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Immunomodulatory drugs (IMiDs) may favor autoimmune disease (AD) occurrence. We conducted a retrospective study to evaluate AD occurrence among IMiD-treated patients with myeloma. Patients were grouped into three classes depending on the type of IMiD engaged. The first group included patients treated with thalidomide (Thal) (n = 474), the second group with lenalidomide (Len) (n = 140) and patients in the third group were first treated with Thal followed by Len (Thal-Len) (n = 94). Absolute risk of AD was 0.4% for patients treated with Thal, 4.3% for Len and 1.1% for Thal-Len. ADs manifested prevalently as autoimmune cytopenias (55%), although we observed one vasculitis, one optic neuritis, one Graves' disease and one polymyositis. ADs occurred preferentially in the first months of IMiD treatment. A previous autologous transplant was shown to be a significant risk factor. All ADs were managed with IMiD discontinuation and steroids, resolving in a few weeks, except for Graves' disease and polymyositis.

To the editor: Graft-versus-host disease (GVHD), both acute and chronic, is still a leading cause of nonrelapse mortality after transplantation.[1][1] High-dose, posttransplantation cyclophosphamide (PTCy) is an attractive approach for in vivo allodepletion across the HLA barrier in allogeneic

Central nervous system myelomatosis (CNS MM) is a rare localization of multiple myeloma (MM) affecting fewer than 1% of patients. This condition has been treated with intrathecal therapy, cranial i...

Patients with advanced refractory Hodgkin Lymphoma (HL) may obtain long-term cure from haploidentical SCT. We experienced a package of haploidentical peripheral blood stem cell transplantation after Treosulfan-based conditioning and Rapamycin GvHD prophylaxis. Between July 1999 and June 2016, 57 patients with classical relapsed/refractory Hodgkin Lymphoma underwent an allogeneic stem cell transplantation (alloSCT) at san Raffaele Scientific Institute in Milan (Italy). Eleven patients received a matched related donor alloSCT, 7 patients received a matched unrelated donor alloSCT, one patient underwent a double cord blood transplant and 38 patients, lacking identical related or unrelated donor, received an haploidentical transplant (haploSCT); 32 out of 38 patients underwent an unmanipulated peripheral blood stem cell transplant. This retrospective study analyzes the outcome of these 32 patients allografted after a Treosulfan based conditioning and a backbone GvHD prophylaxis with the mTOR inhibitor Rapamycin. Median age at alloSCT was 30 years; twenty patients (62,5%) had a primary refractory disease. Median number of previous lines before haploSCT was 4 (range 2-8); thirty patients (94%) received at least one or more autologous stem cell transplant and 12 of them were considered in an auto-allo program. Median time from diagnosis to haploSCT were 30 months (range 8-146). At haploSCT after receiving the last salvage treatment, 10 patients were in complete remission (CR), 6 were in partial remission (PR) and 16 patients had progressive disease (PD). A combination of Melfalan or Thiotepa or TBI4Gy to Treosulfan mieloablative conditioning regimens (MAC) were used in 16 (50%) patients; the others received a Treosulfan-alone based reduced intensity conditioning regimen (RIC). GvHD prophylaxis consisted of in vivo T cell depletion with pre transplant anti-Thymocyte Globulin (ATG) in 19 patient and of post transplant Cyclophosphamide (PT-Cy) in 13 patients; all patients received also Mycophenolate Mofetil till day + 30 and Rapamycin till day + 90. Median numbers of infused CD34+/Kg were 5,4 x 10^6 (range 5-5,8) and median numbers of infused CD3+/Kg were 2.34 x 10^8 (range 1.00-4.76). Median follow up was 46 months (range 1-109); two and 4 years Overall survival (OS) was 52% and 48% respectively, Progression Free Survival (PFS) and Relapse Incidence (RI) were 29% and 59% at both two and four years. Transplant related mortality was 9.5% at 100 days, 13% at 1 year and for the entire follow-up. The 100-day Cumulative Incidence (CI) of grade ≥ 2 and grade ≥ 3 aGvHD were 31% and 19% respectively; CI of cGvHD was 38% and CI of moderate-severe cGvHD was 27% at both a 2 and 4 years. No difference in OS, PFS, RI were found if patients were stratified according to disease status at transplant or according to the use of ATG or PT-Cy. CI of cGvHD and CI of moderate-severe cGvHD were significantly better after RIC regimens vs MAC ones (p value 0.01 and 0.001 respectively), but no difference were found between the two groups in term of OS, PFS and RI. Twelve out of twenty-two patients with active disease at haploSCT achieved a CR after transplantation and median time from aploSCT to CR was 3 months (range 2-6); six of them (4 PD and 2 PR at transplant) achieved and maintained a CR for the entire follow-up without the need for other post transplant treatment. Unmanipulated peripheral blood haploSCT after Treosulfan based conditioning regimen and GvHD prophylaxis with Rapamycin is feasible, even in heavily pretreated patients and with active disease, with acceptable toxicities. Intensification of conditioning increased the toxicities. Disease relapse or progression was the major cause of treatment failure in our series, but 22 patients (69%) had detectable disease at the time of transplant. Six out of those very poor prognosis patients (28%) achieved a long term CR. Hodgkin Lymphoma is characterized by high mTOR activity, and Rapamycin is known to inhibit in vitro and in vivo cell proliferation and to induce apoptosis in Lymphoma cells. Rapamycin in these patients could have played an important role in disease control in immediate post transplant phase by increasing the apoptotic effect of chemotherapeutic agents, until the onset of the Graft versus Lymphoma effect. Disclosures Bonini: Molmed SpA: Consultancy; TxCell: Membership on an entity's Board of Directors or advisory committees. Ciceri:MolMed SpA: Consultancy.

