ALBERT

Description: The objective of this study was to analyze the temporal trend of physical activity and body mass index in young adults aged 18–30 in Spain and to ascertain their relationship with sociodemographic and psychosocial variables in the period of 2009–2017. Methods: A descriptive study with a sample of 10,061 young adults aged 18–30 years was performed. The data were obtained from the European Health Survey in Spain in 2009 and 2014 and the National Health Survey in 2011/2012 and 2017. The chi-square test was used for qualitative variables, and multiple linear regression analysis was performed for physical activity. Results: Sedentary levels had decreased in 2017 as compared to 2011/2012 (p 〈 0.001); smokers were more sedentary than non-smokers (p 〈 0.001); men were more active than women (p 〈 0.001); and the year with the highest physical activity was 2014. Body mass index in the total sample increased from 2009 to 2017 (p 〈 0.01), showing a significant increase in obesity in women (p 〈 0.05) and no difference in men (p ≥ 0.05). Conclusions: In the period 2011/2012–2017, the sedentary lifestyle of young adults was reduced and physical activity was increased, with men being more active than women.

Description: Background: DLBCL is a heterogeneous disease with 30% of patients presenting as refractory/relapsing disease following R-CHOP treatment. Therefore, new prognostic factors to identify the poor-risk population and alternative therapies for them are needed. CD30 is a member of the tumour necrosis factor receptor (TNFR) super family and is expressed by several types of T- and B-cell non-Hodgkin lymphomas. Brentuximab vedotin, an anti CD30 antibody, is used in clinical practice for Hodgkin lymphoma and systemic anaplastic large cell lymphoma. The significance of CD30 expression in DLBCL remains unknown. We aimed to study the expression of CD30 in a large cohort of the novo DLBCL patients homogeneously treated with R-CHOP or R-CHOP-like protocols to evaluate its correlation with clinical and biological characteristics at diagnosis and its impact in clinical outcome. Methods: we prospectively registered 155 patients diagnosed of DLBCL between January 2012 to December 2015 in our center. Twenty-one patients with primary central nervous system DLBCL, transformed lymphoma or post-transplant DLBCL were excluded from the study. Anatomopathology review was performed in all cases, and 14 cases with not enough histological tissue to perform additional staining were also excluded. Immunohistochemistry was performed in 120 cases on 4 microns' paraffin sections using routine protocols,CD30 expression was analyzed using the antibodyCD30 clone BerH2, dilution 1:30; Dako; staining in more than 10% of the malignant cells was considered positive. Samples were classified as germinal center B-cell-like (GCB) vs. non-GCB subtypes by immunohistochemistry according to Hans algorithm. Univariate analyses were assessed by Chi square test. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses for progression-free survival (PFS) were assessed Cox proportional hazard regression model. Results: among the 120 cases analyzed, CD30 was expressed in 40 (33.3%). Clinical and biological characteristics at disease presentation are shown in Table 1. The expression of CD30 was significantly higher in the non-GCB subtype cases (p=0.0001). One hundred and six patients were homogeneously treated with R-CHOP (100 patients) or R-CHOP-like (1 R-COMP, 2 Burkitt scheme, 1 GA101-CHOP and 2 R-Bortezomib-CAP), and were included in the outcome analyses. Response rates and survival of this subgroup of patients are shown in Table 2. With a median follow-up of 16.4 months, no differences were found neither in PFS or OS between CD30 positive and CD30 negative patients (Table 2). In the multivariate analyses including the following independent variables: gender, B-symptoms, Bulky mass (〉5cm), cell of origin (GCB vs non-GCB), International Prognostic Index (IPI) and CD30 expression, IPI 3-5 was de only factor significantly related with poor PFS (HR 2.92, 95% CI:1.18-7.24, p=0.02). Conclusion: CD30 is expressed in one third of DLBCL patients, in whom an anti-CD30 therapy could be used. CD30 expression is significantly higher in patients with non-CGB DLBCL, however and in our experience, its expression does not influence either response to R-CHOP or R-CHOP- like therapy or survival. Disclosures Gonzalez Barca: Gilead: Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Speakers Bureau.

