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'Post-acute coronavirus disease 2019 (COVID-19) syndrome' is a new term that was coined to describe a constellation of persistent symptoms and new complications following recovery from COVID-19 initial illness. Identifying post-COVID-19 complications is crucial for early diagnosis and subsequent initiation of therapies to ensure more favorable outcomes. Severe COVID-19-related hemophagocytic lymphohistiocytosis (HLH) has been previously described during the acute phase of the infection. It is characterized by hyperinflammation, multi-organ involvement, and hemophagocytosis. We report the case of a 69-year-old woman who presented, two weeks after recovery from COVID-19, with hyperosmolar state and high inflammatory markers. Bone marrow aspirate, flow cytometry, extensive viral panel and total body scan were performed. Review of bone marrow aspirate smear showed hemophagocytosis. Flow cytometry, viral panel, and total body scan were normal. The diagnosis of post COVID-19-related HLH was made. Unfortunately, the patient died despite adequate treatment. To our knowledge, this is the first case establishing a high probability of COVID-19-related HLH given its occurrence two weeks following a documented biological and clinical recovery. Awareness and early recognition of HLH features following COVID-19 recovery should prompt timely initiation of therapy.

Sally Temraz,1 Fadi Nasr,2 Joseph Kattan,3 Dany Abigerges,4 Walid Moukadem,5 Fadi Farhat,6 Layal Maatouk,7 Georges Chahine,8 Ali Shamseddine1 1Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; 2Department of Hematology and Oncology, Mount Lebanon Hospital, Beirut, Lebanon; 3Department of Hematology and Oncology, Saint- Joseph University, Beirut, Lebanon; 4Department of Hematology and Oncology, Middle East Institute of Health, Bsalim, Lebanon; 5Department of Hematology and Oncology, Haykal Hospital, Tripoli, Lebanon; 6Department of Hematology and Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon; 7Roche Lebanon SARL, Beirut, Lebanon; 8Department of Hematology and Oncology, Hôtel-Dieu de France University Hospital, Beirut, LebanonCorrespondence: Ali Shamseddine, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon, Tel +961 1 374374, Fax +961 1 370814, Email as04@aub.edu.lbPurpose: When combined with chemotherapy, bevacizumab improves progression-free survival (PFS) in metastatic colorectal cancer (mCRC). This observational trial was designed to assess the safety and efficacy of bevacizumab plus first-line chemotherapy in a real-world setting in Lebanon.Patients and Methods: A non-interventionaL multicenter study of first-LIne AVastin® (bevacizumab) in combination with chEmotherapy in patients with metastatic colorectal cancer (LLIVE) is a multicenter, prospective, Lebanon-based, observational study that enrolled mCRC patients who received first-line bevacizumab plus chemotherapy combination. The primary end point of the study was PFS. Secondary endpoints comprised the overall response rate (ORR) and the safety and tolerability of bevacizumab.Results: A total of 196 patients were enrolled between July 2010 and August 2013. The median duration of follow-up was 11 months. Median duration of bevacizumab treatment was 4 months with FOLFOX being the chiefly chemotherapy regimen used in the first-line setting (26%). Median PFS was 8.22 months (95% confidence interval (CI): 7.005– 9.443). The ORR was 50.3% (complete response 7.5%, partial response 42.8%). The most common adverse event encountered was hypertension (28%) followed by epistaxis (4.8%), diarrhea (4%), anemia (4%) and headache (4%). Grade 3/4 adverse events occurred in 15.2% of patients.Conclusion: The trial further substantiated the efficacy and safety of bevacizumab and chemotherapy in the first-line treatment of mCRC patients in Lebanon.Keywords: metastatic colorectal cancer, bevacizumab, FOLFOX, XELOX

Acquired haemophilia A (AHA) is a rare immune-mediated disorder characterised by the development of autoantibodies against factor VIII. Morbidity and mortality are in general high due to multiple factors including the age of the patient, underlying diseases, toxic effects of available treatments and bleeding itself. To assess the awareness about AHA among healthcare professionals (HCPs) in Lebanon where patients can present to non-haematologists with life-threatening bleeding disorders. A cross-sectional survey was conducted in September and October 2017 all over Lebanon among HCPs. The survey covered: (i) the geographic area of practice and specialty; (ii) bleeding disorders encountered within the last 2 years; (iii) assessment of knowledge on AHA; and (iv) importance of increasing awareness on AHA among HCPs. A total of 362 participants completed and returned the questionnaire (response rate 100%). The majority of the HCPs were practicing in Beirut (n=164; 45.3%) and were internists (n=106; 29.3%). 332 (93%) HCPs have encountered patients with bleeding problems within the last 2 years all over Lebanon. 327 (92.1%) HCPs agreed that increasing awareness on AHA among health care professionals is important. HCPs gave an average of 75.9% of correct answers on the survey. Appropriate treatment and diagnosis are essential when dealing with AHA. Knowledge gaps exist in the clinical practice when dealing with patients who have AHA. This study shows the need for increasing awareness about AHA among HCPs in Lebanon regarding the diagnosis and treatment of this disorder.

