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BACKGROUND: Peripheral T/NK–cell lymphomas (PTCL) are a heterogeneous group of neoplasms with a median survival of 2-3 years. Currently, there is not standard treatment although consolidation of response with autologous stem cell transplantation (ASCT) is recommended as front line therapy, except in anaplastic ALK+ and T/NK nasal localized lymphomas. AIM: To analyze the outcome of patients with PTCL diagnosed and treated in our center between 2000 and 2012. METHODS: An Intention to treat analysis has been performed to assess the response rate, progression-free survival (PFS) and overall survival (OS). RESULTS: Thirty eight patients were identified in this period, 2 were excluded, 1 due to misdiagnosis and the other was not treated in our Department. There were 28 men and 8 women with a median age of 62 years (20-85 y), ECOG ≥ 2: 19%, B symptoms: 61%, IPI ≥ 2: 56% and PIT ≥2: 47%. The histological subtypes are described in Table 1. Five patients died during diagnosis (aspergillosis, septic shock, intestinal perforation, Evans syndrome and hemophagocytic syndrome) and 2 rejected treatment. We treated 29 patients (80.5%) mainly with CHOP-like chemotherapy (77%) adding other schemas in order to achieve best response if needed. In 15 patients ASCT was not indicated (9 due to age and 6 due to histological subtype). After induction, 4 patients achieved complete remission (CR), 3 partial response (PR) and 8 progressed (NR / P). Median number of treatments was 1 (range 1 to 3). Fourteen patients were candidates for transplant but 4 of them could not receive it due to progression, early death, lost to follow-up and medical decision. Finally, 10 patients (71%) proceeded to transplant: 9 ASCT and 1 allo-SCT. The median number of treatments was 2 (1 - 3). Three patients were transplanted in CR, 6 PR and 1 NR/P; no patient improved the response. Three patients died during the procedure (RSV pneumonia, CMV and gram positive sepsis). The allo-SCT patient died of grade IV acute GVHD. Currently, 7 out of 36 patients are alive in CR, 24 have died and in 5 were lost to follow-up. Causes of death were: lymphoma (58%), infection (25%), toxicity (4%) and unknown (13%). With a median follow-up for alive patients was 72 months, OS was 15.34 months (95% CI, 3.98-26.71) and PFS 13.61 months (95% CI, 10.15-17.07). In Table 2 and figure 1 we show the median PFS and OS obtained in transplant- eligible and non-eligible patients. CONCLUSIONS: We confirm the difficulty of long-term control of PTCL with current first-line treatments recommended by guidelines. Even in those patients receiving more intensive treatment with SCT, no improvement in PFS or OS was observed. New drugs and strategies are needed to improve the prognosis of these patients. Table 1. HISTOLOGICAL SUBTYPES N= 36 Peripheral T-cell lymphoma NOS 12 (33%) Angioimmunoblastic T-cell lymphoma 7 (19%) Anaplastic large T-cell lymphoma, ALK+ 6 (17%) Anaplastic large T-cell lymphoma, ALK- 5 (14%) T/NK-cell lymphoma, nasal type 4 (11%) Intestinal T-cell lymphoma 1 (3%) Hepatosplenic γ/d T-cell lymphoma 1 (3%) Table 2. SCT candidates No SCT candidates OS months (CI 95%) 13.97 (6.40-21.53) 11.67 (2.86-20.48) PFS months (CI 95%) 13.61 (7.09-20.12) 11.51 (4.76-18.25) Figure 1. Figure 1. Disclosures Alegre: Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Jansen: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Introduction: Indolent B cell non-Hodgkin lymphomas are entities without curative treatment nowadays. However, survival has significantly improved since the incorporation of immunomodulatory agents and now immunochemotherapy has become the gold standard. Most treatment strategies use progression free survival (PFS) as a surrogate marker for overall survival (OS), although updated long term results are frequently lacking. Since 1990 our group introduced IFNα-2b to Bagley’s CVP induction regimen, for naïve indolent NHL (LNH-pro study). Herein we report our long term results. Aim: To evaluate long term outcome and late toxicities of patients who received immunochemotherapy with IFN α-2b plus CVP. Patients and Methods: From February 1990 to November 2001, patients from 7 Spanish institutions were included. Induction therapy consisted of Cyclophosphamide (400 mgs/m2 po) and Prednisone (100 mg/m2 po) daily for 5 days, Vincristine (1.4mg/m2 iv) on day 1, and subcutaneous IFN α-2b (3 MU/m2, three times a week, for a total of 36 doses). Patients received the number of cycles necessary to achieve maximum response. Updated clinical data were retrieved from participating centres up to March 2012. Results. A hundred and seventy patients with low-grade NHL were analyzed. Included entities were: 65% grade 1-2 follicular lymphoma (FL), 21% lymphocytic lymphoma and 14% marginal zone lymphoma. Median age was 56 yo (range 22-78 yo), elevated LDH and β2-microglobuline were 13.6% and 26% respectively, 57.6% had bone marrow involvement and 7.6% bulky disease (>7cm). According to FLIPI, 33% were high risk, 40% intermediate and 27% low risk FL. Median number of cycles was 6, and overall response rate achieved was 90%, with 68% complete remissions. Median follow up of surviving patients was 12.5 years (range 3-21 ys), with only 14.7% of patients lost to follow-up. Median PFS for all patients was 12.5 years (95% CI 10.5 – 14.5 years) and not reached for FL patients (20-year PFS of 63%; 95%CI: 54-72%). Median OS has not been reached, with a 20-year OS of 59.7% (CI 95%, 50.5-69%) for all low-grade NHL patients and 62% (IC 95%, 50-74%) for FL patients. Long-term toxicity is detailed in table 1. Incidence of secondary malignancies is 13.5%. At time of analysis, 57 out of 170 patients have died (33.5%), mainly due to lymphoma (58% of patients) and other non-lymphoma events (42%). Table Secondary malignancies 23 cases (13.5%) - MDS / AML 3 cases - Solid tumors 18 cases - Dermatologic neoplasia 2 cases Causes of death Number of patients (%) Induction toxicity events 4 (7%) Lymphoma progression / relapse 29 (51%) Secondary malignancies 9 (16%) Other non-lymphoma events 15 (26%) - Miocardiopathy 4 - Chronic Pulmonary disease 3 - Hepatic failure 2 - Brain traumatic injury 1 - Unknown cause 5 Figure 1 Figure 1. Conclusions: Our results confirm that immunochemotherapy with IFN α-2b plus CVP regimen induces a median PFS of 12.5 years and a 20-year OS of 59.7% (median not reached). With a median follow-up of 12.5 years, 58 % died due to lymphoma, 16% from secondary malignancies and 26% for non-lymphoma events. These results highlight the importance of performing long term follow-up in order to assess the real survival benefit of any treatment. Disclosures No relevant conflicts of interest to declare.

Una apreciación humanística de las obras cinematográficas, atenta a su identidad cultural, implica al menos tres premisas. Una: la existencia límites en los umbrales culturales para apreciar el sentido narrativo y dramático, al tiempo estable y abierto de esa obra. Segunda: esos umbrales se configuran en la confluencia de la tradición cultural en que se inserta la película, con la tradición intelectual y cultural en la que participan sus espectadores, analistas e intérpretes. Tercera: la identidad cultural de una película tiene un correlato más estable, respecto de la identidad personal y de las disposiciones habituales y emocionales de cada uno de nosotros como personas, que respecto de las circunstancias históricas y sociales de cada momento.

