MATC?ED UNRELATED DONOR HAEMATOPOIETIC STEM CELL TRANSPLANTATION OFFERS LONG-TERM SURVIVAL IN ABOUT HALF OF ADULTS WITH HAEMATOLOGICAL MALIGNANCIES. THE GREEK EXPERIENCE.
(Abstract release date: 05/21/15)
EHA Library. Karakasis D. 06/12/15; 102816; PB2042
Disclosure(s): Evangelismos HospitalBMT Unit
Dimitrios Karakasis
Contributions
Contributions
Abstract
Abstract: PB2042
Type: Publication Only
Background
Allogeneic haematopoietic stem cell transplants (HSCT) are steadily increasing in number due to the enhanced availability of matched unrelated donors (MUD) over the last decade. The results of MUD-HSCT have improved considerably, mainly due to the introduction of high-resolution molecular HLA typing for donor selection. Currently, more than 50% of allogeneic HSCT are done with MUD worldwide.
Aims
The aim of this study is to retrospectively analyze the outcomes in a cohort of adult patients, who underwent MUD-HSCT for hematological malignancies at three major transplant centers in Greece.
Methods
From 01/2001 until 12/2013, 331 patients (M/F: 197/134) underwent MUD-HSCT for acute myeloid leukemia (n= 148), acute lymphoblastic leukemia (n= 74), non-Hodgkin’s lymphoma/chronic lymphocytic leukemia (n=28), myelodysplastic syndrome (n=26), chronic myeloid leukemia (n=21), Hodgkin’s lymphoma (n=20), myelofibrosis (n=7), or other haematological malignancies (n=7). The median age of patients was 40 (range, 14-66) years. Median time from diagnosis to transplantation was 13 (range, 2-235) months. Disease Related Index (DRI) was low, intermediate or high/very high in 11%, 66% or 23% of cases, respectively. EBMT risk score was ≤3 in 38% and ≥4 in 62% of patients. The comorbidity-age index was ≤1 in 58.4%, and ≥2 in 41.6% of recipients. The conditioning regimen was myeloablative in 252 (76%) or reduced intensity in 79 (24%) of procedures. Peripheral blood was the source of graft in 92% of cases. Donor/recipient HLA allele match at HLA-A, -B, -C and -DRB1 loci was 8/8, 7/8 or <7/8 in 51%, 47% and 2% of cases, respectively. In vivo T cell depletion with antithymocyte globulin or alemtuzumab was performed in 58% of cases. The combination of tacrolimus and methotrexate was used for GvHD prophylaxis in 234 (71%) patients.
Results
Engraftment was achieved in 97% of patients. The incidence of acute and chronic GvHD was 42.5% and 55.5%, respectively. The cumulative incidence (CI) of treatment related mortality (TRM) was 26% and 33% at 1 and 3 years post transplant, respectively. CI of relapse was 25%. With a median follow-up of 36.5 months, 3-year event free survival (EFS) and overall survival (OS) were 44% and 47%, respectively. The major prognostic factors for OS in multivariate analysis were EBMT score (≥4 vs. ≤3, 37.4% vs. 64.1%, HR: 2.32, p<0.001), comorbidity-age index (≥2 vs. ≤1, 32.6% vs. 59.7%, HR 1.81, p<0.001), DRI (high/very high vs. intermediate/low, 26.3% vs. 54.3%, HR: 1.79, p<0.004) and HLA match (≤7/8 vs. 8/8, OS 40% vs. 56.1%, HR: 1.68, p<0.002).
Summary
MUD-HSCT is an effective therapeutic option for adults with haematological malignancies, and offers long-term survival in about half of them. Apart from age and comorbidities, the outcome greatly depends on HLA match and disease stage at transplant. Therefore, timely referral of patients for MUD-HSCT early in the course of disease may further improve the results.
Keyword(s): Allogeneic hematopoietic stem cell transplant
Session topic: Publication Only
Type: Publication Only
Background
Allogeneic haematopoietic stem cell transplants (HSCT) are steadily increasing in number due to the enhanced availability of matched unrelated donors (MUD) over the last decade. The results of MUD-HSCT have improved considerably, mainly due to the introduction of high-resolution molecular HLA typing for donor selection. Currently, more than 50% of allogeneic HSCT are done with MUD worldwide.
Aims
The aim of this study is to retrospectively analyze the outcomes in a cohort of adult patients, who underwent MUD-HSCT for hematological malignancies at three major transplant centers in Greece.
