Bang, S.-M.

Kim, B.-S.

Kim, B.K.

Kim, I.

Lee, D.

Lim, J.H.

Park, S.

Yi, H.G.

Yoon, S.-S.

Elsevier - Publisher Connector 

Poster Session-II 111306
SEVERE TRANSPLANT ASSOCIATED MICROANGIOPATHY (TAM) MAY BE
LINKED TO SEVERE ORGAN INJURY IN PEDIATRIC PATIENTS TREATED
WITH SIROLIMUS (SIR) AND CALCINEURIN INHIBITOR (CNI) FOR PRE-
VENTION OR TREATMENT OF GRAFT-VS-HOST DISEASE (GVHD)
Rosenthal, J., Bolotin, E., Pawlowska, A., Oliver, C., Forman, S. City of
Hope, Duarte, CA
The addition of SIR to CNIs for treatment of GVHD may result
in a higher than expected incidence of TAM. We reviewed the im-
pact of organ injury or active GVHD on the clinical manifestation
of TAM in 2 groups of pediatric patients (pts): 1) pts received SIR
and tacrolimus (TAC) for prevention (GP); 2) pts treated for active
GVHD (TP).
Methods: A retrospective chart review of all pediatric pts who re-
ceived SIR/CNI for prevention or treatment of GVHD. TAM was
defined according to the International Working Group for TAM.
The risk periods were defined as days –1 to 160 in PG and day11
to day 130 after the last dose in TG.
Results: Forty-five pts were identified. The median age was 9.1 yr
(2.9–22) and 14.7 yr (2.9–22) in the PG (n 5 21) and TG (n 5 24),
respectively. Preparative regimens were TBI-based in 64%. Diagno-
ses included ALL (40%), AML (27 %), NHL (9%), Fanconi’s (4 %),
other (9%). SIR and TAC levels were monitored in all pts, and doses
were targeted to maintain levels within the desired range (WDR) of
2–10 ng/ml for both. The median follow up is 31 months. TAM cri-
teria were met in 5 PG pts (23.8%) and 10 TG pts (41.6%). Two PG
patients died from non-TAM related causes (VOD, n5 1 and infec-
tion, n 5 1). TAM presented in both patients as hemolytic uremic
syndrome.One patient had seizures secondary to thrombotic throm-
bocytopenic purpura (TTP). TAC and SIR levels in this pt. were
WDR. In the remaining 12 PG pts TAM findings were asymptom-
atic. SIR/TAC levels in these patients were allWDR. Among 10 TG
pts that met TAM criteria, 2 pts hadHUS and one severe TTP. All 3
patients with complicated TAMdied (HUS, n5 1, other causes, n5
2). Two of TG pts with laboratory, but not clinically apparent TAM
died (fungal infection, n5 1, IP n5 1). In all TG pts with TAM ei-
ther TAC (n5 7) or SIR (n5 6) levels exceededWDR. The follow-
ing possible variables were analyzed: age, conditioning regimen,
diagnosis, HLA disparity. In the PG, only organ failure or GVHD
could be identified as risk factors. In the TG, TAC or SIR levels ex-
ceeding WDR and organ injury from acute or chronic GVHD were
associated with an increased risk for clinically significant TAM.
Conclusion: Laboratory TAM occurs in about 30% of pts treated
withSIR/CNI;however, clinicallysignificantTAMoccursonly inami-
nority of pts. Severe TAM may be associated with organ injury from
GVHD or other reasons. Monitoring TAC or SIR levels may prove
to be critical in patients with progressive organ injury or GVHD.307
OUTCOMES OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLAN-
TATION IN RELAPSED GOOD RISK ACUTE MYELOCYTIC LEUKEMIA
(AML) CARRYING T(8:21) OR INV(16)
Kim, B.-S.1, Lim, J.H.2, Yi, H.G.2, Bang, S.-M.3, Kim, I.4, Lee, D.5,
Yoon, S.-S.4, Park, S.4, Kim, B.K.4 1Seoul National University Boramae
Hospital, Seoul, Korea; 2 Inha University Hospital, Incheon, Korea; 3Seoul
National University Bundang Hospital, Seongnam, Korea; 4Seoul Na-
tional University Hospital, Seoul, Korea; 5Seoul National University Hos-
pital, Seoul, Korea
Objectives: Patients with acute myelocytic leukemia (AML) with
favorable cytogenetics such as t(8;21) and inv(16) are classified as
good risk group and are not subject to hematopoietic stem cell trans-
plantation (HSCT) frontline.However there are limited data follow-
ing HSCT in relapsed good risk AML. Since allogeneic HSCT has
been regarded traditionally as the only curative option in this popu-
lation, we evaluated the outcomes of the patients who were treated
with allogeneic HSCT in relapsed good risk AML carrying inv(16)
or t(8:21).
Methods: We evaluated the outcomes of 22 consecutive patients
who underwent allogeneicHSCTwith eithermyeloablative (n5 17)
or reduced-intensity conditioning (RIC) regimen (n 5 5) between
January 1997 and May 2007 at Seoul National University Hospital.
Results: Among 22 patients (median age 33, 18–70), 13 patients
were classified as AML with t(8;21), 9 patients as AML withinv(16). 13 patients received sibling donor transplantation and the
remaining 9 patients received unrelated donor transplantation.
