Background: Secondary tumors has been described in a variety of patients with either hematologic malignancies or solid neoplasm, and most of the time is related to previous chemotherapy and radiation therapy exposure, but little is found in the literature about synchronous or metachronous neoplasm that can be found in patient with a newly diagnosis of hematologic malignancy; we report 45 cases, presented in a single institution from 2007 to present. Methods: A retrospective review of records using our tumor registry data, from patient with hematologic malignancies at John H. Stroger Hospital of Cook County, was performed and 45 patients with either synchronous or metachronous neoplasm were identified. Results: Lung cancer was the most common malignancy representing 22.2%, Colorectal cancer 20%, Prostate cancer 17.7%, Breast cancer 11.1%, Urothelial cancer (Kidney and Bladder) 8.8%, Myelodisplastic syndrome, Pancreatic cancer, Thyroid cancer, Non-Hodgking lymphoma, Acute Myeloide Leukemia, Vulvar cancer, Testicular cancer and Skin Cancers 2.2% each one respectively. Results: We found that in our heterogeneous population of patient with hematologic malignancies, the incidence of synchronous or metachronous neoplasm practically follows a very similar pattern of the general population, despite that many of this patients have been exposed to chemotherapy and radiation therapy. Disclosures No relevant conflicts of interest to declare.
57 Background: Studies of patient education and communication have been shown to affect patient health outcomes, including emotional and physical health. Effective patient education is challenged by limitations in patient literacy. As much as 20% of the American population was found to have a low literacy level at or below a 5th grade reading level. Our program was based in a public hospital treating underserved patients from lower socioeconomic backgrounds who often have low baseline health literacy and varying educational backgrounds. Methods: A cancer patient education program was organized for recently diagnosed cancer patients and their families. A lecture and interactive learning session was implemented to teach the basics of what cancer is, what chemotherapy is, social services available to patients, and counseling services available. A pre- and post-survey was administered to assess patients’ confidence in their understanding of cancer, chemotherapy, navigation of social and counseling services. Patients self rated their level of understanding as “poor”, “a little”, “average”, “good”, or “very good”. Results: Comparison of pre- and post-survey results showed self-assessed improvement of understanding of cancer, chemotherapy, social services, and counseling services by more than one level of understanding (1.29, 1.37, 1.18, 1.14 level of understanding improvement respectively). Conclusions: A patient education program for cancer patients teaching the basics of cancer and chemotherapy as well as giving patients and families resources for social services and counseling services is a very necessary resource. Better patient understanding of health issues may improve compliance with treatments, help alleviate anxiety, and enable patients and their families to participate actively in their care. This need is especially felt in a hospital treating an underserved population. Survey results show an improvement in patient self-assessed understanding of cancer, chemotherapy, and social services.
e14609 Background: Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 is reported to underestimate response to immunotherapeutic drugs. Therefore, immune related RECIST (iRECIST) based on RECIST 1.1 and immune related response criteria (IRRC) based on WHO response criteria have been studied, mainly in patients with melanoma. Whether RECIST 1.1 underestimates responses in other cancers is not well known. Aim of the present study is to assess response rates to PDL-1 inhibitor Nivolumab in lung, renal and head and neck (H&N) cancers using RECIST 1.1, iRECIST and IRRC. Methods: We reviewed patients from 2012 to present with lung, renal, H&N cancers treated with Nivolumab at John h Stroger Jr. Hospital of Cook County. Incomplete charts and those treated for less than 4 cycles of Nivolumab were excluded. Data was analyzed using descriptive statistics and Fisher exact test. Results: 47 charts were reviewed, 27 met the inclusion criteria. 17 lung (14 adeno, 3 squamous), 7 renal (5 clear cell) and 3 H&N cancer patients were included. Average age was 58.2yrs, 20(74%) were male. Average treatment was for 13 cycles. Response was assessed after at least 4 cycles. Disease control rate for lung, renal, head and neck cancer was 70%,58%, 33% respectively with RECIST 1.1 criteria compared to 77%, 71% and 66% respectively using immune RECIST or IRRC (P > 0.05). No patient developed pseudoprogression. Two had progressive disease per RECIST 1.1 but stable disease with iRECIST and IRRC. 26 of the 27 patients showed concordance between iRECIST and IRRC. One patient had stable disease per iRECIST but partial response per IRRC. Average survival after treatment initiation was 8.3 months for lung, 9.1 months for renal and 5.6 months for H&N cancer. Treatment was discontinued in 2 patients based on progression per RECIST 1.1, both patients had stable disease per iRECIST& IRRC. Conclusions: Trend towards underestimation of treatment response using RECIST 1.1 criteria compared to iRECIST or IRRC was observed. Strong concordance was observed between iRECIST and IRRC. Given relative ease of use, iRECIST might be favored over IRRC in response evaluation for immunotherapeutic drugs.
