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[Figure][1] A 61-year-old woman with Waldenstrom macroglobulinemia (WM) was treated with 6 cycles of cyclophosphamide, rituximab, and dexamethasone between December 2011 and May 2012, and she achieved complete remission. She was given maintenance rituximab once every 3 months. Eighteen

Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently FDA approved for treatment of low and intermediate MDS with complete responses around 50%. And Acute myeloid leukemia (AML) in the eldery In the CALGB studies, the usual dose is 75mg/m2 in 28 day cycles, with dose modifications according to toxicity. In low income countries such as Mexico, one course of Azacitidine is around 500 dollars, median income in Mexico is 4,910 PPP (purchasing power parity); vs 30,616 in the USA. So, azacitidine treatment is far from reach for most of the common population, particularly those who do not have insurance. This is a retrospective observational study, of a compassionate use program of a fixed dose of Aza at 100mg. We analyzed data from patients that were treated with Aza between 2012 and 2016, and collected data in 2016. The aim of the study was to assess the effectivity of the fixed dose. For that purpose, we collected information from the physical and electronic file. We analyzed: Hemoglobin level before and after treatment, independence of transfusion, ANC recovery, number of courses, and overall survival. We conducted our research in a public institution in Mexico (Instituto Nacional de Cancerología) and a private institution (Medica Sur). We included acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients, regardless of age, previous treatment and comorbidities (we included patients with renal failure, hypertension etc.) We included 8 patients in our study, 6 males and 2 females, with a mean age of 69.9 years (49-87). We had 2 AML and 6 MDS. We had 2 high risk AML and according to IPSS-R: 1 very low, 2 low, 1 intermediate, 1 high and 1 very high risk MDS. As for the Karyotype we had 1 complex KT, 4 normal KT and 1 Del 7q Del 5q +8. All patients received at least one dose of Aza, with mean number of cycles of 4. We have a mean survival of 439 days (110-1385). 6/8 patients achieved transfusion independency within 3 doses of Aza. 6/8 patients achieved ANC but lost eventually lost response. 5/8 patients are alive in follow up. 3 patients died of infectious complications. 2 patients never achieved transfusion independence or ANC. The information recovered suggests that a fixed dose of 100mg is as feasible as a higher dose, at least when no other treatment or higher dose can be administered. We still are analyzing the survival data in order to find other bad prognosis factor within this population. Disclosures No relevant conflicts of interest to declare.

Abstract 2284 Background: Apheresis is an efficient method to collect specific blood components such as platelets, leukocytes, plasma and stem cells. Its advantages include: the collection of standardized and high-quality blood products and a higher collection frequency. However, apheresis is usually accompanied by acute metabolic changes (specially in serum calcium and magnesium concentrations) due to citrate infusion during the whole procedure. Aim: To compare pre and post-plateletpheresis serum level concentrations of calcium, magnesium, zinc, copper and parathyroid hormone among donors and correlate these levels with symptoms that donors may experience during the procedure performance. Materials and Methods: This is a prospective study including 105 healthy plateletpheresis donors who attended the National Cancer Institute. Basal and post-procedure serum levels of parathyroid hormone (PTH), calcium (Ca), magnesium (Mg), zinc (Zn) and copper (Cu) were measured by ion selective potentiometry (Ca), final dot (Mg), atomic absorption (Cu, Zn) and solid phase two site chemoluminiscence (PTH) methods. In case of adverse reactions, a blood sample was drawn immediately in order to analyze concentrations of such hormone and minerals. We intended to correlate both, diet and adverse reactions with serum levels of aforementioned elements. Statistical analysis was performed by chi-square and ANOVA. Protocol was approved by the institutional ethical and research committee. Results: One hundred and five consecutive donors were included in the study conducted from June 28th through July 27th, 2012. There were 68 males and 37 females. Median age was 31 years (range 18–56). Pre and post-apheresis PTH, Ca, Mg, Zn and Cu serum levels are shown in table 1. Furthermore we found significant differences in women older than 30 years but did not find any relationship between donors' symptoms and diet. Conclusions: Plateletpheresis induced a secondary hyperparathyroidism state resulting from chelation of calcium and magnesium. We demonstrated that Cu was also chelated by citrate. These results urges us to assess the kinetics of these metabolic changes as well as to follow a cohort of donors with bone densitometry in order to assure that frequent and chronic infusion of citrate during plateletpheresis donations does not become a long-term risk for osteopenia and osteoporosis as already suggested by some authors1,2. If such a risk is demonstrated other preventive measures must be implemented like: 1.- To restrict the number of apheresis donations per person and 2.- To develop new and safer anticoagulants to be used during the apheresis procedures. Disclosures: No relevant conflicts of interest to declare.

