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Objectives: Among patients receiving cancer therapy, pulmonary fungal infections (PFIs) are an important cause of morbidity and mortality. Identifying predictors of PFI can direct targeted prophylaxis to improve outcomes, especially in low- and middle-income countries (LMIC) with limited resources. The objectives of the study were to evaluate the predictors of PFI in hospitalized patients with hematological malignancies in the United States and implications for prioritizing anti-fungal care in LMIC. Materials and Methods: Using the 2018 National Inpatient Sample, we conducted a retrospective study of patients ≥18 years, with acute leukemia or aggressive lymphoma. Demographics and outcomes were compared between patients with and without PFI. Predictors of PFI were evaluated by regression analysis. Results: PFI was diagnosed in 1635 (0.8%) of 205,525 eligible hospitalizations and aspergillosis was noted in 1315 (80.4%) of PFI cases. Patients with acute myeloid leukemia (AML) accounted for 64.2% of cases of PFI. Patients with PFI, when compared with those without PFI, were younger, had higher Charlson comorbidity index, were more likely to be non-Caucasian, and to have AML. Patients with PFI had higher odds of respiratory failure, sepsis, and in-hospital mortality. Variables associated with PFI were Hispanic or native American origin (OR = 1.71; 95% CI: 1.21–2.42), Charlson comorbidity index ≥3 (OR = 1.52; 95% CI: 1.16–2.00), neutropenia (OR = 1.97; 95% CI: 1.58–2.46), malnutrition (OR = 2.30; 95% CI: 1.75–3.01), bone marrow transplant status (OR = 2.28, 95% CI: 1.53–3.39), and AML diagnosis (OR = 3.12; 95% CI: 2.40–4.05). Conclusions: This study identified variables associated with PFI in patients diagnosed with acute leukemia and aggressive lymphomas. In LMIC, where resources are scarce, patients with cancer who have the identified high-risk characteristics should be given priority for antifungal prophylaxis.

There is increasing evidence that rates of atrial arrhythmias (AA), specifically atrial fibrillation and flutter are elevated in patients treated with the tyrosine kinase inhibitor, ibrutinib; however, the exact risk of ibrutinib-associated AA is not definitively established. We conducted a retrospective study of 137 patients diagnosed with B-cell malignancies treated with ibrutinib compared with 106 patients treated with chemotherapy for the same cancers in order to quantify the rates and risk of AA in a "real-world" sample of cancer patients. Fisher's exact test was used to evaluate for any statistically significant differences between groups. Logistic regression was used to generate odds ratios, adjusting for potential confounders. Incidence of AA was 14% (n = 17) in ibrutinib-treated patients compared with 3% (n = 3) in patients treated with chemotherapy (p = 0.009). Ibrutinib-treated patients were significantly older (mean age 67 vs 63 years, p = 0.003); however, there were no other significant differences in baseline characteristics. Ibrutinib use, age, hypertension, and previous use of ACE inhibitors, angiotensin receptor blocker use, β blocker use, and aspirin use were independently associated with incident arrhythmias. In multivariable analysis, patients treated with ibrutinib were associated with a 5-fold increased risk of developing AA (odds ratio = 5.18, 95% confidence interval 1.42 to 18.89). In conclusion, the rates and risk of AA are higher in patients treated with ibrutinib compared with chemotherapy, and this study provides strong evidence that ibrutinib itself is an independent risk factor for the development of incident AA.

