Introduction Chondrosarcoma is well-known to be primarily resistant to conventional radiation and chemotherapy. Case presentation We present the case of a 32-year-old Caucasian man with clear cell chondrosarcoma who presented with symptomatic recurrence in his pelvis and metastases to his skull and lungs. Our patient underwent systemic therapy with sunitinib and then consolidation with proton beam radiation to his symptomatic site. He achieved complete symptomatic relief with a significantly improved performance status and had an almost complete and durable metabolic response on fluorine-18-fluorodeoxyglucose positron emission tomography. Conclusions Our findings have important clinical implications and suggest novel clinical trials for this difficult to treat disease.

Antiangiogenic therapy has shown promise in the treatment of patients with hepatocellular carcinoma (HCC). Bevacizumab, sorafenib, and sunitinib showed efficacy in patients with HCC; and sorafenib is approved by the FDA for treatment of this cancer. In practice, the clinical benefit of these agents has been heterogeneous; and in patients who do respond, the benefit is modest and/or short-lived. Recent advances in the molecular understanding of tumor angiogenesis along with the rapid development of targeted drug discovery have made it possible to explore novel combination therapy for HCC. We review the clinical trial results, discuss possible molecular mechanisms of resistance, and suggest novel combinations with antiangiogenic therapy.

Abstract Abstract 4301 Background: Currently, there is no standard reinduction regimen for relapsed and refractory (RR) AML. In order to evaluate responses to reinduction regimens we present a retrospective side-by-side comparison frequently used AML salvage regimens at our institution: CECA, HiDAC and CLAG-M. Method: From April 2007 to May 2011, 74 consecutive patients with RR AML received CECA (n=44), HiDAC (n=18) or CLAG-M (n=12). The primary outcome was complete remission (CR) rates and secondary outcomes were overall survival (OS) and relapse free survival (RFS). Additional variables such as toxicity and transplant data were also examined. Result: Baseline characteristics among the three groups were similar except for relapse status, with a greater proportion of AML patients receiving CECA after first relapse and HiDAC and CLAG-M after multiple relapses (Table 1). The mean age was 55.6 (range, 24–70), 53.8 (range, 25–71) and 49.5 (range, 23–68) years for CECA, HiDAC and CLAG-M respectively (P=0.38). For CECA, HiDAC and CLAG-M, respectively, 29.5%, 27.7% and 50% of patients were classified with therapy-related AML (P=0.85) and 11.4%, 11.1% and 16.7% of patients were classified with AML transformed from MDS (P=0.62). There was no difference in cytogenetic risk groups between the cohorts with the majority of the patients classified as intermediate risk. The mean blast percentage at the start of treatment was equivalent between the three groups at 39.8%, 27.4% and 26.7% for CECA, HiDAC and CLAG-M respectively (P=0.25). Median follow-up for all patients was 3.5 months. CR rates for CECA, HiDAC and CLAG-M were similar (20.5%, 16.7%, 41.7%; P=0.44). Median OS was 5 months for patients receiving CECA, 5 months for HiDAC and 3.5 months for CLAG-M (P=0.91) (Figure 1A). RFS was also similar among the three groups (p=0.91) (Fig. 1B). Of patients treated with CECA, HiDAC and CLAG-M, 27.2%, 38.8% and 41.6% proceeded to allogeneic hematopoietic cell transplant (P=0.71). Of the 8 patients who achieved CR with CECA but did not proceed to transplant, 5 patients had a CR of less then 3 months, 1 refused further care, 1 was lost to follow up and 1 received further consolidation therapy then relapsed. The mean length of stay in the hospital was 33.6±3.4, 99.7±60.3 and 45.4 ±35.7 days respectively for CECA, HiDAC and CLAG-M (P=0.19). The 30-day treatment related mortality rate was 2.3%, 16.7% and 16.7% respectively (P=0.13). Patients who received CECA had a higher number of total adverse events than patients who received HiDAC and CLAG-M (Table 1), with higher rates of pulmonary edema, sepsis, fungal pneumonia and C. difficle colitis. However, due to the small number of patients per cohort, only descriptive statistics are reported. Conclusion: CECA, HiDAC and CLAG-M are equivalent AML salvage regimens in terms of CR, OS, and RFS. Although each resulted in different adverse event profiles. These data provide a basis for designing prospective clinical studies and sample size estimates to formally compare three common reinduction regimens in RR AML. Disclosures: No relevant conflicts of interest to declare.

