Allogeneic hematopoietic cell transplantation is an effective treatment for patients with Richter syndrome who show an objective response before allografting. Patients must be referred to transplant centers as soon as the diagnosis is confirmed to evaluate candidacy for the procedure and identify a suitable donor in a timely manner.

The coronavirus disease 2019 (COVID-19) has caused many different complications including immunerelated conditions. Hereby, we report a case of a possible association between COVID-19 infection and de novo anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis presenting with severe pulmonary-renal syndrome as a rare complication of COVID-19 infection.We had a 53-year-old male patient who was admitted for a severe COVID-19 pneumonia complicated by septic shock and acute respiratory distress syndrome. He responded to the standard treatments and was discharged. Four months later, he was admitted with a severe acute pulmonary-renal syndrome (severe acute on chronic kidney failure with active sediment and proteinuria, and diffuse alveolar hemorrhage (DAH) requiring mechanical ventilation). Kidney biopsy confirmed pauci-immune fibro-cellular crescentic glomerulonephritis on top of glomerular sclerosis. Perinuclear-ANCA and anti-myeloperoxidase antibody came back positive. Pulse steroids and cyclophosphamide were administered. Given the chronicity of the kidney lesions, the kidney function did not improve significantly, and the patient became dialysis dependent; however, respiratory status responded dramatically, and he was discharged on room air. In conclusion, although COVID-19 infection can mimic ANCA-associated vasculitis (AAV), the growing number of case reports along with our report shows the need for awareness of a potential link between COVID-19 infection and AAV which would dramatically change the treatment strategy.

The prevalence of multiple myeloma (MM) in the US has increased from 50,484 cases in 2002 to 118,539 cases in 2014 per the SEER database. ❖ Overall survival has improved with the advent of novel therapies. ❖ Complications from the disease can lead to hospitalization based on our experience at Washington Hospital Center, however; limited data is available about the nationwide changes in MM related hospitalizations. ❖ The main objective of our study was to analyze patient demographics, outcomes, and comorbid conditions associated with MM hospitalizations.

Iliac crest tuberculosis represents <1% of all skeletal tuberculosis cases. Even in the absence of classic symptoms and risk factors, orthopaedic surgeons should maintain a low threshold for tuberculosis in the differential diagnosis.

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Background: Chronic lymphocytic leukemia (CLL) is associated with significant genomic heterogeneity that might explain its variable clinical course. Although there are established prognostic genomic features already detected by fluorescence in-situ hybridization (FISH), next generation sequencing (NGS) technologies have uncovered a myriad of novel mutations in CLL that may influence both prognosis and treatment decisions (Landau DA et al. 2015). Recently commercial NGS panels are actively used outside of the research spectrum. This study describes the mutational landscape of unselected consecutive CLL patients analyzed using commercial NGS platforms at a single academic institution as a part of routine clinical care. Materials and methods: Using Total Cancer Care (TCC) and Moffitt Cancer Center (MCC) CLL databases (N=1,267 patients) we retrospectively identified a subset of 148 subjects from January 2014 to May 2016 with confirmed CLL diagnosis and an available commercial NGS panel (Genoptix® and FoundationOne®). Molecular testing was done on bone marrow biopsies and/or peripheral blood samples either during the first clinic visit, or at time of disease progression. We used descriptive statistics to annotate demographic characteristics, disease prognostic features, mutation frequencies, and the class and type of molecular changes found in the cohort. We utilized standard statistical methods (Chi-square) to assess associations between known prognostic factors (age, CLL-IPI score, IGHV mutational status, B2M, ZAP-70 and CD38+ status, and FISH detected mutations) and identified mutations. Time to first treatment was estimated with the Kaplan-Meier method and curves compared with log-rank test. All statistical analyses where done using SPSS v24.0 Results: From our cohort of 148 CLL patients with an available commercial NGS panel, 110 and 38 were sequenced using Genoptix® and FoundationOne® panels, respectively. At the time of molecular sequencing 48 (32.3%) had high or very high CLL-IPI scores, 77 (52%) had unmutated IGHV, 22 (14.8%) harbored del11q, 19 (12.8%) had del17q and 10 (6.7%) had a complex karyotype. Seventy (47.2%) patients were treatment naïve and 59 (40%) had received CLL directed therapy before NGS testing. Of the previously treated patients, 56% received fludarabine-based regimens and 27% received at least one B-cell receptor inhibitor. The mean number of mutations in our patient cohort was 6.3 (3.1 per Genoptix® and 9.5 per FoundationOne®). Most common mutations types were missense (74.7%) and frameshift (14%). Most frequently mutated genes (≥7 cases) were: ATM (25.6%), TP53 (15.5%), NOTCH1 (15.5%), SF3B1 (14.1%), FAT1 (8.1%), BCOR (8.1%) and CREBBP (7.4%) (Figure 1). TP53 mutations had higher CLL-IPI scores (p<0.001), del17q (p<0.001), previous fludarabine based therapy (p<0.009), fludarabine resistance (p=0.016) and shorter TFT in comparison to TP53wt (16.5 vs. 64.2 months, p=0.002). Interestingly, FAT1 mutation was universally correlated with mutated IGHV status (p<0.001), and lower probability CLL-directed treatments (p=0.006). Table 1 shows correlation of general characteristics and other mutated genes. Conclusions: NGS, through validated commercial gene platforms, is readily available outside of clinical trials for CLL patients for genomic risk assessment and could accurately replicate findings of earlier reports. Challenges remains in regards of cost, adequate bioinformatics support and accessibility that restrict its availability to academic centers. Figure 1 Percentage of patients with the most common mutated genes Figure 1. Percentage of patients with the most common mutated genes Table 1 Table 1. Disclosures Nodzon: Novartis: Speakers Bureau. Chavez:Janssen: Speakers Bureau. Pinilla-Ibarz:Abbvie: Consultancy, Speakers Bureau; Pharmacyclics: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Novartis: Consultancy; Novartis: Consultancy; Janssen: Consultancy, Honoraria; Gilead: Consultancy, Speakers Bureau; Abbvie: Consultancy, Speakers Bureau.

