ALBERT

Beschreibung: Abstract 1407 Poster Board I-429 Purpose. To compare the requirements of physicians and patients for the Internet interactive service which allows patients to manage their own medical records and communicate with physician via the Internet. Background. USA federal rule defining “the Meaningful Use of Electronic Health Records” is similar to that of the National Standard of Russian Federation “The Electronic Case History (EHR)”, operating since 2008. This National Standard was developed based on experience of EHR system at the National Center for Hematology in Moscow (NCH). In 2009, we started the Personal Health Records service (PHR service) that allows patients to manage their own medical records and have internet-based communication with physicians. Simple interface for patients which blocks the full capacity of the PHR service is similar to that of EHR system of NCH. It permits integrated data presentations on a uniform axis of time and access to additional information (reported to ASH in 2001). The PHR service raises question of “meaningful use” requirements not only for EHR provider organization, but for the service users - patients and doctors. Methods. Using questionnaires and interviews, we compared expectations and acceptance of the PHR service by doctors and their patients. Results and Discussion. Preliminary results indicate that doctors are more likely to use the PHR service than the System of HER. Although the entire format of PHR service is familiar to physicians at NCH, they mostly use its information capabilities (viewing the results of the analysis, making appointments for research and planning patient's visits). The patients use PHR service with great enthusiasm (increasing with younger age and higher level of education). The complexity of integration interfaces, which we leave for the patients in the second term, gives them more inspiration than that the physicians. However, few patients take seriously the responsibilities that exist in relation to the accurate maintenance of their records. Conclusion. PHR can be widely used if integration of sources for medical information and unification format can simplify the “manual” work of PHR management. Key Words: Telemedicine, PHR, EHR Disclosures: No relevant conflicts of interest to declare.

Beschreibung: Abstract 4758 Aim To determine the frequency of transformation of cutaneous T-cell tumors (CTCL) and effect of different therapies. Materials and methods Retrospective analysis of treatment results for 68 patients with two types of CTCL, MF and SS, selected from 263 patients T-cell lymphoma/leukemia treated at NCH during 9 years. All 68 patients have CD 3 +, CD 4+, CD 7-, CD 8-, CD 30- immunophenotype and T-cell clonality (rearranged genes for T-cell receptor). MF was diagnosed in 48 patients (24 men, 24 women) with median age 52 years (26 - 77), SS in 20 patients (12 men, 8 women), median age 61 years (23 -87). Half of the MF patients started surveillance at III - IV stages, 15 of 20 patients with SS - at stage IV. Treatment of CTCL in the indolent phase was conducted in accordance with their stage: monochemotherapy (leukeran or methotrexate) and biologically active agents (interferons, retinoids, monoclonal antibody) were used. Appearance of transformation to large cell lymphoma was consistent with tumor progression as determined by presence of two or more of the following: 1. rapid growth of tumors in MF or leukemization in SS; 2. presence of large anaplastic cells in blood or tumor biopsy; 3. increase in expression of Ki-67 (10-70%); 4. appearance of activation markers (CD30, CD25) in tumor cells, and 5. loss of certain linear T-cell markers. For treatment of patients in large cell transformation phase Promace-Cytabom or FNC protocols were used in 7 patients. Five patients received A-CHOP-14 (with alemtuzumab) and subsequent maintenance therapy (methotrexate 20 mg per week, 6-mercaptopurine 50-100 mg/day in combination with alpha interferon 3 million daily). Results and Discussion The overall median time of observation (before and during treatment) in 48 patients with MF was 96 months (8-264). For 13 patients who died it was 76 months (8-264), mortality rate was 27%. The overall median observation (before and during treatment) in 20 patients with SS was 60 months (6-123), for 8 who died, it was 62 months (6-94), mortality 40%. The median observation for treatment of MF was 30 months (from 3-122) for the SS, it was 18 months (1 - 85). Restraining aggressive therapy for an indolent process resulted in complete or partial remission, while maintaining a good quality of life. Large cell transformation phase was observed in 12 patients (7 of 48 patients with MF (14.5%) and 5 of 20 patients with SS (25%). Seven of the 12 patients died within 2-4 months due to septic complications during Promace-Cytabom or FNC protocols. The remaining 5 patients received A-CHOP-14 (6-7 courses) which reduced tumor formation and /or leukemization. However, the persistence of patches, plaque or erythrodermia was the reason for maintenance therapy. This combination led to further regression of skin manifestations and full or partial remission within 4-12 months. Conclusion Because of the lack of a generally accepted treatment for GM and SS in Large Cell Transformation phase, even small successes should be discussed. The effectiveness of combining of polychemotherapy with maintenance therapy may be effective due to the presence of several distinct clones of tumor cells with different properties. Keywords: treatment of cutaneous T-cell lymphoma, Mycosis Fungoidus, Sezary Syndrome, Large Cell Transformation Phase, immunohistochemical markers of T-cell lymphomas. Disclosures: No relevant conflicts of interest to declare.