Outcome Of Autologous Stem Cell Transplantation Research Articles

Role of upfront autologous stem cell transplantation in patients newly diagnosed with primary CNS lymphoma treated with R-MVP: real-world data from a retrospective single-center analysis.

The role of upfront autologous stem cell transplantation (ASCT) remains unclear in patients with primary central nervous system lymphoma (PCNSL) receiving rituximab and high-dose methotrexate (MTX)-based chemotherapy. We analyzed the outcomes of upfront ASCT in 106 patients with PCNSL (median age, 64 years; range, 34-86) who received rituximab, MTX, vincristine, and prednisolone (R-MVP). The objective response rate was 88.7% (94/106) and included 46 complete responses (43.4%). Upfront ASCT was performed in 38 responders (median age, 51 years; range, 34-69), including 13 patients aged >60 years, after conditioning with busulfan (3.2 mg/kg, days 8 to 5) and thiotepa (5 mg/kg, days 4-3). For 56 responders ineligible for ASCT because of age >70 years, poor performance status, or refusal to undergo upfront ASCT, other consolidation treatments (n = 32) or observation (n = 24) were performed. With a median follow-up of 24.4 months (95% confidence interval, 20.7-28.0 months), no transplantation-related deaths occurred and seven patients relapsed after upfront ASCT. By contrast, 24 relapses occurred in patients who did not receive upfront ASCT. The progression-free and overall survival were significantly better in patients undergoing upfront ASCT (P = 0.001). Our real-world data suggest the benefit from upfront ASCT.

The effect of cryopreserved and noncryopreserved stem cells on the outcome of autologous stem-cell transplantation in multiple myeloma patients: A single-center experience

Background The CD34+ stem cells are either noncryopreserved (non-CP) or cryopreserved (CP) in autologous stem-cell transplantation (ASCT). Some retrospective studies have shown that engraftment failure and engraftment rate are similar in CP cells and infusion reactions are lower in CP cells due to the absence of dimethyl sulfoxide. Objective In this study, we presented our clinical experience comparing the outcomes and safety of ASCT with CP and non-CP stem cells. Patients and methods A total of 163 patients were enrolled between January 2019 and June 2021. Duration of neutrophil/platelet engraftment, rates of infusion-related reactions, febrile neutropenia, and duration of hospitalization were compared between the CP and non-CP groups. Results Fifty five (33.7%) received CP cells, 108 (66.3%) received non-CP cells. The median dose of CD34+ cells was similar in both groups (P=0.755). The median duration of neutrophil and platelet engraftment was not statistically significantly different in CP and non-CP groups (P=0.896 and 0.183, respectively). No statistical difference was observed in the median duration of hospitalization between the two groups [CP: 16 (13–26) vs. non-CP: 15 (11–31) days, P=0.124]. The febrile neutropenia rate was higher in the CP group, but there was no statistical difference between the two groups (CP: 56.4% vs. non-CP, 48.1%, P=0.301). The rates of infusion-related reaction such as nausea, vomiting, and rash were higher in the CP group (21.8 vs. 12%), with no statistically significant difference (P=0.159). Conclusion Non-CP cells have similar outcomes to CP cells and lower toxicity than CP cells, which are safe and effective in ASCT.

Retrospective Analysis of Autologous Stem Cell Transplantation for AL Amyloidosis: A Study from the Multiple Myeloma Working Group of the Japan Society for Hematopoietic Cell Transplantation

Autologous stem cell transplantation (ASCT) is the standard of care for eligible patients with light-chain (AL) amyloidosis, but little is known about it in Asian populations. To investigate the outcome of and prognostic factors for ASCT, we retrospectively analyzed ASCT cases registered to the Transplant Registry Unified Management Program between December 1999 and December 2015, with extra clinical information collected through a secondary survey. The primary endpoint was overall survival (OS). Hematologic response, organ response, and transplantation-related mortality were analyzed as secondary endpoints. The database search identified 330 patients (median age, 57 years; range, 31 to 74), and the secondary survey provided details for the 110 patients (33.3%) included in the study cohort. Fewer than 3 organs were involved in 56.4% of the patients, with cardiac involvement in 57.3%. Performance status (PS) was 0 to 1 in 83.6%. The conditioning melphalan dose was reduced in 54.6%. Overall hematologic response was a partial response or better in 77.6% of the patients and a complete response in 49.3%. The 5-year OS was 70.1%. A PS of 0 to 1 was associated with a significantly better prognosis in terms of OS. Although survival after ASCT for AL amyloidosis improved over time, poor PS and cardiac involvement had negative impacts on prognosis. The early mortality after ASCT was 6.4%. Poor PS and cardiac involvement led to high early mortality. A brain natriuretic peptide (BNP) level of 400 pg/mL was associated with worse OS. Our study has several limitations inherent to a retrospective analysis using a questionnaire. The depth of response and biomarker responses were significantly limited by the degree of missing data. Nonetheless, our data support the importance of careful patient selection for good outcomes of ASCT in patients with AL amyloidosis. In our cohort, poor PS and cardiac involvement had a negative impact on prognosis, and BNP level was a useful prognostic factor.

Improvement in Outcomes of Autologous Stem Cell Transplant in Patients with Lymphoma Older Than 70 Years: The Significance of Age in 2020s?