Description: Introduction As has been described by Dr. Viswabandya et al, the combination of anti-thymoglobulin (ATG), post-transplant cyclophosphamide (PTCy) and cyclosporine (CsA) provides an effective control of graft-versus host disease (GVHD) in peripheral blood (PB) allo-HSCT. We aim to report our experience in reduced intensity conditioning (RIC) allo-HSCT using a novel GVHD prophylaxis composed by a very low dose of ATG, PTCy and CsA for GVHD prophylaxis. Patients and methods Between May 2018 and April 2019, 106 adult patients underwent RIC allo-HSCT with the present GVHD prophylaxis. All these recipients were included in the study. RIC regimen was composed by fludarabine, busulfan, and 200cGy of total body irradiation. For GVHD prophylaxis all recipients received a total dose of 2mg/kg of rabbit-ATG on day -3 (0.5mg/kg) and -2 (1.5mg/kg), PTCy 50mg/m2/day on day +3 and +4, and CsA since day +5. Data was collected retrospectively and updated on July 2019. The median follow-up was 7.6 months (range: 0.4-14.6) and survival percentages were calculated at 6 months. The cum.Inc of GVHD was assessed accounting relapse and death as competing events. Results The main baseline and post-transplant information is summarized in the Table 1 and 2. The cum.Inc of grade II-IV and III-IV acute GVHD at day +100 was 19% and 7.7%. The cum.Inc of grade II- IV was not significantly affected by donor type (P=0.787). However, the cum.Inc of grade III-IV was significantly higher in those recipients who received haploidentical or 9/10 matched unrelated donor (MUD) grafts (p=0.048). Rates of CMV and EBV reactivation were respectively 62.3% and 68.9%. No patients were diagnosed with CMV disease. Biopsy proven post-transplant lymphoproliferative disorder was diagnosed in only 1 recipient and successfully resolved after rituximab. Thirty-two (30.2%) recipients died and 16 (15.1%) relapsed during the follow-up. Main causes of death were relapse 13 (12.3%) and infection 6 (5.7%). The main outcome information is reported in the Table 2 and Plot 1 and 2. Those recipients who received grafts from matched related and unrelated donors had a significant better non-relapse mortality (NRM) (P=0.001), overall survival (OS) (P=0.02), relapse-free survival (RFS) (P=0.03) and GVHD-free/RFS (P=0.006). Table 3 shows the impact of risk factors in transplant outcomes. Those recipients with an HCT-CI score ≥3 had a significant worse OS (HR 2.5; P=0.024) and RFS (HR 2.5; P=0034). Those recipients who received grafts from 9/10 MUD and haploidentical donors had a significant worse RFS (HR 2.1; P=0.049). Disease risk index was not a significant risk factor for OS or RFS. Lastly, those recipients who received grafts from haploidentical donors had a significant worse GRFRS (HR 2.9; P=0.04). Conclusion The dose of ATG for GVHD prophylaxis is not well established. The combination of ATG (2mg/kg), PTCy, and CsA is safe and provides an effective acute GVHD prophylaxis in PB RIC allo-HSCT. Further investigations are required to analyze the effect of this prophylaxis in chronic GVHD to better state long-term outcome conclusions and to improve post-transplant outcomes in those recipients who received grafts from mismatched donor sources (haploidentical and 9/10 matched unrelated donors). Disclosures Michelis: CSL Behring: Other: Financial Support. Mattsson:Celgene: Honoraria; Therakos: Honoraria; Gilead: Honoraria.

Description: Introduction: Dual T-cell depletion with ATG and PTCy combined with cyclosporine (CsA) in peripheral blood (PB) reduced intensity conditioning (RIC) allo-HSCT results in an impressive control of clinically relevant GVHD. We aim to share the largest and unique single center experience using this novel GVHD combination in allo-HSCT for hematological malignancies. Methods Between October 2015 and April 2019, 365 consecutive adult recipients underwent PB RIC allo-HSCT. Conditioning regimen consisted on fludarabine, busulfan and 200 cGy of total body irradiation. For GVHD prophylaxis all cases received ATG, PTCy (50mg/kg/24h x 2 doses on day +3 and +4) and CsA since day +5. Two hundred fifty-nine (71%) recipients, transplanted between 2015 and May 2018, received a total dose of 4.5mg/kg of rabbit-ATG (given on day -3,-2 and -1). In May 2018, the protocol was reviewed and refined decreasing the dose of ATG to a total of 2mg/kg (given on day -3 and -2). A total of 106 (29%) recipients received the lowered dose of ATG. Data was collected retrospectively and updated on July 2019. Cumulative incidence (Cum.Inc) of GVHD, CMV and EBV reactivation analysis was assessed accounting relapse and death as competing events. The multivariate analysis for OS and RFS was controlled by the following significant variables in the univariate analysis: age at transplant, disease risk index (DRI) (low and moderate v's high and very high), Karnofsky performance status (〉80% v's ≤80%), HCT-CI score ≥3 and donor type. Results Baseline characteristics and main post-transplant information and outcome are summarized in Table 1 and 2. The cum.Inc of grade II-IV and grade III-IV at day +100 was respectively 14% (95 confidence interval (CI) 11.1-18.4) and 4.7% (95% CI 2.8-7.2). The cum.Inc of moderate and severe chronic GVHD at 1 year was 13% (95% CI 9.7-16.8). ATG dose and donor type did not influence acute/chronic GVHD rates (Table 3). The cum.Inc of CMV and EBV reactivation at day +180 was comparable between the two cohorts that received different dose of ATG (P〉0.05). However, in the cohort that received a lower dose of ATG (2mg/kg), no CMV disease was documented and the percentage of probable or proven EBV-post-transplant lymphoprolipherative disease (P/P-PTLD) was only 3.7%. The percentages of CMV disease and P/P-PTLD in the group that received a dose of ATG of 4.5 mg/kg were respective 4.6% and 8.8%. Overall survival (OS), relapse-free survival (RFS), non-relapse mortality (NRM) and the cumulative incidence (cumInc) of acute GVHD of the entire cohort and according to the ATG dose are shown in the Table 2 and the Table 3. OS and RFS curves of all 365 patients and stratified according to donor type are shown in the Plots 1 to 4. In the multivariate analysis, age at transplant [(HR 1 (95% CI 1.01-1.02); P=0.046], high and very high DRI score [HR 1.8 (95% CI 1.2-3.6); P=0.001], KPS ≤80% [HR 1.8 (95% CI 1.2-2.7); P=0.001], and HCT-CI score ≥3 [HR 1.4 (95% CI 1.01-2.09); P=0.042] were significant risk factors for worse OS. Donor type was not a significant parameter for OS (P〉0.05). In the multivariate analysis of risk factors for RFS, high DRI score [HR 1.7 (95% CI 1.2-2.4); P=0.002], and a KPS ≤80% prior allo-HSCT [HR 2 (95% CI 1.4-2.8); P

