Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S268 AML-101 Neuro‑Ophthalmologic Manifestations in Acute Leukemia: A Single‑Institution Experience Binoy Yohannan MD, Sama Ilyas MD, Frances CervoniCuret MD, Adan Rios MD McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, USA Context: Ophthalmologic involvement at the time of initial diagnosis can be seen in up to one-third of patients with acute leukemia. However, neuro-ophthalmic involvement is relatively rare. Objective: To evaluate neuro-ophthalmic manifestations in acute leukemia patients treated at our institution. Design: We performed a single-center retrospective review of 170 consecutive cases of acute leukemia treated at Memorial Hermann Hospital, Texas Medical Center, from January 1, 2013, to December 31, 2022. We collected the following data: baseline demographic variables, type of leukemia, cytogenetic information, hematologic parameters at admission, results of neurologic imaging, and neuro-ophthalmic manifestations. Setting: General community, academic hospital. Patients or Other Participants: Among 170 patients with acute leukemia, we identified 11 (6.4%) with neuro-ophthalmologic manifestations. Main Outcome Measures: Neuro-ophthalmologic manifestations, survival. Results: The median age of patients was 40 (range, 20– 81) years. Five patients (45%) were men and 6 (54.5%) women. Leukemia subtypes included: acute myeloid leukemia (AML; n=6), T-cell leukemia/lymphoma (n=2), Philadelphia chromosome– positive acute lymphoblastic leukemia (Ph+ B-ALL; n=1), Phnegative B-ALL (n=1), and acute promyelocytic leukemia (n=1). Neuro-ophthalmic findings included blindness from optic nerve palsy (n=1), isolated sixth nerve palsy (n=1), bilateral facial nerve palsy (n=2), multiple cranial nerve palsies (n=3), bilateral papilledema (n=3), and retinal hemorrhage (n=2). Five patients had neuroophthalmologic features at relapse and 3 patients at initial leukemia diagnosis. Neuroimaging showed leptomeningeal enhancement (n=4), facial nerve enhancement/thickening (n=2), optic nerve/ sheath distension and papilledema (n=3), chloroma (n=1), embolic stroke (n=1), and normal results (n=1). Three patients had bilateral papilledema secondary to pseudotumor cerebri that resolved with supportive care. All patients with leukemic leptomeningeal disease received intrathecal chemotherapy. Overall, patients with relapsed leukemia had poor survival, with 5 (83.3.%) of 6 patients dying from leukemia-related complications. One patient with AML who was diagnosed with pseudotumor cerebri and pachymeningitis at the time of initial leukemia diagnosis remains in complete remission. Conclusions: Neuro-ophthalmic manifestations may occur at the time of initial leukemia diagnosis or at relapse. Isolated or multiple cranial nerve palsies can manifest with or without leptomeningeal disease. Patients with neuro-ophthalmologic manifestations from relapsed leukemia have a poor prognosis. Keywords: AML, neuroophthalmology, acute leukemia AML-102 Infectious Complications in Acute Myeloid Leukemia (AML) Patients Undergoing Induction Chemotherapy With Fludarabine/Cladribine, Cytarabine, and Idarubicin (FIA/CLIA): A Single‑Center Retrospective Study Binoy Yohannan MD, Akanksha Sharma MD, Frances Cervoni-Curet MD, Adan Rios MD McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, USA Context: Triplet induction chemotherapy using purine analogues (fludarabine/cladribine) in combination with cytarabine and idarubicin (FIA/CLIA) is believed to be superior to the standard 7+3 regimen but carries a higher risk of infectious complications due to prolonged myelosuppression. Objective: Evaluate infectious complications in AML patients treated with FIA/CLIA at our institution. Design: Retrospective review of AML patients treated with FIA/CLIA at Memorial Hermann Hospital, Texas Medical Center, from January 1, 2013, to June 30, 2022. Setting: General community, academic hospital setting. Patients or Other Participants: Adults with AML treated with FIA/CLIA. Main Outcome Measures: Infectious complications and related mortality. Results: Among 48 AML patients who were fit for standard induction therapy, 44 received 5 days of standard FIA/CLIA, and 4 patients received 3–4 days of FIA due to age and comorbidities. All patients received antimicrobial prophylaxis with levofloxacin, famciclovir, or valacyclovir. Fluconazole was initially used for antifungal prophylaxis at our institution and was later switched to voriconazole in 2021. The median age was 48.4 years (range, 32–76). Subject races included: white (n=18), African American (n=10), Hispanic (n=9), Asian (n=5), and others (n=6). With respect to adverse events, 31 patients (64.5%) developed febrile neutropenia, and 15 patients (31.2%) had bacteremia. The most common bacterial pathogens included: coagulase negative Staphylococcus aureus (n=5), alpha streptococcus (n=5), methicillin-sensitive S. aureus (n=1), methicillin-resistant S. aureus (n=1), Pseudomonas aeruginosa (n=2), extended-spectrum beta lactamase Escherichia coli (n=2), and Stenotrophomonas maltophilia (n=1). The common viral pathogens included respiratory syncytial virus (n=2), COVID-19 (n=1), influenza A (n=1), and cytomegalovirus (n=1). One patient developed candidemia, and 2 patients developed invasive fungal pneumonia. The major infectious complications included pneumonia (n=6), colitis/typhlitis (n=3), vulvar cellulitis (n=2), prostatic abscess (n=1), dental abscess (n=1), and perirectal abscess (n=1). Seven patients (14.5%) required ICU admission for sepsis-related complications. Three patients (6.25%) died from septic shock and multiorgan failure. Conclusion: Infectious complications continue to be a major challenge during AML induction therapy. Excellent supportive care and antimicrobial prophylaxis can significantly improve outcomes and decrease infection-related mortality. Keywords: AML induction, FIA/CLIA, infectious complications, case
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