Despite advancements in thalassaemia care, survival rates and complications vary significantly by genotype. This study assesses survival outcomes and associated complications in patients with thalassaemia in north-eastern Thailand. A longitudinal cohort study from October 2012 to September 2023 involved patients aged ≥10 years (median: 31 years, range: 20-74) attending Srinagarind and Udonthani Hospitals. Cox regression analyses identified predictors of survival and complications. Of 380 enrolled patients, 340 completed follow-up. Over 10 years, 39 patients (11.4%) died, primarily from cardiovascular complications (61.5%), at a median age of 45 years (range: 22-72). Patients were grouped as HbE/β-thalassaemia, HbH/HbHCS with HbE mutation and HbH/HbHCS. Survival at 60 years was lower in HbE/β-thalassaemia (55.9%) and HbH/HbHCS with HbE mutation (58.3%) compared to HbH/HbHCS (79.6%, p = 0.08). Significant predictors of mortality included cardiovascular complications (HR 2.4; 95% CI, 1.01-5.5; p = 0.04), recurrent bacterial infections (HR 7.6; 95% CI, 3.1-18.8; p < 0.001) and elevated ferritin (>2500 ng/mL; HR 2.0; 95% CI, 1.01-3.9; p = 0.04). Cardiovascular complications, recurrent bacterial infections and high ferritin levels significantly influence survival in thalassaemia patients. Deletional alpha-thalassaemia patients had superior survival, while HbE/β-thalassaemia and non-deletional alpha-thalassaemia or co-inherited HbE mutation had poorer outcomes, underscoring the need for genotype-specific management strategies.

Objective: To describe the epidemiology, survival rate, and prognostic factors of mucosal-associated lymphoid tissue (MALT) lymphoma. Patients and Methods: This investigation utilized the Thai Lymphoma Study Group (TLSG) registry to gather data on patients diagnosed with MALT lymphoma. The analysis included demographic details, therapeutic interventions, and survival statistics. Results: The TLSG registry prospectively included 8404 patients with lymphoma. Among them, marginal-zone lymphoma (MZL) was the second most common subtype, with 670 histologically confirmed cases, accounting for 8.0% of the total cohort. An analysis of the MZL subtypes showed that MALT lymphoma was the most common, accounting for 77.8% of the diagnoses. This was followed by nodal MZL at 17.5% and splenic MZL at 7.7%. The distribution of primary disease sites indicated that the ocular adnexa (49.2%), stomach (12.9%), and sinonasal region (12.5%) were the three most common locations. Three variables were found to be statistically significant predictors of survival in the multivariate analysis: ECOG performance status > 2, age exceeding 65 years, and involvement of more than two extranodal organs. These identified prognostic factors were further assessed for their effect on overall survival (OS) and progression-free survival (PFS). A risk classification was established: the low-risk group comprised patients with zero identified risk factors, whereas the high-risk group included patients who had any of the specified risk factors. A comparison of five-year survival rates showed significantly more favorable outcomes for low-risk patients who had a PFS of 83.3% (vs. 66.1%, p = 0.028) and an OS of 97.8% (vs. 76.7%, p < 0.001) compared to the high-risk group. Conclusions: In this cohort, where MZL was the second most common lymphoma and MALT lymphoma was the predominant subtype, our analysis revealed that patients with no risk factors experienced statistically significant improvements in both PFS and OS.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of T-cell lymphomas with a characteristic feature of subcutaneous nodules associated with hemophagocytic lymphohistiocytosis (HLH). Treatment options for SPTCL are mainly chemotherapy (CMT) or immunosuppressive agents with selection currently dependent on physician decisions. Outcomes between the 2 treatment remedies have not yet been comprehensively compared. This study aimed to compare complete remission (CR) rates between SPTCL patients receiving cyclosporin (CSA)-based regimen (CSA +/- steroid) and CMT. The 5-year overall survival (OS) and 5-year progression free survival (PFS) were also analyzed. Clinical data from patients with SPTCL were drawn from the Thai Lymphoma Study Group registry who were newly diagnosed between 2007 and 2023. A total of 93 patients were selected with 45 cases having received CSA-based regimen and 48 cases having received CMT. There were more patients with limited stage at skin in the CSA group (63.8

