Search

Background: Allogeneic hematopoietic cell transplantation (HCT) has been a successful strategy to treat myelodysplastic syndrome (MDS). With only approximately one-third of patients having an HLA matched sibling, most transplants use mismatched relative (haploidentical) or unrelated donors. In the current analysis we sought to study outcomes after haploidentical related compared to HLA-matched unrelated donor HCT for MDS (de novo or therapy-related). Methods: We retrospectively studied 176 recipients of haploidentical related donor and 427 recipients of 8/8 HLA-matched unrelated donor HCT in the United States between 2012 and 2017. The primary outcome was overall survival. The effect of donor type on survival and other transplant outcomes were studied using a Cox regression model. Results: Patient and disease characteristics are presented in Table 1. Most transplants (85%) were for de novo MDS in both donor groups. Although all patients received reduced intensity regimens, the predominant conditioning regimens were confounded by donor type. Total body irradiation (TBI) 200 cGy/cyclophosphamide/fludarabine (TBI/Cy/Flu; 82%) was the predominant regimen for haploidentical HCT and fludarabine with busulfan or melphalan (Flu/Bu or Flu/Mel; 79%) without in vivo T-cell depletion was the predominant regimen for unrelated donor HCT. Similarly, graft-versus-host disease (GVHD) prophylaxis was also confounded by donor type. Posttransplant cyclophosphamide/calcineurin inhibitor/mycophenolate (PT-Cy/CNI/MMF) was the prophylaxis regimen for all haploidentical transplants. CNI/MMF (31%) or CNI/methotrexate (69%) was used for unrelated donor transplants. Peripheral blood was the predominant graft for both donor types. The median follow-up was 24 months (range 3-77) after haploidentical and 36 months (range 3-74) after unrelated donor HCT. Results of multivariate analysis, adjusted for HCT-CI, prior treatment with hypomethylating agents (HMAs), and IPPS-R did not show differences in survival by donor type (HR 0.98, p=0.85; 40% vs. 37%), Figure 1. However, the relapse rate (adjusted for prior HMAs, IPSS-R, and recipient sex) was higher after haploidentical compared to unrelated donor HCT (HR 1.60, p=0.002, 53% vs. 34%), which led to lower disease-free survival after haploidentical HCT (HR 1.30, p=0.03; 21% vs. 32%), Figure 1. To further test the effect of regimen intensity, low dose TBI regimens were compared to Flu/Bu and Flu/Mel; we did not observe a difference in relapse risk (HR 0.95, p=0.76). Non-relapse mortality did not differ by donor type (HR 0.88, p=0.46). Interval between diagnosis and transplant was also not associated with outcomes. Acute grade II-IV acute GVHD (HR 0.46, p Conclusion: Although the current analysis did not show differences in survival between haploidentical related and matched unrelated donor HCT, the higher relapse and consequently lower disease-free survival associated with the haploidentical HCT approach in this analysis (primarily TBI/Cy/Flu with PT-Cy/CNI/MMF) warrants caution. A more definitive comparison of the two donor types can be accomplished only if more haploidentical transplants were to use Flu/Bu or Flu/Mel conditioning. Figure 1 Disclosures Grunwald: Celgene: Consultancy; Pfizer: Consultancy; Agios: Consultancy; Merck: Consultancy; Abbvie: Consultancy; Medtronic: Equity Ownership; Incyte: Consultancy, Research Funding; Daiichi Sankyo: Consultancy; Amgen: Consultancy; Trovagene: Consultancy; Cardinal Health: Consultancy; Janssen: Research Funding; Genentech/Roche: Research Funding; Novartis: Research Funding; Forma Therapeutics: Research Funding. Bolanos-Meade:Incyte Corporation: Other: DSMB fees. Bredeson:Otsuka: Research Funding. Gupta:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sierra Oncology: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Incyte: Honoraria, Research Funding. Mussetti:Takeda: Honoraria; BMS: Honoraria; Novartis: Honoraria; Italfarmaco: Honoraria. Nakamura:Merck: Membership on an entity's Board of Directors or advisory committees; Celgene: Other: support for an academic seminar in a university in Japan; Alexion: Other: support to a lecture at a Japan Society of Transfusion/Cellular Therapy meeting ; Kirin Kyowa: Other: support for an academic seminar in a university in Japan. Nishihori:Novartis: Research Funding; Karyopharm: Research Funding. Solh:Celgene: Speakers Bureau; Amgen: Speakers Bureau; ADC Therapeutics: Research Funding. Weisdorf:Fate Therapeutics: Consultancy; Pharmacyclics: Consultancy; Incyte: Research Funding.

