Bolwell, Brian

Copelan, Edward A.

Dean, Robert M.

Duong, Hien

Hamilton, Betty Ky

Hanna, Rabi

Hill, Brian

Kalaycio, Matt E.

Rybicki, Lisa

Sekeres, Mikkael

Sobecks, Ronald

Elsevier - Publisher Connector 

Abstracts / Biol Blood Marrow Transplant 19 (2013) S279eS312S290Introduction: Allogeneic Hematopoietic Stem Cell Trans-
plantation (HSCT) is indicated for patients with intermediate
or high risk primary Myeloﬁbrosis (MF), and also in patients
with Policitemia Vera or Essential Thrombocythemia who
have progressed to high risk MF. The results for allogeneic
HSCT with myeloablative conditioning seem to be better for
patients younger than 45 years, determining lower relapse
risk. However, Reduced Intensity Conditioning (RIC) for
patients between 45 and 65 years-old has shown to be
a promising strategy, with less mortality related to the
procedure. This study aims describing a series of patients
diagnosed with myeloﬁbrosis, transplanted in the Hospital
de Clínicas (HC) from the Federal University of Paraná and
Hospital Nossa Senhora das Graças (HNSG) (Curitiba, Brazil).
Patients and Methods: From 1984 to 2011, fourteen patients
with MF were submitted to HSCT, eleven from the HC and
three from HNSG. The median of age was 42 years (10-51).
Therewere ten males and four females. In average, ﬁve blood
transfusions were done per patient (0-61). Five male patients
received the graft from a female donor, and two patients
received an unrelated HSCT. The median of duration of the
disease was 20 months (2-150). According to Dupriez Clas-
siﬁcation, all the patients were of intermediate and high risk.
Five patients had a myeloablative conditioning (Busulfan
plus Cyclophosphamide: 4; Cyclophosphamide plus Total
Body Irradiation:1) while nine had a RIC transplant (Fludar-
abine 150mg/m2 plus Melphalan 140mg/m2:6; Fludarabine
plus Melphalan plus Antithymocyte Globulin:2; Fludarabine
180mg/m2 plus Bulsufan 10mg/m2 plus Antithymocyte
globulin 5mg/kg:1).
Results: In the myeloablative conditioning group (n¼5), all
the patients presented marrow engraftment; one relapsed.
Three patients presented grade II-IV acute graft versus host
disease, and four developed severe chronic graft versus host
disease. Four patients died, and the only survivor was 10
years-old. Median survival was 479 days. In RIC group (n¼9),
engraftment didn't occur in one patient (which had spleno-
megaly of 18 cm at the time of transplantation), and another
three relapsed. The other seven patients remained alive and
free of disease, with median survival of 750 days (34-1872;
P¼ 0,000123).
Conclusion: In spite of the limited number of patients in this
study, data suggest that RIC regimens improved survival in
HSCT for myeloﬁbrosis in our center, even with a slightely
greater relapse risk. Except for very young patients, this
strategy should be considered for further investigation.361
Assessment of the Hematopoietic Cell Transplantation
Comorbidity Index in Patients Receiving Reduced-
Intensity Allogeneic Hematopoietic Stem Cell
Transplantation
John P. Galvin, Joanne Monreal, Jayesh Mehta. Northwestern
Memorial Hospital, Chicago, IL
Allogeneic hematopoietic stem cell transplantation
(HSCT) is an established therapy for malignant and nonma-
lignant hematologic disorders. Reduced-intensity condi-
tioning (RIC) regimens have expanded the use of HSCT to the
elderly patients and to patients that are otherwise ineligible
for conventional transplants. However, RIC HSCT still
remains associated with a signiﬁcant morbidity and
mortality and the careful assessment of risks and beneﬁts
