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

6552 General Poster Session (Board #16C), Mon, 1:15 PM-5:15 PM
Secondary neutropenia (SN) after autologous hematopoietic stem cell
transplantation (AHSCT) in patients (pts) with lymphoma. Presenting
Author: Sunita Nathan, Rush University Medical Center, Chicago, IL
Background: Plerixafor for mobilization of autologous stem cells (ASC) has
increased the yield of transplanted ASC and is evolving as an important
option for mobilization. A prior study reported a 10% incidence of SN after
AHSCT (BMT 2009 Aug; 44(3): 175-83). Incidence and outcome of SN in
the setting of Plerixafor/G-CSF (P/G), is unknown. We report the incidence
and possible etiology for the development of SN in pts undergoing AHSCT
for lymphoma at our institution. Methods: Data from 80 consecutive AHSCT
pts over a 2 year period were reviewed. All pts were mobilized using P/G.
Demographics, AHSCT indication, prior therapies (Rx), conditioning regimen
(CR), engraftment and post-transplant complications were identified
and collected. SN was defined as ANC �1000 after initial engraftment.
Results: 80 pts underwent an AHSCT for lymphoma from 2009-11. 70 pts
had evaluable data. 37 (52.86%) pts (average age 55.4 yrs) were male and
33 (47.14%) pts (average age 48.3 yrs) female. 25 (35.7%) pts had �2
comorbidities. Indications included relapsed/ refractory B-NHL, T-NHL
and HL. 47 (67%) pts had Stage IV ds, 48.9% with BM involvement. 17
(24.3%) pts had �2 Rx, 18 (25.7%) with loco-regional XRT and 3 (4.3%)
with RIT. CR included BEAM, BEC and Benda-EAM �/- Rituxan. # of
CD34� cells given ranged; 1.77-19.99 x 10^6/kg. Neutrophil engraftment
occurred at a median of 11 days. 26 (37.14%) pts developed SN
possibly from PCP prophylactic antibiotics and infections. Prior BM
involvement, Rx or XRT had no role. 5 (45.4%) pts with Benda-EAM CR had
SN. Associated morbidity/mortality were not noted. Conclusions: We conclude
that secondary neutropenia is common after autologous stem cell
transplant using the Plerixafor/GCSF combination for mobilization and is
higher than reported in the literature (37% vs 10%). Patients who received
this combination for mobilization should be followed up closely in the
post-transplant period for secondary neutropenia. About half the patients
who received the Benda-EAM conditioning regimen developed secondary
neutropenia warranting its use with caution outside of a clinical trial.
6554 General Poster Session (Board #16E), Mon, 1:15 PM-5:15 PM
An anthropometric study in children with chronic myeloid leukemia on
imatinib. Presenting Author: Vamshi Krishna Reddy Goteke, Nizam’s
Institute of Medical Sciences, Hyderabad, India
Background: The long-term adverse effects, especially in children with
chronic myeloid leukemia (CML) on imatinib are unknown. There is very
little literature addressing the adverse effects on growth in children on
imatinib. We analysed the effect of imatinib on anthropometry in children
with CML. Methods: The records of children � 18 years with CML diagnosed
at our institute between 2003 and 2011 were retrospectively analysed.
Children who received imatinib for at least one year and on regular follow up
were eligible for growth assessment. The data was analysed using WHO
AnthroPlus v1.0.4 and SPSS.v19 software and the Height for age and BMI
for age/sex “z” scores were computed. Results: A total of 61 children were
started on imatinib. But, only 37 children were eligible for assessment of
growth. Of them 3 were further excluded as the WHO AnthroPlus software
supported data only till 19 completed years. Median age was 12 years
(range: 5 – 17). 17 children were in the prepubertal age (5-11years) at
commencement of imatinib. The mean duration of imatinib therapy was
41.24 months (range: 12–91). The overall z- scores for height for age
(HAZ) on follow up were significantly (p �0.029) lower, compared to
baseline. However when analysed according to age groups, the HAZ was
found significantly (p�0.005) lower among 5-11 year age group compared
to age group of �12 years. No significant differences were observed in BMI
for age/sex z scores by age groups, over the period. Conclusions: Imatinib
appears to cause growth retardation in prepubertal children. Further follow
up may shed more light on the degree of stunting and the deficit in the final
adult height.
