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BACKGROUND Older adults suffering from cancer receive a treatment that, in most cases, causes symptoms such as fatigue, weakness, sleep disturbances, and lethargy. Moreover, the toxicity of the chemotherapy itself can also affect the physical function and the quality of life of cancer patients. Since a poor general health status reduces the chances of survival and these patients are most likely to also suffer from sarcopenia, it is therefore important to be able to improve their physical function through adapted physical activity (APA) as part of a supportive care management. Unfortunately, APA is too often saved for patients in an advanced stage of blood cancer. As a result, there is a lack of data regarding the impact of a regular practice of physical activity (that is concomitant to the administration of chemotherapy) on cancer survival. OBJECTIVE The aim of this study is to assess a new and open rehabilitation program suitable for a frail population of patients that are treated for diffuse large B-cell lymphoma (DLBCL). METHODS PHARAOM (Physical Activity program for the survival of elderly patients with lymphoma) is a phase 3 (1:1) randomized study focusing on a frail population of patients treated for DLBCL. It will include a total of 186 elderly DLBCL patients (aged over 65 years) receiving rituximab plus cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP); of these, 93 patients (the investigational group) will receive APA that will be supervised by a dedicated qualified kinesiologist, in addition to chemotherapy. The primary endpoint of this study will be the patients’ event-free survival. Secondary endpoints will include the overall survival, the progression-free survival, the prevalence rates of sarcopenia and undernutrition, as well as the patients’ quality of life. RESULTS The study has been approved by the internal Ethical Committee, and was registered as a clinical trial (NCT04670029) on December 16, 2020. The study will be undertaken in accordance with the Declaration of Helsinki. CONCLUSIONS This study will highlight the benefits of regular APA on the survival of patients treated for a DLBCL. This study could also contribute to our understanding of how an adapted physical program can reduce sarcopenia in cancer patients, and improve their quality of life. By documenting the prevalence and the relationship between sarcopenia and exercise load, we might be able to help physicians to plan better interventions in DLBCL patients. CLINICALTRIAL Clinical Trial: NCT04670029

The optimal consolidation strategy for primary central nervous system lymphoma (PCNSL) remains controversial. Preventing radio-induced neurotoxicity of consolidation treatment through reduced-dose whole-brain radiotherapy (rdWBRT) at a dose of 23.4 Gy is an interesting alternative to conventional WBRT in patients aged

We analysed the therapeutic outcomes of all consecutive patients with primary central nervous system lymphoma (PCNSL) registered in the prospective French database for PCNSL and treated with intensive chemotherapy (IC) followed by autologous stem cell transplantation (IC-ASCT) between 2011 and November 2019 (271 patients recruited, 266 analysed). In addition, treatment-related complications of thiotepa-based IC-ASCT were analysed from the source files of 85 patients from 3 centers. Patients had received IC-ASCT either in first-line treatment (n = 147) or at relapse (n = 119). The median age at IC-ASCT was 57 years (range: 22-74). IC consisted of thiotepa-BCNU (n = 64), thiotepa-busulfan (n = 24), BCNU-etoposide-cytarabine-melphalan (BEAM, n = 36) and thiotepa-busulfan-cyclophosphamide (n = 142). In multivariate analysis, BEAM and ASCT beyond the first relapse were adverse prognostic factors for relapse risk. The risk of treatment-related mortality was higher for ASCT performed beyond the first relapse and seemed higher for thiotepa-busulfan-cyclophosphamide. Thiotepa-BCNU tends to result in a higher relapse rate than thiotepa-busulfan-cyclophosphamide and thiotepa-busulfan. This study confirms the role of IC-ASCT in first-line treatment and at first-relapse PCNSL (5-year overall survival rates of 80 and 50%, respectively). The benefit/risk ratio of thiotepa-busulfan/thiotepa-busulfan-cyclophosphamide-ASCT could be improved by considering ASCT earlier in the course of the disease and dose adjustment of the IC.

