Comparison of 140mg/m2 vs 200mg/m2 Dose of Melphalan in Myeloma Autograft - a Single Centre Experience from Chennai, India

Introduction: - Melphalan at a dose of 200mg/m2 is considered the standard autograft dose in patients with multiple myeloma without significant co-morbidity. This drug was formulated in the early years before the era of novel agent induction and maintenance. Considering the deeper remission of novel agents and prevailing refractory gram-negative sepsis in most Indian setups, we compared 140mg/m2 (MEL140)vs. 200mg/m2(MEL200) of Melphalan in Indian myeloma patients who achieved a complete remission before transplant without having any significant co-morbidity. Methods and results: - We analysed myeloma autograft patients from September 2014 to August 2017. 42 patients received MEL200, and 43 patients received MEL140. Diabetes on oral medications was randomised equally on both sides. The median age of patients in MEL200 was 52 years, and MEL140 was 53.6 years. There were 60% and 55% of males in MEL200 vs. MEL140, respectively. ISS-III patients was 48% and 49% in MEL200 vs. MEL140, respectively. The standard induction regimen was three to four cycles of RvD chemotherapy. Around 16% of patients in the MEL140 group had a creatinine clearance between 30-50ml/min. The mobilisation regimen followed was five days of GCSF based mobilisation. The stem cell cut-off was kept to a minimum of 2 x 106/CD34+ve cells/kg body weight. Overall, 12% of patients in both groups needed a second-day stem cell collection. Three-year overall survival, progression-free survival, the incidence of relapse, rate of refractory sepsis, the time difference in hematopoietic recovery, and secondary cancers were compared between two groups. In outcome analysis, there was no transplant-related mortality in both groups. The mean day of engraftment was around Day +9 in MEL140 vs. Day +11 in MEL200. The rate of Gram-Negative Bacilli sepsis was around 14% in MEL140 vs. 27% in Mel200 (p 0.02). These findings were reflected in the use of high-end antibiotics like Colistin and Fosfomycin in such patients. There was a delay in engraftment, which may have been confounded by sepsis. The median progression-free survival was 26.1 months in MEL200and 27.2 months in the MEL140 group. The cumulative incidence of relapse at three years was not significantly different between the Mel200 (33.3%) and Mel140 (34.9%) groups. The adjusted HR for relapse was 0.98. Subgroup analysis suggests that in overall survival, progression-free survival, and cumulative incidence of relapse, there was no significant advantage associated with Melphalan 200 mg/m2. Age, renal status, proteasome inhibitor treatment, gender, or Karnofsky score did not interact with overall/progression-free survival or relapse rate in the two melphalan dose groups. One patient in the MEL200 group developed -5q deletion Myelodysplastic syndrome after five years of transplant. Discussion: This study was conducted taking into account the changing scenario in myeloma induction and maintenance to novel agents and increasing rate of resistant gram-negative sepsis in Indian febrile neutropenic patients. As we can achieve a deeper remission before transplant, we formulated to compare lower dose melphalan to prevent a stormy post-transplant course and prevent patients succumbing to sepsis. This may not be an issue in western countries where gram-negative sepsis rates are lower. The biggest worry for us is not compromising the myeloma outcome due to lower doses of Melphalan in fit patients who achieve complete remission. This study concluded that there is not much of a difference in overall survival, Progression-free survival, and cumulative incidence of relapse at three years among MEL200 vs. MEL140. Conclusion: - We conclude that Melphalan autograft at a dose 140mg/m2 can achieve comparable responses to 200mg/m2 in Indian myeloma patients who are taken to transplant post complete remission. We need a more prominent multicentric study and a longer follow-up to recommend MEL140 as a standard of care in Indian settings. References: Auner HW et al. Melphalan 140 mg/m2 or 200 mg/m2 for autologous transplantation in myeloma: results from the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party. Haematologica. 2018;103(3):514-521.Saunders IM et al A lower dose of Melphalan (140 mg/m2) as preparative regimen for multiple myeloma in patients &amp;gt;65 or with renal dysfunction. Blood. 2013;122:5536. Disclosures No relevant conflicts of interest to declare. </jats:sec

