- Email: [email protected]
Allogeneic Stem Cell Transplant in AML with Adverse Cytogenetics
Abstracts transfusions ordered for Hgb>8g/dL was significantly higher amongst NPs with nearly twice as many transfusions occurring in this subgroup (n¼22 vs. n ¼14, p < 0.02). Conclusion: Hematologic malignancy patients utilize blood products at a high rate relative to other malignancies. Despite large meta-analyses demonstrating reduced immunologic events and infections with RTS, the impact on clinical practice has been modest. Our data indicates that these transfusions are not being ordered for traditionally “exempt” indications (e.g. including symptomatic anemia, GI bleed) but due to a lack of familiarity or confidence in RTS, particularly in certain provider subgroups (NP). This lends support that education based initiatives targeting specific provider subgroups might be effective at reducing transfusions occurring at hemoglobin levels higher than the current evidence-based guidelines.
240 A Case Report on Primary Gastro-Intestinal Aspergilloma with Abdominal Wall Invasion Marie-Therezia Hadchiti Hady Ghanem Hematology/Oncology, Lebanese American University Medical Center- Rizk Hospital
Aspergillosis represents a major cause of morbidity and mortality in leukemic and immunocompromised patients. Invasive pulmonary aspergillosis accounts for the vast majority of these cases. Involvement of the gastro-intestinal (GI) tract by aspergillus infections is mostly reported as part of a disseminated infection from a primary pulmonary site, and is only very rarely seen as an isolated organ infection. In this report, we present the case of a 66 year old man who presented with fever and worsening pancytopenia and was diagnosed with acute myeloid leukemia (normal cytogenetics). After receiving Cytarabine and Idarubicine-based induction chemotherapy, the patient developed intractable nausea and vomiting necessitating the placement of a nasogastric tube. As the patient had consistent signs of upper GI obstruction, a Computed Tomography scan was performed and showed a large necrotic jejunal mass extending to the abdominal wall and invading it. A biopsy was performed and cultures were consistent with diffuse bowel involvement by aspergillus hyphae. The rest of his radiologic studies did not identify any signs of invasive aspergillosis. The patient then underwent jejunectomy with placement of colostomy. To date and to the best of our knowledge, this is the first reported case of invasive aspergillosis of the small bowel with invasion of the abdominal wall. Although rare, primary GI aspergillosis should be considered in the differential diagnosis of unexplained gastrointestinal symptoms in immunocompromised patients, especially in the setting of prolonged neutropenia in acute leukemic patients.
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Clinical Lymphoma, Myeloma & Leukemia June 2015
241 Allogeneic Stem Cell Transplant in AML with Adverse Cytogenetics Nasheed Hossain,1 Henry Fung,2 Jean-Pierre Issa,3 Patricia Kropf4 1
Hematology/Medical Oncology, Fox Chase Cancer Center/Temple
University Hospital; 2Bone Marrow Transplant Program, Fox Chase Cancer Center/Temple University Hospital; 3Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine/Temple University Hospital/Fox Chase Cancer Center; 4Bone Marrow Transplant Program, Fox Chase Cancer Center/Temple University Hospital
Context: Cytogenetic abnormalities play a critical role in determining prognosis and treatment for patients with AML. It is unclear if there is a clear survival advantage to treating such patients with allogeneic transplant, or, which patient-specific factors may impact outcome. Objective: To determine outcomes following transplant in AML patients with adverse cytogenetics and to determine if disease status at time of transplant, gender or conditioning regimen impact overall survival [OS] or progression free survival [PFS]. Design: We queried FCCC/Temple BMT’s core database for AML with adverse cytogenetics [based on SWOG/ECOG/CALGB/MRC consensus classifications], diagnosed between 2005 and 2014. Results: A total of 24 patients with AML and adverse cytogenetics were analyzed, 66.7% [16/25] had complex karyotype, 20.8% [5/24] had 5q-, 4.2% [1/24] had 17p-, 4.2% [1/24] had abn 7q, and 4.2% [1/24] had 9q-. Median age at transplant was 48 [range 19-64] and 62.5% [15/24] were male. Approximately 50% [12/24] were transplanted in CR1, 12.5% [3/24] were in CR2, 12.5% [3/24] were in PIF, 8.3% [2/24] were in REL1 and 16.7% [4/24] were a combination of REL2/CR3/UNT/MRD; 29% [7/24] were alive at time of data analysis. Of the seventeen deaths, nine died of disease progression, three of GVHD, two of pneumonitis, two of respiratory failure and one of bacteremia. Five-year overall survival was 10% and five-year progression free survival was 9.5%. Conclusions: The five-year overall survival for patients in our review was 10%. This is similar compared to age matched controls treated with chemotherapy alone based on historical data, in which OS ranges from 4%-21% [Grimwade et al; Blood. 1998 Oct 1;92(7)]. With respect to patient specific factors, disease status at the time of transplant and the specific conditioning regimen did not significantly impact OS. However, we noted a strong trend towards improved OS and EFS in male versus female patients. Though the sample size of our study is small, our initial analysis highlights the lack of impact of CR1 status on OS/EFS and possible impact of gender on outcomes. These observations must be further analyzed with a larger patient population to be validated. Additionally, it raises the question of whether post-transplant intervention, such as maintenance therapy with hypomethylating agents, should be considered for such patients.
