Effect of Pre-Transplant Red-cell Transfusion Events on Transplant Related Mortality and Overall Survival in Children with Leukemia Undergoing Hematopoietic Stem Cell Transplant

2014 ◽  
Vol 02 (02) ◽  
Author(s):  
Jennifer Andrews ◽  
Ruosha Li
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Red Cell ◽  
Hematopoietic Stem ◽  
Red Cell Transfusion ◽  
Related Mortality

Hematopoietic Stem Cell Transplant Comorbidity Index (HCT-CI) Scores Correlates with Increased Readmissions and Days In Hospital In Patients Undergoing Myeloablative Hematopoietic Stem Cell Transplant

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4748-4748
Author(s):  
Szwed A. Ellen ◽  
Jack W. Hsu ◽  
Wei Hou ◽  
Randy A. Brown ◽  
Christopher R. Cogle ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Conditioning Regimens ◽  
Comorbidity Index ◽  
The Impact

Abstract Abstract 4748 Hematopoietic Stem Cell Transplant Comorbidity Index (HCT-CI) Scores Correlates with Increased Readmissions and Days in Hospital in Patients Undergoing Myeloablative Hematopoietic Stem Cell Transplantation. Ellen Szwed, Jack W. Hsu, Wei Hou, Randy A. Brown, Christopher R. Cogle, John W. Hiemenz, W Stratford May, Jan S. Moreb, Baldeep Wirk, John R. Wingard. The hematopoietic stem cell transplant comorbidity index (HCT-CI) was developed to assess the impact of comorbidities in allogeneic stem cell transplant (AlloSCT) recipients. It has been shown to correlate with non-relapse mortality and overall survival in both the myeloablative, non-myeloablative (NMA), and reduced intensity (RIC) settings, regardless of graft source. However, the economic impact of allogeneic transplant in patients with comorbidities has not been assessed. We retrospectively analyzed 181 consecutive patients who underwent AlloSCT from an HLA identical sibling following either myleoablative (n= 109) or NMA/RIC (n=71) conditioning regimens between January 2001 and December 2008. The HCT-CI score was calculated according to the method of Sorror, et al. (Sorror ML, et al. Blood. 2005 106: 2912–2919). Median follow-up of the entire cohort was 2 years. As previously published, there was a statistically significant correlation between HCT-CI and both non-relapse mortality (HR = 1.147, p = 0.0170,) and overall survival (HR = 1.152, p=0.0001) at 2-years of 23% and 50% respectively. We found statistically significant correlations between the HCT-CI score and total number of hospital readmissions (mean = 1.92; r=0.192; p = 0.0098) and total days in hospital after initial discharge from hospital after stem cell infusion (mean = 22.4 days; r=0.156; p = 0.036). Interestingly, the correlation for number of hospital days did not become statistically significant until 180 days or greater after transplantation. There was no correlation between HCT-CI with graft source, relapse or graft-vs.-host disease. When we stratified the HCT-CI to either myeloablative (N=109) or NMA/RIC (N=71) conditioning regimens, the correlations between the HCT-CI and both non-relapse mortality and overall survival were still statistically significant. The differences in days of hospitalization remained statistically significant in the myeloablative setting, but not in the NMA/RIC setting. In conclusion, our analysis of AlloSCT recipients found a correlation between the HCT-CI and the number of readmissions and hospital length of stay for myeloablative but not NMA/RIC conditioning regimens, suggesting a higher HCT-CI score results in greater use of hospital resources and costs. The increase in resource utilization is greater after the immediate post-transplant period. Whether these conclusions also apply in other transplant settings will need to be investigated. Disclosures: No relevant conflicts of interest to declare.

