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Dyslipidemia is a metabolic abnormality leading to a persistent increase in the plasma concentration of cholesterol and triglycerides. Dyslipidemia is known to promote atherosclerosis. It is a complex disease and is a major risk factor for adverse cardiovascular events. Allium sativum commonly known as garlic has been found to have several medicinal value including, lipid-lowering property, blood pressure decreasing, anti-diabetic, anti-cancer and anti-oxidant activity. It was a double-blind, two-parallel-group, prospective interventional clinical trial. Total no of 112 patients were enrolled in the study and divided into two equal groups (56 in each group) viz; Group 1 (Lasuna TM) and Group 2 (placebo). Lipid profile was measured at day 0 and 90. Independent–sample‘t’ test was applied to find out the significant difference between the two groups, P-value being 0.05. The mean difference Total Serum Cholesterol, Serum Triglyceride, Serum LDL Cholesterol and Serum VLDL cholesterol on day 0 was nonsignificant with p being 0.539, 0.811, 0.230, 0.770 and 0.811 and on 90th day was significantly lower in group taking garlic with p being 0.001, 0.014, 0.003 and 0.008 respectively whereas Serum HDL cholesterol on 90th day was significantly higher in group taking garlic with p being 0.001. Garlic, when given as supplement decreases Total Serum Cholesterol, Serum Triglycerides, Serum LDL Cholesterol and Serum VLDL Cholesterol and on the other hand it increases Serum HDL Cholesterol.

BACKGROUND A second primary malignancy is a serious long-term complication in cancer survivors. The aim of this study was to evaluate the risk of second primary malignancies (SPM) in adult patients with bladder cancer. MATERIALS AND METHODS We selected patients ≥18 years diagnosed with bladder cancer from National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 13 database. We calculated the risk of second primary malignancies in the bladder cancer patients using the MP-SIR session of SEER*stat software. RESULTS A total of 103,516 cases of bladder cancer was included in the study. Among them, 17,004 (16.4%) developed 19,318 second primary malignancies. The risk of development of SPM was significantly higher compared to the general population with O/E ratio of 1.42 (95% CI=1.4-1.44, AER=89.22 and p-value of

Combination chemoradiotherapy is the standard of care for treatment of non-metastatic squamous cell carcinoma of the anus (SCCA). This population based study evaluated disparities in receipt of radiotherapy (RT) as well as comparative survival rates for SCCA patients in the United States.The Surveillance, Epidemiology, and End Results (SEER) 18 database was used to identify patients with non-metastatic SCCA diagnosed between 1998 and 2008. Multivariate logistic regression was used to model the relationships between age, sex, and race and the receipt of RT, adjusting for marital status and stage of disease. Relative survival (RS) rates were compared by each factor, with added adjustment for RT status, using Cox proportional hazards model.A total of 3,885 patients with localized or regional SCCA as the only primary malignancy were included in the study, of which, 3,192 (82%) received RT. In our multivariate analysis, lower rates of RT were found for those 65+ years old [adjusted odds ratio (OR) 0.71; P0.001], males (adjusted OR 0.65; P0.001), and blacks (adjusted OR 0.78; P=0.049). Multivariate survival analysis showed worse survival among those 65+ years old (adjusted HR 1.65; P0.001), males (adjusted HR 1.53; P0.001), and blacks (adjusted HR 1.35; P=0.001).This population based study identified older patients, males, and blacks as less likely to receive RT. Worse survival was also found in these groups.

Leptomeningeal metastasis is an uncommon but serious complication in patients with advanced cancers. Leptomeningeal metastasis is diagnosed in approximately 5% of the patients, most commonly among patients with cancers of breast and lung, melanoma, and gastrointestinal malignancies. Treatment goal is to improve survival and quality of the patients. Use of targeted therapies and immunotherapy has led to improved survival of patients with non-small cell lung cancer (NSCLC). In this article, we review emerging data on use of mutation-specific agents and immunotherapy in the treatment of leptomeningeal metastasis among patients with NSCLC.

DOI: https://doi.org/10.3126/jaim.v7i2.23492 Snake bite, is a significant public health problem and medical emergency in tropical countries including Nepal. Acute renal failure is one of the devastating complications of Russell’s viper envenoming which may cause death of patient in the absence of prompt and adequate management. Treatment with anti-venom and hemodialysis can salvage the patient. Although Russell’s viper is widely distributed in Nepal, AKI due to Russell’s viper envenoming was not reported previously from Nepal. Keywords: Kidney injury, Russell's viper, envenomation

Idelalisib, the first in-class phosphotidlyinositol 3-kinase delta (PI3Kδ) inhibitor, was approved by the US Food and Drug Administration in July 2014. It simultaneously received breakthrough therapy designation in combination with rituximab for the treatment of relapsed chronic lymphocytic leukemia (CLL) as well as accelerated approval as monotherapy for the treatment of relapsed follicular lymphoma and relapsed small lymphocytic lymphoma. In a pivotal phase III study of 220 patients with relapsed CLL, the overall response rate of patients who received rituximab plus idelalisib was 81%. The median progression-free survival (PFS) was 5 months with rituximab plus placebo group, but was not reached in the idelalisib arm. At 24 weeks, the PFS in patients receiving idelalisib was 93%. In a phase II trial of 125 patients with relapsed or refractory indolent non-Hodgkin lymphoma who received idelalisib 150 mg twice daily, the response rate was 57%. Complete response was seen in 6% of patients. The median duration of response was 12.5 months, and median PFS was 11 months. Idelalisib is a promising new therapy for relapsed indolent B-cell malignancies.

