ALBERT

Description: Introduction. Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphomas (NHL). The use of chemoimmunotherapy (R-CHOP) in DLBCL has improved Overall Survival (OS). However, there are among 45-55% of patients who will die due to relapse, progression (refractoriness) or toxicity to treatment. Genomic classifications are difficult to use in clinical practice, especially in lain America, due to the need of trained personnel and cost. So, we continue using the International Prognostic Index (IPI) and its variations (e.g. revised-IPI, NCCN-IPI) for prognostic purposes. However, other biological variables have been reported to be prognostic, such as serum beta-2-microglobulin (B2M), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), platelets/lymphocyte ratio (PLR) and serum albumin (SA). These factors have been associated with burden of disease, inflammation and nutritional status. Aim. Therefore, we performed a retrospective analysis of the databases of two Latin American groups to determine which biological variable is the most powerful factor prognostic of OS. Methods. A total of 1,250 patients were analyzed from two databases [(Grupo de Estudio para el Linfoma Mexicano (GELMEX) and the Grupo de Estudio para el Linfoma Latino Americano (GELL)], where 525 patients met the following inclusion criteria: DLBCL diagnosis by immunochemistry; complete data on absolute lymphocyte, absolute monocyte, absolute neutrophil and absolute platelet count, serum B2M and SA; and complete data on traditional variables for calculating risk groups for IPI, NCCN-IPI & R-IPI. The LMR, NLR and PLR was obtained. We evaluated the AUC of the biological variables and the differences among each one of them (including cut-off). Kaplan-Meier curves (KMC) were estimated and subsequently, the inference of OS was evaluated by Hazard Ratio (HR) Cox-regression in univariate/multivariate analyses by forward model. All variables with p3.2 mg/dL vs. ≤3.2 mg/dL) were 72% vs 34% (Log Rank p

Description: Background: The cure rate for advanced classical Hodgkin lymphoma (cHL) is approximately 70%, which is calculated based on data from clinical trials performed in North American and/or European countries (Canellos GP, et al. N Engl J Med. 1992;327:1478-84; Carde P, et al. J Clin Oncol. 2016;34:2028-36; Gordon LI, et al. J Clin Oncol. 2013;31:684-91). However, there are limited outcome data available in other countries, apart from some small hospital-based studies (Ramirez P, et al. Rev Bras Hematol E Hemoter. 2015;37:184-9; Law MF, et al. Arch Med Sci. 2014;10:498-504; Jaime-Pérez JC, et al. Oncologist. 2015;20:386-92; Omer Al-Sayes FM, Sawan A. J Taibah Univ Med Sci. 2006;1:48-56). The B-HOLISTIC retrospective chart review study seeks to address the paucity of data on cHL treatment patterns, clinical outcomes, and healthcare resource utilization in 13 countries across Latin America, Africa, Middle East, and the Asia-Pacific region. Methods: The study will collect data from approximately 2,600 patients aged ≥18 years and newly diagnosed with stage IIB-IV cHL or relapsed/refractory cHL (RRHL) between 01 January 2010 and 31 December 2013, and will follow them until death or chart review, whichever occurs first. The primary objective is to describe progression-free survival (PFS) in patients with RRHL. Secondary objectives include describing demographic and clinical characteristics, clinical outcomes (overall survival, best clinical response after completion of treatment, response duration), key adverse events associated with each line of therapy, and cHL-related healthcare resource use. Results: As of 14 May 2018, a total of 165 patients from 12 sites have been included in the interim analysis, predominantly from Turkey and South Korea. At this time, 150 patients had cHL and 24 patients had RRHL, including 9 patients who were enrolled in the cHL group and had a documented relapse/progression during the study period. Here, we report the results of the newly diagnosed cHL group; data from the RRHL group will be reported in subsequent publications. At diagnosis, 64.7% of the cHL group were male, with a median age of 36.5 years (range, 18-89 years); 22.7% had stage IV disease, 30% had extranodal disease, 59.3% had 'B' symptoms, and 34.9% had an International Prognostic Score (IPS) of ≥4. Patients were classified as 13.3% in stage I-IIA; 24% in stage IIB; 53.3% in stage IIIA-IVB; and 9.3% as unknown. Patients classified as stage I-IIA are a deviation from the clinical study protocol and will be removed from the final study