Backgrounds: Autologous stem cell transplant (ASCT) has been the standard treatment approach for patients with relapsed or high-risk lymphoma for several decades. Despite the improvement in supportive care, age has remained one of the critical factors that determines transplant eligibility and outcomes. Herein, we explored the transplant-related outcomes of patients with lymphoma aged 70 years or older at our institution and compared to those with younger ages.Methods: In this retrospective single center study, we include all patients with diagnosis of lymphoma who underwent ASCT between January 2000 and February 2021 at Mayo Clinic, Rochester, Minnesota. In addition to data obtained from the transplant database, we abstracted data from electronic medical record. We described relevant clinical characteristics and transplant associated outcomes including engraftment, transplant related mortality, relapse incidence, and survival outcomes. We compared the key transplant related outcomes with patients at the younger age group between 65 and 70 years old.Results: A total of 196 patients with lymphoma aged 70 years or older underwent ASCT between January 2000 and February 2021. The median age of patients at the time of ASCT was 72.4 (70.0-78.7) years with 24 patients (12.2%) being older than 75 years old. Of 196 patients, 76 (38.8%) had Charlson comorbidity index of 3 or higher and 10 (5.1%) had performance status of 2 or higher at the time of ASCT. Table 1 summarizes the relevant baseline clinical characteristics of 196 patients in this cohort including the comparison with younger patients (age 65-70 years old, n=296). The most common transplant indication in this cohort was relapsed diffuse large B cell lymphoma. The majority of patients (91.3%) received peripheral blood graft with a median CD34+ cell dose of 5.14x10 6 cells/kg which was significantly lower than younger patients (P=0.01). The rate of neutrophil and platelet engraftment was 99.0% and 98.8% with corresponding median time to engraftment of 13 days for both cell lineages. The 30- and 100-day non-relapse mortality (NRM) of the entire cohort was 1.5% (95%CI 0-3.2%) and 4.6% (95%CI 1.6-7.5%) not statistically different between 70-75 years old and 75 years or older cohorts. With the median follow-up duration of 48 months, the 2-year event free survival (EFS) and overall survival (OS) was 55.9% (95%CI 49.2-63.5%) and 67.4% (95%CI 61.0-74.5%), respectively. Patients from the 70 years old or older cohort had similar EFS but inferior OS compared to the 65-70 years old cohort. However, there was no difference in EFS and OS between 70-75 and >75 years old cohorts. There was overall an improved trend of 30-day NRM, 2-year EFS and 2-year OS over the 3 different transplant periods (Figures). Although not statistically significant, patients who underwent ASCT between 2000 and 2006 had a trend towards higher 30-day NRM compared to patients who were transplanted at later time points (7.3% vs 0%, P=0.06). The major causes of death included progressive lymphoma, infection, and conditioning regimen related organ toxicities.Conclusion: Outcomes of ASCT in older patients with lymphoma have improved over time with an excellent 30-day NRM (0%) in the past recent years. The major cause of treatment failure after ASCT was progressive disease. With appropriate patient selection, ASCT in older patients is feasible and provides acceptable outcomes comparable to the patients from younger age group. [Display omitted] DisclosuresPaludo: Karyopharm: Research Funding. Ansell: Bristol Myers Squibb, ADC Therapeutics, Seattle Genetics, Regeneron, Affimed, AI Therapeutics, Pfizer, Trillium and Takeda: Research Funding.

The Intensity of the Induction Regimen Does Not Affect Post-Transplant Survival Among Patients with Newly Diagnosed Mantle Cell Lymphoma

The routine use of autologous stem cell transplantation (ASCT) in first remission have significantly improved outcomes for patients with mantle cell lymphoma (MCL) (Hermann et al, jco 2009). The choice of the most appropriate induction regimen prior to transplant remains a controversial topic. Adding high dose cytarabine to RCHOP among young patients (<65 years) results in superior PFS, higher toxicity but no improvement in overall survival when compared to RCHOP alone (Hermine O et al, Lancet 2016). The use of bendamustine/Rituxan (BR) compared to RCHOP in 2 randomized studies showed lower toxicity, higher PFS but similar overall survival. In this study, we investigated the effect of induction regimen intensity and the use of high dose cytarabine on post autologous stem cell transplant outcomes among MCL patients treated at our center.59 patients who received ASCT for MCL between 2010 and 2020 were included in this analysis. Data were retrieved from our database where it was entered prospectively. Median age at diagnosis was 60 (45,76) years, stage IV (85%), B symptoms (32%), MIPI score (low 17%, intermediate 47%, high 28%) and ECOG performance 0-1 (81%). Induction regimen included BR (n=14), RCHOP (n=11), R-Hyper CVAD (n=14), RBAC(n=2) and RCHOP/RDHAP (n=18). 85% of patients were in CR and 15% in PR at time of transplant. All patients underwent chemo mobilization with a median time from diagnosis to transplant of 251 (119,1372) days. 30 patients (51%) received post-transplant rituximab maintenance. Patients were compared into 2 groups based on the use of high dose cytarabine in their induction regimen (table 1). Patients who received high dose cytarabine were younger and had a shorter time from diagnosis to transplant that patients who were treated without cytarabine. Survival endpoints for cytarabine based and no cytarabine based induction at 5 years post-transplant were as follows OS (82% vs 69%), DFS (65% vs 50%), Non-relapse mortality (4% vs 9%) and relapse (31% vs 41%) respectively ( figure 1). A multivariable cox analysis for OS, DFS, NRM and relapse showed that cytarabine had no effect on any of the endpoints. For OS, B symptoms and worse ECOG performance at Diagnosis (>=2) were associated with worse OS. For relapse, higher MIPI score and no use of Rituxan maintenance resulted in higher relapse.In conclusion, our data shows that among MCL patients receiving ASCT, the use of more intensive cytarabine based induction does not clearly improve long-term outcomes It is possible that use of ASCT compensates for the use of a less intense induction regimen. Disease (MIPI), Patient (ECOG)characteristics and use of post-transplant maintenance are factors that contribute to post transplant outcomes. [Display omitted] DisclosuresSolh: Jazz Pharmaceuticals: Consultancy; Partner Therapeutics: Research Funding; BMS: Consultancy; ADCT Therapeutics: Consultancy, Research Funding.

Autologous Stem Cell Transplant Outcome in Classic Hodgkin Lymphoma Patients in the Era of Post-Transplant Brentuximab Vedotin Consolidation

