ALBERT

Description: A sixty-one year-old Hispanic female with Waldenstrom’s Macroglobulinemia diagnosed in 2011 and successfully treated with 6 monthly cycles of Cyclophosphamide, Rituximab and Dexamethasone (CDR) from 12/11 through 5/12 was then put on a two-year maintenance scheme with Rituximab every three months. In February, 2014 (six months before the end of the planned treatment), she came to the ER complaining with severe headache, aphasia and blurred vision. A stroke was initially ruled out and she received Paracetamol with partial improvement. Nonetheless, symptoms re-appeared accompanied with disorientation and agitation. Antipsychotic medication was given with no improvement. On PE she was disoriented with aphasia, paraparetic and neck stiffness suggestive of meningitis. Blood tests, a MRI and lumbar puncture were performed showing leptomeningeal hyperintensity with no signs of encephalitis (Figure 1). Figure 1 Leptomeningeal reinforcement as seen in MRI. Figure 1. Leptomeningeal reinforcement as seen in MRI. CSF analysis showed WBC 64 cells/µL, (95% MNC), glucose= 9.8 mg/dL and proteins= 110 g/dL. Gram dye was negative. A geneXpert for Tuberculosis was negative. CSF cytology showed an infiltration of lymphoid neoplastic cells confirmed by cytochemistry (Figures 2a and 2b). Figure 2a: CD 20+ and 2b: kappa + neoplastic cells in CSF Figure 2a:. CD 20+ and 2b: kappa + neoplastic cells in CSF Figure 3 Figure 3. With these results a Bing Neel syndrome was diagnosed and IT Methotrexate was given for a total of 6 doses resulting in a nice reduction of the neoplastic cells. However, she relapsed in April/2014 and IV Fludarabine was started. We are planning to add IT liposomal Cytarabine. Additionally, MYD 88 gene mutation was detected. DISCUSSION: There are only 33 reported cases of Bing-Neel syndrome in the medical literature for the last 80 years and this one has been confirmed with the newest tools such as: MRI, cytochemistry and gene mutation. CONCLUSION: Bing-Neel syndrome should be suspected in every patient with Waldenstrom’s Macroglobulinemia and CNS impairment. Disclosures No relevant conflicts of interest to declare.

Description: Introduction. The umbilical cord stem cell bank was created in Mexico City in june 2003 due to the need to have access to pluripotential stem cells to cover the hematological and immunological pediatric needs. We have so far 300 units of umbilical stem cells available to the medical community. The bank has been designed with a completely automatic process and the standards are based in NETCORD-FAHCT outlines. Objective. In the present study we made a balance of the evaluation of umbilical cord stem cell process including the maternal setting, the standarization of the methodology to obtain the stem cells, compared to other institutions around the world. Material and methods. Bayesian analysis allow us to evaluate our procedures at the different levels. Bayesian networks are directed acyclic graphs (DAGs) where the nodes are random variables and certain independence assumptions hold. Results. In table 1 we show the results of the first 300 units process with the automatic process. The arcs in a bayesian network specify the independence assumptions that must hold between the random variables and the global dependence of the total factors. Figure 1. Conclusion. Through the bayesian analysis, we found a direct influence of the collected volume, the time between the collection and the procedure, and the maternal unit, with respect to the number of recovered cells, specifically with CD34+ the viable ones as well as the totals. Figure 1. Bayesian Analysis between neonatal and process factors. Weight baby (PRN); sex (SRN); cord blood unit collected volume (ml); initial white cell (GBTI); total final white cell(GBTF); % total CD34+ ( PCD34T); % viable CD34+ (PCD34V); total CD43+ (CD34T); viable CD34+ (CD34VA); ginecology unit (UH); time hour (TH). Figure 1. Bayesian Analysis between neonatal and process factors. Weight baby (PRN); sex (SRN); cord blood unit collected volume (ml); initial white cell (GBTI); total final white cell(GBTF); % total CD34+ ( PCD34T); % viable CD34+ (PCD34V); total CD43+ (CD34T); viable CD34+ (CD34VA); ginecology unit (UH); time hour (TH). Results of the first 300 units process with these technology Initial nuclear cells/ml Collectionvolume Initial total nuclear cells % CD 34total Viable% CD 34 Recovery% Average 11.4 x 106/ml 102.8 ml 12.2 x108 0.32 0.31 80 Acceptance criterion 7–20 x 106 〉 75 ml 〉8 x 108 0.1– 0.3 0.1– 0.3 〉60%