ENGRAFTMENT POST AUTOLOGOUS STEM CELL TRANSPLANT FOR MULTIPLE MYELOMA IS UNAFFECTED BY LENGTH OF STEM-CELL STORAGE- EXPERIENCES FROM THE ROYAL MARSDEN HOSPITAL, UK
(Abstract release date: 05/19/16)
EHA Library. Chavda S. 06/09/16; 135070; PB2170
Dr. Selina Chavda
Contributions
Contributions
Abstract
Abstract: PB2170
Type: Publication Only
Background
Multiple myeloma(MM) is the is the second most common bone marrow cancer with almost 5000 patients diagnosed in the UK each year, accounting for 10% of all haematological malignancies. Triplet chemotherapy followed by autologous stem cell transplantation (ASCT) is the gold standard induction treatment in younger fit patients and has significantly improved overall survival rates. A second ASCT at relapse can also improve subsequent remission duration. Peripheral blood stem cell (PBSC) harvest and storage is, therefore, routinely performed by transplant centres with the aim to collect enough cells to enable patients to undergo two ASCTs over the course of their treatment. As survival of patients with MM has dramatically improved in the era of novel agents, duration of storage and associated costs incurred have increased. It is therefore important to examine the feasibility and clinical utility of long term cell storage. There is conflicting data on viability of stored stem cells, with some studies reporting reduced CD34+ count and cell viability over time, and others reporting successful transplantation outcomes with stem cells stored for up to 11 years.
Aims
We analysed the effects of stem cell storage duration on time to engraftment in patients undergoing ASCTs for MM in our centre.
Methods
We undertook a retrospective analysis of all patients undergoing ASCT for MM between 2008 and 2015. Patients undergoing tandem ASCTs were excluded. Days to engraftment was defined as number of days from stem cell infusion to neutrophil count > 0.5 X109/L.
Results
406 patients underwent ASCT between 2008 and 2015, with a median patient age of 65 years (range 25-78 years). 80.3% of patients (n=326) underwent one ASCT and 19.7% (n=80) underwent two. Of those patients receiving a second stem cell transplant, 81.2% percent had stem cells stored for between 0-60 months at the time of second transplant, and 18.8% for between 61-170 months.80% of patients required only one therapy regimen prior to ASCT and 79% of patients were in a complete remission or very good partial response pre-transplant. Novel agents (bortezomib, lenalidomide and thalidomide) were used in 95% of cases as front-line therapy. PBSCs were stored on average for 32 months before being used. Melphalan 200mg/m2 was used as conditioning chemotherapy pre-transplant (140mg/m2 in renal impairment or medical comorbidities) with stem-cell return on Day 0. All patients successfully engrafted. There was no significant difference in time to engraftment in all patients with PBSCs stored between 0-60 months (11.3 days +/- 2.3 days) and 60-170 months (11.0 days +/- 2.6 days), p=0.42 (Student’s unpaired t test)). The longest period of time PBSCs were stored was 165 months with successful engraftment at 12 days. 19.7% of patients had stem cells stored between 60-120 months (n=80) and of these 22.5 % of patients went on to have second autograft using stored PBSCs. All patients with PBSCs stored for more than 120 months went on to have a second successful ASCT (n=3). These patients were all treated with novel agents prior to ASCT.
Conclusion
Our results show that prolonged periods of PBSC storage does not affect stem cell engraftment in MM patients undergoing ASCT. These results support the rationale of ongoing long-term PBSC storage in the era of novel agents as salvage ASCT remains an important treatment option for relapsed or progressive MM.
Session topic: E-poster
Keyword(s): Autologous peripheral blood stem cell tansplantati, Multiple myeloma
Type: Publication Only
Background
Multiple myeloma(MM) is the is the second most common bone marrow cancer with almost 5000 patients diagnosed in the UK each year, accounting for 10% of all haematological malignancies. Triplet chemotherapy followed by autologous stem cell transplantation (ASCT) is the gold standard induction treatment in younger fit patients and has significantly improved overall survival rates. A second ASCT at relapse can also improve subsequent remission duration. Peripheral blood stem cell (PBSC) harvest and storage is, therefore, routinely performed by transplant centres with the aim to collect enough cells to enable patients to undergo two ASCTs over the course of their treatment. As survival of patients with MM has dramatically improved in the era of novel agents, duration of storage and associated costs incurred have increased. It is therefore important to examine the feasibility and clinical utility of long term cell storage. There is conflicting data on viability of stored stem cells, with some studies reporting reduced CD34+ count and cell viability over time, and others reporting successful transplantation outcomes with stem cells stored for up to 11 years.