Introduction:Patients newly diagnosed with classic Hodgkin lymphoma (CHL) have over 80% chance of remission with first-line chemotherapy, such as ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) regime. However, 10-40% of patients relapse eventually and require salvage therapy. High-dose therapy with autologous stem cell transplantation (ASCT) remains the standard of care for patients with relapsed or refractory CHL, offering a cure rate of around 50%. This may be further improved to around 60% with post-transplant consolidation with brentuximab vedotin (BV). Post-SCT BV consolidation has been offered to all patients, regardless of the risk group, in British Columbia since late 2015. We set out to review the ASCT outcome in CHL patients in the recent decade at our institution.Methods:All adult patients who received ASCT for relapsed or refractory CHL between July 2011 and June 2020 were included in this retrospective analysis. Information pertaining to their demographics, disease characteristics, treatment history, transplant details, clinical outcomes and post-relapse therapy was obtained by review of electronic data. The data cut-off date was June 28, 2021. Survival outcomes were censored at the last known clinic visit for patients without relapse or death during follow up. Survival analysis was performed using Kaplan-Meier survival function and log-rank test. Pearson's chi-square test and ANOVA were used for comparison between cohorts. The statistical program used was Stata® version 16.1 (Texas, USA).Results:114 patients underwent ASCT for relapsed/refractory CHL. Bulky disease and extranodal involvement were seen in 11% and 40% respectively at relapse. Looking at the ‘high risk criteria’ as defined in the AETHERA trial: 45/114 (40%) patients had primary refractory CHL, 21/114 (18%) had relapsed within 12 months of completing the front-line chemotherapy and 15/114 (13%) had relapsed beyond one year of completing initial treatment but with an extranodal disease.The most commonly used salvage chemotherapy regime was GDP (gemcitabine, dexamethasone, cisplatin; 111/114; 97%). 10/114 (9%) patients received BV after failing salvage chemotherapy pre-SCT. The median number of lines of therapy pre-SCT was two (range 2-5). 94/108 (98%) had a chemosensitive disease with 35/108 (32%) achieving complete remission. 6/108 (6%) patients had a progressive disease at the time of SCT. For the transplant, all patients had a peripheral blood stem cell source and the conditioning regime was either Carmustine/Etoposide/Cytarabine/Melphalan (76%) or Etoposide/Melphalan (24%).After median follow up of 62.2 months, 50/114 (44%) patients relapsed with median relapse-free survival of 20.2 months (range 0.9 - 113.5) and 16/114 (14%) died. The direct cause of death was lymphoma progression in all but three patients (PJP pneumonia, pulmonary fibrosis, traumatic subdural hematoma).Whereas only 4/51 (8%) patients (2 without relapse) received post-SCT BV consolidation via a compassionate access program between July 2011 and October 2015 (cohort 1), 45/63 (71%) patients (33 in remission) received routine BV consolidation between November 2015 and June 2020 (cohort 2). In cohort 2, 44% had primary refractory CHL compared to 33% in cohort 1 but the number of ‘low risk’ patients was similar at 29% (Table 1). The most common reason for no post-SCT BV consolidation in cohort 2 was patient refusal (7/18; 40%). Other causes included BV pre-SCT, early disease progression and patient comorbidities. Only 9/42 (21%) patients with available data in cohort 2 completed the planned 16 cycles of BV consolidation. The median number of cycles was 10.5 (range 1-16). The most common reasons for early termination of BV consolidation were peripheral neuropathy (22/33; 67%) and disease progression (9/33; 27%). There was no statistically significant difference in PFS or OS demonstrated between the two cohorts (Graphs 1, 2).Conclusion:After median follow up of 5 years, 86% of patients remain alive and 56% are alive in remission. In British Columbia, post-SCT BV consolidation has been widely adopted with over 70% of patients receiving at least one cycle since late 2015. Successful completion of post-SCT BV consolidation is, however, limited by a high rate of treatment-limiting peripheral neuropathy. Relapse-free survival benefit of routine post-SCT BV consolidation is not demonstrated in this single-centre cohort. [Display omitted] DisclosuresWhite: Novartis: Honoraria. Sutherland: Janssen: Consultancy, Research Funding; GSK: Research Funding; Karyopharm: Research Funding; Celgene: Consultancy; Amgen: Consultancy. Sanford: Abbvie: Membership on an entity's Board of Directors or advisory committees; Stellar: Membership on an entity's Board of Directors or advisory committees. Abou Mourad: Amgen: Consultancy; Paladin: Consultancy; Pfizer: Consultancy. Song: Amgen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Takeda: Consultancy, Honoraria; GlaxoSmithKline: Honoraria; Kite, a Gilead Company: Honoraria; Bristol Myers Squibb: Honoraria; Sanofi: Honoraria.

Development of a quantitative prediction model for peripheral blood stem cell collection yield in the plerixafor era

Background aimsPredicting autologous peripheral blood stem cell (PBSC) collection yield before leukapheresis is important for optimizing PBSC mobilization and autologous stem cell transplantation (ASCT) for treating hematological malignancies. Although guidelines for plerixafor usage based on peripheral blood CD34+ (PB-CD34+) cell count are available, their predictive performance in the real world remains unclear. MethodsThis study retrospectively analyzed 55 mobilization procedures for patients with non-Hodgkin lymphoma or multiple myeloma and developed a novel quantitative prediction model for CD34+ cell collection yield that incorporated four clinical parameters available the day before leukapheresis; namely, PB-CD34+ cell count the day before apheresis (day −1 PB-CD34+), number of prior chemotherapy regimens, disease status at apheresis and mobilization protocol. ResultsThe effects of PB-CD34+ cell counts on CD34+ cell collection yield varied widely per patient characteristics, and plerixafor usage was recommended in patients with poorly controlled disease or those with a history of heavy pre-treatments even with abundant day −1 PB-CD34+ cell count. This model suggested a more proactive use of plerixafor than that recommended by the guidelines for patients with poor pre-collection condition or those with a higher target number of CD34+ cells. Further, the authors analyzed the clinical outcomes of ASCT and found that plerixafor use for stem cell mobilization did not affect short- or long-term outcomes after ASCT. ConclusionsAlthough external validations are necessary, the results can be beneficial for establishing more effective and safer mobilization strategies.

Autologous Stem Cell Transplantation For Adult Burkitt Lymphoma In The Rituximab Era: A Retrospective Study Of The Lymphoma Working Party (LWP) Of The European Group For Blood and Marrow Transplantation (EBMT)