BackgroundIbrutinib is a tyrosine kinase inhibitor most commonly associated with atrial fibrillation. However, additional cardiotoxicities have been identified, including accelerated hypertension. The incidence and risk factors of new or worsening hypertension following ibrutinib treatment are not as well known.MethodsWe conducted a retrospective study of 144 patients diagnosed with B cell malignancies treated with ibrutinib (n=93) versus conventional chemoimmunotherapy (n=51) and evaluated their effects on blood pressure at 1, 2, 3 and 6 months after treatment initiation. Descriptive statistics were used to compare baseline characteristics for each treatment group. Fisher’s exact test was used to identify covariates significantly associated with the development of hypertension. Repeated measures analyses were conducted to analyse longitudinal blood pressure changes.ResultsBoth treatments had similar prevalence of baseline hypertension at 63.4% and 66.7%, respectively. There were no differences between treatments by age, sex and baseline cardiac comorbidities. Both systolic and diastolic blood pressure significantly increased over time with ibrutinib compared with baseline, whereas conventional chemoimmunotherapy was not associated with significant changes in blood pressure. Baseline hypertensive status did not affect the degree of blood pressure change over time. A significant increase in systolic blood pressure (defined as more than 10 mm Hg) was noted for ibrutinib (36.6%) compared with conventional chemoimmunotherapy (7.9%) at 1 month after treatment initiation. Despite being hypertensive at follow-up, 61.2% of patients who were treated with ibrutinib did not receive adequate blood pressure management (increase or addition of blood pressure medications). Within the ibrutinib group, of patients who developed more than 20 mm Hg increase in systolic blood pressure, only 52.9% had hypertension management changes.ConclusionsIbrutinib is associated with the development of hypertension and worsening of blood pressure. Cardiologists and oncologists must be aware of this cardiotoxicity to allow timely management of blood pressure elevations.

Most guidelines recommend induction therapy followed by autologous hematopoietic cell transplantation. A Surveillance, Epidemiology, and End Results-Medicare database analysis from 2000 to 2011 noted a lower use of HCT and bortezomib among Black patients, despite adjusting for care barriers, and this practice was associated with a poorer outcome. The goal of this study was to evaluate patterns of acceptance of HCT as consolidative therapy for MM.Cox proportional hazards model was used to investigate the association between the survival time of the patients (overall survival) and age of the diagnosis, race, socioeconomic status, disease cytogenetic, and initial induction regimens. A total of 194 patients with a confirmed diagnosis of MM who were referred for HCT between January 1, 2009, and June 30, 2019, were included in this study. Patients who received autologous stem cell transplant for relapsed MM were excluded.We found that income category was not significantly associated with overall survival, time to transplant or transplant-/relapse-related mortality. High-risk cytogenetic was significantly associated with shorter overall survival, higher transplant-related mortality and relapse-related mortality (P.002). The use of aggressive induction choices was associated with poorer transplant outcomes (P = .02). Time to transplant tended to be shorter in African American compared with other ethnic groups (P = .07).There was no significant difference in the use rate of the HCT between Caucasians and AA patients with MM. Further comparative studies of MM induction therapy and access to clinical trials in African Americans and other racial minorities are warranted.

Although ibrutinib-associated atrial and ventricular arrhythmias have been well described, there is little information about ibrutinib’s effects on other electrocardiographic parameters, particularly the QT interval. Using our database of 137 patients treated with ibrutinib, we retrospectively identified 21 patients in whom an electrocardiogram (ECG) was obtained both prior to and after ibrutinib exposure. All traditional ECG parameters as well as QT dispersion were manually measured by an electrophysiologist. Compared to baseline ECGs, post ibrutinib ECGs demonstrated QT interval shortening from 386 ms to 356 ms ( P = .007), corrected QT interval shortening using Bazett’s formula from 446 ms to 437 ms ( P = .04), and corrected QT interval shortening using Fridericia’s formula from 425 ms to 407 ms ( P = .003). QT dispersion also increased post ibrutinib exposure compared to baseline (39.8 ms vs 57.3 ms, P = .002). There was no significant change in other ECG parameters. In conclusion, both the absolute and corrected QT intervals significantly shortened after ibrutinib exposure, while there was a significant increase in QT dispersion. These findings may point to a common underlying electrophysiologic mechanism of ibrutinib-associated arrhythmias.

