scholarly journals Factors Associated with the Platelet Graft in Hematopoietic Precursor Cell Transplant Patients in a Third Level Hospital in Mexico

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 27-28
Author(s):  
Cynthia Pelayo Mena ◽  
Luis Manuel Valero Saldaña ◽  
Brenda Lizeth Acosta-Maldonado ◽  
Dana Perez Camargo ◽  
Victor Itaí Urbalejo Ceniceros
Keyword(s):  
Statistical Significance ◽  
Allogeneic Transplantation ◽  
Cell Transplant ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Post Transplant ◽  
Factors Associated ◽  
Transplant Patients ◽  
Hematopoietic Precursor ◽  
The Mean

Factors associated with the platelet graft in hematopoietic precursor cell transplant patients in a third level hospital in Mexico Introduction The success of TCPH is affected by various factors such as graft versus host disease (GVHD), relapse, treatment-related toxicity, and infection, leading to increased morbidity and mortality. Thrombocytopenia is almost universal in the pre-graft period in patients sometimes on TCPH, delayed platelet recovery beyond the expected time occurs in 5% to 37% of patients sometimes on TCPH. Various studies have described a relationship between platelet graft delay and CD34 + cell dose, pre-transplant disease status, source of the graft, blood group, and even the development of platelet refractoriness. Male receptor gender and elevated serum hepcidin level have also been associated as risk factors for delayed platelet graft. Aims To assess the factors associated with late platelet grafting in the post-transplant patient of hematopoietic precursor cells. Methods Retrospective, cross-sectional, observational and descriptive study. From January 2018 to December 2019. Results 101 patients were included, 59.4% men and 40.6% women. The mean age was 37 years. Patients diagnosed with MM were 24.8%, ALL 22.8%, NHL 19.8%, HL 15.8%, AML 14.9%, CML 1%. 73.3% of the patients had a CR prior to transplantation and 26.7% had a PR. BUCY was used as a conditioning scheme in 27.7%, PEAM 27.7%, FLUBUCY 16.8%, BORMEL 11.9%, BUMEL 9.9%. 55.4% of the patients underwent autologous transplantation and 44.6% underwent allogeneic. During the peritransplantation period, 32.7% had some type of infection, 21.8% developed GVHD, and 12.9% had a relapse of the disease. Of the 101 patients, 85.1% were alive at the time of this study; 3 of these patients did not achieve a platelet graft, 2 of them required a thrombopoietic receptor agonist, 2 had a diagnosis of ALL and one had MM, the 3 patients died before the +100 day due to infectious complications. The mean platelet apheresis transfusion was 1.80. The mean recovery time for neutrophils was 11 days and for platelets 13 days. The mean follow-up was 25 months. The overall one-year survival is 70% in allogeneic post-transplant patients and 95% in autologous post-transplant patients Of the factors evaluated using the KM method to relate them to overall survival, statistical significance was found: relapse (p = 0.0001), GVHD (p = 0.002) and more than 5 x 106CD34 infused (p = 0.047). The recovery time for the platelet and neutrophil graft was not statistically significant, p=0.288 and p = 0.421 respectively. GVHD was the only factor associated with relapse-free survival. When performing a bivariate analysis, the factors with statistical significance (p= <0.05) related to the platelet graft were: allogeneic transplantation, the amount of CD34 infused, infections and GVHD. Discussion The mean time for neutrophil and platelet grafting was 11 and 13 days, respectively. According to the bivariate analysis performed, allogeneic transplantation confers 6.7 times more risk for the platelet graft to be greater than 13 days p= 0.0001. Begeman et al. have reported that there is an inverse relationship between the amount of CD34 infused and the time of platelet grafting. This observation was not reproducible in our population since we found that an amount greater than 5 x 106 CD34 conferred a 4.4-fold risk for the platelet graft to be greater than 13 days, with a p= 0.0001. This could suggest that it is probable that an amount greater than 5 x 106 could have an opposite effect and prolong the grafting time; this will have to be taken with reserve since in our multivariate a significant result was not confirmed. Overall survival and relapse-free survival were not affected by neutrophil or platelet graft time as described in some studies; probably due to the size of our sample and that in other series the follow-up time has been comparable. The median of relapse-free survival was reached at 5 months and it should be noted that relapse was the only factor that had a negative impact on the survival of our population, and was observed only in patients undergoing allogeneic transplantation; therefore, those patients who present a relapse of the disease have a poor prognosis, whose median was reached at 25 months, so perhaps it would be worthwhile to search for available rescue therapies in these patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Gastric Endocrine Carcinoma: A New Look at a Rare Tumor From Cases in Japan

