ALBERT

Description: Introduction Adult T-cell leukemia/lymphoma (ATLL) is a rare, aggressive T cell neoplasm associated with a retrovirus human T cell lymphotropic virus (HTLV-1) and carries a dismal prognosis. Within the United States, New York, and Florida see the majority of cases due to the concentration of Caribbean immigrants (Zell, Assal et al. 2016, Malpica, Pimentel et al. 2018). SEER data does not include states like New York and Florida where most cases are seen and therefore a true estimate of the disease burden in this country is not known (Chihara, Ito et al. 2012, Adams, Newcomb et al. 2016). Aim We aim to study the epidemiology and clinical outcomes of ATLL in the United States particularly in the state of New York. Methods Data for New York was obtained from the New York State Cancer Registry (NYSCR). Data were also retrieved from 18 Surveillance, Epidemiology, and End Results (SEER) registries in the United States. Patients with ATLL (HTLV-1 positive) (includes all variants) were categorized using the International Classification of Diseases for Oncology, Third Edition codes ICD-O-3 as 9827/3. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, all Hispanic and other/unknown in the NYSCR whereas it was categorized as non-Hispanic white, non-Hispanic black, all Hispanic, non-Hispanic American Indian/Alaska Native, non-Hispanic Asian or Pacific Islander, and non-Hispanic unknown race in SEER. ATLL patients ≥ 15 years of age were identified from 1995 to 2014 in SEER and all ages were included in NYSCR. Survival was estimated from SEER follow-up data with Kaplan Meier survival analysis. For NYSCR mean and median survival time (month) for deceased patients - cases diagnosed through death certificate only were removed. NYSCR does not conduct active patient follow-up and assumes patients are still alive if we didn't find a deathmatch through vital record or National Death Index linkages. Results Five hundred and eleven patients with ATLL were identified in SEER. These patients had a median survival of 8 months (m) which was worse than all other subtypes of peripheral T cell lymphoma. (Figure 1) Four hundred and twenty-nine patients with ATLL were identified in NYSCR and these patients had a median survival of 4.5 m. (Figure 2) Over the years from 2000 until 2014 the number of cases diagnosed within SEER registry coverage areas has not changed. In New York state however there has been a doubling in the number of cases diagnosed from 1995 to 2014. (Figure 3A, B) The non-Hispanic black population was diagnosed at a median age of 52.5 in SEER and 54 in NYSCR while the non-Hispanic whites were diagnosed at a median age of 71 in SEER and 64.5 in NYSCR. The Hispanic patients were diagnosed at a median age of 58.5 in NYSCR and 52.5 in SEER. (Figure 4A, B) There was no gender predominance with 50% males in both registries. ATLL patients in SEER were 47.2% non-Hispanic white, 31.7% non-Hispanic black, 9.8% Hispanic and 11.4% other/unknown. There were 5.5% Japanese patients (n=28) diagnosed in SEER. NYSCR had 22.4% non-Hispanic white, 59.4% non-Hispanic black, 15.9% Hispanic and 2.3% other/unknown. (Figure 5A, B) Within SEER registries most cases occurred in New Jersey, California, Connecticut and Georgia. (Figure 6) New York state had a significantly higher number of cases than these states. Seventy four percent cases diagnosed within New York state are diagnosed in New York city and only 26% of cases are diagnosed in upstate New York. Based on reported country of birth within New York state, only 27% of the ATLL cases diagnosed are born in the US whereas 49% are born in the Caribbean (most likely to be from Jamaica, Dominican Republic and Haiti). (Figure 7A, B, C) For SEER and NYSCR the age-adjusted cancer incidence rate by race year and other factors will be presented at the meeting. Conclusions ATLL has a worse prognosis than all other PTCL subtypes. New York State has a high endemicity for ATLL with a rising number of cases. The higher percentage of non-Hispanic black patients in New York compared to the rest of the country is consistent with the diverse racial demographics in this state. Survival varied significantly by race/ethnicity and disparities were evident especially for non-Hispanic blacks who were diagnosed at a younger median age and had a shorter survival. Further research into this aggressive disease is needed to improve outcomes for these patients. Disclosures No relevant conflicts of interest to declare.