Dans cet article, les résultats d’une étude acoustique sur la production de glides par des locuteurs atteints de la maladie de Parkinson et des locuteurs témoins sont présentés. Notre objectif est d’explorer la dynamique des articulateurs supralaryngés dans la MP, en particulier chez des locuteurs MP non dysarthriques. Nos résultats montrent des différences entre les deux groupes de sujets (locuteurs MP et témoins), en particulier en ce qui concerne l’amplitude des mouvements et la localisation dans le plan F1-F2. Nous notons également que ces différences se produisent en l’absence de dysarthrie, suggérant l’identification de phénomènes infracliniques dans la maladie de Parkinson.

Introduction To investigate voice quality (VQ) impairments in idiopathic Parkinson's disease (IPD) and to explore the impact of medical treatments and L-Dopa challenge testing on voice. Methods Relevant studies published between January 1980 and June 2017 describing VQ evaluations in IPD were retrieved using PubMed, Scopus, Biological Abstracts, BioMed Central and Cochrane databases. Issues of clinical relevance, including IPD treatment efficiency and voice quality outcomes, were evaluated for each study. The grade of recommendation for each publication was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels. Results The database research yielded 106 relevant publications, of which 33 studies met the inclusion criteria, for a total of 964 patients with IPD. Data were extracted by 3 independent physicians who identified 21, 11 and 1 trials with IIIb, IIb and IIa evidence levels, respectively. The main VQ assessment tools used were acoustic testing (N = 27), aerodynamic testing (N = 10), subjective measurements (N = 8) and videolaryngostroboscopy (N = 3). The majority of trials (N = 32/33) identified subjective or objective VQ improvements after medical treatment (N = 10) or better VQ evaluations in healthy subjects compared to patients with IPD (N = 22). Especially, our analysis supports that VQ overall improves during the L-Dopa challenge testing, making the VQ evaluation an additional tool for the IPD diagnosis. The methodology used to assess subjective and objective VQ substantially varied from 1 study to another. All of the included studies took into consideration the patient's clinical profile in the VQ analysis. Conclusion The majority of studies supported that VQ assessments remain useful as outcome measures of the effectiveness of medical treatment and could be helpful for the IPD diagnosis based on L-Dopa challenge testing. Further controlled studies using standardised and transparent methodology for measuring acoustic parameters are necessary to confirm the place of each tool in both IPD diagnosis and treatment evaluation.

This retrospective analysis aimed to assess hematopoietic and immune recovery in a cohort of 53 patients [males: n = 33; median age: 59 yr (range: 22-70)] who received a FB2 (fludarabine 120-150 mg/m² + IV busulfan 6.4 mg/kg + antithymocyte globulin thymoglobulin 5 mg/kg) reduced-intensity conditioning (RIC) allo-stem cells transplantations (SCT). With a median follow-up of 19 months (range: 2-53), the 2-yr overall survival, disease-free survival (DFS), relapse incidence, and non-relapse mortality were 63%, 59.5%, 35%, and 6%, respectively. In univariate analysis, the factors correlated with a significantly higher 2-yr OS and DFS were a higher total circulating lymphocytes count at transplant (>730/mm(3) ; OS: 81% vs. 43%, P = 0.02; DFS: 73% vs. 45.5%, P = 0.03) and a higher recovery of leukocytes (>5300/mm(3) ) (2-yr OS: 81% vs. 44%, P = 0.007; 2-yr DFS: 72% vs. 46%, P = 0.08), neutrophils (>3200/mm(3) ) (2-yr OS: 76% vs. 50%, P = 0.03; 2-yr DFS: 67% vs. 52.0%, P = 0.1), and monocytes (>590/mm(3) ; 2-yr OS: 80% vs. 45%, P = 0.004; 2-yr DFS: 76% vs. 42%, P = 0.01) at day +30 post-transplant. In multivariate analysis, the only independent factors associated with a significantly higher OS and DFS were a better immune status at transplant (lymphocytes count >730/mm(3) ) and a higher monocytes count (>590/mm(3) ) at day +30 post-transplant. These results suggest that immune status and hematopoietic recovery before and after FB2 RIC allo-SCT can be significant predictors of outcome. This paves the way for future studies aiming to closely monitor the kinetics of immune recovery after RIC allo-SCT and to evaluate the impact of growth factors and other immunostimulatory cytokines in the setting of RIC allo-SCT.