2020 ◽  
Vol 104 (3-4) ◽  
pp. 111-115
Author(s):  
Kenichi Iwasaki ◽  
Takeshi Suda ◽  
Hiroshi Yamaguchi ◽  
Kosuke Takahashi ◽  
Takafumi Watanabe ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Radical Resection ◽  
Middle Region ◽  
Relapse Free Survival ◽  
Standard Type ◽  
Free Survival ◽  
Future Studies ◽  
Factors Associated ◽  
Clinicopathologic Factors ◽  
The Mean

Objective: We evaluated the clinicopathologic factors associated with gastric neuroendocrine carcinoma (NEC) in patients who underwent surgical resection. Gastric NEC is rare, accounting for only about 0.6% of all malignant gastric tumors. Neither its pathogenesis nor its treatment has been fully established. Methods: We assessed 10 patients with gastric NEC who underwent surgical resection in our hospital between September 2007 and June 2019. Results: The patients consisted of 9 men and 1 woman, aged 63 to 78 years. The tumors were localized in the upper region (n = 5), middle region (n = 3), and lower region (n = 2). The macroscopic types were evaluated as 0-IIc (n = 3), 1 (n = 3), 2 (n = 1), 3 (n = 2), and 4 (n = 1). The stages were ascertained as IA (n = 3), IIB (n = 3), IIIA (n = 2), IIIB (n = 1), and IIIC (n = 1). Radical resection was performed in all the patients. After surgery, relapse-free survival was achieved in 6 patients. The mean postoperative survival time was 63.5 months. On immunostaining, 6 patients were positive for CD56, and all were positive synaptophysin and chromogranin A. Of the 10 patients, standard-type adenocarcinoma was concomitantly present in 6. Conclusions: Some patients with surgically resected gastric NEC survived over a long period, suggesting the usefulness of radical resection. In future studies, the pathogenesis of gastric NEC should be fully clarified, and therapeutic strategies must be further developed.

scholarly journals Current Graft-Versus-Host Disease (GVHD), Relapse-Free Survival - a Novel, Dynamic Composite Endpoint to Better Define Effectiveness Following Allogenic Hematopoietic Cell Transplantation

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1170-1170 ◽  
Author(s):  
Scott R. Solomon ◽  
Connie Sizemore ◽  
Michelle Ridgeway ◽  
Xu Zhang ◽  
Melhem Solh ◽  
...  
Keyword(s):  
Stem Cell ◽  
Acute Gvhd ◽  
Composite Endpoint ◽  
Cell Transplant ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Post Transplant ◽  
Dynamic Event ◽  
Grade 3 ◽  
Very High