Description: Introduction The combination of anti-thymoglobulin (ATG), post-transplant cyclophosphamide (PTCy) and cyclosporine (CsA) provides an effective control of graft-versus host disease (GVHD) in allo-HSCT using peripheral blood stem cell (PBSC) grafts, as has been reported by Dr. Viswabandya et al. We aim to report a large, single center experience in reduced intensity conditioning (RIC) allo-HSCT using dual T-cell depletion with ATG and PTCy combined with CsA for GVHD prophylaxis using grafts from 10/10 matched unrelated donors. Patients and methods Between October 2015 and April 2019, 167 adult patients diagnosed with hematological malignancies underwent first 10/10 MUD RIC allo-HSCT. RIC regimen was composed by fludarabine, busulfan, and 200cGy of total body irradiation. For GVHD prophylaxis all recipients received rabbit-ATG, PTCy 50mg/m2/day on day +3 and +4, and CsA since day +5. One hundred sixteen (69.5%) recipients, transplanted between 2015 and May 2018, received a total dose of 4.5mg/kg of rabbit-ATG (given on day -3,-2 and -1). In May 2018, the dose of ATG was lowered to a total of 2mg/kg (given on day -3 and -2). A total of 51 (30.5%) recipients received the lowered dose of ATG. The median follow-up of the entire cohort was 14 months (range: 0.4-44.5). For those patients who got a higher dose of ATG was 20 months and for those who received a lower dose of ATG was 8.8 months. Data was collected retrospectively and updated on July 2019. Cumulative incidence (Cum.Inc) of GVHD analysis was assessed accounting relapse and death as competing events. Results Baseline and post-transplant information are summarized in the Table 1 and 2. Ninety-three (55.7%) recipients were diagnosed with acute myeloid leukemia (AML). The cum.Inc of grade II-IV and grade III-IV acute GVHD at day +100 was respectively 15.6% (95% confidence interval (CI) 10.6-21.6) and 3.6% (95% CI 1.5-7.3). The cum.Inc of acute GVHD was not significantly affected by the dose of ATG (P〉0.05). The cum.Inc of chronic GVHD was 10.9% (95% CI 6.6-16.4). Due to the shorter median follow up of the cohort that received a lower dose of ATG, the impact of the reduction of the dose in the cum.Inc of chronic GVHD was not explored. Overall, 48 (28.7%) recipients died and 35 (20.4%) relapsed. Main causes of death were relapse (14.4%) and infection (9.6%). Outcome information is reported in the Table 2 and Plot A, B and C. One-year overall survival (OS), relapse-free survival (RFS) and GVHD-free/RFS (GFRFS) were respectively 75.6%, 70.3%, 60.4%. Table 3 summarizes the impact of the use of a different dose of ATG in acute GVHD and post-transplant outcome. No significant differences were found between the two groups that receive a different dose of ATG. However, median follow-up was shorter in the cohort that received 2mg/kg of ATG. Table 4 reports the main post-allo-HSCT information of patients diagnosed with AML. One-year OS, RFS and GRFRS for this subgroup of patients were 76.8%, 71.9% and 65.9%. Conclusion The unique and modern combination of RIC PB allo-HSCT using ATG, PTCY and CsA for GVHD prophylaxis results in impressive post-transplant outcomes using 10/10 MUD. The use of dual T-cell depletion with ATG and PTCy is safe and provides an extraordinary control of GVHD with acceptable relapse rates using PB stem cell 10/10 MUD grafts. ATG of only 2mg/kg when it is combined with PTCy and CsA, results in an effective control of acute GVHD rates. The optimal dose of ATG for GVHD prophylaxis is not well established. Further investigations need to be done to determine the efficacy of a lower dose of ATG controlling chronic GVHD in this setting. For patients diagnosed with AML, this protocol is safe and an effective approach when a 10/10 MUD is available. Disclosures Michelis: CSL Behring: Other: Financial Support. Mattsson:Celgene: Honoraria; Gilead: Honoraria; Therakos: Honoraria.