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Background The role of fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) in indolent lymphoma has been minimally studied. Objective This study aims to assess the value of FDG-PET/CT in predicting the prognosis of indolent lymphoma. Methods We prospectively recruited 42 patients with indolent lymphoma. A total of 2 patients were excluded, and 40 underwent baseline PET/CT and follow-up at various time points. A total of 9 patients were observed only, 7 received 4 doses of rituximab alone, and 24 received chemoimmunotherapy. Metabolic response on follow-up PET/CT was assessed using the maximum standardized uptake value (SUVmax) and Deauville criteria (DC). We aimed to obtain the best SUVmax and DC to predict optimal survival rates, risk stratification, and optimize therapeutic strategies. The mean follow-up from the initial diagnosis was 33.83 months. Results SUVmax Conclusions We demonstrated the utility of PET/CT in indolent lymphomas. SUVmax (

Purpose of review To summarize the past and current knowledge of the use of unrelated donors (URDs) in allogeneic stem cell transplantation for patients with acute leukaemia. Recent findings The outcome of URD stem cell transplants in terms of treatment-related mortality, relapse rates, disease free survival and overall survival is comparable to sibling donors. Summary Haematopoietic stem cell transplantation (HSCT) is the therapy of choice in many haematological malignant diseases but only one-third of the patients will have an HLA-matched sibling. The possibility of finding a matched URD is more than 70% because of recent advances in HLA typing and continuous expansion of URD registries around the world. The use of URD as a source of stem cells in adult patients are steadily increasing and in the last 8 years, superseded the matched sibling donors and became the most commonly used stem cell source. There is also an increasing trend of using peripheral blood stem cells than bone marrow stem cells. Outcomes following URD transplants depend mainly upon the indication and urgency of transplant, age and comorbidities of recipients, cytomegalovirus matching/mismatching between donor and the recipient and degree of HLA matching.

Background: JAK2 GGCC 46/1 haplotype can be represented by four main SNPs (rs3780367, rs10974944, rs12343867, and rs1159782) which replace one cytosine and three thymidines by two guanosines and two cytosines, generating a "GGCC" combination. These four SNPs located on JAK2 introns 10, 12, 14, and 15, respectively, and are always inherited together, being in complete linkage disequilibrium. The 46/1 component of the name came from Jones et al. study where the haplotype structure of the JAK2 gene was mapped using 14 SNPs genotyped by the Wellcome Trust Case Control Consortium (WTCCC) in 1500 healthy blood donors. Two haplotypes (numbers 46 and 1) were found to be identical except for one SNP, and they have a combined frequency of 0.24 in healthy individuals. Numerous observational studies associate this haplotype with myeloproliferative neoplasms (MPNs), as well as splanchnic vein thrombosis (SVT) and non-splanchnic vein thrombosis (non-SVT). In contrast to 24% frequency noted in healthy population, the frequency goes up to 40-80% in JAK2 V617F mutated MPN, and in 64% of those with JAK2 exon 12 mutations (Anelli et al. IJMS, 2018). We herein report our study of JAK2 GGCC (46/1) Haplotype in unprovoked Venous Thrombotic Events (VTE) in patients with negative thrombophilia workup, including negative JAK2 V617F mutation. Methods: We retrospectively identified patients positive for one of the two SNPs (rs12343867 and rs10974900) and unprovoked venous thrombotic among adult patients with negative thrombophilia workup (including JAK2 mutation) treated at tertiary care center from January 2018 to January 2021. Results: We have identified 8 patients, Table (1), that were positive for JAK2 46/1 haplotype SNPs, of whom 62.5% were homozygous 2/2, 25% heterozygous 1/2, while only 12.5% harbor homozygous 1/1 (a normal variant of JAK2 haplotype). The median age 48.5 years (23-65), and the majority (87.5%) were females. Thrombosis site was noted to be SVT in half of the patients, while non-SVT was noted in the other half (12.5% had cerebral vein thrombosis, 12.5% had deep venous thrombosis, 12.5% had a pulmonary embolism, and 12.5% had jugular vein thrombosis). Half of the patients had more than one site venous thrombosis and the other half had only one site. Around 37.50% of the patients had recurrent venous thrombosis on top of therapeutic anticoagulation. Two patients (25%) had high hemoglobin (17.4/16.7) g/dl, but did not fulfill the criteria for polycythemia vera diagnosis (of whom one is a male smoker and one was a female). None of the patients had leukocytosis or thrombocytosis. By imaging, one patient had mild splenomegaly which could be related to SVT. Conclusion: We report on a potential correlation between unprovoked thrombotic events, mainly venous thrombotic events, with JAK2 46/1 haplotype in patients with a negative thrombophilia workup, a finding that merit further investigation. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Background: Venetoclax combined with hypomethylating agents is a new standard of care for newly diagnosed patients with acute myeloid leukemia (AML) 75 years or older, or unfit for intensive chemotherapy. As precision therapy in AML expanded with the addition of venetoclax among others in the therapeutic armamentarium of AML, efficacy and safety reports in ethnic minorities are limited, with a background of well recognized inter-ethnic differences in drug response. Phase III data from VIALE-A, as well as VIALE-C, was limited for the Arab population as no site opened in the Arab world. We herein report our experience on the use of venetoclax with azacitidine in patients with newly diagnosed or relapsed/refractory AML in the Arab population. Methods: Retrospective-single center review on the use of Azacitidine with venetoclax in older patients (aged ≥60 years) with newly diagnosed AML, not eligible for intensive chemotherapy; secondary AML and relapsed or refractory AML. All patients self-identified of Arabic ethnicity. Patients who received previous BCL2-inhibitor therapy were excluded. Patients who received at least one dose of treatment (Azacitidine ≥3 days, >14 days of venetoclax) were included in the intention to treat analysis. Patients typically received azacitidine 75 mg/m2 intravenously for 7 days with oral venetoclax 400 mg daily for induction, with appropriate dose adjustment for concomitant use of azoles. This is followed by the same regimen in consolidation, with adjustment according to response and side effects at the treating physician's discretion. The primary endpoint was overall survival. The secondary endpoints include response rate, safety, and relapse-free survival. Results: Between July 2019, and July 2021, we identified 19 patients; 13 (68%) had newly diagnosed AML (ND-AML), and 6 (32%) had relapsed or refractory AML (R/R AML). The median age was 70 years (17-82). In the ND-AML, most patients had an adverse ELN 2017 AML (69%) with 23% having either intermediate or adverse AML (Negative for CBF, NPM1, FLT3-ITD and biCEBPA, but missing NGS data for adverse mutations Tp53/ASXL1 and RUNX1). Only one patient was classified as intermediate-risk AML. The overall response rate in the ND-AML was 77%, with 46% achieving complete remission (CR), and 23% CR with incomplete count recovery (CRi) [Table]. One patient achieved PR after the first cycle (blast 7% by morphology and 1.5% by flow cytometry) and did not have a subsequent bone marrow evaluation, however had a full count recovery. Among the responders in the ND-AML cohort, 4 deaths were noted. One death was related to COVID-19 associated pneumonia, one due to graft failure (at day 42 post Haplo-SCT), one due to septic shock, and one was related to relapse disease. The overall survival and relapse-free survival for ND-AML were 5.6 months for both [Figure]. In the R/R AML, 66% had prior HMA exposure, and all patients did receive high-intensity chemotherapy. The median number of prior treatments was 3 (1-5). the response rate was 80% (4/5), with 60% achieving CR. All patients are still alive with a median follow-up of 7.6 months. One patient had progressive disease. One patient is early to evaluate and was not included in the response analysis [Table]. The 30-day mortality was zero in both ND-AML and R/R AML cohorts. Conclusions: In a majority of adverse risk ND-AML, and in heavily pretreated R/R AML, the response rate and overall survival is comparable to what has been previously reported. Our data support the use of this regimen in older patients with newly diagnosed AML, patients with relapsed or refractory disease, and those with adverse-risk features. This analysis is limited by the small number of patients, and by the lack of ELN 2017 favorable-risk AML. Future prospective and randomized studies are needed to clarify activity and safety in the Arab population, as well as in the high-risk AML subset. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Objective: The primary objective is overall response rate (CR/CRi). Design: This is a single-institution, single-arm, phase II study of pre-treatment with azacytidine followed by FLAG for the treatment of relapsed or refractory AML. Setting: Salvage therapy in relapsed/refractory AML. Patients or Other Participants: Patients with relapsed or refractory AML, ECOG performance status ≤2, and patients with preserved organ function. Exclusion criteria: Patients with a diagnosis of acute promyelocytic leukemia (AML-M3), pregnant women, patients previously treated with fludarabine, and patients with uncontrolled intercurrent illness. Twenty-one patients were enrolled, and all were evaluable for toxicity and response. The median number of prior treatments was 1 (range: 1–3). Nine patients (43%) were refractory to the most recent treatment, while most other patients relapsed less than 6 months from the last treatment before enrollment. Interventions: Azacytidine was given at 75 mg/m2 per day for 5 days prior to the standard FLAG therapy. Main Outcomes Measures: Primary study endpoints were safety and ORR [ORR = CR, CRi, PR, morphologic leukemia-free state (MLFS) according to the International Working Group criteria], overall survival, and relapse-free survival. Results: Bone marrow suppression was the most common adverse event and was observed in all patients. The 30-day mortality was noted in 2 patients (10%), related to infection/septic shock with multi-organ failure. The combination was tolerated, and toxicities were as expected for patients receiving salvage intensive chemotherapy. The CR/CR with incomplete blood count recovery (CRi) rate was 53%. Of the 9 primary refractory patients, 5 (56%) achieved CR/CRi. Eight of 11 patients who achieved CR/CRi also attained minimal residual disease-negative status (≤1.0% by flow cytometry), and 8 patients (73%) went for stem cell transplant. Of the 11 patients who achieved CR/CRi, 5 were still alive on the last follow-up. The overall survival for the entire cohort was 4.1 months, and relapse-free survival was 4.7 months. Conclusions: AZA FLAG combination is safe and does not seem to have an added benefit in response rate or survival.

