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We investigated the effects of nilotinib plus multiagent chemotherapy, followed by consolidation/maintenance or allogeneic hematopoietic cell transplantation (allo-HCT) for adult patients with newly diagnosed Philadelphia-positive (Ph-pos) acute lymphoblastic leukemia (ALL). Study subjects received induction treatment that comprised concurrent vincristine, daunorubicin, prednisolone, and nilotinib. After achieving complete hematologic remission (HCR), subjects received either 5 courses of consolidation, followed by 2-year maintenance with nilotinib, or allo-HCT. Minimal residual disease (MRD) was assessed at HCR, and every 3 months thereafter. The molecular responses (MRs) were defined as MR3 for BCR-ABL1/G6PDH ratios ≤10(-3) and MR5 for ratios

Background: Hypomethylating agents (HMAs) are used to treat patients with lower-risk myelodysplastic syndrome (LR-MDS) relapsing after the use of hematopoietic cytokines or presenting initially with more than two lineages of cytopenias. However, the significance of underlying genetics and allelic burden changes after HMAs are still under investigation. This study investigated the effects of allelic burden changes on the long-term outcomes in LR-MDS patients treated with HMAs. Methods: This study included 61 patients with LR-MDS treated with azacitidine. Bone marrow samples were taken at diagnosis and follow-up after median 4 cycles. Targeted deep sequencing on a custom myeloid gene panel of 84 genes (Agilent SureSelect) was performed on trios of T-cell, pre-HMA, and post-HMA samples on 61 LR-MDS patients. Patients were divided into groups according to the post-HMA variant allele frequency (VAF): low-VAF (< 2%), high-VAF (≥ 2%), and no-mutation group (absence of mutations at diagnosis and follow-up). Overall survival (OS) was defined as the time from the azacitidine treatment until death from any cause, which was analyzed using the Kaplan-Meier method and the groups were compared using the log-rank test. The cumulative incidence of AML was calculated using the Gray method, considering death without AML as a competing risk. Fine-Gray proportional hazard regression with a competing event was used to identify risk factors for the incidence of AML. Results: Median age was 67 years (range 31-81), and 41 patients (67%) were male. IPSS risk group were low in 2 patients (3%) and intermediate-1 in 59 (97%). At diagnosis, 38 patients harbored at least one mutation. Most frequently mutated genes were ASXL1 (n=11, 18%), TET2 (n=10, 16%), and SRSF2 (n=7, 11%) followed by RUNX1, SF3B1, U2AF1, IDH2, and DNMT3A. Azacitidine was administered median 8 cycles (range 2-44). The overall response (CR, PR, HI) was achieved in 18 patients (30%). With median follow-up duration of 31 months (range 4.7-135 months), leukemic transformation occurred in 11 patients (18%). Mutational allelic burdens were decreased from median 20.9% (range 0.1-67.2) to 11.0% (range 0.0-74.9%). At follow-up, 5 patients were low-VAF group and 33 were high-VAF group. OS rate was not different between the low-VAF and high-VAF group (50% vs 46% at 3 years; p=0.80). Three-year cumulative incidence of AML was higher in high-VAF group compared to low-VAF (0%) and no-mutation group (4.8%, p=0.02). However, non-leukemic mortality was higher in low-VAF group than no-mutation group (60% vs 23%, p=0.09), which explains similar OS rate between low-VAF and high-VAF group. In the multivariate analysis, high-VAF was an independent predictive factor for an AML transformation in LR-MDS patients treated with azacitidine (HR 5.20, p=0.04). Conclusion: The current study showed that the high residual allelic burden is associated with an increased AML transformation in LR-MDS patients treated with azacitidine, irrespective of the clinical response. The higher non-leukemic mortality explains inferior OS in low-VAF group compared to no-mutation group. Figure Disclosures No relevant conflicts of interest to declare.

