Prognostic Impact of Pretransplant Transfusion Amount on Outcome After Allogeneic Stem Cell Transplantation In Adult Patients with Severe Aplastic Anemia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3503-3503
Author(s):  
Sung-Eun Lee ◽  
Jong-Wook Lee ◽  
Seung-Ah Yahng ◽  
Byung-Sik Cho ◽  
Ki-Seong Eom ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Aplastic Anemia ◽  
Cell Transplantation ◽  
Adult Patients ◽  
Prognostic Impact ◽  
Increased Risk ◽  
History Of ◽  
The Impact ◽  
Transfusion History

Abstract Abstract 3503 Background: Aplastic anemia (AA) is a life-threatening bone marrow failure disorder. Therefore, many patients with AA require blood transfusions as supportive management. Regular transfusions of packed red cell (PRC) lead to the development of iron overload, which is known to increase the risk of complications after stem cell transplantation (SCT). However, the prognostic impact of pretransplant transfusion history of PRC on outcome in AA has not been completely analyzed. We investigated the impact of pretransplant transfusion amount of PRC on outcome after allogeneic SCT in severe AA (SAA). Methods: 221 adult patients with SAA who underwent allogeneic SCT between January 1995 and August 2007 who had not received optimal iron chelating therapy were selected for retrospective analysis. Results: 221 patients were divided into two groups according to the mean amount of pretransplant transfusion (32 PRC units): receiving less than 32 PRC units (n=164), >32 PRC units (n=57) before SCT. The median follow-up duration of survivors after SCT was 47.9 (39.5-56.2) months in ≤32 PRC units of transfusion group and 42.8 (39.7-45.9) months in >32 PRC units of transfusion group. Primary engraftment was achieved in all, but 13 patients (9/164 patient, 5.5% in the ≤32 PRC units of transfusion group, 4/57 patients, 7% in the >32 PRC units of transfusion group, P=0.745) developed secondary graft failure. Acute GVHD (grade II-IV) developed in 27.4% in ≤32 PRC units of transfusion group and 42.1% in >32 PRC units of transfusion group (P=0.04), and extensive type of chronic GVHD occurred in 20.7% and 26.3% among evaluable patients, respectively. In the comparison between two groups, higher pretransplant transfusion group has significantly increased risk of transplant-related mortality (TRM) (<32 PRC units of transfusion: 8.2% vs >32 PRC units of transfusion: 25.2%, P=<0.000), and lower overall survival (OS) (91.8% vs 75.2%, P=0.001) than those with lesser transfusion history. Multivariate analysis revealed that higher pretransplant PRC amount [HR (95% CI) 3.09 (1.44-6.63), P=0.004] and donor type (related vs unrelated) [HR 2.41 (95% CI) (1.10-5.27), P=0.028] were independent prognostic factor for affecting OS. Conclusion: These results indicate that higher pre-transplant transfusion history of PRC was associated with increased TRM and decreased OS, and it has shown to have a negative impact on outcome after SCT in SAA. Disclosures: No relevant conflicts of interest to declare.

The Impact of Center Experience on Results of Reduced Intensity – Allogeneic Hematopoietic Stem Cell Transplantation. A Survey From the Acute Leukemia Working Party (ALWP) of the European Group for Blood and Marrow Transplantation (EBMT)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3517-3517
Author(s):  
Sebastian Giebel ◽  
Myriam Labopin ◽  
Mohamad Mohty ◽  
Didier Blaise ◽  
Charles Craddock ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem ◽  
Therapeutic Decisions ◽  
Increased Risk ◽  
The Impact ◽  
Reduced Intensity

Abstract Abstract 3517 Allogeneic hematopoietic stem cell transplantation with reduced intensity conditioning (RIC-HSCT) is increasingly applied for the treatment of patients with acute myeloid leukemia. However, the procedure is heterogeneous with no standards based on randomized trials being elaborated so far. Hence, particular therapeutic decisions are in major part based on individual experience. The goal of this study was to evaluate the impact of center experience on outcome of RIC-HSCT. Based on the registry of ALWP of the EBMT, we analyzed results of 1413 HLA-matched related (n=1058) or unrelated (n=355) transplantations performed in 203 European centers between 2001 and 2007. Only patients with AML in first complete remission were included. Median recipient age was 55 years (range, 18–77 y.). Centers were categorized by quintiles according to the number of RIC-HSCT procedures in a study period. The 2 years probability of leukemia-free survival (LFS) after RIC-HSCT performed in centers with the lowest activity (1st quintile, ≤ 15 procedures/7 years) equaled 43% compared to 55% in the remaining ones (p<0.001). The incidence of non-relapse mortality (NRM) was 24% and 15%, respectively (p=0.004). In a multivariate model adjusted for other potential prognostic factors low RIC-HSCT activity was associated with decreased chance of LFS (HR=0.69, p<0.001) as well as increased risk of NRM (HR=1.69, p=0.001) and relapse (HR=1.37, p=0.01). No significant differences were found between centers belonging to the 2nd -5th quintile. We conclude that center experience is a strong predictor of outcome and should be considered for future analyses evaluating results of RIC-HSCT. Disclosures: Off Label Use: Dasatinib as first line therapy in Ph ALL.