analysis. The proportion of patients alive was 94%, with the cause of death reported as either HL-related (44.4%), due to an adverse event (11.1%), or other (44.4%). Positron emission tomography (PET) or PET-computed tomography (CT) imaging was performed in 58.5% of patients at baseline, 48% of patients at interim, and 36.6% at end-of-treatment; CT imaging was performed in 68.7% of patients at baseline, 83.6% of patients at interim, and 59.7% of patients at end-of-treatment. At frontline treatment, 95.3% of patients received chemotherapy (mostly doxorubicin, bleomycin, vinblastine, dacarbazine [ABVD], 92.3% [median number of cycles, 6; range, 2-8]), 22.7% of patients received radiotherapy, with 22% of patients receiving radiotherapy and chemotherapy (median total dose, 34.5 Gy; range, 24-45 Gy). The majority of patients received involved-field radiotherapy (53.1%), with other modalities including involved-node (21.9%), involved-site (18.8%), whole body (3.1%), or other (3.1%). The proportion of patients who achieved a complete or partial response to frontline treatment was 52.1% and 21.1%, respectively. The PFS for treatment in frontline cHL in the overall patient population at 48 months was 81% (95% CI, 73.1-86.7; Figure 1), with a median duration of follow-up of 58.9 months (range, 2.6-128.3 months). The PFS for treatment in frontline cHL excluding ineligible patients classified as stage I-IIA (13.3%) at 48 months was 78.9% (95% CI 69.7-85.6). Due to the retrospective nature of this study, adverse events were under-reported and will be presented once the data are mature. Conclusion: The B-HOLISTIC study is ongoing, with final patient enrolment anticipated in December 2018. These interim data provide real-world information on the incidence, treatment, and outcomes of cHL in countries where little is known about this patient population. Disclosures Ferhanoglu: Takeda: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees. Yeh:GNT Biotech & Medicals Crop.: Research Funding. Brittain:Takeda: Membership on an entity's Board of Directors or advisory committees. Karduss:Novartis: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria; Amgen: Honoraria; Takeda: Honoraria. Kwong:Bayer: Consultancy, Honoraria; Beigene: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Merck: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria; Astellas: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. Song:Peking University Cancer Hospital (Beijing Cancer Hospital): Employment. Zerga:Bristol Myers Squibb: Other: Conference fees; Roche: Other: Conference fees; Janssen: Other: Conference fees; Takeda: Other: Conference fees. Blair:Takeda Pharmaceuticals International Co.: Employment. Dalal:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA: Employment, Equity Ownership. Wan:Takeda Pharmaceuticals International Co.: Employment. Hertzberg:Amgen: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; MSD: Membership on an entity's Board of Directors or advisory committees.

Description: Purpose: To evaluate efficacy, safety, Disease-Free Survival (DFS) and Overall Survival (OS) in patients with indolent non-Hodgkin’s lymphoma (NHL) treated with chemotherapy vs. immunotherapy vs immunochemotherapy as first-line therapy, an up-date report. Methods: Patients with indolent NHL were randomized to receive: (A) Rituximab x 6/w, (B) CNOP (cyclophosphamide, mitoxantrone, vincristine and prednisone) x 6 or (C) R-CNOP x 6, at standard doses. Results: 195 patients were included, 183 are evaluable for OS and toxicity (A:62, B:55 and C:66), 144 are evaluable for overall response rate (ORR) and DFS (A:53, B:41 and C:50). Clinical characteristics: 89 male (45.6%), mean age 59±14 (±SD), 148 (75.9%) in stage (III/IV), without significant differences between groups. Overall Response Rate (CR+PR) was: A: 84.9%, B:83.4% and C:90% (P=0.545). Neutropenia grade 3/4 was more frequent in the chemotherapy groups: A: 4.8%, B: 23.6% and C:18.2% (P=0.001) as it was the infectious toxicity (grade 2/4): A:4.8%, B:5.5% and C:15.2% (P=0.07). DFS at 24 months was: A 68%, B:65% and C:70%, (P=0.93) and the OS was A:87%, B:84% and C:78%. P=0.89. Conclusions: We did not find any important differences, between groups, regarding the Overall Response Rate, Disease Free Survival and Overall Survival at 24 months. However, single agent rituximab was better tolerated, with less toxicity in comparison with the chemotherapy containing groups. Based on these findings, it maybe reasonable to use immunotherapy only, as first-line therapy for patients with indolent NHL.

