Impacting VRE Rates on a Hematopoietic Stem Cell Transplant Unit

Abstract

Considering the disease status at SCT and response to prior chemotherapy (CT) we divided the pt in the following groups: 1) 64 pt in 1 st complete remission (CR) after 1 CT line, all with IPI!2; 2) 15 pt in 1 st CR after !2 CT lines; 3) 15 pt in 2 nd CR; 4) 19 pt with more advanced diseased. Rituximab (R) was used with CT in 78 pt before SCT. The 1 st line CT most frequently used was: R-CHOP: 71 pt (63%); CHOP: 28 pt (25%). Conditioning regimen was: 93 pt BEAM and 20 pt FEAM. Hematopoietic stem cells were collected from: peripheral blood (PB) in 100, bone marrow (BM) in 2, and PB+BM in 11 pt. The cause of death was: relapse/progression-17 pt; nonrelapsed mortality e 8 pt and secondary neoplasia 1pt. The median follow up of alive pt was 34 months (1-221). Overall survival (OS) at 1, 3 and 5 years was 85%(AE3); 75%(AE4); 73%(AE5). DFS at 1, 3 and 5 years was 84%(AE4); 80%(AE4); 75%(AE5) respectively. There were significant differences in OS between the 4 groups considered e table 2 (p<0.01). In univariate analysis OS was significantly better if: early stage at diagnosis, less than 2 CT lines before SCT, disease status before SCT in CR, first line CT with R-CHOP, PB stem cells. Conclusion: About 70 % of high-risk pt were free of disease after conventional CT followed by SCT. The outcome is influenced by disease status at SCT. Despite our results don't allow direct comparison of the impact of immunoCT with R, our pt in the R group had a better outcome. Most studies with SCT consolidation in these pt were performed in the pre-R era. There is as need to redefine the role of this treatment strategy nowadays. Further knowledge of prognosis factors is necessary, especially in young pt with high-risk disease at 1 st CR, to determine whether the SCT still improves outcome.