Abstract Introduction GVHD-free, relapse-free survival (GRFS) has been previously developed as a novel composite endpoint designed as a measure of transplant effectiveness, which attempts to take into account the morbidity associated with GVHD (Holtan et al. Blood 2015). The conventional definition of GRFS however considers grade 3-4 acute GVHD and immunosuppression-requiring chronic GVHD (cGVHD) as static endpoints, whereas in reality these outcomes are often reversible. Patients with short-lived GVHD are considered treatment failures, which may not represent an accurate measure of transplant success. Therefore, we have developed a statistical method that provides an estimate of the probability, at any time post-transplant, of being alive, in remission, and without clinically significant cGVHD, defined as moderate-severe by the NIH consensus criteria. Methods In this new composite endpoint, which we call current GRFS (CGRFS), death and relapse are treated as terminal events, while cGVHD is considered a dynamic event, which can "resolve" once manifestations are quiescent and systemic immunosuppression discontinued. Grade 3-4 acute GVHD was intentionally not included in this endpoint, as this event almost universally will either resolve with time or convert to either death or cGVHD, which are both captured as part of CGRFS. Statistically, the CGRFS was defined as the sum of the survival without evidence of relapse and moderate-severe cGVHD and the probability that one recovered from moderate-severe cGVHD. The probability that one recovered from moderate-severe cGVHD was calculated by looking at the differences of relevant Kaplan-Meier estimates. Comparison of CGRFS between two independent samples was implemented by the simulation-based supremum test. Results We evaluated 437 consecutive patients receiving an allogeneic hematopoietic stem cell transplant at a single institution from a matched related (MRD, n=125), matched unrelated (MUD, n=165), or haploidentical (HID, n=132) donor between January 2010 and July 2015. Transplant recipients had a median age of 54 years (range 18-77), DRI high/very high in 30%, and HCT-CI ³3 in 46%. Myeloablative conditioning was used in 50% and PBSC was the stem cell source in 78%. GVHD was prospectively documented by a dedicated practitioner on an ongoing basis. With a median follow-up time of 36 months, estimated 3-yr overall and disease-free survival was 61% and 54%, respectively. Conventionally defined GRFS at 1, 2, 3 and 4 years was 33%, 26%, 23%, and 22% respectively. In contrast, when moderate-severe cGVHD was treated as a dynamic event, corresponding CGRFS was 45%, 46%, 47% and 49%, respectively (Figure 1). The corresponding gain in CGRFS survival, due to the treatment of cGVHD as a dynamic event, was 12%, 20%, 24% and 27% respectively (Figure 2). Patients living with active mod-severe cGVHD decreased over time, quantitated at 23%, 14%, 7% and 4% respectively at 1, 2, 3 and 4 years post-transplant (Figure 3). CGRFS was significantly correlated with DRI (low/intermediate vs. high/very high, p<0.01), but not transplant type, age, HCT-CI, graft source, regimen intensity or year of transplant. Conclusion Whereas only a third of patients achieve "transplant success" by conventional 1-yr GRFS, nearly half of patients by CGRFS are considered cured without the morbidity of ongoing GVHD. We propose that CGRFS may represent are more accurate estimate of transplant effectiveness. Disclosures No relevant conflicts of interest to declare.

scholarly journals Investigating the Relationship between CD34+and CD3+ Cell Doses, One-Year Graft-Versus-Relapse-Free-Survival, Graft-Versus-Host Disease, and Overall Survival in Haploidentical Hematopoietic Stem Cell Transplantation: A Single Center Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2051-2051 ◽  
Author(s):  
Mindy Hsiao ◽  
Anastasia Martynova ◽  
George Yaghmour ◽  
Chris Foss
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Optimal Dose ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Improved Outcomes ◽  
The Mean ◽  
Related Mortality