Abstract 3056 Background: Disease relapse is the most frequent cause of treatment failure following allogeneic haematopoietic cell transplantation (allo-HCT), and carries a very poor prognosis. A second allo-HCT may be the only curative option for the majority of these patients. Patient and transplant factors that may associate with the outcome of a second allo-HCT are required for clinical-decision making in such high-risk patients. Aims and Methods: We performed a retrospective analysis of patients receiving a second allo-HCT for disease relapse after a prior allo-HCT reported by GETH centres. Our aim is to analyze our experience in this setting, and to identify factors associated with patient outcome. Results: We present data on 189 patients who underwent a second allo-HCT for disease relapse in Spain up to December 2010 (median year 2004), with a median follow-up for survivors of 54 months (3–224): median age 35 years (range 4–69); 113 male (60%); initial diagnosis AML 77, ALL 45, MDS/MPD 28, CML 23, lymphoprolipherative disorder 12, and others 4. Seventy-five (40%) received myeloablative conditioning. Donors for second allo-HCT were related in 158 cases (84%), and in 33 cases (17%) were new donors different from the donors in the previous allo-HCT. Only 23 cases (12%) had T-cell depletion. Median time from the first to the second allo-HCT was 19 months (1–151). The cumulative incidence of non-relapse mortality was 37%. Median overall survival (OS) was 297 days, with an OS at 1, 3 and 5 years of 39%, 28% and 25%, respectively. Type of donor (related versus unrelated and new donor versus same donor) and type of conditioning (myeloablative versus non-myeloablative) had no association with patient outcome. However, OS was significantly poorer in patients who underwent second allo-HCT in active relapse or progression than in those with low disease burden (complete response, good partial response, or chronic phase; 29% vs 52% at 1 year, 21% vs 39% at 3 years, 17% vs 35% at 3 years, respectively; p=0.001). Also, patients with early relapse after the first allo-HCT who underwent a second allo-HCT Conclusions: 25% of patients who relapse after an allo-HCT can achieve long-term survival of 5 or more years following a second allo-HCT. Donor type does not appear to influence the outcome. On the contrary, our data suggest that disease status at HCT and time to relapse between first and second HCT are two significant prognostic factors with independent impact on patient outcome. The indication of a second allo-HCT in this context should be thoroughly discussed for individual cases, in particular for patients with early relapse and refractory disease arriving to second allo-HCT, for whom the probability of prolonged survival is extremely low. Disclosures: No relevant conflicts of interest to declare.

Abstract 4942 INTRODUCTION. Patients with Mantle cell lymphoma (MCL) have an adverse outcome after relapse due to chemorefractory disease with conventional treatments. Bendamustine, a nitrogen mustard compound chemically related to the alkylating agents, has demonstrated high efficacy with a low toxicity profile in reported clinical trials. AIM. To analyze the Spanish experience in patients with relapsed/refractory MCL treated with Bendamustine. METHODS. Retrospective analysis of spanish experience in relapsed/refractory MCL treated with Bendamustine alone or in combination. This study has been approved by local ethical committees. RESULTS. Currently, there are 36 patients registered and 28 are available for this analysis. Patients'characteristics: 69% male, median age 65 years old (range 41–81), 87% ECOG≤ 1, 83% Ann Arbor stage IV, 37% high risk MIPI and 9% blastic variant. Previous regimens were CHOP or CHOP like ± R in 42.5%, HyperCVAD/MtxAraC ± R in 42.5%, R-CVP in 9% and other regimens in 6%. Median number of previous treatments were 2.6 (range 1–6), all patients had received prior Rituximab and 73% had chemosensitive disease to the last treatment. Bendamustine regimen was R-B (R-375mg/m2 D1, B-90 mg/m2 D1-2) in 78% patients, R-B with B-70 mg/m2 in 8%, B alone in 3%, R-B-Bortezomib in 3% and R-B plus consolidation (SCT, Y90Ibritumomab-tiuxetan) in 8%. Median number of cycles was 4.61 (range 1–7). G- CSF support was administered in 43% of cycles. Response: Overall response rate was 73%, with 43% CR & uCR and 30% PR. Survival: Median overall survival from diagnosis is 8,26 years (range: 1.6–11,6 years) without plateau. Median progression free survival (PFS) after Bendamustine treatment was 16 months (95% CI: 11.7–20.4), data that compares favourably with patients' PFS to previous therapy (12 months, 95% CI: 6.5–17.5). Median PFS for patients who achieved CR/uCR is 32.6 months (95% CI: 19.9–45.4) versus 11 months in patients with PR (95% CI: 3.9–18.8). With a median follow-up for surviving patients of 12 months since Bendamustine treatment, the estimated OS at 3 years is 47% (+ SD 14%). Toxicity: No treatment related mortality has been described so far. Over 152 cycles, only 10 hospitalizations due to febrile neutropenia were reported. No one case of lysis tumoral syndrome has been reported. CONCLUSION. Bendamustine plus Rituximab is a good rescue treatment in non selected pretreated patients with mantle cell lymphoma. CR rate and duration of response seem to reproduce in current clinical practice the good data reported in previous clinical trials and compares favourably with other available treatments. Disclosures: No relevant conflicts of interest to declare.