BACKGROUND Impact of total-body irradiation (TBI) in conditioning regimen on outcome for patients with mantle cell lymphoma (MCL) remains unknown. METHODS Patients with MCL who underwent autologous stem-cell transplantation (ASCT) in our institution were eligible for the present study (n=73). We analyzed the impact of various biologic and clinical parameters, with and without TBI, on patient outcome. RESULTS All patients presented with chemosensitive disease at transplantation. Median follow-up from ASCT was 37.2 months. One- and three-year overall survival (OS) rates were 90.3% and 74.5%, progression-free survival (PFS) rates were 85% and 59%, respectively. Three-year OS and PFS rates in the non-TBI group versus TBI group were similar: 80% versus 72.5% and 60% versus 57%, respectively. In univariate analysis, the use of TBI did not modify OS or PFS (P=0.93 and P=0.48, respectively). This remains true for patients who underwent ASCT up front. According to multivariate analysis, OS tended to be shorter for patients presenting with high Mantle Cell Lymphoma International Prognostic Index or low hemoglobin level. CONCLUSIONS Absence of TBI in conditioning regimen modifies neither PFS nor OS. The present retrospective and monocentric analysis shows that transplant patients with MCL remain highly exposed to relapse.

Introduction Les troubles moteurs et non moteurs augmentent au cours de l’evolution de la maladie de Parkinson et se manifestent tant au niveau du corps que de la voix [1] . La methode LSVT BIG ® est un programme protocole, specifique a la prise en charge des patients ayant la maladie de Parkinson et base sur l’amplitude de mouvements [2] . Elle s’inspire de la LSVT LOUD ® , methode de « reeducation sensori-motrice » du discours, pratiquee par les orthophonistes [2] . L’objectif de cette etude est de connaitre les effets de la LSVT BIG ® sur la motricite, l’equilibre, la qualite de vie et la voix. Materiel, population et methode Quatorze patients volontaires atteints de la maladie de Parkinson, de stade I a III selon l’echelle de Hoehn and Yahr, ont beneficie de 16 seances de LSVT BIG ® pendant 4 semaines. Les tests utilises ont ete : le Timed Up and Go (TUG), le Timed Up and Go cognitif (TUG cognitif), le Functional Reach Test (FRT), le Lateral Reach Test (LRT), l’echelle de qualite de vie PDQ-39, le score moteur de l’UPDRS, la stabilometrie et des enregistrements vocaux de logatomes pre-definis. Tous les tests ont ete effectues avant et apres la pratique de la LSVT BIG ® . Pour comparer ces resultats, nous avons utilise le test statistique de Student. Resultats Au niveau physique, des ameliorations significatives ( p 0,05) ont ete observees aux items de gene psychologique, communication, inconfort physique et troubles cognitifs du questionnaire de qualite de vie PDQ-39, au LRT et au centre de gravite dans les plans frontal et sagittal. Au niveau vocal, une amelioration significative aux temps maximaux de phonation a ete observee, d’autant plus importante lors de la tenue d’un « a ». L’amplitude de mouvement des articulateurs supralarynges n’a pas ete modifiee par la pratique de la LSVT BIG ® , mais la localisation des voyelles, dans l’espace vocalique, lors de la prononciation de logatome a ete modifie. Conclusion ou discussion La LSVT BIG ® semble appropriee a la neuroreeducation physique de la maladie de Parkinson. Cette methode, bien acceptee par les patients, demande une formation et un protocole rigoureux que nous avons respecte. Notre etude propose une ouverture vers l’exploration des liens entre la neuroreeducation physique et son influence sur la voix des patients atteints de la maladie de Parkinson.

