ALBERT

Description: Olive mill wastewater is a challenging effluent, especially due to its toxicity related to the presence of phenolic compounds. Fenton’s process was analysed on the abatement of phenolic acids typically found in this kind of effluents. To overcome the main drawback of Fenton’s process, a waste from the aluminium industry commonly called red mud was used as a heterogeneous source of iron. The adsorption of simulated effluent on the red mud was negligible. Therefore, the degradation of phenolic acids during Fenton’s process was due to oxidation by hydroxyl radicals. The amount of red mud and hydrogen peroxide were optimized regarding phenolic acids degradation. The optimal conditions leading to the highest removal of contaminants (100% of phenolic acids degradation and 25% of mineralization after 60 min of reaction) were 1 g/L of catalyst and 100 mg/L of hydrogen peroxide. The possibility of recovering treated water for agricultural purposes was evaluated by assessing the toxic impact over a wide range of species. The toxicity observed for the treated samples was mainly related to the residual hydrogen peroxide remaining after treatment.

Description: BACKGROUND: The best treatment strategy in patients with relapsed Follicular Lymphoma (FL) remains controversial. The incorporation of rituximab (R) in the 1st line chemotherapy (CT) regimen and in treatment relapse resulted in better progression-free survival (PFS) but the benefit in overall survival (OS) was observed in only one trial (Hiddemann W. et al, Blood 2006). Hematopoietic stem cell transplant (HSCT) is the only treatment potentially curative, although the ideal time for its implementation remains undefined. AIM: Evaluation of the best treatment strategy and the impact of HSCT in PFS and OS in patients with relapsed FL. METHODS: Retrospective study including 85 patients with relapsed FL followed at a cancer care center between 2000-2012. Selection criteria: treatment naïve patients with the diagnosis of FL; absence of histological transformation at diagnosis and/or during the 1st line treatment. Survival analysis using the Kaplan-Meier method. Type of response defined according to NCCN criteria. RESULTS: Median follow-up of 64 months [4-158]. Disease progression after the 1st line CT was documented in 85 patients (median age 51 years [28-78], 42.4% male). 64 of the 85 patients had an Ann Arbor stage III-IV, of which 85.9% with follicular pattern, 95.3% grade 1/2 and 43.8% FLIPI ≥ 3. All patients underwent one or more CT regimens containing R, except in one case. In this study, 27.1% (n = 23) patients with age ≤ 60 years were submitted to HSCT (52.2% allogeneic HSCT from a related donor versus 47.8% autologous HSCT), almost all with ≥ 2 prior lines of CT (95.6%, n = 22). 78.3% (n = 18) had a CR or PR〉 75% at the time of HSCT, and one death related to graft versus host disease was registered. Patients undergoing HSCT had a better PFS than those not transplanted (p = 0.022). A significant improvement in OS was observed in the HSCT subgroup (p = 0.007), especially in those with stage III-IV (p = 0.006). The type of HSCT had no impact on PFS and OS (p〉 0.05), perhaps due to the small number of patients and short follow-up. By univariate Cox regression analysis, the number of regimens of CT before HSCT and the histological grade were independent predictors of PFS (p

Description: Abstract 1435 Introduction: The response to AML treatment is very heterogeneous and relapse risk is high. Hematogones (HG) are B lymphoid cell precursors present in all individuals. HG absolute count grows after chemotherapy, during medullar recovery and it seems to be related to prognosis. Objectives: Determination of HG number in AML patients with intermediate-risk karyotype, with complete response (CR). Determine prognostic value for HG number in these patients. Methods: Retrospective analysis of 148 patients with non promyelocytic AML, treated with “7+3” chemotherapy induction, followed in our centre, from 1998 to 2011. HG quantification was executed after induction chemotherapy, with flow cytometry pannel (4 colours - CD34, CD10, CD19, CD20 e CD45) in blood marrow samples in patients with CR, according to Cheson et al. (JCO 2003). The patients characteristics were compared with a X2test for binary variables and a Mann-Whitney test for continuous variables. Survival was plotted with Kaplan-Meier curves and the data for the various groups were compared with a log-rank test. Multivariate analysis was performed with a Cox model after the proportional hazard assumption was checked. A p value less than 0.1 was considered to be statistically significant. Results: There were 124 patients achieving CR after induction chemotherapy “7+3”, with a median follow up of 32 months ([0–141]), 46,8% (n=58) were male, median age of 50 years ([17–66]). There were 91,1% (n=113) patients with de novo AML and 63,9% (n=76) with intermediate-risk karyotype. In this study 16,3% (n=20) went on transplantation. Relapse occurred in 53,2% (n=66), with a disease free survival (DFS) of 15 months ([0–140]). HG quantification was possible in 33,1% (n=41) of the patients. Applying a cutoff of 0.01% (Chantepie S et al. Blood 2011) we can find 31,7% (n=13) with HG〉0.01%. These patients had better DFS, when comparing to patients with HG≤0.01% (median 16 vs 9 months, p=0,05), to equal overall survival. According to multivariate Cox model, the HG〉0,01% is a independent predictive value for DFS (IC 95% [0,8533-54.259], p20000/μL), karyotype-risk groups and WHO classification of AML. We established a good prognosis associated to HG〉0,01% group: patients with HG≤0,01% have a 6.8 hazard ratio (HR) or relapse comparing with HG〉0,01% group. Considering this information and applying it to karyotype-intermediate risk patients, it was possible to obtain two different groups with prognostic impact on the DFS: low intermediate risk (HG〉0,01%) and high intermediate risk (HG