Early evidence from China suggested that blood groups may be involved in susceptibility to COVID‐19. Several subsequent studies reported controversial results. We conducted a retrospective matched case‐control study that aims to investigate the association between blood groups and the risk and/or severity of COVID‐19. We compared the blood groups distribution of 474 patients admitted to the hospital for COVID‐19 between March 2020 and March 2021, to that of a positive control group of outpatients infected with COVID‐19 and matched them for sex and age, as well as to the distribution in the general population. Three hundred and eighteen HC+ pairs with available blood group information were matched. The proportion of group A Rh+ in hospitalized patients (HC+) was 39.9% (CI 35.2%–44.7%), compared to 44.8% (CI 39.8%–49.9%) and 32.3% in the positive outpatient controls (C+) and the general population (C−), respectively. Both COVID‐19‐positive groups (HC+ and C+) had significantly higher proportions of group A Rh+ compared to the general population (p = 0.0019 and p

Stage III non-small cell lung cancer is a border line stage between localized and metastatic disease. PDL-1 is gaining an important role in the therapeutic arsenal of lung cancer, the most frequent cancer worldwide. We report for the first time a negativation of PDL-1 status in 2 cases of stage IIIA NSCLC with conversion to operable disease after using immunotherapy. The first patient was a 59-year old female diagnosed incidentally to have stage IIIA inoperable NSCLC that was treated with combination chemo-immunotherapy, and converted to operable disease with a negative PD-L1 in the postoperative setting. The second case is that of a 56-year old male that also had an inoperable stage IIIA NSCLC treated with chemotherapy first line followed by pembrolizumab at progression, then operated after surgical conversion, with negative PD-L1 postoperatively. In front of these findings, further work should be done to elucidate if the reverse of the PDL-1 status and the conversion to operability were due to the use of immunotherapy or to an incidental finding. If confirmed, it may have a therapeutic impact.

Context: BCR–ABL-targeting tyrosine kinase inhibitors (TKIs) constitute the cornerstone of treatment for CML, leading to a life expectancy that is currently very close to that of age-matched individuals in the general population. Objective: To describe aspects of CML in a real-world data setting in Lebanon, including responses to first-line treatment with the first-generation TKI imatinib compared to those with the second-generation TKIs dasatinib and nilotinib. To evaluate the proportion of patients eligible for an attempt to stop TKI treatment. Design: Medical charts of patients diagnosed with CML between 2003 and 2019 were reviewed and updated in January 2020. Settings: Lebanese patients from two university medical centers in Beirut, Mount Lebanon Hospital and Hotel-Dieu de France Hospital, were included. Patients: The registry covered 70 patients, of which 54 patients were included. Inclusion criteria were patients older than 18 years, confirmed diagnosis with CML based on BCR-ABL PCR, and available follow-up data in the clinical chart for at least 2 years. Outcomes: Major and deep molecular responses were based on BCR-ABL1 levels; time of attaining these responses and duration of sustained responses were measured. The reason for switching to another TKI was noted (‘treatment failure’ or ‘intolerance’). Eligibility criteria for an attempt to stop TKI were based on the EURO-SKI trial. Modality of Treatment: Imatinib was given at a dose of 400 mg once daily, nilotinib 300 mg twice daily, and dasatinib 100 mg once daily. Results: 70% of patients were treated with imatinib and 30% with a second-generation TKI. 14% of patients discontinued their first-line treatment, mainly due to intolerance (10%) or treatment failure (5%). At 24 months, deep molecular response (MR4.0 and MR4.5) was achieved, at 15.3% and 40.3%, respectively, for imatinib, and 22% and 33.5%, respectively, for second-generation (p=1). The 5-year cumulative incidence of eligibility for TKI cessation attempt was 37%. Conclusion: We report the experience in CML from two health care institutions in Beirut, Lebanon. There was no statistically significant difference in response between the first- and second-generation TKIs. The criteria for an attempt to stop TKI therapy were met by one-third of patients.