Introduction Voriconazoleis a second-generationtriazolebroad-spectrum antifungal agent indicated in adults and children aged 2 years and above as treatment of invasive aspergillosis, treatment ofcandidaemiain non-neutropenic patients (pts), treatment of fluconazole-resistant serious invasive Candida infections, treatment of serious fungal infections caused byScedosporiumspp. and Fusarium spp. Voriconazoleis associated with a broad spectrum of dermatologically adverse reactions: it seems to be responsible for a multistep process beginning with acute and chronicphototoxicity, followed by actinic keratosis (AK), and finally skin squamous cell carcinoma (SCC), especially if therapy is maintained. Strictphotoprotectionis mandatory; drug replacement by anothertriazolemust be discussed in case of acutephototoxicity.Voriconazolemust be stopped in pts with chronicphototoxicity, and a long-term dermatologic follow-up of skin lesions is required even after withdrawal. It is now established thatvoriconazoleis an independent risk factor for the development of cutaneous malignancy in lung transplant recipients. Recently, a retrospective study from the Mayo Clinic (WojenskiDJ et al, Transplant Infectious Disease 2015, 17, 250-58) confirmed the association betweenvoriconazoleand SCC also after allo-HSCT (allogeneic hematopoietic stem cell transplantation) and identified cumulative days ofvoriconazoleas a risk factor for SCC. Methods The current study seeks to analyze the correlation betweenvoriconazoleexposure and non-melanoma skin cancer (NMSC) in our Center, where it is available an intensive dedicated follow-up after allo-HSCT to prevent and early detect second solid tumors. Results We analyze data prospectively collected at our Long-Term Follow-Up clinic between 2011 and 2016 including 302 adult pts with a minimum follow-up of 24 months. A written consent was given by pts allowing the use of medical records for research in accordance with the Declaration of Helsinki. Baseline characteristics of the 302 pts are outlined in table 1. In total, 25 pts developed NMSC - median time from allo-HSCT 42 months (range, 9 months - 20 years) - median follow-up after NMSC diagnosis 2 years (range, 2 months - 12 years). The estimated cumulative incidence of NMSC at 3 years was 3.2% and at 5 years 6.2%. At the dermatological annual evaluation 3 pts were presenting AK, only one progress to basal cell carcinoma (BCC), the 2 pts with AK are under dermatological follow-up. All pts were treated withvoriconazolefor more than 180 days. In total 19 pts were diagnosed with BCC and 6 pts with SCC. Five pts with SCC and 17 with BCC were treated withvoriconazole, overall 16/22 (4 SCC) for more than 180 days. All pts were treated according to standard practice for NMSC, unfortunately 1 pts deceased due to SCC progression. Only 2 pts were diagnosed and treated for NMSC before transplantation. Six pts had antecedent acute GvHD and 8 pts had antecedent moderate to severe chronic GvHD. History ofvoriconazoleexposure, cumulative days ofvoriconazoleuse, gender, age at transplant, TBI based conditioning regimen, acute/chronic GvHD and skin cancer pre-transplant were considered for analysis. Age at transplant above 48 years (p Conclusions Our experience confirms the correlation betweenvoriconazoleand occurrence of NMSC after allo-HSCT. Incidence of NMSC is higher than previously reported in registry reports, and the occurrence of NMSC in pts exposed tovoriconazoleseems to be precocious. This observation confirms the relevance of counseling and prevention of NMSC in patients benefiting fromvoriconazoleas a crucialmold-active antifungal prophylaxis and treatment. Disclosures Bonini: Molmed SpA: Consultancy; TxCell: Membership on an entity's Board of Directors or advisory committees. Ciceri:MolMed SpA: Consultancy.