Introduction Outcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly higher among blacks and ethnic minority individuals. There is paucity of data on the outcomes of patients with autologous stem cell transplant and concurrent COVID-19 infections, especially from eastern mediterranean region, no similar studies have been reported so far. Methods Here we describe outcomes of five consecutive patients of middle eastern ethnic origin who had a history of autologous stem cell transplant and developed COVID-19 infection, who were admitted at our tertiary care center between April and June 2020 with a minimum of 10 days follow-up. Results A total of five patients were identified who had undergone autologous stem cell transplantation and had developed COVID-19 infection. There were 3 males and 2 females and the median age was 43 years (range 18-59). Indications for transplant were myeloma (n=3), relapsed Hodgkin lymphoma (n=1), and relapsed diffuse large b cell lymphoma (n=1). Three of five patients had other comorbidities. Median time from transplant was 9 months (range 3-33 months). Four of five patients were on active treatment or maintenance at the time of infection. One patient was on brentuximab, and three were on lenalidomide based therapy. Only one of the five patients had active disease at the time of infection while the rest were in remission. None of the patients had severe disease and four were discharged to home isolation and made full recovery, and one needed admission requiring minimal oxygen and eventually made full recovery. At a median follow up of 70 days (range 12-90) all patients were doing well with no sequelae. Conclusion Our study, albeit small, shows excellent outcomes among patients of middle eastern ethnic origin with hematological cancers who had undergone autologous stem cell transplantation and had developed COVID-19 infection, unlike other studies that have shown high mortality among patients with hematological cancers. However, our cohort is relatively younger, most of them were in remission at the time of infection which may have had a protective effect. At the same time, the majority had transplant within the last nine months and four-fifths of the patients were on some sort of immunosuppressive therapy whilst developing COVID-19 infection. It is possible that a dampened immune system due to transplant and recent therapy might have had a protective effect against cytokine storm or severe COVID-19, in our view. More studies are needed to examine this aspect further, however, these results are encouraging. Disclosures No relevant conflicts of interest to declare.