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to a worldwide medical crisis, affecting mostly immunocompromised patients, such as cancer patients. Various cancer societies have issued recommendations regarding patients care, but few studies addressed the perception of cancer patients regarding this pandemic. Objective The aim of the study was to assess the perception of cancer patients regarding their health risks during this pandemic and the preventive measures taken. Materials and methods An anonymous survey was conducted among cancer patients presenting for their treatment, during 10 consecutive working days, at the one-day clinic of Hotel-Dieu de France University hospital in Beirut. We evaluated their state of disease, comorbidities, precautions taken, and their concerns regarding the virus spread. Results A total of 216 patients responded with a mean age of 60 years. The majority had a good performance status (performance status = 0-1 in 79.6%), 51.4% had metastatic disease, and chemotherapy was the main therapy used (65.7%). A total of 52.3% of patients considered themselves to be at increased risk of contracting the virus. A total of 55.1% were more worried about the coronavirus rather than their disease. The priority was for the treatment of their cancer in 47.7% of the total patients studied. Of note, only 2.8% of planned one-day clinic reservations were canceled or postponed to avoid COVID-19 exposure. Conclusions Although cancer is a disease with a high mortality rate, many patients are more concerned about the actual pandemic rather than their disease. Nevertheless, the absenteeism from their treatment sessions during the COVID-19 atmosphere was minimal.

Clinical practice points • There is no real-world data in clinical practice for multiple myeloma in Lebanon • Despite novel therapies, high dose chemotherapy regimens are still used in the treatment of multiple myeloma. • Autologous stem cell transplant improves progression free survival and still a valid option for transplant fit patient despite novel therapeutic novel agents • OS and PFS were not affected by type of regimen • Hypercalcemia was significantly associated with a shorter mean PFS and OS upon presentation • Because most of the time real-world data patients will not meet eligibility criteria for clinical trials such as age and performance status, effort should be multiplied towards developing a Lebanese cancer data base (e.g clinical characteristics, survival outcomes of treatment, statistics…)., OBJECTIVE The present retrospective multicenter study aims at documenting characteristics of multiple myeloma (MM) patients and the effect of autologous stem cell transplant (ASCT) on survival. METHODS A total of 134 adult patients initiating any new MM therapy from January 2002 till December 2019 were included. Enrollment was stratified by disease subtype, induction protocol and transplant status. The characteristics and survival outcomes were recorded. RESULTS Mean age at diagnosis was 61.91 ± 10.83 years, with 62.7% male patients. Regarding the prognostic MM International Staging System (ISS), stage 3 was the most common at diagnosis with 50.8% of patients followed by stage 1 (25.4%) and stage 2 (23.8%). Maintenance treatment was given in 88.5% of the patients. 24.6% patients were transplanted, 41% were not and the remaining were unknown or still in induction. 86.1% of patients were alive at data cut off. A significantly higher mean progression free survival (PFS) was found in transplant patients (p=0.016). Using cox regression, creatinine >2 mg/dl (HR3.78) and hypercalcemia >11 mg/dl (HR=6.48) were significantly associated with a shorter PFS1. A significantly shorter overall survival (OS) was associated with hypercalcemia (HR=6.58), as well as male gender though not statistically significant in the latter. Difference in survival distributions by treatment was not statistically significant (bortezomib thalidomide dexamethasone (VTD) (p=0.211), bortezomib cyclophosphamide dexamethasone (VCD) (p=0.111) or bortezomib Revlimid dexamethasone (VRD) (p=0.312)). The interaction between ISS stage on diagnosis and transplant was not significantly associated with the overall survival. CONCLUSION The results of our retrospective study are in conformity with international data emphasizing the role of transplant in the treatment algorithm of newly diagnosed transplant-eligible multiple myeloma patients.

