Basel Haffar

Nivolumab salvage therapy before or after allogeneic stem cell transplantation in Hodgkin lymphoma

Nivolumab salvage therapy before or after allogeneic stem cell transplantation in Hodgkin lymphoma

Dynamics of molecular response in AML patients with NPM1 and FLT3 mutations undergoing allogeneic stem cell transplant

Dynamics of molecular response in AML patients with NPM1 and FLT3 mutations undergoing allogeneic stem cell transplant

Thiotepa 10 mg/kg Treatment Regimen Is Superior to Thiotepa 5 mg/kg in TBF Conditioning in Patients Undergoing Allogeneic Stem-Cell Transplantation

Micro‐Abstract A study evaluating the optimal dose of myeloablation in thiotepa, busulfan, and fludarabine (TBF) conditioning included 29 patients who received TBF conditioning before allogeneic stem‐cell transplantation. Thirteen patients received 5 mg/kg thiotepa; the remaining 16 patients received 10 mg/kg. Patients deemed fit to receive 10 mg/kg conditioning had better overall and progression‐free survival than those who received 5 mg/kg, with no additional toxicities. Introduction The optimal intensity of myeloablation with a reduced‐toxicity conditioning regimen to decrease relapse rate after allogeneic stem‐cell transplantation without increasing transplant‐related mortality (TRM) has not been well established. Materials and Methods We compared outcomes between 5 mg/kg (T5) and 10 mg/kg (T10) thiotepa‐based conditioning regimens in 29 adults who underwent allogeneic stem‐cell transplantation for hematologic malignancies. Results After a median follow‐up of 11 months, TRM was 0% and 14% at 100 days and 1 year, respectively, with TRM observed only in the T5 group (P = .016). The relapse incidence at 1 year was 20%. No patient had disease in first complete remission at the time of transplantation. At 1 year, progression‐free and overall survival were 30% versus 87% (P = .012) and 46% versus 87% (P = .008) in the T5 and T10 groups, respectively. In univariate and multivariate analysis, only age at transplantation and total dose of thiotepa had a significant impact on TRM, overall, and progression‐free survival. Conclusion Patients deemed fit to receive T10‐based conditioning for allogeneic stem‐cell transplantation to treat high‐risk hematologic malignancies had better overall and progression‐free survival than those who received T5 with no additional toxicities. Patients should be stratified before conditioning, and those judged fit should receive T10, while the others should consider alternative reduced‐intensity conditioning regimens.

Real Life Experience with Plerixafor and Granulocyte Colony-Stimulating Factor for Mobilization of Autologous Peripheral Stem Cell Transplantation

After a median follow up of 36 months, the 1-year TRM was 11% in the FB4 group, and 14% in the FB<4 group (p 1⁄40.7). The incidence of aGVHD grade II-IV was 22% in FB4 vs 14% in FB<4 (p 1⁄40.8), the incidence of cGVHD was 19%, with no significant difference between the two groups. We did not observe any significant difference at one year PFS (FB4: 87% vs FB<4: 67%) and OS (FB4: 84% vs FB<4: 87%). Conclusion: This riskadapted combined approach of selecting conditioning intensity minimizes post-transplant complications, without affecting survival. These findings need to be confirmed in larger studies.

Bendamustine as a bridge to allogeneic transplant in relapsed/refractory Hodgkin lymphoma patients who failed salvage brentuximab vedotin postautologous peripheral blood stem cell transplantation

Jean El Cheikh, Radwan Massoud, Basel Haffar, Elie Fares, Rami Mahfouz, Tamima Jisr, Mohamed A. Kharfan-Dabaja, Anas Mougharbel, Ali Youssef, Ali Bazarbachi and Ahmad Ibrahim Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Hematology and Oncology, Makassed University hospital, Beirut, Lebanon; Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL, USA

Cytomegalovirus reactivation in lymphoma and myeloma patients undergoing autologous peripheral blood stem cell transplantation

BACKGROUND Cytomegalovirus reactivation is often diagnosed in allogeneic hematopoietic cell transplant recipients and therefore could lead to CMV-related disease, involving many organs in these immunocompromised patients. In contrast, few studies investigated CMV reactivation and end-organ disease in patients undergoing Autologous Peripheral Blood Stem Cell Transplant (ASCT) since they are considered at low risk for both reactivation and disease. OBJECTIVES The primary outcome of the analysis was to understand the difference in incidence of CMV reactivation between MM and Lymphoma patients. Secondary outcomes included the difference between MM and Lymphoma patients when considering the effect of CMV reactivation on transplant related mortality (TRM) overall survival (OS) progression free survival (PFS), risk factors for reactivation, and median time to reactivation. STUDY DESIGN In this report, we retrospectively compared the incidence, risk factors, and outcome of CMV reactivation in adult patients with Myeloma (MM) and Lymphoma undergoing ASCT at the American university of Beirut Medical Center in Lebanon (AUBMC). A total of 324 consecutive ASCT were performed between January 2005 and March 2016. Serial weekly monitoring for CMV quantification was done using a quantitative PCR, starting from transplantation until the hospital discharge and afterwards based on the clinical symptoms in cases of clinical suspicion of reactivation after discharge from the hospital. RESULTS The cumulative incidence of CMV reactivation was 16% (n=53) with a median time of 16 (range, 4-242) days after ASCT. The incidence of reactivation was significantly higher in the MM (22%) and NHL (20%) groups, when compared to the HL (4%) (P=0.001). There was a higher incidence of CMV reactivation according to age (≥50 vs ≤50 years) with higher incidence in the older population 24% vs 10% respectively (p=0.0043). The mean time to CMV reactivation was significantly higher in the NHL group with a mean of 53.7days when compared to the HL and MM groups with mean 19.75days and 12.66 (range, 4-34) days respectively (P=0.003). Twenty-two patients (76%) and three patients (75%) patients required specific antiviral therapy in the MM group and HL groups respectively; which was significantly higher (P<0.001) then the NHL group with 13 (65%) patients requiring specific antiviral therapy. Five patients (1.5%) developed CMV disease at a median of 60days (range, 7-107) post ASCT: there was significant difference in the mean-time to reactivation based on disease type MM versus lymphoma 10 versus 33days (P=0.007). In multivariate analysis, a higher age was associated with an increased risk of CMV reactivation; MM and NHL had higher risk of CMV reactivation when compared to HL, and progressive disease at transplant was associated with increased risk of CMV reactivation. After a median follow-up of 21.5 months (range: 1-125), there was no significant impact on PFS, however there was significant decrease in OS of lymphoma patients who had CMV reactivation when compared to those without CMV reactivation (204 and 112days respectively P=0.045). TRM increased from 1.1% in patients with no CMV reactivation to 13% in patients with CMV reactivation (P=0.003). CONCLUSION Our data suggests that CMV reactivation is not uncommon in ASCT recipients and may contribute to increase TRM. MM patients may have a higher incidence, of CMV reactivation with more anti-viral treatment requirements when compared to lymphoma patients, especially in older population.