12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
following allogeneic bone marrow transplantation (BMT), peripheral
blood stem cell transplantation (PBSCT) or umbilical cord blood transplantation
(UCBT). Aims. Considering the different incidence of acute
and chronic GVHD according to the transplanted type of haematopoietic
stem cells and taking into account the supported xenotransplantation-related
vasculopathy, we aimed to further clarify the vascular
impact of the three aforementioned sources of haematopoietic stem
cells. Methods. We studied 21 patients, 13 male and 8 female. Mean age
was 42 years old (21-64). The underlying diseases were: 15 patients presenting
an acute myeloid leukaemia, 3 patients with acute lymphoblastic
leukaemia, 1 patient with multiple myeloma, 1 with bone marrow
aplasia and 1 patient with chronic idiopathic myelofibrosis. Seven
patients underwent BMT after myeloablative conditioning regimen
(cyclophosphamide and busulphan or total body irradiation-TBI at
12Gy), 6 patients PBSCT following non-myeloablative preparative regimen
(fludarabine and TBI at 2Gy) and 8 patients underwent UCBT following
reduced intensity conditioning regimen (cyclophosphamide , fludarabine
and TBI at 2Gy). We assessed the kinetics of plasma levels of
4 endothelial markers: soluble thrombomodulin (sTM), vWF-Ag, FVIII
and the vascular endothelial growth factor (VEGF). Measurements were
performed before the conditioning regimen, on days 0, 15, 30, 60 and
90, by using commercialised ELISA kits from Asserachrom (Diagnostica
Stago, France). We used the Student paired t-test for statistical comparison.
Differences were significant if p normal, and having SD/PD at
the time of AHCT were predictors of a worse OS. Disease status at
transplant and LDH > normal remained significant predictors for OS
(p=0.002) on multivariate analysis. Age, gender, histology, number of prior
chemotherapy regimens, time from diagnosis to AHCT, and type of
conditioning regimen were not significant predictors of OS. Most common
cause of death was disease progression/relapse in 60% of patients.
Eight patients developed sMDS/AML after AHCT. Conclusions. Patients
over 65 yrs of age can undergo AHCT with acceptable toxicity and
should be considered transplant candidates if they have chemosensitive
disease and normal LDH at the time of AHCT.
Table 1. Non-Hematologic RRT Grades 3-5.
0501
EFFICACY AND SAFETY OF CYTARABINE-BASED REGIMENS FOR MOBILIZATION OF
PERIPHERAL BLOOD STEM CELLS IN MULTIPLE MYELOMA
V. Montefusco, 1 F. Spina, 1 L. Farina, 1 A. Dodero, 1 F. Zallio, 2 R. Milani, 1
P. Corradini1 1 Istituto Nazionale Tumori, MILANO; 2 Ospedale Civile di Asti, ASTI, Italy
Background. Autologous stem cell transplantation (ASCT) represents
one of the most effective treatments for multiple myeloma (MM). High
dose cyclophosphamide is generally considered a standard choice for
peripheral blood stem cells (PBSC) mobilization. Unfortunately, a small
but significant proportion of patients can not mobilize an adequate number
of PBSC or can not be treated with cyclophosphamide because of
co-morbidities. Cytarabine has been shown as an effective mobilization
therapy in highly pre-treated lymphoma patients. Aim. The aim of this
study was to exploit the feasibility of PBSC mobilization with cytarabine-based
regimens in MM patients. Methods. Twenty-eight patients
with MM were treated with a cytarabine-based regimen, either an association
of cytarabine 2 gr/sqm bid, cisplatin 50-75 mg/sqm, and dexamethazone
80-160 mg (DHAP) in 20 patients, or cytarabine alone (0.8
gr/sqm bid for 3 days) in 8 cases. For all patients chemotherapy was followed
by a daily administration of G-CSF 5 micrograms/kg starting at
day +3. Patients had a median age of 59 years (range 41-71), 21 were
female, the median number of previous chemotherapy lines was 2 (range
1-5), 6 patients had previously received a melphalan-based chemotherapy,
and 4 patients had previously received radiotherapy. Patients
received a cytarabine-based regimen if they failed a PBSC mobilization
with cyclophosphamide (10 patients) and/or if they had severe co-morbidities
(23 patients), in particular cardiovascular disease (16 patients),
renal failure (4 patients), previous radiation therapy for cancer (3
patients). Results. All patients mobilized PBSC with a median collection
of 15×10 6 CD34 + /kg (range 0.5-53×10 6 CD34 + /kg). Ten patients, failing
a previous mobilization with cyclophosphamide, collected 11×10 6
CD34 + /kg (range 7-43×10 6 CD34 + /kg). All the 6 patients who previous-