Background Lymphomas are ranked as the fifth most common cancer in Lebanon. There is concern about the need of information regarding the prevalence of lymphoid neoplasm particularly Non-Hodgkin lymphoma (NHL) subtypes in the Lebanese population. This study intended to establish a descriptive status of NHL histological subtypes distribution in Lebanon thus identifying the most common types, knowing that the literature is poor regarding the distribution of lymphoid malignancies particularly NHLs in Lebanon. Methods A bicenter retrospective descriptive study was performed. Patients aged above 18, diagnosed with NHL between January 1984 and March 2019 and registered in two Lebanese Medical centers were included in this study; 699 medical files were reviewed and the baseline characteristics of the disease were collected. Histological classification was based on the Working Formulation (WF) and World Health Organization (WHO) classification systems, whereas staging was based on the Ann Arbor system. Disease status was monitored with imaging studies. Results The mean age at diagnosis was 53.52 ± 17.46 years in the studied population, with 380 (54.4%) males and 319 (45.6%) females. B-cell lymphoma (BCL) accounted for 86.3% while T-cell neoplasms accounted for 13.7%. The most common subtype was diffuse large B-cell lymphoma (DLBCL) (54%) followed by follicular lymphoma (FL) (17.2%). Mantle cell lymphoma (MCL) represented 3% of all BCL and small lymphocytic lymphoma (SLL) comprised less than 2%. Mucosa-associated lymphoid tissue (MALT) and Burkitt’s lymphomas represented 3 and 1.7% respectively. 36.5% of the patients had extranodal disease at diagnosis. High-grade tumor represented 80.1% with 33.1% stage IV disease. Conclusion These observations indicate that the epidemiological patterns of NHLs in Lebanon were comparable to Western countries. Aggressive lymphomas account for the majority of NHLs in Lebanon.

Oncotype DX is approved in multiple countries but its cost-effectiveness is a matter of considerable health debate. Lebanon is high-middle income country according to the World Bank classification however it is facing a mounting financial and health care burden from cancer. Therefore, we conducted a costeffectiveness analysis of Oncotype DX based Lebanese on real-life data.We updated a Canadian cost-effectiveness model of Oncotype DX by incorporating Lebanese data. The patient population was a real-life cohort of 82 women diagnosed with hormone receptor - positive and HER2 - negative early breast cancer.Overall, providing Oncotype DX to only intermediate Adjuvant! Online risk patients costs an additional $83 CAD (93,883 LBP) per additional QALY. From this point, extending provision to also cover high Adjuvant! Online risk patients costs an additional $736 CAD (831,578 LBP) per additional QALY. From this point, extending provision further to also cover low Adjuvant! Online risk patients (such that Oncotype DX is provided to all patients) costs an additional $14,562 CAD (16.46m LBP) per additional QALY. Given that most women in our population-based sample were classified as intermediate Adjuvant! Online risk patients, our study focused on this subset in the second analysis. Providing Oncotype DX to intermediate Adjuvant! Online risk patients has a relatively small additional cost compared to not providing Oncotype DX, and results in a relatively large QALY gain. The incremental cost per QALY is $2,022 CAD (2.29m LBP), implying that Oncotype DX is cost-effective for intermediate Adjuvant! Online risk patients if the willingness-to-pay for a QALY is greater than 2.29m LBP.As one of the few economic evaluations to date conducted using Lebanese data, this evaluation provides information to decision makers regarding the cost-effectiveness of providing Oncotype DX to Lebanese patients.

Background. Collecting (Bellini) duct carcinoma (CDC) or Bellini duct carcinoma (BDC) is a rare subtype of kidney tumors, accounting for less than 3% and known to have the worst prognosis. It is known to have multiple clinical presentations; this is why it can be easily misdiagnosed. The aim of this article is to present a case of CDC that was initially misdiagnosed with urothelial papillary carcinoma (UPC) in a 41-year-old male. Case Presentation. Our patient presented with a left flank pain evolving for one month and one episode of gross macroscopic hematuria. Upon presentation, he had left costovertebral angle tenderness. Initial lab tests were normal. Computed tomography revealed a 5 cm solid mass of the left renal pelvis and multiple infracentimetric perihilar lymph nodes. Subsequently, the patient had left nephroureterectomy. Microscopic examination showed the presence of a high-grade urothelial papillary carcinoma of the renal pelvis’ lumen. All four of the dissected lymph nodes showed disease metastasis. Three years after establishing the diagnosis, the patient presented again for chronic abdominal pain, with a recent history of weight loss. CT scan showed a left paraaortic mass infiltrating the left psoas muscle over a length of 12 cm. Immunohistochemical profiling of this mass confirmed the diagnosis of Bellini duct carcinoma, rejecting the initial diagnosis of UPC. Therefore, the patient required a cisplatin-gemcitabine-based chemotherapy regimen. Conclusion. BDC remains one of the rare aggressive subtypes of RCC, having a multitude of initial clinical presentations and an unfavorable prognosis. In this patient, CDC was masquerading as a transitional cell carcinoma that should always be kept in mind as a possible presentation. Corresponding early imaging and histopathology exams are primordial for a correct diagnosis and thus a better prognosis.

