PracticeUpdate: Haematology & Oncology

ASH 2016 17

Clinical allogeneic transplantation: conditioning regimens, engraftment, and acute transplant toxicities Abstract 982: Transplant-associated thrombotic microangiopathy: prevalence, prognostic factors and treatment outcomes in unrelated allogeneic transplant for haematologic diseases. I Sakellari, I Batsis, Z Boussiouu, et al This retrospective study included 179 patients (74 men, 105 women, aged 37±14 years) who underwent HCT from matched HLA A/B/C/DRB1 (n=88) and allele- or antigen-mismatched (n=91) grafts and evaluated transplant-associated thrombotic microangiopathy (TA-TMA) to investigate prognostic factors and treatment outcomes. TA-TMA was diagnosed in 29 patients, which was significantly associated with severe acute GVHD on multivariate analysis. Of these patients with TA-TMA, 8 responded to cyclosporine cessation and plasma infusions, 14 responded to plasma exchange treatment, 1 patient who did not respond to plasma exchange responded to additional rituximab therapy, and the remaining 6 patients eventually succumbed to treatment-related refractory microangiopathic syndrome. This study suggests that TA-TMA is associated with GVHD, highlighting the importance of timely prevention and treatment strategies to prevent complications. Furthermore, TA-TMA is manageable in patients who respond to cyclosporine cessation and plasma exchange, but conventional treatment is inadequate in patients with refractory microangiopathic syndrome.

morphologically defined remission but MRD ≥ 5% exhibit outcomes similar to outcomes in patients who do not achieve morphological remission, suggesting that MRD should replace morphology in defining remission in this patient population. Chronic myeloid leukaemia: therapy Abstract 939: Upfront imatinib with selective early switching to nilotinib leads to excellent achievement of deep molecular response in chronic phase CML: 5 year (final) analysis of the TIDEL-II study. DT Yeung, MP Osborn, DL White, et al This study enrolled 210 patients with a median age of 49.7 years and newly diagnosed CML in chronic phase across 27 Australasian sites. Patients received imatinib (IM) and were switched to nilotinib (NIL) based on IM intolerance or failure to achieve timely molecular response. Prior to 24 months, 75 patients switched toNIL due to IM intolerance (n=20) or failing to achieve targets (n=55). The 5-year OS and transformation-free survival were 95% and 92%, respectively, with 86% of patients achieving major molecular response (MMR) and 59% of patients achieving MR 4.5 (BCR-ABL1 ≤ 0.0032%) by 60 months. Of these patients, 24% achieved MMR and 23% achieved MR 4.5 after switching to NIL. The median IM dose was 500 mg once daily. Only 9/51 patients who dose-escalated to 800 mg once daily remained on this dose through 60 months. These findings demonstrate the success of the combination strategy of IM and NIL through achievement of MR 4.5 in 59% of patients by 60 months.

with secondary AML, 77% achieved CR or CRi. The median relapse-free survival is 9.1 months, with 42% overall survival at a median of 10 months of follow-up. These results demonstrate the tolerability and favourable survival data in patients with AML treated with 33A plus hypomethylating agents. Acute lymphoblastic leukaemia: clinical studies Abstract 758 : Minimal residual disease assessment of remission after induction therapy is superior to morphologic assessment for risk stratification in childhood acute lymphoblastic leukemia: a report from the Children’s Oncology Group (COG). S Gupta, M Devidas, S Chen, et al This cohort of 9350 patients <31 years of age with B-ALL (n=7857) and T-ALL (n=1493) enrolled in COG trials underwent bone marrow assessment of remission following induction therapy via morphology and MRD to evaluate outcomes and for risk assessment. Because few patients with M2/M3 marrows had discordant low MRD values, analyses were restricted to patients with M1 morphology and MRD ≥ 5%. Discordance was significantly more common among patients with T-ALL compared with B-ALL. Patients with B-ALL who had M1 morphology and discordant MRD exhibited improved 5-year event-free survival (EFS) compared with patients with M2 morphology and discordant MRD, but exhibited inferior EFS compared with patients with M1 morphology and discordant MRD. Patients with T-ALL had similar 5-year EFS for M1 and M2 morphologies with discordant MRD. These findings demonstrate that patients with

© ASH 2016

VOL. 2 • NO. 1 • 2017