Methods
From 01/2001 until 12/2013, 331 patients (M/F: 197/134) underwent MUD-HSCT for acute myeloid leukemia (n= 148), acute lymphoblastic leukemia (n= 74), non-Hodgkin’s lymphoma/chronic lymphocytic leukemia (n=28), myelodysplastic syndrome (n=26), chronic myeloid leukemia (n=21), Hodgkin’s lymphoma (n=20), myelofibrosis (n=7), or other haematological malignancies (n=7). The median age of patients was 40 (range, 14-66) years. Median time from diagnosis to transplantation was 13 (range, 2-235) months. Disease Related Index (DRI) was low, intermediate or high/very high in 11%, 66% or 23% of cases, respectively. EBMT risk score was ≤3 in 38% and ≥4 in 62% of patients. The comorbidity-age index was ≤1 in 58.4%, and ≥2 in 41.6% of recipients. The conditioning regimen was myeloablative in 252 (76%) or reduced intensity in 79 (24%) of procedures. Peripheral blood was the source of graft in 92% of cases. Donor/recipient HLA allele match at HLA-A, -B, -C and -DRB1 loci was 8/8, 7/8 or <7/8 in 51%, 47% and 2% of cases, respectively. In vivo T cell depletion with antithymocyte globulin or alemtuzumab was performed in 58% of cases. The combination of tacrolimus and methotrexate was used for GvHD prophylaxis in 234 (71%) patients.
Results
Engraftment was achieved in 97% of patients. The incidence of acute and chronic GvHD was 42.5% and 55.5%, respectively. The cumulative incidence (CI) of treatment related mortality (TRM) was 26% and 33% at 1 and 3 years post transplant, respectively. CI of relapse was 25%. With a median follow-up of 36.5 months, 3-year event free survival (EFS) and overall survival (OS) were 44% and 47%, respectively. The major prognostic factors for OS in multivariate analysis were EBMT score (≥4 vs. ≤3, 37.4% vs. 64.1%, HR: 2.32, p<0.001), comorbidity-age index (≥2 vs. ≤1, 32.6% vs. 59.7%, HR 1.81, p<0.001), DRI (high/very high vs. intermediate/low, 26.3% vs. 54.3%, HR: 1.79, p<0.004) and HLA match (≤7/8 vs. 8/8, OS 40% vs. 56.1%, HR: 1.68, p<0.002).
Summary
MUD-HSCT is an effective therapeutic option for adults with haematological malignancies, and offers long-term survival in about half of them. Apart from age and comorbidities, the outcome greatly depends on HLA match and disease stage at transplant. Therefore, timely referral of patients for MUD-HSCT early in the course of disease may further improve the results.
Keyword(s): Allogeneic hematopoietic stem cell transplant
Session topic: Publication Only
Abstract: PB2042
Type: Publication Only
Background
Allogeneic haematopoietic stem cell transplants (HSCT) are steadily increasing in number due to the enhanced availability of matched unrelated donors (MUD) over the last decade. The results of MUD-HSCT have improved considerably, mainly due to the introduction of high-resolution molecular HLA typing for donor selection. Currently, more than 50% of allogeneic HSCT are done with MUD worldwide.
Aims
The aim of this study is to retrospectively analyze the outcomes in a cohort of adult patients, who underwent MUD-HSCT for hematological malignancies at three major transplant centers in Greece.
Methods
From 01/2001 until 12/2013, 331 patients (M/F: 197/134) underwent MUD-HSCT for acute myeloid leukemia (n= 148), acute lymphoblastic leukemia (n= 74), non-Hodgkin’s lymphoma/chronic lymphocytic leukemia (n=28), myelodysplastic syndrome (n=26), chronic myeloid leukemia (n=21), Hodgkin’s lymphoma (n=20), myelofibrosis (n=7), or other haematological malignancies (n=7). The median age of patients was 40 (range, 14-66) years. Median time from diagnosis to transplantation was 13 (range, 2-235) months. Disease Related Index (DRI) was low, intermediate or high/very high in 11%, 66% or 23% of cases, respectively. EBMT risk score was ≤3 in 38% and ≥4 in 62% of patients. The comorbidity-age index was ≤1 in 58.4%, and ≥2 in 41.6% of recipients. The conditioning regimen was myeloablative in 252 (76%) or reduced intensity in 79 (24%) of procedures. Peripheral blood was the source of graft in 92% of cases. Donor/recipient HLA allele match at HLA-A, -B, -C and -DRB1 loci was 8/8, 7/8 or <7/8 in 51%, 47% and 2% of cases, respectively. In vivo T cell depletion with antithymocyte globulin or alemtuzumab was performed in 58% of cases. The combination of tacrolimus and methotrexate was used for GvHD prophylaxis in 234 (71%) patients.
