bluuebunny/crossref_metadata_2025_split huggingface dataset:
PF728 COMPARISON OF ALLOPURINOL AND FEBUXOSTAT FOR PREVENTION OF HYPERURICEMIA AND TUMOR LYSIS SYNDROME IN ACUTE LEUKEMIAS
Authors: Mirgh S.P. , Mahapatra M. , Seth T. , Dhawan R. , Aggarwal M. , Saxena R. , Pati H. , tyagi S. 
Published: June 2019

Background:Serum uric acid control is of prime importance in prevention of tumor lysis syndrome. Each mg/dl rise in uric acid increases the risk of tumor lysis syndrome and renal events by 1.75‐fold and 2.25‐fold respectively. We compared two xanthine oxidase inhibitors ‐ allopurinol and febuxostat as hypouricemic agents in patients of acute leukemias.Aims:The aims of the study were to assess the change in serum uric acid levels from baseline to day+7 after chemotherapy and to determine the incidence of tumor lysis syndrome in both groups.Methods:In this single‐institution prospective cohort study (study period – January2017 – July2018), acute leukemia patients scheduled to receive induction chemotherapy were administered either allopurinol or febuxostat, starting atleast 1 day prior to chemotherapy till 8 days after chemotherapy. Daily dose for Allopurinol was 300 mg/m2 and for febuxostat, it was 80 mg (10 mg daily for children < = 15years). Patients with baseline uric acid level >8 mg/dl, presence of hepatic or renal dysfunction and history of receiving rasburicase were excluded. The primary objective was to compare both the drugs in terms of decrease in serum uric acid levels analysed by area under curve (AUC) for a 7‐day treatment period.Results:A total of 120 patients (60 patients in each group) were recruited. Both groups were comparable in terms of gender, age, diagnosis and baseline uric acid levels. Mean AUC of serum uric acid day1–8 was 457.68 ± 27.55 mg‐h/dL versus 532.32 ± 34.39 mg‐h/dL, in favour of febuxostat [P = 0.09].The difference between the two study drugs was statistically significant for febuxostat on day+3 [P < 0.05] (Figure 1).10% (n = 6) patients on allopurinol developed TLS compared to 3.33% (n = 2) patients on febuxostat. The Odds ratio for tumor lysis syndrome in patients receiving febuxostat relative to those receiving allopurinol was 0.33. Drug related adverse events were 38.33% (n = 23) in allopurinol group, in contrast to 11.66% (n = 7) in the febuxostat group. Most common adverse event in allopurinol arm was gastrointestinal, whereas in febuxostat arm, it was asymptomatic transaminitis. Cutaneous reactions (6.6%;n = 4) were noticed only in allopurinol group.Summary/Conclusion:Irrespective of type of leukemia, lactate dehydrogenase levels, leukocyte counts and baseline uric acid levels, febuxostat in comparison to allopurinol, performed non‐inferior with respect to its uric acid lowering efficacy. It had relatively lesser risk of tumor lysis syndrome with a trend towards significance and a better safety profile.image
PF730 CHRONIC RENAL FAILURE IN CHILDHOOD CANCER: AN INSIGHT FROM KIDS INPATIENT DATABASE
Authors: Elsabbagh E.M. , Almasri M. 
