Annual Meeting Proceedings Part 1 - American Society of Clinical ...

428s Leukemia, Myelodysplasia, and Transplantation
6548 General Poster Session (Board #15G), Mon, 1:15 PM-5:15 PM
Dose-intensive cyclophosphamide, etoposide, cisplatin reinduction for
relapsed/refractory aggressive non-Hodgkin lymphoma (r/r-aNHL). Presenting
Author: Jan-Willem Henning, University of Calgary and Tom Baker
Cancer Center, Calgary, AB, Canada
Background: Approximately 2/3 r/r-aNHL patients (pts) respond to salvage
R-ICE or R-DHAP, 1/2 proceed to autologous stem cell transplantation
(ASCT), and 1/3 achieve 3 year (yr) progression-free survival (PFS);
however, PFS is only 20% if prior Rituximab, time to progression (TTP)�1yr,
or age-adjusted International Prognostic Index (aaIPI)�2-3 [JCO 2010;28:
4184-90]. Since 1995, we re-induced poor prognosis r/r-aNHL with
dose-intensive Cyclophosphamide 5.25g/m2 , Etoposide 1.05g/m2 and
Cisplatin 105mg/m2 (DICEP), G-CSF days (d) 14-19, and apheresis
d19,20, or 21. Rituximab was added d0,7 after 2006. Methods: We
retrospectively analyzed 113 consecutive transplant eligible r/r-aNHL pts
[diffuse large B-cell�95, transformed�9, peripheral T-cell�6, other�3]
who received one cycle of DICEP (n�93) or R-DICEP (n�20) from
1995-2009. Patient characteristics included: median age�49yr (22-69);
primary refractory�68; TTP�1yr�85; elevated LDH�60; ECOG 2-4�42;
aaIPI 2-3�59; bulk�10cm�26. Results: Of 113 pts, 77% responded to
DICEP and 90% (102) proceeded to ASCT. The median CD34� cells
collected was 19x106 /kg (0.3-142). Early treatment-related mortality
(TRM) occurred in 3 pts (2.7%), and 4 others developed late second
cancers (MDS/AML�2). With 94 months median follow-up (26-194), 5
and 10yr OS rates for all 113pts are 48% and 41%, and PFS rates are 42%
and 37%, respectively. 5 year PFS rates for ASCT vs no-ASCT are 46% vs
9%, for relapse aaIPI�0-1 vs aaIPI�2-3 are 53.3% vs 32.1% (p�0.01),
and for TTP�1yr vs �1yr are 63.9% vs 35.2% (p�0.009). Other
predictors of inferior PFS in univariate analysis were elevated LDH, ECOG
2-4, no response to DICEP; however, PFS for 27 pts who failed prior
Rituximab-chemotherapy (56%) was similar to other 86 pts (38%) (logrank
p�0.09). Predictors of PFS and OS in multivariate analysis include:
TTP�1yr, elevated LDH, bulk, no response to DICEP. Conclusions: (R)DI-
CEP is an effective re-induction regimen for r/r-aNHL, leading to excellent
stem cell mobilization and a high chance of proceeding to ASCT. Long-term
PFS and OS rates compare favourably to reports of other re-induction
regimens, and a prospective multicentre trial is warranted.
6550 General Poster Session (Board #16A), Mon, 1:15 PM-5:15 PM
The comparison of up-front autologous peripheral stem cell transplantation
in first remission and long-lasting intensive chemotherapy protocols in
highly aggressive non-Hodgkin’s lymphomas: Results of a retrospective
analysis. Presenting Author: Mustafa Ozturk, Gulhane Faculty of Medicine,
Departments of Medical Oncology and Bone Marrow Transplantation Unit,
Ankara, Turkey
Background: Optimal therapy in adult patients with Burkitt’s and lymphoblastic
lymphoma are still unknown. Despite long–lasting and intensive
chemotherapy protocols, post-transplant relapse is common and the
chemotherapy period is time consuming. Methods: In this retrospective
study, the results of induction and consolidation chemotherapies followed-by
high dose therapy (HDT) and autologous peripheral stem cell
transplantation (APSCT) (n�21), which was given in a time period of 3
months were compared to long–lasting and intensive chemotherapy protocols
(LICP) (n�39) in patients with Burkitt’s and Lymphoblastic lymphoma,
without bone marrow or central nervous system involvement at
presentation. Cyclophosphamide, vincristine, prednisolone, doxorubicin
(Adriamycin) with or without L–asparaginase were given as induction
chemotherapy, followed-by a consolidation chemotherapy with DHAP and
up-front HDT. Results: More than 60% of patients in both groups were in
the intermediate and high risk group according to International Prognostic
Index. There was no significantly difference according to age, gender, bulky
disease, stage, Burkitt’s and Lymphoblastic lymphoma ratio in both groups
(p�0,05). Median follow up was 32,3 months (min-max: 0-229 months).