Introduction Studies of EBV positive (+) and negative (-) classical Hodgkin lymphoma (cHL) have shown the importance of the immune microenvironment in affecting Reed-Sternberg (hRS) cell survival, proliferation, and biologic behavior. For example, macrophage infiltrates may correlate with inferior disease outcome and survival and proliferation of the hRS cells depends on trophic signals from various inflammatory cells, including CD4+ T cells. The latter finding may explain why HIV-cHL patients (pts) usually present with higher circulating CD4+ T-cell counts (cCD4) compared to HIV-related non-Hodgkin lymphoma. Pathobiologically, HIV-cHL differs from HIV negative cHL (cHL) in that it is nearly always EBV+, has higher numbers of hRS cells, presents with more advanced median stage, exhibits more commonly the mixed cellularity (MC) pattern, and some studies suggest it is more clinically aggressive. To investigate the microenvironment of HIV-cHL and its influence on cHL biology, we assessed the immune cell composition and clinical characteristics of HIV-cHL and compared the findings to those of EBV+ and EBV- cHLs. Methods 31 HIV-cHL and 40 cHL (8 EBV+/32 EBV-) cases were identified and corresponding tissue microarrays (TMAs) created. TMAs were evaluated for EBV (EBER), CD30, and microenvironment-associated antigens: PAX5, CD3, CD4, CD8, CD68, CD163 (% positive), TIA1, FOXP3 (relative number 0-4+); the hRS-macrophage microenvironment was evaluated by assessing the number of hRS where >50% of the circumference of the neoplastic cell was associated with CD68+ cells. Results were compared based on HIV status, EBV status (in HIV negative pts), demographics, cCD4 and histology; each was correlated with overall survival. Analyses were performed using non-parametric Fisher's exact test, Kaplan-Meier method and Cox Proportional Hazards model. Results M:F ratio was 9:1 in the HIV group vs. 1.3:1 in the HIV negative pts (p <0.001). The median cCD4 in the HIV+ pts at HIV-cHL diagnosis was 248 cells/mm3. No differences in age, stage, B symptoms, bulky disease, IPS score, and hRS concentration were found between HIV+ and HIV negative cHLs pts. 7% of cHLs and 33% of HIV-cHLs were classified as MC (p<0.01). 90% of HIV-cHLs were EBV+ compared to 20% of the cHL cases. Statistically significant differences were seen in the number of CD4+ and CD8+ cells between the EBV+ and EBV- cHLs irrespective of HIV status. The only difference among all the immune microenvironment markers observed between EBV+ HIV-cHL and EBV+ cHL cases was that of peri-hRS CD68 cells, which were more abundant in the EBV+ HIV-cHL (Table 1; 51% vs. 30% p<0.005). Similar differences in peri-hRS CD68 staining were observed between the HIV-cHL and all cHL pts. The only deaths in HIV-cHL pts occurred when CD68 was >15% (p<0.05). No statistical differences were noted for OS with respect to cCD4, histologic subtype, race, gender, or HIV status. Conclusions No significant differences were observed between HIV-cHL and cHL pts with respect to stage, B symptoms, bulky disease, IPS score, or overall survival, but there were more MC cases in the HIV-cHL cohort. The microenvironment of HIV-cHL and EBV+ cHL is similar, but different from EBV- cHL with respect to percentages of CD163+, PAX5+, CD4+ and CD8+ cells. The location of CD68+ macrophages was the only discordant result between the EBV+ HIV-cHL and EBV+ cHL cohorts. The differences in location of the CD68+ cells, which may be dependent on HIV status, suggests greater influence of these cells on the biologic behavior of the neoplastic process, correlating with poor survival. However, the similarity in the microenvironments in HIV-cHL and EBV+ cHL with respect to CD4, CD8, and CD163 staining implies an important role for EBV on disease biology, as well. Thus, these data suggest that EBV as well as HIV, play prominent roles in determining the immune response and disease behavior in HIV-cHL, warranting further study Disclosures: No relevant conflicts of interest to declare.