Several prognostic models have been introduced to predict outcomes of patients with diffuse large B-cell lymphoma (DLBCL). Endothelial activation and stress index (EASIX) is a surrogate of endothelial dysfunction which has been shown to predict outcomes of patients with various hematologic malignancies. However, the prognostic implication of EASIX for DLBCL is limited and warrants exploration. We conducted a retrospective study enrolling adult DLBCL patients including a discovery cohort from the single-centered university hospital database and a validation cohort from the independent nationwide multi-center registry. EASIX scores were calculated using creatinine, lactate dehydrogenase, and platelet levels. The receiver operating characteristic curve analysis was used to determine optimal cutoff. Statistical analysis explored the impact of EASIX on survival outcomes. A total of 323 patients were included in the discovery cohort. The optimal EASIX cutoff was 1.07 stratifying patients into low (53.9%) and high EASIX (46.1%) groups. Patients with high EASIX had worse 2-year progression-free survival (PFS) (53.4% vs. 81.5%, p <0.001) and overall survival (OS) (64.4% vs. 88.7%, p <0.001) than patients with low EASIX. Multivariate analysis revealed that older age, bulky disease, impaired performance status, and high EASIX were associated with an unfavorable OS. In the validation cohort of 499 patients, the optimal EASIX cutoff was 1.04. Similar to the discovery cohort, high EASIX score was associated with high-risk diseases, worse PFS, and inferior OS. In conclusion, EASIX score was significantly associated with survival outcomes and may be used as a simple prognostic tool to better risk-classify DLBCL.

Introduction Extranodal natural killer/T-cell lymphoma (ENKTL) is a unique lymphoma associated with Epstein-Barr virus infection. It is more common in Asia than in the Western. The prognosis is usually poor, especially in advanced disease, and no standard treatment exists. Brentuximab vedotin (BV) is a drug-conjugated monoclonal antibody which targets the cell-membrane protein CD30 linked to the potent anti-tubulin agent. Due to frequent expression of CD30 in ENKTL, we investigated the safety and efficacy of BV in combination with methotrexate, L-asparaginase, and dexamethasone (B-MAD) as frontline treatment in Thai patients with ENKTL. Methods The Thai Lymphoma Study Group conducted a prospective, multicenter phase I/II study and enrolled patients aged 18-60 years with newly diagnosed ENKTL between December 2018 and December 2021 from 9 hospitals in Thailand. Patients with localized ENKTL (stage I/II) received concurrent weekly cisplatin and involved-field radiation (IFRT) 40-50 Gy, followed by 3 cycles of B-MAD. Patients with advanced ENKTL (stage III/IV) received only B-MAD for 6 cycles. BV in combination with standard dose MAD chemotherapy was given every 21 days. The primary objective was to determine the safety and optimal dose of BV in B-MAD regimen using a 3+3 dose escalation design. The secondary objective was to evaluate the overall response rate (ORR) at the end of B-MAD treatment, safety, progression-free survival and overall survival. An analysis was performed at the data cutoff date of June 30, 2023. Results Thirty-four patients (pts.) were enrolled; 23 had localized and 11 had advanced diseases. The median age was 42 years (range, 18-59). Four pts. in the localized group did not receive B-MAD due to disease progression during concurrent cisplatin and IFRT (n=3) and consent withdrawal (n=1). Six pts. received B-MAD in phase I study (3 pts. at 1.2 mg/kg and 3 pts. at 1.8 mg/kg of BV). No dose-limiting toxicity was observed among six patients, therefore the recommended dose of BV in phase II study was 1.8 mg/kg. Of 30 evaluable pts., 20 (66.7%) achieved complete response (CR), 5 (16.7%) had partial response, and 5 (16.7%) progressed after treatment. The response rates (ORR/CR rate) in localized and advanced diseases were 89.5%/78.9% and 72.7%/45.5%, respectively. A total of 190 adverse events (AEs) were reported. The most common AEs were anemia 19/190 (10%), leukopenia 9/190 (4.7%), neutropenia 9/190 (4.7%), hypoalbuminemia 9/190 (4.7%), peripheral neuropathy 7/190 (3.7%), elevated ALT 7/190 (3.7%), and elevated serum creatinine level 5/190 (2.6%), respectively. Twenty-four events were classified as grade ≥ 3 including anemia (4/24), leukopenia (7/24), neutropenia (7/24), and elevated ALT (1/24), respectively. A total of 21 serious adverse events (SAEs) were reported. The causes of SAE were varied as follows: acute kidney injury 2/21, pneumonia 2/21, leukopenia 1/21, neutropenia 1/21, and thrombocytopenia 1/21. Most of the SAEs were suspected to be related to the treatment. Two cases of acute kidney injury related to methotrexate and one case of hypersensitivity reactions to L-asparaginase were reported as SAEs. They were manageable and completely resolved upon follow-up. There were no treatment-related deaths. At the data cutoff date, after the median follow up of 11.6 months, 25 pts. were alive, 7 experienced progressions, and 5 had died. Two pts. had progression in the central nervous system. Conclusion Treatment with standard-dose of BV in combination with MAD chemotherapy was well tolerated and showed encouraging efficacy in patients with newly diagnosed ENKTL. Evaluation of long-term survival data is ongoing. (ClinicalTrials.gov identifier: NCT03246750)

Background: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of cytotoxic T-cell lymphoma, characterized by primary cutaneous tissue involvement mimicking inflammatory panniculitis. Treatment for this disease is still under debated between conventional chemotherapy or immunosuppressive agents like cyclosporin and prednisolone. Material and Methods: A multicenter retrospective study was conducted among adult patients who was diagnosed as subcutaneous panniculitis-like T-cell lymphoma from January 2013 to December 2020, in 15 medical centers in Thailand. The patient demographic data, treatment regimens which divided into conventional chemotherapy or immunosuppressive agents, and treatment outcomes were retrieved from the Thai lymphoma registry database. All of aspects were analyzed and compared between the treatment group. Results: A total of 34 patients were reviewed in this cohort. The median age was 30 years (range;16–64) with female predominance (67.6%). The majority of patients was diagnosed as advanced stage of disease as Ann Arbor stage IV (58.8%). All patients presented with skin and subcutaneous involvement while one-fourth of them had extra-cutaneous lesions including liver (14.7%) and bone marrow (11%). B symptom was observed in 64% and elevated LDH level in 70.6% of the patients which represented the high disease burden. However, almost all of our patients were in good performance status (ECOG 1–2). For treatment options, 41% of the patients received conventional chemotherapy, mostly CHOP, while 38% received cyclosporin containing regimens. The overall response rate (ORR) was 64% in chemotherapy group and 76% in cyclosporin group, which was comparable. Precisely 57% and 76% of the patients in conventional chemotherapy and cyclosporin treatment, respectively, had complete remission. Patients with Ann Arbor stage IV were received conventional chemotherapy as first-line treatment for 69%, on the other hand, 31% received cyclosporin-based treatment, which was in complete remission around 60% on both groups. With median follow up time of 35.2 months, the overall survival and progression free survival were not reached in both groups. Conclusions: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of cytotoxic T-cell lymphoma which predominantly affects young female and usually presents with extranodal lesions especially skin and subcutaneous tissues, bone marrow, and liver. Patients were responded well to cyclosporin-based treatment both limited and advanced stages of the disease. Keywords: chemotherapy, cyclosporin, Subcutaneous panniculitis-like T-cell lymphoma Keyword: Cutaneous non-Hodgkin lymphoma No conflicts of interests pertinent to the abstract.

