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  • 1
    Online Resource
    Online Resource
    Unmanipulated Haploidentical Transplant Followed By Post-Transplant Cyclophosphamide and Selective Ex Vivo T-Cell Depleted Haploidentical Transplant Results in Comparable Outcome As Unrelated Cord Blood Transplant for Adults with Haematological Malignancies- a Multicenter Study in Singapore
    American Society of Hematology ; 2019
    In:  Blood Vol. 134, No. Supplement_1 ( 2019-11-13), p. 4588-4588
    Details
    In: Blood, American Society of Hematology, Vol. 134, No. Supplement_1 ( 2019-11-13), p. 4588-4588
    Abstract: Background: Outcomes after haploidentical (Haplo) haematopoietic cell transplantation (HCT) and after unrelated cord blood transplantation (UCBT) are encouraging and have become alternative options to treat patients with high-risk haematological malignancies without human leukocyte antigen (HLA) matched related or unrelated donor. There is paucity of data comparing the outcome of UCBT and haplo HCT. We retrospectively analyse and compare the outcome of adult patients with haematological malignancies receiving UCBT and haplo HCT using two different platform for graft-versus-host disease (GVHD) prophylaxis: selective ex-vivo T cell (TCRαβ and CD45RA+) depleted haplo HCT (Koh LP et al. Blood 2018; 132: 2093a) vs unmanipulated T cell replete haplo HCT with high dose posttransplant cyclophosphamide (PTCy). Methods: We studied 169 adults patients receiving allogeneic HCT using 4-6/6 HLA matched UCB (n=100) graft or Haplo (n=69) for various haematologic malignancies between Aug 2006 and July 2019, following myeloablative (MAC, n=76) or reduced intensity conditioning (RIC, N=93) regimen. 37 Haplo patients received unmanipulated non ex-vivo, T cell depleted graft followed by PT Cy for graft-versus-host disease (GVHD) prophylaxis (Haplo PTCy), whereas 32 patients received haplo-HCT with selective ex vivo T cell (TCRαβ and CD45RA+) depleted grafts for GVHD prophylaxis (Haplo-TCD). Results: Two year overall survival (OS) for patients undergoing UCB, Haplo PTCy and Haplo-TCD transplant were 46%, 54% and 55% (p=0.379), and event free survival (EFS) were 41%, 50% and 45% (p=0.573), respectively; these were not significantly different among the 3 groups. Two year cumulative incidence (C.I.) of non-relapse mortality (UCB 32% vs Haplo PT Cy 20% vs 31%; p=0.514), relapse-related mortality (RRM) (UCB 24% vs Haplo PT Cy 21% vs 16%; p=0.596) and grades 3 - 4 acute GVHD at 6 months (UCB 9% vs Haplo PT Cy 6% vs 10%; p=0.758) were not significantly different among the 3 groups. However, C.I. of chronic GVHD at 2 years was higher in PTCy as compared with others (Haplo PT Cy 28% vs UCB 4% and Haplo TCD 5%, respectively, P 〈 0.001). Multivariable analysis showed a significant association with OS and EFS for disease risk index (DRI) (p 〈 0.001) and HCT comorbidity index (p 〈 0.001), with no statistically significant impact from the type of stem cell graft used. In patients with low/intermediate risk DRI, the 2 year OS for TCD, PTCy and UCB were 71%, 55% and 56%, respectively (p=0.729), and the corresponding 2 year LFS were 59%, 54% and 48%, respectively (p=0.994). In patients with high/very high risk DRI, the 2 year OS for TCD, PTCy and UCB were 19 %, 51% and 18%, respectively (p=0.177), and the corresponding 2 year LFS were 0 %, 18% and 18%, respectively (p=0.774). Conclusions: Haploidentical HCT using either unmanipulated graft and PTCy or selective Ex Vivo TCRαβ and CD45RA+ depleted graft results in equivalent outcome to those HCT performed using UCB. It provides additional alternative for patients lacking HLA matched donors. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2019-125261
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2019
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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  • 2
    Online Resource
    Online Resource
    Asian Experience of Treating Venous Thromboembolism in Patients with Acute Leukaemia
    American Society of Hematology ; 2019
    In:  Blood Vol. 134, No. Supplement_1 ( 2019-11-13), p. 1161-1161
    Details
    In: Blood, American Society of Hematology, Vol. 134, No. Supplement_1 ( 2019-11-13), p. 1161-1161
    Abstract: Background Cancer is a known risk factor for venous thromboembolic (VTE) events. Thromboembolism occurs frequently during acute leukemia and the reported incidence of VTE in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are 5% and 6% respectively. However, majority of studies are conducted in Western population and data on VTE events in Asians with acute leukemia is scarce with only 1 published study. Objectives We aim to retrospectively evaluate the risk of thrombosis in Asian patients with acute leukemia and share our experience treating them. Patients and Methods This was a retrospective analysis on 257 adult patients who had presented to our centre from 1st January 2009 to 31st December 2017 with acute leukemia. There were 69 ALL, 9 acute promyelocytic leukemia (APL; M3 AML), 177 non-M3 AML and 2 acute biphenotypic leukemia (BAL). VTE events