Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations ranging from polyclonal reactive proliferations to overt lymphomas that develop as consequence of immunosuppression in recipients of solid organ transplantation (SOT) or allogeneic bone marrow/hematopoietic stem cell transplantation. Immunosuppression and Epstein–Barr virus (EBV) infection are known risk factors for PTLD. Patients with documented histopathologic diagnosis of primary PTLD at our institution between January 2000 and October 2019 were studied. Sixty-six patients with PTLD following SOT were followed for a median of 9.0 years. The overall median time from transplant to PTLD diagnosis was 5.5 years, with infant transplants showing the longest time to diagnosis at 12.0 years, compared to pediatric and adolescent transplants at 4.0 years and adult transplants at 4.5 years. The median overall survival (OS) was 19.0 years. In the monomorphic diffuse large B-cell (M-DLBCL-PTLD) subtype, median OS was 10.7 years, while median OS for polymorphic subtype was not yet reached. There was no significant difference in OS in patients with M-DLBCL-PTLD stratified by quantitative EBV viral load over and under 100,000 copies/mL at time of diagnosis, although there was a trend towards worse prognosis in those with higher copies.

Abstract Background Immune checkpoint inhibitors (ICI) have become a mainstay treatment of a variety of advanced malignancies, prolonging survival. There are no serologic markers to predict response to ICI, but some small series have suggested eosinophilia predicts improved survival. Methods This is an IRB approved single-center retrospective observational study including all patients (n= 80) from 2014-2019 who received ICI for non-hematologic malignancies at Loma Linda University Medical Center. Data were collected via chart review. Clinically significant increase of absolute eosinophil count was defined as a count > 0.5 bil/L on at least two occasions during treatment. Kaplan-Meier survival estimates were used to estimate overall survival. Results In non-small cell lung cancer (n= 35), patients with eosinophilia (n=5) had no death events compared to the median survival of 17.6 months in those without eosinophilia (p = 0.02). Similarly, in patients with renal cell carcinoma (n=11), those with eosinophilia (n=2) had no death events while the median survival for those without was 16.9 months (p= 0.24). In the metastatic melanoma cohort (n=9), those with eosinophilia (n= 5) had a median overall survival of 45.4 vs 9.9 months in those without (p= 0.02). Conclusions In both NSCLC and metastatic melanoma, eosinophilia during ICI therapy was associated with significantly increased overall survival, while in RCC there was a trend towards improved survival. Interestingly, there were no death events in those with eosinophilia in either NSCLC or RCC cohorts. Citation Format: Jasmine L. Mitchell, Justin Moyers, Huynh Cao. Eosinophilia and improved survival in non-hematologic malignancies treated with immune checkpoint inhibitors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3298.

Abstract Introduction: Even after curative intent resection, stage III melanoma carries poor prognosis and traditional chemotherapy has limited efficacy. Adjuvant immune checkpoint inhibitor (ICI) therapy utilizing the anti-CTLA-4 agent, ipilimumab, was shown to improve survival following resection in Stage III disease. Ipilimumab was FDA approved for adjuvant therapy in 2015. The National Cancer Database (NCDB) is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society and is the largest clinical cancer registry in the world covering 72% of new cancer diagnoses in the US. We aimed to assess the real-world survival data along with sociodemographic factors associated with receipt of adjuvant immunotherapy using the NCDB. Methods: We queried the NCDB for stage III patients since 2015. The most recent dataset available includes treatment data from 2015 and 2016 and survival data from 2015. Patients were included who had documented surgery to primary site; those with systemic therapy before surgery were excluded. Patients were divided into receipt of immunotherapy or no receipt of immunotherapy after surgery; those without documentation of either were excluded. Those who received chemotherapy as their systemic therapy were excluded. Factors compared between the two groups included age, sex, diagnosis year, pathologic stage group, Charlson-Deyo score, primary payer and state Medicaid expansion status, income, treatment region, and facility type. Survival analyses were performed by Kaplan-Meier method. Logistic Regression was used to examine factors associated with immunotherapy receipt. Results: 4,093 patients met criteria to be analyzed for survival with 25% (n=1,014) receiving immunotherapy. Median overall survival has yet to be reached for either treatment group; whereas, the 30-month survival was rate was 78% (95%CI; 74-82%) for those receiving adjuvant immunotherapy versus 73% (95% CI; 72-74%) when immunotherapy was not given (p=0.051). However, adjuvant immunotherapy given to resected stage IIIC patients improved survival 32.8 versus 28.0 months (p<0.01). 8,160 patients met inclusion criteria for treatment pattern analysis of which 28% (n=2,260) received immunotherapy after surgery. Charlson-Deyo Scores of 1-3, 2015 as year of diagnosis, and Medicare as primary payer had lower percentage of patients receiving immunotherapy. Conclusion: We provide the first early analysis of the NCDB in the era of adjuvant ICI. Adjuvant immunotherapy in resected stage IIIC melanoma yielded a superior survival advantage. Additionally, sociodemographic factors appear to play a role in receiving adjuvant immunotherapy. Citation Format: Justin T. Moyers, Esther G. Chong, Jasmine Mitchell, Amie Patel, Il Seok Daniel Jeong, Gayathri Nagaraj. Immunotherapy in resected stage III melanoma: An analysis of the National Cancer Database [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4338.