Abstract Background Allogeneic hematopoietic cell transplantation (allo‐HCT) is the only cure for acute myeloid leukemia (AML) in second complete remission (CR2). Patients lacking a matched sibling donor (MSD) receive transplants from matched unrelated donors (MUDs), mismatched unrelated donors (MMUDs), haploidentical (haplo) donors, or cord blood. Methods This is a retrospective, registry‐based European Society for Blood and Marrow Transplantation study that investigates changes in patient‐ and transplant‐related characteristics and posttransplant outcomes over time. Results We identified 3955 adult patients (46.7% female; median age, 52 years [range, 18–78 years]) with AML in CR2 first transplanted between 2005 and 2019 from a MUD 10/10 (61.4%), MMUD 9/10 (21.9%), or haplo donor (16.7%) and followed for 3.7 years. A total of 725 patients were transplanted between 2005 and 2009, 1600 between 2010 and 2014, and 1630 between 2015 and 2019. Over the three time periods, there was a significant increase in patient age (from 48.7 to 53.5 years; p < .001), use of a haplo donor (from 4.6% to 26.4%; p < .001), and use of posttransplant cyclophosphamide (from 0.4% to 29%; p < .001). There was a significant decrease in total body irradiation and in vivo T‐cell depletion. In multivariate analysis, transplants performed more recently had better outcomes. Leukemia‐free survival (hazard ratio [HR], 0.79; p = .002) and overall survival (HR, 0.73; p < .001) increased over time. Similarly, nonrelapse mortality (HR, 0.64; p < .001) decreased over time. We also observed better graft‐vs‐host disease (GVHD) rates (acute GVHD II–IV: HR, 0.78; p = .03; GVHD‐free, relapse‐free survival: HR, 0.69; p < .001). Conclusions Even in the absence of an MSD, outcomes of allo‐HCT in CR2 for AML have significantly improved over time, with most favorable outcomes achieved with a MUD.
11040 Background: Chimeric antigen receptor (CAR) T-cell therapy is another paradigm-shifting advancement for hematologic malignancies, creating unprecedented treatment options. However, there is still a lack of knowledge and understanding among patients regarding this novel therapy. Most patients turn to online resources, ranging from social media to federal websites, to gather health information to supplement decision-making. Given that the average American adult reads between the sixth- and eighth-grade levels, national organizations recommend that patient resources be written at the sixth-grade level or below. The purpose of this study was to evaluate web-based patient educational material on CAR -T cell therapy resources using measures of readability and compare it to national guidelines. Methods: Online patient information on CAR-T cell therapy from the top 20 U.S Cancer center as per US news ranking was collected. We analyzed the content by six of the most common readability tests- Flesch Reading Ease score (FRE), Gunning Fog (GF), Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, and the Automated Readability Index (ARI). The text from each article was carefully reviewed and analyzed using the software Readable, and the readability scores with standard deviation (SD) were obtained. Results: The mean score FRE score was 48.5 (SD: 6.7), which corresponds to college level and is difficult to read. The mean GF score was 8.7(SD: 1.5), which represents the writing of an 8th grader. The FKGL score was 8.6 (SD: 1.1), which represents a level of 8th grade or above. The mean CLI score was 11.5(SD: 1.3), which is the text level for high school juniors. The mean SMOG index was 10.9 (SD: 1), which is the level of a 12th grader. The ARI score was 7.8 (SD: 1.3), indicating a 7th-grade level. Conclusions: Overall, web-based CAR- T cell therapy patient educational materials scored poorly and does not meet the national recommendations. Authors of patient resources should incorporate readability criteria and prompt a revision or creation of new educational materials including videos and audio to support general patient understanding. By making CAR-T therapy information easily understandable, internet users can be better informed about their treatment decisions.
Hodgkin lymphoma is a highly curable disease. Although most patients achieve complete response following frontline therapy, key unmet clinical needs remain including relapsed/refractory disease, treatment-related morbidity, impaired quality of life and poor outcome in patients older than 60 years. The incorporation of novel therapies, including check point inhibitors and antibody-drug conjugates, into the frontline setting, sequential approaches, and further individualized treatment intensity may address these needs. We summarize the current treatment options for patients with classical Hodgkin lymphoma from frontline therapy to allogeneic hematopoietic stem cell transplantation and describe novel trials in the field.
e18557 Background: T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL/T-LBL) is a rare and aggressive form of malignancy of immature T-Cells. Despite advancements in treatment, disparities in survival rates among different racial/ethnic groups have been reported. While there is some data available comparing survival outcomes in children with ALL based on ethnicity, there is limited data on comparison of survival outcomes in patients specifically with T-ALL. Here we compared the survival outcomes of T-ALL patients from a minority rich cohort including both children and adults. Methods: This is a single center observational retrospective study analyzing T-ALL patients from 2004-2022 who were followed up at our center. We collected and analyzed data on demographics, race, immunophenotype, treatment regimens, and survival outcomes. Race (used here interchangeably with ethnicity) was categorized as Hispanic, Black, White and other races. Immunophenotype was classified as Pro-TALL, Pre-TALL, Cortical TALL, Medullary TALL and Early T cell precursor-ALL. Univariate and multivariate Cox regression models were used for analysis. Overall survival (OS) was compared using the Kaplan-Meier curve and log-rank test. P-values < / = 0.05 were considered as statistically significant. All analyses were done using R statistical software. Results: We included 59 patients with T-ALL (78% males and 22% females) for analysis. The median age at diagnosis was 20 years (range 1-48 years). Thirty two percent were Black, 29% Hispanic, 17% White and 14% were of other races (8%-not reported). Median follow up duration was 30 months. We compared OS based on sex, race, and immunophenotype. Univariate analysis showed significant difference in OS only for race (p value 0.006). Hispanic patients had the worse outcomes with lower OS compared to White (p = 0.02), and other ethnicities (p = 0.04). The difference was still significant (p = 0.016 and 0.01 respectively) after correction for age using multivariate analysis (age groups: < 15 and = / > 15 years; 15 years being the median age for Hispanic population). There was no difference in OS between remaining races. Median overall survival was not reached in any group. Conclusions: Although sample size is small, our study showed that the OS in Hispanics was lower than in White and other races in a minority rich population including adults and children with T-ALL. Whether this difference is due to systemic barriers in accessing care and/or due to inherent characteristics affecting disease severity/response to treatment remains to be explored. Interestingly, we didn’t find any difference in survival outcomes for black race and for different immunophenotypes. This study adds to the literature demonstrating disparities in survival among different racial groups with T-ALL and the need to address these disparities through targeted interventions.
