ALBERT

Description: As previously reported (Colombat, Blood2001;97:101), rituximab (4 weekly doses of 375mg/m²) can lead to high response rates (RR) and prolonged remissions with minimal toxicity as 1st line therapy for low tumor burden FL. We report the final analysis of a trial evaluating long term efficacy and safety of rituximab in untreated low tumor burden FL (GELF criteria). 49 patients (pts) were included in the initial trial (median age 52 yrs), 2 refused consent for the extended F/Up period, and 1 pt died at M12. Molecular bcl2-JH rearrangement was assessed throughout the study. The median F/up was 83.8 mths. Overall best RR, complete/unconfirmed RR and partial RR at D78 were 74%, 50% and 24% respectively. Median PFS was 23.5 mths for the study population. Median duration of response (34 responders at D78, i.e 6 weeks after the last rituximab dose) was 28.6 mths, but response was still maintained without any further treatment in 11 pts after 5 years (24%) and in 7 pts after 7 years (15%). 31/46 pts were bcl2 positive in blood and/or marrow samples before rituximab: 11 (35%) became negative at D50, and 20 remained positive (65%). Median PFS was 37 mths for bcl2-negative pts at D50, and 12 mths for patients remaining positive (p=0.018 Log-rank). Of the 7 pts with sustained response after 7 years, 5 were bcl2 positive at D0, 2/5 became negative at D50, and 5/5 were still negative at M84. At year 7, 4/46 pts have died (1 from myelodysplasia, 3 from NHL), 35/42 have progressed, and 7 have never progressed without any other treatment than the initial rituximab therapy. Time to progression was significantly longer in the bcl2-negative population at D50 (p= 0.018, Log-rank). Duration of response was not correlated with bcl2 status at D50, but was associated with ‘Best response CR/Cru’ (p=0.007 Log-rank). Long-term tolerance was good, with only 13 SAE observed in 13 pts during the additional 4 years of F/Up (4 surgeries for non NHL-related pathologies, 1 node biopsy, 1 sleep apnea syndrome, 1 ischemic cardiopathy, 2 deaths from NHL, 1 depression, 1 pneumonia, 1 erysipela, 1 bronchitis). This long-term update confirms that a single 4-dose rituximab treatment yields durable benefits without the toxicity of chemotherapy for pts with low burden FL : Median PFS of 23.5 mths for the cohort, 28.6 mths for responders and 37 mths for pts turning bcl2-negative at D50, 15% of pts have maintained their response after 7 years, (2bis) the quality (CR/Cru) of the initial response was associated with a longer response duration high overall survival is observed with 4 deaths/46 pts (8.6%).

Description: Background: Umbilical cord blood transplantation (UCBT) is a potentially curative therapy acute leukemia (AL) patients. Transplantation benefit must be balanced against risks, such as transplant related mortality and relapse. The complex nature of hematopoietic stem cell transplantation data (HCT), rich in interactions and possibly nonlinear associations, has motivated us to apply machine learning (ML) for predictive modeling. ML is a field of artificial intelligence and is part of the data mining approach for data analysis. Our group has recently reported on a ML based prediction model for short term HCT outcomes (Shouval R et al; JCO 2015). Using a ML algorithm, the perspective of the current study was prediction of leukemia free survival (LFS) at 2 years after an UCBT, while exploring variables' importance and interactions. Patients & Methods: A cohort of 3,149 UCBT were analyzed. Inclusion criteria encompassed patients at all ages, undergoing an UCBT (single/double unit) in EBMT centers from the year 2004 to 2014, for AL, in all disease status. All conditioning and graft versus host disease prophylaxis regiments were included. A total of 24 variables were considered, including the number of total nucleated cell dose (TNC), donor and recipients HLA typing, as well as recipient, disease and transplant characteristics. The Random Survival Forest (RSF) ML algorithm was applied for model construction and data exploration. RSF is known to be adaptive to data, is able to automatically recover nonlinear effects and complex interactions among variables, and yields nonparametric prediction over test data. The analysis pipeline consisted of prediction model development, assessment of variable importance by their minimal depth from the tree trunk, and exploration of the top ranking variable with dependence plots. The latter promotes understanding of non-trivial associations between variables and outcomes. Results : The 2 years LFS was 49%, with a median follow up of 30 months. A RSF model of 1000 trees was developed, with each tree constructed on a bootstrap sample from the original cohort. A prediction error of 36.0% was