Introduction: The introduction of next-generation sequencing (NGS) has expedited the discovery of novel genetic lesions in acute myeloid leukemia (AML), thereby allowing better risk stratification with respect to overall survival (OS). We have previously reported that AML patients with PTPN11 and NPM1 mutations had longer OS following chemotherapy, while those carrying mutations in ASXL1, JAK2, RUNX1, TP53 and SRSF2 had a shorter OS (Daher-Reyes,ASH 2018). Little is known, however, regarding the impact of genetic profiles (somatic mutations and cytogenetic abnormalities) at initial AML diagnosis on the treatment outcomes following allogeneic hematopoietic stem cell transplantation (HCT). Methods & Patients: We enrolled AML patients who had available NGS data at time of initial diagnosis as part of the AGILE project between February 2015 and December 2018, and who subsequently underwent allogeneic HCT. NGS was performed on DNA samples isolated from peripheral blood or bone marrow samples at diagnosis. Analysis was performed using the TruSight Myeloid Sequencing Panel on the MiSeq sequencer (Illumina; San Diego, CA). Transplant outcomes (overall survival (OS), relapse-free survival (RFS), relapse incidence (RI), and non-relapse mortality (NRM)) after HCT were compared according to genetic profiles defined at diagnosis. Survival analysis for OS and RFS was performed using Cox's proportional hazard model, while the Fine-Gray model was used for RI and NRM analyses. Variables considered in the model included CR status prior to HCT (CR1 vs. beyond CR1), de novo AML (vs. secondary/therapy-related AML), induction chemotherapy used (3+7 vs. others), conditioning regimen (myeloablative vs. reduced intensity), WBC, age, donor type, mutation status of commonly mutated genes, and the composite adverse genetic profile (defined as having at least one of monosomal karyotype (MK), TP53 mutation, del(5), complex karyotype (CK), and monosomy 7), given that these 5 features were highly co-occurring, adverse prognostic factors (Figure 1A). Results: We identified 435 patients in whom frontline NGS was performed, of whom a total of 178 patients (40.9%) received HCT and were included in the final analysis. A total of 598 (median 4, IQR 2-5) mutations were identified in 165 patients (n=165/178, 92.7%). Among 54 genes in the panel, 12 genes were mutated in more than 10% of the cohort, with the most commonly mutated genes being DNMT3A (30.3%), TET2 (25.3%), NPM1 (22.5%), RUNX1 (18.5%), IDH2 (16.9%), FLT3 (15.7%), ASXL1 (12.4%), BCOR (12.4%), CEBPA (11.2%), NRAS (11.2%), IDH1 (10.1%), and SRSF2 (10.1%). In univariate analysis, the groups with a composite adverse genetic profile (n=30/178, 16.9%) showed decreased OS (HR 2.19 [1.30-3.67]; p=0.003), while patients harbouring spliceosome gene (SF3B1, SRSF2, U2AF1, and ZRSR2) mutations (n=37/178, 20.8%) had longer OS (HR 0.39 [0.18-0.85]; p=0.018), with 2-year OS rates of 24.9% and 57.9%, respectively (p=0.002)) (Figure 1B). The composite adverse genetic profile was also associated with shorter RFS (HR 2.23 [1.34-3.69]; p=0.002), while spliceosome gene mutations were associated with longer RFS (HR 0.42 [0.20-0.88]; p=0.022), with 2-year RFS rates of 23.7% vs. 57.9%, respectively (p=0.001)). The composite adverse genetic profile was also associated with higher RI (HR 2.94 [1.52-5.66]; p=0.001), with 2-year RI rates of 47.2% vs. 17.2%, respectively, for patients with and without adverse genetic features (p=0.002) (Figure 1C). Neither the composite adverse genetic profile, nor spliceosome gene mutations, were associated with NRM, with HR of 1.21 [0.55-2.65], p=0.64) and 0.45 [0.16-1.31], p=0.15, respectively (Figure 1D). Multivariate analyses confirmed that the composite adverse genetic profile and spliceosome gene mutations were independent prognostic factors for OS, RFS, and RI (p=0.004, p=0.002, and p=0.001, respectively) and for OS and RFS (p=0.020 and p=0.022, respectively). Conclusion: In our cohort, the composite adverse genetic profile (i.e. having at least one of MK, TP53 mutation, del(5), CK and monosomy 7 remained as a poor prognostic factor even after allogeneic HCT. To clarify the role of genetic risk stratification in HCT, further analysis using a larger cohort is warranted. In addition, a comparative analysis between HCT vs no-HCT groups according to the genetic profile, is ongoing in a in a larger patient cohort. Figure 1 Disclosures Michelis: CSL Behring: Other: Financial Support. Mattsson:Gilead: Honoraria; Celgene: Honoraria; Therakos: Honoraria. Schimmer:Novartis Pharmaceuticals: Consultancy; Otsuka Pharmaceuticals: Consultancy; Jazz Pharmaceuticals: Consultancy; Medivir Pharmaceuticals: Research Funding. McNamara:Novartis Pharmaceutical Canada Inc.: Consultancy. Maze:Pfizer Inc: Consultancy; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Gupta:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sierra Oncology: Honoraria, Membership on an entity's Board of Directors or advisory committees; Incyte: Honoraria, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Yee:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astex: Research Funding; Hoffman La Roche: Research Funding; MedImmune: Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Research Funding; Millennium: Research Funding; Astellas: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees. Minden:Trillium Therapetuics: Other: licensing agreement. Schuh:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria; Teva Canada Innovation: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Background: Primary breast diffuse large B-cell lymphoma (DLBCL) has poor outcomes with frequent extranodal failures, particularly in the central nervous system (CNS). To prevent CNS recurrence, we designed this phase II trial that addressed feasibility and activity of conventional immunochemotherapy and CNS prophylaxis. Methods: This prospective, multicenter, single-arm phase II study was conducted to evaluate efficacy and safety of 6 cycles of conventional rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone every 21 days (R-CHOP) with the addition of 4 doses of intrathecal methotrexate (IT MTX; 12mg) during the first 4 cycles of R-CHOP in patients with primary breast DLBCL. Primary breast lymphoma was defined as lymphoma involving one or both breasts as a sole extranodal site regardless of specific nodal involvement status. The primary end-point was 2-year progression-free survival (PFS). Secondary end-points included cumulative incidence of CNS recurrence, overall survival (OS), and safety. All patients provided written informed consents and the study was registered at www.clinicaltrials.gov as #NCT01448096. Results: Thirty-three patients with primary breast DLBCL were enrolled between Jan 2012 and Jul 2017 in the Consortium for Improving Survival of Lymphoma (CISL) member institutions. The median age was 50 years at diagnosis (range, 29-75) and all were female. Right breast involvement was more common than left (18 [55%] vs 14 [42%]) and bilateral breast involvement was found in one patient (3%). Nodal involvement was present in 16 patients (49%), primarily in regional nodes (14 patients). Thus, the Ann Arbor stage was IE in 17 (52%), IIE in 13 (39%), IIIE in 2 (6.1%), and IV in 1 (3.0%). ECOG performance status was ≥2 in 1 patient (3%) and serum LDH level was elevated in 9 (27%). Therefore, the IPI and the CNS-IPI risk were mainly low (28 patients, 85%; respectively). No patients had CNS involvement at diagnosis. 32 (97%) of the 33 patients completed R-CHOP as planned, and the remaining patient withdraw a consent after four cycles of R-CHOP because of poor tolerance. CNS prophylaxis using IT MTX was completed as planned in 31 patients (94%), but it was discontinued in 2 patients because of patient's refusal. These 2 patients received two and three IT MTX doses, respectively. 32 patients (97%) were evaluable for treatment response and all these patients achieved a complete response. At the cutoff date of this analysis (10 Jul 2019), all patients who entered a follow-up phase had at least 24.0 months of follow-up. With a median follow-up duration of 46.1 months (IQR 31.1-66.8), 6 patients had experienced treatment failure and 3 of these died. The 2-year PFS and OS were 81.3% (95% CI, 67.7-94.8) and 93.5% (95% CI, 84.9-100.0), respectively (fig 1A and B). Of the 6 patients with treatment failure, diseases involved CNS with or without lymph nodes in 4 patients and breasts in 2 patients (1 ipsilateral and 1 contralateral breast recurrence). 3 of the four patients with CNS recurrence had isolated CNS recurrences (2 brain parenchymal and 1 meningeal disease) and one had a concurrent meningeal and lymph nodal recurrence. All 4 patients with CNS recurrence had received prophylactic IT MTX as planned by protocol. The 2-year cumulative incidence of CNS recurrence, taking into account the competing risk of death, was 12.5% (95% CI, 0.3-23.2, fig 1C). Although the number of patients with intermediate CNS-IPI risk was small (5 patients, 15%), the cumulative incidence of CNS recurrence did not differ significantly according to the CNS-IPI risk group. All CNS recurrences occurred within the first 2 years after enrolment. Toxicities were generally manageable during the R-CHOP and IT MTX treatment. No deaths as a result of toxicity occurred during treatment. Conclusion: Our study shows that conventional R-CHOP with prophylactic IT MTX is feasible in patients with primary breast DLBCL. However, given a substantially high rate of CNS recurrence, further studies to properly define the best strategy for CNS prophylaxis should be needed in patients with primary breast DLBCL. Figure 1 Disclosures Yoon: F. Hoffmann-La Roche Ltd: Research Funding. Kim:Celltrion: Research Funding; Novartis: Research Funding; Donga: Research Funding; Kyowa-Kirin: Research Funding; Novartis: Research Funding; J + J: Research Funding; F. Hoffmann-La Roche Ltd: Research Funding.

This study investigated the safety and efficacy of IV-Globulin SN, a 10% intravenous immunoglobulin (IVIg), in patients with severe ITP (platelet count ¡Â20 x 109/L). Among 81 eligible patients, 31 patients were newly diagnosed, 7 patients had persistent ITP, and 43 patients had chronic ITP. Five patients had received splenectomy. Patients received IV-Globulin SN 1 g/kg/day on two consecutive days; infusion rate was initially 1 mg/kg/minute and then doubled every 30 minutes to a maximum of 8 mg/kg/minute. Fifty-eight patients (72%) attained the primary efficacy endpoint of clinical response (platelet count ¡Ã 50 x 109/L within 7 days). Their median time to response was 2 days and the median duration of response was 10 days (range from 1 to 28 days). Complete response (platelet count ¡Ã 100 x 109/L over 7 days) was obtained in 14 patients (17%). Response rates were not significantly different when compared the patients with newly diagnosed, persistent or chronic ITP; previous treatment with immunosuppressant or not; splenectomized or not. IV-Globulin SN 10% was well tolerated and the frequency of mucocutaneous bleeding was decreased during the study period (figure 1). There was no unexpected adverse event. The mean half-life and Cmax of study drug were 28.9 days and 34.6 g/L in 25 tested patients. There were no unexpected adverse events. In conclusion, IV-Globulin SN was efficacious in adult ITP patients regardless of their disease status as well as safe given that the resolution of bleeding and minimal infusion-related adverse events. (NCT02063789) Bleeding rate according the anatomic sites during the study period in 81 patients. *Visit 2 means day 1; visit 3, day 2; visit 4, day 4¡¾1; visit 5, day 6¡¾1; visit 6, day 8¡¾1, visit 7, day 11¡¾1; visit 8, day 15¡¾1; visit 9, day 22¡¾3; visit 10, day 29¡¾3) Bleeding rate according the anatomic sites during the study period in 81 patients. / *Visit 2 means day 1; visit 3, day 2; visit 4, day 4¡¾1; visit 5, day 6¡¾1; visit 6, day 8¡¾1, visit 7, day 11¡¾1; visit 8, day 15¡¾1; visit 9, day 22¡¾3; visit 10, day 29¡¾3) Disclosures Kim: Green Cross Corp.: Employment. Lee:Green Cross Corp.: Employment.