Abstract 4299 Despite extensive research in adult acute myeloid leukemia, refractory and relapsed disease remain challenging to treat. The development of CECA (cyclophosphamide, etoposide, carboplatin, cytosine arabinoside) was promising as it provided another therapeutic option for reinduction (Kornblau, et al. Leuk Lymphoma. 1998 Jan;28:371–5). In addition, in this particular subset of patients, at the time of discovery of refractory (PrR) or relapsed (Rel) disease, the next question we face relates to stem cell transplantation. Thus, the importance of achieving complete responses (CR) becomes even more imperative. However, the reported CR rate by Kornblau et al was 12% in a study including 25 patients. We believe that patients treated with CECA at our institution have greater response rates. Furthermore, there has not been any subsequent published study regarding efficacy of CECA in refractory or relapsed AML. With these questions in mind, we performed a retrospective study of adult patients at our institution with AML who have received the CECA regimen for reinduction to determine response rates and ability to proceed to stem cell transplantation. A total of 50 adult AML patients (14 PrR and 36 Rel) received CECA for reinduction between 1999 and 2009. Median age of patients is 53 (range 24–77). 18 patients (36%) overall achieved CR (defined as less than 5% blasts in a normal or hypercellular marrow lasting at least 28 days after reinduction and peripheral blood count recovery) or CRi (CR without count recovery). Of these 18 patients, 5 had PrR and 13 had Rel. The median number of induction regimens prior to CECA was 2. In the relapsed setting, the median number of days from most recent induction regimen to CECA is 140 days. Of patients who achieved CR, 11 (61%) proceeded to allogeneic stem cell transplantation. Median number of days from CECA to transplant was 65 days. Mean progression-free survival (PFS) of patients who achieved CR was 118 days. Mean overall survival (OS) is 222 days in patients who achieved CR versus 100 days in patients who did not achieve CR. Early toxicity from CECA (defined as an adverse event within 28 days from start of chemotherapy) was fairly common and included bacteremia/sepsis (n=12), fungal pneumonia (n=7), bleeding (n=5, 2 GI, 2 pulmonary, 1 intra-abdominal), acute renal failure (n=5), cutaneous fungal infections (n=2), C. difficile colitis (n=1), and mucositis (n=1). There were 4 deaths within 28 days of therapy. The CECA regimen for reinduction has activity in patients with refractory or relapsed AML, even after receiving several prior induction cycles. The key factor is the ability of CECA to facilitate stem cell transplantation in greater than half of patients who achieve CR. The toxicity profile appears to be reasonable in this population. Our institutional experience with CECA has shown promising results. Outcomes in a large population of patients and when utilized earlier in the disease course may be even greater and warrants further evaluation. Disclosures: No relevant conflicts of interest to declare.

Skin involvement in multiple myeloma (MM) has been described, but is uncommon.1-4 It usually presents in the form of plasmacytoma or nodular skin lesions that involve a well-demarcated area of the skin. We describe a case of unusual cutaneous involvement in a patient with relapsed MM after nonmyeloablative allogeneic stem cell transplantation (allo-SCT) that presented as a diffuse erythematous rash without any evidence of nodularity. Typically, there is a wide differential diagnosis for such skin rash in these patients including graft versus host disease (GVHD), drug reaction, vasculitis, or cellulitis. Thus, our case emphasizes the need to include myeloma in the differential diagnosis of erythematous skin rash.