scholarly journals Tandem Autologous-Autologous versus Autologous-Allogeneic Hematopoietic Stem Cell Transplant for Patients with Multiple Myeloma: Long-Term Follow-Up Results from the Blood and Marrow Transplant Clinical Trials Network 0102 Trial

2020 ◽  
Vol 26 (4) ◽  
pp. 798-804 ◽  
Author(s):  
Sergio Giralt ◽  
Luciano J. Costa ◽  
David Maloney ◽  
Amrita Krishnan ◽  
Mingwei Fei ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Blood And Marrow Transplant ◽  
Long Term Follow Up

scholarly journals Optimizing Data Collection for Long-Term Follow-Up after Hematopoietic Stem Cell Transplant

2017 ◽  
Vol 23 (3) ◽  
pp. S410-S411
Author(s):  
Jaskiran Kaur ◽  
Madhu Ragupathi ◽  
Alysa Pleiner ◽  
Luda Kushner ◽  
Mostafizur Rahman ◽  
...  
Keyword(s):  
Stem Cell ◽  
Data Collection ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Long Term Follow Up

Long-term follow-up of adult hematopoietic stem cell transplant recipients diagnosed with COVID-19.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19028-e19028
Author(s):  
Stephanie Hoffman ◽  
Pavan Reddy ◽  
John Martin Magenau ◽  
Attaphol Pawarode ◽  
Brian Parkin ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Acute Gvhd ◽  
Stem Cell Transplant ◽  
Chronic Gvhd ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Long Term Follow Up

e19028 Background: Long-term complications of COVID-19 in hematopoietic stem cell transplant (HCT) recipients are unknown. Recent studies have described short term outcomes of COVID-19 infection post allogeneic (allo) and autologous (auto) HCT. In this study we provide long term follow-up of the outcomes of COVID-19 infection in allo and auto HCT recipients. Methods: We performed a retrospective study of adult patients who have received allo or auto HCT and were subsequently diagnosed with COVID-19 infection between March-December 2020. We summarized patient characteristics, laboratory and treatment data related to COVID-19 infection in these patients. Results: In this study, we provide long-term follow-up of over 7 months. Fifteen patients were identified for inclusion (allo n = 12, auto n = 3). Median follow-up was 7.8 months (range 1.9-10.7) for surviving patients. Median age at COVID-19 diagnosis was 55 years (range 24-77). Most patients were > 1 year out from transplant (allo n = 10, auto n = 1, 73%). Two patients (allo n = 1, auto n = 1, 13%) had undergone transplant within the preceding month. Most allo patients (n = 11, 73%) had received myeloablative conditioning. At the time of COVID-19 diagnosis, 9 allo patients (75%) were on immunosuppression (IS) (n = 7 for chronic graft-versus-host-disease (GVHD); n = 2 for GVHD prophylaxis). Eleven patients (73%) required hospitalization (allo n = 9, auto n = 2). Per the National Institutes of Health definitions of COVID-19 illness severity, 3 patients had critical disease (allo n = 2, auto n = 1, 20%), 5 severe (allo n = 5, 33%), 3 moderate (allo n = 2, auto n = 1, 20%), and 4 mild (allo n = 3, auto n = 1, 27%). All patients with chronic GVHD required hospitalization. Two patients died (allo n = 1, auto n = 1, 13%)—both had critical COVID-19 infections, were > 65 years old, > 3 years out from transplant, and had significant comorbidities. The allo patient was receiving prednisone < 1 mg/kg for chronic lung GVHD at COVID-19 diagnosis. Two allo patients developed either acute GVHD or chronic GVHD exacerbation within 3 months of their infection. One patient developed biopsy-proven acute GVHD (max grade III) 3 weeks after her infection and another patient developed a severe exacerbation of chronic GVHD within 3 months—both continue to require multi-modal IS. The remaining 7 patients with chronic GVHD have been maintained on either stable or tapered IS. Conclusions: Given the effect of COVID-19 infection, its impact on HCT recipients is important to define. The majority of HCT patients who contracted moderate-critical COVID-19 infections in our study were either on IS or had significant comorbidities. Our observational data points to the importance of long-term follow-up in HCT patients. Future studies are needed to delineate whether there is a relationship between COVID-19 infection and GVHD development or exacerbation. The role of vaccination in HCT recipients remains to be explored.

