scholarly journals Evaluating the Clinical Utility of Staged Bronchoalveolar Lavage (BAL) Fluid Analysis in Adolescent and Adult Acute Leukemia and Lymphoma Patients with Febrile Neutropenia and Lung Infiltrates

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4008-4008
Author(s):  
Venkatesh K ◽  
Dr. Hasmukh Jain ◽  
Jayshree Thorat ◽  
Dr. Manju Sengar ◽  
Sandeep Tandon ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Conflicts Of Interest ◽  
Diagnostic Yield ◽  
Microbiological Diagnosis ◽  
Serological Tests ◽  
Fluid Analysis ◽  
Number Of Patients ◽  
Radiological Response ◽  
Staged Approach ◽  
Lung Infiltrates

Abstract Introduction: Lung infiltrates(LI) are seen in 30-45% of the patients with Febrile neutropenia(FN) in haematological malignancies.In FN patients with LI, accurate/probable microbiological diagnosis is possible in only 30 % with conventional blood culture and serological tests. BAL increases the microbiological diagnostic yield. The battery of microbiological tests done in BAL fluid analysis is not uniform.We evaluated a staged approach while analysing the BAL fluid sample, in the first stage we performed the routine cultures and antigen-based tests and in patients with negative results, we performed Polymerase Chain Reaction(PCR) tests guided by the radiological findings. Methods: This was a prospective observational study initiated after Institutional ethics committee approval and conducted at Tata memorial centre,Mumbai between November 2018 and June 2020.BAL testing was done as per a standard protocol(Sampsonas et al.) in hemodynamically stable patients with Spo2 more than 90% and platelet count above 300x10 9/L.Samples were sent for gram stain & bacterial cultures, ziehl neelsen stain and cultures, fungal stain and cultures and Galactomannan (ELISA) and an extra sample was preserved in an EDTA vacutainer at 10-20 degree C. If none of the initial reports were positive, then stored BAL sample was sent for PCR testing guided by the radiology and clinical picture i.e., with nodular infiltrates(Bacteria,Nocardia,Aspergillus,Mucor,P.Jiroveci,Mycobacterium TB,Atypical Mycobacterium TB) and with diffuse micronodular infiltrates Viruses,Legionella,mycoplasma PCR tests were sent. The causal association of the isolated organism was defined as per AGIHO guidelines(G. Maschmeyer et al.) The Primary objective is proportion of patients with a confirmed microbiological diagnosis using staged BAL analysis. The Secondary Objectives are proportion of patients who had a change in antimicrobial therapy,Feasibility of doing a Bronchoscopy and Proportion of Patients who develop Major or Minor complications during procedure and the 4 and 12weeks Clinical and Radiological Outcomes. A sample size of 130 patients was required for incidence of 50%(40-60%) positivity with 10% variation at 95% confidence interval. Results: A total of 172 patients were eligible of which 50 patients are not enrolled due to physician discretion in 37 patients,9 lost for followup and 2 refused consent and one patient expired and one palliated and 122 patients are enrolled and of these BAL couldn't be done in 20 patients due to hypoxia,low platelets,poor GCS at the time of performing BAL and finally BAL is feasible in 83.6%(n=102/122) patients. Baseline characteristics of patients are mentioned in Table 1.Median age of the patients was 30 (15-65) years with 69.6% males (n=85/122). A confirmed microbiological diagnosis (G. Maschmeyer et al.) was established in 71.3%( 81 /122 ) of cases.Microbiological results are depicted in Table2. A change of antimicrobial based on BAL (addition and removal of antimicrobial) was done for 78 patients(63.8%) of which 42 had removal of antibacterial and 11 patients had removal of antifungals. Among 42 patients who had removal of antibiotics, by the end of 4weeks, 36(85.7%) had clinical response and 34 had radiological response,(4 died and 2 lost for followup). By the end of 12weeks, 31 patients had sustained clinical and radiological response (2 died, 2 lost to follow-up and 1 progressive disease). Among 11 patients with removal of antifungals 9 had clinical and radiological response by the end of 4weeks (1 died and 1 non responder) which was sustained at week 12. Complications of BAL One patient had a major complication (persistent hypoxia), while minor complications were recorded in 27/122 (22%) (Hypoxia-16, hypertension-8,tachycardia-3) during procedure and in 21/122 (17%) (Fever-8, bleeds-6, tachycardia-5,hypertension-2)upto 24 hours post procedure. Clinical and Radiological responses as per criteria( Figure 1) Conclusion: BAL fluid analysis improves the diagnostic yield in febrile neutropenia with lung infiltrates. This leads to a change in antimicrobials in a significant number of patients. It contributes to improved outcomes in this patient population. The test is feasible in a large majority, is safe and the staged approach helps in optimisation of resources. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Initial experience of TAS-102 chemotherapy in Australian patients with chemorefractory metastatic colorectal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 71-71
Author(s):  
Azim Jalali ◽  
Hui-Li Wong ◽  
Rachel Wong ◽  
Margaret Lee ◽  
Lucy Gately ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Febrile Neutropenia ◽  
Metastatic Colorectal Cancer ◽  
Real World ◽  
Performance Status ◽  
Progression Free Survival ◽  
Median Number ◽  
Ecog Performance Status ◽  
Number Of Patients

