bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence, characteristics, and risk factors of venous thromboembolism in adolescent and young adult acute lymphoblastic leukemia patients receiving peg-asparaginase.
Authors: Underwood Brynne , Zhao Qiuhong , Walker Alison R. , Mims Alice S. , Vasu Sumithira , Behbehani Gregory , Blachly James Stewart , Larkin Karilyn T.M. , Wang Tzu-Fei , Bhatnagar Bhavana 
Published: March 2020

e18520 Background: Venous thromboembolism (VTE) is common in acute lymphoblastic leukemia (ALL) patients (pts) receiving peg-asparaginase (ASNase) however there is limited data regarding the incidence of VTE and risk factors for VTE in adolescent and young adults (AYA) treated with ASNase. Methods: This is a single institutional retrospective analysis of AYA pts with ALL who received ASNase from January 2013 to December 2018. Time to VTE was calculated from date of starting treatment to onset of VTE or censored at last assessment date, treating death as a competing risk. The cumulative incidence of VTE was estimated and the Fine and Gray regression models accounting for competing risks were used to examine the association between risk factors and VTE. Results: Forty-six AYA ALL patients were included. Pt characteristics are shown in the Table. Twenty pts had a VTE following ASNase with the cumulative incidence rate of 35% (95% CI: 22-48%) at 100 days. The most common VTE sites were cerebral (n=6) and upper extremity (n=6). Nine pts (43%) had at least one recurrent VTE. After initial VTE, ASNase was continued in 13 pts (62%), stopped in 6 pts (29%), and dose reduced in 2 pts (10%). Nine pts (45%) of those who developed VTE received antithrombin. Out of the 6 pts with VTE who had ASNase discontinued or dose reduced, 2 (33%) had progression of ALL. The hazard ratios (HR) for risk of VTE from univariable regression models are listed in Table 1. Male sex was associated with increased VTE risk, with HR=3.33 (95% CI: 1.13-9.77). Conclusions: Our study estimated the incidence of VTE in the AYA cohort. Only male sex was identified as a risk factor for VTE. Additional studies are needed to assess VTE risk factors in AYA pts with ALL. Pt characteristics and hazard ratios for risk of VTE. [Table: see text]
Blinatumomab is safe and effective in relapsed and MRD-positive B-ALL CD19+ patients: The Bologna Compassionate Program Experience.
Authors: Martinelli Giovanni , Paolini Stefania , Cerchione Claudio , Santoro Alessandra , Robustelli Valentina , Soverini Simona , De Benedittis Caterina , Imbrogno Enrica , Ghelli Luserna di Rorà Andrea , Parisi Sarah , Sartor Chiara , Marconi Giovanni , Lo Monaco Silvia , Abbenante Maria Chiara , Fontana Maria Chiara , Padella Antonella , Ferrari Anna , Simonetti Giorgia , Papayannidis Cristina 
Published: March 2020

e18522 Background: Adult B-ALL patients still have a dismal prognosis, due to a high incidence of relapse even after allogenic SCT. Safety and efficacy of Blinatumomab, anti CD3-CD19 Bite antibody, has been demonstrated both in MRD pos patients and in relapsed/refractory (R/R) setting. To evaluate safety profile and efficacy of Blinatumomab, obtained through a compassionate use, in a cohort of 18 adult patients affected by MRD+ or R/R B-ALL treated at Bologna University. Methods: From March 2015 to December 2017, 18 patients received Blinatumomab at the standard dosage (9 mcg/d x 7 days, 28 mcg/d x 21 days) in 28-days courses. All the patients were hospitalized to receive the 1st course of therapy. The following courses, based on the good safety profile of the compound, were administered in outpatient setting. 18 patients (M/F = 10/8; median age 43, r. 18-73) have been treated. Ph chromosome was detected in 8/18 . 10 were MRD+ (5 Ph pos and 5 Ph neg); E2A-PBX1 and MLL-AF4 rearrangements were found in two patients. 