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Simple Summary Pandemics induce many changes in clinical management. The consequences and extent of these changes are perceived in an individual manner and differ between various stakeholder groups. Using a cross-sectional questionnaire in 11 German institutions we evaluated the different perceptions of related risks and decision-making processes. All the investigated groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. Their perception is dissociated in projection towards other stakeholders. Specific awareness should avoid this dissociation that potentially results in impaired shared decision-making. Abstract Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.

Distress screening has become mandatory and essential in comprehensive cancer care. We evaluated an electronic psycho-oncological adaptive screening (EPAS) which assesses objective indicators of care needs and subjectively perceived care needs and subsequently provides patient feedback with individualized recommendations about psychosocial care services.Patients were assessed within clusters, i.e., different oncological facilities of the competence network of the University Cancer Center Hamburg (UCCH). Patients in the intervention arm underwent the screening, controls received standard care. Patients were assessed at baseline (t0), 3-month (t1), and 6-month (t2) follow-up. Outcomes included information level and use of/access to nine psychosocial services at UCCH, well-being (GAD-7, PHQ-9, SF-8), and treatment satisfaction (SCCC). Conditional linear and logistic regressions were used to identify screening effects at t1 and t2.Of 1320 eligible patients across 11 clusters, 660 were included (50%). The average age was 60 years; 46% were female. The intervention was associated with increased information level for all psychosocial services at t1 and t2 (all p .001), increased use in some of these services at t1 and t2, respectively (p ≤ .02), and better evaluation of access (e.g., more recommendations for services provided by physicians, p .01). At t2, the intervention was associated with a lower level of satisfaction with disease-related information (p = .02).EPAS may improve information about psychosocial services as well as utilization of and access to these services. The effect on information level seems not to be generalizable to other aspects of oncological care. Future studies should incorporate novel technologies and condense the procedure to its core factors.The screening may help to enhance self-management competencies among cancer survivors.The trial was retrospectively registered (2/2021) at ClinicalTrials.gov (number: NCT04749056).

Background: Extramedullary plasma cell (PC) disorders may occur as extramedullary disease in multiple myeloma (MM-EMD) or as primary extramedullary plasmocytoma (pEMP)/solitary osseous plasmocytoma (SOP). In this study, we aimed to obtain insights into the molecular mechanisms of extramedullary spread of clonal PC. Methods: Clinical and biological characteristics of 87 patients with MM-EMD (n = 49), pEMP/SOP (n = 20) and classical MM (n = 18) were analyzed by using immunohistochemistry (CXCR4, CD31, CD44 and CD81 staining) and cytoplasmic immunoglobulin staining combined with fluorescence in situ hybridization (cIg-FISH). Results: High expression of CD44, a cell-surface glycoprotein involved in cell-cell interactions, was significantly enriched in MM-EMD (90%) vs. pEMP/SOP (27%) or classical MM (33%) (p &lt, 0.001). In addition, 1q21 amplification by clonal PC occurred at a similar frequency of MM-EMD (33%), pEMP/SOP (57%) and classical MM (44%). Conversely, del(17p13), t(4, 14) and t(14, 16) were completely absent in pEMP/SOP. Besides this, 1q21 amplification was identified in 64% of not paraskeletal samples from MM-EMD or pEMP compared to 9% of SOP or paraskeletal MM-EMD/pEMP and 44% of classical MM samples, respectively (p = 0.02). Conclusion: Expression of molecules involved in homing and cytogenetic aberrations differ between MM with or without EMD and pEMP/SOP.

Contains fulltext : 87573.pdf (Publisher’s version ) (Closed access) From 2002 to 2007, 49 myeloma patients who relapsed following autologous SCT were included in a prospective multicenter trial to determine the efficacy of a reduced melphalan/fludarabine regimen followed by allogeneic SCT from unrelated donors. All patients showed leucocyte and platelet engraftment after a median of 15 and 19 d, respectively. Grade II-IV acute graft-versus-host disease (GvHD) occurred in 25% of patients and 35% had chronic GvHD. Overall response rate at day 100 was 95% including 46% complete remission (CR). Cumulative incidence of non-relapse mortality at 1 year was 25% [95% confidence interval (CI): 13-37%] and was significantly lower for human leucocyte antigen (HLA)-matched compared to -mismatched SCT (10% vs. 53%, P = 0.001). The cumulative incidence of relapse at 3 years was 55% (95% CI: 40-70%). After a median follow up of 43 months, the estimated 5-year progression-free and overall survival rates were 20% and 26% respectively and were significantly better for matched in CR at day 100 (41% vs. 7%, P = 0.04 and 56% vs. 16%, P = 0.02). We conclude that optimal donor selection is mandatory for a low non-relapse mortality and high relapse incidence, which remains a major concern, should be improved by including post-transplant strategies to upgrade remission status.

