Contributions
Abstract: EP1278
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Atypical electrophoretic profiles (AEP) may appear in patients who required allogeneic hematopoietic stem cell transplantation (allo-HSCT). Nevertheless, their clinical significance remains unkown. AEP combine either monoclonal and oligoclonal components, suspected on serum protein electrophoresis and confirmed by immunofixation.
Aims
The purpose of the study is to analyze the incidence, etiology and prognosis of AEP in patients who received allo-HSCT for myeloid malignancies.
Methods
In this retrospective study, we recruited 117 patients with myeloid disease who received an allo-HSCT between 2012 and 2018. We excluded patients with lymphoid malignancies, multiple myeloma, patients with AEP before transplantation, and patients who died within 100 days after transplantation.
Results
AEP occurred in 42.7% of patients. The cumulative incidence of AEP was significantly higher in patients with acute Graft Versus Host Disease (GVHD, p=0.019) and in patients with CMV reactivation (p=0.0017). Noticeably, we showed for the first time that AEP mainly appeared in patients transplanted from a CMV+ donor (p=0.031). CMV reactivation preceded the onset of AEP in most patients. In patients with AEP, we observed a significantly longer time to relapse (486 vs 189 days, p=0.006) and a better overall survival (OS; 33.1 months vs 28.3 months, p=0.049). The presence of an AEP was the only factor that significantly improves OS in both univariate and multivariate analyses.
Conclusion
The occurrence of an AEP, after allo-HSCT, may result from an adapted post-transplant immune response, as an anti-CMV clonal expansion from pre-immunized donor cells. These atypical profiles could reflect both GVH and GVL activity, leading to favourable outcomes. This study provides new insights for clinicians that monoclonal or oligoclonal components on protein electrophoresis are common, benign and associated with an improved prognosis after allo-HSCT.
Keyword(s): Acute graft-versus-host disease, Allogeneic hematopoietic stem cell transplant, Monoclonal gammopathy, Stem cell transplant
Abstract: EP1278
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Atypical electrophoretic profiles (AEP) may appear in patients who required allogeneic hematopoietic stem cell transplantation (allo-HSCT). Nevertheless, their clinical significance remains unkown. AEP combine either monoclonal and oligoclonal components, suspected on serum protein electrophoresis and confirmed by immunofixation.
Aims
The purpose of the study is to analyze the incidence, etiology and prognosis of AEP in patients who received allo-HSCT for myeloid malignancies.
Methods
In this retrospective study, we recruited 117 patients with myeloid disease who received an allo-HSCT between 2012 and 2018. We excluded patients with lymphoid malignancies, multiple myeloma, patients with AEP before transplantation, and patients who died within 100 days after transplantation.
Results
AEP occurred in 42.7% of patients. The cumulative incidence of AEP was significantly higher in patients with acute Graft Versus Host Disease (GVHD, p=0.019) and in patients with CMV reactivation (p=0.0017). Noticeably, we showed for the first time that AEP mainly appeared in patients transplanted from a CMV+ donor (p=0.031). CMV reactivation preceded the onset of AEP in most patients. In patients with AEP, we observed a significantly longer time to relapse (486 vs 189 days, p=0.006) and a better overall survival (OS; 33.1 months vs 28.3 months, p=0.049). The presence of an AEP was the only factor that significantly improves OS in both univariate and multivariate analyses.
Conclusion
The occurrence of an AEP, after allo-HSCT, may result from an adapted post-transplant immune response, as an anti-CMV clonal expansion from pre-immunized donor cells. These atypical profiles could reflect both GVH and GVL activity, leading to favourable outcomes. This study provides new insights for clinicians that monoclonal or oligoclonal components on protein electrophoresis are common, benign and associated with an improved prognosis after allo-HSCT.
Keyword(s): Acute graft-versus-host disease, Allogeneic hematopoietic stem cell transplant, Monoclonal gammopathy, Stem cell transplant