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Background The distinction of diffuse large B-cell lymphoma (DLBCL) into cell-of-origin (COO) subgroups (germinal center B-cell-like [GCB] or activated B-cell-like [ABC]) based on gene expression profiling is associated with prognosis and has potential therapeutic implications to mitigate the worse outcome for patients with DLBCL. Other phenotypic and molecular/cytogenetic features such as concurrent translocations of oncogene MYC and BCL2 and/or BCL6 (so-called double-/triple-hit lymphoma, DHL/THL) and coexpression of MYC and BCL2 proteins (so-called double-expressor lymphoma, DEL) are also recognized to have great prognostic impact (Swerdlow SH et al. Blood 2016;127(20):2375-2390). This study investigated the prevalence of COO, DHL/THL and DEL in a real-world cohort of patients with DLBCL who had documented results of diagnostic testing. Methods This study used the Flatiron Health electronic health record-derived de-identified database to abstract information on patients diagnosed with DLBCL between 2011-2019. Information on diagnostic testing from immunohistochemistry (IHC) for expression of MYC, BCL2, BCL6, CD10 or MUM1, and from fluorescence in situ hybridization (FISH) or karyotype analysis for rearrangement of MYC, BCL2 or BCL6 was abstracted from pathology reports or clinical visit notes, where available. We calculated the proportions of COO subgroups (GCB vs. ABC) that were derived from IHC testing results according to Hans algorithm (Hans C et al., Blood 2004;103(1):275-282), DHL/THL, and DEL. We also examined concordance of COO classification derived from IHC testing results with that directly reported by the healthcare providers. Differences in patient characteristics between IHC testing results-derived COO subgroups (GCB vs. ABC) were assessed using chi-square tests. Results 4400 patients had documented results of IHC and 73% (n=3194) can be classified into either GCB or ABC DLBCL (GCB/ABC ratio of 1.38). 3205 patients had documented results of FISH or karyotype analysis and 8% (n=245) were DHL/THL; only 33 patients were DEL. Within the GCB DLBCL patients derived from IHC testing results (n=1854), 163 patients were DHL/THL and 11 were DEL, whereas 24 DHL/THL and 18 DEL were identified within the ABC type (n=1340). When comparing COO classification derived from IHC testing results (n=3194) with that directly reported by the healthcare providers (n=2765), additional 695 and 439 patients can be classified as GCB and ABC DLBCL by IHC, respectively (Table). Univariate analysis showed that patients who were non-White ethnic group, diagnosed in academic centers, with lower body mass index but elevated serum lactate dehydrogenase levels and worse ECOG performance status, and without transformation from a prior indolent lymphoid malignancy, were more likely to be associated with ABC DLBCL (for all variables, p Discussion In this large real-world DLBCL cohort, a lower-than-expected proportion of DEL patients were identified vs. the 20-35% reported in the literature (Karube K and Campo E. Hematology 2015;52(2):97-106). This is likely due to our cohort of patients requiring clear evidence of coexpression for MYC and BCL2 (≥40% and >50%, respectively) that are not related to underlying chromosomal rearrangements, and few pathologists reported levels of percent staining for IHC testing among those with documented positive results of MYC/BCL2 protein coexpression. In addition, results from this study showed that only half of cases had COO classification documented by healthcare providers, despite available IHC results. Although this study indicated lack of details in the reporting of diagnostic testing (e.g. COO identification, levels of percent staining, methods for DLBCL subgroup identification), findings should be interpreted with caution, as patients with DLBCL might have been tested but not documented in the electronic health record system or might have biomarker testing performed at sites outside of the Flatiron Health network. Disclosures Yang: F. Hoffmann-La Roche: Current Employment. Zhang:F. Hoffmann-La Roche: Current Employment. Xiao:F. Hoffmann-La Roche: Current Employment. Hammer:Roche: Consultancy, Honoraria, Research Funding; Caris Lifesciences: Honoraria; PER Med education: Honoraria; PathEdEx: Current equity holder in private company. Prime:F. Hoffmann-La Roche: Current Employment.

