418 Long-Term Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation with Intensified Myeloablative Conditioning for Refractory Hematologic Malignancies

Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Naomi Kawashima, MD , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Takahiko Sato , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Miho Kato , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Marie Nakashima , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Yusuke Kagaya , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Kyoko Watakabe , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Aika Seto , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Nobuaki Fukushima , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Shingo Kurahashi , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Yukiyasu Ozawa , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Koichi Miyamura , Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Presentation recording not available for download or distribution as requested by the presenting author.
Prognosis after allogeneic hematopoietic stem cell transplantation (SCT) in patients with relapsed or refractory hematologic malignancies at the time of SCT is poor due to the increased risk of relapse or TRM. Several intensified conditioning regimens have been reported, however, long term outcome after 5 years was not clarified. This study is aimed to evaluate the long term outcome of SCT with intensified conventional myeloablative conditioning regimen. 

We retrospectively analyzed a total of 59 adult patients with advanced hematologic malignancies including refractory AML(n=32), CML with blastic crisis (n=14), refractory ALL (n=8) and others (n=5) who received allogeneic SCT with intensified myeloablative conditioning regimen of busulfan (BU) 8mg/kg + cyclophosphamide 120mg/kg + TBI 10Gy (n=20), melphalan (MEL) 180mg/m2 + BU 8mg/kg + TBI 10Gy (n=32) or MEL180 mg/m2+ TBI 10Gy (n=7) from January 1994 to December 2003 in our institution. GVHD prophylaxis consisted with tacrolimus or cyclosporine and short courses of methotrexate.

The median follow-up of the surviving patients was 8.3 years (0.1-18.8). Median age at transplant was 36 (17-54). Fifty-one patients received BM, 4 received PBSC, 1 received both and 3 received CB; 18 from a matched related donor, 15 from a matched unrelated donor, 7 from a mismatched related donor and 19 from a mismatched unrelated donor. Rejection was observed in only 1 patient. A total of 44.6% and 23.2% of evaluable patients had grade II-IV and grade III-IV acute GVHD, respectively and 57.9% of evaluable patients experienced extensive chronic GVHD. Overall survival and disease-free survival at 5 years was 31.5% and 29.7%, whereas that at 10 years was 28.8% and 23.1%, respectively. Cumulative incidence of TRM at 5 years and 10 years was 40.0% and 42.5%, respectively. Multivariate analysis showed that patients with more than 5% circulating blasts (HR2.06, p=0.05) and more than 80% bone marrow blasts (HR2.35, p=0.04) were associated with poor survival. AML (HR0.42, p=0.02) and conditioning regimen of BU+MEL+TBI (HR0.46, p=0.03) were associated with better OS and DFS. SCT from unrelated donors (HR4.01, p=0.01) was independently associated with increased TRM.

In conclusion, our data demonstrate that these intensified myeloablative conditioning could be alternative regimens that provide a long term durable remission and disease-free survival in patients with refractory hematologic malignancies.

Disclosures:
Nothing To Disclose
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