Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S524 of CMV infection and improve survival outcomes. Additionally, effective treatments for BKV-HC may contribute to improved survival in allo-SCT patients. These results emphasize the importance of implementing preventive strategies and targeted interventions to mitigate infectious complications and improve overall survival in allo-SCT recipients. Keywords: allogeneic stem cell transplantation, BK polyomavirus-associated hemorrhagic cystitis, cytomegalovirus infection, graft-versus-host disease CT-235 A Rare Etiology of Hepatomegaly: Extramedullary Hematopoiesis After Allogeneic Stem Cell Transplantation Bahar Sevgili MD, Ajda Güneş MD, Nur Soyer MD, Filiz Vural MD, Güray Saydam MD Ege University, Faculty of Medicine, Department of Hematology, Izmir, Turkey Introduction: Hepatomegaly is a challenging clinical finding with increased morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Extramedullary hematopoiesis is highly associated with bone marrow failure. We aimed to present a case report about hepatomegaly associated poor graft after alloHSCT. Case: Twenty-one-year-old male patient was admitted to Ege University HSCT unit with B cell acute lymphoblastic leukemia in first remission. He received an allo-HSCT with mismatched unrelated donor. His conditioning regimen included total body irradiation (TBI) + cyclophosphamide (Cy) + anti-thymocyte globulin (ATG). On day 10, cytomegalovirus (CMV) DNA was detected >5000 IU/ml. Ganciclovir treatment was added by infectious disease specialist. Engraftments of three lines were completed on day 15. First month bone marrow (BM) biopsy control was normocellular and his chimerism was 100%; CMV DNA was undetectable. He was discharged with valganciclovir maintenance for 2 weeks. On day 35, he was internalized with ascites, pancytopenia. He complained of no weight change, but loss of appetite. Liver/renal functions, bilirubin, C-reactive protein levels were normal. The BM aspiration and biopsy performed as his pancytopenia were worsened. Biopsy reported no increase of blasts but hypocellular bone marrow without any fibrotic changes. Cytogenetic analysis of BM showed no clinically significant mutations. The ascites sample was also analyzed. Serum-ascites albumin gradient was 1.1; cytological analysis reported neither infection nor malignancy. Abdomen ultrasound reported hepatomegaly (18 cm) and ascites. Liver biopsy reported extramedullary hematopoiesis. There were neither inflammatory changes nor graft versus host disease. Filgrastim 5 mcg/kg/day, eltrombopag 50-300 mg/day titrated by daily complete blood count analysis, were given as supporting treatment. Valganciclovir was discontinued as CMV DNA clearance was detected. On day 90, his cytopenia tended to be improved and liver became non-palpable. He is still under follow-up with full donor chimerism and no cytopenias recurred for 21 months. Discussion: After allo-HSCT, several etiologies of hepatomegaly such as infections, malignant tumor infiltrations, GVHD should be evaluated carefully. Liver biopsy should be performed in case of unexplained hepatomegaly. Keywords: allogeneic hematopoietic stem cell transplantation, extramedullary hematopoiesis, total body irradiation, hepatomegaly, case CT-236 Scabies Induced Hypereosinophilic Syndrome After Allogeneic Stem Cell Transplant: Case Report Yunus Çatma MD1, İpek Yönal Hindilerden MD1, Tarık Onur Tiryaki MD1, Elif Sakcı MD1, Fehmi Hindilerden MD2, Yüksel Aslı Öztürkmen MD2, Elif Aksoy MD2, Meliha Nalçacı MD3 1Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Istanbul, Turkey. 2University of Health Sciences Bakırkoy Dr.Sadi Konuk Training and Research Hospital, Hematology Clinic, Istanbul, Turkey, Istanbul, Turkey. 3Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, Istanbul, Turkey Case Report: Hypereosinophilic syndromes (HES) are disorders in which marked secondary hypereosinophilia (HE) are accounted for organ damage. Parasitic infections can cause HE but whether it can lead to HES is unknown. A 67 year old male allotransplanted for FLT-3(+) AML in first hematological complete response (CR) was evaluated for recurrent eosinophil dominant pleural effusion (PE), which first appeared during AML induction treatment. He complained of widespread itching one month after allotransplantation. On physical examination, scabies lesions were evident. Topical permethrin was administered. Four months after allotransplant, AEC remained as high as 4500 c/uL and PE persisted. Since scabies lesions were still present, oral ivermectin was administered. AEC returned to normal 4 weeks after initiation of ivermectin. Regression was observed in PE. PE and response to antiparasitic therapy may indicate organ involvement of HES induced by scabies, which should be considered in the differential diagnosis of HE. Keywords: allotransplantation, hypereosinophilic syndromes, organ damage, pleural effusion, case CT-277 Acquired Hemophilia A: An Unusual Complication of Immune Checkpoint Inhibitors Georges Gandour MD, Tara Maria Salme MD, Tarek Badra MD, Ahmad Adawiye MD, Georges El Hachem MD Saint George Hospital University Medical Center, Beirut, Lebanon Immune checkpoint inhibitors have been an effective component of the arsenal against different malignancies. Along with their effectiveness comes a list of side effects reported and studied ranging from immune-related dermatological, gastrointestinal, and neurological to almost any organ system. The onset of hematological
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