Background A better understanding of diffuse large B-cell lymphoma (DLBCL) subtypes characterized by cell of origin (COO), molecular and immunophenotypic features is associated with more accurate prognosis and may guide treatment selection to achieve better outcomes. Current World Health Organization (WHO) and National Comprehensive Cancer Network (NCCN) guidelines recommend for all patients with DLBCL, immunohistochemistry (IHC, such as Hans algorithm) as a surrogate of gene expression profiling to identify COO, and molecular testing by fluorescence in situ hybridization (FISH) or karyotype to identify molecular/cytogenetic features. Despite advances in treatment and increasing knowledge of clinical importance of DLBCL subtype classification, socioeconomic disparities persist in the treatment of DLBCL in the US (Shenoy PJ, et al. Cancer 2011;117(11):2530-2540) and the use of guideline-recommended diagnostic testing in clinical practice remains unclear. Understanding whether test utilization varies by socioeconomic determinants is important to enable all patients to achieve better/equal access to health care and optimal outcomes. Methods To understand guideline-recommended diagnostic testing utilization in real-world settings and to assess socioeconomic disparities in relation to test utilization among patients with DLBCL in the US, this retrospective cohort study leveraged data from the Flatiron Health electronic health record (EHR)-derived de-identified database. Patients above 18 years old with a diagnosis of DLBCL between Jan-2011 and Dec-2019 were included in the study. Information on IHC, FISH and karyotype analysis was abstracted from pathology reports or clinical visit notes, where available. Utilization of guideline-recommended diagnostic testing was defined as patients with documentation of a confirmed known result on: 1) expression of MYC, BCL2, BCL6, CD10 or MUM1 protein for IHC; and 2) rearrangement of oncogene MYC, BCL2 or BCL6 by FISH or karyotype analysis for molecular testing. 'Not tested' was defined as patients with no evidence/documentation of diagnostic testing for all of the aforementioned markers. Socioeconomic determinants included age, gender, type of insurance plan, race/ethnicity group and geographic location of residency. We assessed changes in rates of IHC and molecular testing during the study follow-up period using Cochran-Armitage trend tests. To assess the impact of socioeconomic determinants on test utilization, multivariable logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI) for IHC and molecular testing separately, while adjusting for several demographic and clinical characteristics. Results In total 5387 patients with DLBCL were included in the study. Guideline-recommended diagnostic testing rates increased between 2011 and 2019 (66.9 to 85.6% for IHC and 49.5 to 67.0% for molecular testing, both P-values Discussion Although the results of this study showed a significant increase in the adoption of guideline-recommended diagnostic testing for patients with DLBCL in the US between 2011-2019, socioeconomic disparities appeared to still exist in the access to molecular testing. Providing equitable access to diagnostic testing would be a critical parameter for patients' clinical benefit. It should be noted that findings about test utilization need cautious interpretation, as patients with DLBCL might have been tested but not documented in the EHR or might have the test performed at sites outside of the Flatiron Health network. Disclosures Yang: F. Hoffmann-La Roche: Current Employment. Zhang:F. Hoffmann-La Roche: Current Employment. Xiao:F. Hoffmann-La Roche: Current Employment. Hammer:PER Med education: Honoraria; PathEdEx: Current equity holder in private company; Caris Lifesciences: Honoraria; Roche: Consultancy, Honoraria, Research Funding. Prime:F. Hoffmann-La Roche: Current Employment.