Context The molecular characteristics of this disease remain widely unknown in Lebanon. Cytogenetics and molecular testing in AML are becoming routine practice for disease classification and prognosis. In Lebanon, a nationwide study showed an incidence of 1.1% among all cancers in 2003, slightly more predominant in males. Objective The aim of this study was to describe patient's characteristics and outcome in Lebanese patients. Design 80 patients from a single Lebanese center were included. We reviewed disease characteristics of patients diagnosed with AML between January 2008 and December 2020. Medical files were reviewed and SPSS software was used for statistical analysis. Results 48.1 % of patients were males, with a median age of 61 years at diagnosis. Cytopenia was present at 30% of patients. Diagnosis was confirmed by bone marrow aspirate in 95% of the patients. Karyotype was missing in 48% of patients. When available, 13%, 54% and 33% were respectively in the low, intermediate, and high risk group. FLT3 was positive in 47.4% of tested cases and NPM1 in 16.7%. No patient was found to have t (16;16) and 5.4% have inversion 16. PML-RARA was positive in 2% of patients. Idarubicin-cytosar was given as induction treatment for 82% of patients. 58% achieved complete remission, 2% were in partial remission and 40% were primary refractory. 51.7% relapsed after remission. PFS was 11 months with a median OS of 17 months. No significant statistical correlation was found between Karyotype on diagnosis and survival [P = 0.3]. Conclusion Our study is the first to describe AML characteristics in Lebanon. Multicenter studies are needed to elaborate a clinical and epidemiological data register for leukemia patients in Lebanon. Disclosures No relevant conflicts of interest to declare.

Background: The present study reports on the efficacy and safety of adjuvant docetaxel in real-life patients with early-stage breast cancer. Methods: This is a prospective, multicenter, post-marketing study that evaluates the efficacy and safety of docetaxel-based regimens in patients with early breast cancer treated between 2007 and 2012. Results: A total of 698 female breast cancer patients receiving adjuvant docetaxel-based regimens were included in this study. Docetaxel monotherapy was administered in 4.2%, whilst most patients received polychemotherapy. Non-hematological adverse events included skin reactions in 32.7% of the subjects. Multiple adverse events were reported and most commonly included asthenia (66.5%), alopecia (43.4%), and diarrhea (24.2%). It is noteworthy that no fatal toxicities occurred. Several hematological adverse events were reported during treatment, with anemia being the most common. Conclusion: The results of this real-life experience, characterized by a relatively large sample size and long follow-up, confirm that docetaxel is effective and well tolerated in early-stage breast cancer patients.

Context: The molecular characteristics of AML disease remain widely unknown in Lebanon. Cytogenetics and molecular testing in AML are becoming routine practice for disease classification and prognosis. Objective: Our aim was to describe patients’ characteristics and outcome, investigating the association between karyotype on diagnosis, and survival in the Lebanese population. Design: Medical records were retrospectively reviewed for AML patients diagnosed between January 2008 and December 2018. The last update of the data was done in February 2019. Setting: Patients included were treated at Mount Lebanon Hospital University Medical Center or Hotel-Dieu de France University Hospital. Patients: 54 patients were included. Inclusion criteria comprised patients diagnosed with AML and receiving treatment, and availability of data on all sequences of therapy. Patients diagnosed with AML-M3 were not included in the study. Treatment: Fit patients received induction therapy as high dose cytarabine + anthracycline. Then if complete remission: consolidation as cytarabine. Older unfit patients received hypomethylating agent azacytidine. Results: 53.7% were male, median age was 57.06 years at diagnosis. According to FAB classification, the majority (18.5%) were AML-M4, the least (1.9%) M6 and 24.1% were non identifiable. 74.1% were de novo and 16.7% were post-MDS with azacitidine as the major culprit drug. 9.7% were secondary to solid tumors. On diagnosis, 22.6% had hyperleukocytosis and 28.6% were in aplasia. 41.5%, 13.2% and 5.7% were respectively in the intermediate, high, and low risk group. FLT3 was positive in 7.5% of tested cases and NPM1 in 3.8%. No patient was found to have t(16;16) or inversion 16. PML-RARA was positive in 7.5% of patients. 54.7% achieved complete remission, 7.5% were in partial remission and 32.1% were primary refractory. 82.75% relapsed after remission. DFS was 18.4 months with a median OS of 17.8 months ranging from 10.6 months for high-risk group and 20.4 months for the low-risk group. No significant statistical correlation was found between karyotype on diagnosis and survival [P =0.4]. Conclusion: Our study is the first to describe AML characteristics in Lebanon. Multicenter studies are needed to clarify if the Lebanese population has the same molecular and survival pattern as others described in international data.