Management of Indian Haematology Patients during COVID19 Crisis

Introduction :- In current COVID19 situation, we have tried to formulate a practical approach for managing haematology patients, which we have been following for the last four months at our centre. Cancer can kill; COVID also can kill. The aim is to be alive till the end of pandemic - both patients and doctors. Some general points for consideration: Due to lockdown and general panic, the stocks in Blood Banks are in an all-time low. So transfusions and donor arrangements have to be dealt judiciously. [6,7] Telemedicine was encouraged to reduce hospital visits in all chronic follow up patients who are stable with safe blood counts. Our Haematology Management Protocol - COVID19Acute Myeloid Leukaemia For Acute Promyelocytic Leukaemia cases it was the same as before. Acute Myeloid Leukaemia - NON-M3 We admitted all these patients with one attendee for few hours in COVID suspect ward and did COVID19 test before starting treatment. We were worried about intense 7+3 induction regimen. Hypomethylating agent (Subcutaneous Azacitidine or five-day protocol Decitabine) + Venetoclax or Midostaurin was preferred than a 7+3 nightmare. For consolidation, we continued either hypomethylating agents or preferred 1.5gm cytarabine BD on Day 1,2,3. This protocol had a minimal blood product requirement and lessened the chance of febrile neutropenia. Acute Lymphoblastic Leukemia We did a 50% dose reduction of induction drugs and used minimal steroids In elderly patients, Vincristine + steroids were considered and few received 50% dose adjusted R-HYPER-CVAD / MAC For Consolidation we gave home-based Subcutaneous Cytarabine or switched to oral 6-MP/Methotrexate maintenance. We tried to keep WBC counts &amp;gt;2,000/microL in maintenance patients. Myelodysplastic Syndromes Higher-risk MDS (IPSS-R score of &amp;gt;3.5): We gave Hypomethylating agents (without reducing doses). We made Transfusion cut-off asHb &amp;lt; 7gm and Platelet &amp;lt; 10,000/microL or clinical bleeding. Myelo- proliferative Neoplasms the protocol was the same like before. Myeloma [12] For Newly Diagnosed cases if &amp;lt;65 years -VRd x 4 cycles, followed by autograft &amp; Lenalidomide maintenance protocol were continued.We converted Bortezomib to no more than weekly injections.We continued myeloma autograft with 140mg/m2 Melphalan. For Maintenance, we continued single-agent iMID. For Relapse - we tried weekly Carfilzomib with Pomalidomide. Hodgkin Lymphoma We gave ABVD every two weeks with Peg GCSF or mid-cycle home GCSF. This avoided severe neutropenia. We used liberal prophylactic antibiotics. In relapsed cases, Gemcitabine based or three-day admission DHAP salvage were given. We did dose adjusted BEAM autografts. Non- Hodgkin LymphomaIndolent NHL: In asymptomatic patients, Wait &amp; Watch policy with monthly monitoring was done. We gave R-CVP. Oral Ibrutinib home therapy for Marginal zone, Mantle cell, Small cell lymphoma, and Waldenstrom Macroglobulinemia. Relapsed /Refractory cases, we used Lenalidomide, Ibrutinib with or without Rituximab. High-grade Non-Hodgkin Lymphoma If fit - R-CHOP 14/21 was given with GCSF support. For Frail patients, we preferred R-CVP. Suspected CNS lymphoma, we gave R-CHOP with IT Methotrexate than HDMTx. In few patients, we considered Lenalidomide / Ibrutinib maintenance.Dose adjusted BEAM autografts were done. Bone marrow transplant We did a detailed discussion about the pros and cons with patient and attendee. We admitted them in a separate block and got both tested for COVID19. The donor was made to stay as attendee for the patient. We shifted them inside transplant unit and observed for a week to rule out COIVD symptoms. For autograft , we did around 30% dose reduction but for allograft, no drug dose modification was done. Once engrafted, they were discharged early and kept on follow-up. From first lockdown to mid June 2020 , we completed twelve bone marrow transplants in our centre which included five AML haplo-identical transplants. Conclusion As we wait for the situation to better, the normal functioning of hospitals may take some more time even months. These above are the methods we are following in our MIOT hospital at Chennai, India the city which has got around 30,000 COVID19 cases during submission. Our advice is where ever feasible, we should try to stick to time tested conventional protocols. The above protocols may be useful temporarily till the COVID crisis is over. Disclosures No relevant conflicts of interest to declare. </jats:sec

