Division Of Hematology-Oncology Research Articles

Exploring the Utility and Significance of an Adult Academic Non-Cancer Hematology Clinic

Background: Current projections suggest that the demand for adult hematologists will exceed the existing supply in the United States. Despite this, academic centers' hiring practices and fellows' future career choices appear to place an emphasis on oncology over non-cancer hematology. Objective: The primary objective of this study was to assess the overall utility and importance of a clinic dedicated to non-cancer blood disorders within a single academic center by analyzing referral characteristics and select patient demographics. Methods: This study is a retrospective chart review of 755 adults seen in a new single-provider clinic for adults with non-cancer blood disorders within the division of hematology oncology at an academic center between February 2020 and July 2023. This clinic was telemedicine only (video visit or phone visit) between February 2020 and August 2022, after which the clinic switched to a hybrid format. Data analysis included specialty of referring provider, reason for referral, and patient demographics including age, sex, and geographic location. Financial returns for the clinic in the fiscal years 2020-2023 were also analyzed. Results: Of the 755 patients analyzed, 318 were male and 437 were female, with a median age of 53 years (minimum 17 years and maximum 100 years). Referred patients were from 209 unique zip codes in 92 unique cities with a catchment radius of 340 miles to the north and south, and 94.5 miles to the east and west. One third of referrals were from outside of the UCI Health system. Of the 31 referring specialties, Family Medicine (21.25 %), Internal Medicine (18.19 %), and Hem Onc (17.75%) were the top referrers. The most common reason for referrals were anemia (30.58%), cytopenia (23.23%), and thrombosis/hemostasis (including pre-op clearance) (22.32%). The productivity averaged over the last 3 years the clinic was open was 40% above the defined clinic operation target benchmark. The top 3 common health insurances for the fiscal year 22-23 were managed care (33.78%), Medicare (31.65%), and commercial contracted (28.12%). Conclusion: This data analysis demonstrates the growing need for adult hematologists with expertise in non-cancer blood disorders and the high utility and financial revenue potential for non-cancer hematology clinics. Given the vast catchment area of patients being seen, the expertise necessary in the diagnosis and management of non-cancer blood disorders truly shows its value. Furthermore, with such a sizable proportion of referrals originating from other hematology/oncology doctors (3rd highest volume of referrals), it can be inferred that a 2nd opinion from a benign hematologist is valued by those in the field as critical in the diagnosis and management of their patients.

Correlation Between Risk of Febrile Neutropenia Based on Rondinelli Score with Clinical Outcomes in Acute Lymphoblastic Leukemia Patients

Febrile neutropenia (FN) is the most severe complication in patients with blood cancer and chemotherapy. Acute lymphoblastic leukemia (ALL) is the most common type of cancer in children and the most common cause of febrile neutropenia. The low number of neutrophils in ALL patients due to lymphoblast cancer cells and the toxicity of chemotherapy makes patients susceptible to infection which, if not treated immediately, can lead to death. Early risk assessment for infectious complications in FN patients is needed to increase clinician awareness in high-risk patients and eliminate unnecessary therapy for low-risk patients. The Rondinelli scoring system is a reasonably good instrument for predicting severe infectious complications in pediatric patients with ALL who have febrile neutropenia. This study aims to determine the relationship between the risk category for febrile neutropenia (FN) based on the Rondinelli score with clinical outcomes in FN patients with acute lymphoblastic leukemia (ALL) in the Hematology-Oncology division of the child health department of RSUD Dr. Soetomo. This analytic observational study used secondary data FN patients with acute lymphoblastic leukemia (ALL) implementing a total sampling. From 30 samples of pediatric ALL patients with febrile neutropenia at Dr. Soetomo Hospital for June 2018-June 2020 it was found 17 patients (56.7%) had a moderate risk score category, and 13 others were in a low-risk category (43.3 %). Patients were dominated by moderate and severe severity of neutropenia respectively, 43.3%, had neutropenia for 1-7 days (50%), fever less than seven days (66.7%), had a length of stay of 8-14 days, and 15-30 days 33.3% each. Conclusion from this research is that there was a signifi cant relationship between the Rondinelli score category in pediatric ALL patients with FN with the severity of neutropenia p=0.037; R=0.383), duration of neutropenia (p=0.021; R=0.420), duration of fever (p=0.000; R=0.618), and length of stay (p-value 0.005; R=0.496).

