scholarly journals 179: Allogeneic Stem Cell Transplantation for Post-Autologous Stem Cell Transplant Relapse in Hodgkin Lymphoma: Experience at a Single Center

2008 ◽  
Vol 14 (2) ◽  
pp. 66
Author(s):  
J.L. Oliva ◽  
J.L. Kelly ◽  
J.L. Liesveld ◽  
M.W. Becker ◽  
G.L. Phillips ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Hodgkin Lymphoma ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Stem Cell Transplant ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Single Center

Outcomes of Autologous Stem Cell Transplantation for Lymphoma in the Elderly: A Single Center Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5505-5505
Author(s):  
Ghulam Rehman Mohyuddin ◽  
Shaun DeJarnette ◽  
Clint Divine ◽  
Tara L Lin ◽  
Leyla Shune ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Pulmonary Toxicity ◽  
Stem Cell Transplant ◽  
The Elderly ◽  
Median Number ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant

Abstract INTRODUCTION: Autologous stem cell transplant (ASCT) is a potentially curative option for lymphoma, yet there remains a bias against offering this therapy to the elderly. Patients above age 65 are nearly always excluded from clinical trials with ASCT, limiting our understanding of the efficacy and toxicities of ASCT in this population. This lack of data and bias against ASCT in the elderly may delay referral for patients who may benefit from a transplant. Here, we report our single institution outcomes from all patients aged 65 and greater who underwent autologous stem cell transplant for lymphoma at our institution. DESIGN AND METHODS : We identified 93 consecutive patients ³ 65 years of age (median age 68.6 years) with lymphoma who underwent autologous stem cell transplantation at University of Kansas Medical Center from 2000 to 2015. After IRB approval, data was extracted using the institutional database. These patients had frequently received at least two treatments, were often beyond first complete remission at the time of transplantation and received their transplants later after diagnosis. Table 1 below summarizes the pre-transplant characteristics of our patients. RESULTS: All patients received G-CSF mobilized peripheral blood stem cells. Engraftment data is available for 87 out of 93 patients. Median number of days to neutrophil recovery (Absolute neutrophil count >500) was 11 (range 9-14). Median number of RBC and platelet transfusion in this group was 2 (range 0-10) and 3 (range 0-39), respectively. Non-relapse mortality at 100 days for the entire group was 2.15%. Overall survival at 100-days was 96.8%. Three patients (3.2 %) developed grade IV pulmonary toxicity and one patient developed grade IV veno-occlusive disease. With a median follow up of 744 days (41-2431), a disease free survival of 373 days was noted. In 63 patients who underwent transplant prior to 2013, 1-year and 2-year overall survival was found to be 84.2% and 72.1 respectively. Of the deaths in first year, 6 (55%) were related to relapse/progression, two (18%) due to pulmonary toxicity, 2 (18%) due to cardiac toxicity and 1 (9%) due to infection. In 17 patients (18.2%), transplant was performed completely/partially as an outpatient procedure. CONCLUSIONS: Although retrospective in nature, these results suggest that transplant related mortality in elderly patients with lymphoma is similar to historic younger cohorts. Chronological age should not be used alone in evaluating lymphoma patients for autologous stem cell transplantation. Instead, a comprehensive evaluation using Hematopoietic cell transplant comorbidity index and geriatric assessment should be used to guide decision-making. As the elderly population grows, an individualized approach to each patient considering all available treatment options is needed to make a potentially curative ASCT for high risk or relapsed lymphoma available to more patients. Table 1. No of patients (%) GenderMale Female 60 (65) 33 (35) Age at ASCT, median (range) 68.6 ( range 65-80) Hodgkin Disease Non Hodgkin Disease 5 (5) 88 (95) NHL subtypes Diffuse Large B- Cell Lymphoma Mantle Follicular Other 35 (40) 18 (20) 16 (18) 19 (22) Disease Status at ASCTCR1 CR 2 or more CRU PR Relapse1 Relapse 2 or more Primary Refractory 29 (31.2) 29 (31.2) 6 (6.5) 19 (20.4) 5 (5.4) 2 (2.2) 3 (3.2) Response to most recent chemoComplete remission Partial remission Progressive disease 64 (68.9) 19 (20.4) 10 (10.8) HCT-CI (% from those with obtained data) 0 1-2 3 or more N/A 15(19.0) 23(29.1) 41(51.9) 14 Disclosures No relevant conflicts of interest to declare.