Abstract 2867 Introduction. Survival of Follicular Lymphoma patients has significantly increased with the introduction of immunomodulatory agents, such as Interferon (IFN) and Rituximab (R). Until 2002 our Follicular Lymphoma patients were included in a trial and received induction therapy with CVP + Interferon (LNH-pro, JCO 16; 1538–1546). Since 2006, Rituximab is being added to the same induction regimen (LNH-pro-05, EHA 09). Herein we communicate the comparative results between these two trials in Intermediate-High risk Follicular Lymphoma patients. Aim. To compare toxicity and efficacy in terms of complete remission (CR) and Progression Free Survival (PFS) between both trials in Intermediate-High risk Follicular Lymphoma patients. Methods. Patients in the LNH-pro trial (1990-2006) received CVP (CY 400mg/m2 p.o D1-5, VCR 1.4mg/m2 iv D1, PRD 100mg/m2 po D1-5) + IFN (3MU/m2 sc, 3 times/wk, for 12 wks). When it became available, G-CSF support was permited. In the LNH-pro-05 trial (2006-ongoing), Rituximab (R: 375mg/m2 iv D1) was added to the same induction regimen. All patients received 8 cycles as per protocol, with G-CSF support and Pn. jiroveci prophilaxis. In both studies, complete re-assessment was performed after cycle 4, at the end of induction therapy, every 4 months for the first 2 years and every 6 months thereafter. Results. We analysed data from 74 and 36 FL patients with FLIPI≥2, included in the LNH-pro and LNH-pro-05 trials, respectively. Patients' characteristics are shown in table 1. No significant differences were found between groups, except for a higher incidence of elevated B2-microglobulin in patients treated with CVP+IFN and higher Bulky disease (>7cm) among patients with R+CVP+IFN. Median number number of cycles were 6 and 8, respectively. Response: Seventy one patients (96%) in the LNH-pro Trial (CVP+IFN) were evaluable for response. Overall Response (OR) rate was 87%, with 68% Complete Remission (CR) and 19% Partial Remission (PR) (9% non-responders). In the LNH-pro-05 Trial (R+CVP+IFN), 36 patients (92%) and 33 patients (83%) were evaluable for response after 4th and 8th cycle. At cycle 4, all assesed patients achieved remission (15% PRs and 85% CR+uCR), while after the 8th cycle 100% of patients are in CR or uCR. Toxicity. Main hematologic grade 3–4 toxicity was neutropenia, 33% for CVP+IFN and 28% for R+CVP+IFN, with 12% and 6% of infections, respectively. Other non-hematologic toxicities were infrequent and mild (5% and 10% in each group). Eight percent of patients in the LNH-pro trial withdrew treatment due to toxicity. At the moment, none of the patients in the LNH-pro-05 trial have experienced an unacceptable toxicity. Survival . Median follow-up was 7.7 years for CVP+IFN and 2 years for R+CVP+IFN. A significant increase of PFS was seen among patients who received R (66% vs. 86%, at 3 years, P 0.05). There is also a trend to a longer overall survival in patients treated with R+CVP+IFN (P 0.07). Conclusion. The addition of Rituximab to CVP+IFN induction regimen in Intermediate-High risk Follicular Lympoma patients, significantly increases complete remission rates (88% to 100%) and progression free survival (86%, at 3 years), with a low toxicity profile. Disclosure: No relevant conflicts of interest to declare.

