Care Cancer Center Research Articles

Videolaryngoscopy findings in laryngopharyngeal malignancies in Tertiary Cancer Care Centre – A descriptive study of Annual Data

Aim: Our study was intended to analyze the videolaryngoscopy findings and find annual percentage prevalence ofcarcinoma larynx, hypopharynx, oropharynx and its sub-sites, also assessing its effectiveness for diagnosis and follow-up. Materials and methods: Patients who attended ENT OPD and diagnosed later with biopsy-proven carcinoma andpatients referred from the oncology department after chemo radiotherapy for follow-up from April 2023 to March2024 underwent videolaryngoscopy assessment. Results: A total of 132 patients underwent videolaryngoscopy, of whom 92 (69.7%) were male and 40 (30.3%)female. Carcinoma larynx cases were 54 (40.9%), out of which supraglottis 26 (48%), glottis 27 (50%), andsubglottis 1 (2%). Carcinoma hypopharynx cases were 61 (46.2%), out of which pyriform fossa 32 (52.5%),postcricoid 27 (44.3%), and posterior pharyngeal wall 2 (3.2%). There were 15 oropharynx (11.3%) and 2 (1.6%) other malignancy patients. 6 patients (4.5%) had two primary lesions. 25 patients (17.8%) had a T1 lesion, 48patients (34.3%) had a T2 lesion, 47 patients (33.6%) had a T3 lesion, and 20 patients (14.3%) had a T4 lesion. Theoverall purpose of videolaryngoscopy was diagnostic in 51 patients (38.6%) and follow-up after chemoradiotherapyin 81 patients (61.4%). Out of 41 diagnostic patients, (80.3%), a biopsy was done with videolaryngoscopy. In followupafter chemoradiotherapy, 37 out of 81 patients (45.7%) were asymptomatic without any recurrence or residuallesion. 44 out of 81 patients (54.3%) had symptomatic lesions and were advised further follow-up, radiologicalinvestigation, repeat biopsy, and radical surgery. Conclusion: Videolaryngoscopy is a simple outpatient efficacious investigation in the diagnosis follow-up ofpatients with laryngopharyngeal carcinoma.

Identifying Trends in Glycemic Management in the Acute Cancer Care Center at MD Anderson Cancer Center

Identifying Trends in Glycemic Management in the Acute Cancer Care Center at MD Anderson Cancer Center

Do Uro-Oncology Day Care Procedures Need to Be Differed during COVID-19 Pandemic?-An Experience from Tertiary Cancer Care Center.

Mahendra PalBackground The SARS-CoV-2 virus pandemic has affected millions all over the world in very short span and changed the way how health care system work across the globe. It is essential to continue cancer treatment in spite of such pandemics. Various recommendations were proposed for cancer management based on risk stratification, however, in urological malignancies, day care procedures (DCPs) are a part of complete spectrum of cancer care and standard operating procedures (SOPs) for day care procedures (DCPs)in oncology is lacking at present. Materials and Methods This is an institutional review board approved retrospective observational analytical study performed in tertiary cancer care center, with aim to assess the impact of COVID-19 on Uro-oncology day care procedures (U-DCPs)in terms of changes in appointments and actual U-DCPs performed, demographic changes such as sex ratio and age wise attendance in pre and post lockdown period and to provide a SOPs to accomplishU-DCPsefficiently in pandemics. Results There was 67.89% and 68.16% reduction in total numbers of appointment and performed U-DCPs. A statistically significant difference was found in cystoscopy, intravesicalinstallation and miscellaneous UDCPs. Overall, 4.45% reduction and 4.52% increase in male and female patients underwent UDCPs respectively, M:F ratio reduced from 3.58:1 to 2.79:1 and 30% to 50% reduction in overall patient statistics in post lockdown compare to pre lockdown procedures. For various age groups there was a statistically significant change in the number for males underwent cystoscopy in (p<0.001), Intravesical therapies (p<0.001) and miscellaneous procedures(p< 0.004). Conclusion We are now coming up to the fact that effective management of healthcare system during pandemics require establishment and effective implementation of standard protocols. Routine major urological surgical care is continued using a tiered standard of protocols (SOPs) and adequate precautions. This study may provide an insight into impact of COVID-19 on UDCPs and what precautions and strategies can be institutionalized so that the patients and the health care workers remain protected from contracting infection while in performing DCPs during pandemic or similar circumstances.

Distant metastasis at the time of presentation of head and neck squamous cell carcinoma: a retrospective chart review from a tertiary cancer care centre.

To evaluate the rates and patterns of distant metastasis in head and neck SCC at the time of presentation and to study the association between distant metastasis with pre-treatment, clinical, and pathological predictors of outcomes. This is a retrospective study conducted in a tertiary care hospital. All patients with primary head and neck squamous cell carcinoma that had been evaluated at our institute between October 2018 and December 2020 were included in the study. Various clinical data were analysed and pattern of metastasis was studied. Ten per cent (50 cases) of 501 studied patients had distant metastasis. The most common site of distant metastasis was lung. The rate of distant metastasis was high in patients with poorly differentiated cancers. By Kaplan-Meier analysis, the median survival duration after diagnosis of metastasis was four months. The rate of distant metastasis was 10 per cent in the study. Patients with poorly differentiated tumours, locally advanced primary lesions, higher nodal stage, particularly with extra nodal extension, and hypopharyngeal primary, tend to exhibit increased risk for distant metastasis at the time of presentation.

The effectiveness and safety of palbociclib and ribociclib in stage IV HR+/HER-2 negative breast cancer: a nationwide real world comparative retrospective cohort study.