Introduction Tyrosine kinase inhibitor (TKi) has become the standard of care in patients (pts) with chronic myeloid leukemia (CML) and an unavoidable tool in the combined therapy for pts with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL). Nevertheless, because of resistance to TKI and side-effects, allogeneic stem cell transplantation (HSCT) remains the standard therapy of ALL Ph+ and of CML pts failing 1st line therapy with TKi, with failure or insufficient response or intolerance or mutations resistant to 2nd generation TKI, or in the advanced phase at diagnosis (accelerated phase and blast crisis). Unfortunately, despite greater remission with the use of TKi pre-transplant, HSCT transplant outcome have not improved largely due to high incidence of relapse after transplant. In the past decade several multi-institutional studies confirmed the feasibility and safety of post-HSCT imatinib administration as prophylactic or therapeutic strategy. Second and 3rd generation TKi administration after HSCT - targeting mutational status and according to pre-HSCT activity - is today under investigation. Methods Here we are reporting our experience in post-HSCT treatment with the 3rd generation TKi ponatinib in 5 pts (4 CML, 1 ALL Ph+) treated between 2011 and 2016 at our Institution. Pts data and information were collected from Institutional database and chapters revision. A written consent was given by pts allowing the use of medical records for research in accordance with the Declaration of Helsinki. Results Pts and diseases features are reported in table 1. Stem cell source was peripheral blood in all cases, 3 pts were transplanted from a family mismatched donor (haplo), 1 from a family matched donor, 1 from a matched unrelated donor (MUD). The 3 haplo-transplanted pts previously underwent a MUD HSCT. All pts received a treosulfan based conditioning regimen and GvHD prophylaxis consisted on co-administration of MMF and rapamycin. Pre-transplant treatment for the ALL Ph+ consisted of chemotherapy combined with dasatinib, followed by a first MUD HSCT and dasatinib in maintenance. The patient relapsed 1 year after HSCT with documentation of mutation V299L. Ponatinib was introduced as salvage treatment to bridge second haplo HSCT. Pre-transplant treatment for the CML patients consisted of TKi therapy with combination of chemotherapy in case of uncontrolled progression of disease. Two pts received a first MUD HSCT but relapsed respectively 5 months and 4 years later. Four pts received ponatinib 45 mg daily before the last HSCT: one patient achieved sustained major molecular response, 3 pts obtained transient response. All pts were presenting 2nd generation TKi resistant mutation (ref table 1). Ponatinib was started at a median time of 157 days after HSCT (range, 117-583): in 3 cases as salvage treatment in overt relapse, while in one case as prophylaxis and one case as preemptive therapy. Acute GvHD was diagnosed in 4 pts before ponatinib administration, 2 of them also experienced chronic GvHD. No new cases of GvHD were observed after initiation of ponatinib. Immunosuppressive treatment and azoles treatment were discontinued before ponatinib in all but one patient who was under combined treatment for chronic GvHD: therapeutic drug monitoring was closely performed without evidence drug-drug interaction. Pts were regularly evaluated for toxicities. No serious adverse events were reported in our experience: we administered ponatinib at a median maximum dosage of 30 mg daily (range, 15-45 mg), for a median of 24 weeks (range, 4 - 116 weeks). Two pts required anti hypertension drugs. One patient was closely monitored for multifactorial liver cholestasis never requiring ponatinib discontinuation. At last evaluation one patient maintained the status of molecularly undetectable leukemia (follow-up post HSCT 30 months) and two pts obtained molecular response (follow-up post HSCT 25 months and 5 months). Two patients who received therapeutic ponatinib in overt relapse didn't respond and died for progressive disease. Conclusions Ponatinib is safe and well tolerated as bridge to HSCT and to maintain the disease control after transplant. Prophylaxis targeted therapy and pre-emptive therapy with ponatinib may lead the reduction of disease relapse for high-risk Ph+ leukemia. Disclosures Bonini: Molmed SpA: Consultancy; TxCell: Membership on an entity's Board of Directors or advisory committees. Ciceri:MolMed SpA: Consultancy.

Introduction Pre-transplant risk assessment is a crucial issue to improve the HCT decision-making process. Several transplant-related models have been designed to optimize decision-making about suitable candidates for allogeneic HCT. The refined Disease Risk Index (DRI) was developed to stratify disease risk acrosshistologiesand HCT regimens. However, few recipients of haploidentical HCT were originally included in the DRI study cohorts. In 2015 a first large cohort of non-myeloablativehaploidentical HCT with post-transplant cyclophosphamide (PTCy) confirmed the validity of DRI also in this setting. Beside this, in the past few years the novel composite end point of GVHD-free, relapse-free survival (GRFS) after HCT spreads out. GRFS acknowledge that both survival and rates of grade 3-4 acute GVHD, chronic GVHD requiring systemic treatment, relapse, or death are clinically meaningful. GRFS therefore represents ideal recovery from HCT and a measure of cure without ongoing morbidity. Methods We analyzed risk-stratified GRFS according to the refined DRI in haploidentical HCT at our Center, where it was exploited - since 2006 - asirolimus-based,calcineurininhibitor-free prophylaxis of GvHD to allow the safe infusion of unmanipulated haploidentical HCT. We analyze data collected between 2006 and 2014 including 207 adult pts. Data were prospectively collected in Institutional database. A written consent was given by pts allowing the use of medical records for research in accordance with the Declaration of Helsinki. All consecutive pts receiving a haplo HCT as 1st allogeneic transplantation were included - pts receiving haplo HCT as 2nd or 3rd HCT were excluded from the present analysis. Results Baseline characteristics of the 207 pts are outlined in table 1. With 4-year median follow-up, 4-year probabilities of transplant related mortality (TRM),relapse, progression-free survival (PFS), and overall survival (OS) were 25,8%, 42,5%, 31,7%, and 34,4%, respectively. Day-100 cumulative incidence of grade II-IV and III-IV acute graft-versus-host-disease (GvHD) were 30,1% and 15,5% respectively. The 4-year cumulative incidence of chronic GvHD was 33,5% (moderate-severe chronic GvHD 26,2%). Considering the composite end point of GRFS, for the entire population the 4-year GRFS was 17,8%. By refined DRI group, low-intermediate (n 69), high (n 105), and very high (n 33) risk groups had 4-year GRFS estimates of 31,1%, 13,7%, and 3,0% (p < .0001), with corresponding 4-year OS estimates of 56,7%, 28,9%, and 6,1% (p < .0001). On a multivariable Cox model we considered as covariates age, host/donor sex mismatch, host/donor CMV status, stem cell source, conditioning intensity, GvHD prophylaxis ATG-based versusPTCy-based, DRI stratification, HCT Comorbidity Index Score (HCT-CI). On multivariable analyses, the DRI was statistically significantly associated with GRFS, OS, PFS, relapse, TRM and grade II to IV acute GvHD (ref table 2). HCT-CI was statistically significantly associated with GRFS, OS, PFS and TRM. Conditioning intensity was associated with PFS and relapse, while GvHD prophylaxis (PTCyvs ATG) was only associated with OS. Interestingly no risk factors were clearly emerging for chronic GvHD. Conclusions The combination of a refined DRI and GRFS provide a valid tool to improve the HCT decision-making process and will help optimize patient outcomes. Disclosures Ciceri: MolMed SpA: Consultancy.

