THE ROLE OF LYMPHOCYTE RECOVERY AFTER HIGH DOSE THERAPY AND AUTOLOGOUS STEM CELL TRANSPLANTATION IN PATIENTS WITH RELAPSED/REFRACTORY HODGKIN LYMPHOMA AND MULTIPLE MYELOMA
(Abstract release date: 05/19/16)
EHA Library. Todorovic Balint M. 06/09/16; 135095; PB2195
Dr. Milena Todorovic Balint
Contributions
Contributions
Abstract
Abstract: PB2195
Type: Publication Only
Background
In Non Hodgkin lymphoma as well as in Hodgkin lymphoma (HL) and multiple myeloma (MM), lymphocyte recovery after autologous stem cell transplantation (ASCT) has been reported to have association with clinical outcome, but also with contradictory data.
Aims
The aim of study was to evaluate the role of parameters that may be associated with outcome after ASCT.
Methods
The study included 61 patients with relapsed/refractory HL (34 males/ 37 females) aged 30 years (range 18-46) and 85 MM patients (42 males/ 43 females) aged 54 years (range 36-65) who were treated with high dose chemotherapy followed with ASCT. Advanced stage of HL disease (Ann Arbor III-IV) had 41.0% patients. Majority of patients had constitutional B symptoms (88.5%) and bulky disease (54.1%). Low IPS had 15 patients (22.6%). All patients received ABVD therapy and in the course of relapse or refractory disease, DHAP as first salvage therapy, and BEAM (54 patients, 88.5%) or CBV (7 patients, 11.5%) as conditioning regimen due to ASCT. The average value of collected CD34+cells was 11.3x106/kg (range 2-24x106/kg) in the volume of 250 ml (range 100-900ml). The mean aplasia duration was 11 days (range 6-28 days). After ASCT 29 patients achieved CR (47.5%), 21 patients PR (34.3%),, 3 had SD (4.9%) and 8 patients (13.1%) had PD. Median time to recovery of absolute lymphocyte count on 500x106/l (ALC500) was 15 days (range 9-32). Regarding MM population, majority of patients had IgG (59, 69.4%) and IgA (12 pts, 14.1%) type of MM. According to the clinical stage (CS) 6 pts (7.1%) had I, 16 (18.8%) II, and 63 (74.5%) III CS. Renal impairment was present in 15pts (17.6%). MM patients were initially treated with protocol VAD (29 pts, 34.1%) or CTD (56 pts, 65.9%) and high dose Melphalan (200mg/m2) was conditioning regimen prior to ASCT in the first treatment line. The average value of collected CD34+cells was 6.5x106/kg (range 2-96x106/kg) in the volume of 300 ml (range 100-660ml). The mean aplasia duration was 8 days (range 4-26 days). After ASCT only 1 patient (1.2%) had PD, while 22 (25.9%) had PR and the rest achieved at least VGPR (52, 73.0%). Median time to ALC500 recovery was 15 days (range 9-23days).
Results
In HL patients survival after ASCT was 39 (2-100) months, and OS was 70 (16-192) months. Patients with low IPS (0-2) had better survival compared to those with high IPS score (≥3) (Log Rank=3.68, p=0.05). Survival after ASCT was markedly influenced by prolonged recovery duration of ALC500≥18 days (Log Rank=4.54, p=0.03). However, the duration of ALC500 recovery was not in correlation with treatment response (p>0.05). Furthermore, survival was significantly inferior in patients with PD or SD after ASCT (Log Rank=6.07, p=0.014). As expected, treatment response after ASCT significantly influenced OS (Log Rank=11.27, p=0.004). Multivariate Cox regression among independent prognostic factors in univariate analysis (IPS, therapeutic outcome and ALC500 recovery) pointed out therapeutic outcome at D+100 and delayed ALC500 recovery as the most important parameters that influenced both OS and EFS (p<0.05). In MM patients survival after ASCT was 29 (2-115) months, and OS was 48 (16- 127) months. However, delayed recovery of ALC500 after 18th. day from ASCT did not influence neither OS nor survival after ASCT.