Introduction Outcomes of patients with hematological cancers and Corona Virus Disease-19 (COVID-19) have been dismal with high rates of hospitalization, admission to intensive care unit and high mortality of up to 20% compared to general population, more so pronounced among black and ethnic minorities. There is hardly any data on outcomes of patients with lymphoma and concurrent COVID-19 from eastern mediterranean region. From eastern mediterranean area no similar studies have been reported so far. Methods Here we describe outcomes of eleven consecutive patients who had history malignant lymphoma (either treated or currently on treatment) and now had developed COVID-19 infection, recently admitted at our tertiary care center between April and July 2020 with minimum of 10 days follow up. Results Total of eleven (n=11) patients were identified with COVID-19 who also had diagnosis of malignant lymphoma. There were 5 males and 6 females and median age was 31 years (Range 19-59). Diagnoses included five cases of diffuse large b cell lymphoma, two cases of primary central nervous system lymphoma, three cases of classical Hodgkin lymphoma, one case of low grade non Hodgkin lymphoma. Two cases were newly diagnosed and had not received any treatment while six patients were on active treatment and three patients had received treatment more than six months prior. Three patients were on Rituximab based therapy at the time of infection and two patients had prior autologous stem cell transplant. Seven patients had mild COVID-19 while four had severe form of disease. All patients were on supportive care and treatment included various options including chloroquine, antibiotics, convalescent plasma, interferon, enoxaparin, Tocilizumab depending on treating physician's discretion. Four patients had home isolation and recovered fully, while seven patients needed hospitalization of which three made full recovery while three needed admissions to intensive care unit (ICU) due to severe COVID-19. Out of three patients in ICU, two needed noninvasive ventilation, one needed mechanical ventilation. At the time analysis one ICU patient made complete recovery and discharged home while two others are still in hospital. After a median follow up of 37 days (range 10-87), no mortality has been recorded so far. Out of four patients with severe COVID-19, one was newly diagnosed and treatment naïve, and one was in remission for more than a year, the remaining two were on active rituximab based chemotherapy for lymphoma. However, 3 out of 4 patients had cleared COVID-19 by polymerase chain reaction testing. Conclusions Our results suggest that COVID-19 causes significant morbidity in patients with lymphoma like other studies, however there has been no mortality so far in our cohort with relatively long follow up, although some patients are still admitted at the time of analysis. One of the reason for lower mortality could be younger age group. Our study also suggests that over two thirds of the patients had only mild disease out of which majority of them were on some sort of therapy or had undergone recent transplant, making us wonder if recent immunochemotherapy may have some protective effect against cytokine storm or severe COVID-19 by having dampening role on immune system. Half of the patients who had severe disease were not on any therapy while the other two who were on active therapy, although still inpatients, had cleared the virus interestingly. Further studies needed to examine this further, our results from this ethnic community are encouraging. Disclosures No relevant conflicts of interest to declare.

Introduction Granulocyte Colony Stimulating Factor (GCSF) with cyclophosphamide based peripheral blood stem cell (PBSC) mobilization is a widely used strategy among patients with multiple myeloma (MM), however, it is associated with toxicity and morbidity including severe infectious complications needing hospitalization. Plerixafor with GCSF has been widely used for mobilization as a preemptive strategy or during second attempt at collection with encouraging results. Methods We describe our experience from a newly established transplant unit in the Eastern Mediterranean region. A retrospective chart review was done and all consecutive patients of MM who underwent PBSC mobilization by GCSF and plerixafor between 2017 to 2020 were included in the study. Patients received GCSF (filgrastim, 10 µg/kg/day) and if peripheral blood CD34 count was less than 20/µl on day 4, patients received the first dose of plerixafor (240 µg/kg/day) on the evening of Day 4. Daily apheresis started on Day 5 for a maximum of 4 days, or until enough stem cells collected for one or two transplants at physician's discretion. Results A total of seventeen PBSC collections were carried out among patients with myeloma (n=17). There were 10 males and 7 females. The median age was 53 years (range 38-71), and 8/17 were less than 50 years of age. 14/ 17 were of IgG myeloma subtype, 2/17 were light chain myeloma, 1/17 was IgA myeloma type. 6/17 patients had R-ISS stage 3 disease while rest (11/17) had R-ISS stage 2 disease. 15/17 patients were in first remission. Only 1/17 patients had high-risk cytogenetics. 12/17 patients had bortezomib based therapy while 5/17 had lenalidomide based therapy. 13/17 patients had GCSF alone mobilization while 4/17 had GCSF plus pre-emptive plerixafor. 9/17 had a single collection while 8/17 had 2 collections. All patients on plerixafor needed two collections. Median CD34 stem cell dose was 8.6 x10^6 cells/kg (range 3.4-20 x 10^6 cells/kg). No grade 2-4 adverse events were recorded with this strategy post-collection and none required hospitalization for any adverse events. All patients underwent melphalan based conditioning and autologous stem cell transplant, although only 12/17 received a full dose of 200 mg/m2. 13/17 patients had fresh stem cells infused while the rest had cryopreserved stem cells. Median time to neutrophil recovery was 11 days (range 9-27) while median time to platelet recovery was 12 days (range 10-37). Day 100 mortality was zero percent. Conclusions Our study demonstrates successful collection with high stem cell yield enough for two stem cell transplants with GCSF and preemptive plerixafor strategy, in patients with MM, thus saving patients toxic effects of cyclophosphamide including cytopenias, infections which at times are severe causing morbidity and mortality. Over two-thirds of patients collected with GCSF alone. No major adverse events post stem cell collection were noted and all our patients engrafted early thus reducing hospital stay. Although the use of plerixafor increases cost but failure of mobilization, second mobilization, and infections (at times severe), delayed engraftment have their own costs and implications. Our study at our new transplant unit confirms that this pre-emptive strategy is safe, effective and reasonable chemo free first line option with no major adverse events as demonstrated by other studies. Disclosures No relevant conflicts of interest to declare.

