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Tumour-associated Macrophages (TAM) present two different polarizations: classical (M1) characterized by immunostimulation activity and tumour suppression; alternative (M2) characterized by tumour promotion and immune suppression. In this retrospective study, we evaluated the correlation between the two forms of TAM with survival time in radically resected gastric cancer patients. A total of 52 chemo- and radio-naive patients were included. Two slides were prepared for each patient and double-stained for CD68/NOS2 (M1) or CD68/CD163 (M2) and five representative high-power fields per slide were evaluated for TAM count. The median value of the two macrophage populations density and the median value of M1/M2 ratio were used as cut-off. Twenty-seven patients with M1 density above-the-median had a significantly higher survival compared to those below the median. Twenty-six patients with M1/M2 ratio above the median showed median OS of 27.2 months compared to 15.5 months of the patients below the median. No association between M2 macrophage density and patient's outcome was found. In multivariate analysis, M1/M2 was a positive independent predictor of survival. The M1 macrophage density and M1/M2 ratio, as confirmed in multivariate analysis, are factors that can help in predicting patients survival time after radical surgery for gastric cancer.

Light chain (AL) amyloidosis is caused by a small B-cell clone producing light chains that form amyloid deposits and cause organ dysfunction. Chemotherapy aims at suppressing the production of the toxic light chain (LC) and restore organ function. However, even complete hematologic response (CR), defined as negative serum and urine immunofixation and normalized free LC ratio, does not always translate into organ response. Next-generation flow (NGF) cytometry is used to detect minimal residual disease (MRD) in multiple myeloma. We evaluated MRD by NGF in 92 AL amyloidosis patients in CR. Fifty-four percent had persistent MRD (median 0.03% abnormal plasma cells). There were no differences in baseline clinical variables in patients with or without detectable MRD. Undetectable MRD was associated with higher rates of renal (90% vs 62%, p = 0.006) and cardiac response (95% vs 75%, p = 0.023). Hematologic progression was more frequent in MRD positive (0 vs 25% at 1 year, p = 0.001). Altogether, NGF can detect MRD in approximately half the AL amyloidosis patients in CR, and persistent MRD can explain persistent organ dysfunction. Thus, this study supports testing MRD in CR patients, especially if not accompanied by organ response. In case MRD persists, further treatment could be considered, carefully balancing residual organ damage, patient frailty, and possible toxicity.

AdoMet supplementation in patients affected by metastatic colorectal cancer treated with oxaliplatin-based regimen seems to be effective in the prevention of chemotherapy-induced liver injury.

The results of our study demonstrate a protective effect of AdoMet supplementation in patients affected by resected CRC treated with FOLFOX IV adjuvant regimen.

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Background: Prophylactic platelet transfusion is commonly used to prevent life-threatening bleeding events in patients with severe thrombocytopenia associated with chemotherapy courses or hematopoietic stem cells transplantation (HSCT). In adults, the transfusion threshold for prophylaxis is usually set at 10x109plts/L, but in pediatric setting, it is still a matter of debate. Moreover, evidences from the PLADO trial (Slichter SJ et al. N Engl J Med. 2010) and recommendations form international guidelines (ICTMG, Nahirniak S et al. Transfus Med Rev. 2015) suggest two different platelet doses in Inpatients and Outpatients, but clinical experiences in children are still lacking. Aims: In order to confirm the safety of the recommended transfusion threshold, to test two different platelet doses in hospitalized patients and Outpatient setting and to optimize platelet clinical use, as a Children's Hospital, we applied, starting from January 2018, a new prophylactic platelet transfusion policy. Methods: Platelet dose was calculated based on body-surface area (BSA) of each patient (from age-standardized weight). As suggested by ICTMG, different platelets doses were given to Inpatients and Outpatients: (low-dose) 1.1x1011platelets per square meter (plts/m2) and (medium-dose) 2.2x1011plts/m2, respectively. The transfusion threshold for prophylaxis was set at 10x109plts/L, but higher threshold could be considered as per clinical decision (in presence of bleeding signs or risk factors for major bleeding). Patients with platelets refractoriness and newborns, were excluded from our study. Only major bleeding events (grade 3 or higher according to World Health Organization criteria) were collected during the study period. Results: From January 2018 to June 2019, 15278 platelet pediatric aliquots were transfused in our Hospital. Of all the aliquots, 8876 (58.1%) were obtained from apheresis procedures and 6402 (41.9%) from buffy-coat-derived pooled platelet concentrates. Almost 77% (11751) of the all aliquots were transfused in patients with onco-hematologic diseases. Among these, 9771 (64.0%) in the Inpatient group (N=547) and 1980 (13.0%) in the Outpatient group (N=385). Between Inpatients, 6794 (44.5%) aliquots were transfused in Onco-Hematology Ward and 2977 (19.5%) in the HSCT unit. During the study period, only 10 major bleeding events were observed. No fatal hemorrhagic episode was recorded and all of the bleedings occurred in hospitalized patients, and accounted for almost 2% of this population. Intracranial bleeding accounted for five out of six grade 4 bleeding episodes, and occurred in two patients with acute myelogenous leukemia, in one patient with Hodgkin lymphoma and in two patients with advance neuroblastoma. The other grade 4 bleeding event was a massive peritoneal and pleuric hemorrhage with a life-threatening haemodinamic instability in a patient with acute lymphoblastic leukemia (the main characteristics of these patients are reported in the table). Conclusions: our results show that a platelet transfusion policy based on recommendation mainly developed in adults may be safely applied also to pediatric patients with cancer or receiving HSCT. In fact, the lower dose used in Inpatient group resulted in a grade 4 bleeding rate similar to that observed in the PLADO trial (1.0% vs 0.7%). The double dose transfused in Oupatients was effective in preventing major bleeding events. Table. Disclosures No relevant conflicts of interest to declare.

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