before transplantation is essential. Major factors which
inﬂuence non-relapse mortality (NRM) and overall survival
(OS) after HSCT are diagnosis, type of transplant and the
patient's risk proﬁle, which includes age and presence ofcomorbidities. The use of the hematopoietic cell trans-
plantation-speciﬁc comorbidity index (HSCT-CI) has been
proposed to predict the probability of non-relapse mortality
(NRM) and overall survival (OS) following HSCT. Since its
development, HSCT-CI has been evaluated at different insti-
tutions for various hematologic diseases. We performed
a single-center retrospective study to assess the prognostic
value of HSCT-CI on transplant outcomes in a cohort of
patients undergoing RIC HSCT. We analyze patients receiving
a RIC HSCT between January 2005 and December 2010. The
median patient age at the time of transplantation was 57
years (range: 19-75 years). The patient diagnoses included
AML (32%), NHL (28%), MM (15%), MDS (10%), HD (5%), CLL
(5%), ALL (3%), MPD (1%) and nonmalignant hematologic
(1%). The median pre-transplantation HSCT-CI score was 2
(range: 0-9). Among 133 patients, OS at 2 years was 36%. The
2 yr OS is 34%, 33% and 41% in the low-, intermediate-, and
high-risk HSCT-CI groups respectively (P ¼ .72). The corre-
sponding NRM at 2 years was 39%, 41% and 38% (P ¼ .85).
Further subgroup analysis (patient age, diagnosis, condi-
tioning, remission status and prior stem cell transplant)
disclosed no signiﬁcant differences in the OS prediction by
the HCT-CI score. In conclusion, we found no predictive value
of HSCT-CI for the determination of 2-year OS or 2-year NRM
in allogeneic HSCT receiving reduced-intensity condition.362
Risk Factors for Prolonged Length of Hospitalization in
Patients Undergoing Allogeneic Hematopoietic Cell
Transplantation
Betty Ky Hamilton 1, Lisa Rybicki 2, Brian Bolwell 1,
Matt E. Kalaycio 1, Mikkael Sekeres 1, Ronald Sobecks 1,
Rabi Hanna 3, Robert M. Dean 1, Hien Duong 1, Brian Hill 1,
Edward A. Copelan 4. 1 Department of Hematologic Oncology
and Blood Disorders, Cleveland Clinic Taussig Cancer Institute,
Cleveland, OH; 2Quantitative Health Sciences, Cleveland Clinic
Taussig Cancer Institute, Cleveland, OH; 3 Pediatric
Hematology-Oncology, Cleveland Clinic Foundation, Cleveland,
OH; 4Hematologic Oncology and Blood Disorders, Levine
Cancer Institute, Charlotte, NC
Prolonged hospitalization exposes patients (pts) under-
going allogeneic hematopoietic cell transplantation (HCT) to
risks of iatrogenic complications and results in signiﬁcant
morbidity and mortality as well as expense, however, there
are limited data on risk factors that contribute to length of
stay (LOS) in HCT pts.
663 pts underwent HCT from 1/1997 to 12/2011. Among
663 pts, 49 died in the hospital within 6 weeks (wks) of
transplant and were excluded, leaving 614 pts, median age 44
(range 18-71 years), for analysis. Pts underwent HCT for acute
myeloid leukemia (n¼258), acute lymphoblastic leukemia
(n¼98), myelodysplastic syndrome (n¼87), chronic myeloid
leukemia (n¼78), non Hodgkin lymphoma (n¼55), aplastic
anemia (n¼20), Hodgkin disease, myeloproliferative
neoplasm, and plasma cell disorders (remaining n¼18). The
majority of pts underwent myeloablative transplant (n¼599,
97.6%); 15 (2.4%) had a reduced-intensity transplant. 317
(51.6%)pts receiveda transplant fromarelateddonor, 250 from
an unrelated donor (40.7%) and 47 (7.7%) received cord blood.
153 pts (25%) were identiﬁed to have a prolonged LOS,
deﬁned as 6 wks. In univariable analyses, variables asso-
ciated with LOS included: poor performance status (PS)