Background/aim The majority of cancers affect the elderly, but 22.4% of all cases occur in the ages of 21-55. This age range represents common childbearing and child-rearing years, which imply that many of these patients have minor children. Approximately 2.85 million children under 18 live with a parent affected by cancer. Materials and methods The Pubmed and Google Scholar were searched to identify literature on impact of parental cancer on children and potential interventions to support parents and children. Results We reviewed impact of parental cancer on daily routine, role changes, emotional problems and social functioning of children. We also discuss interventions that may be useful for parents and children. Conclusion It is essential that we learn more about the impact of parental cancer on children and ways to support the families using evidence-based interventions.

Background Treatment and prognosis of diffuse large B-cell lymphoma (DLBCL) depends on the stage of lymphoma. We conducted this study to examine unstaged DLBCL in the United States. Materials and methods We used Surveillance Epidemiology and End Result (SEER) 18 registries to select patients with DLBCL diagnosed during January 2000 to December 2012. Limited regional distant Summary stage 2000 was used to determine stage of the disease as localized, regional, distant or unstaged. We used logistic regression to investigate factors associated with unstaged DLBCL. Cox proportional hazards model was used to compare survival outcomes. Results Among 67,765 patients, disease in 3,194 (4.71%) was unstaged. Age (60+years), non-African American, not married marital status, metropolitan residence, median household income >$50,000, lymph node as the primary site and those with other primary malignancies before diagnosis of DLBCL were the factors associated with cases being unstaged. The 5-year relative survival rate for patients with unstaged DLBCL was inferior to that of those with localized and regional disease, and superior to that of those with distant disease (hazard ratios of 0.58, 0.66 and 1.24 for localized, regional and distant disease, respectively, when compared to unstaged cases). Conclusion Several factors are associated with higher risk of unstaged DLBCL. Patients with unstaged DLBC had significantly inferior survival rates compared to patients with localized and regional stage.

Survival in acute myeloid leukemia (AML) has improved in younger patients over the last decade. This study was conducted to evaluate the relative survival rates in older AML patients over two decades in the US.We analyzed Surveillance, Epidemiology, and End Results (SEER) registry database to evaluate relative survival rate in older (≥ 75 years) AML population diagnosed during 1992-2009. We selected AML patients from 13 registries of SEER 18 database to compare RS during 1992-2000 and 2001-2009.The relative survival rates improved significantly during 2001-2009 compared to 1992-2000 for all age groups and sex. For young elderly patients (75-84 years) RS increased from 13.1 ± 0.8% to 17.4 ± 0.9% at one year Z-value = 3.98, p0.0001 and from 2.0 ± 0.4 to 2.6 ± 0.5%, Z-value = 3.61, p0.0005 at five years. Similarly, for very elderly (≥ 85 years) patients RS increased from 5.3 ± 1.0% to 8.0 ± 1.0%, Z-value = 3.03, p0.005 at one year, but no improvement seen at five years.The relative survival in elderly AML has increased significantly during 2001-2009 compared to 1992-2000.

Lenvatinib, an oral multikinase inhibitor, was approved by the US Food and Drug Administration in February 2015. In a pivotal phase III study of 392 patients with progressive radioiodine-refractory thyroid cancer, the overall response rate of patients receiving lenvatinib was 64.8%, with complete response in four patients. The median progression-free survival was 18.3 months in the lenvatinib arm versus 3.6 months in patients receiving placebo. Median overall survival was not reached in either arm. Lenvatinib is a promising new treatment for patients with radioiodine (iodine-131)-refractory differentiated thyroid cancer.

Background: Multiple studies have examined the incidence of secondary primary malignancies (SPM) in gastric cancer patients in Europe and Asia. This retrospective review was conducted to analyze risk of SPM in patients with gastric cancer diagnosed in the United States (US). Methods: We included adult patients diagnosed with gastric cancer from the Surveillance, Epidemiology and End Result (SEER) 13 database. We calculated the risk of secondary primary malignancies in these patients using the multiple primary standardized incidence ratio (MP-SIR) session of SEER*stat software and performed subset analyses of SPM with regard to age, sex, radiotherapy used, and latency period. Results: Among 33,720 patients, 1838 (5.45%) developed 2019 secondary primary malignancies with an observed/expected (O/E) ratio of 1.11 (95% confidence interval (CI) = 1.06-1.16, p

