Adequate and Predictable Stem Cell (SC) Collection and Low Incidence of Neutropenic Fever (NF) with Cyclophosphamide (C) and G-CSF Mobilization in Multiple Myeloma (MM) : A Single Center Analysis


Figure 1.

Figure 2.

Abstracts / Biol Blood Marrow Transplant 21 (2015) S185eS205 S201
ASCT disease status and details about post ASCT mainte-
nance therapy. There were no statistically significant differ-
ences between the groups in disease status or change in
disease status at day 100 post ASCT. Although more patients
in the C group received maintenance therapy post ASCT, this
difference was not statistically significant. Figures 1 and 2
show the relapse free survival (RFS)and overall survival
(OS) of both groups. The median RFS for C and O groups were
32.3 and 20.9 months (p ¼0.63, log rank), respectively. The
median OS of the C and O groups were 73.1 and 47.8 month
(p¼0.31, log rank), respectively.
Our limited experience suggests that there was no effect
of race in the post ASCT outcomes for MM pts with RD.
ASCT was safe with acceptable transplant related mortality
Table 1

C dose (mg/m2) <2000mg/m2

Median age in years (range) 64.5 (44-79)
Number of Patients 18
Median C Dose in mg/m2 (range) 1750 (1318-1983)
Median Total CD34/Kg in 10e6 (range) 14.15 (6.89-39.7)
Days to SC collection (range) 10 (10-14)
Median days of documented neutropenia (range) 1 (0-4)
Number of patients hospitalized for NF 0
and good long-term outcomes for MM pts with renal dys-
function.
265
Adequate and Predictable Stem Cell (SC) Collection
and Low Incidence of Neutropenic Fever (NF)
with Cyclophosphamide (C) and G-CSF Mobilization
in Multiple Myeloma (MM) : A Single Center Analysis
Bhavisha Patel 1, Zheng Zhou 2, Juliet Appiah 3, Glen Raffel 4,
Zankar Desai 5, Jayde Bednarik 6, Tzafra Tessier 7,
Jenna L’Heureux 3, Jan Cerny 8, Muthalagu Ramanathan 8,
Rajneesh Nath 3. 1 Internal Medicine, UMass Memorial
Medical Center, Worcester, MA; 2 Hematology/Oncology,
University of Massachusetts, Worcester, MA; 3 Hematology/
Oncology, UMass Memorial Medical Center, Worcester, MA;
4 Hematology/Oncology Section BMT, UMass Medical Center,
Worcester, MA; 5 Stem Cell Laboratory, University of
Massachusetts Medical Center, Worcester, MA; 6 Pharmacy,
UMass Memorial Health Care, Worcester, MA; 7 UMass
Memorial Medical Center, Worcester, MA; 8 Department of
Medicine; Division of Hematology/Oncology, University of
Massachusetts, Worcester, MA

Background: G-CSF alone or C with G-CSF are most
commonly used for SC mobilization in MM. The use of C
can improve the efficacy of mobilization but is associated
with increased neutropenia. It remains largely unclear how
dose levels of C in mobilization quantitatively influence the
CD34 yield and time to collection; as well as how these
outcomes were influenced by patient’s age. We evaluated
the efficacy and neutropenia secondary to C with G-CSF in
MM patients undergoing SC transplantation. Subgroup
analysis was done comparing patients greater than 70 years
and younger.
Methods: We retrospectively reviewed charts of all pa-
tients with MM who mobilized using C with G-CSF at
UMass Memorial Medical Center from January 2009 to
June 2014.
Results: Fifty-six patients were identified from the stem cell
transplant database. There were 36 males (64%) and 20 fe-
males (36%). Median age was 62 years (range 43 - 79). The
median C dose received was 2548 mg/m2 (range 1318 -
4018mg/m2). The median total CD34 collection was 15.07 x
10e6/kg (range 2.71-113). Median time from C infusion to SC
collection was 10 days (range 10-16). Number of days
required for collection was 1(n¼40), 2 (n¼14) and 3 (n¼2).
Three patients received plerixafor prior to day 2 collection.
Median days of documented neutropenia was 1 (range 0-6).
Only 3 (5.3%) patients were hospitalized for NF requiring
intravenous antibiotics. Optimal collection for two trans-
plants (>10x 10e6 CD34/kg) was achieved in 43 (77%)
patients.

