417 Graft Versus Host Disease Prophylaxis with a Bortezomib-Based Regimen without G-CSF Support for Patients Undergoing MUD Transplant: Evaluation of Engraftment Kinetics and Transplant Outcomes

Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Antonio M Jimenez, MD , Rush University Medical Center, Chicago, IL
Alfonso D Moreno , Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
John Maciejewski, MD, PhD , Section of Bone Marrow Transplantation and Cell Therapy, Rush University Medical Center, Chicago, IL
Andrew Dalovisio, MD , Hematology Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL
Deborah Katz, MD , Hematology Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL
Christina Havey , Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
Nazneen Merchant, MBBS , Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
Henry C Fung, MD , Bone Marrow Transplant Program, Temple University Hospital/Fox Chase Cancer Center, Philadelphia, PA
Sunita Nathan, MD , Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
Presentation recording not available for download or distribution as requested by the presenting author.

Background

The proteasome inhibitor Bortezomib has been successfully used to prevent the development of graft-versus-host disease (GVHD) in recipients of matched unrelated donor (MUD) or mismatch related donor (mMRD) allogeneic HSCT.  We sought to evaluate the efficacy of this agent in our patient population and assess its impact on neutrophil engraftment when G-CSF support was not routinely utilized.  

Methods

We conducted a retrospective review of patients (pts) with hematologic malignancies who underwent MUD allogeneic HSCT at our institution and received GVHD prophylaxis with bortezomib (dose 1.3 mg/m2) administered on days +1, +4, and +7 after stem cell infusion, in addition to standard prophylaxis with tacrolimus and methotrexate. Since our first treated patient developed hyper-acute GVHD, standard G-CSF support was omitted and reserved only for pts with severe sepsis or delayed engraftment.

Results

Twenty-one MUD recipients receiving bortezomib-based GVHD prophylaxis were transplanted at our institution between 2012 and 2014. Median age was 51 years (range: 34-62 yrs); male to female ratio 2:1. Indications for transplantation included: AML (11/52.4%), ALL (6/28.6%), MPN (2/9.5%) CLL (1/4.8%) and NHL(1/4.8%). Graft source was mobilized peripheral blood stem cells for all pts. Seven pts (33.3%) received a myeloablative conditioning regimen, whereas 14 pts (66.7%) received a reduced-intensity regimen. Median donor chimerism at days +30 and +100 was 98.5% (range 70-99%) and 98% (range 81-99%) respectively.  Median time for neutrophil engraftment was 14.38 days +/- 1.86. Cumulative incidence of grade III-IV aGVHD at day +100 was 14.3%. Non-relapse mortality (NRM) at day +100 was 9.5% and the cumulative incidence of relapse was 4.8% at day +180 and 19% at 1 year.

Conclusions

Bortezomib-based GVHD prophylaxis resulted in acceptable rates of acute GVHD and non-relapse mortality; our results are encouraging and similar to those available in the current literature. The use of bortezomib did not result in delayed engraftment or graft failure (when compared to historical controls) even when standard growth factor support was omitted in patients undergoing MUD transplant.

Disclosures:
Nothing To Disclose
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