Since May 2001, imatinib mesylate has become the first-line therapy for chronic myeloid leukemia (CML) but the survival pattern by age, sex, and ethnicity is not clear.We analyzed the Surveillance, Epidemiology, and End Results (SEER*Stat) database to compare survival rates in CML among Caucasians, African-Americans (AA), and other races, and also within each race to see survival differences from the pre-imatinib (1973-2000) to post-imatinib eras (2002-2008). We used Z-tests in SEER*Stat to compare relative survival rates categorized by race, gender, and age groups (all ages,50, 50+ years).The three-year relative survival rates among Caucasians, AA, and other races in the pre-imatinib era were 44.9 ± 0.6%, 46.8 ± 1.8%, and 48.0 ± 2.2%, respectively, and in the post-imatinib era 64.4 ± 0.8%, 67.3 ± 2.4%, and 69.6 ± 1.6%, respectively. The relative survival increased from the pre-to post-imatinib era for all ethnic groups. In the post-imatinib era, three-year relative survival rates among young AA women were significantly lower (Z-value = -2.54, p = 0.011) than young Caucasian women, 80.5 ± 4.5% (n = 105) vs. 90.3 ± 1.4% (n = 589).The relative survival rates of CML patients have improved in the post-imatinib era. However, the improvement in survival rates has been modest in this population-based data compared to those reported from randomized trials. Improvement in survival among older patients is lower than in younger patients. Young (50 years) AA women with CML had lower relative survival rates compared to young Caucasian women in the post-imatinib era.

To the Editor,Pemetrexed is an antifolate chemotherapy agent that acts by inhibiting thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyl transferase [1,2]. The US F...

Background: To evaluate the relative survival rates for patients with metastatic bladder cancer (MBC) over the last two decades in the United States: 1991-2000 and 2001-2010. Materials and Methods: We used the Surveillance, Epidemiology, and End Results (SEERFNx01Stat) Program to analyze 6-month and 12-month relative survival rates of American Joint Committee on Cancer (AJCC) Stage IV bladder cancer patients included in the SEER database. We used Z-test in the SEERFNx01Stat Program to compare relative survival rates among cohorts of patients categorized by race, gender, and age groups (

e18090 Background: There has been significant improvement in survival among patients with primary Chronic Lymphocytic Leukemia (CLL) in recent years but, not much is known about survival among CLL developed after a first primary malignancy. Methods: SEER 18 database, 2015 submission, was used to calculate 5 and 10 year relative survival (RS) by period survival modeling method for 1993 to 2012, with division of the period into 4 cohorts of 5 years each. SEER*Stat software from National Cancer Institute was used to calculate relative survival (RS) for 4 different periods of 5 years duration. The trend in survival for cases with CLL as second primary cancer (CLLSPC) was evaluated using COX proportional hazard method using Cansurv software and also compared with that of primary CLL cases. Results: A total of 8731 patients with CLLSPC were included in the study, which represents 14.5% of all cases of CLL. The median age at diagnosis was 75 years. Median time to diagnosis of CLL was 50 months after diagnosis of first primary malignancy. Prostate cancer, breast cancer and colorectal cancer were 3most common primary cancers. 5-year and 10-year RS improved significantly in the year 2008-2012 compared to 1993-1997 (59.3% to 70.2%,P 0.044 and 40.1% to 50.6%, p 0.045). In subgroup analysis, significant improvement in 5-year and 10-year RS was seen in females and ≥ 80 years age group but no significant improvement was observed in males and age group 60-79 years. Survival among CLLSPC was significant worse compared to first primary CLL in all periods, even after adjusting for age and sex. Conclusions: CLLSPC represents about 14.5% of all CLL cases. Relative survival among patients with CLLSPC is gradually improving but still lags behind that of CLL as first primary cancer.

To the Editor, Follicular lymphoma (FL) is the most common low grade lymphoma. Stage I FL is uncommon [1]. Current treatment options for stage I FL include observation, radiotherapy (RT) and combin...

Port-a-cath is commonly used in patients who require frequent administration of intravenous medications. We describe a rare case of port-a-cath migration into the mediastinum 16 months after its insertion.

Liposomal doxorubicin is used for the treatment of various cancers like epithelial ovarian cancers, multiple myeloma and sarcomas. We report the first case of anaphylaxis to pegylated liposomal doxorubicin.

Disparities in cancer care have been documented. However, less is known about the disparities in diffuse large B-cell lymphoma (DLBCL). We reviewed the Surveillance, Epidemiology and End Results database to evaluate disparities in receipt of radiotherapy (RT) and relative survival among patients diagnosed with stage I DLBCL between 1998 and 2008 on the basis of age, sex and ethnicity. African Americans and other races were significantly less likely to receive RT compared to Caucasians (adjusted odds ratio [OR] of 0.743 and 0.81, respectively). Similarly, patients aged 60 + years and males were less likely to receive RT compared to their counterparts (p < 0.001). Caucasian race, younger age and female sex were associated with better survival among patients receiving RT. This study showed that 38.2% of patients with stage I DLBCL received radiotherapy. Survival rates were significantly higher for patients who received RT.

Introduction: Since the approval of sorafenib in December 2005, several targeted therapeutic agents have been approved by the FDA for the treatment of advanced renal cell carcinoma (RCC). This study was conducted to find out whether the improvements in survival of advanced RCC patients with targeted agents have translated into a survival benefit in a population-based cohort. Methods: We analyzed the SEER 18 (Surveillance, Epidemiology and End Results) registry database to calculate the relative survival rates for advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009. We also evaluated the survival rates by age (Results: The total number of advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009 were 7,047, 4,059, 1,548 and 1,440, respectively. During 2001-2009, the 1- and 3-year relative survival rates were 26.7 ± 0.6 and 10.0 ± 0.4%, respectively. There was no significant difference in 1-year relative survival rates for patients diagnosed during 2006-2007 and 2008-2009 compared to those diagnosed during 2001-2005. Similarly, the 3-year survival rates for patients diagnosed during 2006-2007 were similar to those diagnosed during 2001-2005. Conclusions: This population-based study showed that there was no significant improvement in relative survival rates among advanced RCC patients in the era of targeted agents.

