bluuebunny/crossref_metadata_2025_split huggingface dataset:
PB2322 SPLEEN SIZE AS CLINICAL RISK FACTOR FOR GRAFT FAILURE FOLLOWING ALLOGENEIC STEM CELL TRANSPLANTATION IN ACUTE LEUKEMIA PATIENTS
Authors: Drokov M. , Maslikova U. , Kuzmina L. , Yatsyk G. , Vasilieva V. , Mikhalcova E. , Popova N. , Pyrikova O. , Kireeva A. , Koroleva O. , Nareyko M. , Dubnyak D. , Konova Z. , Usikova E. , Dmitrova A. , Starikova O. , Parovichnikova E. , Savchenko V. 
Published: June 2019

Background:Primary and secondary graft failure (GF) following allogeneic hematopoietic stem cell transplantation (allo‐HSCT) leads to prolonged neutropenia, infection complications and as a consequence lowered overall survival. Bone marrow as a graft source, HLA‐mismatched donor is a main factors which can influence GF in acute leukemia patients (pts) during first six months after allo‐HSCT. Nevertheless not all GF episodes can be explained by this factors. Here we report data about influence of spleen size (length width) assessed by transabdominal ultrasound on graft failure in first 6 months in acute leukemia patients in CR who underwent allo‐HSCT.Aims:Identify risk factors for GF in patients with acute leukemia remission.Methods:We analyzed medical records of 143 pts with acute leukemia (AML n = 100 (69.9%), ALL n = 43 (30.1%)) who underwent allo‐HSCT between 2013 and 2018 at National Research Center for Hematology and was alive for more than 28 days after allo‐HSCT. A median age of patients was 34 (19‐66) years, 66 (46.2%) males and 77 (53.8%) females. At the time of transplantation 124 (86.7%) pts were in complete remission and 19 (13.3%) pts had advanced disease. Most pts (n = 112; 78.3%) received reduced intensity conditioning regimen (RIC) and 31pts (21.7%) underwent myeloablative conditioning (MAC). Donors were: HLA‐matched unrelated (MRD) – 43.4% (n = 62); mismatched unrelated donor (MMUD) 27.3% (n = 39); matched related donor (MRD) ‐25.9% (n = 37); haploidentical (excluding TCR ab‐depletion) – 3.4% (n = 5), Bone marrow (BM) was used as a graft source in 60.1% (86 pts) and peripheral blood stem cell (PBSC) ‐ in 39.9% (57 pts). Spleen size was routinely evaluated before allo‐HSCT using transabdominal sonography. Cox Proportional‐Hazards model was used to identify influence of spleen size (≥3600 mm2 vs <3600 mm2) as independent prognostic factor (conditioning regimen, donor type, graft source, HLA‐disparity were also entered as covariates as well known risk factors for GF).Results:Results of Cox Proportional‐Hazards model are shown on Figure 1. According to our data spleen size (length width) ≥3600 mm2 assessed by transabdominal sonography before allo‐HSCT was associated with high risk of GF within six months of follow up period after allo‐HSCT.HR‐3.67 (95% Cl, 1.05‐12.74, p = 0.04).Figure 1. Results of Cox Proportional‐Hazards modelSummary/Conclusion:HLA‐disparity, BM as a graft source is characterized by increased probability of GF. In addition we identify that spleen size ≥3600 mm2 assessed by transabdominal sonography before allo‐HSCT also increased GF (up to 3.67 times). Due to that fact it's not recommended to use BM as a graft source for acute leukemia patients who underwent allo‐HSCT especially from MMUD.image
PB2327 SUBSTITUTING CARMUSTINE WITH BENDAMUSTINE IN BEAM RESULTS IN DELAYED PLATELET RECOVERY AND LESS MUCOSITIS WITH SIMILAR EFFICACY – A MATCHED PAIR ANALYSIS
Authors: Aurer I. , Zekanovic I. , Durakovic N. , Batinic J. , Dreta B. , Bašić‐Kinda S. , Sertić D. , Roncevic P. , Radman I. , Rincic G. , Bojanic I. , Periša V. , Lozic D. , Petrovic J. , Valkovic T. 