Description: BACKGROUND In recent decades the results in the treatment of acute leukemia's have improved, this due to the optimization of chemotherapy regimens, risk stratification, monitoring of minimal residual disease, development of new agents and best supportive care. Allogeneic hematopoietic stem cell transplantation (HSCT) is a standard option for patients at high risk of relapse. Allogeneic hematopoietic stem cell transplantation (HSCT) is a standard option for patients at high risk relapse. However, patients who relapse after transplantation have a poor prognosis because of subsequent treatments do not confer a success survival. The EBMT has reported a 5.5 months median survival after relapse, overall survival of 8% of ALL and 10-20% to AML to 3 years. AIMS Report outcomes of patients with relapsed acute leukemia after hematopoietic stem cell transplantation (HSCT). METHODS Retrospective analysis of our hematopoietic stem cell transplantation database was undertaken, containing 81 patients with acute leukemia presenting of a period of 10 years. RESULTS We Identified 81 patients, 47 (58%) were men. Median age for ALL was 20 years (7-55 yr) and for AML patients was 34 (15-64yr). ALL was the most frequent diagnosis (61%), 28 patients had AML (35%), other leukemias (4%). 44% patients with ALL had Ph'Chr+. 60% of all patients underwent myeloablative regimen transplantation in first CR and 30% in second remission. The 95% of HSCT was performed allogeneic transplantation and the rest was autologous. In most cases the source of stem cells was peripheral blood. Post-transplant relapse occurred in 51% and 54% of patients with ALL and AML, 10 and 12 months respectively. A total of 6 patients was underwent to second transplant with reduce intensity regimen with very poor response. Table 1 was shows the principal features of patients. Table 1. CHARACTERISTIC ALL=49 % (n) AML =28 % (n) Other leukemia =3 % (n) Age at HSCTMedian (Range) 22 (15-55) 34 (17-64) 18 (16-35) Response before HSCT First CR 63 (31) 53 (15) 100 (3) Second CR 29 (14) 36 (10) 0 Third or more CR 2 (1) 4 (1) 0 Active disease 2 (1) 7 (2) 0 Allogeneic 98% (48) 93 (26) 66.7 (2) Autologous 2 (1) 7.1 (2) 33.2 (1) GVHD Acute 26.5 (13) 17.9 (5) 22.2 (1) Chronic 22.9 (11) 39.3 (11) 0 Relapsed Media time at relapsed 51 (25) 10 months 53.6 (15) 12 months 66.7 (2) Post-Relapse Treatment Without treatment Palliative CT Cytotoxic CT 32 (8) 24 (6) 44 (11) 26.7 (4) 13.3 (2) 60 (9) 0 100 (2) Response after re-induction CT CR Active disease 20 (5) 48 (12) 32 (8) 33.3 (5) 33.3 (5) 33.3 (5) 0 100 (2) 0 Second HSCT 4.1 (2) 14.3 (4) Relapsed at second HSCT 50 (1) 50 (2) Outcome Alive Dead 55.1 (27) 44.9 (22) 39.3 (11) 60.7 (17) 33.3 (1) 66.7 (2) 3-years OS 5-years OS Median 56% 43% 50 months A 3 years 44% A 5 years 34% 36 months 20 months RFS 1-year Median 56% 22 months 28% 5 Months 33% 10 months NRM Mortality to relapse 9.5 (2) 90.5 (19) 23.5 (4) 76.5 (13) O 100 (2) CONCLUSION Our results confirm that treatment options for high risk acute leukemic patients who relapse early after HSCT are limited with extremely poor prognosis, special in patient relapsed early post-transplant. More studies are needed to determinate the best treatment option for patient who relapse after HSCT. Disclosures No relevant conflicts of interest to declare.