8 patients had a R/R disease (3 Ph pos/5 Ph neg). Median WBC count before starting therapy with Blinatumomab was 5400/mmc (r. 500-76500). All patients had previously received many lines of therapy (median 4, r. 1-7). In 4 cases an alloTMO was already performed, and two patients had received two transplants. 12/18 patients were referred to us by other Institutions. All the patients received at least one course of Blinatumomab. Bone marrow evaluations, including cytogenetics, molecular biology and immunophenotyping analysis were performed at the beginning of every course of therapy in order to assess patients' disease status. MRD evaluation was assessed through BCR-ABL fusion transcript quantitative analysis in Ph pos ALL patients and Ig rearrangment in Ph neg patients. Monitoring of adverse events was periodically performed. 16/18 patients are evaluable for response, at least to one cycle. Results: 9/16 (56%) patients obtained a CR (7/9 MRD+ and 2/7 R/R). In 7/9 (78%) responders patients a molecular CR was reached, (in 6 patients after the first course, in one case after the second one). 5 responders proceeded to alloBMT and are actually alive in CR (median follow-up after transplant 240 days). In terms of toxicity, one patient developed a grade IV neurological event (mental confusion, tremor), which completely resolved after a transient drug withdrawal. Conclusions: Our results confirm the high rate of response and to Blinatumomab in a poor patients' population, and the good management profile of the compound.
Evaluation of prognostic factors after induction therapy in AML.
Authors: Devoe Craig E. , Bao Delong , Trotta Christina , Lee Chung-Shien , Fishbein Joanna Stein 
Published: March 2020

e18528 Background: Acute myeloid leukemia (AML) is a hematologic myeloid malignancy that carries a poor prognosis. Standard of care is induction chemotherapy with daunorubicin and cytarabine also known as 7 + 3. Bone marrow aspirates are assessed on day 14 (D14) and day 28 (D28). Achievement of CR (complete remission) is predicative of overall survival (OS ).Morphological review of BM (bone marrow) on D14 remains the standard evaluation for any indication for CR. Methods: Our primary objective was to determine if blast % on the D14 bone marrow aspirate is a prognostic indicator for remission in acute leukemia patients who underwent induction chemotherapy. Institutional review board was approved. A retrospective chart review was conducted at North Shore University Hospital. Adult patients with AML who received standard induction chemotherapy from 2010 to 2015 were included. 150 patients were reviewed and their D14 blast %, initial marrow blast %, gender, age, cytogenetics and initial WBC were assessed. The patients’ D14 blast % biopsies were divided into blast percentiles: < 1%, 1-10%, 10-30%, 30-60% and > 60%. CR was defined as patients having < 5% blasts on their D28 bone marrow or day 63 and corresponding neutrophil count > 1,000 and platelet count > 100,000. Results: Fisher’s exact test was used to compare the proportion of patients who reached CR among the D14 blast % categories. The Wilcoxon test was utilized to compare CR on continuous variables. Results were considered statistically significant if p < 0.05. D14 hemoglobin and D14 platelets were not significantly associated with CR status (p = 0.67, p = 0.33, and p = 0.13, respectively). D14 WBC was significantly associated with CR (p = 0.02), but when both D14 WBC and initial blasts % were included in a multiple logistic model, WBC was no longer a significant predictor of outcome. Only initial blast percent at time of diagnosis was deemed predictive of CR response at day D63 (p = 0.0142). Conclusions: Initial blast > 60% was found to be significantly associated with the greatest CR rate. This study provides evidence of initial blast % being a prognostic factor for CR.
HCT related toxicities and mortality in frail recipients.