IntroductionThe role of autologous stem cell transplantation (ASCT) for Burkitt Lymphoma (BL) in adults in the era of modern intensive chemotherapeutic regimes remains to be defined. The addition of Rituximab has been shown to improve outcomes in patients with BL, but how this influences outcomes for patients receiving ASCT is not clear. Prior studies of ASCT in BL have often included large number of patients treated with outmoded CHOP-like regimes, have often included children, and have combined outcomes of BL and Burkitt-like lymphoma (BLL). MethodWe conducted a retrospective registry based analysis of adult patients who were reported to the EBMT as having a diagnosis of BL and who had received an ASCT in the period of 2000-2011. Treatment history and histology reports were collected as part of the study. ResultsData including histology reports were returned for 125 patients who received a first ASCT between 2000 and 2011. Median age was 38.5y (range 16-64); 89 patients (71%) were male. While the diagnosis by pathology report was considered to be classic BL in 97 (78%) cases, the diagnostic possibility of BLL or atypical BL was considered in 28 (22%) cases. Twenty-one patients (17%) had stage I/II and 99 (80.5%) had stage III/IV disease. Fifty-one patients (53.7%) received Rituximab as part of 1st line treatment. Of all patients, 90 (74%), and 31 (25%) patients received ASCT in CR1/ VGPR1/PR1, and >CR1/ advanced disease (AD), respectively.5 year estimates for overall survival (OS) for the CR1 and VGPR1/PR groups were 80% and 71% respectively (p=0.23). Factor that was significant for OS in multivariate analysis (MVA) by Cox modeling, for the CR1/VGPR1/PR1 group was age <39 vs >39 (HR = 6.21 ; 95%CI 2.03-19 ; p=0.0013); status at transplant, i.e., PR1/VGPR1 vs CR1 (HR = 2.25 ; 95%CI 0.90-5.61) approached significance (p=0.081). Age >39 was the only significant risk factor for disease fee survival (DFS) in this group (HR = 3.11 ; 95%CI 1.27-7.6 ;p=0.0131). CNS involvement was a significant risk factor for relapse (HR 3.58, 95%CI 1.27-11.62, p= 0.017). Of note, administration of Rituximab as part of 1stline therapy did not appear to impact on OS or DFS. For patients receiving ASCT in CR>1 and AD, the OS was 59% and 25% respectively (p=0.042). Achievement of a subsequent CR had a significant impact on OS (HR 2.84, 95%CI 1.03-7.79, p=0.042) and DFS (HR 2.64, 95%CI 0.97-7.17, p=0.056). There was a trend for improved DFS for the BL vs the BLL patients that approached statistical significance (p=0.059). ConclusionIn this analysis of 125 adult patients with BL and BLL who received an ASCT in the era of intensive chemoimmunotherapy, disease status at transplant was the main determinant of outcome; age influenced OS and DFS for patients autografted in CR1/PR1/VGPR1. Prior Rituximab therapy did not predict post ASCT outcomes. Patients in PR1/ VGPR1 at the time of ASCT had outcomes that were not significantly inferior to those transplanted in CR1, and the former group of patients represent a subset who are most likely to derive a benefit from proceeding to an upfront ASCT. For those patients who have a chemosensitive relapse, ASCT offers the probability of salvaging a significant proportion. Patients with AD and chemoresistant disease had poor outcomes, and in such patients modalities of treatment other than ASCT should be pursued. Disclosures:Sureda:Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees. Afanasyev:Alexion: Honoraria. Dreger:Riemser Pharma: Consultancy, Honoraria, Research Funding.

Cyclophosphamide Based Regimens Compared to Plerixafor-Based Regimens for Stem Cell Mobilization in Patients with Multiple Myeloma Result in Higher CD34+ Cell Yield, Lower Cost and Similar Outcome Post Autologous Transplantation

Background: Autologous stem cell transplantation (ASCT) is standard therapy for patients with multiple myeloma (MM). Stem cell mobilization for peripheral blood stem cell collection prior to ASCT is most commonly achieved with cyclophosphamide based chemotherapy regimens and GCSF (Cy-G) or with plerixafor and GCSF (Pler-G). Using a chemotherapy based mobilization regimen for patients with lymphoma has been shown to result in higher CD34+ cell yield and lower cost than plerixafor based regimens (Dhakal, et al. 2016). The question remains if stem cell mobilization regimens impact stem cell collection and ASCT outcomes in patients with MM.Methods: We reviewed 496 patients who received 596 ASCT for MM between January 2005 and December 2015. Data analyzed included stem cell mobilization regimen, number of CD34+ cells collected, number of apheresis procedures, CD34+ cells infused and survival. Univariate and Multivariate Cox Proportional Regression Models were utilized. The purpose of the review was to determine outcome differences between the use of Cy-G for stem cell mobilization vs Pler-G.Results: The median age at transplantation was 61 years (range 39-84) and 59% were male. Cy-G was used for stem cell mobilization for 438 patients (91%) vs 44 patients (9%) who received Pler-G. Significantly greater numbers of CD34+ cells were collected using Cy-G, with a median of 16.17 x 10e6/kg vs a median of 12.47 x 10e6/kg with Pler-G (p=0.0012). Median days of collection were less for Cy-G, 2 vs 3 for Pler-G (p=0.292), although not significant. There was no statistical difference in the dose of CD34+ cells infused, with a median of 5.73 x 10e6/kg for Cy-G vs a median of 5.00 x 10e6/kg for Pler-G. Pre-ASCT therapy using immunomodulatory agents lenalidomide, bortezomib or carfilzomib had no impact on the number of CD34+ cells collected (p=0.3427), number of apheresis procedures (p=0.6336) or CD34+ cell dose infused (p=0.941).OS at 84 months was 58% for patients using Cy-G for stem cell mobilization vs 55% for patients using Pler-G (p=0.9168) indicating no difference. By multivariate analysis, there was no difference in OS between the 2 groups (p=0.488). There was no difference in PFS between the 2 stem cell mobilization regimens by univariate or multivariate analysis (p=0.2737 and p=0.4226). There was no statistical difference (p=0.424) in the incidence of engraftment syndrome based on the stem cell mobilization regimen.Conclusion: For patients with MM, using a Cy-G regimen results in a higher CD34+ cell yield compared to Pler-G. Higher CD 34+ cell yield may be advantageous for patients considering tandem autologous transplantation. Pre-transplant therapy with immunomodulatory agents had no significant impact on CD34+ cell yield or apheresis days. There was no difference in OS or PFS between the 2 groups and no difference in the incidence of engraftment syndrome. The medication cost at our institution for a 70 kg patient receiving cyclophosphamide, dexamethasone and etoposide with GCSF is $8,846.64 compared to $24,846.09 for Pler-G. Cyclophosphamide based regimens for stem cell mobilization results in a higher cell yield with lower cost and equal survival compared to Pler-G in patients with MM. [Display omitted] DisclosuresMcKiernan:Novartis: Speakers Bureau. Siegel:Celgene, Takeda, Amgen Inc, Novartis and BMS: Consultancy, Speakers Bureau; Merck: Consultancy. Vesole:Takeda: Speakers Bureau; Celgene: Speakers Bureau. Skarbnik:Genentech: Speakers Bureau; Seattle Genetics: Speakers Bureau; Novartis: Speakers Bureau; Abbvie: Other: Ad board, Speakers Bureau; Gilead: Speakers Bureau. Biran:Celgene, Amgen: Consultancy, Speakers Bureau; Takeda: Speakers Bureau. Richter:Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Speakers Bureau; Janssen: Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Pecora:Caladrius Biosciences: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; COTA: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties. Goy:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics / J&J: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Acerta: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Genentech: Research Funding. Pereiras:Portola Pharmaceutical: Other: stock holder; TEVA: Consultancy.