Peripherally Inserted Central Catheters (PICCs) Can Be Successfully Utilized in Haematological Patients: Efficacy of an Educational Program.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3161-3161
Author(s):  
Alessandra Malato ◽  
Andrea Luppino ◽  
Raffaele Pipitone ◽  
Maria Grazia Donà ◽  
Francesco Acquaviva ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Stem Cell Transplant ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Intensive Chemotherapy ◽  
Hematopoietic Stem ◽  
Thrombotic Complications ◽  
Central Catheters

Abstract Abstract 3161 Purpose: Patients with haematological disorders frequently require the insertion of medium or long-term central venous catheters (CVCs) for stem-cell transplantation, the administration of chemotherapy, or transfusions. Although peripherally inserted central catheters (PICCs) have been in use for many years, little data exist on their use in patients receiving intensive chemotherapy and blood progenitor cell transplantation. Methods: Evidence-based interventions were implemented in our department from November 2009 to July 2012, and include: 1.An high level nurse education program for correct practices and prevention of catheter-associated complications. was developed for PICC nursing team; 2) The use of ultrasound guide for the insertion of the tip of PICCs, thanks to a special operator training; 3) Bedside placement and confirmed PICC tip placement by chest radiography after removal of the guidewire and before the securing of the catheter; 4) Maintenance of maximum sterile barrier precautions during PICC insertion and aftercare; 5) chlorhexidine preparation, replace 10% povidone iodine for skin antisepsis; 6) adoption of PICC patient nurse archive, including the information of weekly PICC line review at our department for each patient. Aim: Here, we carried out a clinical prospective investigation to determine the efficacy of these interventions in reducing the rate of PICC-related complications (thrombotic events, exit site infection and other complications requiring early removal of PICCs); the studied population included hematology patients receiving intensive chemotherapy compared to allogeneic/autologous stem cell transplant recipients. Results: Three hundred sixty-four (364) PICCs were in place in 299 patients for a total of 41.111 PICC days ( range, 1–482 days; mean 112,94 days); 292 were inserted in patients receiving conventional chemotherapies, and 72 in patients undergoing allogeneic or autologous hematopoietic stem cell transplantation (SCT). Sixty-six (60) PICCs were inserted during severe thrombocytopenia (platelets < 50 × 10(9)/L), seventy (70) during severe neutropenia (neutrophils < 0.5 × 10(9)/L) and thirty-eight (38) during antithrombotic prophylaxis. Predominantly, patients had Lymphoma (50%). The rate of major complication was very low: 15 thrombotic complications PICC-related (4%; 0.36 per 1,000 CVC days), and 3 CRBSI (0,8%; 0.07 per 1,000 CVC days) during neutropenia. Mechanical complications occurred in 52 catheters, and were accidental dislodgement (30), catheter break (3), catheter inadequate (19); other reasons for catheter removal were completion of therapy (137), lumen occlusion (19) and death (58). Interesting, taking in account the underlying disease, lymphoma and leukemia patients have, respectively, an increased risk of developing a CRBSI and a thrombotic PICCs-complication when submitted to hematopoietic stem cell transplantation (SCT) (see table 1). However, compared with allogeneic/autologous stem cell transplant group, the intensive chemotherapy group was associated with a marginally lower incidence of CRBSI complication rate (0.6 % vs 1.0 %, 0.10 vs 0.60 per 1,000 CVC days) [odds ratio (OR) 2,042]; no relevant differences in terms of thrombotic complications between the two cohorts (4.11 % vs 4.17%), 0.29 vs 0.39 per 1,000 CVC days) [odds ratio (OR) 1.014]. Conclusions: Our findings suggest, therefore, PICC devices are a viable and safe option for management of the haematology patients receiving intensive chemotherapy and even in patients particularly prone to infective and thrombotic complications such as patients receiving blood stem cell transplantation. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Update on Salvage Options in Relapsed/Refractory Hodgkin Lymphoma after Autotransplant