Cet article concerne les résultats d’une recherche menée au sein du Service d’Orthopédagogie Clinique de l’Université de Mons sur le développement des stratégies autorégulatrices chez les enfants présentant une déficience intellectuelle modérée. Des recherches (Wehmeyer & Klechner, 1994 ; Haelewyck & Vande Vonder, 2011) montrent l’impact d’une intervention sur le développement des capacités d’autorégulation chez les personnes présentant une déficience intellectuelle, quelle que soit la période de vie considérée. Notre recherche s’inscrit également dans ce cadre. L’objectif est de tester un programme de remédiation cognitive. La démarche porte sur la gestion mentale, en se centrant sur les concepts de perception et d’évocation. L’approche préconisée se centre sur les stratégies de résolution de problèmes au travers d’une démarche individuelle. Elle concerne des enfants âgés entre 10 et 12,7 ans avec un syndrome d’origine génétique (syndrome de Down) ou non. L’application du programme s’est déroulée sur six mois, à raison d’une séance par semaine avec chaque enfant. La comparaison des résultats obtenus suite à la passation de tests en pré-test et post-test a montré des effets sur les capacités à percevoir une situation dans son ensemble, sur l’amélioration des capacités attentionnelles ainsi que sur d’autres stratégies propres à l’autorégulation. This article concerns the results of a research conducted within the service of “Clinical Orthopedagogy” at the University of Mons and focuses on the development of self-regulatory strategies among children with moderate intellectual disabilities. Research shows the impact of an intervention on the development of self-regulatory capacity for people with intellectual disabilities, regardless of the time of life considered. Our research also follow this framework. The aim is to test a cognitive remediation program. The approach is about mental management, focusing on the concepts of perception and evocation. The recommended approach focalize on problem solving strategies through an individual side. It concerns children aged between 10 and 12.7 years with a genetic syndrome (Down syndrome) or else. The implementation of the program took place during six months, one session per week with each child. The comparison of results obtained from the execution of tests in pre-test and post-test showed effects on the ability to perceive a situation as a whole one, on the improvement of attentional abilities as well as other strategies of self-regulation.

Abstract 4045 Lenalidomide is an effective and widely used therapeutic agent for multiple myeloma. This agent exhibits both anti-tumor and immunomodulatory properties. Recent data suggested a positive impact on outcome of this drug in the setting of maintenance therapy in young multiple myeloma patients receiving autologous stem cell transplantation. On the long term, Lenalidomide is thought to enhance activation of T and NK cells, however its precise immune effects remain to be elucidated, and only a few data is available in this field. This single centre pilot prospective study aimed to assess T-cell polarization and the cytokine secretion profile in ten patients treated with lenalidomide alone in the maintenance setting. In this cohort, patients received at time of analysis between 4 and 12 cycles of lenalidomide alone (one cycle=28 days) at a dose ranging between 5 and 15 mg/day. Five patients received prior high-dose therapy (HDT) and autologous peripheral blood stem cell transplant (PBSCT) and 5 patients received maintenance after induction with the VRD (lenalidomide, bortezomib and dexamethasone) combination. Seven patients were in very good partial response (VGPR) and 3 were in complete response (CR) at the time of analysis. Intracellular cytokine secretion by peripheral blood lymphocytes was analyzed in peripheral blood mononuclear cells (PBMC) by multicolour staining. PBMCs were stimulated for 5 hours with PMA and ionomycin in the presence of 10 μg/mL Brefeldin A. Cells were first stained with CD3 APC-H7, CD4 PE-Cy7 and CD8 APC and permeabilized using Cytofix/cytoperm and were then incubated with FITC-, PE-, PeCy7, V450 Horizon-, AlexaFluor 647- conjugated anti-IFN-gamma, IL-4, IL-10, IL-17A and IL-21. In parallel, we analyzed a total of 39 cytokines in the plasma collected simultaneously from these same patients. Concentrations of IL-21, IL-23, TARC (CCL17), TRAIL (Apo2L), CD40L, Flt3L, Fractalkine (CX3CL1), IFNalpha, IFN-gamma, IL-10, IL-12p40, IL-12p70, IL-13, IL-15, IL-17, IL-1a, IL-1b, IL-1Ralpha, IL-2, IL-2Ralpha, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8 (CXCL8), IL-9, IP10 (CXCL10), MCP-1 (CCL2), MCP-3(CCL17), MIP-1alpha (CCL3), MDC (CCL22), MIP-1beta (CCL4), TGFalpha, TNFalpha, TNFbeta, VEGF, Eotaxin and EGF were determined by the bead-based multiplex protein array technology. We observed that T cells derived from myeloma patients receiving lenalidomide maintenance therapy exhibited a significantly higher secretion of TNF-alpha (p=0.03), IL-4 (p=0.003), IL-10 and IL-21 (p=0.004), compared to stimulated T cells obtained from 5 healthy donors (Figure 1 A-B). In the multiplex bead assay, we observed that IP10 (p=0.008), IL-8 (p=0.018), and MIP1beta (p=0.022) levels were also statistically increased in the plasma of patients treated with lenalidomide compared to the control group (Figure 2). Overall, these results suggest that the use of lenalidomide as maintenance therapy in myeloma can induce some potent and critical immunostimulatory activities through induction of a chronic inflammatory reaction. Interestingly, IP10 is a major Th1-related chemokine involved in anti-tumor responses, while IL-8 and MIP1b can positively influence NK cell functions (maturation, migration and augmenting their cytolytic activity). Altogether, these data shed some new light on the immunostimulatory mechanism of action of lenalidomide in the setting of long term maintenance therapy for myeloma, highlighting the need for detailed immunomonitoring studies to be performed as part of the large multicentre randomized trials. Disclosures: No relevant conflicts of interest to declare.

