Purpose The survival rate amongst breast cancer survivors (BCS) have been increasing, with a 5-year survival rate of almost 90%. These women face many quality of life (QOL) issues either due to either cancer itself or the complex treatment regimen. Our retrospective analysis aims to identify at risk populations among the BCS and their most common concerns. Methods This is a single-institution, retrospective, descriptive analysis of patients who were seen at our Breast Cancer Survivorship Program from October 2016 to May 2021. Patients completed a comprehensive survey which assessed self-reported symptoms, their concerns and degree of worry and recovery to baseline. The descriptive analysis on the patient characteristics included age, cancer stage and treatment type. The bivariate analysis included the relationship between the patient characteristics and their outcomes. Analysis of group differences was completed with Chi-square test. When the expected frequencies were five or less, Fisher exact test was used. Logistic regression models were developed to identify significant predictors for outcomes. Results 902 patients (age 26–94; median 64) were evaluated. Majority of women had stage 1 breast cancer. The most common self-reported concerns affecting the patients were fatigue (34%), insomnia (33%), hot flashes (26%), night sweats (23%), pain (22%), trouble concentrating (19%), and neuropathy (21%). Though 13% of BCS felt isolated at least 50% of their time, the majority of patients (91%) reported having a positive outlook and felt that they have a sense of purpose (89%). Younger patients were more likely to worry about their cancer more than 50% of the time (p < 0.0001). Patients that were less likely to return back to at least 50% of their pre-treatment baseline were younger (age ≤ 45) (p = 0.0280), had higher stage breast cancer (Stage 2–4) (p = 0.0061), and had chemotherapy either alone or as part of their multi-modality treatment (p < 0.0001). Conclusion According to our study, younger patients, those with higher stage breast cancer and survivors who had chemotherapy may experience significant QOL issues. Fortunately, majority of BCS report a positive and optimistic outlook post treatment. Identifying common concerns after treatments and vulnerable populations are especially important to deliver quality care and to optimize interventions. Implications for Cancer Survivors Our study identified the most common self-reported concerns affecting BCS. In addition, our results suggest that younger patients, patients with higher stage breast cancer and survivors who had chemotherapy were more likely to have QOL issues. Despite this, our study showed, the majority of BCS reported positive outlooks and emotions.

6643 Background: The American Society of Hematology (ASH) recommends reducing inpatient thrombophilia testing but adherence to these recommendations remains suboptimal. We report the results of a quality improvement (QI) project which aimed to minimize unnecessary testing. Methods: We performed retrospective review of records of patients with a new diagnosis of venous thromboembolism (VTE) across 3 hospitals in Central PA from September 2021 to December 2021 to see how many patients underwent thrombophilia workup. Our QI project consisted of education for physicians based on ASH recommendations with lectures, biweekly emails, and educational posters. We then performed a second retrospective review of patients admitted under the same conditions between June 1, 2022, and August 31, 2022, to reevaluate thrombophilia testing rates. The cost of testing was extrapolated from institutional hospital cost reports. Descriptive statistics included reporting the categorical variables as number and percent. The categorical variables were compared between groups with Fisher’s exact test or the chi-square test. Results: During the first study period, 310 patients had new VTE. Provoking factors were found in 269 patients (86.7%) and 41 patients (13.2%) had unprovoked VTE. Overall, 33 out of 310 patients (10%) underwent thrombophilia workup, with a total of 175 tests performed. Thrombophilia testing rate was significantly higher in the unprovoked group (29.3% vs 7.8%, p = 0.0003). Both groups have equally received inpatient hematology consult (33.83% vs 47.50%, p = 0.0920). Only 16% of thrombophilia tests were recommended by hematology consult while the rest was ordered by the primary team. The cost of all tests ordered outside of hematology recommendation was $34,083 ($344 per person). Of the group that got tested regardless of provoking factors, there was no difference between hospital length of stay (2-12 days vs 3-12 days, p = 0.0665) or anticoagulation choice. During the second study period, 191 patients had new VTE. Provoking factors were found in 157 patients (82.1%) while 34 patients (17.9%) had unprovoked VTE. Overall, 21 out of 191 patients (10.9%) underwent thrombophilia workup, with a total of 78 tests performed. More testing was ordered in the unprovoked group (26.47% vs 7.64%, p = 0.0040). More inpatient hematology consults were performed in the unprovoked group (64.71% vs 40.76%, p = 0.0110). Of the hematology consults, 12 out of 21 patients (57%) had thrombophilia testing recommended by hematologist. The rate of thrombophilia testing ordered outside of hematology consultation has decreased from 84% to 43% after our intervention, resulting in a $16,635 savings for that quarter. Conclusions: Our experience confirmed that thrombophilia work up was costly and did not impact quality of care. Despite the relatively low frequency of inpatient workup, eliminating unnecessary testing saved our health system $16,635 in a 3-months period.

