The prevalence of schistosomiasis in presenting travellers is decreasing. The predominant presenting species has shifted from S. mansoni to S. haematobium. No single test can reliably diagnose schistosomiasis, with eosinophilia and urine dip having low sensitivity. Clinicians need to continue to undertake a wide spectrum of diagnostic tests to ensure cases of schistosomiasis are not missed.

Our findings suggest that most patients are satisfied with the AF ablation experience, but this is not solely dependent on procedural success. Dissatisfaction occurs due to unmet expectations, particularly excess pain, i.e. greater than expected, during and after ablation. An improved consent process may improve patient experience. Physicians should also address initiatives to reduce pain during AF ablation.

Background. Chemotherapy followed by ASCT is standard of care in fit transplant-eligible newly diagnosed patients with Multiple Myeloma (MM). Most patients, however, will relapse and require further treatment. With increasing choice of therapies at relapse, we need to understand the determinants of treatment outcomes for these patients, to aid management decisions and patient counselling. Methods. This was a retrospective analysis of sequential patients who relapsed from upfront ASCT carried out between 2000-2014. PFS1 was defined as time from ASCT to 1st progression or death; PFS2, time from ASCT to 2nd progression or death and 2nd PFS, time from start of salvage regimen to 2nd progression or death. Post relapse survival (PRS) was measured from progression date and overall survival (OS) from ASCT date. Disease response, and adverse FISH were assigned according to IMWG. Survival was estimated using Kaplan- Meier curves and correlative analysis by Cox regression models. Results. Of 474 patients undergoing ASCT (2000-2014), 277 relapsed with a median age of 58 years (range 29-70).The M:F ratio was 1.85:1. Isotypes identified were: IgG 57.0%, IgA 22.7%, light chain 15.9%. Median PFS1 from ASCT was 20 months (0.47-128.3). ORR pre-ASCT was 91.3% (sCR/CR 4.4%, VGPR 25.4%) and post ASCT was 95.3% (sCR/CR 14.5%, VGPR 52.2%). At relapse, median age was 60 years (30-73) and 36.5% of patients had ISS stage2-3 disease. For the 277 patients who relapsed, median OS from ASCT was 67 months (CI 57-73) and median PRS was 40 months (35-44). PFS1 had a strong influence on OS, HR 0.97 (95%CI: 0.96-0.97, p<0.001), and PRS HR 0.99 (0.98-0.996, p=0.004). Patients relapsing before 2008 (prior to bortezomib funding) had shorter OS compared to those relapsing thereafter: median 61 vs 69 months, HR 1.38 (1.01-1.87, p=0.04). Depth of response (CR/VGPR) pre and post-ASCT were associated with longer PFS1- HR 0.70 (0.54-0.92, p=0.01), and HR 0.68(0.51-0.89, p=0.005) respectively, but not OS or PRS. 248 patients (89.5%) received systemic salvage therapy at relapse;106 patients (38.3%) experienced biochemical IMWG progression rather than clinical relapse, with median time to treatment of 5 months (2-64). Salvage regimens included: proteasome inhibitors(PIs) (64.5%), immunomodulatory agents (IMiDs, 29.8%, thalidomide-63.5%, lenalidomide-36.5%) and chemotherapy 5.2%; 26.6% of patients entered clinical trials and 13.7% underwent salvage ASCT. ORR was 70.4% (sCR/CR 10.9%, VGPR 31.6%). Median 2nd PFS was 17 months (16-20) and median PFS2 overall was 39 months (35-41). Achieving a deeper response to salvage treatment (CR/VGPR) was associated with a longer 2nd PFS (21 vs 17 months for PR, HR 0.65, 0.46-0.91, p=0.01), with a trend for PRS, HR 0.89(0.59-1.34, p=0.58) and OS, HR 0.77(0.51-1.17, p=0.22). Novel agents induced deeper responses, CR/VGPR with PI regimens 51.3%, with IMiDs 30%, and with chemotherapy 8%. Patients treated with PIs compared to all other systemic treatment regimens had a significantly longer OS of 80 vs 48 months, HR 0.60(0.43-0.85, p= 0.004). Patients entered into clinical trials (66) had deeper responses, ≥VGPR 61% compared to 31% in non-trial patients, and longer PRS, 64 vs 35 months, HR 0.54 (0.36-0.81, p= 0.003) and OS 90 vs 57 months, HR 0.50 (0.33-0.76, p=0.001). Risk factors at relapse influenced outcomes. Higher ISS was associated with shorter PRS, ISS 2/3 27 vs 50 months for ISS1, HR 2.52(1.74-3.66, p<0.0001) and OS, 46 vs 82 months, HR 2.42(1.67-3.50, p<0.0001). Presence of adverse FISH at relapse (54.1% of 133 patients) also predicted shorter PRS (restricted mean survival time 40 vs 72 months, p<0.001) and OS, 59 vs 97 months for standard FISH, HR 0.46 (0.28-0.73, p=0.0011). Adverse FISH at diagnosis (25.5% of 157) also predicted poorer outcomes. Conclusions. This real-world series shows that timing of relapse, period of relapse (pre-2008), ISS Stage, adverse FISH, and response to salvage regimen influence survival after relapse from frontline ASCT. Use of novel regimens, particularly PIs as salvage therapy post ASCT is associated with longer OS. Our data confirm the importance of entering patients into clinical trials. Multivariable linear regression analyses will be presented. Lastly, the inferior outcomes for patients with high-risk features highlights the need to develop different treatment strategies in this patient subgroup. Disclosures Maciocia: Autolus: Equity Ownership, Patents & Royalties: TRBC1 and 2 Targeting for the Diagnosis and Treatment of T-cell Malignancies. Yong:Janssen: Research Funding; Autolus Ltd: Equity Ownership, Patents & Royalties: APRIL based chimeric antigen receptor.

