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RESEARCH PRODUCT

P0623ACUTE RENAL FAILURE IN HAPOLIDENTICAL HEMATOPOIETIC CELL TRANSPLANTATION. TWO GRAFT VS HOST DISEASE (GVHD) PROFILAXIS PROTOCOL COMPARISON

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Abstract Background and Aims Haplo-hematopoietic cell transplantation (Haplo-HCT) assures a valid donor in short notice in over 95% of the patients with high risk haematological neoplasia. High doses of post-transplant cyclophosphamide, in combination with other inmunosupressive drugs like calcineurin inhibitors, rapamycine and micophenolate mofetil, is safe and useful in GVHD prevention. The aim of the study was to analyze and compare acute kidney injury (AKI) in the first 100 days after transplantation, the characteristics of the patients who went on haplo-HCT, and prophylaxis for GVHD with cyclosporine (n=32) (group 1) or rapamycine (group 2), in combination with other immunossupresors. Method Fifty-two consecutive patients who recieved a Haplo-HCT at our institution between october/2012 and February/2019 were retrospectively reviewed. Results A total of 52 patients were included, 34 male (65.4%), with a median age median age of 52.8 years old (range 18-71). Co-morbidities: hypertension: 13 (25%), Diabetes: 13 (5.8%), previous neoplasia: 4(7.7%). 27 patients received previously platinum-based chemotherapy with and 50% had received a previous HCT. No chronic kidney disease (CKD) were present in any patient. Haematological diseases were :non Hodgkin lymphoma (28.8%), Hodgkin lymphoma (23.1%), acute myeloid leukemia (21.2%), myelodysplastic syndrome (13.5%), other (13.4%). 42 patients (80.8%) received reduced intensity conditioning. Major complications were: TMA: 7(13.5%), Sinusoidal Obstruction Syndrome: 3 (5.8%) and sepsis 27 (51.9%). During the first 100 days post-transplantation follow up, 26 patients (83.2%) in group 1 and 5 patients (25%) in group 2 developed AKI attending KDIGO classification (p<0.0005). At day 100 post-transplantation, 14.5% of survivors had renal failure, defined as increased of serum creatinine ≥ 0.3mg/dL with respect to their baseline. In group 2 none of the patients developed acute kidney injury (0%) at 100 days post-transplantation follow up. Median serum Cr in survivors at day 100 was 0,65mg/dL in group 1 VS 0.62mg/dL in group 2, (p<0.001). In the multivariate analysis, treatment with CI (p<0.01) and sepsis (p<0.05) were independent predictors of ARF. Conclusion Rapamycin use instead cyclosporine is associated with a significatively lower incidence of AKI in the first 100 days post-tansplantation in our group of patients. The findings of this study call for further research identifying if non cyclosporine group have similar results in term of prevention of GVHD and if this protocol has a better impact in renal function and surveillance in the follow up.