Description: BACKGROUND: The outcome of patients with advanced stage Follicular Lymphoma (FL) has improved over the last decade, with the use of monoclonal antibodies (mAbs). The watch and wait approach (WW) in FL with low tumor burden was assumed when treatment options were limited and less effective than nowadays. In FL patients with indolent disease characterized by multiple relapses evolution, the therapeutic strategy should take into consideration the quality and duration of response and the impact on overall survival (OS) versus the risk of long-term toxicity. AIMS: Evaluation of the impact of WW approach compared with chemotherapy (CT) in time to next treatment (TNT), progression-free survival (PFS) and OS. METHODS: Retrospective study of 213 patients with FL, followed in a cancer care center between 2000-2012. Of these, 79 asymptomatic patients at diagnosis, with Ann Arbor stage III-IV were included and divided in 2 subgroups: 58 patients received the first-line treatment and 21 remained in surveillance. Tumor burden defined according to criteria of the Groupe d'Etude des Lymphomes Folliculaires (GELF). Survival analysis using the Kaplan-Meier method. Type of response defined according to NCCN criteria. RESULTS: Median follow-up of 48 months (12-147). 41 of the 58 patients submitted to 1st line treatment [median age 57 years (38-72), 36.2% male], underwent CT regimen containing Rituximab. The majority of these patients presented with follicular pattern and histological grade 1/2 (89.7%), 34.5% had FLIPI ≥ 3 and 50 % high tumor burden (GELF), 15.5% bulky mass, 53.4% had 〉 4 nodal areas involved and 6.9% 〉 1 extranodal area involved. 52 of the treated patients (89.7%) achieved CR and in 4 progression occurred (6.9%). 50 patients (86.2%) were alive without evidence of disease at the end of study (86.2%). In the group of patients undergoing surveillance, 11 suffered disease progression (52.4%), of which 10 (47.6%) stayed alive without evidence of disease. The TNT was higher in patients undergoing 1st CT regimen, compared to patients on WW (median 1480.5 vs. 765 months, p