Clinical And Hematological Profile Of Febrile Neutropenia In Pediatric Patients Who Suffered From Malignancy At Dr. Soetomo General Academic Hospital Surabaya

Background: Febrile neutropenia is a common complication found in the practice of hematology-oncology caused by malignancy and immune-stimulating cytotoxic therapy. The appearance of febrile neutropenia in patients with malignancy often has a negative impact on the patient's prognosis. There has been no research on febrile neutropenia, especially those using data from Dr. Soetomo General Academic Hospital Surabaya until now. This study aims to determine febrile neutropenia's clinical and hematological profile in pediatric patients who suffered from malignancy at Dr. Soetomo General Academic Hospital Surabaya. Methods: A retrospective study using the medical records of febrile neutropenia patients with malignancy at the Division of Hematology-Oncology, Department of Pediatrics, Dr. Soetomo General Academic Hospital Surabaya from January 2018 to December 2019. The descriptive analysis in this study describes the clinical and hematological profile of febrile neutropenia in pediatric patients who suffered from malignancy, including underlying clinical diagnosis, clinical symptoms, clinical signs, and hematological examination results. Results: Thirty febrile neutropenia patients suffered from malignancy. From the data obtained, the most common clinical diagnosis underlying the incidence of febrile neutropenia was acute lymphoblastic leukemia (73%). The most common clinical symptom experienced by patients was fever (100%). The most common clinical sign experienced by patients was anemia (67%). The most common hematological examination results were neutropenia (100%) with absolute neutrophil count <500 cells/?L. Conclusion: Acute lymphoblastic leukemia dominates the clinical diagnosis underlying the development of febrile neutropenia in pediatric patients with malignancy. The most common clinical and hematological profiles were fever, anemia, and neutropenia.

Conduct of neuro-oncology multidisciplinary team meetings and closing the "gaps" in the clinical management of childhood central nervous system tumors in a middle-income country.

Multidisciplinary team meetings (MDTMs) are essential in the clinical management of pediatric central nervous system (CNS) tumors. Evaluations of the impact of MDTMs on childhood CNS tumors and clinicians' perspectives on their effectiveness are scarce. We retrospectively reviewed the clinical data of pediatric patients (aged <18 years) with CNS tumors diagnosed and treated in the Pediatric Hematology-Oncology Division at the University Malaya Medical Center from 2008 to 2019. We also conducted a web-based survey of the core members of the multidisciplinary team to evaluate the impact of the MDTMs. During the pre-MDTM era (2008-2012), 29 CNS tumors were diagnosed and treated, and during the MDTM era (2014-2019), 49 CNS tumors were diagnosed and treated. The interval for histologic diagnosis was significantly shorter during the MDTM era (p=0.04), but the interval from diagnosis to chemotherapy or radiotherapy and the 5-year overall survival of the 78 patients did not improve (62.1% ± 9.0% vs. 68.8% ± 9.1%; p=0.184). However, the 5-year overall survival of patients with medulloblastoma or rare tumors significantly improved in the MDTM era (p=0.01). Key factors that contributed to delayed treatment and poor outcomes were postoperative complications, the facility's lack of infrastructure, poor parental education about early treatment, cultural beliefs in alternative medicine, and infection during chemotherapy. Eighteen clinicians responded to the survey; they felt that the MDTMs were beneficial in decision-making and enhanced the continuity of coordinated care. MDTMs significantly reduced the diagnostic interval and improved the overall outcomes. However, delayed treatment remains a major challenge that requires further attention.

Abstract PO-023: Impact of the Covid-19 pandemic on medical oncology utilization at a busy urban academic medical center