Allogeneic Hematopoietic Stem Cell Transplant in Advanced Multiple Myeloma: Experience from a Single Center

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5536-5536
Author(s):  
Yizel Elena Paz Nuñez ◽  
Beatriz Aguado Bueno ◽  
Isabel vicuña Andrés ◽  
Ángela Figuera Álvarez ◽  
Miriam González-Pardo ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Board Of Directors ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Advisory Committees ◽  
Hematopoietic Stem

Abstract Introduction The prognosis of patients with multiple myeloma (MM) has improved in the last years due to the important advances in the knowledge of the biology of the disease, the implementation of new drugs and the incorporation of autologous hematopoietic stem cell transplant (autoHSCT). The allogenic hematopoietic stem cell transplant (alloHSCT) continues to be controversial: it offers a curative potential but with the cost of high toxicity, limiting the procedure to those young patients with a high-risk disease. This procedure shall be performed in expert centers and, whenever possible, in the context of a clinical trial. In the following we describe the experience of our center with alloHSCT in advance multiple myeloma patients. Patients and methods A total of 18 patients were diagnosed with multiple myeloma received an alloHSCT during a 13 year period (1996-2013), with a median age of 46 ± 5.9 years. All of our patients received an allogenic HLA matched sibling donor with reduced-intensity conditioning. The majority of patients were transplanted because of advanced disease, relapse after an autologous transplant or as part of a sequential transplant in patient with a high risk disease. One patient received, in two occasions, an alloHSCT. Around 70% of patients had received more than 3 previous lines of treatment including, in nearly 95%, an autoHSCT. Patient's characteristics can be found on table 1, characteristics of the procedure can be found in table 2.Table 1.Patient«s CharacteristicsN (%)GenderMale Female10 (55,5%) 9 (44,4%)Secreted ProteinIgGκ IgG λ IgA κ BJ Plasmocitoma8 (44,4%) 4 (22,2%) 2 (11,1%) 3 (16,7%) 1 (5,6%)Debut DS stageII-A II-B III-A III-B Plasmocitoma5 (27,8%) 1 (5,6%) 8 (44,4%) 3 (16,7%) 1 (5,6%)Cytogentics at diagnosisMissing Unfavorable Favorable10 (55,5%) 6 (33,3%) 2 (11,1%)Previous lines of treatment²2 3-4 ³56 (33,3%) 10 (55,5%) 2 (11,1%)Previous autoHSCTYes No17 (94,5%) 1 (5,6%)Previous radiotherapyYes No8 (44,4%) 10 (55,6%)Disease status at transplantComplete remission Partial remission Relapse9 (50,0%) 3 (16,7%) 6 (33,3%)Table 2.Treatment characteristicsN (%)Conditioning regimenMyeloablative Reduced-intensity6 (33,3%) 12 (66.7%)Stem cell sourceBone marrow Peripheral blood4 (22.2%) 14 (77.8%)GVHD prophylaxisCsA+MTXCsA+CSCsA+MMF10 (55.6%) 3 (16.7%) 5 (27.8%)InfectionsYes No16 (88.9%) 2 (11.1%)MucositisYes No12 (66.7%) 6 (33.3%)Acute GVHDYes II-IV III-IV No4 (22.3%) 3 (16.7%) 1 (5.6%) 14 (77.8%)Chronic GVHDNo Limited Extensive8 (44.3%) 5 (27.8%) 5 (27.8%) Results: Transplant related mortality (TRM) before day 100th was one case due to a thromboembolic event. Global TRM was 16.6% (3 cases). The incidence of acute graft versus host disease (aGVHD) was 22%, controlled on most cases when corticosteroids were initiated. More than half of the patients developed chronic graft versus host disease (cGVHD), with an equal distribution on either presentation as limited or extensive. (Table 2) The total number of patients eligible for analysis was 17 (one patient was lost on follow-up). With a median follow up of 11 years, the overall survival (OS) was of 8.06 years [IC 95% 4,33-11,78] (figure 1.) and the estimated progression free survival (PFS) was of 25.83 months [IC 95% 8.87-42.79](figure 2). A total of 5 (29,4%) patients are still alive and 2 (11,7%) of them are in complete remission, of these 1 patient did not have a previous autoHSCT with a follow up of almost 15 years. Conclusions: Our results are similar to those reflected on the literature1-2. However we have to point out that our population is homogenous with advanced MM with more than 3 previous lines of treatment including in most cases auto-HSCT. In spite of this, morbility and mortality in our cohort was acceptable with the limitation of a high rate of cGVHD. There is a need of more studies including more patients to evaluate the role of alloHSCT in the era of new drugs for MM. References 1. Rosi-ol L et al. Allogeneic hematopoietic SCT in multiple myeloma: long-term results from a single institution. Bone Marrow Transplant. 2015. 2. Beaussant Y et al. Hematopoietic Stem Cell Transplantation in Multiple Myeloma: A Retrospective Study of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC). Biol Blood Marrow Transplant. 2015 Disclosures Alegre: Celgene Corporation: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Multiple Myeloma in Adolescent and Young Adults: A SEER and CIBMTR Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 12-13
Author(s):  
Steven J Gibson ◽  
Jennifer A Thornton ◽  
Christin B DeStefano
Keyword(s):  
Multiple Myeloma ◽  
Young Adults ◽  
Medical Center ◽  
The United States ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Blood And Marrow Transplant ◽  
Race Ethnicity

