Similar Risk Of Progression Research Articles

Assessing the Prognostic Utility of the Mayo 2018 and IMWG 2020 Smoldering Multiple Myeloma Risk Stratification Scores When Applied Post Diagnosis

Assessing the Prognostic Utility of the Mayo 2018 and IMWG 2020 Smoldering Multiple Myeloma Risk Stratification Scores When Applied Post Diagnosis

Assessing the prognostic utility of smoldering multiple myeloma risk stratification scores applied serially post diagnosis

The Mayo-2018 smoldering multiple myeloma (SMM) risk score is used routinely in the clinical setting but has only been validated at diagnosis. In SMM patients, the progression risk decreases over time. However, the utility of applying risk stratification models after diagnosis is unknown. We retrospectively studied 704 SMM patients and applied the Mayo 2018 and IMWG-2020 risk stratification models at annual landmark timepoints up to 5 years post diagnosis. The Mayo-2018 and IMWG-2020 models reliably stratified patients based on progression risk when applied post diagnosis. The respective 2-year progression risk in Mayo-2018 high risk patients versus IMWG-2020 intermediate-high risk patients was 51% versus 62% at the 1-year landmark and 47% versus 45% at the 4-year landmark. We showed that patients categorized at Mayo-2018 high-risk at follow-up had a similar risk of progression if the baseline risk assessment was low-intermediate versus high-risk (HR 1.04, 95% CI 0.46–2.36, p = 0.931 at 5-year landmark). Patients migrating to a higher risk category during follow up had a higher progression risk compared to patients with stable/decreased risk categorization. Our findings support the use of these risk scores post-diagnosis and suggest that patients evolving to a high-risk category may benefit from early intervention therapeutic approaches.

OAB-037: Assessing the prognostic utility of the Mayo 2018 and IMWG 2020 smoldering multiple myeloma risk stratification scores applied post diagnosis

<h3>Background</h3> Smoldering multiple myeloma (SMM) prognostication models routinely used in clinical practice were developed for use at diagnosis. However, retrospective studies in SMM patients have shown that the risk of progression to multiple myeloma (MM) decreases over time. Therefore, this study assessed whether the Mayo 2018 and IMWG 2020 scores could be used dynamically to risk stratify patients post-diagnosis, and whether they could identify SMM patients with evolving disease markers. <h3>Methods</h3> We retrospective studied 704 SMM patients diagnosed between January 2000 to January 2020. Patients with a baseline FLCr ≥100 and involved FLC ≥10 mg/dL or baseline bone marrow plasma cells ≥60% were excluded. We collected serial laboratory data and re-applied the Mayo 2018 and IMWG 2020 SMM risk stratification models at annual landmark timepoints up to 4 years post SMM diagnosis. Survival analyses were performed using the Kaplan-Meier method. Time to progression was defined as time from diagnosis or landmark timepoint to treatment initiation for MM or systemic AL amyloidosis. <h3>Results</h3> At SMM diagnosis, 271 (38%) patients were low risk, 228 (32%) were intermediate risk, and 205 (29%) were high risk per the Mayo 2018 score. Applying the IMWG 2020 score at diagnosis, 90 (34%) of patients were low risk, 111 (42%) were low-intermediate risk, 54 (21%) were intermediate risk, and 9 (3%) were high risk. The Mayo 2018 and IMWG 2020 risk scores was re-assessed annually post-diagnosis in patients without progression (respective sample sizes: n=430 and n=197 at year 1 landmark, n=326 and n=143 at year 2 landmark, n=260 and n=106 at year 3 landmark, n=203 and n=73 patients at year 4 landmark). The Mayo 2018 and IMWG 2020 models reliably stratified patients based on progression risk post diagnosis; the respective 2-year progression risk in Mayo 2018 high-risk versus IMWG 2020 intermediate-high risk patients was 51% versus 62% at the 1-year landmark, 60% versus 65% at the 2-year landmark, 47% versus 62% at the 3-year landmark, and 47% versus 45% at the 4-year landmark. Patients evolving to a higher Mayo 2018 or IMWG 2020 risk category during follow up consistently had an increased risk of progression compared to patients with a stable/decreased risk categorization. We showed that patients categorized as Mayo 2018 high-risk at follow-up had a similar risk of progression regardless of whether the baseline risk categorization was low-intermediate versus high-risk (HR 0.87, 95% CI 0.51-1.48, p=0.606 at 2-year landmark; HR 1.01, 95% CI 0.59-1.73, p=0.972 at 3-year landmark; HR 0.75, 95% CI 0.34-1.65, p=0.467 at 4-year landmark). <h3>Conclusion</h3> Our findings support the use of the Mayo 2018 and IMWG 2020 scores post-diagnosis. We showed that patients migrating to a higher risk category have an increased risk of progression, suggesting that patients evolving to a high-risk score during follow-up should be considered for early intervention treatment approaches.