Published: June 2019

Background:Due to availability and pricing problems recently many transplant centers substituted carmustine in the BEAM regimen (carmustine, etoposide, cytarabine, melphalan), used for conditioning of lymphoma patients undergoing autologous stem cell transplantation (ASCT), with bendamustine (BeEAM). Very few comparisons of the toxicity and efficacy of these two conditioning regimens have been reported.Aims:Describe the toxicity and efficacy of BeEAM and compare it to that of BEAM.Methods:We analyzed outcomes of 35 patients with frequent lymphoma types (B‐large cell, follicular, Hodgkin (HL), T‐cell and mantle‐cell) conditioned with BeEAM in 2016 and 2017 and compared them to 37 patients conditioned with BEAM between 2011 and 2015 matched by age, sex, diagnosis and risk according to standard prognostic indices. Bendamustine was administered at a total dose of 160 mg/m2 divided over two days. Etoposide, cytarabine and melphalan were given as usual.Results:Median follow‐up of BeEAM conditioned patients was 18 mo and BEAM conditioned 46 mo. Number of reinfused CD34+ cells/kg body weight was similar between the groups (median 5.87 vs. 5.56 × 106, p = 0,412). One of the BeEAM conditioned patients died of cardiac shock and one progressed before hematologic recovery, no such events occurred in those conditioned with BEAM. There was a trend towards lower incidence of infections and febrile neutropenia (80% vs. 95%, p = 0.0719) and significantly less mucositis in the former group (11% vs. 51%, p = 0,0002). Neutrophil recovery was similar (median 11 days, range 8‐16 vs. median 10 days, range 7‐18; p = 0,215), but platelet recovery was slower after BeEAM (median 16 days, range 8‐29 vs. median 12, range 8‐27; p = 0.00132). Hospitalization duration was similar (median 16 days, range 12‐32 vs. median 17 days, range 12‐24; p = 0.215). OS was almost identical (85% vs. 86% at 2 years, p =  0.781). There was a non‐significant difference in EFS in the whole cohort in favor of BEAM (Fig) (66% vs. 76% at 2 years, p = 0.39), but this was limited to HL (2‐year EFS 61% vs. 82%, p = 0.257). 2‐year EFS of NHL patients was 70% vs. 73%, p = 0.808.Summary/Conclusion:Substituting carmustine in BEAM with bendamustine, at least in the dose of 160 mg/m2, results in somewhat delayed platelet recovery but less mucositis and possibly infectious complications. Efficacy in NHL seems maintained. However, reduced efficacy of the BeEAM conditioning regimen in HL cannot be excluded and additional studies, preferably multicenter, in a larger patient population are needed.image
PB2340 INCIDENCE AND SEVERITY OF ORAL MUCOSITIS AMONG ALLOGENEIC STEM CELL TRANSPLANTATION PATIENTS FOLLOWING FOUR TYPES CONDITIONING REGIMENS
Authors: Torihata S. , Sukedai M. , Shimoide T. , Ehara H. , Kanazawa H. , Yasumoto M. , Yasutake N. , Shimoide A. , Enomoto A. , Hamada S. , Ashida T. 
Published: June 2019

Background:Oral mucositis (OM) is a painful and debilitating complication of allogeneic hematopoietic stem cell transplantation (HSCT). Conditioning regimen correlates development of OM, but no studies have analyzed incidence and severity of OM among various condition regimens.Aims:This study was designed to evaluate the incidence and severity of OM receiving various conditioning regimens in early period after HSCT.Methods:We included 120 adult patients with a median age of 54.5 years (range 18 ‐ 72) who received allogeneic HSCT at Kindai University Hospital. Four conditioning regimens were administered for patients before transplantation based on the underlying diseases. Twenty‐two patients were received cyclophosphamide (CY)/total body irradiation (TBI) regimen (CY/TBI), 27 were received busulfan (BU)/CY regimen (BU/CY), 54 were received fludarabine (FLU)/BU regimen (FLU/BU), and 17 were received FLU/ melphalan (MEL) regimen (FLU/MEL). National Cancer Institute Common Toxicity Criteria for Adverse Events scale was used to assess the severity of OM. Severe OM defined as grade 2 to 4.Results:OM of any grades occurred 77.3% of CY/TBI, 48.1% of BU/CY, 85.2% of FLU/BU, and 70.6% of FLU/MEL. There were significant differences between CY/TBI and BU/CY (p = 0.05), and BU/CY and FLU/BU (p = 0.001). There was no patient with grade 4 OM. The incidence of severe OM (grade 2 ‐ 3) was 54.5% of CY/TBI, 18.5% of BU/CY, 57.4% of FLU/BU, and 52.9% of FLU/MEL. There were significant differences between CY/TBI and BU/CY (p = 0.02), BU/CY and FLU/BU (p = 0.0009), and BU/CY and FLU/MEL (p = 0.02).Summary/Conclusion:Incidence and severity of OM in patients receiving BU/CY regimen was the lowest among 4 types conditioning regimens.