Abstract 2225 Poster Board II-202 Introduction: In spite of significant advances in the diagnosis and treatment of CMV infection post-allogeneic SCT it continues to be associated with significant morbidity and mortality. The human herpesvirus 6 (HHV-6) reactivation has been associated with different complications, including delayed neutrophil and platelet engraftment, interstitial pneumonia, skin rash, severe graft versus host disease (GvHD), and central nervous system disorders. HHV-6 is considered an immunomodulatory and immunosuppressive agent, and thereby, it may the increase the risk of active CMV infection and disease in the transplantation setting Aims: To determine if the HHV-6 facilitates the CMV reactivation or influences the kinetic of CMV replication and its specific immune replication during the first 100 days after allogeneic hematopoietic SCT. Patients and Methods: Between Nov-05 and Feb-08, sixty-eight patients were monitored for plasma HHV-6 and CMV DNAemia by PCR once/week until day +100 after Allo-SCT. Characteristics of patients: median age: 45 yo (18-70); sex (M/F): 37/31. Diagnosis: AML/MDS(n=27), ALL(n=10), lymphoproliferative syndrome(n=17), MM (n=4), CML (n=3), Others(n=7). CMV seropositive (R/D)(%): 88/60. Cell source: PBSC: 53(78%);CB:13(19%);BM:2(3%). Conditioning treatment: RIC: 40 pts, myeloablative: 28 pts. pp65 antigenemia in PMN leucocytes (Light Diagnostics, Chemicon Intern). Positive if ≥1cel+/200.000. Plasma DNA-CMV: PCR-RT Abbott or Amplicor CMV Monitor Roche. Plasma DNA-HHV6: Q-PCR Alert Amplimix, Nanogen Adv. Diag., detection limit: 10 copies/mL plasma. Enumeration of pp65 and IE-1 IFNγ CD4+ and CD8+ T cells was performed by intracellular cytokine staining. (BD Fastimmune, BD-Beckton Dickinson). Pre-emptive antiviral treatment was initiated if pp65 Ag +. Results: HHV-6 DNAemia occurred in 27 out of 68 pts (40%), after a median time of 20 days post-SCT with a peak value of 345 copies (26-13,661) reached on the fourth week in the 52% of patients, with a median duration of 10 days (3-35). Twenty-three out of the 27 patients were HHV-6 seropositive before transplantation. Clearance of most episodes (21 out of 27) occurred in the absence of (val)ganciclovir treatment, which was initiated in the course of the remaining 6 episodes because of the development of antigenemia-positive active CMV infection. HHV-6 DNAemia was significantly associated with subsequent CMV DNAemia in univariate (P=.01), but not in multivariate analysis (P=.056) that included transplant from URD, HLA non identical donor, myeloablative conditioning, CBT, use of prednisone as GVHD prophylaxis and plasma HHV-6 DNA detection. HHV-6 DNAemia was not predictive of development of CMV DNAemia. Timing and kinetics of active CMV infection were comparable in patients either with or without a preceding episode of HHV-6 DNAemia. Occurrence of HHV-6 DNAemia had no impact on the level of CMV-specific T-cell immunity reconstitution early after transplant. The receipt of a graft from an unrelated donor was the principal variable associated with HHV-6 and CMV coactivation. Conclusion: The results of this study suggest that a basal immunosuppressive state, specially the receipt of a graft from an unrelated donor, leads to HHV-6 and CMV coactivation, and argue against an effect of active HHV-6 infection on CMV replication either by a direct interaction or indirectly by suppressing CMV-specific T-cell responses. Disclosures: No relevant conflicts of interest to declare.