Impact of I(17q) in Myeloproliferative Neoplasms

IntroductionChronic myeloid leukemia (CML) is characterized by the presence of Philadelphia chromosome (Ph). Acquired somatic mutations of JAK2, MPL and CALR are defining pathogenetic events in most cases of classical Ph-negative myeloproliferative neoplasms (MPN). Although chromosomal abnormalities observed in Ph-negative MPNs are not specific, chromosomal analysis is still part of the diagnostic work-up given their potential role in disease progression. The prognostic relevance of i(17q) has been well recognized in acute myeloid leukemia and myelodysplastic syndrome. However, other than some sporadic case reports, its role in MPNs remains unclear.MethodCytogenetic data of adult patients diagnosed with CML or classical Ph-negative MPNs from year 1998 through 2016 were reviewed for the presence of i(17q) and its impact on disease progression and patient outcome. Blast phase (BP) was defined as blast percentage in peripheral blood or bone marrow exceeding 20%.ResultsA total of 88 patients, including 71 patients with CML and 17 patients with classical Ph-negative MPNs were identified to have i(17q). In the 17 patients with Ph- MPN, 15 patients had primary myelofibrosis, 1 had polycythemia vera, 1 had essential thrombocytosis.The median age at diagnosis is 48 years for CML patients and 61 for Ph- MPN patients. i(17q) was present at initial diagnosis in 33 patients, including 26 with CML and 7 with Ph- MPN. In the remaining 55 patients, i(17q) emerged after a median follow-up time of 36.9 months in CML patients and 18 months in Ph- MPN patients. At the emergence of i(17q), 33 patients were in BP, including 27 patients with CML and 6 patients with Ph- MPN. In the remaining 55 patients, 20 patients including 16 with CML and 4 with Ph- MPN, developed BP after a median follow-up time of 8 months (range 0.7 to 72.9 months). Overall, in the 43 CML patients with BP, 38 had myeloid BP, 4 had lymphoid BP, and 1 had mixed phenotype BP. In 10 Ph- MPN patients with BP, all had myeloid BP.Overall, the emergence of i(17q) was associated with unfavorable outcome. The one-year probability of blastic transformation was 44.4% in patients with Ph- MPN, and 24.1% in those with CML (Fig 1A). The median survival from emergence of i(17q) was 6.9 months in patients with Ph- MPN and 22.3 months in those with CML (Fig 1B). Patients with i(17q) at initial presentation and patients who acquired i(17q) later in disease course had similar risk of progression (Fig 1C) and overall survival (Fig 1D). Patients with isolated i(17q) and patients with complex karyotype containing i(17q) had similar risk of progression (Fig 1E, p=0.6780) and overall survival (Fig 1F, p=0.4464).Conclusioni(17q) is associated with rapid progression and unfavorable overall survival in both CML and Ph- MPN. CML with i(17q) tends to progress to myeloid BP. The prognostic impact of i(17q) is not affected by the emergence time nor concurrent cytogenetic abnormalities. [Display omitted] DisclosuresVerstovsek:Incyte: Research Funding; Seattle Genetics: Research Funding; CTI BioPharma Corp: Research Funding; Lilly Oncology: Research Funding; Gilead: Research Funding; NS Pharma: Research Funding; Galena BioPharma: Research Funding; Genentech: Research Funding; Promedior: Research Funding; Blueprint Medicines Corp: Research Funding; Bristol Myers Squibb: Research Funding; Roche: Research Funding; Incyte: Research Funding; NS Pharma: Research Funding; CTI BioPharma Corp: Research Funding; Astrazeneca: Research Funding; Promedior: Research Funding; Gilead: Research Funding; Bristol Myers Squibb: Research Funding; Blueprint Medicines Corp: Research Funding; Celgene: Research Funding; Pfizer: Research Funding; Lilly Oncology: Research Funding; Celgene: Research Funding; Astrazeneca: Research Funding; Genentech: Research Funding; Pfizer: Research Funding; Galena BioPharma: Research Funding; Roche: Research Funding; Seattle Genetics: Research Funding. Cortes:ARIAD: Consultancy, Research Funding; ImmunoGen: Consultancy, Research Funding; Novartis Pharmaceuticals Corporation: Consultancy, Research Funding; Teva: Research Funding; BMS: Consultancy, Research Funding; Sun Pharma: Research Funding; Pfizer: Consultancy, Research Funding.