On Demand Plerixafor As a Rescue Strategy in Healthy Donors to Achieve Adequate Stem Cells - a Pilot Study from South India

Aims &amp; Objectives: The aim of the study is to check the safety and feasibility of using Plerixafor in healthy donors who have failed to mobilise &gt; 2 x 10 6/kg of CD34 cells on day 1 of aphresis. The indication at present remains off label. Patients/Materials &amp; Methods: Seventeen healthy donors, all more than 18 years of age were enrolled in this study after a proper written informed consent who failed to mobilise adequately on day 1 collection. The dose of Plerixafor used was 0.24mg/kg body weight of donor, 10-11 hours before the aphresis procedure. The GCSF was given from day -5 and the last dose was given 4 hours before the second day aphresis. CD34 was done in pre-aphresis peripheral blood and in product bag and compared with day 1 data. Results: The median donor bw was 54 kg (IQR, 42 kg to 69 kg) and the median recipient bw was 58 kg (IQR, 44 kg to 76 kg).The median CD34+ count in peripheral blood was 11.2/µl on day 4 after G-CSF alone and 24.7.0/µl on day 5 after G-CSF plus Plerixafor. The use of Plerixafor increased the number of circulating CD34 cells in peripheral blood by 2.2 fold.There were no major side effects except for the manageable bone pains which can be attributed to GCSF also. There were no differences in the engraftment statistics and rates of GVHD in comparison to historical cases. Though this is not a randomised control study to compare with second day high dose GCSF cases, the amount of increase in stem cells were statistically significant comparing with historical controls(p&lt; 0.05). After a median followup of six months, no adverse effects were noted in donors. Discussion &amp; Conclusion: Plerixafor is well tolerated in healthy donors and can be used safely in situations of poor mobilisers or when there is a significant difference in weight of donor to receipient. Its a small pilot study. We need a proper randomised control study and a longer follow up to look infor the side effects on healthy donor. Disclosures No relevant conflicts of interest to declare. </jats:sec

Psychiatric Illness in Indian Bone Marrow Transplant Patients.

Abstract Introduction: Bone marrow transplantation is the main stay treatment for various disorders. Psychosocial morbidity associated with Bone Marrow Transplant are due to the diagnosis of a deadly disease, curative option with its associated risk of death. Several psychosocial factors influence the long-term outcome in patients. Objective: To identify Psychiatric illnesses in Indian patients undergoing hematopoietic stem cell transplantation. Materials and Methods: This cross-sectional study was conducted during the period of July 2015 to March 2017 at Institute of Haematology and Bone Marrow Transplantation, MIOT INTERNATIONAL, Chennai, India. All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE). Results: Out of 72 enrolled patients, twenty-six (36.1%) patients met the psychiatric diagnostic criteria. Adjustment disorder (43%) was more frequently encountered among the affected individuals followed by depressive illnesses (24%). Discussion: We had 36% of patients with symptoms of psychiatric illnesses. Interestingly higher percentage (54% and 41%) of psychiatric morbidity was observed in studies carried out by Leigh et al. and Sasaki respectively. Regarding diagnostic breakup among transplant patients, adjustment disorders (with symptoms of anxiety and depression) was the most frequent diagnosis (43%) in our study, which is similar to research of Sasaki. While on the other hand study done by Jenkin et al.observed higher prevalence (40%) of depression, which was the second highest psychiatric morbidity in our research. Majority of patients appeared to be mentally prepared and tolerant during transplantation and very few patients observed psychological problems. So, any sort of psychological issues encountered during transplantation has no relation with the diagnosis or the therapy per se but rather is more intricately related to the personality and personal history of the patients. Post-transplantation period seems to be highly stressful mainly due to the isolation, high vigilance, expectations, apprehension of the future and reverse barrier nursing. Therefore, most of psychiatric symptoms were observed within first week after transplantation procedure in 69% (n=18) of patients in our study. Other studies by Illescas - Rico et al. and Sasaki also noted that psychiatric disorders mainly developed after transplantation in majority of cases (68.75%). 76%(n=20) required psychotropic medicines in addition to counselling and psychotherapy Psychiatric symptoms settled in 62% (n=16) of cases during their stay in BMT unit. In this study, patients of the age group 24-45 years, were mostly affected comprising of 54% of all the individuals having psychological problems. Another study carried out by Prieto et al.on 220 patients who had recieved stem cell transplantation had however observed that younger age is one of the risk factor associated with psychiatric disorder in BMT. This clearly reflects the more stress observed in younger population secondary to transplantation. Regarding gender, it is believed that psychiatric disorders are significantly more common in females than males. However in this study, the number of males (58%) were more than the number females amongst the affected patients. There are few limitations of our study like the relatively small sample size, single centre study and limited time period. A multi-centric study is mandated to establish the findings more strongly to bring about a comprehensive care for the patients. Conclusion: Significant psychiatric morbidity (&gt;1/3 - 36%) associated with bone marrow transplantation was observed. This study indicates the importance of psychiatric intervention during the transplant procedure as well as pre-transplant psychiatric assessment and counselling regarding transplant procedure. Keywords: Psychiatric disorder, Adjustment disorder, Hematopoietic stem cell transplantation. References Andrykowski MA.Psychological factors in bone marrow transplantation: a review and recommendation. Bone Marrow Transplant 1994; 13: 357-375, PrietoJM, BlanchJ, AtalaJ, CarrerasE, RoviraM, CireraE, et.al. Stem cell transplantation: risk factors for psychiatric morbidity. Eur J Cancer 2006; 42:514-20. Table. Table. Disclosures No relevant conflicts of interest to declare. </jats:sec

