ALBERT

Description: Background: Secondary tumors has been described in a variety of patients with either hematologic malignancies or solid neoplasm, and most of the time is related to previous chemotherapy and radiation therapy exposure, but little is found in the literature about synchronous or metachronous neoplasm that can be found in patient with a newly diagnosis of hematologic malignancy; we report 45 cases, presented in a single institution from 2007 to present. Methods: A retrospective review of records using our tumor registry data, from patient with hematologic malignancies at John H. Stroger Hospital of Cook County, was performed and 45 patients with either synchronous or metachronous neoplasm were identified. Results: Lung cancer was the most common malignancy representing 22.2%, Colorectal cancer 20%, Prostate cancer 17.7%, Breast cancer 11.1%, Urothelial cancer (Kidney and Bladder) 8.8%, Myelodisplastic syndrome, Pancreatic cancer, Thyroid cancer, Non-Hodgking lymphoma, Acute Myeloide Leukemia, Vulvar cancer, Testicular cancer and Skin Cancers 2.2% each one respectively. Results: We found that in our heterogeneous population of patient with hematologic malignancies, the incidence of synchronous or metachronous neoplasm practically follows a very similar pattern of the general population, despite that many of this patients have been exposed to chemotherapy and radiation therapy. Disclosures No relevant conflicts of interest to declare.

Description: Introduction Studies of EBV positive (+) and negative (-) classical Hodgkin lymphoma (cHL) have shown the importance of the immune microenvironment in affecting Reed-Sternberg (hRS) cell survival, proliferation, and biologic behavior. For example, macrophage infiltrates may correlate with inferior disease outcome and survival and proliferation of the hRS cells depends on trophic signals from various inflammatory cells, including CD4+ T cells. The latter finding may explain why HIV-cHL patients (pts) usually present with higher circulating CD4+ T-cell counts (cCD4) compared to HIV-related non-Hodgkin lymphoma. Pathobiologically, HIV-cHL differs from HIV negative cHL (cHL) in that it is nearly always EBV+, has higher numbers of hRS cells, presents with more advanced median stage, exhibits more commonly the mixed cellularity (MC) pattern, and some studies suggest it is more clinically aggressive. To investigate the microenvironment of HIV-cHL and its influence on cHL biology, we assessed the immune cell composition and clinical characteristics of HIV-cHL and compared the findings to those of EBV+ and EBV- cHLs. Methods 31 HIV-cHL and 40 cHL (8 EBV+/32 EBV-) cases were identified and corresponding tissue microarrays (TMAs) created. TMAs were evaluated for EBV (EBER), CD30, and microenvironment-associated antigens: PAX5, CD3, CD4, CD8, CD68, CD163 (% positive), TIA1, FOXP3 (relative number 0-4+); the hRS-macrophage microenvironment was evaluated by assessing the number of hRS where 〉50% of the circumference of the neoplastic cell was associated with CD68+ cells. Results were compared based on HIV status, EBV status (in HIV negative pts), demographics, cCD4 and histology; each was correlated with overall survival. Analyses were performed using non-parametric Fisher's exact test, Kaplan-Meier method and Cox Proportional Hazards model. Results M:F ratio was 9:1 in the HIV group vs. 1.3:1 in the HIV negative pts (p

Description: Introduction Iron plays a critical role in patients with multiple myeloma (MM). The limited availability of iron to the developing erythroid precursors results in the characteristic anemia so frequently seen in these patients. Moreover, iron is also a determinant in growth of the malignant plasma cells that makes it one of the critical factors in progression of the disease. Iron is a key component in success of erythropoietin (EPO) therapy that is often used to maintain hemoglobin (Hb) level of 〉10g/dL in patients with MM. International Myeloma working group (2011) advised transfusing IV iron to aid in success of EPO therapy. However, apart from determining the iron stores on bone marraow aspirate, there is hardly any reliable clinical or lab indicator of the iron stores in the body. The utility of various iron indices in determining the bone marrow iron stores remains anecdotal. In this study we aim to determine the relation between iron indices and iron level in the bone marrow of patients diagnosed with multiple myeloma. Methods A total of 268 multiple myeloma patients, diagnosed from 2004 to 2015, were identified from tumor registry of John H. Stroger Jr. Hospital of Cook County, Chicago. Accuracy of ferritin, iron level, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC) and transferrin saturation (TSAT) was evaluated using receiver operating characteristic curves (ROC). Out of sampled patients, 167 patients had a concurrent bone marrow biopsy and aspirate, serum ferritin and iron panel, and were included in ROC analyses. Results The study population consisted of 57% African-Americans, 18% Caucasians and 16% Hispanics. Median age was 61 years and 51% were females. Past history was significant for hypertension (48%), diabetes (31%), co-existing inflammatory conditions (18%), smoking (25%), alcohol abuse (17%) and illicit drug abuse (8%). Median hemoglobin, mean corpuscular volume (MCV), leukocytes and platelets were 10g/dL, 90.3fL, 6,200/mcL and 219,500/mcL respectively. Bone marrow aspirates for iron were rated as absent (37%), mild/moderate (18%) and adequate/normal (45%). Anemia was found in 79% of males (Hb