e19060 Background: Allogeneic bone marrow transplantation (ABMT) is a life-saving procedure in hematological malignancies and bone marrow failure disorders. Despite advances in the field, literature proposes racial disparities in the outcomes of ABMT. This study aims to investigate this difference among distinct racial cohorts. Methods: We identified patients who underwent ABMT for malignant and nonmalignant hematologic diseases from 2016-2020 using the nationwide inpatient sample (NIS) database. We compared the racial differences in outcomes during the hospitalization, including immunologic and hematologic complications, associated infections, length of stay, and mortality rate. Baseline characteristics were compared using a T-test and Chi-Square. Multivariate regression analysis was applied to estimate differences in outcomes. We used STATA Version 17.0 Software for data analysis. The p-value was set at p < 0.05 for statistical significance. Results: A retrospective study was conducted on a cohort of 14,599 adults who underwent ABMT. Out of which 30% (4,379) developed complications. The mean age for ABMT was 54, and the average length of stay was 29 days. In this cohort, 79.5% (11,325) were whites, 4.2% (610) were blacks, 8.3% (1,185) were Hispanics, and 7.8% (1,125) were others. When comparing the outcomes among racial groups, invasive fungal infections 15.5% (95), mucositis 36% (220), septic shock 9% (55), and respiratory failure 14.7% (90) were more common in blacks (p < 0.05). Neutropenia 41.3% (490) and cytomegalovirus (CMV) infection 12.2% (145) were more common in Hispanics (p < 0.05). However, no significant difference was noted in immunologic complications (graft versus host disease (GVHD), bone marrow rejection (BMR), bone marrow failure (BMF)), pancytopenia, clostridium difficile infection (CDI), and mortality (p < 0.05). Conclusions: Our study shows that blacks had a higher prevalence of invasive fungal infections, mucositis, septic shock, and respiratory failure, while Hispanics reported a higher prevalence of neutropenia and CMV infection. However, no significant differences were noted in GVHD, BMR, BMF, pancytopenia, CDI, and mortality rates. Therefore, it can be concluded that while there are some differences in post-ABMT complications among racial groups, overall, the rates of major complications and mortality do not significantly differ.
Abstract More than 30 years after its introduction, autologous stem cell transplantation (ASCT) remains the standard of care for young patients with newly diagnosed multiple myeloma. Not only did the arrival of novel agents such as immunomodulatory drugs (IMiDs), proteasome inhibitors (PI) and monoclonal antibodies not replace ASCT, instead they solidified its central role as standard of care. Novel agent use is now inarguably essential in induction, maintenance, and possibly consolidation. In light of these new advancements, new challenges arise in deciding on optimal practice. Who is most suited to undergo ASCT? Is there an age threshold that should not be surpassed? Should transplantation be embarked on early or is it reasonable to delay it? What are the optimal induction, consolidation, and maintenance therapies? What is the role of tandem transplantation in the era of novel agents and where do patient-specific cytogenetics come into the equation when deciding on treatment? These are some of the questions addressed in this review which we will attempt to answer with the latest currently available data.
Adult T-cell leukemia/lymphoma (ATLL) remains challenging to treat and has dismal outcome. Allogeneic stem-cell transplantation (allo-SCT) has promising results, but data remain scarce. In this single-center retrospective analysis of 100 patients with ATLL from north America (67 acute, 22 lymphomatous), 17 underwent allo-SCT and 5 autologous SCT (ASCT), with a median follow-up of 65 months. Post-transplant 3-years relapse incidence (RI) and non-relapse mortality (NRM) were 51% and 37%, respectively, and 3-year progression-free survival (PFS) and overall survival (OS) were 31% and 35%, respectively. ASCT 1-year RI was 80% compared to 30% in allo-SCT (p = 0.03). After adjusting for immortal-time bias, allo-SCT had significantly improved OS (HR = 0.4, p = 0.01). In exploratory multivariate analysis, patients achieving first complete response and Karnofsky score ≥ 90 had significantly better outcomes, as did Black patients, compared to Hispanics, who had worse outcome. In transplanted patients, 14 died within 2 years, 4 of which ASCT recipients. Our data are the largest ATLL transplant cohort presented to date outside of Japan and Europe. We show that allo-SCT, but not ASCT, is a valid option in select ATLL patients, and can induce long term survival, with 40% of patients alive after more than 5 years.
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