Prognosis of young patients with monoclonal gammopathy of undetermined significance (MGUS)

Monoclonal gammopathy of undetermined significance (MGUS) is rare in young patients (age <40 years at diagnosis), with a prevalence of <0.3%, representing ~2% of all patients with MGUS. We hypothesized that MGUS detected in young patients may be associated with a higher risk of progression. We examined 249 patients with MGUS < 40 years old. Among these, 135 patients had immune-related conditions, including infections, autoimmune and inflammatory disorders at the time of diagnosis of MGUS. The risk of progression to multiple myeloma or a related disorder at 5 years and 10 years was 6.0% and 13.8%, respectively. The size of M protein was a significant risk factor for progression (HR 4.2, 95% CI 2.2–7.9). There was a trend that the risk of progression was higher in patients without immune-related conditions (HR 2.36, 95% CI 0.85–6.52, p = 0.088). The M protein resolved in 36 (14%) patients, with a greater likelihood of resolution in patients with immune-related conditions (RR 1.9, 95% CI 1.02–3.6). Young patients with MGUS have a similar risk of progression as older patients, 1.4% per year. Over 50% are diagnosed in the setting of immune-related disorders. Patients with immune-related disorders may have a lower risk of progression.

"Associated" or "Secondary" IgA nephropathy? An outcome analysis.

BackgroundWhether differences in outcome between primary (pIgAN) and secondary IgA nephropathy (sIgAN) exist is uncertain.MethodsWe conducted a retrospective, observational study that included all histologically diagnosed IgAN patients between 2010–2017 (N = 306), 248 with pIgAN and 58 with sIgAN. To obtain samples with similar risk of progression, sIgAN patients were grouped as liver disease and autoimmune/viral disease and propensity score matched to corresponding pIgAN samples. Univariate (Kaplan Meier) and multivariate time-dependent (Cox modelling) analyses were performed to identify predictors of the composite end-point (doubling of serum creatinine, end-stage kidney disease or death).ResultsOf the whole cohort, 20% had sIgAN (6% alcoholic cirrhosis, 6% autoimmune disease and 8% viral infections). sIgAN patients were older, had more comorbidities, lower proteinuria and higher haematuria, but similar distribution in MESTC lesions and eGFR as those with pIgAN. They reached the end-point in similar proportions with those with pIgAN (43 vs. 30%; p = 0.09) but their mortality was higher (19 vs. 3%; p<0.0001). Both in unmatched (HR 0.80, 95%CI 0.42–1.52; p = 0.5) and matched samples (log-rank test: liver disease-IgAN vs. pIgAN, p = 0.1; autoimmune/viral-IgAN vs. pIgAN, p = 0.3), sIgAN was not predictive for end-point. In analyses restricted only to sIgAN, those with viral infections (HR, 10.98; 95% CI, 1.12–107.41; p = 0.03) and lower eGFR (HR, 0.94; 95%CI, 0.89–0.98; p = 0.007) had a worse prognosis. Immunosuppression did not influence outcome.ConclusionsThe differences in MESTC score and outcome between pIgAN and sIgAN seems to be minimal, suggesting that “associated” describes better than “secondary” the relationship among the two. Immunosuppression did not to influence outcome of sIgAN.