Published: June 2019

Background:Chronic Renal Failure (CRF) is prevelant in oncology patients. CRF may pre‐exist cancer diagnosis, occur secondry to cancer infiltration, complicate chemotherapy and other toxic drugs or follow hematopoietic stem‐cell transplantation. CRF is associated with prolonged hospital stay, high healthcare cost and increased mortality. Despite the increased prevelance and these associations, the national rate and clinical outcome of CRF among pediatric oncology patients is not well described.Aims:Define CRF incidence and its health outcomes among pediatric oncology patients in the United States (U.S.).Methods:We performed a retrospective cohort analysis of the Health Cost and Utilization Project (HCUP) Kids’ Inpatient 2000–2012 Database (KID) for patient ≤ 20 years of age. Patients with principal diagnosis of acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), lymphomas (Hodgkin and non‐Hodgkin), brain tumor, neuroblastoma, bone tumors (Ewing's Sarcoma and Osteosarcoma) and hepatoblastoma were reviewed. Encounters for chemotherapy were excluded. Patients with medical diagnosis of CRF were identified using ICD‐9‐CM codes. We performed descriptive statistics to characterize the cohort in terms of demographic factors (age, race, sex, insurance type), hospital characteristics and comorbidities. Data weights were applied to sampled patients to provide national estimates. The in‐hospital mortality rate, total charges, and hospital length of stay (LOS) were compared between cancer patients with and without CRF using bivariable analyses.Results:A total of 266,113 admissions were included for analysis. The cohort was comprised of 1,035 patients with CRF, with an overall incidence 4 per 1,000 admissions. The median age was 15 years.51.5% of CKD patients were among the age group above 12‐year‐old. Males (57%), and whites (52.3%) were more commonly affected. South and Midwest regions (59.5%) of the U.S. had higher frequency of CRF. 15% of CRF complicated acute kidney injury (AKI). Lymphoma was the most common diagnosis associated with CRF (1.3%). Patients with CRF had significantly higher mortality rates (5.5% vs. 1.36%, p < 0.0001), longer median LOS (15 days vs. 4 days, p < 0.0001) in CRF patients complicated AKI and higher median total charges per hospitalization ($36,600 vs $18,856) when compared to patients without CRF.Summary/Conclusion:CRF in pediatric oncology patients is significantly associated with increased in‐hospital mortality and higher healthcare cost in pediatric oncology patients. Attention should be directed towards strategies to minimize risk of CRF in those population.
PF733 COMBINED ORAL ANALGESIA AND ANXIOLYSIS FOR PAIN ASSOCIATED WITH BONE MARROW ASPIRATION AND BIOPSY
Authors: Cerchione C. , Martinelli G. , Catalano L. , Pugliese N. , Pepa R. Della , Gravetti A. , Nappi D. , Pane F. , Martinelli V. 
Published: June 2019

Background:Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors.Aims:Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested.Methods:Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo‐group, 51,4%) during BMAB. Pre‐procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0–10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group.Results:At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower (p <  0.05) perception of pain in the patients who received sedoanalgesia (combo‐group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures.Summary/Conclusion:Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.
PF758 MULTI‐CENTER, PHASE II STUDY ON HAPLOIDENTICAL BONE MARROW TRANSPLANTATION USING A RIC REGIMEN AND POST‐TRANSPLANT CYCLOPHOSPHAMIDE IN PATIENTS WITH POOR PROGNOSIS LYMPHOMAS
Authors: Castagna L. , Dodero A. , Patriarca F. , Onida F. , Olivieri A. , Russo D. , Majolino I. , Sarina B. , Mariotti J. , Bramanti S. , De Philippis C. , Tagliaferri E. , Carlo‐Stella C. , Fanin R. , Corradini P. , Santoro A. 
