ALBERT

Description: Abstract 1211 Poster Board I-233 Umbilical cord blood transplantation (UCBT) has extended the availability of allogeneic hematopoietic stem cell transplantation to patients without HLA identical donors, mainly for groups of patients with high frequency of rare haplotypes such as the Brazilian population. We evaluated 173 patients who received a single first UCBT in Brazil between with 1993 and 2009 for hematological malignancies from 13 transplant centers. Median age was 8 years (range 1-60) and 58% were male. Sixty-nine patients (40%) had acute lymphoblastic leukemia, 57 (33%) acute myelogenous leukemia, 23 (13%) myelodysplastic syndrome, 18 (10%) chronic myelogenous leukemia and 6 (4%) chronic lymphoid diseases (4 Hodgkin's lymphoma, 1 non-Hodgkin lymphoma and 1 chronic lymphocytic leukemia). Most patients (55%) were transplanted in advanced phases of their diseases. Based on antigen-level HLA-A and -B and allele-level HLA-DRB1 typing, 64 patients (52%) received a cord blood unit with 2 mismatches, 54 (44%) with one mismatch and 5 (4%) received matched units. Conditioning regimen varied according to the disease and the center. Cord blood (CB) units came from CB banks from the USA (n=86), Europe (n=64), and Brazil (n=23). Most patients (94%) received a myeloablative regimen; TBI was used in 86% of cases and ATG/ALG in 82%. Median number of total nucleated cells infused was 4.4×107/kg of recipient weight and the median number of CD34+ cells infused was 1.7×105/kg. Median follow-up time of survivors was 30 months. The cumulative incidence (CI) of neutrophil engraftment at day 60 was 61%, after a median time of 22 days (range 12-55 days) and the CI of platelet engraftment at day 60 was 42%, after a median time of 41 days (range 16-125 days). CI of neutrophil engraftment was only 39% for patients with CML. Nucleated or CD34+ cell dose, number of HLA disparities, bank origin or other patient, disease or transplant-related factors were not associated with engraftment. Techniques of CB thawing, CB unit transportation or cell viability were not analyzed. Only experience of centers (more than 30 UCBT performed) was associated with improved engraftment rate (p=0.05). CI of grade II-IV acute graft-versus-host disease (GVHD) at 100 days was 19% and of chronic GVHD only 5% at 3 years. CI of non-relapse related mortality (NRM) was 41%. In a multivariate analysis, factors significantly associated with a higher NRM were patients older than the median age (51% vs. 32% for younger patients, p=0.05), and CD34+ cell dose lower than 1×105/kg (54% vs. 25% P=0.002). At 3 years, the CI of relapse or progression was 20%, and the estimated progression-free survival (PFS) was 36%. In a multivariate analysis, the most important factors associated with a decreased PFS rate were advanced disease status (28% vs. 46% for patients in remission, p=0.001), and a CD34+ cell dose lower than 1×105/kg (21% vs. 42%, p=0.04). At 3 years, estimated overall survival was 41%. In conclusion, UCBT in Brazil seems to be associated with lower engraftment rates as compared to the published experience from other countries. Other factors such as CB unit transportation, CB thawing and cell viability may be analyzed in order to explain the lower engraftment rates. Nevertheless, use of HLA-mismatched UCBT is a valuable alternative for patients with hematologic malignancies in Brazil who lack an HLA-matched related or unrelated donor. UCB units with a higher CD34+ cell count and transplants performed for patients in remission may improve outcomes. Disclosures: No relevant conflicts of interest to declare.

Description: T-cell non-Hodgkin Lymphoma (T-NHL) are uncommon malignancies that represent approximately 10% of all NHL. With few exceptions T-NHL have generally been reported to have a worse prognosis compared with B-cell lymphomas. Standard therapy for most T-NHL still need to be defined. To elucidate the feasibility and efficacy, we retrospectively analysed the data of 11 patients who underwent allogeneic hematopoietic stem cell transplantation from July 1991 to july 2006. Five female and five male patients with a matched sibling donor and a female mismatched underwent a transplant. The median age was 22 years (16 – 34). Six patients were diagnosed as lymphoblastic T, two were anaplastic large cell, two were peripheral T-cell unspecified and one was NK/T extranodal nasal-type. One was in first hard remission, three in second remission, one in third complete remission, one in early first relapse, one in second partial remission and four had refractory disease. Six patients were conditioned with TBI + cyclophosphamide (CY-TBI) and five with busulfan 16 mg/kg and melphalan 140 mg/sqm (Bu-Mel). Graft versus host disease (GVHD) prophylaxis was done with cyclosporin and short course methotrexate for most of the cases. 63 % had acute GVHD grade I to III and 45% had chronic GVHD. Overall survival is 36%. Four of the 11 patients are alive, still in complete remission, after one year, 12 years, 14 years, and 15 years from transplantation. Two of these patients were conditioned with CY-TBI and two with Bu-Mel. Allogeneic transplant can be useful to treat advanced T-NHL patients.