2230-PUB: The Role of Baseline Urine ACR and Estimated GFR in the Development of Advanced CKD after 8.4 Years of Follow-Up in Type 2 Diabetic Patients

Background: There is discordance between the presence of albuminuria and the decline in renal function. This study aimed to assess the role of baseline Urine Albumin-to-Creatinine Ratio (UACR) and the estimated glomerular filtration rate (eGFR) in the development of advanced chronic kidney disease (CKD; GFR &amp;lt; 60 mL/minute per 1.73 m2) in type 2 diabetic patients. Methods: A total of 2424 patients who had participated in a comprehensive diabetic care program were studied and were stratified into progressor (n=578) and non-progressor groups (n=1846) according to the status of progression to advanced CKD during the mean 8.4 years follow-up period. Results: By Cox regression analysis, the risk of CKD progression [hazard ratio, HR (95% CI)] for patients with microalbuminuria and eGFR &amp;gt;90, non-albuminuria and eGFR 60~89 or microalbuminuria and eGFR 60~89 were 2.215 (1.592~3.081), 3.091 (2.354~4.059) and 4.351 (3.253~5.820), respectively (P&amp;lt;0.001 for all). By Kaplan-Meier survival curve, the progression rates were 9.4% in patients with non-albuminuria and eGFR &amp;gt;90, 25.6% in patients with microalbuminuria and eGFR &amp;gt;90, 28.0% in patients with non-albuminuria and eGFR 60~89 and 38.5% in patients with microalbuminuria and eGFR 60~89. Conclusions: Our study demonstrated that type 2 diabetic patients with microalbuminuria and eGFR &amp;gt;90 or patients with non-albuminuria and eGFR level of 60~89 were associated with similar risk of progression to advanced CKD. Disclosure L. An: None. H. Hsu: None. Y. Chang: None. T. Lee: None.

Sunitinib in patients with pre-treated pancreatic neuroendocrine tumors: A real-world study

IntroductionBesides data reported in a Phase-III trial, data on sunitinib in pancreatic Neuroendocrine Tumors (panNETs) are scanty. AimTo evaluate sunitinib efficacy and tolerability in panNETs patients treated in a real-world setting. Patients and methodsRetrospective analysis of progressive panNETs treated with sunitinib. Efficacy was assessed by evaluating progression-free survival, overall survival, and disease control (DC) rate (stable disease (SD) + partial response + complete response). Data are reported as median (25th–75th IQR). ResultsEighty patients were included. Overall, 71.1% had NET G2, 26.3% had NET G1, and 2.6% had NET G3 neoplasms. A total of 53 patients (66.3%) had received three or more therapeutic regimens before sunitinib, with 24 patients (30%) having been treated with four previous treatments. Median PFS was 10 months. Similar risk of progression was observed between NET G1 and NET G2 tumors (median PFS 11 months and 8 months, respectively), and between patients who had received ≥ 3 vs ≤ 2 therapeutic approaches before sunitinib (median PFS 9 months and 10 months, respectively). DC rate was 71.3% and SD was the most frequent observed response, occurring in 43 pts (53.8%). Overall, 59 pts (73.8%) experienced AEs, which were grade 1–2 in 43 of them (72.9%), grade 3 in 15 pts (25.4%), and grade 4 in one patient (1.7%). Six pts (7.5%) stopped treatment due to toxicity. ConclusionsThe present real-world experience shows that sunitinib is a safe and effective treatment for panNETs, even in the clinical setting of heavily pre-treated, progressive diseases.

Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy

Background: Tonsillectomy has been considered a treatment for IgA nephropathy (IgAN). It is aimed at removing a source of pathogens, reducing mucosa-associated lymphoid tissue and decreasing polymeric IgA synthesis. However, its beneficial effect is still controversial. In Asia, favorable outcomes have been claimed mostly in association with corticosteroids. In Europe, small, single-center uncontrolled studies have failed to show benefits. Methods: The European validation study of the Oxford classification of IgAN (VALIGA) collected data from 1,147 patients with IgAN over a follow-up of 4.7 years. We investigated the outcome of progression to end-stage renal disease (ESRD) and/or 50% loss of estimated glomerular filtration rate (eGFR) and the annual loss of eGFR in 61 patients who had had tonsillectomy. Results: Using the propensity score, which is a logistic regression model, we paired 41 patients with tonsillectomy and 41 without tonsillectomy with similar risk of progression (gender, age, race, mean blood pressure, proteinuria, eGFR at renal biopsy, previous treatments and Oxford MEST scores). No significant difference was found in the outcome. Moreover, we performed an additional propensity score pairing 17 patients who underwent tonsillectomy after the diagnosis of IgAN and 51 without tonsillectomy with similar risk of progression at renal biopsy and subsequent treatments. No significant difference was found in changes in proteinuria, or in the renal end point of 50% reduction in GFR and/or ESRD, or in the annual loss of eGFR. Conclusion: In the large VALIGA cohort of European subjects with IgAN, no significant correlation was found between tonsillectomy and renal function decline.

Abstract 16290: Racial and Ethnic Differences in Heart Failure Progression in Post-menopausal Women: The Women’s Health Initiative

Background: Heart failure (HF), a leading cause of morbidity and mortality in women, continues to disproportionately affect African-American (AA) women compared to women of other races/ethnicities. In a large cohort of post-menopausal women, we investigated if AA women progress through HF stages and coronary heart disease (CHD) death more rapidly than Caucasian (Cau) or Hispanic/Latina (HL) women. Methods: We assessed the American College of Cardiology/American Heart Association (ACC/AHA) HF stage A upon enrollment into the Women’s Health Initiative (1993-1998) and the progression from Stage A to Stage C, Stage C to CHD death, up to the last date of follow-up (2010). Cox proportional hazard regressions models were used to assess disease progression risk. We adjusted for age, baseline comorbidities, duration of comorbidities, interval development of myocardial infarction, ejection fraction at HF diagnosis, socioeconomic factors, and sex specific variables. Results: At baseline, AA women were younger and had a higher percentage of Stage A HF (76%) than Cau (54%) and HL (55%) women. Overall, AA and HL women had significantly lower risk of progressing from Stage A to Stage C compared to Cau women [AA vs. Cau adjusted Hazard Ratio (HR) 0.77 (95% Confidence Interval (CI) 0.64 -0.93) p = 0.0055; HL vs. Cau HR 0.54 (95% CI 0.40 -0.71) p &lt; 0.0001]. After stratifying by age groups(&lt;65, 65-69, &gt;70 years), AA women had a similar risk of progression from stage A to C compared to Cau women. When compared to Cau women, AA had an insignificant increased risk of progressing from Stage C to CHD death [adjusted HR 1.29 (95% CI 0.72 -2.32) p = 0.3883)]. Conclusions: Cau women were at higher risk for HF progression from Stage A to Stage C compared to HL women, but at similar risk as AA women. AA women had an insignificant but increased risk of progression from Stage C to CHD death compared to Cau women.

Liver transplant patients have a risk of progression similar to that of sporadic patients with branch duct intraductal papillary mucinous neoplasms.