Abstract Background: The unprecedented global pandemic of Covid-19 caused major shifts in medical care throughout the world. Because chemotherapy delays have been shown to lead to worse outcomes, one of the foremost challenges for health care systems during this crisis was maintaining uninterrupted care for patients with cancer. Methods: The Division of Hematology-Oncology at UCLA Health has 56 medical oncologists working at 17 community practices. Using scheduling data stored within our electronic medical record, we defined three distinct periods related to the intensity of precautions related to the COVID-19 pandemic in LA county; 2/3/20-3/15/20 was before stay-at-home orders were announced (baseline), 3/16/20-5/8/20 was during a period of the strict stay-at-home order, and 5/9/20-6/5/20 was during a period of reopening in the new COVID era. Results: In the baseline period, UCLA Health had an average of 4,555 total patient encounters per week, 0% of which were telemedicine encounters (TE). During the strict stay-at-home period, visits dropped to 3,728 per week (an 18% absolute decrease) and an average of 472 (13%) were TE each week. Since reopening was initiated, visits have increased to an average of 4,433 patient encounters per week (97% of baseline), with 516 (14%) TE per week. In the baseline period, UCLA Health had an average of 115 infusion cancellations per day with 51% being patient initiated, 35% physician initiated, and 14% for other reasons (i.e., patient hospitalizations, treatment plan changes, or deaths). During the period of strict stay-at-home orders, cancellations increased from 115 to 133 per day (16% increase), with 47% being patient initiated, 41% being physician initiated, and 12% for other reasons. Since reopening began, UCLA Health has had an average of 98 infusion cancellations per day with 47% being patient initiated, 37% being physician initiated, and 16% for other reasons. Conclusion: The Covid-19 pandemic led to a significant decrease in patient encounter volume and an uptick in chemotherapy infusion cancellations. Future study will be needed to examine the effect of this on patient outcomes. Compared to national statistics of changes in patient encounter volume, oncology fared better than most other specialties, particularly procedural specialties. Upon reopening, there appears to be a rapid return to baseline patient encounter volumes and fewer chemotherapy cancellations per day. The pandemic appears to have spurred an increase in the use of telemedicine in medical oncology, previously not utilized by medical oncologists at UCLA Health, as an important adaptation to maintain continuity of care. This trend has continued even after reopening. Alternative visit models, such as telemedicine, hold promise for ensuring patient-centered continuity care in this critical patient population. Citation Format: Sidharth Anand, Anne Walling, Neil Wenger, Katrina Fischer, Lisset Huerta-Cruz, Lisa Wilen, John Glaspy. Impact of the Covid-19 pandemic on medical oncology utilization at a busy urban academic medical center [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-023.

Implementation and dissemination of a shared mental model of palliative oncology.

58 Background: American Society of Clinical Oncology guidelines support early integration of palliative care (PC) into standard oncology practice; however, little is known as to whether improved outcomes can be achieved by modifying health care delivery and training oncology providers. Methods: We report our five year experience of embedding a nurse practitioner (NP) in an oncology clinic (March 2014-March 2019) to develop a shared mental model (SMM) of early, concurrent advance care planning (ACP) and PC as well as the collaborative effort to further disseminate this SMM throughout the Division of Hematology-Oncology using communication training, quality measurement, audit and feedback, leadership support, and monthly collaborative meetings. We developed PC quality metrics (process measures and end of life utilization measures) using a validated advanced cancer denominator. We used these measures to evaluate the impact of the PC-NP program (2014-2019) and provide individualized metric packets to each oncologist in the context of an annual half-day interactive communication training sessions (1-hr didactic, 3-hr small group role-play) each spring and monthly implementation team meetings from 2017-2019. Results: Compared to patients with advanced cancer not seen by the PC-NP program, patients who are enrolled in the program have higher rates of goals of care note documentation (80% vs. 17%, p &lt; 0.01), higher rates of Physician Orders for Life Sustaining Treatment (POLST) completion (19% vs. 5%, p &lt; 0.01), higher referral rates to the psychosocial oncology program (51% vs. 25%, p &lt; 0.01), and higher referral rates to hospice (60% vs. 33%, p &lt; 0.01). Among decedents, there was less hospital use (12 vs. 18 days) and ICU use (1.5 vs. 2.6 days) in the last 6 months of life. Since spring 2017, 19/21 NP’s, 64/68 physicians, and 17/20 fellows have participated in communication training. Among all patients with advanced cancer, goals of care note documentation has improved from 3% in March 2014 to 21% in March 2019. Conclusions: Embedding a trained PC-NP in oncology clinics to deliver upstream PC to patients on active treatment can lead to opportunities for development and dissemination of a SMM that translates into better primary and specialist PC.

ES02.02 Management of EGFR LA Disease

ES02.02 Management of EGFR LA Disease

The Oncology Evaluation Center: Implementation of a same-day evaluation and treatment center to avoid unnecessary ED visits.