Abstract 1703 Poster Board I-729 Abstract text Background Mantle Cell Lymphoma (MCL) is an entity with a median survival of 2- 4 years, so it is currently considered an aggressive tumour. Standard chemotherapies for other B cell lymphomas have yielded poor results. Better outcomes have been communicated with the use of up front intensive chemotherapy or of high doses schemas with stem cell support as consolidation of the response, although relapses frequently occur. Keeping in mind these considerations, we used the Hyper-CVAD/MTX-AraC squema in association with anti-CD20, followed by consolidation with Ibritumomab-tiuxetan (ZevalinR) with the aim of eradicating minimal residual disease and decrease the risk of relapse. Aims Evaluate the feasibility, safety and, efficacy for overall response, complete response and progression free survival (PFS) in newly diagnosed MCL patients with advanced Ann Arbor stage or with lower stage but with B symptoms or bulky disease. Methods All patients received: Anti-CD20/Hyper-CVAD therapy alternating with anti-CD20/MTX/Ara-C, supported with Peg- Filgastrim. Response was evaluated after 4 cycles and, treatment continued up to a median of 6 cycles if response (complete or partial) was achieved. Consolidation treatment consisted in a single dose of Y90-Ibritumomab-Tiuxetan (Zevalin) (RIT) administered 8 to 12 weeks after the last cycle. We started at a dose of 0.3 mCi/kg with a planned dose escalation to 0.4 mCi/kg if no unacceptable toxicity was observed in the 1st three patients treated. Results From February 2006 until July 2008, 30 patients were enrolled. Patients' characteristics: 77% male, median age of 59 years old (range 41-70), 93.3% Ann Arbor stage IV, 87% bone marrow infiltration, 62% gastrointestinal infiltration and 13%were blastic variant. Induction therapy: The main toxicities over 170 cycles were haematological and greater in the odd cycles (90% vs 53% grade 3-4 Neutropenia and 98% v. 33% grade 3-4 thrombocytopenia). Sixty five SAEs were reported during induction, mainly neutropenic fever and upper tract respiratory infection with 1 death due to sepsis (3.3%), and 5 non-related events (including 1 suicide). Response after induction: 20 patients (66,7%) were in CR, 5 (16,7%) in uRC, 1 (3,3%) progressed, and 4 patients (13,3%) were not evaluable due to early events (2 deaths and 2 toxicities). Consolidation with RIT: dose of RIT was fixed at 0.3 mCi/Kg after treatment of the first 6 patients and total of 18 patients (60%) have finally received it. Grade 3-4 neutropenia and thrombopenia was observed in 72% and 83% of the patients with a median duration of 3 and 8 weeks, respectively. Ten SAEs with no deaths were reported after consolidation. Twelve patients (40%) could not accomplish the whole treatment due to following reasons: 8 because of induction toxicity (5 infection with one death, 1 neurological, 3 delayed haematological recovery); 1 non related death, 1 progression and 1 withdrawal for personal reasons. Survival: With a median follow up of 25 months. Actuarial OS and PFS to 33 months is 90% and 75% respectively. Conclusion treatment of MCL with 6 cycles of Hyper-CVAD/MTX-AraC with anti-CD20 can be accomplished in 70% of the patients up to 70 years, although close follow-up and dose adjustments are frequently required mainly due to haematological toxicity. Consolidation with Ibritumomab-tiuxetan is safe and feasible at a dose of 0,3 mCi/Kg. Efficacy is high with an ORR and PFS of 83% and 75%, respectively although longer follow-up is needed to evaluate the role of consolidation treatment with RIT. Disclosures Salar: Amgen: Honoraria.