Background: Bone marrow necrosis (BMN) affects both stromal tissue and hematopoietic precursors and its prevalence ranges from 0.3–37%, being the hematologic malignancies the most frequent cause. Aim: To describe the clinical and pathological characteristics of 30 patients with BMN diagnosed and treated at our institution. Methodology: We included all adult patients diagnosed during the last 8 years (2000– 2007) via bone marrow aspiration and biopsy. Results: Median age was 44 years (range 14–78); 53.3% were females. 42.2% of the patients died within a month mainly due to adult respiratory distress syndrome (ARDS) and septic shock. Just 5 (16.7%) of them are still alive. In all cases, BMN was of coagulative type, and extense in 23 (76.6%) of the patients. The main symptoms were: bone pain (53%), anemia (53%) and fever (50%), whereas the main underlying diseases were: acute lymphoblastic leukemia (ALL) in 26.7%, non-Hodgkin lymphoma (NHL) in 13.3% and multiple myeloma (MM) in 10% of the patients. Conclusions: BMN is associated to a fatal course and to hematologic malignancies in most of our patients.

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare condition in which granulomas form in tissues through the accumulation of abnormal histiocytes (Langerhans cells), granulocytes and lymphocytes. Prognosis in patients with disseminated disease has been associated with a chronic course, and a high morbidity and mortality rate. In terms of treatment, etoposide and vinblastine are considered to be the most effective agents in monochemotherapy. Here we report the case of an adult patient with LCH who has improved considerably after treatment with 2-CDA followed by IM. CLINICAL CASE: 37 year-old Hispanic female with history of burning epigastric pain, nausea and vomiting starting in 1998. In 1999 diarrhea and steatorrhea appeared. Whipple disease was diagnosed in another hospital but treatment was unsuccessful. She came to our hospital in 2003, complaining of the aforementioned symptoms plus severe malnutrition. Upper GI endoscopy and colonoscopy were performed and the biopsies showed infiltration with LCH. Bone marrow (BM) biopsy showed LCH infiltration too. CD117 (KIT) expression was investigated both in gastric and BM biopsies, turning out to be highly positive. Therapies and outcomes are shown in table 1. | DATE | DRUGS | TREATMENT DURATION | WEIGHT (Kg) | ALBUMIN (g/dL) | GI ENDOSCOPY | BIOPSY | |:------ | ------------- | ------------------ | ----------- | -------------- | -------------------------- | ----------------------------- | | Dec/03 | VBL/VP-16/PDN | 5 cycles | 33.5 | 0.99 | Polyps and pseudopolyps | Infiltrated by LCH. | | Sep/05 | MTX/PDN | 18 mos. | 39.5 | 3.18 | Polyps and pseudopolyps | Infiltrated. | | Jul/07 | 2-CDA | 9 cycles | 55.3 | 4.0 | Polyps | Infiltrated. | | May/08 | IM | 6 mos. | 57 | 4.0 | Nodular pattern. No polyps | Decreased infiltration by LCH | CONCLUSIONS: This case illustrates that multisystemic LCH can be successfully treated with, at least two more drug choices: 2-CDA and, in those patients with expression of KIT and/or PDGF, IM.

Introduction. The umbilical cord stem cell bank was created in Mexico City in june 2003 due to the need to have access to pluripotential stem cells to cover the hematological and immunological pediatric needs. We have so far 300 units of umbilical stem cells available to the medical community. The bank has been designed with a completely automatic process and the standards are based in NETCORD-FAHCT outlines. Objective. In the present study we made a balance of the evaluation of umbilical cord stem cell process including the maternal setting, the standarization of the methodology to obtain the stem cells, compared to other institutions around the world. Material and methods. Bayesian analysis allow us to evaluate our procedures at the different levels. Bayesian networks are directed acyclic graphs (DAGs) where the nodes are random variables and certain independence assumptions hold. Results. In table 1 we show the results of the first 300 units process with the automatic process. The arcs in a bayesian network specify the independence assumptions that must hold between the random variables and the global dependence of the total factors. Figure 1. Conclusion. Through the bayesian analysis, we found a direct influence of the collected volume, the time between the collection and the procedure, and the maternal unit, with respect to the number of recovered cells, specifically with CD34+ the viable ones as well as the totals. Figure 1. Bayesian Analysis between neonatal and process factors. Weight baby (PRN); sex (SRN); cord blood unit collected volume (ml); initial white cell (GBTI); total final white cell(GBTF); % total CD34+ ( PCD34T); % viable CD34+ (PCD34V); total CD43+ (CD34T); viable CD34+ (CD34VA); ginecology unit (UH); time hour (TH). Figure 1. Bayesian Analysis between neonatal and process factors. Weight baby (PRN); sex (SRN); cord blood unit collected volume (ml); initial white cell (GBTI); total final white cell(GBTF); % total CD34+ ( PCD34T); % viable CD34+ (PCD34V); total CD43+ (CD34T); viable CD34+ (CD34VA); ginecology unit (UH); time hour (TH). Results of the first 300 units process with these technology Initial nuclear cells/ml Collectionvolume Initial total nuclear cells % CD 34total Viable% CD 34 Recovery% Average 11.4 x 106/ml 102.8 ml 12.2 x108 0.32 0.31 80 Acceptance criterion 7–20 x 106 > 75 ml >8 x 108 0.1– 0.3 0.1– 0.3 >60%