Standard treatment for patients with Hodgkin lymphoma (HL) unresponsive to upfront therapy or relapsing after primary treatment (RR-HL) consists of salvage chemotherapy followed by autologous stem cell transplant (ASCT). ASCT outcomes are essentially related to two factors: disease burden at the time of transplant and comorbidity status of the patient. Positron emission tomography (PET) scan is a very sensitive diagnostic instrument to measure disease status. In fact, a negative PET status before ASCT is a well-known positive prognostic factor in patients with RR-HL. The recent introduction of the biologically targeted agent brentuximab vedotin has allowed us to treat RR-HL more efficaciously with less toxicity for the patient. Use of this new agent could help achieve a PET-negative status before ASCT in a larger percentage of patients, without severe toxicities, thereby improving ASCT outcomes. Herein we discuss the current evolving scenario of RR-HL treatment.

Multiple myeloma relapsing after allogeneic stem cell transplantation (alloSCT) has a poor outcome. To assess the safety and efficacy of bortezomib and dexamethasone (VD) combination followed by donor lymphocyte infusions (DLIs) in myeloma patients relapsing or progressing after alloSCT, a prospective phase II study was designed. The treatment plan consisted of three VD courses followed by escalated doses of DLIs in case of response or at least stable disease. Nineteen patients were enrolled with a median age of 57 years (range, 33 to 67); 14 patients were allografted from human leukocyte antigen–identical siblings and 5 from alternative donors. Sixteen of 19 patients received the planned treatment, but 3 patients did not: 2 patients because of disease progression and 1 refused. After the VD phase the response rate was 62%, with 1 complete remission, 6 very good partial remissions, 5 partial remissions, 2 patients with stable disease, and 5 with progressive disease. After the DLI phase, the response rate was 68%, but a significant upgrade of response was observed: 3 stringent complete remissions, 2 complete remissions, 5 very good partial remissions, 1 partial remission, 4 with stable disease, and 1 with progressive disease. With a median follow-up of 40 months (range, 29 to 68), the 3-year progression-free survival and overall survival rates were 31% and 73%, respectively. Neither unexpected organ toxicities, in particular severe neuropathy, nor severe acute graft-versus-host disease flares were observed. VD-DLIs is a safe treatment for multiple myeloma patients relapsing or progressing after alloSCT and may be effective.

Extracorporeal photopheresis (ECP) is considered a valid second-line treatment for acute and chronic graft versus host disease (GVHD).Ninety-four patients with acute GVHD (aGVHD) (n = 45) and chronic GVHD (cGVHD) (n = 49), retrospectively recruited in 6 Italian centers, were submitted to ECP for second-line treatment. At the time of ECP, 22 (49%) and 23 (51%) of 45 patients with aGHVD were nonresponsive and in partial remission (PR) after steroids, respectively, and all the 49 patients with cGVHD were steroid refractory.Forty-one (91%) of 45 patients with aGVHD achieved complete remission (CR) after ECP. Fifteen (33%) of 45 patients developed cGVHD. The CR rate in patients who started ECP being nonresponsive and in PR after steroid was 86% and 96%, respectively. After a median follow-up of 20 months (range, 2-72), 15 (33%) of 45 patients developed cGHVD and 16 (35%) of 45 patients died, in 3 cases for aGVHD. A trend for a better survival was seen among patients who started ECP in PR after steroid (80% vs 50% at 2 years; P = 0.07). Overall, 22 (45%) of 49 patients and 17 (35%) of 49 patients with steroid refractory cGHVD achieved CR and PR after ECP, respectively. After a median follow-up of 27 months, 44 (90%) of 49 patients are alive, 21 of whom (48%) are on steroid.Extracorporeal photopheresis is confirmed as an effective second-line treatment in both aGVHD and cGVHD, because it can induce a response in more than 80% of the patients and a long-term survival in at least 50% of the cases.