Description: Introduction Stroger Hospital of Cook County (CCH) and Ruth M. Rothstein CORE Center (CC) are the largest health providers for HIV + patients in Chicago and among the largest in the United States. Together, CCH and CC treat over 5500 HIV + individuals per year and 60 newly diagnosed HIV-associated cancers yearly. In addition CCH is the largest safety net hospital in the Chicago, and in the calendar year 2010 had over 32,000 outpatient hematology/oncology clinic visits. Classical Hodgkin lymphoma (cHL) is the second most common non-AIDS defining cancer at CCH. Recent reports have suggested that the outcomes of HIV (HIV-cHL) vs. non-HIV associated cHL were similar. Many of these studies were multi-institutional, and insights into the inner-city cancer population have yet to be described. In addition, many of these studies compared outcome data to historical controls obtained at different institutions. To gain insights into the racial composition and survival data of patients with cHL, we compared all of disease characteristics and demographic information of HIV-associated and non-HIV cHL at CCH and the CC from the past 15 years. Methods We identified via CCH and CC databases HIV-infected patients with cHL from 1998–2013. We subsequently identified the HIV characteristics, cancer type, overall survival (OS) data, and patient demographics for all patients. Four hundred patients with cHL were screened. Only patients that had complete overall survival and demographic information were included in the study. One hundred seventy-nine non-HIV and 40 HIV-cHL met these criteria. In addition, all patients analyzed were treated with the same treatment regimen, Adriamycin, Bleomycin, Vinblastine, and Dacarbazine (ABVD). Statistics Non-parametric Fisher's exact test was used to examine the difference in proportion of patients in both the HIV and non-HIV arm. Survival data were analyzed using Kaplan-Meier analysis and Cox Proportional Hazards model. Results The M:F ratio was 8.5:1 in HIV-cHL and 2.4:1 in the non-HIV cohort (P

Description: Introduction Classical Hodgkin lymphoma (cHL) is a lymphoma of B cell origin that affects both immune competent and immune suppressed patients. In this study, we sought to determine the complete landscape of microRNA expression in cHL, by performing deep sequencing of microRNAs in 66 patient samples. Further, we examined the associations of microRNA expression with clinical data, including HIV and EBV infection status, mixed cellularity and nodular sclerosis subtypes, and progression free and overall survival. Methods This cohort includes 66 cases of cHL of primarily mixed cellularity and nodular sclerosis subtypes. Nearly 50% of these cases were EBV positive and 39% were HIV positive. All the EBV(-), HIV(-) cases were nodular sclerosis subtype and nearly half of EBV(+), HIV(+) cases were mixed cellularity subtype. From these cases, whole RNA was extracted from which small RNAs were selected via bead purification and subjected to next generation sequencing on the Illlumina platform. MicroRNA expression was assayed by mapping sequencing reads to the human genome and identifying those reads with matching sequences that were typical of a hairpin loop that characterizes microRNA precursors. We were able to identify 367 human microRNAs and 15 EBV microRNAs. The expression of these microRNAs was measured by normalizing the number of sequencing reads mapping to microRNAs within each case and across all the cases. Interestingly, we also found 18 novel microRNAs that have not been described previously in humans. We tested the association of these microRNAs with progression-free and overall survival, as well as with histology, HIV and EBV status. Results We found a number of microRNAs that were robustly associated with stage. miR-138, miR-182, and miR-296 were associated with lower stage across all histologies, whereas miR-378 was strongly associated with higher stage. We found that miR-92b, miR-138 and miR-186 were all associated with favorable prognosis with higher expression being associated with better outcomes. We also found several microRNAs associated with histologic subtype. For example, miR-122 and miR-182 were highly expressed in nodular sclerosis cHL while miR211 was expressed highly in mixed cellularity cHL. miR-21 was highly expressed in all cases. EBV positive cases were defined in all tumors using in situ hybridization using an EBER probe. We found that expression of EBER was highly associated with EBV BART microRNAs, which were present in 100% of the EBV positive patients. We found that miR-455 was highly expressed in HIV positive cases regardless of EBV status whereas miR-511 was expressed highly in all EBV cases in addition to EBV BART microRNAs. Conclusion Together, our data define the landscape of microRNA expression in HIV-associated and non-HIV-associated classical Hodgkin lymphoma and point to a role for microRNAs as novel biomarkers that distinguish histology, stage, outcome and EBV status. Disclosures No relevant conflicts of interest to declare.