Background: There is no standard therapy after the failure of hypomethylating agents (HMAs) in myelodysplastic syndrome (MDS) without only providing supportive cares including transfusion or cytokine therapies when the patient is not eligible for allogeneic hematopoietic cell transplantation. Lenalidomide is the treatment of choice in case of MDS with 5q deletion. A study of lenalidomide for non-5q deletion MDS patients showed that transfusion independency rate was 26% which was relatively acceptable and suggested that lenalidomide could be used for non-5q deletion MDS patients. Method: We conducted the prospective phase II trial to evaluate the efficacy of lenalidomide for patients who failed to HMA (ClinicalTrials.gov Identifier: NCT01673308). Patients took lenalidomide 10mg daily for 3 weeks and rested for a week. New cycle began every 4 weeks. The primary objective was the objective response rate (ORR; CR+PR+marrow CR+HI). Unknown or not evaluable response were regarded as failure. The planed sample size was 29 (P0: 10%, P1: 30%, α-error:0.5, β-error:0.2) patients. The major inclusion criteria were adult MDS by WHO classification and they should be treatment failure after HMAs (azacitidine or decitabine) which were defined as either intolerant to HMAs or progressive disease after HMA. Results: Total 31 patients were included in this analysis. Among them, 1 patient didn't receive study drug at all. Male was 21 (67.7%) patients. Median age was 68 (range 40-82) years. Reasons for stopping HMA were no response in 10, progression in 14, adverse events in 3 and other causes in 4 patients. WHO classification was follows; RA in 4, RARS in 1, RCMD in 8, RAEB-1 in 4, RAEB-2 in 8, MDS with 5q deletion in 2 and not known in 4 patients. IPSS at study enrollment were low (n=4), INT-1 (n=12), INT-2 (n=9), high risk (n=3) and unknown (n=3) risk. Revised IPSS were very low (n=3), low (n=3), intermediate (n=5), poor (n=2), very poor (n=8) and unknown risk (n=3). Median cycles of lenalidomide was 3 (range 0-21). The responses after 4 cycles were CR in 5, PR in 2, SD in 5, failure in 12, unknown in 7 patients. The maximal responses were CR in 5, marrow CR in 1, PR in 4, HI-E in 1, SD in 5, failure in 14 patients. Best ORR was 11/31 (35.5%) patients, with 16/31 receiving clinical benefit (52%, inclusive of SD). The toxicity profile was tolerable except for hematological toxicities including neutropenia and thrombocytopenia. Among 2 patients with 5q deletion, 1 patient achieved CR but 1 patient failed. Median overall survival was 8.936 (95% CI 0.0-19.685) months which compares with a historical estimate in HMA failures of 4.3-5.6 months. Two patients received alloHCT after progression or failure to lenalidomide. Causes of death were infection (n=8) and bleeding (n=1). Patients who failed to benefit from lenalidomide showed significantly poorer survival when comparing with patients who achieved ORR or SD (median overall survival 2.990 vs. 17.774 months; p=0.010). Among 17 patients who had achieved ORR or SD, 6 patients didn't progress while 8 patients progressed and 3 patients were lost to follow up. Conclusion: Lenalidomide showed reasonable response and excellent overall survival after failure of HMA in adult MDS with tolerable toxicities. Therefore, lenalidomide can be a promising option after failure of HMA even in non-5q deletion MDS. Disclosures Kim: Alexion Pharmaceuticals: Research Funding; Celgene: Research Funding; Il-Yang: Research Funding; Novartis: Research Funding. Choi:Alexion Pharmaceuticals: Research Funding.

Background Since the first bariatric surgery was performed in 2003, the number of bariatric surgeries performed in Korea has exponentially escalated along with the trend in Asia and recently surpassed 1,000 cases annually. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most common types of bariatric surgery currently performed. Various types of anemia, commonly secondary to iron, folic acid, and vitamin B12 deficiencies, may complicate bariatric surgery in the long term. Thus, we evaluated the clinical course of iron deficiency anemia (IDA) in patients who underwent bariatric surgery. Methods A retrospective review of the prospectively established database identified all patients who underwent with RYGB for bariatric surgery between January 2008 and Feb 2014. Bariatric surgery candidates were selected according to international federation for surgery of obesity Asia Pacific Chapter Consensus statements in 2011; patients with a body mass index (BMI) ≥ 30kg/m2 with inadequately controlled obesity-related comorbidities (eg. Diabetes, obstructive sleep apnea, hypertension, or obesity related arthropathy) or with a BMI ≥ 35kg/m2. Anemia was defined as a hemoglobin level Results The records of 523 consecutive patients (total 796 bariatric surgeries) who underwent RYGB between January 2011 and 2015 were retrospectively reviewed. The mean preoperative body mass index was 38.0 ± 5.8kg/m2. Female was 419 (80.1%) patients and median age was 38 (range 16-67) years. Of all patients, 17.4 % patients had IDA postoperatively. Median duration from bariatric surgery to time of anemia onset was 13 (3.5-17) months. Oral iron induced 81 % overall response and 13.5% patients were required intravenous iron due to intolerance. Conclusion Anemia after bariatric surgery is mainly IDA, iron supplements should be administered to patients in early postoperative periods. Oral iron supplements were effective than expected. Disclosures No relevant conflicts of interest to declare.