Context: Patients diagnosed with Non-Hodgkin Lymphoma (NHL) have been the subject of many epidemiologic studies done at the time that aimed to explain the distribution of different subtypes among different countries. Because there is unpublished data and only a small percentage of all newly Lebanese cancer cases are diagnosed in tertiary hospitals, there is constant need of studies to supplement the literature. Objective: To establish a descriptive status of NHL histological subtypes distribution in Lebanon, thus identifying the most common types, knowing that the literature is poor regarding the distribution of lymphoid malignancies, particularly NHLs in Lebanon. Design: Multicenter retrospective cohort data analysis. Setting: Two Lebanese medical centers. Patients or other participants: Patients aged above 18 years, diagnosed with NHL between January 1984 and March 2019 inclusive, were included in the study. Interventions: 699 medical files were extracted from the hospital archives and reviewed. The baseline characteristics of the patients and the disease at presentation were collected. Histological classification was based on the Working Formulation (WF) and the World Health Organization (WHO) classification systems for patients diagnosed before and after 2001, respectively, whereas staging was based on the Ann Arbor system. Disease status and response to chemotherapy regimens were monitored with imaging studies. Results: The mean age at diagnosis was 53.52 ± 17.46 years in the studied population, with 380 (54.4%) males and 319 (45.6%) females. The mean age for males was 53.56 ± 17.95 years, and for female 53.48 ± 16.87 years (p=0.954). B-cell lymphoma (BCL) accounted for 86.3% while T-cell neoplasms accounted for 13.7%. The most common subtype was diffuse large B-cell lymphoma (54%) followed by follicular lymphoma (17.2%). Mantle cell lymphoma represents 3% of all BCL and small lymphocytic lymphoma comprised less than 2%. MALT and Burkitt lymphomas represented 3% and 1.7%, respectively. 36.5% of the patients had extranodal disease at diagnosis. High-grade tumor represented 80.1% with 33.1% stage IV disease. Conclusions: These observations indicate that the epidemiological patterns of NHLs in Lebanon were slightly comparable to Western countries. Aggressive lymphomas account for the majority of NHLs in Lebanon.

The use of total parenteral nutrition (TPN) in terminally ill cancer patients is considered an aggressive approach with very limited benefits. We examined the practice of TPN in our end of life cancer patients and we investigated the patient and tumor characteristics that justify this practice. To our knowledge, this is the first study describing TPN administration of Middle Eastern patients with advanced cancer.We conducted this retrospective observational study at Hotel-Dieu de France University Hospital, Lebanon. Eligible cases included all cancer patients that died at our institution between the 1st of January and the 31st of December 2014. The patients and tumors characteristics were analyzed for their potential role as determinant of TPN administration. The patients' hospitalization and causes of death were evaluated for the analysis of TPN benefits.Among the 129 patients enrolled, 39% had received TPN among which TPN administration correlated negatively to hyperlipidemia (OR= 0.33; 95% CI [0.12-0.87]) and to the presence of at least three cardiovascular risk factors (OR= 0.28; 95% CI [0.10 - 0.80]). However, it correlated positively to gastrointestinal tumors (OR= 3.9; 95% CI [1.3- 11.7]) and to imaging studies during the last month of life (OR= 3.4; 95% CI [1.3 - 9.0]). The TPN administration did not correlate to hospitalization during the last two weeks of life.The adoption of an optimal palliative care approach in Middle Eastern cancer patients at the end of life remains challenging. Oncologists seem to consider cardiovascular risk factors as a probable surrogate to predict complications of TPN.

Purpose Improvements in systemic treatment have led to a prolongation of survival and quality of life in patients with metastatic tumors in recent years. However, despite this improved standard of care, it is expected that the progression-free survival (PFS) for patients with refractory cancers will continue to decline over subsequent therapy lines. In those patients, studies and meta-analyses showed that treatment based on multiplatform molecular profiling (MMP) of tumor tissue may derive a clinical benefit. The aim of this study was to analyze if molecular-based therapy may prolong PFS compared with the PFS of the immediately prior therapy. Methods We pooled clinical data of 140 patients treated within 3 recently conducted pilot studies and included an additional 21 patients who were treated within the ongoing ONCO-T-PROFILE program. The PFS of the molecular-based treatment was compared with the PFS of the previous therapy using Kaplan-Meier curves. Results In heavily pretreated cancer patients, the PFS could be significantly improved using molecular-based treatment options (120.0 vs. 89.5 days). More than 50% of patients showed a clinical benefit from MMP-guided therapy as defined by a PFS ratio of 1.3 or greater. Conclusions We conclude that pretreated cancer patients can benefit from incorporation of molecular profiling, as demonstrated by not only an increase of the PFS ratio but also PFS. Further randomized trials in specific tumor subtypes may help establish specific patient populations who might benefit most from MMP guidance.