International audience; Nodular lymphocyte predominant Hodgkin lymphoma represents a distinct entity from classical Hodgkin lymphoma. We conducted a retrospective study to investigate the management of patients with nodular lymphocyte predominant Hodgkin lymphoma. Clinical characteristics, treatment and outcome of adult patients with nodular lymphocyte predominant Hodgkin lymphoma were collected in Lymphoma Study Association centers. Progression-free survival (PFS) and overall survival (OS) were analyzed, and the competing risks formulation of a Cox regression model was used to control the effect of risk factors on relapse or death as competing events. Among 314 evaluable patients, 82.5% had early stage nodular lymphocyte predominant Hodgkin lymphoma. Initial management consisted in watchful waiting (36.3%), radiotherapy (20.1%), rituximab (8.9%), chemotherapy or immuno-chemotherapy (21.7%), combined modality treatment (12.7%), or radiotherapy plus rituximab (0.3%). With a median follow-up of 55.8 months, the 10-year PFS and OS estimates were 44.2% and 94.9%, respectively. The 4-year PFS estimates were 79.6% after radiotherapy, 77.0% after rituximab alone, 78.8% after chemotherapy or immuno-chemotherapy, and 93.9% after combined modality treatment. For the whole population, early treatment with chemotherapy or radiotherapy, but not rituximab alone (Hazard ratio 0.695 [0.320-1.512], P=0.3593) significantly reduced the risk of progression compared to watchful waiting (HR 0.388 [0.234-0.643], P=0.0002). Early treatment appears more beneficial compared to watchful waiting in terms of progression-free survival, but has no impact on overall survival. Radiotherapy in selected early stage nodular lymphocyte predominant Hodgkin lymphoma, and combined modality treatment, chemotherapy or immuno-chemotherapy for other patients, are the main options to treat adult patients with a curative intent.

Few data are available on the efficacy of the combination of lenalidomide plus dexamethasone (Len/Dex) in very elderly patients above 75 years of age with relapsed multiple myeloma (MM). We report here a single-center series of 45 consecutive patients aged 75 years or older with relapsed MM treated with this combination. The overall response rate was 62% and the median progression-free survival was 14 months, which compares favorably to that described in the two pivotal prospective studies that formed the basis for the approval of Len/Dex in the relapse setting. Our study confirms that Len/Dex is an effective combination in very elderly patients with relapsed MM.

We have used the dose of 9 mg/m(2) of mylotarg 4 days after the beginning of a chemotherapy including intermediate-dose aracytin and mitoxantrone (MIDAM) in 17 patients with refractory (n=4) or relapsed (n=13) AML. Thirteen patients (76%) achieved CR (n=12) or partial CR (n=1). All four refractory patients and all four patients with poor risk cytogenetic achieved CR or CRp. Although the dose of mylotarg given in combination with chemotherapy was not reduced, the toxicity profile was acceptable (1VOD/17 patients). The MIDAM protocol appears to be highly effective especially in patients with poor risk cytogenetic and/or refractory disease.