Background With imatinib therapy, the survival of patients with CML has improved dramatically. In recent years, second generation TKI (2G TKI) led to more increased responses. Despite the demonstrated superiority of efficacy and toxicities as previous treatments, several adverse events of TKIs remain. Because CML treatment is lifelong, it is important for patients to maintain adherent to treatment. Correlations between poor adherence to TKI treatment and adverse events and quality of life (QoL) have been demonstrated among CML patients in clinical settings. The FACT-leu is a validated tool that measures leukemia-specific and more general QoL concerns. However, there are few studies about QoL of CML patients in Korea. Therefore, we evaluated the QoL of CML patients treated with TKIs. Methods The CML working party of the Korean society of Hematology was produced by the questionnaire included the questions of FACT-leu. We distributed the questionnaire over the online or offline. QoL of patients with CML was analyzed using these questionnaires. Results A total of 384 patients were surveyed between March 2014 and June 2014. Male was 234 (60.94%) patients. Median age was 47 (range 12-71) years. Current taking medication at survey were imatinib (n=197), dasatinib (n=71), nilitinib (n=88), radotinib (n=28). Patients with high compliance of TKI (taking 90% or more drugs) were 88.28% and lower compliance (taking 70% or less drugs) were 1.82%. In queries about poor adherence to TKI therapy, common causes were forgetfulness (18.49%) and adverse events (8.59%). FACT-Leu scale was higher in patients with 2G TKIs than imatinib (122.9 ± 22.65 vs 116.0 ± 25.00 (p=0.005)). Female, older patients, patients with CML in longer time showed meaningful worse QoL in FACT-leu scale. There was no significant difference between dasatinib (122.2±25.5) and nilotinib (124.6±22.06) in FACT-leu scale. Conclusion In 2G TKI era, QoL of CML patients seemed that is better than before. Additional prospective studies are warranted using adequate measuring tool of QoL. Disclosures No relevant conflicts of interest to declare.

Background Side population (SP) cells are known as enriched source of cancer initiating cells with stem cell properties. The SP cells show a distinct low-staining pattern with the Hoechst 33342 dye. Our aim was to identify SP cells in multiple myeloma (MM) cell lines as well as characteristics of SP cells. Furthermore, we investigated drugs that are effective against SP cells of MM. Methods SP (side population), MP (main population) cells from human multiple myeloma cell line (RPMI8226) were sorted by flow cytometry based Hoechst 33342 staining. We performed proliferative capacity in vitro, colony-forming cell assay, cell cycle analysis, drug toxicity (doxorubicin, dexamethasone, bortezomib, melphalan). Expression of stem cell markers (ABCG2, Oct4, Sox2, and Nanog) was observed by western blotting assay. Results Several established studies have shown a clonogenic MM cell population with CD 138-status. Therefore, we assessed whether there is correlation between CD 138 - subpopulations and SP cells. CD 138- subpopulations of MM cell lines were not consistent with SP cells. And we have found no correlation between expression of CD 19, CD20, and CD 27 and the proportion of SP cells. No difference was observed for expression of stem cell marker between the SP cells and MP cells. We examined cell cycle analysis and proliferation ability of SP and MP cells. SP cells showed a capacity for higher proliferation abilities and clonogenecity than MP cells. (Fig1,2) We investigated target SP cells with several drugs (doxorubicin, dexamethasone, melphalan, bortezomib). Importantly, bortezomib was the most effective drug for SP cells.(Table1) Conclusion In our study, there was lack of evidence that SP cells was consistent with MM stem cells. No difference was observed for any other marker between SP cells and MP cells. However SP cells had higher proliferation index and clonogenicity compared with MP cells. We suggest that SP cells are rather related to resistance of drugs. Furthermore, bortezomib reduced the SP cells more effectively compared to other drugs. Fig 1. Colony assay Fig 1. Colony assay Fig 2. Cell growth ( X 105 ) Fig 2. Cell growth ( X 105 ) Disclosures No relevant conflicts of interest to declare.

HOXA9 helps maintain the balance between hematopoietic stem/progenitor cell self-renewal and myeloid/lymphoid cell differentiation in the bone marrow (BM). HOXA9 encodes a homeodomain-containing transcription factor, which mediates its function in collaboration with other co-factors, e.g., MEIS1. Several genetic alterations observed in acute myeloid leukemia (AML) patients, e.g., chromosomal translocations involving the MLL gene, are associated with aberrant upregulation of HOXA9, thus disrupting the hematopoietic balance towards leukemogenesis. In a proteomic screen combining the use of affinity purification coupled to mass spectrometry analysis (AP-MS) and the yeast two-hybrid system (Y2H), we discovered that HOXA9 interacts physically with OGT, an O-linked N-acetyl glucosamine transferase. We have obtained multiple lines of evidence supporting the HOXA9-OGT interaction: i) Y2H; ii) identification of endogenous OGT by affinity purification using HOXA9 as a bait in both murine leukemic blasts and human THP1 AML cells; and iii) reciprocal protein pulldowns in HEK293T cells (Fig. 1). A domain mapping analysis revealed that the HOXA9 domain D62-135 is required for the OGT-HOXA9 interaction. We also demonstrated that the MEIS interaction motif of HOXA9 is GlcNAcylated by OGT. We used a colony forming assay to measure the clonogenic potential of the OGT-interaction defective allele of HOXA9, i.e., HOXA9(Δ62-135). We observed a higher number of colonies for HOXA9(Δ62-135) in comparison to WT HOXA9 (Fig. 2). In light of these results, we hypothesize that the HOXA9-OGT interaction has an inhibitory effect on HOXA9's ability to promote colony formation. This model is also corroborated by an experiment in which co-transduction of OGT with HOXA9 inhibits clonogenesis, further supporting the hypothesis that the OGT has a suppressive effect on HOXA9. By quantitative RT-PCR, we show that the level of expression of FLT3, a well-characterized target of HOXA9, is higher in HOXA9(Δ62-135)-transduced BM cells than in HOXA9-transduced ones. To identify genes modulated by HOXA9 in an OGT-dependent manner, we analyzed the