12 patients (21%) were over age 70 years. In comparison
with the younger patient, they were noted to receive lower
median dose of C (1988mg/m2 vs. 2714mg/m2, p value
2000-3000mg/m2 >3000mg/m2 p-value

62.5 (43-77) 60.5 (48-68) 0.5905
22 16 -
2584 (2001-2994) 3788 (3033-4018) 0.0001
15.72 (2.71- 36.6) 16.10 (5.27 e 113) 0.6717

10 (10-13) 11 (10-16) 0.0031
2 (0-6) 3 (0-6) 0.0003

1 2 0.2712



Abstracts / Biol Blood Marrow Transplant 21 (2015) S185eS205S202
0.0326). They were also noted to collect slightly lower CD34
(14.1e6/kg vs. 15.85e6/kg, p value 0.0974). There was no
significant difference in days to SC collection or number of
days of neutropenia.
Conclusion: Our retrospective analysis showed that
duration of neutropenia does increase significantly with
increase in C dose, yet with an overall low NF hospitali-
zation rate. Higher C dose usage led to longer time to
collection.

There was no significant difference in CD34 yield, neu-
tropenia, or NF hospitalization in patients >70 years. C+
G-CSF is an effective method of mobilization as proven by
optimal collection
266
Mantle Cell Lymphoma: Outcomes after Hematopoietic
Stem Cell Transplantation
Priyanka Pathak, S Vikas Kumar, Onder Alpdogan,
Matthew Carabasi, Neal Flomenberg, Dolores Grosso,
Ubaldo Martinez-Outschoorn, John Wagner, Mark Weiss,
Barbara Pro, Joanne Filicko-O’Hara. Medical Oncology,
Thomas Jefferson University, Philadelphia, PA

Background: Mantle cell lymphoma (MCL) is a B-cell Non-
Hodgkin’s lymphoma (NHL) comprising 7% of adult NHL in
the US with an incidence of 4-8 cases per million persons
per year. Initial therapy of MCL includes a regimen with R-
CHOP or Hyper-CVAD. The best data for long term survival
includes cytarabine based therapy followed by autologous
hematopoietic stem cell transplantation (HSCT). In the re-
fractory/relapsed setting, allogeneic HSCT has been used
successfully. Barriers to allogeneic HSCT include lack of
donors and potential toxicities. Haploidentical donors
broaden the donor pool. To our knowledge, there is no
published data on outcomes with haploidentical HSCT in
MCL.
Methods: A retrospective chart review examining out-
comes in patients with MCL who underwent either autol-
ogous or allogeneic peripheral blood HSCT at Thomas
Jefferson University Hospital from January 2007 to January
2013.
Results: A total of 12 patients with MCL underwent HSCT
between 2007 to 2012. Nine of 12 patients were males.
Median age at transplant was 58 years (range 38 - 72). Me-
dian time from diagnosis to HSCT was 9.5 months. Five of 12
patients (4 haploidentical & 1 matched unrelated donor)
underwent allogeneic HSCT and 7of 12 patients underwent
autologous HSCT. In the allogeneic HSCT group, median
number of prior therapies was 2. One of 5 patients had re-
sidual disease prior to HSCT. Two of 5 patients had a mye-
loablative regimen; 3 had reduced intensity regimen. There
were no relapses or deaths in the allogeneic HSCT group.
Median progression free survival (PFS) as well as median
overall survival (OS) in this group was 35 months. Major
complications in allogeneic HSCT were acute skin GVHD
(3/5), CMV reactivation(1/5), HHV6 viremia(1/5), and acute
renal failure (1/5) requiring short term dialysis. In the
autologous HSCT group, the median number of prior thera-
pies was 1. Two of 7 patients had refractory disease prior to
autologous HSCT. Post autologous HSCT 2/7 patients relapsed
and 2/7 died. Major complications in this group were DVT
(2/7), enterocolitis (2/7), and CHF (1/7). Median PFS and OS
were 40 and 47 months respectively. Our patients who un-
derwent autologous HSCT were transplanted earlier (08/
2007 - 09/2010) than our patients who underwent allogeneic
HSCT (01/2008 - 02/2012), leading to the difference in sur-
vival times.
Conclusions: Haploidentical HSCT offers a promising cura-
tive treatment for patients with MCL with expected and
manageable toxicities. Although a small number of patients,
this review of our data provides the background for further
study of the use of haploidentical HSCT in this group of
patients.