Pre-Transplant Weight Loss and Total Serum Protein Predict Relapse Of Acute Myeloid Leukaemia After Allogeneic Stem Cell Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3314-3314
Author(s):  
Thomas Luft ◽  
Sascha Dietrich ◽  
Aleksandar Radujkovic ◽  
Friedrich Stölzel ◽  
Christine Falk ◽  
...  
Keyword(s):  
Weight Loss ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Total Serum ◽  
Metabolic Risk ◽  
Increased Risk ◽  
The Impact ◽  
Acute Myeloid

Abstract Background Although allogeneic stem cell transplantation (alloSCT) represents a curative chance for higher risk acute myeloid leukaemia (AML), relapse occurs in a significant proportion of patients. The impact of nutritional status on the outcome of allogeneic stem cell transplantation (alloSCT) is controversial. This study investigates the influence of pre-transplant body mass index (BMI), weight loss, and serological indicators of nutritional homeostasis on relapse and death of acute myeloid leukemia (AML) after alloSCT. Methods Pre-transplant weight loss and BMI along with serum levels of total serum protein (TSP), albumin, C-reactive protein, and leptin were collected retrospectively in a training cohort of 149 patients allografted for AML and correlated with clinical outcome. A metabolic risk score was established and tested in an independent validation cohort (n=167). Results Pre-transplant weight loss exceeding 2%, TSP lower than 70 g/L, and decreased leptin levels were associated with a significantly increased risk of relapse and death. In contrast, we did not observe a consistent pattern for the impact of nutritional indicators on non-relapse mortality (NRM). Multivariate analyses adjusting for age, cytogenetic risk, treatment line, blast count at alloSCT, donor, and conditioning confirmed weight loss and low TSP as independent risk factors of relapse and overall survival, but not of NRM. Weight loss >2% and low TSP were used to build a metabolic score for prediction of relapse risk and mortality. In multivariate analyses with clinical confounders, patients with both metabolic risk factors had a strongly increased risk of relapse (p=0.0003, HR 15.62, 95%CI 3.51-69.71) and death (p=0.002, HR 3.64, 95%CI 1.62-8.18) compared to patients without metabolic risk factor. The risk prediction of the metabolic score could be confirmed in the validation cohort (Figure 1). Conclusions Altered nutritional homeostasis prior to alloSCT predicts the risk of recurrence of AML after transplantation. Studies addressing pretransplant nutritional interventions in order to reduce AML relapse rates are warranted. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clonal Hematopoiesis after Autologous Stem Cell Transplantation Does Not Confer Adverse Prognosis in Patients with AML

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3190
Author(s):  
Alexander D. Heini ◽  
Naomi Porret ◽  
Reinhard Zenhaeusern ◽  
Annette Winkler ◽  
Ulrike Bacher ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Progression Free Survival ◽  
Cure Rate ◽  
Clonal Hematopoiesis ◽  
Increased Risk ◽  
First Remission ◽  
The Impact

Introduction: Despite a 50% cure rate, relapse remains the main cause of death in patients with acute myeloid leukemia (AML) consolidated with autologous stem cell transplantation (ASCT) in first remission (CR1). Clonal hematopoiesis of indeterminate potential (CH) increases the risk for hematological and cardiovascular disorders and death. The impact of CH persisting after ASCT in AML patients is unclear. Materials and Methods: We retrospectively investigated the prognostic value of persisting DNMT3A, TET2, or ASXL1 (DTA) mutations after ASCT. Patients underwent stratification depending on the presence of DTA mutations. Results: We investigated 110 consecutive AML patients receiving ASCT in CR1 after two induction cycles at our center between 2007 and 2020. CH-related mutations were present in 31 patients (28.2%) after ASCT. The baseline characteristics were similar between patients with or without persisting DTA mutations after ASCT. The median progression free survival was 26.9 months in patients without DTA mutations and 16.7 months in patients with DTA mutations (HR 0.75 (0.42–1.33), p = 0.287), and the median overall survival was 80.9 and 54.4 months (HR 0.79 (0.41–1.51), p = 0.440), respectively. Conclusion: We suggest that DTA-CH after ASCT is not associated with an increased risk of relapse or death. The persistence of DTA mutations after induction should not prevent AML patients in CR1 from ASCT consolidation. Independent studies should confirm these data.

scholarly journals Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation

Blood ◽  
2007 ◽  
Vol 109 (10) ◽  
pp. 4586-4588 ◽  
Author(s):  
Philippe Armand ◽  
Haesook T. Kim ◽  
Corey S. Cutler ◽  
Vincent T. Ho ◽  
John Koreth ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Iron Overload ◽  
Cell Transplantation ◽  
Serum Ferritin ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Hematopoietic Stem ◽  
Increased Risk

Abstract Iron overload could be a significant contributor to treatment-related mortality (TRM) for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). We studied 590 patients who underwent myeloablative allogeneic HSCT at our institution, and on whom a pretransplantation serum ferritin was available. An elevated pretransplantation serum ferritin level was strongly associated with lower overall and disease-free survival. Subgroup multivariable analyses demonstrated that this association was restricted to patients with acute leukemia or myelodysplastic syndrome (MDS); in the latter group, the inferior survival was attributable to a significant increase in TRM. There was also a trend toward an increased risk of veno-occlusive disease in patients with high ferritin. Our results argue that iron overload plays an important role in transplantation outcome for patients with acute leukemia or MDS, as it does in thalassemia. They also suggest future prospective trials to examine the potential benefit of chelation therapy in this setting.

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