Contributions
Abstract: PB2425
Type: Publication Only
Background
High dose therapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) is recognized as a standard of care for relapsed/refractory Non-Hodgkin Lymphoma (NHL).There are many studies which have demonstrated improved disease free survival(DFS) and overall survival(OS) with AHSCT in these patients. There have been also several studies which reported better outcome in patients with high risk NHL who had upfront AHSCT.
Aims
This study aims to determine if upfront AHSCT do improve patients’ clinical outcome in Malaysia.
Methods
This is a retrospective study where patients who had undergone AHSCT from October 1997 to September 2017 in 2 major hospitals in Malaysia were included. Patients’ demographic data and clinical information were collected. The risk groups were categorized into 2 groups; whereby IPI score of 0-2 were defined as low risk and IPI score of 3-5 were considered as high risk.
Results
: A total of 169 patients (male: female 105:64) were included. Majority of patients had B cell lymphoma (85.8%) while the rest had T cell lymphoma (14.2%). The median age at diagnosis was 46 (ranges from 15 – 69) years. The median period of diagnosis to AHSCT was 10 (range 3-111) months. Majority of patients (89.3%) were transplanted in complete remission (CR) and the remaining (10.7%) in partial remission (PR). Majority of patients (61%) who were transplanted were in first CR. 68% of patients were categorized as low risk and 32% patients were categorized as high risk. Conditioning regimens used were: BEAM (n=107), Benda-EAM (n=17), BEAC (n=12), TEAM (n=11), TBI-Cyclo (n=6), Thiotepa-BuCy (n=5), CBV (n=4), BuCy (n=4) and C/L-EAM (n=3). The mean CD34+ cell dose infused was 8.8 x106 /kg (ranges 1.53 to 72.3 x 106/kg). The median duration of platelet count remaining <30x106/L and white cell < 1.0x109//L were both 8 days respectively. The mortality rate during follow up was 28%; 3% were due to transplant related mortality and the remaining were from progressive disease. The two years OS for patients transplanted in first CR, second CR, and PR were 87%, 67.8%, 29.4% respectively, (p≤0.0001). The two years event free survival (EFS) for patient transplanted in first CR, second CR, and PR is 81.5%, 52.5%, 17.6% respectively, (p≤0.0001). Using Cox regression analysis, remission status at transplantation was shown to have a significant effect on OS and EFS. Patients who were transplanted at first CR regardless of their IPI risk status had a significantly better OS and EFS compared to the others, p <0.001. The IPI risk status did not demonstrate any significant effect in OS and EFS.
Conclusion
This study demonstrated that upfront AHSCT should be considered in patients with NHL regardless of their IPI risk status.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Clinical outcome, High dose therapy, Non-Hodgkin's lymphoma
Abstract: PB2425
Type: Publication Only
Background
High dose therapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) is recognized as a standard of care for relapsed/refractory Non-Hodgkin Lymphoma (NHL).There are many studies which have demonstrated improved disease free survival(DFS) and overall survival(OS) with AHSCT in these patients. There have been also several studies which reported better outcome in patients with high risk NHL who had upfront AHSCT.
Aims
This study aims to determine if upfront AHSCT do improve patients’ clinical outcome in Malaysia.
Methods
This is a retrospective study where patients who had undergone AHSCT from October 1997 to September 2017 in 2 major hospitals in Malaysia were included. Patients’ demographic data and clinical information were collected. The risk groups were categorized into 2 groups; whereby IPI score of 0-2 were defined as low risk and IPI score of 3-5 were considered as high risk.
Results
: A total of 169 patients (male: female 105:64) were included. Majority of patients had B cell lymphoma (85.8%) while the rest had T cell lymphoma (14.2%). The median age at diagnosis was 46 (ranges from 15 – 69) years. The median period of diagnosis to AHSCT was 10 (range 3-111) months. Majority of patients (89.3%) were transplanted in complete remission (CR) and the remaining (10.7%) in partial remission (PR). Majority of patients (61%) who were transplanted were in first CR. 68% of patients were categorized as low risk and 32% patients were categorized as high risk. Conditioning regimens used were: BEAM (n=107), Benda-EAM (n=17), BEAC (n=12), TEAM (n=11), TBI-Cyclo (n=6), Thiotepa-BuCy (n=5), CBV (n=4), BuCy (n=4) and C/L-EAM (n=3). The mean CD34+ cell dose infused was 8.8 x106 /kg (ranges 1.53 to 72.3 x 106/kg). The median duration of platelet count remaining <30x106/L and white cell < 1.0x109//L were both 8 days respectively. The mortality rate during follow up was 28%; 3% were due to transplant related mortality and the remaining were from progressive disease. The two years OS for patients transplanted in first CR, second CR, and PR were 87%, 67.8%, 29.4% respectively, (p≤0.0001). The two years event free survival (EFS) for patient transplanted in first CR, second CR, and PR is 81.5%, 52.5%, 17.6% respectively, (p≤0.0001). Using Cox regression analysis, remission status at transplantation was shown to have a significant effect on OS and EFS. Patients who were transplanted at first CR regardless of their IPI risk status had a significantly better OS and EFS compared to the others, p <0.001. The IPI risk status did not demonstrate any significant effect in OS and EFS.
Conclusion
This study demonstrated that upfront AHSCT should be considered in patients with NHL regardless of their IPI risk status.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Clinical outcome, High dose therapy, Non-Hodgkin's lymphoma