Rescue chemotherapy or autologous stem cell transplantation (autoSCT) gives disappointing results in relapsed peripheral T-cell lymphomas (PTCLs). We have retrospectively evaluated the long-term outcome of 52 patients receiving allogeneic SCT for relapsed disease. Histologies were PTCL-not-otherwise specified (n = 23), anaplastic large-cell lymphoma (n = 11), angio-immunoblastic T-cell lymphomas (n = 9) and rare subtypes (n = 9). Patients were allografted from related siblings (n = 33, 64%) or alternative donors (n = 13 (25%) from unrelated and 6 (11%) from haploidentical family donors), following reduced-intensity conditioning (RIC) regimens including thiotepa, fludarabine and cyclophosphamide. Most of the patients had chemosensitive disease (n = 39, 75%) and 27 (52%) failed a previous autoSCT. At a median follow-up of 67 months, 27 of 52 patients were found to be alive (52%) and 25 (48%) were dead (n = 19 disease progression, n = 6 non-relapse mortality (NRM)). The cumulative incidence (CI) of NRM was 12% at 5 years. Extensive chronic graft-versus-host disease increased the risk of NRM (33% versus 8%, P = 0.04). The CI of relapse was 49% at 5 years, influenced by disease status at the time of allografting (P = 0.0009) and treatment lines (P = 0.007). Five-year overall survival and progression-free survival (PFS) were 50% (95% CI, 36 -63%) and 40% (95% CI, 27 - 53%), respectively. The current PFS was 44% (95% CI, 30-57%). In all, 8 out of 12 patients (66%) who received donor-lymphocytes infusions for disease progression had a response. At multivariable analysis, refractory disease and age over 45 years were independent adverse prognostic factors. RIC allogeneic SCT is an effective salvage treatment with a better outcome for younger patients with chemosensitive disease. Leukemia (2012) 26, 520-526; doi:10.1038/leu.2011.240; published online 9 September 2011

The present study retrospectively analyzed a cohort of consecutive relapsed/refractory Hodgkin lymphoma (RR-HL) patients receiving allogeneic stem cell transplantation (alloSCT) in a single center with a thiotepa-based conditioning to understand whether the timing of relapse after autologous stem cell transplant (ASCT) or the primary refractory disease would change the survival. Of 247 patients with HL referred to our division from 2001 to 2014, 109 had RR-HL (64 primary refractory). After receiving salvage treatment, 62 patients (57%) underwent alloSCT with a thiotepa-based conditioning; 4 patients (4%) received fludarabine-melphalan conditioning in a phase II study, 43 patients (39%) did not receive alloSCT for progressive disease (31), advanced age (>65 years, 3 patients) or for achieving a complete response after a third-line chemotherapy consolidated by ASCT (9). This study analyzes the outcomes of the 62 consecutive patients allografted with thiotepa-based conditioning, which consisted of thiotepa, fludarabine, and cyclophosphamide (TFC) for patients with an HLA identical sibling donor, TFC plus anti-thymocyte globulin for matched unrelated (MUD) donors, TFC plus alemtuzumab and 2-Gray (Gy) total body irradiation (TBI) for T-deplete haploidentical alloSCT, or TFC plus 2-Gy TBI and post-transplant cyclophosphamide for T-replete haploidentical alloSCT. Multivariate analysis of alloSCT outcomes included as covariates the pre-transplant disease status (CR vs PR vs resistant), donor (HLA identical, MUD, or T-deplete or T-replete haploidentical), primary refractory disease (yes vs no) and timing of relapse after ASCT (12 mos vs no ASCT). Patients had a median of 33 years at alloSCT, 76% of them had a primary refractory disease at diagnosis. 74% of patients relapsed 12 months after ASCT, 11% underwent alloSCT without previous ASCT. At alloSCT, 25% had resistant disease whereas 75% were in partial (31%) or complete response (44%) after the last salvage treatment. Donors were HLA identical siblings (42%), MUD (29%), or haploidentical (21% T-deplete, 8% T-replete). Median follow-up was 5.4 years. Three- and 5-years OS was 61 and 59%, PFS and relapse incidence were 46% and 38% at both 3 and 5 years. Non-relapse mortality (NRM) was 10% at 100 days, 17% at 1 year and for the entire follow-up. In multivariate analysis, the timing of relapse after ASCT and primary refractory disease did not impact the transplant outcomes. OS was reduced by resistant disease at alloSCT (HR=4.01, CI95% 1.34-11.97, p=0.012) and by T-depleted haploidentical transplant (HR=3.81, CI 95% 1.36-10.66, p=0.010). PFS and relapse incidence were impacted only by resistant disease (HR=5.54, CI 95% 2.13-14.37, p In conclusion, the pre-transplant disease status and not the timing of relapse after ASCT or primary refractory disease, impacts OS, PFS and relapse of RR-HL patients allografted with thiotepa-based conditioning. An optimal response before alloSCT is critical to maximize the long-term benefit of alloSCT. In the era of novel agents this can be a realistic goal for the majority of patients. Disclosures Viviani: Takeda Italia SpA: Consultancy; Teva Italia SpA: Consultancy; Italfarmaco SpA: Consultancy; Takeda International: Consultancy.