Conclusion
According to results of Cox regression analysis in HL, no responders at D+100, and delayed recovery of ALC500 are parameters of inferior prognosis and shorter survival. However, similar cut off values of ALC500 are not predictable in MM patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Multiple myeloma, Prognosis
Type: Publication Only
Background
In Non Hodgkin lymphoma as well as in Hodgkin lymphoma (HL) and multiple myeloma (MM), lymphocyte recovery after autologous stem cell transplantation (ASCT) has been reported to have association with clinical outcome, but also with contradictory data.
Aims
The aim of study was to evaluate the role of parameters that may be associated with outcome after ASCT.
Methods
The study included 61 patients with relapsed/refractory HL (34 males/ 37 females) aged 30 years (range 18-46) and 85 MM patients (42 males/ 43 females) aged 54 years (range 36-65) who were treated with high dose chemotherapy followed with ASCT. Advanced stage of HL disease (Ann Arbor III-IV) had 41.0% patients. Majority of patients had constitutional B symptoms (88.5%) and bulky disease (54.1%). Low IPS had 15 patients (22.6%). All patients received ABVD therapy and in the course of relapse or refractory disease, DHAP as first salvage therapy, and BEAM (54 patients, 88.5%) or CBV (7 patients, 11.5%) as conditioning regimen due to ASCT. The average value of collected CD34+cells was 11.3x106/kg (range 2-24x106/kg) in the volume of 250 ml (range 100-900ml). The mean aplasia duration was 11 days (range 6-28 days). After ASCT 29 patients achieved CR (47.5%), 21 patients PR (34.3%),, 3 had SD (4.9%) and 8 patients (13.1%) had PD. Median time to recovery of absolute lymphocyte count on 500x106/l (ALC500) was 15 days (range 9-32). Regarding MM population, majority of patients had IgG (59, 69.4%) and IgA (12 pts, 14.1%) type of MM. According to the clinical stage (CS) 6 pts (7.1%) had I, 16 (18.8%) II, and 63 (74.5%) III CS. Renal impairment was present in 15pts (17.6%). MM patients were initially treated with protocol VAD (29 pts, 34.1%) or CTD (56 pts, 65.9%) and high dose Melphalan (200mg/m2) was conditioning regimen prior to ASCT in the first treatment line. The average value of collected CD34+cells was 6.5x106/kg (range 2-96x106/kg) in the volume of 300 ml (range 100-660ml). The mean aplasia duration was 8 days (range 4-26 days). After ASCT only 1 patient (1.2%) had PD, while 22 (25.9%) had PR and the rest achieved at least VGPR (52, 73.0%). Median time to ALC500 recovery was 15 days (range 9-23days).
Results
In HL patients survival after ASCT was 39 (2-100) months, and OS was 70 (16-192) months. Patients with low IPS (0-2) had better survival compared to those with high IPS score (≥3) (Log Rank=3.68, p=0.05). Survival after ASCT was markedly influenced by prolonged recovery duration of ALC500≥18 days (Log Rank=4.54, p=0.03). However, the duration of ALC500 recovery was not in correlation with treatment response (p>0.05). Furthermore, survival was significantly inferior in patients with PD or SD after ASCT (Log Rank=6.07, p=0.014). As expected, treatment response after ASCT significantly influenced OS (Log Rank=11.27, p=0.004). Multivariate Cox regression among independent prognostic factors in univariate analysis (IPS, therapeutic outcome and ALC500 recovery) pointed out therapeutic outcome at D+100 and delayed ALC500 recovery as the most important parameters that influenced both OS and EFS (p<0.05). In MM patients survival after ASCT was 29 (2-115) months, and OS was 48 (16- 127) months. However, delayed recovery of ALC500 after 18th. day from ASCT did not influence neither OS nor survival after ASCT.
