Annual Conference of the Canadian Blood and Marrow Transplant Group. June 11 to 14, 2014 The Westin Nova Scotian 1181 Hollis Street Halifax, NS

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1 Annual Conference of the Canadian Blood June to 4, 204 The Westin Nova Scotian 8 Hollis Street Halifax, NS Scientific Program In conjunction with the Canadian National Transplant Research Program, Canadian Apheresis Group, Canadian Hematology Society, and Venous Thrombosis Clinical Trials Organization CBMTG Head Office Malachite Management Inc 375 West 5th Avenue Suite 20, Vancouver BC Canada V5Y J6 T F Web:

2 A Message from the Premier of Nova Scotia On behalf of the province, Minister of Health and Wellness Leo Glavine and I are pleased to welcome physicians, nurses and nurse practitioners, lab technologists, program coordinators, and pharmacists from across Canada to the Canadian Blood national annual conference in Halifax. It is dedicated professionals like yourselves who continue to give hope, care and comfort to Canadians suffering with blood and marrow diseases. I know that recipients who are battling this disease, their families, and the families of donors are grateful for your expertise, your compassion and your dedication. I also want to welcome all the volunteers, organizers and sponsors to Nova Scotia. Without your hard work, this conference would not be possible. We wish you a successful conference and hope you will continue your work to make Canada the best place in the world to have a blood and marrow transplant. Regards, Honourable Stephen McNeil, M.L.A. Premier A Message from the Mayor of Halifax As Mayor of Halifax Regional Municipality it is my distinct pleasure to extend warm greetings and a special welcome to all attending the Canadian Blood Annual Conference. Halifax Regional Municipality is the place to be with its dynamic and intriguing mix of heritage and culture. A marquee destination embracing a diversity of people, communities, shops, restaurants, and nightlife, our city will present you with a truly original experience. Our culturally rich and historic port city has been entertaining guests for over 250 years and we take pride in our reputation as one of the world s most hospitable and welcoming destinations. I want to acknowledge, with gratitude, the Conference Planning Committee, led by Dr. Stephen Couban, Director of the Blood and Marrow Transplant Program at QEII Health Sciences Centre, and the rest of the Halifax Blood and Marrow Transplant Team for hosting this event here in our region and for their hard work creating an exciting program and great educational experience for all delegates. I wish you much success and trust your visit will be a truly memorable experience. Kindest regards, Mike Savage Mayor 2

3 Table of Contents Welcome Message...4 Board of Directors and Conference Planning Committee...5 Accreditation...5 Disclosures...6 Invited Speakers, Chairs, and Panelists...7 Partners...8 Conference-at-a-Glance...9 CBMTG Committee and Special Interest Group Meetings...3 CBMTG Session Summaries...4 CNTRP Session Summaries...20 CAG/CAAN/CHS Conference-at-a-Glance...2 Oral Abstracts Index...23 Oral Abstract Summaries...23 Poster Abstract Index...28 Poster Abstract Summaries...3 Non-Presenting Abstracts Index...3 Westin Nova Scotian Floor Plan...62 Social Event Information...63 About CBMTG

4 A Message from the CBMTG President Dear colleagues, On behalf of the executive and board I am pleased to welcome you to our annual conference of the Canadian Blood (CBMTG). We hope that you will find many opportunities to learn and network. This conference would not be possible without the leadership of Dr. Stephen Couban and the conference planning committee, whose work and dedication resulted in the strong scientific program that we are proud to present. Furthermore, we wish to thank the Canadian Apheresis Group (CAG), the Canadian National Transplant Research Program (CNTRP), the Canadian Hematology Society (CHS), and the Venous Thrombosis Clinical Trials Organization (VECTOR), all of whom will be hosting joint sessions with us. We do hope these joint sessions will be the foundation for knowledge exchange and a fertile ground for collaboration. We wish to invite you to attend the annual general meeting of the organization scheduled for Friday, June 3 from 6 to 7 p.m. There you will learn of the work that is being done on your behalf. It was a busy year and the executive will be presenting the CBMTG strategic plan for the next five years. We hope that this conference will support and inspire your practice. Sincerely, Silvy Lachance, MD, FRCPC, CSPQ President Canadian Blood A Message from the Conference Chair Dear friends and colleagues, On behalf of the Canadian Blood conference planning committee and the Halifax BMT team, welcome to Halifax! We are very excited to be hosting the 204 CBMTG Annual Conference and have worked hard to create an interesting and informative academic program for you. The conference planning committee enjoyed the challenge of creating a program that would appeal to the broad range of BMT professionals across Canada and provide information on the latest trends and discoveries in BMT from around the world. We are very fortunate to have both national and international speakers here to share their expertise with us, and we hope that each delegate finds this conference to be a valuable learning and networking opportunity. For the first time in a number of years, a number of groups with interests in hematology are meeting in Halifax at the same time as the annual CBMTG meeting. We are happy to welcome the Canadian Apheresis Group (CAG), the Canadian National Transplant Research Program (CNTRP), the Canadian Hematology Society (CHS), and the Venous Thrombosis Clinical Trials Organization (VECTOR), all of whom will be hosting joint sessions with the CBMTG and/or society meetings here in Halifax. We hope that you get the chance to spend some time in our beautiful city! We are known for a beautiful harbor, fantastic live music, and delicious lobster all three of which you will experience at the conference social event on Saturday night! Sincerely, Stephen Couban, MD, FRCPC Conference Chair Canadian Blood 4

5 Board of Directors President, Silvy Lanchance, MD, FRCPC, CSPQ Past President, Ronan Foley, MD, FRCPC President-Elect, Christopher Bredeson, MD, MSc, FRCPC Treasurer, Andrew Daly, MDCM, FRCPC Secretary, Jennifer Wiernikowski, MN, NP-Adult, CON(C) Director-at-large, Research Donna Wall, MD Director-at-large, Education Naheed Alam, MD Conference Planning Committee Chair: Stephen Couban, MD, FRCPC Committee Members: Imran Ahmad, MD Wanda Hasegawa, MD David Mitchell, MD, FRCPC Christopher Bredeson, MD Joanne Hickey, MD, FRCPC Gizelle Popradi, MD, FRCPC Sherri Briggs, RN Gertrude Kells, RN Tracy Robinson, RN Raewyn Broady, MD Andrea Kew, MD Matthew Seftel, MD, MPH, MRCP, FRCPC Jo-Ann Edwards, NP John Kuruvilla, MD Lynn Savoie, MD Conrad Fernandez, MD, FRCPC Kylie Lepic, MD Marie Tulloch, MLT Angeline Giftakis, MLT Brenda Letcher, MLT Darrell White, MD Lora Jay Gray, BScPharm Joan Macleod Accreditation As an accredited provider, Dalhousie University, CME, designates this continuing medical education activity for up to 4.50 credit hours as an accredited group learning Section activity as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. In keeping with CMA Guidelines, program content and selection of speakers are the responsibility of the planning committee. Support is directed toward the costs of the course and not to individual speakers. Participants should only claim credit for the actual number of hours attended. To receive your certificate of attendance please complete the online or paper version of the CBMTG 204 conference evaluation. 5

6 Disclosures Please note the following disclosures have been submitted: Imran Ahmad, Planning Committee Member Consultant Celgene Andrew Artz, Speaker Research Support Miltenyi Biotec Philippe Bouchard, Speaker Consultant Merck Christopher Bredeson, Planning Committee Member Research Support Celgene, Sanofi, Otsuka Other Financial Support Celgene, Sanofi, Merck, Otsuka Marc Carrier, Speaker Research Support Leo Pharma, Bristol Myers Squibb Consultant Pfizer, Bayer Stephen Couban, Planning Committee Member Research Support Novartis, Bristol Myers Squibb, Sanofi Other Financial Support Novartis, Lundbeck, Bristol Myers Squibb, Pfizer, Seattle Genetics, Hoffman La Roche, Sanofi Ad Board/ Financial Interest Novartis, Lundbeck, Bristol Myers Squibb, Pfizer, Seattle Genetics, Hoffman La Roche, Sanofi Michael Crump, Speaker Research Support Hoffman La Roche Consultant Seattle Genetics, Genentech Joanne Hickey, Planning Committee Member Research Support Amgen, Celgene, Onyx, Gilliad, Alexion Lina Ho, Speaker Consultant Pfizer Atul Humar, Speaker Grant Support Hoffman La Roche, Honoraria Astellas, Chimerix Andrea Kew, Planning Committee Member Research Support Celgene, Glaxo Smith Kline, Sunesis Other Financial Support Celgene, Pfizer, Novartis, Lundbeck Richard Larson, Speaker Research Support Amgen, Ambit, Astellas, Exytech, Ariad, Novartis Consultant Ariad, Bristol Myers Squibb, Celgene, CVS Caremark, Novartis, Pfizer, Sanofi Danièle Marceau, Speaker Research Support Alexion Philip L. Mccarthy, Speaker Consultant Celgene, Janssen, Millenium John Miller, Speaker Employee National Marrow Donor Program, Minneapolis, Mn Gizelle Popradi, Planning Committee Member Research Support Merck Consultant Novartis, Bristol Myers Squibb, Merck, Pfizer, Hoffman La Roche, Janssen, Celgene Lynn Savoie, Planning Committee Member Research Support Novartis, Bristol Myers Squibb, Celgene, Karyopharm Kirk Schultz, Speaker Consultant Healthcord Cord Blood Bank, Bristol Myers Squibb, SBIBiotech Research Support Sanofi, Novartis, Medac, Medimmune Other Financial Support USA Pharma, Medac, Healthcord Cord Blood Bank Matthew Seftel, Speaker, Planning Committee Member Consultant Kiadis Other Financial Support Lundbeck, Otsuka, Pfizer Sudeep Shivakumar, Speaker Research Support Bayer, Pfizer Consultant Bayer, Boehringer Ingelheim, Pfizer, Leo Pharma Leigh Sims Poston, Speaker Advisory Group Member Iccba Daniel Weisdorf, Speaker Research Support Miltenyi Biotec Consultant Amgen, Pharmacyclics Neal Young, Speaker Research Support Glaxo Smith Kline 6

7 Invited Speakers, Chairs, and Panelists Muneer Abidi, MD, Wayne State University, Karmanos Cancer Center, Detroit, MI, USA Imran Ahmad, MD, Hôpital Maisonneuve-Rosemont, Montreal, PQ, Canada Upton Allen, MBBS, MSc, FAAP, FRCPC, The Hospital for Sick Children, Toronto, ON, Canada Andrew Artz, MD, MS, University of Chicago Medicine, Chicago, IL, USA Peter Bader, MD, Hospital for Children and Adolescents, Frankfurt, Germany Christopher Bredeson, MD, MS, FRCPC, The Ottawa Hospital, Ottawa, ON, Canada Philippe Bouchard, BPharm, MSc, BCOP, Hôpital Maisonneuve-Rosemont, Montreal, PQ, Canada Geoffrey Browne, Stemsoft Software Inc., Vancouver, BC, Canada Giovanna Cameron, BMT/Leukemia Program of BC, Vancouver, BC, Canada Marc Carrier, MD, MSc, FRCPC, University of Ottawa, Ottawa, ON, Canada Stephen Couban, MD, FRCPC, QEII Health Sciences Centre, Halifax, NS, Canada Michael Crump, MD FRCPC, Princess Margaret Hospital, Toronto, ON, Canada Jean-Sébastien Delisle, MD, PhD, Hôpital Maisonneuve-Rosemont, Montreal, PQ, Canada Pat Distler, MS, MT(ASCP)SBB, ICCBBA, San Bernadino, CA, USA Jo-Ann Edwards, NP, QEII Health Sciences Centre, Halifax, NS, Canada Conrad Fernandez, MD, FRCPC, IWK Health Centre, Halifax, NS, Canada Angeline Giftakis, MLT, Cell Therapy Lab, CancerCare Manitoba, Winnipeg, MB, Canada Mindy Goldman, MD, FRCPC, Canadian Blood Services, Ottawa, ON, Canada Wanda Hasegawa, MD, Provincial Stem Cell Transplant Program, Dalhousie University, Halifax, NS, Canada Lina Ho, BScPhm, RPh, ACPR, Princess Margaret Hospital, Toronto, ON, Canada Marie-Josée Hébert, MD, FRCPC, Co-Director, Canadian National Transplant Research Program (CNTRP), Montreal, PQ, Canada Joanne Hickey, MD, FRCPC, Memorial University of Newfoundland, St. John s, NL, Canada Atul Humar, MD, FRCPC, University of Toronto, Toronto, ON, Canada Gertrude Kells, RN, QEII Health Sciences Centre, Halifax, NS, Canada Andrea Kew, MD, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada Joanne Kurtzberg, MD, Robertson Clinical and Translational Cell Therapy Program, Durham, NC, USA John Kuruvilla, MD, Princess Margaret Hospital, Toronto, ON, Canada Silvy Lachance, MD, FRCPC, CSPQ, Hôpital Maisonneuve-Rosemont, Montreal, PQ, Canada Richard A. Larson, MD, University of Chicago, Chicago, IL, USA Kylie Lepic, MD, McMaster University/ Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada Wing Leung, MD, PhD, St. Jude Children s Research Hospital, Memphis, TN, USA David Maginley, M. Div., Nova Scotia Cancer Centre, Halifax, NS, Canada Danièle Marceau, MD, CHU de Quebec, Quebec, PQ, Canada Samantha Mayo, University of Toronto, Toronto, ON, Canada Philip L. McCarthy, MD, Roswell Park Cancer Center, Buffalo, NY, USA John Miller, MD, PhD, Donor Medical Services, National Marrow Donor Program, Minneapolis, MN, USA David Mitchell, MD, FRCPC, The Montreal Children s Hospital, Montreal, PQ, Canada Craig Moskowitz, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Kristjan Paulson, MD, University of Manitoba, Winnipeg, MB, Canada Steven Paraskevas, MD, PhD, McGill University, Montreal, PQ, Canada Gizelle Popradi, MD, FRCPC, Royal Victoria Hospital, Montreal, PQ, Canada Mary Lou Robertson, BA, BSW, RSW, Capital Health Cancer Care Program, Halifax, NS, Canada Lynn Savoie, MD, University of Calgary/Tom Baker Cancer Centre, Calgary, AB, Canada Matthew Seftel, MD, MPH, MRCP, FRCPC, Princess Margaret Hospital, Toronto, ON, Canada Kirk Schultz, MD, BC Children s Hospital, Vancouver, BC, Canada Christy Simpson, PhD, Dalhousie University, Halifax, NS, Canada Leigh Sims-Poston, BS, MT(ASCP), Chester, VA, USA Sudeep Shivakumar, MD, FRCPC, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada Marie Tulloch, MLT, Cancer Care Manitoba, Winnipeg, MB, Canada Donna Wall, MD, Cancer Care Manitoba, Winnipeg, MB, Canada Daniel Weisdorf, MD, University of Minnesota, Minneapolis, MN, USA Lori West, MD, PhD, Director, Canadian National Transplant Research Program (CNTRP), Edmonton, AB, Canada Neal Young, MD, NIH, National Heart, Lung, and Blood Institute, Bethesda, MD, USA 7

8 Partners For 204 CBMTG has led the partnership between a number of Canadian hematology and transplant associations who will be hosting sessions at this conference. Please see a description of the associations below. Canadian Blood (CBMTG) The Canadian Blood is a national, voluntary, and multi-disciplinary organization providing leadership and promoting excellence in patient care, research, and education in the field of blood and marrow transplant (BMT). The organization leads education and research across the Canadian BMT field. CBMTG holds an annual conference, organizes free webinars for its members, has a robust clinical trials program and has led the development of the national BMT registry. The conference planning committee, led by Dr. Stephen Couban, has created a scientific program highlighting presentations on topics of interest in the field of BMT. This program was designed for a multidisciplinary audience and topics were chosen with care. CBMTG sessions will be organized from Thursday, June 2 to Saturday, June 4, 204. Canadian National Transplant Research Program (CNTRP) The Canadian National Transplant Research Program (CNTRP) is a national initiative designed to increase organ and tissue donation in Canada and enhance the survival and quality of life of Canadians who receive transplants. The program is led by Drs. Lori West at the Alberta Transplant Institute at the University of Alberta in Edmonton and Marie Josée Hébert at the Université de Montréal and brings together 6 investigators at 2 institutions from across Canada to carry out research and develop resources to help Canadians waiting for a tissue or organ transplant. The Society will host sessions Tuesday, June 0 to Thursday, June 2, 204. Canadian Apheresis Group (CAG) The Canadian Apheresis Group was formed in 980. The group includes representatives from approximately 40 apheresis units in 9 major medical centres in Canada. At the annual meeting of the CAG we focus on new evidence and techniques for plasma exchange, and also carry out a centre-by-centre review. The Society will host sessions Friday, June 3 to Sunday, June 5, 204. Canadian Hematology Society (CHS) The Canadian Hematology Society represents all physicians and scientists with an interest in the discipline in Canada. At present there are over 280 members. The Society will host a combined session with the CBMTG on Friday, June 3, 204. Venous Thrombosis Clinical Trials Organization (VECTOR) VECTOR is a collaborative group of thrombosis physicians from various cities in Canada (Ottawa, Montreal, Halifax, Hamilton, Saskatoon, and London) who discuss current and new research ideas in the area of thrombosis. The VECTOR members are expected to help with progress of multicentre academic projects awarded to individual group members. The executive meets via teleconference on a monthly basis to discuss the group s operations and face-to-face up to four times a year (rotating facility hosting the meeting). The Society will host a combined session with the CBMTG on Friday, June 3, 204. CBMTG Canadian Bone and Marrow Transplant Group CNTRP Canadian National Transplant Research Program CAG Canadian Apheresis Society Canadian Hematology Society 8

9 Conference-at-a-Glance Tuesday, June 0, 204 2:00pm 5:00pm Canadian National Transplant Research Program Meetings Commonwealth Ballroom Wednesday, June, 204 9:00am 5:00pm CBMTG Canadian Bone and Marrow Transplant Group Canadian National Transplant Research Program Meetings Main Session located in Harbour AB, Breakout Rooms TBD See page 20 for more details. 4:00pm 7:00pm Conference Registration Coat Check 4:00pm 8:00pm Speaker Services Northumberland Room Thursday, June 2, 204 7:00am 7:00pm Conference Registration Coat Check 7:00am 4:00pm Speaker Services Northumberland Room Session : CBMTG-CNTRP Joint Session Facing a common enemy, viral infections in SOT and AHCT Chair: Marie-Josée Hébert, MD, FRCPC Commonwealth Ballroom Coffee and pastries will be provided. 8:00am Welcome by the CBMTG and CNTRP: Building bridges between the SOT and BMT scientists where we are after year Silvy Lachance, MD, FRCPC, CSPQ, Marie-Josée Hébert, MD, FRCPC 8:00am :00am 8:40am Viral infections: From bench to beside Atul Humar, MD, FRCPC 9:0am Risk prediction tools based on viral-host interactions that predispose young SOT and HSCT patients to EBV Upton Allen, MBBS, MSc, FAAP, FRCPC 9:40am Adoptive T-cell immunotherapy to treat and prevent virus-related complications post-transplantation Jean-Sébastien Delisle, MD, PhD 0:20am 0:30am Health Break in the Atlantic Ballroom 0:30am Interactive session: Engaging the HSCT and SOT communities within the CNTRP Steven Paraskevas, MD, PhD, Lori West, MD, PHD, Kirk Schultz, MD 0:20am 0:30am Health Break Atlantic Ballroom :00am :00pm Symposium #: Lunch Commonwealth Ballroom :00pm 4:00pm Session 2A: Clinical Trials Network Meeting Harbour Suite AB Chair: Donna Wall, MD CNTRP Canadian National Transplant Research Program Session 2B: Multidisciplinary Allied Health Maritime Room Chairs: Jo-Ann Edwards, NP, Gertrude Kells, RN Access to high cost treatments: Navigating the complex world of oncology drug coverage Mary Lou Robertson, BA, BSW, RSW Near Death Experiences: Hope, Hypoxia, and Hypothesis David Maginley, M. Div Aprepitant in blood and marrow transplantation: To add or not to add? Lina Ho, BScPhm, RPh, ACPR The use of Thiotepa in preparative regimens for hematopoietic cell transplantation Philippe Bouchard, BPharm, MSc, BCOP CAG Canadian Apheresis Society Canadian Hematology Society Session 2C: Laboratory Technologists Lunenburg Room Chairs: Angeline Giftakis, MLT, Giovanna Cameron ISBT 28: From a global picture to the details Pat Distler, MS, MT(ASCP)SBB ISBT 28 product code selection: Which codes do I want? Which codes do I need? Leigh Sims-Poston, BS, MT(ASCP) Getting the most out of your ISBT technology partners Geoffrey Browne 9

10 Thursday, June 2, 204 4:00pm 4:5pm 4:5pm 6:5pm Health Break and Poster Group Presentations Health break located in Atlantic Ballroom, Poster group presentations located in Commonwealth Ballroom Session 3A: CBMTG National Registry Steering Meeting Commonwealth Ballroom Chair: Kristjan Paulson, MD Session 3B: Networking session for Advanced Practice Nurses and Nurse Practitioners Maritime Room 4:5pm 5:5pm Chairs: Jennifer Wiernikowski, MN, NP-Adult, CON(C), Jo-Ann Edwards, NP 6:5pm 7:30pm Welcome Reception with Exhibits Atlantic Ballroom and Foyer Friday, June 3, 204 7:00am 7:00pm Conference Registration Coat Check 7:00am 4:00pm Speaker Services Northumberland Room 7:30pm 8:45am Symposium #2: Breakfast Commonwealth Ballroom 9:00am 2:00pm Session 4: Joint Session CBMTG, CHS, Vector Chairs: Stephen Couban, MD, FRCPC, Joanne Hickey, MD, FRCPC Commonwealth Ballroom 9:00am: Human bone marrow failure: New treatment and new pathophysiologies Neal Young, MD 0:00am 0:20am Health Break in the Atlantic Ballroom 0:20am: Thrombosis and Malignancy: Management of complicated cases Sudeep Shivakumar, MD, FRCPC, Marc Carrier, MD, MSc, FRCPC :0am: News from the PNH network Danièle Marceau, MD 0:00am 0:20am Health Break and Poster Group 2 Presentations Health break located in Atlantic Ballroom, Poster group presentations located in Commonwealth Ballroom 2:00pm 2:00pm Symposium #3: Lunch Commonwealth Ballroom 2:00pm 3:30pm 3:30pm 4:00pm Session 5: Age and Transplant Commonwealth Ballroom Chairs: Gizelle Popradi, MD, FRCPC, Jo-Ann Edwards, NP 2:00pm: Allogeneic transplant for older AML patients: Too little or too much? Andrew Artz, MD, MS 2:45pm: You re going to do what?! A Case Study Wanda Hasegawa, MD, Jo-Ann Edwards, NP, Christy Simpson, PhD CHS Educational Session Lunenburg Room 2:5pm 3:45pm For more information please see page 2 Health Break and Poster Group 3 Presentations Health break located in Atlantic Ballroom, Poster group presentations located in Commonwealth Ballroom CAG Educational Sessions Harbour Suite AB and Boardroom 2:00pm 6:00pm For more information please see page 2 CBMTG Canadian Bone and Marrow Transplant Group CNTRP Canadian National Transplant Research Program CAG Canadian Apheresis Society Canadian Hematology Society 0

11 Friday, June 3, 204 4:00pm 6:00pm Session 6: Choosing the Best Donor Commonwealth Ballroom Chairs: Andrea Kew, MD, Marie Tulloch, MLT 4:00pm: 4:20pm: 4:40pm: 5:00pm: How do we build the best registry? Mindy Goldman, MD, FRCPC Donor selection: Optimizing clinical outcomes and donor safety John Miller, MD, PhD KIR typing and its clinical relevance Wing Leung, MD, PhD Case Studies Mindy Goldman, MD, FRCPC, John Miller, MD, PhD, Wing Leung, MD, PhD CAG Educational Sessions Harbour Suite AB and Boardroom 2:00pm - 6:00pm 6:00pm 7:00pm CBMTG Annual General Meeting Harbour Suite AB For more information please see page 2 7:30pm 9:00pm Symposium #4: Dinner Commonwealth Ballroom Saturday, June 4, 204 7:00am 7:00pm Conference Registration Coat Check 8:00am 3:00pm Speaker Services Northumberland Room 7:30am 8:45am Symposium #5: Breakfast Commonwealth Ballroom 9:00am 2:00pm 9:55am 0:0am Session 7A: Adult Clinical Commonwealth Ballroom Chairs: Imran Ahmad, MD, John Kuruvilla, MD 9:00am: How can we improve outcomes of patients with relapsed/refractory DLBCL in the Rituximab era Craig Moskowitz, MD 9:55am 0:0am Health Break located in the Atlantic Ballroom 0:0am: High dose therapy for relapsed Hodgkin lymphoma: Is that all there is? Michael Crump, MD, FRCPC :05am: Consolidation and maintenance therapy after autologous transplant for multiple myeloma Philip L. McCarthy, MD Session 7B: Pediatric Clinical Maritime Room Chairs: Conrad Fernandez, MD, FRCPC, David Mitchell, MD, FRCPC 9:00am: Metabolic disorders in the age of expanding newborn programs Joanne Kurtzberg, MD 9:55am 0:0am Health Break located in the Atlantic Ballroom 0:0am: KIR typing Wing Leung, MD, PhD :05am: Assessment of MRD pre- and post-transplant in children with ALL Impact on transplant decision making Peter Bader, MD Health Break and Poster Group 4 Presentations Health break located in Atlantic Ballroom, Poster group presentations located in the Fundy Room CAG Educational Sessions Harbour Suite AB 8:30am 5:00pm For more information please see page 2 CBMTG Canadian Bone and Marrow Transplant Group CNTRP Canadian National Transplant Research Program CAG Canadian Apheresis Society Canadian Hematology Society

12 Saturday, June 4, 204 2:00pm 2:00pm Symposium #6: Lunch Commonwealth Ballroom CAG Educational Sessions Harbour Suite AB 8:30am 5:00pm Session 8: Hans Messner Lectureship Commonwealth Ballroom For more information please see page 2 2:00pm 3:00pm 3:00pm 3:5pm 3:5pm 4:5pm Chairs: Stephen Couban, MD, FRCPC, Wanda Hasegawa, MD Primary refractory leukemia What to do next? Richard Larson, MD Health Break and Poster Group 5 Presentations Health break located in Atlantic Ballroom, Poster group presentations located in the Fundy Room Session 9: Oral Abstract Presentations Lunenburg Room Chairs: Silvy Lachance, MD, FRCPC, CSPQ, Christopher Bredeson, MD, MS, FRCPC Session 0: Fred Saunders Debate Commonwealth Ballroom Chairs: Lynn Savoie, MD, Kylie Lepic, MD 4:5pm 5:5pm Be it resolved that patients with acute lymphoblastic leukemia should have an allogeneic transplant in CR For the resolution: Daniel Weisdorf, MD Against the resolution: Matthew Seftel, MD, MPH, MRCP, FRCPC 5:5pm 5:45pm Closing Remarks Commonwealth Ballroom 7:00pm Onwards Evening Social See details on page 63 Waterfront Warehouse Sunday, June 5, 204 8:00am 9:00am Symposium #7: CAG Breakfast Symposium Harbour Suite AB 9:00am 2:00pm CAG Sessions For more information please see page 2 Harbour Suite AB CBMTG Canadian Bone and Marrow Transplant Group CNTRP Canadian National Transplant Research Program CAG Canadian Apheresis Society Canadian Hematology Society 2

13 CBMTG Committee and Special Interest Group Meetings Clinical Trials Network Meeting Thursday, June 2, :00pm 4:00pm Harbour Suite AB The mission of the CBMTG-CTN is to improve the safety, availability, and efficacy of hematopoietic stem cell transplantation for adults and children in Canada and to perform clinical research trials that will define optimal hematopoietic stem cell transplantation for adults and children. This committee strives to conduct laboratory research that will translate into more effective treatments with reduced short and long-term side effects and to build partnerships that will help fulfill the missions of the Canadian Blood and improve the health of adults and children throughout the world. All conference delegates are invited to attend this session. National Registry Steering Meeting Thursday, June 2, 4:5pm-6:5pm Commonwealth Ballroom The purpose of the national registry Steering Committee is to provide national oversight and direction to the Canada-wide registry. All conference delegates are invited to attend this session. Laboratory Technologists Special Interest Group Meeting Thursday, June 2, 4:30pm 5:00pm Lunenburg Room The laboratory technologist special interest group is a networking/ resource opportunity for laboratory professionals. It focuses on technical and regulatory issues. The group currently has 40 members from across Canada and continues to grow along with CBMTG. All laboratory technologist conference delegates are invited to join this special interest group and attend this face-to-face meeting at the annual conference. Advanced Practice Nurses and Nurse Practitioners Networking Session Thursday, June 2, 4:5pm 5:5pm Maritime Room All advanced practice nurses and nurse practitioners are invited to attend this networking session. We encourage you to take advantage of this opportunity to connect with APN and NP nurses from across Canada. Refreshments will be served. This session will be immediately followed by the Interdisciplinary Psychosocial Special Interest Group meeting. Interdisciplinary Psychosocial Special Interest Group Meeting Thursday, June 2, 5:5pm 6:5pm Maritime Room The CBMTG Interdisciplinary Psychosocial Special Interest Group (SIG) invites any interested CBMTG members to join this newly formalized group focused on enhancing the psychosocial and supportive care provided to patients undergoing HSCT. Over the past two years a draft terms of reference and list of priorities has been drafted. This meeting will officially launch the work of this group. Work to date will be presented, partnerships explored and a preliminary list of objectives for will be discussed. Webinar Planning Committee Meeting Friday, June 3, 3:30pm 3:45pm Tradewinds The purpose of the webinar planning committee is to guide the association in developing educational webinars for BMT health care workers. All delegates who wish to be included in the planning process for the CBMTG webinar series are invited to attend this meeting. We encourage all delegates to attend a CBMTG committee or special interest group meeting! Please note that in order to become a member of a committee or SIG you must be a current member of the CBMTG. 3