We report the construction and standardization of a new comprehensive battery of tests for the assessment of semantic memory disorders. The battery is constructed on a common set of 48 stimuli, belonging to both living and non-living categories, rigidly controlled for several confounding variables, and is based on an empirically derived corpus of semantic features. It includes six tasks, in order to assess semantic memory through different modalities of input and output: two naming tasks, one with colored pictures and the other in response to an oral description, a word-picture matching task, a picture sorting task, a free generation of features task and a sentence verification task. Normative data on 106 Italian subjects pooled across homogenous subgroups for age, sex and education are reported. The new battery allows an in-depth investigation of category-specific disorders and of progressive semantic memory deficits at features level, overcoming some of the limitations of existing tests.

Grade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P < 0.001), 61% vs 20% (P < 0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR) = 0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR = 3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR = 0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.

Bendamustine is an old bi-functional alkylating agent which, thanks to its extended efficacy and good tolerability, is living a second youth with growing use in several lympho-proliferative maligna...

Relapsed and refractory (rel/ref) mantle cell lymphoma (MCL) portends a dismal prognosis. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents the only potentially curative therapy in this setting. We analyzed survival outcomes of 29 recipients of non-myeloablative allo-HSCT for rel/ref MCL, and studied possible prognostic factors in this setting. The cumulative incidence of disease progression and non-relapse mortality at 3 years were 28% (95% confidence interval [CI]: 13-46%) and 29% (95%CI: 13-47%), respectively. The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) at days +100 and +180 were 34% (95%CI: 18-52%) and 45% (95%CI: 26-62%), respectively. With a median follow-up in survivors of 53 (range 24-83) months, the 3-year overall survival (OS) and progression-free survival (PFS) were 54% (95%CI: 38-76%) and 41% (95%CI: 26-64%), respectively. In vivo T-cell depletion with alemtuzumab (n=6) was associated with inferior 3-year PFS (0% vs. 51%, p=0.007) and OS (17% vs. 64%, p=0.014). Conversely, a second line international prognostic index (sIPI) at transplantation equal to 0 (no risk factors) was associated with an improved 3-year PFS (52% vs. 22%, p=0.020) and OS (71% vs. 22%, p=0.006) compared to sIPI ≥1. Performing an allo-HSCT before 2007 was associated with a decreased 3-year OS (25% vs. 76%, p=0.015) but not with a significantly inferior PFS (17% vs. 59%, p=0.058). In this single center series, we report encouraging results with allo-HSCT for patients with rel/ref MCL. High alemtuzumab doses should probably be avoided in this context.

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...

The management of relapsed/refractory mantle cell lymphoma (MCL) remains a clinical challenge. A standard second-line treatment for relapsed/refractory MCL does not exist. Management of relapsed/refractory MCL requires an individualized treatment approach, incorporating factors such as: functional status, prior treatments, response to prior therapies, and disease biology. Generally, there are two categories of salvage therapy; the first, non-cross-resistant cytotoxic chemotherapeutic agents and, the second, pathway-targeted agents. For transplant eligible patients, the optimal therapy usually consists of salvage, remission re-induction phase followed, whenever possible, by a consolidation phase. Bendamustine and/or high dose cytarabine plus rituximab based chemotherapy represent the most common salvage therapy with an overall response rate of 70-80%. Consolidation with a reduced intensity conditioning allogeneic stem cell transplantation represents the only potentially curative treatment. Overall survival ranges from 30% to 50% at 5 years with this approach. For transplant ineligible patients, ibrutinib is the most effective treatment with an overall response rate of almost 70% and median response duration of 17.5 months. Lacking an effective consolidation, this approach is not considered curative. In this review we characterize the main therapeutic approaches available in this setting and summarize our preferred clinical treatment approach.

Objectives: Richter transformation (RT) represents the rare occurrence of a secondary aggressive lymphoma in the setting of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Methods: Here we describe the peculiar case of a patient with trisomy 12+ and atypical (CD5+, CD23−) CLL/SLL who developed a two-step RT with complex morphologic and molecular features. Results: Molecular analysis of a CLL/SLL population detected two different immunoglobulin rearrangement patterns corresponding to a main peak and a minor peak. Transformation took place both as gastric diffuse large B-cell lymphoma and as a synchronous bone marrow classic Hodgkin lymphoma with the same immunoglobulin rearrangement pattern corresponding to the minor peak detected in CLL/SLL at diagnosis. During chemotherapy, progression occurred as axillary nodal involvement by a CD5+ high-grade lymphoma with an immunoglobulin rearrangement pattern corresponding to the main CLL peak. Conclusions: In this case, the elaborate clinical and molecular picture may be correlated to an alternate dominance of two distinct clonal populations probably influenced by therapeutic and environmental factors.