Authors: Pamukcuoglu Merve , Bhatia Smita , Weisdorf Daniel Jordan , DeFor Todd E. , Ustun Celalettin , Nayar Manju , Holtan Shernan , El Jurdi Najla H. , Thyagarajan Bharat , Brunstein Claudio , Bachanova Veronika , Warlick Erica D. , Arora Mukta 
Published: March 2020

e18534 Background: Frailty is a state characterized by diminished physiological reserve and increased vulnerability to stress, and adversely affects outcomes in older patients with cancer. Geriatric assessments are not routinely used to screen older HCT (hematopoietic cell transplant) recipients. There is limited knowledge of the impact of pre-HCT frailty on severe/ life-threatening (CTCAE, version 5.0) grade 3-4 non-hematologic toxicities within 1y after HCT. We aimed to determine the relationship between pre-HCT frailty and grade 3-4 non-hematologic toxicities and mortality in HCT recipients, and also examined whether age at HCT moderated that association. Methods: In a prospective longitudinal study of 117 patients undergoing HCT at age ≥ 40y, we performed pre-HCT geriatric assessments. Frailty was assessed using Fried’s criteria. Post-HCT toxicities were abstracted through chart reviews Results: Median age at HCT was 60y (40-73). Pre-HCT frailty could be evaluated in 98 (84%) patients [(51 autologous, 47 allogeneic (allo)]. Pre-HCT comorbidity index (CI) was high in 27%, intermediate in 40% and low in 33%. The prevalence of pre-HCT frailty was 21%. Overall, frail recipients (vs. non-frail) had a higher cumulative incidence of any grade 3-4 toxicity [86% (95% CI: 62-100%) vs. 70% (57-83%), p = 0.03]; and the following organ specific grade 3-4 toxicities: non-neutropenic infections [(38% (17-59%) vs. 13% (6-20%), p < 0.01)]; nervous system disorders [(19% (3-35%) vs. 4% (0-8%), p = 0.02)]; and pneumonia [(38% (17-59%) vs. 10% (4-17%), p < 0.01]. Frail recipients also had a higher overall mortality [52%, (30-75%) vs. 19%, (11-28%) (p < 0.01)]. In Cox regression analysis controlling for age, donor type, disease risk, conditioning and HCT-CI, frail recipients were 1.9 fold more likely to suffer any grade 3-4 toxicities (p = 0.03), 4-fold more likely to suffer non-neutropenic infections and pneumonia, both p = 0.01; and 8.6-fold more likely to suffer nervous system disorders, p = 0.01. Frail recipients who underwent an allo-HCT were at 2.7 fold higher risk of death vs. non-frail allo- HCT recipients, p = 0.06. Conclusions: The higher toxicity and mortality in frail recipients needs attention. Studies focusing on pre-HCT interventions to reduce frailty are needed.
Outcomes of autologous blood collection prior to bone marrow harvest for matched unrelated donors.
Authors: Ramnaraign Brian Hemendra , Rogers Brittany Kayla , McGorray Susan P. , Sugrue Michele , Murthy Hemant S. , Hiemenz John W. , Hsu Jack W. , Wingard John R. , Farhadfar Nosha 
Published: March 2020

e18535 Background: Autologous (auto) blood collection prior to bone marrow (BM) harvest is a common procedure however there is little data to say whether this is beneficial. Methods: This is a retrospective study evaluating the efficacy of pre-op auto blood collection in healthy unrelated donors who underwent BM harvesting at our institution between 9/2009 and 8/2017. Unrelated donors aged 18 or older who underwent their first BM harvest were included. Comparisons were made using two sample t-tests. Results: Among the 73 BM donors, 54 (74%) underwent auto blood collection resulting in 78 units collected. The cohorts with and without auto blood collected were similar in age and gender (mean age 31.0 vs 30.2; female 59% vs 41%). Those with auto blood collected donated larger volumes of marrow (mean 1395 mL vs 799 mL, p = 0.0002). Baseline hemoglobin (Hb) was similar between the cohorts (mean 14.1 g/dL vs 14.0 g/dL, p = 0.87). However, those with auto blood collected had lower pre-harvest (mean 13.1 g/dL vs 13.8 g/dL, p = 0.0430) and post-harvest Hb (mean 10.0 g/dL vs 11.3 g/dL, p = 0.0120). Of the 78 auto blood units collected, 45 units (58%) were used with 92% of women and 56% of men receiving their auto blood post-op. 33 (42%) auto blood units were discarded. Donors who were given back their auto blood were more likely to be female and have lower pre- and post-harvest Hb. Reasons for auto blood transfusion were blood availability (31%), donor post-op symptoms (i.e. hypotension, dizziness, syncope, and bleeding; 23%), intra-operative transient hypotension (26%), post-op anemia (11%) and patient request (9%). None of the patients who were transfused auto blood, or donors without auto blood collection, required allogeneic blood. Conclusions: Based on our results, collection of auto blood prior to bone marrow harvest leads to lower pre-op Hb and increases the likelihood of post-op blood transfusion. In addition, availability of auto blood can lead to over transfusion which may be detrimental to donor health. Although there may be a subset of donors who might benefit, routine auto blood collection prior to bone marrow harvesting is unnecessary and can be potentially hazardous to donors.