Myeloid neoplasm with eosinophilia and FIP1-like-1-platelet-derived growth factor receptor-alpha (FIP1L1-PDGFRA) rearrangement is a multi-organ disease with diverse clinical presentation. Thrombotic thrombocytopenic purpura (TTP) is characterized by the concomitant occurrence of often severe thrombocytopenia, microangiopathic hemolytic anemia, and a variable degree of ischemic organ damage. To our knowledge, only one case of eosinophilia with FIP1L1-PDGFRA rearrangement presented as a case of thrombotic thrombocytopenic purpura reported in the literature. We herein report a case of a young male patient with hypereosinophilic syndrome and FIP1L1-PDGFRA rearrangement who presented with asthma, transient ischemic attacks (TIA), and confusion. He had an acquired TTP that was successfully treated with plasma exchanges (PLEX), corticosteroids, rituximab, and later with the addition of imatinib mesylate (Gleevec, Novartis). He remains in complete remission on imatinib 100 mg daily for more than 28 months of follow-up.

Background: Hematology practice in developing countries has some unique issues including a higher prevalence of infectious disease markers. Epstein-Barr virus (EBV) is an oncogenic virus and implicated in Burkitt's lymphoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, nasopharyngeal carcinoma and leiomyosarcoma in the immunocompromised (Ito Y et al. 2009). Cytomegalovirus (CMV) infection/reactivation in patients with hematological malignancies causes serious morbidity and mortality. Saudi Arabia is a high income rapidly developing country, but seroprevalence of CMV and EBV is reportedly higher compared to developed countries (Ghazi 2002, Seale et al., 2006, Joseph et al., 2005). EBV & CMV co-infection is not infrequent & occurs most commonly in the immunocompromised host. A significantly higher prevalence of antibodies (Abs) against CMV & EBV in some disease groups compared to controls has been reported from the same communities (Ocak et al., 2006, Al-Hakami et al., 2016). Interestingly, CMV disease occurrence in sibling donor hematopoietic stem cell transplant (HSCT) is infrequent in our area in spite of the occurrence of CMV reactivations (Aljurf et al., 2009, Saovic et al., 1999). Hence, knowledge of seroprevalence of these viruses in hematological malignancies may be helpful in strategic planning for transplants & transfusions. It may help in establishing any plausible etiological linkage with certain hematological malignancies. Methods: We retrospectively examined the records of adult patients (>14 years) with hematological malignancies for CMV and EBV status (IgG and IgM Abs by chemiluminescence immunoassay). We identified 2,007 patients (1104 males and 903 females) and grouped them according to gender along with broad hematological malignancy categories (Table 1). We tried to establish if any disease category had extraordinary seropositivity for CMV (IgG ≥20 U/ml) or EBV (IgG ≥12 U/ml). We also studied the prevalence of IgM Abs in those tested positive for IgG Abs. Results: Of 2,007 patients (males significantly more than females, p = 0.001), age range 14-93 year (mean 47.2), 503 underwent testing for CMV status and 520 for EBV. Among these tested patients, there was no significant gender difference as 96.1% males were CMV positive, and 95.4% females were CMV positive. On the other hand, 96.9% males were EBV IgG Abs positive compared to 92.5% of females, which was 2.56 (95% CI; 1.12 - 5.96) times more likely to be positive in the studied male patient population (p = 0.021). Overall seroprevalence for CMV IgG Abs was 95.4%, and for EBV IgG Abs it was 95% (Table 1). Among those with CMV IgG Abs, 25/482 (5.1%) had very high antibodies titer (>180 U/ml), and 23/25 patients (92%) had lymphoid malignancies (11 NHL, 7 HL, 2 ALL, 3 MM) and 2 had CML. Among those with EBV IgG Abs 59/495 (11.9%) had very high antibodies titer (>750U/ml); and 46/59 (77.97%) of these patients had lymphoid malignancies (20 HL, 16 NHL, 6 ALL, 4 CLL, 1 MM) and 13/59 (22.03%) had myeloid neoplasms (6 AML, 5 CML, 1 MDS, 1 MPN). Six patients had very high titers for both EBV and CMV antibodies. In CMV IgG Abs positive patients only 1.03% (5/482) had IgM antibodies, and in EBV IgG Abs positive only 2.22% (11/495) had IgM antibodies. Table 1 shows the prevalence across the gender and in different disease categories. The highest seroprevalence for CMV was found in CLL, multiple myeloma and MDS patients (100%); and for EBV it was highest in MDS and MPN patients (100%). Relatively lower seroprevalence of EBV was noted in ALL patients group (86.2%), and lower seroprevalence of CMV was noted in MPN patients group (87.5%). However, overall, there was no significant difference across the disease categories for either CMV (p = 0.362) or EBV (p = 0.114). Conclusions: In this large study on our patients with hematological malignancies, we report very high seroprevalence of CMV and EBV Abs, reaching up to 100% in some disease categories. Among those with very high titer of EBV IgG Abs, the majority had lymphoid malignancies. Short of establishing any etiological linkage, we noticed 100% of MDS patients had both CMV and EBV Abs. Contrary to other reports, our male patients were more likely to be EBV positive compared to the females. Our results support the need for further studies to investigate possible cooperative linkage of EBV and CMV in carcinogenesis. Disclosures No relevant conflicts of interest to declare.