Human herpesvirus-6 (HHV-6) may enhance cytomegalovirus (CMV) replication in allogeneic stem cell transplant (allo-SCT) recipients either through direct or indirect mechanisms. Definitive evidence supporting this hypothesis are lacking. We investigated the effect of HHV-6 replication on active CMV infection in 68 allo-SCT recipients. Analysis of plasma HHV-6 and CMV DNAemia was performed by real-time PCR. Enumeration of pp65 and IE-1 CMV-specific IFNgamma CD8(+) and CD4(+)T cells was performed by intracellular cytokine staining. HHV-6 DNAemia occurred in 39.8% of patients, and was significantly associated with subsequent CMV DNAemia in univariate (P=.01), but not in multivariate analysis (P=.65). The peak of HHV-6 DNAemia was not predictive of the development of CMV DNAemia. Timing and kinetics of active CMV infection were comparable in patients either with or without a preceding episode of HHV-6 DNAemia. The occurrence of HHV-6 DNAemia had no impact on CMV-specific T cell immunity reconstitution early after transplant. The receipt of a graft from an HLA-mismatched donor was independently associated with HHV-6 (P=.009) and CMV reactivation (P=.04). The data favor the hypothesis that a state of severe immunosuppression leads to HHV-6 and CMV coactivation, but argue against a role of HHV-6 in predisposing to the development of CMV DNAemia or influencing the course of active CMV infection.

Enunciados teóricos sobre los modos narrativos y dramáticos.

Abstract 3010FN2 Background: There is a need to improve the conditioning regimens for allogeneic HSCT, both reducing the regimen related toxicity and improving the anti-leukemic effect. The myeloablative (MA) regimen consisting in intravenous (iv) busulfan (BU) with fludarabine (F) might be a better option than the conventional BU-CY (Cyclophosphamide) combination, since BU and F act synergistically against leukemia cell lines and previous studies with iv BU-F conditioning have reported an improved safety profile over BU-CY. Objective: We aimed to evaluate the efficacy and safety of the MA BU-F regimen, delivering iv BU in a one-daily dose after F infusion, since previous pharmacologic and clinical data supported its safety compared with the standard four-daily doses in the HLA identical sibling allogeneic HSCT setting. Patients: One hundred thirty seven consecutive adult patients with myeloid malignancies from nine Spanish institutions were recruited from 2005 to 2011. They had a median age of 47 years (range 19–74) and 60% were males. Diagnosis were AML: 80 (58.4%), AML secondary to MDS: 24 (17.5%), MDS: 23 (16.8%) and MPD: 10 (7.3%). At HSCT, the disease stage was 1st CR or untreated in 85 (62%) and more advanced stage in 52 (38%) cases. Patients having Karnofsky < 90% and Sorror CI >1 accounted for 11.7% and 38.3%. The conditioning regimen consisted in F, 40 mg/m2 daily for 4 days (total dose 160 mg/m2) followed by BU, one-daily IV 3.2 mg/kg infusion (total dose 12.8 mg/kg). GVHD prophylaxis consisted in cyclosporine and methotrexate. HSC infusion and post-transplant supportive measures and follow-up were made according each institution policies. Results: Donor graft source was peripheral blood (PB) in 93 (67.9%) and bone marrow (BM) in 44 (32.1%) cases. Median CD34+ cells infused were 4.5 millions/kg (range 0.6–17.8). All but one patient engrafted, with a median of 15 days (range 8–49) to >0.5 ×10E9 PMN/L and 13 days (range 7–149) to >20 ×10E9 platelets/L. The most frequent toxicity was mucositis, which was grade >1, in 68.8% cases. Three patients had hepatic SOS grade >1, and all of them resolved. Median hospitalization time was 30 days (range 17–114). Acute GVHD grade 2–4 incidence was 25% with a median of 32 days (range 12–87) to GVHD onset. The day-100 mortality was 4.8%. The chronic GVHD incidence in 114 patients at risk is 61.4%, with 37.7% of cases in extended form. At the time of this analysis, the median follow-up is 12 months (range 1–74). Crude survival data showed 106 (77.4%) patients remaining alive and 106 (77.4%) relapse free. Overall, 31 patients have died, 19 relapse-related (13.9%) and 12 (8.8%) due to transplant related mortality. Actuarial survival at 12 months is 79.4% and disease free survival is 71.3% in the whole series. Kaplan-Meier analysis showed that advanced age, comorbidities or advanced disease status at HSCT did not predict an inferior outcome. In conclusion, in the HLA identical sibling allogeneic HSCT setting, the BU-F regimen provides an adequate control of myeloid malignancies, with low regimen related toxicity and both reduced day-100 and non-relapse related mortality. Disclosures: Lahuerta: Janssen: Honoraria; Celgene: Honoraria.