Description: This is a retrospective analysis of 1084 patients who received an allogeneic HSCT in 10 Brazilian Centers, from February 1983 to March 2003, aiming to validate the EBMT risk score. Data from transplanted patients and donors regarding patients age, disease stage at transplantation, HLA full-match sibling donor or full-match unrelated donors, donor-recipient gender match and the interval from diagnosis to transplantation, were used as variables to calculate the EBMT risk score. This score was analyzed using Cox Proportional Hazards Model. The OS, DFS, TRM and relapse were analyzed using Kaplan-Meier and cumulative incidence, whenever appropriate. In all there were 647 (60%) males and 437 (40%) females, the median age was 32 years old (range 1 – 59); 898 (83%) were in chronic phase, 146 (13%) were in accelerated phase and 40 (4%) were in blast crisis; 151 (14%) were younger than 20 years old, 620 (57%) were between 20 and 40 and 313 (29%) were older than 40; 1025 (95%) received HLA full-match sibling transplant and only 59 (5%) received an unrelated transplant. Female donor to male recipient occurred in 283 (26%) transplants. The interval from diagnosis to transplantation was less than 12 months in 223 (21%) cases and greater in 861 (79%). The OS, DFS, TRM and, relapse were 49%, 50%, 45%, 25%, respectively. The risk score 0–1 occurred in 179 (17%), score 2 in 397 (37%), score 3 in 345 (32%), score 4 in 135 (12%), and score 5–6 in 28 (2%). The risk scores 0–1 and 2 did not show any difference in terms of OS (58% and 55%, respectively) but they were significantly better than scores 3 or more (score 3 – 44%, 4 – 36 % and, 5-6 - 27%, respectively) (P

Description: Abstract 4216 Introdution/ Backgound Acquired Aplastic Anemia (AAA) is a rare hematologic disorder characterized by pancytopenia and hypocelular bone marrow. The pathophysiology is immune mediated in most cases. Environmental exposures to drugs, viruses and toxins, are thought to trigger the aberrant immune response in some patients. However, 50 to 74 percent of cases are classified as idiopathic. The highest frequency occurs in young population (15 to 25 years) with a second peak at age of 65 to 69 years. Immunosuppressive therapy is the best treatment in children with AAA who do not have a suitable donor for allogeneic stem cell transplantation. Materials and methods We reviewed the medical records of patients diagnosed with severe (SAA) and very severe acquired aplastic anemia (vSAA) at the Department of Pediatrics, Instituto da Criança – Hospital das Clínicas, University of Sào Paulo, Brazil from December, 1992 to December, 2007. We analyzed the clinical characteristics of the patients at diagnosis and the response to immunosuppressive therapy (IST) and hematopoietic stem cell transplantation (HSCT). Results In this study, 47 patients (27 boys and 20 girls), younger than 16 years, were diagnosed with vSAA (n= 21) or SAA (n=26). The median age was 7,71 years, ranging from 0.5 to 16 years and the average time history (beginning of signs and symptoms related to the disease and diagnosis) of the disease was 4,82 months, ranging from 0,25 to 48 months. Of the 47 patients, 45 had idiopathic AAA and 2 had hepatitis-associated. The median follow-up was 6,91 years for the patients treated with IST and 3,10 years for the patients who underwent to HSCT. One patient died before any treatment. For the eight patients who underwent to allogenic HLA-matched HSCT the 5-years-survival probability was 50%. For the 38 patients treated with IST, ten of them received cyclosporine and a short course of corticosteroids (CsA/CE) and 28 received antithymocyte globulin plus cyclosporine (ATG/CSA). The 5 years survival probability was 40% and 55%, respectively (p:0,0054). According to the severity of AAA, we did not show a significant difference in survival (p:0,32). Eight patients received second treatment after 1 year and 6 months (6 ATG from different species and CsA, 1 CsA and 1 thalidomide) and the probably of survival at 5 years was 60%. Among the 18 patients who responded to IST, four relapsed (22%). Two patients developed acute myeloid leukemia at 5 and 12 years after diagnosis. Conclusion Our results both for patients undergoing HSCT, as well as patients undergoing IST are lower in comparison to other hematological centers. Probably, this discrepancy is related to the prolonged time of disease when patients are admitted to our service. Unfortunately, the difficulty of access to specialized centers for diagnosis and early treatment in our country is a reality and this fact contributes to the delay to the beginning of treatment. Disclosures: No relevant conflicts of interest to declare.

Description: In 1997, a measles outbreak was identified in São Paulo. Between February and December, 20 185 cases were confirmed. From April to July 1997, a seroepidemiologic survey was conducted to identify the recipients of bone marrow (BM) transplants who were susceptible to measles and the occurrence of measles in this population. A total of 156 patients were screened by enzyme immunoassay (EIA). Patients with IgG titers more than 100 mIU/mL were considered immune. Measles reimmunization records were also reviewed. Thirty-two vaccinated patients underwent serologic evaluation. Six of 22 patients (27.3%) within 3 years after vaccination lost measles immunity, in contrast to 7 of 10 patients (70%) vaccinated longer than 3 years previously (P = .049). Among the 122 nonvaccinated patients, 41 (33.6%) were susceptible to measles: 4 of 47 patients (8.5%) within the first year after BM transplantation (BMT), and 37 of the 75 patients (49.3%) after the first year after BMT (P