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

mild. Fas and soluble Fas ligand levels were found to be higher on day
0, when compared to day 15 levels and this finding suggests that Fas-Fas
ligand apototic pathway is active during the acute phase of the VZV
infection and remits after recovery of illness. NK cell count and activity,
perforin expression, Fas and soluble Fas ligand levels will be analyzed in
future studies in severely complicated VZV infected patients.
Financially supported by, Hacettepe University, Bilimsel Arastirmalar Kurumu
(project number: 05 D11 101 007)
1258
CIRCUMCISION IN PATIENTS WITH HEMOPHILIA: TEN YEARS EXPERIENCE IN ADANA,
TURKEY
I. Sasmaz, B. Antmen, G. Leblebisatan, R. Tuncer, Y. Kilinc
Cukurova University Medical Faculty, ADANA, Turkey
Fiftyty-one boys with hemophilia (age range, 6 months to 18 years),
37 (72,5%) with hemophilia A and 14 (27,5%) with hemophilia B were
circumcised in Cukurova University, Faculty of Medicine, Department
of Pediatric Hematology, between 1997 and 2007. Two of children with
hemophilia have inhibitors. 12 (23,5%) cases were mild, 24 (47,0%) cases
were moderate and 15 (29,5%) cases were severe hemophilia. After
starting systemic prophylaxis including factor substitution and DDAVP
(desmopressin acetate) in for reducing factor doses, 5 patients underwent
circumcision under local anesthesia and 46 patients underwent circumcision
under general anesthesia. All patients were given tranexamic
acid. Duration of the hospitalization period was 2 to 7 days according
to whether or not complication. Transient minimal bleeding was
observed in 23 (45%) patients and easily responded to factor administration.
No life treatening hemorrahges were observed. Minimal local
edema and hyperemia along the excision line was observed in all
patients. The objective of this retrospective study was to reported the
experience of circumcision in patients with hemophilia in the Cukurova
University, Faculty of Medicine, Department of Pediatric Hematology.
1259
INTENSIFIED IMMUNOCHEMOTHERAPY WITH HIGH DOSE CONSOLIDATION
AND AUTOLOGOUS STEM CELL RESCUE IN MANTLE CELL LYMPHOMA
M. Binder, R. Ziebermayr, O. Krieger, H. Kasparu, M. Girschikofsky,
D. Lutz
Elisabethinen Hospital Linz, LINZ, Austria
Background. Mantel cell lymphoma (MCL) is an aggressive B- cell lymphoma
which is characterised by early dissemination and unfavourable
clinical course. The implementation of autologous stem cell transplantation
(mid 1990s) extended the therapeutic options for this poor- risk
subtype. Particularly the intensification of the chemotherapeutic regimen
and the combination with the monoclonal antibody Rituximab led to
sustained disease control. We evaluated the efficacy of an intensified
immunochemotherapy combined with high-dose therapy (HDT) and
autologous stem cell rescue (ASCT) in patients with mantle cell lymphoma.
Methods. Since 1995 14 out of 25 consecutive patients with newly
diagnosed or pre-treated MCL of stage III-IV were eligible for HDT
followed by autologous stem cell transplantation. Exclusion criteria for
the remaining 11 patients were age over 70 (6), resistance to chemotherapy
(2), severe comorbidity (apoplexia (1), chronic atrial fibrillation(1))
and recurrent infectious complications (tuberculosis (1)). Induction therapy
consisted of Rituximab (375 mg/m2 ; d1) plus CHOP-21 for 4-6 cycles
followed by intensification (and priming) chemotherapy for 2 to 3 cycles
of CLAEG (3 days Cladribine 0,2 mg/kg, ARA- C 1,5 g/mÇ, Etoposid 60
mg/m2 ) and on day 1 Daunoxome 80 mg/m2 or Idarubicine 8 mg/m2 .
Autologous stem cell transplantation was performed at a median of 9 (7-
13) months from diagnosis with 11 primary patients and 3 patients in
relapsed disease status. In addition to high dose conditioning chemotherapy
(BEAM) 4 doses of Rituximab (d -9, -1, +48 and +55) were administered.
Results. Fourteen Patients (6 female, 8 male) at a median age of
57 (49- 66) years were treated. 5 reached CR, 4 VGPR and 5 PR before
receiving ASCT. In 4 patients Rituximab at day +48 and +55 was cancelled
due to complications such as pneumonia (2), herpes zoster (1) or
exanthema (recurrent folliculitis/ erythema like lesions) (1). A median
number of 5,64 ×106 /kg CD 34 positive cells (1,65-29,5) were reinfused.