12118 Background: Chimeric antigen receptor T cell therapy (CART) has shown efficacy in acute lymphoblastic leukemia (ALL), diffuse large B cell lymphoma (DLBCL), and primary mediastinal B cell lymphoma (PMBCL). While neurological toxicities of CART are known, neuropsychiatric disorders (NPD) in patients undergoing CART has not been well described. Our study assessed the prevalence of NPD in hospitalized patients (pts) undergoing CART, and explored association of NPD with clinical variables. Methods: Using the National Inpatient Sample database, we conducted a retrospective study of pts with ALL, DLBCL and PMLCL aged ≥ 18 years who underwent CART in 2018. Hospitalizations were selected using International Classification of Disease, Tenth Revision (ICD-10) codes. NPD of interest included anxiety, depression, adjustment disorder, insomnia, psychosis, dementia, bipolar disorder. Delirium was not included in the inventory of NPD since delirium is a neurotoxicity of CART, and inclusion of delirium as NPD would confound results. Patient, disease, and CART complications were extracted from hospitalization records. Regression analyses were used to assess association of NPD with clinical variables. Results: 945 CART procedures met the inclusion criteria (56 % males and 60% Caucasians). Majority of CART (88%) were performed for DLBCL and PMBCL. NPD was diagnosed in 31 % of pts. Anxiety was the most common NPD, followed by insomnia and depression. ALL pts were more likely to have NPD compared to pts with lymphoma (52% versus 28%, p

e19042 Background: For patients undergoing intensive chemotherapy, pulmonary fungal infections (PFI) represent a major cause of morbidity and mortality. Our study examined predictors and outcomes of PFI in hospitalized patients (pts) with hematological malignancies in the current era of antifungal prophylaxis for high-risk patients. Methods: Using the 2018 National Inpatient Sample (NIS) database, we conducted a retrospective study of hospitalized pts aged ≥ 18 years, with acute leukemias or aggressive lymphomas. Hospitalizations were selected using International Classification of Disease, Tenth Revision (ICD-10) codes for leukemias, lymphomas and PFI (candidiasis, aspergillosis, cryptococcus, and mucormycosis). Demographics, comorbidities, and outcomes were compared between pts with and without PFI using Chi-squared test. Multivariable logistic regression was performed to explore predictors associated with PFI. Results: Of 205,525 hospitalizations that met the inclusion criteria, PFI was diagnosed in 1635 (0.8%). Frequent infections were aspergillosis (80%) and candidiasis (11%). Pts with acute myeloid leukemia (AML) accounted for 64% of all PFI. The PFI group, compared to non-PFI, were more likely to be non-Caucasian (39% vs 32%, p

e19020 Background: Allogeneic stem cell transplantation (alloSCT) is increasingly being offered to older patients with acute myeloid leukemia (AML) due to availability of reduced-intensity conditioning regimens and better supportive care. Though studies have shown improving alloSCT survival outcomes in older age groups, it is still not known if older age confers higher mortality and morbidity during transplant hospitalization. We queried a national inpatient database to evaluate in-hospital mortality and resource utilization during alloSCT for AML in patients >70 years compared to a younger age group. Methods: We conducted a retrospective study of alloSCT for AML patients ≥ 18 years using the 2018 National Inpatient Sample database. Hospitalizations were selected using International Classification of Disease, tenth revision (ICD-10) codes. Demographics, comorbidities, transplant, and outcome variables were compared between a reference age group (18-70 years) and a comparator group (> 70 years). Study outcomes were in-hospital mortality, length of stay (LOS) and transplant complications. Regression models were fit to assess the association between predictors and outcomes. Results: During the study period, 2610 alloSCT met the inclusion criteria. This cohort consisted of 50% males and 77% Caucasians. Only 7% of these alloSCT were performed for patients > 70 years. Patients >70 yrs had a lower proportion of females compared to the reference age group (32% versus 52%, p70 years were 3% and 5% respectively (p=0.35). In a multivariable model, we found no association between age >70 years and in-hospital transplant mortality. Acute graft versus host disease was more frequent among the reference age group (14% versus 2%, p=0.04), but there were no differences in LOS or rates of graft failure, respiratory failure, sepsis, and acute renal failure between the 2 groups. Conclusions: Despite similar in-hospital transplant outcomes as their younger counterparts, patients >70 years comprised only a small proportion of alloSCT performed for AML in our study. Females were more disproportionately affected by this age disparity. More studies are necessary to identify barriers to alloSCT for older AML patients, more so for older females.