e19031 Background: BCR–ABL-targeting tyrosine kinase inhibitors (TKIs) constitute the cornerstone of treatment of CML leading to a life expectancy that is currently very close to that of age matched individuals in the general population. The aim of the current study was to describe aspects of CML in a real world data setting in Lebanon including responses to first lines with a specific focus on the impact of first-line treatment with imatinib compared to that of the second-generation TKI, dasatinib and nilotinib. We also evaluated what proportion of patients become eligible to attempt to stop their TKI treatment. Methods: Chronic myeloid leukemia registry was analyzed to evaluate response rates in the first line and eligibility for a treatment cessation attempt in adults diagnosed between 2003 and 2019. The registry covered 60 patients. 46 eligible patients were included in the study. BCR-ABL1 levels of ≤ 0.1%, ≤0.01% and ≤0.0032% on the international scale were defined as the molecular response end-points major molecular response(MMR), MR4.0 and MR,4.5 respectively. In the case of a switch in TKI therapy, the clinical chart was reviewed for the reason why the treating physician had changed the therapy (‘treatment failure’ or ‘TKI intolerance’). For the determination of eligibility to stop TKI, the inclusion criteria for the EURO-SKI trial were applied. Results: Seventy-two percent of the patients were treated with imatinib, 28% with a second-generation tyrosine kinase inhibitor (nilotinib and dasatinib). 15% of patients had discontinued their first-line treatment, mainly due to intolerance (10%) or treatment failure (5%). At 24 months, deep molecular response (MR 4.0 and MR4.5) were achieved at 16.7% and 38.9% respectively for imatinib, and at 22.2% and 33.3% respectively for second generation (p=1). The 5-year cumulative incidence of eligibility for a tyrosine kinase cessation attempt, according to EURO-SKI criteria, was 37%. Conclusions: In the current study we report the experience in CML from two health care institutions in Beirut, Lebanon. Our findings showed no statistically significant difference in response between the first and second generations. The criteria for an attempt to stop tyrosine kinase inhibitor therapy are met by a third of the patients.

The present study was performed to determine whether the adherence to regular follow-up assessments using standardized real-time quantitative polymerase chain reaction (qPCR) and/or cytogenetic tests in Lebanese patients with chronic myeloid leukemia (CML) meet the European LeukemiaNet recommendations. The present study was a retrospective analysis of 34 patients diagnosed with chronic phase CML who had been treated with tyrosine kinase inhibitors and monitored with regular cytogenetic tests and/or measurement of the BCR-ABL transcript level at 3, 6, and 12 months from 2006 until 2015 in 3 university hospitals in Lebanon. All patients were included and monitored in an adherence program (SAWA program). The male/female ratio was 3:1. The median age was 50 years, and the mean age was 50 years. As frontline treatment, 29 patients started imatinib and 5 patients received second-generation tyrosine kinase inhibitors. We defined compliance to the monitoring tests as regulary realizing the qPCR at 3, 6, and 12 months. Of the 36 patients, 15 underwent the recommended tests at 3, 6, and 12 months, representing a compliance rate of 41.6%; 28 of the 34 patients underwent the recommended tests only twice in the first follow-up year. Only 14 patients underwent qPCR at 3 months. We believe that despite the inclusion of our patients in an adherence program, the compliance rate is still low. We also believe that greater effort is required to improve the adherence to regular follow-up examinations.

Background: Research in the field of informational needs of breast cancer patients is scarce. In the few published articles, these needs were usually not satisfied. The main objective of this study was to evaluate satisfaction regarding informational needs in women with breast cancer. The long-term goal was to guide physician-patient communication to meet these needs. Materials and Methods: A survey with 21 questions was completed by 84 female patients receiving chemotherapy in a one-day hospital in Beirut, Lebanon. All patients were aware of their disease and agreed to participate in the survey. Results: The doctor was the major source of information for patients followed by media (radio and television). The level of knowledge of patients concerning their disease was proportional to the number of information sources. Women aged younger than 45 years, diagnosed during the last three months before the survey and certified from high school were less satisfied with information given by the oncologist. The missing information was in relation with the steps of the treatment after the chemotherapy regimen, the risk of a family member (sisters and daughters) of developing the disease and management of lymphedema. Conclusions: This study generated a scale for the degree of satisfaction of information received by women with breast cancer from their oncologist. The physician can use this scale to improve his or her skills of communication to patients and diminish their level of fear and anxiety.