81 Background: Oncology patients have high rates of both Emergency Department (ED) visits and readmissions. The Hematology-Oncology Division at this urban, 776-bed academic medical center established the Oncology Evaluation Center (OEC) to provide cancer patients with prompt ambulatory evaluation for new symptoms that may otherwise lead to ED visits and unplanned admissions. With new therapeutic options associated with unique complications, the OEC Advanced Practice Providers are knowledgeable in providing care to this high-risk population. ED providers can lack oncology-specific training, comfort, and confidence when caring for cancer patients, resulting in sub-optimal care. Methods: A retrospective review of the chief complaints (CC) of oncology patients presenting to the ED was conducted. Using Plan Do Study Act methodology, in 2016 the OEC was opened to provide same day evaluations and interventions to patients with symptoms related to their cancer diagnosis, their treatment, or their comorbidities. Inclusion and exclusion criteria were developed to ensure appropriate referrals to the OEC. A hospital awareness campaign launched to promote OEC referrals, including educational sessions at multidisciplinary tumor boards. Additionally, two Lean Six Sigma trained infusion RNs led initiatives to promote OEC utilization. Results: The OEC resulted in quick evaluation and intervention for oncology patients. The most common CC are pain, dehydration, fever, nausea/vomiting, and fatigue. Of the 2721 patients seen to date in the OEC, 72% were discharged to home. According to survey results, 81% of oncology providers agree that if the OEC were not in existence, patients referred to the OEC would be referred to the ED. Oncology readmission rates have decreased from 14% (2016) to 12% (2018). Conclusions: The OEC has proven to be an innovative solution for prompt evaluation and ambulatory treatment of cancer patients with complications. This is a valuable component of comprehensive patient-focused care, resulting in ED visit and readmission avoidance. The OEC is an effective low cost, high reward programmatic strategy to expand access to care while improving patient experience.

Standardization of Inpatient CPR Status Discussions and Documentation Within the Division of Hematology-Oncology at UPMC Shadyside: Results From PDSA Cycles 1 and 2.

In December 2016, 49% of patients admitted to inpatient oncology services at University of Pittsburgh Medical Center Shadyside Hospital had cardiopulmonary resuscitation (CPR) status discussion documentation before discharge. The aim of this project was to improve the rate of CPR status conversations. During Plan-Do-Study-Act (PDSA) cycle 1, a stakeholder workgroup was formed in January 2017 by oncology faculty, fellows, nurses, advance practice providers (APPs), medicine housestaff, and palliative care faculty. All oncology clinicians and inpatient team members were reminded weekly to discuss and document CPR status preferences. APPs received training on efficient and effective CPR status assessment from palliative care faculty. Oncology leadership received monthly e-mail updates of CPR status documentation rates and endorsed CPR status best practice guidelines. For PDSA cycle 2, patient charts without CPR status documentation in March 2018 were reviewed, and themes were shared with oncology leadership and reviewed with APPs. After PDSA cycle 1, CPR status assessment rates increased from 49% to greater than 80%. In 2017, more than 1,500 more CPR status discussions were documented than in 2016. The percentage of patients discharged with "comfort measures only" or "do not resuscitate" orders increased from 14.2% (95% CI, 9.5% to 19.0%) to 19.8% (95% CI, 15.6% to 24.0%). For PDSA cycle 2, charts of 60 patients without CPR assessment were reviewed. Of these, 52% were admitted overnight by nocturnists and 48% by daytime APPs. Fifty-five percent of patients (n = 33 of 60) had metastatic disease. CPR status was documented on previous admissions for 53% of patients (n = 31 of 60) in the past 12 months. Fifteen percent (n = 11 of 60) were admitted for scheduled inpatient chemotherapy. A multipronged approach significantly increased CPR status assessments. More patients transitioned to comfort measures only or do not resuscitate when their preferences were clearly assessed and documented.

Standardization of inpatient CPR status discussions and documentation within the division of hematology-oncology at UPMC Shadyside: Results from PDSA cycle 1 and 2.

