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Background Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is associated with a high fatality rate (34%), which is higher in the presence of co-morbidities. The aim of the current study was to assess the clinical course and the outcome in hematological or oncological malignancy cases, diagnosed with MERS-CoV. Methods This is a case series of hematological /oncological cases, diagnosed with MERS-CoV, in a tertiary care setting in 2015. The cases were identified based on the World Health Organization (WHO) MERS-CoV case definition. The demographic, clinical, and outcome data were retrieved from the patients’ medical charts and electronic health records. Results In total, nine hematological or oncological cases were identified, diagnosed with MERS-CoV. The baseline malignant condition was hematological malignancy in seven patients, as well as colon cancer and osteosarcoma in one patient each. Six (67%) patients were male. The median age was 65 years (range 16–80 years). Co-morbidities included chronic kidney disease (n = 3.33%), diabetes mellitus (n = 3.33%), and hypertension (n = 2.22%). The presenting symptoms were shortness of breath (n = 6.66%), fever (n = 5.55%), cough (n = 2.22%), and diarrhea (n = 2.22%). Chest x-rays indicated bilateral infiltrates in 6 patients (66%). The PCR (polymerase chain reaction) test was repeated in six patients to confirm the diagnosis. The mortality rate was 100%, and the median time to death was 26 days (range 15–77 days). Conclusion MERS-CoV infection in this small cohort of hematology or oncology patients has a 100% mortality rate, regardless of the status of the underlying disease. The confirmation of the diagnosis may require repeated testing. Additional studies are required to verify the findings and to elucidate the disease pathogenesis in cancer patients.

Background: Although the prevalence of genetic hematological disorders varies widely between geographical regions, region-specific hematological reference ranges have not been defined in Saudi Arabian adults. Methods: A multicenter retrospective cross-sectional study was conducted with 1127 participants who completed their pre-employment screening and recruitment process between January 2013 and December 2016. Data related to the demographic and hematological indices were extracted. Results: The mean age was 28.0±5.2 years (range 19.4-72.8 years) and gender was distributed equally (47.5% female vs. 52.5% male). The WBC reference range was 3.3-11.4 ×109/L; hemoglobin 111-174 gm/l; platelet 163-412 ×109/L; MCV 80-95.7 fl, and neutrophils 1.2-8.8 ×109/L. A robust regression model was used to evaluate the effect of the participant's characteristics on the hematological indices. Except for WBC, the rest of the hematological indices were significantly influenced by gender, region, and age. The 2.5 percentile hemoglobin values were 135 gm/L in males and 104 gm/L in females, while platelet values were 173 x109/L in females and 159 x109/L in males. Conclusion: The study defined local hematological reference ranges, which were mostly lower than reported in international studies used in our center. Hematological values were mainly influenced by gender and region. A community nationwide screening study is required to create reference ranges specifically for the Saudi population. Disclosures No relevant conflicts of interest to declare.

Management of patients with immune thrombocytopenia (ITP) refractory to standard treatment is difficult. Recent studies show that rituximab, a chimeric anti-CD20 monoclonal antibody, is useful in the treatment of ITP. We retrospectively studied 24 patients who received 29 rituximab treatments for relapsed or refractory ITP. Patients had received a median of 3 treatment regimens before (range 1–8) and 11 patients had prior splenectomy. Responses were achieved in 19 of 29 (66%) treatments. The median time to response was 3 weeks (range 1–20) from the start of therapy and median duration of response was 13 weeks (range 1 week–55 months). Responses were mostly short lived and after a median follow-up of 22 months (range 2–70), 10 (34%) responses were sustained after 6 months, 7 (24%) responses sustained after 1 year and only 5 patients continued to have a response at last visit after 8, 10, 24, 30 and 54 months of follow-up. Previous splenectomy was associated with a poor response (p = 0.034). Patients who failed rituximab and had prior multiple treatments including splenectomy, had a poor outcome of further therapies. We conclude that rituximab is well tolerated and is useful in some patients with relapsed or refractory ITP; however, only about one-fifth of patients achieved sustained remissions. Patients refractory to rituximab had a poor response to further treatment.