240 A Case Report on Primary Gastro-Intestinal Aspergilloma with Abdominal Wall Invasion Marie-Therezia Hadchiti Hady Ghanem Hematology/Oncology, Lebanese American University Medical Center- Rizk Hospital
Aspergillosis represents a major cause of morbidity and mortality in leukemic and immunocompromised patients. Invasive pulmonary aspergillosis accounts for the vast majority of these cases. Involvement of the gastro-intestinal (GI) tract by aspergillus infections is mostly reported as part of a disseminated infection from a primary pulmonary site, and is only very rarely seen as an isolated organ infection. In this report, we present the case of a 66 year old man who presented with fever and worsening pancytopenia and was diagnosed with acute myeloid leukemia (normal cytogenetics). After receiving Cytarabine and Idarubicine-based induction chemotherapy, the patient developed intractable nausea and vomiting necessitating the placement of a nasogastric tube. As the patient had consistent signs of upper GI obstruction, a Computed Tomography scan was performed and showed a large necrotic jejunal mass extending to the abdominal wall and invading it. A biopsy was performed and cultures were consistent with diffuse bowel involvement by aspergillus hyphae. The rest of his radiologic studies did not identify any signs of invasive aspergillosis. The patient then underwent jejunectomy with placement of colostomy. To date and to the best of our knowledge, this is the first reported case of invasive aspergillosis of the small bowel with invasion of the abdominal wall. Although rare, primary GI aspergillosis should be considered in the differential diagnosis of unexplained gastrointestinal symptoms in immunocompromised patients, especially in the setting of prolonged neutropenia in acute leukemic patients.
S200
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Clinical Lymphoma, Myeloma & Leukemia June 2015
241 Allogeneic Stem Cell Transplant in AML with Adverse Cytogenetics Nasheed Hossain,1 Henry Fung,2 Jean-Pierre Issa,3 Patricia Kropf4 1
Hematology/Medical Oncology, Fox Chase Cancer Center/Temple
University Hospital; 2Bone Marrow Transplant Program, Fox Chase Cancer Center/Temple University Hospital; 3Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine/Temple University Hospital/Fox Chase Cancer Center; 4Bone Marrow Transplant Program, Fox Chase Cancer Center/Temple University Hospital
Context: Cytogenetic abnormalities play a critical role in determining prognosis and treatment for patients with AML. It is unclear if there is a clear survival advantage to treating such patients with allogeneic transplant, or, which patient-specific factors may impact outcome. Objective: To determine outcomes following transplant in AML patients with adverse cytogenetics and to determine if disease status at time of transplant, gender or conditioning regimen impact overall survival [OS] or progression free survival [PFS]. Design: We queried FCCC/Temple BMT’s core database for AML with adverse cytogenetics [based on SWOG/ECOG/CALGB/MRC consensus classifications], diagnosed between 2005 and 2014. Results: A total of 24 patients with AML and adverse cytogenetics were analyzed, 66.7% [16/25] had complex karyotype, 20.8% [5/24] had 5q-, 4.2% [1/24] had 17p-, 4.2% [1/24] had abn 7q, and 4.2% [1/24] had 9q-. Median age at transplant was 48 [range 19-64] and 62.5% [15/24] were male. Approximately 50% [12/24] were transplanted in CR1, 12.5% [3/24] were in CR2, 12.5% [3/24] were in PIF, 8.3% [2/24] were in REL1 and 16.7% [4/24] were a combination of REL2/CR3/UNT/MRD; 29% [7/24] were alive at time of data analysis. Of the seventeen deaths, nine died of disease progression, three of GVHD, two of pneumonitis, two of respiratory failure and one of bacteremia. Five-year overall survival was 10% and five-year progression free survival was 9.5%. Conclusions: The five-year overall survival for patients in our review was 10%. This is similar compared to age matched controls treated with chemotherapy alone based on historical data, in which OS ranges from 4%-21% [Grimwade et al; Blood. 1998 Oct 1;92(7)]. With respect to patient specific factors, disease status at the time of transplant and the specific conditioning regimen did not significantly impact OS. However, we noted a strong trend towards improved OS and EFS in male versus female patients. Though the sample size of our study is small, our initial analysis highlights the lack of impact of CR1 status on OS/EFS and possible impact of gender on outcomes. These observations must be further analyzed with a larger patient population to be validated. Additionally, it raises the question of whether post-transplant intervention, such as maintenance therapy with hypomethylating agents, should be considered for such patients.