Description: Background Approximately 20% of classical Hodgkin’s Lymphoma (cHL) patients are over 60 years of age. There is no standard of care for this age group. Although most patients receive ABVD (Doxorubicin, bleomycin, vinblastine and dacarbazine), a standard regimen in younger patients, little is known regarding the clinical presentation of cHL, and the long term efficacy of ABVD in young and elderly Latin American Mestizo patients.. Defining whether individuals in all age groups and social circumstances benefit from a common treatment approach requires investigation.. Thus we sought to evaluate and compare the clinical presentation and the efficacy of ABVD in the elderly (60 years of age and above) versus the younger population of individuals with cHD. Methods We retrospectively analyzed 44 consecutive cHL patients treated with ABVD at the National Cancer Institute in Mexico between 2006 and 2013, as compared to 218 patients under 60 years of age. Results Median age for the elderly was 65 (60-89y), without a difference in gender (21m/2 f). According to Ann Arbor staging 6-8-13-14 were stage I, II, III, or IV , respectively. The International Prognostic Score (IPS) was 〉 3 in all patients. B symptoms were present in 34 patients (77.3%). Mixed cellularity subtype was present in 52.3% of cases and nodular sclerosis subtype (34.1%). The great majority of patients (93%) received at least 1 ABVD (1-6), 27 patients received chemotherapy alone, 14 patients received combined modality treatment and 3 patients only received radiotherapy. Twenty four patients achieved a CR (54.5%), 5 partial responses, 5 had refractory /relapsed disease and 10 couldn’t be evaluated. Unlike younger patients a better response was not demonstrated with combined treatment modality (Table 1). Overall survival for the whole group at 7.2 years was estimated at 75.4% (95% CI 57.1-79.4) The OS (7 y) in elderly group was 75% versus 92% in younger group, however patients with age 〉75 had a lower survival, 50%. The median follow-up was of 8 years. Summary Our study showed no clinical differences between elderly vs younger population and confirms the efficacy of ABVD in elderly patients. The lower OS compared to other series may be related to the advanced stage of disease and poor IPS in our series Table 1.Clinical characteristics of elderly versus younger patientsFeature〈 60 years (%)〉60 years (%)P valueGenderMale/female61.8/38.247.5/52.30.10B Symptoms77.077.30.86Ann Arbor stage I II III IV7.424.931.835.913.618.224.538.60.45IPS 〉348.865.90.07Bulky disease48.838.60.26Histology Mixed cellularity Nodular Sclerosis43.848.852.334.10.60Treatment ABVD ABVD + RT RT Other42.455.32.32.361.431.86.84.50.37Response CR PR Relapse/progression NV60.89.718.910.654.511.411.422.70.37Overall survival (8 years)92%75%0.000 Disclosures No relevant conflicts of interest to declare.

Description: Follicular lymphoma (FL) is the most common indolent lymphoma with a median survival approaching 20 years. However, there is significant clinical heterogeneity with subsets of patients experiencing transformation, early recurrence or refractory disease. Some authors found that progression of disease within 24 months of diagnosis, in patients treated with chemoimmunotherapy (POD24), is associated with poor overall survival (OS). OBJECTIVE Evaluate the POD24 as an early clinical endpoint in FL and evaluate FL international prognostic index (FLIPI), and other baseline risk factors at diagnosis for overall survival and relapse. METHODS We conducted a retrospective and observational study in which 160 patients with follicular lymphoma who received R-CHOP at National Institute of Cancerology, Mexico from 2011 to 2017. We analyze with Kaplan Meier curves, log rank test and logistic regression model. RESULTS We analyze 160 patients, median of age was 53 years (26- 88), with a female : male ratio of 1.17:1. In this group: 86% had hemoglobin 〉12 mg/dL, LDH was normal in 62%, 1-4 nodal areas were affected in 64%, 56% of patients had high FLIPI score, 27% had B symptoms and we found bone marrow infiltration in 30% of cases; grade 2 Follicular lymphoma was the most common histological subtype (40.5%). Most of patients achieved complete response (81%), 12% partial response after the first line therapy. Only 13 patients (8%) presents relapse. Sixty four percent received maintenance. Only 13 of patients relapsed, 10 after 24 months and only 3 in first 24 months from diagnostic (POD 24). Fig. 1 Overall survival in our population was 89% to 8 years, the factors with statistical significance in the bivariate analysis were the more nodal regions affected (1-4), high FLIPI score and POD 24 POD 24, adjusted to FLIPI score, was an independent predictor of survival in regression analysis (p

