INTRODUCTION: The outcome of Hodgkin lymphoma (HL) has improved in recent years with the incorporation of targeted therapy and checkpoint inhibitors. However, a significant number of patients have refractory disease or relapse after the frontline. Salvage therapy followed by autologous stem cell transplant (SCT) is the standard of care for those patients. Global shortage and interruption of medication availability can affect the choice of treatment. Here, we compare the outcome of patients who received multiagent chemotherapy versus single-agent melphalan as conditioning chemotherapy for SCT in patients who responded to salvage therapy. METHODS: We retrospectively evaluated 60 patients who underwent SCT at King Fahad Specialist Hospital from (2015 - 2023). The objectives were to compare progression-free survival (PFS), overall survival (OS), transplant toxicity, and length of hospital stay between patients receiving multiagent chemotherapy [BEAM (carmustine, etoposide, cytarabine, melphalan), BuEMel (Busulfan, etoposide, melphalan), BuMel (Busulfan, melphalan) Or BeEAM (Bendamustine, etoposide, cytarabine, melphalan)] versus single agent melphalan. Independent sample t-test, Pearson Chi-square test or Fisher Exact test as appropriate were used to compare clinical characteristics between single melphalan vs multiagent chemotherapy group. The overall survival and progression free survival were evaluated using the Kaplan-Meier estimator, and compared between the two groups using the log-rank test. A “P” value <0.05 (two-tailed) were considered statistically significant. Results: Of sixty patients included in our analysis, 60% were male, and the median age at transplant was 28.4 years with standard deviation (SD) of 10.3; 27 patients (45%) received multiagent chemotherapy, 33 patients (55%) received single-agent melphalan, 83% patients had either primary refractory or relapsed within one year, and extranodal disease was present in 27.6% of the patients. More patients achieved complete metabolic response (CMR) before transplant in the single melphalan group compared to the multiagent chemotherapy group (87.9% vs 51.9%, p=0.002). Primary refractory and early relapse patients were 75.8% and 92.6% (p=0.162), and extranodal at relapse were 18.8% and 38.5% (P= 0.095) for the melphalan group and multiagent chemotherapy group respectively, advance stage at relapse were 21.9% and 18.5% (P= 0.75) and IPS ≥4 was 12.1% and 7.4% (P= 0.68) for melphalan group and multiagent chemotherapy group respectively. Incidence of all grade mucositis was 15.2% vs. 48.1% (P= 0.01), and febrile neutropenia was 15.2% vs. 25.9% (p= 0.34) for the single-agent melphalan group and multiagent group, respectively. The mean time for neutrophil engraftment in the melphalan group was 11.3 ± SD (2.3) days vs. 10.7 ± SD (1.9) days in multiagent groups (P= 0.266), and mean time for platelets engraftment was 13.5 ± SD (2.9) days for single-agent melphalan vs 11.2 ± SD (3.1) days in the multiagent group (p= 0.004). The Melphalan group had fewer days of admission as most of them were treated as outpatients except for six patients who were admitted during the transplant period for complications, namely febrile neutropenia, and mucositis. The 5-year PFS was 48.6% vs. 60.4% (p=0.56), and the 5-year OS was 88% vs. 100% (p=0.221) in the single-agent Melphalan group and multiagent group, respectively. CONCLUSIONS: Our results did not show any statistical difference in PFS or OS between the two groups. Despite that, more patients achieved CMR prior to SCT in the single melphalan group. There is a trend toward favoring the multiagent condition chemotherapy group. Because of the small number of the two cohorts and the low event rate between the two, we propose multicenter or registry collaboration.

