SURVIVAL OUTCOMES OF HEMATOLOGIC MALIGNANCIES USING THE LENT SCORE

Abstract

SESSION TITLE: Disorders of the Pleura Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Malignant pleural effusion (MPE) may portend limited survival in certain cancers. The LENT (pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group (ECOG) performance score (PS), neutrophil-to-lymphocyte ratio and tumor type) scoring system was the first validated prognostic score for MPE. Based on their analysis, hematologic malignancies are considered a low risk tumor type with a LENT score between 0 to 1, but their analysis only included a small number of these tumors which were primarily lymphoma. We hypothesize significant heterogeneity in terms of disease course and survival exist among the various hematologic malignancies. Our objective was to evaluate the LENT score in various hematologic malignancies and compare outcomes. METHODS: A retrospective review of all hematologic malignancies undergoing pleural intervention from 1/2004 to 8/2018 was performed. Hematologic malignancies were categorized into lymphoma, acute leukemia, chronic leukemia and multiple myeloma. MPE was confirmed based on cytology, flow cytometry, pleural biopsy, radiographic evidence of malignancy, or clinical consensus. Pleural effusions due to other etiologies were excluded. Survival time was calculated from the date of first pleural intervention for MPE to death. Preliminary data for 584/999 patients is included. RESULTS: Of the 584 patients identified, there were 57% women, and the median age was 64 (17 to 94). Hematologic malignancies included 57.4% lymphoma, 17.6% acute leukemia, 14.2% chronic leukemia, and 10.8% multiple myeloma. 50.5% had newly diagnosed disease, and 49.5% had evidence of disease relapse. Most (72.4%) were on active treatment for their cancer. The majority (82.5%) were performed in the inpatient setting, and 87.1% had unilateral effusions. Confirmation of MPE was based on cytology in 86.8%, flow cytometry in 60.6%, radiographic imaging in 29.1%, pleural biopsy in 1.0% and clinical consensus in 16.9%. LENT score distribution was as follows: 0 in 0.7%; 1 in 15.7%; 2 in 29.8%; 3 in 32.9%; 4 in 15.7%; 5 in 5.1%. Median survival for groups were as follows: lymphoma 156 days 95% CI (106 to 217); acute leukemia 82 days 95% CI (57 to 97); chronic leukemia 198 days 95% CI (131 to 370); multiple myeloma 149 days 95% CI (70 to 215). Log –rank test for equality of survivals showed significant differences in survival between groups (p<0.001) CONCLUSIONS: For the majority of hematologic malignancies in our cohort, the LENT score was 2 or greater. Median survival differs among the various hematologic malignancies, and the current LENT score may overestimate survival for certain hematologic malignancies. CLINICAL IMPLICATIONS: The LENT prognostic scoring system is a useful tool for risk stratification and prognostication in MPE, but there may be significant differences in survival among hematologic malignancies. DISCLOSURES: No relevant relationships by Lara Bashoura, source=Web Response no disclosure on file for George Eapen; No relevant relationships by Saadia Faiz, source=Web Response No relevant relationships by Horiana Grosu, source=Web Response No relevant relationships by William Harding, source=Web Response No relevant relationships by Carlos Jimenez, source=Web Response No relevant relationships by Oriana Salamo, source=Web Response No relevant relationships by Mark Warner, source=Web Response No relevant relationships by Kathleen Zavalla, source=Web Response