2017 ASCO Annual Meeting!
Session: Hematologic Malignancies—Leukemia, Myelodysplastic Syndromes, and Allotransplant
Type: Oral Abstract Session
Time: Tuesday June 6, 9:45 AM to 12:45 PM
Allogeneic hematopoietic cell transplant (alloHCT) for hematologic malignancies in human immunodeficiency virus infected (HIV) patients (pts): Blood and Marrow Transplant Clinical Trials Network (BMT CTN 0903)/AIDS Malignancy Consortium (AMC-080) trial.
Allogenic Stem Cell Transplantation
Hematologic Malignancies—Leukemia, Myelodysplastic Syndromes, and Allotransplant
2017 ASCO Annual Meeting
J Clin Oncol 35, 2017 (suppl; abstr 7006)
Author(s): Richard F. Ambinder, Juan Wu, Brent Logan, Christine Durand, Ryan Shields, Uday R. Popat, Richard F. Little, Deborah Mcmahon, John Watson Mellors, Ernesto Ayala, Lawrence D. Kaplan, Ariela Noy, Alan Howard, Stephen J. Forman, Adam M Mendizabal, Mary M. Horowitz, Willis H. Navarro, Joseph C. Alvarnas; Bunting Blaustein Cancer Research Building, Baltimore, MD; Emmes Corporation, Rockville, MD; Medical College Wisconsin, Milwaukee, WI; Johns Hopkins School of Medicine, Baltimore, MD; University of Pittsburgh, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; University of South Florida, Tampa, FL; University of California San Francisco, San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; National Marrow Donor Program, Minneapolis, MN; City of Hope, Duarte, CA; Department of Epidemiology and Biostatistics, The George Washington University, Washington, DC; Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Atara Biotherapeutics, San Francisco, CA; City of Hope Comprehensive Cancer Center, Duarte, CA
Background: AlloHCT has been regarded as risky in HIV pts, with concern about fatal infection. We set out to assess feasibility and safety of alloHCT in this first prospective multicenter trial. Methods: The primary endpoint was 100-day non-relapse mortality (NRM). Pts had drug-susceptible HIV; age ≥ 15 yr; adequate organ function; acute myeloid leukemia (AML) or acute lymphocytic leukemia (ALL), high risk myelodysplastic syndrome (MDS), or Hodgkin (HL) or non-Hodgkin lymphoma (NHL) beyond first CR; an 8/8 HLA-matched related or at least a 7/8 unrelated donor. Pts received myeloablative (MA) or reduced intensity (RI) regimens. HIV outgrowth assays (VOA) were performed with resting CD4+T-cells in pts who had clinically undetectable HIV plasma RNA at 1 yr. Results: Between 5/2012 and 12/2015, 17 pts underwent alloHCT. Pts were: male (17); white (11), African American (3), Other/Unknown (3); median age 47 yrs (25-64). Associated malignancies were AML (9), ALL (2), MDS (2), HL (1), NHL (3). Median CD4 was 224 (55-833). Conditioning was MA (8) and RI (9). At 100 days there was no NRM, 13 pts were in CR, 4 pts had relapsed/progressive disease; and 8 pts achieved complete chimerism. The cumulative incidence of Grades (Gr) II-IV acute Graft vs Host Disease (GvHD) was 41 % (95%CI: 18 %, 64%). At 6 mo, OS was 82 % (95% confidence interval [CI]: 55%, 94%); 9 pts achieved complete chimerism. At 1 year, OS was 57 % (CI: 31%, 77 %); 8 deaths were from relapsed/progressive disease (5), acute GvHD (1), adult respiratory distress syndrome (1) and liver failure (1). Infections were reported in 11 pts (3 Gr 2, 8 Gr 3). Infectious HIV was detected by VOA in 2 of 3 pts who were mixed chimeras but 0 of 2 who were 100% donor. Median follow up of survivors is 24 mo (7 to 27 ). Conclusions: HIV pts with heme malignancies underwent MA or RI alloHCT without any100-day NRM and there were no infectious deaths at 1 year. AlloHCT should be considered the standard of care for HIV pts who meet usual eligibility criteria. Clinical trial information: NCT01410344
1. Factors associated with allogeneic hematopoietic stem cell transplantation (HSCT) outcomes in patients (pts) with relapsed/refractory acute lymphoblastic leukemia (R/R ALL) treated with inotuzumab ozogamicin (InO) versus (v) conventional chemotherapy (C).
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