Results
Engraftment was achieved in 97% of patients. The incidence of acute and chronic GvHD was 42.5% and 55.5%, respectively. The cumulative incidence (CI) of treatment related mortality (TRM) was 26% and 33% at 1 and 3 years post transplant, respectively. CI of relapse was 25%. With a median follow-up of 36.5 months, 3-year event free survival (EFS) and overall survival (OS) were 44% and 47%, respectively. The major prognostic factors for OS in multivariate analysis were EBMT score (≥4 vs. ≤3, 37.4% vs. 64.1%, HR: 2.32, p<0.001), comorbidity-age index (≥2 vs. ≤1, 32.6% vs. 59.7%, HR 1.81, p<0.001), DRI (high/very high vs. intermediate/low, 26.3% vs. 54.3%, HR: 1.79, p<0.004) and HLA match (≤7/8 vs. 8/8, OS 40% vs. 56.1%, HR: 1.68, p<0.002).
Summary
MUD-HSCT is an effective therapeutic option for adults with haematological malignancies, and offers long-term survival in about half of them. Apart from age and comorbidities, the outcome greatly depends on HLA match and disease stage at transplant. Therefore, timely referral of patients for MUD-HSCT early in the course of disease may further improve the results.
Keyword(s): Allogeneic hematopoietic stem cell transplant
Session topic: Publication Only
Type: Publication Only
Background
Allogeneic haematopoietic stem cell transplants (HSCT) are steadily increasing in number due to the enhanced availability of matched unrelated donors (MUD) over the last decade. The results of MUD-HSCT have improved considerably, mainly due to the introduction of high-resolution molecular HLA typing for donor selection. Currently, more than 50% of allogeneic HSCT are done with MUD worldwide.
Aims
The aim of this study is to retrospectively analyze the outcomes in a cohort of adult patients, who underwent MUD-HSCT for hematological malignancies at three major transplant centers in Greece.
Methods
From 01/2001 until 12/2013, 331 patients (M/F: 197/134) underwent MUD-HSCT for acute myeloid leukemia (n= 148), acute lymphoblastic leukemia (n= 74), non-Hodgkin’s lymphoma/chronic lymphocytic leukemia (n=28), myelodysplastic syndrome (n=26), chronic myeloid leukemia (n=21), Hodgkin’s lymphoma (n=20), myelofibrosis (n=7), or other haematological malignancies (n=7). The median age of patients was 40 (range, 14-66) years. Median time from diagnosis to transplantation was 13 (range, 2-235) months. Disease Related Index (DRI) was low, intermediate or high/very high in 11%, 66% or 23% of cases, respectively. EBMT risk score was ≤3 in 38% and ≥4 in 62% of patients. The comorbidity-age index was ≤1 in 58.4%, and ≥2 in 41.6% of recipients. The conditioning regimen was myeloablative in 252 (76%) or reduced intensity in 79 (24%) of procedures. Peripheral blood was the source of graft in 92% of cases. Donor/recipient HLA allele match at HLA-A, -B, -C and -DRB1 loci was 8/8, 7/8 or <7/8 in 51%, 47% and 2% of cases, respectively. In vivo T cell depletion with antithymocyte globulin or alemtuzumab was performed in 58% of cases. The combination of tacrolimus and methotrexate was used for GvHD prophylaxis in 234 (71%) patients.
Results
Engraftment was achieved in 97% of patients. The incidence of acute and chronic GvHD was 42.5% and 55.5%, respectively. The cumulative incidence (CI) of treatment related mortality (TRM) was 26% and 33% at 1 and 3 years post transplant, respectively. CI of relapse was 25%. With a median follow-up of 36.5 months, 3-year event free survival (EFS) and overall survival (OS) were 44% and 47%, respectively. The major prognostic factors for OS in multivariate analysis were EBMT score (≥4 vs. ≤3, 37.4% vs. 64.1%, HR: 2.32, p<0.001), comorbidity-age index (≥2 vs. ≤1, 32.6% vs. 59.7%, HR 1.81, p<0.001), DRI (high/very high vs. intermediate/low, 26.3% vs. 54.3%, HR: 1.79, p<0.004) and HLA match (≤7/8 vs. 8/8, OS 40% vs. 56.1%, HR: 1.68, p<0.002).
Summary
MUD-HSCT is an effective therapeutic option for adults with haematological malignancies, and offers long-term survival in about half of them. Apart from age and comorbidities, the outcome greatly depends on HLA match and disease stage at transplant. Therefore, timely referral of patients for MUD-HSCT early in the course of disease may further improve the results.
Keyword(s): Allogeneic hematopoietic stem cell transplant
Session topic: Publication Only
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