Blood Cancer Patients Research Articles

Risk factors and outcome of COVID-19 in patients with hematological malignancies

BackgroundPrognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined.Patients and methodsThis was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020.ResultsWe included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1–93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2–3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6–5.2, p < 0.0001); ECOG 3–4 (OR, 2.56, 95% CI 1.4–4.7, p = 0.003); neutropenia (< 0.5 × 109/L) (OR 2.8, 95% CI 1.3–6.1, p = 0.01); and a C-reactive protein (CRP) > 20 mg/dL (OR 3.3, 95% CI 1.7–6.4, p < 0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2–0.89 and OR 0.31, 95% CI 0.11–0.87, respectively, p = 0.02) whereas the use of hidroxycloroquine did not show significant improvement in OM (OR 0.64, 95% CI 0.37–1.1, P = 0.1).ConclusionsIn most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of inflammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19.

Abstract 4343: Retrospective study of incidence and survival for patients with hematological malignancies residing at the U.S./Mexico border

Abstract Introduction: Hispanics represent the largest minority group in the United States (U.S.), with 57.5 million individuals. The majority of Hispanics in the U.S. reside in the Southwest region, and &amp;gt;11 million live in the state of Texas. Health disparities for Hispanic cancer patients have previously been linked to disproportionate poverty and other barriers to optimal healthcare. In the case of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), Hispanics were found to be diagnosed at a younger age and have worse overall survival (OS) compared with non-Hispanic whites (NHWs) (ACS Cancer Facts &amp; Figures for Hispanics/Latinos 2018-2020). However, little is known about incidence and survival for Hispanic blood cancer patients residing at the U.S./Mexico border. Methods: We retrospectively reviewed data from the Texas Cancer Registry for hematologic malignancies diagnosed in the state of Texas between 1995 and 2016, focusing our analysis on chronic and acute leukemia's (both myeloid and lymphoid), myelodysplastic syndrome (MDS), and myeloproliferative neoplasms (MPNs). Survival for Hispanic and NHW groups was compared using the log-rank test, and Cox regression analyses adjusting for age and diagnosis. Differences in age at diagnosis were evaluated using t-tests and generalized linear models. Research was conducted according to a local IRB-approved protocol in accordance with the Declaration of Helsinki. Results: Of the 69,941 cases of hematologic malignancies with available information throughout the state of Texas, 18.29% identified as Hispanic. We found that Hispanic patients were diagnosed at a significantly younger age in all diseases analyzed (p&amp;lt;0.0001). Surprisingly, in unadjusted analyses, Hispanics had significantly better OS than NHWs diagnosed with myeloid malignancies (p&amp;lt;0.0001), but no significant differences for patients with other types of leukemia. After adjusting for age, there was a clear disparity in OS for Hispanic versus NHW patients with ALL (p&amp;lt;0.0001) and acute promyelocytic leukemia (APL, p=0.03), with no significant differences in other diseases. We also compared Hispanic patients diagnosed in El Paso versus Hispanics from the rest of Texas. Hispanics in El Paso had a significant reduction in OS compared to Hispanics in other areas of Texas for ALL (p=0.0164), AML (p&amp;lt;0.0001), and chronic myeloid leukemia (CML, p=0.016). Conclusions: Hispanics are diagnosed at a significantly younger age than NHWs in all blood malignancies analyzed. Hispanic patients with AML, MDS, and CML had significantly better OS compared to NHWs in unadjusted analyses, which could be explained by the reduced age of diagnosis. Hispanics with ALL, AML, or CML diagnosed near the U.S./Mexico border demonstrate worse OS compared with Hispanics diagnosed in other areas of Texas. In age-adjusted analyses, Hispanic patients with ALL or APL have a worse OS compared with NHWs. There appears to be evidence that disparities in outcome by ethnicity may be different in El Paso compared with the rest of Texas. Future Directions: Our data demonstrates blood cancer disparities present in our region. Further study is required to identify factors responsible for the disparity in OS, and to identify ways to address it. Citation Format: Alfonso E. Bencomo, Andres J. Rubio, Mayra A. Gonzalez, Idaly M. Olivas, Joshua J. Lara, Kiran Ghimire, Osvaldo Padilla, Angelica Padilla, Nawar Hakim, Attilio Orazi, Javier Corral, Alexander Philipovskiy, Sumit Gaur, Anna M. Eiring. Retrospective study of incidence and survival for patients with hematological malignancies residing at the U.S./Mexico border [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4343.