BACKGROUND:Ineffective erythropoiesis (IE) is a significant risk factor for osteoporosis in individuals with thalassemia. Growth differentiation factor-15 (GDF15), a biomarker of IE, was found to be elevated in thalassemia patients. This study aimed to examine the association between GDF15 levels and osteoporosis in patients with thalassemia.METHODS:A cross-sectional study was conducted in 130 adult patients with thalassemia in Thailand. Bone mineral density (BMD) at the lumbar spine was evaluated by dual-energy X-ray absorptiometry (DXA), and with a Z-score of less than -2.0 SD was defined as osteoporosis. GDF-15 was measured using the enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was used to examine the associated factors with the development of osteoporosis. Receiver operator characteristic (ROC) curve analysis was used to estimate the threshold of GDF15 in predicting osteoporosis.RESULTS:Osteoporosis was detected in 55.4% (72/130) of the patients. Advanced age and high GDF15 levels were positively associated with osteoporosis, while an increased hemoglobin level was negatively associated with osteoporosis in patients with thalassemia. In this study, the GDF15 level's ROC demonstrated a good performance in predicting osteoporosis (AUC=0.77).CONCLUSIONS:The prevalence of osteoporosis is high among adult thalassemia patients. Age and high GDF15 levels were significantly associated with osteoporosis in this study. A higher hemoglobin level is associated with a lower risk of osteoporosis. This study suggest that GDF15 could be used as a predictive biomarker for osteoporosis in patients with thalassemia. Adequate red blood cell transfusions and suppression of GDF15 function may be beneficial in preventing osteoporosis.

Introduction: Marginal zone lymphoma (MZL) is the second most common lymphoma subtype in Thailand. Extranodal MZL or mucosal associated lymphoid tissue (MALT) lymphoma is the highest prevalent entity. Although gastric MALT lymphoma is the most common organ of this entity but for Thai population, ocular adnexa MALT lymphoma is the most common primary organ of MALT lymphoma. Objective: This study aimed to describe epidemiology of MALT lymphoma in Thai population and develop prognostic model for MALT lymphoma. Patients and methods: Patients (pts) diagnosed with MALT lymphoma were enrolled to the TLSG registry. Demographic data, treatment modalities, survival data were gathered. Univariate and multivariate analyses were done by Cox regression. To test the prognostic indices, Kruskal-Wallis test was performed. Kaplan Meier curves were plotted and log rank test was used to test the difference between risk groups. STATA® version 17 was performed for statistical analyses. Results: From January 2007 to March 2022, the TLSG has prospectively enrolled 8,404 lymphoma patients to the registry from 15 nationwide medical institutes; of these 670 patients (7.97%) were histologically diagnosed with MZL. Among MZL, MALT lymphoma was the most common entity with 501 pts (77.8%) followed by nodal MZL (117; 17.5%), and splenic MZL (52; 7.7%). Of these MALT lymphoma population, 457 pts with completed follow-up data were eligible for long-term survivals analyses. The three most common primary organs were ocular adnexa (225; 49.2%), gastric (59; 12.9%), and sinonasal (57; 12.5%). Median age at diagnosis was 59 (range;20-95). 162 pts (35.4%) of these were 65 years or older. For gender, male was slightly predominant (56.9%). High ECOG performance status (3-4) in 15 (3.5%). Extensive extranodal organs (>2) in 78 (17%). Advanced stage (III-IV) in 162 (35.4%). High lactate dehydrogenase (LDH) in 112 (24.5%). Presence of B-symptoms in 103 (22.5%). Regarding treatment, chemotherapy (CMT) only was administered in 27.5%, CMT + rituximab (R) 13.4%, CMT + radiation (RT) 11.6%, R+CMT+RT 2.2%, R monotherapy 0.4%, antibiotic eradication 6.6%. Locoregional therapy with RT 24.2% and surgical removal alone in 3.6%. Univariate analysis was performed and found that ECOG>3, age>65, number of extranodal organs>2, B-symptom, stage III-IV, and LDH were potential factors to be used for multivariate analysis. For multivariate analysis, ECOG>3, age>65, and number of extranodal organs >2 were found to be statistically significant affected survivals. These prognostic factors were used and tested for overall and progression-free survivals (OS and PFS, respectively). Patients without any risk factor were classified to be low-risk pts and pts with any of these risk factors were categorized to be high-risk pts. Five-year PFS and OS were significantly better in low-risk pts; vs 83.3% vs 66.1% (p=0.028) and 97.8% vs 76.7% (p<0.001) respectively. (Figures 1A, B) Conclusion: MZL is the second most prevalent lymphoma subtype in Thailand and MALT lymphoma is the most common entity. The prognostic index for MALT lymphoma showed that patients without any risk factor (ECOG>3, age>65, and number of extranodal organs >2) had statistically significant better PFS and OS. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Febrile neutropenia (FN) is considered an oncologic emergency in acute leukemia. There were 250 FN events in 124 hospitalized patients with hematologic malignancy. These data imply that two FN events may occur per patient, yet data on the prevalence, risk factors, and outcomes of recurrent FN in adult patients with leukemia are limited. A retrospective cohort study was conducted that enrolled adult patients diagnosed with acute leukemia who developed FN. The eligible patients were categorized as with or without recurrent FN. A stepwise, multivariate logistic regression analysis was performed to identify predictors of recurrent FN. A total of 203 patients met the study criteria; of these, 46 (22.66%) had recurrent FN, and this group had a median of three recurrent FN emergencies. After adjusted, three independent factors remained in the final model including ALL, FN at admission, and treatment with idarubicin (3 days) and cytarabine (7 days). The three factors were positively associated with recurrent FN with adjusted odds ratios of 6.253, 4.068, and 10.757, respectively. No significant differences were found between the two groups in terms of other sources of infection, other pathogens, ICU stay, hospital stay, and mortality. ALL and FN at admission and treatment with idarubicin (3 days) and cytarabine (7 days) were associated with recurrent FN in acute leukemia patients with FN. Clinical outcomes for patients with or without recurrent FN were mostly comparable; however, due to its small sample size, further studies are required to confirm the results of this study.