The engraftment was generally prompt and durable (granulocytes > 0,5
G/l day +10 (9-11), platelets > 50 G/l day +14 (10-17)). Only in one case
(male patient, age at TX: 55 years) a delayed regeneration (d +140; granulocytes
> 0,5 G/L +11, platelets day +21) was observed. Side effects of
transplantation were mucositis grade I- II in 12 patients, 4 suffered from
emesis grade II- III and 4 from enteritis grade I- II. Fever of unknown ori-
12 th Congress of the European Hematology Association
gin occurred in 4, septicaemia in 2 and pneumonia in 2. Grade 4 toxicities
and treatment related deaths were not observed. Following transplantation
all patients reached clinical and molecular CR. 12 patients are
still in CCR with a median observation period of 33 months (5-58). 2
patients relapsed after 17 and 26 months and died 58 and 34 months after
transplantation. As late infectious complications 3 patients developed
pneumonia and 3 herpes zoster. A propagation of erythema migrans
and sarcoidosis was seen in 1 patient each. Conclusions. R- CHOP intensified
by high dose treatment (CLAEG- D or CLAEG- Ida) including
ASCT using BEAM regimen and Rituximab is accompanied by acceptable
toxicity and improves outcome of patients with MCL, allowing
long-term disease control.
1260
RESULTS OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKAEMIA TREATMENT USING
EORTC 58881 AND EORTC 58951 PROTOCOLS
M.A. Laatiri, F. Ben Moussa, I. Makhlouf, M. Bedoui, K. Zahra,
M. Kortas, A. Khelif
Farhat Hached Hospital, SOUSSE, Tunisia
Childhood acute lymphoblastic leukemia (ALL) results have improved
over time. The current results of the Department of Hematology in treating
childhood ALL are being reported. From 1/1995 to 12/2004, 135 children
(86 boys and 49 girls) with ALL have been treated with an ALL-
EORTC 58881 (N=102 patients) or ALL-EORTC 58951 based protocol
(since 1/2002, N=33 patients). Median age of diagnosis was 5,1 years
(range, 1-15 years). The median WBC count at diagnosis was 22.3×109 /L
(range 1.2×109 /L-1420.0×109 /L). Immunophenotype done in only 60
patients revealed 45 B-cell precursor (40 CD10 + , 5 CD10 – ) and 15 T-cell
ALL. Cytogenetic analysis was performed for 105 patients and revealed
abnormalities in 47%. Persistent circulating leukemic blasts more than
1.0×109 /L were present at day 8 in 22 patients (16%). Compared with
the blast-negative group, these patients had a significantly higher frequency
of several adverse clinical features (WBC >50×109 /L, mediastinal mas,
T-cell phenotype) and a significantly poorer prognosis (overall survival
at 5 years 30% vs 70% for blast-negative group. Relapses were more frequent
after EORTC-58881 particularly in blast-positive group. We conclude
that the EORTC-based protocol as applied in our Department is
tolerable with acceptable toxicity and that the modifications made to the
protocol by using EORTC 58951 improved the prognosis of patients
with poor prognosis particularly T-cell leukaemia and blast-positive group.
Longer follow-up is necessary to further validate the results and credit
of value the modifications made to the protocol.
1261
POST ASCT RITUXIMAB CONSOLIDATION THERAPY ELIMINATES PERSISTING FDG
PET POSITIVITY IN DIFFUSE LARGE B CELL LYMPHOMA (DLBCL) PATIENTS
P. Remenyi, 1 Szomor, 2 , . Bátai, 1 B. Kapás, 1 , A. Sipos, 1 Z. Csukly, 1
M. Réti, 1 V. Goda1 , S. Lueff, 1 I. Bodó, 1 M.T. Masszi1 1 2 National Medical Center, BUDAPEST; University of Pécs I.Dept.of Medicine,
PÉCS, Hungary
Background. there is evidence in the literature that combination of ASCT
and rituximab is beneficial for DLBCL patients but the best treatment plan
has not been established yet. Aims. to characterize post ASCT minimal
residual disease by FDG PET scan and the effect of post ASCT rituximab
consolidation therapy on overall survival. Patients. between 04/2005-
08/2006 16 consecutive DLBCL patients underwent autologous stem cell
transplantation in two transplant centers . Transplant indication was
relapse after conventional R-CHOP treatment, except for two pts who
were transplanted in CR1 because of high risk disease. The median age
was 50 years (19-60), female/male ratio was 8/8. All patients received rituximab
containing salvage treatment (R-DHAP, RIME, R-GEMP) resulted
in complete remission proved by CT scan in 12/16 cases. Conditioning regimen
consisted of BEAM, the graft contained median 5.62×10 6 (3.77-11.41)
CD34 + cells. One patient died of sepsis. FDG PET scan was performed two
months after SCT. 3 months after SCT patients received standard dose
(375 mg/m 2 ) rituximab in four consecutive weeks. Results. unfortunately 2
patients relapsed within 2 months following SCT. Rituximab administration
had no additive toxicity. 3/13 patients showed FDG PET positivity
with low tumor burden indicating minimal residual disease. 3 months
post rituximab treatment FDG PET scan turned to negative in all the previously
positive (3/3) cases. 13/16 (81%) patients are in complete remission
at a median 12 months (6-20) follow up time. Conclusions. post SCT
rituximab may control low tumor burden without additive toxicity in
DLBCL patients. Our data needs further confirmation especially regard-
haematologica/the hematology journal | 2007; 92(s1) | 457