Pyridoxine impact on patients with myelodysplastic syndromes with ring sideroblasts: Single institution retrospective study.
Authors: Zblewski Darci , Nguyen Phuong L. , He Rong , Greipp Patricia T. , Begna Kebede , Patnaik Mrinal Mahesh , Gangat Naseema , Shah Mithun Vinod , Alkhateeb Hassan , Litzow Mark Robert , Al-Kali Aref 
Published: March 2020

e18549 Background: Many vitamin deficiencies can cause anemia. It is prudent prior to diagnosing a myeloid neoplasm, to check for vitamin deficiencies and correct them. Myelodysplastic syndromes with ring sideroblasts (MDS-RS) are associated with anemia. Pyridoxine (Vit B6) replacement may improve anemia found in sideroblastic anemia. The study was to determine how frequently Vit B6 was assessed, replaced and impact replacement had on outcomes in MDS-RS. Methods: Study subjects were from the Mayo Clinic Myelodysplastic syndrome (MDS) database which contains 1315 patients (pts). Appropriate IRB approval was obtained. Diagnosis of MDS and its sub-classification was done according to World Health Organization 2016 criteria. A response was any improvement in hemoglobin. Overall survival (OS) estimates were calculated using Kaplan-Meier curves and univariate and multivariate analysis was done using JMP software version 13. Results: Among 1315 pts with MDS, 161 pts had a diagnosis of MDS-RS. Median age was 73, and 55 (34%) pts were females. Thirty-nine (36%) pts had very low, 53 (50%) low, 9 (8%) intermediate, 3 (3%) high, and 2 (1%) had very high revised international prognostic score. The median white blood cell count was 5.4 x109, platelet count was 255 x109, and hemoglobin was 9.9 gm/dL. Five pts (3%) had a Vit B6 levels done; out of whom, 4 (80%) were not Vit B6 deficient. Among 42 (26%) pts who had Vit B6 replacement, 21 (50%) had no response, 4 (10%) had a response and 17 (40%) had unknown response. 103 (64%) of the pts were transfusion independent (TI). Overall survival in pts who are transfusion dependent was 68 months compared to 85 in pts who are TI (Wilcoxon P =.03). There was an improvement in OS in the group that had Vit B6 replacement compared to the group with no Vit B6 replacement (92 months vs 68 months, Wilcoxon P =.07). Response to Vit B6 replacement did not show OS benefit. Acute Leukemia transformation in Vit B6 replacement was 2% and 6% in pts. who did not have Vit B6 replacement (P= .4). Conclusions: Vit B6 was not checked often in MDS-RS pts. There was a borderline improvement in OS in Vit B6 replacement group (p= .07). Response did not affect OS. A larger prospective study is needed to study Vit B6 role in MDS-RS.
Thrombotic episodes in myeloproliferative neoplasms: A population based study.