Conclusion
According to results of Cox regression analysis in HL, no responders at D+100, and delayed recovery of ALC500 are parameters of inferior prognosis and shorter survival. However, similar cut off values of ALC500 are not predictable in MM patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Multiple myeloma, Prognosis
Abstract: PB2195
Type: Publication Only
Background
In Non Hodgkin lymphoma as well as in Hodgkin lymphoma (HL) and multiple myeloma (MM), lymphocyte recovery after autologous stem cell transplantation (ASCT) has been reported to have association with clinical outcome, but also with contradictory data.
Aims
The aim of study was to evaluate the role of parameters that may be associated with outcome after ASCT.
Methods
The study included 61 patients with relapsed/refractory HL (34 males/ 37 females) aged 30 years (range 18-46) and 85 MM patients (42 males/ 43 females) aged 54 years (range 36-65) who were treated with high dose chemotherapy followed with ASCT. Advanced stage of HL disease (Ann Arbor III-IV) had 41.0% patients. Majority of patients had constitutional B symptoms (88.5%) and bulky disease (54.1%). Low IPS had 15 patients (22.6%). All patients received ABVD therapy and in the course of relapse or refractory disease, DHAP as first salvage therapy, and BEAM (54 patients, 88.5%) or CBV (7 patients, 11.5%) as conditioning regimen due to ASCT. The average value of collected CD34+cells was 11.3x106/kg (range 2-24x106/kg) in the volume of 250 ml (range 100-900ml). The mean aplasia duration was 11 days (range 6-28 days). After ASCT 29 patients achieved CR (47.5%), 21 patients PR (34.3%),, 3 had SD (4.9%) and 8 patients (13.1%) had PD. Median time to recovery of absolute lymphocyte count on 500x106/l (ALC500) was 15 days (range 9-32). Regarding MM population, majority of patients had IgG (59, 69.4%) and IgA (12 pts, 14.1%) type of MM. According to the clinical stage (CS) 6 pts (7.1%) had I, 16 (18.8%) II, and 63 (74.5%) III CS. Renal impairment was present in 15pts (17.6%). MM patients were initially treated with protocol VAD (29 pts, 34.1%) or CTD (56 pts, 65.9%) and high dose Melphalan (200mg/m2) was conditioning regimen prior to ASCT in the first treatment line. The average value of collected CD34+cells was 6.5x106/kg (range 2-96x106/kg) in the volume of 300 ml (range 100-660ml). The mean aplasia duration was 8 days (range 4-26 days). After ASCT only 1 patient (1.2%) had PD, while 22 (25.9%) had PR and the rest achieved at least VGPR (52, 73.0%). Median time to ALC500 recovery was 15 days (range 9-23days).
Results
In HL patients survival after ASCT was 39 (2-100) months, and OS was 70 (16-192) months. Patients with low IPS (0-2) had better survival compared to those with high IPS score (≥3) (Log Rank=3.68, p=0.05). Survival after ASCT was markedly influenced by prolonged recovery duration of ALC500≥18 days (Log Rank=4.54, p=0.03). However, the duration of ALC500 recovery was not in correlation with treatment response (p>0.05). Furthermore, survival was significantly inferior in patients with PD or SD after ASCT (Log Rank=6.07, p=0.014). As expected, treatment response after ASCT significantly influenced OS (Log Rank=11.27, p=0.004). Multivariate Cox regression among independent prognostic factors in univariate analysis (IPS, therapeutic outcome and ALC500 recovery) pointed out therapeutic outcome at D+100 and delayed ALC500 recovery as the most important parameters that influenced both OS and EFS (p<0.05). In MM patients survival after ASCT was 29 (2-115) months, and OS was 48 (16- 127) months. However, delayed recovery of ALC500 after 18th. day from ASCT did not influence neither OS nor survival after ASCT.