INTRODUCTION:Patients with thalassemia increase the risk of developing cognitive impairment. Chronic anemia, oxidative stress from excess iron, and hypercoagulable state were related to this condition. The study regarding its prevalence and the associated factor in Southeast Asia is limited. Therefore, the study aimed to investigate the prevalence of cognitive impairment and associated factors.METHODS:This was a cross-sectional study of thalassemic patients aged 18 years or more at the Hematology Clinic of Srinagarind Hospital, Khon Kaen University, Thailand, from January to May 2021. The Thai version of the Mini-Cog test was used to determine the presence of cognitive impairment. The clinical and laboratory parameters indicated as potential risk factors for dementia were evaluated in all patients. A stepwise logistic regression analysis was used to determine the associated risk factors for cognitive impairment.RESULTS:Among 150 patients, cognitive impairment was found in 40 patients (26.7%). Age per 10-year increase (adjusted odds ratio [AOR] of 1.6), no iron chelation therapy (AOR of 9.8), current smoking (AOR of 5.0), hemoglobin (Hb) (AOR of 0.63), and ferritin (AOR of 1.0001) were independent factors associated with cognitive impairment.CONCLUSIONS:The prevalence of cognitive impairment was high among thalassemic patients. Increasing age, low Hb, iron overload, and current smoking were significant associated factors with cognitive impairment. Screening for dementia in these patients is recommended, particularly in patients with high-risk factors.

Introduction Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is the most common subtype of marginal zone lymphoma (MZL) in Thailand. Results from the TLSG showed that almost half of the patients were ocular adnexal subtype (49.2%). However, there has been no validated prognostic index to predict outcome in these patients. Objectives This study aimed to describe epidemiology and develop prognostic index for ocular adnexa MALT lymphoma in Thai population. Methods Data from the TLSG were collected during January 2007 to March 2022. Patients who were diagnosed with ocular adnexa MALT lymphoma were enrolled. Demographic data including age, performance status (Eastern Cooperative Oncology Group; ECOG), stage of disease, lactate dehydrogenase (LDH), number of extranodal sites, presence of B symptoms and hepatitis profile were collected. Univariate and multivariate analyses were performed by using Cox regression. Parameters found to be associated with progression-free survival (PFS) and overall survival (OS) in multivariate analysis were used to perform prognostic index. Kaplan-Meier survival curves were analyzed to predict PFS and OS stratified by this prognostic index. Results Two hundred twenty-five patients were enrolled to this study. Male was predominantly affected (60.4%). Median age at diagnosis was 59 years (range: 28-87). Most of the patients (216, 96%) had good performance status (ECOG 0-1). Thirty-three patients (14.3%) had more than 1 extranodal sites. Thirty-five patients (15.6%) had high LDH at first diagnosis of lymphoma. Approximately half of the patients (116, 51.6%) were treated with chemotherapy. Twenty-three patients (10.2%) received immunotherapy (rituximab). Seventy-eight patients (34.7%) were radiated alone but only 3 patients (1.3%) in this registry underwent only surgery for treatment of ocular adnexa MALT lymphoma. Three parameters (age >65 years, ECOG 2-4, and advanced stage) were found to be potentially affecting survival in multivariate analysis. The prognostic index was categorized into low, intermediate, and high risk, according to the number of these parameters (0, 1, ≥ 2, respectively). Estimated 4-year OS for low-, intermediate- and high-risk groups were 97.4%, 90.9% and 77.9%, respectively, as shown in figure 1A (p-value=0.011). Estimated 4-year PFS for low-, intermediate- and high-risk groups were 82.5%, 69.2% and 55.4%, respectively (p-value=0.053), as shown in figure 1B. Conclusions This prognostic index can statistically discriminate among patients with ocular adnexa MALT lymphoma into low-, intermediate- and high-risk groups by OS. Although PFS can be stratified into 3 groups from this prognostic index, it has no statistical significance. Longer time of follow-up and more numbers of patients may result in statistical significance in near future. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

