Contributions
Abstract: PB1793
Type: Publication Only
Session title: Stem cell transplantation - Clinical
Background
Introduction:
Autologous stem-cell transplantation (ASCT) is a prevalent therapy with firmly established efficacy and safety indices. However, to perform this procedure is necessary to transfer patients to referral centers with obvious implications for patients and their relatives. Besides, the increasing demand of autologous and allogeneic transplants may cause transplant delays.
Aims
Based on previous studies carried out in Canadian centers (Crump. Bone Marrow Transplant. 1992), an autologous transplant sharing program has been set between 3 centers in Spain to increase the availability of ASCT, avoid transplant delays and improve patient and family comfort.
Methods
Retrospective, observational and analytical study of the ASCT enrolled in this program between July 2017 and October 2019.
Selected ASCT candidates for multiple myeloma (MM), lymphoma and acute myeloid leukemia (AML) from Infanta Leonor (ILH) and Nuestra Señora del Prado Hospitals (NSPH) were included after signing the informed consent.
Uniform clinical protocols were used between the 3 hospitals. A clinical transplant update program for nurses and physicians was set up before the program started.
The program is divided into 2 stages: First stage: Pre-transplant patient evaluation, stem-cell apheresis collection and cryopreservation as well as administration of high-dose therapy and hematopoietic stem-cell infusion were performed at 12 de Octubre hospital (H12O). Second stage: in absence of significant clinical events patients were transferred to the referring center (NSPH and ILH) on day +1 for supportive care.
Results
Results:
- Population: 12 patients (4 female, 8 male). Median age: 58 years (23-71). Diagnosis: multiple myeloma (MM): 9, acute promyelocytic leukemia (APL): 1, follicular lymphoma: 2. Conditioning regimens: Melfalan 200 (75%), CyBU (8%), BEAM (17%) All patients received standard prophylaxis with acyclovir, fluconazole and cotrimoxazole. G-CSF was allowed from day +5.
- HSCT and engraftment: no patient needed an additional bridge therapy because of transplant delay. All 12 patients were transferred on day +1. Median time to neutrophil (> 0.5x109/l) and platelets (> 20x109/l) engraftment was 11 days (10-14) and 12 days (11-20) respectively. Secondary graft failure: 1/12 patients.
- Adverse events: Febrile neutropenia was observed in all patients with microbiological documentation in 42%. Documented pathogens: bloodstream infections due to Pseudomonas Aeruginosa, Enterobacter cloacae and Streptococcus gallolyticus. Urinary tract infection: Klebsiella pneumoniae. 1 infectious colitis caused by Campylobacter jejuni. Engraftment syndrome was observed in 2 patients (17%) and grade ≥ 3 mucositis in 6 patients (50%). 7 patients (58%) required parenteral nutrition.
- Results: 11 patients were successfully discharged. 1 patient died due to secondary graft failure. Follow up was provided as needed in the referring center. Patients were reviewed in H12O on day +100 and annually therafter.
Conclusion
Conclusions:
The sharing transplant program is a feasible and safe network that eases the access of patients to this therapy avoiding delays and prolonged stays in reference centers, with the consequent psychological and social benefit for patients and their families. Outcome and adverse events were according to literature. This is a pilot study that aims to extend to other centers within the PETHEMA group.
Keyword(s):
Abstract: PB1793
Type: Publication Only
Session title: Stem cell transplantation - Clinical
Background
Introduction:
Autologous stem-cell transplantation (ASCT) is a prevalent therapy with firmly established efficacy and safety indices. However, to perform this procedure is necessary to transfer patients to referral centers with obvious implications for patients and their relatives. Besides, the increasing demand of autologous and allogeneic transplants may cause transplant delays.
Aims
Based on previous studies carried out in Canadian centers (Crump. Bone Marrow Transplant. 1992), an autologous transplant sharing program has been set between 3 centers in Spain to increase the availability of ASCT, avoid transplant delays and improve patient and family comfort.
Methods
Retrospective, observational and analytical study of the ASCT enrolled in this program between July 2017 and October 2019.
Selected ASCT candidates for multiple myeloma (MM), lymphoma and acute myeloid leukemia (AML) from Infanta Leonor (ILH) and Nuestra Señora del Prado Hospitals (NSPH) were included after signing the informed consent.
Uniform clinical protocols were used between the 3 hospitals. A clinical transplant update program for nurses and physicians was set up before the program started.
The program is divided into 2 stages: First stage: Pre-transplant patient evaluation, stem-cell apheresis collection and cryopreservation as well as administration of high-dose therapy and hematopoietic stem-cell infusion were performed at 12 de Octubre hospital (H12O). Second stage: in absence of significant clinical events patients were transferred to the referring center (NSPH and ILH) on day +1 for supportive care.
Results
Results:
- Population: 12 patients (4 female, 8 male). Median age: 58 years (23-71). Diagnosis: multiple myeloma (MM): 9, acute promyelocytic leukemia (APL): 1, follicular lymphoma: 2. Conditioning regimens: Melfalan 200 (75%), CyBU (8%), BEAM (17%) All patients received standard prophylaxis with acyclovir, fluconazole and cotrimoxazole. G-CSF was allowed from day +5.
- HSCT and engraftment: no patient needed an additional bridge therapy because of transplant delay. All 12 patients were transferred on day +1. Median time to neutrophil (> 0.5x109/l) and platelets (> 20x109/l) engraftment was 11 days (10-14) and 12 days (11-20) respectively. Secondary graft failure: 1/12 patients.
- Adverse events: Febrile neutropenia was observed in all patients with microbiological documentation in 42%. Documented pathogens: bloodstream infections due to Pseudomonas Aeruginosa, Enterobacter cloacae and Streptococcus gallolyticus. Urinary tract infection: Klebsiella pneumoniae. 1 infectious colitis caused by Campylobacter jejuni. Engraftment syndrome was observed in 2 patients (17%) and grade ≥ 3 mucositis in 6 patients (50%). 7 patients (58%) required parenteral nutrition.
- Results: 11 patients were successfully discharged. 1 patient died due to secondary graft failure. Follow up was provided as needed in the referring center. Patients were reviewed in H12O on day +100 and annually therafter.
Conclusion
Conclusions:
The sharing transplant program is a feasible and safe network that eases the access of patients to this therapy avoiding delays and prolonged stays in reference centers, with the consequent psychological and social benefit for patients and their families. Outcome and adverse events were according to literature. This is a pilot study that aims to extend to other centers within the PETHEMA group.
Keyword(s):