Hematopoietic stem cell transplantation (HSCT) is the therapy of choice in many hematological malignant and non-malignant diseases by using human leukocyte antigen (HLA)-matched siblings as stem cell source but only one third of the patients will have HLA-matched siblings. Hence, physicians rely on the availability of matched unrelated donors (URD). The possibility of finding a matched URD is now more than 70% due to continuous expansion of URD registries around the world. The use of URD in adult patients is steadily increasing and in the last 8 years has superseded the numbers of matched sibling donor transplants and has become the most commonly used stem cell source. There is also an increasing trend to use peripheral blood (PB) stem cells rather than bone marrow (BM) stem cells. Outcomes following URD transplants depend mainly upon the indication and urgency of transplant, age and comorbidities of recipients, cytomegalovirus (CMV) matching/mismatching between donor and the recipient, and degree of HLA matching. In some studies outcome of unrelated stem cell transplants in terms of treatment-related mortality (TRM), disease-free survival (DFS), and overall survival (OS) is comparable to sibling donors.

Background: Indolent lymphomas (ind-LYM) are a subset of B-cell lymphomas, characterized by slow growth, protracted course without treatment and a tendency to reoccur after therapy. The management of ind-LYM is varied and evolving. To-date reliable tools for imaging based prognostication and treatment strategies are limited. We explored the utility of serial FDG PET scans (baseline (BL), interim/6 months (INT) end of therapy/1 year (EOT)), in managing ind-LYM). Methods: From an ongoing prospective study, examining the role of PET scan in ind-LYM at our institution, we performed an interim analysis of all patients hitherto enrolled in our study. Patients diagnosed as ind-LYM and having undergone serial PET scans from 2015 to date (N=40, males= 27, females =13) had median age of 59.68 ± 14.5 (28-82 at diagnosis. All PET scans were obtained per accepted protocols. SUVmax and Deauville scores (DS) were obtained from five target lesions. The average of composite SUV (cSUV) and composite Deauville scores (cDS) were computed for each patient. Statistical analyses (using t-test, mean delta change) were performed with the cSUV and cDS. Results: The types of ind-LYM were CLL/SLL (17), Follicular (15), mantle cell (3), marginal zone lymphoma (3), and 1 each of MALT and lymphoplasmacytic lymphoma. The data were analyzed for two arms of the study treatment chemotherapy arm (CHEMO-22/40) and Rituximab + observation arm (OBSR-18/40). At BL, patients on CHEMO had significantly higher cSUV and cDS compared to those who were on OBSR (SUV: 6.99 vs. 4.32 p-value 0.0124; cDS: 4.37 vs 3.71 p-value 0.0075 respectively). Although there was a delta change in the cSUV and cDS in both arms after INT and EOT, both treatment lines showed no significant difference in the SUV mean and DS (p-value: 0.754 and 0.5721, receptively). A 2-tailed T-test was used for delta change of cSUV. BL to INT cSUV was statistically significant (p-valve 0.05) and difference in cSUV was not significant for BL to EOT (p-valve 0.98). Difference in cDS was not significant between BL, INT and EOT. Conclusion: The higher cSUV/cDS at BL for the treatment arm may be due to disease profile at the time of presentation and/or selection bias. At EOT no difference in both estimates were noted. Both arms showed similar trends in delta change from BL-INT-EOT. Our findings suggest that SUV and DS at BL maybe an independent criterion for treatment selection in ind-LYM. Disclosures No relevant conflicts of interest to declare.

