Severe Mucositis with Bendamustine Etoposide Ara-C and Melphalan (Be-EAM) As Conditioning Regimen in Non-Hodgkin Lymphoma (NHL) Patients Undergoing Autologous Stem Cell Transplantation (AutoSCT) Table 1 Systems Symptoms G-I Nausea vomiting abdominal pain cramping Respiratory Cough dys/tachypnoea hypoxia SOB TRALI Cardiac Hypo/hypertension brady/tachycardia arrhythmia chest heaviness/pain MI cardiac arrest Neuro Amnesia seizure stroke numbness uc Other Fever chills flushing headache hypothermia anxiety vertigo allergy visual neuropathy back pain Cause of SCIAR is either the graft (DMSO, cell content, volume, clumping) or the patient (age, gender, disease). Abstracts / Biol Blood Marrow Transplant 21 (2015) S127eS146 S143 Objective: To acquaint transplant infusionists with SCIAR causative factors and associated symptoms to guard for AE during infusion. Method: Study of published literature as available on PubMed website in the last 7 years. Result: 11 articles by authors from diverse nations were reviewed. Only 1 publication is from USA. Reports are for autologous cryopreserved HPC-A (including few allogeneic or marrow products). 3 studies reported SCIAR after DMSO wash. Data size is from 51-952 in- fusions. AE ranges from 0.6 to 67%. Various symptoms are reported. Discussion: Minor AE are attributed to DMSO, AE from washed cells to granulocyte or TNC content of graft. Cordoba R et al have reported 67% SCIAR despite DMSO wash. 7 years ago, Donmez A et al (Turkey) suggested re- striction of infusion to <100 E+9 TNC; and Wang JW et al (China) advised fractionated infusions (vs. single infusion) in pediatric patients. Khera N et al (USA) have compared 2 groups over 2 years reporting 0.6% SCIAR on infusion of <1.63 E+9 TNC/Kg/day, fractionating infusions on different days. Conclusion: Despite multiple variables, transplant centers can lower incidence of SCIAR by restricting graft dose. Table 2 Article Infusions AE % Finding/Symptoms Feb 07 Donmez A, Turkey 194 Allo 25 25 0 Non cardiac > cardiac Apr 07 Wang JW, China Ped 70 x G-I Jun 07 Mueller LP, Germany 51 2 Cardiac ^DMSO Jul 07 Calmels B, France 490 (washed) 14 x Nov 07 Foïs E, France 952 (washed) 19 x Dec 07 Cordoba R, Spain 144 (washed) 67 Allergic > G-I > Respiratory 2007 Milone G, Italy HPC-A 157 HPC-M 22 31 5 Cardiac ^vol/kg & inf time Non cardiac ^age & non-MNC Jul 08 Bojanic I, Croatia 215 57 1 symptom 21% >1 36% Jul 10 Curcioli AC, Brazil 114 Allo 47 Haplo 5 58 DMSO but not DMSO vol Oct 10 Martìn-Henao GA, Spain 423 25 G-I Respiratory Seizure 0.7% Feb 12 Khera N, USA (Comparative) 2006-07: 288 2008-09: 479 4 0.6 Infusions increased 4 fold 165 Severe Mucositis with Bendamustine Etoposide Ara-C and Melphalan (Be-EAM) As Conditioning Regimen in Non- Hodgkin Lymphoma (NHL) Patients Undergoing Autologous Stem Cell Transplantation (AutoSCT) Sunita Nathan 1, Antonio M. Jimenez 2, Alfonso D. Moreno 1, John Maciejewski 3, Henry C. Fung 4. 1 Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL; 2 Rush University Medical Center, Chicago, IL; 3 Section of Bone Marrow Transplantation and Cell Therapy, Rush University Medical Center, Chicago, IL; 4 Bone Marrow Transplant Program, Temple University Hospital/Fox Chase Cancer Center, Philadelphia, PA Introduction: Bendamustine is effective for front-line or salvage therapy in patients (pts) with NHL. Benda-EAM conditioning has been used in heavily pre-treated relapsed/ refractory lymphoma pts undergoing autologous stem cell transplantation (AutoSCT) and is noted to be a safe and effective regimen. We report our experience with using Be- EAM conditioning regimen for AutoSCT with special note on the toxicity profile. Methods: Data from 22 consecutive patients (pts), under- going AutoSCT