(median follow-up 17.5 months) and 10 had FK/MTX (me- dian follow-up 9.8 .... 3 Apollo Gleanagles hospital, kolkata, India; 4 Tata Medical centre, kolkata, India ...
Abstracts / Biol Blood Marrow Transplant 22 (2016) S19eS481
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Patient Outcomes, % (n)
CSP/MMF
Low ALC30(n ¼ 17)
High ALC30 (n ¼ 27)
FK/MTX
Low ALC30 (n ¼ 0) High ALC30 (n ¼ 10)
Graft source
aGVHD, GradesI-IV
aGVHD, GradesIII-IV
Deaths by days 100(GVHD)*
Deaths by 6 months(GVHD)*
100-day survival
6-month survival
PB sib: 1 PB MUD: 8 BM MUD: 8 PB sib: 13 PB MUD: 13 BM MUD: 1 n/a PB sib: 3 PB MUD: 6 BM MUD: 1
100% (17)
65% (11)
35% (6)
47% (8)
65% (11)
53% (9)
67% (18)
18% (5)
7% (2)
15% (4)
92% (25)
70% (19)
n/a 30% (3)
n/a 0% (0)
n/a 0% (0)
n/a 0% (0)
n/a 90% (9)
n/a 80% (8)
Abbreviations: PB ¼ peripheral blood. BM ¼ bone marrow, MUD ¼ matched unrelated donor, sib ¼ sibling; *, deaths due to GVHD
Kristy Martin, Cindy Kramer, Molly Schneider, Valeriy Sedov, Juan Carlos Varela, Elizabeth J. Williams, Robert Stuart, Saurabh Chhabra. Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, SC Background: Previous reports have shown a correlation between day 30 absolute lymphocyte count (ALC30) after allogeneic hematopoietic cell transplantation (alloHCT) and patient outcomes. These reports included patients with various conditioning regimens and reported decreased overall survival and increased acute Graft-versus-Host disease (aGVHD) in patients with lower ALC30. The objective of this study was to find correlation between ALC30 and outcomes after alloHCT using reduced intensity conditioning (RIC) of fludarabine (25mg/m2 IV/d d -5 to -1) and melphalan (70mg/m2 IV/d d -2 to -1) conditioning (Flu/Mel). Methods: A retrospective chart review of patients receiving RIC alloHCT from Jan 2012 to May 2015 was conducted. Patients received cyclosporine/mycophenolate mofetil (CSP/ MMF) or tacrolimus/methotrexate (FK/MTX) for GVHD prophylaxis. The indications for alloHCT were AML (40), MDS (7), CML (2), ALL (3), NHL (1) and HL (1). Only patients who had one alloHCT using T cell-replete graft were included. Results: Fifty four patients were analyzed; of these, 17 had ALC30 lower than 400x106/L. With a median follow-up of
11.8 months, the day 100 and 6 month survival were 65% and 53% for the low ALC30 group and 92% and 73% for the high ALC30 group. Of the 54 patients, 44 received CSP/MMF (median follow-up 17.5 months) and 10 had FK/MTX (median follow-up 9.8 months). None of the FK/MTX patients had low ALC30 while 17 of 44 (39%) CSP/MMF patients did. There were seven deaths before d100 in the low ALC30 group, all due to aGVHD. Of the three deaths before d100 in the high ALC30 group, two were due to aGVHD and one due to infection. Eleven patients (65%) in the low ALC30 group had Grade III-IV aGVHD compared to five (14%) in the high group. None of the FK/MTX patients had GIII-IV aGVHD compared to 36% of the CSP/MMF patients. Five patients relapsed, all of whom received CSP/MMF and had high ALC30. Overall survival at d100 and 6 months was 90% (9/10) and 80% (8/10) for the FK/MTX group compared to 82% (36/44) and 64% (28/44) for the CSP/MMF group, respectively. Conclusion: Post-transplant day 30 ALC over 400x106/L is predictive of lower incidence of Grade III-IV aGVHD and lower risk of early mortality, regardless of the GVHD prophylaxis in patients receiving RIC (Flu/Mel) allogeneic transplantation.
453 Cardiac Risk Factors and Echocardiographic Variables As Predictors of Mortality in Bone Marrow Transplant Patients Neeraj Saini 1, Zheng Zhou 2, Kinan Yarta3, Carol Mathew4, Muthalagu Ramanathan 2, Rajneesh Nath 2, Jan Cerny 5. 1 Division of Hematology/Oncology, University Of Massachusetts, Worcester, MA; 2 Section BMT, Division of Hematology/Oncology, University of Massachusetts, Worcester, MA; 3 Internal Medicine, NYU Lutheran, New york, NY; 4 Internal Medicine, University of Massachussetts, Worcester, MA; 5 Department of Medicine; Division of Hematology/ Oncology, University of Massachusetts, Worcester, MA Background: The pre-Bone marrow transplant (BMT) evaluation of cardiac function by echocardiographically measured left ventricular ejection fraction (LVEF) is one of the fitness criteria. However, the data documenting the usefulness of such criteria are sparse. The aim of our study is to investigate whether pre-transplant cardiac risk factors and echocardiographic parameters could predict survival/mortality in BMT patients.
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Abstracts / Biol Blood Marrow Transplant 22 (2016) S19eS481
3
Apollo Gleanagles hospital, kolkata, India; 4 Tata Medical centre, kolkata, India; 5 Haematology and stem cell transplant, AMRI hospitals, kolkata, India
Methods: We retrospectively reviewed consecutive patients undergoing BMT at our institution from January 2009 to December 2012. We compared clinical outcome in patients with regards to cardiac risk factors (history of coronary artery disease (CAD), myocardial infarction (MI), arrhythmias, Heart failure (HF), smoking, hyperlipidemia and diabetes mellitus) and multiple parameters from pre-transplant Echo. Echo variables were Left ventricular in Diastole diameter (LVIDd), Left Atrium size (LA), Left Ventricular Mass (LVM), Left ventricular mass index (LVMI), Relative wall thickness (RWT) and left ventricular geometry/remodeling. Survival was defined as months from BMT to death or the most recent follow-up. Patient’s whose Echo images were of poor quality or couldn’t be located in the system were excluded from the study. Results: Of the 208 eligible patients (86 females, 41%), 121 (58%) patients underwent autologous transplant and 87 (42%) patients had an allogeneic transplant, respectively. The mean age was 56.9 years (range, 19-83 years). The prevalence of CAD, MI, CHF and history of arrhythmia in our cohort was approximately 35 (17%), 16 (7%), 16 (8%) and 17 (9%) respectively. Fourteen (7%) patients had LVEF less than 50% and 194 (93%) patients had LVEF >¼ 50%. History of cardiac arrhythmias showed borderline significance for association with mortality with a hazard ratio (HR) of 1.88(p¼0.0534) compared to no history of arrhythmia. Patients with history of CAD and CHF showed a trend toward increased mortality, albeit did not reach statistical significance. Decreased LVEF