Pattern of Bacterial Infections in Indian Bone Marrow Transplant Patients - Experience from Chennai India

Abstract Introduction: Bone marrow transplant, both Autograft and Allograft produces profound immune-suppression and breach of mucosal surfaces leading to many opportunistic infections. There is a difference between infection pattern in countries like India compared to western countries. The western literature is more bothered about reactivation of viral and fungal infections, whereas Indian bone marrow transplant physicians are worried about losing patient to refractory gram negative sepsis. In this study, we have tried to decode the pattern of bacterial infections in Indian transplant patients and tried to suggest an antibiotic stewardship for the same. Materials and methods: This retrospective study included all bone marrow transplants with Febrile neutropenia done at our hospital from September 2014 to July 2021. A total of 440 patients were included and their pattern of bacterial infections with culture sensitivity and response to antibiotics were noted. Results: 36% of patients we included in the study were aged between 40 to 60 years and the age range was from 2 years to 72 years. 59% were autograft and among Allograft 36% were haplo-identical bone marrow transplant. Nearly half the patients presented with fever above 99.5 F and tachycardia as the presenting sign. The WBC count during first episode febrile neutropenia was less than 100cells/cumm in around 25% patients. Empirical antibiotics post culture samples were initiated within 10 min in 95% of patients. Cefoperazone Sulbactum and Amikacin were started empirically as first line in all. Culture positivity rate was 22.7% of which 60% were multi-drug resistant gram negative bacilli which were sensitive only to Colistin / Fosfomycin / Tigecycline. This 60% MDR GNB is very high which may be partially due to MDR bugs in normal intestinal flora of patients from this part of the world. The common Gram-negative bacteria are Pseudomonas, Escherichia coli and Klebsiella. This made us to change antibiotic stewardship policy to Colistin / Fosfomycin / Ceftazidime avibactum very early in course in case of second fever / Hypotension or tachycardia. Our transplant related mortality is around 3% in Allograft due to sepsis and 0% in autograft. The rate of gram positive bacteremia is only 2% and this makes us think of avoiding drugs like Teicoplanin / Glycopeptides in first line empirical therapy. Conclusion: This seven year study had shown 22.7% culture positivity rate in febrile neutropenia transplant patients of which 60% are multi-drug resistant bacteria which is highly contrary to western literature. The rate of gram positive culture growth is only 2% which is lower than western literature. This study implies the importance of region and center specific antibiotic policy for febrile neutropenia and a generalized policy may not work always. Reference:- 1. Ghafur A, Devarajan V, Raj R, Easow J, Raja T. Spectrum of bacteremia in posthematopoietic stem cell transplant patients from an Indian center. Indian J Cancer 2016;53:590-1 2. Krüger W,et al. Early infections in patients undergoing bone marrow or blood stem cell transplantation--a 7 year single centre investigation of 409 cases. Bone Marrow Transplant. 1999 Mar;23(6):589-97. doi: 10.1038/sj.bmt.1701614. PMID: 10217190. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. </jats:sec