Description: Abstract 872 Background: All-trans retinoic acid (ATRA) with contemporary therapeutic strategies for the treatment of patients with newly diagnosed acute promyelocytic leukemia (APL) have dramatically improved outcome. Currently, the major cause for treatment failure is death during induction mostly due to hemorrhage, infection and differentiation syndrome. Since there is virtually no primary resistance to induction and the relapse rate once in complete remission (CR) is very low, reducing the early death rate would be critical to further improve the cure rate. The true rate of early death in the United States (US) is not yet clear. Cooperative group multicenter studies report early death rates of 5–10% within 1 month of starting therapy which is likely an underestimation, in part, due to failure to account for those who die prior to registration on study or possibly other selection biases for enrollment. Methods: We performed an epidemiologic study of the true rate of early death and overall survival (OS) using US population-based datasets of all newly diagnosed patients with APL. The datasets from SEER Program 13 (includes 5 states: Connecticut, Hawaii, Iowa, New Mexico and Utah; 8 metropolitan areas including Detroit, Atlanta, San Francisco-Oakland, Seattle-Puget Sound, Los Angeles, San Jose-Monterey, Alaska Native Registry and rural Georgia) and the New York (NY) State Cancer Registry were used to identify patients with APL registered in the US and NY state from January 1, 1992 to December 31, 2007. Patterns of APL incidence, early death rate, long-term OS over time, and differences in OS by region (urban vs. rural) were analyzed in pre-set time periods of 1992–1996, 1997–2001, and 2002–2007. Results: A total of 1,400 and 721 patients with APL were identified in the SEER program and the NY registry, respectively. The number of registered APL patients was similar between men and women in both datasets, and has steadily increased from 1992–1996 (295 cases in SEER and 143 in NY) to 2002–2007 (681 cases in SEER and 371 in NY). Early death rate, defined as death reported within the first month of diagnosis, was 22.7% in the years 1992–1996, 15.6% in 1997–2001, and 18.1% in 2002–2007 in the SEER program, and 10.9%, 11.9% and 11.2% in the NY registry. No significant differences in the early death rate were observed between urban and rural areas in either datasets. OS at 1 year improved from 59.8% in 1992–1996 to 69.6% in 1997–2001; at 2 years from 53.7% to 65.3%; and at 3 years from 50.2% to 63.7% in the datasets from the SEER program. There were no significant changes in OS from 1997–2001 to 2002–2007, and similar trends in OS were observed in the NY datasets (Figure). Interestingly, when the survival data were analyzed by the urban/rural regions in the SEER program, the greatest improvement was observed in patients treated in the urban counties with absolute increases in 2- and 3-year OS of 15.3% (from 53.1 in 1992–1996 to 68.4% in 2002–2007) and 17.6% (from 49.8 to 67.4%), respectively. In contrast, in patients treated in rural counties, increases in 0.4% (from 62.5 in 1992–1996 to 62.9% in 2002–2007) and 7.3% (from 55.6 to 62.9%) were observed in 2- and 3-year OS, respectively. However, the latter statement should be interpreted with caution since the rural OS estimates are imprecise due to small numbers. Conclusions: The large number of newly diagnosed APL patients and the long follow-up reported here confirm improvement in OS over time in a US population-based study. Disappointingly, the early death rate has changed only modestly since 1992 (22.7% in 1992–1996, and 18.1% in 2002–2007), and appears significantly higher than what is reported in contemporary clinical trials. Furthermore, the long-term OS, though improved over time, appears lower than that reported in clinical trials. In fact, more than 25% of patients are not cured of their disease. OS in patients treated in rural areas appears worse, possibly related, in part, to less access to specialized centers, although the analysis is limited due to small numbers. Strategies to reduce the early death rate in APL and improve OS should include very early introduction of ATRA, arsenic trioxide or both and aggressive blood product support at the very first suspicion of the diagnosis well before genetic confirmation. Disclosures: No relevant conflicts of interest to declare.

Description: The incidence of early death in a large population of unselected patients with acute promyelocytic leukemia (APL) remains unknown because of the paucity of outcome data available for patients treated outside of clinical trials. We undertook an epidemiologic study to estimate the true rate of early death with data from the Surveillance, Epidemiology, and End Results (SEER) program. A total of 1400 patients with a diagnosis of APL between 1992 and 2007 were identified. The overall early death rate was 17.3%, and only a modest change in early death rate was observed over time. The early death rate was significantly higher in patients aged ≥ 55 years (24.2%; P 〈 .0001). The 3-year survival improved from 54.6% to 70.1% over the study period but was significantly lower in patients aged ≥ 55 years (46.4%; P 〈 .0001). This study shows that the early death rate remains high despite the wide availability of all-trans retinoic acid and appears significantly higher than commonly reported in multicenter clinical trials. These data highlight a need to educate health care providers across a wide range of medical fields, who may be the first to evaluate patients with APL, to have a major effect on early death and the cure rate of APL.

Description: The solvent vapor phase drying process is one of the most important processes during the production and maintenance for large oil-immersed power transformer. In this paper, the working principle, system composition, and technological process of mobile solvent vapor phase drying (MVPD) equipment for transformer are introduced in detail. On the basis of necessary simplification and assumption for MVPD equipment and process, a heat and mass transfer mathematical model including 40 mathematical equations is established, which represents completely thermodynamics laws of phase change and transport process of solvent, water, and air in MVPD technological processes and describes in detail the quantitative relationship among important physical quantities such as temperature, pressure, and flux in key equipment units and process. Taking a practical field drying process of 500 KV/750 MVA power transformer as an example, the simulation calculation of a complete technological process is carried out by programming with MATLAB software and some relation curves of key process parameters changing with time are obtained such as body temperature, tank pressure, and water yield. The change trend of theoretical simulation results is very consistent with the actual production record data which verifies the correctness of mathematical model established.

Description: Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. However, pooling required time consuming steps: obtaining Institutional Review Board (IRB) approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring 〉20 weeks. Records from FDNY (n = 16,221), WTCHR (n = 29,372), and GRC (n = 33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.