COVID‐19 in bone marrow transplant recipients: reflecting on a single centre experience

Covid-19 disease is caused by a novel SARS-CoV-2 virus and has been declared a pandemic on the 9th of March by WHO. Hallmark of COVID-19 management is supportive care and there is still no convincing evidence on a treatment which will reduce mortality. Severe COVID-19 associated sepsis characterized by acute respiratory distress syndrome (ARDS), secondary bacterial pneumonias thrombotic complications, myocarditis, and gastrointestinal involvement are more prevalent in those with comorbidities such as hypertension, diabetes, cardiac disease, cancer and age>70 years (Liang et al; 2020, Guan et al; 2019).

Investigations of Bioactivity of Acalypha indica (L.), Centella asiatica (L.) and Croton bonplandianus (Baill) against Multidrug Resistant Bacteria and Cancer Cells

The rate of infections caused by multidrug resistant (MDR) bacteria has recently increased worldwide. Such infections are prevalent in blood cancer patients increasing the risk of disease complications and mortality. This study aimed to investigate the potential of ethnomedicinal plants to inhibit the growth or survival of MDR bacteria and blood cancer cells. A series of major steps were conducted. First, 190 gram-negative clinical pathogens were collected in central region of Saudi Arabia, of which 89 (46.84%) were identified as extended spectrum of β-lactamase producers and 43 (22.63%) were Carbapenem-resistant. Second, ethanolic fraction and petroleum ether fraction were generated from Acalypha indica (L.), Centella asiatica (L.) and Croton bonplandianus (Baill). Third, antimicrobial analyses revealed that the ethanolic fraction of C. bonplandianus (Baill.) and A. indica (L.) exhibited superior activity against MDR pathogens with minimum inhibitory concentrations (MICs) = 1024–256 μg/mL and 1024–512 μg/mL, respectively. Fourth, cellular viability assay showed that the ethanolic fraction of C. bonplandianus had the highest activity against the survival of blood cancer cells (50% cytotoxic concentration (CC50) of K562 cells = 86.33 ± 10.06 μg/mL and CC50 of Raji cells = 470 ± 35.57 μg/mL). Fifth, flow-cytometric analyses indicated that necrosis was the type of cellular death induced in the malignant cells by C. bonplandianus (necrotic cells = 44%, p = 0.004, n=3). Finally, gas chromatography and tandem mass spectrometry (GC-MS/MS) analyses further supported these findings by identifying phytocompounds with known antibacterial and anticancer properties in the active plant fractions. Overall, the findings indicated a dual activity of C. bonplandianus against MDR bacteria and blood cancer cells.

Perspectives Regarding Hospice Services and Transfusion Access: Focus Groups With Blood Cancer Patients and Bereaved Caregivers

ContextPatients with blood cancers have low rates of timely hospice use. Barriers to hospice use for this population are not well understood. Lack of transfusion access in most hospice settings is posited as a potential reason for low and late enrollment rates. ObjectivesWe explored the perspectives of patients with blood cancers and their bereaved caregivers regarding the value of hospice services and transfusions. MethodsBetween June 2018 and January 2019, we conducted three focus groups with blood cancer patients with an estimated life expectancy of six months or less and two focus groups with bereaved caregivers of patients with blood cancers. We asked participants their perspectives regarding quality of life (QOL) and about the potential association of traditional hospice services and transfusions with QOL. A hematologic oncologist, sociologist, and qualitatively trained research assistant conducted thematic analysis of the data. ResultsTwenty-seven individuals (18 patients and nine bereaved caregivers) participated in the five focus groups. Participants identified various QOL domains that were important to them but focused largely on a desire for energy to maintain physical/functional well-being. Participants considered transfusions a high-priority service for their QOL. They also felt that standard hospice services were important for QOL. Bereaved caregivers reported overall positive experiences with hospice. ConclusionOur analysis suggests that although patients with blood cancers value hospice services, they also consider transfusions vital to their QOL. Innovative care delivery models that combine the elements of standard hospice services with other patient-valued services like transfusions are most likely to optimize end-of-life care for patients with blood cancers.