using the Be-EAM [Bendamustine200mg/m2 daily D-7,-6, Etoposide 200mg/m2 daily D-5 to -2, Ara-C 200mg/m2 Q12 D-5 to -2 and Melphalan 140mg/m2 on D-1], treated at our institution between 2011 and 2013, were collected. Demographics, indication for AutoSCT, time to engraftment (TE), side effect profile, tolerability and out- comes were analyzed. WHO oral mucositis score was used for grading mucositis. Results: 22 pts (average age 60.36 yrs, range: 39-72 yrs) were identified and analyzed as a retrospective cohort with a follow-up duration of 26.1 months (Range 9-43 mos). 15 (68%) pts were male and 7 (32%) pts fe- male. 72.7% were Caucasian. 8 (36.4%) pts had �2 AE Cause Suggestion/Conclusion Vol infused DMSO TNC � 100 E+9 TNC Single vol infusion Fractionated infusion Neurotoxicity unrelated to DMSO vol DMSO safe in neurologic disease TNC Improve apheresis quality TNC Clumps AE ^TNC Granulocyte Clumping � 6.065 E+9 granulocytes Age Non-MNC � 5.0 E+8 non-MNC Female gender Multiple myeloma Granulocyte AE ^graft composition & disease DMSO Good documentation required AE ^granulocyte x x � 1.63 E+9 TNC/Kg/Day Multiple infusions Abstracts / Biol Blood Marrow Transplant 21 (2015) S127eS146S144 comorbidities. Indication for AutoSCT included relapsed/ refractory follicular lymphoma, diffuse large B cell lym- phoma and lymphoplasmacytic lymphoma and upfront consolidation for mantle cell lymphoma. 8 (36.4%) pts underwent AutoSCT as consolidative therapy and 14 (63.6%) pts for relapsed/refractory disease. Therapies prior to AutoSCT were 1-3 regimens. Time to engraftment was 11.7�1.79 days for neutrophils and 15.32�2.6 days for platelets. Be-EAM-related toxicities included nausea, emesis, diarrhea, neutropenic fever and mucositis. 13 (59%) pts had severe mucositis (Grade 3/4) with 5 pts developing neutropenic enterocolitis including 1 patient with pneumatosis intestinalis. Overall, 18 (81.8%) pts were in CR and 2 (9%) pts had minimal disease at D100. 5 (22.7%) pts had relapsed disease. 4 (18.2%) pts died from relapsed or progressive disease. Conclusion: Bendamustine based conditioning is an effec- tive regimen in patients with NHL undergoing autologous stem cell transplantation as previously reported. It has the potential of causing severe mucositis irrespective of age, comorbidities, disease type or number of prior therapies. This regimen although moderately tolerated should be used cautiously especially in patients who have had prior thera- pies that can affect the gastrointestinal tract. 166 Pegfilgrastim and Planned Plerixafor for Autologous Stem Cell Mobilization Is Safer Than and As Effective As Chemo-Mobilization in Patients with Hematological Malignancies Manish Sharma 1, Sherilyn Tuazon 2, Tingting Zhan 3, John Wagner 2, Margaret Kasner 2, Onder Alpdogan 2, Ubaldo Martinez 4, Dolores Grosso 2, Joanne Filicko 5, Thomas Klumpp 6, Barbara Pro 2, Matthew Carabasi 2, Neal Flomenberg 2, Mark Weiss 2. 1 Medical Oncology, Thomas Jefferson University, Philadelphia, PA; 2 Medical Oncology, Thomas Jefferson University, Philadelphia, PA; 3 Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA; 4 Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; 5 Thomas Jefferson University Hospital, Philadelphia, PA; 6 Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA Introduction: We have previously shown that as compared with chemo-mobilization (CHM) cytokine mobilization (CTM) is associated with a better chance of Table 1 Primary Endpoint Analysis Chemo- mobilization (N[19) Cytokine mobilization (N[55) p-value Median total CD34 cells/kg collected (in millions/kg): Myeloma 14.9 8.37 0.01 Non-myeloma 4.47 5.03 0.71 Median number of apheresis days (mean): Myeloma 1 (1.75) 1 (1.76) 0.99 Non-myeloma 2 (1.67) 