7543 Background: Acute graft versus host disease (aGVHD) is a well-described complication of allogeneic stem cell transplantation (allo-SCT). Complete response to steroids is achieved in 40-50% of cases, with steroid refractory GVHD requiring second line therapy. Currently, there is no accepted standard of care in this setting. In our study, we assessed the safety and efficacy of etanercept with ECP for steroid refractory aGVHD in a single center tertiary care hospital. Methods: Thirty adult patients who underwent peripheral blood allo-SCT and developed steroid-refractory aGVHD between January 2010 - July 2019 were retrospectively analyzed. Patients were planned to receive etanercept 25 mg subcutaneously twice weekly for at least 4 weeks. Safety was assessed by estimating infection related mortality. For efficacy, we analyzed the change in grade of aGVHD using the Wilcoxon signed-rank test. Results: Median age at the time of allo-SCT was 57.6 years and the most common indication for transplant was Myelodysplastic syndrome. Median time from allo-SCT to steroid initiation was 39.5 days (range 14-183 days). Median time from steroid initiation to etanercept was 6 days, with 7.5 median number of etanercept doses received. A total of 25 patients (83.3%) received ECP. As depicted in the table, there was a significant improvement in severity of aGVHD after etanercept therapy compared to that before its initiation. Overall response rate was 83.3%, while overall mortality was 86.7%. Median overall survival for responders was 306 days (range 59-2005 days) and for non-responders was 181 days (range 89-261 days). Death attributed to infection alone occurred in 28% (n=7), infection along with GVHD in 28% (n=7) and infection with relapsed disease in 1 patient. Active infection within 6 months of transplant occurred in 93.3% patients. Conclusions: The use of Etanercept with ECP resulted in improvement of steroid refractory aGVHD following allo-SCT, with responses noted in the majority of patients. High rates of infection related mortality were also noted and remain a cause of concern. [Table: see text]

e20504 Background: Multiple Myeloma (MM) accounts for about 17% of hematologic malignancies in the United States. It is a disease of older adults, with a median age at diagnosis of 66 years. The incidence in African Americans is 2 to 3 times more that in Whites, and this disparity has been found to be greater among patients less than 50 years. Most guidelines recommend induction therapy with a triplet regimen followed by autologous hematopoietic cell transplantation (HCT). Unfortunately, racial and ethnic minorities have been found to be less likely to receive ASCT. A SEER-Medicare database analysis from 2000 to 2011 noted a lower utilization of ASCT and Bortezomib among black patients. The goal of this study was to evaluate patterns of acceptance of ASCT as consolidative therapy of MM. Because the receipt of upfront ASCT is dependent on response to induction therapy, our study also investigated disparity in transplant outcomes and time to transplant, which are areas that previous studies had not looked at. Methods: In this retrospective review we used Cox PH model to investigate the association between the survival time of the patients (OS) and age of the diagnosis, race, socioeconomic status, disease cytogenetic, and initial induction regimens. 194 patients with a confirmed diagnosis of MM who were referred for autologous hematopoietic stem cell transplantation (ASCT) between January 1st 2009 and June 30st 2019 were included in this study. Patients who received ASCT for relapsed MM were excluded. Results: Using Cox PH model, we found that high risk cytogenetic were significantly associated with shorter overall survival, higher transplant related mortality and relapse related mortality (P < 0.002). Use of aggressive induction choices was associated with poorer transplant outcomes (P 0.02). Time to transplant tended to be shorter in African American compared to other ethnic groups (P 0.07). Income category was not significantly associated with overall survival, time to transplant or transplant / relapse related mortality. Conclusions: Cytogenetic continues to be a significant factor in transplant outcomes affecting overall survival. Time to transplant tended to be shorter in African American comparing to others, potentially reflecting the differences in disease course. Our study provides a more real life data on ASCT outcome patterns. It is hoped that the results of this study will better guide interventions to improve utilization of ASCT as consolidative therapy for MM.

Chronic myelogenous leukemia (CML) is a pluripotent stem cell disease characterized by the presence of the Philadelphia chromosome and the bcr-abl gene. The discovery of tyrosine kinase inhibitors (TKIs) revolutionized therapy for CML, such that durable response, increased overall survival, and increased progression-free survival of patients in chronic phase CML is now possible. Due to resistance and intolerance to imatinib, there was need for development of second- and third-generation TKIs for the treatment of CML. This review examines the role of nilotinib, an oral second-generation TKI, in the treatment of Philadelphia positive CML. The pharmacology, efficacy, and safety of nilotinib are critically evaluated. Patient-related issues, including tolerance, drug interactions, and quality of life issues are also examined.