Meeting the Information and Support Needs of Blood Cancer Patients and Caregivers: A Longitudinal Study of a Model of Patient-Centered Information Delivery.

Access to reliable, up-to-date information and resources can assist individuals managing and living with cancer. The Leukemia & Lymphoma Society, through its Information Resource Center, provides personalized information and support to individuals affected by blood cancer. To examine its value and impact, we conducted qualitative interviews (n = 18) and an online survey of patients and caregivers (N = 515) after they talked with an Information Resource Center Information Specialist by phone, with a follow-up survey about 6 months later. Respondents most commonly contacted the Information Resource Center to get referrals to support programs (40.4%) and to obtain information about getting a second opinion (36.5%) and financial assistance (36.2%). After talking with an Information Specialist, respondents felt more hopeful (85.9%), more confident in managing care (82.9%), and more knowledgeable about their diagnosis (49.5%) and financial resources (42.4%). After speaking with an Information Specialist, respondents changed how they advocated for themselves/loved one (23.8%), changed how they communicated with doctors/other providers and family/friends (both 15.9%), received financial assistance (22.2%), and took other actions. Among respondents who took actions, most said that the conversation(s) had positively impacted the action. Respondents who spoke with an Information Specialist more than once were more likely to report positive impacts, including changing how they advocate for themselves/loved one and communicate with providers (both p < 0.05). Respondents diagnosed more recently were also more likely to report positive impact, including changing the way they communicate with providers (p < 0.05). Findings highlight the value of cancer helplines and suggest ways they can be most effective.

Investigating the Relationship Between Posttraumatic Growth Dimensions and Posttraumatic Stress Symptoms in Blood, Colorectal and Breast Cancer Patients

Investigating the Relationship Between Posttraumatic Growth Dimensions and Posttraumatic Stress Symptoms in Blood, Colorectal and Breast Cancer Patients

Retrospective Study of Incidence and Survival for Patients with Hematologic Malignancies Residing at the U.S./Mexico Border

