128
Incidence and Risk Factors for the Development of Idiopathic Pneumonitis Syndrome (IPS) after Autologous Hematopoietic Cell Transplantation (AutoHCT) for Patients with Lymphoma

Track: Poster Abstracts
Wednesday, February 26, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Yi-Bin Chen, MD , Massachusetts General Hospital, Boston, MA
Andrew A. Lane, MD, PhD , Dana-Farber Cancer Institute, Boston, MA
Brent R. Logan, PhD , Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
Richard T. Maziarz, MD , Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
Xiaochun Zhu, MS , CIBMTR, Medical College of Wisconsin, Milwaukee, WI
Görgun Akpek, MD, MHS , Banner MD Anderson Cancer Center, Gilbert, AZ
Hillard M. Lazarus, MD , University Hospitals Case Medical Center, Cleveland, OH
Christopher N. Bredeson, MD, MSc , The Ottawa Hospital Blood & Marrow Transplant Program, Ottawa, ON, Canada
Richard Olsson, MD, PhD, MMSc , Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
Wael Saber, MD, MS , CIBMTR, Medical College of Wisconsin, Milwaukee, WI
Gregory A. Hale, MD , All Children's Hospital, St. Petersburg, FL
Franklin O. Smith, MD , University of Cincinnati Medical Center, Cincinnati, OH
Mahmoud D. Aljurf, MD, MPH , King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Andrew S. Artz, MD, MS , University of Chicago Hospitals, Chicago, IL
Vincent T. Ho, MD , Dana Farber Cancer Institute, Boston, MA
Philip L. McCarthy, MD , Medicine, Roswell Park Cancer Institute, Buffalo, NY
Marcelo C. Pasquini, MD, MS , CIBMTR, CIBMTR/Medical College of Wisconsin, Milwaukee, WI
Kenneth R. Cooke, MD , Pediatric Bone Marrow Transplant, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD

Introduction: High-dose therapy with AutoHCT is a standard component of therapy for many patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL).  IPS is a known toxicity of AutoHCT which can cause significant morbidity and mortality.  The most common agent associated with IPS has traditionally been high-dose BCNU (carmustine). Data on incidence of IPS in recent era and its relation with conditioning regimens are scarce.

Methods and Patients: Using the Center for International Bone Marrow Transplant Registry (CIBMTR), we studied 4,573 patients with lymphoma who underwent AutoHCT from 1995-2008 using the following conditioning regimens: BEAM (n=1730), CBVlow (n=1249), CBVhigh (n=604), BuCy (n=789), and CyTBI (n=545). We investigated the reported incidence of and explored clinical risk factors for its development, including the dose of BCNU and its impact on outcome (above vs. below 375 mg/m2 in CBV regimens).  We then analyzed the impact of IPS on outcomes including transplant-related mortality (TRM), progression-free survival (PFS), and overall survival (OS).  Use of different regimens was as follows:

Results: The incidence of IPS by 1 year after AutoHCT was: BEAM (3%), CBVlow (3%, HR 1.07 [0.72, 1.60], p=0.742), CBVhigh (6%, HR 1.88 [1.24, 2.83], p=0.003), BuCy (4%, HR 1.25 [0.82, 1.92], p=0.30), and CyTBI (5%, HR 2.03 [1.30, 3.19], p=0.002). Multivariate analysis showed the following risk factors for developing IPS: 1) HL (HR 2.33, [1.68, 3.24], p < 0.001), 2) female gender (HR 1.39 [1.05, 1.82], p=0.019), 3) chemotherapy-resistant disease at time of AutoHCT (HR 1.9 [1.29, 2.79], p=0.001), and age ≥ 55 (HR 1.54, [1.13, 2.09], p=0.006). In the entire cohort, patients who developed IPS had a significantly higher rate of TRM (HR 4.02, [3.09, 5.24], p < 0.001), shorter PFS (HR 1.82, [1.51, 2.20], p < 0.001), and shorter OS (HR 2.46, [2.06, 2.94], p < 0.001).

Conclusion: IPS remains an important toxicity after AutoHCT for patients with lymphoma and adversely effects overall outcomes.  Risk factors include higher doses of BCNU, TBI, female gender, older age, chemotherapy resistant disease and a diagnosis of HL. Investigation into strategies for the prevention of IPS after ASCT is warranted.

 

Disclosures:
Nothing To Disclose
See more of: Poster Session 1: Autologous Transplants
See more of: Poster Abstracts
<< Previous Presentation | Next Presentation >>