Survival Outcomes Are Similar for Younger and Older AYA Patients Post Allogeneic Hematopoeitic Stem Cell Transplants

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Abstracts / Biol Blood Marrow Transplant 22 (2016) S19eS481

Conclusion: This study demonstrates that adding ZevalinÒ to Flu/Mel leads to improve outcome in chemoresistant and PET positive B-NHL undergoing allo-HCT and suggest that pre-transplant PET positive does not preclude successful allo-HCT especially in low-grade B-NHL. However, this approach was not effective in DLBCL and transformed lymphoma thus novel approach with new target agents should be explored.

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while disease status at HCT (p¼<.0001) and histology (p¼<.0001) predict for relapse. OS based on histology is shown in figure 1.

Survival Outcomes Are Similar for Younger and Older AYA Patients Post Allogeneic Hematopoeitic Stem Cell Transplants Seema Naik 1, Paul J. Shaughnessy 2, Jose C. Cruz 2, Jaime Estrada 3, Troy C. Quigg 4, Robert Sanders 5, Carlos Bachier 2, Ellen Bajorek 6. 1 Blood and Marrow Transplantation, Texas Transplant Institute, San Antonio, TX; 2 Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX; 3 Hematology and oncology, Methodist Childrens Hospital, San Antonio, TX; 4 Pediatric Blood and Marrow Stem Cell Transplant, Texas Transplant Institute, San Antonio, TX; 5 Pediatric Blood and Marrow Stem Cell Transplant, Texas Transplant Institute, San Antonio, TX; 6 Bone Marrow Transplant, Methodist Hospital, San Antonio, TX

Table 1 Patient Characteristics Variable Allotransplants Grafts BM PB Donor MRD MUD KPS>90 (90 vs.100) Regimen Full dose TBI (Y/N) Disease Categories CR1

ALL AML/MDS CML Lymphoma Other

Comorbidities Seizure Substance abuse Depression Asthma Infection arrhythmia Iron overload HCT-CI >3 Diagnosis to Transplant NRM at 1 yr

Relapse at 1 yr Survivors All survivors >One year >5 years

Total

Age <25 years

No. (%) 101 (100%)

No. 50

(%) 100%

No. 51

(%) 100%

31 (30%) 70 (70%)

26 24

52% 48%

5 46

9% 91%

48 (48%) 53 (52%) 57 (55%)

26 24 35(13:22)

52% 48% 70%

22 29 20(15:5)

44% 56% 40%

41 (41%)

20

40%

21

42%

41(41%)

10ALL; 3 AML; 1 Lymphoma 17 15(14/1) 3 4 11 (SAA7,SCD2,Th2)

28%

16ALL; 11 AML

26%

34% 30% 6% 8% 22%

20 25(18/7) 2 1 3 (SAA 3)

39% 49% 4% 2% 6%

37 (36%) 40 (40%) 5 (5%) 5 (5%) 14 (14%)

Age > 25years

3 (3%) 1 (1%) 2 (2%) 2 (2%) 5 (5%) 2 (2%) 2 (2%) 2 (2%) 6.2 months

3 1 1 1 1 1 0 1 9 months

6% 2% 2% 2% 2% 2% 0% 2%

0 0 1 1 4 1 2 1 5.7 months

0% 0% 2% 2% 8% 2% 4% 2%

20 (20%)

10 ( Infection 3, Other 7)

20%

20%

12 (12%)

4

8%

10 (Infection 4; Other 4; AGVHD 1; CGVHD 1) 8

16%

52 (52%) 50 (96%) 20 (40%)

29 27 12

58% 93% 41%

23 23 8

46% 100% 35%

Abstracts / Biol Blood Marrow Transplant 22 (2016) S19eS481

Introduction: Hematopoietic cell transplantation(HSCT) provides durable disease control for adolescents and young adults (AYA) with refractory malignancies. We evaluated transplant outcomes of younger (15-25) compared to older (26-40) AYA patients. Methods: A total of 101 AYA patients (pts) (F38:M65) underwent allogeneic HSCT at Methodist Hospital/Methodist Children’s Hospital from June 2007 until June 2015. Bone marrow (BM) was graft source in 31(30%), peripheral blood (PB) in 70(70%) allografts. Donors were MRD 48% and MUD 52%. Results: Diagnosis was AML (n¼31), MDS (n¼8), ALL (n¼41), CML (n¼5), lymphoma (n¼5), aplastic anemia (n¼9), sickle cell anemia(n¼2), thalassemia (n¼2). A total of 41%(26 ALL, 14 AML, 1 lymphoma) pts were in CR1 at transplant. Age in years (yrs) at HSCT was 15-25(51%) and 26-40 for (49%) pts. KPS was 90 in 57(55 %) pts. Comorbidities (HCT-CI) are included in table 1. HCT-CI>3 was present in only 2 (2%) pts. Preparative regimens included Cy/TBI (n¼37); Bu/Cy (n¼29); Bu/Flu (n¼9); Cy/Thio/TBI (6); Flu/Cy (n¼5); Flu-Mel (n¼7); others (n¼10). FK/MTX was GVHD prophylaxis in 92(89%) pts. The Median time from diagnosis to transplant was 6.2 months (16 days SAA-17.5 yrs SCD). Day100 NRM was 12% due to relapse (n¼4); infection (n¼2); Acute GVHD (n¼1); other (n¼5). One year NRM was 20% due to infection (n¼8); VOD (n¼1); AGVHD (n¼1); CGVHD (n¼1); other (n¼9) and relapse mortality was12% (n¼12). Median survival was 3.5 years (10.5 months-8.2 years) for 52 survivors. A total of 50 (22 MRD: 28 MUD (96%) survivors are 1 yr post HSCT; 20 (38%) are 5 yrs post transplant. Conclusion: AYA HSCT survivors have a high prevalence of long-term complications with relapse, GVHD and infection. No differences were seen in this analysis for younger versus older AYA patients. A larger study in a more homogenous population is needed to confirm these results.

