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Conditioning Regimen ◽  
Disease Status ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Stem Cell Source ◽  
Donor Type ◽  
Time To Relapse ◽  
Risk Categorization

Abstract Introduction: Allogeneic stem cell transplant for acute myeloid leukemia (AML) is curative for a subset of patients, however carries a substantial risk of adverse outcomes. Additional information identifying factors relating to relapse, in particular early relapse within one year, can be useful in counseling patients on the risks and benefits of this procedure. The current study represents a retrospective analysis on the UCLA patient population with the goal of identifying the subset of patients at higher risk for relapse. Methods: Data were obtained from the UCLA allogeneic stem cell transplant registry and electronic medical record on patients receiving allogeneic stem cell transplants for acute myeloid leukemia between January 2008 and September 2015. Fischer's exact (categorical variables) or t-tests (continuous variables) were used to determine differences between relapsed and non-relapsed patients, while Cox proportional-hazards regression was used to determine how time-to-relapse varied with age, gender, American Society for Blood and Marrow Transplant (ASBMT), risk categorization (low vs. intermediate or high), donor type (matched related vs. matched unrelated or cord blood), stem cell source (peripheral blood vs. bone marrow or cord blood), conditioning regimen (myeloablative vs. reduced intensity), disease status at transplant (first complete remission vs. later remission), and the presence of chronic graft vs. host disease (GVHD) with statistical software (SAS v. 9.4). For the time-to-relapse analyses, patients not relapsing by the last UCLA clinic visit were included as censored patients, while patients who died prior to relapse were treated as a competing risk. Patients who relapsed or died within 100 days of transplant were not included in the chronic GVHD analyses. Results: 164 patients receiving allogeneic stem cell transplant for AML were included in the analysis of which 49 patients had relapsed by June 2016. Median time to relapse was 158 days (range: 41-2449) and for non-relapsed patients median follow-up was 547 days (range: 31 - 2893). Median age for relapsed patients was 54 years (range: 21-71) and for non-relapsed patients was 55 years (range: 18- 75). Chronic GVHD occurred more often in non-relapsed patients (p=0.008), however no significant differences were found between relapsed and non-relapsed patients for age (p=0.99), gender (p=0.24), conditioning regimen (p=0.29), stem cell source (p=0.82), donor type (p=0.86), ASBMT risk categorization (p=0.31), and disease status at transplant (p=0.59). For patients who relapsed within 1 year compared to those who remained in remission at 1 year, chronic GHVD occurred more frequently in patients who remained in remission (p=0.0004), but no significant differences were found for age (p=0.32), gender (p=0.36), conditioning regimen (p=0.34), stem cell source (p=1.00), donor type (p=1.00), ASBMT risk categorization (p=0.27), and disease status at transplant (p=0.70). Time-to-relapse [hazard ratio (95% confidence interval); p-value] was significantly increased by the presence of chronic GVHD [2.88 (1.45-5.70); p=0.0024], while no significant differences were seen with age (1.00 (0.98-1.02); p=0.82), gender [0.75 (0.43-1.31); p=0.31], ASBMT risk categorization [1.49 (0.85-2.58); p=0.16], conditioning regimen [0.70 (0.40-1.24); p=0.22], stem cell source: peripheral blood stem cell vs. bone marrow [1.21 (0.58-2.54);p=0.61] or cord blood [0.91 (0.46-1.82);p=0.80], donor type [1.16 (0.67-2.03); p=0.59], and disease status at transplant [1.28 (0.72-2.27); p=0.41]. Conclusions: The presence of chronic GHVD was found to significantly decrease the risk of relapse after allogeneic stem cell transplant, however no significant differences in factors that can be assessed prior to transplant were found between the relapsed and non-relapsed patient population. It is important to note that the ASBMT criteria may insufficiently assess the risk of relapse since molecular analysis is not routinely captured. Further studies will be needed to determine predictive factors leading to a higher risk of relapse and the patient population that may benefit from clinical trials rather than allogeneic stem cell transplant. Disclosures Schiller: Incyte Corporation: Research Funding.

Sign in / Sign up

Export Citation Format

Share Document