Th ere were 3848 and 6501 patients with the diagnosis of chronic myeloid leukemia during the periods 1991 – 2000 (pre-imatinib era) and 2001 – 2009 (post-imatinib era). Table I lists 3- and 5-year relative survival rates among patients with CML according to age group and sex. Elderly patients represented 55.22% and 53.68% of patients during the pre- and post- imatinib eras, respectively. Th ere was a male predominance among each category in both periods. Th e 3- and 5-year relative survival rates improved signifi cantly among patients aged 50 years in the pre-imatinib era compared to the post-imatinib era (44.1 0.9% vs. 59.9 0.8%; p 0.001 and 31.4 0.9% vs. 46.9 0.9%; p 0.0001 for 3 and 5 years, respectively). Th e survival rates for old patients (50 – 69 years) in the pre-imatinib era were 57.7 1.2% and 44.8 1.3% compared to 72.3 1.0% and 64.3 1.2% in the post-imatinib era at 3 and 5 years (3 years: p 0.0001; 5 years: p 0.0001). Similarly, the 3- and 5-year relative survival rates for elderly patients with CML during the pre- and post-imatinib eras were: 32.4 1.2% vs. 41.3 1.1%; p 0.0001 at 3 years and 19.3 1.1% vs. 31.2 1.2%; p 0.0001 at 5 years. Survival rates were signifi cantly higher in the post-imatinib era when analyzed by sex. Th e survival of patients with chronic myeloid leukemia has improved signifi cantly since the FDA approval of imatinib

e18511Background: Use of all trans-retinoic acid (ATRA), Arsenic trioxide and anthracycline based chemotherapy has significantly improved long term survival in acute promyelocytic leukemia(APL). Th...

e20027Background: The risk of second primary malignancy is early stage non-small cell lung cancer is not well known. We evaluated the risk of second primary malignancies (SPM) in adult patients wit...

e18047Background: Treatment and prognosis of non-small cell lung cancer (NSCLC) depends on the stage of the disease. Little is known about unstaged NSCLC in the United States. Methods: Surveillance...

Background: Treatment and prognosis of diffuse large B cell lymphoma (DLBCL) depends on the stage of lymphoma. We conducted this study to examine unstaged DLBCL in the United States. Methods and methodology: We used Surveillance Epidemiology and End Result (SEER) 18 registries to select patients with DLBCL diagnosed during January 2000 to December 2012. We used LRD Summary stage 2000 was used to determine stage of the disease - localized, regional, distant or unstaged. We used Logistic regression to investigate factors associated with unstaged DLBCL. We used Cox Proportional Hazard model to compare survival outcomes. Results: Among 67765 patients, 3194 (4.71%) were unstaged. Age (60+years), "Others" and Caucasian races, single or single/divorced/widow marital status, metropolitan residence, median household income> $50,000, lymph node as the primary site and cased with other primaries before diagnosis of DLBCL were the factors associated with unstaged cases (Table 1). The 5- year relative survival rate for unstaged patients was inferior to those with localized and regional disease, and superior to those with distant disease (HRs of 0.58, 0.66 and 1.24 for localized, regional and distant respectively when compared to unstaged cases). Conclusion: In this large population-based study, 4.71% patients with DLBCL had unstaged disease. Patients with unstaged DLBC had significantly inferior survival rates compared to patients with localized and regional stage. Table 1. Factors associated with unstaged DLBCL cases Parameters Unadjusted OR (95% CI) P value Adjusted OR (95% CI) P value Age (60+ Vs. 25,000-50,000 01.009 (0.753 - 1.354) 0.951 0.927 (0.675 - 1.271) 0.636 >50,000 0.758 (0.563 - 1.021) 0.068 0.673 (0.486 - 0.933) 0.017 Sequence (Not first or only primary vs. first or only primary) 1.261 (1.156 - 1.377) Disclosures No relevant conflicts of interest to declare.

Limited knowledge about the palliative care options among HCPs is one of the major reasons for this hesitation to talk about it. In fact, not many physicians and other HCPs have been trained in end-of-life care during their training period including residency and fellowship programs. Several studies conducted among the residents and fellows of different specialties in medicine, surgery, and neurology report that they feel inadequately prepared to deal with end-of-life issues [8, 9]. A study by Cherny et al. [10] found that, although most of the European Society of Medical Oncology (ESMO) members recognized the importance of palliative and supportive care for patients with advanced cancer, many are inadequately prepared for these tasks. Dr. Tara Tucker, in her guest editorial for the Journal of Palliative Medicine, points out that most medical curricula do not address the issues of death and dying, and the culture of death denial puts the physicians into a difficult situation when faced with these unavoidable circumstances [11]. The good news is that internal medicine residency programs are now required to integrate palliative care teachings into their conferences [12]. This is an encouraging step. However, more practical training experience will better prepare them to communicate and provide palliative care to the patients and families. This approach should also be emulated by other specialty and subspecialty training programs. Like basic life support training/cardiopulmonary resuscitation, if end-of-life care training is made mandatory and provided to all HCPs before entering the workforce and on a regular basis, it could help alleviate the uneasiness they may have about palliative care. Palliative care programs in hospitals improve patient satisfaction among terminally ill patients and result in an improved overall well-being of the patient, the caregiver, and the family [1]. Unfortunately, despite the fact that the number of hospitals having palliative care services has doubled since 2000, the 2008 American Hospital Association’s annual survey data shows that only 31% of the US hospitals have palliative care programs [13]. This also means that the remaining 69% still do not have palliative care services. Including palliative care services as an indicator of the quality of care may

