Autologous Stem Cell Transplantation in Multiple Myeloma Patients Over 60 Years Old

The incidence of Multiple myeloma (MM) increases with age; two-thirds of the patients are older than 65 years. Induction treatment, including new agents such as thalidomide, bortezomib, and lenalidomide followed by a conditioning regimen and upfront autologous stem cell transplantation (ASCT), has been accepted the standard treatment approach for newly diagnosed fit MM patients. We aimed to search the real-life data, the efficacy and safety of upfront ASCT following induction in patients with MM over 60 years old retrospectively. The data of MM patients who were ≥60 years old during autologous stem cell transplantation and treated at our center between 2010 and 2018 retrospectively analyzed. The study results were 63 patients included at the age of ≥ 60 years who underwent upfront ASCT. Median PFS was 15.5±2.6 months, and the median overall survival (OS) was 28.15±5 months. According to age groups, median PFS was 12±2.3 months in the 60-64 age group, 18.4±6 months in the 65-69 age group, and 26±15 months in the ≥70 age group. Median OS was 26.5±6.1 months in the 60-64 age group, 39.66±8.9 months in the 65-69 age group, and 18 months in the ≥70 age group. A significant relationship between the quantity of infused CD34+ stem cells and PFS and OS (p:0.05 and

Early Relapse After Autologous Stem Cell Transplantation in Multiple Myeloma is Still Prognostic in The Era of Novel Agents

Significant improvements in the prognosis of Multiple Myeloma(MM) have recently observed in the era of novel agents. Induction treatment, including new agents followed by conditioning regimen and upfront autologous stem cell transplantation(ASCT), has been accepted as the standard treatment approach for newly diagnosed eligible MM patients. Despite novel agents, upfront ASCT is still superior to conventional chemotherapy alone. Previous studies revealed that the duration between ASCT and relapse had predicted overall survival(OS), and meantime, it was widely used to determine the potential benefit from a second ASCT. However, the majority of the data collected reflects the treatment modalities before novel agents. In this study, we aimed to investigate the impact of post-transplantation early relapse(ER) on survival in the era of novel agents. The results of 155 MM patients that underwent ASCT at our center between January 2010 and May 2018 were analyzed retrospectively. The median follow-up duration was 20 months in the ER group, 27 months in the non-ER group, and 24 months in all patients. 33.3% of patients in the ER group and 71.4% of patients in the non-ER group were alive at the time of analysis. Median OS was 20.77±3.66 months in the ER group and 40.89±4.21 months in the non-ER group. We found a statistically significant relationship between the ER and the poor OS (p

Polatuzumab vedotin, rituximab, and bendamustine combination in relapsed or refractory diffuse large B-cell lymphoma: A real-world data from Turkey

Polatuzumab vedotin (Pola) with bendamustine and rituximab (BR) is a promising option for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We analyzed the data of 71 R/R DLBCL patients who had been treated with Pola-BR in the named patient program from March 2018 to April 2021 from 32 centers in Turkey. All patients received up to six cycles of Pola 1.8 mg/kg, rituximab 375 mg/m2 on day 1, and bendamustine 90 mg/m2 on days 1–2 of each cycle. Median age at Pola-BR initiation was 55 (19–84). The overall response rate was 47.9%, including 32.4% CR rate when a median of 3 cycles was applied. With a median follow-up of 5 months, the median OS was 5 months. Grade 3–4 neutropenia and thrombocytopenia were the most common hematological toxicities. The real-world data from our cohort showed the Pola-BR is an effective option with a manageable toxicity profile

The Incidence and Risk Factors for Central Venous Catheter Related Thrombotic Complications in Autologous Hematopoietic Stem Cell Transplantation