Description: Background: There are well-established prognostic factors for predicting the overall survival (OS) of patients involved by diffuse large B cell lymphoma (DLBCL). These prognostic factors are age, performance status (PS; ECOG score), high serum lactate dehydrogenase level (LDH), advanced disease (Ann Arbor stage: III, IV) and extranodal sites involved (EN). The patients are distributed in different risk groups according to the score obtained and as established by each research group who developed each international index. However, these prognostic indexes do not explore new markers and just readjust the five known variables since 1993 when The International Non-Hodgkin's Lymphoma Prognostic Factors Project was developed. Serum albumin (SA) has been shown to be a prognostic biomarker in DLBCL prior to R-CHOP treatment (Ngo et al. Leuk Lymph 2008). In another study of patients older than 80 years receiving R-miniCHOP treatment, SA ≤3.5 g/dl was the only factor with a significant effect on OS on (Peyrade et al Lancet Oncol 2011). Studies of non-Hodgkin's lymphoma reported that SA

Description: Background: Defining the extent of disease is essential for determining the prognosis and management of patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL) as the presence of advanced disease, including involvement of an extralymphatic site, is associated with inferior outcomes (Cheson et al, 2014). 18F-fluorodeoxyglucose positron emission tomography (FDG PET-CT) has an excellent diagnostic performance for evaluation of bone marrow infiltration (BMI) in patients with lymphoma but it is expensive and not always available at low and middle-income health care facilities. Unilateral bone marrow biopsy (BMB) is a more accessible test and has been the standard to identify lymphomatous BMI. Unfortunately, it is an unpleasant procedure for the patient and can be limited by technical constraints. The aim of this single-center retrospective cohort study was to evaluate the diagnostic performance of FDG PET-CT for BMI in lymphoma patients, comparing it with BMB as the gold standard. Also, we evaluated for discordant results between both studies along with its effect on patient treatment. Methods: Newly diagnosed lymphoma patients evaluated at the National Cancer Institute between July 2017 and December 2018 were identified from our institutional lymphoma data base. Five hundred patient files were reviewed for bone marrow evaluation at diagnosis by BMB and FDG PET-CT as well as for other clinical characteristics. Only 355 patients had both FDG PET-CT and BMB performed and adequately reported, so the rest were excluded from the analysis. Fisher's exact and Pearson Chi-square tests were used to compare categorical variables. Comparisons of continuous variables were performed using Mann-Whitney U test. Setting BMB as the gold standard, diagnostic performance of FDG PET-CT for detecting BMI was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR) and accuracy were calculated for the most common histological subtypes. Logistic regression model was used for univariate and multivariate analysis of predictors for positive BMB and positive FDG PET-CT for BMI. Results: The most common histologic type was diffuse large B-cell lymphoma (DLBCL) in 42.4% of cases, followed by HL in 20.4%, and follicular lymphoma (FL) in 11.2%. Median age was 53 years. B symptoms were present in 59.6% of cases and 71.4% debuted with advanced stage of disease (Ann Arbor III and IV). BMB was positive in 17% of all patients and 28% had a positive FDG PET-CT for BMI (Table 1). BMB was positive in 17.2% of HL, 12.3% of DLBCL, 29.8% of FL and 15.6% of other types of lymphoma patients. Overall, sensitivity of FDG PET-CT was 74.1%, specificity 80.1%, PPV 42.2%, NPV 94.1%, +LR 3.73, -LR 0.32 and accuracy 79.2%. The diagnostic performance of FDG PET-CT in patients with HL, DLBCL, FL and other types of lymphoma is shown in Table 2. As for predictors for BMB positivity, the presence of B symptoms, neutropenia and thrombocytopenia were independent factors for BMI with adjusted OR of 2.44, 95% CI (1.19, 4.99), 5.64, 95% CI (1.32, 24.08) and 4.12, 95% CI (1.66, 10.26), respectively. For positive FDG PET-CT, the presence of B symptoms, thrombocytopenia and advance stage remained significant with adjusted OR of 2.96, CI 95% (1.73, 5.05), 2.75, 95% CI (1.17, 6.48) and 19.22, 95% CI (5.90, 62.66), respectively. Seventy-four patients had discordant results between BMB and FDG PET-CT. The discrepancy in BMB and FDG PET-CT results did not have an effect on treatment. Conclusions: In addition to international clinical practice guidelines recommendations, in our center we recommend performing a BMB to those patients with HL and FDG PET-CT negative for BMI who present with cytopenias and B symptoms at the time of diagnosis. For patients with DLBCL our FDG PET-CT sensitivity was lower than expected, so we recommend a complementary BMB to all DLBCL patients with a positive FDG PET-CT for BMI (stage IV) that otherwise would be early stages (I and II) and would benefit from less aggressive therapy. In all other NHL including FL, we recommend performing a unilateral BMB with immunohistochemical analyses and flow cytometry, if available, for initial evaluation of BMI. Still in the absence of FDG PET-CT, a whole-body contrast-enhanced CT along with a unilateral posterior iliac crest BMB could adequately stage most types of lymphoma at low and middle-income health care facilities. Disclosures No relevant conflicts of interest to declare.