Introduction: GvHD is a significant cause of morbidity and mortality in recipients of allogeneic hematopoietic cell transplant (HCT). The prevention, management, and treatment of GvHD vary in different regions worldwide. This WBMT study aims to better understand the current clinical practices of GvHD prevention and management around the globe. This study presents our survey results in the Eastern Mediterranean Region. Methodology: This is a cross-sectional survey-based study involving hematopoietic cell transplant (HCT) centers in the EM region. Participants of the survey were programs' directors or their designees. The survey comprised two parts; the first part aimed to study the practices of GvHD prevention, whereas the second part aimed to study GvHD management and treatment. The survey was distributed and filled out between December 2022 and May 2023. Results: Thirty participants from 28 institutions responded. Participants were from eleven different countries in the EM region. Fourteen participants (50%) filled it for combined pediatrics and adult HCT programs. The remaining participants filled it for programs performing HCT, either only in adult (27%) or pediatrics (23%) patients. The majority of participants indicated that cyclosporine and methotrexate combination is the most used GvHD prophylaxis therapy in both myeloablative and reduced intensity HCT in their centers. Cyclosporine was the predominantly used calcineurin inhibitor (CNI), followed by tacrolimus. All centers using cyclosporine indicated that they monitor its level, with 200-300 mcg/L being the target in 66% of the survey. Cyclosporine was typically given for 2-12 months after HCT, with around 80% of centers stopping it at 3-4 months post-HCT in recipients with malignant indications and around 90% of centers stopping it around 6-12 months post-HCT in recipients with non-malignant indications. When tacrolimus is used, results showed that it is typically used for similar duration to cyclosporine. Twenty-nine participants reported using post-transplant cyclophosphamide (PTCy) in their centers, with seven centers (24%) reporting its use in indications other than haploidentical transplants. Additionally, the results show that PTCy is typically used in combination with other medications, with 53% of participants reporting that it is used along with mycophenolate mofetil and cyclosporine and only one participant reported its use as a single agent. Seven participants (23%) reported that PTCy is typically used in doses less than 50 mg/kg. In patients with established GvHD, steroids were most commonly used alone as a first-line therapy in acute and chronic GvHD. The majority of centers report re-introducing or continuing the immunosuppressive agent used in GvHD prevention, with few centers indicating that they switched to another CNI. 64% and 55% of centers indicated that they have a standard-operating procedure (SOP) for steroid-refractory acute GvHD (aGvHD) and chronic GvHD (cGvHD), respectively. Only two centers reported involving steroid-refractory GvHD patients in clinical trials. Second-line therapy for steroid-refractory aGvHD and cGvHD varies significantly between centers depending on the type of GvHD and organ involved. In steroid-refractory aGvHD, ruxolitinib was the most frequently listed agent to be considered in the second line, regardless of the involved organ. Ruxolitinib was followed by Extracorporeal photopheresis in Skin aGvHD, Budesonide in lower GI tract aGVHD, and Mycophenolate Mofetil in liver aGvHD. In cGvHD, ruxolitinib was also the most frequently listed medication. However, more significant variability between centers was noted in treating organ-specific cGvHD. Conclusion: GvHD prevention and management practices vary between the different EM region centers. Some variations could be related to access to some medications. This might indicate the need for more evidence-based practices in preventing and managing GvHD and possibly adjusting the guidelines according to access and availability of some medications. WBMT is currently working on understanding the global patterns of GvHD practices in other regions and, ultimately, a global comparative study of all data combined.