14 Session Summaries Session : Joint Session Canadian Blood (CBMTG) and Canadian National Transplant Research Program (CNTRP) Thursday, June 2, 204 8:00am :00am FACING A COMMON ENEMY, VIRAL INFECTIONS IN SOT AND AHCT Silvy Lachance, MD, FRCPC, CSPQ, Hôpital Maisonneuve-Rosemont, Montreal, PQ, Canada Marie-Josée Hébert, MD, FRCPC, Co-Director, Canadian National Transplant Research Program (CNTRP), Montreal, PQ, Canada Atul Humar, MD, FRCPC, University of Toronto, Toronto, ON, Canada Upton Allen, MBBS, MSc, FAAP, FRCPC, The Hospital for Sick Children, Toronto, ON, Canada Jean-Sébastien Delisle, MD, PhD, Hôpital Maisonneuve-Rosemont, Montreal, PQ, Canada Steven Paraskevas, MD, PhD, McGill University, Montreal, PQ, Canada Lori West, MD, PhD, Director, Canadian National Transplant Research Program (CNTRP), Edmonton, AB, Canada Kirk Schultz, MD, BC Children s Hospital, Vancouver, BC, Canada The Canadian National Transplant Research Program (CNTRP) unites the solid organ transplant (SOT), critical care and donation, and allogeneic hematopoietic cell transplant (AHCT) researcher communities and as such, is the only national initiative of its kind in the world. One of the main ambitions of the CNTRP is to provide a comprehensive platform where SOT and AHCT scientists can collaborate and provide fresh ideas on various central issues such as organ and cell donation, immune tolerance and opportunistic infections. Viral infections plague both SOT and AHCT recipients. This joint CNTRP- CBMTG session will focus on ongoing work within the CNTRP as well as on emerging aspects of virus-host interactions and cell therapy aimed at treating opportunistic viral diseases. Dr Atul Humar, lead of CNTRP Viral Pathogenesis Project and head of transplantation at the University Health Network in Toronto will provide the keynote presentation on several basic and translational aspects of virus-related complications after transplantation. Following this presentation, Dr Upton Allen from the Hospital for Sick Children in Toronto and co-lead of the CNTRP Pediatric Project will discuss host-pathogen interactions predisposing certain patients to viral infections. Finally, Dr Jean-Sébastien Delisle, CNTRP scientist who is leading a T-cell adoptive immunotherapy program at Hôpital Maisonneuve-Rosemont in Montreal, will discuss cellular therapy approaches to prevent and treat viral infections post-transplantation. This session will also emphasize the importance of collaborations and include a discussion about the interactions between the SOT and AHCT communities within the CNTRP. Session 2A: Clinical Trials Network Meeting Thursday, June 2, 204 :00pm 4:00pm Donna Wall, MD, Cancer Care Manitoba, Winnipeg, MB, Canada Session 2B: Multidisciplinary Allied Health Thursday, June 2, 204 :00pm 4:00pm ACCESS TO HIGH COST TREATMENTS: NAVIGATING THE COMPLEX WORLD OF ONCOLOGY DRUG COVERAGE Mary Lou Robertson, BA, BSW, RSW, Capital Health Cancer Care Program, Halifax, NS, Canada This session will provide an opportunity for professionals from a range of health care backgrounds to learn how drugs are approved, funded, and accessed in Canada. Participants will gain an understanding of how drugs move from trials to market and how insurers and provinces make decisions on whether to fund them. Participants will gain a stronger appreciation of provincial funding disparities and the growing presence of private insurance in funding high cost treatments in oncology. Specific attention will be given to how to understand and navigate insurance and public plans, how to deal with funding rejections or complex cases, and how to navigate the growing role of patient assistance programs. By the end of the session, participants will have a better understanding of potential drug funding challenges and how to deal with them. Case examples will be used and there will be time provided for questions and answers. This is an ideal session for clinic nurses, nurse practitioners, pharmacists, pharmacy technicians, physicians, social workers, and program managers. NEAR DEATH EXPERIENCES: HOPE, HYPOXIA AND HYPOTHESIS David Maginley, M. Div., Nova Scotia Cancer Centre, Halifax, NS, Canada In , about half (45%) of Canadian cancer deaths occurred in acute care hospitals. Health care providers are repeatedly exposed to death and terminal prognosis, providing compassion care to stave off what, in the end, is a 00% statistic. We all die. But a growing body of research indicates that we do not end something much greater occurs. Health care staffs are among those most likely to witness this most mysterious and even beautiful aspect of death visitations by deceased loved ones, visions of angels, stories of a patient glimpsing the other side. These transcendent moments do not fit into the medical model, one that wrestles with the nature of consciousness itself, and so have been predominantly dismissed as hallucination or reduced to bioelectrical cascade. Near Death Experiences (NDEs) are mystical phenomena in which a patient may have an out-of-body experience, feel profound peace and 4

15 love, encounter deceased relatives or spiritual beings, obtain unique knowledge, be told to return, and have permanent physiological and life changes. Many accounts include corroboration of events witnessed while dead. Accounts worldwide show that while details are culturally specific, NDEs occur across all belief systems, nationalities, ages educations and time periods. This presentation will explore the characteristics of NDEs through ten years of work with the dying. We will examine various medical explanations, review the unique and permanent affects NDEs have on people s lives, memory, intelligence and physiology, and consider the implications of an integrative theory of consciousness which has developed thanks to advances in medical imaging and new models of the mind/body connection. APREPITANT IN BLOOD AND MARROW TRANSPLANTATION: TO ADD OR NOT TO ADD? Lina Ho, BScPhm, RPh, ACPR, Princess Margaret Hospital, Toronto, ON, Canada Aprepitant (Emend ) is an antiemetic drug with a different mechanism of action from pre-existing antiemetics. As such, the addition of Aprepitant to 5-HT3 antagonist plus dexamethasone is now standard of care for patients receiving highly emetogenic chemotherapy, mostly in the solid tumour setting (combined anthracycline and cyclophosphamide regimens and high-dose cisplatin regimens). Although most of the conditioning regimens in BMT are also highly emetogenic, the use of Aprepitant in this setting is less characterized. Due to various factors such as local funding models and concern for drug interactions, different practices are seen in transplant centers across Canada. The objective of this presentation is to:. Explain the mechanism of action of Aprepitant and potential drug interactions commonly seen in the BMT setting 2. Review three recent publications on the use of Aprepitant in autologous and allogeneic BMT 3. Discuss with the audience the considerations for adding Aprepitant to the antiemetic regimens in various BMT conditioning protocols THE USE OF THIOTEPA IN PREPARATVE REGIMENS FOR HEMATOPOIETIC CELL TRANSPLANTATION Philippe Bouchard, BPharm, MSc, BCOP, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada Although not commercially available in Canada, the alkylating agent thiotepa is increasingly used in preparative regimens for hematopoietic cell transplantation. The pharmacology of the agent and the evidence supporting its use prior to transplantation are reviewed. Hematological toxicity limits the use of thiotepa in solid tumor oncology. At doses used in hemtopoietic cell transplantation, significant myelosuppression is expected. Non-hematological toxicities are also discussed: skin cleansing is recommended in order to prevent dermatological toxicity. Mucosal toxicity is also of concern and requires standard preventative and therapeutic management. Finally, recommendations for drug authorization and acquisition, preparation and administration of thiotepa are provided. Session 2C: Laboratory Technologists Session Thursday, June 2, 204 :00pm 4:00pm ISBT 28: FROM THE GLOBAL PICTURE TO THE DETAILS Pat Distler, MS, MT(ASCP)SBB, ICCBBA, San Bernadino, CA, USA Increasing numbers of cellular therapy facilities around the world are implementing ISBT 28, an international terminology, coding, and labeling system. The World Health Organization has an organizationwide initiative for the governance of medical products of human origin (MPHO) that includes the global use of ISBT 28. ISBT 28 is endorsed by many cellular therapy professional societies. This session will provide information about the global status of ISBT 28, major steps in implementation, and label design. It will cover the changes made to the terminology in August 203 and the impact of these changes to current users of the system. It will:. Discuss the global strategy of ISBT 28 implementation for medical products of human origin and how cellular therapy facilities fit into this vision 2. Describe key features of the ISBT 28 label design identifying which elements are rigidly standardized and which are not 3. List key steps in implementation of ISBT Identify recent changes to the terminology and the impact of these changes to current users ISBT 28 PRODUCT CODE SELECTION: WHICH CODES DO I WANT? WHICH CODES DO I NEED? Leigh Sims Poston, BS, MT (ASCP), Chester, VA, USA This session will focus on the details of product code selection for cellular therapy products. Many users try to apply individual preferences to product code selection. This session will help the user understand how to apply product classes and attributes to identify a product code within the existing database or to request a new product code if needed. The session will review the tools and resources available within ICCBBA to assist the user in the code selection process. This session will:. Review the ISBT 28 terminology concept for cellular therapy and 5

16 203 terminology changes to help the user better understand the tools used to create product code descriptions 2. Review product code selection through scenarios and audience participation GETTING THE MOST OUT OF YOUR ISBT TECHNOLOGY PARTNERS Geoffrey Browne, Stemsoft Software Inc., Vancouver, BC, Canada An ISBT implementation can feel like a daunting task, but you are not alone. Whether you intend to buy, build or borrow your ISBT solution, this session will talk about getting the most out of the vendors and inhouse technology specialists. This session will: Review the key phases of an ISBT technology implementation from selection through validation Discuss the potential cost and regulatory implications of hardware, software and label design choices Discuss the relative merits of buying, building or borrowing your ISBT solution from another department Demonstrate how an ISBT solution can be integrated into your existing workflow Poster Group Presentations Thursday, June 2, 204 4:00pm 4:5pm Session 3A: CBMTG National Registry Steering Meeting Thursday, June 2, 204 4:5pm 6:5pm Kristjan Paulson, MD, University of Manitoba, Winnipeg, MB, Canada Session 3B: Advanced Practice Nurse/Nurse Practitioner Networking Session Thursday, June 2, 204 4:5pm 5:5pm Jennifer Wiernikowski, MN, NP Adult, CON(C), Hamilton Health Sciences Centre, Hamilton, ON, Canada, Jo-Ann Edwards, NP, QEII Health Sciences Centre, Halifax, NS, Canada Session 4: CBMTG Joint Session with Canadian Hematology Society and Venous Thrombosis Clinical Trials Organization Friday, June 3, 204 9:00am 2:00pm HUMAN BONE MARROW FAILURE: NEW TREATMENT AND NEW PATHOPHYSIOLOGIES Neal Young, MD, NIH, National Heart, Lung, and Blood Institute, Bethesda, MD, USA Dr. Young will discuss recent advances in the treatment of aplastic anemia, especially the utility of the thrombopoietin synthetic mimetic eltrombopag, a drug which appears to stimulate the human hematopoietic stem cell. The new telomeropathies, which manifest as marrow failure, are due to mutations in the telomere repair complex; telomeres also shorten secondary to stem cell proliferation in the setting of marrow stress. Telomere biology appears to predict clonal evolution, the development of myelodysplasia and acute leukemia in setting of immune-mediated aplastic anemia. Telomere repair may be achievable using an old remedy, androgens, which in vitro upregulate telomerase gene activity and in vivo improve blood counts in patients with telomerase deficiency and elongate leukocyte telomeres. THROMBOSIS AND MALIGNANCY: MANAGEMENT OF Complicated CASES Sudeep Shivakumar, MD, FRCPC, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada Marc Carrier, MD, MSc, FRCPC, University of Ottawa, Ottawa, ON, Canada Patients with malignancies are at an increased risk of venous thromboembolism. Hematologic malignancies post unique challenges in the treatment of thrombosis, including the management of central venous catheters, thrombocytopenia, and recurrent events. These issues will be presented in case-based format. News from the PNH network Danièle Marceau, MD, CHU de Quebec, Quebec, PQ, Canada Poster Group 2 Presentations Friday, June 3, 204 0:00am 0:20am 6

17 Session 5: Age and Transplant Friday, June 3, 204 2:00pm 3:30pm ALLOGENEIC TRANSPLANTION FOR AML: TOO MUCH OR TOO LITTLE? Andrew Artz, MD, MS, University of Chicago Medicine, Chicago, IL, USA Acute myeloid leukemia (AML) is both more common and more fatal in older adults relative to younger patients. Observational data have shown promising long-term outcomes in older AML patients undergoing allogeneic hematopoietic cell transplantation (HCT) relative to historical controls although prospective data are sorely lacking. Both the proportion and absolute number of patients 60 years (and 70 years of age) undergoing allogeneic HCT for AML have risen steadily from 2000 to 200. Still, the enthusiasm to extend HCT to older patients is limited by concerns over transplant related morbidity and mortality and the absolute long-term benefit. Better methods to gauge patient health and, by extension, tolerance to transplant are gaining acceptance. Comorbidity by the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) facilitates risk stratification but high comorbidity alone does not preclude long-term survival after allogeneic HCT. More detailed health inventories through geriatric assessment and serum biomarkers better captures patient health by documenting the presence or absence of deficits across numerous health domains. For example, the combination of comorbidity and self-report functional status may enhance prognostication sufficient to reliably inform transplant candidacy. Clarity is emerging regarding donor sources for older AML patients. Older matched sibling donors produce equivalent, if not better, outcomes compared to matched unrelated donors. In addition, alternative donor sources are emerging as acceptable grafts for patients lacking matched donor options. Still, for patients (and donors) 70 years and older, published experience is very limited and requires careful pre-transplant evaluation. The field sorely needs prospective comparative trials to fully ascertain the benefits and risks of allogeneic HCT in older AML patients. You re going to do what?! A case study Jo-Ann Edwards, NP, QEII Health Sciences Centre, Halifax, NS, Canada, Wanda Hasegawa, MD, Provincial Stem Cell Transplant Program, Dalhousie University, Halifax, NS, Canada Christy Simpson, PhD, Dalhousie University, Halifax, NS, Canada Using a case study, this interactive session will explore ethical issues in the context of decisions around stem cell transplants. Poster Group 3 Presentations Friday, June 3, 204 3:30pm 4:00pm Session 6: Choosing the Best Donor Friday, June 3, 204 4:00pm 6:00pm HOW DO WE BUILD THE BEST REGISTRY? Mindy Goldman, MD, FRCPC, Canadian Blood Services, Ottawa, ON, Canada This presentation will focus on donor registry issues related to the recruitment and retention of the best donor for potential transplantation. Challenges in donor recruitment will be discussed from the perspective of the OneMatch donor registry and include recruiting and retaining registrants that are most likely to be selected as donors, and establishing criteria in contentious areas, such as a history of high risk behaviors, pain syndromes, or mental health disorders. Case studies will be presented to illustrate some of these issues. DONOR SELECTION: OPTIMIZING CLINICAL OUTCOMES AND DONOR SAFETY John Miller, MD, PhD, Donor Medical Services, National Marrow Donor Program, Minneapolis, MN, USA Hematopoietic cell transplantation (HCT) is used to treat an everincreasing number of patients with malignant and nonmalignant diseases and would not be possible without the altruistic donors of marrow, PBSC and cord blood. This session will discuss how to select which potential HCT donor is likely to be associated with the best clinical outcomes for a particular patient. In addition to HLA matching, this session will address how donor demographics including age, gender, ABO mismatch and parity for female donor may impact survival and GVHD. From a donor safety perspective, a careful medical assessment of donors to identify increased risks of donation is an integral part of the donation process. The evaluation of HCT donors differs from that of blood, tissue and organ donors and this presentation will provide an overview of the medical evaluation process to determine donor suitability and ensure HCT product safety. KIR TYPING AND ITS CLINICAL RELEVANCE Wing Leung, MD, PhD, St. Jude s Children Hospital, Memphis, TN, USA HLA and KIR genes are the two most polymorphic families in human genome. Donor- and patient-derived products from these two gene families determine the T-cell and NK-cell alloreactivity in hematopoietic cell transplantations, thus substantially affecting the risk of graft rejection, graft-versus-host disease, infection, and leukemia relapse. This lecture will provide an overview of KIR immunogenetics, NK cell biology, clinical KIR typing, KIR mismatch models, KIR effects on patient outcomes, and algorithm in donor selection. The goal is to optimize NKcell and T-cell alloreactivity to improve transplant results. Controversies and future research opportunities will be discussed. 7

18 CASE STUDIES: CHOOSING THE BEST DONOR Mindy Goldman, MD, FRCPC, Canadian Blood Services, Ottawa, ON, Canada, John Miller, MD, PhD, Donor Medical Services, National Marrow Donor Program, Minneapolis, MN, USA, Wing Leung, MD, PhD, St. Jude s Children Hospital, Memphis, TN, USA Session 7A: Adult Clinical Saturday, June 4, 204 9:00am 2:00pm HOW CAN WE IMPROVE THE OUTCOMES OF PATIENTS WITH RELAPSED/REFRACTORY DLBCL IN THE RITUXIMAB ERA Craig Moskowitz, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, USA For relapsed/refractory patients who are candidates for HDT/ASCT, available second-line regimens include DHAP, ICE, ESHAP GDP, or GEMOX, among others. There is presently no data to support superiority of one regimen over another, so choice of regimen should be selected based on the patient s prior therapy, comorbidities, and risk profile of the regimen. The role of Rituximab does not appear to have improved the efficacy of second-line therapy, although it is included. That being said, the prognosis for cure with HDT/ASCT has significantly worsened in the rituximab era, with more patients being cured in the upfront setting and higher risk patients relapsing after R-CHOP. Only half of patients who received prior rituximab achieved a response to second-line therapy, compared to an 83% response rate in rituximab naïve patients. The role or prognostic factors, clinical and molecular as well as pre- ASCT PET imaging are important, however how to use these effectively remains controversial as well. These issues will be discussed at the seminar. However it is clear to lymphoma experts that management of relapsed/refractory DLBCL is at a standstill and novel therapies are critically needed. HIGH DOSE THERAPY FOR RELAPSED HODGKIN LYMPHOMA: IS THAT ALL THERE IS? Michael Crump, MD, FRCPC, Princess Margaret Hospital, Toronto, ON, Canada CONSOLIDATION AND MAINTENANCE THERAPY AFTER AUTOLOGOUS TRANSPLANT FOR MULTIPLE MYELOMA Philip L. McCarthy, MD, Roswell Park Cancer Center, Buffalo, NY, USA Consolidation and maintenance therapy after autologous hematopoietic stem cell transplant improves and maintains response and disease control in MM patients. Consolidation is usually a more intense therapy design to improve response whereas maintenance may improve response but is more often designed to control disease long-term and maintain response. The proteasome inhibitor Bortezomib and the immunomodulatory drugs thalidomide and lenalidomide have been used alone or in combination as both consolidation and maintenance. The lecture will discuss the current trials and those in progress that will help to define optimal approaches to long term disease control of multiple myeloma. Session 7B: Pediatric Clinical Saturday, June 4, 204 9:00am 2:00pm METABOLIC DISORDERS IN THE AGE OF EXPANDING NEWBORN PROGRAMS Joanne Kurtzberg, MD, Robertson Clinical and Translational Cell Therapy Program, Durham, NC, USA KIR TYPING Wing Leung, MD, PhD, St. Jude s Children Hospital, Memphis, TN, USA Killer-cell immunoglobulin-like receptors (KIRs) are highly polymorphic. Among known NK receptors, KIRs are the primary determinant of NK cell response. KIRs are also expressed in subsets of T cells. Clinically, KIR typing is not only useful for allogeneic donor selection but also for prognostication in autologous settings. This lecture will provide an overview of the three levels of clinical KIR typing: () genotyping for gene content and A/B haplotype categorization, (2) phenotyping for gene expression and number of KIR+ cells, and (3) allelotyping for functional strength. Cases will be discussed with audience participation to demonstrate the approach to interpretation of KIR typing results. ASSESSMENT OF MRD PRE- AND POST-TRANSPLANT IN CHILDREN WITH ALL IMPACT ON TRANSPLANT DECISION MAKING Peter Bader, MD, Hospital for Children and Adolescents, Frankfurt, Germany During the past decades, tremendous progress has been made in the treatment of children and adolescents with acute lymphoblastic leukemia (ALL). Nowadays more than 80% of children with ALL can be cured with intensive, risk-based chemotherapy protocols. Several cytogenetic and response-based risk factors which are associated with poor outcome could be identified either at presentation, during therapy or after relapse. Allogeneic stem cell transplantation (SCT) has been of benefit for many children with these risk factors who relapsed after initial chemotherapy (e.g. relapse on treatment, early relapses and others). Relapse remains the major cause for treatment failure after allogeneic SCT for high risk pediatric ALL. In 998 the retrospective study of Knechtli et al. showed that the level of minimal residual disease (MRD) immediately prior to transplantation represented an important prognostic factor for successful allogeneic SCT. These findings were confirmed by other retrospective studies all showing that patients who entered transplantation with high MRD load faced an extremely elevated risk to develop relapse after transplantation. Based on the potential clinical impact of these studies the European Study Group on MRD detection in ALL (ESG-MRD-ALL) was founded. 8

19 This group standardized MRD methods and set up a quality assurance network as the technical fundament for multi-centre trials. Recently, we could confirm in a prospective study in children with relapsed ALL that the risk of subsequent post-transplant relapse was strongly depending on the MRD level at the time of transplant. The cumulative incidence of relapse (CIR) was 0.57 for patients with an MRD load of 0-4 leukemic cells compared to 0.3 for patients who received transplant while having an MRD load of <0-4 leukemic cells. These results strengthened the need for further studies aiming to improve the quality of remission prior to transplant. However, MRD assessment before transplantation could scarcely identify those individuals with post-transplant impending relapse who need and might profit from intervention therapy. For those, additional interventions can influence outcome by augmenting or improving an immune graft versus leukemia (GvL) effect after transplantation. Such approaches include abrupt cessation or rapid tapering of immune suppression, administration of cytokines, and donor lymphocyte infusion (DLI) with or without cytokines. To elucidate the importance of MRD characterization post-transplant we have evaluated the results out of the prospective ALL-BFM-SCT-2003 trial, which will be presented and discussed. Poster Group 4 Presentations Saturday, June 4, 204 9:55am 0:0am Session 8: Hans Messner Lectureship Saturday, June 4, 204 2:00pm 3:00pm PRIMARY REFRACTORY LEUKEMIA WHAT TO DO NEXT? Richard A. Larson, MD, University of Chicago, Chicago, IL, USA Approximately 75% of young and middle aged adults with acute myeloid leukemia (AML) will achieve a complete remission after one or two courses of intensive remission induction chemotherapy. Primary refractory leukemia is the cause for failure in most of the remainder. Specific clonal cytogenetic abnormalities present at diagnosis identify those at highest risk. Since allogeneic hematopoietic cell transplantation can rescue some of these patients, a search for histocompatible donors should begin at diagnosis. Pre-transplant conditioning therapy and post-transplant therapeutic interventions are investigational and are being studied in prospective trials. Poster Group 5 Presentations Saturday, June 4, 204 3:00pm 3:5pm Session 9: Oral Abstract Presentations Saturday, June 4, 204 3:5pm 4:5pm For information regarding the oral abstract presentations please see page 23. Session 0: Fred Saunders Debate Saturday, June 4, 204 4:5pm 5:5pm BE IT RESOLVED THAT PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA SHOULD HAVE AN ALLOGENEIC TRANSPLANT IN CR For the Resolution: Daniel Weisdorf, MD, University of Minnesota, Minneapolis, MN, USA Dr. Daniel Weisdorf is Professor of Medicine, Division Chief of Hematology, Oncology and Transplantation, Director of the University of Minnesota Blood and Marrow Transplant Program and Associate Chair for clinical research in the Department of Medicine. He is currently Senior Research Advisor for the Center for International Bone Marrow Transplant Research (CIBMTR) and Scientific Director for its Acute Leukemia Committee. He is a past chair of the NIH-sponsored Blood and Marrow Transplantation Clinical Trials Network (BMT CTN) Steering Committee and past-president of the American Society of Blood and Marrow Transplantation. His clinical and research interests are in application of blood and marrow transplant therapies for hematologic malignancies as well as extensive study of the clinical complications of transplantation including acute leukemia and graft versus host disease (GVHD). Against the resolution: Matthew Seftel, MD, MPH, MRCP, FRCPC, Princess Margaret Hospital, Toronto, ON, Canada Dr. Seftel is a hematologist/oncologist based at Princess Margaret Hospital in Toronto. He leads the allogeneic blood and marrow transplantation program and is a member of the leukemia group. He is an associate professor at the University of Toronto in the division of internal medicine. He is actively involved in clinical trials and outcomes based research related to the hematologic malignancies and BMT. 9

20 Canadian National Transplant Research Program Annual Scientific Meeting 204 June 0-2, 204 The Westin Nova Scotian, Halifax, Nova Scotia Conference Co-Chairs: Dr. Marie-Josée Hébert, CRCHUM, Dr. Jean-Sébastien Delisle, CR Hôpital Maisonneuve-Rosemont The purpose of the CNTRP annual meeting is to encourage researchers from the solid organ transplant (SOT), allogeneic hematopoietic cell transplant (AHCT), and critical care and donation communities to think differently by promoting synergistic collaboration and ample networking opportunities and to strengthen the cross-project/core integrations within the CNTRP and encourage new collaborations This CNTRP session will focus on ongoing work within the CNTRP, with highlights presented from each of the 3 supportive cores as well as the six collaborative projects. Following these updates, external advisory board member Dr. Kathryn Wood will share her views on the progress of the program, followed by a discussion on future directions by the CNTRP Director, Dr. Lori West. Become a member of the Canadian Blood! Are you a Physician, Researcher, Nurse, Pharmacist, Laboratory Technician, or Program Coordinator working in blood and marrow transplant? Join CBMTG and take advantage of the exciting benefits that membership has to offer! Benefits: Discounted rate for the annual conference Free registration for association educational webinars Get involved with committees and working groups Opportunity to apply for small budget research grants Access to Sosido Network with your colleagues in BMT Help advance the BMT profession across Canada! Visit cbmtg.org today to learn more! 20

21 Friday, June 3, 204 AGENDA The Canadian Apheresis Group (CAG) Canadian Association of Apheresis Nurses (CAAN) The Canadian Hematology Society (CHS) 34TH ANNUAL GENERAL MEETING AND SCIENTIFIC SESSIONS June 3-5, 204 The Westin Nova Scotia Halifax, Nova Scotia 7:30am 8:45am Registration Harbour Suite AB 7:30am 8:45am CBMTG Breakfast Symposium Commonwealth Ballroom 9:00am 2:00pm Joint session CHS, CBMTG, VECTOR Moderators: Stephen Couban, MD and Joanne Hickey, MD, FRCPC 9:00am: Commonwealth Ballroom Human bone marrow failure: New treatment and new pathophysiologies Dr. Neal Young 0:00 0:20am: Break (Atlantic Ballroom) 0:20am :0am: Thombosis and Malignancy: Management of complicated cases Sudeep Shivakumar, MD, FRCPC and Marc Carrier, MD, MSc, FRCPC Overview of Paroxismal Nocturnal Hemoglobinuria (PNH) Danièle Marceau, MD 2:00pm 2:00pm CBMTG Lunch Symposium Commonwealth Ballroom 2:00pm 6:00pm Planning Group Meeting Boardroom 2:00 6:00pm CAAN Nursing Workshop Harbour Suite AB 2:00 5:00pm Welcome Remarks Eduard Cojocari, RN, Chantal Goupil, RN Differentiation of Thrombotic Microangiopathy Dr. Pavenski SMH ABO Incompatible Kidney transplants Megan Buchholz SMH SDP who is doing what? Kerri Gallo LHSC Collection Efficiency in Stem Cell Collections Eduard Cojocari An Overview of THERAKOS Photopheresis James V. Greco 6:30pm Onwards CAAN Nursing Evening Social Salty s Hemophilia therapies Lunenburg Room 2:5pm 3:00pm In the clinic and in the future Dr. P. Moorhead 3:00pm 3:45pm Single unit transfusion Dr. E. Kahwash Saturday, June 4, 204 7:30am 8:30am Registration and Breakfast Harbour Suite AB 8:30am 8:45am Welcome Review of Agenda Harbour Suite AB 2