Median follow up duration was 8.3 months (range: 5.9 – 10.7
months). 20 patients attained remission after HSCT and 10 patients
relapsed after remission with HSCT, 8 (61.5%) with t(8;21) and 2
(22.2%) with inv(16). At the time of analysis, only 7 patients are alive
(3 patients (23%) with t(8;21), 4 patients (44%) with inv(16). 2
patients with inv(16) were lost to follow up. 13 patients (61.5%)
expired, 10 with t(8;21) and 3 with inv(16). 9 patients with mye-
loablative conditioning regimen and 4 patients with RIC regimen ex-
pired. There was no statistical difference between the myeloablative
and RIC regimen groups (p 5 .14). The main causes of death were
relapse (53.8%, 7 patients), infection (23%, 3 patients) and GVHD
(23%, 3 patients). 3-year survival rate was 43.8%. However, in
patients with t(8;21) AML (n 5 13), 3-year survival rate was
28.7%. On the contrary, in patients with inv(16) AML (n 5 9),
3-year survival rate was 65.8%.
Conclusion: Patients with relapsed favorable risk AML showed
divergent outcomes after allogeneic HSCT according to cytogenetic
abnormalities. Patients with relapsed t(8;21) AML particularly ex-
hibited high relapse rate and poor prognosis after allogeneic
HSCT which is similar to treatment outcome of poor risk group
AML. New treatment approaches including frontline HSCT with
either allogeneic or autologous approaches should be tried in a
prospective setting in this population.308
ROLE OF ANTI THYMOCYTE GLOBULIN (ATG) PRIOR TO UNRELATED
DONOR STEM CELL TRANSPLANTATION (URD SCT) IN PATIENTS WITH
HEMATOLOGIC MALIGNANCIES: A SINGLE CENTER EXPERIENCE
Ganguly, S., Koya, B., Divine, C., Abhyankar, S., Aljitawi, O., Deauna-
Limayo, D., Bodensteiner, D.C., Skikne, B.S., McGuirk, J.L. University
of Kansas Medical Center, Kansas City, KS
Introduction: Long-term outcome in patients undergoing URD
SCT depends partly upon the balance between complications from
graft versus host disease (GVHD) and graft versus leukemia
(GVL) effect. Use of ATG prior to URD SCT in an attempt to
decrease the incidence and severity of GVHD may actually increase
the risk of relapse secondary to reduced GVL effect.
Methods: In an attempt to examine whether addition of ATG
provides long-term disease control in patients with hematologic
malignancies undergoing URD SCT, we retrospectively evaluated
our experience and analyzed the outcomes of URD SCT with or
without ATG in patients with hematologic malignancies from
1995 to 2007. Fisher’s exact test with two-tailed comparison was
used for statistical purposes.
Results: Forty-six males and 22 females (n5 68) of median age 47
years (range: 15–64 years) were treated. Most common indication of
transplantation was AML (n 5 28) followed by CML (n 5 12) and
NHL (n5 12). Twenty-eight patients received ATGbased regimen.
Sixty-two of 68 patients engrafted (91%). Median time for neutro-
phil recovery was 15 days. There was no difference in the engraft-
ment kinetics between ATG and non-ATG group of patients.
Seventeen (25%) patients died within 100 days of transplantation.
Median duration of follow-up was 12.6 months (range: 7–1026
days). Overall, 37 patients (53%) of this cohort died after transplan-
tation. Of all the patients that died, 11 (39%) received ATG and 26
patients (65%) did not receive ATG (p\0.05). Infection was the
commonest cause of mortality (n 5 15; Five in the ATG group
and 10 in non-ATG group; p 5 0.5). Graft versus host disease was
the direct cause of death in 6 patients (3 of them had received
ATG) and 6 patients died from relapse of their disease (3 patients
received ATG). These differences were not statistically significant
(p 5 0.6). Overall survival (OS) of all patients was 50% at 1 year
and 47% at 4 years. There was no difference in the OS at 1-year
between the ATG (64%) and non-ATG groups (40%) (p 5 0.08),
whereas at 4 years, OS in the ATG (60%) was superior to the non-
ATG group (35%) (p\0.05).
Conclusion: Patients who received ATG as a part of the prepar-
ative regimen prior to URD SCT seemed to have a better long-term
survival compared to patients that did not receive ATG.Use of ATG
did not have any impact on relapse, infection rate or GVHD related
mortality.


Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Relapsed Good Risk Acute Myelocytic Leukemia (AML) Carrying T(8:21) or INV(16) 

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Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Relapsed Good Risk Acute Myelocytic Leukemia (AML) Carrying T(8:21) or INV(16)

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