257 Background: In December 2016, 49% of patients admitted to inpatient oncology services at UPMC Shadyside had CPR status discussion documentation prior to discharge. This project aims to improve quality and rates of CPR status conversations. Methods: During Plan-Do-Study-Act (PDSA) cycle 1, a stakeholder workgroup was formed in January 2017 by oncology faculty, fellows, nurses and advance practice providers (APPs), medicine house staff, and palliative care faculty. All oncology clinicians were reminded weekly to discuss and document CPR status preferences. APPs received communication training with palliative care specialists. Oncology leadership received a monthly update of CPR status documentation rates, and endorsed CPR status best practice guidelines developed by the workgroup. For PDSA cycle 2, patient charts without CPR status documentation in March 2018 were reviewed. Results: PDSA cycle 1 resulted in CPR status assessment rates increasing from 49% to &gt; 80%. 1400+ more CPR status discussions were documented in 2017 than 2016. The percentage of patients discharged “Comfort Measures Only” or “Do Not Resuscitate” increased from 14.2 (S.D. 2.4) to 20.0 (S.D. 2.1). For PDSA cycle 2, 60 patients without CPR assessment were reviewed. Fifty-two percent were admitted overnight by nocturnists, 48% by daytime APPs, and none by housestaff. 55% (33/60) had metastatic disease. Fifty-three percent (31/60) of patients had prior CPR status documentation in the past 12 months. Fifteen percent (11/60) of patients were admitted for scheduled inpatient chemotherapy. Conclusions: PDSA 1 showed that standardization of CPR status assessment with formal training increased CPR status assessments. More patients wanted CMO or DNR when asked, which may indicate the need for earlier goals of care discussions. PDSA 2 indicated that focusing efforts on completing CPR assessment as part of the admission process, especially for scheduled inpatient chemotherapy admissions, is critical in further improving our rates.

Standardization of inpatient CPR/code status discussions and documentation within the division of hematology-oncology at UPMC Shadyside.

e18776Background: Lack of discussion and/or documentation about resuscitation preferences has led to care incongruous with patient’s wishes as previously documented or reported to providers or fami...

Obstacles to Clinical Research

John Marshall, MD, is a global leader in the research and development of drugs for colon cancer and other gastrointestinal cancers. He has been the principal investigator of over 150 clinical trials at local, as well as national, levels. Dr Marshall is the clinical director of oncology for Georgetown University Hospital, associate director for clinical care of the Lombardi Comprehensive Cancer Center, and chief of the Division of Hematology-Oncology. In 2009, Dr Marshall became the founding director of the Otto J Ruesch Center for the Cure of Gastrointestinal Cancers. Combining expertise in molecular medicine, translational research, and a patient-centered philosophy, the Ruesch Center is dedicated to realizing the dream of individualized curative therapies through research, care, and advocacy.

The incidence of ototoxicity in child malignancy cases that received carboplatin therapy with otoacoustic emission (OAE) examination

Malignancy is a significant public health problem, both globally and in Indonesia. Chemotherapy is one of the modality in malignancy cases. Carboplatin (cis-diammine-cyclobutanedi-carboxylato platinum) is a second-generation platinum compound that has often been used in the management of cases of malignancies. On the other hand, side effects of cytotoxic drugs need to be considered, especially ototoxic effects. Ototoxicity is dysfunction and damage to the structure of the inner ear that has been caused by drugs or other certain chemicals. The aim of this study is to assess ototoxic effects due to the influence of carboplatin in the cases of children with malignancy. This study uses a serial cross-sectional design to evaluate otoacoustic emission (OAE) signal-to-noise ratio (SNR) change as a result of ototoxic effects and risk factors due to the use of ototoxic carboplatin in the Division of Hematology-Oncology of the Department of Pediatrics at Cipto Mangunkusumo General Hospital in Jakarta, where two of 52 studies’ subjects experienced ototoxicity. In the group were receiving chemotherapy, two (5%) of the 40 subjects has experienced ototoxic events characterized by SNR values less than six, whereas SNR values were not less than six in the group that had not received chemotherapy. Risk factors such as gender, age, carboplatin dose, and cycles of chemotherapy did not have a statistically significant relationship to ototoxity.