To the editor: Acute lymphoblastic leukemia (ALL) accounts for one-fifth of leukemia in adults.[1][1] The rates of second primary malignancies (SPMs) in childhood ALL are significantly higher than in the general population.[2][2],[3][3] However, there is a lack of information on SPMs in adult

9563 Background: A second primary malignancy is a serious long term complication in cancer survivors. The aim of this study was to evaluate the risk of second primary malignancies in patients with ...

7063 Background: Survival of chronic myeloid leukemia (CML) has improved since FDA approval of imatinib in May 2001. However, there is limited data on survival pattern of elderly patients. We condu...

e18522 Background: Interstitial lung disease (ILD) is an uncommon side effect of pemetrexed. We conducted this study to identify different factors associated with pemetrexed-induced ILD. Methods: W...

e18049 Background: Limited data exists on the prognosis of patients with sAML following HL. The aim of this study was to compare the survival of sAML with de novo cases using a large database. Meth...

721 Background: Combination chemoradiotherapy is the standard of care for treatment of non-metastatic squamous cell carcinoma of the anus (SCCA). This population-based study evaluated disparities in receipt of radiotherapy (RT) and its effect on survival in patients with localized and regional SCCA in the United States. Methods: The Surveillance, Epidemiology, and End Results (SEER) 18 database was used to identify patients with localized and regional SCCA diagnosed between 1998 and 2008. We used univariate and multivariate logistic regression to model the relationships between receipt of RT and age, sex, marital status, stage, and race. Relative survival rates were calculated and compared using two sample z-tests. A Cox proportional hazards model was used to find adjusted hazard ratios (HR). Results: A total of 3,971 patients with localized or regional SCCA as the only primary malignancy were included in the study, of which 3,278 (82.6%) received RT. After adjusting for covariates, those 65 years and older (adjusted OR 0.82, p=0.029) were less likely to receive RT. Females were more likely to receive RT compared to males (adjusted OR 1.54, p

136 Background: In February 2002, imatinib was approved by US FDA for treatment of patients with advanced gastrointestinal stromal tumor (GIST). This study was performed to evaluate survival trends in patients with advanced GIST in pre- (1992-2001) and post- (2002-2008) imatinib era in the United States. Methods: We selected adult patients (≥18 years) with advanced GIST (regional and distant metastasis based on SEER’s LRD staging) from the Surveillance, Epidemiology, and End Results 18 database diagnosed during 1992-2008. We excluded patients diagnosed at autopsy or from death certificate only, or those without survival date. We analyzed 1- and 3- year relative survival (RS) rates of the patients by age (all ages,18-64yrs,64+yrs), race [White, Black and Others (American Indian/AK Native, Asian/Pacific Islander)], and gender in pre-imatinib (1992-2001) and post-imatinib (2002-2008) eras. We used Z-test in SEER*Stat to compare RS rates. Results: There were total of 1,734 cases of advanced GIST (regional and distant metastasis) during the study duration. Of the total population, 744 were females and 990 were males. The 1- and 3- year RS rates were significantly higher for patients diagnosed in post-imatinib era compared to those in pre-imatinib era (83.8±1.1% vs 72.5±2.3%; Z 4.47 at one year and 68.8±1.4% vs 51.0± 2.6%; Z 6.25). The survival rates in younger patients (18-64 years) improved significantly in post-imatinib era compared to pre-imatinib era (88.60±1.2% vs 74.20±2.9%; Z 5.19 at 1 year and 75±1.6% vs 56.1±3.4%; Z 5.81 at 3 years). Among older patients, there was improvement in 3- year survival rate (76.90±2% vs 70.40±3.5%; Z 1.22 at 1 year and 59.80±2.5% vs 44.9±4%; Z 2.82 at 3 years). Survival rates improved for both sexes and for Whites and Blacks (1 year RS: 83.80±1.3% vs 73.40±vs2.6%; Z 3.45 for Whites and 85±2.4% vs 68.80±6%; Z 2.53 for Blacks; 3 year RS: 68.60±1.7% vs 51.20±3.1%; Z 5.02 for Whites and 69.10±3.3% vs 42.6±6.6%; Z 3.76 for Blacks). There was no improvement in survival rates for Others. Conclusions: Overall, survival rates of advanced GIST patients have improved significantly in post-imatinib era compared to pre-imatinib era. There was no improvement in survival rates of Others.

191 Background: Risk of second primary malignancies (SPM) is not known in gastric cancer. In this population based study, we analyzed rates of SPM in gastric cancer. Methods: We selected adult (≥18 years) patients with gastric cancer as first primary malignancy diagnosed from January 1992 to December 2011 from Surveillance, Epidemiology and End Result 13 database. We used SEER*stat’s multiple primary standardized incidence ratio (MP-SIR) session to calculate the risk of SPM diagnosed 6 months after the diagnosis of index gastric cancer. Results: Among 31,818 patients with first primary gastric cancer, 1674 (5.26%) developed 1,839 SPM with observed/expected (O/E) ratio of 1.09 (95% CI = 1.05-1.15, p

534 Background: Survival of cancer patients is increasing. Therefore, there is a need to evaluate long term complications in cancer survivors. There is no data on second primary malignancies in anal cancer. This study was conducted to evaluate second primary malignancies in patients with anal carcinoma. Methods: We selected adult patients diagnosed with anal cancer from National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) 13 database We calculated the risk of second primary malignancies in the anal cancer patients using multiple primary standardized incidence ratio (MP-SIR) session of SEER*stat software. Results: Among 7,661 patients with anal carcinoma, 3,196 were men and 4,465 were women. Median follow up duration was 87 months (range: 7-239 months). Median age at the time of diagnosis of SPM was 69.33 yrs (range: 34-103 yrs). Median latency for SPM was 52 months (range: 6-219 months). A total of 675 patients (9.07%) developed 747 second primary malignancies, with an observed/expected (O/E) ratio of 1.41 (95% confidence interval =1.32-1.52, p

383 Background: Sorafenib was approved by FDA for treatment of advanced unresectable hepatocellular carcinoma (HCC) patients in November 2007. In this study, we update survival trends in advanced HCC using Surveillance, Epidemiology, and End Results (SEER) data. Methods: We selected patients with advanced HCC diagnosed from January 2001 to December 2010 from SEER 18 registries. We excluded diagnosed at autopsy, from death certificate only, or those without survival date. We calculated 1- and 2- year relative survival rates in pre-sorafenib (2001-2007) and post-sorafenib (2008-2010) era by age, sex and ethnicity among using SEER*stat software. Results: The total number of advanced HCC patients during 2001-2010, 2001-2007 and 2008-2010 were 5,092, 2,747 and 2,345 respectively. The 1- and 2- year survival rates of patients improved significantly from pre-sorafenib era to post-sorafenib era (1 year RS: 17.20±0.7% to 19.90±0.80%, Z=2.63; 2 year RS: 8.00±0.5% to 8.7±0.60%, Z=2.31). Survival rates of male patients improved significantly in post-sorafenib era (1 year RS: 16.4±0.80 to 19.4±0.90%, Z=2.18; 1 year RS: 7.4±0.60% to 8.6±0.70%, Z=2.18). There was no improvement in survival rates of female patients. Similarly, younger patients had improvement in survival rates in post-sorafenib era compared to pre-sorafenib era (1 year Z value 2.46; 2 year Z value 2.23). There was no improvement in survival rates of older patients. Conclusions: Since FDA approval of sorafenib, survival rates of patients with advanced hepatocellular carcinoma have improved. The improvement in survival rates is limited to males and younger patients

Primary chest wall lymphoma is a rare but curable condition. This paper reports a case of a 52-year-old female patient who presented with a primary chest wall diffuse large B-cell lymphoma.

Introduction: Patients with non-Hodgkin lymphoma are at significantly increased risk of second primary malignancies (SPM). There are few studies on SPM in diffuse large B-cell lymphoma. We aim to evaluate the risk of SPM after diagnosis of primary DLBCL using Surveillance, Epidemiology and End Results (SEER) database. Methods: We used SEER 13 database to select adult patients with primary DLBCL diagnosed between 1992- 2009. We used SEER*Stat’s Multiple Primary - Standardized Incidence Ratios (MP-SIR) to calculate SPM in DLBCL. We analyzed SPM by age (≥20, 20-59 and ≥60 years), sex and latency. Second primary malignancy was defined as a metachronous malignancy developing six months or more after an index DLBCL. Results: A total of 28,368 adult DLBCL patients were selected for analysis. Among them, 54.4% were male, 44.1% were In young DLBCL patients (20-59 years) group, 12,509 patients developed 830 all site SPMs with O/E: 1.56, P value < 0.05, excess risk 37.01. SPMs which were significantly increased as compared to general population were: head & neck, anus & colorectal, lung, kidney, thyroid, Kaposi sarcoma and hematological malignancies. Similarly, 15,859 older (≥60 years) DLBCL patients developed 1,767 all site SPMs with O/E: 1.11, P< 0.05, excess risk 24.07. SPMs which were significantly increased in this age group as compared to general population were: head & neck, skin, colon, kidney, thyroid and hematologic malignancies. There was significantly higher risk of tumors of anus & colorectal, liver, kidney, thyroid, Kaposi sarcoma and hematologic malignancies within 5 years of latency. Malignancies of head & neck, anus &, colorectal, skin, breast, urinary bladder and hematologic malignancies were significantly higher after 5 years of latency. Conclusion: Patients with DLBCL were at significantly increased risk of developing SPMs as compared to general population. Survivors of DLBCL need to be closely followed with special attention to SPM. Disclosures No relevant conflicts of interest to declare.

Introduction: NCCN guidelines recommend involved site radiotherapy is the preferred treatment option for Stage I follicular lymphoma. Other options include immunotherapy, immunotherapy ± chemotherapy, immunotherapy ± chemotherapy + involved site radiotherapy and observervation only. Studies have not shown overall survival benefit with one modality over other. We conducted this study to evaluate survival rate among patients who are treated with observation alone or external beam radiation. Methods: We selected patients with stage I follicular lymphoma diagnosed during 1992-2006 from Surveillance, Epidemiology and End Results (SEER) 18 database. We analyzed 1- and 5-years relative survival (RS) rates using SEER*stat program. We used Z test to compare relative survival rates of patients treated with (RT) or without radiotherapy (no RT) by age (>18 years, 18-60 years and >60 years) and sex. Results: A total of 1914 out of 5,145 adults patients with stage I follicular lymphoma diagnosed during 1992-2006 received radiotherapy. 1- and 5- year RS in patients with out vs with EBT were : 96.1 vs 100% ( Z value 6.9/ p value < 0.001) and 89.3 vs 98.7%.( Z value: 7.6/ p value < 0.001). The survival rates were significantly higher in the RT group for younger patients (1 year: 98.4 vs 100%; Z value 2.99/ p value < 0.01 and 5 year: 93.2 vs 98%; Z value 4.45/ p value < 0.001) and older patients (1 year: 94.6 vs 100%; Z value 5.8/ p value < 0.001 and 5 year: 86.5 vs 99.2%; Z value 6.21/ Similarly 1- and 5-yr RS rates were significantly higher in the RT group compared to no RT group for all cohorts (Table 1). Conclusion: This study showed that relative survival rates of stage I follicular lymphoma patients receiving radiotherapy were significantly better compared to those who did not receive radiotherapy. Abstract 1317. TableSexAge in yearssurvival yearsNo External Beam RadiationExternal Beam RadiationZ value/ p valueNRelative survival ± SE %NRelative survival ± SE%Male and female≥1813,23196.10±0.401,914100.00±0.006.90/ Disclosures No relevant conflicts of interest to declare.

Background Rituximab became commercially available in Novermber 1997. It was FDA approved in February 2006 for the first line treatment of patients with advanced diffuse large B cell lymphoma (DLBCL). The incidence of diffuse large B cell lymphoma increases with age, with >100 cases per 100000 persons aged >80 years. There is a limited data on survival very elderly patients with DLBCL. This study was conducted to evaluate survival trends of very elderly (≥80 years) patients with advanced DLBCL in the United States. Methods We selected very elderly patients (age ≥80 years) diagnosed with Stage III and IV DLBCL from the Surveillance, Epidemiology, and End Results (SEER) 18 database. We calculated 1- and 2- year relative survival rates of the patients during 1992-1997 (Pre-rituximab era) and 1998-2009 (post –rituximab era). We also analyzed survival rates of patients diagnosed before (1998 – 2005) and after (2006-2009) FDA approval of rituximab for the first line treatment of DLBCL. We used SEER Stat software to calculate relative survival (RS) rates. Results There were 2709 advanced DLBCL patients reported during 1992-2009. Overall median survival of the group was 6±0.240 months. The 1- and 2- year relative survival rates of the patients improved significantly from pre-rituximab era to post-rituximab era (1 year RS: 30±2.0 vs 38.9±1.2; Z value 4.16 and 2 year RS: 19.7±1.8 vs 32.8±1.2; Z 5.16). The survival rates were higher in the post-rituximab era for all the cohorts except the Blacks and Others. However, there was no difference in the survival rates of the patients diagnosed during 2006-2009 compared to those diagnosed during 1998-2005 (Table). Conclusion Our population based study showed that the survival rates of very elderly patients with advanced DLBCL have improved in the post-rituximab era for all groups except the Blacks and Others. There is no significant improvement in survival of patients before- and after approval of rituximab in the post-rituximab era. | Cohorts | Survival | 1992-1997 | 1998-2009 | 1998-2005 | 2006-2009 | Z value (92-97 vs 98-09) | Zvalue (98-05 vs 06-09) | | ------------- | -------- | --------- | --------- | --------- | --------- | -------------------------------- | ------------------------------- | --- | | N | RS ± SE% | N | RS ± SE% | N | RS ±SE % | N | RS ± SE% | | Male & Female | 12 mo | 633 | 30±2.0 | 2,076 | 38.9±1.2 | 1,274 | 38.1±1.5 | 802 | 40.1±1.9 | 4.159 | 0.796 | | 24 mo | 19.7±1.8 | 2,076 | 32.8±1.2 | 31.2±1.5 | 35.3±1.9 | 5.162 | 1.166 | | Male | 12 mo | 263 | 30.6±3.1 | 950 | 39.7±1.7 | 583 | 38.3±2.2 | 367 | 41.0±2.8 | 2.798 | 0.632 | | 24 mo | 18.6±2.7 | 950 | 33.7±1.8 | 30.6±2.2 | 38.4±3.0 | 3.750 | 1.304 | | Female | 12 mo | 370 | 29.5±2.5 | 1,126 | 38.2±1.5 | 691 | 37.4±2.0 | 435 | 39.4±2.5 | 3.036 | 0.478 | | 24 mo | 20.4±2.3 | 1,126 | 32.1±1.6 | 31.7±2.0 | 32.7±2.5 | 3.620 | 0.335 | | White | 12 mo | 572 | 29.8±2.0 | 1,786 | 39.8±1.3 | 1,101 | 38.5±1.6 | 685 | 41.8±2.0 | 4.145 | 1.106 | | 24 mo | 19.9±1.9 | 1,786 | 33.7±1.3 | 32.0±1.6 | 36.4±2.1 | 5.029 | 1.266 | | Black | 12 mo | 20 | 21.0±9.4 | 77 | 27.0±5.4 | 46 | 30.9±7.3 | 31 | 21.2±7.8 | 1.499 | -1.030 | | 24 mo | 17.3±9.2 | 77 | 23.6±5.5 | 25.1±7.0 | 19.5±8.0 | 1.476 | -0.894 | | Other | 12 mo | 41 | 36.1±7.8 | 211 | 35.4±3.5 | 126 | 36.3±4.5 | 85 | 34.1±5.4 | 0.349 | 0.029 | | 24 mo | 16.7±6.3 | 211 | 28.1±3.4 | 25.4±4.1 | 31.7±5.4 | 1.114 | 0.631 | Abstract 2640. Table: Advanced DLBCL relative survival rates in elderly (age ≥ 80 years) N: Number of patients Disclosures No relevant conflicts of interest to declare.