The t(14;18)(q32;q21) involving the immunoglobulin heavy chain locus (IGH) and the MALT1 gene is a recurrent abnormality in mucosa-associated lymphoid tissue (MALT) lymphomas. However, the nucleotide sequence of only one t(14;18)–positive MALT lymphoma has been reported so far. We here report the molecular characterization of the IGH-MALT1 fusion products in 5 new cases of t(14;18)–positive MALT lymphomas. Similar to the IGH-associated translocations in follicular and mantle cell lymphomas, the IGH-MALT1 junctions in MALT lymphoma showed all features of a recombination signal sequence–guided V(D)J-mediated translocation at the IGH locus. Furthermore, analogous to follicular and mantle cell lymphoma, templated nucleotides (T-nucleotides) were identified at the t(14;18)/IGH-MALT1 breakpoint junctions. On chromosome 18, we identified a novel major breakpoint region in MALT1 upstream of its coding region. Moreover, the presence of duplications of MALT1 nucleotides in one case suggests an underlying staggered DNA-break process not consistent with V(D)J-mediated recombination. The molecular characteristics of the t(14;18)/IGH-MALT1 resemble those found in the t(14;18)/IGH-BCL2 in follicular lymphoma and t(11;14)/CCND1-IGH in mantle cell lymphoma, suggesting that these translocations could be generated by common pathomechanisms involving illegitimate V(D)J-mediated recombination on IGH as well as new synthesis of T-nucleotides and nonhomologous end joining (NHEJ) or alternative NHEJ repair pathways on the IGH-translocation partner.

Abstract 3359 Poster Board III-247 Allogeneic stem cell transplantation (SCT) with myeloablative conditioning is potentially curative therapy for multiple myeloma, but is associated with excessively high rates of non-relapse mortality (NRM). Reduced-intensity conditioning (RIC) allows reduction of NRM compared with myeloablative conditioning but relapse rate is increased. The role and timing of allogeneic SCT during the disease course are still controversial. There is also only limited data on the long-term outcome of RIC in the relapsing/ refractory setting. We retrospective analyzed SCT outcomes in 50 patients, given RIC for relapsing/ refractory myeloma between the years 2000-2004. The median age was 53 years (range, 32-64), 29 male, 21 female. This was a relatively heavily pretreated patient group, a median of 3 years from diagnosis (0.5-14 years). Forty-seven patients failed one (n=31) or two (n=16) prior autologous transplants, while 3 patients did not have an autologous transplant due to a failed stem-cell collection, but failed other therapies. The median time from the last autologous SCT was 2 years (range, 3 months to 6.5 years). Thirty patients were in partial (PR, n=26) or complete remission (CR, n=4) at the time of SCT and 20 patients had stable or progressive disease (PD). Patients given an auto/allo tandem transplant (rarely performed outside prospective clinical studies) were not included in this analysis. All patients were given fludarabine-melphalan (100-140 mg/m2) based conditioning and stem-cell grafts from a related (n=27) or unrelated donor (n=23). Disease response was assessed at day +100. Forty patients were evaluable for assessment; seven have died by day +100 of non-relapse causes and three have already relapsed. Twenty-three patients achieved a CR (4 in CR pretransplant, 15 of 26 in PR pretransplant; 4 of 20 in stable/PD) and 17 patients achieved a partial response. Twenty-four patients had disease progression after SCT with a cumulative incidence of 48% (95% CI, 36-64). There were no late relapses beyond three years from SCT. The cumulative incidence of acute GVHD grade II-IV and grade III-IV were 51% (95 C.I. 39-67%) and 19% (95 C.I. 10-37%), respectively. Chronic GVHD occurred in 20 of 40 evaluable patients with an overall cumulative incidence of 63% (95 C.I. 47-84%). With a median follow-up of 6.4 years (range, 5-7.9 years), 16 patients are alive and 34 have died. Thirteen patients died of treatment-related complications [cumulative incidence 26% (95 C.I. 17-42%)] and 21 of disease relapse. Three additional patients relapsed, but are currently alive with further therapies. In all, the median survival is 2.3 years and the estimated 7-year overall and progression-free survival (PFS) rates were 34% (95 C.I. 21-47%) and 26% (95 C.I. 14-38%), respectively. The PFS curve showed an apparent plateau after 3 years, suggesting a potential cure. In a multivariate analysis, adverse prognostic factors for survival included SCT not in remission, long duration of disease (> 5 years from diagnosis) and transplantation from a female donor to a male recipient. Related and unrelated donor transplants had a similar outcome. The 7 year PFS in 19 patients with none of these adverse prognostic factors was 47%. Chronic GVHD and achievement of complete remission after SCT were associated with improved outcome. In conclusion, allogeneic SCT can result in long-term progression-free survival in a subset of myeloma patients failing prior therapy and should be considered early after failure and preferably after achieving a response with salvage therapy. The treatment goal is to achieve a CR as this is associated with better outcome. Relapsing disease is still the major cause of treatment failure. Additional strategies, such as maintenance therapy with novel agents or judicious use of donor lymphocyte infusions merit further investigation for converting PR to CR and for reducing post-transplant relapse risk. Disclosures: No relevant conflicts of interest to declare.