Introduction Allogeneic hematopoietic cell transplantation (HCT) is an effective therapeutic option for high-risk hematological malignancies; 80% of those who survive the first 2 years are expected to become long-term survivors. The prevalence of chronic health conditions approaches 75% among HCT survivors and that for severe or life-threatening conditions exceeds 20%. Patients and Methods A standardized follow-up of HCT survivors is applied at our Center, according to Jacie Standards. Here we report the analysis of data collected between July 2014 and July 2015 in 260 adult patients (pts) who underwent an HCT between 1992 and 2014. Data on 7 items - selected to monitor relevant comorbidities - were prospectively collected in our Institutional database. A written consent was given by pts allowing the use of medical records for research in accordance with the Declaration of Helsinki. Results Pts characteristics are reported in table 1, median time of follow-up 4.4y (r1-22), cumulative follow-up 1404y; 13 pts deceased during the time of observation (6 due to disease relapse, 2 to late major infection, 2 to second cancer, 1 to GvHD, 1 to myocardial infarction, 1 unknown). - chronic Graft-versus-Host-Disease (c-GvHD): at a median follow-up of 43 months (r 16 months - 21 years) 84 (32%) pts are presenting c-GvHD features. According to NIH 2014 consensus criteria 23 cases were classified as mild, 32 moderate, 29 severe. Median number of involved organs 2 (r1-5), 39 pts were experiencing skin lesions, 55 eyes, 28 mouth, 19 joint and fascia, 18 lungs. Topical therapy was the treatment of choice for mild cases, while moderate and severe were treated with systemic therapy. The partnership with the lung specialist and the ophthalmologist was crucial for the management of lung and eyes GvHD. - Late infectious manifestation: 38 (15%) pts present late infection, 2 pts deceased due to major events. Of note pneumonia was reported in 12 pts, Varicella Zoster virus reactivation in 7, CMV late reactivation in 4 pts. - Second cancer screening was performed according to international guidelines. The incidence of new cases is 10% (26 pts) and 11 pts are actually under work-up for suspicious lesions. Non-melanoma skin cancer was the most frequent diagnosis (13 cases); 3 pts were diagnosed with cervix cancer, 2 with lung cancer. The prevalence of second cancer in our population is 18% (47 cases). All pts were treated according to standard for general population, 45/47 are alive. - Cardiovascular diseases were frequently observed in our setting: hypertension was documented in 36 pts, arterial diseases in 10 pts, cardiomyopathy in 28 pts. Overall 27% of pts were diagnosed with cardiovascular comorbidities. - Metabolic syndrome (MS) is reported as a very common complication in long-term survivors: 65 (25%) pts were presenting features of MS (3/5 among hypertension, dyslipidemia, raised fasting glucose, and central obesity). A concomitant thyroid dysfunction - requiring hormonal replacement - was present in 27/65 pts. - Secondary hemosiderosis was documented (with MRI and blood parameters) and treated in 39 pts (15%) - 8 pts received deferasirox while phlebotomy was used in 31. - Osteoporosis and bone loss were evaluated measuring bone mineral density using dual-energy X-ray absorptiometry; osteopenia was detected in 81 pts and osteoporosis in 42 (47%). Pts were evaluated in conjunction with the endocrinologist and treated according to the fracture risk score. According to donor source no difference were observed (Chi-square test - p ns) except for higher incidence of moderate/severe GvHD incidence in HLA identical sibling (p 0.0097) as compared to alternative donors. Discussion HCT survivors are at a defined relevant risk of developing long-term complications that have a direct impact on the morbidity and mortality.A multidisciplinary active screening within routine HCT long-term follow-up care is mandatory to enhance early diagnosis/treatment and overall outcome. The next challenge will be to enhance the primary prevention to reduce the incidence of preventable comorbidities. Table 1. patients characteristics N (range) Pts 260 Age At transplant 48y (10 - 76) At follow-up 54y (20 - 82) Male / Female 169 / 91 Diagnosis AML / ALL 106 / 33 MDS 27 HD / NHL 23 / 29 MM 14 CML 8 CLL 5 SAA / EPN 4 / 1 Others 10 Status at transplant CR / PD 169 / 91 Donor Haploidentical 100 HLA identical Sibling 76 Match Unrelated Donor 82 Cord Blood 2 Disclosures Bonini: MolMed S.p.A: Consultancy.