22 Background: The American Society of Hematology (ASH) Choosing Wisely campaign have created thoughtful conversations between providers and patients in recommending care that is supported by evidence to reduce duplicative testing. However, some have raised concerns regarding the impact on patient care. We provide our institutional experience in exploring the clinical feasibility of the recommendation on reducing unnecessary inpatient thrombophilia testing. Methods: This was a retrospective review of patients admitted with a diagnosis of venous thromboembolism (VTE) across the 3 hospitals in Central PA from September 2021 to December 2021. Pregnancy was an exclusion criterion. Thrombophilia workup included tests for factor V Leiden mutation, activated protein C resistance, protein S activity, antithrombin deficiency, prothrombin gene mutation, anti-cardiolipin antibodies, dilute Russell viper venom time, lupus anticoagulant, anti-beta2-glycoprotein antibodies. The cost of testing was extrapolated by institutional hospital cost reports. Descriptive statistics included reporting the categorical variables as number and percent. The categorical variables were compared between groups with the use of Fisher’s exact test or the chi-square test. Results: During our study period, 310 patients had new VTE. Of those, 47.9% had pulmonary embolism, 33.7% upper or lower extremities deep vein thrombosis (DVT), 1.6% splanchnic DVT, 14.6% multiple DVTs, and 2.2% DVTs in other locations. The median age was 64. Provoked factors were found in 269 patients (86.7%) and 41 patients (13.2%) had unprovoked VTE. Overall, 33 out of 310 patients (10%) underwent thrombophilia workup with a total of 175 tests performed. More thrombophilia testing was ordered in unprovoked group (29.3% vs 7.8%, p = 0.0003) compared to provoked. There was no difference between the amount of inpatient hematology consults in both groups (33.83% vs 47.50%, p = 0.0920). Of the hematology consult, 19 out of 118 patients (16%) had thrombophilia testing recommended by hematologist. The cost of all tests ordered outside of hematology recommendation was $34,083 (avg $344 per person). Of the group that got tested regardless of provoking factors, there was no difference between hospital length of stay (2-12 days vs 3-12 days, p = 0.0665). Anticoagulation choice was also not affected by thrombophilia testing between the two groups. Conclusions: Our experience found that many thrombophilia work up were costly and did not impact quality patient care. Despite the relatively low frequency of inpatient workup (10%), eliminating testing could save our health system approximately $136,332 per year ($34,083 per quarter). Therefore, we support ASH’s campaign in reducing inpatient thrombophilia testing. We aim to work with our administration to provide education in reducing unnecessary testing.