The Effect and the Cost of Tandem Transplantation in Multiple Myeloma Patients with Adverse Cytogenetics

Introduction:Autologous stem cell transplantation (ASCT) plays a major role in the treatment of multiple myeloma. However, the result of STaMINA trial showed no extra benefit of second transplantation or consolidation therapy in addition to single ASCT; there is still argue about the optimal intensity of the treatment in patients with high-risk cytogenetic abnormalities. We analyzed retrospectively, the effect of the tandem ASCT and the cost.Methods:We analyzed multiple myeloma patients with Adverse Cytogenetics who were treated with ASCT in National Center for Global Health and Medicine Hospital from January 2010 to the end of March 2017. Most patients were treated with bortezomib based induction therapy. Patients who failed to achieve very good partial remission or better after the first ASCT proceeded to the second ASCT. Most patients received consolidation therapy and/or maintenance therapy. Overall Survival (OS) and progression free survival (PFS) was analyzed using the Kaplan-Meier methods, and the log-rank test. Also, cumulative cost for the treatment was evaluated. Adverse cytogenetics were defined as hypodiploidy, del(17p), t(4;14), and t(14;16).Results:Ten patients were treated with tandem ASCT, and fifteen patients were treated with single ASCT. Twenty-one patients were treated with BD regimen, two patients with CyBorD regimen, and two patients with VAD regimen. The median number of induction therapy was 4 cycles (4-6). The PFS of the tandem ASCT group (3yrs PFS was 87.5%) was superior to the single ASCT group (3yrs PFS was 37.2%) (P = 0.0038). The OS of the tandem ASCT group (3yrs PFS was 100%) was superior to the single ASCT group (3yrs OS was 49.5%) without statistical significance (P = 0.057). We compared cumulative costs of tandem ASCT patients with single ASCT patients. We plotted the average cumulative cost of every 3 months in each group. The first 21 months and beyond 54 months, the rate of cost increment was apparently higher in the single ASCT group than tandem ASCT group. A regression line was calculated for the average cumulative cost of single ASCT group and tandem ASCT group. Regression analysis revealed that overall inclination of the regression line of the cost in single ASCT was significantly larger than that of the cost in tandem ASCT (P = 0.0024).Conclusion:The outcome of tandem ASCT was superior to single ASCT in patients with adverse cytogenetics. Also, the total cost in patients with tandem ASCT was lower than that with single ASCT. Tandem ASCT may reduce the rate of relapse and the cost for salvage treatment. Therefore, tandem ASCT should be considered for multiple myeloma patients with adverse cytogenetics from a cost-benefit point of view. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Outcomes of Autologous Stem Cell Transplantation in Very Elderly Patients with Multiple Myeloma

Background: Autologous stem cell transplantation (ASCT) is considered standard of care for patients with multiple myeloma (MM). The majority of patients with MM are diagnosed over the age of 65 and 37% are over the age of 75 (Van de Donk and Sonneveld, 2014). As treatment outcomes and survival improve across age groups for patients with MM (Libby, et al. 2013), more elderly patients are potential candidates for ASCT. Elderly patients have been defined as greater than age 65 in many studies of ASCT, but as referral age for transplantation continues to increase, the ASCT outcomes of patients 75 years and older need to be elucidated.Methods: Between January 2005 and December 2015, 24 patients age 75 or older received ASCT for MM. High-risk disease (HRD) was defined as t(14;16), t(14;20), del 17p, t(4;14) or 1q gain by FISH, del 13q, monosomy 13 or hypodiploidy by standard cytogenetics, or high risk signature gene expression profiling. Patients were mobilized for peripheral blood stem cell collection with either a cyclophosphamide-based mobilization chemotherapy regimen with GSCF (Cy-G), plerixafor and GCSF (Pler-G), or with GCSF alone. Conditioning regimens were melphalan based, with patients receiving either 140 mg/m2 (Mel 140) or 200 mg/m2 (Mel 200). Response criteria was based on the International Working Group Diagnostic Criteria for MM. Outcomes reported included disease response, progression free survival (PFS), overall survival (OS) and cause of death.Results: The ages ranged from 75 to 84 years and 71% were male. HRD at diagnosis was reported for 8 patients (33%). Twenty patients (83%) were in a partial response (PR) or better at time of transplantation, with 1 patient in a complete response (CR), 10 patients (42%) in a very good partial response (VGPR), and 9 patients (37%) in a PR. No patient had progressive disease at the time of ASCT and 4 patients (17%) had stable disease (SD). Twelve patients (50%) received Cy-G for stem cell mobilization, 11 (49%) received Pler-G, and 1 patient received GCSF alone. Five patients received Mel 140 and 19 patients received Mel 200, 21% and 79% respectively. Best response post ASCT was CR in 10 patients (42%), VGPR in 5 patients (21%), PR in 4 patients (17%) and 2 patients (8%) had SD. There were 2 early deaths prior to day 100 post ASCT. One patient died of a subdural hematoma at day +11 and the other patient died of a staphylococcus aureus sepsis at day +25. PFS was 40% at 5 years and OS was 56% at 5 years. There was no difference in OS (p=0.1511) for patients age 75 and older at the time of transplantation compared to patients younger than age 75 (n=472).Conclusions: ASCT for very elderly patients 75 years or older is feasible and can result in long-term survival. Elderly patients can tolerate chemotherapy for mobilization and doses of melphalan 200 mg/m2 for conditioning. Elderly patients with MM should not be denied ASCT based on age alone. [Display omitted] DisclosuresMcKiernan:Novartis: Speakers Bureau. Siegel:Celgene, Takeda, Amgen Inc, Novartis and BMS: Consultancy, Speakers Bureau; Merck: Consultancy. Vesole:Takeda: Speakers Bureau; Celgene: Speakers Bureau. Skarbnik:Novartis: Speakers Bureau; Abbvie: Other: Ad board, Speakers Bureau; Seattle Genetics: Speakers Bureau; Genentech: Speakers Bureau; Gilead: Speakers Bureau. Biran:Celgene, Amgen: Consultancy, Speakers Bureau; Takeda: Speakers Bureau. Richter:BMS: Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Pecora:Caladrius Biosciences: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; COTA: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties. Goy:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genentech: Research Funding; Pharmacyclics / J&J: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Acerta: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Impact of time to relapse and response to salvage therapy on post autologous stem cell transplant outcomes in relapsed or refractory diffuse large B-cell lymphoma.

