ALBERT

Description: Background: Understanding health-related quality of life (HRQOL) profile, including functional aspects and symptom burden, of yet untreated patients with myelodysplastic syndromes (MDS) is important to help clinicians to better identify subgroup of patients in need of special attention from the very beginning of therapy. Aims: The primary objective of this study was to investigate baseline (i.e., pretreatment) HRQOL profile of untreated patients with lower-risk MDS, examining differences by age, gender, risk score category and comorbidity. A secondary objective was to provide age and sex baseline reference HRQOL values, according to the EORTC QLQ-C30 questionnaire, to be used as benchmark comparisons in future MDS studies. Methods: This analysis is based on 443 newly diagnosed adult MDS patients with International Prognostic Scoring System (IPSS) risk score of low (46 %) or intermediate-1 (54%), enrolled in an international prospective cohort observational study. Median age was 75 years (range 32-94), with 261 men (59%) and 182 (41%) women. HRQOL was assessed by the EORTC QLQ-C30 questionnaire at study entry, before any treatment (except for transfusions). This well validated questionnaire consists of five functioning scales: physical, role, emotional, cognitive and social; three symptom scales: fatigue, nausea/ vomiting and pain; six single item scales: dyspnoea, sleep disturbance, appetite loss, constipation, diarrhea and financial impact; and the global health status/HRQOL scale. The items were scaled and scored using the recommended EORTC procedures. At the time of baseline HRQOL assessment, 111 (25%) patients had received at least one red blood cell transfusion. We used Wilcoxon-Mann-Whitney and Kruskal-Wallis tests for all comparisons. We used the false discovery rate approach to account for multiple testing, with a nominal α-level=0.05. In addition to statistical significance, clinically relevant HRQOL differences were also evaluated based on previously published criteria (Cocks K, et al, J Clin Oncol 29:89-96, 2011). Results: There were not statistically significant differences in any of the HRQOL scales measured by the EORTC QLQ-C30, by the specific IPSS risk category (i.e., low risk vs intermediate-1 risk score). Overall, women reported worse HRQOL scores than men, with clinically relevant differences for physical (Δ=-7.1, P=0.002), role (Δ=-9.9, P=0.002) and emotional functioning, (Δ=-10, P

Description: Abstract 1239 Poster Board I-261 Background Purine analogues, in particular fludarabine, are considered the gold standard of treatment of CLL. However, fludarabine therapy is sometimes complicated by autoimmune haemolytic anemia (AHA). The mechanism of this side effect is not clear but it is conceivable that a fludarabine-induced suppression of some regulatory systems, including T-reg, is responsible for this phenomenon. In addition, we have observed that patients affected by autoimmune diseases such as AHA or PTI have a reduced number of T lymphocytes bearing the CD200 antigen that is considered a tolerogenic molecule. In this perspective, we evaluated the variation of T-reg and CD200+ T lymphocytes induced by incubating in vitro peripheral blood mononuclear cells (PBMC) of CLL patients and normal subjects with purine analogues and other drugs active against CLL. Method PBMC obtained from patients with chronic lymphocytic leukaemia (CLL) (n=9) and from normal adult (n=6) were isolated by density gradient and cultured in RPMI supplemented with 10% FBS and 1% of penicillin streptomicyn. Cells were then incubated for 24 hours with drugs at two concentrations: bendamustine (1 and 50 μg/ml) campath (1 and 5 μg/ml) prednisone ( 1 and 10 nM), fludarabine (0,25 and 10 μg/ml) pentostatin (3 and 60 μg/ml). The cytotoxicity was evalutated after 24 hours by trypan Blue and flow cytometry. T-reg cells were identified as CD4+/CD25+/FoxP3+ T cells and expressed as a percentage of the CD4+T-cell population. Results Although all of these drugs induced lymphocytes cytotoxicity, fludarabine, prednisone, and campath reduced also the percentage of T-reg and CD200+ T –lymphocytes, while bendamustin and especially pentostatin induced the same cytotoxicity but spared T-reg populations and CD200+ T-lymphocytes. Table I indicates results obtained with the highest concentration of drugs. In conclusion, pentostatin and bendamustine seems to be active drugs against CLL and their usage shouldn't be complicated by autoimmune phenomena. Disclosures No relevant conflicts of interest to declare.

