Maria Król

Status of minimal residual disease after induction predicts outcome in both standard and high-risk Ph-negative adult acute lymphoblastic leukaemia. The Polish Adult Leukemia Group ALL 4-2002 MRD Study

The treatment of adults with Philadelphia‐negative acute lymphoblastic leukaemia (ALL) depends on the presence of risk factors including age, white blood cell count, immunophenotype and time to complete remission. In recent years, status of minimal residual disease (MRD) has been postulated as an additional risk criterion. This study prospectively evaluated the significance of MRD. Patients were treated with a uniform Polish Adult Leukemia Group (PALG) 4‐2002 protocol. MRD status was assessed after induction and consolidation by multiparametric flow cytometry. Out of 132 patients included (age, 17–60 years), 116 patients were suitable for analysis. MRD level ≥0·1% of bone marrow cells after induction was found to be a strong and independent predictor for relapse in the whole study population (P < 0·0001), as well as in the standard risk (SR, P = 0·0003) and high‐risk (P = 0·008) groups. The impact of MRD after consolidation on outcome was not significant. The combination of MRD status with conventional risk stratification system identified a subgroup of patients allocated to the SR group with MRD <0·1% after induction who had a very low risk of relapse of 9% at 3 years as opposed to 71% in the remaining subjects (P = 0·001). We conclude that MRD evaluation after induction should be considered with conventional risk criteria for treatment decisions in adult ALL.

Injection of G-CSF During Leukaphereses Reduces the Number of Aphereses Needed for Mobilization in Unrelated Hematopoietic Stem Cell Donors

BACKGROUND This is a single-center, retrospective study in the field of mobilization of hematopoietic stem cell from unrelated donors. We aimed to investigate whether delaying the last G-CSF dose after the start of apheresis influences its results. MATERIAL AND METHODS The medical records of 55 unrelated hematopoietic stem cell donors during the period 2010-2013 were analysed. In this series, 40 received donors the last G-CSF injection prior to the leukapheresis procedure, and 15 received the last injection after apheresis was initiated. RESULTS In the delayed G-CSF application group, more donors had already reached the requested cell number during first apheresis than in the group treated following the standard procedure (73% vs. 35%, respectively; p<0.01). Also, the average total G-CSF dose needed to mobilize the requested cell number was lower (41 µg/kg vs. 48 µg/kg, respectively, p=0.002). CONCLUSIONS Delayed G-CSF use in donors undergoing stem cell mobilization shows a better efficiency of stem cell mobilization.

Continuous Mononuclear Cell Collection (cMNC) protocol impact on hematopoietic stem cell collections in donors with negative collection predictors

BACKGROUND Recently, novel protocol utilizing Continuous Mononuclear Cell Collection (cMNC) have been introduced for leukapheresis. We compared the efficacy of cMNC with an older protocol - mononuclear cell collection (MNC) for CD34+ cell collection in unrelated donors with negative stem cell collection predictors. MATERIAL AND METHODS Retrospective data from a series of 258 consecutive unrelated hematopoietic stem cell donors was included in this single-center study (80 donors collected with cMNC and 178 with MNC). The donors with poor predictors for collection such as low number of circulating CD34+ cells and/or weight disproportion were assigned to the cMNC arm. RESULTS The cMNC protocol yielded a higher number of CD34 + cells per donor body weight (7.63 × 106/kg vs 6.82 × 106/kg, p = 0.027). One apheresis was sufficient for collection of target cell number in 89% individuals from both groups despite negative predictors in the cMNC group. In donors with CD34 + cell count <100/μL and a body weight disproportion between donor and recipient one apheresis was sufficient in 83% of donors in cMNC group and in 58% in MNC group (p = 0.0345) with collection efficiency CE2% values of 61% for cMNC and 62% for MNC (p = 0.77). CONCLUSION cMNC protocol is more efficient in donors with low pre-apheresis CD34+ cell count and weight disproportion between donor and recipient. This suggests that the use of cMNC in unrelated donors could possibly further improve the results of HSC collections.

Stem cell mobilization in patients with dialysis-dependent multiple myeloma: Report of the polish multiple myeloma group

High‐dose chemotherapy with autologous hematopoietic stem cell transplantation (auto‐HSCT) improves the outcome of patients with multiple myeloma (MM). It seems that auto‐HSCT is also a feasible therapeutic option in MM dialysis‐dependent (MMDD) patients. However, to perform transplantation, a sufficient number of stem cells must be collected.

Intrapericardial and Intrapleural Administration of Rituximab to a Patient with Marginal Zone Lymphoma

The addition of rituximab to standard chemotherapy has improved the results of the treatment of B cell non-Hodgkins lymphomas. Under specific circumstances, it can be administered locally, as an alternative to systemic administration. We administered rituximab intrapericardially in an attempt to control pericardial effusion. We report the case of an 85-year-old woman, diagnosed with marginal zone lymphoma, who developed heart failure due to lymphomatous infiltration of the pericardium. We discuss in detail the possibility of intrapericardial treatment of such patients. The patient received rituximab intrapericardially at a dose of 100 mg in addition to systemic rituximab, cyclophosphamide, vincristine and prednisone immunochemotherapy. The treatment proved to be safe and effective. The patient has remained in good health for more than 3 years at the time of writing. Intrapericardial administration of rituximab may be a valuable therapeutic option for patients with lymphoma that involves the pericardium and heart.

Evaluation of relative anti-myeloma activity of high-dose melphalan followed by the first peripheral blood stem cell transplantation, as compared with the second transplantation, and to VAD chemotherapy.

Current treatment in multiple myeloma consists of three courses of chemotherapy in low doses with subsequent hematopoietic stem cell mobilization to the peripheral blood using high-dose cyclophosphamide, collection and conditioning with high-dose chemotherapy (melphalan) followed by retransplantation of autologous peripheral blood stem cells (PBSCT). Only a few studies compare the effects of different phases of therapy on parameters, such as monoclonal immunoglobulin level and the presence of malignant CD38(+) and CD56(+) cells in blood and marrow. The aim of this study was to compare the effects of these two major phases of treatment (conventional and high dose) in the same patients, and furthermore, to compare the effects of the second course of high-dose therapy followed by PBSCT with the effects of the first one. Fifteen patients were included in the study. On average, conventional chemotherapy only slightly reduced the values of all disease markers. In contrast, high-dose therapy resulted in a dramatic effect, rapidly normalizing the values of all parameters. The effects of second PBSCT were only modest compared to the first. These data suggest that high-dose therapy is an efficient method to reduce tumor load in multiple myeloma. Conventional-dose chemotherapy may be simply a waste of time for some patients and may be either omitted or administered after high-dose therapy to consolidate remission.