ALBERT

Beschreibung: Abstract 2349 Introduction: Incidence of hematological malignancies is higher in elderly population. However, standard chemotherapy has not been established and the potential role of RICBT has remained unclear. This study reports the results of RICBT for elderly patients with hematological malignancies, retrospectively. Objective: To investigate the feasibility of RICBT. Primary endpoints were engraftment and overall survival (OS). secondary endpoint was transplant-related mortality (TRM). Patients and Methods: Between Feb.2009 and Jun.2010, 29 patients (median age 70 years, range 58–76) received RICBT for hematological malignancies. Primary diseases were divided into 2 groups; advanced (intermediate and high risk; n=21) or standard (n=8). All cases in 70's were included in the high risk. Median follow up time was 238 days (range 8–464).Conditioning regimen and GVHD prophylaxis consisted of fludarabine, busulfan or cyclophosphamide, and TBI 2Gy with tacrolimus± MTX for 70 years (n=11) and 500/μL) and platelet engraftment (〉20,000/μL) were observed in 89.6% (95% CI; 79–100) at day 60 (median; 18.0 days, range; 13–28), and 62.1% at day 100 (median; 36.5 days, range; 17–60), respectively. Neutrophile engraftment was 100% in TBI regimen (median; 18 days, range; 13–28), 75% in ATG regimen (95% CI; 51–100, median; 19 days, range; 16–27)(p=0.04). Platelet engraftment was 77% in TBI regimen, 42% in ATG regimen, respectively (p=0.06). Primary graft failure occurred in 3% of all cases. Cumulative incidence of acute GVHD (II-IV) was 58% (95% CI; 39–78) at day 100 (median; 27.5 days, range; 13–82), 81% (95% CI; 62–100, median; 28 days, range; 17–82) in TBI regimen and 12.5% (95% CI; 0–35, median; 13 days, range; 13) in ATG regimen, respectively (p=0.01). The 1-year estimated OS was 51% (95% CI: 25–77) in all cases, 51% (95% CI: 13–90) in TBI, and 48% (95% CI: 18–77) in ATG, respectively (p=0.08). According to the age, OS was 80% (95% CI: 45–80) in 50's, 53% (95% CI: 20–86) in 60's, and 38% (95% CI: 0–77) in 70's (P=0.0765). Causes of TRM included infections (n=5 including 3 cases in 70's), TMA (n=2). Incidence of TRM at day 100 was 20% (95% CI; 4–35, median; 47 days, range; 8–79), 7% in TBI regimen (95% CI; 0–21, median; 79days), 41% in ATG regimen (95% CI; 9–72, median; 30 days, range; 9–72). Incidence of TRM, according to the age, was 40%,0%, and 52% in 50's,60's, 70's, respectively. Discussion and Conclusion: Because of the high incidence of high risk disease and TRM, despite low incidence of GVHD, RICBT is associated with a low OS in patients over 70 years compared with those who are under 70 years. Eligibility of RICBT needs to be investigated, especially in 70's patients, and further studies are warranted to clarify the safety in elderly patients. Disclosures: No relevant conflicts of interest to declare.

Beschreibung: Abstract 4495 Incidence of myeloid malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) is higher in elderly population. However, standard chemotherapy has not been established and the potential role of RICBT has remained unclear. This study reports the results of RICBT for elderly patients with myeloid malignancies. To investigate the feasibility of RICBT. Primary endpoints were engraftment and overall survival (OS). 2nd endpoints were transplant-related mortality (TRM) and relapse rate. Between Mar.2009 and Jul.2011, 21 patients (median age 70 years, range 65–74) received RICBT for myeloid malignancies (de novo AML; n=7, MDS related; n=14). Primary diseases were divided into 2 groups; advanced (high risk; n=11) or standard (CR1 & 2; n=10). Median follow up 9.5 months (0.3–29).Conditioning regimen was fludarabine 200mg/m2, busulfan, and TBI 2Gy(n=9) or ATG 7.5mg/kg (n=12).Immunosuppresants were tacrolimus± MTX (n=13) or cyclosporine ± MTX (n=8). Median total nucleated cells (TNC): 2.6 × 10^7 cells (2.0–4.8); Median CD34+: 0.4 × 10^5 cells (0.2–2.9); HLA match: 5/6 (n=1), 4/6 (n=20). Time to event curves were plotted by using the actuarial method of Kaplan-Meier, and differences between curves were analyzed by log-rank tests. Neutrophile (〉500/μ L) and platelet recovery (〉20,000/μ L) were observed in 86% (95% CI; 82–87) at day 60 (median; 17 day, range; 12–27), 62% (95% CI; 41–83) at day 100 (median; 32 day, range; 41–83), respectively. Neutrophile engraftment was 100% in TBI regimen (median; 16 days, range; 13–20), 79% in ATG regimen (median; 19 days, range; 12–27) (P=0.09). Platelet engraftment was 86% (95% CI; 60–100) in TBI regimen, 42% (95% CI; 14–70) in ATG regimen, respectively (p=0.02). Cumulative incidence of acute GVHD (II-IV) was 33% (95% CI; 13–53) at day 100 (median; 24days, range; 10–82), 73% (95% CI; 17–82, median; 25 days, range; 17–82) in TBI regimen and 14% (95% CI; 0–33, median; 11.5 days, range; 10–13) in ATG regimen, respectively (P=0.02). The 1-year OS was 64% (95% CI; 46–86) in all cases, 71% (95% CI; 38–100) in TBI regimen, 63% (95% CI; 37–89) in ATG regimen, respectively (P=0.55,Figure1). According to the age, OS was 81% (95% CI; 57–100) in 60’s, 45% (95% CI; 14–76) in 70’s, respectively (P=0.04). Causes of TRM included infections (n=2) and late graft failure (n=1), all cases in 70’s and received ATG. Relapse rate was 19% (95% CI; 2–36) in all cases, 43% (95% CI; 6–80) in TBI regimen, and 7% (95% CI; 3–68) in ATG regimen at 500 days, respectively (P=0.06). RICBT with ATG regimen is associated with a high TRM in over 70 year-old high risk patients. However, ATG regimen may conduct low incidence of acute GVHD and relapse rate. Eligibility of RICBT needs to be investigated, especially in over 70 patients, and further studies are warranted to clarify the safety in elderly patients. Disclosures: No relevant conflicts of interest to declare.