Description: Imatinib mesylate (IM), a tyrosine kinase inhibitor, currently used in chronic myeloid leukaemia (CML) may also affect the growth of other cellular systems besides CML cells. It has been reported that IM may affect bone tissue remodeling mainly by an inhibitory activity on osteoclastogenesis. We therefore evaluated possible effects of IM on osteoblatic differentiation of Mesenchymal Stem Cells derived from bone marrow (BMSCs). BMSCs are multi-potent non-haematopoietic progenitor cells that differentiate into osteoblasts, adipocytes, chondrocytes, skeletal myocytes and nervous cells. Culture of normal human BMSCs were treated with osteogenic medium (OM) with or without IM 1 μM. By RT-PCR, we assessed mRNA expression of osteogenic markers such as RUNX2, osteocalcin (OCN) and osteopontin (OPN) at 7, 14, and 21 days of culture. BMSCs treated with OM and IM 1 μM showed increased levels of osteogenic markers mRNA as compared to BMSCs cultured with OM only (RUNX2 ctrl=0,37±0,02 vs OM+IM=0,79±0,06; OCN ctrl=0,36±0,04 vs OM+IM= 0,97±0,03; OPN ctrl=0,94±0,01 vs OM+IM= 1,55±0,13). We also evaluated the OCN levels, and the OPG (osteoprotegerin)/RANKL (receptor activator of nuclear factor-kappa B ligand) ratio (OPG/RANKL ratio) in the surnatant of the culture at day 21 by ELISA assays. OPG/RANKL ratio (OM alone = 55,4±0,4 vs OM+IM = 65,3±0,7; P

Description: Background. The addition of Rituximab to chemotherapy significantly improves the clinical outcome in previously untreated follicular Lymphoma (FL) patients. Rituximab mediates its anti lymphoma effect by complement dependent cytotoxicity (CDC) and antibody dependent cellular cytotoxicity (ADCC). Genomic polymorphism corresponding to phenotype expression of valine (V) or phenylalanine (F) at amino acid 158 on the FcgRIIIA influences the affinity of IgG1 to this receptor and the ADCC activity played by NK cells, macrophages and neutrophils. The presence of a FcgRIIIA-158V on NK cells has been shown to be associated with a better clinical response after treatment with Rituximab in Follicular Lymphoma but not B-CLL patients. Aim of the study. To correlate the achievement of a clinical and molecular response after the sequential treatment with CHOP and Rituximab with a) the presence of FcgRIIIA-158V/F polymorphism type in 88 previously untreated FL patients and b) the amount of follicular lymphoma cells detected at diagnosis in the bone marrow (BM) by quantitative PCR analysis of BCL2/IgH+ cells. Methods. FcgRIIIA-158V/F genotyping was performed using two different methods: a PCR with FRET probes and fluorescence melting curve analysis, on a LightCycler platform (Roche Diagnostics) and a Snapshot sequencing, using an ABI Prism 310 Genetic Analyzer (Applied Biosystems). Real Time Quantitative PCR (RQ-PCR) analysis of BCL2/IgH+ cells was performed using the ABI PRISM 7700 Detection System (Applied Biosytstems); standard curves were constructed using DNA from the cell line Karpas 422. Results. Among the 88 patients analyzed for FcgRIIIA polymorphism, 17 were homozygous for V/V (19%); 30 patients were homozygous for F/F (34%) and 41 heterozygous for V/F (46%). A complete clinical response (CR) was obtained in 76% of patients homozygous for V/V and in 68% of patients carrying an FcgRIIIA F polymorphism (p=NS). A molecular evaluation performed on BM one year after the end of Rituximab administration was available for 63 patients. In this group a disappearance of BCL2/IgH+ cells in BM was observed in 30% of homozygous V/V patients and 58% of FcgRIIIA-F carriers respectively (p=NS). A similar result was also obtained when the molecular analysis was performed on peripheral blood (PB). The multivariate analysis did not show any association between FcgRIIIA polymorphism and the achievement of a clinical complete response or combined clinical and molecular response. As previously reported (Rambaldi et al, Blood 2005) the best predictor of clinical CR was the quantitative molecular evaluation of BM BCL2/IgH+ cells which at diagnosis was performed in 50 out of 88 patients analyzed for FcgRIIIA polymorphism (p 〈 0.02). The freedom from recurrence (FFR) of patients who achieved a molecular response in BM after CHOP and Rituximab administration was 50% as compared to 31% for patients who did not (p 〈 0.02). Conclusions. FcgRIIIA polymorphism is not predictive of response for FL cases treated with sequential administration of CHOP-Rituximab. In this setting the quantitative evaluation of BCL2/IgH+ cells at diagnosis in BM remains the best predictor of clinical response. Moreover the achievement of a durable molecular response is associated with a better FFR.