Mixing control in microchannels is a problem of paramount importance in a variety of situations ranging from applications in chemistry and biochemistry [1] to fundamental research in fluid mechanics and transport [2]. The main problem to solve is related to the fact that purely hydrodynamic fluid instabilities are inhibited due to negligible inertia of microchannel flow. Since mixing times or distances can be very long, strategies are required to enhance mixing in microdevices [3, 4]. Along this line, the suggestion of a new strategy is the main concern of our paper. Two different approaches are commonly used to induce mixing, according to their active or passive character [5]. Active micromixers use the disturbance generated by an external time-dependent field for the mixing process, eg., pressure gradient [6], electric fields [7] and sound [8]. Those methods are often difficult because of the tiny scales involved and they also pose several problems from a manufacturing point of view. Passive micromixer do not require external energy, the mixing process relies entirely on diffusion [9] or chaotic advection [4]. In the first approach, the molecular diffusion is enhanced by increasing the contact surface and decreasing the mixing path [9]. In the second, the geometrical structure of the microchannel is projected to trigger Lagrangian chaos (and thus mixing via eddy-diffusivity mechanisms [10– 12]). Suitable non-Newtonian fluid solutions [17, 18] often provide an alternative valid answer to trigger mixing exploiting elastic instabilities in the limit of very small Reynolds numbers [13–16] or, eventually, turbulence [19–21]. Our aim here is to show how, exploiting state-ofthe-art control/optimization techniques, the mixing of a passive scalar quantity emitted in a microchannel can be easily enhanced by a time-dependent injection in punctual and multi-source configuration. The control we propose relies on the optimal interplay between advection, injection and diffusion for the actual mixing. The technique is active but does not require any time-dependent variation of the emission source position. The system is especially suitable for noncontinuous mixing [22] and, at the same time, for dosing with a minimal emitted substance. G. Mussetti (&) Dipartimento di Informatica, Bioingegneria, Robotica e Ingegneria dei Sistemi, Universita di Genova, Via Montallegro 1, 16145 Genova, Italy e-mail: mussetti.gianluca@gmail.com

Backgrounds: Allogeneic Hematopoietic Cell Transplantation (HCT) is a potentially curative treatment for fit patients with relapsed/refractory multiple myeloma (MM). When a HLA-identical donor is not available, haploidentical HCT (haploHCT) represents an acceptable therapeutic option, especially when post-transplant cyclophosphamide (PT-Cy) is used as anti-GVHD prophylaxis. Patients and methods: Twenty-nine patients (median age 56 years, range 47-70) undergoing myeloablative (n=15) or reduced-intensity (n=14) haploHCT from February 2011 to November 2015 are included in this retrospective analysis. The median number of previous lines of therapy was 2 (range 1-7) with 27 (93%) of patients having previously performed an autologous HCT. Both bortezomib and lenalidomide were used in 27 (92%) patients before haploHCT. Eighteen patients (62%) had chemosensitive disease at time of haploHCT (CR=4, VGPR=9, PR=5) and 11 (38%) had chemorefractory disease (PD=7, SD=4). Graft source was marrow-derived in 59% (n=17) and peripheral blood in 41% (n=12) of patients. Standard post-transplant cyclophosphamide anti-GVHD prophylaxis (50mg/mq day +3 and +4 or +5) plus mycophenolate and cyclosporine (n=24) or tacrolimus (n=3) or rapamycine (n=2) was used for the whole study cohort. Overall survival (OS) and Progression Free Survival (PFS) were performed with Kaplan-Meier analysis. Neutrophil and platelets engraftment, acute GVHD, chronic GVHD, Non-Relapse-Mortality (NRM) and Relapse Incidence/Progression of Disease (RI/POD) were obtained with competing risk analysis. Results: At day +30, neutrophil and platelets engraftments were 86% (95%CI:65-95) and 59% (95%CI:38-74), respectively. Acute GVHD grade >2 at days +100 and +180 were 38% (95%CI: 20-55%) and 41% (95%CI: 23-59%), respectively. All grade chronic GVHD at 12 and 18 months was 21% (95%CI: 8-37. At 18 months, RI/POD was 39% (95%CI:20-58%) and NRM 15% (CI95%:5-32). With a median follow-up in survivors of 16 months (range 5-55 months), the 18-month OS and PFS were 68% (95%CI: 47-82%) and 34% (95%CI: 15-54%), respectively. Chemorefractory disease at transplant was associated with a worse 18-month RI/POD (70% vs 18%, p= Conclusions: HaploHCT is a feasible and effective strategy in patients with relapsed/refractory high-risk multiple myeloma. Chemorefractory disease at transplant was the only prognostic factor associated with a significant reduced RI/POD, PFS and OS. Figure Kaplan-Meier estimates of progression free survival from time of transplant of the chemosensitive and chemorefractory disease. Figure. Kaplan-Meier estimates of progression free survival from time of transplant of the chemosensitive and chemorefractory disease. Disclosures No relevant conflicts of interest to declare.

