ABSTRACT
Background: The management of acute myeloid leukemia (AML) patients usually requires long inpatient treatments that can affect the limited care facilities, the quality of life, and increases healthcare costs. Additionally, leukemia treating centers in developing countries face limited sources to deliver high-dose chemotherapies as inpatient treatments. Therefore, several reports have established the feasibility and safety of outpatient consolidation. We aimed to implement a high-dose cytarabine outpatient program for AML in a limited-source institution at a public center in Peru.Methods: We conducted a prospective pilot study starting in January 2019 and ending before the COVID-19 Pandemic in March 2020. Eligible patients were ≥ age 14, met inclusion criteria for inpatient induction regimens, were without active infection, and had the following: normal chest x-ray and biochemistry, complete remission after one cycle of 7+3 induction. Logistical requirements included a 3-hours distance residence near the treatment center, caregiver support, trained nursing staff, infusion room capacity, and participation in follow-up. Patients received prophylactic antimicrobials such as oral levofloxacin, fluconazole, and acyclovir and were admitted to the hospital for predetermined complications of therapy (fever, G3-4 toxicity, febrile neutropenia, bleeding or refractory thrombocytopenia). Risk stratification was based on conventional cytogenetics and multiplex PCR using Leukemia.net criteria. Results: Forty-two patients were included during the study period. The median age was 38 years (16-63) and Female/Male ratio 4:3. According to Leukemia.net, 24% were classified as high, 50% intermediate and 26% as low risk group. Including FLT3 mutations in 26% of cases. Twenty-two and 20 subjects received 1-2 and 3-4 cycles of ambulatory HiDAC, respectively. About one-third of cases had emergency admissions during consolidation and 74% complete at least 3 cycles of cytarabine. Only 4 patients underwent sibling-donor allo-SCT. Sixty-four percent experienced relapses, and at 2 years follow-up only 21 subjects were alive. Median OS was 15 months, a better survival was shown among patients who received 3-4 cycles of ambulatory HiDAC (2-year OS 18 vs 23%, p=0.031). Conclusion: Our pilot study shows the feasibility to deliver HiDAC as outpatient consolidation in selected AML cases in a limited setting. Additionally, a high rate of relapses and poor survival was noted in our cohort that requires further consideration. Disclosures: No relevant conflicts of interest to declare.
ABSTRACT
Background:Brentuximab Vedotin (BV) is an active drug in patients with relapsed / refractory (R/R) Hodgkin Lymphoma (HL). Autologous stem cell transplantation (ASCT) remains standard of care for these patients and achieving a clinical response pre-ASCT predicts favorable outcomes. Pre-ASCT salvage chemotherapy combinations with BV have been explored in this setting. Objective:To evaluate the efficacy and safety of the combination of BV and chemotherapy in heavily pretreated R/R HL patients eligible for ASCT. Methods:We reviewed the clinical characteristics, treatment, response, safety, and survival of 21 heavily pretreated R/R HL patients in 2 Peruvian institutions between June 2018 and February 2020. Survival curves were estimated using the Kaplan-Meier method. Results:A total of 21 patients (15 (71%) refractory and 6 (29%) relapsed) were included. The median age was 31 years (range, 19-55), 13 (62%) patients were female. The median of previous treatment lines was 3 (range, 1-4). Patients received BV plus chemotherapy (CT) on day 1: Dexamethasone, Cytarabine and Cisplatin (DHAP) (43%), Gemcitabine-based CT (33%), Ifosfamide, Carboplatin and Etoposide (ICE) (14%), and other CT (ESHAP, Bendamustine) (10%). After a median of 3 cycles of combination therapy (range, 2-7), the objective response rate was 81 %, with 8 (38%) patients achieving CR. 10 (48%) patients had successful peripheral blood stem cell (PBSC) collection. 7 (33%) patients underwent ASCT, the remaining responding patients had a delay in either collection or ASCT due to COVID-19 pandemic. The most significant adverse events were thrombocytopenia (69%) (G3-4: 53%), neutropenia (47%) (G3-4: 28%), infections (37%), febrile neutropenia (33%) and G1-2 peripheral neuropathy (16%). The Progression Free-Survival (PFS) at 1 year was 86% in ASCT patients. Conclusion:The combination of Brentuximab and chemotherapy is active as a bridge for ASCT in heavily pretreated R/R HL patients. The CR rates were lower than previously reported and it could be related with the number of previous lines of treatment received;there was also a higher incidence of febrile neutropenia in our cohort. We could hypothesize that the combination of Brentuximab and chemotherapy provides greater benefit if it is administered earlier in patients with R/R HL. [Formula presented] Disclosures: No relevant conflicts of interest to declare.
ABSTRACT
The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global public health crisis. Many reports indicate disappointing results in cancer patients compared to the general population. Therefore, experts in the management of oncohematological malignancies from the National Institute of Neoplastic Diseases, national hospitals and a private clinic in Metropolitan Lima have developed recommendations obtained by consensus to continue with the management of patients with oncohematological neoplasms safely in the face of the pandemic.