Obesity is associated with higher overall survival in patients undergoing an outpatient reduced-intensity conditioning hematopoietic stem cell transplant

2013 ◽  
Vol 51 (1) ◽  
pp. 61-65 ◽  
Author(s):  
José Carlos Jaime-Pérez ◽  
Perla R. Colunga-Pedraza ◽  
Balbina Gutiérrez-Gurrola ◽  
Alma S. Brito-Ramírez ◽  
Homero Gutiérrez-Aguirre ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Reduced Intensity Conditioning ◽  
Hematopoietic Stem ◽  
Reduced Intensity

scholarly journals Outcomes of HMA and Venetoclax in Relapsed AML Post-Allogenic Hematopoietic Stem Cell Transplant

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Osama Diab ◽  
Haitham Abdelhakim ◽  
Joseph P. McGuirk ◽  
Tara Lin
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Complete Remission ◽  
Hematopoietic Stem Cell ◽  
Research Funding ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Pharmaceutical Research ◽  
Cell Transplant ◽  
Hematopoietic Stem

Background: There is no standard of care treatment for Acute Myeloid Leukemia (AML) in relapse post-allogeneic hematopoietic stem cell transplant (post-HSCT), with overall 5-year survival about 5-10%. Venetoclax (Ven) is a novel BCL2 inhibitor approved by the FDA for treatment of newly diagnosed AML in combination with hypomethylating agents (HMA) or low dose cytarabine for patients unfit for intensive induction. However, data in relapsed/refractory AML are limited, especially in the post-HSCT setting. In this retrospective study, we reviewed outcomes of patients with AML relapse post-HSCT who received Ven in combination with HMA in a single center. Methods: Charts of 17 patients who had AML relapse post-HSCT treated with combination of Ven and HMA between November 2018 - March 2020 at the University of Kansas Medical Center were reviewed. We utilized descriptive statistics for baseline characteristics and outcomes, and Kaplan-Meier log-rank test for calculating overall survival. Results Seventeen patients received Ven+HMA for AML relapse post-HSCT in our center. At the time of SCT, patients were in first complete remission (CR) (n=15); second CR (n=1) and primary failure induction (1). Median age was 62 at time of relapse (31-71) years, and 8 patients were female (47%). 9 patients (53%) had adverse risk AML (ELN 2017) 8 of them were in CR1 and 1 with primary induction failure. Common mutations included DNMT3a, ASLX-1, TET2 (3); TP53 (2); IDH1/2 (2); NPM1/FLT3 (1); NPM1/IDH2 (1); NPM1 (1 transplanted in CR2); FLT3 (1). 2/17 had received Ven+HMA prior to SCT; 4 patients received HMA alone prior to SCT. 11 patients (65%) were naïve to either Ven or HMA prior to relapse. Median time to relapse was 181 (44-851) days post-HSCT. 9 (53%) patients received Azacitidine+Ven and 8 (47%) received Decitabine+Ven. HMA+Ven was the first line of therapy post-HSCT relapse in 14 patients. 2 had donor lymphocyte infusion (DLI) after either MEC or dacogen but relapsed prior to Ven+HMA. 1 had IDH (2) inhibitor. Patients received median of 2 (1-10) cycles of HMA+Ven. Six (35%) patients achieved complete remission/complete remission with incomplete hematologic recovery (CR/CRi), and 2/6 patients had negative measurable residual disease by multiparameter flow cytometry. Median overall survival was 361 days from relapse (Figure 1). 3/14 patients received subsequent DLI with Ven+HMA. Disease progression was the most common cause of death in 8/9 of patients who died during the follow up period. Most common side effects included neutropenic fever (n=8, 47%) and acute graft versus host disease (aGVHD) (n=5, 30%). 2/5 developed new aGVHD on HMA+Ven with no prior history of aGVHD. However, aGVHD was mainly grade I-II and responsive to therapy. Discussion HMA+Venetoclax demonstrates potential activity in patients with AML relapse post-HSCT with a CR/CRi rate of 35%, comparable to other salvage therapies. There were no unexpected side effect in this high-risk population. Larger studies are needed to confirm efficacy and toxicity in this setting. Disclosures McGuirk: Pluristem Ltd: Research Funding; Kite Pharmaceuticals: Consultancy, Honoraria, Research Funding, Speakers Bureau; Gamida Cell: Research Funding; Bellicum Pharmaceutical: Research Funding; Allo Vir: Consultancy, Honoraria, Research Funding; Juno Therapeutics: Consultancy, Honoraria, Research Funding; Astellas: Research Funding; Fresenius Biotech: Research Funding; Novartis: Research Funding. Lin:Aptevo: Research Funding; Abbvie: Research Funding; Bio-Path Holdings: Research Funding; Celgene: Research Funding; Gilead Sciences: Research Funding; Incyte: Research Funding; Jazz: Research Funding; Mateon Therapeutics: Research Funding; Ono Pharmaceutical: Research Funding; Pfizer: Research Funding; Prescient Therapeutics: Research Funding; Seattle Genetics: Research Funding; Tolero Pharmaceuticals: Research Funding; Trovagene: Research Funding; Genetech-Roche: Research Funding; Celyad: Research Funding; Astellas Pharma: Research Funding.

