ALBERT

Beschreibung: Introduction Acute lymphoblastic leukemia (ALL) represents 20-30% of acute leukemia in adults. Higher incidence and inferior outcomes in Hispanic population have been described. In Latin Americans induction mortality (IM) is a major cause of death representing 20-50% vs.7-11% in developed countries. Our aim was to determine risk factors (RF) related to IM in ALL Hispanic adult patients. Methods We retrospectively analyzed clinical data of ≥18yo patients with ALL diagnosed and treated at our institution within 2009 and 2016. Results A total of 170 patients were included. Median age was 29 years (16-70), 64% were AYA, 96.8% had B-cell ALL, and 62.3% received Hyper-CVAD. IM rate was 13.4%. In 64.1% IM was related to an infectious cause. The most frequent infection was pneumonia (39.8%). Gram-negative etiology was more prevalent (35.5% vs. 10.2%), however, IM rate was higher in gram-positive infections (26.3% vs .13.6%; p=.028). RF related to IM in univariate analysis were: CNS involvement (OR4.6,95%IC2.8-9.5;p=

Beschreibung: Introduction Latent tuberculosis infection (LTBI) affects one third of the world population. It is well known that patients with immunodeficiency are at a higher risk of developing active tuberculosis (ATBI). Hematopoietic stem cell transplant (HSCT) recipients have an incidence of ATBI 10 to 40 times greater when compared to the general population, this being related to a higher morbidity and mortality. The aim of this study was to determine the prevalence of LTBI and incidence of ATBI after transplant in recipients and donors of HSCT living in an endemic region. Methods Retrospective single-center study that included all HSCT recipients and donors treated and followed at our Institution between February 2000 and June 2018. LTBI and ATBI were categorized according to WHO definitions. Results A total of 411 patients were included: 125 allogeneic HSCT (allo-HSCT) recipients, 167 autologous HSCT (auto-HSCT) recipients, and 119 HSCT donors. Median age of the group was 34 years (range 11-70) and 59.9% were male (n=246). Baseline diagnoses that led to HSCT were: acute leukemia in 30.9% (n=127), lymphoma in 17.3% (n=71), and monoclonal gammopathy (MG) in 10.7% (n=44) (Figure 1). Allo-HSCT donors were matched related donors (MRD) in 84.8% (n=106), matched unrelated donors (MUD) in 3.2% (n=4), haploidentical in 10.4% (n=13), and umbilical cord in 1.6% (n=2). The source of HSCT was peripheral blood (PB) in 175 patients (59.9%), bone marrow (BM) in 50 patients (17.1%), primed-BM in 65 patients (22.3%), and umbilical cord in 2 patients (0.7%). All patients were evaluated pre-HSCT with tuberculin skin test (TST) and thoracic imaging. LTBI was diagnosed in 109 patients (26.5%): 21%, 20%, and 41.2% of patients were auto-HSCT recipients, allo-HSCT recipients, and allo-donors; respectively. One-hundred and seven patients had a positive TST and two patients presented findings suggestive of LTBI on chest X-ray. Seventy-eight percent of LTBI-HSCT recipients were further evaluated with chest CT (n=29), sputum (n=26), gastric fluid (n=15), and/or urine (n=25) cultures to rule out ATBI according to treating physician's criteria. In contrast, only 42.9% (n=21) of donors were further evaluated with chest CT (n=11), sputum (n=15), gastric fluid (n=2) and/or urine (n=12) cultures. All cultures were negative at follow-up. At LTBI diagnosis 80 patients (73.3%) initiated treatment with isoniazid (INH) 300mg daily for a minimum of 6 months. Treated HSCT recipients represented 91.7% and donors were 51%. Median days of therapy received before HSCT were 76 days (range 0-732) in HSCT recipients and 48 days (range 0-401) in donors. Distribution of cases according to the patient's state of residency, excluding Mexico City, revealed an increase prevalence of cases in the southern border of the country (Figure 2). ATBI incidence at 1 year of follow-up in the cohort was 0%. Only one patient developed a pulmonary mycobacterial-related infection; however, the species identified was M. chelonae. Conclusions To our knowledge, this is the first study that evaluates the prevalence of LTBI among HSCT recipients in a Latin American country where tuberculosis is endemic. We identified a prevalence of LTBI similar to what the WHO estimates; however, the presence of lower rates in recipients compared to donors in our population suggests a negative impact of depressed humoral immunity over the TST diagnostic yield. Interestingly, we do not report any ATBI cases post-transplant; pre-transplant diagnostic strategies, as well as length of treatment may be influencing factors for these outcomes. Collaborative working groups are required to stablish the best diagnostic and therapeutic approach in order to improve ATBI-attributable morbidity and mortality in this vulnerable HSCT-patient population. Disclosures Demichelis: AMGEN: Research Funding, Speakers Bureau; Abbvie: Speakers Bureau; Celgene: Speakers Bureau; Novartis: Research Funding, Speakers Bureau; Shire: Speakers Bureau.

Beschreibung: Introduction Prostate cancer is the most frequent malignant neoplasm diagnosed in men worldwide. Patients with prostate cancer have higher rates of thrombotic events when compared with other groups of cancer patients; that can be explained because of the presence of multiple risk factors such as age, histopathology, type of therapy, and associated comorbidities. The aim of this study was to determine the risk factors related to development of thrombosis in patients with prostate cancer in a tertiary care center. Methods Retrospective cohort study that included patients ≥18yo diagnosed with prostate cancer at our institution between 2014 and 2017. Univariate and multivariate analysis were performed including all previously described thrombosis risk factors in cancer patients. Results A total of 101 patients were included. Median age was 72 years (52-92). A total of 23 patients (22.8%) presented with a thrombotic event. Regarding baseline characteristics, patients with thrombosis were older (77 vs. 71 years; p=.015), had lower levels of HDL (40.4 vs. 48 mg/dL; p=.033), and a higher prevalence of primary hypertension (65.2% vs.34.6%; p=.009). In patients with thrombosis, 52.2% (n=12) were venous thrombosis and 47.8% (n=11) were arterial. The most common events were pulmonary thromboembolism (n=7; 58.3%) for venous thrombosis and acute coronary syndromes (n=6; 54.5%) for arterial events. In univariate analysis risk factors related to the development of thrombosis were: prostration 〉 3 days (p=.039), immobility (p=.023), central venous catheter (p=.004), congestive heart failure (p=.021), history of TE (p=.021), major surgery (p=.031) and hip fracture (p=.021). Table 1. On multivariate analysis factors that remained statistically significant were: central venous catheter OR 8.8 (CI 95% 2.2-35.7, p=.002), previous thrombosis OR 10.3 (CI 95% 1.5-72.8, p=.020), and hip fracture OR 8.5 (CI 95% 1.2-63.5,p=.037). Conclusions In conclusion, our study confirms findings from previous studies regarding factors that significantly predispose cancer patients to thrombosis development. Considering our population age, it is not surprising that risk factors in patients with prostate cancer were mainly related to the presence of other comorbiditiesparticularly cardiovascular and atherothrombotic disease. The main risk factor was history of previous thrombosis, suggesting that closer and prolonged anticoagulation therapy should be consider. Multicenter prospective studies most be urged in our population to asses and validate risk factors, and design prognostic scores that can help on determining which patients could be candidates to early intervention modifying preexisting factors and/or receiving prophylactic dose of anticoagulants. Disclosures No relevant conflicts of interest to declare.