Click to increase image sizeClick to decrease image size AcknowledgmentThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Disclosure statementNo potential conflict of interest was reported by the author(s).Author contributionsPK: responsible for study design, extracting and analyzing data, interpreting results, updating reference lists and creating the summary of findings and writing the manuscript. MAZ: contributed to data collection, analyzing data and results and provided feedback on the manuscript. MAD: contributed to the design of the study, data analysis and results interpretation and provided feedback on the manuscript. MAB: contributed to data collection, analyzing data and results and provided feedback on the manuscript. AAG: evaluated all the tissue blocks and confirmed disease diagnosis and provided feedback on the manuscript. AAN: evaluated the imaging tests and assessed the disease burden prior and after chemotherapy and provided feedback on the manuscript. HAH: contributed to the design of the study, results interpretation and provided feedback on the manuscript. SK: contributed to the design of the study, and provided feedback on the manuscript.Data availability statementThe datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

AbstractBackgroundThe vast majority of chronic myeloid leukemia (CML) patients have a single translocation t(9;22)(q34;q11), BCR/ABL1 fusion genes, which is regarded as the hallmark of CML. However, around 5 to 10% of CML patients exhibit the involvement of a third chromosome. In some very rare cases a fourth or even fifth chromosome can be involved with the t(9;22).MethodsThis case report is based on a 40‐year‐old Saudi Arabian male patient, diagnosed with CML in lymphoid blast crisis, and observed to have a four‐way 46 XY, t(9;22;5;2)(q34;q11.2;p13;q44) translocation. The BCR/ABL1 fusion was identified by fluorescent in situ hybridization (FISH). Additionally, the BCR/ABL1 p210 mRNA fusion transcripts were identified by a molecular test.ResultsThe clinical and prognostic impact of additional partner chromosomes to t(9;22) remains unknown. The CML patient with this novel four‐way translocation t(9;22;5;2) progressed to blast crisis and was resistant to Tyrosine Kinase Inhibitor (TKI) therapy. Therefore, this case is more in alignment with the negative impact of additional partner chromosomes to the translocation at t(9;22).ConclusionHere we report for the first time a novel four‐way translocation at t(9;22;5;2)(q34;q11.2;p13;q44).

Objective: Patients (pts) who have undergone allogeneic stem cell transplantation (alloSCT) are at high-risk for life-threating complications post SARS-CoV-2 infection, and the mortality rates has been reported of approximately 30-35%. The currently available vaccines proved their effectiveness in the general population by reducing the severity of the COVID-19 infection however, scant data exist regarding the safety and efficacy of the commercially available vaccines in allografted pts. Methodology: After a median of 2,7 (0,3-6,7) ys post alloSCT, 20 pts received within a median of 42 days, 2 vaccines of either Pfizer (n=17) or combinations of Pfizer with Moderna (n=2) or AstraZeneca (n=1). Off immunosuppression without evidence of active GvHD were 14 pts, 1 was only on Cyclosporine (CSP) while 5 were on steroids plus CSP or MMF or Ibrutinib for GvHD treatment. Automated commercial chemiluminescence immunoassay (CLIA) against spike (S1/S2) protein was used for antibody responses detection. Results: During vaccination program no side effect grade ≥3 (including allergy, thrombosis, heart dysfunction or laboratory abnormalities) was reported. The commonest complains were fatigue (20%), bony pain (10%) and fever <38.5 oC (10%). Satisfactory antibody responses were observed in 66% and 95% of pts after the 1st and 2nd dose respectively. Importantly, active GvHD and intensive immunosuppression, did not negatively affect the antibody responses. None of the vaccinated pts developed COVID infection Conclusion: Our retrospective study although with small number of patients and with short term follow-up, in agreement with others, confirms that the current commercially available vaccines against SARS-CoV-2 are safe and highly effective in producing effective humoral responses in allografted patients. Prospective studies with longer follow-up are needed to elucidate the proper timing and the number of necessary doses for a safe and effective approach in preventing severe COVID-19 infection

Objective: The effectiveness of vaccinations post hematopoietic stem cell transplantation (HSCT), is a reliable marker for immune system's functionality assessment. In autologous HSCT (AHSCT) setting, the general aspect is that the immune system recovers quite soon and patients (pts) are considered to be immunocompetent in a period of approximately 3-6 months post AHSCT. We evaluated the hepatitis B virus (HBV) vaccination responses in autografted pts who were in remission and off chemotherapy post AHSCT. Methodology: 27 autografted pts aged 51,6 (22-67) ys, who had antiHbs titers <10 IU/ml before AHSCT and at the time of vaccination, were studied. After a successful engraftment the median absolute lymphocytes count at +3 months was 1740(450-4090)/mm3. In 4,3(0,6–8,5) ys post AHSCT, 3 doses of recombinant HBV vaccine were given monthly. The response rates for pts who completed 3 vaccine doses, compared with an internal group of healthy individuals, vaccinated in the same period with the same product. Results: After the 1st, 2nd and 3rd dose the response rates in the study group were 11%, 81% and 88% respectively. No factor statistically significantly influenced the achievement of protective antiHbs titers. The responses were lower as compared to product's efficacy profile (19%, 86% and 100% after the 1st, 2nd and 3rd dose respectively), while in the comparative analysis with the internal control group, a trend for inferior responses in autografted pts was also noticed (88% vs 100%, p=0,07). Conclusion: This study, in a relatively homogenous group of pts, to our knowledge, is the only one that directly compares the HBV vaccine responses in autografted pts with healthy individuals. Although vaccination was offered late post AHSCT, the responses were lower compared to healthy individuals, indicating a possible long lasting immune impairment post AHSCT highlighting the necessity of prolonged surveillance and intensified vaccination programs for autografted pts.