transcriptome of HOXA9(Δ62-135)-transduced BM cells by expression profiling studies using next-generation sequencing (RNA-seq). We identified 1,083 and 551 genes that are further up- or further down-regulated with HOXA9(Δ62-135) in comparison to HOXA9. Increased chromatin binding of HOXA9(Δ62-135) at the loci of some of these genes was also confirmed by chromatin immunoprecipitation followed by qPCR (ChIP-qPCR). We note that pro-oncogenic genes such as FLT3, LCK and ERG, which have been previously characterized as being HOXA9-upregulated, demonstrate even higher levels of expression in cells transformed by HOXA9(Δ62-135). The most striking observation, though, arose from the integrative analysis of two RNA-seq datasets [HOXA9 and HOXA9(Δ62-135)-transformed BM cells] and two ChIP-seq datasets (HOXA9 and OGT ChIP-seq in BM cells). Remarkably, we observed that HOXA9-downregulated genes that are further downregulated in presence of HOXA9(Δ62-135) (N = 82) are specifically enriched for OGT-bound genes (N = 41 out of 82; P < 4 x 10-10). In contrast, such enrichment is not observed for HOXA9-upregulated genes (N = 22 OGT-bound genes out of 108 HOXA9/HOXA9(Δ62-135)-upregulated genes; no statistical enrichment). Thus, our transcriptome-wide analysis of the OGT-dependent regulation of HOXA9 gene targets highlights the critical importance of HOXA9 as a negative regulator of transcription, rather than a positive regulator. This observation is further validated by the analysis of gene expression profiles in human leukemia samples. Indeed, a larger than expected number of the human orthologs of the murine HOXA9-downregulated genes have a low level of expression in MLL translocation-driven AML patient samples compared normal samples. In comparison, such trend is not as prevalent for the human orthologs of the murine HOXA9-upregulated genes. In conclusion, our data support a model in which OGT inhibits HOXA9's ability to transform primary bone marrow cells, thus defining OGT as a potential tumor suppressor of HOXA9-driven AML. The biomedical relevance of the OGT-HOXA9 interaction to HOXA9-driven leukemogenesis is being investigated in vivo using a HOXA9-induced mouse model of AML. This project is supported by the WES Foundation and the American Society of Hematology. Disclosures No relevant conflicts of interest to declare.

Background Venous thromboembolism (VTE) is a critical complication of malignant disease. Pancreatic cancer is one of the cancers most commonly associated VTE. In general, the VTE incidence rate of Asians is lower than that of Caucasians. In 2007, a Korean study reported that only four cases of VTE (5.3%) occurred in Seventy five patients with advanced pancreatic adenocarcinoma. We evaluated VTE incidence in pancreatic cancer and characteristics of pancreatic cancer patients with VTE. (We found out that VTE incidence rate among Asians was not lower, and the event of VTE was poor prognosis.) Method We retrospectively reviewed the medical records of patients with histopathologically proven pancreatic cancer from January 2006 to December 2012 at Soonchunhyang university hospital. We detected VTE through CT (chest CT, pulmonary embolism CT) and low extremity ultrasoundgraphy. Results Five hundred and fourteen patients with pancreatic adenocarcinoma were enrolled. (M: F, 300:214, localized: locally advanced: metastatic=31:230:253, mean age: 66.7 years). Ninety six of 514 patients (18.6%, symptomatic: aymptomatic=38:58, PE: DVT: PE+DVT: visceral thrombosis=20:19:19:38) were diagnosed as VTE. At the time of DVT diagnosis, cancer status of 50 patients cancer was progression, and that of 15 was stable. Thirty one patients were diagnosed with the pancreatic cancer and VTE, at the same time. They all had metastatic lesions. Fifty VTE patients were treated with antithrombotic therapy. Ninety three of 96 patients died, and three of them have probability that cause of death was VTE. The others died of pancreatic cancer progression. From pancreatic cancer diagnosis to VTE diagnosis, the period is 1.7month. (95%CI 1.1-2.3 month). Median overall survival (OS) was not significantly different between pancreatic cancer with VTE or without VTE. OS was significantly longer VTE patients after pancreatic cancer diagnosis than VTE patients with pancreatic cancer at the same time (10.73m vs. 1.7, p=0.00). Conclusion The incidence of VTE (18.6%) in Soonchunhyang university hospital with pancreatic cancer was not lower than that in western groups. Disclosures: No relevant conflicts of interest to declare.

All-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) combination yields a high quality remission and survival in newly diagnosed acute promyelocytic leukemia. For subsequent similar data, NCCN guidelines indicate that ATRA plus ATO is an alternative for patients who cannot tolerate anthracycline therapy. We demonstrated that SFK (Src Family Kinase) inhibitor PP2 enhanced acute promyelocytic leukemia (APL) cell differentiation when combined with either ATRA or ATO with difference in activation of RA-induced genes. In this study, we investigated SFK inhibitor PP2 could enhances the differentiation of NB4 APL cells when combined with ATRA and ATO and the changes in the expression of intercellular adhesion molecule-1 (ICAM-1) derived from the retinoic acid receptor (RAR) target gene. Treatment of NB4 cells with 1 nM of ATRA, 0.5 uM of ATO, or 10 uM of PP2 for 72 hours induced expression of CD11b-positive cells by 13.01%, 11.53% or 13.28%, respectively. However, the combination of ATRA and ATO and the combination of three agents (ATRA, ATO, and PP2) led to a significant higher expression of CD11b-positive cells (30.96% and 63.17%, respectively). The synergistic effect of the combination of three agents was more significant than the combination of ATRA and ATO. These results were confirmed by NBT staining. These effects were not related with apoptosis. Annexin-V-fluorescene staining revealed that combination of ATRA and ATO and combination of three agents did not induced apoptosis in NB4 cells. The expression of ICAM-1 was markedly increased in cells treated with the combination of three agents. These findings suggest that the SFK inhibitor can enhances differentiation of APL cells combined with ATRA and ATO. FDA approved SFK inhibitors, such as dasatinib and bosutinib, may be beneficial for the treatment of APL in combination with ATRA and ATO. Disclosures: No relevant conflicts of interest to declare.