22 Saturday, June 4, 204 CAG 204 PE Data Review Plasma exchange procedures Dr. Rock Neurological/ metabolic and gastroenterological Dr. Pavenski Hematological Dr. Foley Renal/collagen vascular and dermatological Dr. Clark Miscellaneous Dr. Amber 8:45am :45am Photopheresis Dr. Klassen Discussions and Recommendations All 0:00am 0:30am BREAK Type and amount of fluids used Dr. Laroche Adverse reactions/deaths Dr. Quarni Hepatitis E Post Plasma Exchange Dr. Rock Pathogens in blood Dr. Pavenski Harbour Suite AB :45am 2:00pm TMA Registry Dr. Rock Harbour Suite AB 2:00pm :30pm LUNCH Tradewinds :30pm 3:30pm CBS Report Dr. M. Golden SDP Use in Patients Dr. Pavenski Rituximab Study Dr. Foley Harbour Suite AB Discussion/Direction All 3:30pm 3:45pm BREAK Harbour Suite AB 3:45pm 5:00pm Physician Workshop Maritime Room ahus/tma Dr. Lawrence The Pexivas Study Dr. Clark CAAN Nursing Workshop Harbour Suite AB CAAN round table discussion / Business Meeting 7:00pm Onwards CBMTG Social Event Pre-registration is required to attend this event. Waterfront Warehouse Sunday, June 5, 204 8:00am 9:00am Breakfast Harbour Suite AB 9:00am 9:30am Photopheresis: Mechanisms of action Dr. Marcu Harbour Suite AB 9:30am 0:00am cgvhd NIH Classified H. Kerr Harbour Suite AB 0:00am 0:30am Plerixafor TBA Harbour Suite AB 0:30am :00am BREAK Harbour Suite AB :00am :30am The Optia: Preformance in bone marrow processing M. Pidduck Harbour Suite AB :30am 2:00pm The Canadian stem cell data Dr. Foley Harbour Suite AB 22

23 Oral Abstract Index Saturday, June 4, 204 3:5pm 4:5pm # Title Topic Presenting Author 0 A Randomized Trial of Rituximab vs. Observation Following Autologous Stem Cell Transplantation (ASCT) for Relapsed or Refractory CD20-Positive B Cell Lymphoma: Final of NCIC CTG LY.2. Clinical Trials and Observations Michael Crump, MD, FRCPC 02 CD34 Cell Dose is Correlated with Hematologic Recovery but not Chronic Graft vs Host Disease: of the CBMTG Trial Comparing G-CSF-Mobilized Peripheral Blood (G-PB) versus G-CSF Stimulated Bone Marrow (G-BM) in Sibling Allografts for Hematologic Malignancies Clinical Trials and Observations Stephen Couban, MD 03 Plasma Levels of Mitochondrial DNA (MtDNA) Are Able to Stimulate B Cells to Produce Proinflammatory Cytokines and Are Increased at the Onset of Chronic Graft Versus Host Disease Basic/Translational Research Kirk Schultz, MD 04 Cognitive Functioning as a Predictor of Medication Management Ability Among Stem Cell Transplant Recipients Pharmacy, Nursing and Other Transplant Support Samantha Mayo 05 Utilization of Hematopoietic Stem Cell Products Cryopreserved at the Time of Allogeneic Stem Cell Transplant Laboratory/Quality Muneer Abidi, MD 0. A Randomized Trial Of Rituximab Vs Observation Following Autologous Stem Cell Transplantation (ASCT) For Relapsed Or Refractory CD20-Positive B Cell Lymphoma: Final Of NCIC CTG LY.2. Michael Crump MD FRCPC, John Kuruvilla, MD, C. Tom Kouroukis, MD, MSc, FRCP(C) 2, Ann Benger, MD, FRCP(C) 2, Matthew C. Cheung, MD, FRCPC 3, Neil L Berinstein, MD 3, Stephen Couban, MD, FRCPC 4, Matthew D. Seftel, MBChB, FRCP(C), MRCP 8, Kang Howson-Jan, MD 6, Armand Keating, MD, Massimo Federico, MD 0, David A Macdonald, MD, FRCPC 4, Harold J. Olney, MD 8, Morel Rubinger, MD 5 *, Michael Voralia 9, A. Robert Turner, MD, FRCPC 0, Tara Baetz, MD, Annette E Hay, MBChB 2, Marina Djurfeldt, MSc 2, Ralph M. Meyer, MD 2, Bingshu Chen, PhD 2 and Lois Shepherd, MD 2 Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada 2 Division of Malignant Hematology, Dept of Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada 3 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada 4 Health Sciences Centre, Halifax, NS, Canada 5 Cancer Care Manitoba, Winnipeg, MB, Canada 6 London Health Sciences Centre, London, ON, Canada 7 Department of Diagnostic and Clinical Medicine, and Public Health, University of Modena and Reggio Emilia, Modena, Italy 8 Universite de Montreal, Montreal, QC, Canada 9 Saskatoon Cancer Centre, Saskatoon, SK, Canada 0 Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada Department of Oncology, Cancer Centre of Southeastern Ontario, Queen s University, Kingston, ON, Canada 2 Queens University, NCIC Clinical Trials Group, Kingston, ON, Canada Rationale NCIC CTG LY.2 was an international randomized trial evaluating two treatment strategies for patients (pts) with aggressive lymphoma relapsing after or with progressive disease following primary therapy. The first randomization demonstrated that gemcitabine, dexamethasone, cisplatin (GDP) was non-inferior to and significantly less toxic than dexamethasone, cytarabine, cisplatin (DHAP) as salvage therapy (ASH 202). Here we report the results of the second randomization, testing the ability of the CD20 antibody rituximab (R) administered post-asct 23

24 to improve event-free survival (EFS) compared to no further therapy. Methods Pts with CD20-positive aggressive lymphoma who underwent ASCT after GDP or DHAP who had recovered from ASCT-related toxicities and who remained clinically progression-free within 3-5 weeks posttransplant were stratified by centre, salvage regimen received, response to salvage therapy (CR vs PR/SD) and prior treatment with R, and were randomized using a minimization algorithm to receive R 375 mg/m2 every 2 months for 6 doses, or observation. Response assessment by CT scanning was required at 3,7,3 and 25 mos post-asct or as needed to evaluate possible disease recurrence. The primary endpoint of the second randomization was 2 year EFS; to detect an improvement by 5% (from 50 to 65%, hazard ratio 0.62) required 42 events, with a 2-sided α 0.05 and power Because of the low event rate over the last year and a projected time of many years to reach the protocol specified event rate, the Data Safety Monitoring Committee approved a request for study closure and analysis, with 8 events recorded. 230 patients were randomized to R maintenance (5) or observation (5). Baseline patients and disease characteristics were well balanced: median age was 53 yrs, 28% were age >65 and 40% were female; 52% received GDP and 48% DHAP; 55% had an IPI score of 2 or more at relapse/progression, and 7% had transformed (TR) from previous indolent lymphoma. Response to salvage pre-asct: CR 24%, PR 58%; 70% had received R with chemotherapy prior to study enrolment, and 69% received R with protocol salvage treatment. All analyses are ITT. There have been 8 EFS events (R 53, observation 65). After a median follow-up of 63 months, 2 year EFS was 64% for pts treated with maintenance R vs 5% for those on observation (HR 0.74, 95% CI , p= 0.); there was no difference in overall survival (OS) at 4 years (R 69%, observation 68%, p=0.64). Grade 3-4 neutropenia was reported in 36% of pts on R maintenance vs 25% during observation; and Gr 3-4 thrombocytopenia in % and 6%, respectively. Febrile neutropenia occurred in 0 pts (9%) on R maintenance and 2 pts (2%) on observation. Two year EFS was similar in subsets defined by stratification variables at randomization: GDP salvage therapy: R 57.0% vs observation 45.9% (HR 0.84, 95% CI ), DHAP: R 70.0% vs observation 57.% (HR 0.68, ); response to salvage CR/CRu: R 69.0% vs 52.9% (HR 0.7, ), PR: R 64.5% vs observation 57.4% (HR 0.90, ); R use with prior treatment: R 53.7% vs observation 42.0% (HR 0.8, ); no prior R: R 83.3% vs observation 70.6% (HR 0.64, ). In multivariable analysis, only age >60 was significantly associated with EFS; ECOG PS, treatment arm, stage and extra-nodal disease were not significant. s This evaluation of rituximab maintenance treatment every 2 mos for one year after ASCT for aggressive lymphoma failed to meet the study endpoint of improved EFS, compared to observation. 02. CD34 Cell Dose is Correlated with Hematologic Recovery but not Chronic Graft vs Host Disease: of the CBMTG Trial Comparing G-CSF-Mobilized Peripheral Blood(G-PB) versus G-CSF Stimulated Bone Marrow(G-BM) in Sibling Allografts for Hematologic Malignancies. Stephen Couban, MD, Mahmoud Aljurf 2, Silvy Lachance, MD 3, Irwin Walker, MBBS 4, Cynthia L. Toze, MD, FRCP(C) 5, Morel Rubinger, MD 6, Jeff H. Lipton, PhD, MD 7, Stephanie J. Lee, MD, MPH 8, Jeffrey Szer, MD 9, Richard Doocey 0, Ian D Lewis, MB, BS, PhD, Lothar B. Huebsch, MD 2, Kang Howson-Jan, MD 3, Faisal Al Mohareb, MD 4 *, Naeem Chaudhri, MD 5 *, Aminia Kariminia, PhD 6 *, Sabine Ivison, PhD 7 *, Diane L. Fairclough, PhD 8 *, Gerald Devins 9 *, David Szwajcer, MD, FRCPC 20, Stephen Ronan Foley, MD, FRCPC 2, Clayton A. Smith, MD, FRCPC 22, Tony Panzarella, M.Sc 23 *, Holly Margaret Kerr, RN, BSN 24 *, Kirk R. Schultz, MD 25, and Marc Lalancette, MD 26 Dalhousie University and Capital District Health Authority, Halifax, NS, Canada 2 Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia 3 Blood and Marrow Transplant Program, Hematology Department, Maisonneuve- Rosemont Hospital, University of Montreal, Montreal, QC, Canada 4 Medicine, McMaster University, Hamilton, ON, Canada 5 Leukemia and Bone Marrow Transplantation Program of BC, British Columbia Cancer Agency, Vancouver, BC, Canada 6 Section of Hematology and Medical Oncology, CancerCare Manitoba, Dept of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada 7 Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada 8 Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 9 The Royal Melbourne Hospital, Parkville, Australia 0 Auckland City Hospital, Auckland, New Zealand Directorate of Hematology and Centre for Cancer Biology SA Pathology, Adelaide, Australia 2 University of Ottawa, Ottawa, ON, Canada 3 London Health Sciences Centre, London, ON, Canada 4 King Faisal Specialist Hospital, Riyadh, Saudi Arabia 5 Adult Hematology/HSCT Section, King Faisal Cancer Center, King Faisal Specialist Hospital, Riyadh, Saudi Arabia 6 Pediatric Hematology/Oncology/BMT, BC Children s Hospital, Vancouver, BC, Canada 7 Div. Pediatric Hem./Onc./ BMT, BC Children s Hospital, Vancouver, BC, Canada 8 University of Colorado Anschutz Medical Campus and Colorado School of Public Health, University of Colorado, Denver, CO 9 University of Toronto, Toronto, ON, Canada 20 CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada 2 Department of Pathology, McMaster University, Hamilton, ON, Canada 22 Division of Hematology, Hematologic Malignancies, University of Colorado AMC, Aurora, CO 23 Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada 24 Vancouver General Hospital, Vancouver, BC, Canada 25 B.C. Children s Hospital, University of British Columbia, Vancouver, Canada 26 L Hôtel De Québec, Québec City, Québec, Canada Background We completed a randomized trial comparing G-PB with G-BM in sibling allografts for hematologic malignancies (Couban et al, ASH, 203) and 24

25 report the association of allograft cell counts with hematologic recovery and cgvhd and the pattern of organ-specific cgvhd. Methods A phase III randomized trial of matched sibling G-PB vs G-BM allografts in adults with hematologic malignancies was conducted. The primary endpoint was time to treatment failure defined as the first occurrence of extensive cgvhd, disease progression/relapse or death. Adaptive stratification (minimization) balanced treatment arms by centre, disease, early vs late disease and conditioning. Donors received G-CSF 5 g/kg/d sc for 4 or 5 days with apheresis on Day 5 and, if necessary, Day 6 or BM harvest on Day 5. Recipients between 6 and 65 years received myeloablative conditioning and cyclosporine/methotrexate as GvHD prophylaxis. 230 sibling donor-recipients were randomized; 7 were unevaluable. Indication for allograft was AML (09; 49%), ALL (57; 25%); MDS/ MPD (3; 4%), CML (3; 6%), lymphoproliferative disorder(2; 5%) and biphenotypic leukemia (). Median total nucleated cells (TNC)/kg were 7.59x08 (range: ) and 5.92x08 (range: ) in the G-PB and G-BM arms (P<0.000). Median CD34 cells/kg were 5.50x06 ( ) and 3.22x06 ( ) (P<0.000). At a median follow-up of 36 months (range ), using Cox proportional hazards multivariable modelling adjusted for the 4 minimization factors, time to treatment failure did not differ significantly between arms (HR 0.9; 95% CI ; P= 0.52). There was also no OS difference (3- year OS 56.8% vs 60.4%; G-PB vs G-BM; p=0.90). Outcome G-PB G-BM p-value Grade II-IV agvhd 9.7% (SE 3.9%) 5.% (SE 3.4%) 0.43 Grade III-IV agvhd 9.9% (SE 3%) 3.8% (SE.9%) 0.09 Any cgvhd by 2 yrs 80.9% (SE 4.5%) 68.4% (SE 5.%) 0.03 Extensive cgvhd by 2 yrs Neutrophil recovery, median d (range) Platelet recovery, median d (range) 67.% (SE 5.0%) 59.9% (SE 5.0%) (0-32) 20 (2-38) < (5-9) 2 (9-64) <0.000 Neutrophil and platelet recoveries were related to CD34 cells/kg in G-PB (neutrophils: regression slope (RS) -0.39; platelets: RS -0.2) and G-BM (neutrophils: RS -0.93; platelets RS -0.49). There was no correlation of CD34 cells/kg or TNC/kg with overall or extensive cgvhd. More hepatic cgvhd was reported with G-PB. s In this large, randomized trial, there were no differences in time to treatment failure, overall survival or cumulative incidence (CI) of agvhd, overall or extensive cgvhd despite substantive differences in cellular composition of the allografts. Correlation of CD34 cell dose with hematologic recovery is expected. The finding of no difference in the CI of overall and extensive cgvhd between the two arms, despite the anticipated 0-fold difference in T-cell dose and the lack of correlation between CD34 cell dose and cgvhd suggest that factors other than T-cell and CD34 dose must affect the likelihood of developing cgvhd. Use of G-CSF as a mobilizing agent may increase the likelihood of developing cgvhd more than has been appreciated. 03. Plasma Levels Of Mitochondrial DNA (MtDNA) Are Able To Stimulate B Cells To Produce Proinflammatory Cytokines And Are Increased At The Onset Of Chronic Graft Versus Host Disease Ivison S, Kariminia A, Sung S, Leung V, Cote H,Schultz KR BC Children s Hospital, Child and Family Research Institute, University of British Columbia Background During hematopoietic stem cell transplantation (HSCT) there are a number of factors that contribute to recipient cell damage including cytotoxic agents and alloimmunity associated with cgvhd. Previously, our group was the first to describe an activated memory B cell phenotype with an exaggerated response to TLR9 agonists associated with the onset of extensive cgvhd. TLR9 agonists usually are from bacterial single stranded DNA although another TLR9 agonist may be human mitochondrial DNA (mtdna). Plasma mtdna have been reported to increase after injury or trauma with cellular release from necrotic cells. It is likely that recipient cellular damage results in increased plasma concentrations of immunostimulatory damage-associated molecular patterns including mtdna. We hypothesized that plasma mtdna levels will be increased in patients with cgvhd compared to patients post transplant that do not develop cgvhd and that increased mtdna result in B cell activation. Methods Thirteen patients with cgvhd, 7 post HSCT patients without cgvhd, and 30 non transplant controls were evaluated. Mitochondrial DNA concentrations were measured in the plasma by real-time PCR using specific primers COX. Briefly, a plasmid containing the COX region amplified by the COX primers was used as standard, each plate contained a standard with a known number of plasmid copies in serial dilutions. Copy number was determined by Ct comparison to standard. In order to accommodate for immune reconstitution in the analysis, 25

26 patients with cgvhd onset < 9months (early onset) post BMT were compared to patients without cgvhd measured at 6 months post HSCT and patients with a late onset of cgvhd were compared to 2 month post HSCT controls. In addition, we evaluated the ability of mtdna derived from an ALL cell line (679) to stimulate B cells isolated from 5 healthy individuals. Up-regulation of co-stimulatory molecules and proinflammtory cytokine production including IL-6 and TNF were investigated in vitro. It was shown that mtdna isolated from cell line 697 is able to upregulate expression of co-stimulatory molecules and secretion of proinflammatory cytokines, IL-6 and TNFα, by human B cells. We found that mtdna concentrations in plasma was increased in all HSCT patients compared to non HSCT controls (p<0.000). It was also found that mitochondrial DNA plasma concretions were significantly higher in patients at onset of early and late cgvhd compared to the plasma of patients at 6 and 2 months post transplant with no cgvhd (p<0.02). Our findings confirm that mtdna are able to activate B cells. We show that although all patients post HSCT have higher concentrations of mtdna, that the highest concentrations of mtdna are associated with cgvhd. Although further investigation are required to establish a direct linkage of mtdna to TLR9 mediated activation of B cells, these data support the hypothesis that this may be one of the mechanisms leading to the exaggerated B cells response resulting in autoimmunity and cgvhd. 04. Cognitive functioning as a predictor of medication management ability among stem cell transplant recipients Mayo S, Metcalfe K, Messner H 2, 3, Rourke S 3, 4, Howell D, 2 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, 2 Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, 3 The Ontario HIV Treatment Network, Toronto, 4 Department of Psychiatry, University of Toronto, Toronto, 5 University Health Network, Toronto Objective To investigate the impact of cognitive functioning on medication management ability among patients treated with allogeneic stem cell transplantation. Rationale A growing body of evidence suggests that patients with hematological cancers may experience impairments in cognitive functioning, particularly after treatment with stem cell transplantation. However, the real-world implications of such deficits are unclear. Research conducted across non-cancer clinical settings suggests that cognitive impairments may reduce the ability to manage medications effectively. Given that adherence to complex medication regimens is essential for minimizing medical complications after stem cell transplantation, the relationship between cognitive functioning and medication management ability in this population was investigated. Methodology As part of a longitudinal study of cognitive functioning following allogeneic stem cell transplantation, transplant recipients were invited to complete a standardized battery of cognitive tests prior to transplant, at Day 00 and six months post-transplant. This battery included neuropsychological tests of learning and memory, processing speed and psychomotor efficiency, and executive functioning and working memory. To measure medication management ability at each time point, participants also completed a task in which they were asked to dispense and make inferences about a simulated medication regimen. Finally, socio-demographic, medical, and symptom characteristics were collected through chart abstraction and self-administered questionnaires. Eligible participants were English-speaking adults receiving their first allogeneic stem cell transplant. Non-linear multilevel modeling was used to compare participants who met the criteria for impaired medication management ability to those who were not impaired, on cognitive functioning and various confounders. 56 participants who completed baseline study measures as well as at least one follow-up visit (Day 00 and/or six months) were included in the analysis. 46% (26/56), 38% (9/50) and 29% (2/42) met the criteria for cognitive impairment at baseline, Day 00 and six months, respectively. 43% (24/56), 40% (9/48) and 36% (5/42) had impaired medication management ability at baseline, Day 00 and six months, respectively. At each time point, greater severity of cognitive impairment was significantly correlated with worse medication management ability. Based on non-linear multi-level models, specific cognitive abilities that predicted impaired medication management ability were identified overall and at each time point. In particular, worse performance in the domain of executive functioning and working memory consistently predicted impaired medication management ability, even when controlling for confounders, such as pre-morbid IQ and conditioning intensity. Depressive symptoms, fatigue or physical symptom distress were not significant predictors of impaired medication management ability at any time point. While medication adherence can depend on a range of factors, these findings suggest that poor cognitive functioning, particularly in the area of executive functioning and working memory, may affect patients ability to manage medications within the first six months of transplant. 26

27 05. Utilization of Unrelated Hematopoietic Stem Cell products cryopreserved at the time of Allogeneic Stem Cell Transplant Rishi Agarwal, Lois Ayash, 2 Abhinav Deol, 2, Lawrence Lum, 2 Voravit Ratanatharathorn, 2 Joseph Uberti, 2 Muneer H. Abidi, 2 University of Cincinnati, Cincinnati, Ohio, USA Wayne State University/Karmanos Cancer Center, Detroit, Michigan, USA Background The optimal dose of CD34+ hematopoietic stem cells (HSC) for allogeneic stem cell transplant (SCT) is not well defined. Reports exists that higher CD34+ cell dose is associated with better engraftment and may increase the risk of GVHD. In the absence of clear guidelines, it is unclear if transplant centers infuse the entire HSC product or cryopreserve the surplus dose. To the best of our knowledge, there is no data regarding the practice of cryopreservation in the setting of allogeneic SCT. We designed a retrospective study to analyze the clinical, ethical and economical aspects of cryopreservation of unused HSC after an allogeneic SCT. Methods Wayne State University institutional review board approved this retrospective study. Patients >8 years, who received unrelated peripheral HSC between January, 2000 and July,200 were included in the analysis. Total 360 unrelated allogeneic SCTs were performed and a portion of HSC was cryopreserved in 43 of 360 patients. These patients were included in the analysis. Patient demographics: M/F-25/8, median age at transplant was 48 (range 8-67) years, median Karnofsky score was 90% (range 60-90). Twenty two out of forty three patients (52%) were alive at the time of analysis. Diagnosis included acute myelogenous leukemia (n=9) (44%), acute lymphoblastic leukemia (n=9) (20%), non-hodgkin s lymphoma (n=8) (8%), myelodysplatic syndrome (n=4), and chronic lymphocytic leukemia (n=3). Median number of stem cells acquired was 5.9 ( ) X 06 cells/kg. Median stem cells infused were 8.03 (range ) X 06 cells/kg. The median volume of stem cell product used was 75 (range ) ml. Median stem cells unused and cryopreserved were 7.68 (range ) X 06 cells/kg, and the median volume cryopreserved was 300(range ) ml. The median day of platelet engraftment (n=37) was 7(range 0-32) days, and median day of white blood cells engraftment (n=42) was (range 0-3) days. In terms of post-transplant course, incidence of grade I-IV acute graft versus host disease (GVHD) was 29/43(67%). The median day of occurrence of acute GVHD was 26 (range 3-9) days. Median duration for HSC cryopreservation till this analysis was 364(range 2-546) weeks. The cryopreserved HSCs were not reused for a second transplant in any patient. In our analysis the cryopreserved surplus HSCs were never used for a second transplant. No specific guidelines exist regarding the use of surplus related or unrelated HSCs which are being cryopreserved indefinitely. The cryopreservation of these HSCs is an ethical as well as economic and logistic concern for institutions involved in this practice and specific guidelines need to be developed in this regard. 27

28 Poster Abstract Index Poster group : Pharmacy, Nursing, and Laboratory Abstracts Thursday, June 2, 204 4:00pm 4:5pm Commonwealth Ballroom # Title Presenting Author THE UBC STEM CELL CLUB: IMPROVING THE QUALITY AND QUANTITY OF MEMBERSHIP ON CANADA S STEM CELL DONOR DATABASE Warren Fingrut, MD Candidate 2 IMMUNIZATIONS POST-HCT: A CROSS-CANADA EVALUATION Laura McGillis, BSc, RN 3 TRANSITIONING FROM PEDIATRIC TO ADULT CARE POST ALLOGENEIC HSCT: A QUALITY IMPROVEMENT INITIATIVE Laura McGillis, BSc, RN 4 THE IMPACT OF MATCHING PATIENTS NEEDS TO NURSING RESOURCES: LESSONS LEARNED FROM APPLYING THE SYNERGY MODEL IN A HEMATOLOGY/HSCT UNIT Yayra Amenudzie, RN 5 BONE LOSS IS SEEN AS EARLY AS 00 DAYS IN PATIENTS POST ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT Raewyn Broady, MD 6 MULTIDISCIPLINARY CARDIO-ONCOLOGY REVIEW PRIOR TO AUTOLOGOUS SCT Nanette Cox-Kennett, MN 7 EVALUATING THE BENEFITS OF TRANSITIONING FROM INTRAVENOUS TO SUBCUTANEOUS RITUXIMAB FOR ALBERTA CANCER PATIENTS 8 EXTRACORPOREAL PHOTOPHERESIS IN A pediatric AMBULATORY SETTING: ESTABLISHING A NURSING PROTOCOL FOR CARE 9 IDENTIFICATION AND MANAGEMENT OF GLUCOCORTICOID-INDUCED HYPERGLYCEMIA ON A BONE MARROW TRANSPLANT WARD: A QUALITY IMPROVEMENT INITIATIVE Cherie C. Severson, RN, MN, CON(C) Christine Armstrong, RN (EC), NP Andrew Aw, MD, CM, MEng 0 COUNT RECOVERY AND VIABILITY AFTER SERIAL REFREEZING OF CRYOPRESERVED STEM CELL GRAFTS Nazir Jamal COLLECTION EFFICIENCY IN STEM CELL COLLECTIONS: EXPLORING FACTORS AFFECTING COLLECTION EFFICIENCY Eduard Cojocari 2 ENUMERATION OF CD34+ CELLS USING AN ACCURI C6 CYTOMETER Susie Joron 3 ANTIMICROBIAL ACTIVITY IN CORD BLOOD UNITS: OCCURRENCE AND LEVELS OF ANTIBIOTICS Susie Joron 4 OPTIMIZING THE USE OF G-CSF FOLLOWING AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANT FOR HEMATOLOGIC MALIGNANCIES: AN ANALYSIS OF CANADIAN PRACTICE Christopher Hillis, MD, BSc 5 INFECTION PREVENTION AND CONTROL RELATED TO RESPIRATORY VIRAL ILLNESS IN HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) RECIPIENTS: THE OTTAWA HOSPITAL EXPERIENCE FROM Carey Landry, BSc, PhD 6 THE HEMA-QUEBEC PUBLIC CORD BLOOD BANK (CBB): DISTRIBUTION AND CLINICAL OUTCOMES OF TRANSPLANTED UNITS Susie Joron 7 HUMAN ALBUMIN EYE DROPS IS SAFE AND EFFECTIVE ALTERNATIVE FOR THE INDICATION OF KERATOCONJUNCTIVITIS SICCA SECONDARY TO GVHD POST ALLO-STEM CELL TRANSPLANTATION Jack T. Seki, RPh, BSc (Phm), PharmD 28