BACKGROUND Acute leukemia is mainly treated with chemotherapy leading to febrile neutropenia (FN). There is limited data on clinical factors predictive of mortality in adults with acute leukemia and FN. METHODS This was a retrospective cohort study and enrolled adult patients, diagnosed as acute leukemia, and developed FN. The eligible patients were admitted and followed up with mortality as the primary outcome. A stepwise, multivariate logistic regression analysis was used to find predictors for mortality. RESULTS There were 203 patients met the study criteria. Of those, 14 patients died (6.89%). AML was the most common type of acute leukemia with FN (64.04%). There were five remaining factors in the final model: AML, FN at admission, prolong broad spectrum antibiotics, lower respiratory tract infection, and Aspergillosis. Only lower respiratory tract infection was significant with adjusted odds ratio of 7.794 (95% CI of 1.549, 39.212). The Hosmer-Lemeshow Chi square was 2.74 (p value 0.907). The lower respiratory tract infection group had higher proportions of Gram negative and fungus than the non-lower respiratory tract infection group; specifically E. coli (p 0.003), and Aspergillus (P < 0.001). CONCLUSIONS There were two independent predictors of mortality in acute leukemia patients with FN: septic shock and lower respiratory tract infection regardless of leukemia type or pathogen. E. coli and Aspergillus were more common in those with lower respiratory tract infection than those without. No specific pathogens were found in cases of septic shock.

Introduction Liver iron overload is common in patients with thalassemia. In patients with beta-thalassemia, the correlation between serum ferritin and liver iron concentration is well established. The correlation between serum ferritin levels and liver iron concentrations in patients with alpha-thalassemia remains limited. Methods This is a cross-sectional study in patients with alpha-thalassemia aged >= 18 years old at Srinagarind Hospital, Khon Kaen University, Thailand. Liver iron concentration (LIC) was evaluated by the MRI-T2* technique. Linear logistic regression analysis was used to determine the correlation between serum ferritin levels and liver iron concentrations. Results One hundred and thirty-one of the MRI-T2* measurements from 65 patients with alpha-thalassemia were evaluated. Patients with non-deletional alpha-thalassemia had higher LIC compared to patients with deletional alpha-thalassemia. The serum ferritin levels were relatively low at the same levels of LIC in patients with non-deletional alpha-thalassemia compared to deletional alpha-thalassemia. Conclusions The correlation of serum ferritin levels and LIC was modest and different among alpha-thalassemia genotypes. A different serum ferritin threshold is needed to guide iron chelation therapy in patients with alpha-thalassemia. Evaluation of liver iron concentration is necessary for patients with alpha-thalassemia, especially in patients with non-deletional alpha-thalassemia.

