scholarly journals Successful Engraftment and Reduced Early Mortality in Unrelated Donor (UD) Cord Blood (CB) Stem Cell Transplantation (SCT) Using a Preparative Regimen of Thiotepa, Fludarabine, Melphalan and Rabbit Anti-Thymocyte Globulin (TFM/r-ATG) in Older Adults With a Single Unmanipulated CB Unit

2011 ◽  
Vol 17 (2) ◽  
pp. S228-S229
Author(s):  
R. Nath ◽  
R. Glen ◽  
W. William ◽  
C. Jan ◽  
M. Ramanathan ◽  
...  
Keyword(s):  
Older Adults ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Early Mortality ◽  
Unrelated Donor ◽  
Preparative Regimen

scholarly journals Unrelated Donor (UD) Cord Blood (CB) Stem Cell Transplantation (SCT) from a Single CB Unit in Older Adults: Excellent Engraftment and Low Early Mortality with a Preparative Regimen of Melphalan (M), Thiotepa (T), Fludarabine(F), and Rabbit (r) Anti Thymocyte Globulin (ATG)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1152-1152
Author(s):  
Rajneesh Nath ◽  
Muthalagu Ramanathan ◽  
Jan Cerny ◽  
Zheng Zhou ◽  
Glen D Raffel ◽  
...  
Keyword(s):  
Older Adults ◽  
Stem Cell ◽  
Mycophenolate Mofetil ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Single Unit ◽  
Early Mortality ◽  
Gvhd Prophylaxis ◽  
Preparative Regimen

Abstract Background: Success of single unit UD-CBSCT has been limited by graft failure, delayed engraftment and high early mortality. Preparative regimen of Busulfan with TF and horse ATG has reduced early mortality and improved engraftment in single unit UD-CBSCT in adults (Sanz. BMT 2012: 47; 1287-1293). M with TF and r-ATG has previously been used as a preparative regimen in double expanded UD-CBSCT in adults (De-Lima. NEJM 2012: 367; 2305-2315). Outcomes of this regimen will be of interest in single unit UD-CBSCT. Methods: We retrospectively analyzed the outcomes of all patients that underwent UD-CBSCT from single unit using MTF-rATG conditioning at UMass Memorial Medical Center. Results: Twenty five underwent single unit UD-CBSCT from January 2009 to June 2014. There were 15 males and 10 females. The median age was 63 years (range, 28 -81) and median weight was 68.9 kg (range, 58.9 - 119). Nine patients (36%) were over age 65 years. Diagnosis was AML/MDS (n= 18), CLL (n= 2) and others (n=5)- ALL/Aplastic Anemia/MM/NHL/Blastic NK cell malignancy. Disease status CR1 (n=11), CR2 (n=1) and persistent disease (n=13). Four patients had undergone a prior autologous SCT. Preparative regimen consisted of T (5-10 mg/kg) day -7, F (30 mg/m2) from day -6 to -2, M (100-140 mg/m2) day -1 and r-ATG (3 mg/kg). Graft versus host disease (gvhd) prophylaxis consisted of mycophenolate mofetil (day -1 to 56) and tacrolimus (level 5-15 ng/ml) starting day -1. Tacrolimus was replaced in 2 patients: Sirolimus (n=1) and Cyclosporine (n=1). HLA matching was 6/6 (n=1), 5/6 (n=1) and 4/6 (n=23). The median total nucleated cell (TNC) dose based on pre-cryopreserved sample was 3x10e7/kg (range, 1.9 - 5.3). The median TNC and CD34 cells infused was 2.5x10e7/kg (range, 1.3-4.2) and 1.13x10e5/kg (range, 0.16-3.05) respectively. Day 100 mortality was 16% (CI,6-37%). Cumulative incidence of neutrophil engraftment (NE) was 92% (CI, 62- 99%) and that of platelet engraftment (PE) was 84% (CI, 57- 95%) Figure 1 & 2.The median time of NE was 19 days (range, 13-37) and that of PE was 40 days (range, 24-73). All 23 patients surviving beyond day 10 engrafted their neutrophils. “Transplant Success" defined by a composite end point (NE by day 26, PE by day 60 and survival at day 100) was 60% (CI,38% -77%). The incidence of acute gvhd (I &II only) was 18% (CI,6-41%) and that of chronic gvhd was 25% (CI10-49%). 9 patients are currently alive at a median followup of 932 days (range, 97-1875 ) .All survivors are gvhd free and off immune suppression.The 2 year overall survival (OS) based on Kaplan Meier estimate is 36 %(CI,18-55%). Figure 3 Discussion: Preparative regimen of MFT-rATG results in excellent engraftment, low early mortality and acceptable “Transplant Success” in single unit UD-CBSCT in older adults. Our outcomes in high risk older adults compare favorably to other studies using “double cord” or “cord blood expansion” strategies. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures Nath: Celgene: Consultancy, Honoraria. Off Label Use: Thiotepa,Melphalan,rabbit ATG,Fludarabine, mycophenolate mofetil All these have been used in preparative regimens and gvhd prophylaxis for allogeneic stem cell transplantation. Cerny:Incyte: Consultancy, Honoraria; Ariad Pharmaceuticals: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria.

Poor Performance Status, Chemorefractory Disease At Transplantation, and Umbilical Cord Blood As Donor Source Were Adverse Prognostic Factors for Overall Survival After Allogeneic Stem Cell Transplantation for Follicular Lymphoma: Retrospective Study of the Japan Society of Hematopoietic Stem Cell Transplantation (JSHCT) Lymphoma Working Group

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3093-3093
Author(s):  
Koji Izutsu ◽  
Ritsuro Suzuki ◽  
Shinichi Kako ◽  
Rika Sakai ◽  
Takehiko Mori ◽  
...  
Keyword(s):  
Stem Cell ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Related Donor

Abstract Abstract 3093 Allogeneic hematopoietic stem cell transplantation (allo SCT) is potentially curative treatment for relapsed follicular lymphoma (FL) that remains non-curative disease even with modern immunochemotherapy. Number of potential candidate of allo SCT for FL has been increasing with the development of reduced intensity conditioning (RIC) regimens and increased donor availability due to use of hematopoietic stem cell from unrelated donor including cord blood (CB). However, short-term and long-term transplantation-related complications are still major obstacles in applying this treatment. Recently, EBMT and CIBMTR reported a prognostic score of allo SCT for FL (Ann Oncol 2011;22 :Suppl 4, iv94). However, this score awaits validation. To elucidate prognostic factors for OS after allo SCT for FL, we conducted a retrospective study using the national registry data of the Japan Society of Hematopoietic Cell Transplantation (JSHCT). In total, 472 cases of allo SCT for FL performed from 2000 to 2008 were identified. 220 (46.6%) were male and the median age at allo SCT was 50 yo (range: 27–75). Forty six (9.7%) patients were 60 yo or older. Eighty two (17.3%) patients had previous history of autologous transplantation (ASCT). Stem cell source was BM or PB from related donor in 215 (45.5%), unrelated donor BM in 180 (38.1%), and unrelated donor umbilical cord blood (CB) in 77 (16.3%). Conditioning regimen was myeloablative (MAC) in 20.7% and reduced intensity (RIC) in 79.3%, respectively. Patients undergoing MAC were younger than those with RIC (45 vs 50 yo, P<0.01). T-cell depletion with ATG or ALG was performed in 7.5%. ECOG performance status (PS) at allo SCT was ≥ 2 in 10.7%. 71.5% had chemosensitive disease at allo SCT and disease status was CR in 38.9%. With a median follow up of 47.3 mo (range: 0.9–122) among survivors, overall survival rate at 4years after allo SCT (4y OS) was 52.6%. Patients who had CB transplantation had worse OS than those transplanted from related donor or unrelated BM (30.0%, 58.5%, 54.6%, P =1.35e-6, logrank). Additionally, in univariate analysis, PS ≥2, chemoresistant disease at allo SCT, older age, male sex were adverse prognostic factors for OS, while previous history of ASCT, time from diagnosis to allo SCT (<3y vs ≥3y), disease status at allo SCT (CR vs non CR), conditioning regimen (MAC vs RIC), and year of allo SCT (2000–2 vs 2003–5 vs 2006–8) were not. 4y OS of patients undergoing MAC and RIC were 46.2% and 54.0% (P =0.28), respectively. In multivariate analysis with proportional hazard modeling, PS ≥2 (HR 3.2, P =0.00015), chemorefractory disease (HR 2.7, P =0.039), and use of CB (HR 3.8, P =0.039) were independent adverse predictors of OS. Although risk factors that are incorporated in the proposed EBMT/CIBMTR risk score other than PS were not predictive of OS in the present analysis, we applied this score to the population of the present study. In the entire population, 4y OS were 61.0% and 38.5% (P =9.5e-08) in patients with the score <3 (n=294) and ≥3 (n=77), respectively. This score was predictive of OS in patients who underwent transplantation from related donor (65.4% vs 36.7%, P =3.77e-08) and from unrelated BM (59.0% vs 41.7%, P =0.0217). In conclusion, this retrospective study of JSHCT registry data showed that allo SCT for FL is a reasonable option for patients with relapsed FL when suitable donor is available. Poor PS, chemorefractory disease, and CB as donor source were adverse prognostic factors for OS. Disclosures: No relevant conflicts of interest to declare.

Compare The Outcome Of Patients With Hematological Malignancies Treated With Allogeneic Stem Cell Transplant In Patients Age Over 50 Conditioned With Reduce Intensity Regimens With Those Under 50 Conditioned With Standard Intensity Regimen In a Rural University Hospital – A Single Institution Experience

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5549-5549
Author(s):  
Luke N. D'Cunha ◽  
Nicholas C. D'Cunha ◽  
Deanna Harville ◽  
Everardo Cobos
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Hematological Malignancies ◽  
Standard Dose ◽  
Conditioning Regimen ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Active Disease

Abstract Background Majority of hematological malignancies occurs in older individuals and most can only be cured with high dose chemotherapy followed by stem cell transplantation. Unfortunately these patients who need transplantation the most cannot tolerate chemotherapy well. Development of reduced-intensity transplant regimens has allowed older patients be treated with allogeneic transplantation. Aims To compare the outcome of allogeneic hematopoietic stem cell transplantation in patients age over 50 conditioned with reduce dose intensity regimens with those under 50 conditioned with standard dose intensity regimen Methods We analyzed retrospectively the data in a cohort of 50 consecutive patients with hematological malignancies treated with allogeneic stem cell transplant. We divided the patients into two groups, those under 50 years and those over 50 years. Those under 50 years received standard dose conditioning regimen, while those over 50 years received reduced dose regimen except for one patient. Cyclosporine and standard dose methotrexate was used as GVHD prophylaxis in patients under 50yrs while Cyclosporine and low dose methotrexate was used in patients over 50. Type of hematological malignancies, disease condition at transplant, type of transplant, conditioning regimen, dose of CD34+ stem cell and nucleated cell infused, day to myeloid and platelet engraftment and day 90 mortality is shown in the table. Patients who received unrelated donor transplant received ATG. Five high risk patients received peri-transplant Keratinocyte Growth Factor. All patients received G-CSF beginning day-0. Results 43% of patient < 50 years of age underwent match unrelated donor transplant vs. 30% in those over 50. Four underwent cord blood transplant in patient < 50 yrs. old vs. one in those over 50. 50% of patients had active disease in < 50 years group vs. 70% in those over 50. All but two patients (underwent cord blood transplantation <50 years of age) engrafted. Four patients died prior to engraftment in each group. Myeloid engraftment occurred at a median day 14 in each group. Platelet engraftment occurred at median day 16 in patients age under 50 years vs. day 18 in patients over 50. One patient with double cord blood transplant had platelet engraftment on day +68 (age >50). Two patients who received cord blood under 50 years group had engraftment failure. Ninety day mortality was 30% in those under 50 vs. 45% in those over 50. Conclusions Reduced intensity allogeneic stem cell transplantation is feasible and well tolerated in older patients with hematological malignancies with good engraftment however with high early (day 90) mortality. 70% of the patients had active disease at the time of transplant which could account for their high mortality. To prevent early peri-transplant mortality patients with active disease should not go to transplant or should be treated with newer chemotherapy or targeted agents to bring them into remission prior to transplantation Disclosures: No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document