Background: POLARIS is a prospective, real-world study of palbociclib in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer (ABC) in the United States and Canada. These analyses evaluated the difference in tumor mutation profiles of patients receiving palbociclib in the first line versus second line or greater and examined the applicability of circulating tumor DNA (ctDNA) monitoring in a real-world setting. Methods: The clinical database cut-off date was March 16, 2021. Patients in the biomarker analysis group provided consent for serial blood sample collections, received ≥1 dose of initial palbociclib combination treatment, and had ≥1 ctDNA measurement available. The Guardant360 platform with somatic single-nucleotide variants in complete or critical exons of 73 genes was used. The association between early changes in ctDNA mutation allele fractions at Cycle 2 Day 1 (C2D1) and disease progression at Week 24 was evaluated using univariate and multivariable logistic regression analysis adjusting for line of therapy. Results: Among patients with HR+/HER2– ABC (N=347), 93.9% (n=326) had ctDNA measured at baseline, of which 85.9% (n=280) had ≥1 ctDNA alteration detected; 66.6% of patients received palbociclib treatment in the first line and 33.4% as second line or greater ABC setting. The frequencies of gene mutations at baseline were generally higher in patients receiving palbociclib as a second-line or greater therapy compared to those who received it as first-line therapy, particularly for ESR1 mutations (30% vs 15%) and FGFR1 mutations (13% vs 9%). With a median (range) follow-up duration of 18.5 (0.1-46.3) months, patients with total ctDNA increase at C2D1 (log ratio change >0) were 3.74 times more likely to have disease progression at Week 24 (odds ratio, 3.74 [95% CI, 1.71-8.17]; P=0.001) compared with those without change or with a decrease in ctDNA at C2D1 (log ratio change ≤0). The observed significant association remained after adjusting for line of therapy in the multivariable regression analysis (odds ratio, 2.62 [95% CI, 1.14-6.04]; P=0.023). Conclusions: Among patients with HR+/HER2- ABC receiving palbociclib, early changes in ctDNA mutations were significantly associated with disease progression. Further studies are needed to confirm these findings and to evaluate the clinical utility of ctDNA-guided “adaptive” early therapeutic interventions to improve outcomes in patients with metastatic breast cancer. Pfizer; NCT03280303 Citation Format: Debu Tripathy, Zhe Zhang, Joanne L. Blum, Meghan S. Karuturi, Steven L. McCune, Bijoy Telivala, Shailendra Lakhanpal, Kamal Patel, Richard C. Frank, Kit Lu, Chetan Deshpande, Yao Wang, Yuan Liu, Aditya Bardia. Early changes in circulating tumor DNA and its effect on clinical outcomes in patients with advanced breast cancer receiving the CDK4/6 inhibitor palbociclib: Genotyping results from POLARIS [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-05.

Background Breast cancer is the second leading cause of cancer death in women. There are multiple pathogenic mutations in addition to BRCA1/2 that are implicated in causing hereditary breast cancer. Methods and results We conducted a retrospective analysis of 1568 patients with breast cancer diagnosed between January 1, 2015, and December 31, 2018. The age range is 23-87. Among the study population, 26% had genetic testing and 8% of those were found to carry a pathogenic variant, as designated in NCCN (National Comprehensive Cancer Network) Guidelines. Of that 8%, 3.4% were BRCA1 and BRCA2 mutations, and the rest were other prevalent pathogenic variants. Discussion Expanded panel testing has the potential to increase the detection rate of pathogenic variants compared to testing for BRCA1/2 alone. Diagnostic accuracy of genetic causes of breast cancer has a significant clinical impact on patients and their families in terms of targeted treatment and prevention strategies. There is a strong need for further understanding of genetic patterns and variations in hereditary breast cancer. Awareness of the possibility of moderate to low penetrance genes and variants of uncertain significance (VUS) is important to assist with appropriate genetic counseling. We believe that physicians should consider re-testing with an expanded panel if patients previously had BRCA1 and BRCA2 testings only with a negative result as it may identify additional mutations.

BACKGROUND The incidence of multiple primaries in cancer patients is 2-17%. However, the synchronous co-occurrence of adenocarcinoma of the breast and follicular lymphoma is rare. CASE REPORT We describe a case series of 3 post-menopausal women who presented to our institute with a breast lump. On further investigations, 2 of them had invasive ductal carcinoma and 1 had invasive lobular carcinoma of the breast. All 3 cancers were estrogen/progesterone receptor (ER/PR)-positive and human epidermal growth factor receptor 2 (HER-2)-negative. During the staging PET scans, all 3 patients had increased FDG uptake in axillary, mesenteric, and inguinal lymph nodes, respectively, raising concerns for metastatic disease. However, subsequent biopsies revealed them as follicular lymphomas occurring as a second concurrent primary malignancy. All patients underwent radical mastectomies with sentinel lymph node dissection followed by chemotherapy and hormonal therapy. Most of the lymphomas were low grade, which the oncologist closely followed. CONCLUSIONS Very few cases of breast cancer and follicular lymphoma co-occur; this is not limited to the axillary lymph nodes and can occur in any part of the lymphatic chain. Regional lymph node enlargement detected on examination or imaging does not always indicate metastasis. A high index of suspicion is needed followed by lymph node biopsy to rule out any second primary malignancy.

