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

The Timing of Granulocyte Colony-Stimulating Factor in Hematopoietic Stem Cell Transplant in the Pandemic

Granulocyte-colony stimulating factors (G-CSF) are used to shorten the duration of neutropenia after hematopoietic cell transplantation (HCT). However, there is no consensus on which days treatment should be started post-transplantation during the COVID-19 pandemic. In this study, we looked at the influence of G-CSF on clinical outcomes on the fifth (G-CSFd5) and tenth (G-CSFd10) days following allo-HCT. Our study includes the data of 60 patients (G-CSFd5, n=28 vs G-CSFd10, n=32) who underwent HCT with the diagnosis of acute lymphoblastic leukemia (ALL) between 2015 and 2022. Primary outcome is the effect of G-CSF on hospital stay. Secondary outcomes are the development and duration of febrile neutropenia (FEN), neutrophil engraftment (NE), platelet engraftment (PE), engra ftment syndrome (ES), acute graft versus host disease (aGVHD), cytomegalovirus (CMV) viremia, and effects on antimicrobial use . Length of hospital stay, 34.5 days vs. 30 days (p=0.19); median NE, 13.85 vs 15.03 days (p=0.007); median PE, 15.5 vs 12 days (p =0.12); ES, 28.5% vs 12.5% (p=0.12); FEN, 85.7% vs 84.3% (p=0.88); aGVHD, 39.2% vs 40.6% (p=0.92); were observed for G-CSFd5 and G-CSFd10, respectively. Although starting G-CSF in the early period after allo-HCT shortened the duration of NE, positive effects on clinical outcomes were not observed. On the contrary, the frequency of ES increased in the group that received GCSF early

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

The effect of pre-conditioning immunoglobulin and absolute lymphocyte count on the outcomes of allogeneic hematopoietic cell transplantation

Introduction: The prevention of mortality and morbidity related to the increasingly used allogeneic hematopoietic cell transplantation (allo-HCT), along with the effects of pre- and post-transplant immune status on transplant outcomes, have become the focus of the studies conducted on this subject in recent years. In parallel, this study was designed to investigate the effects of pre-conditioning immunoglobulin (pre-conditioning-Ig) and pre-conditioning absolute lymphocyte count (pre-conditioning-ALC) levels on transplant outcomes. Methods: This study was designed as a retrospective, observational and cross-sectional study. The objective of the study is to investigate the effects of pre-conditioning-Ig and ALC levels primarily on the rate of patients with febrile neutropenia (FEN) and the duration of FEN and length of hospital stay (LoS), and secondarily on acute graft-versus-host disease (aGVHD), cytomegalovirus (CMV) viremia, and mortality in the acute leukemia patients who underwent allo-HCT. Results: A total of 104 acute leukemia patients, of whom 55 had acute lymphoblastic leukemia (ALL) and 49 had acute myeloid leukemia (AML), were included in the study. Compared to the AML group, the median pre-conditioning-IgG, IgA, and IgM levels were found to be significantly lower in the ALL group (11.3 vs. 6.6, p < 0.001; 1.8 vs. 0.9, p < 0.001; and 0.7 vs. 0.4, p < 0.001; respectively). But, there was no significant difference between the groups in pre-conditioning-Ig and ALC levels and transplant outcomes. However, subgroup analysis revealed that high pre-conditioning-ALC levels were significantly correlated with aGVHD levels (Odds Ratio: 1.02; p = 0.034) and low pre-conditioning-IgM levels were significantly correlated with increased mortality rate (Hazard Ratio: 0.08; p = 0.042) in AML patients. Conclusion: The significant difference determined between the ALL and AML groups in pre-conditioning-Ig levels was not reflected on the effects of pre-conditioning-Ig and ALC levels on transplant outcomes. However, we observed that pre-conditioning-IgM and ALC levels have an impact on transplant outcomes in AML patients

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

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