Intraductal papillary mucinous neoplasms (IPMNs) have malignant potential and can progress from low- to high-grade dysplasia to invasive adenocarcinoma. The management of patients with IPMNs is dependent on their risk of malignant progression, with surgical resection recommended for patients with branch-duct IPMN (BD-IPMN) who develop high-risk features. There is increasing evidence that liver transplant (LT) patients are at increased risk of extrahepatic malignancy. However, there are few data regarding the risk of progression of BD-IPMNs in LT recipients. The aim of this study was to determine whether LT recipients with BD-IPMNs are at higher risk of developing high-risk features than patients with BD-IPMNs who did not receive a transplant. Consecutive patients who underwent an LT with BD-IPMNs were included. Patients with BD-IPMNs with no history of immunosuppression were used as controls. Progression of the BD-IPMNs was defined as development of a high-risk feature (jaundice, dilated main pancreatic duct, mural nodule, cytology suspicious or diagnostic for malignancy, cyst diameter ≥3 cm). Twenty-three LT patients with BD-IPMN were compared with 274 control patients. The median length of follow-up was 53.7 and 24.0 months in LT and control groups, respectively. Four (17.4%) LT patients and 45 (16.4%) controls developed high-risk features (P = 0.99). In multivariate analysis, progression of BD-IPMNs was associated with age at diagnosis but not with LT. There was no statistically significant difference in the risk of developing high-risk features between the LT and the control groups.

Colposcopy Prediction of Progression in Human Papillomavirus Infections With Minor Cervical Lesions

To evaluate the risk of progression to cervical intraepithelial neoplasia (CIN) grade 2 or 3 in women with positive human papillomavirus (HPV) testing and low-grade (low-grade squamous intraepithelial lesions), borderline (atypical squamous cells of undetermined significance), or no cervical lesions, and to determine the accuracy of initial colposcopy to predict progression. Women with HPV infection and low-grade squamous intraepithelial lesions, atypical squamous cells, or normal cytology were recruited and grouped according to cytologic or histologic diagnosis. Exclusion criteria were histologic CIN 2 or 3, previous cervical cancer and HPV infection, cervical disease, or treatment for CIN 2 or 3 in the past 3 years. Four-hundred sixty-five women were included and monitored by cytology, Hybrid Capture-2 test, and colposcopy every 6 months. Colposcopy results were described as normal, with minor or major changes, and lesion size was recorded in quadrants. Forty-three women (9.3%) had progression to CIN 2 or 3. No significant differences were found in rate of progression between women with low-grade squamous intraepithelial lesions, atypical squamous cells, or negative results (8.2%, 13.4%, and 9.8%, respectively; P=.679). Neither colposcopy pattern (P=.284) nor lesion size (P=.170) at recruitment provided any information on the risk of progression. History of cervical lesion and worsening of the colposcopy pattern during follow-up were associated with progression (P<.001). Initial colposcopy findings do not provide relevant information on the risk of progression in HPV-positive women with minor or no cervical lesions. These women have a similar risk of progression and should benefit from the same follow-up strategies.

Randomized phase III trial of tamoxifen versus thalidomide in women with biochemical-recurrent-only epithelial ovarian, fallopian tube or primary peritoneal carcinoma after a complete response to first-line platinum/taxane chemotherapy with an evaluation of serum vascular endothelial growth factor (VEGF): A Gynecologic Oncology Group Study

Purpose To compare progression-free survival (PFS), overall survival (OS) and toxicities of thalidomide versus tamoxifen and to evaluate serum vascular endothelial growth factor (VEGF) in biochemical-recurrent epithelial ovarian cancer, primary peritoneal cancer or fallopian tube carcinoma (EOC/PPC/FTC). Methods Biochemical recurrence was defined as a rising CA-125 exceeding twice the upper limit of normal without evidence of disease as defined by RECIST 1.0 criteria. Women with FIGO stages III and IV, histologically confirmed EOC/PPC/FTC who were free of disease following first-line chemotherapy were randomized to oral thalidomide 200 mg daily with escalation to a maximum of 400 mg or tamoxifen 20 mg orally twice daily for up to 1 year, progression or adverse effect prohibited further treatment. VEGF was quantified by ELISA in pre and post-treatment serum. Results Of the 139 women randomized, 138 were eligible. Interim analysis showed that thalidomide did not reduce the recurrence rate relative to tamoxifen, and the trial was closed. Thalidomide versus tamoxifen was associated with a similar risk of progression (HR = 1.31, 95% confidence interval [CI] = 0.93–1.85), an increased risk of death (HR = 1.76, 95% CI = 1.16–2.68) and more grades 3 and 4 toxicities (55% versus 3%). The most common grades 3 and 4 toxicities were constitutional (12%), somnolence (12%), pulmonary (9%), venous thromboembolism (VTE) (6%) and peripheral neurologic (6%) for thalidomide, with VTE (1.4%) and gastrointestinal (1.4%) for tamoxifen. Serum VEGF was not associated with clinical characteristics, treatment, PFS or OS. Conclusion Thalidomide was not more effective than tamoxifen in delaying recurrence or death but was more toxic. VEGF was not prognostic in this cohort.