Palbociclib and ribociclib are indicated in the first-line treatment of hormonal receptor-positive HER-2 negative (HR+/HER2- negative) advanced breast cancer. Although randomized-controlled trials (RCTs) proved their clinical efficacy, there are no observational studies yet to validate the clinical findings in the real-world. Therefore, this study aimed to evaluate and compare the clinical effectiveness and safety profiles of palbociclib and ribociclib in Qatar. A retrospective observational study was conducted on HR+/HER-2-negative stage-IV breast cancer patients receiving palbociclib or ribociclib in the state of Qatar. Clinical data were collected from the National Center for Cancer Care and Research (NCCCR) in Qatar using Cerner®. Primary outcomes were progression-free-survival (PFS) and overall-survival (OS) generated by Kaplan-Meier curves. Moreover, safety profiles of both two treatments were evaluated. The data from 108 patients were included in the final analysis. There was no statistically significant difference in PFS between the palbociclib and ribociclib groups; PFS was 17.85 versus 13.55 months, respectively(p> 0.05). Similarly, there was no statistically significant difference in OS between the two medications, 29.82 versus 31.72 months, respectively(p>0.05). Adverse events were similar between the two groups. Neutropenia was the most common side effect in the study population accounting for 59.3% of the patients. Therefore, both treatments have similar efficacy and safety profiles. Further research on a larger-scale population and longer follow-up period is recommeneded.

Abstract A092: “It’s not worth it”: A case study of one breast cancer patient’s barriers to treatment adherence

Abstract Lower treatment adherence rates are a factor in disparate outcomes for cancer patients of color and cancer patients from lower-income backgrounds. Causes of reduced adherence are less clear. Social determinants of health and systemic racism likely play a role alongside individual and tumor biology, but how they impact individual patients may vary. This case study highlights the intersecting barriers that a post-menopausal, lower-income woman of color faced at a comprehensive cancer care center in the first months of her stage 3 triple negative breast cancer diagnosis. After presenting to her gynecologist with breast cancer symptoms, the patient was able to access same day diagnostic imaging. The next morning, the radiologist contacted her provider with the results: BIRADS 5. The provider referred the patient to the lay navigator partnering with her Federally Qualified Health Center to increase cancer screenings, and the navigator contacted the local comprehensive cancer care center to expedite diagnosis and treatment. The patient was biopsied and diagnosed with stage 3 triple negative breast cancer. She agreed to treatment at the cancer center, including enrollment in a clinical trial. The patient had dodged the disparities around diagnosis and connection to care, but everything seemed to go wrong once she started treatment. She relied on transportation offered by the cancer center, and her scheduled taxis arrived late or not at all, causing her to miss appointments. Her disability paperwork was delayed. Her prescriptions were sent to the wrong pharmacy. Infusion clinic appointments were cancelled or rescheduled at the last minute, without communicating changes to the patient or rescheduling transportation. The patient also struggled with the costs of cancer after losing her steady paycheck. She had difficulty paying for her medications and had to deal with inadequate insurance coverage. Her landlord threatened to evict her. There were delays in processing her Supplemental Nutrition Assistance Program (SNAP) application and subsequent coverage, so she relied on food pantries where fresh food was hard to find. The patient repeatedly faced barriers that were compounded by her socioeconomic status. The navigator supported her when possible, advocating and connecting her to social work, legal aid, and the cancer center’s new financial empowerment lead, who in turn connected the patient to more resources. It was enough to keep the patient in treatment, though she often spoke to the navigator about stopping, saying it was not worth all the difficulties. She was unable to focus on her health and her treatment; there was always another barrier on the horizon. In this case, a lower-income woman of color faced barriers to treatment adherence such as hours late taxis, cancelled appointments, and delays with Disability and SNAP. This patient’s fight to stay in treatment highlights adherence barriers beyond symptom burden and distrust of institutions. Her story is likely many cancer patients’ stories. We must change this broken system. Citation Format: Laura A. Brady, Tameka Brooks, Kathryn Glaser. “It’s not worth it”: A case study of one breast cancer patient’s barriers to treatment adherence [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A092.

Parent and clinician perceptions and recommendations on a pediatric cancer pain management app: A qualitative co-design study.

Pain is one of the most prevalent and burdensome pediatric cancer symptoms for young children and their families. A significant proportion of pain episodes are experienced in environments where management options are limited, including at home. Digital innovations such as apps may have positive impacts on pain outcomes for young children in these environments. Our overall aim is to co-design such an app and the objective of this study was to explore the perceptions of children's parents about app utility, needed system features, and challenges. We recruited parents of young children with cancer and multidisciplinary pediatric oncology clinicians from two pediatric cancer care centers to participate in audio-recorded, semi-structured, co-design interviews. We conducted interviews structured around technology acceptance and family caregiving theories until data saturation was reached. Audio-recordings were then transcribed, coded, and analyzed using thematic analysis. Forty-two participants took part in the process. Participants endorsed the concept of an app as a useful, safe, and convenient way to engage caregivers in managing their young child's pain. Overall, the app was valued as a means to provide real-time, multimodal informational and procedural pain support to parents, while also reducing the emotional burden of pain care. Recommendations for intervention design included accessibility-focused features, comprehensive symptom tracking, and embedded scientific- and clinically-sound symptom assessments and management advice. Predicted challenges to app use included the workload burden it may place on parents and clinicians. The insights gathered will inform the design principles of our future childhood cancer pain digital research.