Description: Abstract 3578 Introduction: Chronic lymphocytic leukemia (CLL) patients bearing 13q14 deletion are known to experience a more favorable clinical course. Recent studies, focusing on patients with loss of 13q as the sole cytogenetic aberration at diagnosis (del13q-only cases), showed that the number of malignant cells carrying this genetic lesion correlates with a more aggressive clinical behavior. However, whether the size of the 13q deletion may also influence the clinical outcome remains to be elucidated. Patients and Methods: Probes for chromosome 13q (LSI-RB1, LSI-D13S319), 11q (LSI-ATM), 17p (LSI-p53) and chromosome 12 (CEP12) were utilized on nuclei collected at diagnosis from: i) a multi-institutional CLL cohort (342 del13q-only cases) and ii) a consecutive unselected single-institution cohort of 265 cases. RB1 deleted cases (delRB1) were defined as having at least 5% of deleted nuclei. Time to treatment (TTT) intervals, as well as Rai staging, IGHV mutational status, CD38 and ZAP70 expression, B2-microglobulin levels, all evaluated at diagnosis, were also available for all cases that entered the study. Genome wide DNA profile was performed in a pilot series of 90 CLL samples using Affymetrix GeneChip Human SNP6 arrays. Results: According to genome wide DNA analysis, delRB1 occurred in a proportion of del13q-only cases (36/90; 40%), always comprising the deleted region detected with the LSI-D13S319 probe (that covers the miR-15a/16-1 cluster and the DLEU2 gene) and characterized by a larger chromosome loss (median size 2.07 Mb vs. a median size of 0.86 Mb for the canonical del13S319). Maximally selected log-rank statistics identified the 70% of nuclei bearing del13S319 as the most appropriate cut-off value capable of separating del13q-only cases into two subgroups with different TTT distributions. Consistently, del13q-only cases with at least 70% of nuclei bearing del13S319 showed a significantly shorter TTT than del13q-only cases with less than 70% deleted nuclei (p=0.0001). Del13q-only cases were then divided in four subsets according to the percentage of nuclei bearing del13S319 with or without a concomitant delRB1: del13S319 70% + delRB1 (group 4), 39 cases. The median TTT of group 1 (not reached) was significantly longer than the median TTT of group 2 (92 months, p=0.012), group 3 (68 months, p

Description: Abstract 3386 It has been demonstrated that long term treatment of CML patients with Imatinib (IM) is associated with altered bone and mineral metabolism. The mechanisms that are responsible for this effect are not fully understood but an inhibition of the PDGF-Rβ (Platelet Derived Growth Factor- Receptor beta) axis has been documented. In order to evaluate if stimulation of osteoblastogenesis is a common feature of other tyrosine kinase inhibitors (TKIs) approved for the treatment of patients with CML, we evaluated the osteoblatic differentiation of Mesenchymal Stem Cells derived from adult bone marrow donors (BM-MSCs) after in vitro treatment with Dasatinib (DA), Nilotinib (NI) or Bosutinib (BO). BM-MSCs were induced to differentiate in osteoblastic cells by treatment with osteogenic medium (OM) with or without DA, NI or BO. BM-MSCs was induced to differentiate in osteoblastic cells by treatmet with osteogenic medium (0.2 mM ascorbic acid, 0.1 μ m dexamethasone and 10 mM β-glycerophosphate, OM) with or without DA 2nM, BO 5nM or NI 100nM. After 21 days of treatment, in the cultures treated with DA e NI for 21 days we have observed a significant increase of extracellular mineralization and of osteogenic markers such as bone morphogenetic protein (BMP2) (p