[Figure][1] A 26-year-old male was evaluated for chest pain and was found to have a white cell count of 63 000 per cubic millimeter, hemoglobin 10.5 g/dL, platelets 102 000 per μL, with 18% blasts and promyelocytes (panel A). Bone marrow was hypercellular, with promyelocytes and myeloblasts

Introduction: Brown recluse spider bites are encountered commonly in endemic areas of North and South America. Loxosceles reclusa is the species of Loxosceles most commonly seen in the states of MO, KS, OK, TX, AK, LA, KY, TN, MS, AL and parts of IL, IA, IN and GA. The incidence of hemolytic anemia with systemic loxoscelism in the USA seems to be significantly higher and more severe than the incidence and severity reported in studies from South America (13%-15% incidence). In our 6 cases of loxoscelism associated with severe hemolysis, we noticed that there are signs and symptoms that could be helpful to guide the follow up and facilitate early diagnosis. Method: We reviewed 6 cases of hemolytic anemia from Loxoscelism treated at the University of Missouri Hospitals. Of these 6 cases 4 were treated within 1 year. All of the cases presented with systemic and cutaneous manifestations. Each patient was initially treated symptomatically and discharged without a close follow up. This resulted in delayed presentations with symptoms of severe hemolytic anemia associated with significant morbidity [Syncope (1), Syncope with fracture (1), Hypotension needing ICU care (1), Necrotizing fasciitis (1), and severe hepatosplenomegaly with hyperbilirubinemia (1)]. We have summarized the systemic symptoms, peripheral blood smear and laboratory findings that correlate with hemolytic anemia. Results:Patients presented with Nausea (6/6), Vomiting (5/6), Fever (5/6), and Target lesion (6/6) within 48 hours after spider bite [Table 1]. Severe hemolysis developed at a median of 6.5 days after the spider bite. DAT was positive for IgG and C3 in all of the cases. Peripheral smear findings included leukocytosis with toxic granulations, Dohle bodies and left shift, Nucleated RBC, anisopoikilocytosis with some schistocytes, hemophagocytosis and normal to decreased platelets [[Figure 1][1]] [[Figure 3][2]]. When not recognized patients presented with sudden and severe hemolysis (median drop in Hb =7.5 g/dL) [Table2] resulting in hospitalization with severe morbidity ([Figure 2][3]). | | Initial Presentation | Significant Morbidity | | --------- | ------------------------------------------------------------------------------------------------ | --------------------------------------------------------- | | Patient 1 | Nausea and vomiting. Fever. Diffuse rash, RUQ pain Target lesion on back | Severe Jaundice Hepatomegaly Splenomegaly | | Patient 2 | Nausea, vomiting and diarrhea. Fever Target lesion on left arm | Syncope Ankle fracture | | Patient 3 | Nausea, fatigue and malaise. Target lesion on right back | Recurrent syncope | | Patient 4 | Nausea, Vomiting Fever Target lesion right arm. | Severe Hypotension ICU care | | Patient 5 | Nausea, dry heaves Fever. Thigh pain Target lesion right thigh. | Necrotizing fasciitis Fasciotomy | | Patient 6 | Nausea, vomiting and fatigue. Fever. Target lesion right shoulder. | | Table 1 ![Figure 1:][4] Figure 1: Peripheral Smear Findings of Systemic Loxoscelism ![Figure 2:][4] Figure 2: Significant Morbidity from Systemic Loxoscelism ![Figure 3:][4] Figure 3: Peripheral smear findings | | Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | Median | | ------------------------------------ | --------- | --------- | --------- | --------- | --------- | --------- | ------ | | Age | 34 | 31 | 21 | 25 | 21 | 22 | 23.5 | | Days after bite to lowest Hemoglobin | 8 | 5 | 6 | 6 | 7 | 9 | 6.5 | | Baseline Hb (g/dL) | 11 | 12 | 15 | 13 | 13.8 | 15.7 | 13.4 | | Lowest Hb (g/dL) | 5.7 | 4 | 5 | 6 | 6.6 | 8.4 | 5.85 | | MCV with lowest Hb (fL) | 70 | 107 | 100 | 90 | 96.6 | 101 | 98.3 | | WBC (103/µL) | 12.6 | 42 | 32.3 | 14.5 | 33.4 | 26.6 | 29.45 | | Platelets (103/µL) | 160 | 141 | 234 | 64 | 261 | 576 | 197 | | LDH (unit/L) | hemolysed | 2080 | 951 | 1348 | 744 | 346 | 951 | | T. Bili (mg/dL) | 35.4 | 13.2 | 5 | 1.8 | 3.7 | 7.4 | | | D. Bili (mg/dL) | >10 | 9.2 | .3 | .5 | 0.3 | 1.4 | | | Ind. Bili (mg/dL) | | 3.9 | 4.7 | | | | | | AST (unit/L) | 100 | 52 | 25 | 201 | 120 | 156 | | | ALT (unit/L) | 86 | 95 | 19 | 91 | 104 | 294 | | | Alk phos (unit/L) | 94 | 88 | 67 | 36 | 160 | 159 | | | Blood group | A Pos | A Pos | O Pos | B Pos | O Pos | | | Table 2 Discussion: Systemic loxoscelism from Loxosceles reclusa in USA is associated with a high incidence of severe hemolytic anemia. Increased awareness of the delayed presentation with hemolysis after initial signs of systemic loxoscelism could avoid life threatening events. Initial symptoms developed within 48 hours of the spider bite and led to medical attention in all of the reported cases. With appropriate follow up, peripheral smear review and labs at 5-7 days after the spider bite most of the cases would have been recognized early and could have potentially avoided life threatening complications. The different species of Loxosceles prevalent in South America could explain the difference in the incidence of hemolytic anemia. Studies from Brazil have reported the use of antivenom in about 50% of loxoscelism cases. Effectiveness of antivenom is not established and is seldom used in the USA but, could account for some differences in the incidence of hemolysis. Disclosures No relevant conflicts of interest to declare. [1]: #F1 [2]: #F3 [3]: #F2 [4]: pending:yes