Aims
We analysed the effects of stem cell storage duration on time to engraftment in patients undergoing ASCTs for MM in our centre.
Methods
We undertook a retrospective analysis of all patients undergoing ASCT for MM between 2008 and 2015. Patients undergoing tandem ASCTs were excluded. Days to engraftment was defined as number of days from stem cell infusion to neutrophil count > 0.5 X109/L.
Results
406 patients underwent ASCT between 2008 and 2015, with a median patient age of 65 years (range 25-78 years). 80.3% of patients (n=326) underwent one ASCT and 19.7% (n=80) underwent two. Of those patients receiving a second stem cell transplant, 81.2% percent had stem cells stored for between 0-60 months at the time of second transplant, and 18.8% for between 61-170 months.80% of patients required only one therapy regimen prior to ASCT and 79% of patients were in a complete remission or very good partial response pre-transplant. Novel agents (bortezomib, lenalidomide and thalidomide) were used in 95% of cases as front-line therapy. PBSCs were stored on average for 32 months before being used. Melphalan 200mg/m2 was used as conditioning chemotherapy pre-transplant (140mg/m2 in renal impairment or medical comorbidities) with stem-cell return on Day 0. All patients successfully engrafted. There was no significant difference in time to engraftment in all patients with PBSCs stored between 0-60 months (11.3 days +/- 2.3 days) and 60-170 months (11.0 days +/- 2.6 days), p=0.42 (Student’s unpaired t test)). The longest period of time PBSCs were stored was 165 months with successful engraftment at 12 days. 19.7% of patients had stem cells stored between 60-120 months (n=80) and of these 22.5 % of patients went on to have second autograft using stored PBSCs. All patients with PBSCs stored for more than 120 months went on to have a second successful ASCT (n=3). These patients were all treated with novel agents prior to ASCT.
Conclusion
Our results show that prolonged periods of PBSC storage does not affect stem cell engraftment in MM patients undergoing ASCT. These results support the rationale of ongoing long-term PBSC storage in the era of novel agents as salvage ASCT remains an important treatment option for relapsed or progressive MM.
Session topic: E-poster
Keyword(s): Autologous peripheral blood stem cell tansplantati, Multiple myeloma
Abstract: PB2170
Type: Publication Only
Background
Multiple myeloma(MM) is the is the second most common bone marrow cancer with almost 5000 patients diagnosed in the UK each year, accounting for 10% of all haematological malignancies. Triplet chemotherapy followed by autologous stem cell transplantation (ASCT) is the gold standard induction treatment in younger fit patients and has significantly improved overall survival rates. A second ASCT at relapse can also improve subsequent remission duration. Peripheral blood stem cell (PBSC) harvest and storage is, therefore, routinely performed by transplant centres with the aim to collect enough cells to enable patients to undergo two ASCTs over the course of their treatment. As survival of patients with MM has dramatically improved in the era of novel agents, duration of storage and associated costs incurred have increased. It is therefore important to examine the feasibility and clinical utility of long term cell storage. There is conflicting data on viability of stored stem cells, with some studies reporting reduced CD34+ count and cell viability over time, and others reporting successful transplantation outcomes with stem cells stored for up to 11 years.
Aims
We analysed the effects of stem cell storage duration on time to engraftment in patients undergoing ASCTs for MM in our centre.
Methods
We undertook a retrospective analysis of all patients undergoing ASCT for MM between 2008 and 2015. Patients undergoing tandem ASCTs were excluded. Days to engraftment was defined as number of days from stem cell infusion to neutrophil count > 0.5 X109/L.