PB2343 INDIVIDUALIZED TREATMENT AGAINST BACTERIAL INFECTIONS IN STEM CELL RECIPIENTS ‐ SINGLE CENTER EXPERIENCE
Authors: Stojanoski Z. , Pivkova A. , Panovska‐Stavridis I. , Cadievski L. , Georgievski B. , Ivanovski M. , Karanfilski O. , Cevreska L. 
Published: June 2019

Background:Multidrug resistant (MDR) bacteria are increasingly frequent in HSCT recipients, but significant differences in etiology of bacterial infections and prevalence of resistant strains exist between different transplant centers Extended‐spectrum beta‐lactamase producing Escherichia coli, Vancomicyn resistant enterococci, Penicillin‐resistant Pneumococci Methicillin‐resistant Staphylococcus aureus and are major problem to manage.Aims:Aim: to evaluate the frequency of multidrug resistant bacteria in our center.Methods:During a 19 years period we have transplanted 500 patients with different hematological malignant and nonmalignant diseases. All patients were treated in sterile room conditioned with HEPA filters and low bacterial diet. Antibacterial prophylaxis consisted Ciprofloxacine 1,0gr/day. As empirical antibiotics regimen we administered combination of third‐generation cephalosporin + amynoglicoside, while as second line therapy Imipenem + VancomycinResults:in every patient 3 times a week we monitor: blood culture, central venous catheter culture, sputum, urine culture. From all 288 bacterial isolates the distribution of MDR bacteria were: ESBL positive Escherichia coli 3 (0,10%) VR Enterococcus 2(0,06%) MDR Pseudomonas aer. 1 (0,03%) Klebsiella aerogenes 2 (0,06%) MRSA 17(0,06%) Acinetobacter baumanii 2(0,06%) Stenotrophomonas Maltophilia 2(0,06%). There were fatal outcome due to sepsis in 3 patients (VRE 1, MDR Pseudomonas 1, Stenotrophomonas maltophilia 1).Summary/Conclusion:The monitoring of local microflora is crucial for every transplant center. Empirical first‐line therapy must be individualized and according to ECIL 4 escalation and de‐escalation strategy is necessery for better outcome in this group of immunocompromised patients.
PB2346 RISK FACTORS ANALYSIS FOR DISEASE RECURRENCE AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN PATIENTS WITH HIGH‐RISK ACUTE LEUKEMIA
Authors: Zhang R. , Wu Q. , Jiang Z. , Wan D. , Li L. , Xia L. 