A woman aged 48 years presented with fevers, chills, weight loss, and night sweats. She had significant lymphadenopathy of the left neck as well as the left axilla. Her history was significant for bilateral breast augmentation with textured silicone implants more than 25 years ago. Excisional biopsy of a cervical lymph node revealed large, atypical cells positive for CD4 and CD30 and negative for Epstein-Barr virus-encoded ribonucleic acid, CD2, CD3, CD5, CD7, CD8, CD15, CD20, pan-keratin, S100, anaplastic lymphoma kinase (ALK), and paired box 5. These findings were consistent with Ann Arbor stage IIIB ALK-anaplastic large cell lymphoma (ALCL). The patient was started on 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone. She initially had no signs or symptoms of breast involvement; however, after developing seroma during the clinical course, the patient underwent capsulectomy and removal of the intact, textured silicone implants. Pathological evaluation demonstrated ALK-ALCL in the left breast capsule with cells displaying a significant degree of pleomorphism with binucleated forms and numerous mitoses. Fluorescence in situ hybridization confirmed the tumor was negative for t(2;5). She presented 8 weeks later showing evidence of recurrent systemic disease.

Infection is a serious complication of hematopoietic stem cell transplantation (SCT). However, the optimum oral agent for antibacterial prophylaxis in SCT recipients remains uncertain. Different antibiotics might affect incidence of blood stream infections, resistance, Clostridium difficile, gut microbiome, GVHD and relapse. To explore this we started this first clinical trial of levofloxacin (Levo) versus ciprofloxacin (Cipro) at our center. Methods: This is a single center prospective randomized study. Patients who meet the SCT program criteria to undergo autologous or allogeneic hematopoietic stem cell transplantation are eligible. Results: We present interim results. 111 consecutive patients were randomized since June 2018. At the time of the present report 102 of these patients have follow up for 60 days or more. There were 62 males and 40 females. Median age at time of SCT was 61. Fifty received Cipro and 52 received Levo. Fifty-six patients had autologous (27 Cipro and 29 Levo) while 46 patients had allogeneic SCT (23 Cipro and 23 Levo). For allogeneic SCT, 12 patients in each group had ATG. Time to engraftment and length of stay were similar in both groups. In the Cipro group 6 patients (12%) had bacteremia while in the Levo group 7 (13%) had bacteremia. Of patients with bacteremia, in the Cipro group none had Gram negative bacteremia while in the Levo group 4 had gram negative bacteremia (OR 9.37, p = 0.137). In the Cipro group 6 patients had gram positive bacteremia while in the Levo group 3 patients had gram positive bacteremia (OR 2.22, p = 0.277). In the Cipro group, 6 (12%) had clostridium difficile while in the Levo group only 1 (1.9%) had Clostridium difficile (OR 6.95, p = 0.078). Acute GVHD of all grades accrued in 17 patients (34%) in Cipro group and in 16 patients (30.7%) in the Levo group. Grade III-IV aGVHD occurred in 6 patients (12%) in Cipro group and in 3 patients (5.8%) in the Levo group (OR 2.23, p = 0.277). The hazard ratio for progression free survival was 0.67 (95% CI: 0.27, 1.67), p=0.395 for Levo vs. Cipro. The hazard ratio for overall survival, adjusted for auto/allo and age at transplant was 0.29 (95% CI: 0.09, 0.95), p = 0.041, for Levo vs. Cipro. However, 3 of deaths in the Cipro group were not related to type of antibacterial prophylaxis (listeriosis from contaminated food, fungal pneumonia in a wooden-house builder and stroke from intraventricular thrombus). So, unadjusted hazard ratio for overall survival (Levo vs. Cipro): 0.41 (95% CI: 0.13, 1.34), p = 0.142. Hazard ratio for overall survival (Levo vs. Cipro), adjusting for allo/auto and age at transplant: 0.39 (95% CI: 0.11, 1.33), p = 0.132. Conclusion: At this point, in this interim analysis, there seems to be a trend for Cipro to protect patients from gram negative bacteremia compared to levo. As a trade-off, there is higher trend for Clostridium difficile in the Cipro group compared to Levo group, but none is statistically significant so far.