Background: Tyrosine kinase inhibitors (TKI) are associated with marked improvements in molecular response and survival compared with previous therapies for patients with chronic myelogenous leukemia (CML) in chronic phase (CP). We previously reported efficacy and safety of TKI at 12-month follow-up (Firwana et. al.JCO. 2014; 32(15_suppl): 7054). Here, we summarize the evidence of TKI efficacy and safety of TKI, comparing them directly and in-directly, in the mature follow-up for patients with newly diagnosed CP-CML. Methods: We included randomized controlled trials (RCTs) evaluating TKI in adults with newly diagnosed CP-CML. TKI (imatinib, dasatinib and nilotinib) were included if used as an initial treatment. Studies on bosutinib were excluded as it is only approved in the US for the treatment of CP-CML after failure of initial therapy. Studies that included patients with accelerated- or blast-phase CML, intolerant or resistant patients to first-line treatment, those on IFN-α, older agents or stem cell transplantation were excluded. Main outcomes are efficacy, represented by major molecular response (MMR, ≤ 0.1% BCR-ABLIS) and deeper molecular responses (MR4.5, ≤ 0.0032%IS), survival, represented by overall survival (OS) and progression free survival (PFS), and safety represented by medication discontinuation rate due to adverse events. Latest period of reporting outcome data were considered. As available trials provides direct comparison with imatinib, with no head-to-head trials to compare other TKI, we conducted a mixed treatment comparison (MTC) analysis which pools evidence from direct and indirect comparisons to facilitate simultaneous inference regarding all treatments. Bayesian mixed-treatment comparison method was used to rank TKI in terms of effectiveness. Results: Four landmark trials reported in 15 published articles and conference abstracts were identified involving 1647 patients with CP-CML. Follow-up times ranged from 3 months to 6 years. Table-1 depicts the results of MTC for imatinib, dasatinib and nilotinib. MTC analysis demonstrated superiority of both nilotinib and dasatinib over imatinib in terms of efficacy and safety. Nilotinib ranked first in efficacy with better improvement in MMR and MR4.5 at 48-month follow-up despite its different regimens, followed by dasatinib. Dasatinib has the highest medication discontinuation rate due to adverse events or drug-related toxicity. Among TKI, nilotinib was found to have the best survival profile; however, it was statistically nonsignificant. Conclusion: Both nilotinib and dasatinib are associated with significantly better efficacy and safety profiles compared to imatinib. At 48-month follow-up period, nilotinib ranked first to achieve MMR and MR4.5, with lower discontinuation rate due to adverse events. This analysis shows that new generation TKI are not only showing faster response, but also maintaining a more potent one through longer follow up period. It is important to note out that MTC is not a substitute for well conducted RCTs investigating direct comparisons. Table-1: Results of mixed treatment comparison for imatinib, dasatinib and nilotinib using fixed-effect Bayesian method. Comparison Mean risk difference (95% CrI) compared to from reference standard (Imatinib) Rank* MMR MR 4.5 PFS OS Discontinuation due to adverse events 48 months 48 months 36 months 48 months 48 months Imatinib Reference Reference Reference Reference Reference 4 Dasatinib 0.62 (0.26 to 1.01) 0.32 (-0.05 to 0.69) 0.21 (-0.43 to 0.85) 0.17 (-0.49 to 0.83) 0.59 (-0.05 to 1.25) 3 Nilotinib 300 0.92 (0.56 to 1.28) 0.81 (0.45 to 1.18) 1.02 (0.24 to 1.86) 0.19 (-0.51 to 0.89) -0.11 (-0.66 to 0.43) 1 Nilotinib 400 0.76 (0.41 to 1.12) 0.68 (0.31 to 1.05) 0.05 (-0.57 to 0.65) 0.81 (0.01 to 1.67) 0.30 (-0.20 to 0.81) 2 *Reported rank is valid for all outcomes, except for PFS and OS, where Nilotinib 400 ranks #1 and Nilotinib 300 ranks #2. Also, for rate of medication discontinuation due to adverse events, Dasatinib has the highest rate for discontinuation, followed by Nilotinib, both doses. Abbreviations: CrI, credible intervals; MMR, major molecular response, BCR-ABLIS ≤ 0.1%; MR4, deeper molecular responses, BCR-ABLIS ≤ 0.0032%; PFS, progression free survival; OS, overall survival. Disclosures No relevant conflicts of interest to declare.

