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Predictive Factors in Allogeneic Stem Cell Transplantation Using RIC Regimens

A retrospective analysis on 116 patients to assess the impact of patient and transplant-related variables on the outcome after reduced intensity conditioning hematopoietic stem cell transplantation (RIC HSCT) for hematological malignancies.

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Predictive Factors in Allogeneic Stem Cell Transplantation Using RIC Regimens

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  1. PREDICTIVE FACTORS AFFECTING THE OUTCOME OF ALLOGENEIC STEM CELL TRANSPLANTATION USING RIC REGIMENS: EXPERIENCE FROM A SINGLE CENTRE Dott.ssa M. Medeot Clinica Ematologica e Centro Trapianti “Carlo Melzi” Azienda Ospedaliero-Universitaria di Udine Senigallia, October 23th, 2008

  2. OBJECTIVES To assess the impact of patient- and transplant-related variables on the outcome (TRM, DFS and OS) after RIC HSCT for hematological malignancies. Retrospective analysis on 116 patients treated from January 2002 to June 2007 in our centre.

  3. Sex (male/female): 64/52 Median age, years (range): 56 (19-69) Diagnosis, n (%): Acute leukemia 28 (25%) Aggressive NHL 22 (19%) Indolent NHL 18 (15%) Hodgkin lymphoma 19 (16%) Multiple myeloma 21 (18%) Idiopathic myelofibrosis 8 (7%) Previous treatments, n (%): 1 CHT line 29 (25%) 2 CHT lines 37 (32%) ≥3 CHT lines 50 (43%) Autologous SCT 50 (43%) HCT - Comorbidity Index, n (%): 0 59 (52%) 1 27 (23%) 2 18 (7%) 3 19 (16%) >3 3 (2%) Pre-HSCT disease status, n (%): CR 41 (35%) PR 26 (22%) SD/PD 49 (43%) PATIENTS’ CHARACTERISTICS: total 116

  4. TRANSPLANT PROCEDURES’ CHARACTERISTICS CONDITIONING REGIMEN, n (%): Thiotepa-CTX ± fludarabine 83 (72%) TBI 200 + fludarabine ± melphalan 18 (15%) Melphalan or busulfan + fludarabine 15 (13%) GvHD PROPHYLAXIS, n (%): Cyclosporin + MTX 49 (42%) Cyclosporin + MTX + ATG 48 (41%) Cyclosporin + MMF or alemtuzumab19 (17%) DONORS, n (%): Sibling HLA-matched 53 (46%) Unrelated 63 (54%) HSC SOURCE, n (%): Bone marrow 19 (16%) Peripheral blood 97 (84%)

  5. OUTCOMES Engraftment 107 (92%) Autologous recovery 5 (4%) Engraftment not evaluable 4 (4%) Median time BMT- last follow-up: 11 months (1-71)

  6. TRM CAUSES • GvHD 11 (42%) • Infections 10 (38%) • Ictus cerebri 3 (12%) • Microangiopathy 1 (4%) • Car accident 1 (4%)

  7. GvHD

  8. CUMULATIVE INCIDENCE OF TRM 100 % probability 75 TRM: 13% at 1 year 28% at 3 years 50 25 0 20 40 60 80 Months from transplant

  9. KAPLAN-MEIER ANALYSIS OF OVERALL SURVIVAL AND DISEASE-FREE SURVIVAL 100 % probability 75 OS: 66% at 1 year 52% at 3 years 50 DFS: 50% at 1 year 38% at 3 years 25 0 20 40 60 80 Months from transplant

  10. VARIABLES EXAMINED

  11. UNIVARIATE ANALYSIS

  12. MULTIVARIATE ANALYSIS

  13. CONCLUSIONS • Our data confirm the feasibility of RIC transplant in a setting of “unfit” and heavily pre-treated patients, with a TRM around 20%. • Despite the application of RIC regimens, advanced age and presence of comorbidities significantly affect the outcome of transplant. • Development of fungal infections showed to be one of the principal predictive factors for outcome in RIC transplants.

  14. THANKS TO… Team Trapianti: Francesca PatriarcaProf. RenatoFanin Marta Battista Alessandra Sperotto MichelaCerno AntonellaGeromin

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