Clinically Significant CMV Infection in Allogeneic Stem-Cell Transplant Recipients: A Single Center Experience

Introduction: Cytomegalovirus (CMV) infection is one of the major causes of concern in allogeneic stem cell transplantation (allo-HSCT). Here we report the clinically significant CMV infections among allo-HSCT recipients at the National Center for Cancer Care and Research (NCCCR) in Qatar. Methods: A retrospective review of the electronic health records of all malignant hematology patients who underwent allo-HSCT at NCCCR was performed from September 2017 to December 2022. Results: Fifty-one malignant hematology patients have been transplanted during the data collection period. Patient characteristics are summarized in Table 1. The median age was 34 years (range 14-53 years). CMV-serostatus was positive in fifty recipients (98%) and all donors. Thirty-two patients (62.7%) have received matched-related grafts. The most frequent indication for HSCT was acute myeloid leukemia, followed by acute lymphoblastic leukemia. Forty-six patients (92%) underwent myeloablative conditioning therapy. Graft-versus-host disease (GvHD) prophylaxis used in the non-haploidentical group was cyclosporine and short-course methotrexate while haploidentical recipients received cyclosporine, mycophenolate mofetil, and post-transplant cyclophosphamide. Letermovir prophylaxis was accessible for use for high-risk patients from February 2022. CMV-PCR was monitored twice per week for all patients until day +100. The clinically significant CMV infection rate was 51%. The cumulative incidence of CMV infection in haploidentical and non-haploidentical groups was 70% and 30%, respectively (figure 1). The median CMV-PCR viral load was 1783.5 IU/mL (range 133- 9600 IU/mL), with the earliest CMV reactivation on day -1 of transplantation. The clinically significant CMV infection incidence was significantly higher in patients who did not receive letermovir prophylaxis. Preemptive antiviral therapy was initiated to prevent CMV disease in all indicated recipients. Foscarnet was the preferred first-line pre-emptive treatment option for patients during cytopenia. No CMV disease or CMV-related mortality occurred in our population. Conclusion: This is the first report from Qatar to report CMV infection post-allogeneic stem cell transplantation. Future in-depth analysis of our population and treatment responses is needed.

Establishment of a Clinical Pharmacist-Led Multiple Myeloma Clinic with Collaborative Prescribing Model at the National Center for Cancer Care and Research in Qatar

Introduction Multiple Myeloma (MM) is a chronic and incurable hematologic malignancy affecting the plasma cells, and is more prevalent among the elderly. Interprofessional patient care showed superiority over physician-only care in multiple settings, including MM. (Sweiss K et al.2019)In Qatar, real-world data analysis of MM patients treated in the ambulatory setting at the National Center for Cancer Care and Research (NCCCR) showed that clinical pharmacists (CPs) had an evident role in therapy optimization and ensuring adherence to treatment protocol schedule and supportive medications.(Elazzazy S et al.,2023) We aimed to provide a more structured and accessible link to MM patients considering the complexity of their treatment protocols and supportive care through the establishment of a clinical pharmacist-led clinic (CPLC). The most common challenges to optimum care of MM patients in the NCCCR before CPLC were identified and categorized (Figure 1) and then used to design the collaborative model for the MM CPLC (Figure 2). Methods The collaborative MM CPLC was initiated at NCCCR in February 2022. A collaborative practice agreement was established for this clinic, to allow clinical pharmacists -managing MM patients- to issue refills for supportive medications, and order any necessary laboratory tests. To investigate the quality of care provided by the clinic, data was retrospectively collected and analyzed for all MM patients managed in the clinic between February 2022 and February 2023. All patients who were newly diagnosed with MM were eligible for referral by the attending physician. Dedicated advanced hematology CPs provided consultation twice weekly for referred patients without additional fees. The provided services (in-person or virtual) included thorough medication profile review (prescribed antineoplastic and refills of supportive medications), and ordering follow-up laboratory tests. Services also included assessment and optimization of medication adherence, including immunomodulators and supportive medications (i.e., Venous Thromboembolism (VTE) prophylaxis, antimicrobial prophylaxis, bone modifying agents and vaccinations), providing comprehensive patient education, and communicating the recommended adjustments with physicians. Results During the 12-month period, there was a total of 22 patients referred to the clinic. The average age for patients was 51 years (range 36-72). Patient characteristics are summarized in Table 1. The total number of documented encounters with the pharmacists was 73 visits, corresponding to a median of 4 visits per patient (range 1-11). The total amount of time spent with each patient over the course of their referral was 15 minutes. A total of 343 CPs interventions (average of 5 interventions per visit) were performed with an acceptance rate of 100%. The most common intervention was medication reconciliation (n=124), followed by monitoring for medication outcomes (n=72, safety and efficacy), addition of required medication (n=40), patient education (n=27), issuing refills (n=24), drug interactions review and management (n=19), suggesting referrals to relevant subspecialities (n=16), identification of adverse drug reactions (n=7), and required dose adjustments (n=12). Twenty-two medication refills for supportive medications and eight pre-chemotherapy laboratory investigations were issued and ordered by CPs, respectively. All newly diagnosed patients were started on the appropriate bisphosphonate therapy without the previously observed delay, with the median from diagnosis to initiation being 14 days [range from 1 to 117 days]. All clinic patients were maintained on the appropriate VTE prophylaxis (aspirin [n=14], rivaroxaban [n=7], warfarin [n=1]). All patients were adherent to antiviral and Pneumocystis jirovecii Pneumonia prophylaxis. Conclusion CPLC for MM patients treated in the ambulatory setting provided a robust and timely link to patients in alignment with the published literature. The newly implemented collaborative prescribing model in MM clinic encouraged the expansion of pharmacy services in other ambulatory clinics. Our collaborative model could be potentially applied to different cancer settings to optimize a safe and effective patient care. Further analysis is planned to compare the adherence to international MM care guidelines pre- and post-launch of our CPLC.