e19501 Background: The current standard of care for patients with relapsed or refractory (RR) diffuse large B-cell lymphoma (DLBCL) following frontline immunochemotherapy (IC) is salvage therapy, followed by high-dose chemotherapy and autologous stem cell transplant (ASCT) rescue in patients responding to salvage therapy. Time to first relapse (or refractory status) and response to salvage therapy in patients with RR DLBCL may reflect the chemosensitivity of the underlying disease. The aim of this study is to determine whether these factors impact post-ASCT outcomes. Methods: Patients with DLBCL that relapsed after R-CHOP or R-CHOP-like frontline therapy who underwent salvage therapy and ASCT at Mayo Clinic or University of Iowa between 07/2000 and 4/2020 were identified from institutional lymphoma and transplant databases. Clinical characteristics, treatment information, and outcome data were abstracted. Progression-free survival (PFS) and overall survival (OS) from the time of ASCT were analyzed using Kaplan-Meier method and Cox proportional hazards models. Results: A total of 437 patients with RR DLBCL who underwent salvage therapy and ASCT were identified. 280 (64%) were male. Median time from initial diagnosis to 1st relapse/salvage was 1.0 years (range 0.1-16.4). A median of 1 line (range 1-3) of salvage therapy was required. Response prior to ASCT was complete response (CR) in 211 (48%), partial response in 199 (46%), stable disease in 24 (5%), and unknown in 3 (1%) patients. Median age at ASCT was 61 years (range 19-78), and median follow up after ASCT was 8.0 years (95% CI 7.2-8.7). Median PFS and OS was 2.7 (95% CI 1.5-4.3) and 5.4 (4.2-7.4) years, respectively. Time to 1st relapse/salvage (≤1 vs 1-2 vs &gt; 2 years) was not associated with PFS (median 0.8 vs 2.4 vs 4.9 years, p = 0.170) but was associated with OS (2.4 vs 7.4 vs 6.8 years, p = 0.013). Patients who required &gt; 1 line of salvage therapy had significantly inferior PFS (median 0.3 vs 4.5 years, p &lt; 0.001) and OS (0.9 vs 7.4 years, p &lt; 0.001). In addition, patients who failed to achieve a CR prior to ASCT had significantly worse PFS (median 0.8 vs 5.3 years, p &lt; 0.001) and OS (2.7 vs 9.2 years, p &lt; 0.001). In multivariate Cox regression models adjusted for age and sex, time to 1st relapse/salvage was not associated with PFS (p = 0.313) or OS (p = 0.081); however, lines of salvage and response prior to ASCT remain significantly prognostic for PFS ( &gt; 1 line of salvage: HR 2.14, 95% CI 1.59-2.87, p &lt; 0.001; non-CR: HR 1.61, 95% CI 1.26-2.05, p &lt; 0.001) and OS ( &gt; 1 line of salvage: HR 2.25, 95% CI 1.66-3.05, p &lt; 0.001; non-CR: HR 1.63, 95% CI 1.26-2.12, p &lt; 0.001). Conclusions: In patients with RR DLBCL following frontline IC, requiring more than 1 line of salvage therapy and failure to achieve CR are strong independent risk factors for poor PFS and OS after ASCT. Novel therapies such as CAR-T cell therapy should be studied in this population.

Real-world utilisation of ASCT in multiple myeloma (MM): a report from the Australian and New Zealand myeloma and related diseases registry (MRDR).

Supported by clinical trial proven survival benefit, clinical guidelines recommend upfront autologous stem cell transplantation (ASCT) for eligible MM patients. However, reported real-world utilisation is lower than expected (40-60%). We reviewed ASCT utilisation, demographics and outcomes for MM patients (≤70 years, ≥12-month follow-up) enroled onto the Australian/New Zealand MRDR from June 2012 to May 2020. In 982 patients (<65 years: 684, 65-70 years: 298), ASCT utilisation was 76% overall (<65 years: 83%, 65-70 years: 61%, front-line therapy: 67%). Non-ASCT recipients were older (median age: 65 years vs 60 years, p < 0.001), had more comorbidities (cardiac disease: 16.9% vs 5.4%, p < 0.001; diabetes: 19.1% vs 7.0%, p < 0.001; renal dysfunction: median eGFR(ml/min): 68 vs 80, p < 0.001), inferior performance status (ECOG ≥ 2: 26% vs 13%, p < 0.001) and higher-risk MM (ISS-3: 37% vs 26%, p = 0.009, R-ISS-3 18.6% vs 11.8%, p = 0.051) than ASCT recipients. ASCT survival benefit (median progression-free survival (PFS): 45.3 months vs 35.2 months, p < 0.001; overall survival (OS): NR vs 64.0months, p < 0.001) was maintained irrespective of age (<65 years: median PFS: 45.3 months vs 37.7 months, p = 0.04, OS: NR vs 68.2 months, p = 0.002; 65-70 years: median PFS: 46.7 months vs 29.2 months, p < 0.001, OS: 76.9 months vs 55.6 months, p = 0.005). This large, real-world cohort reaffirms ASCT survival benefit, including in 'older' patients necessitating well-designed studies evaluating ASCT in 'older' MM to inform evidence-based patient selection.