Background Multiple myeloma (MM) is a disease of the elderly, with less than 3% of cases diagnosed in adolescents and young adults (AYA). Data on demographics, use of autologous stem cell transplant (ASCT), second primary malignancies (SPMs) and survival are scant to non-existent in the AYA MM population. To our knowledge, this study is the first to better understand characteristics and survival trends of this unique population. Methods The Surveillance, Epidemiology, and End Results (SEER)-18 and Center for International Blood and Marrow Transplant Research (CIBMTR) datasets were utilized. Inclusion criteria were patients younger than 40 years old diagnosed with MM (ICD-O code 9732/3) between 2000-2017 (SEER) and 2008-2018 (CIBMTR). Variables assessed included age (&lt;30 vs. 30-39), gender, income (&lt;65K vs. ≥65K), race/ethnicity, place of residence (metropolitan vs. non-metropolitan), and year diagnosed (2000-2005 vs. 2006-2011 vs. 2012-2017). Incident SPMs were characterized as standardized incidence ratios (SIR). Analyses were conducted with STATA and data were censored at time of death or loss to follow up. Kaplan-Meier curves were generated for myeloma-specific survival (MSS). Individual variables were compared via log rank tests and Cox proportional hazard regression models. Model fit was assessed with Akaike's information criterion and Snell residuals. Assumptions of the Cox proportional hazards model were evaluated with log-time. Results There were 1,087 and 1,142 patients meeting criteria in SEER and CIBMTR, respectively. Median MSS was 181 months (15 years). The most common causes of death were MM (76%), SPMs (5.5%), and infection (3.6%). Statistically significant incident SPMs were lung cancers (SIR 4.94, p&lt;0.05), non-Hodgkin lymphoma (NHL) (SIR 5.28, p&lt;0.05), and acute myeloid leukemia (AML) (SIR 14.62, p&lt;0.05). Year of diagnosis strongly influenced survival. Compared to those diagnosed in 2000-2005, there was a 36% reduction in the risk of death among those diagnosed 2006-2011 (HR 0.64, 95% CI 0.49-0.82, p=0.001), and a 61% reduction among those diagnosed 2012-2017 (HR 0.39, 95% CI 0.26-0.58, p&lt;0.001). Race/ethnicity, gender, and age did not impact MSS. Among the AYA MM patients who received ASCT, notably 26% had a hematopoietic cell transplant comorbidity index (HCT-CI) of ≥ 3, nearly all received melphalan conditioning, and 80% received ASCT within the first year of diagnosis. One and four-year post-ASCT survival were 96% and 81%, respectively. Discussion To our knowledge, this is the first study assessing MM trends in the AYA population. Despite AYAs being underrepresented in MM clinical trials, the dramatic improvement in survival over time reflects efficacy of new drug approvals in this young population. It is also interesting that racial and socioeconomic disparities which are pervasive in the older adult MM population were not demonstrated in AYAs. AYA patients died from SPMs at rates similar to the adult MM population (3-6%), and notable incident SPMs in the AYA population were lung cancer, NHL, and AML. Also noteworthy was the high number of AYA MM patients who underwent up-front ASCT, which was nearly the same number of patients from the SEER dataset over half the amount of time. Since AYA MM patients have been underrepresented in trials utilizing ASCT, a survival benefit of ASCT in this population has not been demonstrated in the era of novel therapies. Further, given possible underlying genetic predisposition in AYA MM patients, long-term post-ASCT follow up is needed to better understand long-term toxicities including risk of hematological SPMs. Disclosures The findings and opinions contained herein are those of the authors and do not represent the views/opinions of the United States Air Force, Walter Reed National Military Medical Center, David Grant Medical Center, Department of Defense, or the Center for International Blood and Marrow Transplant Research (CIBMTR). Disclosures No relevant conflicts of interest to declare.