Characteristics and Outcomes of Adolescent, Young Adults, and Adults 40-50 Years Old with Multiple Myeloma: A Single Center Experience

Background Multiple myeloma (MM) is a malignant tumor with abnormal proliferation of plasma cells. Adolescent and Young Adult (AYA) patients are defined as patients between 15-39 years of age. Multiple myeloma is uncommon in non-elderly populations. Its prevalence is only 2% in AYA age group and only 10% in patients 40-50 years old. The feature of MM is not well known or understood in those two age groups. In this retrospective study we describe the clinical characteristics, cytogenetics, prognostic markers, treatments given and outcomes of MM in AYA and 40-50 years old patients. Methods We retrospectively analyzed data from the clinical database of our single tertiary hematology center, The National Center for Cancer Care and Research, Doha, Qatar. This center serves a country's population of about 2,8 million people. All patients diagnosed with MM between the age 50 or less during the period of January 2007 to December 2022 were included. Results Seventy-four patients were diagnosed at our centre with MM before the age of 50 years, total of all MM cases 222 (33%) Males was predominant 55/74 (74.3 %) with a median age of 41 years (range, 15-49). Most of the patients were from Asian 55%. At diagnosis patients had a median hemoglobin of 10.2 g/dl, creatinine 294 umol/L, total protein 90 gm/L, albumin 34.75 gm/L, calcium 2.7 mmol/L, LDH 255 U/L, IgG 2289.75 mg/dl, IgA 424.15 mg/dl, IgM 34.2 mg/dl, FLC-Kappa 1993 mg/L and FLC-Lambda 1177 mg/L. Median of bone marrow filtration by plasma cell was 51 %. Most of the patients presented at advance stages with 44 patient (59%) presented as IIIA Durie Salmon or stage III and IV by ISS 70 %. IgG Kappa most frequent type of MM 18 patients (24%), followed by Free light chain kappa (23%), IgG Lambda (18%) and others including two cases of plasmacytoma (Most recurrent cytogenetics were diploid cytogenetics in 42 patients (57%), while 7 patients (9%) had complex cytogenetics. Twenty-eight patients had spinal cord compression at single or multiple levels ( thoracic were most common site 20%) while 3 patients had pathological fractures. Bortezomib based regimen is most one used to treat our patients. Daratumumab- Velcade, Revlimid, and dexamethasone (D-VRD) was used for 35 patients (74%) and Velcade,Cyclophosphamide and Dexamethasone VCD in 20 patients (27%). The first response to treatment showed completed remission (CR) in 35 patients, very good partial remission in 10 patients, partial response in 9 patients, four patients either refractory or primary refractory disease and one patient with stable disease. Thirty -five patients (48%) underwent their first autologous bone marrow transplant ASCT. A total of 8 patients underwent second ASCT and one patient underwent third ASCT. After a median duration of follow up of 6.25 years and 72 % of the patients were still alive. We compared the characteristics and outcome for the AYA group (18-39) with patient age group 40 to 49 years. Although there was no statistical significance difference between the two groups regarding overall survival (p=0.21) , the older group had more cases of spinal cord compressions and more cases of refractory disease. Patient characteristics are described in Table 1. Conclusion One third of MM patients in our center are younger than 50 years. These patients tend to present with advanced stage and serious manifestation such as spinal cord compression. IgG kappa and free light chain are the most common myeloma type in this cohort. D-VRD is the most used protocol with a good response rate. Patient characteristics and treatment outcomes are the same for AYA patients compared with patients 40-49 years old (p=0.21). Patients who received first transplant had better OS compare the those who didn't (p0.01)

Transplant Associated Thrombotic Microangiopathy: Acomprehensive Review and Local Experience

Introduction Thrombotic Microangiopathy (TMA) is a rare, life-threatening severe condition characterized by microangiopathic hemolytic anemia, thrombocytopenia and microthrombi in the walls of small blood vessels leading to ischemic organ dysfunction. Transplant-associated TMA (TA-TMA) can occur as a complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). The mechanism of TA-TMA is not fully understood, and conventional treatment options are based on targeting the identified risk factors and hypothesized pathophysiology. This review aimed to compile the information to date about TA-TMA and possible treatment strategies and report successful cases at the National Center for Cancer Care and Research (NCCCR). Methods Scientific databases were scoped for reviews on TA-TMA, its pathophysiology, risk factors and therapeutic strategies. Results were compiled to formulate an understanding of TA-TMA. Local cases of TA-TMA at NCCCR were also reported. Results TA-TMA pathophysiology and risk factors are described in Figure 1 and Table 1, respectively. Due to the complexity of the patient cases under investigation, TA-TMA diagnosis is clinical. Proposed diagnostic criteria include anemia, thrombocytopenia, elevated LDH, presence of schistocytes, hypertension, proteinuria, and elevated sC5b-9. Therapeutic approaches start the management of modifiable risk factors such as withdrawal or decreasing the dosage of calcineurin inhibitors (CNIs), control of hypertension and AKI, treatment of active infections and management of graft versus host disease (GvHD). Therapeutic plasma exchange (TPE) may benefit some patients who are positive for factor H autoantibodies. eculizumab, a humanized antibody against complement protein, can be highly effective in patients with TA-TMA. It is recommended for patients with high-risk features such as elevated sC5b-9 and proteinuria and can also be used for patients with organ damage or disseminated disease. Other available treatment options include rituximab and defibrotide. Other therapeutic agents are under clinical trials such as ravulizumab (C5 inhibitor), nomacopan (C5 and leukotriene B4 inhibitor) and narsoplimab (mannan-binding lectin-associated serine protease-2 [MASP-2] inhibitor). Four cases were diagnosed with TA-TMA at NCCCR between September 2017 and February 2023, as described in Figure 2. All cases recovered; however, the challenge remains in the choice of therapy. Thus far, the choice is to individualize therapy according to comorbidities, severity of clinical presentation and availability of the treatment options. Conclusion TA-TMA remains a significant clinical challenge for transplant physicians, and more research is needed to improve our understanding of its pathogenesis, diagnosis, and management, particularly in guiding the choice of therapy.

