Immune thrombocytopenia (ITP) has been widely reported as a complication of SARS-CoV-2 infection, but to our knowledge, there have been no reports on the association of the COVID-19 vaccine with thrombocytopenia. Here, we report a case of secondary ITP in a patient who was recently immunised with the messenger RNA COVID-19 vaccine BNT162b2 (Pfizer–BioNTech).

Frequency of anemia 1 year after RYGB in our population was low (4 %). Anemia non-attributable to malabsorption was frequently present (n = 9/19). Iron deficiency was found exclusively in women. The most common non-malabsorptive types of anemia were inflammation and dysfunctional uterine bleeding.

Cancer cells are characterized by having chromosomal abnormalities. The number of aberrations and the specific chromosomes affected are likely correlated with tumor progression. In this study, we analyzed the karyotype of 126 plasma cell leukemia (PCL) patients to identify the most frequently occurring imbalances and to design a model of karyotypic evolution. The Mitelman database of chromosome was searched and abnormal karyotypes were assessed. The main clones were analyzed and chromosomal gains and losses were used to design a model of genetic acquisition based on the calculation of a variable called time to occurrence. Our comprehensive study of genetic abnormalities of a large number of PCL karyotypes suggests that PCL is mainly characterized by the presence of whole chromosome losses as well as IgH rearrangements which is similar to that observed in non-hyperdiploid multiple myeloma (MM). Temporal analysis suggests that most PCL have around 10 abnormalities at diagnosis. It is possible that accumulation of abnormalities such as 17p13 (TP53) and 1p losses may trigger the extramedullary features of PCL. Our study demonstrates that cytogenetics is a valuable tool to evaluate the role of genetic imbalances on karyotypic evolution by using a mathematical model.

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Purpose:The aim of this study was to report a unique clinical presentation of paraproteinemic keratopathy after a myopic uneventful laser in situ keratomileusis (LASIK) procedure that led to the diagnosis of gammopathy of undetermined significance.Methods:This was an interventional case report. A 55-year-old woman present with bilateral branching opacities limited to the optical zone of myopic LASIK. The patient's medical history was unremarkable.Results:After ruling out a mutation in TGF-β1, a systemic workup was performed, revealing an IgG level of 12.8 mg/dL, lambda-free light chain of 12.8 mg/dL, and M-spike of 0.6 g/dL. Bone marrow aspiration was slightly hypercellular, without evidence of neoplastic infiltration by plasma cells. The patient underwent 3 cycles of systemic chemotherapy, with improvement in best-corrected visual acuity.Conclusions:Paraproteinemic keratopathy is a rare clinical presentation that may lead to a systemic diagnosis of hematologic malignancy. To the best of our knowledge, this is the first reported case of paraproteinemic keratopathy after LASIK.

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4138 Background: Allogeneic stem cell transplantation (ASCT) is the standard treatment for several diseases. However, the morbidity and mortality associated with the procedure limit its widespread use in developing countries. We implemented a novel conditioning method to reduce complications and improve survival. We hypothesized that the dose reduction in this regimen (about 20–25%), would preserve its myeloablative and immunosupressive effect, but with significantly reduced toxicity and mortality. Objectives: Describe clinical characteristics, toxicity, frequency of GVHD and survival of adult mexican patients undergoing ASCT using reduced BUCY2 and G-CSF primed bone marrow as a conditioning method. Material and Methods: Prospective cohort study of patients with matched related donor allotransplant using this new method from November 1999 to December 2011. Stem cell collection was obtained from iliac crests by multiple aspiration. The donor received GCS-F (10μg/kg/day) 3 to 5 days prior to harvest. The conditioning included: Busulfan 12mg/kg PO (3mg/kg/d in -7, -6, -5, -4), Cyclophosphamide 80mg/kg IV (40mg/kg/d in −3, −2), and GVHD prophylaxis with Cyclosporine A (1.5mg/kg bid, beginning at -1: target 200–300 ng/μL) and a short course of Methotrexate. All patients received antimicrobial prophylaxis once the neutrophil count reached < 500/μL. Weekly CMV antigenemia was performed until the 4th month post-transplant. Neutrophil and platelet engraftment were defined as the first of three consecutive days with a neutrophil count □ 0.5 × 109/L and □ 20 × 109/L without transfusion, respectively. Transplant related mortality was defined as any death directly attributed to the conditioning regimen, to aplasia during transplant and/or to infectious or GVHD complications. Engraftment failure was defined as the inability to achieve neutrophil and platelet engraftment during the first 28th days postransplant. Statistical Analysis: Descriptive analysis was used for continuous and categorical variables. Kaplan–Meier curves to asses overall survival, and central tendency measures to analyze: general features, time of engraftment and hospitalization days (SPSS 17.0). Results: 29 patients undergoing ASCT with reduced BUCY2 and GCS-F primed-bone marrow were included. All had a HLA-matched related donor, median age of 29 years. 19 patients (65.5%) were male. The diagnosis was: MDS in 10 patients (34.5%), CML in 9 (31%), ALL in 6 (20.7%), AML in 2 (6.9%) and PNH in 2 (6.9%). The median CD34+ transfused cells: 1.9 × 106/kg. Median time to neutrophil and platelet recovery: 20 days (range 14–29) and 15 days (range 7–36), respectively. All patients engrafted. The most common toxicity was mucositis (79.3%) with grade III-IV in 48.3% of cases. Hepatic (41.4%) and renal (48.3%) toxicities, were mild, transient and easily managed with support measures (table 1). Acute and chronic GVHD developed in 6.9% and 34.5% of patients, respectively. There was no mortality at 30 days, and 100-day mortality was 7% (2 patients), attributed to infectious complications. Transplant related mortality was 10% (3 patients) and 5-year overall survival was 70.3%. Discussion and conclusions: Our results show some advantages compared with standard regimens: noteworthy 5-year OS (70%), similar time to engraftment as for HSC from peripheral source and low GVHD incidence. There was a low TRM (10%), compared to myeloablative regimens, and probably lower than reduced intensity transplants. Main toxicities were grade II-III mucositis and hepatic toxicity, without serious clinical significance. Also, there was a low incidence of acute GVHD (6.9%) probably related to reduced tisular toxicity associated to the conditioning dose reduction, as well as the use of primed bone marrow. In conclusion, this strategy preserves an immunosuppressive and cytotoxic effect allowing eradication of the malignant clone with adequate bone marrow engraftment, acceptable toxicity, low incidence of GVHD and low TRM, representing a new alternative for ASCT. Disclosures: Armengol-Alonso: European Society of Clinical Oncology: Fellowship Other. Neme-Yunes:Agrupación Mexicana para el Estudio de la Hematología: Employment.

Peripheral T cell lymphomas are aggressive neoplasms with an overall bad prognosis. As occurred with B cell lymphomas, some T cell lymphomas have been correlated with a normal T cell counterpart. According to the actual WHO classification of tumors of hematopoietic and lymphoid tissues, the only T cell lymphoma characterized by a T reg phenotype is adult T cell leukemia/ lymphoma (ATCLL), an entity defined by its etiologic association with HTLV-1 infection. We present a case of peripheral T cell lymphoma with a Treg phenotype not associated with HTLV-1 infection. We describe its pathological and clinical characteristics and discuss the presence of a T reg phenotype in T cell lymphomas.