Hematopoietic Stem cell transplant in National Oncology Cancer Institute of Panama. Ten Years of Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4524-4524
Author(s):  
Jose Luis Franceschi Diaz
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
Hematopoietic Stem Cell Transplants

Abstract Abstract 4524 Panama has a population of 3.5 million inhabitants. Between 2,000 and 2,010 there were 123 hematopoietic stem cell transplants at the INSTITUTO NACIONAL DE ONCOLOGIA (ION). Even though, there are two other specialized centers doing the same procedures that we do, the ION has the greatest experience in the whole country. The objective of this document is to show you our experience and the results of a third level cancer center in an undeveloped country with limited financial resources however with pathologies and diseases that request bone marrow transplant programs installed and developed. The bone marrow transplant program (BMT) of ION initiated at the beginning of 2,000 and since then, it has been doing approximately 10–12 HSCT annually. Material and Methods: We did a review of the data during this first decade and the most important epidemiological and statistics data are presented next. Results: There were 85 autologous and 28 allogeneic hematopoietic stem cell transplants. In the allo group there were 4 reduced intensity included. In every single auto hematopoietic stem cell transplants the source of progenitor stem cells were peripheral blood and in the case of allo, hematopoietic stem cell transplants the source was the bone marrow in 18 cases and the peripheral blood in 20 cases. The mean of CD34 + progenitor cell infused was 3.23×106 (range 2.12–9.93). The peripheral blood progenitor cells were cryopreserved in liquid nitrogen until −136° celsius degrees using controlled rate temperature computerized freezers. The cells were protected from damages during the cryopreservation with cryoprotectant, in this case dimethil sulphoxide 10% was used. The age range was from 17 to 65 years old with a mean of 39 years old with a median of 40 years old. There were 66 males and 57 females. The main indication for Hematopoietic stem cell transplant was Hodgkin disease in 20 cases; follicular lymphoma in 13 cases; large cell lymphoma in 12; chronic myeloid leukemia in 21; adult acute lymphoblastic leukemia 17; adult acute myeloid leukemia in 10; multiple myeloma in 22 (2 pts. were transplanted twice upfront); severe aplastic anemia in 1; myelodisplastic syndrome in 1; lymphoblastic lymphoma in 4, and gray zone lymphoma in 1. The day 100, mortality rate for all patients was 16.3 per 100 with a range between 5–21.1 per 100 according to different diseases and types of transplants. The overall survival for all patients has a median of 59 months but when it is analyzed according to the transplant type with log rank test, there was no significative difference in the overall survival (p = 0.063). However, when all the population is grouped in categories according to diseases in Hodgkin disease; lymphomas; multiple myeloma and leukemias there is a clear difference in plot overall survival, in all four groups statistically significative with the most desfavorably outcome in the leukemia group. Indeed, if all the group is divided in two groups leukemia vs. others, there would be a clear difference in overall survival with a median overall survival of 12 months in the leukemia group that hasn’t been reached in the other group after more than 5 years of follow up (log rank p = 0.014). In all the groups there have been 55 deaths; 20 in the allo hematopoietic stem cell transplant group; and in these patients the main causes were relapse in 12 patients; graft vs. host disease in 3; infection in 4, organ toxicity in 1. There were 35 deaths in were in the auto hematopoietic stem cell transplant group, and in these patients the main group of deaths were relapse in 25 patients; infections in 3; organ toxicity in 2. Acute graft vs host disease (aGVHD). in allo hematopoietic stem cell transplant did affected desfavorably the outcome as we can see in the overall survival plot in comparison to patients without aGVHD (log rank test, p = 0.014). Chronic graft versus host disease (cGVHD) also affected desfavorably the outcome in allo hematopoietic stem cell transplant in comparison to patients with cGVHD (log rank p = 0.002). Conclusion: these results show that a BMT program can be performed in an undeveloped country with efficiency and efficacy. Disclosures: No relevant conflicts of interest to declare.

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