Introduction: Hispanics represent the largest minority group in the United States (U.S.), with 57.5 million individuals (18% of the population). Most U.S. Hispanics are of Mexican origin (63.2%), followed by Puerto Rican (9.5%), Cuban (3.9%), Salvadoran (3.8%), and Dominican (3.3%), but distribution varies by state. The majority of Hispanics in the U.S. reside in the Southwest region, and &gt;11 million live in the state of Texas. Cancer is the leading cause of death in the Hispanic population, accounting for 21% of deaths in people of all ages. Health disparities for Hispanic cancer patients have previously been linked to disproportionate poverty and other barriers to optimal healthcare, and in the case of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), Hispanics were found to be diagnosed younger and to have worse overall survival (OS) than Non-Hispanic whites (NHWs) (ACS. Cancer Facts &amp; Figures for Hispanics/Latinos 2018-2020). However, little is known about incidence and survival for Hispanic blood cancer patients residing at the U.S./Mexico border. To understand the impact of Hispanic ethnicity on outcomes for blood cancer patients diagnosed in this area, we examined OS in adult patients with hematologic malignancies throughout the state of Texas compared to Texas Health Service Region (HSR) 10, encompassing El Paso County. Methods: We retrospectively reviewed data available from the Texas Cancer Registry for hematologic malignancies diagnosed in the state of Texas between 1995 and 2016, focusing our analysis on chronic and acute leukemias (both myeloid and lymphoid), myelodysplastic syndrome (MDS), and myeloproliferative neoplasms (MPNs). Survival for Hispanic and NHW groups was compared using the log-rank test, and Cox regression analyses adjusting for age and diagnosis. Differences in age at diagnosis were evaluated using t-tests and generalized linear models. Similar analyses compared Hispanic patients from HSR 10 versus Hispanic patients from the rest of Texas. Research was conducted according to a local Institutional Review Board-approved protocol in accordance with the Declaration of Helsinki. Results: Of the 69,941 cases of hematologic malignancies with available information throughout the state of Texas, 18.29% self-identified as Hispanic. Surprisingly, in unadjusted analyses, Hispanic patients had significantly better OS than NHWs diagnosed with AML (p&lt;0.0001), MDS (p&lt;0.0001), and chronic myeloid leukemia (CML, p&lt;0.0001), with no significant differences in OS for patients with ALL, MPN, acute promyelocytic leukemia (APL), or chronic lymphocytic leukemia (CLL). However, Hispanic patients were diagnosed at a significantly younger age in all diseases analyzed (Table 1), possibly explaining the improved survival. After adjusting for age, ALL (HR 1.32, p&lt;.0001), CLL (HR 1.11, p=0.002), and CML (HR 1.15, p=0.008) showed significantly worse outcomes for Hispanics, with better outcomes in MDS (HR 0.92, p=0.0004), and no significant differences for AML, APL or MPN. Running the same analyses for the entire El Paso population versus the rest of Texas, we found no significant interaction except for a suggestion of a greater ethnic disparity in CML patients from El Paso (p=0.06). We also compared Hispanic patients diagnosed in El Paso versus Hispanics from the rest of Texas. Hispanics in El Paso had a significant reduction in OS compared to Hispanics in other areas of Texas for patients with ALL (p=0.0164), AML (p&lt;0.0001), and CML (p=0.0160), but not for patients with APL, CLL, MDS, or MPN. Again the negative effects become less marked after adjustment for age, as those diagnosed in El Paso tended to be 3 years older at diagnosis than elsewhere in Texas. In analyses adjusted for age and diagnosis, there was again a suggestion that differences between El Paso and the rest of Texas were greater in Hispanics than NHW (p=0.08). Conclusions: While Hispanic patients with AML, MDS, and CML had significantly better OS compared to NHWs in Texas as a whole, this could be explained by a significant reduction in the age of diagnosis for Hispanics. However, when comparing across Texas, El Paso Hispanics with ALL, AML, and CML have a worse prognosis than in the rest of the state. There appears to be evidence that disparities in outcome by ethnicity may be different in El Paso compared with the rest of Texas. Further study is required to identify factors responsible for the disparity in OS. Disclosures No relevant conflicts of interest to declare.

Correlation of Oxidative Stress Biomarkers and Hematological Parameters in Blood Cancer Patients from Sardinia, Italy

Background: Over the last few decades, there has been a dramatic increase in hematological malignancies (HMs) in the population of Sardinia. It is accepted that oxidative stress biomarkers have been demonstrated to be prognostically important in various neoplastic diseases. The aim of this study is to evaluate serum vitamin E, total antioxidant capacity (TAC), Malondialdehyde (MDA) and reactive oxygen species (ROS) levels in 80 Sardinian patients with different HMs [acute myeloid leukemia (AML)(n=20), myelodysplastic syndromes (MDS) (n=20), Hodgkin lymphoma (HL) (n=20) and non-Hodgkin lymphoma (NHL) (n=20)] on the day of their diagnosis. Materials and Methods: Samples from all participants were obtained after an overnight fast (at least 10 hours). This study was approved and conducted in accordance with Good Clinical Practice guidelines and the Declaration of Helsinki. Patients and controls provided written, informed consent before entering the study. All study participants' medical history and their medication were documented upon enrolling. Results: Lower levels of TAC and Vitamin E were observed in most of the studied groups compared to healthy controls (0.41-0.49 mmol/L vs. 0.56 mmol/L) (19.55-28.55 μmol/L vs. 34.51 μmol/L). Moreover, higher average MDA levels were observed in HL and NHL patients compared to healthy controls (16.6 ng/ml-17.8 ng/ml vs. 7.4 ng/ml). Additionally, the ROS values of all studied groups were found elevated. Serum TAC showed significant negative correlations with MDA values (R= -0.51; P<0.001). Statistical significance was observed in all hematological parameters, producing either positive or negative correlation with at least one OS biomarker. Conclusion: The present data suggest that Sardinian patients with HL and NHL on the day of their diagnosis presented the highest OS in comparison to AML and healthy subjects. Moreover, MDS patients presented high OS status. Likewise, our results also indicated that changes in their hematological indices are eminent of their oxidative and antioxidative status.