29 Poster Group 2: Basic and Translational Research Abstracts Friday, June 3, 204 0:00am 0:20am Commonwealth Ballroom # Title Presenting Author 8 EFFECTS OF IONIZING RADIATION ON MESENCHYMAL STEM CELLS IN PATIENTS WITH AML: IMPLICATIONS FOR TBI-BASED HEMATOPOIETIC CELL TRANSPLANTATION STRATEGIES 9 MESENCHYMAL STROMAL CELL TREATMENT IN XENOGENEIC CHRONIC GRAFT-VERSUS-HOST DISEASE MOUSE MODEL 20 MAJOR ABO INCOMPATIBLE BONE MARROW TRANSPLANTATION IN CHILDREN: DETERMINING WHAT RESIDUAL VOLUME OF DONOR RED CELLS CAN SAFELY BE INFUSED FOLLOWING RED CELL DEPLETION 2 ANTIBIOTIC PROPHYLAXIS THERAPY FOR PATIENTS UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANT: A TALE OF 2 CENTERS 22 CD8+ T-LYMPHOCYTES FROM PEDIATRIC RECIPIENTS OF BONE MARROW OR UMBILICAL CORD BLOOD TRANSPLANTATION EXPRESS DIVERSE ASSORTMENTS OF INHIBITORY RECEPTORS AT THEIR SURFACE IN THE EARLY POST-TRANSPLANT PERIOD 23 PATHOGEN-SPECIFIC T-CELL LINE GENERATION FOR THE TREATMENT OF VIRUS-RELATED COMPLICATIONS AFTER TRANSPLANTATION 24 IMPAIRED INTERFERON-ALPHA PRODUCTION BY PLASMACYTOID DENDRITIC CALLS AFTER CORD BLOOD TRANSPLANTATION: IMPLICATION FOR POST-TRANSPLANT TLR-LIGAN BASED IMMUNOTHERAPY Yevgeniya Le, PhD Hisaki Fujii, MD, PhD Tal Schechter-Finkelstein, MD Tal Schechter-Finkelstein, MD Insaf Salem Fourati, Ing, MSc Jean-Sébastien Delisle, MD, PhD Paulo Cordeiro, MSc 25 CANADIAN PILOT CLINICAL TRIAL: LENTIVIRUS-MEDIATED GENE THERAPY FOR ADULT FABRY DISEASE Ronan Foley, MD, FRCPC 26 EFFECT OF G-CSF STIMULATION ON DONOR BLOOD PARAMETERS FOLLOWING PBSC DONATION: A ONEMATCH PILOT STUDY Karena Volesky 27 DEVELOPING EDUCATIONAL RESOURCES TO ADVANCE ETHICAL UMBILICAL CORD BLOOD RESEARCH: A CANADIAN PERSPECTIVE Sophie Chargé, PhD Poster Group 3: Clinical Trials and Observations Abstracts Friday, June 3, 204 3:30pm 4:00pm Commonwealth Ballroom # Title Presenting Author 28 POLYCLONAL HUMAN INTRAVENOUS IMMUNE GLOBULIN (IGIV) WITH HIGH-LEVELS OF RSV NEUTRALIZING ANTIBODIES: A SUMMARY OF ANIMAL AND HUMAN STUDIES James Mond 29 AN ASSESSMENT OF THE OUTCOMES OF SECOND DONATION REQUESTS THROUGH THE CANADIAN ONEMATCH UNRELATED REGISTRY Iain Arseneau, BSc (Hons) 30 INTERACTIONS BETWEEN ALEMTUZUMAB AND CYTOMEGALOVIRUS SEROSTATUS OF RECIPIENT IN UNRELATED DONOR TRANSPLANT FOR MYELOID MALIGNANCIES Mohamed Shanavas, MD 3 MULTICENTER CLINICAL STUDY TO ASSESS ORAL COMPLICATIONS OF CONDITIONING THERAPY AND STEM CELL TRANSPLANTATION- ORASTEM STUDY Firoozeh Samim, DMD, MSc 32 MYELOABLATIVE BUSULFAN CONDITIONING REGIMENS: SINGLE CENTER EXPERIENCE OF PATIENTS WITH MYELOID NEOPLASMS Renju V. Raj, MD 33 PROFILING STUDY CHARACTERISTICS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION: A LIMITED SCOPING REVIEW Sophie Pilon 29

30 34 PROJECT COBRA: COMPENDIUM OF BEST EVIDENCE FROM RCTS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION 35 A SYSTEMATIC REVIEW OF PRECLINICAL STUDIES ON THE THERAPEUTIC POTENTIAL OF MESENCHYMAL STROMAL CELL-DERIVED MICROVESICLES 36 CHRONIC GRAFT-VERSUS-HOST DISEASE IS A SIGNIFICANT RISK FACTOR FOR THE DEVELOPMENT OF NOCARDIOSIS IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS: A MATCHED CASE- CONTROL STUDY OF RISK FACTORS, CLINICAL FEATURES, AND OUTCOMES 37 SERUM ALBUMIN LEVEL < 32 G/L ON DAY 30 CAN PREDICT HIGHER RISK OF NON-RELAPSE MORTALITY IN ACUTE LYMPHOBLASTIC LEUKEMIA FOLLOWING ALLOGENEIC STEM CELL TRANSPLANTATION 38 VALIDATION OF FAVOURABLE IMPACT OF LARGE GRANULAR LYMPHOCYTOSIS AFTER ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION 39 NEPHROTIC RANGE PROTEINURIA AS A POSSIBLE MANIFESTATION OF CHRONIC GRAFT-VERSUS-HOST DISEASE David Allan, MD, FRCPC David Allan, MD, FRCPC Nadia Bambace, MD, FRCPC Feras Alfraih, MD Marc Poch Martell, MD Renju V. Raj, MD Poster Group 4: Clinical Trials and Observations Abstracts Saturday, June 4, 204 9:55am 0:0am Fundy Room # Title Presenting Author 40 IMPORTANCE OF MONITORING COMPLETE MOLECULAR REMISSION IN PEDIATRIC ACUTE MYELOID LEUKEMIA BEARING MLL REARRANGEMENTS: FOCUS ON THE RARE AND NOT ALWAYS GOOD PROGNOSIS T(;)(Q2;Q23) TRANSLOCATION Lucie Pécheux, MD 4 RELAPSE AFTER AUTOLOGOUS STEM CELL TRANSPLANTATION FOR AGGRESSIVE NHL: CLINICAL CHARACTERISTICS AND FACTORS PREDICTING OUTCOME Shane Gangatharan, MD 42 ISOLATED PENILE MEATAL CHRONIC GVHD IN A BOY FOLLOWING ALLOGENEIC TRANSPLANT FOR JMML Carol Spicer, RN, BN 43 ESCALATED DOSE-TOTAL BODY IRRADIATION (8GY) FOLLOWED BY AN ALLOGENEIC CELL TRANSPLANTATION FOR THE TREATMENT OF REFRACTORY ACUTE MYELOID LEUKEMIA: EARLY RESULTS Sultan Altouri, MD 44 PRE-TRANSPLANT REMISSION STATUS AND USE OF PERIPHERAL BLOOD STEM CELLS CONTRIBUTE TO LONG-TERM OUTCOME AFTER MYELOABLATIVE ALLOGENEIC TRANSPLANT FOR MULTIPLE MYELOMA Imran Ahmad, MD Poster Group 5: Clinical Trials and Observations Abstracts Saturday, June 4, 204 3:00pm 3:5pm Fundy Room # Title Presenting Author 45 AN EXPLORATION FOR A MINIMUM CD34+ DOSE FOR MULTIPLE MYELOMA PATIENTS AGED 65 TO 7 BASED ON AN ASSOCIATION BETWEEN CD34+ DOSE AND LONG-TERM PLATELET COUNTS FOLLOWING HIGH DOSE THERAPY Ronan Foley, MD, FRCPC 46 WHEN AN UNEXPECTED EVENT CHANGES TRANSPLANT INTO FAITH: THE UNTOLD STORY OF CBMTG 060 Imran Ahmad, MD 47 HIGH PROGRESSION-FREE SURVIVAL AT 0 YEARS AFTER TANDEM AUTOLOGOUS/NONMYELOABLATIVE ALLOGENEIC TRANSPLANT FOR MULTIPLE MYELOMA: IMPACT OF DISEASE STATUS AND CHRONIC GVHD Imran Ahmad, MD 48 PSEUDOTUMOR CEREBRI ASSOCIATED WITH ALL-TRANS RETINOIC ACID TREATMENT IN FEMALE PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA: A CASE SERIES Mohamed Ali, PharmD 30

31 49 POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME ASSOCIATED WITH CYCLOSPORINE USE IN A CHILD UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM CELLS TRANSPLANTATION FOR FANCONI ANEMIA: A CASE REPORT 50 FIRST LINE TYROSINE KINASE INHIBITORS (TKIS) THERAPY IN CHRONIC MYELOID LEUKEMIA AT THE CANCER PROGRAM OF WINDSOR REGIONAL HOSPITAL ( ) Mohamed Ali, PharmD Caroline Hamm, MD Non-Presenting Abstracts # Title Topic Author 5 ENHANCING HEALTHCARE PROFESSIONALS AWARENESS AND UNDERSTANDING OF PSYCHOSOCIAL DISTRESS AMONG SPOUSAL CAREGIVERS OF HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS: A ROLE FOR DIGITAL STORIES AND ILLNESS NARRATIVES 52 EXPLORING THE CONCEPT OF WAITING AMONG SPOUSAL CAREGIVERS OF HSCT PATIENTS: THE BETWIXT AND BETWEEN 53 THE EXPERIENCE OF SEXUALITY IN INDIVIDUALS WHO HAVE UNDERGONE HEMATOPOIETIC CELL TRANSPLANTATION 54 THE DEVELOPMENT OF AN ADULT BLOOD AND MARROW TRANSPLANT SURVIVORSHIP CLINIC Pharmacy, Nursing, and other transplant support Pharmacy, Nursing, and other transplant support Pharmacy, Nursing, and other transplant support Pharmacy, Nursing, and other transplant support Brenda Sabo, RN, PhD Brenda Sabo, RN, PhD Reanne Booker, MN, BScN Reanne Booker, MN, BScN. THE UBC STEM CELL CLUB: IMPROVING THE QUALITY AND QUANTITY OF MEMBERSHIP ON CANADA S STEM CELL DONOR DATABASE Fingrut W, Charman E., Sokalski K, McIntyre M, Boudreau K, Hicks R, Li C, Subedi M University of British Columbia, Vancouver, BC, Canada Background Many patients with blood diseases require a hematopoietic stem cell transplant as part of their treatment, and frequently rely on unrelated donors. Canada s stem cell donor-database is used to match potential donors to patients in need. Individuals age 7-35 can register to join this database online or at stem cell drives, where they provide consent and swab their cheeks to provide a tissue sample. Patients are more likely to match to a donor in their own ethnic group. Additionally, young, male donors are preferred, as they improve recipient outcomes. However, males under age 35 only represent 2% of the current Canadian donor-database (5% non-caucasian males). The UBC Stem Cell Club was founded two years ago, aiming to increase membership on the stem cell donor-database and address the need for young, ethnically-diverse, and male registrants. training emphasizing target demographics and informed consent. were compiled from post-event reports. We have coordinated 2 stem cell drives and recruited 2309 potential stem cell donors. Our university drives in Metro Vancouver, Victoria, Prince George, and Kelowna have signed up 9, 434, 95, and 87 registrants respectively. Our community drives have recruited 457 registrants. From November 202-February 204, 73.5% of the 22 registrants recruited at our university drives were male. From October 203-February 204, of the 8 males recruited at our university drives, 34.7% self-reported as non-caucasian and 86.4% were under age 25. Our rural drives recruited 28 Aboriginal males under age 35, increasing the representation of this demographic group on Canada s database by up to 5.5%. The UBC Stem Cell Club recruits Canadians to become stem cell donors. Our drives improve the quantity and quality of membership on Canada s stem cell donor-database. Methods The UBC Stem Cell Club is a community partner of OneMatch. We run stem cell drives across British Columbia. Our volunteers complete 3

32 2. IMMUNIZATIONS POST-HCT: A CROSS-CANADA EVALUATION McGillis L, Deotare U, Kumar D,2, Seftel M,2 Princess Margaret Cancer Centre, and 2 The University of Toronto Introduction Immunization of recipients of HCT is an important element of posttransplant care. Despite the existence of national guidelines, the approach to post HCT immunization in Canadian HCT centres is unknown. Our goal was to understand the type, timing and uptake of vaccinations being provided to Canadian HCT recipients. Main Thesis We performed a survey of post HCT immunization schedules from all Canadian HCT centres. We asked for details of () type and schedule of vaccines (2) logistics of vaccine administration (3) proportion of patients actually receiving vaccination, and (4) suggestions for improvement in practice. We compared Canadian HCT centre immunization schedules with guidelines from the CDC (203), EBMT (202) and NACI (203). Summary Surveys were returned from 0/3 (77%) HCT centres. In general, immunization timing and choice of vaccine fell within recommended guidelines. Recommendations for Meningococcal, HPV, and Varicella vaccines varied between centres. All centers recommended pneumococcal vaccines although timing of Pneumococcal vaccines varied more frequently between centres than other vaccines. Most immunizations were given by family physicians or the community health team. The majority of centres provided patients with a letter and schedule asking the patient to assume responsibility of receiving vaccines. Most centres reported having a poor understanding of how many of their patients were receiving immunizations. Funding of vaccines from a provincial level varied amongst centres which may account for variations in practice. Vaccination practices were similar to recommendations by CDC/EBMT/NACI. We found substantial variation in post HCT immunization practice at Canadian HCT centres. The measurement of vaccine uptake remains a challenge for most HCT centres. As vaccine preventable diseases pose a threat to the health of HCT recipients and represent a public health priority in Canada, we recommend the development of uniform vaccine schedules, reimbursement practices, and measurement of immunization compliance. 3. TRANSITIONING FROM PEDIATRIC TO ADULT CARE POST ALLOGENEIC HSCT: A QUALITY IMPROVEMENT INITIATIVE L Mcgillis, C Armstrong 2, A Gassas 2,3, A Gascadi 2, S Courtney 2, J Lowry 2 Princess Margaret Cancer Centre, Toronto; 2 The Hospital for Sick Children, Toronto, and 3 The University of Toronto Introduction Princess Margaret Cancer Centre (PMC) and The Hospital for Sick Children (HSC) teamed up to improve pediatric to adult transition for adolescent HSCT survivors and identify late health effects for adolescents post -HSCT. Thesis Adolescents post allogeneic HSCT often have chronic and complex medical needs and unique challenges navigating the health care system as they transition from pediatric to adult health care models. PMC and HSC worked to improve transition care by identifying gaps in the current transition model, identifying common medical concerns for adolescents post-hsct and an assessing how and why patients are lost during transition. Summary Since 2005, 27 patients transitioned from HSC to PMC. Ongoing health care needs include osteopenia, AVN, secondary malignancy, endocrine dysfunction, and significant chronic GVHD requiring therapy amongst others. Through a review of charts we discovered 9% of patients were lost to follow-up during the currently practiced transition process. Needs assessment led to development of check-lists of important information to be sent from HSC to PMH, receiving and reviewing of referrals by Nurse Practitioner, education pamphlets for patients and families, earlier discussions with patients regarding transition, and in-hospital meetings with patients at HSC prior to transition. These initiatives led to improved communication between HSC and PMC, fewer clinic visits for patients, and no patients lost to follow up for their initial appointment since starting the new transition process. Childhood HSCT survivors are at risk of developing late complications post-hsct. Patients must remain closely monitored by a transplant specific team to assess and treat late effects as they occur. Poorly transitioned adolescents may be less likely to follow-up with the transplant team leading to inappropriate management of long-term late complications post-hsct. Our new transition model aims to solidify and improve patient transition leading to improved satisfaction and overall quality of care of adolescent HSCT survivors. 32

33 4. THE IMPACT OF MATCHING PATIENT NEEDS TO NURSING RESOURCES: LESSONS LEARNED FROM APPLYING THE SYNERGY MODEL IN A HEMATOLOGY/HSCT UNIT Amenudzie, Y, O Sullivan L, Georgiou G, Ho E 2, Heelam E, Hematology/Hematopoietic Stem Cell Transplant Program, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, 2 Performance & Improvement, Hamilton Health Sciences Introduction The Hematology/Hematopoietic Stem Cell Transplant (HSCT) Program at the Juravinski Hospital and Cancer Centre identified a unique opportunity to enhance patient care and the work environment by piloting the Synergy Model (Curly, 2007), a professional practice framework which involves assessing patient acuity and making assignments based on a fit between patient needs and staff competency. Published research suggests the models patient-centered philosophy optimizes patient outcomes, enhances collaboration and teamwork around the common goal of better care provision, provides a unified language for discussing care and measuring patient acuity, helps teams make objective decisions about staffing assignments, and helps administrators establish staffing levels for effective patient care and workload management. The model has been shown to be beneficial in various health care settings, but has yet to be applied with a hematology/hsct patient population. Thesis A pilot project was undertaken to examine the adaptability, applicability, and effectiveness of the Synergy Model in a Canadian inpatient hematology/hsct setting. Summary A previously developed toolkit was used to build a hematology/ HSCT patient acuity tool which measures patient complexity, stability, predictability, and participation in care. An interrater reliability analysis of the tool revealed high internal consistency (4 items, α > 0.7) and moderate rater agreement(kappa= 0.68, p <.05). A nurse competency assessment was developed using the Canadian Association of Nurses in Oncology practice standards. Processes were created for scoring patient acuity, making patient assignments, and for making decisions about staffing levels. The tool and processes were piloted starting in October 203. The Synergy model can be adapted and applied to a hematology/hsct population. We will share the processes used to adapt and implement the model as well as key enablers and barriers to implementation. By April 204 we will have a detailed analysis of the model s impact on the unit. These findings will be presented. 5. BONE LOSS IS SEEN AS EARLY AS 00 DAYS IN PATIENTS POST ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANT Pajerksi, B., Broady, R.,2, Kendler D. 2,3 University of British Columbia. Leukemia/BMT Program of British Columbia, 2. Department of Medicine, University of British Columbia 3. Prohealth Clinical Research Centre Introduction Bone loss is a common complication for survivors of allogeneic haematopoietic stem cell transplant (HSCT); osteoporosis is reported in up to 50% of transplant recipients. Multiple risk factors contribute to bone loss including chemotherapy, radiotherapy, GVHD, gonadal failure and glucocorticoid use. Older age, poor nutrition, weight loss and physical inactivity also increases the risk for declines in bone mineral density (BMD) in this population. Previous studies have demonstrated that bone loss occurs within the first 6-2 months after HSCT; the appropriate time to initiate BMD testing is not known. Delay in BMD testing may delay needed preventative strategies in patients who may already have or be at risk for osteoporosis. Aim Few studies have addressed early changes in BMD in the 00 days post HSCT. BMD testing before and early after HSCT could identify both patients with low pre-existing bone density and those with rapid loss post transplant and allow for early interventions to prevent or reverse bone loss. Methods We reviewed charts of patients who underwent an allogeneic HSCT between 20 and 203. BMD was measured at the lumbar spine, total hip, and femoral neck using dual energy x-ray absorptiometry (DXA) before HSCT and at day 00 post HSCT. Risk factors for osteoporosis were evaluated, including personal history of fracture, family history of hip fracture, alcohol, smoking, rheumatoid arthritis, weight changes, transplant conditioning therapy, and history of steroid use. A total of 9 patients, 56 male and 35 female were reviewed. Mean age was 48. The hematologic diagnoses were AML: 35; ALL; 4; CML: 7; CLL: 0; NHL: 9; RAEB: 5; other:. At day 00 post HSCT patients experienced a mean decline of 3.27% ± 4.9% in lumbar spine BMD, 4.43% ± 4.83% in total hip BMD and 4.53% ± 5.25% in femoral neck BMD (P = < for lumbar spine, total hip, and femoral neck). The 42 patients who received glucocorticiods for GVHD had a significantly greater decline in BMD at the total hip (5.79% vs. 3.27% p=0.02) and femoral neck (5.96% vs. 3.27% p=0.05) sites compared to the patients not receiving glucocorticoids. Weight changes over the first 00 days post transplant were not significantly associated with changes in BMD. Since least significant change in BMD at a good DXA facility 33

34 may be around 3%, we queried how many patients had a significant decline in BMD over the 00 days post transplant. At spine, 46 patients (50.4%); at total hip 56 patients (6.5%); and at femoral neck 55 patients (60.4%) had a greater than 3% decline. Discussion We demonstrate that HSCT recipients have significant declines in both hip and spine BMD in the 00 days post-allogeneic HSCT. The declines in femoral sites imply rapid cortical bone loss as well as the expected trabecular bone loss.. Early detection of changes in BMD may help to target osteoporosis therapies to patients at the greatest risk of bone loss and eventual fracture. 6. MULTIDISCIPLINARY CARDIOONCOLOGY REVIEW PRIOR TO AUTOLOGOUS SCT Cox-Kennett N, Paterson I 2, 3, Sandhu I,2, Venner C, 2, Becher H 2, 3, Pituskin E, 2. Cross Cancer Institute, Edmonton AB, 2 University of Alberta, Edmonton AB, 3 Mazankowski Alberta Heart Institute, Edmonton AB Background Cancer patients (PTS) referred for autologous bone marrow transplantation (autobmt) are frequently pre-treated with established cardiotoxic medications including cyclophosphamide, anthracyclines and kinase inhibitors. As a result, PTS may not have adequate cardiac function to meet eligibility criteria for potentially lifesaving autobmt. Furthermore, with mobilizing and consolidation chemotherapy, PTS receive serial exposures to cardiotoxins, with acute and long-term negative cardiac sequelae. Accordingly, these PTS represent a population with a major unmet need for appropriate screening and interventions. Aim: to determine the effects of a prospective multidisciplinary cardiooncology assessment and intervention in an unselected patient population referred for autobmt. Methods Between January, 203 December 3, 203, PTS referred for autobmt were systematically screened for comorbid conditions, cardiovascular risk factors and eligibility for transplant. All underwent complete physical assessment, laboratory (ECG, complete profile) and transthoracic echocardiogram with contrast. Those with EF < 50%, increased IVsd/LVpWd, ECG abnormalities +/- significant cardiac history also received probnp and high sensitivity troponin testing. PTS with abnormal findings or decreased left ventricular (LV) function were referred to the Edmonton Cardio-Oncology REsearch (ENCORE) program. ENCORE is a novel multidisciplinary & multispecialty rapidaccess program of oncology, cardiology and allied health disciplines. 73 unique PTS were screened by the Edmonton autobmt program. Of these, 6 (20%) were reviewed by ENCORE. Reasons for referral included: decreased LV function (n = 6, 38%); increased IVsd (n = 5, 3%); arrhythmia (n = 4, 25%); angina (n =, 5%). Pharmacotherapy was initiated for 6 PTS; additional modality or serial cardiac imaging for 2 PTS; urgent stent for PT. 00% of PTS proceeded to autobmt. s As a result of systematic screening, a high proportion of PTS referred for autobmt received assessments and cardio-oncology interventions, with all PTS subsequently proceeding safely through transplantation. ENCORE represents a novel approach in the provision of cardiooncology expertise for autobmt PTS acutely during the mobilizing and transplantation period. Future examination of our prospective dataset will elucidate the longer term effects of our interventions. 7. EVALUATING THE BENEFITS OF TRANSITIONING FROM INTRAVENOUS TO SUBCUTANEOUS RITUXIMAB FOR ALBERTA CANCER PATIENTS Cherie C. Severson RN, MN, CON(c). Tom Baker Cancer Center, Calgary Alberta, Canada. Introduction A novel approach to treating cancer in the settings of Non-Hodgkin s Lymphoma (NHL) and Chronic Lymphocytic Leukemia (CLL) is the use of a subcutaneous (SC) injection of Rituximab (in addition to standard combination chemotherapy). Currently in Alberta, Rituximab is given intravenously (IV) in addition to standard combination chemotherapy. The infusion doses can take hours and patients are at risk for hypersensitivity reactions. Main Thesis Alberta cancer patients can safely benefit from the administration of subcutaneous Rituximab in numerous ways while still ensuring efficacy and optimal treatment for their cancer. Summary Review of the American literature revealed several studies indicating the benefits of SC Rituximab. BP22333 Stage (Spark Thera trial) revealed pharmacokinetic results of Rituximab concentrations on day 28 in NHL patients administered 625mg/m2 SC were comparable to those in patients administered the standard IV dose of 375mg/m2. A fixed dose of 400mg SC Rituximab is expected to achieve non-inferior C-trough and AUC levels compared with the standard Rituximab IV dosing of 375mg/m2 for NHL. The SABRINA study reports Rituximab SC delivers comparable efficacy to IV administration. The results revealed an ORR 54% (IV+ chemo) versus 57% (SC + chemo); CR 9% vs 29% 34

35 respectively and PR 35% versus 37% respectively. The safety profiles of Rituximab SC and IV are comparable. However the administration related reactions (ARR) were higher in the SC arm than the IV arm (3% versus 4% respectively). ARRs reported include local erythema (3%), local injection site erythema (5%), myalgias (5%), vomiting, puritis and chills (3-6%). The majority of events were reported as mild and reversible. The Sawyer B02534 Phase b study shows non-inferior pharmacokinetics and comparable safety profiles of Rituximab SC to Rituximab IV in CLL patients receiving combination (FC) chemotherapy. This study further reports a fixed dose of Rituximab 600mg SC is non-inferior to 500mg/m2 of Rituximab IV. Although the ARR profile is higher with the patients who received SC Rituximab, the severity of the ARRs reported are erythema and transient injection site reaction. A higher incidence of neutropenia was reported in the patients receiving Rituximab IV. A follow up questionnaire clearly indicated from both patients and nurses that the preferred route of administration is SC injection. Saler et al., reports relative reductions in mean chair time, reduced pharmacy preparation time and increased ability to improve the number of other patients that can be treated increasing a facility s overall efficiency by administering Rituximab SC versus Rituximab IV. This is supported by De Cock et al. time and motion study compiled by 8 different countries highlighting the benefits of subcutaneous administration of Rituximab. To date SC Rituximab is non-inferior and has a comparable safety profile when compared to IV Rituximab. A SC injection of Rituximab could have many benefits for Alberta cancer patients including reduced wait times for patients and families, reduced health care provider time related to administration and supplies, reduced drug preparation time for pharmacists, and increased availability of space for other patients needing cancer treatments overall improving efficiency in a Cancer Center. These benefits are possible ensuring efficacy and optimal treatment of the patient s disease. Limitations: Currently no clinical trials in Alberta related to the administration of Rituximab SC. Limited Canadian studies. 8. EXTRACORPOREAL PHOTOPHERESIS IN A pediatric AMBULATORY SETTING: ESTABLISHING A NURSING PROTOCOL FOR CARE Christine Armstrong, RN(EC), NP/Pediatrics,2, Anna Gascadi, RN, BScN, Jane Lowry, RN Blood and Marrow Transplant Program. The Hospital for Sick Children, Toronto, Ontario, 2. Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto Abstract Body Often used in many adult treatment settings such as the protocol for T-Cell Lymphoma, Extracorporeal photopheresis (ECP) has in recent years become a viable treatment option for some pediatric patients requiring treatment for both acute and chronic Graft vs. Host (G vs. H) disease. It has been demonstrated to be safe and efficacious offering clinical benefits for refractory graft vs. host disease particularly but not limited to the skin. Limited experience and data however, is available re: a treatment protocol for children. We now frequently treat children in our outpatient clinic with ECP, many who travel from referral centres, which has necessitated the need to address specific pediatric and resource implications. This includes working together with the interdisciplinary team in the pre procedure planning to identify potential issues both procedure and patient specific. Issues related to patient selection, venous access, diet, medication adjustment and maintenance of adequate blood counts must be assessed and addressed. The role of nursing is additionally important in both the pre and post treatment family teaching in order to maintain patient safety. Ongoing liaison and coordination with the multiple services involved and advocating for the patient and family have been essential for successful implementation of the schedule of treatments due to both the significant length and psychological impact of treatment protocols. Objectives include a brief overview of chronic G. vs. H. disease together with mechanisms of action of ECP, discussion of patient selection, pre and post procedure treatment complications and patient and family teaching necessary for the safe implementation of a course of ECP therapy. 9. IDENTIFICATION AND MANAGEMENT OF GLUCOCORTICOID-INDUCED HYPERGLYCEMIA ON A BONE MARROW TRANSPLANT WARD: A QUALITY IMPROVEMENT INITIATIVE Aw A, Dutton H 2, Malcolm J 2, Keely E 2, Tay J,3 Division of Hematology, The Ottawa Hospital; 2 Division of Endocrinology, The Ottawa Hospital, and 3 Ottawa Hospital Research Institute Background Hyperglycemia in malignant hematology inpatients has been associated with increased adverse events. Glucocorticoids (GC) are commonly used to treat hematologic malignancies, increasing the likelihood of hyperglycemia. Studies identifying quality interventions in this setting are lacking. Methods We performed a retrospective review of all admissions to the Bone Marrow Transplant (BMT)/Malignant Hematology ward at The Ottawa Hospital between September to November 30, 202 to document current practices for identifying and managing GC-induced hyperglycemia. Admissions were included if at least one dose of GC was given during hospital stay. We assessed ) glucose monitoring strategies, 2) glycemic control quality and 3) hyperglycemia therapies during the first 7 days of GC use, and up to 24 hours post discontinuation. Associations between 35