Conclusion
According to results of Cox regression analysis in HL, no responders at D+100, and delayed recovery of ALC500 are parameters of inferior prognosis and shorter survival. However, similar cut off values of ALC500 are not predictable in MM patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Multiple myeloma, Prognosis
Type: Publication Only
Background
In Non Hodgkin lymphoma as well as in Hodgkin lymphoma (HL) and multiple myeloma (MM), lymphocyte recovery after autologous stem cell transplantation (ASCT) has been reported to have association with clinical outcome, but also with contradictory data.
Aims
The aim of study was to evaluate the role of parameters that may be associated with outcome after ASCT.
Methods
The study included 61 patients with relapsed/refractory HL (34 males/ 37 females) aged 30 years (range 18-46) and 85 MM patients (42 males/ 43 females) aged 54 years (range 36-65) who were treated with high dose chemotherapy followed with ASCT. Advanced stage of HL disease (Ann Arbor III-IV) had 41.0% patients. Majority of patients had constitutional B symptoms (88.5%) and bulky disease (54.1%). Low IPS had 15 patients (22.6%). All patients received ABVD therapy and in the course of relapse or refractory disease, DHAP as first salvage therapy, and BEAM (54 patients, 88.5%) or CBV (7 patients, 11.5%) as conditioning regimen due to ASCT. The average value of collected CD34+cells was 11.3x106/kg (range 2-24x106/kg) in the volume of 250 ml (range 100-900ml). The mean aplasia duration was 11 days (range 6-28 days). After ASCT 29 patients achieved CR (47.5%), 21 patients PR (34.3%),, 3 had SD (4.9%) and 8 patients (13.1%) had PD. Median time to recovery of absolute lymphocyte count on 500x106/l (ALC500) was 15 days (range 9-32). Regarding MM population, majority of patients had IgG (59, 69.4%) and IgA (12 pts, 14.1%) type of MM. According to the clinical stage (CS) 6 pts (7.1%) had I, 16 (18.8%) II, and 63 (74.5%) III CS. Renal impairment was present in 15pts (17.6%). MM patients were initially treated with protocol VAD (29 pts, 34.1%) or CTD (56 pts, 65.9%) and high dose Melphalan (200mg/m2) was conditioning regimen prior to ASCT in the first treatment line. The average value of collected CD34+cells was 6.5x106/kg (range 2-96x106/kg) in the volume of 300 ml (range 100-660ml). The mean aplasia duration was 8 days (range 4-26 days). After ASCT only 1 patient (1.2%) had PD, while 22 (25.9%) had PR and the rest achieved at least VGPR (52, 73.0%). Median time to ALC500 recovery was 15 days (range 9-23days).
Results
In HL patients survival after ASCT was 39 (2-100) months, and OS was 70 (16-192) months. Patients with low IPS (0-2) had better survival compared to those with high IPS score (≥3) (Log Rank=3.68, p=0.05). Survival after ASCT was markedly influenced by prolonged recovery duration of ALC500≥18 days (Log Rank=4.54, p=0.03). However, the duration of ALC500 recovery was not in correlation with treatment response (p>0.05). Furthermore, survival was significantly inferior in patients with PD or SD after ASCT (Log Rank=6.07, p=0.014). As expected, treatment response after ASCT significantly influenced OS (Log Rank=11.27, p=0.004). Multivariate Cox regression among independent prognostic factors in univariate analysis (IPS, therapeutic outcome and ALC500 recovery) pointed out therapeutic outcome at D+100 and delayed ALC500 recovery as the most important parameters that influenced both OS and EFS (p<0.05). In MM patients survival after ASCT was 29 (2-115) months, and OS was 48 (16- 127) months. However, delayed recovery of ALC500 after 18th. day from ASCT did not influence neither OS nor survival after ASCT.
Conclusion
According to results of Cox regression analysis in HL, no responders at D+100, and delayed recovery of ALC500 are parameters of inferior prognosis and shorter survival. However, similar cut off values of ALC500 are not predictable in MM patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Multiple myeloma, Prognosis
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