(odds ratio [OR] 1.31 per 10 point decrease on Karnofsky
scale, P ¼ .017), unrelated donor transplant (OR 3.45,
P < .001), cord blood transplant (OR 7.86, P < .001), HLA
mismatch (OR 4.45, P < .001), and CD34+ cell dose (median
Abstracts / Biol Blood Marrow Transplant 19 (2013) S279eS312 S2912.04x106/kg, range 0.01-26), (OR 1.43 per 1x106/kg decrease,
P < .001). Prior chemotherapy, lymphoid malignancies,
longer interval fromdiagnosis toHCT, andpositiveCMVstatus
were also associated with LOS, with a trend towards signiﬁ-
cance (P ¼ .06 for all). In multivariable, logistic regression
analyses, poor PS (OR 1.31 per 10 point decrease,P ¼ .031),
unrelateddonor (OR3.14 P< .001), cord blood transplantation
(OR 2.42, P¼ .048), CMVpositivity of either donor or recipient
(OR 1.91, P¼ .018), and CD34+ cell dose (OR 1.35 per 1x106/kg
decrease, P < .001) were signiﬁcantly associated with pro-
longed LOS. 5-year non-relapse mortality (NRM) for pts
hospitalized 6 wks was signiﬁcantly worse than for pts
hospitalized<6 wks (60.2% vs. 31.8%, P< .001), as was overall
survival (OS) at 5 years, (16.6% vs. 42.8%, P< .001). Therewere
no differences in the incidence or degree of acute GVHD.
In conclusion, hospitalization 6 wks following HCT is
associated with signiﬁcantly worse NRM and OS. Poor PS,
CMV positivity, decreased CD34+ cell dose, and unrelated
and cord blood transplants have previously been identiﬁed
as factors predictive of poor outcome and are also factors that
contribute to prolonged LOS. Efforts should be made to
optimize modiﬁable factors such as cell dose in HCT pts,
especially those with other risk factors, such as having an
unrelated or cord blood donor.363
Cytomegalovirus Viremia is a Risk Factor for Late-Onset
Hemorrhagic Cystitis Following Allogeneic
Hematopoietic Stem Cell Transplantation
Ting-ting Han, Lan-ping Xu, Dai-hong Liu, Kai-yan Liu,
Hai-xia Fu, Xiao-jun Huang. Institute of Hematology, Peking
University People's Hospital, Beijing, China
Purpose: Late-onset hemorrhagic cystitis (LOHC) is
a common complication following allogeneic hematopoietic
stem cell transplantation (allo-HSCT), which was mainly
associated with BK virus and adenovirus (ADV). However,
there still some patients developed LOHC without infection
of BKV and ADV. Several retrospective studies showed that
CMV infection was associated with LOHC. So, we design this
prospective study to deﬁne the relationship between CMV
infection and LOHC.
Design and Methods: Fifty consecutive patients who
received allo-HSCT between October 2011 and December
2011 were prospectively investigated to screen BKV, ADV and
CMV in the urine and plasma using Real-time Polymerase
Chain Reaction (RT-PCR).Results: Twenty-one out of the 50 patients developed LOHC
with a cumulative incidence of 42%7.1%.The median time
from transplantation to onset of LOHC was 29 (range, 4-64)
days. There are 34 patients and 21 patients developed CMV
viremia and CMV viruria, respectively, within day 100. The
cumulative incidence of LOHC in patients with CMV viremia
was signiﬁcantly higher than those without CMV viremia
(58.8% vs. 6.3%, P ¼ .001) on day 100 after transplantation.
Patients with CMV viruria had a signiﬁcant higher cumula-
tive incidence of LOHC than those without CMV viruria
(60.7% vs. 18.2%, P ¼ .006). The cumulative incidence of CMV
viremia and CMV viruria in patients with LOHC (n¼21)
versus those without LOHC (n¼29) were 95.2% vs. 48.3% (P ¼
.001) and 80.9% vs. 34.5% (P ¼ .001), respectively. The
cumulative incidence of LOHC in patients whose plasma BKV