Introduction: Despite novel therapies are under investigation in peripheral T-cell lymphomas (PTCL), the majority of the patients (pts) still have a dismal outcome. AlloSCT seems an effective approach in the salvage setting, but very small series of pts have been transplanted at diagnosis. Methods: We report the long-term outcome (median follow-up of 60 months) of 72 pts affected by PTCL who underwent AlloSCT at diagnosis (Allo1) (n=23) or for chemosensitive relapse (Allo2) (n=49) that have been enrolled in two transplantation protocols. Pathological classification included: 20 PTCL-not otherwise specified (PTCL-NOS), 2 anaplastic large cell lymphoma (ALCL) and 1 rare subtype in Allo1 group; 18 PTCL-NOS, 11 ALCL, 8 AILD and12 rare subtypes in Allo2 group. Donor sources were HLA-matched siblings [n=39: n=13 Allo1 and n=26 Allo2 (p=0.80)], matched or mismatched unrelated donors [n=25: n=10 Allo1 and n=15 Allo2 (p=0.30], and haploidentical family donors [n=8, only in the Allo2 group]. All pts underwent transplant with chemosensitive disease: 45 in complete remission (CR) (63%) [n=20 Allo1, n=25 Allo2 (p=0.003)]; 27 in partial remission (PR) (37%) [n=3 Allo1, n=24 Allo2 (p=0.003)]. In the Allo2 group, 37 pts (75%) were allografted in first relapse and 12 in second relapse. Results: In the Allo1 group, at a median follow-up of 59 months, of the 23 pts 15 (65%) are alive in CR, 4 (17%) died for progressive disease (PD), 3 for non-relapse mortality (NRM, 13%) and 1 for myocardial infarction. In the Allo2 group, at a median follow-up of 64 months, of the 49 pts 31 (63%) are alive (29 in CR), 11 (22%) died for PD and 6 (12%) for NRM while 1 for a second cancer. Five years crude cumulative incidence of relapse was 18% and 38% in Allo1 and Allo2 group (p=0.11), respectively. Five-year relapse-free survival (RFS), progressive-free-survival (PFS), and overall-survival (OS) were as follows: 80%, 60% and 62%, respectively, in Allo1 group; 61%, 47%and 59%, respectively, in Allo2 group without any statistical difference. However, we observed a significant difference in PFS between pts allografted at diagnosis and those in second-relapse (5-year PFS 61% versus 16%, p=0.0044) but not between the allografted at diagnosis and first-relapse (5-year PFS 61% versus 57%, p=0.92). When analyzed pts affected by PTCL-NOS, a better PFS trend was confirmed in pts receiving allograft at diagnosis or in first relapse as compared to second relapse [5-year PFS: 65% versus 55% versus 25%, respectively, (p=0.2)]. Pts who went to alloSCT in first CR did not have a significant advantage [5-year PFS and OS: 59% versus 43% (p=0.44); 60% versus 58% (p=0.82) in Allo1 and Allo2 group, respectively]. Conclusions: Despite the limitations due to the sample size, this is the first analysis in this setting. AlloSCT should be not indicated as a consolidation of first complete or partial remission approach/treatment outside a clinical trial. In fact, AlloSCT is very effective in patients with chemosensitive first relapse. Disclosures No relevant conflicts of interest to declare.

Introduction Allogeneic stem cell transplantation (alloSCT) is an effective salvage therapy for relapsed B-cell lymphomas. Different studies have shown that Rituximab (R) is implicated in the pathophysiology of acute and chronic GVHD. Methods: We analyzed 153 adult patients who received alloSCT for relapsed/refractory B-cell lymphomas. All patients received the same preparative conditioning consisting of thiotepa/cyclophosphamide/fludarabine, and GVHD prophylaxis consisting in cyclosporine and short course methotrexate. ATG (7 mg/kg) was added to patients allografted from class I antigen mismatched sibling or unrelated donors. Eighty-two patients (group A) received high-dose Rituximab (R 500 mg/ms on day -6) and were enrolled in a prospective multicenter study, whereas 71 consecutive patients (group B, control group) were part of a previous study without R. The two groups were not significantly different in terms of diagnosis (p=0.10), donor types (p=0.74), rate of complete remission at transplant (p=0.51). Results: The cumulative incidence (CI) of non-relapse mortality (NRM) at 2-years was 16% in group A and 18% in group B (p=0.84). Main cause of death were infections without GVHD in group A (7/13) and extensive GVHD in group B (6/14). Deaths associated to acute or chronic GVHD were significantly lower in group A (5 of 13) as compared to group B (13 of 14) (p=0.004). The CI of grade II-IV and III-IV acute GVHD was 23% versus 35% (p=0.11) and 7% versus 14% (p=0.11) in group A versus B, respectively. The CI of chronic GVHD was 48% versus 47% (p=0.73) in group A versus group B, respectively. The CI of acute GVHD and chronic GVHD in unrelated recipients was 20% versus 31% (p=0.41) and 32% versus 40% (p=0.83) in patients who received R in the conditioning comparing to group B. A delayed immune reconstitution of B-cells was still evident at 2 years after alloSCT in group A versus B [median value CD19+: 126/µL versus 300/µL with a significant higher percent of IgD+CD27- in group A and reduced immunoglobulin production: 502 versus 778 mg/dL of IgG (p=0.04)]. Progression free survival (PFS) and overall survival (OS) at 3-years were similar in group A and group B [PFS: 54% versus 58% (p=0.50); OS: 64% versus 67% (p=0.51)]. PFS at 3-years in indolent and aggressive lymphomas was 66% versus 75% and 42% versus 43% with and without R; OS at 3-years in indolent and aggressive lymphomas was 74% versus 78% and 55% versus 57% with and without R. In multivariate analysis, acute GVHD, extensive chronic GVHD and aggressive hystotype were associated to a lower OS [HR=3.6, p=0.0003; HR=2.3,p=0.03;HR=2.1,p=0.01] and only acute GVHD and aggressive hystotype to lower PFS [HR=2.7, p=0.002; HR=2.3, p=0.001]. Rituximab in the conditioning regimen, year of transplant and donor type did not influence the outcome. Conclusions: Rituximab administration in the setting of alloSCT is associated with reduced GVHD-related deaths and increased infection-related deaths, likely due to delayed B-cell immune-reconstitution. Disclosures: No relevant conflicts of interest to declare.