Abstract 3108 Introduction: RIC regimens are increasingly used for allo-SCT in older patients or patients with co-morbidities. The FB2 regimen (Fludarabine 120–150 mg/m2 + I.V. Busulfan 6.4 mg/Kg + ATG 5 mg/Kg) using PBSC as stem cell source is currently the most widely used RIC regimen in many European centres. On the other hand, in patients without a suitable HLA-matched donor, the use of umbilical cord blood stem cells for allo-SCT (uCBT) is increasingly considered, especially using the RIC regimen developed by the Minneapolis group. Series comparing PBSC vs CB as stem cells source for RIC allo-SCT are still scarce and using various RIC regimens before allo-SCT. Patients and Methods: This retrospective single centre analysis compared two homogeneously treated cohorts of patients who had received between January 2007 and November 2010 in our department either a FB2/PBSC allo-SCT (n=52, males: 61%; median age: 59 years (range: 22–70)) or a FC-TBI/uCBT (Fludarabine 200 mg/m2 + Cyclophosphamide 50 mg/Kg + TBI 2 Grays regimen; n=39, males 49%; median age 56 years (range: 22–70). Except for age (p=0.03), there were no significant differences between the 2 groups regarding patients and diseases characteristics: gender (p=0.22), interval between diagnosis and transplant (PBSC: 9 months vs CB: 10 months, p=0.85), disease type (PBSC: myeloid disease 63% vs CB: 67%, p=0.75), status at transplant (complete remission PBSC: 77% vs CB: 67%, p=0.28), prior auto-SCT (PBSC: 35% vs CB: 33%, p=0.90). Donors in the PBSC group were as follows: sibling donors, n=30; HLA-MUD n=20, mismatched unrelated n=2. All patients from the CB group received 2 CB units (HLA matching 4/6 n=25; 5/6 n=53). As for GVHD prophylaxis, patients received cyclosporine (CsA) alone in case of an HLA-identical sibling donor, and CsA+ mycophenolate mofetyl in all other cases. None of the patients from the PBSC group received G-CSF after transplant, while it was administered to all CB recipients. Results: Median follow-up was respectively 19 and 20 months for the PBSC and the CB groups (p=NS). Engraftment and median time for neutrophils recovery were similar between the 2 groups: PBSC: 96% vs CB: 90%, p=0.22; and 17 days (range: 0–39) vs 16 days (range: 8–60), p=0.88, respectively. The median time for platelets recovery (>20000/mm3) was significantly higher in the CB group: 38 days (range: 13–150) vs PBSC: 0 days (range: 0–186) (p Conclusion: Our study suggests that RIC uCBT is a valid alternative in patients lacking an HLA-matched related or unrelated donor and candidate for RIC allo-SCT. Prospective and randomized studies are warranted in order to establish the definitive role of uCBT, especially in patients with acute leukemia, where CB cells may offer a rapidly available source of stem cells in diseases with high tumor kinetics. Disclosures: No relevant conflicts of interest to declare.