Description: Abstract 4861 Introduction: Hodgkin lymphoma (HL) is a highly curable disease, however, approximately 15%–20% of patients with stage I–II and 35%–40% of patients with stage III–IV, relapse after first-line therapy (Barlett et al. Annals of Oncology, 2007). Cytoreductive chemotherapy followed by autologous stem cell transplantation (auto-SCT) has become the treatment of choice in patients with relapsed or refractory HL. The selection of an effective regimen of chemotherapy with acceptable toxicity profile, that does not impair the ability to mobilize stem cells for autotransplantation, acquired great importance (Kuruvilla et al. Hematology, 2009). The GVD (gemcitabine, vinorelbine, and pegylated liposomal doxorubicin) protocol has been used in this context. Objectives: Evaluation of the toxicity profile, treatment response and overall survival associated with treatment with GVD in patients with relapsed or refractory Hodgkin's lymphoma. Methods: Retrospective analysis of medical files of patients with HL treated with GVD in the institution between January 2006 and January 2012. Staging according to the Ann Arbor system. In stages I and II, prognostic factors (PF) were considered as defined by the German Hodgkin Study Group. In stages III, IV and IIB with large mediastinal mass or extraganglionar involvement by contiguity, PF were classified according to International Prognostic Factor Project. Toxicity was assessed according to the scale of adverse effects of the National Cancer Institute. The International Harmonization Project response criteria were used to classify treatment response. Statistical analysis using the SPSS version 18.0. Analysis of survival performed by Kaplan-Meiermethod. Results: Nineteen patients were treated with GVD protocol, in a total of 84 cycles (median cycles/patient− 5), with the following characteristics at diagnosis: median age -28 years (15–48 years), 52,6% of patients were males and the ECOG performance statuswas ≤ 1 in 89,5% of patients. Nodular sclerosis was the histological subtype in 94,7% of patients. The stage at diagnosis was IV in 42,1%; III in 15,8% and II in 42,1% of patients and 47,4% had PF ≥ 2. Sixty-three percent of the patients treated with GVD had been treated with four or more lines of chemotherapy. Grade 3 and 4 toxicities observed were: neutropenia (84,2%), leukopenia (78,9%), thrombocytopenia (68.4%), lymphopenia (63,2%), anemia (57,9%), febrile neutropenia (31.6%), oral mucositis (26,3%), increased aspartate aminotransferase (10,5%), increased alanine aminotransferase (10,5%) and fatigue (5,3%). There were no treatment-related deaths. Six patients (31,6%) were treated in relapse after auto-SCT and 11 patients performed auto-SCT after GVD. The overall response rate was 89,4% with 52,6 % of patients achieving complete response; 36,8% partial response and 10,5% disease progression. The median follow-up time was 27 months (7–72 months). The disease-free survival and progression-free survival at 24 months, were respectively, 57.1% and 35.7%. Overall survival (OS) at 24 months was 80,7 %. Conclusions: GVD showed a toxicity profile predominantly hematological and allowed to get a response even in patients previously treated with multiple regimens of chemotherapy and/or auto-SCT. This scheme may be an option to consider as salvage therapy prior to auto-SCT or in patients with relapse after auto-SCT, with OS at 24 months exceeding 50%. Disclosures: No relevant conflicts of interest to declare.

Description: Abstract 4875 Background: Some studies have showed high activity for low-dose radiotherapy (LDRT) in low-grade Non-Hodgkin Lymphoma (NHL). However, this therapeutic approach is often forgotten and other approaches are used - chemotherapy and/or conventional radiotherapy - associated with greater toxicity. The efficacy of total body LDRT (1.5–2 Gy, fractions 0.1–0.25 Gy in 2 – 5 times a week) in disseminated disease is associated with 10 year progression free survival (PFS) of 15 – 25%, with response rates of 70 – 90% (Gérard et al., IJ Radiation Oncology 2010; 78), despite hematologic toxicity and leukemogenic effects. Although its mechanism of action is unknown, its effectiveness has been confirmed (Jones et al., Cancer 1973; 32) suggesting that low dose radiation induces localized lymphocytes apoptosis that can trigger local and systemic benefits. More recently, LDRT was used in palliative treatment for patients with localized disease (4Gy into two fractions, for 3 days) with a low toxicity, and with an objective response (partial or complete) in 24/37 patients, 89% (G Ganem et al., Hematol Oncol1997; 42). Objectives: To assess the response to treatment with LDRT. Explore the predictive factors of response. Determine the progression-free survival (PFS) after LDRT. We will present PFS after LDRT and compare PFS in second line treatment: LDRT vs convencional chemotherapy. Methods: Retrospective study of 44 patients with new or recurrent NHL, treated with LDRT (4Gy in 2 fractions) in 1stor more lines, in a cancer care centre between 2004 and 2011. All transformed lymphomas were excluded (4 patients), as well all diagnosis that weren't centrally reviewed. Patients with complete resolution of the disease according to clinical and/or image studies were considered to have achieved complete response (CR). Results: We identified 40 patients undergoing LDRT, with a median follow-up of 69,5 months after LDRT ([28–87]). 52,5% (n = 21) were male, median age at the time of LDRT was 69 years ([31–85]). 75% of patients (n = 30) had follicular NHL, 12,5% (n = 5) Mantle cell NHL, 10% (n = 4) Marginal Zone NHL and 2,5% (n = 1) lymphoplasmacytic lymphoma. The median numbers of lines of chemotherapy completed before LDRT were 2 lines ([0–5]). There wasn't any impact on PFS on using Rituximab containing regimens after LDRT (p〉 0,05). The overall response rate to LDRT was 92,5% (n = 37): 42,5% (n = 17) achieved complete response (CR), 50% (n = 20) partial response (PR) and 7,5% (n = 3) had disease progression. There weren't any treatment related toxicities, nor was histological transformation recorded after treatment with LDRT. The logistic regression analysis showed that irradiated areas with dimension