Superior Survival after Autologous vs. Allogeneic Hematopoietic Stem Cell Transplantation (HCT) for Diffuse Large B-Cell Lymphoma (DLBCL) Not Explained by Differences in Chemosensitivity.

No randomized trials have compared autologous HCT (autoHCT) to allogeneic HCT (alloHCT) for DLBCL. We analyzed the outcomes of 916 patients (pts) (837 autoHCT and 79 alloHCT) ages 18–60yrs after a first autoHCT or HLA-identical sibling alloHCT for DLBCL between 1995 and 2003 reported to the CIBMTR. Pts receiving T-cell depleted allografts or reduced-intensity conditioning were excluded. There were significant baseline differences between the groups in disease stage, B symptoms, extranodal disease and marrow involvement. AlloHCT pts were significantly more likely to have >3 chemo regimens prior to HCT (53 vs 40%), and resistant induction failure or relapse (39 vs 16%). At 1yr, treatment-related mortality (TRM) was higher after alloHCT (41%, 95% CI, 30–52%) than after autoHCT (11%, 95% CI, 9–14%, p<0.001), but risks of relapse/progression were similar (30%, 95% CI, 21–41%) and (33%, 95% CI, 29–36%, p=0.69), respectively. Cumulative incidence of outcomes and univariate probabilities of progression free (PFS) and overall survival (OS) at 5 yrs are summarized in table 1. In multivariate analysis, allo and autoHCT had differential early and late effects on outcomes. In the first 12 mo after transplant, alloHCT was associated with higher TRM (RR 4.76, 95% CI, 3.14–7.22, p<0.001), treatment failure (RR 2.08, 95% CI, 1.56–2.77, p<0.001) and mortality (RR 2.78, 95% CI, 2.06–3.77, p<0.001) but similar risk of progression (RR 1.14, 95% CI, 0.75–1.74, p=0.54) compared to autoHCT. Among pts surviving 12 mo post-transplant, no significant difference was observed between autoHCT and alloHCT for TRM, progression, PFS, or OS. Covariates that increased the risks of TRM and OS were older age (51–60 years), KPS <90%, chemoresistance at transplant, and earlier transplant yr (before 2001 vs later). Older age and chemoresistance were also associated with progression and lower PFS. There were no significant interactions between graft type and other prognostic variables; in particular, relative risk of outcomes with allo vs autoHCT were similar for patients with chemosensitive and chemoresistant disease. In summary, myeloablative alloHCT increased risks of early TRM and mortaliy without an effect on progression (compared to autoHCT). Transplant type did not affect outcomes after 12 months post-transplant. AutoHCT was associated with superior survival (fig 1), and the difference was not explained by differences in chemosensitivity at the time of transplant.AutoHCTAlloHCTOutcomes(95%CI)(95%CI)AGVHD @ day 100N/A42 (31–53)CGVHD @ 5yrsN/A27 (18–38)TRM @ 5yrs18 (15–20)45 (34–57)Relapse/progression @ 5yrs39 (36–43)33 (23–44)PFS @ 5yrs43 (40–46)26 (18–37)OS @ 5yrs49 (46–53)27 (18–27) [Display omitted]