36 adverse events of infection, readmission, or Emergency Department visit within 30 days of GC initiation were assessed using regression analyses. We identified 77 encounters: median age 57, commonest diagnosis acute leukemia (3%), and stem cell transplant most frequent reason for admission (9%). At least one glucose measurement was performed in 95% of cases. Scheduled qid point-of-care testing (POCT), correctional scale insulin, and scheduled basal or prandial insulin were ordered in 9%, 4%, and 3% of admissions respectively. Average fasting glucose was < 6. mmol/l in 38%, mmol/l in 57%, mmol/l in 3%, and > 4.0 mmol/l in.5%. In the 48 admissions with at least one glucose measured in the non-fasting state, 0% had an average non-fasting glucose greater than 0.0 mmol/l. There were 4% and 0% of admissions with hypoglycemic (<4.0 mmol/l) and extreme hyperglycemic (>4.0 mmol/l) events respectively. No associations between fasting glucose and adverse events were identified. GC-induced hyperglycemia is common in patients admitted to the BMT ward. Only 9% of cases had scheduled qid POCT. The Canadian Diabetes Associations recommends glycemic monitoring for at least 48 hours in patients started on GC, identifying a practice gap. Our local audit provides a foundation for future Quality Improvement interventions. 0. COUNT RECOVERY AND VIABILITY AFTER SERIAL REFREEZING OF CRYOPRESERVED STEM CELL GRAFTS Jamal N, Alvarez M, Lopez-Perez O, Bardia D, Yasay J, Messner HA Princess Margaret Cancer Centre, University Health Network, Toronto Rationale and Study Objective The integrity of cryopreserved stem cell grafts may be compromised by equipment failure resulting in unplanned thawing of products, breakage of the container or other events that may delay the infusion of an already thawed product. Viability of thawed products declines within 24 hrs. to levels that do not facilitate engraftment. We investigated the question of whether or not viability of a thawed stem cell product could be sustained by rapid re-freezing. Methodology The study was performed using a pair of products from 5 patients cryopreserved in the vapor phase of liquid nitrogen for 6, 2, 0 and 9 (x2) years. The grafts were not further required for infusion into the intended recipient and released with consent for the purpose of this investigation. The products were thawed following standard procedure and serially re-frozen. One of the pairs was cryopreserved in a mechanical freezer at -86 C, the other at -80 C in the vapour phase of liquid nitrogen. Viability was evaluated after each thaw by Trypan- Blue staining. The thawing and re-freezing procedure was repeated 7 0 days after the first thaw. Four of the pairs were subjected to a subsequent final thaw days following the initial thaw. Viability studies were completed after each thaw and reported as the proportion of viable cells that were initially cryopreserved. Four of the 5 pairs demonstrated a high degree of consistency with respect to viability at first thaw (70 85%). There was a significant discrepancy in one pair that had been cryopreserved for 6 years (75 and 40%). The mean viability after the initial thaw was 74%. The recovery after re-freezing for 7 0 days declined to approximately 60% of the original cryopreserved cell number (Table ). A further reduction of viability to approximately 42 % was observed at the third thaw. The viability was similar after re-freezing at - 86 C and -80 C. Cell viability of control samples kept at room temperature or 4 C dropped to less than 5% within 24 hrs. Post Thaw (Mean %) Cell viability* Re-frozen at Post Thaw 2 (Mean %) Post Thaw 3 (Mean %) 74 (40 85) -86 C 67 (60 75) 46 (4 50) -80 C 57(20 75) 4 (5 58) *The Mean and Median viability of 9 independent control samples at thaw before infusion was 7.5 and 72 % respectively. s Previously cryopreserved stem cell products with prolonged storage intervals of 9 to 6 years at -80 C can be serially re-frozen with a reasonable recovery of viable cells. The yield is independent of the respective refreezing temperature of -86 C and -80 C, and is substantially higher than that observed after storage at room temperature or at 4 C. Rapid re-freezing of a compromised thawed stem cell product might represent an effective strategy to salvage sufficient cells for successful engraftment. At this time there are no clinical data available.. COLLECTION EFFICIENCY IN STEM CELL COLLECTIONS: EXPLORING FACTORS AFFECTING COLLECTION EFFICIENCY Cojocari E, Clarke S,2, Messner H 2 Apheresis Unit, Princess Margaret Cancer Centre, University Health Network, Toronto; 2 Blood & Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada Background In many stem cell collection centres, the decision-making process of planning an apheresis stem cell collection involves first an estimation of the CD34 + cell yield. The ability to accurately predict as to the CD34 + cell yield using a formula 36

37 is important to ensure an optimal collection procedure. However, some stem cell collections may unexpectedly result in poor CD34 + cell yields, due to low collection efficiency (CE). The current methods to estimate stem cell yield typically are inadequate in predicting when collection efficiency will be less than optimal as they are based on pre-cd34 + cell counts, volume of processed blood and the donor s weight. Current formulas do not adjust for other factors which could influence collection efficiency. Methods The goal of this study was twofold: ) to identify the most probable factors which may contribute to low stem cell collection efficiency and 2) to develop a decision making algorithm in order to improve predictions of CD34 + yield. To explore these issues, we undertook a retrospective study of allogeneic and autologous stem cell collections which were harvested with two types of apheresis systems at a large apheresis unit at the University Health Network, Toronto, Canada. A total of 0 consecutive apheresis procedures were performed on 78 donors/patients. We analyzed the interactions between CE and the following variables: type of apheresis system utilized (Cobe Sprectra versus Spectra Optia ), donor type (autologous, allogeneic), diagnosis, age, sex, weight, mobilization method (granulocyte-colony-stimulating factor with or without chemotherapy), peripheral blood CD34 + cell concentration, total processed blood volume, hematocrit, white blood cell, platelets count, and mean inlet rate. Our preliminary results demonstrate that CD34 + cell CE may considerably vary from one stem cell collection to another when comparing the COBE Spectra (Mean 46.8 %, SD 5.) to the Spectra Optia (Mean 52.4 %, SD 3.7) apheresis systems. 2. ENUMERATION OF CD34+ CELLS USING AN ACCURI C6 CYTOMETER Simard C, Cloutier M, and Néron S Research and development, Héma-Québec, Quebec City, QC. CD34+ cell enumeration by flow cytometry: a comparison of two Health Canada approved kits analyzed on an Accuri C6. Background Enumeration of CD34+ cells in umbilical cord blood, bone marrow or peripheral blood is an important data for critical clinical choices in stem cell transplantation therapy. Single platform cytometry assays have become the primary option for stem cell enumeration. The purpose of this study was to assess the feasibility of using commercial kits from BD and Beckman Coulter on an Accuri C6 cytometer for the enumeration of CD34+ cells in umbilical cord blood. Methods The Stem Cell Enumeration Kit from BD and the Stemkit from Beckman Coulter were used to stain either a solution of blood doped with known quantities of CD34+ cells or a commercial stabilized leucocytes solution containing validated concentrations of CD34+ cells (Streck CD-Chex CD34). Stained samples were analyzed on an Accuri C6 cytometer according to the ISHAGE protocole. The staining with both kits resulted in stable, sensitive, reproducible and specific results when analyzed on the Accuri C6. The regression analysis gave R-square values of and for the Beckman Coulter and BD kits, respectively. Staining of the CD-Chex CD34 resulted in numbers of CD34+ cells inside the range given by the manufacturer. In conclusion, both the BD and Beckman Coulter kits, coupled with the cytometer Accuri C6, allow the quantification of CD34+ in a range of concentrations corresponding to the three major sources of stem cells. This presentation will describe our analysis and proposal of a decision making algorithm which would assist apheresis clinicians to maximize collection efficiency and thus improving the overall quality of stem cell collections. 3. ANTIMICROBIAL ACTIVITY IN CORD BLOOD UNITS: OCCURRENCE AND LEVELS OF ANTIBIOTICS Marie-Pierre Cayer, Mélissa Girard, Diane Fournier 2, Gilles Delage 3, Louis Thibault Héma-Québec, Research and Development, Quebec (QC), Canada, GV 5C3; 2 Héma- Québec, Public Cord Blood Bank, Montreal (QC), Canada, H4R 2W7, and 3 Héma-Québec, Medical Affairs, Montreal (QC), Canada, H4R 2W7 Purpose Antibiotic prophylaxis treatment at delivery is highly recommended for reducing the risk of infection for mothers positive for group B streptococcus. It is therefore expected that some cord blood (CB) 37

38 products will contain residual antibiotics. This study aimed to determine the incidence and level of β-lactam antibiotics in CB products. Methods The antimicrobial activity of 60 CB plasma by-products was evaluated using disk diffusion assays on 0 bacteria species. Plasma samples showing antimicrobial activity were either treated with β-lactamase enzyme to inhibit β-lactam antibiotics or heated to 56 C for 30 minutes to inhibit complement proteins. β-lactam antibiotic concentrations were determined in these plasma samples and in 5 samples of final stem cell concentrate by comparison with a standard curve obtained with known concentrations of antibiotics. Antimicrobial activity, mostly against Gram positive microorganisms, was observed in 33% of CB units. The β-lactamase enzyme abolished the antimicrobial activity in the majority of these CB products whereas the inhibitory activity remained after heating at 56 C, indicating that complement proteins are not involved. Up to 5 µg/ml of penicillin and 4 µg/ ml of ampicillin were measured in CB plasma and in stem cell concentrates. About one third of CB products can contain significant amounts of plasma with residual antibiotics which can affect the survival and growth of bacterial contaminants when performing sterility testing and potentially lead to false negative results. Additional work is required to better understand whether residual antibiotics in cord blood affect penicillin-allergic patients. 4. OPTIMIZING THE USE OF G-CSF FOLLOWING AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANT FOR HEMATOLOGIC MALIGNANCIES: AN ANALYSIS OF CANADIAN PRACTICE Hillis C, Brown M 2, Walker I,2 Department of Medicine, McMaster University and 2 The Juravinski Hospital and Cancer Centre Objective To determine Canadian practice patterns for the use of granulocyte colony stimulating factor (G-CSF) after autologous hematopoietic stem cell transplant (HSCT) for hematologic malignancies in adults. Rationale There are guidelines and meta-analyses of randomized controlled trials that support the use of G-CSF following autologous HSCT to reduce both length of hospital stay and post-transplant morbidity. It is unclear, however, what day following stem cell reinfusion (day 0) is optimal for starting G-CSF to balance clinical benefit and minimize costs. Previous studies have shown no difference in post-transplant stay and complications for groups with early (day 0 or +) vs delayed (day +5) administration of G-CSF. At our centre alone delaying G-CSF administration by 2 days (changing from d+5 to d+7) could potentially save $33,800-$54,08 annually. Prior to instituting a practice change, we sought to determine if a standard regime for G-CSF following autologous HSCT exists across Canada and major centres in the United States. Methodology All adult centres performing autologous HSCT for hematologic malignancies in Canada were electronically polled along with selected major US centres. Descriptive statistics were performed using Microsoft Excel. Data was collected from 4 Canadian centres and 7 US centres. 7/2 (33%) do not routinely use G-CSF following autologous HSCT. Of the Canadian centres routinely using G-CSF post-transplant: 3/9 start on day +5 and 6/9 on day +7. Weight-based with a cap of 300/480mcg was the most commonly reported dosing method. The decision to stop G-CSF is based on neutrophil recovery in all centres. s Despite evidence and guidelines that support the routine use of G-CSF following autologous HSCT for hematologic malignancies there is marked heterogeneity in practice. The most common dosing regimen reported is to start d+7 with a capped weight-based dose and to stop when the ANC is greater than.5. However, this protocol represents only one-third of reporting Canadian centres. Future work needs to be directed to determine if variation in practice results in clinically meaningful outcomes. 5. INFECTION PREVENTION AND CONTROL RELATED TO RESPIRATORY VIRAL ILLNESS IN HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) RECIPIENTS: THE OTTAWA HOSPITAL EXPERIENCE FROM Landry C, Hamelin L, Duke K 2, Bruce N 3 ; Doyle T 3 ; Roth V 3, Bredeson C The Ottawa Hospital Blood and Marrow Transplant Program; 2 The Ottawa Hospital Cancer Centre; 3 The Ottawa Hospital Department of Infection Control. Introduction Respiratory viral illnesses (RVI) can present a significant cause of morbidity and mortality in the immunocompromised HSCT recipient. The onset of RVI correlates with the prevalence of viruses circulating in the community. In order to avoid an outbreak defined as any hospitalacquired case of RVI on the 24 bed Blood and Marrow Transplant (BMT) unit of our adult transplant program, interventions (quality initiatives) were required to ensure patient health and safety was not compromised. An interdisciplinary committee was established to review 38

39 current practices and develop a standardized approach to managing patients during peak season. Specifically, modifications have been made to () patient environment; (2) staff and patient education; (3) the program approach to staff vaccination; (4) existing processes to prevent nosocomial outbreaks and reduce instances of microbial transmission. Summary In 2008 our program experienced an outbreak of parainfluenza-3. Total instances of RVI in patients post-hsct equaled 2/7 (0.2%), with /3 of those requiring ICU admission linked to RVI and 3 deaths attributed to RVI-related complications. Measures indicated in Table were implemented between 2009 and 202. Annual instances of RVI in HSCT patients transplanted annually from 2009 to 202 were 7/23 (5.69%), 2/07 (.87%), 5/9 (4.20%), and 8/08 (7.4%) respectively. Table. Modifications implemented by program to reduce microbial transmission and avoid escalation of nosocomial outbreaks. Patient Environment Initiative BMT day program private rooms reserved in low traffic area of wing Transitioned to secured unit with visitor screening Medical day care unit (MDCU) moved offunit to limit traffic on unit Outpatient waiting room modified with glass barriers Education Additional patient education provided, including letters to patients/caregivers Education module given to nurses Vaccination Mobile flu shot clinics; posters; stations outside cafeterias; newsletter communication Weekend flu shot clinics for family/staff All BMT caregiver/family members encouraged strongly to get flu vaccine, administered by BMT program when required in outpatient clinics Process Improvement Increased collaboration/communication with hospital infection control on emergent trends Development of guidelines/action plan for staging outbreak scenario Febrile Respiratory Illness (FRI) screening tool implementation Fast turnaround pre-bmt nasopharyngeal swab (NPS) screening, with BMT delay if needed Increasing constraints with bed availability and a growing number of patients eligible for HSCT underscored the importance of developing a strategy in order to avoid a closure of the BMT unit (crisis). No outbreaks have been reported on our unit during the current 204 flu season. Continued vigilance and future monitoring of trends associated with community respiratory outbreaks will complement our efforts to reduce the burden of RVI transmission in order to lower the incidence of RVIassociated morbidity and mortality at our centre. 6. THE HEMA-QUEBEC PUBLIC CORD BLOOD BANK (CBB): DISTRIBUTION AND CLINICAL OUTCOMES OF TRANSPLANTED UNITS Joron S, Fournier D, Pelletier G, Richard L, Chevrier MC, Champagne M Héma-Quebec Public Cord Blood Bank, Montreal, Québec. Introduction Héma-Quebec s CBB was established in 2004 to increase transplant accessibility in both Canada and worldwide. The Héma-Quebec CBB has both FACT-NETCORD and ASHI accreditation as well as NMDP IND licensing. Our CBUs have been recently added to the BMDW international database as of October 202. Recently, the aim of our CBB has been to increase ethnic diversity, as well as increasing the number of CBUs with high TNC. Non-Inherited Maternal Antigen (NIMA) HLA typing was also introduced march 203. Methods Qualification is based on a questionnaire that identifies risk factors for infectious and genetic transmissible diseases. Cell count criteria range between, x 09 TNC (non-caucasian) and,3 x 09 TNC (Caucasian) based on ethnicity. CBUs are plasma and red cell reduced (Optipress II) and cryopreserved in 0% DMSO with a target volume of 25mL. HLA-A, B and C are typed at intermediate/high resolution, DRB at high resolution. Clinical outcome information was volunteered directly by transplant centers and via CIBMTR. As of January st, 204, 5 units have been distributed for 47 patients (26 pediatrics and 2 adults). In 203, our CBB has distributed 26 CBUs in 8 countries: 6 in Canada; 0 in the United-States; 9 in Europe and in South America. 2 out of the 5 units were used for single unit transplants and 22 for multiple CBU transplants (8 unknown). Post-processing median cell dose of distributed units is 7,0 x07 TNC/kg (median of 9,8 x07 TNC/kg for pediatric patients; median of 2,9 x07 TNC/kg for adult patients) and median viable CD34+ count is 3,8 x05 CD34+/kg (median of 5, x05 CD34+/kg for pediatric patient; median of 2,0 x05 CD34+/kg for adult patients). Out of the 5 distributed units, 7 were 6/6 HLA match, 23 were 5/6 match and 2 were 4/6 match. 39

40 For 20 of the 47 post-transplant patient outcome data received (5 pediatric; 5 adults), median hematopoietic recovery (ANC 0,5 x09/l, platelets 50 x09/l) was 8 and 39 days (2 patients never engrafted), respectively. Half of the patients had no incidence of GVHD. Out of the 20 post-transplant data received, 8 patients survived year post transplant (4 recently transplanted). 2 out of the 20 patients are still alive (8 pediatric and 4 adult). Units provided by Héma-Québec s CBB resulted in favorable hematopoietic recovery when compared to published data. Prospective post-transplant outcome data collection for patients transplanted with Héma-Quebec CBU is ongoing. 7. HUMAN ALBUMIN EYE DROPS IS SAFE AND EFFECTIVE ALTERNATIVE FOR THE INDICATION OF KERATOCONJUNCTIVITIS SICCA SECONDARY TO GVHD POST ALLO-STEM CELL TRANSPLANTATION Jack T. Seki,6, Sarah Moldenhauer,5, Naoko Sakurai, Jessica Dam, Eshetu G. Atenafu, Paul M. Yip 2, Tony Mazzulli 3,6, Tina Henderson 4, Jacob Pendergrast 2, Christine Cserti 2, Juan P. Velazquez, Rand Simpson, Giorgio Felluga, Hans Messner, Jeffrey H. Lipton Princess Margaret Cancer Centre, Toronto General Hospital 2, Mount Sinai Hospital 3, The Hospital for Sick Children 4, Drake University 5, Iowa, Leslie Dan Faculty of Pharmacy, University of Toronto 6, Toronto, Ontario, Background Eye complication of Keratoconjunctivitis Sicca (KS) from graft-versushost disease (GVHD) post allogeneic stem cell transplantation (AT) is common. Patient complaints are described as feeling of severe dry eye, foreign object-like or grittiness, irritating, burning, itchiness, blurry vision and pain. When examined, the eyes can be erythematous, hyperpigmented, edematous with discharge and inflammation of the cornea and conjunctiva. It can lead to severe damage and blindness if not treated. Remedies have included topical corticosteroids, lubricating eye drops, punctal plugs, immunomodulation, and autologous serum eye drops. We sought to examine the efficacy and safety of pooled Human albumin eye drops (HAE) as a viable therapeutic option. Methods We analyzed retrospectively 39 AT patients between Jan 2000 and July 203, for clinical efficacy and safety using HAE for KS symptom relief after other alternatives had failed. The HAE were subjected to quality assurance testing on Day for sterility, oncotic pressure, albumin measurement, viscosity, ph and purity by protein electrophoresis. A random 4% sampling rule applied for all tests. These tests mimicked freeze (minus 20 C)-thaw cycle during transportation of HAE from hospital to patients home during summer months. Similar tests performed over a period of 6 hours mimicking eye applications while awake. These tests were repeated on Day 30. General symptom relief occurred in 34 (87%) patients, including 6 patients who required ongoing HAE treatment, compared to five (3%) patients who failed to improve with HAE (p <0.000). Initial symptoms and levels of severity were compared to the post treatment symptom relief using the CTCAE v4 grade scale. The proportion of post treatment symptom relief by two grade levels from 3- (59%) is significantly higher than that of one grade level from 3-2 (8%) and from 2- (23%) (p=0.0064). Time to achieve symptom relief ranged from 2-28 weeks. Nineteen (48%) patients had symptom relief between weeks 2-4 of start of treatment. Five (3%) patients responded in 8 weeks. HAE was generally very well tolerated. Thirty-five (90%) patients had no adverse reactions (ADR), while one each had burning and stinging pain. No record of any documentation of ADR in 2 patients. Prior and/or concurrent therapies included acetylcysteine, topical lubricating eye drops and ointment, lower tear duct cauterization, topical corticosteroids, topical antibiotics, cyclosporine eye drops, topical non-steroid anti-inflammatory agents, and lacrimal punctual plugs. Test # Test Day Day 30 Hour 0 Hour 6 Hour 0 Hour 6 Sterility Negative n/a n/a n/a 2 Oncotic Pressure (mmhg) 3 Albumin (g/l) Viscosity (Centipoise) 5 ph Purity 96% n/a 97% n/a Patients with post AT-related ocular complications were well managed with HAE in conjunction with other remedies when they have failed. HAE was well tolerated overall. Quality assurance tests showed that HAE maintained chemical and physical stability over a period of 30 days. 8. EFFECTS OF IONIZING RADIATION ON MESENCHYMAL STEM CELLS IN PATIENTS WITH AML: IMPLICATIONS FOR TBI-BASED HEMATOPOIETIC CELL TRANSPLANTATION STRATEGIES Yevgeniya Le,2,3, Richard B. Richardson, Mitchell Sabloff 2,3 and David S. Allan 2,3 Atomic Energy of Canada Ltd., 2 Ottawa Hospital Research Institute, 3 University of Ottawa. Ottawa, ON, Canada. Background Conditioning regimens based on total body irradiation are being studied 40

41 in allogeneic hematopoietic cell transplantation (HCT) for high risk acute myeloid leukemia (AML). Following transplant, the bone marrow microenvironment remains predominantly patient-derived and host mesenchymal stromal cells (MSCs) maintain the cellular components that support hematopoietic niches. We hypothesize that persistent abnormal MSC function after HCT contributes to a permissive bone marrow environment and an elevated risk of relapsing disease. In this study, we have compared MSC function from patients with AML and healthy controls and tested the effects of high dose radiation. Methods and Normal and AML-derived MSCs were treated with TBI-like gamma radiation (200 cgy x 6 fractions). Flow cytometric analysis revealed typical surface marker expression profiles for MSCs derived from patients with AML and from normal controls and no significant changes were observed following radiation. However, MSCs from AML patients had increased adipogenic and decreased osteogenic capacity in comparison to normal controls and irradiation of healthy MSCs resulted in the same abnormal differentiation profile as observed in AML-derived MSCs. AML- MSCs had decreased proliferation, as measured by BrdU incorporation and CFU-F assay, and increased necrotic cell death. Radiation treatment substantially decreased both normal and AML-MSC cell proliferation rates and completely inhibited colony formation. Finally, immunocytochemistry demonstrated substantial generation of H2A.X histone following irradiation in both normal and AML-derived MSCs, suggesting extensive DNA damage and induction of DNA repair mechanisms. s Taken together, MSCs from AML patients exhibited skewed differentiation potential with increased adipogenesis and decreased osteogenesis and had reduced proliferation capacity compared with controls. Radiation treatment induced similar changes in normal MSCs. The persistence of abnormal marrow-derived MSC function following HCT may be exacerbated by TBI and measures to restore normal MSC function may be required. Strategies that could restore normal MSC function in conjunction with HCT appear worthy of further development and testing. 9. MESENCHYMAL STROMAL CELL TREATMENT IN XENOGENEIC CHRONIC GRAFT-VERSUS-HOST DISEASE MOUSE MODEL Hisaki Fujii,2, ZhijuanLuo 2, Hye Jin Kim 2, Xinghua Wang 3, Susan Newbigging 4, Armand Keating 3, Maarten Egeler,2 Div. of Hematology/Oncology, Developmental Stem Cell Biology 2, The Hospital for Sick Children, Cell therapy program, Princess Margaret Hospital 3, Toronto Centre for Phenogenomics 4, Toronto, Canada Background Chronic Graft-versus-Host disease (cgvhd) is the major cause of late transplantation-related mortality (TRM) in allo-hsct survivors. Despite a number of clinical observations showing potential of Mesenchymal stromal cells (MSCs) in reducing acute GvHD, the mechanism of action of MSCs especially for cgvhd remains elusive due to lack of in vivo model to test humscs. A subtype of MSCs shows strong immune suppressive function (called MSC2) after stimulation of TLR3 ligand or IFN-γ. We hypothesize that MSC2 is able to inhibit cgvhd. Given the inconsistent result of mumscs treatment in murine (mu)gvhd models, and the biological differences between mouse and humscs, there is a need for establishing a pre-clinic humanized cgvhd model. Here, we established a humanized cgvhd model with lung fibrosis mimicking human cgvhd 8 weeks after transplantation to test the effect of MSCs/MSC2. Material and Method NSG mice were treated with cyclophosphamide/tbi followed by injection of x06 G-CSF mobilized human PBMCs or x05 CD34+ cells. Samples of skin, lung, liver, spleen were taken, and fixed in 0% neutral-buffered formalin, embedded in paraffin, and stained with H&E and Masson s trichrome and were evaluated by a pathologist in a blinded manner. Fibrosis was quantified on trichrome-stained sections as a ratio of area of blue staining to area of total staining. hubm-mscs were stimulated with huifn-γ or PolyIC in vitro and assessed for IDO expression level in MSCs by real time PCR and flowcytometry. Mice will receive either non-stimulated MSCs, IFN-γ or polyic stimulated MSCs 4 and 6 weeks post HSCT via tail vein. Mice that received over 60mg/kg of cyclophosphamide lost weight and died earlier than those receiving 20mg/kg or less. Subsequently we used 20mg/kg cyclophosphamide combined with 200cGy TBI as conditioning for the study. Mice that received x06 hupbmcs did not show any sign of acute illness, weight loss or diarrhea, however, exhibited the pathological changes 8 weeks post-transplantation. There were aggregates of inflammatory cells surrounding portal triads and blood vessels in liver and a few areas of expansion of airways in the lung. Masson s trichrome revealed that mice with G-CSF mobilized hupbmcs had significantly increased lung fibrosis compared to controls, which is confirmed with the imaging quantitative analysis and the pathology score. Immunohistochemistry (IHC) analysis showed abundant hucd4+t and macrophage infiltration in the affected lung, which is likely to play major roles in fibrosis formation in this mouse model. We found that IDO mrna expressions in humscs were continuously increased with IFN-γ (500IU/ml) up to 24 hrs in dose dependent manner, but was increased when incubated with polyic (mcg/ml) only for 4 hrs. IDO protein expression was also confirmed by flowcytometry. MSCs/MSC2 in vivo effect on this model is currently under investigation. Here we presented the first humanized cgvhd with lung fibrosis in which we will be able to study the effect of pathophysiology of IDO 4

42 inducible Mesenchymal Stromal Cells. This approach may be able to lead to better treatment in patients with cgvhd. 20. MAJOR ABO INCOMPATIBLE BONE MARROW TRANSPLANTATION IN CHILDREN: DETERMINING WHAT RESIDUAL VOLUME OF DONOR RED CELLS CAN SAFELY BE INFUSED FOLLOWING RED CELL DEPLETION Katharine Patrick, Wendy Lau 2, Elizabeth McDougall 2, John Doyle 3, Muhammad Ali, Adam Gassas, Jane Lowry, Maarten Egeler, Tal Schechter Division of Hematology & Oncology, The Hospital for Sick Children, Toronto; 2 Department of pediatric laboratory medicine, The Hospital for Sick Children, Toronto; 3 Section of Pediatric Hematology/Oncology, Department of Pediatrics and Child Health, University of Manitoba Background Red cell depletion of major ABO incompatible bone marrow (BM) reduces the risk of acute haemolysis during haematopoietic stem cell transplantation (HSCT). However, residual red cells remain. In children, this volume can be significant relative to their body weight. We sought to determine the volume of incompatible red cells (irbcs) from a major ABO mismatched donor that can safely be given to children. This will answer a highly relevant clinical question, for which no clear evidence based recommendation could previously be made. Methods All patients undergoing HSCT using fresh BM from a donor with a major ABO blood group mismatch between January 2000 and August 203 at SickKids, were identified. A retrospective chart review was conducted. 78 patients with a median age of 9.2 years (range 0.6 to 8 years) were identified. BM was red cell depleted using pentaspan sedimentation in 74 of the cases. Antihistamines, acetaminophen and hyperhydration (25ml/m2/hr) for 2 hours before BM infusion and at least 4 hours after were given to all patients. The duration of the BM infusion varied, depending on the volume of BM, the weight of the child and the volume of irbcs. The median duration was 4.5 hours (0.3ml of irbcs/kg/hr). The median volume of irbcs transfused to patients was.6ml/kg (range ml/kg). Patients were observed for clinical and biochemical signs of haemolysis including hypotension, haemoglobinuria, significant increases in creatinine (> 50% increase from baseline) and significant increases in unconjugated bilirubin. 43 patients had no signs of haemolysis. 24 patients had a significant rise in unconjugated bilirubin. 2 patients had a significant rise in creatinine but neither required dialysis. 2 patients became hypotensive, one required a single fluid bolus and one required a brief period of inotropic support which was felt most likely to be related to infection due to the absence of other signs of haemolysis. The only serious reaction occurred in a patient who received 3.9ml/kg of irbcs. The BM was given at a rate of 35ml/hr (.75ml of irbcs/kg/hr). He developed hypoxia, an unconjugated bilirubin 4 times the ULN and a doubling in creatinine. Symptoms improved with prolonged hyperhydration, oxygen and steroids. With a median follow up of 8.5 years, 5 patients were still alive. Of the 27 deaths, 8 were due to non-relapse mortality, although none were attributable to the infusion of ABO incompatible BM. We describe a large cohort of children who received HSCT from major ABO incompatible donors and demonstrate that with careful hydration, close attention to urine output, and monitoring of biochemical markers of renal function and haemolysis, at least 3ml/kg of irbcs can safely be given to children. It should be expected that a degree of haemolysis will occur and this should be monitored for. We recommend that if more than 3ml/kg of irbcs has to be given, BM is divided into aliquots and given at 4 to 8 hour intervals to allow monitoring of renal function between each infusion. 2. ANTIBIOTIC PROPHYLAXIS THERAPY FOR PATIENTS UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANT : A TALE OF 2 CENTERS Tal Schechter, Adam Gassas, Joshua Klein, John Doyle 2, Amanda Berger 3, Muhammad Ali, Pengcheng Lu 3, Jennifer Domm 3, Maarten Egeler, Sarah Alexander, Haydar Frangoul 3 Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; 2 Cancer Care Manitoba, 3 Vanderbilt University, Nashville, TN, Background Bacterial infections are a leading cause of morbidity and treatmentrelated mortality in children following hematopoietic stem cell transplant (HSCT). Meta-analysis of studies of bacterial prophylaxis in adult oncology patients with neutropenia showed a significantly decreased risk of death associated with prophylaxis regimens. However, the use of prophylaxis vs. empiric treatment is controversial in the setting of HSCT and data in children is limited. The concerns for using prophylaxis therapy are development of antibiotic resistance and increased drugrelated toxicity. An empiric approach to antibiotic therapy prompts the concern that therapy is delayed until an infection has already occurred. Our study aimed to compare the bacteremia rates in two pediatric centers that use contrasting approaches; empiric vs. prophylaxis. Methods We compared the incidence of bacterial infections in pediatric HSCT patients in two units; The Hospital for Sick Children (SickKids) where an empiric antibiotic strategy is utilized and Vanderbilt University Medical Center, where prophylaxis antibiotic (Cefipime) is given. Baseline characteristics were compared between the 2 groups with 2 sample tests, where categorical variables and continuous variables were evaluated using double-sided Fisher exact tests respectively. 42

