Asif Alavi

Age does not adversely influence outcomes among patients older than 60 years who undergo allogeneic hematopoietic stem cell transplant for AML and myelodysplastic syndrome

Allogeneic hematopoietic stem cell transplant (AHSCT) outcomes data of older AML/myelodysplastic syndrome (MDS) patients are limited. We retrospectively evaluated consecutive patients ⩾60 years old with AML/MDS who underwent AHSCT between January 2005 and December 2014. The primary objectives were to determine nonrelapse mortality (NRM), relapse, relapse-free survival (RFS) and overall survival (OS) at 1 year post AHSCT. A total of 159 patients underwent AHSCT with a median age of 64 (range, 60–75) years. Of these, 103 patients (65%) had AML and 56 patients (35%) had MDS. At 1 year post AHSCT, grade III–IV acute GvHD and chronic GvHD occurred in 20.8% (95% confidence interval (CI), 14.9–27.5%) and 54.1% (95% CI, 46.0–61.5%) of patients, respectively. NRM, RFS, relapse rate and OS at 1 year post AHSCT were 25.3% (95% CI, 18.8–32.3%), 53.3% (95% CI, 46.1–61.7%), 21.4% (95% CI, 15.4–28.1%) and 56.4% (95% CI, 49.2–54.7%), respectively. High disease risk index was associated with poor RFS, OS and higher relapse rate (P<0.03), whereas non-thymoglobulin-based GvHD prophylaxis, higher comorbidity index (⩾3) and MDS were associated with higher NRM (P<0.03). Importantly, age did not have an adverse effect on NRM, relapse, RFS and OS. AHSCT was well tolerated. Hence, older age alone should not be considered a contraindication to AHSCT.

Relationship between clostridium difficile infection and gastrointestinal graft versus host disease in recipients of allogeneic stem cell transplantation

Clostridium difficile infection (CDI) is a common infection in patients undergoing allogeneic stem cell transplantation (allo-SCT), with reported incidence ranging from 9 to 24% in the first 100 days, post transplantation [1–4]. The signs and symptoms of CDI bear resemblance to patients with acute gastrointestinal graft versus host disease (GI GVHD), making it difficult to differentiate between these two common complications of allo-SCT [5]. It has also been reported that the development of either CDI or GI GVHD can increase the risk of subsequent development of the other in the post-transplant period [1]. We examined the relationship between CDI and GI GVHD in the related and unrelated allo-SCT. At our center, combination of tacrolimus, mycophenolate mofetil plus ATG (TM-thymo) at a total dose of 4.5 mg/kg as GVHD prophylaxis (IV infusion over 3 days: day −3, 0.5 mg/kg; day −2, 1.5 mg/kg; and day −1, 2.5 mg/kg) is used for all unrelated donor transplants since 2012; we previously reported excellent outcomes with relatively low rate of grade III–IV acute GVHD [6, 7]. For the matched related donor transplants and matched unrelated donor transplants done prior to 2012 we used a combination of tacrolimus and mycophenolate mofetil for GVHD prophylaxis. Mechanism of action of ATG in GVHD prevention is mediated through in vivo depletion of T cells, thus activation and expansion of effector cells are effectively attenuated [8]. The consequence of this action also can subject patients to increased risk of infections [7]. We retrospectively studied a total of 310 consecutive patients in 2 cohorts who underwent allo-SCT at our institution between 2009 and 2013. Two distinct cohorts were: 100 patients who received related donors (group 1, transplanted between 3/2010–12/2013), and 210 patients who received unrelated (group 2 transplanted between 12/ 2009–12/2013) allo-SCT. This study protocol was approved by Wayne State University Institutional Review Board. CDI was defined as infection in a patient with diarrhea and a positive result of a laboratory assay for toxigenic clostridium difficile qPCR in the stool. Descriptive statistics were used to summarize demographic and baseline characteristics among study populations. Chi-square (or Fisher’s exact) and Kruskal–Wallis tests were used to compare among groups for categorical and continuous variables, respectively. The Kaplan–Meier method was used to describe the distributions of CDI-free survival (CFS), acute GI GVHD-free survival (giGFS), acute GVHD-free survival (aGFS), and overall survival (OS) after treatment. CFS, giGFS, and aGFS were defined as the time from transplantation to development of C. difficile, acute GI GVHD, and acute GVHD, respectively, and to death from any cause; OS was defined as the time from transplantation to death from any cause. Univariate and multivariable Cox proportional hazards regression models were fitted to assess associations between patient characteristics and survival benefit (CFS, giGFS, aGFS, and OS). Baseline characteristics of the two groups are outlined in Table 1. All patients received acyclovir/fluconazole/norfloxacin for prophylaxis against infections and received daily GCSF starting on day 6 post-transplant until * Divaya Bhutani db3203@cumc.columbia.edu

A phase II study of tacrolimus and thymoglobulin as graft-versus-host-disease prophylaxis in related donor allogeneic hematopoietic cell transplantation

Ayalew Tefferi , Sravanthi Lavu , Mythri Mudireddy , Terra L. Lasho, Christy M. Finke, Naseema Gangat , Animesh Pardanani, Curtis A. Hanson, Carmela Mannarelli, Paola Guglielmelli, Alessandro M. Vannucchi Division of Hematology, Mayo Clinic, Rochester, Minnesota Division of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy