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Simple Summary Follicular lymphoma (FL) is the most prevalent subtype of indolent lymphoma, accounting for 70% of all cases. The estimated risk of histological transformation (tFL), such as diffuse large B cell lymphoma (DLBCL), varies from 2-3% per year to 7-8% at 10 years in different series. Treatment after transformation is not clearly established. Allogeneic hematopoietic stem cell transplantation (alloSCT) could be an option for these patients, but it has not been widely explored. We analyze the efficacy and toxicity of alloSCT in 43 patients from 14 Spanish centers. We observed long-term survival in around one third of the patients, especially those who developed chronic graft versus host disease, indicating that alloSCT continues to be a potentially curative option for patients with tFL, mainly due to the graft versus lymphoma effect. Background: Transformation of follicular lymphoma into an aggressive lymphoma (tFL) worsens the prognosis and the standard treatment is not completely defined. Allogeneic hematopoietic stem cell transplantation (alloSCT) could be a potentially curative option for these patients, but it has not been widely explored. Methods: We designed a retrospective multicenter study to analyze the efficacy and toxicity of alloSCT in tFL patients and potential prognostic factors of survival. Results: A total of 43 patients diagnosed with tFL who underwent alloSCT in 14 Spanish centers between January 2000 and January 2019 were included. Median age was 44 (31-67) years. After a median follow-up of 58 months, estimated 5-year overall survival (OS) and progression-free survival (PFS) were both 35%. Estimated 100-day and 1-year non-relapse mortality (NRM) were 20% and 34%, respectively. The type of conditioning regimen (3-year OS of 52% vs. 20%, respectively, for reduced-intensity vs. myeloablative conditioning) and development of chronic graft versus host disease (cGVHD) (3-year OS of 75% vs. 40%) were the only factors significantly associated with OS. The only variable with an independent association with OS was cGVHD (HR, 3.4; 95% CI, 1.2-9.6). Conclusions: Our results indicate that alloSCT continues to be a potentially curative option for patients with tFL.

In pancreas transplantation, complications can arise at each step of the process, from the initial selection of donors and recipients through the surgical technique itself and the post-operative period, when lifelong immunosuppression is required. In the early steps, careful retrieval and preservation of the pancreas are crucial for the viability of the organ and ultimate success of the transplant. The pancreas is a low-flow gland, making it highly sensitive to transplantation conditions and presenting risk of pancreatitis due to periods of ischemia. The two groups of donors - after brain death (DBD) or after cardiac arrest (DCD) - require different strategies of retrieval and preservation to avoid or reduce the risk of complications developing during and after the transplantation. For DBD donor transplantation, multiorgan retrieval and cold preservation is the conventional technique. Asystole donor (DCD) transplantation, in contrast, can benefit from the newest technologies, such as hypothermic and especially normothermic preservation machines (referred to as NECMO), to optimize organ preservation. The latter has led to an increase in the pool of donors by facilitating recuperation of organs for transplantation that would have been discarded otherwise.

Introduction: Due to its high transmissibility, measures aimed at reducing the spread of SARS CoV2 have become mandatory. Different organizations have recommended performing polymerase chain reaction tests (PCR) as part of the preoperative screening of surgical patients. We aimed to determine the performance of PCR testing to detect asymptomatic carriers.Methods: Observational study carried out at a tertiary care center. We compared the results of preoperative real-time reverse-transcription-PCR test (RT-PCR) performed on a cohort of patients pending surgery with the results we would have expected assuming the epidemiological data released by government offices.Results: We registered no positives in the 2,722 preoperative RT-PCR tests performed in our health care area between epidemiological Weeks 18 to 21, meaning a cumulative incidence trending to zero. Assuming public epidemiological data, the probabilistic projection of potential asymptomatic individuals ranged from 0.27*10e -4 (according to official data of new cases diagnosed by PCR) to 4.69*10e -4 if we assumed cases confirmed by IgG test in our province. Assuming a RT-PCR sensitivity of 95%, to obtain a positive result we should perform 38,461 and 2,028 tests respectively.Conclusions: In scenarios of very low prevalence and despite high sensitivity scores, indiscriminate preoperative RT-PCR screening is of a questionable effectiveness for detecting asymptomatic carriers. Our findings evidence the difficulty of establishing reliable predictive models for the episodic and rapidly evolving incidence of infections such as has characterized the SARS CoV2 pandemic. (C) 2020 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.

Resumen Antecedentes y objetivo La alta transmisibilidad de la infeccion por SARS CoV2 ha obligado a los sistemas de salud mundiales a arbitrar medidas para evitar su expansion. En Espana, el consenso alcanzado entre diferentes sociedades cientificas recomienda la realizacion de la prueba de reaccion en cadena de la polimerasa (PCR) como cribado preoperatorio de portadores asintomaticos. Nos propusimos evaluar el rendimiento de la PCR preoperatoria para detectar portadores asintomaticos. Material y metodos Estudio observacional realizado en un hospital de tercer nivel. Comparamos los resultados de la prueba de PCR en tiempo real (RT-PCR) realizada en una cohorte de pacientes quirurgicos de nuestra area asistencial con los resultados que hubieramos esperado asumiendo los datos epidemiologicos publicados por las oficinas gubernamentales. Resultados No registramos resultados positivos en las 2722 RT-PCR realizadas en nuestra area entre las semanas epidemiologicas 18 a 21, lo que implica una incidencia acumulada de nuevos casos tendente a cero. Asumiendo los datos epidemiologicos publicados, la proyeccion probabilistica de individuos asintomaticos vario de 0.27 * 10e-4 (datos oficiales de nuevos casos diagnosticados por PCR) a 4.69 * 10e-4 si asumimos casos confirmados por IgG en nuestra provincia. Suponiendo una sensibilidad de RT-PCR del 95%, para obtener un resultado positivo, deberiamos realizar 38,461 y 2,028 pruebas respectivamente. Conclusiones En escenarios de muy baja prevalencia y a pesar de su alta sensibilidad, la deteccion preoperatoria de portadores asintomaticos mediante de RT-PCR es de una efectividad cuestionable. Nuestros hallazgos evidencian la dificultad de establecer modelos predictivos fiables en el contexto de epidemias de evolucion rapida, como la pandemia de SARS CoV2.

BACKGROUND: The treatment of patients with Hodgkin lymphoma (HL) who develop disease progression after undergoing allogeneic stem cell transplantation (allo‐SCT) remains challenging. METHODS: The authors assessed outcomes in 184 adult patients with HL who developed disease recurrence or progression after a matched related or unrelated allo‐SCT at European Society for Blood and Marrow Transplantation–participating centers between 2010 and 2014. RESULTS: Eighty patients who received brentuximab vedotin (BV) salvage therapy were compared with 104 patients who did not. Patients in the BV group were younger (median age of 30 years vs 34 years) and were more likely to receive pretransplant BV (65% vs 46%) or posttransplant donor lymphocyte infusion (66% vs 33%). The 2 groups otherwise were comparable. Patients in the BV group received a median of 6 doses of posttransplant BV, resulting in a complete remission rate of 29%, a partial response rate of 45%, and a stable disease rate of 26%. Response to BV after allo‐SCT did not appear to be affected by receipt of pretransplant BV. Despite a longer median follow‐up for surviving patients in the BV group (33 months vs 23 months; P

The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloHSCT) is not defined. The use of high-dose post-transplant cyclophosphamide (PTCy) in haploidentical transplantation has proven feasible and effective in overcoming the negative impact of HLA disparity on survival. We hypothesized that PTCy could also be effective in the setting of MMUD transplantation. We retrospectively analyzed 86 consecutive adult recipients of alloHSCT in our institution, comparing 2 contemporaneous groups: PTCy MMUD (n = 26) versus matched unrelated donor (MUD) (n = 60). Graft source was primarily peripheral blood (92%). All PTCy MMUD were HLA 7/8 (differences in HLA class I loci in 92% of patients) and received PTCy plus tacrolimus ± mofetil mycophenolate as GVHD prophylaxis. No differences were observed between PTCy MMUD and MUD in the 100-day cumulative incidence of acute GVHD grades II to IV (31% versus 22%, respectively; P = .59) and III to IV (8% versus 10%, P = .67). There was a trend for a lower incidence of moderate to severe chronic GVHD at 1 year after PTCy MMUD in comparison with MUD (22% versus 41%, P = .098). No differences between PTCy MMUD and MUD were found regarding nonrelapse mortality (25% versus 18%, P = .52) or relapse rate (11% versus 19%, P = .18). Progression-free survival and overall survival at 2 years were similar in both cohorts (67% versus 54% [HR, .84; 95% CI, .38 to 1.88; P = .68] and 72% versus 57% [HR, .71; 95% CI, .31 to 1.67; P = .44], respectively). The 2-year cumulative incidence of survival free of moderate to severe chronic GVHD and relapse tended to be higher in the PTCy MMUD group (47% versus 24%; HR, .60; 95% CI, .31 to 1.14; P = .12). We conclude that HLA 7/8 MMUD transplantation using PTCy plus tacrolimus is a suitable alternative for those patients who lack a MUD.

This paper presents the identification of the instantaneous modal properties and the experimental response of a full-scale, five-story base-isolated RC building tested on a shake table. A suite of earthquake motions of various intensities was applied to the building to progressively increase the seismic demand. The deterministic-stochastic subspace identification method is employed to estimate the variations of the modal properties of the building by employing a short-time windowing approach. The changes of the modal parameters during the seismic motions are tracked and analyzed. Observed and measured responses of the structure are analyzed and correlated with the variation of the identified modal parameters. The nonlinear behavior of the isolators generates the variation of the identified natural frequencies and equivalent damping ratios of the building, which change in agreement with the input motion intensity. A high correlation between the effective stiffness of the isolators and the instantaneous frequency of the first mode is found. The effective damping ratio of the isolation system and the instantaneous damping ratio of the fundamental mode of the building are highly correlated.

Introduction Frailty is a strong predictor of adverse health events, but its impact on cognitive function is poorly understood. Aim To assess cognitive performance in frailty and to identify the frailty stage where cognitive impairment begins. Methods Data were taken from 2044 people aged ≥65 years without cognitive impairment selected from the Toledo Study for Healthy Aging, a population-based cohort of older adults. Frailty status was assessed by 3 different scales: Frailty Phenotype (FP), Frailty Trait Scale (FTS), and Frailty Index (FI). Neuropsychological assessments of different cognitive domains included the Mini-Mental State Examination, Short and Long-Term Memory Recalling Test, the Boston Naming Test, Verbal Fluency Test, Digit Span Forward, Go/No-go Test, Luria Orders Test, Clock Drawing Test, and Serial Word Learning Test. The relationships between the score of the scales and frailty status (robust, prefrail, and frail for FP and quartiles for FTS and FI) were analyzed using multivariate linear regression models including age, sex, and educative level as possible confounders. Results Participants classified as the worst degree of frailty (frail in FP and fourth quartile of FTS and FI) presented more cognitive domains affected and to a higher extent than moderate frail (prefrail and second quartile and third quartile of FTS and FI) and robust (and first quartile of FTS and FI) participants. Conclusions Cognitive performance progressively declined across the frailty state, regardless of the instrument used to assess frailty. In prefrail participants, cognitive impairment may be an early marker of frailty-dependent cerebral involvement and could be already subject to interventions aimed at reducing the transition to frailty.

Haploidentical stem cell transplantation (haploSCT) is becoming a major transplant modality for lymphoma. To assess the effects of donor characteristics, stem cell source and conditioning on outcomes, we identified 474 adults with Hodgkin (HL; 240), peripheral T-cell (PTCL; 88), diffuse large B-cell (77), mantle cell (40) or follicular lymphoma (FL; 29), who received haploSCT with post-transplant cyclophosphamide. Median follow-up of alive patients was 32 months. On multivariate analysis, acute graft-versus-host disease (GVHD) grade 2-4 was lower with offspring donors or bone marrow cells, whereas extensive chronic GVHD was higher in partial response at haploSCT or when using sisters, haploidentical donors beyond first degree, or female donors in male patients. Progression-free survival (PFS) was better for FL, HL and PTCL, whereas overall survival (OS) was better for HL and PTCL. Complete remission at haploSCT improved PFS and OS whereas these were negatively affected by cytomegalovirus donor positive/recipient positive status. No other donor characteristics (age, gender, human leucocyte antigen mismatch, ABO incompatibility) affected PFS or OS except use of haploidentical donors beyond first degree, which negatively affected OS. PFS and OS are mostly influenced by disease status and lymphoma subtype, supporting the use of any first degree haploidentical family member as a donor.

Background Antiseizure prophylaxis is recommended when high-dose of busulfan is given as part of the conditioning regimens in the allogenic hematopoietic stem cell transplant. Phenytoin has been widely used but its pharmacokinetics and pharmacodynamics profile makes its use complicated. Levetiracetam is a safe, effective and well tolerated antiseizure drug with good results in epileptic patients. Objective To describe our experience using oral (p.o) levetiracetam 1000 mg every 12 h (q12h) as an antiseizure prophylaxis, evaluating its preventive effects and adverse event rates after a high-dose of intravenous (i.v.) busulfan, as part of the conditioning regimen Methods Retrospective study of patients who underwent an allogenic hematopoietic stem cell transplant with a conditioning regimen based on high-dose of busulfan between January and November 2017. Results The study population comprised 36 patients, of whom 18 (50%) had acute myeloid leukemia as diagnosis. No seizures occurred in any patient. Levetiracetam was well tolerated and no serious adverse events were reported. Conclusions Our results suggest that giving levetiracetam at 1000 mg q12h p.o starting 12 h before the administration of i.v. busulfan until 48 h after the last dose, can be used as an alternative in the prevention of busulfan-induced seizures in adults.

A full scale five-story reinforced concrete building was built and tested on the Large High Performance Outdoor Shake Table (LHPOST) at the University of California, San Diego in 2012. The main objective of the test program was to study the seismic response of the structure and the nonstructural components (NSCs) and their dynamic interaction at different levels of seismic excitation. The building specimen was first tested base-isolated and then fixed at its base. In the fixed-base configuration, a suite of six earthquake motions of various intensities was applied to the building to progressively increase the seismic demand. In this paper, the modal parameters of the fixed-base building are identified using the input-output dynamic data recorded during the seismic tests. The deterministic-stochastic subspace identification method (DSI) is employed to estimate the variations of the modal properties of the building during the seismic tests by employing a short-time windowing approach. The changes of the modal parameters during the seismic motions are tracked, analyzed, and compared to those previously obtained from ambient vibrations and low-amplitude white noise base excitation tests. The identified natural frequencies and equivalent damping ratios of the building changed with the intensity of the input motions and damage in the structure, while the mode shapes are found to be insensitive to them.

INTRODUCTION: Allogeneic hematopoietic stem cell transplantation (alloSCT) is the only curative strategy for relapsed/refractory T cell lymphoma (T-NHL). In the past ten years, there have been several improvements in conditioning regimens and graft versus host disease prophylaxis (GVHD), which have contributed to lower transplant-related mortality (TRM). Also, selective and low toxicity therapies, might improve response quality in some T-NHL Recently, haploidentical stem cell transplantation (Haplo) with post-transplant cyclophosphamide is a new option for those patients who do not have an HLA-identical sibling or a suitable unrelated donor, but also it has shortened the time for urgent cases. METHODS: This study analyzes overall outcomes of 211 consecutive patients diagnosed with T-NHL who received an alloSCT from 1995 to 2018 in GELTAMO/GETH centers. Previous therapies (chemotherapies and autologous stem cell transplantation) and baseline diagnostic parameters were recorded. RESULTS The median age at alloSCT was 47 years (range, 17-69). (see table 1). Forty-nine (23%) had primary extranodal disease. Disease status pre alloSCT was available in 202 patientes: 54% were in complete response (CR), 30% in partial response (PR) and 16% with stable/progressive disease (PD). Since 2013 BV was used as a bridge therapy in ≥ 3rd line in 25 patients with CD30+ tumor expression, it was effective in 20 (CR 68% (n=17), PR 12% (n=3) PD 16% (n=4), not assessed in 1 case). The use of BV was not associated with a better response probability pre alloSCT compared with other regimens used after third line and it did not impact on post alloSCT outcomes. Reduced intensity conditioning (RIC) was the most frequent (76%, n=156). (see table 2) GVHD prophylaxis were Methotrexate + CsaA or Tacrolimus (n=72, 35,8%), sirolimus-tacrolimus (n=37; 18,4%), Cy-post based (n=44, 21,9%; used in Haplo setting n= 29). The median follow-up of all cohort was 22.5 months (range, 0-280). The two year overall survival (OS) and disease free survival (DFS) were 60% (CI95%, 53-67%) and 76.7% (CI95%, 69.3-82.5%) (Figure 1A) We observed a significant improvement in alloSCT outcomes since 2011 (OS Disease status was the only pre alloSCT variable that impacts 2 years - OS: CR 72.8% (CI95%, 63-80.4%), PR 52%(38.7-63.7%), PD 43.8 (26.5-59.8%) (p=0.002) (Figure 1C). Forty-three (21%) cases relapsed after alloSCT. To analyze the impact of GVHD on OS and DFS we selected landmark time point at day +100 and +1 year after alloSCT for acute (aGVHD) and chronic GVHD (cGVHD) respectively, which allowed us to capture the majority of events that could interfere with the analysis. A landmark analysis (day +100) showed a 2 year OS for grade 3-4 aGVHD was 18% and for 1-2 aGVHD 54,6% (p Cumulative incidence of acute GVHD at 90 days was 51.6% (CI95%, 43.9-58.2%) being 27% grade 3-4. Chronic GVHD at 6 months was 53.9% (46.1-60.5), 54% of cases were grade 3-4). The 2 years non relapse mortality (NRM) was 30.2% (CI95%, 23.3-36.5%); the main causes contributing to NRM were GVHD (40%) and infections (44%) Haploidentical (Haplo) alloSCT was introduced in 2012 (29 of 128). With a median follow up of 13 months (range, 0-60) we found that outcomes in terms of 1 year OS (Haplo 60.7% vs. others 67,5%), 1 year DFS (Haplo 74.8% vs. others 83.8%) and 1 year NRM (Haplo 29.7% vs. 26%) are similar to other alloSCT modalities (Figure 1D). Not additional analysis could be estimated due to the low number of population at risk for each category. CONCLUSION Overall outcomes of alloSCT for T-NHL have improved over time. Complete response pre alloSCT is the only determinant for OS. Haploidentical alloSCT is not significantly different from other approaches and should be considered as an alternative. Disclosures Sierra: Novartis: Honoraria, Research Funding, Speakers Bureau; Astellas: Honoraria; Pfizer: Honoraria; Daiichi-Sankyo: Honoraria, Speakers Bureau; Abbvie: Honoraria, Speakers Bureau; Roche: Honoraria; Jazz Pharmaceuticals: Honoraria.

Introduction Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity, showing a highly variable outcome. In patients with DLBCL relapsed/refractory to first-line treatment with rituximab the usefulness of the revised International Prognostic Index (R-IPI) as a prognostic tool remains unexplored. Some biological parameters (B-cell lymphoma 6 [Bcl-6], Bcl-2, p53, and multiple myeloma 1 [MUM1]) and blood populations (lymphocyte and monocyte counts) have been described as International Prognostic Index-independent prognostic factors. The objective was to evaluate the R-IPI to predict the outcome of DLBCL patients at the time of relapse after a front-line treatment with chemotherapy and rituximab and to establish in this population the relationship between biological parameters and outcome. Patients and Methods We included patients with refractory/relapsed DLBCL after first-line treatment with rituximab-containing regimens; patients must have already finished a rescue treatment also including rituximab. Immunohistochemical assessment of Bcl-2, Bcl-6, p53, and MUM1 expression were undertaken in available biopsies. R-IPI factors were identified from the clinical data at diagnosis and at relapse. Response was assessed using National Cancer Institute-sponsored Working Group guidelines. Results R-IPI prognosis at relapse was not significantly associated with overall response rate (ORR) after Rituximab-chemotherapy rescue therapy. None of the immunohistochemical parameters analyzed correlated with rescue therapy results. In contrast, patients with absolute lymphocyte count (ALC) ≥ 1 × 10 9 /L at relapse were more likely to respond than patients with ALC 9 /L ( P = .05). Conclusion The R-IPI score calculated at relapse could not predict the ORR to second-line treatment. Lymphopenia is a simple and useful predictor for outcome in relapsed/refractory DLBCL and the only prognostic factor that in our hands could predict the overall response to a second-line treatment with rituximab and chemotherapy.

Background Haematopoietic stem cell transplantation [HSCT] is considered a therapeutic option for patients with severe Crohn's disease [CD] unresponsive to currently available therapies. Methods Autologous HSCT was considered for CD patients with active disease, unresponsive or intolerant to approved medications and unsuitable for surgery. After HSCT, patients were closely followed up every 6 weeks during the first 2 years and every 6 months thereafter up to 5 years. Colonoscopy and/or magnetic resonance imaging were performed at Months 6, 12, 24, and 48 after HSCT. Results From December 1, 2007 to December 31, 2015, 37 CD patients were assessed for HSCT. Of these, 35 patients [13 within the ASTIC trial] underwent mobilisation. Six patients did not complete the transplant for various reasons and 29 patients were finally transplanted. Patients were followed up during a median of 12 months [6-60]. At 6 months, 70% of patients achieved drug-free clinical remission (Crohn's Disease Index of Severity [CDAI] < 150). The proportion of patients in drug-free remission (CDAI < 150, Simple Endoscopic activity Score [SES]-CD < 7] was 61% at 1 year, 52% at 2 years, 47% at 3 years, 39% at 4 years, and 15% at 5 years. Patients who relapsed were re-treated and 80% regained clinical remission. Six out of the 29 [21%] required surgery. One patient died due to systemic cytomegalovirus infection 2 months after transplant. Conclusions HSCT is a salvage therapy for patients with extensive and refractory CD. Although relapse occurs in a majority of patients within 5 years after transplant, drug responsiveness is regained and clinical remission achieved in 80% of cases.

El sindrome de POEMS (polineuropatia, organomegalia, endocrinopatia, banda monoclonal y alteraciones cutaneas) es una entidad infrecuente, que se caracteriza por una proliferacion clonal de celulas plasmaticas que da lugar a un componente monoclonal, por lo general poco abundante y con restriccion de la cadena lambda. Clinicamente cursa con afectacion multisistemica, dentro de la cual predomina la polineuropatia periferica. No existe un tratamiento especifico para esta enfermedad. Se presentan 4 casos de sindrome de POEMS tratados mediante trasplante autologo de progenitors hematopoyeticos en nuestro centro. Todos ellos mejoraron de sus manifestaciones neurologicas y sistemicas, al tiempo que presentaron una disminucion o desaparicion del componente monoclonal y de las lesiones oseas. En conclusion, el trasplante autologo de progenitores hematopoyeticos constituye una opcion terapeutica util en el sindrome de POEMS.

Objective To evaluate the feasibility and toxicity of autologous haematopoietic stem cell transplantation (HSCT) for the treatment of refractory Crohn9s disease (CD). Design In this prospective study, patients with refractory CD suffering an aggressive disease course despite medical treatment, impaired quality of life and in whom surgery was not an acceptable option underwent HSCT. Toxicity and complications during the procedure and within the first year following transplantation were evaluated, along with the impact of the introduction of supportive measures on safety outcomes. Results 26 patients were enrolled. During mobilisation, 16 patients (62%) presented febrile neutropaenia, including one bacteraemia and two septic shocks. Neutropaenia median time after mobilisation was 5 days. 5 patients withdrew from the study after mobilisation and 21 patients entered the conditioning phase. Haematopoietic recovery median time for neutrophils (>0.5×10 9 /L) was 11 days and for platelets (>20×10 9 /L) 4 days. Twenty patients (95%) suffered febrile neutropaenia and three patients (27%) presented worsening of the perianal CD activity during conditioning. Among non-infectious complications, 6 patients (28.5%) presented antithymocyte globulin reaction, 12 patients (57%) developed mucositis and 2 patients (9.5%) had haemorrhagic complications. Changes in supportive measures over the study, particularly antibiotic prophylaxis regimes during mobilisation and conditioning, markedly diminished the incidence of severe complications. During the first 12-month follow-up, viral infections were the most commonly observed complications, and one patient died due to systemic cytomegalovirus infection. Conclusions Autologous HSCT for patients with refractory CD is feasible, but extraordinary supportive measures need to be implemented. We suggest that this procedure should only be performed in highly experienced centres.

Constitutive activation of CXCR4, a chemokine receptor commonly overexpressed in cancer, is associated with tumor progression, invasion, and chemotherapy resistance. Although the CXCR4 pathway has recently been suggested as an adverse prognostic marker in diffuse large B-cell lymphoma (DLBCL), its biological relevance remains underexplored as the evolution of the malignant clone has been traditionally thought to rely mainly on microenvironment-independent factors, including MYC. To evaluate a possible interplay between CXCR4 and MYC signaling in DLBCL we have analyzed the expression of CXCR4 and its ligand CXCL12 in tissue biopsies of a homogeneous cohort of 86 patients with de novo DLBCL, and correlated it with clinico-pathological characteristics and gene expression profiling. We found that co-expression of CXCL12 and CXCR4 was associated with an inferior overall survival when compared to the sole expression of CXCR4 (p=0.017). An ELISA-based array covering 175 human cytokines further showed that tissue levels of CXCL12 best correlated with high microvessel density (p=0.02) pointing out a role for both CXCR4 and CXCL12 in DLBCL tumor aggressiveness. In support of the established role of nuclear CXCR4 on tumor metastasis, abundant nuclear CXCR4 was detected in DLBCL primary tumors and cell lines compared to normal tonsils. This feature was significantly associated with the migratory potential of the tumor cells, thus suggesting CXCR4 as a potential therapeutic target to hamper lymphoma cell dissemination. In silico and in vitro screening of a CXCR4 inhibitor (CXCR4i) library further identified the tetra-amine IQS-01.01 as a potent inhibitor of CXCR4 nuclear translocation. IQS-01.01 prevented CXCL12-mediated chemotaxis and triggered apoptosis in a panel of 14 DLBCL cell lines and primary cells, with improved pharmacological properties than the standard CXCR4i, AMD3100. Mechanistically, IQS-01.01-mediated blockage of CXCR4 signaling was associated with downregulation of p-AKT, p-ERK1/2 and MYC. The combined use of IQS-01.01 with the BET bromodomain inhibitor CPI203 exerted a synergistic cytotoxic effect in DLBCL cell lines in vitro (mean combination index: 0.6±0.2). In a xenotransplant model of DLBCL the IQS-01.01/CPI203 combination decreased tumor burden (p=0.004) through prevention of CXCR4 nuclear import and MYC downregulation, resulting in a synergistic apoptosis induction. Our results point out an emerging role of nuclear CXCR4 in the pathogenesis of DLBCL and support the simultaneous targeting of CXCR4 and BET bromodomain as a promising, rationale-based strategy for DLBCL. Citation Format: Clara Recasens-Zorzo, Teresa Cardesa-Salzmann, Laia Ros-Blanco, Anna Esteve-Arenys, Guillem Clot, Martina Guerrero-Hernández, Alejandra Valera, Alejandra Moros, Gonzalo Gutierrez, Isolda Casanova, Ramón Mangues, Alejandra Sanjuan, Pablo Menéndez, Vanina Rodriguez, Antonio Martínez, Pedro Jares, Dolors Colomer, Jordi Teixidó, José Ignacio Borrell, Elias Campo, Armando López-Guillermo, Luís Colomo, Patricia Pérez-Galán, Gaël Roué. Pharmacological modulation of CXCL12-CXCR4 intracellular trafficking potentiates the in vitro and in vivo activity of the BET bromodomain inhibitor CPI203 in diffuse large B-cell lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2169. doi:10.1158/1538-7445.AM2017-2169

Varon de 43 anos de edad, sin antecedentes de interes, que consulta por una tumoracion cervical izquierda de un mes de evolucion. No relaciona su aparicion con una infeccion de vas u otro desencadenante. No refiere otra sintomatologia asociada. En la exploracion fisica se objetiva una tumoracion laterocervical izquierda de 4 cm de diametro, mayor a la altura del tercio superior del musculo esternocleidomastoideo. El resto de la exploracion ORL fue normal. En una puncion citologica con aguja fina no se observaron signos histologicos de malignidad. Una tomografia computarizada del cuello fue informada como probables metastasis quisticas cervicales izquierdas secundarias a carcinoma papilar de tiroides (fig. 1). Se realizo una cervicotomia y diseccion de las adenopatias cervicales que presentaban un color negro (fig. 2). El estudio histologico intraoperatorio de una de ellas fue informado como metastasis ganglionar por carcinoma papilar de tiroides. Se realizo un vaciamiento cervico-ganglionar izquierdo selectivo y una tiroidectomia total. El postoperatorio curso sin incidencias. El estudio de la pieza operatoria demostro un carcinoma papilar en hemitiroides izquierdo con metastasis cervicales multiples. Entre un 21 y un 50% de las adenopatias metastasicas secundarias a carcinoma papilar de tiroides presentan una

Introduction: Allogeneic haematopoietic stem cell transplantation (alloHCT) is a potentially curative approach for patients (pts) with multiple myeloma (MM). The high transplant related mortality (TRM) rate with myeloablative conditioning has resulted in a shift to reduced intensity conditioning regimens (RIC). However, most MM pts who receive an alloRIC ultimately relapse and their treatment remains a challenge. Since alloHCT can modify the biology of the disease, including the immune environment, responses after alloHCT to rescue therapies previously used before alloHCT could be improved. Our main objective was to evaluate the efficacy of regimens including new drugs in MM pts relapsing after alloHCT comparing the efficacy achieved before and after alloHCT. Material and Methods: We report a retrospective multicenter analysis of 126 consecutive pts that underwent alloHCT for MM from 2010 to 2013 at 8 Spanish centers. Results: Baseline pts and transplant characteristics are shown in Table I. The median of prior therapies prior to alloHCT was 3 (1-9), 83% had received previous autologous HCT and 26% had high risk cytogenetic. 71 (56%) and 48 pts (38%) had been treated with regimens containing proteasome inhibitors (PI) and immunomodulatory drugs (IMIDs) before transplantation, respectively. Disease status at transplant was complete remission (CR) in 16 (13%) pts, partial response (PR) or very good PR in 86 (68%) and 24 (18.5%) had relapsed/progressive disease. 35 pts (28%) had active extramedullary disease at transplant. The majority of pts received peripheral blood HCT (90%), RIC (90%) with fludarabine plus melphalan based conditioning regimen (61%) and calcineurin inhibitor plus MTX as GVHD prophylaxis (68%). 19% receiving allo-HCT from an unrelated donor (91% 10/10 HLA matched). All pts engrafted. Grade II-IV acute GVHD occurred in 54% pts (grade IV 8%) and chronic GVHD in 45% (moderate 15%, severe 12%). TRM within the first 100 days after transplant was 6% (overall TRM 28%). 60% pts improved their pre-transplant response, with an overall response rate of 74% (56% CR). After a median follow-up of 92 months for pts alive (22-197), the OS was 51 and 43% at 2 and 5 years respectively. 75 pts (59.5%) relapsed after alloHCT, 57 of them with extramedullary involvement. Median time to relapse was 8 months post-transplant (1-141). The cumulative incidence of relapse was 79% at 3 years. Median OS after relapse was 22 months (8-33). Seventeen out of 75 pts who relapsed received IP both in the pre-transplant and in the post-transplant period. Sixteen pts out of 17 who received IP achieved at least PR pre-transplant while 10 out of these 16 pts responded again to PI post-HCT. Moreover, 1 patient reached a deeper response (CR) post as compared to pre alloHCT (PR) and 1 patient who was refractory pre-alloHCT did respond post-alloHCT. In addition, 6 out of 7 pts who did not respond to IP post-transplant reached stable disease with time to progression (TTP) lasting 4 to 12 months. Twelve out of 75 pts who relapsed received IMIDs both pre and post-alloHCT. Ten pts out of 12 who received IMID pre-alloHCT achieved at least PR, and 8 out of these 10 pts responded again to IMIDs post-alloHCT. Moreover, 1 patient who had been refractory to IMIDs in the pre-transplant period reached CR after alloHCT. In addition, 2 out of 4 pts who were refractory to IMIDs in the post-transplant period reached stable disease with TTP of 8 to 13 months. Remarkably, among pts who respond both in the pre and the post-transplant period to IP or IMIDs, the time to response (TTR) and time to progression (TTP) was similar despite the regimens used in the pre-transplant setting were more aggressive (TTR 3 vs 3.5 and TTP 9 vs 7 months before and after alloHCT for IP, and TTR 4 both before and after alloHCT and TTP 10 vs 9.5 months before and after alloHCT for IMIDs). All but 2 pts received first generation IP pre and post-alloHCT (two pts received carfilzomib) and all but 5 received first generation IMIDs (5 pts were treated with pomalidomide). Conclusions: MM pts relapsing after alloHCT should be considered candidates to receive new drugs, as they can achieve response rates at least in a similar proportion and durability to those observed in the pre-transplant setting. This finding is in contrast to the usual course of the disease outside the alloHCT setting, where response rates and TTP decreases with consecutive lines of treatment. Disclosures Mateos: Janssen: Honoraria; Celgene: Honoraria; Takeda: Honoraria; Amgen: Honoraria.

Resumen Los procesos fundamentales de la dinámica embrionaria en el reino animal, y particu- larmente en los vertebrados, obedecen a un programa genético que solo ha comenzado a comprenderse en los últimos años. Uno de los principales objetivos de los biólogos del desarrollo es develar el misterio de cómo un oocito, después de ser fecundado, se transfor- ma en un organismo multicelular. Esta dinámica requiere la activación de un complejo programa de desarrollo en el que genes específicos se expresan en una secuencia temporal precisa, y en la ubicación correcta, para dar origen a diferentes tipos de tejidos como la piel, músculos y nervios, entre otros. Mediante el estudio de mutantes en Drosophila se han identificado genes que participan en la organización del patrón de desarrollo del embrión, los cuales son activos en las hembras. Asimismo, en los últimos años, gracias a las técnicas moleculares, se han realizado grandes avances en el conocimiento de los mecanismos que controlan este intrincado proceso. Este trabajo plantea diversos aspectos relacionados con la teratogenia asociada a la gastrulación, periodo que es muy sensible a las agresiones, así como el aporte de casos y un análisis de los avances en el conocimiento de los procesos moleculares implicados en la dinámica embrionaria. Palabras clave: Desarrollo embrionario, malformaciones congénitas, dinámica embrionaria, procesos moleculares.Abstract The fundamental processes of embryonic dynamics in the animal kingdom and particu- larly in vertebrates are due to a genetic program that has begun to be understood in recent years. One of the developmental biologists’ main goals is to unravel the mystery of how after being fertilized an oocyte becomes a multicellular organism. This dynamic requires activation of a complex development program in which genes are expressed in a temporal, precise sequence and in the correct location to give rise to different types of tissues suchas skin, muscles and nerves among others. The genes involved in the embryo development pattern, active in females, have been identified by studying Drosophila mutants. Also, thanks to molecular techniques, advances in understanding the intricate mechanism that control this process have been significant in recent years. This work raises several issues related to teratogenicity associated with gastrulation, embryonic stage sensitive to dam- ages. Also, this work provides study cases and a review of the progress in the understand- ing of molecular processes involved in embryonic dynamics. Keywords: Embryonic development, congenital malformations, embryonic dy- namic, molecular process.

Liver transplantation is a surgical technique designed for the treatment of patients suffering from end stage liver disease and who would not otherwise have a chance to survive. After the first liver transplantation, performed by Thomas Earl Starzl on the first of March, 1963 in Denver, Colorado, thousands of procedures have been performed all around the world. 5300 liver transplantations were performed in the USA during 2002 and 5142 in Europe. The European liver transplantation registry has 93634 transplantations registered until December 2009 (www.eltr.org).

Follicular lymphoma (FL), a typically nodal disease, can arise in extranodal sites in about 10% of cases. The present study aimed to analyse the main differential features of patients with primary extranodal FL. Thirty-nine patients with primary extranodal FL were identified from a series of 354 patients with FL diagnosed at a single institution and their main clinicobiological features were analysed. Twenty patients (5·6%) had a primary extranodal non-cutaneous FL, and 19 (5·4%) a cutaneous FL. BCL2(+) and CD10(+) expression and BCL2/IGHJ@ rearrangement were less frequently observed in cutaneous FL. Absence of 'B'-symptoms, early stage, absence of bone marrow involvement and low-risk Follicular Lymphoma International Prognostic Index (FLIPI) were more frequent in extranodal FL. Five-year overall survival (OS) was 100%, 83% and 78% for cutaneous, non-cutaneous and nodal FL, respectively. When stage I patients were analysed separately, no differences were seen in terms of OS. In multivariate analysis, FLIPI was the most important variable to predict outcome. In conclusion, extranodal FLs, particularly cutaneous, have particular clinico-biological features, which differentiate them from nodal cases. Nevertheless, primary site of the disease is not the main issue to predict outcome.

Background Extranodal involvement, including central nervous system (CNS), is a frequent event in patients with mantle cell lymphoma (MCL). However, the incidence, risk factors, and impact on outcome remain controversial. Patients and methods Main clinical, biological, and evolutive features of 82 patients (60 males/22 females; median age: 61 years) diagnosed with MCL (blastoid, 26%) in a single institution were analyzed for risk of CNS involvement and prognosis. Results Most patients had advanced stage and intermediate or high-risk International Prognostic Index (IPI). Eleven patients eventually developed CNS involvement with an actuarial 5-year risk of 26% (95% confidence interval 10% to 42%). In one asymptomatic patient, cerebrospinal fluid infiltration was detected at staging maneuvers (1/62; 1.6%). The remaining 10 patients developed neurological symptoms during the course of the disease (median time from diagnosis, 25 months). Initial variables predicting CNS involvement were blastoid histology, high proliferative index measured by Ki-67 staining, high lactate dehydrogenase (LDH) and intermediate- or high-risk IPI. Histological subtype and serum LDH maintained significance in multivariate analysis. Treatment of CNS infiltration consisted of intrathecal chemotherapy (two cases), and intrathecal chemotherapy plus systemic treatment (seven cases). Median survival after CNS involvement was 4.8 months, patients with this complication having shorter survival than those with no CNS disease. Conclusion This study confirms the high incidence of CNS involvement in MCL patients. Treatments aimed at preventing this complication are warranted.

Introduction: Allogeneic stem cell transplant (alloHSCT) is the treatment of choice in patients with high-risk acute myeloid leukemia (AML). However, it is uncertain exactly how many of these patients actually undergo alloHSCT as planned initially. Moreover, the real efficacy of this therapeutic option remains controversial. Since few studies have addressed these questions, to shed light on these issues, we have analyzed the results of a policy of early donor search, the proportion of patients in which initially planned alloHSCT was performed, and the outcome of alloHSCT in our center. Patients and Methods: We included in the study 246 AML patients (median age, 51 years, 16-70; 51% males) considered fit for intensive chemotherapy, who were treated according to 3 consecutive protocols of the Spanish CETLAM cooperative group (CETLAM-99, CETLAM-2003, and CETLAM-2012). Patients were diagnosed between 2003 and 2013 in our center or referred to our center for alloHSCT; median follow-up of alive patients was 70.4 months (12.5-143.8). Indication of allloHSCT in CR1 was established according to the stratification risk of each protocol, based on AML origin (de novo vs. secondary), cytogenetics, number of courses to achieve CR, NPM1/FLT3-ITD/CEBPA mutational profile, and MRD status at end of consolidation. Statistical analyses were performed using R v3.1 and SPSS v20. The effect of alloHSCT was analyzed by Mantel-Byar test with SCT as a time-dependent covariable. Results: AlloSCT was planned in 167 (68%) patients deemed of high-risk and it was actually performed in 130 out of these high-risk AML patients (78%). Types of donor were: matched related donor (MRD), n=63; 7/8 or 8/8 matched unrelated donor (MUD), n=51 (HLA matching: 8/8 or 10/10= 32; 7/8 and 9/10, n=19); unrelated cord blood (UCB) n=14; and family haploidentical donor, n= 2. Status at SCT was first CR (CR1) in 63 patients (48%), ≥CR2 n=23 (18%), and non-CR AML in 44 patients (34%). The type of conditioning regimen was myeloablative in 66 (51%) of the patients. Ninety-eight patients out of 167 patients with an indication for alloHSCT, lacked a MRD (59%). An unrelated donor search was performed in 80 (82%) out of these 98 patients, and was successful in 54 (67.5%). An UCB unit was selected in 14 patients without a MUD in a timely fashion. The main reasons for not initiating an unrelated donor search were poor performance status (n=5), refractory disease (n=4), and age (n=4). Median time from start of search to finding of an adequate donor was 50 days, and median time from start of search to SCT was 131 days. The overall outcome of these 167 patients with an indication of alloHSCT was 2-year OS: 48±8% and 5-year LFS: 36%±8% with a markedly better outcome among patients in whom alloHSCT was finally performed (2-year OS: 57±8% vs. 11%±10%; Mantel Byar, p Conclusions: A policy of early search of MUD enabled alloHSCT to be performed in the majority of patients for whom it was planned. Performing of alloHSCT in patients improved outcome of this cohort of high-risk AML patients, compared to patients not achieving alloHSCT. An adequate MUD was identified in a two thirds of patients, and a similar outcome was found after alloHSCT for all donor sources (MRD, MUD, and alternative source) in this study. Disclosures Rosiñol: Celgene, Janssen: Honoraria.

Introduction: Allogeneic hematopoietic stem cell transplantation (alloHSCT) is currently considered the standard of care for those patients with HL that relapse after autologous HSCT. Several studies have shown that fit patients with chemosensitive disease can benefit from alloHSCT using and identical sibling (SIB) or matched-unrelated (MUD) donors. Recently, encouraging results have been obtained using haploidentical donors (HAPLO) and post-transplantation cyclophosphamide (ptCY) as graft-versus-host disease prophylaxis (GVHD). Because information regarding the results of alloHSCT using alternative donors is still scarce, we aimed to compare outcome of umbilical cord blood (UCB) and HAPLO transplants with conventional SIB and MUD for HL. Patients and methods: Information of patients older than 17y with HL who received an alloHSCT from a SIB, MUD (8/8 antigen matched), UCB or a ptCY-based HAPLO between 2010-2013 was downloaded from the EBMT and GETH databases. Results: 773 patients with HL were identified meeting the inclusion criteria. 339 received a transplant from a SIB donor, 276 from a MUD, 101 from HAPLO, and 47 from UCB. A significant higher number of patients treated with alloHSCT from UCB and HAPLO donors received reduced intensity (RIC) regimens in comparison to SIB and MUD (76% and 88% vs. 69% and 69%, respectively, p=0.001). Bone marrow was more frequently used as source of stem cells in the HAPLO group in relation to SIB and MUD (61% vs 10% and 11%, respectively, p=0.001), Other variables such as sex, age, performance status, chemorefractory disease, and previous autologous SCT were balanced. Median follow-up after alloHSCT for all patients was 12 months (1-60). The 1-year probabilities of overall survival (OS) and progression-free survival (PFS) were 80% and 49% after SIB transplant, 69% and 54% after MUD, 65% and 40% after UCB, and 73% and 56% after HAPLO, respectively. The 1-year probabilities of non-relapse mortality (NRM) and relapse rate (RR) were 12% and 38% after SIB, 21% and 25% after MUD, 20% and 40% after UCB, and 18% and 27% after HAPLO. Multivariate analysis showed that, in comparison with standard SIB alloHSCT, UCB was associated with a trend to a higher NRM (p=0.08) and RR (p=0.06), leading to a significant lower OS and PFS (p=0.009, HR 2.1, 95% CI 1.2-3.6; p=0.02, HR 1.6, 95% CI 1.1-2.3; respectively). NRM was also significantly higher after MUD (p=0.004, HR 1.8, 95% CI 1.2-2.6), but in contrast, RR was lower (p=0.003 HR 0.6, 95%CI 0.5-0.9) with a lower OS (p=0.002, HR 1.6, 95% CI 1.2-2.1) and no significant differences in PFS. No significant differences were observed between HAPLO and SIB in NRM, RR, PFS and OS. Conclusions: This registry study suggests that in adults with advanced HL, the outcome of pt-CY-based HAPLO HSCT may be comparable to that of conventional SIB alloHSCT and MUD across multiple centers and conditioning regimens. These findings need to be corroborated by longer follow-up. Figure 1. Figure 1. Disclosures Peggs: Autolus: Consultancy, Equity Ownership; Cellectis: Research Funding. Milpied:Celgene: Honoraria, Research Funding. Afanasiev:CELLTRION, Inc.: Research Funding. Russell:Therakos: Other: shares. Sureda:Takeda: Consultancy, Honoraria, Speakers Bureau.

Background Peritoneal carcinomatosis from a gastrointestinal carcinoid tumour is rare and the long-term management and prognosis have not been clearly defined. The natural history is different from gastrointestinal adenocarcinoma, although its capacity to invade regional lymph nodes and generate distal metastasis can make the management more complex. Whilst the development of carcinomatosis is uncommonly reported, it may be higher than expected. Case presentation A 63 years-old woman underwent emergency surgery in 1993 for right iliac fossa pain and a mass that was found to be an ileal carcinoid tumour. Over the next ten years, further surgery was required for disseminated disease with peritoneal carcinomatosis and liver metastasis. Systemic chemotherapy had little effect, although Somatostatin was used effectively to relieve symptoms caused by the disseminated disease (flushing and diarrhoea). Conclusion Peritoneal carcinomatosis from carcinoid tumours is not well documented in the literature. Aggressive surgery must be performed in order to control the disease since chemotherapy has not been reported to be effective. With repeated surgery long-term survival can be achieved in these patients.

Numerous articles relate atmospheric variables to health indicators. In large regions, such as Castilla-La Mancha, it may be necessary to divide the region into areas in terms of the atmospheric variables available by selecting a representative weather station for each zone. This article focuses on analyzing the daily temperature data from numerous Castilla La Mancha observatories and reducing the number thereof to a few representative stations for being used in studies relating atmospheric variables to health indicators in this region.Castilla-La Mancha weather stations were selected in terms of the number of years available and missing data. After filling in the gaps in the selected series, to detect any possible discontinuities and to homogenize the series, the daily temperature data is used in hierarchical cluster and factorial analyses by principal components.Factorial analyses extract one single factor by using the maximum, mean or minimum temperature series. For the maximum temperatures, this factor explains 93.45% of the variance, with an eigenvalue of 39.249. The "Compuesta" station in Toledo shows correlation coefficients in the principal components matrix of 0.987, 0.991 and 0.981 respectively for the maximum, mean and minimum temperature series.Castilla-La Mancha is an isoclimatic region in terms of the temperature, the "Compuesta" station in Toledo being selected as the representative station for the region for public health studies. The results afford the possibility of conducting studies broken down into small units such as the provinces, with the stations in the government capitals as a reference.

Fundamento: Numerosos trabajos relacionan variables atmosféricas con indicadores sanitarios. En regiones extensas, como Castilla- La Mancha, puede ser necesario dividirla en áreas en función de las variables atmosféricas disponibles, eligiendo una estación meteorológica representativa para cada zona. El objetivo de este artículo es analizar los datos diarios de temperaturas de numerosos observatorios de Castilla- La Mancha y su reducción a unas pocas estaciones representativas para ser utilizadas en estudios que relacionen variables atmosféricas con indicadores sanitarios de esta región. Métodos: Se seleccionaron estaciones meteorológicas de Castilla- La Mancha en función del número de años disponibles y de datos perdidos. Tras rellenar las lagunas de las series elegidas, detectar posibles discontinuidades y homogeneizar las series, los datos diarios de temperaturas se utilizan en análisis de conglomerados jerárquico y factorial mediante componentes principales. Resultados: El análisis factorial extrae un solo factor utilizando las series de temperaturas máximas, medias o mínimas. En las máximas, ese factor explica el 93,45% de la varianza, con autovalor 39,249. La estación Toledo «Compuesta» tiene coeficientes de correlación en la matriz de componentes principales de 0,987; 0,991 y 0,981 para las series de temperaturas máximas, medias y mínimas respectivamente. Conclusiones: Castilla-La Mancha es una región isoclimática en función de la temperatura y la estación Toledo «Compuesta» la elegida como representativa regional para estudios en salud pública. Los resultados permiten la realización de estudios desagregados en unidades menores como las provincias, con las estaciones de las capitales administrativas como referencia.

Abstract 1945 Poster Board I-968 T-cell Subpopulations Quantified by Flow Cytometry in Lymph Node Cell Suspensions Identify a Group of Patients with Follicular Lymphoma with Good Prognosis Neus Villamor, Gonzalo Gutiérrez, Joaquim Carreras, Eva Giné, Gabriela Ghita, Marta Aymerich, Montserrat Torrebadell, Antonio Martínez, Lluís Colomo, Emili Montserrat, Elías Campo, Armando López-Guillermo Hematopathology Unit and Department of Hematology, Hospital Clínic, IDIBAPS, Barcelona, Spain. Introduction: Tumor microenvironment plays an important role in the behavior of follicular lymphoma (FL), as demonstrated by gene expression profile analysis. Using this technique, an increase in macrophages has been associated with poor outcome, whilst an increase in T-cells is associated with better prognosis. Immunohistochemical analysis has been performed as alternative method to gene expression profile, but the quantification is time consuming and poorly standardized. Patients and methods: T-cell populations from lymph nodes of 68 patients (35M/33F, median age 59, range 29 to 81) with FL at diagnosis were quantified by flow cytometry in cell suspensions. The percentage of CD3, CD4, CD8, CD57, and germinal center (GC) CD4 cells (CD4+CD57+), as well as the ratio B/T, CD4/CD8, CD4/CD3, CD8/CD3 and GC-CD4/CD4 were correlated with the main initial features and the clinical outcome of the patients. The distribution according to the histological grade was: grade 1 and 2, 53 patients; grade 3a, 14; grade 3b, 1. Fifty-one percent of patients had low-risk FLIPI. 62 patients have received polychemotherapy, including rituximab in 33, whereas in 6 a watchful waiting policy was established. After a median follow-up of 4 years, 17 patients have died, with a 5-year overall survival (OS) of 77%. Results: The mean (±SD) percentage of B-cells, CD3, CD4, CD8 and GC-CD4 was 58.6% (±14.2), 36.1% (±15.2), 27.1% (±12.3), 8.7% (±5.1), and 3.4% (±2.4). No correlation was found between percentages of T cell subpopulations, B/T, CD4/CD3 and CD8/CD3 cell ratios and the clinical characteristics, failure-free survival (FFS) and OS. The median value CD4/CD8 and GC-CD4/CD4 ratios was 3.4 (range: 0.51 to 1) and 0.11 (n=56) (range: 0.02 to 0.34), respectively. Grade 3 histology was more frequently observed in patients with CD4/CD8 ratio Disclosures: No relevant conflicts of interest to declare.