Background: Adults with high risk ALL features at diagnosis, slow responders or with recurrent disease have a poor outcome with standard chemotherapy and are considered for unrelated transplants in most centers if a matched sibling donor is not available. Unrelated cord blood (UCB) has emerged as an option for unrelated transplant in adult patients. Aim of the study: to compare the outcome of adult patients with unrelated transplant for poor prognosis ALL based on the hematopoietic source used for transplant. Patients and Methods: One hundred and forty- nine adult patients (median 29 years [15–59], 90M/59F) with poor prognosis ALL received an unrelated transplant in 13 Spanish institutions from 2000 to 2007. Patients in 1st CR at transplant met at least one adverse prognostic factor (adverse cytogenetics, hyperleukocytosis or a slow-responder). ALL was of precursor B lineage in 111 (74%), T-cell lineage in 28 (19%) and undetermined lineage in 10 (7%) patients. ALL was in 1st CR in 81 (54%) patients, in 2nd CR in 37 (25%), in 3rd CR in 11 (7%) and overt disease in 20 (13 %) patients. Both groups were comparable for the main clinical and biologic ALL features except for patients with more overt disease in UCB transplant group. Conditioning therapy consisted on TBI-CY in 68 (46%), BU-CY in 9 (6%), Thiotepa- BU-CY/FLU in 60 (40%) patients (all of them UCB transplants) and other regimens in 12 (8%) patients (6 of them were non-myeloablative). The source of hematopoietic progenitors was UCB in 62 (41%), mobilized PB in 41 (28%) and BM in 46 (31%) patients. HLA compatibility requirements for selecting unrelated donors (BM and mobilized PB) were 7–8 out of 8 allelic identities, and for UCB were 4–6 out of 6 A / B antigenic and DR allelic identities. Results: Acute GVHD was most frequent after PBSCT and BMT thanin UCBT. There was no significant difference for limited and extensive chronic GVHD between UCBT and PBSCT/BMT. The median follow-up was 16 months (0.3–101.4). DFS estimated at 5 years for patients transplanted with any source was not significantly better in transplants in 1st CR versus 2nd CR or more advanced disease (median 12 [2–22] vs 5 [2–9], p=0.106). There was no statistical difference in OS or DFS at 5 years between UCB and PBSCT/BMT). TRM was significantly lower in UCB transplants (p=0.021). The relapse probability was 17% for the PBSCT/BMT versus 29% for UCBT (p=0.088). The use of TBI as conditioning therapy was not associated with a lower relapse rate. 5y-OS (95%CI) Median OS (month, 95%CI) 5y-DFS (95%CI) Median DFS (month, 95%CI) 5y-TRM (95%CI) *p=0.021 Whole series 26% (17–35) 10 (4–17) 21% (13–29) 7 (3–11) 54% (44–64) PBSCT/BMT 22% (11–33) 9 (2–17) 21% (11–31) 5 (2–9) 63% (50–76)* UCBT 33% (18–48) 15 (7–22) 22% (8–36) 9 (1–17) 39% (25–53)* 1st CR ALL 30% (16–44) 12 (0–29) 24% (11–37) 12 (2–22) 57% (43–71) PBSCT/BMT 27% (9–45) 27 (2–51) 24% (8–40) 12 (2–22) 63% (44–82) UCBT 35% (14–56) 10 (0–23) 24% (4–44) 10 (0–26) 50% (31–69) GVHD was the main cause of death for unrelated PBSCT/BMT in contrast with infection and relapse for UCBT (p=0.001). Conclusions: UCB transplant and unrelated PBSCT/ BMT are equivalent options for poor prognosis adult ALL patients without a sibling donor. However, all modalities are associated with high transplant related mortality.