Authors: Ball Somedeb , Bandyopadhyay Dhrubajyoti , Hajra Adrija , Ghosh Raktim K , Tijani Lukman Aderoju , Maiti Abhishek 
Published: March 2020

e18554 Background: Myeloproliferative neoplasms (MPN) are complicated with high incidence of thrombotic episodes, often requiring chronic anticoagulation in high risk patients (pts). To improve our knowledge on risk stratification, we undertook a large population study on National Inpatient Sample (NIS) to investigate the demographic and health factors associated with venous thromboembolism (VTE) and acute coronary syndrome (ACS) in pts with MPN. Methods: In this retrospective cohort study using the most recent 2016 NIS, we included all pts with discharge diagnosis (dx) of MPN with or without current or prior dx of VTE and ACS using appropriate ICD-10 codes. Demographic and health characteristics were compared between groups. Multivariate logistic regression was done to compare length of stay and cost of care. STATA 13.0 was used for statistical analysis. Results: Among 162,435 pts with MPN, 3750 (2.3%) had VTE and 2820 (1.73%) had ACS. MPN pts with VTE had significantly higher age (mean 61.3 years) compared to those without VTE (mean 59.3 years). Smoking, obesity, and JAK2 mutation were significantly more common in MPN with VTE group. Pts with MPN and ACS were significantly older than those without ACS (67.85 vs. 59.2 years). These pts were mostly males and more likely to have hypertension, diabetes, smoking, dyslipidemia, obesity, and chronic kidney disease as comorbidities. Total hospital cost was significantly higher in MPN pts with VTE and ACS. Conclusions: In agreement with prior reports, age, smoking, and presence of JAK-2 mutation seem to be an important prognostic factors for both VTE and ACS in MPN. Other common comorbidities mandate critical consideration in assessment of thrombotic risk in MPN pts. [Table: see text]
Role of ethnicity in thrombotic and hemorrhagic complications of myeloproliferative neoplasms.
Authors: Peseski Andrew , Saliba Antoine , Sayar Hamid 
Published: March 2020

e18555 Background: Philadelphia-chromosome negative myeloproliferative neoplasms (MPN) are a group of hematologic malignancies with known complications of hemorrhage and thrombosis. Age and a previous history of thrombosis are well-documented risk factors for future vascular events. Variations in the rates of these complications among ethnicities and sexes have not been extensively explored. Methods: Our retrospective analysis included 301 adult patients with a diagnosis of MPN without a history of thrombosis or hemorrhagic event seen at the Indiana University Simon Cancer Center between 1992 and 2019. Relationships between ethno-racial backgrounds and vascular complications and disease outcomes were evaluated using multivariate logistic regression analysis and Cox regression models. Results: Two hundred seventy-one patients (90.0%) were Caucasian and 30 patients (10.0%) were non-Caucasian. Non-Caucasian patients were comprised of African America, Asian, and Middle Eastern ethnicities. Median age at diagnosis was 56 years, and 43.9% were male. No association was found between the incidence of thrombotic complications and ethnicity using the log-rank test ( p 0.68). The incidence of hemorrhagic events was significantly increased in non-Caucasian patients (OR = 4.33; 95% CI [1.15 – 16.36], p 0.03). Patients with higher hemoglobin concentration at diagnosis were at a significantly lower risk of bleeding complications (OR = 0.79; 95% CI [0.65 – 0.95], p 0.01). Non-Caucasian patients were at 2.98 times (95% CI [1.19 – 7.44], p 0.02) higher risk when vascular complications were pooled together. Our models also showed that male sex (OR = 0.14; 95% CI [.02 – .98], p 0.048) and a higher platelet count at the time of diagnosis (OR = 0.99; 95% CI [.993 –.999], p 0.03) had a marginally significant association with decreased rate of progression to acute myeloid leukemia. Conclusions: This study suggests that in patients without a history of thrombosis or bleeding, non-Caucasian ethnicity was associated with an increased adjusted risk of hemorrhagic complications in patients with MPN. This observation may inform future studies to further characterize those disparities in outcomes at the genetic or socioeconomic level.
Pattern of rasburicase (RAS) use in community oncology programs and impact on tumor lysis syndrome (TLS) outcomes.
Authors: Balcerski Wynter , Howard Scott C. , Napier Nicholas 
Published: March 2020

e18559 Background: TLS complicates management of bulky chemosensitive cancers. Incidence and severity have increased with new, effective therapies. Prophylaxis/management vary widely. We assessed impact of RAS on outcomes of pts at risk for TLS. Methods: We examined medical records of 5860 pts newly diagnosed with hematologic cancers treated in 101 community hospitals (2010–2018) in the Guardian Research Network. We assessed TLS risk factors, use of uric acid-lowering therapy, e.g. RAS and TLS-related outcomes. RAS doses were grouped as very low/low: 0.01–0.09 mg/kg; medium/full: ≥ 0.1 mg/kg. Acute kidney injury (AKI) was defined using Risk, Injury, Failure, Loss, and End-stage kidney criteria. Early dialysis and early death occurred ≤ 30 days of diagnosis. Results: Of 5860 pts, 206 (3.6%) died early and 17 (0.3%) had early dialysis. AKI occurred in 441 (7.5%); 317 (72%) had AKI at presentation. TLS management varied by region, with RAS used in 4.7–8.1% (p < 0.001), and by baseline creatinine, with RAS used in 5.1% vs 38% (p < 0.001) with normal vs ≥ 3 mg/dL baseline creatinine, respectively. More than half of pts with elevated uric acid (EUA) or elevated creatinine (EC; > 2 mg/dL) at baseline did not receive RAS; they had disproportionate AKI (EC p < 0.001; EUA p < 0.001), early dialysis (EC p < 0.001; EUA p < 0.12) and early death (EC p < 0.001; EUA p < 0.001). Conclusions: Clinicians often use low RAS doses. Pts with hematologic cancers and EC and EUA at baseline have increased rates of AKI, early dialysis and early death. While immediate, aggressive supportive care for TLS is needed, it is inconsistently applied in this high-risk population. Funding Sanofi.
Outcomes of tbo-filgrastim, filgrastim-sndz or filgrastim for mobilization in patients undergoing an autologous hematopoietic stem cell transplant: A single center experience.
Authors: Neme Klodiana , Henkin David , Mikulandric Nancy , Grycki Meredith , Michael Angela , Smith Cassandra , Emole Josephine 
Published: March 2020

e19000 Background: Studies have reported that use of filgrastim (G) or any biosimilar result in similar stem cell yield during hematopoietic stem cell mobilization, but little is known on the effect of these biosimilars on length of hospitalization for the transplant procedure, engraftment, and long term survival of autologous hematopoietic stem cell transplant (HSCT) patients. Beginning January 2017, the Henry Ford Cancer Institute (HFCI) began utilizing tbo-filgrastim (TBO) and filgrastim-sndz (SNDZ) as part of mobilization. This study was conducted to evaluate transplant specific outcomes in HSCT patients comparing biosimilar and reference filgrastim products. Methods: This study retrospectively evaluated all patients treated at HFCI who received G-CSF based mobilization for HSCT between 1/2017 and 11/2018. Patient-, mobilization- and transplant specific variables were collected and analyzed. Results: A total of 113 patients underwent stem cell mobilization followed by collection and autologous HSCT. Of the 73 patients analyzed, 62% had a diagnosis of Multiple Myeloma (MM), 22% had Non-Hodgkin Lymphoma (NHL). Approximately 45% of patients received TBO, 44% received G and remainder received SNDZ. The percentage of patients who proceeded to HSCT was 86%. There was no difference in adequate CD34+ yield among the three G-CSF products (P = 0.074). There was no difference in mobilization associated complications including bone pain and thrombocytopenia. Plerixafor use was similar among the groups (P = 0.55). Actual CD34+ (P = 0.31) and the number of apheresis sessions required to collect an adequate CD34+ yield (P = 0.30) were not different among the groups. No significant differences were noted in time to neutrophil (P = 0.96) or platelet engraftment (P = 0.91) and hospital length of stay (P = 0.78). We found similar rates of infection, febrile neutropenia, and mucositis among the three groups. Relapse rates were also similar among the groups. Conclusions: In our institution transplant related outcomes were similar among patients who received TBO, SNDZ, and G as part of their pre-transplant mobilization protocol.