Introduction : Cell source and graft composition are known to have a prognostic role in allogeneic hematopoietic cell transplant (HCT). Currently, there are no data in the setting of haploidentical-HCT with post-transplant cyclophosphamide (PT-Cy). Patients and methods : One-hundred patients undergoing haplo-HCT with PT-Cy from Sept 2011 to Nov 2015 were included in this multicenter retrospective analysis. Bone marrow (BM) was used as graft source in 25 patients and peripheral blood stem cell (PBSC) in 75. The two groups (BM vs PBSC) were similar in terms of age, Disease Risk Index (DRI) and HCT-CI. The only differences were on disease type (lymphoid malignancies 76% vs 57%, p=0.02) and conditioning regimen (myeloablative: 100% versus 30%, p Graft cellular subsets analysis was performed by means of flow cytometry (CD34, CD3, CD4, CD8, CD56, CD19, CD38, CD31, CD25, CD45RA, CD95, CD127, CCR4, CCR6, CCR7). Overall Survival (OS) and Progression Free Survival (PFS) were performed with Kaplan-Meier analysis. Acute GVHD, chronic GVHD, Non-Relapse Mortality (NRM) and Relapse Incidence/Progression of disease (RI/POD) were obtained with competing risk analysis. Results : For the whole cohort, neutrophil and platelet engraftment cumulative incidences at day +30 were 97% (95% CI: 91-99) and 64% (95% CI: 53-73), with no differences between BM or PBSC. Grade II-IV and grade III-IV aGVHD cumulative incidences at day +100 were 36% (95% CI: 26-48) and 10% (95%CI: 5-18), respectively. Acute GVHD cumulative incidence was significantly lower for BM grafts [16% (95% CI: 5-33) vs 43% (95% CI: 31-54), p=0.02], but no differences were observed regarding grade III-IV acute GVHD [8% (CI 95%: 1-24) vs 11% (CI 95%: 5-20), p=0.73]. Chronic GVHD cumulative incidence at 18 months was 23% (95%CI: 15-32) with no difference between BM or PBSC. With a median follow up of 16.5 months (range 0.8 - 40.6), the 18-months PFS and OS were 43% (95%CI: 32-54) and 63% (95% CI: 52-73), respectively. NRM and RI/POD at 18 months were 18% (95%CI: 11-26) and 38% (95%CI: 27-49). Multivariable analysis was performed using patient (age, gender, HCT-CI, DRI) and transplant characteristics (donor gender, donor-recipient relation, graft source). A DRI>1 was the only factor associated with higher RI/POD (HR 3.45, 95% CI: 1.4-8.2, p Graft cell composition analysis was performed separately for BM and PBSC cohorts. For the BM group, univariable analysis showed that CD4 graft count ≥20x10^6/kg was associated with a prolonged PFS [60% (95%CI: 28-81) vs 0%, p Conclusions : In our retrospective analysis, we did not observe significant differences in survival outcomes based on graft source. Patients receiving BM grafts developed fewer grade II-IV aGVHD, but grade III-IV aGVHD incidence was similar between the two groups. For the BM group, a higher CD4 count was predictive of better PFS, TRM and OS, as reported with standard GVHD prophylaxis and matched donors (Waller EK, J Clin Oncol 2014. 32: 2365-2372). Interestingly, of the CD4 population, only naive T cells and RTEs were associated with an improved PFS and OS. A protective effect of CD8 cell count was observed in the PBSC group. This is similar to the non PT-Cy setting where higher CD8 cells are associated with better survival outcomes (Reshef R, J Clin Oncol 2015). These data should be validated in a prospective analysis to guide the choice of cell source in the haplo PT-Cy setting. Figure 1 Kaplan-Meier estimates of progression free survival from time of transplant associated to the CD4 graft content. Figure 1. Kaplan-Meier estimates of progression free survival from time of transplant associated to the CD4 graft content. Disclosures Corradini: Celgene: Honoraria; Janssen: Honoraria; Novartis: Honoraria; Roche: Honoraria; Takeda: Honoraria; Sanofi: Honoraria; Servier: Honoraria; Gilead: Honoraria; Takeda: Consultancy.