Strength in Complementary Weaknesses: An Effective Dual Specificity Antibody Approach against Ovarian Cancer

Ovarian cancer (OvCa) is the most lethal of gynecological diseases and is known for chemoresistance and frequent reoccurrence with no effective treatment available(1). Therefore, developing safe and efficacious therapies that improve long‐term progression free survival remains an urgent unmet medical need. Recent clinical data indicates that immune system activating antibodies (mono‐specific or bispecific) are highly effective in chemoresistant blood cancer and melanoma patients(2–5). However, in the solid tumors of epithelial origin, including high‐grade serous ovarian carcinomas, antibody‐based approaches have not produced similar clinical outcomes. One major roadblock to the success of therapeutic antibodies in solid cancers is the ineffective penetration of the immune effector cells into the sturdy tumor bed(6, 7), a requisite for the natural killer cell‐mediated antibody‐directed cell cytotoxicity (ADCC) and killer T‐cell‐mediated cytotoxicity (8–10). In support, various solid epithelial cancer approved antibodies targeted against receptor tyrosine kinases have also indicated that ADCC contribution is not a major part of their efficacy in breast(11–14), colorectal(15–17), renal(18), and lung cancers(19).Farletuzumab, an ADCC activating humanized antibody targeted against folate receptor alpha‐1 (FOLR1) improves survival for a very small subset of OvCa patients having low Cancer antigen‐125 levels (20–24). Thus we strongly argue that in larger OvCa populations, which highly overexpress Cancer antigen‐125, ADCC‐based targeting approaches are not clinically feasible options (25–27). Since FOLR1 levels are strikingly elevated in &gt;80% of high‐grade serous tumors, we hypothesize that if farletuzumab's activity is significantly enhanced beyond the ADCC function, the potential to achieve effective clinical response is very high in a larger subset of OvCa patients. One such approach is epithelial cancer enriched death receptor 5 (DR5/TRAIL‐R2) activating antibodies (28, 29). TRAIL‐R2 is a major extrinsic apoptotic pathway receptor expressed in tumors of epithelial origin(30)and we have engineered a novel OvCa selective Bispecific‐anchored Cytotoxicity‐activator (BaCa) antibody that combines the specificities against the FOLR1 and TRAIL‐R2 and is highly superior to failed clinical antibodies both in vitro and in vivo. Importantly, the cytotoxic function of the BaCa antibody is self‐sufficient on readily available inhibitory Fc‐gamma receptor expressing tumor‐associated leukocytes(31), and does not require distinct infiltration of immune effector NK cells or T‐cells into the tumor microenvironment. Since extrinsic TRAIL‐R2 induced cell‐death is independent of intrinsic p53‐mediated apoptosis, the BaCa antibody reflects a tailored treatment strategy for the majority of serous ovarian carcinomas (&gt;90%) harboring p53 loss‐of‐function mutations(29, 32). Therefore, if given opportunity to present this work (as a talk) in the meeting, I will show detailed data on BaCa antibody engineering, selectivity, safety and efficacy using relevant OvCa models.Support or Funding InformationUniversity of Virginia Cancer CenterThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Alloanergization Method for Inducing Allospecific Hyporesponsiveness in PBMC Exposed to Allostimulation In Vitro in the Context of Costimulatory Molecule Blockade.