Hematopoetik kök hücre nakil (KHN) alıcılarında merkezi venöz katater ilişkili trombotik komplikasyon gelişme sıklığı ve risk faktörleri hakkında kapsamlı veri bulunmamaktadır. Çalışmamızda Eylül 2003- Nisan 2014 tarihleri arasında Gazi Üniversitesi Tıp Fakültesi Kök Hücre Nakil Ünitesinde otolog KHN yapılmış toplam 306 hastanın dosya kayıtları kök hücre mobilizasyonu ve nakil sürecinde merkezi venöz katater ilişkili trombotik komplikasyon gelişme sıklığı ve risk faktörleri açısından değerlendirilmiştir. Kök hücre mobilizasyonu sırasında merkezi venöz kateter ilişkili tromboz 12 hastada (% 3,9) ve kök hücre nakil döneminde 24 hastada (% 7,8) saptanmıştır. Merkezi venöz katater ilişkili trombotik komplikasyon mobilizasyon sürecinde ortanca 14 günde (aralık 4- 48 gün) ve nakil sürecinde ortanca 18 günde (aralık 3- 33) ortaya çıkmıştır. Merkezi venöz katater ilişkili trombotik komplikasyon gelişimi üzerinde yaş, cinsiyet, tanı, nakil öncesi hastalık durumu, önceden geçirilmiş tromboemboli öyküsü, mobilizasyon vs kök hücre nakli için kataterin takılmış olması, katater kalış süresi, vücut kitle indeksi (VKİ), Faktör V Leiden ve protrombin gen mutasyonu ve nakil öncesi D-dimer düzeyinin etkili olmadığı gösterilmiştir. Kataterin sol tarafa takılması ve katater enfeksiyonu varlığı katater ilişkili tromboz gelişimi üzerinde çok değişkenli analizde etkisini koruyan risk faktörleri olarak tespit edilmiştir (p<0,001). Hematopoetik kök hücre nakli yapılan hastalarda MVK ilişkili tromboz gelişmesinin risk faktörlerinin tanımlanması, tromboproflaksi uygulanacak hasta grubunun belirlenmesinde yol gösterici olacaktır.The incidence and risk factors for central venous catheter related thrombotic complications in autologous hematopoietic stem cell transplantation is not well described. We retrospectively examined the incidence and risk factors for central venous catheter related thrombotic complications during both mobilization and transplantation in 306 hematopoietic stem cell transplantation recipients at Gazi University Faculty of Medicine Stem Cell Transplantation Unit between September 2003 and April 2014. The incidence of thrombotic complications was 3,9 % (12 patients) during stem cell mobilization and 7,8 % (24 patients) during stem cell transplantation. The median duration of central venous catheter until the development of thrombotic complications was 14 days (range 4- 48 days) in stem cell mobilization and 18 days (3- 33 days) in stem cell transplantation. Age, gender, primary diagnosis, pretransplantation disease status, previous history of venous thromboembolism, catheter replacement for mobilization vs transplantation, duration of catheter, body mass index, Factor V Leiden or prothrombin gene mutation and pretransplantation D-dimer level were not associated with central venous catheter related thrombotic complications. Left sided catheter replacement and catheter related infectious complications showed significant correlation with catheter related thrombotic events both in univariate and multivariate analysis. In hematopoietic stem cell transplantation patients identification of risk factors for central venous catheter related thrombotic complications may help to identify patient groups who have indications for thromboprophylaxi

Is the Optimal Timing First Complete Remission for Autologous Stem Cell Transplantation in Patients with Peripheral T-Cell Lymphoma?

Aim:Outcome for most patients with peripheral T cell lymphomas (PTCLs) is poor, with low response rates and short durations of remission. We aim to analyze the outcome of PTCL patients who underwent autologous stem cell transplantation (ASCT) at our center and we researched whether first complete remission (CR) was the optimal timing for ASCT in patients with PTCL.Materials and Methods:The data of PTCL patients who underwent ASCT between January 2010 and December 2020 at our center were retrospectively analyzed.Results:Twenty-five patients with PTCL underwent ASCT. The median ASCT age was 44 years (range: 19-68). 68% of the patients were performed upfront ASCT after the first CR; 32% of the patients underwent ASCT after relapse or refractory (R/R) disease. The median follow-up time from diagnosis was 40 months (13-144 months). The five-year PFS and OS were 50.8% and 55.7%, respectively. Five-year OS was 82.4% in the up-front ASCT group, while the five-year OS was 15.6% in the R/R patients (p=0.019). The median OS was 25 months [95% confidence interval (CI): 0-50.4] in patients who had CR2, while it was 13 months (95% CI: 0-35) in patients who had PR before ASCT (p=0.03). According to subtypes of PTCL, OS and PFS were not statistically different in all groups (p=0.96 and p=0.79, respectively). Conclusion:Even the prognosis is poor in patients with PTCL, Overall survival was significantly longer among the upfront ASCT group. Patients should be consolidated with ASCT in the first CR, and relapse should not be waited to perform ASCT