Objective: Fluorescence in situ Hybridisation (FISH) is a widely used and useful cytogenetic technique for diagnosis and monitoring treatment responses in chronic myeloid leukaemia (CML). The positive or negative FISH result is interpreted based on individual standard normal cut off percentage, but universal cut off is unaddressed. We aimed to determine the performance of the FISH technique based on our routine normal cut off. Materials and Methods: A retrospective descriptive and analytical study was conducted on CML patients followed-up at Srinagarind Hospital. Data has been collected from laboratory records over the past ten years. We excluded patients who were not completely tested FISH and chromosome or RQ-PCR. Results: 675 FISH tests from 255 CML patients were analyzed. Specimens were mainly from bone marrow (98.2%) Chromosome analysis (G-banding) showed no metaphase in 31.9%. FISH test was positive in 99 samples with normal cut off at 9.7%. The falsenegative rate of FISH was 2.6% (0.65% by using the standard cut off at 1%) and the false positive rate was 3%. Conclusion: The FISH results should be interpreted carefully. Undue high level of normal cut off causes a high false-negative rate of FISH. The standard normal cut off for double signal FISH (D-FISH) was 1%. However, the cutoff FISH interpretation should be individually set and regularly validated. The FISH result should also be construed with G-banding, and RQ-PCR, which will improve the accuracy and will prevent misdiagnosed of CML. Keywords: Fluorescence in situ Hybridisation (FISH); Chronic Myeloid Leukemia (CML); Cut off; False positive; False negative

Background: Pateints with acute leukemia along with febrile neutropenia is at risk for fungal as well as bacterial infections. Fungal infection is a more serious and common infection in this setting, leading to a high mortality rate. There is limited data on clinical factors predictive of fungal infection in acute leukemia with febrile neutropenia. Objective: This study aimed to evaluate clinical predictive factors of fungal infection in acute leukemia patients with FN. Methods: This was a retrospective analytical study and included adult patients diagnosed with acute leukemia, who developed FN, and had positive culture with either bacterial or fungal infection. Predictors for fungal infection were calculated by using logistic regression analysis. A subgroup analysis in patients with acute myeloid leukemia (AML) was also performed. Results: There were 94 patients who met the study criteria. Of those, 29 patients had positive culture for fungus (30.82%), categorized as Aspergillus (19 patients; 65.51%) and Candida (10 patients; 34.49%). The mortality rate was significantly higher in the fungal infection group than the bacterial infection group (24.14% vs. 6.15%; p 0.031). There were six factors in the final model predictive of fungal infection with one independent predictor: treatment regimen of Idarubicin plus Ara-C with an adjusted odds ratio of 5.188 (95% CI of 1.386, 19.419). A subgroup analysis for fungal infection in patients with AML showed that only the treatment regimen of Idarubicin plus Ara- C was a significant factor. Its adjusted odds ratio was 5.138 (95% CI of 1.156, 24.467). Conclusion: Treatment with idarubicin and Ara-C may increase the risk of fungal infection in acute leukemia patients with FN.

Event-free survival at 12 months (EFS12) is a surrogate endpoint for long-term outcomes in many histologic lymphoma subtypes. However, most reports have primarily investigated the implication of EFS12 in advanced-stage non-Hodgkin lymphoma (NHL). There are limited data regarding the significance of EFS12 in early-stage NHL. Herein, we evaluated the prognostic significance of EFS12 in patients with stage 1 diffuse large B-cell lymphoma (DLBCL). Out of 282 patients with stage 1 DLBCL who received intensive therapy, 227 (80.5%) achieved EFS12. The 4-year overall survival (OS) was 91.4% and 4.0% for patients who achieved and failed to achieve EFS12, respectively. Multivariable analyses demonstrated response to treatment and achievement of EFS12 as independent predictors for OS. In conclusion, our study demonstrated EFS12 as a powerful prognostic factor for stage 1 DLBCL. Further validation in more extensive prospective studies is warranted.

Introduction: Peripheral T cell NHL (PTCL) and natural killer/T cell NHL (NKTCL) are relatively rare disorders. Data on clinical presentation, treatment and outcome are limited especially in older age groups. Methods: We identified 127 patients with PTCL and NKTCL, excluding cutaneous T/NK cell lymphoma, aged over 60 years old from Thailand nationwide multicenter registry. Results: Of 127 patients, median age of diagnosis was 67 years old. Patients aged older than 75 years old had similar characteristics to younger (60-74 years old) but higher comorbidity index. Seventy-nine patients (62.2%) received intensive/definite multi-agent chemotherapy, however, the proportion was significant lower in older patients (70.4% vs 34.5%, p < .001). After a median follow up duration of 17.3 months, 2-year progression free survival and overall survival were 38.1% and 48.5%. Univariate and multivariable analysis demonstrated older age, poor performance status and absence of definite multi-agent chemotherapy were associated with inferior survival. Definite multi-agent lymphoma specific chemotherapy was an independent factor for overall survival after adjustment for age, comorbidity index, performance status and prognostic index for T cell lymphoma. Conclusion: Despite overall poor prognosis of PTCL and NKTCL in older adults, chemotherapy could result in objective response and long-term survival in selected patients of this vulnerable age group thus emphasizing the importance of comprehensive geriatric evaluation. (C) 2019 Published by Elsevier Ltd.

Introduction: Stage I disease represents a minor subset of aggressive Non-Hodgkin Lymphoma (NHL) accounting around 10%. Overall prognosis is generally good but varied upon different histologic subtypes and topographic presentation. Herein, we describe an implication of event free survival at 12 months (EFS12) as a predictor for outcomes of stage I aggressive NHL including real-world data on clinical characteristics and treatment patterns of stage I aggressive NHL in a resource-limited country. Patients and methods: Thai lymphoma study group conducted the lymphoma registry which prospectively enrolled and systematically followed newly diagnosed lymphoma patients between 2007 and 2014 from 13 nationwide major University hospitals. We abstracted data of stage I aggressive NHL patients from the registry and obtained additional information from medical record. Clinical characteristics, treatment patterns and survival outcomes were described. EFS12 was a binary endpoint defined as whether patients developed events at 12 months after treatment initiation. Overall survival (OS) was defined as duration from a specific time-point either at the time of diagnosis, at EFS12 time-point to or at the event to death from any causes. Logistic regression model was used to evaluate the association between clinical characteristics and EFS12. Cox regression with EFS12 as a time-dependent co-variate and other clinical parameters were applied to evaluate association between EFS12 and OS. Results: Of 4,371 newly diagnosed lymphomas, there was a total of 636 stage I lymphoma patients (6.86%) including 590 NHL (519 B cell, 71 T/NK cell) and 46 HL. Among 590 stage 1 NHL, 435 were considered patients (356 diffuse large B cell lymphoma (DLBCL) and 8 Burkitt lymphoma (BL), 19 peripheral T cell lymphoma not otherwise specified (PTCL-NOS), 7 angioimmunoblastic T cell lymphoma (AITL), 11 anaplastic large cell lymphoma (ALCL), 1 other PTCL subtypes and 33 extranodal NK T cell lymphoma (ENKTL)). Table 1 summarizes baseline characteristics and treatment data of stage I aggressive NHL. At the time of analysis 61 patients relapsed and 146 patients had died. Major causes of death included infection related events (n=37, 25.3%), non-infectious related complication (n=21, 14.4%) and disease progression (n=60, 41.1%) respectively. With a median follow up of 47.3 months, both median event free survival (EFS) and overall survival (OS) were not reached with corresponding 4 years EFS and 4 years OS of 79.0% and 68.9% respectively (Figure 1A). Four-years OS of patients with aggressive B cell NHL, PTCL and ENKTL was 70.2%, 75.5% and 48.0% respectively. A total of 328 patients achieved EFS12 (No event within the first 12 months after first line treatment initiation). Patients who achieved EFS12 had significant better OS than patients who failed to achieve EFS12 (4-years OS 89.1% vs 7.1%, Hazard ratio 25.9, 95% Confidence Interval 17.7-37.9, P<0.001) (Figure 1C, 1D). Non-relapsed mortality and cumulative incidence of relapse was 15.1% and 19.0% respectively (Figure 1B). By using multivariable cox regression analysis, factors associated with favorable survival outcomes included absence of B symptoms, complete remission from therapy and achieving EFS12 (Table 2). Conclusion: Stage I disease represented a small proportion of aggressive NHL. Natural history and prognosis were highly varied depending upon histology. EFS12 was a power prognostic factor for stage I aggressive NHL and could be used as a clinical tool to stratify patients. Optimal treatment is to be defined to improve outcome and meanwhile minimize toxicities for stage I aggressive NHL patients. Disclosures No relevant conflicts of interest to declare.