Alloantigen-specific hyporesponsiveness can be induced in alloreactive T cells contained within the whole peripheral blood mononuclear cell (PBMC) population by stimulating these responder cells ex vivo with HLA-mismatched stimulator PBMC as the antigen presenting cell (APC) source, in the presence of a CD28 costimulation blocking agent. As a result of this approach, specific alloreactivity is markedly decreased (by 1-2 logs), but third-party alloresponses and in vitro responses relying on the activation of pathogen- and tumor-associated antigen T-cell functional activities are not globally impinged upon (Guinan et al. N Engl J Med 340(22):1704-1714, 1999, Davies et al. Transplantation 86(6):854-864, 2008, Davies et al. Cell Transplant 21(9):2047-61, 2012). This method has been used clinically to alloanergize bone marrow and PBMC allografts, creating ex vivo cell therapies for adoptive transfer to blood cancer patients at high risk of disease relapse whose best option was to receive haploidentical hematopoietic cell transplants. These early phase trials consisting of, or containing, alloanergized T-cell infusions show promise in reducing graft-versus-host disease (GvHD), providing more rapid immune reconstitution, and decreasing severe post-transplant infectious complications and disease relapse. Herein, we describe this straightforward technique for generating alloanergized PBMC as it is performed in the research lab setting using belatacept for CD28-mediated costimulatory blockade (CSB) and PBMC isolated by Ficoll Hypaque gradient centrifugation as responders and APC. We also describe methods for evaluating subsequent alloproliferation to first and third party stimulation as well as assessment of cell division, pathogen-specific immunity, or allosuppression. The technique has successfully been transferred to collaborating labs, largely owing to the flexibility of using fresh or frozen PBMC, the lack of a requirement for specially isolated APC populations, and the ability to scale up or scale down the cell numbers that are to be anergized.

Adult-related haematopoietic stem cell donor experiences and the provision of information and psychosocial support: A systematic literature review.

For blood cancer patients, haematopoietic stem cells (HSC) donated by a relative can be lifesaving. However, related donors can face significant physical and psychosocial challenges. As the demand for adult-related HSC donors is increasing, it is important to review our understanding of adult-related HSC donors' need for and availability of information and psychosocial support with a view to identifying gaps in the literature. A systematic review of relevant studies (2000-2017) was conducted using five databases with supplementary hand searching. Sixteen studies involving 1,024 related HSC donors met the following criteria: English or Dutch language, peer-reviewed, sampled first-time-related HSC donors, ≥18years, haematological malignancies, assessed psychosocial aspects, retrospective or prospective and with or without comparison group. Data were abstracted, and study quality was assessed using the PRISMA criteria. Studies contained limited information on the provision of information and psychosocial support. Most studies addressed pre-donation information, and none reported providing information or support to donors post-donation. Additionally, few studies formally assessed unmet needs. Recommendations include improved transparency of reporting for the availability, sources and timing of information and psychosocial support, and the identification of unmet needs to enable the development of educational and psychosocial interventions for this invaluable donor population.

Association between Toxoplasma gondii exposure and paediatrics haematological malignancies: a case-control study.

The possible association between Toxoplasma gondii infection and paediatric haematological malignancies in a group of patients and control subjects was evaluated in the present study. We performed an age-, gender- and residence frequency-matched case-control study of 101 blood cancer patients under 18 years of age, all of which were treated in Amirkola Pediatric Hospital. One hundred and thirty-eight control samples were gathered from the outpatient clinic in the hospital. All cases and controls were tested for the presence of anti-Toxoplasma IgG antibodies and then IgG-positive subjects were evaluated for IgM antibodies by enzyme-linked immunoassays. Anti-T. gondii IgG antibodies were found in 37 (36.6%) of the cases and 12 (8.7%) subjects in the control group (odds ratio 6.07, 95% confidence interval 2.963-12.437, P < 0.0001). The median and interquartile range (IQR) of IgG titre from case group (7.7 (IQR 0.25-13.5)) was higher than the control (0.2 (IQR 0.1-0.5)) (P < 0.0001). The frequency of anti-T. gondii antibodies (IgG) in lymphoblastic leukaemia (acute lymphoblastic leukaemia), Hodgkin's lymphoma and T-cell lymphoma were 33 (31.9%), 3 (50%) and 1(100%), respectively. Anti-T. gondii IgM was not detected in the IgG-positive patients in case group. In the case subjects, no significant difference was seen in the positive rates of T. gondii infection between genders (37.3% in male; 35.7% in female; P = 0.52) and ages groups (P = 0.31). This study demonstrated that T. gondii infection is prevalent in children with blood cancer. It also showed that toxoplasmosis may possibly be linked with an increased risk of childhood haematologic malignancies. Furthermore, these results may be helpful in research on blood neoplasia aetiology.

