NON RELAPSE MORTALITY (NRM) ANALYSIS IN 93 UNRELATED DONOR TRANSPLANTATION - SINGLE CENTRE EXPERIENCE - HLA HAPLOTYPE ROLE?
(Abstract release date: 05/18/17)
EHA Library. Mensah-Glanowska P. 05/18/17; 182891; PB2178
Patrycja Mensah-Glanowska
Contributions
Contributions
Abstract
Abstract: PB2178
Type: Publication Only
Background
Unrelated donor stem cell transplantation has a curative potential against
haematological malignancies. However there are concerns about associated risk of non-relapse mortality. We performed a retrospective single centre study of causes of non-relapse mortality over four year period - 2012-2016
Aims
Purpose of the study was to analyse non-relapse mortality (NRM) in patients subjected to unrelated donor transplantation in four-year-period: 2012 to 2016 - 93 transplant procedures in 86 patients.
Methods
Study cohort was analysed - relapse rate and non-relapse mortality were assessed. Causes of both - early and late NRM were studied.
Results
There were 23 relapses in the group of assessed patient cohort (24,7%). 7 patients undergone the second transplant - five patients - because of AML relapse, later two - because of secondary graft failure. Out of re-transplanted 7 patients - 3 patients are alive - 2 patients with graft failure and one with post-transplant AML relapse in 2nd CR.
Out of 93 procedures of unrelated donor transplantation there were 16 cases of death - assumed as non relapse mortality NRM (17%). There were 9 early deaths (before day +100) - 6 cases in patients with relapsed/refractory acute leukaemia without remission after conventional chemotherapy. These patients were subjected to sequential conditioning with cytreduction phase. Active disease and highly active antileukaemic treatment can be reason for higher treatment related toxicity and elevated risk of death. Later two patients developed infectious bacterial complications with septic shock. In one patient - antiviral treatment refractory CMV encephalitis with massive macrophage activation syndrome was diagnosed. Analysis of NRM after day100 revealed 7 affected patients. All these patients GVHD 2-4 was diagnosed previously, accompanied by transplant associated microangiopathy (TAM) and infections - both viral and fungal.
Additionally to factors connected to NRM - age, comorbidity score, patient/donor HLA allelic and antigen and sex mismatches, HLA patient/donor haplotypes were analysed. It was possible to categorise 15 out of 16 NRM patients into 5 HLA class II haplotype groups connected with autoimmune diseases in Caucasian population - rheumatoid arthritis and lupus erythematosus: DRB1 01:01 DQB1 05:01 (5 patients), DRB1 03:01 DQB1 02:01 (4 patients), DRB1 11:01 DQB1 03:01 (3 patients), DRB1 15:01 DQB1 06:02 (2 patients), DRB1 04:01 DQB1 03:02 (1 patient).
Conclusion
Based on these results we create working hypothesis that HLA class II haplotype may predispose to severe post-transplant infectious or/and non-infectious complications and affect the risk of NRM. Because small number of analysed patients and documented high frequency of these haplotypes in population, further analysis is required.
Session topic: 22. Stem cell transplantation - Clinical
Keyword(s): unrelated donor, Mortality, Complications
Abstract: PB2178
Type: Publication Only
Background
Unrelated donor stem cell transplantation has a curative potential against
haematological malignancies. However there are concerns about associated risk of non-relapse mortality. We performed a retrospective single centre study of causes of non-relapse mortality over four year period - 2012-2016
Aims
Purpose of the study was to analyse non-relapse mortality (NRM) in patients subjected to unrelated donor transplantation in four-year-period: 2012 to 2016 - 93 transplant procedures in 86 patients.
Methods
Study cohort was analysed - relapse rate and non-relapse mortality were assessed. Causes of both - early and late NRM were studied.
Results
There were 23 relapses in the group of assessed patient cohort (24,7%). 7 patients undergone the second transplant - five patients - because of AML relapse, later two - because of secondary graft failure. Out of re-transplanted 7 patients - 3 patients are alive - 2 patients with graft failure and one with post-transplant AML relapse in 2nd CR.
Out of 93 procedures of unrelated donor transplantation there were 16 cases of death - assumed as non relapse mortality NRM (17%). There were 9 early deaths (before day +100) - 6 cases in patients with relapsed/refractory acute leukaemia without remission after conventional chemotherapy. These patients were subjected to sequential conditioning with cytreduction phase. Active disease and highly active antileukaemic treatment can be reason for higher treatment related toxicity and elevated risk of death. Later two patients developed infectious bacterial complications with septic shock. In one patient - antiviral treatment refractory CMV encephalitis with massive macrophage activation syndrome was diagnosed. Analysis of NRM after day100 revealed 7 affected patients. All these patients GVHD 2-4 was diagnosed previously, accompanied by transplant associated microangiopathy (TAM) and infections - both viral and fungal.
Additionally to factors connected to NRM - age, comorbidity score, patient/donor HLA allelic and antigen and sex mismatches, HLA patient/donor haplotypes were analysed. It was possible to categorise 15 out of 16 NRM patients into 5 HLA class II haplotype groups connected with autoimmune diseases in Caucasian population - rheumatoid arthritis and lupus erythematosus: DRB1 01:01 DQB1 05:01 (5 patients), DRB1 03:01 DQB1 02:01 (4 patients), DRB1 11:01 DQB1 03:01 (3 patients), DRB1 15:01 DQB1 06:02 (2 patients), DRB1 04:01 DQB1 03:02 (1 patient).
Conclusion
Based on these results we create working hypothesis that HLA class II haplotype may predispose to severe post-transplant infectious or/and non-infectious complications and affect the risk of NRM. Because small number of analysed patients and documented high frequency of these haplotypes in population, further analysis is required.
Session topic: 22. Stem cell transplantation - Clinical
Keyword(s): unrelated donor, Mortality, Complications
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