Introduction Venous thromboembolism (VTE) is a major cause of morbidity and mortality after gynecologic and urologic surgeries and previously reported VTE incidence in major genitourinary surgery without VTE prophylaxis was 15-40% in Western countries. VTE is a preventable complication using thromboprophylaxis, however, pharmacologic thromboprophylaxis after major abdomino-pelvic surgery may involve serious bleeding complication. Here, we evaluated the exact incidence and risk factors of VTE following major genitourinary surgery in Korean patients and proposed evidence-based VTE prevention guidelines in such patients. Methods In March 2012, the committee for the development of guidelines for preventing VTE in Korea was organized by receiving recommendations from the VTE working party members in the Korean Society on Thrombosis and Hemostasis (KSTH). Using nation-wide date from Korea Health Insurance Review and Assessment Service (HIRA) from 2007 to 2011, symptomatic VTE frequencies after major genitourinary surgeries were retrospectively collected and evaluated. For the categorization of those patients by their VTE incidences, we used the methods described in AT9 guidelines (American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th ed.) Results According to the HIRA database, 255,324 and 85,191 patients' data were collected and evaluated their incidence of VTE and risk factors, which underwent major gynecologic and urologic surgeries, respectively. In detail, there were 87,136 hysterectomies for benign uterine diseases (76,284) and uterine cervical cancer (10,852), 168,188 oophorectomies for benign ovarian diseases (156,697) and ovarian cancer (11,491), 35,970 prostatectomies for benign prostatic hyperplasia (BPH, transurethral, 26,590) and prostatic cancer (retropubic, 9,380), 12,462 nephrectomies for renal cell cancer and 36,759 radical cystectomies for bladder cancer. As shown in Table 1, most Korean patients undergoing genitourinary surgeries were identified as very low VTE risk category. In the aspect of gynecologic cancer surgery, ovarian cancer showed highest rate of VTE incidence (1.21%, moderate risk; 0.70% deep vein thrombosis, DVT + 0.51% pulmonary embolism, PE) and cervical cancer showed 0.59% (low risk; 0.47% DVT + 0.12% PE). On the basis of these data and a literature search results, the recommendation was made by a consensus of the guideline development committee. To take the advice of outside experts, survey and review for the developed guidelines were performed by other KSTH members and the related Academic Societies. Conclusions Even when considering relatively lower incidence of VTE in Asian people than that in Western, Korean genitourinary surgery patients revealed very low incidence of VTE. As stated above, abdomino-pelvic surgery is a procedure for high risk of bleeding complications. Therefore, it is reasonable to assume that the recommendation of pharmacologic thromboprophylaxis for other gynecologic surgeries except ovarian cancer surgery should be deferred until they reveal hard evidence of higher incidence of VTE in Korea. Disclosures: No relevant conflicts of interest to declare.

Abstract 4800 Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) with distinctive biologic and clinical features that is now highly curable. Leukemic promyelocytes have the unique ability to undergo differentiation after exposure to retinoic acid and both differentiation and apoptosis after exposure to arsenic trioxide (As2O3, ATO). Emerging evidence has implicated Src family kinases (SFKs) as regulators of proliferation and survival of myeloid lineage cells. Recent studies showed that inhibition of SFKs resulted in enhancement of retinoic acid-induced myeloid differentiation. In this study, we demonstrated that the SFK inhibitor PP2 enhanced the differentiation of NB4 cells when combined with ATO as well when combined with as all-trans-retinoic acid (ATRA) and the difference in the retinoic acid-induced gene expression between the cells treated with PP2 in combination with ATRA and the cells treated with PP2 in combination with ATO. SFK inhibitor PP2 significantly enhanced ATRA- or ATO-induced differentiation of NB4 cells. The synergistic effect was significantly stronger when PP2 was combined with ATRA than when PP2 was combined with ATO. Flow cytometric analysis demonstrated a significant increase in CD11b-positive granulocytes up to 60.73% and 31.58%, respectively. These results were confirmed by morphologic analysis using Wright stain and NBT staining. These effects were not related to apoptosis. Annexin-V-fluorescein staining revealed that PP2 combined with ATRA or PP2 combined with ATO did not induce apoptosis in NB4 cells. Retinoic acid-induced gene expression was different in both groups. ICAM-1 expression was significantly increased in the cells treated with PP2 in combination with ATRA whereas cathepsin D expression was significantly increased in the cells treated with PP2 in combination with ATO. These findings suggested that the synergistic effect of SFK inhibitor PP2 in combination with ATRA was significantly stronger than that of PP2 in combination with ATO on NB4 myeloid leukemia cell differentiation and this difference was related to the disparate activation of retinoic acid-induced genes. Disclosures: No relevant conflicts of interest to declare.