71 Background: For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. In Australia, TAS-102 was initially made available locally through patients self-funding, later via an industry sponsored Medicine Access Program (MAP) and then via the Pharmaceutical Benefits Scheme (PBS). This study aims to investigate the efficacy and safety of TAS-102 in real world Australian population. Methods: A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to all TRACC patients and those enrolled in the registration study (RECOURSE). Results: Across 13 sites, 107 patients were treated with TAS-102 (non-PBS n = 27, PBS n = 80), The median number of patients per site was 7 (range: 1-17). The median age was 60 years (range: 31-83), compared to 67 for all TRACC patients and 63 for RECOURSE. Comparing registry TAS-102 and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 39% vs 49% were RAS wild type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median clinician assessed progression-free survival was 3.3 compared to RECIST defined PFS of 2 months in RECOURSE study, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths in the real-world series, where TAS102 dose at treatment initiation was at clinician discretion. In the RECOURSE study there was a 4% febrile neutropenia rate and one treatment-related death. Conclusions: TRACC registry patients treated with TAS102 were younger than both TRACC patients overall and those from the RECOURSE trial. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS. However overall survival outcomes achieved with TAS102 in real world patients were comparable to findings from this pivotal trial with an acceptable rate of major adverse events.

Factors associated with pressure ulcer onset after knee replacement

2021 ◽  
Vol 30 (11) ◽  
pp. 924-929
Author(s):  
Cristiana Forni ◽  
Nicola Cerantola ◽  
Gianfranco Ferrarelli ◽  
Luana Lombrosi ◽  
Andrea Bolzon ◽  
...  
Keyword(s):  
Knee Replacement ◽  
Predictive Factors ◽  
Conflicts Of Interest ◽  
Area Under The Curve ◽  
Factors Associated ◽  
Replacement Surgery ◽  
Braden Scale ◽  
Combined Use ◽  
Number Of Patients ◽  
Knee Replacements

Objective: The aim of this study was to find the rate of pressure ulcers (PUs) in patients with knee replacements and identify predictive factors. The ability of the Braden scale to predict the onset of PUs was also investigated. Method: A retrospective prognostic cohort study was carried out involving all consecutive patients undergoing knee replacement surgery. The data were collected from patient records. The variables collected were grouped into two categories: those connected to the patient's own characteristics; and those linked to the care methods used. Results: The total number of patients included in the study was 565. Of these, 2.3% had developed a PU: 0.5% at the heel and 1.8% at the sacrum. Multivariate analysis showed that the variables actually correlated to the outcome were age (p=0.074; odds ratio (OR)=1.08), body mass index (BMI, p=0.037; OR=1.13) and Braden scale (p=0.029; OR=0.72). A combination of these three parameters showed better predictivity of PUs (area under the curve (AUC) 84%). Conclusion: Age, BMI and preoperative Braden score were shown to be independent predictive factors of the onset of PUs in patients with knee replacements. The combined use of all three variables increased the ability to identify the patients at most risk of developing a PU. Declaration of interest: The study was financed by the Professional Nurse Register of Bologna as winner of a competition for research projects in the province of Bologna. The authors declare no conflicts of interest.

Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit

2020 ◽  
pp. 104990912096997
Author(s):  
Ricardo Diaz Milian
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Conflicts Of Interest ◽  
Quality Care ◽  
Surgical Intensive Care Unit ◽  
Care Needs ◽  
Surgical Intensive Care ◽  
Quality Reporting ◽  
Number Of Patients ◽  
Hospice And Palliative Care

End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month of life. Multiple barriers exist to the initiation of these conversations, including: miscommunication between clinicians and surrogates, a paternalistic approach to surgical patients, and perhaps, conflicts of interest as an unwanted consequence of surgical quality reporting. Goal discordant care refers to the care that is provided to a patient that is incapacitated and that is not concordant to his/her wishes. This is a largely unrecognized medical error with devastating consequences, including inappropriate prolongation of life and non-beneficial therapy utilization. Importantly, hospice and palliative care needs to be recognized as quality care in order to deter the incentives that might persuade clinicians from offering these services.

The Certainty of a Post-Bone Marrow Diagnosis: A Study of the Yield of Bone Marrow Biopsies in a Community Hospital Setting

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-35
Author(s):  
Manasi M. Godbole ◽  
Peter A. Kouides
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Fever Of Unknown Origin ◽  
Conflicts Of Interest ◽  
Diagnostic Yield ◽  
Hospital Setting ◽  
Unknown Origin ◽  
Nutritional Deficiencies ◽  
Bone Marrow Biopsies

Introduction: Most studies on the diagnostic yield of bone marrow biopsy including the one by Hot et al. have focused on the yield of bone marrow biopsies in diagnosing the source of fever of unknown origin. However, there have not been any studies performed to our knowledge looking at overall practice patterns and yield of bone marrow biopsies for diagnoses other than fever of unknown origin. We aim to determine the most common indications for performing bone marrow biopsies in a community-based teaching hospital as well as the yield of the biopsies in patients with specified and unspecified pre-test indications to estimate the rate of uncertain post-test diagnoses. Methods: We performed a retrospective data collection study at Rochester General Hospital, NY. A comprehensive search was conducted in our electronic medical data to identify all patients who underwent bone marrow biopsies over a 5 year period from January 2011 - December 2016 for indications other than fever of unknown origin. Patient data including demographics, pre-bone marrow biopsy diagnosis and post-bone marrow diagnosis was obtained. All patients above the age of 18 who underwent bone marrow biopsy for indications other than fever of unknown origin or follow up treatment of a hematological malignancy were included. Results: A total of 223 biopsies were performed. The median age was 59 years (age range- 23-95). One hundred and sixteen patients were male and 107 were female. The most common indications for performing bone marrow biopsy were evaluation of the following possible conditions: multiple myeloma (n=54), myelodysplastic syndrome [MDS] (n=47), lymphoma (n=28) and leukemia (n=18) as well as non-specific indications such as pancytopenia (n=40), anemia (n=22) and thrombocytopenia (n=11). The proportion of cases confirmed by bone marrow biopsy was 45/54 (83%) with the pre-marrow diagnosis of multiple myeloma, 34/47 cases (72%) with the pre-marrow diagnosis of MDS, 15/18 (83%) with the pre-marrow diagnosis of leukemia and 13/28 (46%) in those with the pre-marrow diagnosis of rule out lymphoma. Thirteen cases (18%) with possible MDS had post-bone marrow diagnoses of leukemia, anemia of chronic disease, myelofibrosis or medication-related changes. Five out of twenty two cases (23%) for anemia and 3/11 cases (27%) for thrombocytopenia without otherwise specified pre-bone marrow etiology had uncertain diagnosis after bone marrow biopsy. Conclusion: In about a fifth of patients necessitating a bone marrow, the diagnosis is discordant and can be surprising. It is also worth reporting that in these discordant results, non-hematological causes such as medications, anemia due to chronic diseases or conditions such as cirrhosis or splenomegaly from other etiologies were among the final diagnoses. Interestingly, 20% of the patients with unspecified pre-bone marrow diagnoses such as anemia or thrombocytopenia in our study had an unclear post-bone marrow diagnosis despite undergoing bone marrow biopsy. Our findings are a reminder that the bone marrow exam does not always lead to a definitive diagnosis and the need by exclusion to include in the differential non-hematological etiologies such as nutritional deficiencies, chronic kidney disease or autoimmune disorders. Disclosures No relevant conflicts of interest to declare.

scholarly journals P54 Pneumocystis jirovecii prophylaxis in patients on rituximab

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Kishore Warrier1 ◽  
Catherine Salvesani ◽  
Samundeeswari Deepak
Keyword(s):  
Risk Factors ◽  
T Cell ◽  
B Cells ◽  
B Cell ◽  
Conflicts Of Interest ◽  
Pneumocystis Jirovecii ◽  
Current Evidence ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Number Of Patients ◽  
Increased Risk

Abstract Background Rituximab is a chimeric monoclonal antibody that depletes the B cell population by targeting cells bearing the CD20 surface marker and is used widely in the management of paediatric rheumatological conditions like juvenile systemic lupus erythematosus (JSLE), juvenile dermatomyositis (JDM), mixed connective tissue disease (MCTD) and juvenile idiopathic arthritis (JIA). Pneumocystis jirovecii pneumonia (PCP) is a potentially fatal opportunistic infection associated with congenital and acquired defects in T cell–mediated immunity. Our guideline did not recommend prophylaxis against PCP for patients on rituximab, unlike patients on cyclophosphamide, who are on cotrimoxazole until three months after cessation of the treatment. Cyclophosphamide is an alkylating agent which affects both B and T lymphocytes. Following the death of 16 year-old girl with JSLE due to PCP, the team reviewed the possible contributing factors, undertook a review of literature and discussed this at multi-disciplinary meetings involving the microbiology and immunology teams. This patient was found to have other risk factors for PCP – low CD4 T cells, concomitant use of corticosteroids and hypogammaglobulinaemia (IgG 3.0g/L). Although there is limited evidence that rituximab on its own increases the risk of PCP, there is emerging data that B cells may have a role in the protection against pneumocystis. Following the review, it was concluded that children on rituximab and an additional immunosuppressant (including corticosteroids) should receive prophylactic cotrimoxazole to cover PCP. Methods Retrospective audit carried out by the team to look at adherence to the new guideline regarding the use of cotrimoxazole for PCP prophylaxis in patients who have had rituximab between August 2017 and May 2019. Results P54 Table 1 Total number of patients who had rituximab 10 Number of patients who had other immunosuppressants concomitantly / recently (within previous 3 months) 7 Number of patients on rituximab monotherapy 2 Number of patients who are 6 months post-treatment 1 Number of patients with other risk factors for PCP 1 (hypogammaglobulinaemia) Number of patients who are eligible for prophylaxis, as per the guideline 8 (7 for concomitant immunosuppression and 1 for hypogammaglobulinaemia) Number of patients on cotrimoxazole 7 (87.5%) - one of the patients is on methotrexate, which is advised not to combine with cotrimoxazole We achieved 87.5% compliance in prescribing cotrimoxazole for PCP prophylaxis to all rheumatology patients receiving rituximab alongside another immunosuppressant agent; the one patient who this was not adhered to was due to potential adverse drug pharmacodynamic interaction between cotrimoxazole and methotrexate. Conclusion Although the current evidence points to increased risk of PCP in patients with inherited and iatrogenic defect of T cell function, there is emerging evidence that B cells may have a role too. Hence more work is required to determine the risk of PCP in patients on B cell targeted therapy (BCTT) and the need for prophylaxis. Conflicts of Interest The authors declare no conflicts of interest.

PS02.125: NEOADJUVANT CHEMOTHERAPY PLUS SURGERY FOR NON-T4 CSTAGE II/III ESOPHAGEAL CANCER: A SINGLE INSTITUTION EXPERIENCE IN JAPAN

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 156-157
Author(s):  
Masahiko Ikebe ◽  
Mitsuhiko Ohta ◽  
Masahiko Sugiyama ◽  
Masaru Morita ◽  
Yasushi Toh
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Adverse Events ◽  
Standard Treatment ◽  
Conflicts Of Interest ◽  
Radical Surgery ◽  
Hospital Death ◽  
Number Of Patients ◽  
Grade 3

Abstract Background In Japan, following the results of JCOG 9907 trial, neoadjuvant chemotherapy (NAC) and radical surgery has been a standard treatment for Non-T4 cStage II/III esophageal cancer. Since 2009 we have also positioned NAC as standard treatment. We examined treatment outcomes and problems in our institute. Methods From 2009 to 2015, there were 64 patients with non-T4 stage II/III esophageal cancer treated with chemotherapy who are planned to undergo curative surgery. The standard NAC regimen consists of 2 courses of CDDP/5-FU (CF) therapy. As standard surgical procedure, subtotal esophagectomy, cervical anastomosis, three regional lymph node dissection were performed. Results The number of patients was 23/41 cases of cStage II/III respectively. 53 patients (88%) completed two courses of NAC. At the end of first course, NAC was terminated due to adverse events in 4 cases and due to the increasing tendency of tumors in 7 cases. NAC-induced adverse events of grade 3 or higher consists of myelosuppression in 27 cases (42%), appetite loss in 5 cases and so on. Surgery was performed in 61 cases (95%), of which R0 operation in 56 cases (88%), R1 operation in 3 cases and R2 operation in 2 cases. Three patients did not undergo surgery due to progressive disease. There were 7 cases (11%) of postoperative complications of Grade 3 or higher, but there was no in-hospital death. In the histological therapeutic effect, there were 5/41/7/4/3 cases for Grade 0/1a/1b/2/3, respectively. Three-year and five-year overall survival rate of all 64 patients were 68% and 47%. In 56 patients who underwent R0 surgery, they were 76% and 61% respectively. Conclusion From the viewpoint of adverse events and postoperative complications, NAC plus radical surgery for cStage II/III esophageal cancer could be performed safely. Considering that more than 60% of the patients belong to cStage III, this treatment strategy resulted in relatively favorable prognosis. Disclosure All authors have declared no conflicts of interest.

CAPD Fluid Examination using the Bactec 460

1986 ◽  
Vol 6 (1) ◽  
pp. 9-11 ◽  
Author(s):  
Maurice Terence Dalton ◽  
Eva Prevost
Keyword(s):  
Pilot Study ◽  
Blood Culture ◽  
Culture System ◽  
Work Load ◽  
Major Advance ◽  
Blood Culture System ◽  
Fluid Analysis ◽  
Number Of Patients ◽  
Daily Sampling ◽  
Stage Renal Disease

In the microbiological laboratory CAPD fluid analysis is an unstandardized and sometimes a labor intensive procedure. This pilot study was set up to demonstrate the value of in-place technology -the Bactec 460 blood culture system, in reducing the work-load. Our results indicate that it is at least as effective as other, more tedious conventional methods. Since its introduction, continuous ambulatory peritoneal dialysis (CAPD) has proved to be a major advance in the management of end-stage renal disease (I). Despite refinements in technique over the years leading to more widespread use of CAPD, the major hazard remains peritonitis and other infections (2). Also peritonitis is a major cause of failure of CAPD (3,4). Because CAPD allows more freedom of movement, several laboratories receive the postdialysis effluents from the same patient; furthermore there is no widely recognized, single method for the examination of these fluids (2, 5). Some centers recommend daily sampling for microbiological studies and while this is ideal for patient management, it imposes a significant workload on the microbiology laboratory, particularly in a larger centre (2). Currently it appears that the number of patients on CAPD will continue to increase for the foreseeable future and so will the numbers of specimens to be examined. To facilitate these examinations, we carried out a five-month pilot study using the Bactec 460 blood-culture system to examine CAPD fluids. We compared these results with a conventional method used previously in our laboratory.

Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia

2020 ◽  
Author(s):  
Gabrielle M Haeusler ◽  
Richard De Abreu Lourenco ◽  
Hannah Clark ◽  
Karin A Thursky ◽  
Monica A Slavin ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Bloodstream Infection ◽  
Healthcare Workers ◽  
Diagnostic Yield ◽  
Infectious Complications ◽  
Blood Cultures ◽  
Children With Cancer ◽  
Persistent Fever ◽  
Empiric Antibiotics ◽  
Clinical Instability

Abstract Background The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics. Methods Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken. Results A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures. Conclusions In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.

Incorporation of Posttransplant Cyclophosphamide (PCy) As Part of Standard Immunoprophylaxis (IP) for All Allogeneic Transplants: A Retrospective, Single Institution Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4485-4485
Author(s):  
Dennis Cooper ◽  
Jackie Manago ◽  
Vimal Patel ◽  
Dale Schaar ◽  
Tracy Krimmel ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Cell Transplantation ◽  
Disease Risk ◽  
Conflicts Of Interest ◽  
Risk Index ◽  
Chronic Gvhd ◽  
Number Of Patients ◽  
One Year ◽  
Disease Free

Background: The incorporation of PCy in IP has allowed transplantation of stem cells from haploidentical (HI) family members such that nearly all patients have a potential donor. Thus far, HI stem cell transplantation with PCy appears to yield comparable results to matched unrelated (MUD) and matched sibling donors (MSD) who have been treated with conventional GVHD regimens, but with less chronic GVHD (cGVHD). Particularly in light of the low incidence of cGVHD, which has not been achieved with other IP strategies after T cell-replete products, PCy is being investigated after MUD and MSD transplantation where complications from cGVHD remain the major cause of non-relapse mortality. A recent study from the BMTCTN showed that in patients conditioned with reduced intensity regimens and who received MSD and MUD stem cells, the addition of PCy to standard IP (SIP) was superior to either bortezomib or maravoric in the composite endpoint of graft-versus-host disease-free, relapse-free survival (GRFS). However, this study did not include patients who received ablative conditioning regimens and did not report on the percentage of patients who were disease-free and off immunosuppression (DFOI) at 1 year after transplant. In the present study, we have compared our experience with the addition of PCy for essentially all allogeneic stem cell transplants treated over a 2 year period with the results of patients treated with SIP in the prior two year span. Outcomes of interest included one-year overall survival (OS) and one-year GRFS as well as the percentage of patients DFOI at one year. Methods: With the exception of patients receiving umbilical cord blood transplants, beginning in April 2016, all but two patients who received allogeneic transplants were given mobilized peripheral blood stem cells and then treated with PCy on days +3 and +4 followed by tacrolimus and mycophenolate on day 5. In the absence of GVHD, mycophenolate was stopped at days +35-50 and tacrolimus was tapered beginning after day +100 unless there was low donor chimerism or a suspicion of relapse in which case tacrolimus could be tapered sooner. In order to have at least one-year follow-up, the last patient included in the study was treated before April 2018. During this time period, MSD were prioritized over MUD which in turn were chosen over haploidentical donors. For comparison, we looked at the prior 2 year period (2014-2016) in which patients were treated with SIP (including ATG in patients who received MUD stem cells). Because of a higher percentage of patients with an advanced disease risk index (DRI) in the years 2014-2016, we restricted our analysis in the SIP cohort to those patients with low and intermediate risk disease but included all patients in the more recent period who received PCy. Results: There were 68 patients treated in the PCy group, including 2 patients who received PCy after HI transplants in the years 2014 and 2015. After eliminating patients with high DRI there were 40 patients in the earlier SIP cohort of patients. The resulting patient groups were similar with respect to median age (53) and diagnosis (approximately 80% of patients with AML and ALL). There was a slightly higher percentage of patients in the SIP group with hematopoietic cell transplantation-comorbidity index scores of 3 or more (52.5 vs 48.5). In the PCy group the number of patients with early, intermediate and advanced DRI were 2, 53 and 13, whereas in the (modified) SIP category 2 patients had a low DRI and 38 had intermediate DRI. In the PCy group, HI donors comprised 26.5% of the total compared to 19.1% MSD and 54.4% MUD donors. In the SIP group, MSD and MUD donors accounted for 30% and 70% of the donors. One-year percentages of OS, GRFS and DFOI were 79.4, 47.1 and 44.1 in the PCy group compared to 72, 45 and 35 in the SIP cohort. If the analysis of the PCy group is limited to the 50 patients with MSD and MUD donors (as in the SIP cohort), the one-year OS, GRFS and DFOI are 88, 52 and 52. Conclusions: PCy in combination with SIP resulted in at least comparable results as SIP despite the inclusion of 19% of patients with a high DRI and 26.5% HI donors. The results with the addition of PCy are excellent in patients with MSD and MUD donors with more than half of the patients GRFS and DFOI at one year. Future studies on GVHD prophylaxis should report DFOI as the latter status may be the best platform for posttransplant strategies aimed at eliminating minimal residual disease and for improving QOL. Disclosures No relevant conflicts of interest to declare.