Casting Hope, Defying Odds: Unveiling the Impact of Haplo-Identical Stem Cell Transplant in Myeloid Malignancies - a Tertiary Cancer Care Center Experience

Background &amp; Significance: Only 30% to 40% of patients in need of a curative stem cell transplant (SCT) could find a suitable matched sibling donor. For Indian patients, the likelihood of locating a 10/10 HLA identical unrelated donor within limited donor registries is approximately 14%. However, this probability has the potential to rise to 60% if registries with over 1,000,000 registered donors are available. 1,2 Consequently, there is an increasing inclination in India to perform haploidentical transplantations utilizing the post-transplantation cyclophosphamide (PTCY) platform developed by the Johns Hopkins group. 3 The outcomes of haploidentical stem cell transplantation (haplo-SCT) for the treatment of AML were enhanced in the 1990s with the introduction of a T-cell depletion (TCD) strategy followed by a myeloablative conditioning regimen. 4,5 In the last two decades, significant progress in haplo-SCT for hematological malignancies, especially AML, includes donor selection algorithms, improved grafts, GVHD prophylaxis, and enhanced immunologic recovery, benefiting patients. 6 Here, we present our experience of haplo-identical stem cell transplants in myeloid malignancies at our centre. Study design &amp; Methods: We conducted a retrospective study at our site. Patients with myeloid malignancy who underwent haplo-identical stem cell transplant between Jan 2018 - Jan 2023 were included in the study and the follow-up was done till July 2023. Haplo-identical transplants done for diagnosis other than myeloid malignancy were excluded. The objectives of the study were to assess the non-relapse mortality [NRM] rate at day +100, relapse rate, graft-versus-host disease - free relapse-free survival [GRFS] and overall survival [OS] of the study cohort. GRFS was defined as a combined outcome including mortality from any cause, recurrence of malignancy, acute GVHD of grade 3 to 4, or chronic GVHD necessitating systemic immune suppression therapy. 7 Descriptive statistics (including median, mean, and range) were used to describe the central tendency and dispersion of variables. The probability of overall survival [OS] and graft versus host disease relapse free survival [GRFS] was estimated by the method of Kaplan and Meier. Probabilities of relapse or progression of malignancy, RRM, and day-100 NRM were summarized using cumulative incidence estimates All statistical analysis were done using statistical package for social science software (SPSS 21, IBM SPSS Statistics). Results: We have analysed 29 patients with various myeloid malignancies who have underwent haploidentical SCT from Jan 2018 to Jan 2023. There were 28 AML and 1 MDS patients. The median age was 35 (range, 16 - 59) and there were 22 males and 7 females. Conditioning intensity was myeloablative in 19 (65.5%), reduced intensity conditioning (RIC) in 8 (27.6%) and NMA in 2 (6.9%) patients. There were 10 (34.5%) patients in complete remission 1(CR1) and 19 (65.5%) in CR2. Hematopoietic Cell Transplantation-specific Comorbidity Index [HCT-CI] score was as low 11 (37.9%), intermediate 8 (27.6%) and high 10 (34.5%) patients respectively. Median time to neutrophil engraftment was 16 days (range, 12 - 25) and platelet engraftment was 17 days (range, 11 - 32). Median CD34 stem cell dose was 6.25 x 10*6/kg (range, 3.1 - 8.09) x 10*6/kg. Grade II-IV acute GVHD over first +100 days post SCT was observed in 6 (20.7) patients, and grade III-IV acute GVHD and chronic GVHD at follow up of one year was 3 (10.3) respectively. CMV reactivation by +100days was seen in 18 (62.06%) patients. Relapse was seen in 10 (34.5%) patients, out of which 2 patients are alive and 8 expired due to progressive disease. At median follow up of 13 months, OS is 60.3% (CI: 39.7% - 75.9%) and GRFS is at a median follow-up of 6 month was 51.2% (CI: 35.6% - 71%). Fig:1 NRM was 10.3% and 17.24% at +100 days and at last follow-up respectively. Fig:2 Conclusion: In conclusion, our study demonstrates favorable outcomes in terms of NRM (non-relapse mortality) with a low rate of 10.3% at 100 days after haploidentical SCT. The results also show promising overall survival (OS) and GVHD-free, relapse-free survival (GRFS) rates, supporting the potential of haploidentical transplants as an effective treatment option for myeloid malignancies. Further long-term follow-up and research are needed to validate and optimize these findings.