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Background: Association of hepatitis C virus (HCV) infection and B-cell non-Hodgkin Lymphoma (B-NHL) is well-established. Directly-acting antiviral HCV therapy (DAA) results in very high rates of sustained viral response (SVR) and HCV cure. Studies of the impact of successful antiviral therapy on lymphoma outcomes in HCV-infected patients can have important implications for patient management and for understanding of the biology of different lymphomas. The strongest evidence of positive impact of HCV antiviral therapy on lymphoma regression is available for indolent lymphomas, especially marginal zone lymphoma. Impact of antiviral therapy on HCV-associated aggressive B-NHL is still under investigation. Furthermore, there is no data on outcomes for HCV-associated B-NHL in African-American (AA) patients. The aim of this study was to evaluate lymphoma characteristics and outcomes in HCV-associated B-NHL, in a predominantly AA population. Methods: All consecutive patients with lymphoma and reactive HCV Antibody (HCV Ab+) diagnosed and treated at our center between January 2003 and December 2017 were studied. Patients with HCV-associated mixed cryoglobulinemia without any overt lymphoma, HCV-associated paraproteinemia and patients who did not have antiviral treatment history available were excluded. All information was obtained by review of electronic medical records. Baseline patient characteristics including age, sex, race, comorbidity including HIV infection, lymphoma stage, histology, prognostic score and baseline lactate dehydrogenase (LDH) were recorded. Lymphomas were classified according to the 2016 WHO classification. Prognostic score was calculated using International Prognostic Index (IPI) for aggressive lymphomas, Follicular Lymphoma International Prognostic Index (FLIPI) for indolent lymphomas other than chronic lymphocytic leukemia (CLL) and CLL-IPI for CLL. Details of lymphoma treatment and antiviral therapy were recorded. Virologic clearance (VC) was used to collectively describe both SVR (undetectable HCV RNA 12 weeks after completion of antiviral treatment) and spontaneous clearance of HCV without treatment. Study outcomes were overall response rate (ORR), complete response rate (CR), overall survival (OS) and progression free survival (PFS). Results: We found 397 patients with lymphoma at our institution, of which, 40 patients had HCV. Thirty-eight patients had complete lymphoma and antiviral treatment history available and were included in the analysis. Median age was 58 years, 90% were AA; 68% were men. Diffuse large B-cell lymphoma (DLBCL) was the predominant histology (50%). Advanced stage (64%), aggressive lymphoma (60%), good prognostic score (74%) and elevated LDH (66%) were common. A total of 21 patients were treated, 18 with DAA and 3 with interferon-based therapy. Twenty-two patients had VC, either spontaneous or with antiviral therapy. Patients with VC, had significantly higher ORR (95% vs 69%, RR 2.4, CI95 1.3-4.4, p<0.05) and CR (73% vs 38%, 2.29, CI95 1.1-5.0.0, p<0.05) compared to patients without VC. Median OS was also significantly higher in patients with VC than patients without VC (not reached vs 89 months, RR 0.4, CI95 0.2-0.6, p<0.05) . Median PFS was not significantly different between two groups. We analyzed ORR and CR in subgroups of aggressive lymphoma, indolent lymphoma and DLBCL. Patients with VC had significantly higher CR then patients without VC in the subgroups of aggressive lymphoma and DLBCL (100% vs 46% and 100% vs 45% respectively, p<0.05), while ORR was not different. Conclusions: Hepatitis C VC is associated with improved CR and OS in predominantly AA lymphoma patients including patients with aggressive B-NHL. The precise role and timing of HCV antiviral therapy in HCV-associated aggressive B-NHL should be assessed in large prospective studies that include AA patients. Disclosures No relevant conflicts of interest to declare.