Introduction: Incidence of secondary malignant neoplasm in patients with chronic lymphocytic leukemia (CLL) is already established. Genetic predisposition has been considered to be a possible contributory factor for the preponderance of second cancers in this population. In the present study, we examined the frequency, characteristics, and clinical outcomes of secondary malignancies in patients with CLL based on their Interphase fluorescence in situ hybridization (FISH) panel. Methods: We reviewed the medical records of consecutive patients with CLL observed or treated at Ellis Fischel Cancer Center during the period from 2007-2014. We collected demographic data, CLL Rai stage, treatment history, Interphase fluorescence in situ hybridization (FISH) panel results and the presence of a secondary malignancy (skin cancers, solid tumors and hematologic malignancy excluding CLL transformation).Our aim was to investigate the association between secondary malignancy and chromosomal abnormalities and other risk factors using Chi2test for categorical variables and Wilcoxon rank-sum test for continuous variables. Cox proportional hazard models and logistic regression models were used to evaluate risk factors of developing secondary malignancy and overall survival. Results: We identified 142 CLL patients who were either observed (n=62) or had a history of treatment (n=80) for CLL. 67% were male and 33% were female. 85% of patients were Caucasians, 10% African Americans, and 5% other. Familial CLL was present in 6% of cases. 51% of patients were non-smokers. 5% of patients had cancers preceding the diagnosis of CLL (non-melanoma skin cancers=3, melanoma=1, Hodgkin's lymphoma=1, Prostate=2). 28% of patients developed secondary malignancies after the diagnosis of CLL; among them non-melanoma skin cancers were the most common (78%), followed by cutaneous melanoma (9.5%) and papillary thyroid cancer (4.7%). Other malignancies included lung (2.3%), kidney (2.3%), prostate (2.3%) and ocular melanoma (2.3%). 12% patients had aggressive non-melanoma recurrent skin cancers that require multiple treatments along-with systemic therapy for progressive CLL. CLL-FISH panel at diagnosis was available in 98 patients. Among these patients,13q deletion was present in 45%. Within the 13q deletion group, secondary malignancy was noted in 50% during a median follow up of 7 years. All cases of papillary thyroid cancers were also present in 13q deletion. In contrast, 11q deletion was detected in 15% and trisomy 12 in 18% of patients with incidence of secondary malignancy 40% and 10%, respectively. No solid malignancy other than skin was identified in the 11q deletion and trisomy 12 groups. 17p deletion was present in 5% of cases and 60% of 17p deletion cases had secondary cancers (skin 80%). Normal FISH panel was present in 17% cases and 20% of normal FISH had secondary malignancy (solid 10%, skin 10%). The median overall survival time is 6 years for the entire cohort (IRQ: 3-9 years). Secondary malignancy was associated with worse overall survival (OS) (HR=0.57, 95% CI:0.33-0.98, p=0.04) compare to patients who did not have secondary malignancy. The risk of secondary malignancy is increased in patients with advanced age (OR=1.05, 95% CI:1.00-1.10, p=0.04) and in those who were treated with alkylating agent for CLL OR=6.62, 95% CI:2.08-21.03, p=0.001. However, there were no significant difference on risk of developing secondary malignancy based on specific chromosomal FISH result, Rai stage, smoking, family history and gender. Conclusion: Secondary malignancies are frequent in patients with detectable chromosome abnormality on FISH panel. However, the increased risk of secondary malignancy does not correlate with specific cytogenetic abnormality. Non melanoma skin cancers are exceedingly common in CLL patients and carries aggressive couse in progressive CLL patients. Larger studies are required to identify subtype of CLL based on integrated mutational and cytogenetic subgroup that are at increased risk of specific secondary malignancies. Disclosures No relevant conflicts of interest to declare.