How We Did Bone Marrow Transplants amidst the COVID19 Pandemic

Introduction COVID19 is the most heard name for the last six months, and the situation seems to worsen now. This pandemic has created significant stress on the healthcare system. Most of the resources are being diverted to COVID care, and care of non-COVID patients is compromised. As haematologists dealing with frail immune-compromised patients, challenges we are facing are staff attrition, near-empty blood banks, less intensive care beds, the chance of our patients getting infected with COVID during the hospital stay, fear of donors being asymptomatic COVID carriers to mention a few. In this situation, we have tried to formulate a practical approach for doing bone marrow transplants, which we have been following for the last few months at our centre. Our Transplant Protocol Initially we tried to postpone transplants. But as the COVID situation was becoming a chronic one, we formulated our ways to start transplants. Amidst lockdown, we successfully completed Autografts in myeloma and Lymphoma. We also started Allogeneic transplants including haplo-identical transplant for acute leukemia. In this hour of need, we had to strike a balance in transplant management. We tried to be practical in our decision-making skills at this hour of need. Being students of science, it was time to show practicality in ordering tests, therapy, and transfusions to the patient. Due to lockdown and general panic, the stocks in Blood Banks were at an all-time low. So transfusions and donor arrangements were be dealt judiciously. The hospital was divided into COVID and NON-COVID zones. All patients with fever and respiratory symptoms go directly to the COVID zone and get examined and tested by physicians with proper PPE as per WHO protocol.Even there are no symptoms of COVID like dry cough, fever, and throat pain, the patients entering NON-COVID also will be screened by a general physician at the single point of entry with proper protection and then patient with one attendee was allowed to come to transplant outpatient department. This helped us reduce risk to the medical professional and other patients waiting in a specialty department like ours. We had a detailed discussion about the pros and cons with patient and attendee. We admitted them in a separate block and got tested for COVID19 RTPCR. The patient had HRCT thorax to check for early radiological signs of COVID19. The blood parameters which serve as prognostic markers for COVID were checked alongside to double confirm false negativity of tests.The donor was made to stay as attendee for the patient. We shifted them inside transplant unit and observed for a week to rule out COVID symptoms. Radiological investigations were done before starting procedure. Minimal physical interaction was established and in Myeloma and Lymphoma autograft, we did around 20% dose reduction of conditioning regimen drugs. For allograft, no drug dose modification was done. The threshold for antibiotic stewardship was kept very low and high end antibiotics like Colistin / Fosfomycin were initiated early. We collected single donor platelets and kept stocks ready to avoid exposure to multiple random donors. The blood bank also was very careful in selecting donors after a thorough screening for symptoms of COVID19. Once engrafted, they were discharged early and kept on follow-up mostly by tele-consultation. The personal visits were kept to a minimum of once in four weeks. From first lockdown to date of submission, we completed nine bone marrow transplants at our centre which included three AML haplo-identical transplants. Conclusion Postponing transplant is not feasible in all situations, as few of our refractory diseases will ultimately relapse and transplant becomes the only live saving procedure. As we wait for the situation to better, the normal functioning of hospitals may take some more time.These above are the methods we are following in our MIOT hospital at Chennai, India the city which has got around 100,000 COVID19 cases during submission. Our advice is where ever feasible, we should try to stick to time tested conventional protocols. The above protocols may be useful temporarily till the COVID crisis is over. Reference Willian J. Care of hematology patients in a COVID-19 epidemic. British Journal of Hematology, 2020.Dholaria, Savani B.N. How do we plan hematopoietic cell transplant and cellular therapy with the looming COVID-19 threat? British Journal of Haematology, 2020.https://doi.org/10.1111/bjh.16597 Disclosures No relevant conflicts of interest to declare. </jats:sec

Experience of Low Dose (25mg/Kg) of Cyclophosphamide (Chennai-Chezhian-Kishore PTCy Protocol) As Post Transplant Cyclophosphamide (PTCy) Dose in Haploidentical Bone Marrow Transplant