509 Umbilical Cord Blood Transplantation with Non-TBI Conditioning Regimens for Advanced Hematological Malignant Diseases Nobuaki Nakano, Yoshifusa Takatsuka, Ayumu Kubota, Mashahito Tokunaga, Mayumi Tokunaga, Torahiko Makino, Shogo Takeuchi, Atae Utsunomiya. Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan Recently, umbilical cord blood transplantation (UCBT) is widely practiced for advanced hematological diseases by its tolerance of HLA matching. Although noneTBI regimens are easy to prepare, few reports investigated noneTBI regimens for UCBT. With respect to UCBT with noneTBI conditioning regimens, we examined efficacy and feasibility of them for higherisk hematological diseases. Non-CR hematological malignancies, and inte2⁄high risk MDS categorized by IPSS were defined as advanced hematological disease. From June 2011 to January 2015, 47 patients consecutively underwent UCBT at our center. Thirtyefive of 47 patients (23 male, 12 female), who were suffered from advanced hematological diseases were undergone first-time UCBT with noneTBI conditioning regimens. There were five non-TBI regimens such as fludarabine (Flu) 180mg/m2 + intravenous buslufan (Bu) 12.8mg/kg + melpharan (Mel) 80mg/m2 (FB4M) and Flu 125mg/m2 + Mel 200 mg/m2 (FM200) as the myeloablative conditioning regimens (MAC) and Flu 125mg/m2 + Mel 140mg/m2 (FM140), Flu 180mg/m2 + Bu 6.4mg/kg + Mel 140mg/m2(FB2M140) and Flu125mg/m2 + cyclophosphamide (Cy) 120mg/kg + ATG 2.5mg/

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m2(FCyATG) as the reduced intensity conditioning regimens (RIC) has been used at our center. We investigated patients’ characteristics, engraftment, overall survival (OS), incidence of non-relapse mortality (NRM) and disease related death (DRD). OS was calculated with KaplaneMeier method and the cumulative incidence of neutrophil engraftment, NRM and DRD was calculated with Gray0 s method. Statistical significance was regarded as less than 0.05 of p-value. Statistical analyses were carried out using EZR. Median age at UCBT was 57 years (21-70). Fourteen patients with myeloid diseases (11 AML, 3 MDS) and 21 lymphoid diseases (17 ATLL, 1 ALL, 3 NHL) were included. 25 patients used MAC, 21 patients received FB4M, 4 FM200 followed by UCBT. On the other hand, 10 patients recieved RIC, 8 patients with FM140 and 1 each FB2M140, and FCyATG. Median time to neutrophil engraftment was 23 days (14-58) and cumulative incidence of neutrophil engraftment at day100 with the competing risk as early death was 82.9% (95%CI: 64.192.4). Cumulative incidence of NRM at day 100 after UCBT was 37.4% (95%CI: 21.5-53.3). Also cumulative incidence of DRD at 3 month after UCBT was 14.9% (95%CI: 5.3-29.2). These results suggested that additional use of melpharan will be contributed to high incidence of engraftment and low incidence of relapse. In patients with myeloid diseases, cumulative incidence of DRD at 6 months after UCBT was only 7.9% (95%CI: 0.4-31.3). Although a lot of problems to solve were still remained in lymphoid diseases (OS at 1 year: 21.4%; 95%CI: 9.3-66.8), UCBT with noneTBI regimens would be feasible in the aspect of neutrophil engraftment and can be a promising treatment for patients who suffered from advanced myeloid diseases (OS at 1 year: 55%; 95%CI: 25.8-76.8).

510 Role of Recipient CD34 Specific Chimerism (CSC) in the Bone Marrow (BM) to Predict BM Relapse Post Allogeneic (Allo) Stem Cell Transplant (SCT) Austin Kim 1, Zheng Zhou 1, Jan Cerny 1, Muthalagu Ramanathan 1, Glen Raffel 1, Lindsey Shanahan 1, Zeina Al-Mansour 1, Neng Yu 2, Rajneesh Nath 1. 1 Section BMT, Division of Hematology/Oncology, University of Massachusetts, Worcester, MA; 2 HLA Laboratory, American Red Cross, Dedham, MA Background: BM relapse is a major cause of treatment failure post Allo-SCT in hematological malignancies (HM) with prior BM involvement. Unfractionated whole bone marrow chimerism (WMC) and CSC are frequently used to monitor engraftment after Allo-SCT. Since several of these HM express CD 34 antigen, one can hypothesize that persistence of recipient CSC in the BM post Allo-SCT may be a tool to predict impending relapse. Methods: We performed a single institution retrospective analysis of all patients who underwent Allo-SCT for AML, ALL, MDS/MPN, and CLL between October 2009 and December 2013 on an IRB approved protocol. We included patients with at least two separately recorded WMC and CSC studies who survived at least 100 days after Allo-SCT. Engraftment analysis was performed on the whole BM and the CD34 subset using Promega PowerPlex 24 loci STR system. CD34 subset was obtained by positive selection from the BM using antibody coated magnetic particles from STEMCELL Technologies. >5% or 10% chimerism of recipient stem cells detected on either whole BM or CD34 subset were used for prediction of relapse. Sensitivity, specificity, false positive, false negative and receiver operator curve (ROC) by the 4 test