Background: venous thromboembolism (VTE) is a well-known complication in adults with acute lymphoblastic leukemia (ALL), especially in patients treated with asparaginase (ASNase)-including regiments. However, VTE risk in adult Philadelphia-positive ALL (Ph+ve ALL) patients treated with non-hyperCVAD chemotherapy is unclear. In this study, we examined VTE incidence in adult Ph+ve ALL patients treated with imatinib plus a pediatric-inspired asparaginase (ASNase)-free regimen modified from the Dana Farber Cancer Institute (DFCI) ALL protocol. Methods: a single centre retrospective review of Ph+ve ALL patients treated at Princess Margaret Cancer Center (PMCC) from 2008–2019 with imatinib plus modified DFCI protocol was conducted. Results: of the 123 patients included, 30 (24.3%) had at least 1 radiology confirmed VTE event from diagnosis to the end of maintenance therapy. 86.7% (26/30) of the VTE events occurred during active treatment. Of all VTE events, the majority (53.3%) were DVT and/or PE while another significant portion were catheter-related (40.0%). Major bleeding was observed in 1 patient on VTE treatment with low molecular weight heparin (LMWH). Conclusion: a high VTE incidence (24.3%) was observed in adults Ph+ve ALL patients treated with imatinib plus an ASNase-free modified DFCI pediatric ALL protocol, suggesting prophylactic anticoagulation should be considered for all adult Ph+ve ALL patients including those treated with ASNase-free regimens.

BACKGROUND:In adult B cell precursor acute lymphoblastic leukemia (BCP-ALL), CD20 expression has generally been associated with an adverse prognosis. Incorporating rituximab to standard of care is found to improve the outcome of CD20+ BCP-ALL. The aim of this study is to estimate the prognostic effect of CD20 expression and the impact of rituximab in BCP-ALL in Saudi Arabia. PATIENTS AND METHODS:We performed a retrospective study of 55 Saudi adult patients with BCP-ALL in King Fahad Specialist Hospital in Dammam from 2008 to 2017. RESULTS:The proportion of CD20+ cases was approximately 55%. Excluding rituximab-treated patients, the 5-year overall survival (OS) rate of CD20+ patients was lower than CD20- patients (56% vs. 66%; P = .62). Among CD20+ patients, the proportion that received rituximab was approximately 27%. Comparing CD20+ patients with and without rituximab, all patients who received rituximab achieved complete remission (CR) 4 weeks post-induction. The 3-year OS rate (88% vs. 63%; P = .35) and the 2-year event-free survival rate (70% vs. 68%; P = .75) were in favor of rituximab. In univariate and multivariate analyses, CR 4 weeks post-induction is recognized as an independent predictor of outcome. However, differences in survival rates did not have a statistical significance. CONCLUSION:CD20 expression in adult patients with BCP-ALL seems to be higher in Saudi Arabians than in Caucasians, and it seems to have a tendency towards an inferior outcome in terms of OS. Incorporating rituximab to standard of care seems to improve the outcome in terms of CR, OS, and event-free survival.

