Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S242 Rohan Halder MD1, Rayaz Ahemad MD2, Dinesh Bhurani MD, DM1, Narendra Agrawal MD, DM1 1Department of Hemato-Oncology and BMTU, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India. 2Department of Hemato-Oncology and BMTU, Max Superspeciality Hospital, New Delhi, India Context: Survival in AYA ALL has been poor in low-income countries like India although it has globally improved with the use of paediatric-inspired regimens. Objective: To evaluate the outcome and various factors affecting long term survival in AYA ALL treated with modified Children’s Oncology Group-0232 (COG0232 protocol). Design: Ambispective study of adult ALL treated from 2016 to 2021. COG0232 induction protocol was modified and steroids were given on alternate weeks for a total 2-week duration instead of standard 4 weeks to reduce infectious and noninfectious complications and early mortality. Patients: 132 patients were included and univariate analysis performed to study factors affecting long term outcomes. Main Outcome Measure: We assessed various factors like age, gender, white blood cell counts, blast percentage, subtype of ALL, central nervous system disease, cytogenetics, and end-of-induction (EOI) measurable residual disease (MRD). Patients were stratified into Ph-positive ALL, high-risk (HR) ALL (MLL rearrangement, TP53-mutated, complex cytogenetics, hypodiploidy, EOI MRD ≥ 0.01) and standard-risk (SR) ALL. Outcome measures were overall survival (OS), event free survival (EFS) and relapse free survival (RFS). Results: The median age of cohort was 24yrs (range:15-40yrs) and there were 107 (81%) males and 25 (19%) females. Five (3.7%) patients had induction mortality within 2 weeks due to infections. Post induction(n=127), there were 23 (17.4%) Ph-positive ALL, 61 (46.2%) standard-risk ALL and 48 (36.4%) high-risk ALL patients as per risk stratification. On univariate and multivariate analysis, only risk stratification (HR=2, P=0.005; HR=3.8, P=0.019 and HR=2.5, P=0.03 for EFS, OS and RFS, respectively) and positive EOI MRD (HR=2.6, P=0.019 and HR=3.6, P=0.03 for EFS and OS, respectively) were found to significantly affect survival. At median follow-up of 30 months (n=132), OS, EFS and RFS were 82.5%, 65.3% and 75.3% (P=0.01), respectively for entire cohort. EFS at 30 months for EOI MRDnegative and -positive patients was 80.3% (CI, -62.57–87.44%) and 58.5% (CI,- 38.22–74.15%, P=0.01), respectively. Median EFS at 30 months for SR ALL was 71.5%, Ph-positive ALL was 76.1% and HR ALL was 51.9%. Conclusion: Modified COG0232 protocol significantly improved survival outcomes by reducing mortality. HR-ALL represents chemotherapy-resistant subtype and early intensification with immunotherapy post induction may further improve long-term outcomes for this subtype. Keywords: ALL, adolescents, young adults, COG0232 regimen, measurable residual disease ALL-253 Evaluation of Aberrant Expression of CD Markers in Acute Leukemia Cells Nawsherwan Mohammed MBChB FIMS1,2, Lava Najim MBChB MSc3 1Nanakaly Hospital for Blood Diseases and Oncology, Erbil, Iraq. 2Hawler Medical University, College of Medicine, Erbil, Iraq. 3Kirkuk Oncology and Hematology Center, Kirkuk, Iraq Background: Worldwide immunophenotyping by flow cytometry (FC) in acute leukemia (AL) is the golden step in the diagnosis. It’s very common for acute leukemias to aberrantly express antigens or cluster of differentiation (CD) markers which are usually expressed in other lineages of the disease. Objectives: This study aimed at determining the prevalence of aberrancy in AL and to find out the frequency of each aberrant CD marker and their association with the clinic-hematological profile of the cases. Patients and Method: Following history and clinical examination of enrolled patients, blood and/or bone marrow aspirate was drawn for morphological examination and immunophenotyping by FC from 86 newly diagnosed acute leukemia cases, then a multi-step procedure was applied followed by interpretation of the results over a period extending from 1st of September 2021 to 1st of April 2022. Results: The aberrant phenotype constituted 46.5%. The proportional frequency of aberrant phenotype in acute myeloid leukemia (AML) was 41%, in B-acute lymphoblastic leukemia (B-ALL) was 48.8% and in T-acute lymphoblastic leukemia (T-ALL) was 66.6%. The most common aberrant CD markers in AML were CD22 and CD2, in B-ALL were CD66c and CD13 while in T-ALL were CD13 and CD33. The aberrant phenotype harbored lower white blood cell (WBC) count and blast percentage in PB, also splenomegaly was more frequent in lymphoid positive (Ly+) AML while in B-ALL, lymphadenopathy (LAP) was more frequent in myeloid negative (My-) B-ALL. Conclusions: In conclusion, aberrant phenotype prevalence in our study sample was comparable to other studies, considerable frequency of aberrant markers is present in cases of AL and some variations exist regarding the clinical and hematological profile of the aberrant group. Keywords: AML, B-ALL, T-ALL, aberrant phenotype, CD markers ALL-256 Nelarabine, Etoposide, and Cyclophosphamide for Adult T Cell Acute Lymphoblastic Leukemia/lymphoma Relapsing After Pediatric‑Inspired Frontline Approaches: Report of 3 Cases From a Real‑Life Setting Andrea Pasquini MD1, Gaia Ciolli MD1, Francesco Mannelli MD1,2, Barbara Scappini MD3, Giacomo Gianfaldoni MD3, Sofia Pilerci MD1, Laura Fasano MD1, Elisa Quinti MD1, Vivian Paradiso Biologist1, Francesca Crupi MD1, Roberta La Starza MD4, Alessandro Maria Vannucchi MD1,2,3, Matteo Piccini MD3 1Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Florence, Italy. 2CRIMM, Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, Florence, Italy. 3Hematology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, Florence, Italy. 4Hematology and Bone
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