Description: Introduction It is acknowledged that an accurate histological diagnosis may distinguish Essential Thrombocythemia (ET) from early Primary Myelofibrosis (early-PMF), which is projected to worse outcome in terms of survival and disease evolution into acute leukemia (AL) or overt myelofibrosis (MF). It is also accepted that the outcome of ET is related to the mutational status, with JAK2V617F mutation having a negative impact. In previous analyses, outcome data derived from the admixture of the two variables, histology and mutational status. Here, we present a large cohort of ET/early-PMF patients positive for the JAK2V617F mutation, with the aim to evaluate the impact on outcome of the sole histological definition. Methods A clinic-pathologic database of ET patients followed in four Italian Hematology Centers was created and a total of 475 WHO-diagnosed ET or early-PMF JAK2V617F-positive patients was collected. Bone marrow specimens were performed or reviewed at local institution. Baseline clinical/molecular characteristics and outcome measures (vascular complications, disease transformation/progression, overall and event-free survival) were evaluated. In all patients, JAK2V617F allele-burden was assessed in granulocyte DNA by using ipsogen JAK2 MutaQuant Kit (qPCR). The study was approved by the Ethic Committee of each participating Centers. Results Overall, 329 WHO-defined ET and 146 early-PMF patients positive for the JAK2V617F mutation were included in the study. Median follow-up was 6.6 years (range: 0.5-32.4). Compared to ET patients, early-PMF patients presented with older age (median, 57 versus 53.5yr, p=0.02), lower hemoglobin levels (median, 14.2 versus 14.5 g/dl, p=0.01), higher leukocyte count (median, 10.4 versus 9.5x109/l, p=0.01), and higher incidence of spleen enlargement (35.9% versus 13.9%, p

Description: Abstract 3882 Inflammation dominates both the histological and the clinical pictures of Hodgkin's Lymphoma (HL) and there are several clues that accessory cells (neutrophils, macrophages, and lymphocytes) have an important role in the development and progression of the disease. Recent studies have also highlighted the importance of interim PET (after 2 cycles of chemotherapy) as the most important prognostic factor for HL. Indeed, the positivity of interim PET is linked to the persistence of the reactive microenvironment that promotes tumor cells survival. CD68+ tumour associated macrophages have been recently identified as new marker of disease and their putative progenitors in peripheral blood are identified as Myeloid Derived Suppressor Cells (MDSC). This subpopulation of cells has been studied in some solid tumors where it has been documented its ability to suppress T-cell immune responses by several mechanisms, including expression of arginase and nitric oxide synthase. In order to identify an additional HD marker with prognostic significance, we evaluated 35 HL patients for circulating levels of MDSC, identified as CD34+, CD45+, CD11b+, CD13+, CD14- in peripheral blood by flow cytometry at diagnosis and correlated lab findings to clinical features and response to early 18FDG-PET, performed after the 2nd cycle. We found that at diagnosis HL patients have higher levels of circulating MDSC when compared to matched for sex and age healthy controls (mean 3,66 ± 1,94/mmc vs 1,69 ± 0,87/mmc, p=0.0001). Absolute number of MDSC was not correlated to markers of inflammation (ferritin, ESR, CRP,) tumor burden (stage, IPS, presence of bulky disease) and SUV at diagnosis PET. However, an interesting correlation was found between MDSC count at diagnosis and positivity of interim PET: all patients with a positive interim PET (5/35) had increased MDSC count at diagnosis and 5/7 patients with a count larger than 4.5 cells/uL had a positive early PET, with documented progression/relapse of disease for 4 of them. In order to confirm the immunosuppressive abilities of MDSC, we co-cultured myeloid cells (isolated by CD33+ or CD66+) from three HL patients, together with lymphocytes obtained by Ficoll-Hypaque from healthy donors and we found that lymphocytes were unable to become effectors after stimulation with PMA as documented by reduction of CD25, CD69 expression and increase of CD62L in comparison with control lymphocytes incubated with PHA alone. In conclusion, MDSC 1) are increased in peripheral blood of HL patients at diagnosis 2) correlate with interim PET 3) have a strong prognostic value, that is earlier and more easily accessible than interim PET 4) represent a paradigma of how a myeloid compartment may favour the development of a lymphoid neoplasia through T-cell impairment. Disclosures: No relevant conflicts of interest to declare.

Description: Abstract 3385 Heme oxygenase 1 (HO-1) is a rate-limiting enzyme in heme degradation (from hemoproteins and hemoglobin), leading to the generation of free iron, biliverdin and carbon monoxide. Recent studies have reported that HO-1 expression may represent an important protective endogenous mechanism against physical, chemical and biological stress. The cytoprotective role of HO-1 has been demonstrated for several solid tumors and acute leukemias. In addition, HO-1 is considered to play an important role as a survival molecule in CML cells, and an overexpression of HO-1 has been found to inhibit apoptosis induced by imatinib. In our experiments, K562 cells were incubated for 24 hrs with imatinib (1 uM) alone, or with an inductor of HO-1 (Cobalt protoporphyrin, CoPP, 10uM), or with inhibitor of HO-1 activity (Tin- mesoporphyrin, TIN) and viability of cells was evaluated by the ATP-lite1step assay (PerkinElmer). As expected, addition of CoPP was able to overcome the inhibitory effect of IM on K562 cells (p

Description: BACKGROUND: Ruxolitinib (RUX) is a potent JAK1/JAK2 inhibitor that demonstrated improvements in splenomegaly and disease-related symptoms, as well as improved survival, in patients (pts) with intermediate (Int)-2- or high-risk myelofibrosis (MF), and has proved superior to placebo and best available therapy in the phase 3 COMFORT studies. JUMP is an expanded-access phase 3b trial designed to assess the safety and efficacy of RUX in pts with MF and includes patients with no access to RUX outside a clinical trial. As of Dec 2014, final enrollment was 2233 pts in 26 countries. METHODS: Eligible pts had Int-2- or high-risk MF with or without splenomegaly, or Int-1-risk MF with a palpable spleen (≥ 5 cm from the costal margin). Pts received starting doses of RUX based on platelet counts at baseline (5 mg twice daily [bid; ≥ 50 to 〈 100 × 109/L], 15 mg bid [100 to 200 × 109/L], or 20 mg bid [〉 200 × 109/L]). The primary endpoint was assessment of safety and tolerability of RUX. Additional analyses included changes in palpable spleen length and symptom scores as measured by the FACT-Lymphoma total score (FACT-Lym TS). The final analysis will be performed after all pts have completed 24 months of treatment or discontinued the study. RESULTS: This analysis includes 1869 pts (primary MF, 59.1%; n = 1105) who started treatment ≥ 1 year before the data cutoff date (01 Jan 2015). At baseline, median age was 67 y (range, 18-89 y); 54.1% were male; median palpable spleen length was 12 cm below the costal margin; 87 pts did not have splenomegaly. Median hemoglobin (Hb) was 106 g/L, and 38.9% of pts had Hb levels ˂ 100 g/L; median platelet count was 257 × 109/L; mean FACT-Lym TS and FACIT-Fatigue score were 113.7 and 33.2, respectively. At data cutoff, 37.0% of pts remained on treatment; 26.1% had completed treatment per protocol. Primary reasons for discontinuation included adverse events (AEs; 17.4%), disease progression (8.2%), and death (3.4%). Median exposure was 13.6 months; the median average daily dose was 36.7 mg for pts starting at 20 mg bid (n = 1168; 62.5%) and 23.2 mg for pts starting at 15 mg bid (n = 559; 29.9%). The majority of pts (66.0%) had dose modifications, and 26.2% had a dose interruption. Grade 3/4 hematologic AEs included anemia (34.0%), thrombocytopenia (14.9%), and neutropenia (3.9%), which led to discontinuation in 2.2%, 3.3%, and 0.2% of pts, respectively. The most common nonhematologic AEs (≥ 10%) were pyrexia (14.5%), asthenia (13.8%), diarrhea (12.4%), and fatigue (10.3%), and were primarily grade 1/2; grade 3/4 AEs were low overall (≤ 2%), except pneumonia (3.9%), which led to discontinuation in 9 pts (0.5%). Rates of infections were low; all-grade infections ≥ 5% included pneumonia (6.2%), urinary tract infection (5.7%), and nasopharyngitis (5.3%). Tuberculosis was reported in 5 pts (0.3%; grade 3/4, 0.1%); hepatitis B was reported in 1 pt (0.1%; grade 3/4, 0.1%). At wk 24 and 48, 57.2% (742/1297) and 62.0% (588/949) of pts with baseline splenomegaly achieved a ≥ 50% reduction from baseline in palpable spleen length; 22.9% (297/1297) and 19.0% (180/949) had 25% to 50% reductions, respectively. Most pts (70.5%; 1208/1713) experienced a ≥ 50% reduction at any time; 23.3% (399/1713) had complete resolution of splenomegaly (Figure). At wk 24 and 48, 96.6% (57/59) and 91.5% (43/47) of evaluable pts without splenomegaly at baseline continued to have a nonpalpable spleen; 1.7% (1/59) and 4.3% (2/47) had a spleen that was 0-5 cm, and 1.7% (1/59) and 4.3% (2/47) had a spleen ≥ 5 cm. A large proportion of pts achieved a response (ie, a clinically significant improvement) on the FACT-Lym TS and FACIT-Fatigue at wk 24 (43.0% [525/1220]; 47.1% [593/1258]) and wk 48 (43.2% [368/852]; 45.7% [396/867]). Similar responses were seen in pts without a palpable spleen (FACT-Lym TS: wk 24, 44.0% [22/50]; wk 48, 36.1% [13/36]; FACIT-Fatigue: wk 24, 49.1% [27/55]; wk 48, 35.1% [13/37]). CONCLUSIONS: To date, JUMP includes the largest cohort of pts with MF treated with RUX. Consistent with previous findings, anemia and thrombocytopenia were the most common AEs but rarely led to discontinuation. As observed previously, most pts experienced reductions in splenomegaly and symptoms with RUX treatment. Clinically meaningful improvements in symptoms were also seen in pts with no palpable spleen, a pt group not included in the COMFORT studies. Overall, the safety and efficacy profile of RUX in JUMP is consistent with that in the phase 3 COMFORT studies. Disclosures Palumbo: Novartis: Honoraria, Other: Advisory Board. Le Coutre:Novartis: Honoraria. Al-Ali:Celgene: Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Ullrich:Novartis: Honoraria. Brittain:Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pierre Fabre: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Foltz:Promedior: Research Funding; Gilead: Research Funding; Novartis: Honoraria, Research Funding. Raanani:Bristol-Myers Squibb: Other: Advisory Board; Novartis: Other: Advisory Board, Research Funding; Ariad: Other: Advisory Board; Pfizer: Other: Advisory Board. Gupta:Incyte: Honoraria, Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees. Ghosh:Novartis Pharmaceuticals Corporation: Employment. Tannir:Novartis Pharma AG: Employment. Perez Ronco:Novartis Pharma AG: Employment. Vannucchi:Novartis: Other: Research Funding paid to institution (University of Florence), Research Funding; Shire: Speakers Bureau; Baxalta: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.