Introduction Iron plays a critical role in patients with multiple myeloma (MM). The limited availability of iron to the developing erythroid precursors results in the characteristic anemia so frequently seen in these patients. Moreover, iron is also a determinant in growth of the malignant plasma cells that makes it one of the critical factors in progression of the disease. Iron is a key component in success of erythropoietin (EPO) therapy that is often used to maintain hemoglobin (Hb) level of >10g/dL in patients with MM. International Myeloma working group (2011) advised transfusing IV iron to aid in success of EPO therapy. However, apart from determining the iron stores on bone marraow aspirate, there is hardly any reliable clinical or lab indicator of the iron stores in the body. The utility of various iron indices in determining the bone marrow iron stores remains anecdotal. In this study we aim to determine the relation between iron indices and iron level in the bone marrow of patients diagnosed with multiple myeloma. Methods A total of 268 multiple myeloma patients, diagnosed from 2004 to 2015, were identified from tumor registry of John H. Stroger Jr. Hospital of Cook County, Chicago. Accuracy of ferritin, iron level, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC) and transferrin saturation (TSAT) was evaluated using receiver operating characteristic curves (ROC). Out of sampled patients, 167 patients had a concurrent bone marrow biopsy and aspirate, serum ferritin and iron panel, and were included in ROC analyses. Results The study population consisted of 57% African-Americans, 18% Caucasians and 16% Hispanics. Median age was 61 years and 51% were females. Past history was significant for hypertension (48%), diabetes (31%), co-existing inflammatory conditions (18%), smoking (25%), alcohol abuse (17%) and illicit drug abuse (8%). Median hemoglobin, mean corpuscular volume (MCV), leukocytes and platelets were 10g/dL, 90.3fL, 6,200/mcL and 219,500/mcL respectively. Bone marrow aspirates for iron were rated as absent (37%), mild/moderate (18%) and adequate/normal (45%). Anemia was found in 79% of males (Hb <12.9g/dL) and 76% of females (Hb<11.7 g/dL). Of the patients with anemia, 36% of males and 39% of females had absent iron stores (determined by prussian blue staining method) on bone marrow aspirate. MCV was not significantly related with iron deficiency. Iron level, TIBC, UIBC and TSAT were not significantly associated with bone marrow iron (P>0.05). Only ferritin was significant predictor of iron deficiency and presence of iron in bone marrow (AUC 0.64, 95%CI 0.55-0.74, P=0.002). Ferritin levels of ≤15mcg/L (positive LR 3.77, sensitivity 3.4%, specificity 99.1%), ≤30mcg/L (positive LR 2.59, sensitivity 11.9%, specificity 95.4%) and ≤50mcg/L (positive LR 4.35, sensitivity 32.2%, specificity 92.6%) predicted iron deficiency. Ferritin levels of ≥100mcg/L (positive LR 1.47, sensitivity 76.9%, specificity 47.5%), ≥200mcg/L (positive LR 1.46, sensitivity 54.6%, specificity 62.7%) and ≥500mcg/L (positive LR 1.94, sensitivity 23.1%, specificity 88.1%) ruled out iron deficiency. Conclusion Of all the indices predicting iron deficiency, only ferritin was significantly associated with absent iron in bone marrow aspirates. In MM patients, iron supplementation should be considered with ferritin levels of ≤50mcg/L and can be deferred with ferritin levels of ≥500mcg/L. Further studies are needed to explore the association. Disclosures No relevant conflicts of interest to declare.
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