e13054 Background: Approximately 70% of all breast cancer cases are hormone receptor (HR) positive. One of the most important treatment strategies for HR positive, human epidermal growth factor receptor 2 (HER2) negative subtype was endocrine treatment monotherapy by targeting estrogen receptor or aromatization and thus reducing estrogen level. However, resistance to this treatment and disease progression is universal. In the past few years, palbociclib, an oral inhibitor of cyclin dependent kinase 4 and 6 have been approved by the FDA, as a new standard of care in the metastatic or locally advanced setting either as front line therapy or after progression. The aim of our study is to describe the real world experience with palbociclib. Methods: Eligible patients had histologically confirmed metastatic breast cancer estrogen and progesterone receptors positive and HER2 receptor negative. Palbociclib was given 125 mg orally for 21 consecutive days of a 28 day cycle. Patients were followed over one year. Primary objective was progression free survival (PFS). Tumor response and treatment tolerability were defined as secondary objectives. Results: From 2002 to 2018, we identified a total of 44 breast cancer patients. All patients were females. The median age at diagnosis was 57 years. Among all the patients, 33.3% had visceral metastasis, 35.9% had non visceral metastasis and 30.8% had the two types of metastasis. 64.1% were de novo metastatic and 35.9% were not de novo metastatic. 82.5% had less than 3 sites of metastasis. 47% of the study patients had received both chemotherapy and endocrine therapy during treatment course, and 13 % had only received prior adjuvant endocrine therapy. 28.26% took only prior systemic therapy for breast cancer. By the cutoff date for the final analysis (1/11/2018), a total of 8 events of disease progression occurred, no death events happened. The median progression free survival was 262.6 months for palbociclib combined with letrozole as first line. Conclusions: no data was published before on palbociclib in Lebanon. We are the first to describe these characteristics. Our result (PFS 26 2.6 months) is in conformity with the PFS obtain with PALOMA-2 (24 months).

e20526 Background: Multiple myeloma is a clonal plasma cell malignancy that accounts for slightly more than 10% of hematologic cancers. Novel agents and stem-cell transplantation are changing disease prognosis and patient’s survival. Our objective was to do a multicenter retrospective analysis in order to look at the effect of autologous bone marrow transplant on progression free survival (PFS) of multiple myeloma. Methods: 134 myeloma patients from different Lebanese centers were included in a retrospective, observational study. We reviewed disease characteristics of patients that were diagnosed with multiple myeloma between July 2002 and January 2018. Results: 62.7% were males and 33.7% females with a median age of 65.5 years at diagnosis. 37 patients had a Karyotype on diagnosis, of which 21.6% were normal and 78.4% had abnormal cytogenetics including loss of chromosome Y, hypoploidy and tetraploidy. Regarding the M component, we had 52.2% IgG, 17.9% IgA, 1.4% IgM, 11.2% Kappa, 5.2% lambda, and 0.7% had 2 spikes M and G. 53.7% patients had bony lesions on diagnosis, 16.4% didn’t and 29.9% patients were unknown. According to ISS staging, 11.9% patients had an ISS of 1, 11.2% an ISS of 2, and 23.9% an ISS of 3. The majority (40.3%) were transplanted, 24.6% were not and 6.7% were still on induction therapy at the time of data cutoff [31/12/2018]. 28.4% had an unknown transplant status. 6.7% patients were diagnosed based on atypical plasmacytosis, 22.4% had monoclonal spike and 67.8% had multiple diagnostic modalities including immunofixation and urine studies. 29.1% of patients had plasmocytes between 10 and 60% and 9% had more than 60% plasmocytes on bone marrow at diagnosis. VCD was the main induction protocol used (38.8%) followed by VTD (14.2%) and VRD (9%). For the transplant group, 11.7% were in CR, 23.5% in VGPR and 19.6% were in PR before high dose melphalan. No death occurred during induction. 126 patients were still alive and taking treatment at the time of data cutoff. Mean PFS was 49.69 months (± 32.83) and 22.28 months (± 16.36) in the transplant and non-transplant group respectively (p = 0.001). Conclusions: Few previous reports described transplant data in Lebanese myeloma patients. As in the international data, we found a significant progression free survival in the transplanted group compared to the non-transplanted one.