43 224 pediatric patients from SickKids and 294 pediatric patients from Vanderbilt who underwent autologous and allogeneic HSCTs between were evaluated. Total bacteremia rate (Gram positive and Gram negative) was significantly higher at SickKids (66/224) vs. Vanderbilt (49/294), p<0.00 (double sided Fisher exact test). At SickKids, 9% presented with Gram positive infection as their first infection (mean 8.9 d after transplant ) and % with gram negative infection ( mean 4.0 d after transplant), whereas at Vanderbilt 4% presented with gram positive infection (mean 9.5 d after transplant) and 2% with gram negative infection ( mean 5.2 d after transplant). No treatment-related mortality in the first 00 days was attributed to bacterial infections in either center. SickKids had significantly more gram negative bacteremia than Vanderbilt (p=<0.00). There was also a trend toward lower incidence of gram positive bacteremia at Vanderbilt (p=0.052). The use of antibiotic prophylaxis in pediatric HSCT decreased the incidence of bacteremia during transplant. The use of Cefipime as a prophylaxis agent significantly decreased the incidence of gram negative bacteremia with a trend toward reduction of gram positive bacteremia. The use of antibacterial prophylaxis in pediatric patients undergoing HSCT should be considered, and prospective studies are needed to confirm our results. 22. CD8+ T LYMPHOCYTES FROM PEDIATRIC RECIPIENTS OF BONE MARROW OR UMBILICAL CORD BLOOD TRANSPLANTATION EXPRESS DIVERSE ASSORTMENTS OF INHIBITORY RECEPTORS AT THEIR SURFACE IN THE EARLY POST-TRANSPLANT PERIOD Insaf Salem Fourati,2, Catherine Gravel,2, Martine Caty, Samira Mezziani 4,5, Armelle Le Campion, Michel Duval 3,4,5, Hugo Soudeyns,2,3,5. Centre de recherche du CHU Sainte-Justine; 2 Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal; 3 Department of Pediatrics, Faculty of Medicine, Université de Montréal; 4 Hemato-oncology Service, CHU Sainte-Justine; 5 Groupe de recherche en transplantation et immunologie du sang de cordon (GRETISC), Centre de cancérologie Charles-Bruneau, Montreal, Quebec, Canada. Background Umbilical cord blood transplantation (UCBT) is commonly used to treat a variety of hematologic or neoplastic disorders in children. Compared to bone marrow transplantation (BMT), UCBT is associated with slow engraftment and a higher incidence of graft failure and opportunistic infections. During chronic viral infection and cancer, CD8+ T cells undergo functional and phenotypic changes that characterize a unique state of differentiation termed «clonal exhaustion». Our team previously showed that CD8+ T cells expressed the PD- exhaustion marker during the early phases of immune reconstitution in pediatric UCBT recipients, and that higher frequencies of PD-+ T cells were associated with leukemic relapse. The aim of this study was to identify combinations of exhaustion biomarkers that are expressed by CD8+ T cells and that could predispose patients to develop complications following UCBT or BMT. Methods Pediatric patients who underwent UCBT (n=6) or BMT (n=9) for the treatment of leukemia or other hematologic disorders were enrolled at CHU Sainte-Justine. Samples were obtained from graft inoculums and from transplanted subjects during 24 months of follow-up. Expression of inhibitory receptors associated with CD8+ T cell exhaustion, including PD-, CTLA-4, CD244, TIM-3, BTLA and LAG-3, was measured ex vivo using multi-parameter flow cytometry. showed that all inhibitory receptors examined were expressed at very low levels in UCB graft inoculums. However, a transient increase in the frequency of CD8+ T cells that expressed either PD-, CD244, BTLA, or LAG- 3, or co-expressing PD- and CD244 or PD- and BTLA was observed during the first 00 days following UCBT. With the exception of PD-, this transient increase was not readily observed after BMT. In addition, frequencies of CD8+ T cells that expressed either PD- or CD244, or co-expressing PD- and CD244, PD- and BTLA, or PD- and LAG-3 were inversely correlated with absolute CD8+ T cell counts. These results are suggestive of a relationship between clonal exhaustion and delayed reconstitution of the CD8+ T cell subset. Finally, CFSE dilution assays revealed that CD8+ T cells that expressed at least one exhaustion marker did not proliferate as extensively as control cells following in vitro stimulation. These results indicate that expression of exhaustion markers by CD8+ T cells in UCBT and BMT recipients during the early post-transplant period may lead to functional impairment of these cells. This impairment could potentially be relieved by the use of inhibitory receptor blockade. 23. PATHOGEN-SPECIFIC T-CELL LINE GENERATION FOR THE TREATMENT OF VIRUS-RELATED COMPLICATIONS AFTER TRANSPLANTATION Orio J, Carli C,Taillefer J, Richaud M, Giroux M, Janelle V, Delisle JS,2 Centre de recherche de l hôpital Maisonneuve-Rosemont (CR-HMR), 2 Hematologyoncology division, Department of medicine Hôpital Maisonneuve-Rosemont, University of Montréal Background Opportunistic viral infections/reactivations post-transplant are associated with significant morbidity and mortality. While some viral complications can be prevented or treated with anti-viral medications 43

44 (or anti-cd20 in the case of EBV-driven lymphoproliferation), others rely exclusively on adequate and timely immune reconstitution. Adoptive immunotherapy using ex-vivo expanded pathogen-specific T-cell lines has the unique potential to effectively treat opportunistic infections and restore anti-viral immunity. We sought to develop clinical-grade compliant T-cell cultures systems that would permit the rapid generation of anti-viral T-cell lines from both memory and naïve repertoires. Methods We adapted the system developed at the Baylor College of Medicine to differentiate and expand pathogen-specific T-cell lines from seropositive healthy donors. Briefly, peripheral blood mononuclear cells are pulsed with overlapping peptide libraries covering the entire sequence of antigenic proteins and cultured in gas-permeable rapid expansion cultureware (G-REX) along with IL-7 and IL-4. For seronegative donor, we further adapted our systems by testing various combinations of cytokines and using professional antigen-presenting cells (papc). Using EBNA and LMP2 peptide libraries to generate anti-ebv cell lines, we observed a 0-20 fold expansion of T cells after 2 to 5 days in culture. On average the cultures generated around.5-.8x08 T cells. Considering that several trials used a cell dose in the range of 07 to 2x07/m2 to treat active viral infections, a number of cell doses can be prepared from a single culture. The generated T-cell lines showed a slight CD8 predominance. Both CD4 and CD8 cells acquired a central (CD45RO+/CD62L+) or effector (CD45RO+/CD62L-) memory phenotype. The cell lines displayed antigen-specific interferon-gamma release and cytotoxicity. No cytotoxicity towards allogeneic targets was detected. T-cell lines with specificities directed against EBV, CMV, Adenovirus and BKV were also generated. Our preliminary results using CMV seronegative donors suggest that the use of papc is required to create a CMV-specific T-cell line in this setting. We are currently investigating the role of various cytokines to optimize T-cell differentiation and expansion in this population. Viral complications post-transplantation are a significant cause of morbidity and mortality, especially in patients receiving their graft from an alternate donor source. Attempting to treat these infections by restoring anti-viral immunity is possible through adoptive immunotherapy with donor or third party-derived T-cell lines. We have adapted, designed and validated culture systems that can readily be made clinical-grade compliant. Virus-specific adoptive immunotherapy trials are in preparation at our institution. 24. IMPAIRED INTERFERON-ALPHA PRODUCTION BY PLASMACYTOID DENDRITIC CELLS AFTER CORD BLOOD TRANSPLANTATION: IMPLICATION FOR POST-TRANSPLANT TLR-LIGAND BASED IMMUNOTHERAPY Emily Charrier, 2, Paulo Cordeiro, Rose-Marie Brito, Michael Harnois,3, Samira Mezziani, Sabine Herblot, Françoise Le Deist,3,4, Michel Duval - 4 Groupe de Recherche En Transplantation et Immunologie du Sang de Cordon (GRETISC), Centre de Cancérologie Charles Bruneau, Centre de recherche du CHU Sainte-Justine. 375 chemin de la Côte Sainte-Catherine, H 3 T C 5 Montréal, Québec, CANADA; 2 Département de Sciences Biomédicales, Université de Montréal, 3 Département de Microbiologie et d Immunologie, Université de Montréal, 4 Département de Pédiatrie, Université de Montréal. Abstract Body Post-transplant immunotherapy is a promising therapeutic avenue to stimulate the graft-versus-leukemia (GvL) effect following allogeneic hematopoietic stem cell transplantation (HSCT) and, in particular, cord blood transplantation (CBT). Plasmacytoid dendritic cells (pdcs) are attractive targets for post-transplant immunotherapy since they initiate both innate and adaptive immune responses. Toll like receptor (TLR) agonists are currently studied for pdc stimulation in various clinical settings. Their efficacy depends on the number and functionality of pdcs, which are unknown after CBT. We performed a longitudinal study of pdc reconstitution in bone marrow transplanted (BMT) and CBT patients. pdc blood counts were higher in CBT patients than in healthy volunteers from 2 to 9 months post-transplant whereas pdc blood counts were lower in BMT patients. We showed accordingly that CB progenitors gave rise in vitro to 500-fold more pdcs than BM counterparts. Upon stimulation with TLR agonist, pdcs from both CB and BM recipients up-regulate T-cell costimulatory molecules, while interferon-α (IFN-α) production was impaired for 9 months post-cb transplantation. TLR agonist treatment is thus not expected to induce IFN-α production by pdcs after CBT, limiting its immunotherapeutic potential. Fortunately, in vitro production of large amounts of functional pdcs from CB progenitors paves the way for post-transplant adoptive transfer of pdcs. 25. CANADIAN PILOT CLINICAL TRIAL: LENTIVIRUS- MEDIATED GENE THERAPY FOR ADULT FABRY DISEASE Foley R, Khan A, Klassen J, Au BC, Tailor C, Rothe M, Bischof D, Sirrs S, Auray-Blais C, Rupar T, Prokopishyn N, O Hoski P, Huang J, Paul G, Benabid R, Viswanathan S, Morel C, Raiman J, Schambach A, West M, Keating A, Cornetta K and Medin JA. Members of the CIHR-funded FACTs Study Team Background Fabry disease is the result of deficiency of alpha-galactosidase A (alpha-gal A). Enzyme replacement therapy has limited clinical utility and is costly. Advances in lentiviral-based gene transfer have revitalized 44

45 corrective stem cell therapy particularly in Lysosomal Storage Disorders (LSD) where metabolic co-operativity effects can correct primary cells and also get secreted and taken up into naive secondary populations. Study Our team has developed a first in human clinical trial in adult Fabry patients. The platform is based on both laboratory and clinical experience in autologous stem cell transplant and includes efforts of the CBMTG. Our strategy is to employ high-dose (>0.0 x 06 /kg rec. wt.) autologous CD34+ selected transduced cells infused into patients following a single dose of melphalan (00mg/m2). Mobilization with growth factors alone includes Filgrastim (0ug/kg) and Plerixafor (240ug/kg) with large volume apheresis (25L) on days 5 and 6. CD34+ cells have been enriched from apheresis products collected from clinically stable volunteer adult male Fabry patient donors mobilized with G-CSF alone. CD34+ cell yields to date have been in a range similar to what is seen for normal SCT donors. GLP LV/FAB virus produced by the Indiana University Vector Production Facility (IUVPF) at an MOI of 0 has consistently led to >70% of input CD34+ cells positive for transgene expression. Additional studies have measured specific gene transfer frequency in progenitor colonies and viral integration events. An in vitro assay has failed to show any evidence of immortalization of murine hematopoietic stem cells and negligible cytotoxicity following transduction with LV/FAB compared to controls. LV/FAB transduced human Fabry CD34+ cells have been xeno-transplanted into a pure NOD/SCID/Fabry mouse line with enzyme activity and substrate levels (Gb3 and isoforms along with lyso-gb3 and analogues) measured in tissues from transplanted recipient animals. Effectiveness of the safety cell-fate element have also been confirmed. We are currently at the stage of completing a full clinical dry run using clinical-grade virus under GMP conditions. These results will support the CTA and hopefully lead to timely initiation of a clinical trial directed towards gene-based enzyme replacement for adult patients with Fabry disease. 26. EFFECT OF G-CSF STIMULATION ON DONOR BLOOD PARAMETERS FOLLOWING PBSC DONATION: A ONEMATCH PILOT STUDY Volesky K, Yi Q-L, Goldman M, Haun S, Stewart V, & Dufresne A Background To assess the possible long-term effects of granulocyte colonystimulating factor (G-CSF), OneMatch peripheral blood stem cell (PBSC) donors provided a complete blood count (CBC) with differential blood test each year following donation. Approximately 75% of PBSC donors have submitted results at least once, and the cumulative year to year response rate is 47.9%. Methods Annual means were calculated for each blood parameter and compared between 30 randomly selected donors with all blood parameters in-range prior to G-CSF administration (referred to as group A) and 3 randomly selected donors with at least one out-of-range blood parameter prior to G-CSF administration (referred to as group B). Donors pre- and post-g- CSF administration blood parameters were also compared. Mixed model analysis was performed to determine if the differences between groups A and B, and if donors pre-versus post-g-csf administration results were statistically-significant. Statistically-significant differences in white blood cell (WBC) count, hemoglobin, hematocrit, mean platelet volume (MCV), mean corpuscular volume (MCH), and absolute neutrophils, monocytes, eosinophils, and basophils between group A and group B and in donors pre- and post- G-CSF blood work results, were not observed. Between groups A and B, differences in mean red blood cell (RBC) count (p=0.0423) and absolute lymphocytes (Lymph)(p=0.0493) were statistically-significant. Within both groups of donors, mean platelets (PLT) were lower at year (p<0.0) and 3 years (p<0.05) post-donation, and mean corpuscular hemoglobin concentration (MCHC) was also lower post donation (p<0.0). Mean platelet volume (MPV) levels were higher post-donation at years and 2 (p<0.00). The mean results for select blood parameters are presented below, where * denotes a statistically-significant result (p<0.0) between the pre-g-csf and post-g-csf result: Mean x0 9/L RBC MCHC WBC LYMPH PLT MPV Group Pre G-CSF n=6 Year n=45 Year 2 n=44 Year 3 n=24 Year 4 n=22 A B A * * 336.2* 335.0* B * * * * A B A B A * * * B * 24.02* * A * 0.68* B * 0.7*

46 Data from 6 OneMatch PBSC donors demonstrated differences in MCHC, PLT, and MPV results pre- and post-g-csf administration. In this pilot study, no differences were observed in donors pre-versus postdonation WBC count with differential parameters. A forthcoming study will examine all follow-up blood work results submitted to OneMatch to validate these findings and to provide more long-term data. 27. DEVELOPING EDUCATIONAL RESOURCES TO ADVANCE ETHICAL UMBILICAL CORD BLOOD RESEARCH: A CANADIAN PERSPECTIVE Beak C, Allan DS 2, Chargé SBP 3, Isasi R, Knoppers BM. Centre of Genomics and Policy, McGill University, Montreal, QC; 2 Ottawa Health Research Institute, Ottawa, ON; 3 Centre for Innovation, Canadian Blood Services, Ottawa, ON. Abstract Body As the therapeutic use of cord blood stem cells in transplantation continues to grow, so too does the use of cord blood in research. From studies to improve cord blood collection, manufacturing and storing processes; to studies of the utility of cord blood to treat various hematopoietic and non-hematopoietic disorders; to the use of cord blood cells to derive pluripotent stem cells - cord blood research is making important contributions to the scientific and clinical advancement of the stem cell field. Obtaining an ample supply of such samples has been a challenge for the research community. In 203 Canadian Blood Services (CBS) launched the National Public Cord Blood Bank (NPCBB) which collects, tests and stores cord blood units for use in transplantation. As part of their services, CBS is developing a system by which units that are not suitable for storage and transplantation are available to the scientific community for biomedical research purposes. To contribute to capacity building of Research Ethics Boards (REBs), who will be tasked with ensuring this research protects donors, we developed educational resources designed to assist REBs in the evaluation of research protocols which utilize cord blood samples. The REB Primer on Research and Cord Blood Donation (the Primer), outlines key ethical and legal considerations and identifies Canadian normative documents that are relevant to the use of cord blood in research. It also introduces CBS Cord Blood for research Program and describes the systems CBS is implementing to address governance issues. The Primer is intended to assist REBs in evaluating the ethical acceptability of research protocols, facilitate harmonized decision making by providing a common reference, and highlight the role of REBs in governance frameworks. However, it was written to be accessible to the general public and may serve a broader purpose to increase public awareness of cord blood banking and the policies and procedures public systems have put in place to protect donors. 28. POLYCLONAL HUMAN INTRAVENOUS IMMUNE GLOBULIN (IGIV) WITH HIGH-LEVELS OF RSV NEUTRALIZING ANTIBODIES: A SUMMARY OF ANIMAL AND HUMAN STUDIES Ann R. Falsey, Edward E. Walsh, University Of Rochester School Of Medicine, Rochester N.Y. and James J Mond ADMA Biologics, Ramsey NJ Abstract Body Respiratory syncytial virus (RSV) is a common cause of respiratory infections in the bone marrow transplant population. Effective anti- RSV agents are not available and current treatment options are limited. To determine whether high titer neutralizing antibody to RSV might be of benefit in this patient population we prepared a plasma derived, human polyclonal immune globulin using plasma obtained from donors tested for the presence of high levels of neutralizing titers to RSV. We studied its ability to prevent infection in the cotton rat RSV model. Animals were injected with the investigational product, RI-002, 0% IVIG, ( ADMA IVIG ), and one day later were infected intranasally with RSV/A/Long 05 PFU/ animal and four days after infection with RSV. Plaques were counted and viral titers were expressed as PFU per gram of tissue. The control group had mean titers of ~4.7 Log0 PFU/g of tissue in the lungs and the experimental groups given ADMA IVIG had undetectable RSV viral titers in the lungs of all animals. This product was also used in a compassionate use study in patients who were immunosuppressed and had evidence of lower respiratory tract infection. Many had been ill with RSV for days or weeks and had a high probability of mortality. 5 compassionate use patients aged 3 months to 7 years were treated with ADMA IVIG at a dose of 500mg/kg followed by 750mg/kg on day 3.The majority of these seriously ill patients had favorable outcomes and there were no reports of serious adverse events attributable to the study drug. Early administration of ADMA IVIG was associated with a significantly higher survival rate compared to those who received late treatment. These data support the further development of ADMA IVIG for the prevention and treatment of RSV disease in the immune suppressed population. 29. AN ASSESSMENT OF THE OUTCOMES OF SECOND DONATION REQUESTS THROUGH THE CANADIAN ONEMATCH UNRELATED REGISTRY Arseneau I, Couban S 2, Ross M 3, Thompson K 4, Green M 3, Amer B 3, Theriault C 4, Goldman M 3, and Shivakumar S 2. Faculty of Medicine, Dalhousie University; 2 Department of Medicine, Division of Hematology, Dalhousie University; 3 Canadian Blood Services; 4 Research Methods Unit, Department of Medicine, Dalhousie University Abstract Body Few studies have examined second unrelated allohsct or DLI in a consecutive series of patients and none involved the Canadian registry. 46

47 We examined Canadian patients who received a second unrelated allohsct or DLI through OneMatch between January 2002 and December 20. Disease type, status at first transplant, transplant date, indication and date of second transplant or DLI, graft types (bone marrow, G-CSF stimulated peripheral blood or unstimulated DLI), conditioning. Survival, disease status, and engraftment at last follow-up and donor and recipient age and weight were collected. 28 consecutive Canadian patients received a second allohsct or DLI. Median recipient age was 37 (2-68). There were 73 males, 36 females, and 9 patients whose sex was unknown. The most common indication for second transplant or DLI was disease relapse (n=68, 53%), followed by graft failure (n=37, 29%). The most common indication for the first transplant was AML (n=37, 29%), followed by lymphoproliferative disorders (n=29, 23%). Most second transplants used unstimulated peripheral blood (65, 5%), and 0 of 28 (79%) used the same donor. Median survival was.03 years (95% CI = ). Median time between transplants was 0.6 months ( ). Patients whose time between transplants was above the median were more likely to survive, (p=0.029) and had higher survival in the first year post-transplant. No other factors significantly affected survival. This study is the first to examine a consecutive series of unselected patients receiving a second donation from an unrelated donor using the Canadian registry. Survival is comparable to studies from the American (Schriber et al., 200) and German (Platzbecker et al., 2008) registries. This study shows that outcomes do not differ significantly based on disease, age, gender, conditioning and graft type. Further studies to identify factors that better predict outcomes when utilizing this scarce resource are needed. presence of alemtuzumab was not previously reported. Outcomes of unrelated-donor HCT (n=92) performed for myeloid malignancies at our institution during were analyzed. Patients had T-cell depletion with alemtuzumab (n=), or TR- HCT (n=8). Recipients were CMV seropositive in 57%, and 59% of alemtuzumab group and TR-HCT respectively. In CMV seronegative patients no difference was observed in cumulative incidence of relapse (CIR), non-relapse mortality (NRM), relapse free survival (RFS) or overall survival (OS) between alemtuzumab and TR- HCT. However, in CMV seropositive recipients alemtuzumab was associated with higher 28% vs. 2% (p<0.00), a trend towards inferior 24% vs. 49% (p=0.05), and a trend towards inferior 22% vs. 49% (p=0.06). There was no difference in NRM. In CMV seropositive recipients alemtuzumab was associated with lower incidence of grade 2-4 acute GVHD at 6 months; 46% vs. 69% (p=0.04), and lower cumulative incidence of chronic GVHD at 3 years; 50% vs. 67% (P= 0.04). These effects were not observed in seronegative patients. In summary, the protective effect of CMV seropositivity on relapse was not observed in alemtuzumab recipients; additionally, the negative effect of alemtuzumab on relapse appears to have augmented in the presence of CMV seropositivity. This needs to be confirmed in a larger population, and further exploration of this may leads to better understanding of (anti-leukemia) tumor immunity and immune reconstitution after HCT. 30. INTERACTIONS BETWEEN ALEMTUZUMAB AND CYTOMEGALOVIRUS SEROSTATUS OF RECIPIENT IN UNRELATED DONOR TRANSPLANT FOR MYELOID MALIGNANCIES Mohamed Shanavas, MD, Naheed Alam MD, Vikas Gupta MD, John Kuruvilla MD, Jeffrey H. Lipton MD, PhD, Hans A. Messner, MD, PhD, Mathew Seftel MD, MPH, Jieun Uhm MD, and Dennis (Dong Hwan) Kim MD, PhD Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Canada Abstract Body Several studies have suggested a protective effect of cytomegalovirus (CMV) serostatus on relapse risk after hematopoietic cell transplantation (HCT). Generally these reports were in T-cell-replete HCT (TR-HCT), and it is not clear whether such an effect is present in T-cell depleted HCT. Alemtuzumab is a T-cell depleting agent with beneficial effect on graft versus host disease (GVHD), but results in increased risk of relapse and infections including CMV. The overall effect of CMV serostatus in the 47

48 conditioning (high dose chemotherapy with or without total body irradiation -TBI) and stem cell transplantation. This study will help to improve the understanding of how oral complications are related to other side effects and to determine whether objective and subjective oral complications related to treatment can predict negative clinical and economic outcomes and reduced quality of life (QoL). Materials and Methods All adult patients who received a conditioning regimen followed by stem cell transplantation (autologous or allogeneic) were eligible for recruitment to the study. A standardised questionnaire was developed, pilot tested and used to collect the clinical data prior to admission, upon admission and following transplantation. This study is currently in progress. A preliminary data analysis, prior to and upon admission and 3 months follow up, was done with emphasis on transplantationrelated oral mucositis. Fisher s exact test and Correlation test were used to analyze data. Overall, 46 patients from only Vancouver site were evaluated in this interim analysis. The mean age was 58.3 years. Twenty two patients underwent autologous stem cell transplant and twenty four patients underwent allogeneic stem cell transplant. In total, 30% of patients presented with oral mucositis. The most common sites of involvement were the buccal mucosa and ventrolateral tongue. There was a strong relation between Mucositis and teeth with plaque visible (P=<.00). There were no statistically significant differences in oral mucositis among different conditioning regimens (P=0.306), donor (P=0.74), gender (0.825) or type of transplant (0.425). Dry mouth and altered taste sensation were the most common oral complications (85%, 83% respectively) followed by throat pain (68%). 3. MULTICENTER CLINICAL STUDY TO ASSESS ORAL COMPLICATIONS OF CONDITIONING THERAPY AND STEM CELL TRANSPLANTATION - ORASTEM STUDY Samim F, Aluck A 2, Brennan M.T. 3, von Bültzingslöwen I 4, Williams P.M., 2. University of British Columbia, Faculty of Dentistry, Vancouver, BC 2 BC Cancer Agency, Vancouver, British Columbia, Canada 2, 3 Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, 4 Sahlgrenska Academy, Göteborg, Sweden. Objectives The overall aim of this prospective international observational multicenter study is to establish the nature, incidence, severity and temporal relationship of oral complications related to high dose s Level of oral hygiene has a strong relationship with oral mucositis and its severities. This study is in progress and interim result will be presented. 32. MYELOABLATIVE BUSULFAN CONDITIONING REGIMENS: SINGLE CENTER EXPERIENCE OF PATIENTS WITH MYELOID NEOPLASMS Raj R V, Dozeman L, Button A, Silverman M, University of Iowa, Iowa City Background The use of Busulfan with Cyclophosphamide (BuCy) as a myeloablative conditioning regimen for allogeneic stem cell transplantation (allo- SCT) is limited by significant regimen-related toxicity. Several reports suggest that the combination of Busulfan and Fludarabine (BuFlu) in ablative doses may provide effective control of myeloid neoplasms with less toxicity. The aim of the study was to compare outcomes of 48