AIM To examine the optimal absolute lymphocyte count (ALC) cut-off utilizing receiver operator characteristics (ROC) in addition to graft characteristics associated with early ALC recovery. METHODS Patients who received T-cell replete peripheral hematopoietic cell transplantation (HCT) for acute leukemia were identified. ALC cut-off was established using ROC analysis and subsequently the cohort was stratified. Time to endpoint analysis and cox regression modelling was computed to analyze outcomes. RESULTS A total of 72 patients met the inclusion criteria and were analyzed. Optimal ALC cut-off was established to be on day 14 (D14) with ALC > 0.3 × 109/L. At 2 years, cumulative incidence of relapse was 16.9% vs 46.9% (P = 0.025) for early and delayed lymphocyte recovery cohorts, respectively. Chronic graft vs host disease was more prevalent in the early lymphocyte recovery (ELR) group at 70% vs 27%, respectively (P = 0.0006). On multivariable analysis for relapse, ELR retained its prognostic significance with HR = 0.27 (0.05-0.94, P = 0.038). CONCLUSION ELR is an independent predictor for relapse in patients receiving allogeneic HCT for acute leukemia. ELR was influenced by graft characteristics particularly CD34 count.

Background: Morphologic complete remission (CR) is the gold standard for assessing response in acute leukemia. Patients who achieve CR with incomplete count recovery (CRi) in acute myeloid leukemia typically have inferior overall survival and lower event free survival (Walter et al, JCO 2010 and Chen et al, JCO 2015). Incomplete hematologic recovery is likely not an independent risk factor for inferior outcome but possibly correlates with adverse disease characteristics such as high risk cytogenetics or minimal residual disease post therapy. Furthermore, remission status prior to allogeneic stem cell transplantation (SCT) is an important predictor of post-transplant outcome. However, the prognostic role hematologic recovery carries prior to allogeneic transplantation for acute leukemia is not known. Aim: To study the impact of CRi with corresponding impact on relapse incidence (RI), non-relapse mortality (NRM) and overall survival (OS) in allogeneic SCT for acute leukemia. Methods: Patients with acute myeloid or lymphoid leukemia who received allogeneic SCT at our institution between 2010-2015 were identified. All clinical and pathologic data were retrospectively extracted. All patients were deemed in morphologic remission at the time of transplant without evidence of active disease. CR and CRi were defined in accordance to previous international working group definitions. Categorical and continuous variables were analyzed using Pearson's chi-squared and Wilcoxon / Kruskal-Wallis, respectively. Survival estimates were calculated using the Kaplan-Meier and log-rank test. RI was estimated accounting NRM on a competing event analysis using Grey's model. Methods: Patients with acute myeloid or lymphoid leukemia who received allogeneic SCT at our institution between 2010-2015 were identified. All clinical and pathologic data were retrospectively extracted. All patients were deemed in morphologic remission at the time of transplant without evidence of active disease. CR and CRi were defined in accordance to previous international working group definitions. Categorical and continuous variables were analyzed using Pearson's chi-squared and Wilcoxon / Kruskal-Wallis, respectively. Survival estimates were calculated using the Kaplan-Meier and log-rank test. RI was estimated accounting NRM on a competing event analysis using Grey's model. Results: A. Baseline characteristics: A total of 68 patients were identified. A total of 36 were in CR while 32 were in CRi. Baseline patient, disease and transplant characteristics stratified by group are shown (Table 1). Importantly, there were no significant differences between the cohorts with regards to gender, disease status at SCT, intensity of conditioning regimen, use of total body irradiation (TBI), HLA and ABO matching. B. Transplant outcomes: Median follow up of the entire cohort was 13.6 (2-64.9) months. During which 2-year rates of RI, NRM and OS were 42.4, 12.8% and 63.9%, respectively. Stratified by count recovery, the 2-year rates of RI for CR and CRi were 36.2 vs. 43.1, respectively (p = 0.39). 2-year NRM for CR and CRi were 21.7% vs. 11%, respectively (p = 0.1). 2-year OS for CR and CRi were 59% vs. 61.8%, respectively (p = 0.58). Conclusion: We observed comparable post-transplant outcomes between CR and CRi. This suggests that in contrast to acute myeloid leukemia, SCT had a role in mitigating the negative prognostic implication of CRi. These results could have implications as physicians may not need to postpone SCT to await hematologic recovery. This important question should be further validated in a larger cohort of patients. Table 1 Patient characteristics stratified by count recovery Table 1. Patient characteristics stratified by count recovery Figure 1 Cumulative incidence of relapse stratified by count recovery Figure 1. Cumulative incidence of relapse stratified by count recovery Figure 2 Overall survival stratified by count recovery Figure 2. Overall survival stratified by count recovery Disclosures No relevant conflicts of interest to declare.