calculated. The 10 most predictive variables (in ascending order) were disease status, age, TNC harvested and infused, recipient CMV serostatus, interval from diagnosis to UCBT, transplant year, previous autologous transplant, and use of anti-thymocyte globulin (ATG). Selected findings from exploration of variables-outcome relationship with dependence plots included a varying effect of TNCs in specific subpopulations. Increasing the number of infused TNCs had a positive effect on predicted LFS in patients receiving HLA mismatched (2 or more HLA mismatch) (figure) or single unit CB grafts, and patients in earlier disease status or older age. ATG administration was associated with worse LFS, whether unadjusted or adjusted to all other variables. However, there was an additional negative effect in advanced disease status patients, recipients of HLA mismatched or single CB units grafts, and older patients. Patients in 1st complete remission (CR) had higher predicted LFS as compared to those in 2nd CR. However, in patients receiving a HLA mismatched or a double CB graft, the difference in LFS between CR1 and CR2 was attenuated. Younger age had a favorable impact in early disease status, but lost its positive effect in advanced disease. Conclusions: A prediction model for LFS 2 years post UBCT was developed using the RSF ML algorithm. Variables were ranked according to their predictive contribution. Disease status, age, and TNC count were found to be the most important factors. Dependence plots revealed interactions and nonlinear associations between variables and the outcome, such as the effect of cell dose on HLA disparity. Apart from the study's clinical findings, it carries a methodological significance. A novel ML approach for prediction, variable selection and data exploration, accounting for long term time to event outcomes, has proved useful in the field of HCT. Figure 1. Variable marginal dependence coplot of predicted LFS at 2 years against TNC, conditional on HLA matching. Individual cases are marked with blue circles (alive or censored) and red `x's (event). Linear smooth (a linear extrapolation of the prediction function), with shaded 95% confidence band, indicates trends of variable dependence. Figure 1. Variable marginal dependence coplot of predicted LFS at 2 years against TNC, conditional on HLA matching. Individual cases are marked with blue circles (alive or censored) and red `x's (event). Linear smooth (a linear extrapolation of the prediction function), with shaded 95% confidence band, indicates trends of variable dependence. Disclosures Mohty: Janssen: Honoraria; Celgene: Honoraria. Sanz:JANSSEN CILAG: Honoraria, Research Funding, Speakers Bureau. Bader:Neovii: Other: Institutional grants; Medac: Other: Institutional grants; Riemser: Other: Institutional grants; Amgen: Consultancy; Novartis: Consultancy; Jazz Pharmaceuticals: Consultancy.

Description: Abstract 3375 Poster Board III-263 Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (Allo-HCT) has become a feasible and effective therapeutic approach for younger patients with relapsed or refractory follicular lymphoma (FL). However, there is still much debate regarding the most appropriate conditioning regimen or whether the use of in vivo T-cell depletion (TCD) is beneficial or not for these patients. We analyzed the outcome of 164 patients with advanced FL reported to the EBMT from 1999 to 2007, who underwent RIC Allo-HCT conditioned with fludarabine plus an alkylating agent. Donors were HLA-matched siblings in all cases. Patients receiving transplants from alternative donors or conditioned with other agents were specifically excluded. The alkylating agent was melfalan in 48% of cases, busulfan in 32% and cyclophosphamide in 20%. Forty-six patients (28%) received anti-thymocyte globulin (ATG), 41 (25%) received alemtuzumab and 77 (47%) did not receive TCD in vivo. Median age at transplantation was 50 (range 29-64) years, and patients receiving alemtuzumab were significantly younger [45 (33-63)] than those receiving ATG [52 (29-64)] or no TCD [50 (32-64)], P = 0.05. There were no other differences among groups in terms of disease stage or presence of bulky masses at diagnosis, interval from diagnosis to HCT, number of prior therapies, or disease status at HCT. Engraftment was observed in 161 (98%) patients, with no significant differences among groups. Median follow-up was 43 (1–110) months for survivors. At three years, non-relapse mortality (NRM), relapse rate (RR), progression-free survival (PFS) and overall survival (OS) were 17% (95% CI 12-24%), 23% (17-31%), 60% (52-68%) and 75% (67-82%), respectively, for the entire cohort. The incidence of grade 2-4 acute graft-versus-host disease (GVHD) was significantly higher for patients not