When HDT and LICP groups were compared: CR achieved in 76,3% and
82,1% of patients (p�0,05); Median PFS was 10,4 months (min-max:
6,1-20,3) and 10,1 months (min-max: 6,3- 69,0) (p�0,05); One year
overall survival rate was 64,7% and 74,4% and five year overall survival
rate was 50,1% and 56,7% (p�0,05) respectively. Conclusions: The
current study suggests that induction and consolidation chemotherapies
followed by HDT and APSCT have similar CR, PFS and OS rates when
compared to more time consuming LICP therapies. This provides a short
period of treatment with a high rate of survival in adult patients with highly
aggressive lymphomas in first remission.
6549 General Poster Session (Board #15H), Mon, 1:15 PM-5:15 PM
Effect of lenalidomide induction therapy on peripheral blood stem cell
collection in patients undergoing autologous stem cell transplant for
multiple myeloma. Presenting Author: Divaya Bhutani, Karmanos Cancer
Institute, Detroit, MI
Background: Autologous stem cell transplant (ASCT) remains part of
standard therapy for Multiple Myeloma (MM). Lenalidomide (LEN) is a
newer, effective therapy for MM. It has been suggested that prior LEN
therapy is associated with an increased risk of stem cell collection failure,
particularly when only G-CSF is used for mobilization. Methods: We
conducted a retrospective chart review of 310 consecutive MM pts who
underwent pheresis to collect stem cells for first ASCT between July 1,
2007 and June 30, 2011 at the Karmanos Cancer Institute. We compared
differences in quantity of CD34 cells collected, days needed to collect the
target number of cells (� 2.5 x 10*6 CD34� cells/kg), days to platelet and
neutrophil engraftment. We also evaluated the association between CD34�
cells collected and the number of cycles of LEN therapy. Results: Of 310
patients, 90% were mobilized with only G-CSF initially. Patients were
analyzed as two groups: LEN exposed (LEN(�); n � 128) and LEN
naive(LEN(-); n � 182). Median age in both groups was 58 years. No
differences in race, sex and MM stage distribution were observed between
the two groups. The median number of stem cells collected in the LEN(�)
group was significantly less than the LEN(-) group (6.46 vs. 7.56 x 10*6
CD34 cells/kg; p� 0.0004). In addition, the median number of pheresis
sessions required for adequate stem cell collection were significantly more
in the LEN(�)group as compared to LEN(-) group (2 vs.1 sessions;
p�0.002). In the LEN(�) group, there was a negative correlation between
CD34� cells collected and the prior number of cycles of LEN (p�0.0001).
There was no statistically significant excess in the number of stem cell
collection failures with G-CSF in the LEN(�) group (7% vs. 4% p�0.31).
All pts who failed collection after G-CSF were successfully collected with
Cytoxan or Plerixafor priming. LEN exposure had no effect on post-ASCT
neutrophil or platelet recovery. Conclusions: Although Lenalidomide exposure
is associated with a slightly lower CD34� stem cell yield and on
average an extra session of pheresis when G-CSF is used for mobilization,
collection failure is uncommon and post-ASCT engraftment is normal.
6551 General Poster Session (Board #16B), Mon, 1:15 PM-5:15 PM
Validation of the M. D. Anderson Symptom Inventory multiple myeloma
module. Presenting Author: Nina Shah, University of Texas M. D. Anderson
Cancer Center, Houston, TX
Background: Validated scales exist for quality of life assessment in patients
with multiple myeloma (MM); however, no existing tool comprehensively
assesses disease- and treatment-related symptoms in these patients. The
aim of this study was to validate a module of the M. D. Anderson Symptom
Inventory developed for patients with MM (MDASI-MM). The MDASI-MM
includes 13 core symptoms, 6 interference items, and 7 MM-specific
items: constipation, muscle weakness, diarrhea, sore mouth/throat, rash,
difficulty concentrating, and bone aches. Methods: The MDASI-MM was
administered to 2 cohorts of patients with MM. The first cohort (N�86)
consisted of cross-sectional symptom data from patients at the beginning
of induction chemotherapy or autologous hematopoietic stem cell transplant
(HSCT). This cohort was used to demonstrate i) known-group validity,
by detecting differences in groups by performance status; ii) concurrent
validity, by correlating selected items and subscales from the MDASI-MM
with those from the Short Form Health Survey (SF-12) and the EORTC-
QLQC30; and iii) reliability, by computing Cronbach alpha values. The
second cohort (N�53) consisted of symptom data collected at 2 points:
prior to transplant and 7 days post-HSCT. This cohort was used to
demonstrate the sensitivity of the MDASI-MM to detect acute worsening of
patients’ symptoms post-HSCT. Results: The MDASI-MM detected significant
differences in symptoms and interference levels according to patients’
performance status (P � .001). MDASI-MM scores correlated with those
from SF-12 subscales for physical, emotional, cognitive, and social
functioning (all P �.001) and with comparable items from the EORTC-
QLQC30 (such as pain, fatigue, difficulty concentrating, constipation, and
diarrhea, all P � .001). Cronbach alphas were 0.85 for symptom severity
and 0.87 for interference. The MDASI-MM’s overall mean scores worsened
between pre- and post-HSCT (1.32 vs. 2.55 (range � 0-10), P � .001).
Conclusions: The MDASI-MM is a valid, reliable, and concise tool that can
be used to quantitatively assess symptom severity and interference in
clinical trials and care of MM patients.
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