Leukemia, Myelodysplasia, and Transplantation
429s
6553 General Poster Session (Board #16D), Mon, 1:15 PM-5:15 PM
Cost-effectiveness analysis of bendamustine plus rituximab versus CHOP-R
in treatment-naive patients with mantle cell (MCL) and indolent lymphomas
(IL). Presenting Author: Wayne Su, United BioSource Corporation,
Bethesda, MD
Background: To assess the cost-effectiveness of bendamustine plus rituximab
(B-R) vs cyclophosphamide, doxorubicin, vincristine, prednisone,
and rituximab (CHOP-R) for treatment-naive patients with MCL or IL from a
US healthcare payer perspective. Methods: A discrete event simulation was
developed for a mixed population of patients with MCL or IL. Two arms were
simulated, each containing 1000 identical MCL or IL patients treated with
B-R or CHOP-R. Input data for baseline characteristics, overall response,
and risks for treatment-related adverse events (AEs) and infections were
obtained from the NHL 1-2003 trial (n�549, primarily stage IV MCL and
IL); gaps were filled by consultation with experts. Direct medical costs and
utilities were estimated based on US databases and published literature.
Costs and benefits were discounted at 3% per annum. Base case model
predictions were performed by selecting regression models that had a best
fit to progression free survival (PFS). Robustness of these models was
evaluated by testing other models with reasonably good fit. Results: In the
base case, model predicts longer PFS for B-R than for CHOP-R in MCL
(average of 49.8 vs 28.6 months) and IL (67.9 vs 51.0). Quality-adjusted
life-years (QALYs) per patient were higher for B-R than CHOP-R for MCL
(3.51 vs 2.68) and IL (4.42 vs 3.58). For MCL, total per-patient costs were
$115,191 for B-R and $100,261 for CHOP-R; for IL, respective costs were
$134,814 and $110,065, resulting in incremental cost-effectiveness
ratios (ICERs) for B-R vs CHOP-R of $18,161 per QALY for MCL and
$29,549 for IL (ICER�$50,000 to be cost-effective). Higher complete
and partial response rates for B-R than for CHOP-R impacted subsequent
treatment costs, which were lower for B-R by $21,632 for MCL and
$24,961 for IL, as well as AE costs, lower by $10,113 and $10,570,
respectively. The model results were robust with respect to the use of
alternative regression models for PFS estimation. Conclusions: In patients
with MCL or IL, the model demonstrates that B-R is a cost-effective
alternative to CHOP-R. Alternative regression models confirmed robustness
of results. Support: Teva Pharmaceutical Industries Ltd.
6555 General Poster Session (Board #16F), Mon, 1:15 PM-5:15 PM
Prevalence of autoimmune manifestations in patients with large granular
lymphocytic leukemia: Exploratory analysis of a series of consecutive
patients. Presenting Author: Bruno Bockorny, Department of Medicine,
University of Connecticut, Farmington, CT
Background: Review of literature suggests certain autoimmune abnormalities
to accompany LGL leukemia. The present study was set to identify the
prevalence of autoimmune phenomena in LGL leukemia patients and
compare it with same in general population. Methods: We conducted both
retrospective and prospective analyses in a series of consecutive patients
(n�11) with LGL leukemia that had been followed in outpatient setting.
Median age was 71 years ( � 14 years). The presence of associated
autoimmune disorders in our cohort was compared to the published
prevalence of these conditions in general population. Statistical analysis:
The obtained values were tested for statistical significance using Fisher’s
exact test for small number of observations (95% confidence); a p value �
0.05 was considered significant. Results: A total of 45% patients in our
study were diagnosed with autoimmune conditions. Identified autoimmune
disorders included rheumatoid arthritis [RA] (n�3), Hashimoto thyroiditis
(n�3), Felty syndrome (n�1), aplastic anemia (n�1), pernicious anemia
(n�1), and leukocytoclastic vasculitis (n�1). Statistical analysis showed
the following significance: Hashimoto thyroiditis (p�0.044), RA (p�0.003),
Felty syndrome (p�0.001), aplastic anemia (p�0.001), pernicious anemia
(p�0.001), and leukocytoclastic vasculitis (p�0.001). Statistical
difference was also noted for autoimmune serologic abnormalities, with
ANA positivity present in 63.6% of the cases (p� 0.001) and RF present in
50% of the patients (p�0.005). Conclusions: Nearly half of LGL leukemia
patients in our cohort had autoimmune conditions, thus significantly
exceeding the overall prevalence in general population. Statistically significant
differences were recorded for RA, Hashimoto thyroiditis, Felty syndrome,
aplastic anemia, pernicious anemia, leukocytoclastic vasculitis,
ANA and RF positive serologies. The prevalence of Hashimoto thyroiditis
and ANA positivity in our patient cohort was significantly higher than the
one in existing literature. Given the relatively small size of the analyzed
cohort, larger studies are expected to confirm our findings.
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