1 (1.59) 0.89 Target dose achieved: 0.05 Yes 16 (84.2%) 51 (92.7%) No 3 (15.8%) 4 (7.3%) Median day 1 CD34 collection (in millions/kg): 0.01 Myeloma NA 6.86 Non-myeloma NA 3.67 achieving a target autologous stem cell dose for patients with multiple myeloma (MM). We now review our expe- rience of autologous stem cell mobilization using a similar strategy for all patients referred for an autologous trans- plant (auto-SCT). Methods: We analyzed consecutive patients who received an auto-SCT for hematological malignancies at our center from July 2010 to June 2013. CHM was achieved with cyclophosphamide (4 g/m2), pegfilgrastim (12 mg) and plerixafor (0.24 mg/kg once daily until target dose collected or maximum of 4 days apheresis). CTM was achieved with pegfilgrastim and plerixafor. We recorded the total CD34+ cells/kg collection, number of apheresis days, and if the prescribed dose of CD34+ cells/kg was achieved. The prescribed cell dose in patients with MM is 6.0 x 106/kg, and 3.0 x 106/kg for all other hematological malignancies. We compared the median total CD34+ cells/ kg dose collection (Wilcoxon test), the mean number of apheresis days (Poission), and target stem cell dose collection (non-inferiority test on two proportions). We also compared day 1 stem cell collection in the CTM group based on disease (myeloma vs. non-myeloma) (Wilcoxon test). Finally, we analyzed the probability of successful stem cell dose collection if the target collection dose was higher than our own criteria. Results: A total of 74 patients were included. Fifty-three patients had a diagnosis of MM and twenty-one patients had other hematological malignancies, non-Hodgkin (n¼15) and Hodgkin lymphoma (n¼2). There was no statistically signif- icant difference in age, gender, number of prior induction treatment, prior treatment with lenalidomide and time from diagnosis to transplant between the two groups. In the CHM group, 7 (47%) were hospitalized from complications of mobilization regimen, whereas no patients were hospital- ized in the CTM group (p<0.001). There was no statistically significant difference in neutrophil or platelet engraftment between CHM and CTM. Multivariate analysis did not reveal predictive factors which lead to >1 apheresis attempts. Table 1 describes the primary outcomes. Conclusion: Cytokine-mobilization with pegfilgrastim and planned plerixafor is an effective strategy for stem cell mobi- lization in patients being considered for autologous transplant. 167 Pre-Transplant Serum Biomarkers Predict Early Relapse in Classical Hodgkin Lymphoma Patients Undergoing Autologous Stem Cell Transplantation Bryan Trottier 1, Holly Miller 2, Qing Cao 3, Jeffrey S. Miller 4, Michael R. Verneris 5, Daniel J. Weisdorf 6, John Levine 7, Linda J. Burns 6. 1 Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN; 2 Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI; 3 Biostatistics and Bioinformatics, University of Minnesota, Minneapolis, MN; 4 Blood and Marrow Transplantation Program, University of Minnesota, Minneapolis, MN; 5 Pediatric Hematology and Oncology, University of Minnesota Medical Center, Fairview, Minneapolis, MN; 6 University of Minnesota Medical Center, Minneapolis, MN; 7 Pediatric Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI Background: Serum biomarkers in classical Hodgkin Lym- phoma (cHL) reflect both tumor biology and burden in the non-transplant setting. We sought to determine the prognostic value of cHL serum biomarkers in predicting early relapse following autologous stem cell transplantation (ASCT). Severe Mucositis with Bendamustine Etoposide Ara-C and Melphalan (Be-EAM) As Conditioning Regimen in Non-Hodgkin Lymphoma ( ... Introduction Methods Results Conclusion