Dissecting bloodstream infections in febrile neutropenic patients with hematological malignancies, a decade-long single center retrospective observational study (2009–2019)

BackgroundThe use of ill-suited antibiotics is a significant risk factor behind the increase in the mortality, morbidity, and economic burden for patients who are under treatment for hematological malignancy (HM) and bloodstream infections (BSI). Such unfitting treatment choices intensify the evolution of resistant variants which is a public health concern due to possible healthcare-associated infection spread to the general population. Hence, this study aims to evaluate antibiograms of patients with BSI and risk factors associated with septicemia. MethodsA total of 1166 febrile neutropenia episodes (FNE) among 513 patients with HM from the National Center for Cancer Care and Research (NCCCR), Qatar, during 2009–2019 were used for this study. The socio-demographic, clinical, microbial, and anti-microbial data retrieved from the patient’s health records were used. ResultsWe analyzed the sensitivity of gram-negative and gram-positive bacilli reported in HM-FN-BSI patients. Out of the total 512 microorganisms isolated, 416 (81%) were gram-negative bacteria (GNB), 76 (15%) were gram-positive bacteria (GPB) and 20 (4%) were fungi. Furthermore, in 416 GNB, 298 (71.6%) were Enterobacteriaceae sp. among which 121 (41%) were ESBL (Extended Spectrum Beta-Lactamase) resistant to Cephalosporine third generation and Piperacillin-Tazobactam, 54 (18%) were Carbapenem-resistant or multidrug-resistant organism (MDRO). It's noteworthy that the predominant infectious agents in our hospital include E. coli, Klebsiella species, and P. aeruginosa. Throughout the study period, the mortality rate due to BSI was 23%. Risk factors that show a significant correlation with death are age, disease status, mono or polymicrobial BSI and septic shock. ConclusionDecision pertaining to the usage of antimicrobials for HM-FN-BSI patients is a critical task that relies on the latest pattern of prevalence, treatment resistance, and clinical outcomes. Analysis of the antibiogram of HM-FN-BSI patients in Qatar calls for a reconsideration of currently followed empirical antibiotic therapy towards better infection control and antimicrobial stewardship.

Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer

Pain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown. To compare the effects of acupuncture and massage on musculoskeletal pain among patients with advanced cancer. A multicenter pragmatic randomized clinical trial was conducted at US cancer care centers consisting of a northeastern comprehensive cancer center and a southeastern cancer institute from September 19, 2019, through February 23, 2022. The principal investigator and study statisticians were blinded to treatment assignments. The duration of follow-up was 26 weeks. Intention-to-treat analyses were performed (linear mixed models). Participants included patients with advanced cancer with moderate to severe pain and clinician-estimated life expectancy of 6 months or more. Patient recruitment strategy was multipronged (eg, patient database queries, mailings, referrals, community outreach). Eligible patients had English or Spanish as their first language, were older than 18 years, and had a Karnofsky score greater than or equal to 60 (range, 0-100; higher scores indicating less functional impairment). Weekly acupuncture or massage for 10 weeks with monthly booster sessions up to 26 weeks. The primary end point was the change in worst pain intensity score from baseline to 26 weeks. The secondary outcomes included fatigue, insomnia, and quality of life. The Brief Pain Inventory (range, 0-10; higher numbers indicate worse pain intensity or interference) was used to measure the primary outcome. The secondary outcomes included fatigue, insomnia, and quality of life. A total of 298 participants were enrolled (mean [SD] age, 58.7 [14.1] years, 200 [67.1%] were women, 33 [11.1%] Black, 220 [74.1%] White, 46 [15.4%] Hispanic, and 78.5% with solid tumors). The mean (SD) baseline worst pain score was 6.9 (1.5). During 26 weeks, acupuncture reduced the worst pain score, with a mean change of -2.53 (95% CI, -2.92 to -2.15) points, and massage reduced the Brief Pain Inventory worst pain score, with a mean change of -3.01 (95% CI, -3.38 to -2.63) points; the between-group difference was not significant (-0.48; 95% CI, -0.98 to 0.03; P = .07). Both treatments also improved fatigue, insomnia, and quality of life without significant between-group differences. Adverse events were mild and included bruising (6.5% of patients receiving acupuncture) and transient soreness (15.1% patients receiving massage). In this randomized clinical trial among patients with advanced cancer, both acupuncture and massage were associated with pain reduction and improved fatigue, insomnia, and quality of life over 26 weeks; however, there was no significant different between the treatments. More research is needed to evaluate how best to integrate these approaches into pain treatment to optimize symptom management for the growing population of people living with advanced cancer. ClinicalTrials.gov Identifier: NCT04095234.

A Pilot Study Using a Standardized Method of Measuring Distress Demonstrates Higher Levels in Septic Revisions

BackgroundCombined Orthopaedic Infectious Disease Clinics facilitate care for prosthetic joint infection (PJI) patients similar to multidisciplinary care in cancer centers. The National Comprehensive Cancer Network developed a standardized distress thermometer (DT) to measure distress in cancer patients. We propose using this tool to assess distress in PJI patients. MethodsIn this pilot study, a retrospective review of patients treated in our combined clinic over 2 years was conducted. In addition to providing information surrounding their treatment, patients completed a questionnaire and DT, adapted with permission from the National Comprehensive Cancer Network. DT scores were compared to a chronologically collected matched aseptic control group. ResultsThere were 122 patients in the septic group and 40 patients in the aseptic group. On a scale of 0-10 (10, the highest level of distress), the septic group reported a mean DT score of 6.18 (±3.2), which was significantly higher than the aseptic mean score of 3.33 (±2.06) [P < .0001]. Over 75% of patients in the septic group reported a DT score ≥4, the cutoff used in most cancer centers to warrant additional support. Twenty-one percent of the septic group (26/122) reported extreme distress (defined as a score ≥10) compared to 0/40 of aseptic patients. ConclusionsPatients treated for PJI experience significantly higher levels of distress compared to aseptic revision patients. More attention is needed to measure and clinically address distress. Improved screening for distress would allow us to provide more comprehensive care and possibly improve compliance, outcomes, and resources available for the treatment of PJI patients.