Background: Haploidentical hematopoietic cell transplantation (haplo-HCT) has emerged as a popular alternative to traditional HLA-matched hematopoietic cell transplant. As the number of haplo-HCT's rises, investigating the factors that may affect outcomes is necessary in order to improve overall survival and reduce transplant-related mortality. The optimal dose of CD34+ cells used during haplo-HCT to ensure favorable outcomes using PTCy has not yet been reported though a range of 2 to 5.00x106 cells/kg is commonly used.Furthermore, the optimal dose of CD3+ cells is unknown however recent data has suggested less than 3.00x108 cells/kg may prevent the development of acute GVHD. The importance of studying the impact of CD34+/CD3+ cell dosing may help to improve outcomes in this setting. Methods: We retrospectively analyzed adult patients at USC Norris Cancer Hospital (age ≥ 21) who received haplo-HCT from 2014 to 2019. The primary end-point assessed was 1-year GVHD-free/relapse-free survival (GRFS) defined as grade 3-4 acute GVHD, systemic therapy-requiring chronic GVHD, relapse, or death in the first post-HCT year. Secondary end-points included 1-, 2-, and 3-year relapse-related mortality (RRM) and overall survival (OS) in addition to 1-year transplant related mortality (TRM) and incidence of both acute and chronic GVHD. Results: A total of 67 adult haplo-HCT recipients were reviewed. Of the patients evaluated, approximately 50% (n = 33) were male and 49% (n = 32) were female. The age range was 21-71 years old (median = 44), and the most common underlying hematologic disorders included AML (40%), ALL (38%), aplastic anemia (7.7%), and others (MDS, lymphoma, myelofibrosis, and HLH) (13.8%). 67% of patients received myeloablative conditioning regimens while 33% received reduced intensity regimens. 70% (n = 47) of patients received peripheral blood as a stem cell source with 30% (n = 20) receiving bone marrow. The mean CD34+ dose infused was 6.07x106 cells/kg and the mean CD3+ dose was 2.94x108 cells/kg. The mean time to recovery of platelets, neutrophils, and lymphocytes was 25, 18, and 37 days respectively. CD34+ stem cells ≥5.00x106 cells/kg was significantly associated with shorter time to lymphocyte recovery (p = 0.0265) though recovery less than 30 days was not significantly associated with OS (p = 0.5268). Incidence of 1-year GRFS was 71% (n= 46) and 1-, 2-, and 3-year RRM were 4.6%, 6%, and 7.7% respectively. 1-year TRM was 15.3% with 50% of deaths from acute GVHD. 1-, 2-, and 3-year OS were 80%, 78%, and 77% respectively. Factors significantly associated with increased mortality included use of RIC regimen (p = 0.004) and disease status at time of transplant (p = 0.04). Cumulative incidence of GVHD was 63% (n = 42) with 33% (n = 22) and 30% of patients (n = 20) with acute and chronic GVHD respectively. Lack of mild chronic GVHD was associated with increased mortality (p = 0.0029) and use of a myeloablative regimen (p = 0.0029) was significantly associated with GVHD. Subgroup analysis of those who received CD34+ dose ≥7.00x106 cells/kg (n = 24) and ≥10x106 cells/kg (n = 7) were found to have 1-year OS of 87.5% and 85.7% compared with 77% and 80% in those that received lower doses (p= 0.2229 and p = 1.00) respectively however this was not found to be significantly associated with increased incidence of GVHD, relapse, or mortality. Discussion: Our results demonstrate improved outcomes specifically 71% survived 1 year without experiencing at least 1 GRFS event compared with 24-35% reported by CIBMTR, Holtan et al 2015, and Solh et al 2016 with 3-year OS of 77% when compared with a previously reported 48%. The mean CD34+ cell dose of our population is higher than the standard range which may account for the improved outcomes however the dosing of CD34+/CD3+ cells were not significantly associated with our primary and secondary end-points. It was significantly associated, however, with shorter time to lymphocyte recovery, a factor that has been reported to be associated with decreased RRM and therefore improved OS. Furthermore, subgroup analysis of higher CD34+ dose did show a better 1-year OS though this was not statistically significant. Limitations of this study include small sample size and short follow-up period. Further research with a prospective study identifying the optimal CD34+/CD3+ cell dose in addition to comprehensive evaluation of immune recovery is warranted in order to improve haplo-HCT outcomes. Figure Disclosures Yaghmour: Jazz Pharmaceutical company: Consultancy, Speakers Bureau; Astella company: Speakers Bureau; Takeda: Speakers Bureau.

scholarly journals Estimate of long-term relapse-free survival (RFS) and analysis of baseline factors associated with RFS in the COMBI-AD trial

2018 ◽  
Vol 29 ◽  
pp. viii445
Author(s):  
R. Dummer ◽  
D. Schadendorf ◽  
A. Hauschild ◽  
M. Santinami ◽  
V.G. Atkinson ◽  
...  
Keyword(s):  
Relapse Free Survival ◽  
Free Survival ◽  
Factors Associated ◽  
Baseline Factors

High Levels of Interleukin-12 Are Associated with Reduced Incidence of Relapse and Death without Increasing Acute Graft-Versus-Host Disease (AGVHD) after Allogeneic Stem Cell Transplantation (SCT).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 295-295
Author(s):  
Vijay Reddy ◽  
Andrew G. Winer ◽  
Erika Eksioglu ◽  
Jeffery Levine ◽  
Herwig-Ulf Meier-Kriesche ◽  
...  
Keyword(s):  
Stem Cell ◽  
Disease Risk ◽  
Significant Risk ◽  
Interleukin 12 ◽  
P Value ◽  
Group Level ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Post Transplant ◽  
Medium Group

