1100. Tandem Autologous Stem Cell Transplantation for Relapsed Hodgkin’s Disease Does Not Increase Risk of Infection
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

Tandem autologous stem cell transplantation (ASCT) is sometimes used in the treatment of high risk patients with relapsed Hodgkin’s disease (HD) who respond poorly to cytoreductive chemotherapy.  Data regarding infectious complications of this strategy is lacking. We hypothesized that tandem ASCT may lead to greater incidence of infection, increased length of hospital stay, and a significant increase in infection associated morbidity/mortality in the first year after transplant; resulting from a greater net state of immunosuppression and longer duration of immune reconstitution.

Methods: 

We performed a retrospective case-control study comparing patients with relapsed HD, treated with salvage chemotherapy and tandem ASCT to age and gender-matched controls treated with chemotherapy and a single ASCT.  Data on infections were collected from the bone marrow transplant registry at Cleveland Clinic and verified by review of electronic medical records.

Results: 

Sixty two patients were analyzed from 2002-2010.  Forty-eight percent were female.  Curative intent chemotherapy was administered at diagnosis to all patients.  All but one patient received salvage chemotherapy upon relapse prior to ASCT.  Ninety-four percent of cases (for their first ASCT) and controls received busulfan, cyclophosphamide, and etoposide as preparatory regimen prior to ASCT.  The preparatory regimen for the second transplant was melphalan.  The table compares infectious complications in patients who underwent tandem ASCT to those who underwent a single ASCT. 

 

 

Tandem ASCT (n = 31)

Single ASCT (n = 31)

P-value

Number of patients with any infection (%)

12 (38.7%)

11 (25.5%)

0.84

Absolute number of infections

19

17

0.76

Number of patients with >1 infection

4

3

0.84

Number of re-hospitalizations for fever

12

9

0.57

Length of hospitalization for ASCT (days)

15.7

22.1

<0.001

1 year mortality rate

16%

26%

0.36

Conclusion: 

Tandem ASCT for patients with relapsed HD does not increase the risk of infection or infection-related morbidity and mortality.  This affirms observational data of toxicity in trials performed to establish treatment efficacy for this modality.  Hospital length of stay is shorter after second ASCT compared to single ASCT.


Subject Category: O. Transplant infectious diseases

Christopher Kovacs Jr., MD, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, David van Duin, MD, PhD, Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH; Infectious Diseases, Medicine Institute and Transplant Center, Cleveland Clinic Foundation, Cleveland, OH, Matt Kalaycio, MD, Hematologic Oncology and Blood Disorders, Cleveland Clinic Foundation, Cleveland, OH, Robert Butler, MS, Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, Sherif Mossad, MD, Infectious Diseases, Medicine Institute and Transplant Center, Cleveland Clinic Foundation and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH and Brian Bolwell, MD, Hematologic Oncology and Blood Disorders, Cleveland Clinic, Cleveland, OH

Disclosures:

C. Kovacs Jr., None

D. van Duin, Pfizer: Consultant, Consulting fee
Astellas: Speaker's Bureau, Speaker honorarium

M. Kalaycio, None

R. Butler, None

S. Mossad, roche: Investigator, Research support
GSK: Investigator, Research support
Chimerix: Investigator, Research support

B. Bolwell, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.