Description: Introdution Follicular Lymphoma (FL) presents a recurrent clinical behavior. The proliferative activity of B-cells in NHL subtypes varies amongst different subtypes, being higher in high grade NHL. In FL without t(14; 18), high proliferative activity appears to be a better predictor of progression free survival (PFS). Objectives Evaluation of proliferative activity of neoplastic B cells in patients with FL and its association with underlying cytogenetic changes (such as t(14;18)). Determination of the prognostic value of proliferative activity of neoplastic B cells and t(14, 18) in patients with FL. Methods Retrospective analysis of 139 patients with FL, followed in our center from 2006 to 2011. Evaluation of the cytogenetic changes and percentage of cells in S phase at the time of diagnosis, performed on lymph nodes. The cell cycle analysis was evaluated by flow cytometry, resorting to DNA labeling kit B-NHL (Cytognos) ModFit software (Verity). The adopted cut-off of S phase cells was based on the median value. The type of response was defined in accordance with the criteria proposed by the NCCN. The patients´ characteristics were compared with a X2 test for binary variables and a Mann-Whitney test for continuous variables. The survival curves were estimated based Kaplan-Meier curves and the data for the various groups were compared with a log-rank test. The multivariate analysis was carried out using a Cox model, after the proportional hazard assumption was checked. A p value below 0.05 was considered as being statistically significant. Results The median follow-up was 34 months ([8-75]). The S phase was analysed in 45 patients with an median age of 56 years ([31-78]). 89% (n = 40) of the patients presented an Ann Arbor stage III-IV, 86.7% (n = 39) a follicular pattern, 89% (n = 40) a grade 1/2 and 57.8% (n = 26) a FLIPI ≥ 3. The t(14;18) was found in 25 patients (55.6%), in 9 patients cytogenetic analyses was not performed. In this study was given immunochemotherapy to 82.2% (n = 37) patients. Thirty patients (66.7%) achieved CR and 15.6% (n = 7) PR, with a PFS of 22 months in 53.3% of patients. In univariate Cox regression analysis, the histological pattern, the number of S-phase cells and the t(14;18) are independent predictors of PFS (p

Description: Introdution Optimal treatment of young patients with high-risk diffuse large B-cell lymphoma (DLBCL) remains a matter of debate. With the addition of rituximab, response rates (RR) and overall survival (OS) have improved significantly, but the best treatment option for this subset of patients with high risk DLBCL is not consensual. Historically, these patients are treated with conventional immunochemotherapy protocols (RCHOP - Rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by autologous stem cell transplantation (ASCT) as a consolidation treatment. Several studies tried to clear the exact role of ASCT, and others were design to answer about addition of other drugs to RCHOP, without conclusive results. Recently, our department review the protocol according to the state of the art, and an intensification of treatment was made for high risk DLBCL in young patients (

Description: Introduction: The incidence of central nervous system (CNS) relapse in diffuse large B-cell lymphoma (DLBCL) is approximately 5%. Although the introduction of rituximab for the treatment of DLBCL has reduced the risk of CNS relapse, the median overall survival of these patients remains only few months, emphasizing the need to accurately identify at-risk patients, screen for CNS disease, and develop effective therapeutic/prophylactic strategies. Aim: To identify risk factors for CNS relapse in patients with DLBCL. Methods: Retrospective analysis of patients with DLBCL diagnosed from January 2012 to December 2017 at a Cancer Institute. Patients with exclusive extranodal (EN) disease were excluded. Factors associated with CNS relapse were evaluated using Chi-square, Fisher's Exact Test, Mann-Withney U or T-Test, according to variable types and distributions. Survival was evaluated by Kaplan-Meier method and groups were compared by Log-rank test. Independent predictive factors were identified using Logistic Regression. A p value 〈 0.05 was considered statistically significant. Results: Four hundred and seventy-nine patients were identified, 122 were excluded due to exclusive EN disease, and 357 patients were included in the study. With a median follow-up of 33 months, there were 10 (3%) CNS relapses. According to International Prognostic Index (IPI) factors in addition to involvement of kidneys and/or adrenal glands (CNS-IPI), 5 (50%) of these patients were classified as high risk, 4 (40%) intermediate risk and 1 (10%) low risk. Patients who development CNS involvement were significantly younger (57 vs. 65 years, p=0.036), presented higher levels of lactate dehydrogenase (LDH) (median 738 vs. 282 U/L, p600 was the only independent predictive factor (HR 15.3, CI 95% 3.5 - 65.8, p