Published: June 2019

Background:Relapse is a major cause of treatment failure for high‐risk acute leukemia after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Prognosis is considered dismal but data about risk factors associated with disease recurrence have not been elucidated.Aims:We aim to explore the pre‐ and post‐transplantation risk factors on relapse and survival in order to formulate individualized prophylaxis and treatment protocol for primary reoccurrence in high‐risk patients before and after transplantation.Methods:We retrospectively analyzed the outcomes of 321 high‐risk acute leukemia patients who underwent allogeneic hematopoietic stem cell transplantation (allo‐HSCT) who were diagnosed and treated at Union Hospital, and further evaluated the impact of pre‐ and post‐transplantation risk factors on relapse and survival by multivariate analysis.Results:Overall, 104 patients relapsed after allo‐HSCT with relapse cumulative incidence of 31 ± 2%. The median time of relapse was 4 (1.5‐26) months. With a median follow‐up of 50 months, the 3‐year overall survival (OS) and disease‐free survival (DFS) were 70%, 60%, respectively. Multivariate analysis showed that conditioning regimen (HR, 0.309; 95% CI, 0.119‐0.806, p = 0.016), type of disease (HR, 0.335; 95% CI, 0.125‐0.896, p = 0.029), and disease status at transplantation (HR, 1.964; 95% CI, 1.156‐3.338, p = 0.013) were independent factors influencing relapse for high‐risk acute leukemia patients following allo‐HSCT.Summary/Conclusion:Since the prognosis of patients with acute leukemia who experienced relapse after allo‐HSCT was poor, we emphasize the urgent need for formulating individualized prophylaxis and treatment protocol for primary reoccurrence in high‐risk patients before and after transplantation.
PB2356 IMPACT OF ABO BLOOD GROUP INCOMPATIBILITY ON THE OUTCOMES OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: Çiftçiler R. , Goker H. , Buyukasık Y. , Aksu S. , Demiroglu H. 
Published: June 2019

Background:Impact of ABO Blood Group Incompatibility on the Outcomes of Allogeneic Hematopoietic Stem Cell TransplantationAims:ABO and Rh compatibility are not required between the donor and recipient for alloHSCT. Although ABO incompatibility is not considered a contraindication in HSCT, its clinical outcomes are still a doubtful. In this study, we analyzed the neutrophil and platelet recovery, GVHD, relapse rate, mortality rate, non‐relapse mortality and survival in patients who underwent alloHSCT.Methods:Two hundred and sixty eight patients with hematopoietic malign diseases and inborn errors of metabolism or the immune system who received an alloHSCT in our HSC transplant center between the years of 2001 and 2018 were evaluated.Results:There were 264 (98.5%) matched sibling, and 4 (1.5%) haploidentic transplants. Indications for HSCT included both hematological malignancies (n = 261) and benign conditions (n = 7). Of these donor recipient pairs, there were 193 (72%) matches, 36 (13.4%) major, 29 (10.8%) minor and 10 (3.7%) bidirectional ABO mismatches. The median follow‐up of 120 months (range, 6‐213) for the entire group. The OS and DFS were not statistically significant different between two groups. The seventy one (41.1%) of the ABO match patients and 27 (35.5%) of the ABO mismatch patients developed GvHD. There was no significant difference between the two groups in terms of GvHD (p = 0.86). The median neutrophil engraftment day was 11 (7‐20) day in ABO match patients and 11 (7‐19) day in ABO mismatch patients (p = 0.44). The median platelet engraftment day was 12 (8‐38) day in ABO match patients and 12 (8‐40) day in ABO mismatch patients (p = 0.48).Summary/Conclusion:In conclusion, this study showed major ABO incompatibility does not lead mainly to delayed RBC recovery, platelet engraftment and neutrophil engraftment after alloHSCT. Major ABO mismatch does not seem to have a significant effect on other major outcomes after alloHSCT, such as GVHD, relapse rate, mortality rate, non‐relapse mortality rate, DFS and OS.image
PB2373 LIVER DISEASE DURING AND AFTER AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN EGYPT (SINGLE CENTER EXPERIENCE)
Authors: Moaty I. Abdel 
Published: June 2019

Please indicate where the abstract has been published before: egyptian socitey of hepatology and gastroenterology journalBackground:Hematopoietic stem cell transplantation has a rapid increase over the last decade. It is an established therapy for many hematological disorders. HSCT had many possible serious complications. One of those complications is hepatic dysfunction.Hepatic complication in autologous HSCT survivors could be early complications include drug toxicity, infections and long‐term liver complications from chronic viral hepatitis, iron overload or original disease relapse.Aims:is to determine the prevalence, etiology of liver disease in Egyptian population who had HSCTMethods:this study is cross‐sectional study in December 2016 including 88 patients who had autologus transplantation in Ain Shams University HospitalsResults:In autologus patients the first cause of hepatotoxicity is conditioning regimen involving 27% of the patients. Second cause is flare of viral hepatitis affecting 8% of the patients. In third place is sepsis that leads to elevated liver function which occurred in 6% of our patients, these figures were also dramatically changed after D + 100 and lower hepatotoxicity percentage occurs as 11% of the patients had liver injury caused by drugs and only 1% patients had viral hepatitis reactivation.imageSummary/Conclusion:Drug hepatotoxicity is main cause of liver injury in BMT unit in Ain Shams University in Egyptian population.