Several groups have reported the results of Allo-SCT following a RIC regimen in relapsed and refractory lymphomas. However, the long-term efficacy of this strategy is still unknown. We report herein the results of a prospective multicenter phase II trial at median follow-up of 5 years. A total of 194 relapsed/refractory lymphomas received the same RIC regimen (thiotepa, cyclophosphamide and fludarabine) followed by Allo-SCT from sibling donors. Histologies were non-Hodgkin’s lymphomas (NHL) [indolent (LG-NHL, n=68), including follicular lymphoma (FL, n=29), chronic lymphocytic leukemia (CLL, n=35), other (n=4); aggressive (HG-NHL, n=87), including B-cell phenotype (n=43), T-cell phenotype (n=28), mantle cell lymphoma (MCL, n=16)] and Hodgkin’s lymphoma (HL, n=39). 133 (68%) of 194 patients (pts) had chemosensitive disease and 100 (52%) of 194 failed a previous autologous transplantation. Median follow-up was 60 months (range, 15–113). At last follow-up, 116 pts are alive (59%) and 78 died from any cause [n=47 for disease progression, n= 30 for non-relapse mortality (NRM), n=1 not assessable]. The 5-year overall survival (OS) and progression-free survival (PFS) were 62% and 70% for LG-NHL, 61% and 59% for HG-NHL, and 42% and 19% for HL, respectively. The median time to relapse was 7 (range, 2–30), 4.5 (range, 1.6–33), and 5.5 (range, 0.4–42) months for LG-NHL, HG-NHL, and HL respectively. Pts with chemosensitive disease at Allo-SCT had 5-year OS and PFS of 69% and 61%, while those with refractory disease had 5-year OS and PFS of 35% and 45%, respectively. Status of disease at Allo-SCT influenced significantly long-term outcome in HG-NHL and HL [chemosensitive versus chemorefractory: 73% versus 32% (p

Patients with relapsed and refractory Hodgkin lymphoma (HL) may experience long-term survival after allogeneic stem cell transplantation (alloSCT), but disease recurrence represents the main cause of treatment failure. Positron-emission tomography (PET)–positive patients after alloSCT have a dismal outcome. Serum thymus and activation-regulated chemokine (TARC) is produced by Reed-Sternberg cells and may be a marker of disease. Our study aimed at assessing whether TARC levels after alloSCT correlated with disease status and whether TARC monitoring could increase the ability to predict relapse. Twenty-four patients were evaluated in a prospective observational study. TARC serum level and PET were assessed before and after alloSCT during the follow-up (median, 30 months; range, 2 to 54). Before alloSCT, the median TARC level was 721 pg/mL (range, 209 to 1332) in PET-negative patients and 2542 pg/mL (range, 94 to 13,870) in PET-positive patients. After alloSCT, TARC was 620 pg/mL (range, 12 to 4333) in persistently PET-negative patients compared with 22,397 pg/mL (range, 602 to 106,578) in PET-positive patients (P < .0001). In 7 patients who relapsed after alloSCT, TARC level increased progressively even before PET became positive, with a median fold increase of 3.19 (range, 1.66 to 7.11) at relapse. The cut-off value of 1726 pg/mL had a sensitivity of 100% and a specificity of 71% for PET positivity. Patients with at least 1 TARC value above 1726 pg/mL during the first year after alloSCT had a worse progression-free survival (P = .031). In conclusion, TARC was correlated with disease status and its monitoring may be able to predict PET positivity after alloSCT, thus potentially allowing an early immune manipulation.

Background: Patients with R/R HL, failing to achieve a complete remission (CR) or a good partial remission (PR) after conventional dose salvage chemotherapy as well as those having severe comorbidities or advanced age, are generally ineligible for a transplant procedure. Furthermore approximately 50% of the patients able to proceed to ASCT, will eventually relapse and will need effective treatment to proceed to alloSCT. BV is a safe and highly effective treatment in R/R HL after ASCT and 75% objective remissions have been reported . Limited data exist regarding BV in transplant naive R/R HL or in R/R HL after ASCT. The aim of our retrospective study was to assess the efficacy and tolerability of BV in R/R HL patients, treated at a single institution, the Istituto Nazionale Tumori of Milan Italy (INT-MI). Methods: Patients with R/R CD30-positive HL, treated with BV between January 2011 and April 2014 for failure of at least two prior therapies, when ASCT was not considered a treatment option (Group A), or for failure following ASCT (Group B), were included in this retrospective analysis. BV was given at the standard dose of 1.8 mg/kg iv every 21 days. The study protocol was approved by the ethical committee of INT-MI. The primary endpoint of this study was to evaluate efficacy of BV in obtaining FDG-PET remission and in enabling patients to proceed to ASCT or alloSCT. Secondary endpoints included BV toxicity, Progression-free Survival (PFS) and Overall Survival (OS). Results: Sixteen R/R HL patients for Group A (ASCT-ineligible) and 10 patients for Group B (ASCT failures) were identified. Main characteristics at start of BV were as follows: | Characteristics | Group A (n=16) | Group B (n=10) | | -------------------------------------------- | -------------- | -------------- | | Males/Females | 7/9 | 2/8 | | Median age (range) yrs | 40 (22-72) | 43 (13-63) | | B Symptoms | 5 | 4 | | Stage III-IV | 8 | 7 | | Extra ± nodal involvement | 8 | 5 | | ³ 3 involved sites | 6 | 3 | | Bulky disease (>7 cm) | 4 (1 na) | 2 | | ECOG PS 0/1/2 | 7/7/2 | 4/4/1 (1 na) | | Refractory/relapsed after front-line therapy | 11/5 | 7/3 | | Median number prior regimens (range) | 4 (2-12) | 4 (3-9) | Table Median time from HL diagnosis to BV therapy start was 19 months (range, 8-330) in Group A and 24 months (range, 16 to 254)in Group B, respectively. A median of 6 BV cycles (range, 3 to 19) were administered. Overall response rate in Group A and B was 87.5% and 60%, respectively; CR was documented in 8 patients (50%) in Group A and 2 patients (20%) in Group B. Best response was reported after a median of 3 cycles (range, 2-9). Three patients in Group A and 1 in group B, achieving a negative PET scan, by continuing BV therapy, had PD and were considered transplant ineligible. BV enabled 3 patients in Group A and 1 patient in Group B, achieving CR , to receive a transplant procedure. Moreover two complete responders in Group A underwent ASCT, although PET scan before transplant documented the reappearance of FDG-avid lesions; they are both alive in CR after 14 and 7 months from ASCT, respectively. Two pts in Group B, achieving a PR, underwent alloSCT and relapsed 6 and 11 months after transplant, respectively. Six patients (23%) had grade 3 or higher adverse events (1 sensory peripheral neuropathy, 5 hematological toxicities), no patient discontinued treatment due to toxicity. After a median follow-up of 15 months (range, 3 to 36) since the first BV cycle, median PFS was 5 months and median OS was still not reached. Conclusions: These data confirm that BV is highly effective in R/R transplant ineligible HL patients, who have generally limited conventional treatment options and a low median OS. BV may overcome chemorefractoriness and enable patients to receive ASCT or allo-SCT, while omitting the significant toxicity of multiagent chemotherapy regimens. Disclosures Viviani: Takeda: Consultant for 40th EBMT Symposium Other.