Abstract Introduction:- Haploidentical Bone marrow transplantation has become one of the most commonly employed alternative donor techniques, with many centers applying T-cell-replete strategies developed by the Baltimore group using high-dose post-transplant cyclophosphamide. The usefulness of this technique is to reduce graft acquisition cost, lesser grade of GVHD, and reduction in non-relapse mortality. One problem we face in a country like India is the worry of engraftment delay leading to refractory multi-drug resistant gram-negative sepsis increasing the risk of transplant-related mortality. We took up this pilot study to check for the feasibility of a low dose (50%) 25mg/kg of cyclophosphamide as PTCy and its impact on transplant outcomes especially GVHD. Methodology:- This study was done from January 2016 to June 2019. 41 Haploidentical bone marrow transplants were done for Acute Myeloid leukemia at this time under this protocol. 23 Cases had Busulfan / Fludarabine as conditioning and in 18 cases; we used Treosulfan / Fludarabine-based conditioning regimen. The study protocol PTCy dose was 25mg/kg on Day +3 and Day +4. Cyclosporine / Tacrolimus was used from day -1 in all patients as GVHD prophylaxis. The parameters analyzed are engraftment dynamics, rates of gram-negative sepsis, hemorrhagic cystitis, rates of acute and chronic GVHD, and 2-year Non-relapse mortality. Results: Parents were the haploidentical donors in 22 cases whereas siblings in the rest 19 cases. Peripheral blood stem cell collection was chosen in all cases. The average CD34 dose was 6.8 x 10 6/Kg of the recipient. The mean number of days to achieve engraftment was around day 11. Culture-proven gram-negative sepsis was seen in 11 cases (26.8%). Two patients died within Day +30. Both due to sepsis. The rates of acute GVHD of grade I/2 was 18 (43.9%) and grade 3/4 acute GVHD was seen only in 2 patients (5%). No mortality was due to GVHD. With a median follow-up of two years, chronic skin and liver grade 1/2 GVHD was noted in 29 patients (74.3%) but were manageable with oral and topical medications not needing admission. Three patients had hemorrhagic cystitis. CMV reactivation needing medications was seen in 5(12.2%) patients indicating a higher incidence of post-transplant viral reactivation with PTCy. At data cut-off, we had lost 12 patients due to relapse and there was no non-relapse mortality except for the two sepsis-related death. Conclusion: The results of this pilot study indicate the feasibility of using a low dose PTCy (25mg/kg) in Haploidentical transplant as a methodology for in vivo T cell depletion without increased incidence of GVHD and Non-relapse mortality in Indian patients. This is a small study and it needs further follow-up with drug metabolism analysis and a bigger cohort to make this Chennai-Chezhian-Kishore PTCy Protocol a validated standard in Haplo-identical transplants. This is a pilot study and we are planning to incorporate genetic polymorphism in drug metabolism to validate the proposed protocol more scientifically. Reference: 1. Wang, Y et al. Low-dose post-transplant cyclophosphamide and anti-thymocyte globulin as an effective strategy for GVHD prevention in haploidentical patients. J Hematol Oncol 12, 88 (2019). https://doi.org/10.1186/s13045-019-0781-y 2. Shannon R. McCurdy, Leo Luznik How we perform haploidentical stem cell transplantation with posttransplant cyclophosphamide Blood (2019) 134 (21): 1802-1810. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. </jats:sec

IgM myeloma: a rare entity characterized by a CD20-CD56-CD117- immunophenotype and the t(11;14)

IgM myeloma is a very rare and poorly defined entity. In a detailed assessment of 10 cases, it was demonstrated that 70% had an aberrant phenotype based on the expression of CD19, CD45, CD27 and Cyclin D1 but all cases lacked CD56 and CD117. Interphase fluorescence in situ hybridization demonstrated deletion 13 in 50% while 5/8 cases assessed had a t(11;14). Despite the high incidence of the t(11;14), CD20 was only expressed in one of nine cases. We conclude that IgM myeloma is a distinctive subset characterized by a CD20-CD56-

Prognostic value of end-of-induction PET response after first-line immunochemotherapy for follicular lymphoma (GALLIUM): secondary analysis of a randomised, phase 3 trial

International audiencePET investigators from the GALLIUM study (2018). Prognostic value of end-of-induction PET response after first-line immunochemotherapy for follicular lymphoma (GALLIUM): secondary analysis of a randomised, phase 3 trial. The Lancet Oncology