MB-23RECURRENT SHH/TP53 MUTANT MEDULLOBLASTOMA TREATED WITH A COMBINATION OF LITHIUM AND RADIATION THERAPY

MB-23. RECURRENT SHH/TP53 MUTANT MEDULLOBLASTOMA TREATED WITH A COMBINATION OF LITHIUM AND RADIATION THERAPY Anne-Sophie Carret1, Louis Crevier2, Yvan Samson1, Benjamin Ellezam3, and Anne-Marie Charpentier4; Department of Pediatrics, Division of Hematology-Oncology, CHU Sainte-Justine/Universite de Montreal, Montreal, QC, Canada; Department of Neurosurgery, CHU Sainte-Justine/ Universite de Montreal, Montreal, QC, Canada; Department of Pathology, CHU Sainte-Justine/Universite de Montreal, Montreal, QC, Canada; Department of Radiation Oncology, Centre Hospitalier de l’Universite de Montreal, Montreal, QC, Canada INTRODUCTION: TP53 mutations remain a poor prognotic factor and account for a high proportion of the treatment failure in SHH subgroup medulloblatoma. Poor survival of patients with P53 mutant medulloblastoma may be related to radiation/chemotherapy resistance. Lithium, an activator of the WNT pathway, sensitizes TP53 mutant medulloblastoma to radiation. CASE REPORT: a 12-yo boy presented with left localized hemispheric medulloblastoma. After a complete excision of the tumour he was randomized and treated according to COGACNS0331 and received a standard-dose craniospinal radiation with a boost to the entire posterior fossa, followed by maintenance chemotherapy. Patient was considered in complete remission. 15 months post-end of treatment, MRI showed a local recurrence. After 2 cycles of temozolomide, irinotecan and bevacizumab chemotherapy, patient had tumor progression. He then underwent a complete resection of the tumour. Pathology showed anaplastic type, SHH/TP53 mutant medulloblastoma. Due to the expected poor survival and the lackof known and consensual curative treatment, the patient was treated with a combination of therapeutic dose of lithium and focal radiation therapy to a dose of 54 Gy. One year later, the patient remains asymptomatic and, in complete remission. CONCLUSION: Lithium combined to radiation therapy may represent an interesting therapeutic avenue for higher risk groups of medulloblastoma in a context of a pilot study. Neuro-Oncology 18:iii97–iii122, 2016. doi:10.1093/neuonc/now076.21 #The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Anionic surfaces with minimal charge density can restore burst coagulation of microparticle/exosome-depleted blood plasma