Impact of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) on central line-associated bloodstream infections (CLABSIs) in department of hematology at single university hospital in Japan.

Central line-associated bloodstream infections (CLABSIs) are among the most serious complications especially in blood cancer patients. In January 2013, Centers for Disease and Prevention (CDC) introduced a new surveillance definition of mucosal barrier injury-associated laboratory-confirmed bloodstream infection (MBI-LCBI). This study was to determine the impact of MBI-LCBI on CLABSIs and compare the clinical characteristics of MBI versus non-MBI-LCBI cases. We retrospectively reviewed the records of 250 consecutive patients. They were admitted in department of hematology at Aichi Medical University Hospital. We applied the revised 2013 CLABSI surveillance protocol to all CLABSI cases identified during the 47-months period from May 2012 through June 2016. A total of 44 CLABSIs were identified. The median patient age was 65 years (range, 12 to 89). Among 44 patients, 31 patients were diagnosed as leukemia (70.5%) and 12 patients as lymphoma (27.3%). Six patients underwent bone transplantation for leukemia or myelodysplastic syndrome (13.6%). A total of 20 patients (45.5%) were classified as MBI-LCBI and 24 (54.5%) were classified as non-MBI-LCBI. The primary disease type (P=0.018), neutropenic within 3 days before CLABSI (MBI-LCBI vs. non-MBI-LCBI: 95.0% vs. 26.3%, P=<0.0001), line(s) removed owing to CLABSI (15.0% vs. 54.2%, P=0.011) and Gram-negative organisms cultured (70.0% vs. 37.5%, P=0.004) showed significantly difference between the groups. Our data showed that MBI-LCBI cases account for 45.5% of the CLABSI cases identified in blood cancer patients, and constituted a significant burden to this high-risk patient population.

Heart failure following blood cancer therapy in pediatric and adult populations.

The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N=23434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

ContextHematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests that these patients have a sizable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited. ObjectivesTo compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services. MethodsUsing a novel data registry of initial palliative care encounters, we performed a cross-sectional analysis of cancer patients receiving care across 17 sites within the Global Palliative Care Quality Alliance. We compared clinically-significant symptoms (rated as four or greater in severity) between hematologic and solid tumor patients and performed multivariate logistic regression analyses examining the relationship between symptom burden and tumor type. ResultsWe identified 1235 cancer patients, 108 of which had hematologic malignancies. Pain, dyspnea, nausea, and anorexia burden were as high among patients with hematologic as those with solid malignancies. Blood cancer patients had higher rates of clinically-significant tiredness (51% vs. 42%; P = 0.03) than solid tumor patients. Finally, blood cancer patients had greater odds of being tired (odds ratio 2.19; CI 1.22–3.91) and drowsy (odds ratio 1.81; CI 1.07–3.07) than solid tumor patients independent of age, gender, race, and performance status. ConclusionsHematologic and solid tumor patients have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population.

Safe fluoroquinolones prophylaxis in blood cancer patients with chemotherapy-induced neutropenia and Glucose-6-Phosphate-Dehydrogenase deficiency.