Results
406 patients underwent ASCT between 2008 and 2015, with a median patient age of 65 years (range 25-78 years). 80.3% of patients (n=326) underwent one ASCT and 19.7% (n=80) underwent two. Of those patients receiving a second stem cell transplant, 81.2% percent had stem cells stored for between 0-60 months at the time of second transplant, and 18.8% for between 61-170 months.80% of patients required only one therapy regimen prior to ASCT and 79% of patients were in a complete remission or very good partial response pre-transplant. Novel agents (bortezomib, lenalidomide and thalidomide) were used in 95% of cases as front-line therapy. PBSCs were stored on average for 32 months before being used. Melphalan 200mg/m2 was used as conditioning chemotherapy pre-transplant (140mg/m2 in renal impairment or medical comorbidities) with stem-cell return on Day 0. All patients successfully engrafted. There was no significant difference in time to engraftment in all patients with PBSCs stored between 0-60 months (11.3 days +/- 2.3 days) and 60-170 months (11.0 days +/- 2.6 days), p=0.42 (Student’s unpaired t test)). The longest period of time PBSCs were stored was 165 months with successful engraftment at 12 days. 19.7% of patients had stem cells stored between 60-120 months (n=80) and of these 22.5 % of patients went on to have second autograft using stored PBSCs. All patients with PBSCs stored for more than 120 months went on to have a second successful ASCT (n=3). These patients were all treated with novel agents prior to ASCT.
Conclusion
Our results show that prolonged periods of PBSC storage does not affect stem cell engraftment in MM patients undergoing ASCT. These results support the rationale of ongoing long-term PBSC storage in the era of novel agents as salvage ASCT remains an important treatment option for relapsed or progressive MM.
Session topic: E-poster
Keyword(s): Autologous peripheral blood stem cell tansplantati, Multiple myeloma
Type: Publication Only
Background
Multiple myeloma(MM) is the is the second most common bone marrow cancer with almost 5000 patients diagnosed in the UK each year, accounting for 10% of all haematological malignancies. Triplet chemotherapy followed by autologous stem cell transplantation (ASCT) is the gold standard induction treatment in younger fit patients and has significantly improved overall survival rates. A second ASCT at relapse can also improve subsequent remission duration. Peripheral blood stem cell (PBSC) harvest and storage is, therefore, routinely performed by transplant centres with the aim to collect enough cells to enable patients to undergo two ASCTs over the course of their treatment. As survival of patients with MM has dramatically improved in the era of novel agents, duration of storage and associated costs incurred have increased. It is therefore important to examine the feasibility and clinical utility of long term cell storage. There is conflicting data on viability of stored stem cells, with some studies reporting reduced CD34+ count and cell viability over time, and others reporting successful transplantation outcomes with stem cells stored for up to 11 years.
Aims
We analysed the effects of stem cell storage duration on time to engraftment in patients undergoing ASCTs for MM in our centre.
Methods
We undertook a retrospective analysis of all patients undergoing ASCT for MM between 2008 and 2015. Patients undergoing tandem ASCTs were excluded. Days to engraftment was defined as number of days from stem cell infusion to neutrophil count > 0.5 X109/L.
Results
406 patients underwent ASCT between 2008 and 2015, with a median patient age of 65 years (range 25-78 years). 80.3% of patients (n=326) underwent one ASCT and 19.7% (n=80) underwent two. Of those patients receiving a second stem cell transplant, 81.2% percent had stem cells stored for between 0-60 months at the time of second transplant, and 18.8% for between 61-170 months.80% of patients required only one therapy regimen prior to ASCT and 79% of patients were in a complete remission or very good partial response pre-transplant. Novel agents (bortezomib, lenalidomide and thalidomide) were used in 95% of cases as front-line therapy. PBSCs were stored on average for 32 months before being used. Melphalan 200mg/m2 was used as conditioning chemotherapy pre-transplant (140mg/m2 in renal impairment or medical comorbidities) with stem-cell return on Day 0. All patients successfully engrafted. There was no significant difference in time to engraftment in all patients with PBSCs stored between 0-60 months (11.3 days +/- 2.3 days) and 60-170 months (11.0 days +/- 2.6 days), p=0.42 (Student’s unpaired t test)). The longest period of time PBSCs were stored was 165 months with successful engraftment at 12 days. 19.7% of patients had stem cells stored between 60-120 months (n=80) and of these 22.5 % of patients went on to have second autograft using stored PBSCs. All patients with PBSCs stored for more than 120 months went on to have a second successful ASCT (n=3). These patients were all treated with novel agents prior to ASCT.
Conclusion
Our results show that prolonged periods of PBSC storage does not affect stem cell engraftment in MM patients undergoing ASCT. These results support the rationale of ongoing long-term PBSC storage in the era of novel agents as salvage ASCT remains an important treatment option for relapsed or progressive MM.
Session topic: E-poster
Keyword(s): Autologous peripheral blood stem cell tansplantati, Multiple myeloma
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