Outcomes of mini-invasive transoral surgery without neck dissection in supraglottic laryngeal cancer: Real world data from a tertiary cancer center

PurposeThe neck management in early-stage cN0 supraglottic cancer represents an argument of debate. The aim of our study is to evaluate the oncological and functional outcomes in patients with early-stage cN0 supraglottic carcinoma treated with a wait-and-see policy for the neck. Materials and methodsRetrospective monocentric cohort study in a referral cancer care center. We collected a consecutive sample of patients from 2000 to 2020 with Squamous Cell Carcinoma of the supraglottis without clinical evidence of nodal metastases (cN0), surgically treated with Transoral Surgery (Laser or Robotic) without neck dissection. From 316 supraglottic cancer we finally selected 66 eligible participants that met all inclusion criteria. ResultsSixty-six patients (M 75.8 % vs F 24.2 %), median age 65.8 years (IQR 60.9, 70.5). The most common subsite was the epiglottis (62.1 %). Tumor stage distribution was as follows: 35 % cT1, 53 % cT2, 15.2 % cT3. Neither deaths nor major treatment-related complications were reported after surgery. The median follow-up was 62 months. For oncological outcomes, we evaluated 56 patients (10 excluded for adjuvant radiotherapy): 5-year overall survival rate 87 % (CI 95 %: 73.1–94), disease- specific survival rate 95.3 % (CI 95 %: 82–98.8) and neck recurrence-free survival rate 87 % (CI 95 %: 73.1–94). Six patients developed neck recurrence, with a median time of 13 months. ConclusionsSupraglottic carcinoma has been historically associated to a considerable risk of occult metastasis. However, in early-stage cases data are still inconclusive. Our results suggest that in such patients a wait-and-see policy does not impact negatively on survival outcomes, while granting the reduced morbidity associated to a minimally invasive surgical approach.

Organizational models of cancer patient routing at the regional level

The main objective of the oncology patient routing system in the region is to ensure the accessibility and quality of outpatient oncology care. According to the regulatory documents of the Ministry of Health of Russia, the key role in the routing system is assigned to outpatient cancer care centers. We analyzed the regulatory requirements for the operation of the centers and proposed algorithms for their integration in the regions. Based on the developed algorithms, routing modeling and a rank assessment of the models were performed with a subsequent risk assessment and rationale for organizational measures to mitigate the risks.

Hyperleukocytosis in Patients with Acute Myeloid Leukemia Characteristics and Outcome, a Single-Center Experience

Background Hyperleukocytosis is the condition where Acute myeloid leukemia (AML) is presented with white blood cell counts equal to or greater than 100,000. A small proportion of AML patients are presented with this condition which is associated with significant morbidity and mortality caused by related serious complications including leukostasis, tumor lysis syndrome (TLS) and disseminated intravascular coagulation. Hyperleukocytosis is a hematological emergency requiring immediate intervention. In this retrospective study we describe the general characteristics, cytogenetics, mutational profile, treatment given, and outcome of AML patients having hyperleukocytosis at diagnosis. Methods Data were retrieved from the clinical data base of our tertiary cancer center (National Center for Cancer Care and Research, Doha, Qatar). All patients with AML diagnosed during the period January 2017 through December 2021 were included. Results A total of 186 AML patients were included. Twenty-one patients (11.5%) were presented with hyperleukocytosis. Males were more predominant 13/21 (62 %) and more than half of the patients had an Asian origin 52%. The median age for the group was 40.0 years (18-89). Complete blood count (CBC) showed median hemoglobin of 9.2g/dl, white blood cells of 176x10^3/uL and platelets 6x10^3/uL. the median percentage of the blast in the peripheral blood was 71 % and 72 % in bone marrow. Bone marrow cellularity was high in all the cases 100%. Bone marrow dysplasia was assessed with dysgranulopoiesis observed in 24%. All patients had de novo AML. In these patients the diploid KT was most common cytogenetic findings (57%), followed by CBF recurrent cytogenetics abnormalities in 4 patients (19%). FLT 3-ITD was positive in 7 patients (33%) and NPM1 mutation in 5 patients (28%). Hydroxyurea (HU) was used as cytoreductive therapy in 90% of patients. More than half of the patients 11/21 (52%) were admitted to intensive care unit (ICU). One patient had CNS relapse. Seven patients (33%) underwent allogenic bone marrow transplant. Progression occurred in 6 patients 28 (median1.4 years) and Overall survival in this cohort was 76 % (median1.9 year) and the average duration of follow-up of 24.8 months. Early death within 30 days observed, with median time to death 4 days (1-12) among those who died. Conclusion One of ten AML patients are presented with hyperleukocytosis. Most of our AML patients with hyperleukocytosis were young males. This is most probably related to the young general population in our country. All patients had hypercellular marrow with high blast percentage. Diploid Karyotype, CBF rearrangements, FLT 3-ITD mutation and NPM1 mutation were frequent in this cohort. Most of the patients developed complications requiring intensive care admission. Hydroxyurea was the first choice for cytoreduction. Both disease progression and mortality were relatively high (28% and 24 % respectively) and occurred very early, within less than a week from presentation. Early diagnosis and immediate management are mandatory to tackle the complications of this hematological emergency and improve morbidity and mortality.

Li-Fraumeni Syndrome: The Two Faces of a Coin in Myeloid Malignancies

Background Li-Fraumeni Syndrome (LFS) is a rare, autosomal dominant genetic disorder caused by germline mutations in the TP53 tumor suppressor gene. It is characterized by a predisposition to a wide range of cancers, including hematological malignancies. Hematological malignancies account for approximately 3-4% of all LFS-related cancers of which are acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Myelodysplastic syndromes (MDS) and lymphomas. Method and Results We retrospectively analyzed our clinical data for patients with hematological malignances from the period of Jan 2016-Jan 2022 at the national center for cancer care and research (NCCCR), the only tertiary hematology center in the country. We report on two cases with Li Fraumeni syndrome with acute leukemia and their variable spectrum of the disease manifestations and prognosis. Case 1: 16 years old male known case of rheumatic heart disease presented with double malignancy; left mandible osteosarcoma and lymphoblastic leukemia/ lymphoma concurrently in 2020. For his Leukemia he received BFM*2009 protocol and after remission he underwent surgical resection and received radiotherapy for the osteosarcoma. Patient has family history of breast cancer in his maternal aunt and his paternal great aunt. Germline Genetic testing from buccal swab revealed a pathogenic variant in TP53 gene confirming Li Fraumeni syndrome which is most likely De novo as it was not detected in both parents and his 3 siblings. In 2022 patient presented with pancytopenia and therapy related AML/MDS with complex Karyotype. He was started on salvage therapy and was planned for allogenic stem cell transplant (SCT) from his HLA matched brother, however, unfortunately, patient didn't achieve complete remission thus could not receive the SCT and he passed away one year later in 2023. Case 2: 60-year-old female known case of hypertension who was diagnosed with right breast cancer in 2011 for which she underwent surgery, chemotherapy, and radiotherapy. A year later, patient was diagnosed with left upper lobe squamous cell lung carcinoma, and underwent left upper lobectomy, chemotherapy and radiotherapy. Patient was in remission for 6 years, until 2018 when she presented with pancytopenia and therapy related AML with complex monosomic Karyotype. Due to patient's age and comorbidities, she was unfit for intensive therapy, thus she received hypomethylation agent (Azacitidine) till disease progression and was referred to genetic counseling. Patient has a family history of unknown cancer in her paternal half-sister at the age of 77 and an unknown cancer in her paternal cousin. Genetic testing reveled a mosaic pathogenic variant in TP53 gene present in 17% of the 1137 next generation sequencing reads. Shortly later, patient passed away without confirmatory fibroblast testing. Conclusion: Genetic testing indications for Li-Fraumeni syndrome present challenges as patients with full mutationin TP53 often but not always present with the full spectrum of the disease, whereas patients with mosaic profilepresent with a later onset of the disease and might not be identified early. In both scenarios, patients can be miss-identified and exposed to radiotherapy thus testing criteria warrants further evaluation. Acute Leukemia in Li-Fraumeni syndrome is associated with poor prognosis and usually presents in the context of therapy related myeloid malignancies . Identification of patients with Li-Fraumeni syndrome early on is crucial to avoid exposures to radiotherapy whenever possible thus reducing the risk of subsequent malignancies and the tragic outcomes of the disease. There are unmet clinical needs in Li-Fraumeni syndrome diagnostic and therapeutic approaches which needs further attention.

Spiritual care support of goal concordant care in the oncologic emergency setting.

274 Background: Many patients admitted through emergency departments are near the end of life. Patients who have previously indicated that they do not wish for advanced resuscitation efforts are often admitted to the hospital with a presumption of full code status. Documentation of goals of care discussions (GOC) increases the likelihood of receiving goal concordant care during the ensuing hospitalization. In the fast-paced environment of emergency care, physicians often hesitate to introduce these critical conversations. Healthcare has evolved beyond the physician–patient dyad, it includes a variety of professions. A multi-disciplinary team including physicians, nursing, social work, and spiritual care providers (SCPs) was established to improve compliance of documenting goals of care. Methods: This quality improvement project was initiated in the institution's Acute Cancer Care Center. SCPs, a previously underutilized resource, were enlisted to assist in GOC discussions and advance care planning (ACP) documentation on patients who had previously elected do not resuscitate/do not intubate (DNR/DNI) status. The goal was to increase ACP documentation for these patients by 50% over baseline. The project employed a Plan-Do-Study-Act technique. Patients who had a history of DNR/DNI were automatically identified upon arrival to emergency care based on any of 4 criteria extracted from the electronic medical record: 1) History of DNR order within the past year; 2) advance care plan notes documenting the patient is not “full code”; 3) out of hospital DNR; and 4) previous discharge to hospice. Track boards were updated across multiple disciplines (attending physicians, SCPs, nursing and social work) to identify these patients. SCPs rounded on identified patients who were expected to be admitted based on discussions with nurses/attending physicians. They met with patients to provide support while confirming/updating their goals of care. This allowed attending providers to more easily confirm the patient’s wishes and place appropriate documentation/orders. The project took place during May 2023, using April 2023 as baseline data. Results: The goal of a 50% increase in ACP compliance was exceeded. In the month of April, 25 of 131 identified patients had ACP notes. In May 55 of 151 identified patients had ACP documentation. This represents a relative 89% increase in ACP documentation. An increase in DNR orders was also noted (table). Conclusions: SCPs can serve as a resource for establishing and documenting goals of care for patients in the emergency care setting. Collaborating with SCPs can increase compliance with local and national GOC initiatives.[Table: see text]