ISRN Oncology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Nida Iqbal ◽  
Lalit Kumar ◽  
Naveed Iqbal
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Hodgkin Lymphoma ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Clinical Success ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Dose ◽  
Cell Transplant

Despite a high clinical success, relapse in Hodgkin lymphoma occurs in 10–30% of cases and 5–10% patients are nonresponsive to initial chemotherapy. The standard management of these patients includes high-dose chemotherapy followed by autologous stem cell transplant. However, 50% of patients ultimately relapse after autotransplant which poses a big challenge. Allogeneic stem cell transplantation offers the only chance of cure in these patients. For patients who are not candidates for allogeneic stem cell transplantation, achieving cure with other possible options is highly unlikely, and thus the treatment plan becomes noncurative. Various novel agents have shown promising results but the duration of response is short lived. A standard approach to deliver the most effective treatment for these patients is still lacking. This review focuses on the treatment options currently available for relapsed and refractory disease after autotransplant.

scholarly journals Letermovir profilaxis allogén vérképző-őssejt transzplantációban: egy hazai centrum gyakorlati tapasztalatai

2021 ◽  
Vol 54 (3) ◽  
pp. 153-157
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Cytomegalovirus Infection ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Antiviral Compound ◽  
Transplant Patients

Összefoglaló. Bevezetés: A humán cytomegalovírus infekció direkt és indirekt szövődményei napjainkban is veszélyeztetik az allogén őssejt-transzplantációval kezelt betegeket. A széles körben alkalmazott preemptív stratégia mellett előnyös lehet a kórokozó reaktivációjának megelőzése profilaktikusan adagolt vírusellenes vegyülettel. A letermovir innovatív hatásmechanizmusú, szűk spektrumú antivirális szer, mely allogén őssejt-transzplantáltak körében végzett, placebo kontrollált klinikai vizsgálatban csökkentette a cytomegalovírus infekciók gyakoriságát és javította a túlélést. A szerzők 23, allogén őssejt-transzplantált beteg retrospektív módon gyűjtött adatait ismertetik, akik a beavatkozás kapcsán letermovir profilaxisban részesültek. A betegek több mint fele akut leukémiában szenvedett, harmaduk aktív betegséggel került transzplantációra, kétharmaduk donora haploidentikus egyezést mutatott. A letermovir adagolása során 2, azt követően további 3 személyben lépett fel cytomegalovírus infekció. Szervi érintettséggel járó cytomegalovírus betegség egyetlen esetben sem alakult ki. A megfigyelési időszak során 2 fő hunyt el, cytomegalovírustól független okok miatt. Az alkalmazhatóságot korlátozó mellékhatást nem észleltek. A letermovir a mindennapi klinikai gyakorlatban is hatékonynak és biztonságosnak bizonyult az őssejt-transzplantáltak cytomegalovírus fertőzésének megelőzésére. Summary. Introduction: Direct and indirect effects of cytomegalovirus infection remain an ongoing threat to patients treated with allogeneic stem cell transplantation. In addition to the widely used preemptive approach, prevention of viral replication with a prophylactically administered antiviral drug seems to be feasible. Letermovir, a narrow-spectrum antiviral compound with an innovative mechanism of action, has been shown to decrease the incidence of cytomegalovirus infection and to improve survival in a placebo-controlled clinical trial recruiting allogeneic stem cell transplant patients. Authors present retrospectively collected data from 23 patients receiving letermovir prophylaxis as a part of their allogeneic stem cell transplantation procedure. More than half of prophylaxed individuals had acute leukemia, a third of them underwent transplantation with an active disease and two third of the cohort had a haploidentical donor. During prophylaxis 2, subsequently further 3 patients developed a cytomegalovirus infection. No organ-specific disease could be detected. Through the observational period 2 patients have died due to causes unrelated to cytomegalovirus. No side effect interfering with drug use could be revealed. In this real-life case series letermovir has been shown to be effective and safe for the prevention of cytomegalovirus infection in allogeneic stem cell transplant patients.

Improved Outcomes with Allogeneic Stem Cell Transplantation for Aplastic Anaemia Using HLA Identical Sibling Donors: The Indian Stem Cell Transplant Registry (ISCTR) Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4386-4386
Author(s):  
Biju George ◽  
Manoranjan Mahapatra ◽  
Pravas Mishra ◽  
Shashikant Apte ◽  
Sharat Damodar ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Retrospective Analysis ◽  
Aplastic Anaemia ◽  
Cell Transplantation ◽  
Median Time ◽  
Allogeneic Stem Cell Transplantation ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Transplant Registry

Abstract Introduction: Allogeneic stem cell transplantation (SCT) is the best form of therapy for a young patient (< 50 years) with severe aplastic anaemia. In developing countries, there is a big time interval between diagnosis and SCT leading to increased transfusions and increased risk of infections, both of which adversely affects transplant outcome. This retrospective analysis is aimed at studying the outcomes of SCT among Indian patients with aplastic anaemia. Methodology: The Indian Stem cell transplant registry (ISCTR) is a group of transplant physicians representing about 30 active transplant centres in India. This retrospective analysis was done on data reported on 634 patients by 20 centres who reported outcomes of SCT for aplastic anaemia. Data was collected from individual medical records and databases. Analysis was done using SPSS software version 16.0 Results: Six hundred and thirty four patients [445 males and 189 females] with a median age of 21 years (range: 2 - 65) underwent allogeneic SCT between 1990 and March 2015. There were 209 children (age < 15 years). The median time from diagnosis to SCT was 5 months (range: 1 - 120) while the median number of transfusions was 20 (range: 1 - 150). All donors were HLA identical sibling or family donors; matched unrelated and haplo-identical donor transplants were excluded from this analysis. Conditioning regimen was Cyclophosphamide based (Cy/ Cy+ ATG/ Cy+ TBI/TLI) in 78 patients (12.3%) while majority received Fludarabine with Cyclophosphamide (n = 481; 75.8%) and 75 received other conditioning regimens (Flu/TBI, Flu/Bu, Bu/Cy etc). Graft source was bone marrow [BM] in 124 (19.5%) and peripheral blood stem cells in 510 patients (80.5%). Graft versus host disease (GVHD) prophylaxis predominantly consisted of Cyclosporine and methotrexate in 543 patients (85.6%). Engraftment was seen in 572 patients (90.4%) while 19 (2.9%) had primary graft failure and 43 (6.7%) expired prior to engraftment due to infection or bleeding. The median time to neutrophil engraftment was 13 days (range: 8 - 21) while platelet engraftment occurred at 13 days (range: 5 - 37). Grade II - IV acute GVHD occurred in 29.3% while grade III-IV was seen in 14.1%. Chronic GVHD was seen in 41% of evaluable patients which was limited in most patients. At a median follow up of 43 months (range: 1 - 264), 431 patients are alive. The 5 yr OS for the entire group is 66.3 + 2.0%. The OS was higher in children compared to adults (73.4 + 3.3% vs 62.8 + 2.5%; p = 0.006), better for Flu/Cy compared to Cy based conditioning (69.8 + 2.2% vs 57.8 + 5.6%; p = 0.002) and better for PBSC compared to BM (68.9 + 2.2% vs 56.1 + 4.8%; p = 0.020). There has been significant improvement in outcomes over the past 15 years [3 yr OS of 41.9 + 1.3% for 1984-1995, 40.9 + 1.2% for 1996-2000, 70.6 + 5.0% for 2001 -2005, 70.3 + 3.1% for 2006-2010 and 68.8 + 3.0% from 2011 onwards]. Conclusion: Outcomes of patients with aplastic anaemia are improving and patients have a 70% chance of getting cured with a HLA identical sibling donor transplant. The use of PBSC as graft source is not associated with inferior outcomes. Disclosures No relevant conflicts of interest to declare.

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