were identified to be those with clinical symptoms of VTE and had objective diagnostic imaging findings. Results Among the 257 patients, there were 65% Chinese (n=166), 26% Malays (n=67), 5% Indians (n=12), 4% others (Bengali, Emiratis, Eurasians and Filipinos). The overall incidence of VTE was 8% (n=21). The incidence of VTE was 16% in ALL (11 out of 69), 22% in APL (2 out of 9) and 5% in non-M3 AML (8 out of 177). VTE was present at time diagnosis of leukemia in 0.7% of the patients (n=2). At 1 month from diagnosis of leukemia, the cumulative incidence (C.I) of thrombosis was 2.3% (n=6). At 6 months from diagnosis of leukemia, the C.I. of thrombosis was 5.8% (n=15). There were 48% line-related deep vein thrombosis (n=10), 19% non-line related deep vein thrombosis (n=4), 14% pulmonary embolism (n=3), 14% cerebral venous thrombosis (n=3) and 5% portal vein thrombosis (n=1). All 10 cases with line-related deep vein thrombosis had the line removed. All 3 cases of cerebral venous thrombosis occurred in patients with ALL on a L-Asparaginase containing regimen. Seventeen out of 21 patients with VTE were treated with anti- coagulation. Four out of 21 patients did not receive any anti-coagulation due to thrombocytopenia. Of those who received anti-coagulation, 80% (n=14) received full dose anti- coagulation while 20% (n=3) received reduced dose anti- coagulation. In all 3 cases, the dose of anti- coagulation was reduced due to thrombocytopenia. Thirty-five percent received the full duration of anti- coagulation, 65% had anti-coagulation stopped earlier due to severe thrombocytopenia. The median duration of anti- coagulation received was 82 days. The mortality rate due to VTE was 0.4% (n=1). This patient had massive pulmonary embolism with hemodynamic instability and demised within hours of diagnosis of pulmonary embolism. None of the patients had bleeding complications. Recurrent thrombosis occurred in 14% (n=3) of patients. All 3 patients had ALL and had completed the full duration of full dose anti- coagulation. None of the patients who did not receive anti-coagulation, received reduced dose anti-coagulation or had their anti-coagulation stopped earlier developed recurrent thrombosis. Conclusion The incidence of VTE in Asians with acute leukaemia is similar to that of the Western population. Main risk factors for thrombosis are that of line or chemotherapy related. The treatment of VTE remains challenging due to thrombocytopenia, with only 35% being able to complete the full course of treatment. However, despite so, there were no fatalities or recurrent thrombosis among those who were not started on therapy or did not have a full course of therapy. The role and duration of anti-coagulation needs to be explored in a prospective trial. Table. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2019-130041
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2019
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Thrombotic Complications in COVID-19 Patients: Low Incidence of Thrombotic Complications Among Critically Ill COVID-19 Patients in Singapore
    American Society of Hematology ; 2020
    In:  Blood Vol. 136, No. Supplement 1 ( 2020-11-5), p. 37-38
    Details
    In: Blood, American Society of Hematology, Vol. 136, No. Supplement 1 ( 2020-11-5), p. 37-38
    Abstract: Objective Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients. This study aims to describe the thrombotic and bleeding rates in COVID-19 patients admitted to intensive care units (ICU) in Singapore. Design Retrospective observational study involving all consecutive adult COVID-19 patients who required ICU admission between 23 January 2020 and 30 April 2020. Setting National multicenter study involving all eight public hospitals in Singapore. Patients 111 consecutive COVID-19 patients who required ICU admission were included. Measurements and Main Results Primary outcome was any venous or arterial thrombotic events occurred in ICU. Other measures included (1) the overall, venous and arterial thrombotic events throughout the hospitalisation, (2) major and minor bleeding events. The overall thrombotic rate in ICU was 11.7% (n=13), with 1.8% (n=2) venous and 9.9% (n=11) arterial events. The overall thrombotic rates throughout hospitalisation, censored at 30 April 2020, increased to 18.0% (n=20) with 6.3% (n=7) venous and 11.7% (n=13) arterial events. Major and minor bleeding rates were 14.8% (n=16) and 3.7% (n=4), respectively. Two-third of the patients received pharmacological thromboprophylaxis in ICU. Conclusions Critically ill COVID-19 patients in Singapore have lower VTE but higher arterial thrombosis rates with higher bleeding manifestations than other reported cohorts. Standard thromboprophylaxis may be sufficient to prevent thrombotic complications in patients with similar demographics. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2020-138610
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2020
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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    Online Resource
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