Autologous HSCT for patients with MCL can also provide
long term disease survival.

Further follow up of both groups will provide better data
regarding long term (>5 year) outcomes.

Therapy for MCL in the future is likely to include newer
agents (e.g. ibrutinib) in the front line, but HSCT will remain a
viable option.
267
Outcome of Patients with Multiple Myeloma with t(4;14)
after Autologous Hematopoietic Stem Cell
Transplantation
Koji Sasaki 1, Rima Saliba 2, Gary Lu 3, Nina Shah 2,
Qaiser Bashir 2, Krina Patel 2, Fabian Bock 2, Simrit Parmar 2,
Chitra Hosing 2, Uday R. Popat 2, Ruby Delgado 2,
Gabriela Rondon 2, Richard E. Champlin 2,
Muzaffar H. Qazilbash 2. 1 Leukemia, The University of Texas
MD Anderson Cancer Center, Houston, TX; 2 Stem Cell
Transplantation and Cellular Therapy, The University of
Texas MD Anderson Cancer Center, Houston, TX;
3 Hematopathology, The University of Texas MD Anderson
Cancer Center, Houston, TX

Background: The cytogenetic abnormality t(4;14)(p16;q32)
results in the fusion of immunoglobulin heavy chain
(IgH) gene on chromosome 14q32 with the fibroblast
growth factor 3 (FGFR3) gene on chromosome 4p16 in
patients with multiple myeloma (MM), and is associated
with shorter progression-free survival (PFS) and overall
survival (OS). Recent studies indicate that treatment with
proteasome inhibitors (PI) may overcome the adverse
prognostic features. The aim of this study is to assess the
outcome of patients with t(4;14) after high-dose chemo-
therapy and autologous hematopoietic stem cell transplant
(Auto-HCT).
Methods: We identified 23 patients with MM who had
t(4;14) on conventional cytogenetic or fluorescent in situ
hybridization (FISH) studies prior to auto-HCT at our insti-
tution between 2008 and 2013. We compared their out-
comes to a matched control group (n¼92) without t(4;14)
prior to HCT who were treated during the same time period.
Matching was based on age and response to the last therapy
prior to HCT.
Results: Patient characteristics are summarized in Table 1.
Median follow-up intervals were 41 months and 23
months in the t(4;14) and control groups, respectively. PFS
at 2 years was 18% (95% confidence interval [CI], 6-37) in
the t(4;14) and 65% (95% CI, 53-75) in the control group
(Fig. 1), (p<.001; hazard ratio [HR], 5.2; 95% CI, 3.1-11.0). OS
at 2 years was 43% (95% CI, 22-62) in the t(4;14) and 81%
(95% CI, 70-89) in the control group (Fig. 2), (p<.001; HR,
5.2; 95% CI, 2.4-11.0). On multivariate analysis for PFS,
t(4;14) (p <.004; HR, 4.6; 95% CI, 2.5-8.4) emerged as the
only significant adverse prognostic factor. Relapsed disease
at auto-HCT was associated with a trend for lower PFS
(p¼ .06; HR, 1.7; 95% CI, 0.97). On multivariate analysis for
OS, t(4;14) (p <.001; HR, 4.2; 95% CI, 1.9-9.2) and relapsed


	Adequate and Predictable Stem Cell (SC) Collection and Low Incidence of Neutropenic Fever (NF) with Cyclophosphamide (C) an ...
	Background
	Methods
	Results
	Conclusion