Bacterial infections are the leading causes of morbidity and mortality in haematologic patients with chemotherapy-induced neutropenia. The only strategy shown to be effective in reducing febrile neutropenia incidence is fluoroquinolone prophylaxis, but the safety of this class of drugs in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD-), the most common human enzyme defect, is still controversial because of the claimed association with acute haemolytic anaemia. We retrospectively analysed 242 patients treated with 628 intensive chemotherapy courses. Of these, 59 patients were with G6PD-. All patients underwent fluoroquinolone prophylaxis and were transfused according to our single-unit transfusion policy. The principal endpoint was the incidence of acute haemolytic anaemia. Secondary endpoints included the incidence of febrile neutropenia, microbiologically and clinically documented infection (MDI and CDI) and the incidence of Gram-positive or Gram-negative infections. No episode of acute haemolytic anaemia was observed in the entire cohort. The incidence of MDI and CDI was similar, but the incidence of invasive fungal disease (IFD; P<.0001, HR 11.4, 95%CI 3.5-37.05) and Candida sepsis (P=.008, HR 37, 95%CI 2.01-680.9) was higher in patients with G6PD-. Interestingly, we observed a reduced incidence of febrile neutropenia in patients with G6PD- (P=.01, HR 0.46, 95%CI 0.25-0.8). Our data suggest that fluoroquinolone prophylaxis in patients with G6PD-, treated with intensive chemotherapy, is feasible and safe. Our findings on the incidence of IFD and febrile neutropenia suggest that G6PD may be important in susceptibility to opportunistic pathogens and host response in neutropenic patients.

Supportive Care Requirement in Accordance with the Therapeutic Purposes of Hematologic Malignancies Undergoing Chemotherapy

Objectives This study was performed to investigate the supportive care needs in accordance with therapeutic purposes of blood cancer patients. Methods The study was conducted among 100 subjects treated as hematologic malignancies during 2016 in Daegu. The questionnaires included various disease-specific characteristics including Supportive Care Needs Survey-long form 59. We analyzed data using descriptive statistics, t-test, ANOVA and ANCOVA. Results Of 6 domains in Supportive care needs survey (SCNS), the psychological domain showed the highest score followed by the patient care and support domain and the physical and daily living domain. The supportive care needs had a significant relationship with therapeutic purposes of blood cancer patients. The health system and information domain of supportive care needs was the highest in the patients who had been taking remission induction chemotherapy, while psychological domain was the highest in those who had been taking chemotherapy about consolidation therapy or relapse, and physical and daily living domain was the highest in the patients who had been taking chemotherapy before bone marrow transplantation. Conclusions The patients with hematologic malignancy showed a distinct difference of supportive care needs depending on their therapeutic purposes. Patients’ supportive care needs with hematologic malignancy should be assessed and used to provide patient-centered care. Key words: Hematologic neoplasms, Needs assessment, Chemotherapy, Patient-centered care

Differences in the economic valuation and determining factors of informal care over time: the case of blood cancer

ObjectiveTo estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. Methods139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. Results123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 €/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. ConclusionsInformal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients.

Development and implementation of clinical pathways across a network of blood cancer programs.

161 Background: The Sarah Cannon Blood Cancer Network (SCBCN) is comprised of 7 blood cancer and Hematopoietic Cell Therapy (HCT) programs providing care for complex blood cancer patients. Network commitment to achieving standardization of care for quality and clinical platforms led to process design for development of evidence-based pathways. Methods: Standard operating procedures and a document control process were developed by the network quality management (QM). With oversight by physician leaders, initial efforts focused on standardizing patient selection criteria for HCT followed by formation of disease-specific work groups (leukemia, lymphoma, multiple myeloma, HCT). Physician-led and composed of key network team members (PharmDs, QM professionals, SCBCN leaders, research staff), the groups are responsible for developing evidence-based diagnostic and treatment pathways/algorithms for hematologic malignancies. Members participate in monthly teleconferences to develop the pathways. Annual review and deviation tracking are conducted, providing a mechanism for subsequent pathway revisions reflecting changing treatment paradigms and updated clinical evidence. QM oversees implementation and tracking across the network. Deviation tracking is managed locally using pathway-associated algorithms, with attending physician attestation to either compliance or pathway deviation/reason (e.g. co-morbidity, age, disease status, enrolled on clinical trial, other). Results are reported quarterly with review by QM. Results: See table. To date, 13 HCT pathways (18 algorithms) have been developed and released to SCBCN programs. Final approval is pending for 5 disease-based pathways (19 algorithms). Conclusions: The first compliance report will be submitted to QM in December, 2016. While deviation tracking has been paper-based, work efforts are underway to implement an electronic solution, enabling automated real-time monitoring. Implementation is expected in early 2017. [Table: see text]