Abstract We recently found that a low number of circulating dendritic cells (DC) is predictive of increased relapse, acute GVHD, and poor survival following allogeneic SCT (Reddy V et al, Blood2004;103(11):4330–5). Interleukin-12 (IL-12) is an immunostimulatory cytokine involved in the activation of naïve T cells by DC (Rissoan et al. Science1999;283(5405):1183–6). We hypothesized that patients with high levels of circulating IL-12 in the post transplant period have improved relapse free survival. We studied 134 patients, 120 of whom were evaluable and transplanted during the period of July 1999 to April 2004. Seventy-two patients had transplants from related and 48 from unrelated donors, for predominantly high risk (88%) hematologic malignancies. Median follow up was 1158 days (range 70–1792). Blood samples were collected as baseline prior to conditioning, on day 0 prior to stem cell infusion and during the first week (day 4 and/or 7) after transplant. Plasma IL-12 levels were measured by ELISA. To determine the independent effect of post-transplant IL-12 levels and clinical outcomes, a cluster analysis was performed on the logarithmically transformed mean IL-12 concentration at days 4 and 7 post-transplant. The analysis generated a low, medium and high IL-12 group. Forty-six patients had low levels of IL-12 (median=2 pg/ml, range 0–6.5), 49 patients had medium (median=20.5 pg/ml, range 7–75.5) and 25 patients had high levels (median=181 pg/ml, range 84–623). There was a significant association between IL-12 level and onset of relapse. Using a multivariate Cox model with the low group level as reference, the high IL-12 group level had an adjusted hazard ratio (HR) of 0.27 (95% C.I. 0.09–0.79) and the medium group level a HR of 0.65 (95% C.I. 0.31–1.36). Incidence of relapse at 500 days by Kaplan-Meier analysis by IL-12 group were 23.0% (high group), 40.3% (medium group), and 48.8% (low group). Covariates in the multivariate models were gender match, disease risk, graft source, patient age, donor relation. There was a significant relationship between IL-12 levels and composite death and relapse, the high IL-12 group had a HR of 0.37 (95%C.I.=0.17–0.80) and the medium group a HR of 0.85 (95%.C.I. 0.50–1.45). There was no association between IL-12 levels and risk of AGVHD (p-value=0.51). In addition to IL-12, disease risk was a significant risk factor for the composite endpoint of relapse or death (HR=5.4, p-value=0.0052). The model generated for the outcome of relapse only did not have any additional significant risk factors. In conclusion, high post-transplant levels of IL-12 are associated with less relapse and improved relapse free survival after transplantation. This data suggests that IL-12 administration should be considered as a possible component in studies addressing treatment of relapse after transplantation. Figure Figure

Voriconazole for Secondary Prophylaxis of Invasive Fungal Infection in Allogeneic Stem Cell Transplant Recipients: Results of the VOSIFI Study. on Behalf of the VOSIFI Study Group and the Infectious Diseases Working Party of the European Bone and Marrow Transplantation Group.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1159-1159 ◽  
Author(s):  
Catherine Cordonnier ◽  
Hermann Einsele ◽  
Montserrat Rovira ◽  
Johan Maertens ◽  
Eduardo Olavarria ◽  
...  
Keyword(s):  
Stem Cell ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Secondary Prophylaxis ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Adequate Treatment ◽  
Post Transplant ◽  
The Mean