Abstract 3542 Patients affected by Hodgkin's lymphoma (HL) who are chemorecfractory or relapsed after an autologous transplantation (autoSCT) may be eligible to a reduced intensity allogeneic stem cell transplantation (RIC alloSCT). Patients in progressive (PD) or stable disease (SD) at transplant seem to do worse than those in complete (CR) or partial remission (PR). We reviewed 43 cases of HL patients treated with a RIC alloSCT in our Institute from 2001 to 2010, focusing on the outcome based on disease status, disease characteristics, and treatment used to induce remission before transplant. Thirty patients (70%) were affected by nodular sclerosis HL. Median age at transplant was 31 (range, 53-19), 22 patients (51%) were female. The median number of previous chemotherapy was 4 (range, 2–10). Seven patients (16%) underwent autoSCT followed by alloSCT and 3/7 of them (43%) were in CR before allografting. All but one of the other 36 patients (81%) relapsed after an autoSCT and before allografting, were treated as follows: 19 received hyperfractioned polichemotherapy (D-PACE n=16, HypercHidam n=2, EPOCH n=1), 8 patients received conventional chemotherapy (gemcytabin based-chemotherapy n=4, BEACOPP n=1, bendamustine n=2, mecloretamin n=1) and 12/27 (44%) of these patients achieved CR, 8 patients received non-chemotherapy drugs alone or combined with chemotherapy in the setting of phase I-II trials and 3/8 (37%) were in CR at transplant, only one patient was in untested relapse. Thirty two (74%) patients had previously received radiotherapy. Disease status at transplant was: CR n=18 (42%), PR n=16 (37%), PD/SD n=9 (21%). Sixteen patients (37%) had extranodal disease. C-reactive protein (PCR) value at admission was above the normal range in 14 patients (33%). In 40 patients HCT-CI was assessed and it was 0 in n= 5 (13%), 1–2 n= 11 (27%), and ≥3 n= 24 (60%), with almost all the patients having abnormal pulmonary function tests. The type of donor was: HLA identical sibling n= 15 (35%), haploidentical sibling, n= 16 (37%), matched unrelated (MUD) n= 12 (28%). The conditioning regimen was based on thiotepa, fludarabine and cyclophosphamide; 2Gy TBI and T-cell depletion with alemtuzumab or ATG were used in case of haploidentical donor. The median follow-up of living patients was 26 months (range, 2–70). All but one patients engrafted. The median PFS and OS were 10 months and 38 months, respectively. The estimated 3-year progression free survival (PFS) and 3-year overall survival (OS) were 37% and 52%, respectively. One year and 2-year transplant related mortality (TRM) was 7.6% and 10.8%, respectively. We performed an univariate analysis based on sex, histology, donor type (sibling versus MUD versus haploidentical), number of previous therapies (3), extranodal disease, disease status before transplant (CR versus PR versus SD/PD), treatment received at relapse before alloSCT (chemotherapy versus autoSCT versus experimental drugs), previous radiotherapy, HCT-CI (0 versus ≥1), PCR value (normal versus abnormal). OS was influenced by sex (p=0.008, female patients did worse), disease status before alloSCT (p=0.025, both PR and PD/SD patients did worse than CR patients), extranodal disease (p=0.001), and elevated PCR (p=0.002). PFS was adversely correlated to female sex (p= 0.009), PR/PD/SD (p=0.0001), HCT-CI >=1 (p=0.03), extranodal disease (p=0.01), and abnormal PCR (p< 0.001). Haploidentical recipients showed a lower cumulative incidence of relapse (p=0.05), despite a higher NRM (0.02). Of note, the type of therapy received before transplant, either chemotherapy, autoSCT or experimental drugs, did not influence the outcome. In multivariate analysis including disease status, PCR value and extranodal disease, the latter was predictive of OS (p=0.04), disease status (CR versus PR/PD/SD) (p In conclusion, RIC alloSCT may be a feasible and efficacious treatment option in chemorefractory and relapsed HL patients, but CR status has been confirmed as one of the strongest predictor of outcome independently of the therapy used to achieve the response. An abnormal PCR value at the time of admission for transplant and a history of extranodal disease are also adverse prognostic factors. Disclosures: No relevant conflicts of interest to declare.