receiving any TCD (31%) compared to TCD patients (18%), P = 0.05, and the incidence of chronic GVHD at one year was also significantly higher for the former compared to the latter group (68% vs. 25%, P 〈 0.001). There were no significant differences in NRM among groups, but there was a trend towards a higher RR in patients receiving alemtuzumab (40%) or ATG (24%) compared to patients receiving no TCD (16%) (P = 0.15), which translated into a trend towards a significantly shorter 3-year PFS for the alemtuzumab group (42% vs. 69%; P = 0.18). However, there were no differences in the 3-year OS among groups, which was 77% for patients receiving alemtuzumab, 73% for those receiving ATG and 77% for patients not receiving any TCD. In conclusion, results with RIC Allo-HCT from HLA-identical siblings were very promising for patients with advanced FL. Both alemtuzumab and ATG were effective in reducing acute and chronic GVHD, but had no significant impact on NRM. There was a trend towards a shorter PFS for patients receiving alemtuzumab, which did not translate into a significantly different OS. Disclosures: Delgado: Bayer Schering Pharma: Consultancy, Research Funding; Genzyme: Research Funding. Off Label Use: The use of alemtuzumab as a T-cell depleting agent in the context of hematopoietic transplantation is considered off-label.

Description: Reduced-intensity conditioning regimens (RIC) had become a classical strategy of allogeneic hematopoietic stem cell transplantation (HSCT) and many patients are now transplanted with unrelated donor. The aim of this restrospective study was to evaluate the impact of HLA mismatches between donor (D) and recipient (R) at the allelic level on survival after RIC. We analyzed 103 patients registered in France from Jan 1999 to Dec 2003 with a median age of 46 years (18–67). All patients had hematologic malignancies: AL (n=35), MM (n=18), CLL (n=5), NHL (n=11), HD (n=9), CML (n=12), MDS (n=9), and MPS (n=4). 39% of the patients were in an advanced phase of the disease at time of HSCT. Anti-thymocytes globulins (ATG) were part of the conditioning regimen for 77% of patients. The main source of stem cells was PBSC (n=65). Seventy-one D/R pairs (69%) were 10/10 HLA match at the allelic level. Mismatches concerned 5, 6, 15, 2 and 7 D/R pairs for HLA-A, -B, -C, -DRB1 and -DQB1, respectively. The results showed that 96% of patients engrafted. Acute GVHD grade II to IV and grade III/IV occurred in 46% and 19% of patients, respectively. The risk of developing cGvHD was 45% at 2 years. Overall survival (OS) was 42% at five years. Among the 47 patients alive, the median disease free survival (DFS) was 28 months. Among non-HLA parameters studied, the only factor associated with a good OS was the diagnosis of lymphoid disease (HD or NHL or CLL) (p=0.003). Recipient age

Description: Background: B-PTLD is a rare but severe complication observed after organ transplantation. There is no consensus on treatment modalities in this setting but Rituximab monotherapy has been presented as an effective and well tolerated treatment. Long term efficacy is unknown. Aim: We recently published results of the first prospective study on PTLD treatment, using four weekly injection of Rituximab in progressive or non responding tumours after immunosuppression diminution (Blood2006; 107; 3053–7). We present here update results up to 6 years after inclusion. Methods: From may 2000 to December 2001, 43 PTLD after solid organ transplantation have been enrolled in M39037, a franco-belgian multicentric prospective trial. The primary end point was day 80 response rate and one year results were also presented. Participating centres were contacted in order to obtain update data on surviving patients at one year, especially for their tumour status (complete response (CR), partial response (PR) or progressive disease (PD)), date of last information, eventual death and cause of death. Results: At one year, on 43 included patients, 26 were still alive, 12 in CR or Cru, one in PR, 10 in PD and two with insufficient information. At this time, update data are available on eight patients, six were in CR or Cru at one year and two in PD. Five patients died by organ failure (n=1), graft rejection (n=1), sudden death (n=2) or heart biopsy complication (n=1); all but one were in CR at this time. Three patients are still alive and in CR. No relapse has been diagnosed and median survival is 1188 days (with a median follow up of 1689 days for surviving patients). Final analysis on all patients will be presented at the ASH meeting. Conclusion: Rituximab in monotherapy seems to have a durable efficacy on PTLD after solid organ transplantation with a follow up of more than 4,5 years. Complete results will be presented at the ASH Meeting.

Description: Abstract 3005 Allo-SCT is an effective postremission therapy when compared to chemotherapy for adult patients with ALL. However, some studies suggested that the benefits from allo-SCT antileukemia effects are offset from the high non-relapse mortality (NRM), especially when using high dose TBI-based myeloablative conditioning. At present, it is well established that IV BU is as potent in inducing apoptosis of primary ALL cells as it is in AML. Marrow ablative or nonmyeloablative doses of IV BU were shown to be well tolerated in older adults when used as part of the conditioning regimen. With this background, this survey performed between 2000 and 2010, aimed to assess the outcome of 467 adult patients with ALL who received IV Bu-based conditioning regimen (without TBI) prior to allo-SCT. In this series, the median age was 37 years (range, 18–71) and the median year of allo-SCT was 2008. A B-lineage ALL was diagnosed in 317 cases (68%). 274 patients (59%) received allo-SCT from an HLA-matched related donor, while 168 patients (36%) received an HLA-matched unrelated graft (at least 6/6 match), and 25 (5%) received an HLA-mismatched graft. G-CSF-mobilized PBSCs were used as stem cell source in 387 cases (83%), and bone marrow in the remaining 80 cases (17%). At time of allo-SCT, 301 patients (64%) were in first CR, 88 patients (19%) in second CR and 78 cases (17%) in more advanced phases. As per inclusion criteria, all patients from this series received a conditioning regimen combining IV Bu and other chemotherapeutic drugs. 359 patients (77%) received a standard myeloablative conditioning (MAC) regimen (252 cases consisting of IV Bu 3.2 mg/Kg/day for 4 days and Cy; 77 cases IV Bu and Fludarabine, and 30 cases of IV Bu and other drugs). The remaining patients (23%) received a so-called reduced-intensity conditioning (RIC) consisting of nonmyeloablative doses of IV Bu (total dose ≤ 9.6 mg/Kg) and Fludarabine in the majority of cases (89%). In this series, 96% of patients achieved neutrophil engraftment at a median time of 15 days after allo-SCT. The incidences of grade II and grade III-IV acute GVHD were 18% and 10%, respectively. When considering patients in first CR who received transplant from an HLA-identical sibling, the cumulative incidence of NRM was 14±3% at 2 years. NRM was 29±8% at 2 years in patients transplanted in second CR from an HLA-identical sibling. In the unrelated transplant group, NRM incidences were 31±6% at 2 years for patients transplanted in first CR and 41±8% for patients transplanted in second CR. The cumulative incidences of relapse were 38±4% at 2 years for patients transplanted in first CR and 41±7% for patients transplanted in second CR using a matched related donor. In the unrelated transplant group, relapse rates were 31±5% at 2 years for patients transplanted in first CR and 44±8% for patients transplanted in second CR. With a median follow-up of 12 months (range, 1–88) after allo-SCT, leukemia-free survival (LFS) was 48±5% at 2 years for patients transplanted in first CR using an HLA-identical sibling. LFS was 30±8% at 2 years for patients transplanted in second CR using an HLA-identical sibling. In the unrelated transplant group, LFS rates were 38±6% at 2 years for patients transplanted in first CR and 15±6% for patients transplanted in second CR. In summary, results from this survey suggest that the use of IV Bu-based conditioning regimen may represent a valid option for the conditioning of adult ALL patients prior to allo-SCT. The use of IV-Bu-based RIC allowed a significant number of ALL patients not eligible to MAC to proceed to allo-SCT. Outcomes (NRM, LFS and relapse incidence) achieved after such regimens (especially in patients in first CR) compare favourably to figures from historical series using TBI-based conditioning, warranting a prospective randomized trial. Disclosures: Mohty: Pierre Fabre: Consultancy, Honoraria, Speakers Bureau. Nagler:Pierre Fabre: Honoraria.