OUTCOME OF ALLOGENEIC STEM CELL TRANSPLANTATION WITH ACTIVE DISEASE IN ACUTE MYELOID LEUKEMIA

Introduction: Despite multiple lines of chemotherapy, some patients with acute myeloid leukemia (AML) can not achieve remission. The prognosis of these patients is quite poor and they should be evaluated for clinical trials, otherwise myeloablative conditioning regimens followed by allogeneic stem cell transplantation (Allo-SCT) should be performed to over come the active disease which is resistant to conventional doses and as it is the only curative option. Method: In this study, we evaluated the outcome of AML patients who underwent Allo-SCT with active disease in our center retrospectively. Results: A total of 161 AML patients underwent Allo-SCT between December 2009 and November 2018 at our center. 130 of them underwent Allo-SCT in complete remission while 31 of 161 had to undergo Allo-SCT with active disease due to refractoriness to salvage therapies. The median overall survival (OS) was7.9±2.8 months. 6-month OS was 25% and 1-year OS was only 6%. Progression-free survival (PFS) was 3.53±1.1 months. The transplant-related mortality rate was12.8%. Conclusion: OS and PFS are short in patients who undergo Allo-SCT with active diseases on oveltreatment approaches and targeted therapies should be developed to overcome active disease that are refractory to conventional chemotherapies

Single-Dose Rasburicase Might Be Adequate To Overcome Tumor Lysis Syndrome In Hematological Malignancies

Introduction: Tumor lysis syndrome (TLS) is a commonly observed oncological emergency that requires prompt diagnosis and treatment. Rasburicase is a recombinant urate oxidase endorsed in TLS for the treatment of hyperuricemia. The effect of single-dose 7.5 mg rasburicase at longer follow-ups was not widely investigated. Patients and Methods: Eighty-two patients included in the study with clinical TLS and laboratory TLS. The primary endpoint was the normalization of uric acid (<6mg/dL) within 24 hours of rasburicase administration, which was described as treatment success. The secondary endpoint was defined as having sustained response at the first week. The third endpoint was defined as the reaching the baseline renal function before TLS. Results: We found that the use of a 7.5 mg dose of rasburicase controlled uric acid in 74 of 82 (90,2%) patients at the 24th hour. In the first week, uric acid remained at normal levels in 69 of 82 (84,1%) patients. At 24 hours, the TLS risk group was the only predictor for failing uric acid normalization; at the end of the first week, no predictive factor was identified for failing uric acid normalization. Conclusion: Rasburicase at 7.5 mg dose is an important agent for controlling laboratory and clinical TLS at 24 hours and extending its effect to the first week

The effect of bulky mass on prognosis in diffuse large-B-cell lymphoma: still poor?

The introduction of rituximab to the CHOP protocol has demonstrated an improvement in PFS and OS in DLBCL patients with both early and advanced stages. Most studies in the pre-rituximab period indicated that bulky disease has an unfavorable impact on clinical outcomes of DLBCL. The effect of bulky mass on the outcome of DLBCL patients undergoing R-CHOP therapy remained uncertain. One-hundred-twelve newly diagnosed DLBCL patients aged 18 and older were enrolled in the study. Patients were divided into groups-based presence of bulky disease. 56 patients with bulky disease and their age, gender, ECOG score, Ann Arbor stage, immunohistochemical origin, treatment, radiotherapy and comorbidity 1:1 matched 56 control patients with non-bulky disease included. Overall response rate at end of treatment was similar among groups (p = 0.1). Patients with bulky disease and non-bulky disease were comparable regarding overall survival (p = 0,9). All cohort investigated for predictors for survival, after multivariate analysis, ECOG score, Ann arbor stage, IPI score and LDH level were found significant. Here, we found no impact of bulky disease on remission and survival. We believe, with increasing available data, poor prognostic value of bulky disease will be weakening in the rituximab era