Background: Acute Myeloid Leukemia (AML) is a group of heterogeneous clonal disorder of myeloid progenitor cells. Relapsed and refractory AML represent a clinical and therapeutic challenge to hematologist because of chemotherapy resistant disease and are associated with poor outcome. Allo-SCT is the only potentially curative therapy for such patients and is only possible after achieving second remission. FLAG is used more commonly and is associated with around 50%. We hypothesize that pretreatment with azacytidine will improve the overall response rate and remission status. Objectives : The primary objective of this study is to evaluate the overall response rate (ORR) of pretreatment with azacytidine followed by FLAG for the treatment of relapsed/refractory AML. Methods: This is prospective phase II study of patients with diagnosis of refractory/relapse AML at King Fahad Medical City, Riyadh, Saudi Arabia between January 2015 and July 2018. Patient confirmed to be relapse/refractory AML based on bone marrow biopsy results were included. Eligible patients received pretreatment with azacytidine for 5 days (days -5 to -1). The FLAG protocol was started on the next day after the completion of 5-azacytidine. G-CSF was started on day 0 (24 hours after last 5-azacytine dose) and continued for a total of seven days (days 0 to 6). Fludarabine and cytarabine was started on next day after G-CSF start day and continued daily for 5 days (days 1 to 5). Patients were followed up with daily clinical examination and labs until next bone marrow examination at count recovery up to day 35. The bone marrow sample was analyzed for cell cycle and global DNA methylation status before and after azacytidine treatment. The ORR is the proportion of the treated patients who achieved CR or Cri. The toxicity was graded base on the frequency of Adverse Events (the NCI-CTCAE version 4.0 scoring system). Results: Sixteen refractory/relapsed AML patients (5 females; 11 males) admitted to our Center from January 2105 to July 2018 were included in the study. Twelve patients were evaluable after exclusion of three patients from analysis based on exclusion criteria. One patient died during induction. The mean age was 39.38 ± 15.11 years. The mean WBC, hemoglobin, platelets, peripheral blood blasts, bone marrow blasts were 26.44 ± 23.15, 7.43 ± 1.55, 61.81 ± 85.20, 49 ± 30.36, and 57.36 ± 29.23 respectively at diagnosis. The mean bone marrow blasts were 42.09 ± 29.75 at relapse/refractory disease. Seven patient had normal Cytogentics. One patient had BCR (9q43), PML (15q22), RUNX1T1(8q22) & MLL (11q23) genes. Another one had EGR1 (5q31) deletion, while t(8;21) was found in another patient. One patient was positive for 7q31 deletion. Four out of twelve patients had abnormal molecular cytogentics including FLT3 -ITD, CEBPA, FLT3 -TKD mutation and KITD816V. No patient has extramedullary disease at diagnosis or relapse settings. Seven out of twelve patients had primary refractory disease while five patients had relapsed disease with 6 months' median duration of remission (Range 1.25-84). Nine patient received 3+7 induction regimen at diagnosis while three had ICE protocol. Eight out of twelve patients showed complete response (67%). Four out of five relapsed patients achieved complete response (80%) whereas four out of seven (57.14%) achieved complete response in refractory disease. Eight patients were referred for stem cell therapy. The most common toxicity was cytopenia and bacterial infections. One patient has left arm cellulitis whereas one had arthritis with myositis. All patients were successfully treated with antibiotics, one patient died during study period because of severe invasive fungal infection. Conclusion Our phase II study preliminary results indicate that the addition of Azacitidene prior to standard therapy can improve the overall response rate and remission status in relapsed/refractory AML. This may provide an opportunity to responding patients to proceed to curative therapy with stem cell transplant. Disclosures No relevant conflicts of interest to declare.