49 two myeloablative Busulfan-containing regimens in a cohort of 83 consecutive patients (pts) who received allo-sct for myeloid disease Methods Retrospective analysis of pts with myeloid neoplasms (AML, MDS or CML) who underwent allo-sct after myeloablative conditioning with BuFlu or BuCy between 2006 and 202 was done. Forty-five pts received BuFlu and 38 received BuCy. Median age at transplant was 58 (range 22-68) in the BuFlu group and 53 (range 9-68) in BuCy. Disease risk by CIBMTR classification was high in 27 (60%) pts in BuFlu group and 0 (26.3%) in BuCy. GVHD prophylaxis consisted of tacrolimus and methotrexate in all pts in the BuFlu group and 82% in the BuCY group. Seven pts in BuCy received cyclosporine and mycophenolate. Thymoglobulin was administered in unrelated and mismatched donor transplants. All pts engrafted except in the BuCy group. Mortality at day 00 posttransplant was 4.4% in BuFlu and 2% in the BuCy (p=0.038). Grade 3 or 4 GVHD was diagnosed in 6.6% in BuFlu and 2% in BuCy. After a median follow-up of 554 days the risk of relapse or death for pts in the BuCy group was 2.7 times (95% CI , p=0.028) higher than for pts in BuFlu. The trend for overall survival was better in the BuFlu group compared to BuCy (HR -.97, 95%CI , p=0.059). Relapse-free survival was also favored in BuFlu pts. s With the caveats of not being a randomized study, we found that conditioning with BuFlu is better tolerated, has better 00-day mortality, improved time to progression and overall survival, in spite of the fact that the pts in the BuCy group had a higher CIBMTR risk score. 33. PROFILING STUDY CHARACTERISTICS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION: A LIMITED SCOPING REVIEW Sophie Pilon, Daniel Jedrysiak, Jason Tay,2,3, Dawn Sheppard,2,3, Christopher Bredeson,2,3, David Allan,2,3 Blood and Marrow Transplant Program, The Ottawa Hospital; 2 Department of Medicine, University of Ottawa and 3 Ottawa Hospital Research Institute, Ottawa, ON. Background Evidence-based practice patterns in allogeneic hematopoietic cell transplantation (HCT) is reliant on observational clinical studies and randomized controlled trials (RCTs). The extent to which specific aspects of care in allogeneic HCT have been studied and the types of studies that have been performed remains incompletely documented. Methods Studies in allogeneic HSCT were systematically identified from selected journals between We assessed these articles for design and other characteristics, comparing the study characteristics for specific aspects of care related to allogeneic HSCT to identify trends and areas in need of greater study. A total of 6 articles were reviewed in detail by 2 investigators. 39% of the papers in our study were conducted in North America. 42% of the papers analyzed adult patients, 7% analyzed pediatric patients, and 5% analyzed both. 46 studies were prospective, including 4 RCTs. 75 articles were retrospective studies with 36 involving multiple centers. Areas that have been studied with RCT include conditioning regimen (n=), graft-versus-host- disease (n=) and infections (n=2). Multi-center observational studies (registry-based) have emerged as a powerful tool in the study of care related to allogeneic HSCT and 36 studies were identified (3% of studies). The most studied areas in this study type involved donor selection, source of cells (BM vs PB) and conditioning regimens while transfusion practices and management of infections or GVHD were rarely addressed. s Our findings suggest retrospective observational studies performed through cooperative registries represent a feasible and informative method of studying various aspects of care in allogeneic transplantation such as donor selection, source of cells, and conditioning regimens. However, interventions for the management of infections or GVHD may be best addressed using prospective RCTs, which remains scarce. Moreover, our limited scoping review provides a potential tool for the comparison of concordance between RCTs and observational studies. 34. PROJECT COBRA: COMPENDIUM OF BEST EVIDENCE FROM RCTS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION Abhinav Iyengar, Risa Schorr 2, Nicholas Scrivens 3, David Moher 4, Dawn Sheppard,3,4, Christopher Bredeson,3,4, Jason Tay,3,4 & David Allan,3 Division of Hematology, Department of Medicine, University of Ottawa; 2 Library and Information Services and 3 Blood and Marrow Transplant Program, The Ottawa Hospital; and 4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON Canada. Background Allogeneic hematopoietic cell transplantation (AHCT) represents a multi-faceted and complex health care intervention. The strength of evidence from randomized controlled trials regarding specific aspects of care in AHCT remains imprecise. Through a systematic scoping review of the literature, we sought to create a compendium of best evidence from randomized controlled trials (RCTs) addressing aspects of AHCT (coined COBRA). The chief goal of Project COBRA is to provide a foundation of evidence that can allow us to identify areas of transplant care that are understudied, assess the quality of evidence that underpins intuitional practice in AHCT and to plan future trials. 49

50 Methods A systematic scoping review of published studies was performed by searching multiple electronic databases (Medline, EMBASE, Cochrane Reviews) using the following search concepts: RCTs and AHCT. Relevant articles were reviewed in full and trial level data extracted accordingly : We identified over,000 articles. After screening for relevance and removing duplicates, 627 articles were included in the compendium and were classified into specific aspects of AHCT care. RCTs were identified for the following aspects of care in AHCT: collection and/or harvesting of cells (n=46), conditioning regimens (n=50), prevention and/or treatment of GVHD (n=06), transfusion-related interventions (n=20), prevention and/or treatment of infections (n=228), prevention and/or treatment of sinusoidal obstruction syndrome (n=5), prevention and/or treatment of bronchiolitis obliterans (n=), and others that included studies of exercise, anti-emetics, mucositis and nutrition (n=5). It appears there is a maldistribution of RCTs in AHCT with a disproportionate number of studies addressing anti-infective strategies and relatively few RCTs addressing other important aspects of care such as transfusion practices. Project COBRA provides a powerful compendium of best evidence that provides a foundation for performing meta-analyses, assessing the quality of current evidence, the validity of current institutional practices and for planning future trials in AHCT. 35. A SYSTEMATIC REVIEW OF PRECLINICAL STUDIES ON THE THERAPEUTIC POTENTIAL OF MESENCHYMAL STROMAL CELL-DERIVED MICROVESICLES Celine Akyurekli, Yevgeniya Le,3, Richard B. Richardson 3, Jason Tay,2, David S. Allan,2 Regenerative Medicine Program, Ottawa Hospital Research Institute, and 2 Department of Medicine, University of Ottawa, Ottawa ON Canada, 3 Atomic Energy of Canada Limited, Chalk River, ON Background The therapeutic potential of mesenchymal stromal cells (MSCs) may be largely mediated by paracrine factors contained in membrane bound microvesicles released from endosomes. A systematic review of preclinical studies was performed to identify strategic aspects that could accelerate clinical translation of MSC-derived microvesicle therapy in regenerative medicine. Methods Using the OVID interface, we performed an electronic database search (MEDLINE, EMBASE, PUBMED) between 946 and July 203 using the following search concepts: MSC-derived microvesicles, therapy and animal models. Subsequently, articles were screened for relevance, with relevant articles reviewed in full and study level data extracted using a standardized extraction form. The results of this extracted was collated accordingly. We identified 90 published articles and after screening for relevance, a total of 7 controlled studies underwent comprehensive review and data extraction. Thirteen studies addressed the regenerative potential following organ injury (6 studies were included on acute kidney injury, 4 on myocardial infarction and reperfusion injury, study of hind limb ischemia, study of liver injury, and study of hypoxic lung injury) and 4 studies addressed immunological effects of MSC-derived microvesicles on inhibiting tumor growth. Therapeutic intervention involved isolated exosomes (40 00 nm) in 8 studies, while 9 studies tested microvesicles (< 000 nm). The 3 studies of tissue regeneration all reported that treatment with MSC-derived microvesicles improved at least one parameter associated with organ dysfunction. Three of 4 studies addressing the inhibition of tumor growth reported benefit. Four studies compared MSC-derived microvesicles with MSCs and reported equivalent (2 studies) or improved (2 studies) outcomes with MSCderived microvesicles. s The use of MSC-derived microvesicles is strongly associated with improved organ function following injury and may be useful for inhibiting tumor growth in preclinical animal models. Progress towards clinical trials is warranted to assess feasibility and safety of this therapeutic approach in humans. 36. CHRONIC GRAFT-VERSUS-HOST DISEASE IS A SIGNIFICANT RISK FACTOR FOR THE DEVELOPMENT OF NOCARDIOSIS IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS: A MATCHED CASE- CONTROL STUDY OF RISK FACTORS, CLINICAL FEATURES AND OUTCOMES Nadia M. Bambace, MD, FRCPC¹, Louise Poirier, MD, FRCPC², Imran Ahmad, MD, M.SC¹., Jean Roy MD, FRCPC¹, Miguel Chagnon, M.SC., P.Stat ³ and Silvy Lachance, MD, FRCPC¹ Division of Hematology-Oncology, Hôpital Maisonneuve-Rosemont, Montreal, 2 Department of Infectious Diseases, Hôpital Maisonneuve-Rosemont, Montreal, 3 Biostatics Unit, Université de Montréal, Montreal, Canada. Introduction Despite indisputable advances in supportive care, opportunistic infections (OI) remain an important cause of morbidity and mortality among hematopoietic stem cell transplant (HSCT) recipients. The incidence of disseminated nocardiosis, a relatively infrequent infection involving the airways, skin and the central nervous system (CNS) has increased significantly among this population within the last decade. 50

51 The risk factors and outcomes of nocardial infection in HSCT recipients remain undefined to date. Methods We performed a case-control study to identify the risk factors and outcomes of infection with Nocardia among 433 allogeneic HSCT recipients transplanted between January 2007 and December 202 at Maisonneuve-Rosemont Hospital. Fourteen cases of Nocardia infection were identified. Control subjects were matched for age (+/- 5 years), transplant type, and date of transplant (+/- 6 months). The 6-year cumulative incidence of nocardiosis was 3.2%. Fifty percent had disseminated disease with documented CNS involvement in 2% of cases. Infection clustered in autumn and occurred at a median of 35 days after HSCT. N. farcinica was the most commonly isolated strain (29%). Copathogens were detected in 7% of cultures. Nocardia isolates were often resistant to several antimicrobials, with the exception of amikacin, imipenem and linezolid, for which 00% susceptibility was documented. The resistance rate to TMP-SMZ was 33%. Although there was no difference in overall survival (OS) (37% vs. 5%, p =.05), the 2-year OS following HSCT was significantly reduced in the Nocardia cohort (78% vs. 00%, p=.0) and better captures the mortality associated with this infection. All case patients had extensive chronic GVHD and had received treatment with high dose corticosteroids and calcineurin inhibitors in the preceding 6 months. Rituximab treatment within the last year was also associated with the development of this infection (p =.00). On univariate analysis, steroidinduced diabetes mellitus (p= <.00), bronchiolitis obliterans syndrome (BOS) (p=.008), lymphopenia (p =.043) and opportunistic infection in the previous 6 months (p<.00) emerged as significant variables. We observed no association with donor type, graft size, stem cell source, type of GVHD prophylaxis, conditioning regimen/intensity, disease risk, and engraftment time. Outpatient non-myeloablative transplant was not associated with an increased probability of infection. Interestingly, steroid-refractory chronic GVHD was not associated with increased risk of nocardiosis, suggesting that steroid therapy and not GVHD severity represents the most powerful predictor of infection. Our study represents the only contemporary series of Nocardia infection arising in HSCT recipients, and establishes chronic GVHD as the major risk factor. Clinicians should have an elevated clinical index of suspicion for nocardiosis in chronic GVHD patients receiving prolonged high doses of steroids or rituximab, particularly between October and December. Patients with BOS may represent a particularly vulnerable subpopulation in which chemoprophylaxis may be considered. Lastly, our results challenge the use of TMP-SMZ as initial therapy, given the elevated resistance rates to this agent, which may have developed as a result of microbial selection from current transplant prophylactic practices. 37. SERUM ALBUMIN LEVEL < 32 G/L ON DAY 30 CAN PREDICT HIGHER RISK OF NON-RELAPSE MORTALITY IN ACUTE LYMPHOBLASTIC LEUKEMIA FOLLOWING ALLOGENEIC STEM CELL TRANSPLANTATION Feras Alfraih,,2 Jieun Uhm, Vikas Gupta, John Kuruvilla, Jeffrey H. Lipton, Hans A. Messner, Matthew Seftel and Dennis (Dong Hwan) Kim, * Allogeneic Blood and Marrow Transplant Program, Department of Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada, 2 Adult Hematology and Bone Marrow Transplant Program, King Faisal Hospital and Research Centre, Riyadh, Saudi Arabia Introduction It is extremely significant to predict hematopoietic stem cell transplant (HSCTs) outcomes using a biomarker. In this study, we attempted to evaluate the impact of post-transplant serum albumin on outcomes in patients with acute lymphoblastic leukemia (ALL). Methods 23 patients with ALL receiving HSCTs between year 999 and 202 at our center were evaluated for post-transplant serum albumin levels and their correlation with transplant s outcome. The level of serum albumin was retrospectively retrieved in certain time point ± 3 days at month pre HSCT and weekly after transplantation for first 3 months. 00 patients had available serum albumin levels. The ROC analyses were used to determine the most statistically significant cutoff level of serum albumin correlating with NRM at year. Level of 32 g/l at 4 weeks post HSCT was suggested as the best cutoff for further analysis. Patients were stratified into low versus high albumin level group. Median age for all patients is 37 with range of (7-6). 35% were female. Related donors were 57%. Matched donors were 83%. 7% were in st complete remission. 37% were Philadelphia chromosome positive. GVHD prophylaxis was CSA/MTX 60%, CSA/MMF 22%. Conditioning regimen was myeloablative in 95%. 6% received peripheral blood stem cells. With a median follow-up of 60 months for survivors (range 2 to 00 months), 6% patients showed albumin level 32g/l at day 30 while 39% showed dropped albumin level <32 g/l at day 30. OS rate at 2 years was 6% in high albumin group versus 23% in low albumin group (p < 0.00). NRM rate was 62% in high albumin group versus 7% in low albumin group (p < 0.00). However, no difference of relapse incidence was noted between the two groups. Cumulative incidence of overall acute GVHD, grades 2/4, grades 3/4 at day 20 and overall chronic GVHD at 2 years was 67%, 59%, 6% and 45% in high albumin group versus 72%, 70%, 49% and 39% in low albumin group, suggesting higher incidence of grade 3/4 acute GVHD in low albumin group. 5

52 In multivariate analysis, serum albumin level < 32 g/l at 4 weeks was confirmed as an independent adverse risk factor for NRM (p=0.04, HR 2.8) together with acute GVHD grades 3/4 (p 0.0, HR 3.79) and chronic GVHD (p 0.00, HR 0.2). For OS, albumin level was not confirmed as an independent risk factor, but acute GVHD grade 3/4 (p< 0.00, HR 3.36) and chronic GVHD (p <0.00, HR 0.008) were found to be independent factors. For relapse, chronic GVHD grade 3-4 was the only independent prognostic factor (p <0.00, HR 0.27). The present study suggested that ) serum albumin level less than 32 g/l at day 30 can predicts higher risk of NRM and 2) dropped serum albumin might be affected by in part the occurrence of severe acute GVHD, and by independent mechanism of gut GVHD. Further study is strongly warranted to confirm the prognostic role of serum albumin level on transplant outcomes in a prospectively designed study. 38. VALIDATION OF FAVOURABLE IMPACT OF LARGE GRANULAR LYMPHOCYTOSIS AFTER ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION M Poch Martell, J Uhm, N Alam, V Gupta, J Kuruvilla, JH Lipton, M Seftel, HA Messner and D Kim Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto Introduction We previously reported on the incidence of large granular lymphocytosis (LGL) following allogeneic hematopoietic cell transplantation (allo-hct), its favourable impact on outcome and the predictive factors associated with its development (D Kim, BMT, 203). In the current study we aimed to validate our previous findings in an independent set of patients. Methods All 408 patients undergoing allo-hct at Princess Margaret Cancer Centre, Toronto, from 2007 to 202 (replication set) were included retrospectively. Data from the previously reported set of patients undergoing allo-hct from 2000 to 2007 (n = 48) (original set) were updated. There were significant differences between original and replication sets in baseline characteristics (age, underlying disease, conditioning, GvHD prophylaxis, graft source, donor type, incidences of GvHD and CMV viremia) in accordance to the changes over a decade in allo-hct procedures. The cumulative incidence of LGL lymphocytosis at 3 years was 2.8% in the original set and.7% in the replication set (P < 0.00). Median onset of LGL lymphocytosis was 362 days after HCT in the original set and 223 days in the replication set. Patients with LGL lymphocytosis showed a persistent elevation of lymphocyte count compared to patients without LGL lymphocytosis (P < 0.00). Patients with LGL lymphocytosis showed a higher overall survival (OS) (86.4% vs 46.%, P < 0.00, Fig. A) and lower non-relapse mortality (NRM) (0.5% vs 36.3%, P < 0.00, Fig. B) at 3 years. No significant difference was found in relapse incidence according to the development of LGL lymphocytosis (3.9% vs 9.6%, P = 0.25). Multivariable analysis confirmed the favourable impact of LGL lymphocytosis on OS (HR 0.30, P = 0.02) and a trend towards lower NRM (HR 0.27, P < 0.00, original set; HR 0.50, P = 0.22, replication set). No effect of LGL lymphocytosis on relapse incidence was demonstrated (HR.24, P = 0.37, original set; HR 0.53, P = 0.29, replication set). Patients with LGL lymphocytosis showed a trend towards a higher incidence of IST cessation after cgvhd: 63.6% at 7 years vs 53.4% in patients without LGL lymphocytosis, P = The previously identified predictive factors for the development of LGL lymphocytosis were replicated: higher incidence of LGL lymphocytosis with ) CMV seropositive recipients (29.6% vs 5.%, P < 0.00); 2) CMV viremia (3.0% vs 8.9%, P < 0.00) and 3) chronic GvHD (28.2%, vs 5.0%, P < 0.00). The favourable impact of LGL lymphocytosis following allo-hct in OS and NRM, as well as the predictive factors for the development of LGL lymphocytosis were successfully validated in an independent cohort of patients. No impact of LGL lymphocytosis on relapse incidence was noted. The difference in transplantation procedures between the two cohorts, such as GvHD prophylaxis/t-cell depletion, may explain the lower incidence of LGL lymphocytosis in the replication cohort. Patients with LGL lymphocytosis showed a trend towards a higher incidence of IST cessation after cgvhd, which may explain the lower NRM. Patients with LGL lymphocytosis showed a persistent elevation of lymphocyte count and had an indolent course. OS and NRM according to the development of LGL lymphocytosis 52

53 transplant. One year after transplant he developed bilateral lower extremity edema and was found to have nephrotic range proteinuria of 24.5 g over 24 hours. He underwent renal biopsy which showed minimal change disease. He was started on high-dose steroids with good clinical response. All three patients underwent workup for other causes of nephrotic syndrome including hepatitis B and C serology which was negative. 39. NEPHROTIC RANGE PROTEINURIA AS A POSSIBLE MANIFESTATION OF CHRONIC GRAFT-VERSUS-HOST DISEASE Raj R V, Silverman M M, Division of Hematology-Oncology & Blood and Marrow transplantation, University of Iowa, Iowa City Background Nephrotic syndrome after allogeneic stem cell transplant is a rare renal complication. There have been several case series of nephrotic range proteinuria as a possible manifestation of chronic graft-versushost disease. The common pathological findings in a renal biopsy for such patients are membranous glomerulonephritis and minimal change disease. Nephrotic range proteinuria is not included as a manifestation of chronic graft-versus-host disease in the NIH consensus criteria. Methods We report our clinical experience with three patients who developed nephrotic range proteinuria after allogeneic stem cell transplantation. Patient : 55 year old male who underwent sibling matched peripheral blood stem cell transplant for chronic myelomonocytic leukemia. Eighteen months after transplant he developed disease relapse and underwent donor lymphocyte infusion (DLI). Three months after DLI he developed nephrotic range proteinuria of 4.5 g in 24-hour urine. There were associated skin and eye manifestations of chronic GVHD at the same time. Serum creatinine at the time of diagnosis was.5 mg / dl. He was treated with high-dose prednisone with good clinical response. Patient 2: 53 year old male who underwent sibling matched peripheral blood stem cell transplant for multiple myeloma. Two years after transplant he was on high-dose steroids for skin and liver GVHD. Six months after his steroids were tapered and stopped, he developed generalized edema and was found to have proteinuria of 8.4 g over 24 hours. He was restarted on high-dose steroids with complete resolution of proteinuria. Patient 3: 46 year old male with diagnosis of acute lymphocytic leukemia underwent matched unrelated peripheral blood stem cell Nephrotic range proteinuria appears to be a manifestation of chronic graft-versus-host and it should be considered as a renal manifestation of chronic graft-versus-host disease. Monitoring for proteinuria in postallogeneic stem cell transplant recipients is warranted. Inclusion of nephrotic range proteinuria as a manifestation of chronic graft-versushost disease in the NIH consensus criteria may help for early diagnosis and prompt treatment in allogeneic stem cell transplant recipients. 40. IMPORTANCE OF MONITORING COMPLETE MOLECULAR REMISSION IN PEDIATRIC ACUTE MYELOID LEUKEMIA BEARING MLL REARRANGEMENTS: FOCUS ON THE RARE AND NOT ALWAYS GOOD PROGNOSIS T(;) (Q2;Q23) TRANSLOCATION Pécheux L., Dormoy-Raclet V. 2, Couture F. 2, Bittencourt H., Cellot S.,2 Pediatric Hemato-oncology and HSCT Unit, 2 Molecular Biology Laboratory, CHU-Saint- Justine, Montréal Abstract Body MLL gene is frequently rearranged with various fusion partners in high risk pediatric acute myeloid leukemia (AML). While the results of a recent study have shown a particularly good prognostic when MLL is rearranged with MLLT on q2 (previously called AFq) compared to other partners, some authors have also reported MLL-MLLT pediatric AML cases with relapse and death, illustrating that all these MLL- MLLT AML are maybe not equal in prognosis. Monitoring treatment response through detection of remaining leukemic cells using highly sensitive methods is already effective to improve patient outcome in several leukemia subtypes. Here we report the case of a young patient with MLL-MLLT AML of FAB-M2 subtype and CNS involvement. While morphological remission was documented after the second induction (presence of 7% of blasts after induction and less than 5% after induction 2) and while absence of blasts was demonstrated after the first consolidation using immunophenotypic analysis (kinetics of decrease in the percentage of immunophenotypic blasts: 9% post induction,.3% post induction 2, and none after consolidation ), the persistence of detectable MLLfusion transcript using specific reverse transcription polymerase chain reaction (RT-PCR) after consolidation justified treatment intensification with allogeneic hematopoietic stem cell transplantation (HSCT). As 53

54 the MLL-fusion transcript was still detectable after HSCT despite full hematologic recovery, 00% donor chimerism and maintenance of morphological and immunophenotypic remission, the patient received donor lymphocyte infusions (DLI) to achieve sustained complete molecular remission. Five months after the second DLI, the patient is well and the MLL-fusion transcript specific PCR remains negative. In MLL-rearranged leukemia and other high risk leukemia, sensitive detection of fusion transcripts using RT-PCR during and after completion of planned therapy, is not only prognostic as persistence of MLL-fusion transcript may be indicative of short-term relapse, but can also identify patients that could benefit from additional treatment to achieve complete molecular remission. 4. RELAPSE AFTER AUTOLOGOUS STEM CELL TRANSPLANTATION FOR AGGRESSIVE NHL: CLINICAL CHARACTERISTICS AND FACTORS PREDICTING OUTCOME Shane Gangatharan, John Kuruvilla, Armand Keating, Vishal Kukreti, Rodger Tiedemann, Michael Crump Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto Background High-dose chemotherapy and autologous stem cell transplantation (ASCT) is the only curative therapy for relapsed/refractory aggressive NHL. Despite this 30-50% will still relapse, predicted by second-line IPI, initial therapy with rituximab and early relapse. There is no standard of care for the management of patients who relapse post-asct, and survival has been < year. We aim to review the patterns of relapse post-asct and examine factors influencing outcome. Methods The transplant database at Princess Margaret Hospital was interrogated for patients undergoing ASCT from for relapsed/refractory aggressive NHL. Retrospective chart review identified patients who relapsed post-asct and data was collected on pre- and post-transplant characteristics, therapies and outcome. 39 patients were identified with relapse post-asct (29 DLBCL, 7 transformed, 3 T-cell). Median age 55 (range 32-67). Prior to ASCT, second-line IPI: 0 7.7%, 5.4%, 2 46.%, %. 59% relapsed within 2 months after initial therapy. Of B-cell lymphomas, 86.% received rituximab with primary therapy. Median time to relapse after ASCT was 3 months (range -52). Stage at relapse after ASCT: I 7.9%, II 23.%, III 7.7%, IV 5.3%. Bone marrow was involved in 2/39 (30.8%). Extranodal sites were involved in 8/39 (46.2%); common sites being bone 6, skin 5, lung 2, adrenal 2, CNS 2, liver 2. Time to relapse after ASCT was not predicted by second-line IPI, early relapse after primary therapy, or primary treatment incorporating rituximab. After relapse post-asct, management was palliative in 4 patients, IV chemotherapy in 8 and oral in 7. Ten patients received a novel agent most of which were as part of a clinical trial, the most common being panobinostat (n=6). Two patients had further salvage chemotherapy followed by allogeneic stem cell transplant. Radiotherapy was used in 22 (56.4%) patients which in 7 was the only treatment used. With median follow-up 23 months after post-asct relapse, 25 patients have died. Median overall survival (OS) after relapse was 8.5 months (2-year OS 27.6%). Median OS according to second-line IPI: high - 4. months, intermediate months, low not reached (p=0.09). Relapse within year of primary therapy (p=0.42) and previous use of rituximab (p=0.86) were not associated with OS. Time to relapse after ASCT <6 months predicted survival after relapse (2-year OS 7.4% v 55.6%, p=0.03). At time of relapse post-asct, stage (p=0.43), bone marrow involvement (p=0.69) and extranodal sites (p=0.53) did not predict OS. No intervention after relapse significantly predicted OS. Radiotherapy was associated with improved survival (median OS 9.46 months v 4.5 months) though not significant (p=0.07). In patients who relapse post-asct, second-line IPI and early relapse after ASCT predicts survival, while clinical presentation of stage, bone marrow involvement and extranodal sites at relapse do not. Additional agents with activity in this patient population are needed; where feasible, radiotherapy should be considered for patients with localized recurrence. 42. ISOLATED PENILE MEATAL CHRONIC GVHD IN A BOY FOLLOWING ALLOGENEIC TRANSPLANT FOR JMML Spicer C, MacLellan D,2, Fraser R,3, Crooks BNA,4, Fernandez CV, 4. IWK Health Centre, 2 Department of Urology, 3 Department of Pathology, 4 Department of Pediatrics, Dalhousie University. Background Graft versus host disease (GVHD) is a major complication following allogeneic hemaotopoietic stem cell transplant (HSCT). Chronic GVHD can occur in any organ in the body. Genital GVHD is less commonly reported than areas such as liver, gastrointestinal tract and skin. Genital GVHD occurs in at least a third of women. Up to 20% of men have cgvhd of the penis including balanoposthitis, lichen sclerosis-like lesions and phimosis. It is very rarely described in pediatric male patients. Case Report A 0 year old male was diagnosed with juvenile myelomonocytic leukemia (JMML). He underwent a living unrelated donor transplant (LURD) with a preparative regimen of Busulfan, Cyclophosphamide and Melphalan. He received Cyclosporin and Methotrexate as GVHD 54

55 prophylaxis. He developed grade III acute GVHD involving skin, liver and GI tract, and subsequent extensive chronic GVHD (eyes, mouth, skin, liver, GI tract) that required a variety of immunosuppression including cyclosporine A, steroids, tacrolimus, sirolimus over a 2 year period, including eventually Extracorpeal Photopheresis (ECP). The ECP was given 2 days every 2 weeks, for one year. He was tapered off systemic immunosuppressive medications 6 months into the ECP, and there was no evidence of active cgvhd at completion of treatment with ECP. Approximately 3 months after stopping the ECP he developed genitourinary symptoms which included hematuria, urinary hesitancy, straining to void, and narrowing of the urinary stream. The glans penis was clinically normal except for meatal erythema and a pin-point urinary meatus. He was diagnosed with meatal stenosis with an abnormal uroflow study consistent with obstruction. Glans biopsy at the time of meatotomy demonstrated active cgvhd. There were no other signs of active GVHD in this patient, except for sequelae of ocular GVHD, for which he is receiving topical Cyclosporin A and lubricant drops. He had recurrence of his symptoms within several weeks after meatotomy and recurrent meatal stenosis was confirmed on examination. He has been successfully managed using topical steroid as lubrication on a urinary catheter, with twice daily catheter dilations, without reinitiating any systemic immunosuppression. Isolated meatal cgvhd in a child has not, to our knowledge, been previously reported. It is our hope that sharing this case report will emphasize that genital GVHD is a potential complication among pediatric and adult HSCT patients and the importance of regular genitourinary assessment in males as well as females. 43. ESCALATED DOSE-TOTAL BODY IRRADIATION (8GY) FOLLOWED BY AN ALLOGENEIC CELL TRANSPLANTATION FOR THE TREATMENT OF REFRACTORY ACUTE MYELOID LEUKEMIA: EARLY RESULTS Sultan Altouri., Harry Atkins, David Allan, Jason Tay, Mai Le, Linda Hamelin, Dawn Sheppard, Lothar Huebsch, Tim Ramsay, Christopher Bredeson, Rajiv Samant, Mitchell Sabloff Blood and Marrow Transplant Program, The Ottawa Hospital. Introduction Refractory AML (raml) has a poor overall survival (OS) after a standard allogeneic hematopoietic cell transplantation (allohct). Higher doses of TBI (5.75 vs. 2Gy) have been shown to reduce AML relapse for patients in complete remission (CR). Preliminary work, replacing cyclophosphamide in the conditioning, with escalated doses of TBI (6Gy), followed by an HLA matched related or unrelated donor (MRD or MUD)-alloHCT has resulted in long-term remissions in 2 out of 4 patients. Based on these encouraging results we initiated and report on the preliminary results of a prospective phase 2 ethics approved study of single agent, escalated dose TBI (ED-TBI) (8Gy) followed by an allohct. Methods Patients (8-60 years old) with raml and an HLA MRD or MUD received an allohct after ED-TBI, 2.25Gy BID (days -4 to -) x 8 fractions (total 8Gy). Donor cells were infused on day 0. Graft vs. host disease (GVHD) prophylaxis consisted of tacrolimus (day -3-90) and mycophenolate mofetil (MMF) (day - 60). The primary end point, treatment related mortality (TRM), was measured using the CTCAE v.4 and the LENT- SOMA scales. Patients: Seven have undergone an allobmt (d8 - >365). Two patients had raml following 2-4 inductions. One patient relapsed during consolidation. Another patient had raml (secondary) after one induction attempt and three had relapsed (<6 months) raml. Two also had CNS disease, treated prior to transplant. All had persistent leukemia at the start of ED-TBI, with 5 out of 7 having > 50% blast cells in the marrow. Three patients required moderate doses of chemotherapy (daunorubicin, cytarabine, azacitidine or hydroxyurea) to maintain their disease prior to allohct. Toxicity: Early (<30 days): Two patients had grade 3 mucositis. Two patients required parenteral feeding. One patient experienced reversible venoocclusive disease. All patients developed diarrhea. All of them resolved. Late (>30 days): Two patients suffered grade 3 dehydration, requiring prolonged intravenous hydration (days 37-07). Two patients had CMV reactivation at days 39 and 60 and were treated with ganciclovir. One patient developed asymptomatic 250 cc reduction of lung volumes with a restrictive pattern on PFT. Engraftment: Neutrophil engraftment occurred between days 5-25 and the patients were discharged from the hospital between days GVHD: Acute GVHD occurred in patient <day 30, treated successfully with prednisone. Chronic (cgvhd) occurred in all patients, involving the GI tract (n=2) and liver (n=2). One patient had persistent cgvhd at one year involving the mouth and skin. Four did not complete tapering immune-suppression before relapse. Response: Circulating blast cells, at the time to allohct, all were cleared by day in 5 patients. Two patients are in continuous CR on days 40 and 464. Four patients have relapsed at days 96, 0, 39 and 392 and died on days 06, 45, 257 and 397 respectively. To date, ED-TBI (8Gy) followed by an allohct has a toxicity profile which is comparable to other allohct conditioning regimens. Safety and efficacy are continuing to be assessed with a goal to recruit 20 patients. 55

