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Abstract 3340 Poster Board III-228 Aim: To identify factors predicting outcome of patients admitted to intensive care (ICU) following allogeneic haematopoietic stem cell transplantation (allo-HSCT). Methods: Retrospective audit of all allo-HSCT patients requiring ICU admission. Results: Between 2000 and 2009, 392 patients underwent allo-HSCT. Of these, 106 (27%) had 129 ICU admissions. The median age was 47 (range 16-65) with myeloablative transplant in 89 and reduced intensity in 40 patients. Respiratory failure was the main reason for admission (54.6%) followed by sepsis (41.5%). During the period of ICU admission, 29.2% demonstrated improvement in organ failures, 39.2% remained stable and 28.4% deteriorated. Sixty-seven patients (51.9%) were discharged from ICU but only 48 (37%) were subsequently discharged from the hospital (ICU). Univariate analysis identified ICU admission within 30 days post HSCT, number of organ failures at admission, progression of organ failure during ICU admission, APACHE II score at admission, steroid refractory GVHD, and requirement for inotropic support or dialysis as significant predictors for survival in ICU. Patients requiring intubation and mechanical ventilation had a poorer outcome than the group who did not (84.4% Vs 20.0%, p=0.001). Those who required only non-invasive ventilation generally had a good outcome with 84.4% surviving til ICU discharge. While bacterial infection prior to ICU admission did not alter the outcome (p=0.221), the onset of a new infection in ICU was associated with a poor outcome (p=0.0001). Logistic regression analysis identified steroid refractory GvHD (P=0.027; 95% CI of 1.17-14.8), APACHE II score > 30 (p=0.003; 95% CI 1.5-10.5), admission Conclusion: More than 50% of patients admitted to ICU following allogeneic HSCT survive. A high APACHE II score, steroid refractory GVHD, admission into ICU within 30 days of HSCT, multiorgan failure, progression of organ failure during ICU stay, and the need for ventilation or dialysis, carries a dismal prognosis. Identification of risk factors associated with a poor outcome will assist in clinical management and may ultimately improve the outcome of patients requiring ICU admission following allogeneic HSCT. Disclosures: No relevant conflicts of interest to declare.

Flow cytometric analysis of eosin-5′-maleimide-labeled red blood cells has been proposed as a method of identifying hereditary spherocytosis (HS). The flow cytometric test measures the fluorescence intensity of intact red cells labelled with the dye eosin-5-maleimide (EMA), which reacts covalently with Lys-430 on the first extra cellular loop of band 3 protein. Patients with HS have reduced fluorescence compared to other patient groups and normal controls. The aim of the present study was to assess the utility of flow cytometry in the diagnosis of hereditary spherocytosis. Fresh peripheral blood from 40 normal controls was collected in Lithium Heparin, stained with the dye EMA and analysed by flow cytometry. The normal range was established as 55–74 channel numbers. On 7 known cases of Hereditary Spherocytosis the MFI range was 35.6–44.6 channel numbers, and therefore samples falling into this range were considered to be positive for a diagnosis of HS by EMA. Equivocal results were defined when the MFI was in the range of 45–54 channel numbers. A total of 98 samples were sent for investigation or exclusion of HS. Clinical problems were grouped into the following categories: peripheral blood spherocytosis with negative Coomb’s test and no family history of HS, positive family history of HS, Neonatal hyperbilirubinaemia, haemolytic anaemia of unknown origin. Indications Coomb’s −ve, Spherocytosis, no FH (n=50) (51%) Positive family history (FH) (n=18) (17%) Neonatal hyperbilirubinemia (NNH) (n=8) (8%) Haemolytic anaemia (HA) (n=16) (17%) Results of EMA Pos Neg Equi Pos Neg Equi Pos Neg Equi Pos Neg Equi Number 19 17 13 9 7 2 2 4 2 0 14 2 Percentage 38 34 26 50 39 11 25 50 25 0 87.5 12.5 Within this cohort the group with FH of HS had the highest positive and least equivocal results. The group with suspected HS (peripheral blood spherocytosis with negative coomb’s test) resulted in positive in 38% and equivocal in 26% cases. The group with NNH had positive results in 25% of cases and the group with HA had no positive results. Equivocal results occurred in 20% of cases suggesting further investigations are required to confirm or exclude HS. The EMA dye method by flow cytometry is a useful test for diagnosing red cell membrane abnormalities due to band 3 defects, but the assay produces a substantial number of equivocal results, and has poor utility in the investigation of haemolytic anaemia of unknown origin.

