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Andrew Schaefer,1 Ying Huang,2 Adam Kittai,2 Joseph E Maakaron,3 Caner Saygin,4 Jonathan Brammer,2 Sam Penza,2 Ayman Saad,2 Samantha M Jaglowski,2 Basem M William5 1Department of Medicine, University of Wisconsin, Madison, WI, USA; 2Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; 3Department of Medicine, University of Minnesota, Minneapolis, MN, USA; 4Department of Medicine, University of Chicago, Chicago, IL, USA; 5OhioHealth Blood and Marrow Transplant Program, Columbus, OH, USACorrespondence: Basem M WilliamOhioHealth Blood and Marrow Transplant Program, 500 Thomas Lane, Columbus, OH, 43214, USAEmail basemmwilliam@gmail.comIntroduction: Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) have poor outcomes. Treatment with CD19 chimeric antigen receptor (CAR-T) cells, tisagenlecleucel and axicabtagene ciloleucel, has been associated with improved outcomes. Cytopenias were observed in clinical trials with both products; however, little is known regarding the patterns and outcomes of these cytopenias.Subjects and Methods: We reviewed DLBCL patients (n=32) receiving either product between January and September 2018 at our institution.Results: Median duration of leukopenia, neutropenia, lymphopenia, anemia, and thrombocytopenia was 49, 9, 117.5, 125, and 95.5 days after CAR-T infusion, respectively. Filgrastim was used in 63% of patients, and 50% of patients received red cell or platelet transfusions. With the exception of neutropenia, increase in the duration of cytopenia of any lineage was associated with improvement in progression-free survival, and in overall survival in case of anemia. There was no association between the duration of cytopenias with either cytokine release syndrome or neurotoxicity.Discussion: Our data suggest a correlation between cytopenias and survival outcomes after CD19 CAR-T therapy. If validated, cytopenia may be proven useful as a biomarker of response and survival after CAR-T therapy.Keywords: diffuse large B-cell lymphoma, transformed follicular lymphomas, chimeric antigen receptor T-cells, immunotherapy, cytopenias

Nathan M Denlinger, Narendranath Epperla, Basem M William Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center (OSUCCC-James), The Ohio State University, Columbus, OH, USA Abstract: Marginal zone lymphomas (MZLs) consist of a diverse family of malignancies, which are derived from B-cells. The disease subtypes are recognized extranodal, nodal, and splenic MZLs. The disease characteristics, clinical course, and treatment vary considerably based on the site of involvement. In 2017, the US Food and Drug Administration approved ibrutinib, a first in class Bruton’s tyrosine kinase inhibitor that revolutionized the care of chronic lymphocytic leukemia patients; for, the treatment of relapsed/refractory MZL based on pivotal open-label Phase II trial demonstrated an overall response rate of 48%, with a complete response rate of 3%, median progression-free survival of 14.2 months, and median overall survival not yet reached at a median follow-up of 19.4 months. In this review, we aim to summarize the current conundrums in the management of MZL and the evolving role of ibrutinib in the treatment of MZL. Keywords: non-Hodgkin’s lymphoma, marginal zone, ibrutinib