Patients with high risk myelodysplastic syndromes (MDS) and acute myelogenous leukemia (AML) are commonly older with multiple co-morbidities, rendering them unsuitable for intensive induction chemotherapy or transplantation. We report preliminary cellular immune profiling of four cases receiving sequential clofarabine and lenalidomide for high risk MDS and AML in a phase I study. Our results highlight the potential of immune profiling for monitoring immune-modifying agents in high risk MDS and AML.

Ovarian vein thrombosis (OVT) is a rare condition most often seen in the immediate postpartum period. We report a 40-year-oldwoman with no significant past medical or surgical history who presented to the emergency room for acute right lower quadrant pain of 1 day duration. A computed tomography (CT) scan showed a normal appendix but a new finding of right ovarian venous thrombosis. To date, only nine cases of idiopathic OVT have been reported. In this case report, we present a summary of these cases and review of literature regarding management of OVT.

200 Background: The number of cancer diagnosis and oncology visits have increased by 30% over the past decade nationwide. Similarly, our institution also experienced more than 30% growth this past year due to increased number of physicians and patients. However, the amount of resources including staffing, infusion chairs, and hour of operation remained the same. This has caused significant delays for patients and decreased patient/staff satisfaction. Methods: Visual Management tools can be used to communicate information by using visual diagrams instead of text. Various instruments were used to visually assess patient flow during their chemotherapy admission in the infusion unit. The workflow process was organized into a Value Stream Map. Root cause analysis was performed for high problematic areas. Results: Average patient wait time were as follows: patient registration to infusion chair (20min; range 5-45min), chair to nurse assessment (15min; range 0-30min), blood draw to “ok for treatment” (60min; range15-90min), “ok to treatment” to drug delivery (20min; range 15-30min). Through visual stream mapping, we identified the complexity of work flow and areas of highest impact for patient wait time (ex. blood draw/laboratory process, drug delivery). We used root-cause analysis to identify deficiencies and limitation in the process. Pick chart was created to assess and stratify useful ideas and current resources. We achieved several low effort/high impact interventions (i.e. designated parking space for drug delivery, supplying tools in nursing stations) and some high effort/high impact interventions (i.e. extending office hours and making changes to our computer order systems). These strategies has improved efficiency and decreased wait time by more than 50%, and also improved patient and staff satisfaction. Conclusions: Incorporation of Visualization Management tools helped engaged our high stake holders in the improvement processes. These tools helped facilitate a deeper understanding of department workflow, identify issues in the process, standardize the process and improve efficiency.

Abstract INTRODUCTION: Haploidentical allogeneic stem cell transplantation (haplo-SCT) incurs a risk of bidirectional immune reactions with either severe acute graft versus host disease (aGVHD) or graft rejection. Induction of immune tolerance with post-graft cyclophosphamide dramatically improves the outcomes of haplo-SCT. However the optimal duration and the combination of systemic immunosuppressive agents in haplo-SCT remain controversial. Ultra-low dose interleukin 2 (ULD IL-2) preferentially expands regulatory T cells (Tregs) and natural killer (NK) cells, promoting both GVHD prevention and graft versus leukemia (GVL) effects. These properties suggest that ULD IL-2 could play a useful role in haplo-SCT. Here we report the outcomes of a pilot study to determine the safety and feasibility of ULD IL-2 as GVHD prophylaxis in haploidentical allo-SCT (14-H-0180, Clinical Trials.gov ID: NCT02226861) METHODS: Ten subjects with high risk hematological malignancies received a myeloablative conditioning regimens of fludarabine 120mg/m2 (day -10 to day -8) and total body irradiation (TBI; 600-1200 cGy, day -10 to day -6). Thereafter the subjects received donor lymphocyte infusion (DLI) products (2x108 CD3+/kg) on day -6, followed by post-DLI cyclophosphamide 120mg/kg on days -3 and -2. CD 34+ selected, peripheral blood stem cell product was infused on day 0. Sirolimus was initiated on day -1 with goal trough level of 5-12ng/mL until day+60. ULD-IL2 (aldesleukin, 100,000 IU/m2) was given subcutaneously daily for 12 weeks starting day +1. Peripheral blood mononuclear cells (PBMC) and plasma samples were collected at days 14, 28, 60, 84, 100 post-transplant. Multi-color flow cytometry immunophenotyping assay were performed to characterize the subsets of memory T cells, Tregs, NK cells, and monocytes with various functional markers. Plasma levels of biomarkers (ST2, Reg3α, sTNFR1, ANG1, IL-6) were measured using a multiplex microfluidic channel assay. RESULTS: The median age at transplant was 35 years (range 20-66). Most subjects had a high risk EBMT score (median 4, range 2-7) and HCT co-morbidity index (median 4, range 2-7). All subjects achieved successful engraftment (neutrophil >500/uL; median 13 days, platelet >20k/uL; median 15 days) and rapid full donor myeloid and lymphoid chimerism by day 21. At median follow up of 6 month, the overall survival was 71%. One subject died of hepatic veno-occulusive disease (VOD) on day 32 and one subject died of relapse on day 178. All evaluable subjects tolerated ULD-IL2 without significant toxicities. Four subjects experienced either de-novo or rapid exacerbation of acute GVHD after discontinuation of ULD IL-2, resulting in the cumulative incidence of grade II-IV aGVHD of 61% and grade III-IV aGVHD of 36% (Figure A). ULD IL-2 expanded and maintained Helios+FoxP3+Tregs population (pre-transplant, 4.7%±3.1%; day 30, 36.2%±23.1%; day 84, 17.4%±10.6%) as well as CD56brightNK cells population (pre-transplant, 10.7%±13.7%; day 30, 49.7%±10.8%; day 84, 26.1%±6.8%). However on discontinuation of ULD IL-2 both populations decreased to low levels within one week. The timing of aGVHD correlated with a fall of %Tregs in PBMC and a sharp increase of ST2 level in plasma (Figure B). CONCLUSION: ULD IL-2 can be safely administered as GVHD prophylaxis after haplo-SCT. Rebound GVHD after discontinuation of ULD IL-2 implies that donor-derived Tregs acquired dependency to exogenous ULD IL-2. Our study is proof of principle that ULD IL-2 induces immune tolerance through Tregs expansion in haplo-SCT, inspiring further clinical and basic researches in human IL-2 biology. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

The purpose of the present study was to evaluate the impact of ex vivo T cell depleted (TCD) by CD34+ selection on the incidence and severity of oropharyngeal mucositis (OM) after myeloablative allogeneic stem cell transplant (allo-SCT) with total body irradiation (TBI) conditioning. This approach has the advantage of avoiding methotrexate for graft versus host disease (GVHD) prophylaxis.

A 40 year old premenopausal female presented with right lower quadrant abdominal pain of 2 days duration. She denied any recent history of pregnancy, abdominal wall surgeries or use of oral contraceptive pills. She has no personal or family history of hematological conditions. On physical examination, tenderness of right lower quadrant was noted. She was afebrile. Results of laboratory studies were unremarkable except for mildly elevated white blood cell count of 12,300 cells/mm3. She underwent computed tomography to rule out appendicitis which revealed right ovarian vein thrombosis. (Figure 1) shows axial section with arrow pointing to thrombosed vein, (Figure 2) shows coronal section Hypercoagulable work up was negative. She has no known risk factors for thromboembolism and can be termed as idiopathic ovarian vein thrombosis. She is currently on anticoagulation. To date, only nine cases of idiopathic ovarian vein thrombosis have been reported.

Abstract Introduction: High risk myelodysplastic syndromes (MDS) and acute myelogenous leukemia (AML) commonly affect individuals of advanced age with multiple co-morbidities unsuited for curative standard treatments with allogeneic stem cell transplantation (allo-SCT) or intensive chemotherapy (ICT). New reduced intensity therapeutic approaches bringing improved life expectancy are needed for such patients. We conducted a phase I clinical trial to evaluate the safety and activity of sequential therapy with low-dose clofarabine followed by lenalidomide in older high risk MDS or AML. We hypothesized that lympho-depletion by clofarabine could "reboot" lymphocyte reactivity against the malignancy and promote favorable immune modulation by lenalidomide. Here we report preliminary clinical outcomes and associated cellular and molecular immune profiles. Methods: Four subjects (median age 68 years, range-60-79) with relapsed or refractory high-risk MDS (IPSS risk score>intermediate 2) or AML were enrolled to the protocol (12-H-0146, clinicaltrials.gov ID: NCT01629082). All subjects had been previously treated with at least one hypomethylating agent. Subjects received a single course of intravenous low-dose clofarabine 5mg/m2/d for five days, followed by consolidation therapy with oral lenalidomide with dose escalation from 25 mg daily up to 50 mg daily for 2 cycles. In the absence of dose limiting toxicity (DLT) or disease progression, subjects received lenalidomide maintenance 10 mg daily in 28 day cycles, with dose adjustments, for up to 12 cycles. Blood and marrow samples were collected before starting clofarabine, before consolidation with lenalidomide, and during maintenance. Multiparameter flow cytometric analysis was performed to characterize T cell subsets (memory T cells, T regs), natural killer (NK) cells, with functional markers representing T cell exhaustion (PD-1, LAG-3, TIM-3, PDL-1), activating and inhibitory NK cell receptor (KIR, LIR1, NKG2A, CD57). Relative changes in RNA expressions of target genes related to cancer immunology were evaluated by PCR array. Results: Of four subjects enrolled, two subjects showed responses at 28 days post clofarabine and at 28 days post first cycle of lenalidomide. These two responders tolerated subsequent maintenance lenalidomide for 4-6 months. The other two subjects were non-responders. Three subjects were taken off study due to disease progression on day 70, 162, and 206, and 1 subject for DLT on day 69. The clinical trial is now closed without dose escalation beyond the first cohort for reasons of poor accrual and lack of long term responses. In responders immunophenotype analysis showed a decrease in CD4+ %PD-1 expression in blood or bone marrow (0.87±0.29 fold change) after clofarabine and lenalidomide treatment, rising again after lenalidomide discontinuation in one responder (Figure). In contrast, CD4+ %PD-1 expression was increased in non-responders (1.23±0.19 fold change). In pre-treatment samples terminally differentiated CD57+ NK cell with high LIR1 expression (34.6±23.5%) were increased. In responders, both the levels of CD57 and LIR1 expression fell with reciprocal increase in CD56brightNK cells, suggesting restoration of NK cell repertoires after clofarabine. RNA expression profiles in one responder on maintenance lenalidomide showed significant up-regulation of gene expressions in IL-1A, FASLG, ICAM1, IL-27, WT1 (p<0.01) in comparison to the pre-treatment sample. Conclusion: Sequential treatment of low-dose clofarabine and lenalidomide is feasible for elderly patients with high risk MDS and AML. However individuals vary in the lenalidomide dose tolerated. Immune reconstitution profiles supports a potential immune-rebooting effect of clofarabine leading to restoration of CD4 cell and NK cell repertoires with fewer exhaustion or inhibitory markers. Lenalidomide may further promote a favorable anti-leukemic immune milieu. Immune profiling of T and NK cells can help to guide the application of these immune-modifying agents in high risk MDS and AML. Figure Figure. Disclosures Battiwalla: NIH/NHLBI: Employment.

CD34+ dose significantly impacts transplant outcomes. Donor characteristics that impact CD34+ mobilization are particularly relevant in haploidentical transplantation, where there may be several eligible donors. A previous study in our institution (Vasu et. al, 2008) reported various predictors of CD34+ yield. We aimed to validate and further understand these predictors.

Significant increases in CAD risk and cardiovascular events have been described in long-term allo-SCT survivors compared to age and gender-matched population controls. Since pharmacologic interventions, such as statins, positively influence the evolution of CAD and subsequent cardiovascular events, an effective screening strategy is essential. Screening for CAD has hitherto relied upon clinical assessments such as the Framingham cardiovascular risk score but the optimum screening strategy in this unique population is undefined.

Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is common in developing countries but its occurrence and management in allogeneic hematopoietic stem cell transplantation (HSCT) has not been reported previously, to our knowledge. We report the case of an immigrant female patient who underwent a matched-related allogeneic HSCT for acute lymphoblastic leukemia and was incidentally found to have a solitary viable neurocysticercosis lesion. However, despite severe immunosuppression, the size of the cyst did not increase. More importantly, restoration of the immune system did not induce significant inflammation or seizures. Subsequent follow-up demonstrated complete resolution of the neurocysticercosis lesion. Thus, in the setting of HSCT, an asymptomatic patient with a single neurocysticercosis lesion was successfully managed without the use of anthelmintics, steroids, or anti-epileptics.

Clinical comorbidity measures enhance the estimates of HCT tolerance and outcomes, thereby aiding therapeutic decisions. Ex vivo T cell depletion (TCD) of the graft reduces the risk of graft-versus-host disease and improves the tolerability of allogeneic transplantation in patients with impaired pretransplant performance. However, prediction tools such as the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), have only been validated in conventional T-replete HCT. To improve outcome prediction in TCD transplants we therefore evaluated published comorbidity measures and other potential biomarkers of outcome in a series of myeloablative TCD transplant recipients. Pre transplant (week -2) factors measured were: HCT-CI, ECOG performance status, serum C-reactive protein (CRP), albumin (ALB), pre-albumin (PAB), ferritin, absolute lymphocyte counts (ALC), and absolute lymphocyte / monocyte ratio (LMR). CRP was also studied serially post transplant. CRP increased after conditioning, peaked (p =0.0001) in the first week of HCT, with recovery to baseline at 5 weeks post-HCT. We evaluated outcomes in a cohort of 79 patients in our institute with hematological malignancies receiving myeloablative total-body irradiation, and an HLA-identical sibling peripheral blood HCT, T cell depleted using Miltenyi CD34+ selection. The median age of recipients was 43 years (range 13-68 years). Of the 79, 34 (43%) had standard risk disease, and 45 (57%) recipients had high-risk disease. At a median follow up of ∼ 5 years, overall survival (OS) was 42.9% and nonrelapse mortality (NRM) was 33.9%. Comorbidity measures were first screened to eliminate highly-correlated covariates. Univariate Cox regression models were used to identify significant factors (p 0 were found to be significantly associated with the cumulative incidence of relapse (both p=0.01). In conclusion, this is the first study to explore comorbidity scores and biomarkers to predict outcome after ex vivo TCD HCT. Our results suggest that HCT-CI score, preCRP, postCRP and the LMR are important independent clinical predictors of OS and NRM in TCD HCT. Disclosures: No relevant conflicts of interest to declare.

Chronic graft versus host disease (GvHD) after allogeneic stem cell transplantation (SCT) may involve any organ system, but male genital involvement is rare. Peyronie's Disease (PD) is an acquired, localized fibrotic disorder of the tunica albuginea, which leads to penile deformity, pain, and eventually to erectile dysfunction. We report the case of a 52 year old African American male with Acute Myeloid Leukemia who underwent human leucocyte antigen (HLA) matched sibling allogeneic peripheral blood SCT. His post transplant course was complicated by development of acute and multi-organ chronic GvHD requiring prolonged immunosuppression. He developed progressive dorsal curvature of the penis with erections within 1 year of ultra low dose interleukin -2 (IL2) treatment for his chronic GvHD but concealed symptoms for several months. Color Doppler Duplex ultrasound evaluation of the erect penis revealed a 75-degree curvature and appropriate hemodynamic response to prostaglandin injection. He underwent successful incision and grafting of the penile plaque. There is no significant residual curvature and is now able to engage in intercourse. A strong temporal association between GVHD (or its treatment) and Peyronie's is documented here. Awareness of the possible link between PD and chronic GVHD is required in this era of rapid growth in numbers of SCT.