Retrospective analysis of autologous stem cell transplantation outcomes in multiple myeloma patients with renal insufficiency

Aim: The most seen complication of multiple myeloma (MM) is renal insufficiency (RI). Although MM is known as one of the causesof reversible end-stage renal disease, these patients are usually not suitable for autologous stem cell transplantation (ASCT). We aimed in this study to reveal the clinical course of MM patients with renal insufficiency that underwent ASCT. Materials and Methods: We included 25 MM patients with RI who has undergone ASCT in this study. Creatinine levels more than 2 mg/dL was defined as renal insufficiency at the time of diagnosis. For survival analysis, we included patients with a minimum 100 days post-transplantation follow-up.Results: Median age was 56.6±7.9 (42-65) years. Melphalan was given 140 mg/m 2 . Nine patients (36%) required dialysis at the time of diagnosis. Six patients became dialysis-free with induction therapy. After ASCT, none of the patients needed dialysis. Cox regression analysis showed a significant increase in disease-free survival (DFS) and overall survival (OS) times compared to patients with very good partial response in patients with complete response on the 100 th day of ASCT (for DFS; 15.7 months vs 63.7 months, p=0.009 and for OS; 37.9 months vs 97.3 months p=0.01, respectively). Conclusion: There are studies showing that ASCT performed with reduced dose of melphalan is a renal protective and effective method in patients with renal impairment. Our study confirms this thesis, as well as emphasizing the significant effect of CR on DFS and OS on the 100 th day after transplantation in these patients.

Autologous stem cell transplantation for multiple myeloma patients aged ≥ 75 treated with novel agents.

Autologous stem cell transplantation (ASCT) has been used for treating multiple myeloma (MM) for over three decades and is generally reserved for patients younger than 65. Herein we report on outcomes of outpatient ASCT in a cohort of patients with MM aged ≥75 years. Between October 2005 and August 2020, 50 patients aged ≥75 years, received an ASCT at Mayo Clinic, Rochester. Median time from diagnosis to ASCT was 6.85 months (IQR 5.2-10.52) and 50%. received reduced intensity conditioning with melphalan 140 mg/m2. 48% of patients completed the ASCT without requiring hospitalization and 52% (n = 26) of patients required hospitalization with a median duration of hospital admission of 9 days (IQR 5-13). Reasons for hospitalization included fever or infection (32%), cardiac arrhythmia (36%), and dehydration (32%). Overall response rate was 100% with a complete response seen in 57% of patients. Median overall survival and progression free survival for the cohort were 82 months and 33 months, respectively. One patient died within 100 days of transplant representing a 2% 100-day mortality rate. ASCT is safe and efficacious in carefully selected MM patients aged 75 or above and we believe that age should not be an exclusion factor for ASCT in MM.

Outcomes after Autologous Stem Cell Transplant in Patients with Relapsed Multiple Myeloma

Outcomes after Autologous Stem Cell Transplant in Patients with Relapsed Multiple Myeloma

Next-Generation Sequencing Minimal Residual Disease of Mantle Cell Lymphoma in Autologous Stem Cell Grafts and Its Implication on Tumor Recurrence

Background &amp; Purpose The clinical course of mantle cell lymphoma (MCL) is often inflicted with tumor recurrence even though front-line autologous stem cell transplantation (ASCT) is the current standard of care. To elucidate the mechanism of post-transplant recurrence, this study aimed to interrogate the minimal residual disease (MRD) of MCL in the autologous grafts. Materials &amp; Methods Paired samples of 17 MCL patients' lymphoma diagnostic FFPE specimens were analyzed in parallel with their harvested autologous stem cell grafts. Extracted genomic DNA was subjected to LymphoTrackⓇ Dx IGH/IGK assay coupled with Illumina MiSeq sequencer to characterize the post-recombination immunoglobulin VDJ sequences. Positivity of MRD was defined for any identical sequences identified both in the diagnostic FFPE and in the autologous graft DNA. As the control for recombined VDJ protein motif analysis, diagnostic FFPE samples from 23 patients with diffuse large B cell lymphoma (DLBCL) were analyzed with the same platform. Results Of the 17 patients undertaking autologous stem cell harvest, 11 patients achieved complete response and 6 were in partial response before stem cell harvest. Sixteen of these actually underwent transplantation while one died of disease before transplantation. MRD was detected via next-generation sequencing (NGS) in 5 patients' autologous grafts with variable MRD loads and recombined VDJ stereotypes (Table 1). VH3-21 was the most prominent stereotype (41%), followed by VH4-59 (14%). The median somatic hypermutation rate was 0.88% (range 0 - 5.17%). Interestingly, a 46-amino-acid domain in recombined VDJ sequences, which was hydroxyl and amine group-rich, differed between MCL and DLBCL: hydrophilic amino acids were enriched in 6 positions of this domain in MCL (p&amp;lt;0.05). Among the five patients who had MRD in autologous grafts, the median MRD read number was 12,764 reads (range 89 - 33,554) with the median read depth of 195,865 reads (range 94,820 - 396,894). The MRD loads in the autologous grafts were inversely correlated with post-harvest PFS (Figure 1a and 1b). As for post-ASCT outcomes, patients with MRD had a trend toward worse PFS and OS than those without MRD (medians, 10 months vs 27 months, and 25 months vs 66.8 months, respectively). In subgroup analysis, a higher load of NGS-MRD (&amp;gt;1%) correlated with shorter post-ASCT PFS and OS than those without MRD (medians, 1.9 months vs 27 months (p=0.024) in Figure 1c, and 11.9 months vs 66.8 months (p=0.001) in Figure 1d, respectively). Conclusions Identification of MRD in autologous grafts by deep-sequencing VDJ recombination helped stratify MCL patients' post-ASCT outcomes. Higher MRD loads correlated with inferior post-ASCT PFS and OS. The implication of recombined VDJ stereotypes and their impact on ASCT outcomes warrants further investigation. Disclosures Ko: Roche: Honoraria.

Pegfilgrastim improves the outcomes of mobilization and engraftment in autologous hematopoietic stem cell transplantation for the treatment of multiple myeloma.

Autologous stem cell transplantation (ASCT) is the only curable therapy for multiple myeloma (MM), while its success primarily relies on mobilization to obtain sufficient hematopoietic stem/progenitor cells (HPC). Although the role of Pegfilgrastim (PEG), a novel PEGylated form of the recombinant G-CSF filgrastim (FIL), in mobilization has been demonstrated, it remains unclear whether this approach is cost-effective in MM treatment. Here, we performed a real-world analysis to evaluate the efficacy and cost of PEG for mobilization in a cohort of MM patients, of which 53% carried high-risk cytogenetic abnormalities. A total of 91 patients who received either a single dose of PEG (6 or 12 mg, n = 42) or multiple dosing of 10 μg/kg/day FIL (n = 49) after chemotherapy for HPC mobilization were included. The yield of MNCs and CD34+ cells per milliliter of blood collected via apheresis was significantly greater in the PEG group than that in the FIL group (P = 0.014 and P = 0.038). Mobilization with PEG yielded significantly higher median number of collected CD34+ cells than FIL (5.56 vs. 4.82 × 106/kg; P = 0.038). Moreover, the average time-to-recovery of leukocytes and platelets after transplantation was markedly shorter in the PEG group than that in the FIL group (leukocyte, 11.59 ± 1.98 vs 12.93 ± 2.83 days, P = 0.019; platelet, 12.86 ± 2.62 vs 14.80 ± 5.47, P = 0.085). However, the total cost of mobilization and apheresis using PEG or FIL was comparable (P = 0.486). Of note, mobilization with 12 mg PEG further shortened time-to-recovery of leukocytes (10.64 ± 0.51 vs. 12.04 ± 2.26 days, P = 0.05) and platelets (10.60 ± 2.89 vs. 13.33 ± 2.35 days, P = 0.031) compared with 6 mg PEG. Our results support a notion that PEG (especially 12 mg) combined with chemotherapy is a cost-effective and convenient regimen of mobilization, which might improve the outcome of ASCT in MM.