Description: Abstract 2940 Poster Board II-916 Introduction. Nasal NK/T cell lymphoma (NNK/TCL) is a tumor with a low prevalence but is more frequent in Asia and South America. There is no standard treatment for these patients, although radiotherapy is usually recommended. Few reports describe the frequency of central nervous system (CNS) involvement in this type of lymphoma and, in consequence, little is known about the benefit of carrying out screening procedures such as cerebrospinal fluid (CSF) cytology or image studies, nor it is known if prophylactic radiotherapy to the CNS or intrathecal chemotherapy improves the outcome of these patients. Patients and methods. We reviewed the clinical files of 63 patients of the National Cancer Institute in Mexico City with a diagnosis of angiocentric, centrofacial or NNK/TCL between january 1996 and december 2008. We excluded those patients who had a doubtful histopathological diagnosis, who were not completely studied or who did not received treatment in our institution. We collected the following variables: age, gender, histopathological diagnosis, localization of the tumor, clinical stage, symptoms at presentation, IPI score, CNS involvement, CSF cytology, image studies, LDH level, type of treatment and global response to treatment. Results. We found a total of 48 patients with a diagnosis of primary nasal lymphoma who met the inclusion and exclusion criteria. The mean age was 45.6 (range 16-81) years. The male to female ratio was 2:1. The most frequent localization and histopathological type was the nasal T cell lymphoma (58.3% and 43.8%, respectively). Thirty one percent of the tumors were classified as diffuse large cell and small cell lymphomas due to the lack of immunopathology at the time of diagnosis. Most of the patients were at stage I or II (81.3%) of the disease and had a low or low intermediate IPI score (85.4%). Of the 48 patients 89.6% recieved combined treatment with chemotherapy (CHOP) and radiotherapy, the other 10.4% recieved treatment with radiotherapy alone. Thirty nine point six percent and 23% of the patients had complete and partial response to the treatment, respectively. The remaining patients had either stable or progressive disease. Only 10.9% of the patients complained of neurologic symptoms and 85.4% had a spinal tap done. Nine patients had central nervous system infiltration (18.8%), 55.5% presented with neurological symptoms. Seven of the nine patients with CNS infiltration were diagnosed with a positive CSF cytology (77.8%). Two patients had a negative CSF cytology but had a positive MRI (22.2%). None of these patients had a positive CT scan for CNS involvement. Eight of the nine patients were treated with combined chemo and radiotherapy and 1 patient was treated with radiotherapy alone. Three patients achieved complete response (33.3%). Although there is a great difference in complete response between the patients with and without CNS involvement (6.25% vs 54.17% respectively, p= 0.07), this difference was not statistically significant. This can be due to the small number of patients with CNS involvement. There was no significant difference in the IPI score, LDH levels, stage of the disease or age between the groups. Conclusions. CNS involvement is present in a considerable proportion of patients with primary nasal lymphoma. Based on these data we think CSF cytology should be done in all patients. The results also suggest that the CT scan is not sensitive enough to detect CNS involvement. The treatment of these patients is an open question because there is virtually no data in the literature regarding therapy for this complication. Disclosures: No relevant conflicts of interest to declare.

Description: Background. In Classic Hodgkin's lymphoma (cHL), malignant cells constitute only about 1% of the bulk of tumor tissue, the rest constitutes the microenvironment and is made up of a compound of inflammatory cells. Lymphocytopenia and increased CD68+ tumor-associated macrophages (TAMs) are adverse prognostic factors in cHL. TAMs are derived from circulating monocytes and are possibly related to absolute monocyte count (AMC). We have sought to investigate the relationship of circulating lymphocytes and monocytes with response and survival in patients. Recently, Porrata et al. reported that a low absolute lymphocyte count/absolute monocyte count at diagnosis [ALC/AMC-Dx] (