scholarly journals Should healthcare organisations offer ongoing rehabilitation services for patients undergoing haematopoietic cell transplant? A narrative review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jaleel Mohammed ◽  
Russell Kabir ◽  
Hadeel R. Bakhsh ◽  
Diana Greenfield ◽  
Volkova Alisa Georgievna ◽  
...  
Keyword(s):  
Hematopoietic Stem Cell Transplant ◽  
Insurance Companies ◽  
Cell Transplant ◽  
Term Care ◽  
Hematopoietic Stem ◽  
Content Type ◽  
Long Term Follow Up

PurposeHematopoietic stem cell transplant (HSCT) patients can suffer from long-term transplant-related complications that affect their quality of life and daily activities. This study, a narrative review, aims to report the impact of HCT complications, the benefits of rehabilitation intervention, the need for long-term care and highlights the research gap in clinical trials involving rehabilitation.Design/methodology/approachA comprehensive search strategy was performed on several databases to look for relevant articles published from 1998 to 2018. Articles published in English with the following terms were used: hematopoietic stem cell transplant, chronic graft-versus-host disease, rehabilitation, exercise, physical therapy, occupational therapy. A patient/population, intervention, comparison, and outcomes (PICO) framework was employed to ensure that the search strategies were structured and precise. Study year, design, outcome, intervention, sample demographics, setting and study results were extracted.FindingsOf the 1,411 records identified, 51 studies underwent title/abstract screening for appropriateness, 30 were reviewed in full, and 19 studies were included in the review. The review found that, for the majority of patients who underwent HSCT and developed treatment-related complications, rehabilitation exercises had a positive impact on their overall quality of life. However, exercise prescription in this patient group has not always reflected the scientific approach; there is a lack of high-quality clinical trials in general. The review also highlights the need to educate healthcare policymakers and insurance companies responsible for rationing services to recognise the importance of offering long-term follow-up care for this patient group, including rehabilitation services.Practical implicationsA large number of HSCT patients require long-term follow-up from a multidisciplinary team, including rehabilitation specialists. It is important for healthcare policymakers and insurance companies to recognise this need and take the necessary steps to ensure that HSCT patients receive adequate long-term care. This paper also highlights the urgent need for high-quality rehabilitation trials to demonstrate the feasibility and importance of rehabilitation teams.Originality/valueHealthcare policymakers and insurance companies need to recognise that transplant patients need ongoing physiotherapy for early identification of any functional impairments and appropriate timely intervention.

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