e282 survival (OS) and progression-free survival (PFS) were 69% (95% CI:6-55%) and 35% (95% CI:6-22%), respectively (Figure 1). On multivariate analysis, chemorefractory disease at alloHCT was associated with an inferior PFS (Hazard risk [HR] 5.75 [95% CI:2.32-14.23]), inferior OS (HR 5.19 [95% CI:2.05-13.14]), higher toxicity related mortality (TRM, HR 6.60 [95% CI: 1.1139.02]) and higher RI/POD (HR 4.04 [95% CI: 1.07-15.21]). Being younger than 55 years emerged as a protective factor for both PFS (HR0.29 [95%CI:0.14-0.60]) and OS (HR 0.29[0.01-0.10]). Chronic GVHD conveyed a higher TRM (HR 1.15 [95%CI:1.021.30]) but not a reduced RI/POD. Conclusion: Our retrospective data show that RIC alloHCT is a safe and effective therapeutic option in MM patients, allowing long survival outcomes even in heavily pretreated patients. Figure 1 OS (A) and PFS (B) of the whole study population 15th International Myeloma Workshop, September 23-26, 2015 PO-349 Durable Remission and Survival in Relapsed/Refractory Multiple Myeloma After Allogeneic Hematopoietic Stem Cell Transplantation A.M. Cornelison, R.M. Saliba, S. Ahmed, Y. Nieto, Q. Bashir, N. Shah, S. Parmar, K. Patel, C. Hosing, U. Popat, E. Shpall, R. Champlin, M.H. Qazilbash Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas Background: The role of allogeneic hematopoietic stem cell transplantation (allo-HCT) in the setting of refractory multiple myeloma (MM) is still controversial. Although potentially curative in a subset of pts, 10-15% treatment related mortality (TRM) and chronic graft vs. host disease (cGVHD) preclude its universal use. In this study, we evaluated the role of allo-HCT for pts with relapsed MM. Methods: We identified 110 consecutive pts with relapsed MM who underwent allo-HCT at our institution between 2000 and 2014. The primary objective was to assess progression-free (PFS) and overall survival (OS). Results: Median age at allo-HCT was 54 (range, 32-71) years and median time from diagnosis to alloHCT was 35.7 (range, 8.6 to 228.8) months. Fifty-two (47%) and 49 (45%) pts had standard-risk (SR) and high-risk (HR) cytogenetics (CG) at the time of allo-HCT, respectively. Pts received a median of 5 (range, 1-9) prior chemotherapy regimens and 99 pts (90%) had at least 1 (range, 0-3) prior auto-HCTs. One hundred one(92%) pts received either a proteasome inhibitor (PI) or an immunomodulatory drug (IMiD) prior to allo-HCT, with 65 (59%) receiving both. Sixty eight (62%) received allo-HCT from a matched related, 34 (31%) from a matched unrelated, 5 (4%) from a cord blood, and 3 (3%) from a mismatched donor. Preparative regimen was fludarabine/melphalan-based in 88 (80%) and fludarabine/busulfan-based in 16 (15%) patients. Median time to neutrophil and platelet engraftment was 12 (range, 8-30) and 13 (range, 0-81) days, respectively. Ten pts died of non-relapse causes within 100 days (100-day TRM: 9%) and 20 (18%) within 1 year. Grade 1-4 acute GVHD was seen in 50 (45%) and cGVHD in 35 (32%) pts, respectively. Eighteen (16%) achieved a CR, 26 (23%) a VGPR and 38 (34%) achieved a PR, with an overall response rate of 73%. With a median follow up of 11.4 months (range 0.3 to 164) in all pts, and 32.7 months (range 3.6 to 164.3) in surviving pts, 1and 2-year PFS were 24% and 16%, respectively. Similarly, 1and 2-year OS were 52% and 32%, respectively. HR CG at allo-HCT and a response