INTRODUCTION:Recent advances in allogeneic hematopoietic stem cell transplant (HSCT) have allowed us to offer HSCT to older, advanced disease patients with more co-morbidities. Cardiovascular toxicity post-transplant is a major concern due to the increased risk of mortality. Few studies have examined the prevalence of CV events including CAD (MI, angina, PCI, CABG, CHF, arrhythmias), HTN, stroke/TIA, and death in the first 100 days post-transplant. PATIENTS:We assessed the impact of pretransplant MUGA results in predicting postallogeneic HSCT CV events and overall survival in the first 100 days, and whether or not transient anthracycline-induced cardiomyopathy or cumulative anthracycline dose affected overall survival. This retrospective, cohort study included 665 patients with a median age of 52 years who underwent HSCT from 2009 to 2015. RESULTS:The most frequent CV event in the first 100 days post-HSCT was arrhythmia seen in 2.9% of patients followed up by CHF (12.3%), MI (9%), and angina (8%). Two patients had PCI, and both survived the first 100 days. Cardiovascular risk factors predict for a poor MUGA scan but not survival. Higher dose anthracycline pretransplant predicted for a poor outcome. CONCLUSION:A history of CV disease, MI, or CAD was the most important predictive of CV events, P-value = .00002. 88.6% survived the first 100 days. Patients with an EF < 50% had a significant likelihood of having a CV event compared to patients with an EF > 60% (OR = 5.3, 95% CI [1.6-18.1], P = .0219). Cumulative anthracycline dose did not have a significant impact on overall survival.

Introduction: Gut dysbiosis is an imbalance of the gut microbiome. The presence of dysbiosis can be a cause of systemic inflammation in the body or can be a contributing factor to it. Chronic systemic inflammation is a common feature of CLL, creating an environment in which CLL cells have a survival advantage. NF-κB and STAT3, master transcriptional regulators of pro-inflammatory markers, like IL-1 and IL-6, are reported to be involved in this process as are the Toll-like receptors (TLRs), key innate immunity receptors that are implicated in CLL pathophysiology. With increasing evidence for the role of dysbiosis in chronic inflammation, as well as the role of systemic inflammation in CLL, it seems relevant to prove the presence and the possible role of microbiome in the pathophysiology of CLL, to unravel the complex interaction between microbiome, nutrition and the host in patients with CLL. Our research investigate the hypothesis that dysbiosis i.e. the loss of "health-promoting" commensal gut microbes and/or the overgrowth of pathogenic bacteria distinguishes untreated patients with CLL versus aged-matched unaffected individuals. Methodology: Eight untreated CLL patients were with no history of gastrointestinal disorders, other malignancies and have not been on antibiotics for 4 weeks prior to samples collection. Two of them were not followed for logistical reasons. Six healthy volunteers matched for sex and age were also enrolled in the study. Stool samples from six patients and additional six matched healthy controls were collected and stored in a -40 freezer immediately until they were used for DNA isolation. Total genomic DNA was extracted using the Qiamp DNA stool mini kit and sequenced using Next Generation Sequencing and then analysis were done as per the manufacturer recommendations. Results: Our data indicates a reduced diversity and variability in bacterial phyla of gut microbiota in CLL patients as compare to healthy controls. Lower diversity with increase in certain bacterial types is a well-accepted sign of gut dysbiosis, which have been shown in many disorders such as; type-2 diabetes, obesity, and various autoimmune and neurological diseases. An increase in Proteobacteria numbers has been recognized as the signature of gut dysbiosis which we confirmed in our cohort of patients. Proteobacteria, Firmicutes and Bacteriodetes were also the most abundant bacterial phyla in CLL patients of our study which were reported previously in breast cancer patients. An elevated Firmicutes to Bacteroidetes ratio with altered gut microbiota in CLL patients compared with healthy subjects was also suggested in clinical studies involving obese individuals with insulin resistance. We have observed in CLL patients of this study relative increase in the numbers of Firmicutes and reduction in Bacteriodetes which is considered to be an inverted ratio as compared to healthy individuals which were also reported in ulcerative colitis, colonic and ileal crohn's disease as compared to healthy subjects. . Our finding of gut dysbiosis in this study is linked the association between CLL, inflammatory processes and dysbiosis. The microbiota may play a role in promoting malignancy through chronic inflammation, by disturbing the balance of cell proliferation, death and by initiating unwanted innate and adaptive immune responses. Conclusion: Restoring gut microbiota might open a new avenue for future researches as potential therapeutic intervention in CLL patients. Figure Disclosures No relevant conflicts of interest to declare.

Background: Damage associated molecular patterns (DAMPs) are considered important contributors to acute Graft vs Host Disease (aGvHD) pathogenesis. Uric acid (UA), a DAMPs family molecule, upon its release from damaged tissues post high dose chemo/radio therapy, triggers activation of donor derived T-cells. Currently, only two published studies evaluated the association between UA levels at day 0 and aGvHD occurrence, with totally conflicting results. Given that aGvHD is a dynamic process which takes place during the whole early post-transplant period, contrasting to previous studies, we evaluated serum UA levels not only once but in 4 different time points during the early transplant period, at days -7, 0, +7, +14, and investigated its correlation to aGvHD incidence, non-relapse mortality (NRM) and survival rates. Methods: We retrospectively evaluated 57 patients (pts), with a median age of 36.8 years (range, 17-62), who underwent allogeneic stem cell transplantation (alloSCT) from full matched sibling donors for malignant (n=48) or non-malignant (very severe aplastic anemia =9) hematological diseases. A median of 5.6 x106/kg CD34+ cells were infused after a myeloablative (n=34) or reduced intensity (n=23) regimen. At the time of alloSCT, 42 pts were in remission (CR1: 30, CR2: 10, >CR2: 2). All pts received either allopurinol or rasburicase from the day of conditioning initiation till day -1. The ROC-curve method, t-test, Kaplan-Meir method, and log-rank test were used for the univariate while the binary logistic regression method for the multivariate statistical analysis. Disease phase [early (CR1) vs. intermediate (CR2) and advanced (>CR2 or presence of residual disease)], donor gender, patient and donor age, UA levels at day -7, 0, +7, +14, type of conditioning regimens and number of infused CD34+ cells were tested as possible factors that can affect aGvHD incidence. Results: Median UA levels were 3.2, 2.4, 2.2 and 2.9 mg/dl at days -7, 0, +7 and +14 respectively; using the ROC curve method the cutoff point was determined at 4.4 mg/dl for day -7 and 2.2 mg/dl for days 0, +7 and +14. Overall, 20/57 (35%) pts developed aGvHD; 18 (31%) were assessed as gr ≥II, while 10 (17%) as gr III-IV. The incidence of the aGvHD gr ≥II was higher for pts with UA levels ≤ 4.4 mg/dl at day -7 (14 vs 4) and for pts with UA levels ≥2.2 mg/dl at days 0 (12 vs. 6 pts) and +14 (13 vs. 5 pts) however these differences did not reach statistical significance. UA levels at +7 day had no impact on aGvHD incidence. In multivariate analysis, only the number of CD34+ >6x106/kg was an adverse factor for aGVHD gr≥II (p=0.04) while intermediate & advanced disease phase along with a number of CD34+ cells >6x106/kg, proved to be significant contributors for severe aGvHD (gr III-IV) occurrence (p<0.03). We observed a better 4 years overall survival for patients with UA levels < 2.2 mg/dl at day +14 (85% vs. 55%, p=0.06). Fifteen pts succumbed to NRM causes; 8/15 deaths were attributed to aGvHD complications. The NRM was higher in patients who had UA levels ≥2.2 mg/dl at day +14 (32% vs. 15%) though this difference was not significant (p=0.2). Conclusions: The present study bears the limitations of a small series of pts and it's retrospective nature. However, it has the advantage of evaluation of UA levels, as an aGvHD mediator, at multiple time points during the peri-transplant period. Our results, though not of strong statistical significance, demonstrated that UA levels might affect aGvHD incidence as well as survival and the NRM rates post alloSCT. Definitely, well designed prospective clinical trials are warranted to clarify the role of UA on alloSCT outcome. Disclosures No relevant conflicts of interest to declare.

Allogeneic stem cell transplantation is a high-risk procedure which has traditionally been reserved for the treatment of immediately life-threatening hematologic malignancies which have failed less intensive therapies. With advances in supportive care, conditioning regimens, and immune suppression,

Background: The significant advances which have been achieved in the field of allogeneic transplantation (alloHCT) have resulted in better post-transplant outcome and prolonged survival. Therefore, complications other than the Graft vs. Host disease (GvHD) or disease recurrence have become increasingly important. The post-transplant metabolic syndrome (PT-MS), caused by several factors (i.e. immunosuppressive agents, chemo-radiotherapy, anti-viral, and biologic therapies) is a well known post-transplant complication in pediatric allografted long-term survivors however, only a few studies have evaluated the prevalence of the PT-MS in adults. In this retrospective study, we sought to evaluate the incidence, risk factors and impact of the PT-MS on alloSCT outcome. Methods: From 1/2011 to 12/2018, 54 patients (34 males and 20 females) with adequate clinical and laboratory data and a minimum follow-up of 6 months were included in the study. Median age was 35.6 years (range, 16-67) and following a myeloablative (n=34) or reduced intensity (n=20) regimen patients received either a mobilized peripheral blood stem cell (n=45) or marrow (n=9) graft originating from full-matched siblings (n=46) or haploidentical (n=8) donors. Calcineurin inhibitors plus either short-term Methotrexate or Mycophenolate Mofetil were given as GvHD prophylaxis. Diagnosis of PT-MS was based on NCEP-ATPIII criteria; for patients with unknown data for abdominal circumference, a modified criterion of body mass index (BMI) ≥25kg/m2 was utilized instead. The independent t-test, logistic regression analysis and log-rank tests were used for statistical analysis. Results: Twenty-four (44%) patients (14 males, 10 females) fulfilled the criteria for PT-MS. Twenty had been diagnosed after the 1st trimester, 3 patients after the 2nd and in addition 1 after the 3rd trimester post alloSCT. Twenty out of 24 (83%) patients had elevated glucose, 19/24 (80%) had BMI>25kg/m2, 18/24 (75%) elevated triglycerides levels, 14/24 (60%) low HDL levels and 13/24 (55%) hypertension. Six (25%) had a known history of MS before alloSCT (10 patients had no available data to assess for MS diagnosis prior to alloSCT). Interestingly, in 8/24 (33%) patients who had PT-MS diagnosed early, either in the 1st or 2nd trimester, the syndrome was completely reversible beyond the 6-month post alloSCT follow-up period. In the aforementioned statistical models, patients' gender, age, BMI, type of conditioning regimen and GvHD co-existence were evaluated as potential predisposing factors for the PT-MS. In univariate and multivariate analysis only BMI>25kg/m2 and age>35 years were detected as significant risk factors (p< 0.01) for development of PT-MS. The PT-MS did not adversely impact survival or the NRM incidence post alloSCT. Conclusions: In our study, in agreement with other publications, we demonstrate that the PT-MS is not an uncommon complication in the early post-transplant period however, for approximately 1/3 of patients the syndrome was reversible. For patients with high risk features (BMI>25kg/m2, age> 35 years, known history of diabetes-mellitus, dyslipidemia, hypertension) apart of close monitoring, specific diet and encouragement for exercise might help reduce the incidence and severity of PT-MS. Nevertheless, prospective and well design trials are warranted to determine the incidence, severity and impact of PT-MS on alloSCT outcome for adult patients. Disclosures No relevant conflicts of interest to declare.