Description: Twenty four patients (pts) with planned autologous stem cell transplantation for lymphoma diseases (Hodgkin’s disease=4; non-Hodgkin’s lymphoma=20) received chemotherapy (CT) (Induction CT=3 and salvage regimen= 21) followed by a fixed single dose (6 mg) administration of Pegfilgrastim (PF) after the last day of CT for peripheral blood stem cell collection (PBSC) (target cell dose of 3 2×106 CD34+/kg). Median age was 53 yrs (24–68) and median weight was 72, 5 kg (45–98). Among the 24 pts, 7 received more than 2 lines of CT regimens. The injection of PF was well tolerated. Median time interval between day 1(D1) of the cycle of CT mobilization and first leukapheresis session was 14 days (10–18) while the median time interval between injection of PF and first leukapheresis session was 9 days (6–13). Stem cell collection was started when the absolute number of circulating CD34+ cells was 〉10×106/L and performed with standard volume leukapheresis. Median CD34+ cells level at D1 of leukapheresis was 35, 5/mm3 (11–320) and interestingly, more than 35 % of pts could reach this median level of CD34+ early after PF injection (around D6). Notably, 22 pts reached the target cell dose in 2 sessions of leukapheresis or less (10 pts after 1 session, 10 other pts after 2 sessions, 2 pts after 3 and 4 sessions respectively). The median number of leukapheresis sessions was 2(1–4) and the median CD34+ cells harvested was 4×106/kg (0,8–26,6). Two pts (DLBCL = 1 and FL = 1) could not reach the level of CD34+ required to start leukapheresis and both became secondary refractory to CT. In univariate analysis, PBSC collection of 〉 4×106/kg was highly correlated with pts who started their collection at D9 of PF administration (P=0,01) and with those presenting a CD34+ cells level 〉 35.5/mm3 at D1 of leukapheresis (P=0,033). White blood cells level higher than 9 G/l was also predictive of circulating CD34+ cells 〉35,5/mm3 (P=0,033). These data suggest that PF may represent an attractive option for PBSC mobilization particularly for pts with lymphoma when optimal compliance of frequent sequential regimens of CT is required. We also emphasize that stem cell mobilization is effective even in pts in second or subsequent salvage CT regimen. Importantly, the circulating CD34+ count should be performed from D6 of PF administration. The presentation will include the updated data.

Description: The results of RIC allo-SCT for MM are still under considerable debate. While EBMT data did not support the universal use of RIC for MM allografts, the Italian and spanish randomized multicenter trials suggested that in newly diagnosed myeloma, outcome in recipients of a hematopoietic stem-cell autograft followed by RIC allo-SCT from an HLA-identical sibling is superior to that in recipients of tandem stem-cell autografts. The aim of this multicenter retrospective national study was to identify prognostic factors for outcome of high-risk patients with MM after allo-SCT prepared by RIC. Data from 219 patients (median age 52 years, range 27–66), who received grafts from a sibling (n=197) or unrelated donor (n=22) were analyzed. At time of transplant, only 37 patients (17%) received RIC allo-SCT in CR or VGPR, while 134 patients (61%) were transplanted in PR. 48 patients were transplanted either in stable disease (n=15) or were in refractory/ progressive disease (n=33). All patients have received at least one autologous transplant prior to RIC allo-SCT. The graft source was PBSCs in the majority of patients (n=183). 21% of the patients received the Seattle Fludarabine and low dose TBI RIC regimen, while 53% of patients received Fludarabine, Busulfan and ATG. 32 patients (15%) died of transplant-related complications. The incidences of grade 2–4 acute GVHD and extensive chronic GVHD were 37% and 20% respectively. At 3 years, overall and progression free survivals (OS, PFS) were 41% (95%CI, 34–49) and 19% (95%CI, 14–27) respectively. Disease status (CR, PR, SD vs. progressive) was significantly associated with overall survival (P=0.0002). In multivariate analysis, disease status at time of RIC allo-SCT, was the strongest parameter associated with an improved OS and PFS (P=0.005 and P=0.004 respectively). Despite its obvious caveats, the relatively low TRM observed in this series, suggest that there is still space to investigate RIC allo-SCT for MM. However, RIC allo- SCT appears to result in a durable response only if it is applied early in the disease history, especially when patients are still chemosensitive. Since the latter results are also expected to be further improved with the systematic and early use of maintenance therapies (Bortezomib and/or Lenalidomide) after RIC allo-SCT, randomized or quasirandomized prospective studies are still warranted.