Risk-Adapted Therapy with ABVD for Low- and Intermediate-Risk Patients and Oepa-Copdac for High Risk Patients Plus Involved-Field Radiation Therapy (IFRT) Based on Prognosis at Diagnosis and Early Response: Results from Pediatric Argentinian Collaborative Group Gatla Study for Children and Adolescents with Hodgkin Lymphoma

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-13
Author(s):  
David Alejandro Veron ◽  
Patricia Streitenberger ◽  
Cecilia Riccheri ◽  
Monica Matus ◽  
Pedro Negri Aranguren ◽  
...  
Keyword(s):  
High Risk ◽  
Pediatric Patients ◽  
Conflicts Of Interest ◽  
Risk Groups ◽  
Early Response ◽  
Collaborative Group ◽  
Bulky Disease ◽  
Number Of Patients ◽  
Field Radiation ◽  
Risk Patients

Background: The GATLA Collaborative Group has a 50 year (y) long experience of running cooperative trials for lymphomas in Argentina. Aim: Describe the outcome of pediatric patients(pts) treated according to the international cooperative work with AHOPCA and St. Jude Children's Research Hospital (11-EHP-12) adopting OEPA/COPDAC strategy for High Risk (HR) pts and ABVD for Intermediate (IR) and Low Risk (LR) pts. Methods: 11-EHP-12: Risk assignment according Stanford/Danna Farber/ SJCRH Consortium classification. LR: ABVD x 4± IFRT (20 Gy). IR: ABVD x 6 ± IFRT (20 Gy). HR: OEPA-COPDAC+IFRT (20/25 Gy). Response evaluation: LR after 4th cycle, IR and HR after the 2nd cycle. Complete Remission (CR): response > 80% reduction and PET negative. Partial Remission (PR): response >50% and <80% reduction and/or PET positive. 170 pediatric patients (pts) were enrolled since November 2012. 133 evaluable pts. 37 on treatment and/or a follow up of less than 5 years. Sex: M/F: 85 (63,9%) /48. Median age: 13 y (range 4-18 y). Histology: nodular sclerosis 91 (68,4%), mixed celularity 31 (23.3%), lymphocyte rich 1 (0,7%), lymphocyte depleted 1 (0,7%), nodular lymphocyte predominant 8 (6,9%). Stage: I :16 (12%), II: 51 (38.4%), III: 27 (20.3%), IV: 39 (29.3%). B Symptoms: 66 (49.6%). Interim evaluation: PET/TC: 109/133 (82%), TC: 24. Distribution by risk groups: HR pts.: 77 (57,9%), IR: 35 (26,3%), LR: 21 (15,8%). Results: 5 y OS was 94% (100% for LR and IR, and 91% HR) and 5y EFS was 88% (100% for LR, 91% IR, and 84% HR). 95% of the LR pts and 72% of the IR pts did not undergo radiotherapy. 70% of the HR pts achieved CR after the 2nd OEPA and received 20 Gy IFRT. According PR or CR after 2nd OEPA, the 5y EFS in HR pts was 84% and 90% respectively. Conclusion: Thanks to this international cooperation We could significantly improve the results in Argentina compared to our previous experience (7-PHD-96: COPP-ABV x 6 + IFRT Bulky disease or PR (20/25Gy): 5yOS:85%, 5yEFS:67%), reduce the number of patients who required radiotherapy and reproduce the Euronet experience for HR pts in a different context. Figure Disclosures No relevant conflicts of interest to declare.

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