Introduction: Critically ill onco-hematology patients (pts) admitted to intensive care units (ICU) have poor prognosis. Mechanical ventilation, multiple organ failures and severe sepsis are factors associated with high mortality. Current literature identifies day 5 in ICU as a specific time point at which ceilings of care should be re-addressed. Patients and methods: We retrospectively reviewed all consecutive onco-haematology patients admitted to the ICU between October 2010 and December 2015. We classified pts according to the reason for ICU admission in 5 groups: a) respiratory failure without mechanical ventilation during the first 24h; b) respiratory failure and mechanical ventilation in the first 24h; c) sepsis without respiratory failure and without renal replacement therapy in the first 24h; d) renal replacement therapy without respiratory failure regardless of septic status; and e) needing hemodynamic support without respiratory failure, sepsis or renal replacement therapy in the first 24h. After 5 days of full intensive therapy we defined a successful 5-day ICU trial for each of the five groups as follows: a) no mechanical ventilation during 5 days; b) neutrophils > 1.0 or ² 2 organ failures by day 5; c) C-reactive protein decreased by 50% or normalised lactate by day 5; d) off renal replacement therapy by day 5; and e) no inotropic support on day 5. Patients who died during the first 5 days of ICU admission were considered failures and pts who were discharged from the ICU before day 5 were considered successes. Results: 166 pts were identified, with 202 ICU admissions. The median number of ICU admissions was 1 (1-4), with 138 (84%) having 1 admission, 20 (12%) 2 admissions, 4 (2.4%) had 3 admissions and 3 (2%) 4 admissions respectively. The median length of stay in ICU was 6 days (1-95). The median duration of hospital stay prior to ICU admission was 14 days (0-104). The diagnoses were: AML 28% (n= 57), ALL 8% (n=16), CML 8% (n=16), myelofibrosis 4% (n=7), MDS 4% (n=7), myeloma 11% (n=23), NHL 30% (n=61) and Hodgkin's lymphoma 2% (n=4). Regarding pre ICU treatment, 44% (n=88) received chemotherapy, 11% (n=22) underwent autologous stem cell transplantation and 40% (n=81) allogeneic stem cell transplantation. Of those, 30% had myeloablative and 70% reduced intensity conditioning and 29 (35%) were from HLA identical sibling, 47 (58%) unrelated and 6 (7%) haplo-identical donors. The disease status was complete remission (n=77, 38%), partial remission (n=28, 14%) and stable disease (n=96, 48%). The reason for admission to ICU was respiratory failure in 53% (n=107), 19% sepsis (n=39), 16% renal failure (n=32) and 11% hemodynamic failure (n=22). The median APACHE II score was 24 (10-51), the median SOFA score was 10 (2-21) and the median SAPS-II score was 45 (0-100). APACHE II and SOFA scores were significantly greater in non-survivors vs survivors (p For the 5-day ICU trial we selected 138 pts with one admission. The distribution according to the different groups was: a) 56; b) 34; c) 17; d) 17 and e) 14. Overall 58 (42%) successfully passed the trial: a) 30 (53%); b) 14 (41%); c) 4 (23%); d) 7 (41%) and e) 3 (21%). Overall 41 (30%) pts failed the trial and were alive on day 5 and 39 (28%) died before day 5. The overall survival (Figure 1) for the 58 pts who passed the trial was 28% at 3 years. The overall mortality in ICU was 33% (19/58) for those who successfully passed the 5-day ICU trial, and was 71% (29/41) for those who failed. The overall survival for pts that successfully completed the 5-day ICU trial and were discharged to the hematology ward (n=39), was 49% at 3 years. Conclusions: In this study, 50% of onco-hematologic patients survived their ICU admission. The long-term overall survival was 15% at 3 years. Patients could be stratified according to the reason for admission and given an individualised 5-day trial: those who successfully completed their trial (42%) had a low ICU mortality (33%) and those who were subsequently discharged home had a long-term survival of 49% at 3 years. This study raises the possibility of offering a short-term ICU trial to onco-hematologic patients and perhaps allows for the ceiling of intensive care for those who fail the trial. Figure Figure. Disclosures MacDonald: Gilead Sciences: Speakers Bureau. Milojkovic:Ariad: Honoraria; Novartis: Honoraria; BMS: Honoraria; Pfizer: Honoraria. Apperley:Incyte: Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Ariad: Honoraria, Speakers Bureau; Bristol Myers Squibb: Honoraria, Speakers Bureau.

The diagnosis of constrictive pericarditis requires a high degree of clinical suspicion, for the signs and symptoms of this disease can be falsely attributed to other causes. Herein, we present a case of a 70-year old retired farmer whose symptoms of right heart failure were initially attributed to co-existing pneumonia and pulmonary embolism. He was discharged. Three weeks later he presented with worsening breathlessness and ascites. Echocardiography, computed tomography and cardiac catheterization revealed the diagnosis of constrictive pericarditis. He underwent complete pericardectomy and to date has made a good recovery. This case exemplifies the difficulty in diagnosing this condition, the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment.