Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S270 AML-109 When It Rains It Pours. A Case Report of Unexpected Double Malignancy in An Egyptian Female Patient Ahmed Ibrahim MSc1, Manal Atef MSc2 1Mansoura Student Hospital, Mansoura, Egypt. 2Dar El-Salam Cancer Center, Cairo, Egypt Context: There are very few reports of the coexistence of acute myeloid leukemia (AML) and breast cancer since 1965. Usually, this double malignancy carries poor prognosis; it is different from therapy-related (t-AML) where the cancer occurs secondary to chemotherapy. Objective: Here we present a case of double malignancy: hematological and solid neoplasms in a female patient. Design and Setting: This is a case report of a patient diagnosed with AML at Mansoura Student Hospital who went to Dar ElSalam Cancer Center for further management. Patient: A female patient 55-years old, with no significant medical history, complained of persistent fatigue; blood work up revealed leukocytosis (TLC 137×109/L), thrombocytopenia (PLT 16×109/L) and normocytic anemia (Hb 9.3 g/dL). Bone marrow (BM) examination was normocellular with 26% blasts, a picture of acute leukemia. Interventions: On completing diagnostic workup, radiological assessment discovered a left breast suspicious lesion, supra- and infra-diaphragmatic lymphadenopathy and splenomegaly with multiple focal lesions. Combined bilateral mammogram revealed left breast upper outer quadrant malignant looking mass (BIRADS 6) and right breast 3 o’clock indeterminate nodule (BIRADS 2) as well as malignant-looking bilateral axillary and supraclavicular lymph nodes. Tru-cut biopsy from left breast mass showed invasive carcinoma with signet ring features, Grade II, ER and PR positive and Her2 negative, and KI 67, 15%. No metastasis was detected. The patient went to Dar El-Salam Cancer Center for further assessment and treatment. BM biopsy specimen revision illustrated hypercellular BM, normal count and morphology of erythrocyte lineage, depressed granulocytic and megakaryocytic lineages, and infiltrated by myeloblasts, monoblasts, promonocytes and increased basophils (AML-M4). Immunophenotyping revealed positive MPO, CD13, CD33, CD117, CD 64, CD11b, CD11c, HLADR and dim CD4; t(8;21) and Inv (16) were negative. The decision was to start standard intensified chemotherapy (3+7) protocol plus neoadjuvant treatment (aromatase inhibitor). Results: The patient did not achieve response to induction therapy: her BM aspirate showed 49% blasts. The patient received salvage chemotherapy (high-dose cytarabine and mitoxantrone - HAM). Conclusion: Synchronous occurrence of these 2 neoplasms is rarely reported. Collaboration of various expertise in the field of hematology and oncology is needed to deliver the best care for this patient. Keywords: AML, breast cancer, double malignancy, case AML-110 Outcome of Acute Myeloid Leukemia Relapse After Allogenic Stem Cell Transplantation: A Single‑Institution Retrospective Study Yosr Hicheri MD, Cecile Castoldi MD, Raynier Devillier MD, PhD, Marie Anne Hospital MD, Evelyne D’Incan MD, Sylvain Garciaz MD, PhD, Valerio Maisano MD, Colombe Saillard MD, Jerome Rey MD, Angela Granata MD, Samia Harbi MD, Faezeh Legrand MD, Sabine Furst MD, Didier Blaise MD, PhD, Norbert Vey MD, PhD Hematology Department, Institut Paoli Calmettes, Marseille, France We present a single-institution series of 118 AML patients who relapsed after allogeneic stem cell transplant (allo-SCT) between January 2009 and December 2019. Median age was 53 (20–69) years; 22% of patients had FLT3 mutation; 53% had adverse genetic risk according to European LeukemiaNet; 79% have been transplanted and are in complete remission (CR); 21% have active disease. Conditioning regimens were myeloablative in 39% and reduced intensity in 61%. Eighteen patients received prophylactic donor lymphocyte infusion (DLI). Twenty-two developed grade >1 aGVHD, and 23, cGVHD. Median time from allo-SCT to relapse was 4.7 months (0.43–88.6). Intensive salvage therapy was used for 28% of the cohort, with a CR rate of 54% and an early mortality of 18%. Sixty-four percent of patients received nonintensive salvage therapy with a CR rate of 18%. Four of these patients are still in CR, all after an association of azacytidine plus sorafenib with or without DLI. Eight percent received supportive care only. Seventeen patients underwent a second allo-SCT: 14 are in CR (13 after intensive salvage, 1 after nonintensive); 6 are with active disease. Conditioning regimen was reduced intensity in 65%; 90% of patients had a different donor. The aGVHD (grade ≥1) and cGVHD (all grades included) rates were, respectively, 25% and 15%. Early treatmentrelated mortality after second allo-SCT was 25%. Four patients (25%) are alive in CR after intensive salvage treatment and a second alloSCT. One-year overall survival (OS) from relapse was 25%, and median OS was 5.1 months. Factors influencing OS in univariate analyses were Sorror comorbidity score ≥3 at first allo-SCT (1year OS 17% vs 32%, P=0.036), time to relapse after allo-SCT <6 months (1-year OS 16% vs 35%, P=0.020), and intensive salvage treatment (1-year OS 33% vs 24%, P=0.019). By multivariate analysis, only performance status at relapse (2–3 vs 0.1, HR 1.96, P=0.01) independently influenced OS. Median follow-up was 70.2 (46.3–83.5) months. Our data confirm the poor outcome of posttransplantation relapse. Intensive salvage therapy shows a reasonable response rate, but subsequent cellular therapy seems necessary to provide long term disease-free survival. Azacytidine in association with targeted therapy and/or DLI could be an alternative option. Keywords: AML, relapse, allogeneic stem cell transplant, salvage therapy
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