Event Abstract Back to Event Anionic surfaces with minimal charge density can restore burst coagulation of microparticle/exosome-depleted blood plasma Angel Contreras-Garcia1, Desgagné Maxime2, D'Elia L. Noelia3, Charles-Hubert Lafantaisie-Favreau4, Juan Carlos Ruiz5, Georges-Etienne Rivard6, Wertheimer Michel1, Paula Messina3 and Caroline D. Hoemann2, 4 1 Ecole Polytechnique, Engineering Physics, Canada 2 Ecole Polytechnique, Chemical Engineering, Canada 3 Universidad Nacional del Sur, Chemistry, Argentina 4 Ecole Polytechnique, Institute of Biomedical Engineering, Canada 5 Universidad Autónoma Metropolitana-Iztapalapa, Basic Sciences and Engineering, Chemical Engineering, Mexico 6 Hôpital Sainte Justine, Division of Hematology-Oncology, Canada Introduction: Blood contains microparticles (MP) and exosomes derived from a variety of cell types including activated platelets. MPs are procoagulant because their surfaces can express tissue factor and/or calcium-binding sites for coagulation factors that cooperate to induce burst thrombin activation [1]. Platelet-poor plasma (PPP) contains low levels of MPs and can be induced to coagulate after contact with both hydrophilic and hydrophobic surfaces [2]. In a standard thromboelastography (TEG) assay with plastic cups and pins, PPP undergoes spontaneous burst coagulation, as revealed in the TEG trace by a variable clotting time (10 to 26 minutes), a low Angle (~33º) and reproducible low clot tensile strength or Maximum Amplitude (MA ~28 mm) [3] (Fig. 1). PPP coagulates faster and more reproducibly in TEG cups and pins coated with anionic carboxylate-rich nanolayers suggesting FXII activation [2], however the role of MPs is unclear. This study tested the hypothesis that MPs are necessary for PPP burst coagulation in plastic TEG cups, and that anionic surfaces are sufficient to restore burst coagulation of MP-depleted plasma. Materials and Methods: Plastic Cyrolite® TEG cups and pins (Hemoscope, IN, USA) were modified by plasma-enhanced chemical vapor deposition to make hydrophobic (PP-HMDSO, poly(hexamethyldisiloxane) or variable anionic (L-PPE:O, 0, 4.4% or 6.8% carboxylate functional group content) nanocoatings [3]. Coagulation in the TEG cup was initiated by combining i) human citrated PPP (Precision Biologics, NS, Canada), ii) MP-depleted plasma (by ultracentrifugation 150,000xg, 30 min) or iii) PPP 2xenriched for MP, with 20 µL of 200 mM CaCl2 containing 2.5 mg/mL 10 µm diameter beads (latex, borosilicate glass, carboxylated plastic), or 0.25 to 25 mg/mL hydroxyapatite (HA) nanoparticles (2.03 Ca/P ratio) [4]. Bead composition was analyzed by XPS. Statistical tests used ANOVA (Statistica). Results: Glass beads with 9% Si and 4% Ca content triggered the fastest PPP clotting time (p<0.05 vs all hydrophobic surfaces). PPP burst coagulation was enhanced by glass beads, L-PPE:O (6.8% carboxylate), and HA nanoparticles, as shown by the Angle increasing from 36º to >55º. HA nanoparticles accelerated PPP burst coagulation in a dose-dependent manner (p=0.004). MP-depleted plasma failed to clot in plastic TEG cups (Fig. 1), and burst coagulation was progressively restored by L-PPE:O with 4.4 to 6.8% carboxylate content (p<0.001, Fig. 2A). MP-depleted plasma coagulation was also induced by 2.5 mg/mL glass beads and 25 mg/mL HA nanoparticles but not by Latex beads, HMDSO, or 1% carboxylated beads (Fig. 2B). In MP-depleted plasma, L-PPE:O with 6.8% carboxylate content triggered the highest Angle (50º) with a clot tensile strength similar to PPP and MP-enriched PPP (Fig.2B). Discussion: Glass beads, >4.4% carboxylated surfaces and HA were effective MP biomimetics that restored burst coagulation. These results suggest that inorganic anionic surfaces can serve as functional binding sites for the calcium-binding gla domain of factors FIXa, FXa and prothrombin. This study is consistent with the notion that tenase and prothrombinase form side-by-side on the same anionic surface [1]. Conclusions: A minimal 6.8% anionic charge group density is required to bring tenase and prothrombinase in close physical proximity for optimal cooperative behavior. Funding: Natural Sciences and Engineering Research Council of Canada (NSERC) and the Canadian Institutes of Health Research (CIHR). Salary support was from the Fonds de la Recherche Québec Snaté (FRQ-S), CONACyT (México), MEDITIS Program (NSERC and Ecole Polytechnique), Emerging Leaders in the Americas Program, and The Arthritis Society (Canada)

Maggot Debridement Therapy of a Leg Wound From Kaposi's Sarcoma: A Case Report.

Yuankai Lin, Molly Amin, Xuan Nguyen, and Surabhi Amar, Maricopa Medical Center, Phoenix; Abigail F.W. Donnelly, Mayo Clinic, Scottsdale, AZ; and Surabhi Amar, University of Arizona College of MedicinePhoenix, Phoenix, AZ Authors’ disclosures of potential conflicts of interest and contributions are found at the end of this article. Corresponding author: Surabhi Amar, MD, Division of HematologyOncology, Maricopa Integrated Health System, 2601 East Roosevelt St, Phoenix, AZ 85008; e-mail: surabhi_amar@dmgaz. org. INTRODUCTION

Quality of life in children with cancer and their normal siblings

Background Cancer treatment in children influences the quality of life of patients and their families. The Pediatric Quality of Life (PedsQL) inventory is a questionnaire to assess quality of life of the healthy and ill children. Objective To compare quality of life in children with cancer and their normal siblings, and to compare quality of life in those with hematologic malignancies to those with solid tumors. Methods A cross-sectional study was conducted among 5-to-18- year-olds at the Hematology-Oncology Division at Haji Adam Malik Hospital, Medan, North Sumatera, from May to July 2012. The case group (subjects with cancer) filled the PedsQL 3.0 and 4.0 questionnaires, while the control group (normal siblings) filled only the PedsQL 4.0 questionnaire. Independent T-test was used to compare the quality of life between children with cancer and their normal siblings. Results There were 46 children in each group. The PedsQL 4.0 results in children with cancer and their normal siblings, and PedsQL 3.0 between hematology malignant and solid cancer were as follows: physical function 36.9 vs. 80.7, respectively (95%CI of differences -52.639 to -34.990; P= 0.0001), emotional function 40.4 vs. 69.3, respectively (95%CI of differences -35.912 to -21.914; P=0.0001), social function 71.5 vs. 93.9, respectively (95%CI of differences - 29.238 to -15.587; P=0.0001), school function 20.7 vs. 74.2, respectively (95%CI of differences - 62.124 to -44.832; P=0.0001), and total score 42.1 vs. 79.3, respectively (95%CI of differences - 43.066 to -31.344; P=0.0001). School function was the most affected parameter in children with cancer compared to their normal siblings. Conclusion There is a significant difference in quality of life between children with cancer and their normal siblings, for all four parameters examined by the PedsQL inventory. However, there are no significant differences in quality of life between children with hematologic malignancy and those with solid cancer.

Peripheral T-cell lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

F. d’Amore1, P. Gaulard2, L. Trumper3, P. Corradini4, W.-S. Kim5, L. Specht6, M. Bjerregaard Pedersen1 & M. Ladetto7, on behalf of the ESMO Guidelines Committee* Department of Hematology, Aarhus University Hospital, Aarhus, Denmark; Department of Pathology, Hopital Henri Mondor, Creteil, France; Department of Hematology and Oncology, Georg August University, Gottingen, Germany; Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy; Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Seoul, Korea; Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

A national experience of the efficacy and safety of long-term treatment with Lenalidomide in patients with relapsed Multiple Myeloma

e310 PO-393 The efficacy and safety of lenalidomide in multiple myeloma with severe renal impairment K.S. Jung, H.-N. Song, K.H. Yoo, J.Y. Lee, S.H. Lim, H.S. Kim, S. Park, S.J. Kim, S.J. Kim, J.W. Jung, J.S. Kim, J.H. Jang, W.S. Kim, C.W. Jung, K. Kim Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of Medicine; Severance Hospital, Younsei University of Medicine

Protein-Losing Enteropathy and Lytic Bone Lesions in an HIV-positive Male

Kaposi sarcoma (KS) is considered one of the most common neoplasms in HIV-positive patients. Herein we report a case of an HIV-positive man diagnosed 6 years prior who had never received highly active anti-retroviral therapy (HAART) who presented with anasarca and cutaneous KS. The patient was found to have significant hypoalbuminemia in the setting of normal renal and liver function. An esophagogastroduodenoscopy (EGD)and fecal alpha-1antitrypsin assay revealed that the patient had a protein-losing enteropathy secondary to gastrointestinal involvement ofKS. Additionally, a vertebral body biopsy of a lytic bone lesion found on computed tomography (CT) scan revealed osseous involvement of KS. Our patient provides an interesting case of diffuse KS, a fairly uncommon presentation as many patients now receive HAART and osseous involvement is rare. Kaposi sarcoma (KS) is considered one of the most common neoplasms in HIV-positive patients. Since the advent of highly active antiretroviral therapy (HAART) in the mid-1990s, there has been a significant decrease in both the riskofdevelopingKS1aswell as the incidenceof this disease.2,3 Numerous reports of AIDS-related KS illustrate its diffuse nature as it can involve the skin, lungs,gastrointestinal tract, liver, and spleen.4-9 In rare instance, KS can involve the bones.4 A 24-year-oldHispanicmalewith a six year history of HIV who had never received HAART presented with increasing lower extremity swelling over the last three months. The swelling had spread to his thighs and inguinal region involving the scrotum, and it had progressed to thepoint that hewasunable tourinate. He reported a history of intermittent fevers, difficulty swallowing, hemoptysis, hematemesis, loosewatery stools, andbright redbloodper rectum. At the time of admission, his vitals were stable and he appeared cachectic. On physical exam, there was 3+ pitting edema in the lower Protein-Losing Enteropathy and Lytic Bone Lesions in an HIV-positive Male 1University of California, Irvine School of Medicine, Irvine, CA 2Department of Medicine, Division of Hematology-Oncology, University of California, Irvine, Orange, CA Lauren S. Marshall, MS1; Wilson Tong, MD2,3; Chaitali S. Nangia, MD2,3