Published: June 2019

Background:Allogeneic stem cell transplantation from haploidentical donor using unmanipulated bone marrow and post‐transplantation cyclophosphamide (PT CY) has been largely used to cure high‐risk lymphomas. Using nonmyeloablative conditioning regimen, the relapse incidence is considered a concerning issue.Aims:The aim of our study was to prospectively evaluate the efficacy and the feasibility of thiotepa‐based RIC regimen in high risk lymphoma patients.Methods:We enrolled 49 patients, and of these 47 were evaluable. The conditioning regimen consisted of thiotepa 10 mg/kg in 2 days, fludarabine 90 mg/m2 in 3 days, CY 60 mg/kg in 2 days, and TBI 2 Gy or TMI‐TLI 2 Gy. Unmanipulated bone marrow stem cells from a haploidentical family donor was infused at day 0. Graft versus host disease (GVHD) prophylaxis consisted of cyclophosphamide 50 mg/kg/day on days 3 and 4, mycophenolate mofetil and cyclosporine from day 5. The primary end point was the 1‐year progression free survival (PFS).Results:Patient characteristics are reported in the Table. Median age was 43 years (19–68). 49% of patients was affected by HL and 51% was in CR. The median time to absolute neutrophil count (ANC) and platelet recovery were 22 days (14–44) and 27 (17–151), respectively. The cumulative incidence (CI) of ANC engraftment at 30 days and platelet count at 60 days were 89% (75–95) and 84% (66–92). 2 patients (DSA negative) had a primary graft failure. The cumulative incidence at 6‐month of grade 2–4 acute GVHD and 2‐year moderate‐severe chronic GVHD was 26% (14–39) and 23% (13–37), respectively. After a median follow‐up of 35 months (12–64), the 1‐year and 3‐year PFS were 67% (51–79) and 67% (51–79), respectively. The 1‐year and 3‐year OS were 77% (62–86) and 67% (51–79), the 3‐year relapse incidence was 26% (14–39), and the 1‐year NRM was 15% (7–27). The 1‐year GRFS was 58% (43–71). The cause of death in 7 patients was: bilateral not documented pneumonia, acute GVHD, transplant‐associated microangiopathy, graft failure, CNS hemorrhage and other toxicities (2).Summary/Conclusion:In a prospective multicenter study in poor risk lymphoma patients, a thiotepa‐based RIC was well tolerated with an encouraging 1‐year PFS. Both relapse incidence and NRM were acceptable. A comparison with similar patients conditioned with a nonmyeloablative conditioning regimen has been planned.image
PF762 EFFECTS OF TWO DOSES OF ANTITHYMOCYTE GLOBULIN IN CONDITIONING REGIMENS FOR HAPLOIDENTICAL PERIPHERAL BLOOD STEM CELL TRANSPLANTATION
Authors: wang M. , fang X. , jiang Y. , sui X. , li Y. , liu X. , wang X. , xu H. , wang X. 
Published: June 2019

Background:Antithymocyte globulin (ATG), an important in vivo T‐cell depletion strategy, has been used for graft‐versus‐host disease (GVHD) prophylaxis and shown significant clinical benefit. However, the optimal ATG dose remains unclear.Aims:To assess the effectiveness of ATG at a total dose of 10.0 mg/kg and 7.5 mg/kg for haploidentical peripheral blood stem cell transplantation (PBSCT).Methods:We retrospectively analyzed patients who underwent haploidentical PBSCT, receiving myeloablative conditioning and standard GVHD prophylaxis. ATG (rabbit thymoglobulin) at a total dose of 10.0 mg/kg (2.5 mg/kg on days −5 to −2) and 7.5 mg/kg (2.5 mg/kg on days −4 to −2) were used in the two groups.Results:40 and 35 patients were enrolled in the ATG‐10 and ATG‐7.5 groups, respectively. No significant difference was observed regarding the cumulative incidence of 100‐day grade II‐IV acute GVHD (20.0% vs 14.3%; p = 0.53) and 3‐year chronic GVHD (13.7% vs 15.7%; p = 0.83). The 3‐year probability of overall survival (OS) was 72.6% vs 74.4% (p = 0.81) and the 3‐year probability of GVHD‐free/relapse‐free survival (GRFS) was 69.0% vs 53.0% (p = 0.16). The incidence of relapse in the ATG‐7.5 group (30.9%) was higher compared with the ATG‐10.0 group (17.1%), but this difference was not statistically significant (p = 0.20). In multivariate analysis, the ATG dose was not associated with relapse, while no further respond to therapy (NR) before PBSCT predicted relapse (HR 1.19, p = 0.04). There were 5 patients (12.5%) and 8 patients (22.9%) in NR in the ATG‐10 and ATG‐7.5 groups, respectively (p = 0.19). Additionally, the ATG‐7.5 group had a trend for lower 300‐day incidence of EBV reactivation (92.5% vs 80.0%; p = 0.14) and CMV reactivation (90.5% vs 80.0%; p = 0.16), and lower 100‐day incidence of hemorrhagic cystitis (42.5% vs 28.6%; p = 0.15).Summary/Conclusion:7.5 mg/kg ATG led to lower incidence of EBV reactivation, CMV reactivation and hemorrhagic cystitis without compromising control of grade II‐IV acute GVHD, chronic GVHD and OS when compared with 10.0 mg/kg ATG. Therefore, ATG at a dose of 7.5 mg/kg could be considered for further study.