e19000 Background: Studies have reported that use of filgrastim (G) or any biosimilar result in similar stem cell yield during hematopoietic stem cell mobilization, but little is known on the effect of these biosimilars on length of hospitalization for the transplant procedure, engraftment, and long term survival of autologous hematopoietic stem cell transplant (HSCT) patients. Beginning January 2017, the Henry Ford Cancer Institute (HFCI) began utilizing tbo-filgrastim (TBO) and filgrastim-sndz (SNDZ) as part of mobilization. This study was conducted to evaluate transplant specific outcomes in HSCT patients comparing biosimilar and reference filgrastim products. Methods: This study retrospectively evaluated all patients treated at HFCI who received G-CSF based mobilization for HSCT between 1/2017 and 11/2018. Patient-, mobilization- and transplant specific variables were collected and analyzed. Results: A total of 113 patients underwent stem cell mobilization followed by collection and autologous HSCT. Of the 73 patients analyzed, 62% had a diagnosis of Multiple Myeloma (MM), 22% had Non-Hodgkin Lymphoma (NHL). Approximately 45% of patients received TBO, 44% received G and remainder received SNDZ. The percentage of patients who proceeded to HSCT was 86%. There was no difference in adequate CD34+ yield among the three G-CSF products (P = 0.074). There was no difference in mobilization associated complications including bone pain and thrombocytopenia. Plerixafor use was similar among the groups (P = 0.55). Actual CD34+ (P = 0.31) and the number of apheresis sessions required to collect an adequate CD34+ yield (P = 0.30) were not different among the groups. No significant differences were noted in time to neutrophil (P = 0.96) or platelet engraftment (P = 0.91) and hospital length of stay (P = 0.78). We found similar rates of infection, febrile neutropenia, and mucositis among the three groups. Relapse rates were also similar among the groups. Conclusions: In our institution transplant related outcomes were similar among patients who received TBO, SNDZ, and G as part of their pre-transplant mobilization protocol.

With the success of tyrosine kinase inhibitor (TKI) therapy for the treatment of patients with chronic myeloid leukemia (CML), CML is now treated as a chronic disease. As such, the community of oncologists may see patients with CML more often than the primary-care physician and must focus on long-term management of adverse events and adherence. BCR-ABL1 TKIs are effective therapies in CML but are associated with distinct safety profiles. Thus, selection of long-term treatment with any TKI requires assessment of patient comorbidities and regular monitoring to identify the potential emergence of adverse effects or new risk factors. With a focus on long-term safety, this review provides a holistic picture of the primary care needs of patients with CML, emphasizing on the importance of community oncologists who in many cases act as both oncologists and primary-care physicians.

Background Chronic lymphocytic leukemia (CLL), the most prevalent leukemia in the Western world, is predominantly a disease of older individuals who also have other comorbidities as well as declining organ and bone marrow reserve. Although chemoimmunotherapy is the frontline therapy for fit CLL patients who can tolerate the therapy, many elderly patients cannot tolerate such intense therapy. Methods The authors first reviewed the most recent findings concerning CLL cytogenetics, molecular biology, and prognostic models. They then surveyed recent and ongoing trials of novel CLL agents and strategies, with a focus on those most relevant to elderly patients. Results Novel therapies, revised staging procedures, and careful assessment of individual patients' frailty and functional status will allow clinicians to provide optimal care management for older CLL patients. Conclusion Therapy for the elderly CLL population must be tailored to each patient's fitness level and comorbid conditions, with special consideration for the potential quality-of-life impacts of various treatment recommendations.

e19028Background: Most of the information about ibrutinib-associated atrial fibrillation (AF) has been extrapolated from clinical trials for B cell lymphomas, however there is little information ab...