Abstract Background: Despite adequate treatment and favorable initial outcome, the risk of recurrence of a previous invasive fungal infection (IFI) or acquisition of a new one is a major obstacle to the success of stem cell transplantation (SCT). The rate of IFI relapse is estimated to be 30 to 50%. Secondary prophylaxis could increase survival and reduce the burden of fungal infections to these patients. Methods: A prospective open multicenter trial was performed to evaluate the efficacy of voriconazole (VORI) (4mg/kg/12h IV or 200mg/12h oral) as secondary prophylaxis in allogeneic SCT patients with previous proven or probable IFI (2002 EORTC/MSG consensus criteria). Adult patients (Age &gt; 18 y) were eligible if the prior IFI had occurred within the 12 months prior to SCT. Exclusion criteria were prior resistance to VORI, prior history of zygomycosis, or active IFI at time of transplant. VORI was started within 3 days before transplant and planned for 100 days. Prophylaxis could be prolonged up to 150 days in case of persistent graft-versus-host disease (GVHD) and ongoing immunosuppression on day 100. All patients were followed until 12 months post-transplant, or until death, whichever occurred first. The primary endpoint was the rate of proven and probable IFI between the start of VORI prophylaxis and the 12 month follow-up. Diagnosis of prior IFI, diagnosis of IFI occurring during the study, and cause of deaths, were assessed by a Data Review Committee including an independent radiologist. Results: 45 patients from 17 EBMT centers were included from Feb 2005 to March 2007. The mean age was 48 y (22–72). Forty-one had acute leukemia, and 24 were in first complete remission. Previous IFI included proven (n= 6) or probable (n=26) aspergillosis, proven candidiasis (n=5), and others (n=8). The mean time from diagnosis of the previous IFI to SCT was 151 days. Twenty four patients were transplanted from a family donor (HLA-id: 18; mismatched: 5; twin: 1), and 21 from an unrelated donor. The graft was bone marrow (n=6), peripheral blood stem cells (n=38) or cord blood (n=1). The conditioning regimen was myeloablative in 27 and non myeloablative in 18 patients. The median follow-up was 360 days (range 5–469). Twenty-six (58%) patients experienced at least one episode of GVHD. Three cases of IFI were recorded after transplant: one C. albicans candidemia, one S prolificans fungemia and one zygomycosis, at day 3, 16, and 66 after transplant, respectively (incidence: 7%). Two of these 3 IFI were relapses of a previous IFI. The median duration of the VORI prophylaxis was 94 days (5–180). Eleven patients (24%) died between 96 and 326 days post-transplant (median: 136 days) from scedosporiosis (n=1), leukemia relapse (n=4), respiratory failure or pneumopathy of unknown origin (n=3), GVHD (2), or sepsis (n=1). Conclusion: Voriconazole appears to be an efficient drug for secondary prophylaxis of proven and probable IFI after allogeneic SCT, with few adverse events. Considering an expected rate of IFI occurrence or recurrence after transplant of around 30%, the observed rate of 7%, and only one death from IFI in this high-risk adult population are promising.

Immunologic Recovery after Autologous Transplant in Multiple Myeloma and Progression Free Survival

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4444-4444
Author(s):  
Fernanda Maria Rodrigues Trigo-Miranda ◽  
Rui Cordeiro Bergantim ◽  
Ricardo Moreira Pinto ◽  
Patricia Guimarães ◽  
Jose E. Guimaraes
Keyword(s):  
Multiple Myeloma ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
Cell Transplant ◽  
Haematopoietic Progenitor Cell ◽  
Free Survival ◽  
Post Transplant ◽  
Historical Comparison ◽  
Significant Difference

Abstract Several factors influencing disease progression and survival have been identified in multiple myeloma (MM). We analysed a series of 49 consecutive patients with MM that underwent autologous haematopoietic progenitor cell transplant (HPCT) in one center regarding the following variables: use of G-CSF for haematopoietic recovery post-transplant; recovery of normal IgM levels at day +100 post-transplant; levels of lymphocytes namely of the CD4+ and CD8+ subsets also at day +100. Before 2006, all patients had G-CSF starting 24 hours after the cell infusion until neutrophil &gt; 500×10^9/L in two consecutive days; in the years 2006–2008, no G-CSF was given to transplanted patients. A historical comparison was done and at the time of this study no significant difference in progression free survival (Kaplan-Meyer analysis), was detected between the two groups, possibly due to the shorter follow-up of the “no G-CSF” (n=19) group; nevertheless median progression free survival (PFS) in the “G-CSF” group was 12 months while median PFS was not attained in the “no G-CSF” group (median follow-up = 7 months). Post transplant IgM levels were also determined in 39 patients. Eighteen patients recovered normal IgM levels at day +100 (46.8 %) and 21 (53.8 %) did not. Comparison of Kaplan-Meyer curves for the two groups did not show any statistically significant difference but there is a sharp difference between median PFS of the “low IgM” (10 months) and the “normal IgM” (27 months) groups. CD4/CD8 ratio was determined in 18 patients at day +100. The ratio varied between 0 and 0.63 (median – 0.305). No correlation was found between post-transplant IgM recovery and CD4/CD8 ratio. In conclusion, in our series of MM patients treated with autologous HPCT we could not find a definite relationship between immunologic recovery and response to treatment although there is a trend to a better outlook of the patients which recover normal IgM levels. It is also uncertain whether use of G-CSF in the post-transplant period would have any effect on disease behaviour.

