Syed A. Abutalib, MD
The BMT Tandem Meetings are the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society of Blood and Marrow Transplantation. Held recently in Honolulu, Hawaii, this year’s BMT Tandem Meetings drew 3,000 attendees from 35 countries, with 785 abstracts presented on new developments in research, transplantation, donor selection, and more. Four important abstracts are discussed below. For the full study abstracts, visit www.bbmt.org/issue/S1083-8791(15)X0004-8.
Depression and Transplantation
Abstract 4: Association of pretransplant depression with clinical outcomes and resource utilization after allogeneic hematopoietic cell transplantation1
Question Asked: What is the impact of an existing diagnosis of depression in adults prior to allogeneic hematopoietic cell transplantation?
Abstract Conclusion: In this retrospective analysis (2008–2012), pre–hematopoietic cell transplantation depression was associated with higher mortality (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.04–1.23, P = .004), fewer days out of the hospital in the first 100 days after hematopoietic cell transplantation (means ratio = 0.97, 95% CI = 0.95–0.99, P = .004), and higher risk of grades II–IV, acute graft-vs-host disease (HR = 1.25, 95% CI = 1.14–1.37, P < .0001). These data support early and appropriate medical and psychological interventions in this particular group of patients. (Also see abstract 10.2)
Abstract 9: Risk factors for human papillomavirus reactivation in the genital tract of female hematopoietic cell transplant survivors3
Question Asked: What is the incidence of human papillomavirus (HPV) disease after allogeneic hematopoietic cell transplantation? Importantly, the cohort of patients studied here had a median age of 36 years (range, 10–68), acute leukemia was the most frequent diagnosis (45%), and 93% received myeloablative ex vivo T-lymphocyte–depleted grafts.
Abstract Conclusion: In this prospective long-term study, the cumulative rates of genital infection with HPV at 1, 3, 5, 10, and 20 years were 4.8%, 14.9%, 28.1%, 36.7%, and 39.7%, respectively. Among all women studied, 18% (n = 15) had an abnormal Pap test prior to transplant, which was the strongest risk factor for persistent HPV infection. This study highlights the wide window of opportunity for HPV vaccination and stresses the need for regular gynecologic follow-up.
Abstract 23: Updated efficacy and safety data from the trial of consolidation with brentuximab vedotin after autologous hematopoietic cell transplant in Hodgkin lymphoma patients at high risk of relapse4
Question Asked: What is the impact of brentuximab vedotin (Adcetris) maintenance therapy compared to placebo?
Abstract Conclusion: Results of this phase III, randomized, placebo-controlled trial showed a sustained plateau, with improved progression-free survival at 3 years post randomization with brentuximab vedotin consolidation (not reached; n = 165) vs placebo (15.8 months; n = 164). The 3-year progression-free survival rate was 61% (95% CI = 53%–68%) for the brentuximab vedotin arm and 43% (95% CI = 36%–51%) for the placebo arm. No additional secondary malignancies have been observed, and most patients experienced resolution of peripheral neuropathy symptoms associated with brentuximab vedotin.
Relapsed Multiple Myeloma
Abstract 64: Efficacy and safety of carfilzomib, lenalidomide, and dexamethasone vs lenalidomide and dexamethasone in patients with relapsed multiple myeloma after autologous hematopoietic cell transplantation: Secondary analysis from the phase III Aspire study (NCT01080391)5
Question Asked: What did this phase III trial show regarding progression-free survival, overall response rate, and adverse events for these two treatment regimens?
Abstract Conclusion: Median progression-free survival was 26.3 months for carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone vs 17.8 months for lenalidomide and dexamethasone (HR = 0.68, 95% CI = 0.526–0.873). The overall response rate was 90.3% and 65.5% for carfilzomib/lenalidomide/dexamethasone and lenalidomide/dexamethasone, respectively (odds ratio = 4.92, 95% CI = 2.905–8.319). Grade ≥ 3 adverse events occurred in 87.4% and 79.5% of carfilzomib/lenalidomide/dexamethasone and lenalidomide/dexamethasone recipients, respectively. ■
Disclosure: Dr. Abutalib reported no potential conflicts of interest.
1. El-Jwahri A, Chen Y-B, Brazauskas R, et al: Association of pre-transplant depression with clinical outcomes and resource utilization after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 22(3 suppl):S22-S23, 2016.
2. El-Jawahri A, Wood B, Cutler CS, et al: Self-reported depression and anxiety by patients with chronic graft-versus-host disease identify a group with worse quality of life, symptoms, and functional status. Biol Blood Marrow Transplant 22(3 suppl):S27, 2016.
3. Shanis D, Anandi P, Grant C, et al: Risk factors for human papilloma virus reactivation in the genital tract of female stem cell transplant survivors. Biol Blood Marrow Transplant 22(3 suppl):S26, 2016.
4. Sweetenham JW, Walewski J, Nademanee A, et al: Updated efficacy and safety data from the AETHERA trial of consolidation with brentuximab vedotin after autologous stem cell transplant (ASCT) in Hodgkin lymphoma patients at high risk of relapse. Biol Blood Marrow Transplant 22(3 suppl):S36-S37, 2016.
5. Hari PN, Song K, Bensinger W, et al: Efficacy and safety of carfilzomib, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone in patients with relapsed multiple myeloma after autologous stem cell transplantation: Secondary analysis from the phase 3 Aspire study (NCT01080391). Biol Blood Marrow Transplant 22(3 suppl):S66-S67, 2016.