AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ITS MAIN INDICATIONS: A SINGLE-CENTER, RETROSPECTIVE STUDY OF 30 YEARS

Objective: Autologous hematopoietic stem cell transplantation is widely used in patients with hematological cancers and in some solid tumors. We aimed to describe the transplant procedures performed in a single institution along 30 years. Methods: We describe retrospectively the autologous transplants performed from 1987 to 2016 for: acute myeloid leukemia (AML), Hodgkin (HL) and non-Hodgkin lymphoma (NHL), and multiple myeloma (MM). Results: We analyzed 378 consecutive patients, all with neutrophil engraftment, which was faster with higher CD34 counts (p=0.0001) and slower in patients with AML (p=0.003). Five-year overall survival (OS) was 61%. Receiving transplant in the most recent period (2008-2017) was a protective factor (p<0.0001). For MM, the incidence of relapse was significantly higher in patients not achieving a partial response (hazard ratio, HR = 4.02, p = 0.03). For lymphomas, both patients with partial response (p=0.003) and refractory (p=0.007) had higher relapse rates. The 5-year incidence of disease relapse was 42% for AML, 49% for MM, 41% for HL and 41% for NHL (p=0.88). Non-relapse mortality was 13% in 1 year. Conclusion: There was an improvement in the outcomes of patients undergoing autologous transplants for oncological and onco-hematological diseases across the last 30 years in our institution.

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High-dose chemotherapy following autologous hematopoietic stem cell transplantation for multiple myeloma in the real world setting. Single-center experience

Modern Oncology ◽

10.26442/18151434.2020.2.200179 ◽

2020 ◽

Vol 22 (2) ◽

pp. 126-132

Author(s):

Nikita E. Mochkin ◽

Vladislav O. Sarzhevskiy ◽

Julia N. Dubinina ◽

Elena G. Smirnova ◽

Denis A. Fedorenko ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Partial Response ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

High Dose Chemotherapy ◽

High Dose ◽

Hematopoietic Stem

Aim. To assess the long-term results of high-dose chemotherapy following autologous hematopoietic stem cell transplantation (autoHSCT) for multiple myeloma (MM) in the real setting and influence of different factors on the results. Materials and methods. From 2006 till 2018 in Pirogovs Center were performed 205 autoHSCT for patients with MM, aged between 3172 years (median 55). 55 (26.8%) autoHSCT were tandem. The study population consisted of 45% men and 55% women. Median follow up was 75 months. For the majority of patients autoHSCT was performed after achieving at least partial response according to the IMWG criteria. For less than 9% patients, autoHSCT was done for chemo refractory disease as a salvage therapy. Most of the patients 179 (87.4%) were treated using melphalan-based conditioning regimens (140 or 200 mg/m2). Initial staging according to ISS was done for less than 30% and to R-ISS less than 5% patients. No transplant-related mortality till D + 100 was registered. 186 patients were included in the final analysis. Results. The 5-year OS and PFS were 73% and 34%, respectively, that corresponds with international data. For patients, younger than 60, 5-year OS was 82%; for patients older than 60, it was 49% (p0.05). For tandem autoHSCT, 5-year PFS was 44%; for single autoHSCT 26% (p0.05). 5-year PFS after autoHSCT was significantly higher in patients with complete and stringent complete response after autoHSCT (44%) in comparison with the group with partial and very good partial response (77%). Sex, response before and after autoHSCT, immunomodulatory drugs in induction, number of prior lines of induction therapy, conditioning regimen and maintenance therapy had no influence on OS. PFS had the same tendencies, except tumor response after autoHSCT. Conclusion. In a real setting, we recommend tandem autoHSCT for all eligible patients with chemosensitive disease, despite the depth of response and induction therapy. Patients younger than 60 and patients with complete of greater response after autoHSCT, benefit from the autoHSCT most. Implementation of total cytogenetic testing according to the R-ISS is of a great value for further development of autoHSCT for MM in Russia.

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Continuous Intravenous Injection Of Mesna Can Reduce Acute Hemorrhagic Cystitis Occurrence Rate In Hematopoietic Stem Cell Transplantation: 359 Allo-HSCT Cases Report

Blood ◽

10.1182/blood.v122.21.4556.4556 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4556-4556

Author(s):

Qianli Jiang ◽

Qifa Liu ◽

Jing Sun ◽

Hongsheng Zhou ◽

Zhiping Fan ◽

...