Autologous Stem Cell Transplantation Outcomes in Patients with Myeloma and Renal Dysfunction

Background Renal impairment (RI) is a common complication and a negative prognostic factor in patients with Multiple Myeloma (MM). Patients with severe renal dysfunction may not benefit from optimal therapy as they are often excluded from autologous stem cell transplantation (ASCT). The aim of this study was to analyze the outcome of MM patients with prior RI undergoing ASCT and to evaluate the effect of transplant on renal and hematologic response. Methods From 147 eligible MM patients who underwent ASCT between 2002 and 2019, 131 were included in this single-center retrospective cohort study. Renal function (eGFR in ml/min/1.73m2 by MDRD) was evaluated at the time of MM diagnosis and prior to ASCT, as well as 30 and 100 days after ASCT. Patients were classified by renal function: A) eGFR &lt;30; B) eGFR 30-59; or C) eGFR &gt;60 prior to ASCT. ANOVA was used for comparison of renal function at diagnosis, at transplant, 30 days post ASCT, and 100 days post ASCT. Log rank testing was used for overall survival (OS) analysis of group A, B and C Results: Patients with renal dysfunction at baseline had lower ORR than controls to induction therapy, 71 v 78%. ASCT provided deepening responses to both groups, ORR 83 v 86% respectively. No renal responses were seen with ASCT, whereas 16% of patients with renal dysfunction at diagnosis had renal response prior to transplant. Of note, only 51% of patients with renal dysfunction received conditioning with Mel200, compared with 94% of control group. Overall survival benefit is seen for patients with eGFR&gt;60 over any level of dysfunction (p = 0.0079). Conclusion Myeloma patients with renal dysfunction are a high risk group, and require special attention. Rapid and effective induction therapy remains an important step in reversing renal damage. In patients who do not recover kidney function, autologous stem cell transplantation should be considered, providing depth of response benefit. The conditioning regimen used for these patients warrants further investigation. Figure Disclosures Niesvizky: Takeda, Amgen, BMS, Janssen, Celgene: Consultancy, Research Funding. Coleman:Gilead, Bayer, Celgene: Consultancy, Research Funding, Speakers Bureau; Merck: Research Funding; Pharmacyclics: Speakers Bureau; Kite Pharmaceuticals: Equity Ownership. Rossi:BMS: Research Funding; Janssen, Celgene, Amgen: Consultancy.

Autologous Stem Cell Transplantation in Multiple Myeloma Patients Older Than 65 Year-Old, 12-Years Analysis of National Cancer Database

Introduction. The diagnosis of multiple myeloma (MM) is often made in elderly individuals (median age at diagnosis 69 years) with over a third of patients exceeding 75 years of age. Many elderly patients are frequently excluded from clinical trials because of predefined upper age limit of 65 years limiting accessibility to autologous stem cell transplant (ASCT) for a large proportion of MM patients. Based on limited multicenter studies and randomized clinical trials in this population, we used the National Cancer Database (NCDB) to assess the outcomes of ASCT in MM patients older than 65 years of age. Methods. We queried the NCDB for patients with MM diagnosed between 2004 -2015 treated with ASCT as frontline therapy, yielding a final cohort of 9,383 patients. Multivariable logistic regression was used to determine the likelihood of receiving ASCT. Overall survival (OS) was calculated from the date of diagnosis to the date of last contact or death using Kaplan Meier methodology. Adjusted hazard ratios (HR) and 95% confidence interval (CI) are reported, with α=0.05 used to indicate statistical significance. Results. The median age was 67.0 (range: 19-90). The majority of patients were older than 65 (58.5%), male (54.7%), Caucasian (75.6%), had government insurance (88%)and had a Charlson-Deyo Comorbidity score (CDCS) of 0 (75.5%). In addition to older age, insurance status, low annual income higher CDCS were associated with lower chances of receiving ASCT (Table 1). Patients in Urban areas (OR 1.377, CI 95% 1.286-1.475), and patients in Academic/Research Centers (OR 4.379 were CI 95%, 3.852-4.978) were more likely to receive ASCT. In patients younger than 65-years of age rate of ASCT was 7.0% in 2004 and increased to 16.7% in 2015. The annual rate of ASCT in patients older than 65-years of age was 1.1% in 2004 and increased to 4.7% in 2015. The multivariable cox proportional hazards of death in patients receiving ASCT was associated with improved survival (HR 0.492, CI 95% 0.473-0.512). Age (&gt;65 years old HR 1.184, 95% CI 1.053-1.331), insurance status (uninsured HR 1.361, CI 95% 1.302-1.422, Medicaid HR 1.365, 95% CI 1.318-1.414, Medicare HR 1.271, 95% CI 1.244-1.299) and higher comorbidity score were associated with worse survival (Table 2). Median survival in patients younger than 65-years old receiving ASCT was 102.6 month versus 66.6 months in patients not receiving ASCT (HR 0.596, 95% CI 0.568-0.624) (Figure 1). Median survival in patients older than 65 years old and not receiving ASCT was 86.3 months versus 28.4 months in patients not receiving ASCT (HR 0.344, 95% CI 0.0320-0.371). Conclusions. The findings of the present study demonstrate decreased utilization of ASCT in older patients with MM, despite significant survival benefit of such therapy. Other factors associated with decreased likelihood of ASCT are such as insurance status and annual income unfold existing disparities in patients with MM receiving ASCT. Disclosures No relevant conflicts of interest to declare.