PB2377 SECONDARY HYPOGAMMAGLOBULINEMIA AFTER HIGH DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM CELL TRANSPLANTATION FOR LYMPHOMA
Authors: Nakaya A. , Ishii K. , Fujita S. , Satake A. , Nakanishi T. , Azuma Y. , Tsubokura Y. , Saito R. , Konishi A. , Hotta M. , Yoshimura H. , Ito T. , Nomura S. 
Published: June 2019

Background:Secondary hypogammaglobulinemia is associated with hematological malignancy, particularly related to lymphoid malignancy. Other than malignancy itself, treatments induce iatrogenic hypogammaglobulinemia. In standard, eligible patients with advanced lymphoma receive high dose chemotherapy with autologous stem cell transplantation (HDT/ASCT). However, frequency and risk of hypogammaglobulinemia in auto‐setting is unknown.Aims:To clarify frequency and risk of hypogammaglobulinemia in auto‐setting.Methods:We retrospectively analyzed 101 patients with advanced lymphoma who received HDT/ASCT at Kansai Medical University Hospital and Kansai Medical University Medical Center from August 2006 to September 2018. All patients received MEAM regimen with/without rituximab as a conditioning.Results:Median age was 59(24‐71) y/o. Among 101 patients, 92% of patients(n = 93) was measured immunoglobulin levels routinely. 52% of patients(n = 53) had hypogammaglobulinemia(IgG < 700 mg/dl) and 25%(n = 25) of patients remains hypogammaglobulinemia presently. 14 patients recovered from hypogammaglobulinemia. Median period to recovery was 28(0.7‐56.8)months. Among the patients developed hypogammaglobulinemia, 87% was with B cell lymphoma, 9% with T cell lymphoma and 4% with Hodgkin lymphoma. Severe infection(≥grade3) was seen in 16 patients. The most frequent infection was bacterial infection unknown species(n = 5), followed HBV reactivation(n = 3) and Herpes zoster(n = 3), and BKV(n = 2).Summary/Conclusion:52% of patients had hypogammaglobulinemia after HDT/ASCT, which was not only with B cell lymphoma but also with T cell and Hodgkin lymphoma. Median period of immunoglobulin recover is over one year. Addition to common bacterial infections, we should be careful about virus infections.
PB2379 INVASIVE FUNGAL INFECTIONS IN PATIENTS UNDERGOING ALLOGENEIC STEM CELL TRANSPLANTATION CONDITIONED WITH REDUCED BUCY2
Authors: Armillas F. M. , Franco M. Rivera , Rodríguez E. León 
Published: June 2019

Background:Invasive fungal infection (IFI) is a major cause of morbidity and mortality in patients undergoing allogeneic stem cell transplantation (allo‐SCT). We previously reported (Ann Hematol 2017) that reduced BUCY2 (rBUCY2) preserves an immunosuppressive and myeloablative effect, achieving an adequate bone marrow engraftment with acceptable toxicity, low graft‐versus‐host disease (GVHD), and low transplant‐related mortality (TRM)Aims:To determine the frequency of IFI in patients undergoing allo‐HSCT using rBUCY2 as the conditioning regimenMethods:We conducted a retrospective study of consecutive patients undergoing allo‐SCT using rBUCY2 between November 1998 and December 2014. The median follow‐up was 90 months. Data was analyzed in March 2018.All the SCT procedure and follow‐up was performed at the National Institute of Medical Sciences and Nutrition “Salvador Zubiran”, a public tertiary/referral center in Mexico City.Patients were conditioned with rBUCY2 (busulfan 12 mg/kg, ORAL and cyclophosphamide 80 mg/kg, IV), using G‐CSF‐primed bone marrow as the stem cell source. Antifungal prophylaxis consisted of low‐dose amphotericin B (0.2 mg/kg/day) administered until neutrophil engraftment.The primary endpoint was 1‐year cumulative incidence of proven or probable IFI and the secondary endpoint was the IFI‐associated mortality. Risk factors of IFI were also assessed.Results:From all the cohort, 57% were male and the median age was 39 years (range, 17‐67). Hematological malignancies were the underlying diseases in most patients (n = 55, 94.8%). Within 100 days post‐SCT, IFI was presented in 4 patients (6.8%) and only 1 patient presented late IFI. The multivariate analysis showed that cytomegalovirus (CMV) viremia was the main risk factor associated with the development of IFI (p = 0.031). IFI‐associated mortality was 5% and showed an association with matched unrelated donors (p = 0.022), parenteral nutrition (p = 0.027), and early IFI (p = 0.004). The TRM was 17%Summary/Conclusion:Our results highlight the low incidence of IFI using our modified conditioning regimen compared to international literature. As other studies have reported, we demonstrated that CMV was associated with the development of IFI. We emphasize the safety of rBUCY2 demonstrated by the low incidence of IFI and the low TRM.