PF771 CHIMERISM MONITORING BY QPCR, A ROBUST PERFORMANCE FROM 0.05% TO 100%
Authors: Bouwmans E.E. , van Deutekom H.W. M. , Malestein R. , Luiken B. , Rozemuller E.H. , Penning M.T. 
Published: June 2019

Background:Investigating the chimeric status after stem cell transplantation is required for the detection of adverse transplant events. In comparison to STR analysis, qPCR allows for a quick and easy measurement with better sensitivity that can be as low as 0.05% for the recipient chimeric status. In comparison to STR analysis this is a substantial improvement.Aims:The presumption is that qPCR is most accurate in its detection of percentages below 20–30% and less accurate for higher percentages. Here however, we provide evidence that qPCR data can be trusted regardless the level of measured percentage.Methods:We have collected the data of 19 studies, spanning 6 years, from the UK NEQAS ‘Post‐Stem Cell Transplant Chimerism Monitoring’ trial. Each study consisted of four samples; one from the recipient, one from the donor and two samples with a chimeric status representing two time points after transplantation. The recipient and donor samples were genotyped applying the KMRtype workflow (GenDx) and the chimeric mixtures were then examined with all found informative assays applying the KMRtrack workflow (GenDx). Tests were performed on either a Viia7 or QuantStudio 6 qPCR system (Thermo Fisher).Collected data was compared with the results reported by UK NEQAS, which are based on the results from all participating labs. From this comparison the standard deviation and relative error of the qPCR assay were calculated and plotted in an overview.Results:The chimerism percentages obtained covered a full range of chimeric status from 0 to 100%. When comparing the qPCR data with the data provided by UK NEQAS it indeed shows a higher absolute deviation with higher percentages in the qPCR data. However, in the qPCR data the relative error is the same throughout the whole range of chimeric status.Summary/Conclusion:From these results we can conclude that the qPCR technique is able to accurately detect genetic material in a chimeric mixture, not only in the lower levels but confidently from 0.05% to 100%.
PF796 THE EFFECT OF ANTI‐BETA2‐GLYCOPROTEIN I ANTIBODY UPON THROMBIN GENERATION IN NORMAL, LEIDEN HETEROZYGOUS AND FACTOR DEFICIENT PLASMAS
Authors: Szabó G. , Tarr T. , Soltész P. , Kappelmayer J. 
Published: June 2019

Background:The antiphospholipid syndrome (APS) is an acquired hypercoagulable condition, in which venous or arterial thromboses are caused by the presence of antiphospholipid antibodies (aPL). Anti‐β2glycoprotein I (anti‐β2GPI), highly correlating with the clinical manifestation of the syndrome, is the most significant aPL. Much evidence has uncovered insights into its molecular mechanisms, the exact molecular or cellular events are still not delineated.Aims:Our aim was to examine the effect of anti‐β2GPI antibodies from APS patients on pooled normal plasma (NP), Leiden heterozygous plasma (LP) and factor deficient plasmas (DP).Methods:Serum samples were collected form triple positive (anti‐β2GPI, anticardiolipin, lupus anticoagulant) APS patients with thrombosis in their history. Anti‐β2GPI IgG was purified in a two‐step affinity chromatography by Protein G and β2GPI affinity columns. Purified anti‐β2GPI IgG was added to NP, LP, or DP in thrombin generation test (TGT) up to 125 U/mL concentration in the presence of 1 pM tissue factor and 4 μM phospholipid.Results:In TGT, time (Lag Time) and quantity parameters (Peak and Endogenous Thrombin Potential [ETP]) were assessed. Having lupus anticoagulant effect, anti‐β2GPI showed significant prolongation in Lag Time in pooled NP (n = 9) by 24% (p < 0.001). Despite the fact that anti‐β2GPI delayed thrombin generation in time, it significantly increased ETP by 11% (p < 0.001). We assessed thrombin generation in LP samples without antibodies. Thrombin generation in LP began at the same time as that of the NP, there was