Abstract 1866 Background: In multiple myeloma (MM), the association between the response to induction before autologous stem cell transplantation (ASCT) and long-term outcome is less clear but the situation may change with the introduction of novel agents. We therefore assessed the clinical relevance of response of bortezomib induction treatment or post-ASCT response for patients who received bortezomib-combined induction chemotherapy followed by ASCT. Methods: We retrospectively assessed 183 MM patients who received bortezomib-containing induction therapy (BTZ-IT) followed by ASCT in 24 institutions throughout Korea between 2003 and 2010. Records of these patients were reviewed using the Korean Myeloma Registry database (www.myeloma.or.kr). Each institution was requested to reconfirm the data using additional case report forms. Patients who had overt MM based on International Myeloma Working Group diagnostic criteria were selected. Results: One-hundred seventy eight patients were eligible. Their median age was 56 years (range, 28–69 years) and 96 (53.9%) were male. Forty nine (27.5%) received bortezomib as front-line therapy and 129 (72.5%) as second-line treatment. All patients underwent ASCT and 22 (12.4%) were treated with tandem ASCT. Ninety-seven (54.5%) patients were treated with maintenance therapy after ASCT. After BTZ-IT, the response rates in this selected series of patients were 37.6% CR, 12.4% VGPR, 41.0% PR, 7.3% SD and 1.7% PD (Figure 1A, 1B, 1C); the corresponding post-ASCT rates were 69.2% CR, 14.0% VGPR, 11.0% PR, 2.9% SD and 2.9% PD. At a median follow-up of 46.6 months, the 3-year overall survival (OS) and event-free survival (EFS) rates were 70.0% and 31.9%, respectively. Multivariate analysis showed that factors independently predictive of OS and EFS included achievement of BTZ-IT response °Ã PR (P=0.025 and P=0.014, respectively) and the treatment with maintenance therapy (P=0.048 and P=0.001, respectively). Post-ASCT CR vs. °Â VGPR was also an independent prognostic factor for OS and EFS (P=0.0001 and P=0.002, respectively). Conclusion: At least PR to BTZ-IT and CR after ASCT were predictive of survival. These findings suggest that patients who responded to BTZ-IT may benefit from ASCT due to an enhanced quality of response. Maintenance therapy can also affect patient outcomes. Disclosures: No relevant conflicts of interest to declare.

Abstract 2021 Background: High dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become the standard approach for relapsed or high risk non-Hodgkin's lymphoma (NHL). Several different high dose therapy (HDT) conditioning regimens have been used for non-Hodgkin's lymphoma (NHL), such as BEAM (carmustine, etoposide, cytosine arabinoside, melphalan), BEAC (carmustine, etoposide, cytosine arabinoside, cyclophosphamide), and CBV (cyclophosphamide, carmustine, etoposide). Carmustine is an active drug in the HDT of NHL but the supply of carmustine is limited in some countries including Korea. Intravenous busulfan containing regimens as conditioining regimen have been used for both allogeneic and autologous stem cell transplantation in patients with hematologic and non –hematologic malignancies. The purpose of this prospective multicenter phase II study was evaluate the efficacy and safety of iv busulfan/melphalan/etoposide regimen as a conditioining regimen for high dose chemotherapy in the patients with relapsed or high risk NHL. Methods: Patients with relapsed or primary refractory NHL or chemosensitive high risk NHL underwent high dose chemotherapy followed by ASCT at 13 centers in Korea. The conditioning regimen consisted of iv busulfan 3.2mg/kg/day i.v. on days −8, −7 and −6, etoposide 400mg/m2/day i.v. on days −5 and −4 and melphalan 50mg/m2/day i.v. on days −3 and −2. Results: Fifty one patients were enrolled onto the study. Main subgroups were DLBCL (n=25, 49%) and T cell lymphoma (n=19, 37%). At the time of ASCT, the disease status of patients was as follows: 13 patients were high risk in remission, 16 were primarily refractory to inducton therapy, 15 patients were in chemosensitive relapse. All patients had successful stem cell engraftment with a median time to neutrophil recovery of more than 500/mm3 of 10 days (range, 2 to 30 days). Platelet recovery of more than 20,000/mm3 was seen after a median of 10 days (range, 2 to 51 days) with delayed recovery in one patient. Treatment related toxicities included nausea/vomiting in 28 patients (55%), diarrhea in 28 patients (55%) and mucositis in 33 patients (65%), which were grade I or II in the majority of cases. Grade I/II hepatic toxicities occurred in 24% (n=12) and grade III in 6% (n=3). There were no VOD and treatment related death. The median duration of hospitalization for ASCT was 30 days (range, 12 to 80 days). Forty one patients (80%) achieved a complete response 1 month after ASCT, while three patients showed progressive disease. At a median follow up of 14.7 months, 21(41%) patients exhibited a relapse or progression, while 11 patients had died of disease and one patient had died of heart failure. The estimated 2-year overall and progression free survival for all patients was 64% and 40%, respectively. Conclusion: This preliminary analysis suggests that conditioning regimen of i.v. busulfan/melphalan/etoposide would be well tolerated and effective in patients with relapsed or high risk NHL. Accordingly, this regimen may be regarded as an important treatment option to substitute for BEAM regimen. Disclosures: Lee: Novartis: Research Funding.