PB2389 UNDERDOSING DEFERIPRONE IN TM: MYTH OR REALITY?
Authors: Spasiano A. , Meloni A. , Pistoia L. , Roccamo G. , Commendatore F. V. , Pulini S. , Benni M. , Iacono N. Dello , Campisi S. , Allò M. , Vallone A. , Riva A. , Positano V. , Pepe A. 
Published: June 2019

Background:Data from clinical practice show that some patients with thalassemia major (TM) received underdoses of deferiprone (DFP).Aims:This retrospective real‐life study aimed to investigate the reasons of the underdosing of DFP and to assess if the underdosing could result in an inadequate response.Methods:Among the 1746 TM patients consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network between 2006 and 2015, we selected the 171 consecutively patients (100 M and 71 F) patients who were treated with DFP dosages<75 mg/Kg/day. Mean age at starting underdosed therapy was 30.95 ± 8.78 years. Heart and liver iron overload were measured by T2∗ Magnetic resonance imaging (MRI) technique.Results:Fifty‐four patients were treated with DFP in monotherapy (60.31 ± 12.82 mg/kg/die for 6.96 ± 0.19 days/week), 87 with combined DFP + deferoxamine (DFO) therapy (52.28 ± 21.29 mg/kg/die for 6.00 ± 1.43 days/week), and 30 with sequential DFO/DFP therapy (60.53 ± 9.75 mg/kg/die for 4.07 ± 0.69 days/week).Table 1 shows the motivations of underdosage, divided by chelation regimens. The most frequent motivation was the weight‐driven adjustment of the dosage, followed by the presence of low ferritin levels and side effects (gastric disturbances = 14/33 pts, increase of transaminases 6/33 pts and neutropenia 5/33).Sixty‐eight patients maintained the same chelation regimen (24 monotherapy, 27 combined and 17 sequential) during the execution of two consecutive MRI scans, performed in a time span of 18 months. At the first MRI 17 patients showed myocardial iron overload (MIO‐global heart T2∗ value<20 ms). In this subgroup there was a significant increase of global heart T2∗ values (12.39 ± 3.77 ms vs 20.43 ± 10.71 ms; P = 0.002) and six (35.3%) patients reached a global heart T2∗ > 20 ms at the second MRI. None of the 51 patients with a normal global heart T2∗ value at the first MRI showed MIO at the second MRI. In the 39 patients with hepatic iron overload (MRI liver iron concentration‐LIC≥3 mg/g dw) at the first MRI, there was not a significant decrease in LIC values, although 7 (17.9%) patients reached a normal value at the second MRI. Out of the 21 patients with a normal LIC value at the first MRI, 5 (17.2%) showed hepatic iron at the second MRI.Summary/Conclusion:In the real world the weight‐driven adjustment of the dosage, low ferritin levels and sides effects were the main causes of the DFP underdosage in TM. DFP dosages<75 mg/Kg/day can be effective in improving myocardial siderosis but do not allow an improvement in terms of hepatic iron.image