load increased more than or equal to 103-fold over baseline
was signiﬁcantly higher than those with plasma load
increase less than 103-fold (67.9%9.2%vs. 9.1%6.3%, P <
.001). The cumulative incidence of LOHC in patients whose
urine BKV load increased more than or equal to 104-fold over
baseline was signiﬁcantly higher than those with urine load
increase less than 104-fold (66.7% 10.3% vs. 19.2%7.9%, P ¼
.002). ADV was positive in 4 patients including one patient
with LOHC. Multivirariate analysis showed that CMV viremia
(HR¼10.496, 95% CI: 1.527-86.570, P ¼ .018) and plasma BKV
load increased more than or equal to 103-fold compared to
baseline level (HR¼10.669, 95% CI: 2.452-46.419, P ¼ .002)
were two independent risk factors for LOHC.
Conclusion: Our data suggest that CMV viremia is a risk
factor for LOHC following allo-HSCT.364
Investigation of ADAMTS13 and VWF in the Patients with
Thrombotic Complications Following Hematopoietic
Stem-Cell Transplantation (HSCT)
Yue Han, Luping Hu, Jian Su, Aining Sun, Huiying Qiu,
Depei Wu. Department of Hematology, the First Afﬁliated
Hospital of Soochow University, China
Objective: Plasma ADAMTS13 may play a role in the patho-
genesis of hematopoietic stem-cell transplantation (HSCT)
related thrombosis by cleaving the prothrombotic ultralarge
VWF into less active VWF. This study was to investigate the
alterations of ADAMTS13 and VWF in HSCT recipients during
transplantation, and to evaluate their signiﬁcance in trans-
plantation-related thrombotic complications.
Methods: Plasma ADAMTS13 activity was detected by ﬂuo-
rescence resonance energy transfer substrate VWF73
(FRETS-VWF73) assay in 113 hematologic patients receiving
allogeneic-HSCT. Of all the patients recruited for his study, 8
patients were diagnosed to have the thrombotic disorders
and 49 patients were classiﬁed to have acute graft-versus-
host disease (aGVHD). The alterations of ADAMTS13 activity
and VWF level in the plasma of patients were analyzed
during transplantation, and the correlation between
ADAMTS13/VWF and transplantation-related thrombosis
was evaluated using the SAS program (version 9.3).
Results: The average plasma ADAMTS13 activity in 113 cases
following HSCT at each period were less than the healthy
controls (P< .01), while the VWF antigen level in each period
were higher than the controls (P < .05). Among all the
patients after pretreatment, 69 showed decreased plasma
ADAMTS13 activities (59.3%), including 9 patients with more
than 60% (8.0%) decrease, while the average plasma VWF
antigen level of this 69 patients was signiﬁcantly increased in
patients after pretreatment (P< .05). Considering thrombotic
complications, the data showed that 8 patients with


Risk Factors for Prolonged Length of Hospitalization in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation 

Hamilton, Betty Ky

Rybicki, Lisa

Bolwell, Brian

Kalaycio, Matt E.

Sekeres, Mikkael

Sobecks, Ronald

Hanna, Rabi

Dean, Robert M.

Duong, Hien

Hill, Brian

Copelan, Edward A.

University of Miami: Scholarship Miami

Biology of Blood and Marrow Transplantation

Risk Factors for Prolonged Length of Hospitalization in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Betty Ky Hamilton

Lisa Rybicki

Brian Bolwell

Matt E. Kalaycio

Mikkael Sekeres

Ronald Sobecks

Rabi Hanna

Robert M. Dean

Hien Duong

Brian Hill

Edward A. Copelan

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Risk Factors for Prolonged Length of Hospitalization in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

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