56 44. PRE-TRANSPLANT REMISSION STATUS AND USE OF PERIPHERAL BLOOD STEM CELLS CONTRIBUTE TO LONG- TERM OUTCOME AFTER MYELOABLATIVE ALLOGENEIC TRANSPLANT FOR MULTIPLE MYELOMA Imran Ahmad, Sandra Cohen, Silvy Lachance, Guy Sauvageau, Denis- Claude Roy, Lambert Busque, Thomas Kiss, Jean-Sébastien Delisle, Léa Bernard, Richard LeBlanc, Jean Roy. Blood and Marrow Transplant Program, Hôpital Maisonneuve-Rosemont and Université de Montréal. Objective/Rationale Although myeloablative (MA) allogeneic hematopoietic stem cell transplantation (HSCT) has cured a minority of patients with MM, it is now seldom used because of the high transplant mortality. We sought to describe various outcomes and their predictive factors in MA allogeneic HSCT recipients at our institution. Methodology Data on all patients treated with MA sibling allogeneic HSCT at Maisonneuve-Rosemont Hospital (HMR) were analyzed retrospectively. Probabilities of overall survival (OS), progression-free survival (PFS), relapse, nonrelapse mortality (NRM) and GVHD incidences were estimated and multivariate analyses conducted on these outcomes. Between 990 and 200, 39 patients (median age 39 years) received a sibling MA allogeneic HSCT at HMR; 68% had Durie-Salmon stage III disease and more than half had received more than one line of treatment. Cytogenetics was not available on these patients. Total body irradiation-based conditioning was used in 77%; source of stem cells was G-CSF mobilized peripheral blood (PB) stem cells in 46%. Incidences of grade II-IV acute and extensive chronic GVHD were 29% (95%CI: 6-44) and 40% (95%CI: 24-55), respectively. With a median follow-up of 3 years, incidences of progression and NRM were 43% (95%CI: 26-59) and 38% (95%CI: 22-54), respectively. Probabilities of 0-year OS and PFS were 33% (95%CI: 9-48) and 29% (95%CI: 6-44), respectively. The probability of taking immunosuppressants at 0 years in survivors was 3% (95%CI: 3-58). In multivariate analysis, PB stem cells and complete remission at transplant were protective for relapse (HR 0.34, CI: ), and PFS (HR 0.28, CI: ), respectively. Nevertheless, the effect of these variables on OS was nonsignificant. The time-dependent effect of chronic GVHD on various outcomes was also inconclusive. In our experience, one third of selected patients with MM are alive 0 years after MA allogeneic HSCT. Achievement of CR before HSCT and the use of PB stem cells were protective. While being done later in the course of MM treatment and well before the introduction of newer therapies, the risk of relapse in our cohort is similar to published results in frontline reduced-intensity allogeneic HSCT. We speculate that MA HSCT could carry a stronger anti-mm effect as an upfront approach and could be revisited in young and fit patients, especially those with refractory disease. Figure (left) shows the probability of progression-free survival from allogeneic transplant, with 95% confidence interval. Figure 2 (right) shows the stacked cumulative incidences of progression (light grey) and nonrelapse mortality (dark grey). 45. AN EXPLORATION FOR A MINIMUM CD34+ DOSE FOR MULTIPLE MYELOMA PATIENTS AGED 65 TO 7 BASED ON AN ASSOCIATION BETWEEN CD34+ DOSE AND LONG-TERM PLATELET COUNTS FOLLOWING HIGH DOSE THERAPY R Martin, M Ricci 2, C Ross 3, A MacDonald 3 and R Foley. 3 Department of Anthropology, University College London, London, United Kingdom, 2 School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland, 3 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada Background Multiple myeloma is the most common current indication for autologous stem cell transplantation (auto-sct). Many centers employ an upper age limit of 70 years as opposed to clinical trials that typically restrict patients to 65 years and younger. Transplant is not curative and additional post transplant therapies are increasingly utilized. The ability to safely administer post transplant therapy depends on satisfactory blood counts post auto-sct. Assessment of platelet recovery may include: (i) time to initial recovery, (ii) number of platelet transfusions and (iii) long-term sustained engraftment. In patients 65 and younger platelet recovery correlates with number of autologous CD34+ progenitor cells infused, however less data is available for older patients. Our current study (N=3) shows that for a grouping of MM patients under 65 (34 to 64 years of age) CD34+ dosage significantly correlates with time to platelet engraftment (P = 0.000), the number of platelet transfusions before platelet engraftment (P = 0.000), and platelet count at 30 days from CD34+ reinfusion (P = 0.003), but not with platelet counts 56

57 at 80 days (P = 0.06) or 360 days (P = 0.48). Conversely, for MM patients 65-7 years of age CD34+ dose significantly correlates with the number of platelet transfusions (P = 0.038), and platelet counts at 30 days (P = 0.000), as well as 80 days (P = 0.02), and 360 days (P = 0.005). These data suggest for older MM patients the current minimum target CD34+ dosage of cells/kg may be inadequate for maintaining an adequate platelet count up to year post auto-sct. Exploratory analysis from this study suggests a minimum autologous CD34+ dosage of approximately cells/kg would be required for older MM patients to sustain platelets 50 09/L at 360 days. The current minimum dosage of cells/kg appears to be adequate for longterm platelet engraftment in the under 65 age group. 46. WHEN AN UNEXPECTED EVENT CHANGES TRANSPLANT INTO FAITH: THE UNTOLD STORY OF CBMTG 060 Imran Ahmad, Robert Bélanger, Chantal Baron, Sandra Cohen, Jean Roy and Silvy Lachance. Hematopoietic Cell Transplantation Program, Division of Hematology and Clinical Oncology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada. Introduction Hematopoietic progenitor cell (HPC) collection in healthy donors carries a small risk of death ( in 0,000 donors). We report the case of a 6 year-old female patient with acute myeloid leukemia (AML) in first remission, randomized under the CBMTG 060 study, who received a cadaveric bone marrow (CBM) graft from her 63-year-old brother, who died before planned collection. Procedure On the day after G-CSF mobilization failure was recorded, the donor became septic and presented cardiorespiratory arrest. Resuscitation maneuvers were initiated promptly, but death was declared 50 minutes later. His spouse was informed during resuscitation and consented to last-resort BM collection. A total of liter of BM was harvested immediately after resuscitation was stopped. The collected product was processed by centrifugation for red cell depletion (RCD), due to bidirectional ABO incompatibility. Total nucleated cell recovery after RCD was 56 %. (from 3.6 to 2.0 x08 /kg of recipient weight). CD34 count was 0.3 x06 /kg. Cell viability study was adequate. After graft infusion sterility was established and BM culture yielded the following results in terms of HPC colonies: 0.2 x04 CFU-GM, 0.0 x04 CFU- GEMM and.07 x04 BFU-E /kg. The CBM graft was infused without complication. It was decided not to infuse the back-up cord blood graft. The recipient was prescribed daily G-CSF from day +5 and achieved a neutrophil recovery ( 0.5 x09/l) on day +25 after transplantation. Full engraftment of polynuclear and monuclear cells by short-tandem repeat chimerism study was achieved on day +37 and remained unimpaired at last follow-up 37 months post-transplant. The recipient later developed de novo chronic graft-versus-host disease (GVHD) on day +5 with muco-cutaneous and lower intestinal involvement (biopsies both positive) successfully treated with prednisone and tacrolimus. At +2 years post CBM transplantation, the recipient remained ambulatory (Karnofsky score 80%), in continuous complete remission, with ocular, muco-cutaneous and liver chronic GVHD. BM examination was undertaken several times after transplantation. No feature of relapse or myelodysplasia could be seen. Marrow cellularity varied between 5% on day +00, to 25% at +8 months and up to 40% at +3 year when last evaluated. BM megakaryocytes remained steadily low. The +3 year BM specimen confirmed cytogenetic remission and complete donor chimerism. HCT with CBM is feasible. The possibility of routine collection and storage of BM from deceased individuals should be further studied, especially in the wake of ex vivo stem cell expansion technologies. This could become a novel source for hematopoietic transplantation and further revive the interest of mixed chimerism induction at time of solid organ transplant to induce tolerance and improve graft survival from deceased donors. The most pertinent observation is the extraordinary capacity of very few CBM stem cells to support long-term hematopoiesis in our recipient. The most challenging issue is to define how many HPCs are needed to secure complete and sustained engraftment. After more than 50 years of hematopoietic transplantation, the definition of the optimal graft (source and composition) is still open for debate. 47. HIGH PROGRESSION-FREE SURVIVAL AT 0 YEARS AFTER TANDEM AUTOLOGOUS/NONMYELOABLATIVE ALLOGENEIC TRANSPLANT FOR MULTIPLE MYELOMA: IMPACT OF DISEASE STATUS AND CHRONIC GVHD Imran Ahmad, Sandra Cohen, Silvy Lachance, Thomas Kiss, Guy Sauvageau, Lambert Busque, Denis-Claude Roy, Jean-Sébastien Delisle, Léa Bernard, Richard LeBlanc, Jean Roy. Blood and Marrow Transplant Program, Hôpital Maisonneuve-Rosemont and Université de Montréal. Objective/Rationale Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative option for multiple myeloma (MM). However, factors affecting long-term outcomes have not been clearly defined in tandem transplant recipients; we sought to identify these in a large prospective cohort of 93 recipients. Methodology Patients with Durie-Salmon stage II-III MM received induction therapy, 57

58 followed by upfront autologous HSCT and outpatient nonmyeloablative (NMA) allogeneic HSCT. Conditioning consisted of fludarabine (30 mg/ m2 x 5 days) and cyclophosphamide (30 mg/m2 x 5 days), followed by infusion of matched sibling donor G-CSF mobilized peripheral blood stem cells. GVHD prophylaxis included mycophenolate mofetil 000 mg BID from day + to +50 (no taper) and tacrolimus from day - to + 50, with complete taper by day +00. Probabilities of overall survival (OS) and progression-free (PFS), relapse, non-relapse mortality (NRM) and GVHD incidences were estimated, and multivariate analyses performed on these outcomes. From May 200 to March 200, 93 patients (median age 52 years) received a tandem HSCT; Durie-Salmon stage III was present in 76%. Cytogenetics were available in only a minority of patients and could not be used for analysis. A partial or better response was obtained in 84% before tandem HSCT. After a median follow-up of 7 years, cumulative incidences of grade II-IV acute and extensive chronic GVHD were 9% (95%CI: 4-5) and 85% (95%CI: 75-9), respectively. Cumulative incidences of NRM and progression were 0% (95%CI: 3-22) and 47% (95%CI: 37-58). Probabilities of 0-year OS and PFS were 64% (95%CI: 50-74; Fig. 2) and 44% (95%CI: 3-56). In multivariate analysis, at least stable disease (SD) prior to allogeneic HSCT was a protective factor for progression and PFS (respectively, HR 0.8, CI: , and HR 0.2, CI: ). Extensive chronic GVHD was also correlated with a better PFS (HR 0.39, CI: ). The most significant protective factor for OS was at least SD status before allogeneic HSCT (HR 0.5, 95%CI: ). In survivors, the probability of taking immunosuppressants was 5% (95%CI: 4-42) at 0 years. s We report an impressive PFS of 44% at 0 years in a large cohort of 93 NMA allogeneic HSCT recipients. Chronic GVHD and disease control before allogeneic HSCT were both associated with better PFS. We believe our survival to be superior to other published studies as a result of the high incidence of chronic GVHD and associated graft-versus-myeloma effect. Despite the increased risk of chronic GVHD, NRM and prevalence of immunosuppression at 0 years were low. Agents active against both MM and GVHD should be prospectively tested to improve long-term remission rates while reducing the burden of GVHD. Figure (left) shows the probability of progression-free survival from allogeneic transplant, with 95% confidence interval. Figure 2 (right) shows the stacked cumulative incidences of progression (light grey) and nonrelapse mortality (dark grey). 48. PSEUDOTUMOR CEREBRI ASSOCIATED WITH ALL- TRANS RETINOIC ACID TREATMENT IN FEMALE PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA: A CASE SERIES Ali M, 2, 3, Mutahar E, Sagheir A, Hashmi H King Fahad Specialist Hospital Dammam, KSA. 2 Manitoba Blood and Bone Marrow Transplant Program. 3 Health Science Centre, Winnipeg, MB Abstract Body All-trans retinoic acid (ATRA), a carboxylic acid form of vitamin A was a revolutionary discovery in the treatment of acute promyelocytic leukemia (APL) that was found largely by chance in late 80 s. The molecular hallmark of APL is the presence of a balanced reciprocal translocation resulting in the PML/RAR-α gene fusion, which represents the target of ATRA therapy. ATRA is considered to be a safe drug. Pseudotumor cerebri (PTC) is a rare neurological adverse event of ATRA that was mainly reported in pediatric population.it is characterized by neurologic and ocular signs and symptoms of increased intracranial pressure in the absence of any intracranial pathology or secondary causes of intracranial hypertension. Herein we report four cases of young female patients who were diagnosed with APL and experienced PTC with ATRA treatment. In three cases fluconazole was taken concurrently. Symptoms completely subsided with the temporary withdrawal of ATRA and discontinuation of fluconazole. PTC symptoms did not recur after reintroducing ATRA. In conclusion, we report a case series of young female patients that is suggestive of young age, female gender and concurrent use of fluconazole to be associated with increased risk of developing PTC with ATRA treatment. Fluconazole should not be used concurrently with ATRA. We also conclude that the drug could be safely reintroduced once the symptoms had resolved. 58

59 49. POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME ASSOCIATED WITH CYCLOSPORINE USE IN A CHILD UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM CELLS TRANSPLANTATION FOR FANCONI ANEMIA: A CASE REPORT Ali M, 2, 3, Al-Afghani S King Fahad Specialist Hospital Dammam, KSA. 2 Manitoba Blood and Bone Marrow Transplant Program. 3 Health Science Centre, Winnipeg, MB Abstract Body Posterior reversible encephalopathy syndrome (PRES) is a neuroclinical and radiological syndrome that commonly consists of parietooccipital and posterior frontal cortical and subcortical edema. The neurologic manifestations are variable, but frequently include headache, altered mental status, visual disturbances and seizures. Known associated causative agents include calcineurin inhibitor immunosuppressives such as tacrolimus and cyclosporine. We herein report a case of 2 years old boy that was diagnosed with fanconi anemia and underwent allogeneic Hematopoietic Stem Cells Transplantation (HSCT) with Fludarabine (35 mg/m2/ day x 5), Cyclophosphamide (0 mg/m2/day x4) and Anti-thymocyte Globulin (Rabbit ATG) (2.5 mg/kg/day x4). GVHD prophylaxis included Cyclosporine (65 mg/m2/dose BID) starting day -3 and Mycophenolate Mofetil 600 mg/ m2/dose BID) starting on day 0. Pre stem cells infusion course was complicated with ICU admission due to ATG anaphylaxis reaction. Post stem cells infusion, the patient had elevated blood pressure and experienced seizure. MRI brain confirmed PRES. Cyclosporine was discontinued. Patient was put on methylprednisolone 2 mg/kg for GVHD prophylaxis. The patient did not experience any seizure afterwards. PRES resolved based on follow up imaging. The patient was started on tacrolimus with no further PRES episodes. Although it is a rare complication, it can be concluded that PRES should be suspected with neurological symptoms in children undergoing HSCT and taking a calcineurin inhibitor. If confirmed by imaging, rigorous control of arterial blood pressure and discontinuation of the offending agent is recommended. We also conclude that it s safe to rechallenge the patient with a different calcineurin inhibitor once the PRES resolves. 50. FIRST LINE TYROSINE KINASE INHIBITORS (TKIS) THERAPY IN CHRONIC MYELOID LEUKEMIA AT THE CANCER PROGRAM OF WINDSOR REGIONAL HOSPITAL ( ) D Sayegh, S Kanjeekal, J Mathews, R Gupta, C Hamm Cancer Program, Windsor Regional Hospital, Windsor, Ontario, Canada Objectives To evaluate the overall response to first- line TKIs therapy in CML patients and to examine opportunities for improvement in patients outcome. Material and Methods Electronic files were reviewed. Hematological, cytogenetic and molecular responses were assessed according to blood count and clinical exam, fluorescent in situ hybridization (FISH) and/or real time quantitative polymerase chain reaction (RT-Q-PCR), respectively. Classification of responses was done according to the European Leukemia Network (ELN) Guidelines. Imatinib, nilotinib and dasatinib were the first line therapy in 86%, 5% and 2% of CML patients, respectively. Changes from imatinib therapy to other TKIs and /or bone marrow transplant were seen in 55% of cases. Optimal responses were seen in 97%, 95%, 86% and 67% at 3, 6, 2 and 8 months on TKIs therapy, respectively. Overall survival was 92% at 5 years and 86% at 7 years, 75% of overall deaths occurred due to other co morbidities. Optimal responses if alive at 5 years were, 94%, 90%, 90% and 63% at 3, 6, 2 and 8 months, respectively, and at 7 years were 90%, 83%, 83% and 50% for same corresponding times. At 6 months 50% of suboptimal responders and 00% of the optimal responders were alive at 7 years. High rates of optimal responses to TKIs therapy were reported at 3, 6 and 2 months. High survival rates were achieved at 5 and 7 years and most of the mortalities were related to other co morbidities. The 8 months outcome did not predict the overall survival, while 3 and 6 months outcomes appear to predict survival at 7 years supporting the new 203 ELN guidelines. 5. ENHANCING HEALTHCARE PROFESSIONALS AWARENESS AND UNDERSTANDING OF PSYCHOSOCIAL DISTRESS AMONG SPOUSAL CAREGIVERS OF HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS: A ROLE FOR DIGITAL STORIES AND ILLNESS NARRATIVES Background: Building on earlier research undertaken by BS, DM and SC, an innovative approach to knowledge sharing was developed to enhance psychosocial support for spousal caregivers of hematopoietic stem cell transplant recipients. The use of digital stories and illness narratives provide important insight into the meaning of phenomena such as caregiving. With greater emphasis on patient/family or relationship-centered care delivery, approaches to education that enhance awareness, empathy and the meaning of existentially important experiences become imperative. From a pedagogical perspective, stories can make challenging information coherent, meaningful and easily understood by situating complex concepts into practice and practical situations. Such an approach may be transformative by challenging the HCP/student s existing world-view (values, beliefs) through self-reflection. 59

60 Method/Methodology Three to five HSCT survivors and their spousal caregivers will take part in a 3-day workshop to be held March 7-9, 204. Caregivers will create digital stories of the experience of caring for an HSCT recipient; illness narratives will be collected from the HSCT survivor. An educational module and workbook for HCPs/students will be created, implemented and evaluated. Highlights from the workshop, educational module and workbook along with its role as an educational tool will be presented. Enhancing awareness, knowledge and understanding of the implications of informal caregiving is a potentially effective approach to: ) address the needs of HSCT spouses whose health may be compromised as a result of their role, 2) reduce the financial costs/burden to the healthcare system, and 3) introduce HCPs/students to practice development strategies that better support optimal healthcare delivery for this underserviced population spousal caregivers. 52. EXPLORING THE CONCEPT OF WAITING AMONG SPOUSAL CAREGIVERS OF HSCT PATIENTS: THE BETWIXT AND BETWEEN Background: Few studies have explored the meaning of waiting within the context of cancer beyond wait times, watchful waiting, or waiting for relapse. Even fewer studies have explored the meaning given to the experience of waiting and its emotional/psychosocial implications despite the fact that waiting may be considered a universal experience. While a few studies have focused on this phenomenon as it pertains to patients little no to research exists on waiting from the spousal caregiver perspective suggesting a taken-for-granted notion of waiting. Method A mixed method exploratory study examined the experience of caregiving for spouses of hematopoietic stem cell transplant recipients. A narrative analytic approach grounded in interpretative phenomenology was used to analyze the interviews of spouses across 4 points in time over one year. Waiting emerged as one of four key findings from this study. This theme highlighted both the complexity and multiple interpretations spouses assign to the experience of caregiving. In a healthcare system that conceptualizes waiting within the context of linear time, spouses struggled to make sense of their experience as both linear and embodied. I suggest that our understanding of waiting may be enhanced by conceptualizing the phenomenon as having residency within liminal space the betwixt and between. Conceptualizing waiting as a liminal space may offer an alternative perspective to understanding this phenomenon by suggesting that waiting is a time of transition and/or transformation where individuals create and recreate the self as they bridge the gulf between their old world and the new. 53. THE EXPERIENCE OF SEXUALITY IN INDIVIDUALS WHO HAVE UNDERGONE HEMATOPOIETIC CELL TRANSPLANTATION Background Autologous and allogeneic hematopoietic cell transplantation (HCT) are used as treatment for various hematological diseases. The modalities of therapy that are part of HCT, namely high dose chemotherapy with or without total body irradiation (TBI), may have a negative impact on an individual s sexuality. Research has revealed that altered sexual function following HCT is common, affecting between 25-80% of patients. The primary objective of this study was to identify patients experience of sexuality following autologous or allogeneic HCT. Methods This study utilized a concurrent, mixed qualitative-quantitative design. Participants completed the Functional Assessment of Chronic Illness Therapy-BMT (FACT-BMT) as well as underwent semi-structured interviews. Eleven individuals participated in the study. The mean age at time of transplant was 43 years (range: 7-62) and mean number of months from transplant to time of study participation was 29 (range: 2-86). Participants scored relatively high on the FACT-BMT (mean 06 [range: 56-34] out of a possible 48), where higher scores indicate better quality of life. Regarding sexual function, the most common changes experienced by the participants were: decreased libido (67% of female participants; 63% of male participants), difficulties with erectile function (88% of male participants), dyspareunia (67% of female participants), vaginal dryness (00% of female participants) and not feeling desirable (33% of female participants; 38% of male participants). Analysis of the qualitative data obtained from the interviews revealed several themes pertaining to sexuality and HCT including: changes in sexual function, coping with impaired fertility, the impact of the disease/ treatment on relationships, and the experience of discussing sexuality with health care providers. 60

61 s In this study, all participants reported changes in sexuality following HCT. Further study is planned with a view to involve a larger cohort of transplant recipients as well as to include the partners/spouses of transplant recipients. 54. THE DEVELOPMENT OF AN ADULT BLOOD AND MARROW TRANSPLANT SURVIVORSHIP CLINIC Background With the number of survivors of hematopoietic cell transplantation (HCT) continuing to rise, questions abound regarding the optimal care of such individuals. While the risk of relapse may abate over time, survivors of HCT are faced with an array of additional potential health and psychosocial challenges. Following the Institute of Medicine s seminal report on cancer survivorship in 2005, survivorship programs are being established in many oncology centres throughout the world. Methods In June 202, we launched the Adult Blood and Marrow Transplant Survivorship Clinic at our tertiary oncology centre. The clinic model was developed after review of existing survivorship clinic models in several prominent oncology centres as well as after consultation with members of the multidisciplinary team of care providers at our centre. The survivorship care plan that is utilized in the clinic integrates components of the published report on the recommended screening and preventive practices for survivors of HCT. The purpose of this presentation is to provide an overview of the clinic, highlighting the planning and development of the clinic as well as to discuss how the clinic operates, the clinical issues that have been identified and review some of the successes and challenges that have been encountered since the clinic s inception. For this quality improvement project, the charts of patients who had been seen in the clinic from June 202 until October 203 were examined. Demographic data and basic clinical data were reviewed retrospectively. Ninety patients were seen in the clinic between June 202 and October 203. All of the patients seen in the clinic had undergone at least one allogeneic HCT; 3 patients had undergone 2 allogeneic HCTs while 4 patients had undergone prior autologous HCT. The mean age at time of clinic visit was 49 years (range 23-69) with a mean time of years since time of transplant (range 2-28). The most common chronic health issues reported were fatigue, hypertension, type II diabetes mellitus, hypothyroidism and chronic pain. Two cases of hyperthyroidism were picked up in the clinic; both patients went on to see endocrinologists who diagnosed Graves disease. Few patients (n=5) had active chronic graft versus host disease (GVHD); 4 of the 5 cases had been mild and had involved the oral cavity. One case involved the skin and the patient was referred back to the transplant physician for further management of progressive sclerodermatous-type GVHD of the skin. Many of the patients reported ongoing psychosocial concerns, including the inability to return to work due to chronic health issues, financial concerns and relationship distress. Difficulties with sexual function were common with women reporting diminished libido, vaginal dryness and dyspareunia and men reporting diminished libido and erectile dysfunction. s As the population of cancer survivors continues to grow, so too will the need for effective and timely survivorship care. We present the preliminary findings from our Adult Blood and Marrow Transplant Survivorship Clinic. Our clinic continues to evolve as we aim to help survivors of HCT achieve the best possible quality of life. 6

62 Westin Nova Scotian Floor Plan lobby level ground floor Harbour Suite A Harbour Suite B Mens Room elements on hollis Tradewinds Service Elevators Main Elevators Washrooms Foyer Catering & Reservations Offices Ladies Room Elevator to Pool/Fitness Centre Spa Front Desk / Reception To VIA Rail Train Station Retail Space Seaport Room Roy s Lounge & Cafe Business Centre Main Lobby Gift Shop Sales Office Transportation Concierge Meeting Space Dining Facilities conference level first floor Commonwealth Ballroom A Service Elevators Main Elevators Ladies Room Atlantic Ballroom Atlantic Foyer Elevator to Pool/Fitness Centre Boardroom Northumberland Room Commonwealth Foyer Mezzanine Mens Room Commonwealth Ballroom B Coat Check Maritime Room Bedford Room Fundy Room Lunenburg Room Meeting Space 62

63 Social Event Information Waterfront Warehouse 549 Lower Water Street, Halifax, NS Saturday, June 4, 204 7:00pm onwards About CBMTG The Canadian Blood (CBMTG) is a national, voluntary, and multi-disciplinary organization providing leadership and promoting excellence in patient care, research, and education in the field of BMT. CBMTG s vision is that Canada will be the best place in the world to have a blood and marrow transplant. Furthermore, the mission of the association is that the Canadian Blood is the voice of experts working in the field of blood and marrow transplant. The CBMTG s values are: excellence, innovation, integrity, collaboration and professionalism in care, education and research in blood and marrow transplant. While the association s philosophy is: CBMTG believes that every patient has a right of equal access to the highest quality of life saving care that can be provided by blood and marrow transplant professionals in Canada. Based on this, our strategic priorities are as follows: Education Providing high quality educational programs that advance the practice of blood and marrow transplantation in Canada. Research Establish and organize an effective and sustainable research infrastructure for translational and clinical research. Outreach Increase the visibility and influence of CBMTG among members and the public. Financial Capacity To support, education, research and outreach initiatives through fundraising, partnerships and the establishment of a charitable organization. CBMTG Membership: The CBMTG membership is made up of national and international physicians, nurses, laboratory technicians, pharmacists, and coordinators working in blood and marrow transplant. For more information, please visit 63

64 May 2-5, 205 Le Centre Sheraton Montreal Hotel We invite all BMT health care professionals to attend our conference in Montreal in 205. The 205 conference planning committee, led by Dr. Silvy Lachance and the Montreal BMT team, will work to create an exciting program that will feature presentations on the latest developments in BMT patient care and clinical and laboratory research breakthroughs. The format of the 205 CBMTG conference will include scientific plenary sessions, keynote presentations, multidisciplinary and discipline-specific sessions, oral research presentations, committee and society meetings and corporate satellite symposia. CBMTG Head Office: 375 West 5th Avenue, Suite 20 Vancouver, BC V5Y J6 T: F: E: W: Annual Conference of the Canadian Blood An educational conference for professionals in the field of Blood and Marrow Transplantation

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