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Intravenous Injection ◽

Protective Factor ◽

Continuous Group ◽

Hematopoietic Stem ◽

Micro Pump

Objective Acute hemorrhagic cystitis (HC), a severe complication of hematopoietic stem cell transplantation (HSCT), being considered mainly as a result of cyclophosphamide (CTX), seriously affects the quality of life of patients. Mesna, whose half-life is about 70min, is widely used to prevent HC. Aim of this research is to explore the effect of preventing HC in HSCT by continuous intravenous injection of mesna using micro pump on HC in HSCT. Methods (1) 359 patients who underwent allogenic HSCT in Nanfang hospital from January 2003 to December 2012 were recruited into this study (227 male and 132 female). Conditioning regimens were BuCy or TBI-Cy, in which CTX were given 60mg/kg·d,d-3,-2; or GIAC, in which CTX were given 1.8g/m2, d-5, -4. Intravenous injection of mesna was used to prevent HC continuously using micro pump (continuous group, n=250) or intermittently (intermittent group, n=185). Graft versus host disease (GVHD) prevention regimen was cyclosporine A+MTX for HLA-matched sibling donors and cyclosporine A+MTX+ATG for unrelated donors or HLA partial-matched related donors. (2) Both groups received the same daily dose of mesna, which is about 150% of CTX daily dosage. In the intermittent group, 25% of mesna’s daily dosage was injected at 0h, 3h, 6h and 9h after the use of CTX at each time-point; while in the continuous group, 25% of mesna’s daily dosage was injected before the use of CTX, with the rest dosage being continuously injected intravenously for 24hs using micro-infusion pump (25% daily dosage of mesna dissolved in 40ml 0.9% sodium chloride lasting for 8h was given, q8h), from the first dose of CTX till 48hs after the last injection of CTX. Incidences and grades of HC in the two groups were followed up and analyzed. (3)The mesna concentration in urine of two groups was detected by High Performance Liquid Chromatography (HPLC), with the comparison of the trough concentrations and the peak concentration. Results (1) Within 30d after transplantation, HC occurs in 30 of the 160 (18.75%) cases in the intermittent group vs. 16 of 199(8.04%) in the continuous group (P=0.00077). Within 60d after transplantation, HC occurs in 45 of 160 (28.13%) cases in the intermittent group (17cases of I°, 18cases of II°, 8 cases of III°, 2 cases of IV°) with the mean occurrence time being +18.16d (-5-+41d); while only 24 of 199 (12.06%) cases (15 cases of I°, 6 cases of II°, 3 cases of III°, 0 cases of IV°) in the continuous group with the mean time of +26.58d (+2d-+58d). There were statistical significances of the incidence within 60d(P=0.000123) and occurrence time(P=0.018), however there was no statistical significances of grade/severity (P=0.057) of HC between the two groups. (2) Logistic regression analysis shows that within 30d after transplantation, the HC occurrences relates with the way of using mesna (P=0.004), with continuous mesna injection being a protective factor (OR=0.299, 95% CI=0.130-0.684); while age, sex, 24h mean liquid intake, 24h mean excretion, 24h mean urinary volume (each P>0.2) and HLA matching (P=0.099) were unrelated factor. Within 60d after transplantation, the HC occurrences relates with the way of using mesna (P=0.001)and GVHD (P=0.007); continuous mesna injection is a protective factor (OR=0.296, 95% CI=0.146-0.600) and HLA matching is a risk factor (OR=2.422, 95%CI=1.280-4.580). (3) Althrough 73 samples were detected by HPLC for mesna in urine, there were no significant difference of peak and trough concentration between groups. Discussion Early occurrence of HC is mostly related to high dose of cyclophosphamide, while late occurrence of HC can also be related with GVHD and infections. The continuous injection of mesna is a better way for the prevention of HC in HSCT patients, due to its short half-life of mesna. While injection with micro-infusion pump can reduce liquid intake, especially suitable for those who have heart or kidney dysfunctions. Conclusion Continuous intravenous injection of mesna is efficient to prevent HC in hematopoietic stem cell transplantation. Disclosures: No relevant conflicts of interest to declare.

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