Background: Routine bone marrow biopsy (BMB) for the initial staging of Hodgkin Lymphoma (HL) is not recommended in the era of FDG-PET/CT staging (J Clin Oncol. 2014;32(27):3059). However, patients from the Middle East and North Africa (MENA) region have epidemiologic and clinical features of lymphoma that are different from patients of other ethnicities (J Natl Compr Canc Net2010;8:S-29-S-35). Therefore, it is unknown whetherFDG-PET/CT can substitute for staging BMB in this population.At our center, we perform routine BMB for all newly diagnosed lymphoma cases. Aim: To investigate whether routine BMB is essential in detecting bone marrow disease where FDG-PET/CT is used in initial staging for HL in patients from the MENA region. Methods: Patients with HL at our institution between 2010 - 2015 were identified. Inclusion criteria included newly diagnosed patients who had BMB and FDG-PET/CT as part of initial staging. All baseline and laboratory features were retrospectively extracted. Pathology reports of bone marrow aspirate and trephine biopsies were reviewed by two independent Hematologists. All written FDG-PET/CT reports were retrieved and carefully reviewed and cases with positive skeletal uptake were re-interpreted by an experienced radiologist. Pattern of skeletal FDG-PET/CT uptake was determined and classified as unifocal or multifocal. Sensitivity and specificity was computed while defining bone marrow disease by positive BMB and / or focal skeletal uptake on FDG-PET/CT. Categorical and continuous variables were analyzed using Pearson's chi-squared and Student's t-test, respectively. Results: A. Baseline characteristics: A total of92 patients met the inclusion criteria and were considered for this analysis. All patients were from the MENA region and > 90% were from the Arabian peninsula. From this cohort, bone marrow disease was detected in 7 (7.6%) patients using BMB while 20 (21.7%) patients had unifocal or multifocal bone marrow uptake on FDG-PET/CT. An additional 21 patients (23%) had diffuse homogenous FDG uptake and was not considered to represent HL. The cohort was characterized by a male to female ratio of 1.4 and a median age at diagnosis of 27 years (6-83). About two thirds of the cases were classical HL of the nodular sclerosis subtype (Table 1). Almost 60% of cases were stage III - IV with corresponding median IPS of 2 (0-6). Incidence of bulky disease and B-symptoms among the entire cohort was 32% and 50%, respectively. B. Comparison of FDG-PET/CT and BMB No patient with involved BMB (iBMB) had early stage disease on FDG-PET/CT and BMB identified only one patient with positive BM involvement yet negative skeletal uptake on FED-PET/CT. Involvement by BMB upstaged 3 patients previously assessed by CT scan as having stage III, however, none of the patients were allocated to a different treatment plan based on the BMB result. On the other hand, FDG-PET/CT upstaged 24 patients (26%); 9 patients from stage III to IV and 14 patients from early to advanced stage resulting in change of therapeutic plan in the latter group. Focal skeletal FDG-PET/CT lesions identified positive marrow disease with a sensitivity and specificity of 95.2% and 70.4%, respectively. On the other hand, sensitivity and specificity of BMB was 35% and 100%, respectively (Table 2). Abnormal skeletal FDG uptake was seen in a total of 20 patients (21.7%); 11 (55%) had unifocal / bifocal while 9 (45%) had multifocal disease of the axial skeleton. Patients with iBMB compared to those with negative BMB but positive unifocal / multifocal skeletal FDG-PET/CT lesions were more likely to be male (p = 0.002), have B-symptoms (p = 0.028), extranodal disease (p = 0.017) and more likely to have multifocal uptake on FDG-PET/CT (0.017) (Table 3). Conclusion:To our knowledge, this is the first analysis to examine the role of FDG-PET/CT for detection of bone marrow involvement in HL in a patient cohort from the MENA region. We observed that FDG-PET/CT had a higher sensitivity and negative predictive value compared to BMB leading to a treatment change in a significant proportion of patients. This analysis highlightsthat FDG-PET/CT can substitute for BMB in routine staging for newly diagnosed patients with HL from the MENA region. Disclosures No relevant conflicts of interest to declare.

Background: Hodgkin Lymphoma (HL) has improved markedly overtime. This study aims to assess our experience in treating advanced HL. Method: In a retrospective cohort study, patients age >14 with advanced HL from 2007-2010 were included. Using IPI, patients were categorized into low and high risk. ABVD and Hybrid ABVD+BEACOPP regimens were used. Result: 74 patients were included with the median age at diagnosis of 25.5 years. 50% presented with stage IV. Two different protocols were used (ABVD and Hybrid ABVD + BEACOPP). Median follow up was 30.3 months. Male gender and stage V were most often to receive hybrid regimen (odd ratio 3.74 and 6.58 respectively). When the two groups were compared, the higher risk group (mostly treated with hybrid regimen) showed similar survival rates to the lower risk group (treated mostly with ABVD) with p-values of 0.41 for OS and 0.42 for PFS. Conclusion: This study shows quite similar results to the published studies in the OS and PFS with a tendency to overcome the high-risk features by the hybrid regimen in advanced HL. However, this needs to be confirmed in a prospective randomized study. Disclosures No relevant conflicts of interest to declare.