Abstract 4483 Introduction: RIC regimens are increasingly used prior to allo-SCT. The FB2 regimen (Fludarabine 120–150 mg/m2 + IV Busulfan 6.4 mg/Kg + ATG Thymoglobuline 5mg/Kg) is currently the most widely used RIC regimen in many European centres. This retrospective analysis aimed to assess the hematopoietic and immune recovery in a homogeneously treated cohort of 53 patients (males: n=33; median age: 59 years (range: 22–70)) who received the FB2 regimen between January 2007 and October 2010 in our department. Patients and Methods: Diagnoses were as follow: AML n=23; ALL n=1; biphenotypic leukemia n=1; lymphoma n=16; myelodysplastic syndrome n=9; multiple myeloma n=3. Nineteen patients (36%) had received a prior autologous SCT. The majority of patients (n=40, 75.5%) were transplanted in complete remission. Thirty patients received a graft from a matched sibling donor (56.5%). All patients, but one (who received unmanipulated bone marrow) received G-CSF-mobilized PBSCs. GVHD prophylaxis consisted of cyclosporine (CsA) alone in patients transplanted with an HLA-identical sibling, and CsA+ mycophenolate mofetyl in other cases. None of the patients received G-CSF during aplasia following transplant while nine patients received erythropoietin before day+100. Results: Engraftment was achieved in 96% of patients (n=51). Median times for neutrophils (n=51) and platelets (n=22) recovery were 17 days (range: 0–39) and 10 days (range: 4–186), respectively. The majority of patients (n=31, 58%) did not receive platelet support during aplasia. The cumulative incidences of grade II-IV and grade III-IV acute GVHD were 30% and 15%, respectively, while overall incidence of chronic extensive GVHD was 33%. With a median follow-up of 19 months (range: 2–53), the 2-year OS, DFS, relapse incidence, and NRM were 63%, 59.5%, 35% and 6%, respectively. In univariate analysis, when regarding pre-transplant factors associated with outcome, the only factor correlated with a significantly higher 2-year OS and DFS was a higher total circulating lymphocytes count at transplant (> 730/mm3) (OS: 81.5% vs 43.2%, p=0.01; DFS: 73.2% vs 45.5%, p=0.03). Regarding post-transplant factors, we found that higher recovery of leukocytes (>5000/mm3) (2-year OS: 78% vs 46%, p=0.007; 2-year DFS: 70% vs 48%, p=0.08), neutrophils (>3230/mm3) (2-year OS: 76% vs 50%, p=0.02; 2-year DFS: 67.5% vs 52.0%, p=0.09), and monocytes (>590/mm3) (2-year OS: 80% vs 47%, p=0.004; 2-year DFS: 75% vs 42%, p=0.007) at day+30 post-transplant were the most significant factors associated with outcome. In multivariate analysis, the only independent factors associated with a significantly higher OS and DFS were a better immune status at transplant (lymphocytes count >730/mm3; HR 0.22; 95%CI: 0.08–0.63, p=0.005; and HR: 0.29; 95%CI: 0.12–0.71, p=0.006, respectively) and a higher monocytes count at day+30 post-transplant (>590/mm3) (HR: 0.24; 95%CI: 0.08–0.66, p=0.006; and HR: 0.28; 95%CI: 0.11– 0.68, p=0.005; respectively). Conclusion: These results suggest that hematopoietic status and recovery before and after FB2 RIC allo-SCT can be significant predictors of outcome. This paves the way for future studies aiming to closely monitor the kinetics of immune recovery after RIC allo-SCT and to evaluate the impact of growth factors and other immunostimulatory cytokines in the setting of RIC allo-SCT. Disclosures: No relevant conflicts of interest to declare.

Abstract 3620 AML in elderly patients is characterized by a poor prognosis, especially in those patients aged >70, and/or in frail patients with comorbidities or poor performance status (PS). Moreover, several studies already suggested that elderly AML patients with unfavorable karyotype may not benefit from intensive chemotherapy. With this background, and using a matched analysis, this report aimed to assess the outcome of a single centre series of elderly AML patients who received either non intensive therapy by hypomethylating agents, or standard induction with intensive therapy. All patients were aged over 60 and had de novo or secondary AML. For the purpose of this comparison, the cohort was divided in two distinct groups. Group A included 36 cases treated by intensive chemotherapy between 1995 and 2005 according to the GOELAMS AML-SA2002 or SA3&4 protocols (5+7 induction with idarabicine 5 mg/m2/d and cytarabine 100 mg/m2/d). In this group, patients who could achieve CR received either 3 or 6 consolidation courses delivered over 1 or 2 years (according the protocol AML-SA2002 versus SA3&4). Group B included another 36 patients who were treated between 2006 and 2010 with AZA according to the recommendations of the “compassionate use program” authorized by the French Health Agency (one cycle of AZA = 7 days of subcutaneous administration 75mg/m2 every 28 days until progression).In this group, response was assessed after 3 cycles and qualified using IWG criteria. These two groups were matched based on cytogenetic features and age. The median age for the total cohort was 72 years (range, 60–86). Groups were comparable for WBC, % marrow blasts infiltration, WHO subtypes, and cytogenetic features at diagnosis. A higher rate of secondary AML was observed in the AZA arm. CR and CR with incomplete hematological recovery (CRi) rates were significantly higher in the intensive vs. AZA arm (63% vs. 28%, p This analysis suggests that the use of AZA as an alternative to intensive chemotherapy in elderly patients with de novo or secondary AML may lead to similar OS, despite a significant difference in terms of CR and CRi rate. The different mechanism of action of AZA in comparison to conventional chemotherapy, and the higher rate of PR that can be achieved after AZA therapy might contribute to improved OS through relatively long lasting disease control. These results set the frame for a prospective controlled trial to test AZA as an ambulatory alternative to standard intensive chemotherapy in elderly AML patients, especially those patients with unfavorable karyotype or poor PS and comorbidities. Disclosures: No relevant conflicts of interest to declare.