Description: Allo-SCT is a well established therapy for adult patients with AML. In the setting of standard myeloablative allo-SCT, the fear of early death as a result of the procedure led to the restriction of allo-SCT in CR1 to patients who presented with high risk AML features, especially taking into account the impact of cytogenetics risk on outcome determining standard (good)-, intermediate-, and poor-risk populations. In the last decade, RIC allo-SCT has emerged as an attractive modality to decrease toxicity and widen the spectrum of AML patients who are candidate to allo-SCT. However, the issue of possible higher relapse rates after RIC allo-SCT, and continuous improvements in non-allo-SCT strategies, raise concern about the utility of this approach in AML patients in CR1 (e.g. in comparison to intensive chemotherapy and new drugs). Of note, no large studies have yet assessed the impact of cytogenetics risk on outcome in the context of RIC allo-SCT. This report describes the results of 378 AML patients (185 males) transplanted in CR1 using a RIC regimen and reported to the EBMT registry between 2000 and 2007, and for whom detailed cytogenetics data were available. All patients received RIC allo-SCT from an HLA identical sibling. RIC was defined as Busulfan conditioning regimens containing 〈 8mg/kg total dose, or TBI

Description: Abstract 2008 We have previously reported a dismal outcome for patients with Plasma Cell Leukaemia (PCL) undergoing autologous transplantation, although such patients represent the younger and fittest with this condition and show superior survival to reports of non transplant patients. In this study we report two analyses of 85 eligible patients with PCL who received an allogeneic transplantation (Allo) between 1984 and 2009 and 411 patients receiving autologous transplantation (Auto) in the same period and a further comparison with 850 (Allo) myeloma MM.The first analysis was restricted to the years 1998 to 2009 allowing the identification of a large Myeloablative (MAC) population (n=45) and a smaller reduced intensity (n=17) conditioning (RIC) group. On account of the number of comparisons in the study and the size of the sub populations, only statistically highly significant differences are reported; less significantly powerful differences are viewed as a trend. Patients treated with MAC and RIC were essentially similar although significantly younger (45.9 and 52.9 yrs respectively) than the Auto patients (55.9 yrs) at the time of diagnosis, with similar differences at the time of transplant. RIC patients had a longer time (10.2 months) to transplant than the MAC (6.0m) and Auto (5.8m) groups. No difference was seen in rates of engraftment, acute or chronic graft versus host disease. MAC patients had a higher Complete Response (CR) than Auto. Progression Free Survival (PFS) at 12 and 60 months respectively (with Confidence Intervals) was as follows: Auto; 0.51 (0.45 – 0.57) and 0.10 (0.06 – 0.15), MAC; 0.39 (0.26 – 0.57) and 0.19 (0.09 – 0.39), RIC; 0.43 (0.23 – 0.80) and 0.11 (0.02 – 0.67) with the MAC and RIC curves possibly crossing the Auto curve between 2 and 4 years. These differences are due to highly significant differences in Non Relapse Mortality (Auto better) and Progression (Auto worse) This translates into Overall Survival (OS) at similar times (12 and 60 months) to PFS as follows: Auto; 0.73 (0.68 – 0.78) and 0.25 (0.19 – 0.33), MAC; 0.46 (0.33 – 0.65) and 0.27 (0.16 – 0.47), RIC; 0.59 (0.38 – 0.91) and 0.19 (0.04 – 0.93). The differences between MAC and RIC were not statistically significant. It was noted that whereas Auto patients continue to relapse with time there is a (small) plateau of survivors in both MAC and RIC. These findings are confirmed in the larger non selected analysis of all Auto and Allo patients Although age is seen as a strong prognostic factor favouring the Allo patients appropriate adjustment was made in the analysis. In the comparison of Allo in PCL v. MM the PFS and OS for PCL was inferior to MM: Data at 48 months for PFS and OS respectively: MM 0.22 (0.19 – 0.26) and 0.44 (0.40 – 0.48), PCL 0.20 (0.10 – 0.41) and 0.32 (0.19 – 0.53). In all three analyses the PCL Allo group shows a clear plateau at about 0.2 (20%) similar that seen in a number of recent studies of Allo transplantation in MM, but at a lower level. This contrasts with the ongoing attrition of patients experiencing progression in Auto transplantation. This study presents the first major analysis of Allo transplantation in PCL, confirms the poor prognosis with all types of transplant therapy while indicating it remains the best option for patients with PCL. Further improvements in the management of NRM can improve the outcome for these patients. Disclosures: No relevant conflicts of interest to declare.