Risk Factors Associated with VOD with RIC and MAC Hematopoietic Stem Cell Transplant and the Early Estimation of VOD

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4315-4315
Author(s):  
Shoichi Nagakura ◽  
Tetsuyuki Kiyokawa ◽  
Michihiro Hidaka ◽  
Takahiro Yano ◽  
Kazutaka Sunami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Goodness Of Fit ◽  
Time Course ◽  
Laboratory Data ◽  
P Value ◽  
Cell Transplant ◽  
Data Set ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Factors Associated

Abstract BACKGROUND: Despite recent increase of reduced intensity conditioning (RIC) transplantation, mortality rates after RIC and myeloabrative conditioning (MAC) HSCT remain high and hepatic veno-occlusive disease (VOD) cannot accurately predicted. OBJECTIVE: To determine the value of risk factors associated with the development of VOD after allergenic HSCT with RIC and MAC. Estimating VOD based on clinical factors may further improve results of allogenic HSCT. PATIENTS AND METHODS: A retrospective review of 415 consecutive allogenic HSCT was performed with attention to VOD, pre-transplant factors and laboratory data in five hematopoietic cell transplantation centers between 2000 and 2005. Patients underwent transplantation with MAC (n=247) or RIC (n=168). Main outcomes and risk factors were analyzed in multivariable analyses (a logistic regression model) with RIC and MAC. Three kind of laboratory data set, pre-transplant (day −10), post-transplant (day 20) and differences from pre-transplant to post-transplantation were analyzed. RESULTS: VOD occurred in 65 of 415(15.7%) transplant recipients; 40 of 247(16.1%) with MAC and 25 of 168(14.9%) with RIC. Multivariate analyses identified risk factors with the development of VOD with MAC (albumin level, creatinine level) and with RIC (HCT-CI, number of prior chemotherapy regimen, ALT) in pre-transplant laboratory data set. The risk factors of VOD were identified in post-transplant and differences (Table). The Akaike’s information criterion (AIC) of risk factors with differences was better than with the post-transplant. CONCLUSION: Our results provided risk factors of VOD with MAC and RIC. The estimation of VOD before transplantation may be useful for the selection of conditioning regimens. Differences of laboratory data with the time course of transplant may be useful for the early diagnosis of VOD. MAC Pre-transpant data Post-transplant data Differences data OR P-Value OR P-Value OR P-Value Age - - 0.945 0.0090 - - Alb 0.290 0.0125 - - - - Cr 10.204 0.0307 1.786 0.0039 1.984 0.0139 TPro - - 0 358 0.0019 - - TBi I - - 1.385 0.0027 1.314 0.0037 Ara-C - - 5.000 0.0139 goodness of fit AIC 106.727 126.499 86.931 RIC Pre-transpant data Post-transplant data Differences data OR P-Value OR P-Value OR P-Value Sex - - 3.401 0.0446 - - HCTCI 3.922 0.0050 2.000 0.0123 - - ImpScore 2.000 0.0314 - - - - TPro - - 0.366 0.0091 - - TBi I - - 1.675 0.0042 2.273 0.0004 ALT 0.969 0.0432 - - - - CY - - - - 5.682 0.0447 goodness of fit AIC 61.552 91.09 52.808

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