no difference in Lag Time, but surprisingly Peak and ETP values were significantly lower than in NP (ETPNP: 1467 nM∗min, ETPLP: 920 nM∗min, p < 0.001), less thrombin was generated in LP. Anti‐β2GPI was able to exert similar effects on LP as in NP. Lag Time was delayed by 36% (p < 0.001), there was a non‐significant increase in ETP, but the Peak thrombin value was elevated by 32% (p < 0.05, n = 6). The effect of anti‐β2GPI was investigated on FVII, FIX, FXI and FXII deficient plasmas. Similar tendency was seen in intrinsic factor deficient plasmas, Lag Time was prolonged, Peak and ETP was elevated, but anti‐β2GPI could not exert significant effect on any of the deficient plasmas. However, the lack of FVII completely prevented the effect of anti‐β2GPI on thrombin generation.Summary/Conclusion:Anti‐β2GPI delayed thrombin generation in time, while it enhanced the amount of thrombin generated, which may in part explain the lupus anticoagulant paradox. In plasma from Leiden heterozygous patients, thrombin generation was also enhanced by anti‐β2GPI. In intrinsic factor (FIX, FXI, FXII) deficient plasmas, similar tendency was seen as in normal or Leiden plasmas, which was non‐significant, but FVII seems a crucial mediator in the prothrombotic effect of anti‐β2GPI antibodies.
PF812 INTRAVENOUS IRON SUPPLEMENTATION PROTOCOL FOR POST‐PARTUM ANEMIA
Authors: Volpato E. , Cuppari I. , Lissoni D. , Pugliano M.T. , Crocchiolo R. , Rossini S. 
Published: June 2019

Background:The World Health Organization (WHO) determines as post‐partum anemia values of harmoglobin (Hb) less than 10 g/dl. In most cases, it's an iron deficiency anemia and affects about the 27% of new mothers and has as a consequence a strong socio‐economic impact. One of the most important causes is the post partum haemorrhage (PPH), that's to say 500 ml of blood loss in the first 24 hours after a vaginal delivery or more than 1000 ml after a caesarean section. Nowadays PPH is one of the most common causes of mortality and morbidity rate among obstetric population and its frequency is between the 5% and the 22 % of the total deliveries.Aims:The objective of the present study is to determine the efficacy of an iron supplementation protocol for post‐èartum anemia.Methods:Our protocol provides a valuation of Hb in the post partum period. When Hb is greater than 8..5 g/dl, the new mother can be discharged from hospital and is treated by oral iron supplementaion with ferrous sulfate but it will be necessary to control the Hb value after 30 days. In case of HB belove 8..5 g/dl, parenteral iron is used (iron carbossymaltose) in the Obstretician Unit, then there will be a new assessment after 10/15 days at Service of Immunohaematology and Trasfusional Medicine to decide if to go on supplementation.Results:From 01/06/2017 to 31/12/2018 36 new mothers, average age 34 years (range 23 ‐ 43) have been enrolled. During the recovery, 34 new mothers have been treated with ferric carboxymaltose: 26 with a dosage of 500 mg and 8 with 1 g. Among these 34 women, 4 have been trasfused after a severe PPH and concomitant thalassaemic trait. Only 2 of the new mothers have been discharged with ferrous sulfate. At discharge, average Hb was 7.3 g/dl. At first access in Transfusional Center, the average Hb value was 10.8 g/dl with a medium delta of 3.5 g/dl. According to the hemoglobin values, 18 new mothers have continued oral iron therapy, 14 have been treated with ferric carboxymaltose and only 2 didn’t need therapy.Summary/Conclusion:Our protocol has been implemented thanks to the indications of National Blood Center about the PMB to ensure, through the multidisciplinarity, the transfusion appropriatness, the resource optimization and the improvement of the patient's outcome. The intravenous iron therapy with ferric carboxymaltose in new mothers suffering a severe iron deficiency anemia allows a fast rise of hemoglobin values and an improvment of psychophysical wellbeing of the new mother and a lowering of the number of blood transfusions.