[Figure][1] A 56-year-old male presented to the emergency department with acute abdominal pain. Computed tomography scan showed multiple cervical, supraclavicular, periaortic, and mesenteric lymphadenopathy; a ruptured spleen measuring 19 cm; and free intraperitoneal hemorrhage. He underwent

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma, accounting for about 1/3rd cases of NHL. At diagnosis, DLBCL involves the bone marrow in approximately 15-25% of cases. However, the bone marrow may reveal discordant morphology from the lymph node, usually an indolent lymphoma. Bone marrow biopsy is routinely used in the staging evaluation of patients with DLBCL. The aim of this study was to determine if clinical variables could predict bone marrow involvement by DLBCL. Methods Retrospective chart review of all patients with a diagnosis of DLBCL at University of Missouri-Columbia/Ellis Fischel Cancer Center from 1993-2013. The following parameters were reviewed: bone marrow biopsy reports, anemia (Hb Results 80 charts were available for review and 7 patients had bone marrow involvement by DLBCL. Univariate analysis for cytopenias (p=0.459), elevated LDH (p=0.442), anemia (p=0.436), leukopenia (p=1.0) and thrombocytopenia (p=0.434) and bone marrow involvement by DLBCL showed no statistical significance (Fischer Exact test). Multivariate analysis comparing anemia, leukopenia, thrombocytopenia, elevated LDH and clinical stage with respect to bone marrow involvement revealed p=0.789, p=0.134, p=0.062, p=0.827 and p=0.521 respectively, and disclosed no statistical significance (logistic regression analysis). Univariate (Fisher exact tests and Cochran-Mantel-Haenszel statistics) and multivariate (logistic regression) analyses were used to test for the relationship of these parameters with bone marrow involvement. Disclosures: No relevant conflicts of interest to declare.

4967 Background: Multiple myeloma (MM) is a common hematological malignancy affecting all races and the incidence is increasing. The rise in incidence is partly due to an increase in average life span in the patient population above the age of 65. It is estimated that 21, 700 individuals will be diagnosed with and 10, 710 patients will die of myeloma in 2012. The comparative epidemiological and survival data on different ethnic groups has not been analyzed on a large population scale. The aim of this study is to analyze and compare the epidemiologic and survival parameters of MM in major US ethnic groups which may provide new insights into disease pathophysiology. Methods: The SEER (Surveillance Epidemiology and End Results) database has been reporting cancer incidence since 1973. Using SEER 18 registries database 1973–2009, appropriate frequency and survival analyses (Kaplan-Meier survival method age adjusted) were performed and compared. Results: US whites (USW) accounted for the highest reported cases (77%) while the next highest reported cases were AA population (17%) ([Table 1][1]). On the contrary, the incidence of MM was highest in AA (11. 7%) and lowest in the US-Hispanic group (3. 4%). Male to female distribution was similar among groups. The median age at diagnosis was 63yrs in AA and 62yrs in US-Asians compared to ∼70yrs in the other ethnic groups. The cancer at presentation was more advanced in the AA and US-Asian groups. However, as shown in both [Tables 1][1] & [2][2], the mortality rates were significantly lower in the US-Asian population when compared to other ethnic groups (2. 4%). | Variables | All | USW | AA | Hispanic | US-Asian | |:-----------------------:| ------------- | ------------ | ------------ | ---------- | ---------- | | Reported cases (%) | 79,186 (100%) | 61,083 (77%) | 13,611 (17%) | 2,393 (3%) | 1,872 (3%) | | Incidence rate | 5.8 | 5.3 | 11.7[*][3] | 3.4 | 4.1 | | Male | 7.4 | 6.9 | 14.3 | 6.3 | 4.7 | | Female | 4.7 | 4.1 | 10.1 | 4.7 | 3.9 | | M% - F% | 53%–47% | 54%–46% | 49%–51% | 53%–47% | 49%–51% | | Median age of diagnosis | 69 | 71 | 63[*][3] | 70 | 62[*][3] | | Age

[Figure][1] A 72-year-old male with a history of increasing dyspnea and weight loss underwent a chest X-ray that revealed a pulmonary mass and thus he was seen by pulmonary service for bronchoscopy. However, routine blood count showed a platelet count of 35 × 109/L with a normal hemoglobin