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Aggressive NK cell leukemia (ANKL) is an exceedingly rare form of leukemia and carries a poor prognosis, with a median survival of only 2 months. Using the Center for International Blood and Marrow Transplant Research database, we evaluated outcomes of allogeneic hematopoietic cell transplantation (alloHCT) in patients with ANKL. Twenty-one patients with a centrally confirmed diagnosis of ANKL were included. Median patient age was 42 years and 15 patients (71%) were Caucasian. Fourteen patients (67%) were in complete remission (CR) at the time of alloHCT, and 5 patients had active disease. Median follow-up of survivors was 25 months (range, 12 to 116). The 2-year estimates of nonrelapse mortality, relapse/progression, progression-free (PFS), and overall survival (OS) were 21%, 59%, 20%, and 24%, respectively. The 2-year PFS of patients in CR at the time of alloHCT was significantly better than that of patients with active disease at transplantation (30% versus 0%; P = .001). The 2-year OS in similar order was 38% versus 0% (P .001). In conclusion, this registry analysis that included majority non-Asian patient population shows that alloHCT can provide durable disease control in a subset of ANKL patients. Achieving CR before transplantation appears to be a prerequisite for successful transplantation outcomes.

Introduction L-type amino acid transporter 1 (LAT1) and 2 (LAT2) are responsible for the transport of large neutral amino acids across the intracellular membrane. These transporters appear to have drug-carrying functionality with certain medications such as gabapentin (GP), pregabalin (PG), melphalan, levodopa, methyldopa, and baclofen. It is likely that concurrent administration of either GP or PG occurs in patients receiving HD-Mel conditioning which could theoretically result in changes in cellular uptake, mucosal injury, and survival. Methods A retrospective review of patients with multiple myeloma who received outpatient HD-Mel from January 2012 to July 2016 was conducted. Patients? 18 years who received melphalan ? 140 mg/m2 were included. Exclusion criteria included concomitant use of levodopa, methyldopa, or baclofen; or deviation from an anti-emetic regimen of steroids, ondansetron, and fosaprepitant. The primary endpoint was rate of mucositis. Secondary endpoints included hospital admission rate, parenteral nutrition (TPN) utilization, patient-controlled analgesia (PCA) initiation, intravenous (IV) opioid requirements, use of topical mucosal agents, use of antidiarrheals, use of rescue anti-emetics, number of days of nausea or vomiting, median daily pain scores, time to neutrophil engraftment, time to platelet-20 engraftment, time to platelet-50 engraftment, 30-day treatment-related mortality (TRM), 100-day TRM, progression-free survival (PFS), and overall survival (OS). Results Eighty patients were enrolled including 30 patients who received concomitant GP/PG and 50 control patients. Rates of mucositis were 59% vs. 52% for grade 1, 24% vs. 19% for grade 2, 7% vs. 10% for grade 3, 10% vs. 19% patients with no mucositis (p = 0.833) in the GP/PG group vs. the control group, respectively. Admission rate was found to be to be 10% in the GP/PG treated group compared with 18% in the control group (p = 0.439). No significant differences in TPN or PCA usage, IV opioid use, topical mucosal agent use, antidiarrheal use, rescue anti-emetic use, days of nausea/vomiting, or pain scores were observed. Time to neutrophil engraftment, platelet-20 engraftment, and platelet-50 engraftment were not significantly different between treatment groups. No patients in the GP/PG treated group and 6% (n = 3) of patients in the untreated group experienced TRM within 100 days (p = 0.288), with similar median PFS and OS. When patients were stratified by GP/PG dose, a correlation with higher doses and lower incidence of mucositis, nausea, vomiting, and pain was observed, although statistical significance was not reached. Conclusion It appears safe to continue GP/PG therapy throughout HD-Mel therapy with no negative outcomes described currently. Larger studies are needed to better characterize the clinical implications of concomitant therapy.

Inadequate mobilization of peripheral blood progenitor cells (PBPC) is sometimes a limiting factor to proceed with an autologous hematopoietic cell transplantation (auto-HCT), in an otherwise eligible patient. In such situations, a bone marrow harvest (BMH) procedure may be considered to achieve the CD34+ target dose for an autograft. Plerixafor-based mobilization has recently been shown to improve PBPC collection yields. However, the feasibility and outcomes of BMH in patients failing plerixafor-based mobilization is not known. We report here, 6 patients who underwent BMH after PBPC mobilization failure with plerixafor. The median CD34+ yield with plerixafor mobilization and BMH were 1.15 x 10^6/Kg (range, 0.2-1.7 × 10^6/Kg) and 0.32 (range, 0.12-0.38 × 10^6/Kg), respectively. Three patients proceeded to an auto-HCT, with only 1 patient receiving CD34+ cell dose of at least 2 × 10^6/Kg. While neutrophil recovery was seen, platelet recovery and red cell transfusion independence were delayed. All 3 autografted patients experienced disease progression by day +100. These data suggest, limited incremental benefit of a salvage BMH after plerixafor mobilization failure, cautioning against routine use of this strategy.

s / Biol Blood Marrow Transplant 20 (2014) S104eS127 S117 incidence of PJP, suggesting that PJP prophylaxis is not routinely warranted in this patient population. Patients who require systemic corticosteroids posteHSC may be considered for PJ prophylaxis.