Many cancer patients will first present to a primary care provider either in the clinic or acutely in the inpatient setting before a definite diagnosis of cancer is made. Thus, an accurate clinical evaluation through history taking and physical examination by a general practitioner could reveal malignant diseases at their early stages. In some instances, cancer is incidentally detected while a patient is being treated for other unrelated diseases. Plain radiographs ordered by the primary care physician for pneumonias or back pains, for instance, have been known to reveal occult lung tumors or bone metastasis.

s / Biol Blood Marrow Transplant 21 (2015) S266eS321 S297 multivariate analysis using the LASSO approach to logistic regression analysis. Results: Of 134 allo-HSCTs, 29 (21.6%) patients experienced CMV viremia. Among these patients, median age was 51 years (range 27-67), with 48 episodes of viremia. Nine (31%) viremic patients developed CMV disease. CMV disease occurred at a median of 124 days post HSCT (range 61-322). Patients with CMV disease had a median of 2 viremic episodes before disease (range 1-4). Disease occurred at a median of 33 days from the start of the last viremic episode, and 75 days from the start of the first episode of viremia. On univariate analysis, factors associated with progression to CMV disease were: steroid-refractory acute GVHD (60 vs. 20%, p1⁄40.028); number of episodes of viremia >1x103 copies/mL (mean 2.4 vs 1.1, p1⁄40.016); longer duration of viremia (mean 38 vs. 22 days, p1⁄40.01); higher peak viral load (mean 4.49x105 vs. 8.31x103 copies/mL, p 1x103 copies/mL, a longer duration of viremia, and to have failed first-line pre-emptive ganciclovir therapy. This study, while limited, suggests that these risk factors may be predictive of CMV disease. Larger, prospective studies are needed to confirm these risk factors, some of which may be amenable to more aggressive anti-viral therapy.

Introduction Pretransplant patient and donor characteristics can predict outcomes after allogeneic hematopoietic cell transplantation (HCT), but the utility of post-transplant characteristics to predict outcomes after HCT remains unknown. Our group previously noted that hypoalbuminemia ( Methods We identified pts with lymphoid malignancies who underwent allo-HCT at Moffitt Cancer Center from 2/1/2005 to 3/22/2013. Patient, donor and transplant characteristics from before and day+90 after HCT were retrospectively reviewed. OS was calculated by Kaplan-Meier estimates. NRM was determined by competing risk analysis. Multivariable models were developed for both endpoints. Patient's age, Center for International Blood and Marrow Transplantation Research (CIBMTR) risk category and acute graft versus host disease (aGVHD) grade were forced into the multivariate model along with significant covariates. Results 271 pts met the inclusion criteria (65% male, 35% female) with median age of 50 years. HCT indications were chronic lymphocytic leukemia (14%), Hodgkin's lymphoma (7%), non-Hodgkin's lymphoma (44%) and acute lymphoblastic leukemia (35%). CIBMTR disease risk categories were low (30%), intermediate (55%), or high (15%). Stem cell source was mainly peripheral blood (92%). Most common conditioning regimens were fludarabine + busulfan (69%) and pentostatin + busulfan (12%). 25 pts (9.2%) died prior to day+ 90 and were excluded from outcomes analyses. For the 249 evaluable pts, median OS was 78.4 months (95% CI: 32.1, NR). The 2-year and 5-year OS were 59% and 54% respectively. The 2-year and 5-year cumulative incidence of NRM were 19% and 21% respectively. On univariate analysis, transfusion of any blood product prior to day +90 (HR 1.82, CI 1.23-2.70, p=0.0028), prednisone dose of ≥20mg/day at day +90 (HR 2.18, CI 1.43-3.33, p=0.0003), and serum albumin(SA) of Similarly, univariate analysis showed that transfusion of any blood product prior to day+90 (HR 1.82, CI 1.04-3.18, p=0.03), SA of 3-3.5g/dl (HR 2.04, CI 1.14-3.65, p= 0.02) and prednisone dose of ≥20mg/day (HR 3.07, CI 1.76-5.37, p A prior or current diagnosis of aGVHD did not predict for NRM or OS in the multivariable models consistent with results on the myeloid malignancy study. Patient age, disease risk, comorbidity index, CD34 cell dose and GVHD prophylaxis type did not significantly predict for OS or NRM (Table 1). Conclusion Our study supports the adverse prognostic value of day +90 hypoalbuminemia (< 3g/dl) in regards to NRM and OS in pts who undergo allo-HCT for lymphoid malignancies. We propose inclusion of serum albumin at day +90 in algorithms to predict HCT outcomes. Disclosures No relevant conflicts of interest to declare.