Abstract 2837 Poster Board II-813 Age is a critical prognostic factor in many hematological malignancies. The reasons for this major prognostic impact are not univocal. For a large part, its prognostic value is in fact related to the therapy intensity tolerated by the patients. Because of frequent renal, hepatic, cardiac impairments, intensive therapies are not tolerated after 60 or 65 years, leading physicians to dramatically reduce treatment intensity in elderly patients. The question of a specific prognostic value of age in a more homogeneous population is an unresolved issue. In myeloma, it has been suggested that patients under 50 years of age presented more favorable features, explaining the better outcome observed in these patients (Ludwig et al., Blood 2008). However, the population was highly heterogeneous, treated both with conventional and intensive therapeutic strategies. In order to address this question, we reviewed the files of 1897 patients under 65 years of age, homogeneously treated within the IFM with high-dose melphalan, from 2000 to 2007. The median age was 56 years (range=23-65), the sex-ratio male/female was 54%. We addressed the issues of the prognostic impact of young age (177 μmol/l), hypercalcemia, low hemoglobin ( Disclosures: Attal: Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees. Moreau:Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees. Facon:Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees. Harousseau:Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees.

Positron emission tomography using fluorine 18-fluorodeoxyglucose (FDG-PET) is required in the assessment of therapeutic response in diffuse large B-cell lymphoma. Limited studies addressed the interest of FDG-PET prior autologous stem cells transplantation (auto-SCT) in High-grade non Hodgkin’s lymphoma (HG-NHL). Between April 2002 and December 2005, 42 HG-NHL (DLBCL in 35 cases and aggressive transformation in 7 cases) patients underwent auto-SCT in our institution and were systematicaly explored prior and after auto-SCT using computed tomography (CT) and FDG-PET. The therapeutic strategy included R-CHOP or R-DHAP as induction chemotherapy followed by auto-SCT. In note, auto-SCT was always included in the initial strategy and scheduled after completion of induction chemotherapy for patients at least in partial response (PR) according CT assessment. Pre-auto-SCT FDG-PET results did not influence the scheduled strategy. Auto-SCT was performed as part of the first-line therapy in 35 cases (83 %) or at the time of relapse in 10 cases. Prior auto-SCT, 14 patients were in PR and 24 in CR/Cru. Conditioning regimen consisted of BEAM in all cases (except one patient). The median follow-up (calculated from the time of auto-SCT) for living patients was 34,5 months [19–74 months]. The 2-years EFS and OS estimates were 79,6 % [63,2%; 89,3%] and 90,5 % [76,6%; 96,3%], respectively. According to pre and post auto- SCT FDG-PET results, patients were classified into 3 groups: NEG/NEG (n=25) POS/ POS (n=8) and POS/NEG (n=9). The 2-years EFS and OS estimates for NEG/NEG, POS/ POS and POS/NEG patients were 88 % versus 19 % versus 100 % (p= 0,0001) and 92 % versus 75 % versus 100 % (p = 0,19), respectively. According to FDG-PET response after auto-SCT, the 2-years EFS estimates for NEG versus POS patients were 90, 9 % versus 19 % (p