Introduction: Development of tyrosine kinase inhibitors has led to significant improvement in survival of chronic myeloid leukemia (CML) patients. We conducted this study to evaluate any ethnic disparity in CML survival. Methods: We analyzed surveillance, Epidemiology, and End Results, SEER 18 registry to compare 1 and 3 years relative survival rates of CML patients diagnosed between 2001- 2008 by ethnicity - Caucasian, African American (AA), Others (O). We analyzed survival rates by age (≤65, >65), and time periods: (2001-2004) and (2005-2008). We used SEER*Stat software to calculate Z value. Results: There were 6,306 CML patients during (2001-2008); 3,111 during (2001-2004) and 3,195 during (2005-2008). The 1-year relative survival rates among Caucasians (n=6,306), AA (n=790), and Others (n=532) were 80.0±0.5%, 83.8 ±1.4%, and 84.0±1.7% [Z value 2.43 (AA vs Caucasian), 2.15 (O vs Caucasian)] respectively. The 3 years RS rates were 65.6±0.7%, 70.2±1.8%, and 70.9 ±2.1% respectively with Z value 2.49 (AA vs Caucasian) and 2.42 (Caucasian vs O). Among younger patients (age ≤65 years, n=4,245) Caucasians had better RS compared to AA (83.1±0.7% vs 78.7±1.8%, Z value 2.24) at 3 years. There was no difference survival at 1and 3 years in older patients (age >65 years, n= 3,383). The survival rates of patients diagnosed during 2001-2004 were similar for all ethnic groups. Among patients diagnosed during 2005-2008, survival rates were significantly higher for AA versus Caucasians (1 year RS 86.6±1.8% vs 81.3±0.7%, Z value 2.45, and 3 year RS 73.8±2.4% vs 68.3±0.9%, Z value 2.20). Others also had better RS compared to Caucasians (87.1±2.1% vs 81.3±0.7%, Z value 2.22) at 1 year. There was no racial disparity in survival rates when analyzed by age (≤65 and >65) and sex at 1 and 3 years during 2001-2004 and 2005-2008. Conclusions: Our study showed that there is ethnic disparity in CML survival. Among CML patients diagnosed during 2005-2008, AA and Other races had superior survival rates compared to Caucasians. Disclosures No relevant conflicts of interest to declare.

Tumor lysis syndrome (TLS) is characterized by hyperkalemia, hyperuricemia, hypocalcemia and hyperphosphatemia. This report describes a case of hypercalcemia in TLS in a patient with diffuse large B cell lymphoma.

Autoimmune hemolysis is rare in multiple myeloma. We describe a rare case of multiple myeloma who presented with autoimmune hemolytic anemia at initial presentation.

Pemtrexed is a chemotherapy drug classified as a folate antimetabolite. it is chemically similar to methotrexate. Pemetrexed is approved for the treatment of mesothelioma, locally advanced and metastatic non-squamous non-small cell lung cancers [1,2]. We report a case of aseptic meningitis associated with the first intravenous (iV) administration of pemetrexed. a 54-year-old male with metastatic non-small cell lung cancer was treated with pemetrexed as second-line chemotherapy. he was started on folic acid and vitamin B12 a week prior to chemotherapy. after premedication with dexamethasone, pemetrexed infusion was given at a rate of 500 mg/m2 over a period of 10 minutes. The patient tolerated chemotherapy without any immediate side effects. One week later, the patient developed fever, headache, diffuse erythematous macular rash and altered mental state manifesting primarily as difficulty walking and a decreased level of consciousness that prompted a hospital admission. Computed tomography (CT)-scan of brain was negative for any acute intracranial process. Cerebral spinal fluid (CSf) analysis showed a white blood cell count (WBC) of 5/cumm, with 14% neutrophils. CSf glucose was 67 mg/dl (serum glucose 132 mg/dl) and protein level was 142 mg/l (normal 15–45 mg/dl). Both viral and bacterial studies were negative. Cytology results were also negative for malignant cells. The patient received antibiotics empirically, including ceftriaxone, vancomycin, ampicillin and acyclovir until viral and bacterial studies were reported. With supportive care, patient improved. he was discharged after two weeks.

To the Editor,A 48-year-old man originally from Asia presented to clinic with a six month history of diarrhea. He reported two to four loose stools per day which was watery in nature and consisting...