Background: Bone marrow (BM) has been utilized as a source of stem cells for transplantation for many years. Although the use of BM has decreased with the advent of mobilized stem cells, utilization is increasing once again due to the lower rate of chronic GVHD associated with BM as a stem cell source. There is no generally accepted technique for harvesting BM. Protocols vary both in relation to the volume of each aspirate, the number of aspirates performed at each puncture site and the total volume of harvests. Method: BM was collected from the posterior iliac crests (PIC) in 2 separate bags: 10ml aspirates from the left and 20 ml aspirates from the right. Samples taken at the start and after 100, 150, 200, 250, & 500 ml were analyzed for TNC, CD34+ and CD3+ cell counts. Results: The following table shows cell number (mean ± SEM ×106) for the parameters indicated. Aspirate Volume (mls) Parameter Start (n=4) 100mls (2) 150mls (2) 200mls (2) 250mls (4) 500mls (4) 10 TNC 555 ± 28 286 ± 38 257 ± 40 226 ± 8 199 ± 11 158.5±18.5 CD34 5.8 ± 0.05 1.8 ± 0.1 1.7 ± 0.2 1.3 ± 0.4 1.1 ± 0.2 0.8 ± 0.1 CD3 65.8 ± 12.0 35.8 ± 6.9 32.8 ± 8.0 29.9 ± 1.5 28.4 ± 5.1 29.8 ± 6.2 20 TNC 914 ± 52 627 ± 137 458 ± 44 429 ± 113 391 ± 81 264 ± 24 CD34 9.1 ± 0.5 3.8 ± 0.2 2.4 ±0.2 2.7 ± 0.1 2.3 ± 0.7 1.0 ± 0.2 CD3 106.9 ±22.1 64.6 ± 5.3 55.0±14.1 56.5±14.7 53.7±14.6 41.2 ± 9.6 There is a rapid fall in the yield of CD34+ cells obtained with increasing harvest volume (19 and 25% of the initial number after 250 ml for 10 and 20 ml aspirates respectively; 14 and 11% respectively after 500 ml). In contrast the CD3+ cell numbers fall more slowly (43 and 50% after 250 ml, 45 and 38% after 500 ml). By the time 500 ml has been aspirated, there is no difference in the total number of CD34+ cells obtained from a 10 ml versus a 20 ml aspirate of bone marrow. Conclusion: CD34+ cell yields fall rapidly when BM is harvested along the PIC. Using additional areas such as the anterior iliac crests may be preferable to a large volume PIC harvest for optimizing CD34+ stem cell collection. After 500 ml of BM has been harvested, 20 ml BM aspirates do not increase CD34+ cell numbers and 10 ml aspirates should be taken to minimize unnecessary blood loss and reduce T cell contamination.

INTRODUCTION: In many centers an initial period of induction treatment followed by peripheral blood stem cell (PBSC) harvest and autologous stem cell transplantation (ASCT) has become standard of care for multiple myeloma (MM) in patients =< 65 years of age. Commonly induction regimens contain intravenous cytotoxic agents and oral corticosteroids. There are interests in oral regimens, including thalidomide-containing combinations (1). Recently Spencer et al from Australia reported a small multicenter study in which the induction treatment prior to ASCT comprised an outpatient-based oral chemotherapeutic regimen CID-- cyclophosphamide, idarubicin, dexamethasone, in previously untreated MM patients (2). AIM: To evaluate the efficacy of oral CID in MM in our own institution. METHODS: thirteen patients with MM (relapsed n=2, previously untreated n=11) were treated with CID. Courses were repeated every four weeks, with the aim of harvesting PBSC after 3 to 6 courses, depending on response. Efficacy of treatment was assessed on the following parameters: paraprotein level, b2 microglubulin and bone marrow plasma cell content. Wilcoxon Signed Ranks Test was used to analyze treatment outcomes and Kaplan-Meier curves were used for analysis of overall survival and event free survival. RESULTS: All 13 patients (median age 61 yrs, range-41–72 yrs; male-7, female-6) were evaluable for response, with a median follow up of 40 (12–84) weeks. In total, eleven patients (10 previously untreated, and one relapsed) were planned to have an elective ASCT. All had successful stem cell mobilization after 3–6 cycles of chemotherapy, and subsequently received an ASCT. One patient died 42 days post transplantation due to infection and ARDS. The median time between completion of CID and ABMT was 6 weeks (range 4–16). One previously untreated patient and one relapsed patient, both aged >65, received CID only without an ASCT. Comparison of pre and post chemotherapy levels of paraprotein, b2 microglubulin and bone marrow plasma cell content showed statistically significant results with p values of 0.002, 0.001 and 0.002 respectively. According to International standard criteria, 3/13 achieved complete response (CR), 7/13 had very good partial response (VGPR) or partial response (PR), 1/13 stable disease (SD) and 2/13 had relapse or progressive disease (PD), resulting in an overall response rate (>/=SD) of 84%. The median time to maximum response was 4 months. The Kaplan-Meier estimates of event-free survival and overall survival at 1 year were 64% and 84%, respectively. There were no major toxicities except weight gain (National Cancer Institute Common Toxicity Criteria Grade III) was seen in 23% of the patients, possibly due to the dexamethasone component in CID. CONCLUSIONS: Our results confirm the efficacy and safety of this outpatient based all oral induction regimen for patients with MM. The favorable side effect profile, the convenience of drug delivery with oral dosing, and the ease of PBSC mobilisation are the main advantages.