Background. With increasingly effective treatments, patients with Multiple Myeloma ('MM') are living longer, but burden of disease and cumulative toxicities of therapy impair quality of life ('QoL') and well-being. Fatigue and bone pain frequently persist long after treatment, and during disease stability. Research in solid cancers indicates that patients who are more physically active have reduced symptom burden, less fatigue and improved QoL. Less work has been done in MM, partly due to the older and frailer patient group, and the high prevalence of osteolytic bone disease and fracture risk. The MASCOT survivorship study aims to explore the main determinants of fatigue and QoL in patients who have completed chemotherapy, with particular emphasis on bone pain, physical fitness and strength. Methods. Multivariable linear regressions were performed between: 1) fatigue and measures of physical health and fitness and 2) each of 6 measures of QoL as outcome variables (fatigue, emotional well-being, functional well-being, global well-being, EQ5D QoL, and overall health status) with each of pain, depression and anxiety; all adjusted for age, sex, time since treatment, Hb, fat body %, fat trunk %, BMI, VO2peak, left grip strength, right grip strength, left leg muscle strength, right leg muscle strength, and muscle mass. Results are shown as regression coefficients B (change in fatigue score for 1 unit increase in physical health or fitness; or a change in QoL for 1 unit increase in pain, depression or anxiety). 80 patients aged 36-78 years (male, n=46), were studied at median 13.5 months (range 2-161) since last treatment. Physical health and cardiovascular fitness were assessed using objective measures: % body and trunk adiposity, muscle mass, body mass index (TANITA scales), VO2peak (CPET on a cycle ergometer), leg muscle strength and grip strength. The presence of bone pain was self-reported and evaluated in a clinical consultation. Standardised questionnaires were used to assess mood (HADS), fatigue (FACIT), functional and emotional well-being (FACT-G) and health related QoL (EQ5D). Higher scores on FACT-G and FACIT, health status scales and lower scores on HADS and EQ5D indicated better quality of life. Results. We investigated the influence of physical fitness on levels of fatigue, using multivariable regression. We found that higher levels of fatigue were associated with higher BMI (B = -1.28, CI =-2.28 to -0.28, p=0.013) and greater left leg muscle strength (B=0.16, CI=0.003 to 0.32, p=0.046) were linked to lower levels of fatigue independent of sex, age, time since treatment, pain and all other indicators of physical fitness. We observed that pain was associated with more fatigue (B = -6.80, CI = -11.45 to -2.15, p=0.005), decreased well-being (emotional: B = -1.92, CI =-3.50 to -0.35, p=0.018; global: B = -2.55, CI -4.59 to -0.51, p=0.015), decreased health related QoL (B =1.34, CI=0.42 to 2.26, p=0.005) and worse depression (B = 1.37, CI=-0.01 to 2.74, p=0.05), even when adjusting for sex, age, time since treatment and physical health and fitness. Depression was found to be an independent predictor of QoL with higher depression scores associated with greater fatigue (B = -2.52, CI=-3.09 to -1.96,p=<0.001), decreased emotional (B=-0.52, CI=-0.77 to -0.26, p<0.001), functional (B=-1.39, CI=-1.88 to -0.90, p<0.001) and global well-being (B=-0.96, CI=-1.24 to -0.67, p=<0.001), decreased health related QoL (B=0.30, CI=0.15 to 0.45, p<0.001) and health status (B= -3.07, CI=-4.36 to -1.78, p<0.001), and higher levels of anxiety (B=0.81, CI=0.54 to 1.08, p<0.001). Higher anxiety was also associated with greater fatigue, decreased emotional, functional, and global well-being, decreased health related QoL and health status, with similar strength of correlations to those found between depression and QoL. Conclusions. Our findings confirm the important contribution of physical fitness to fatigue and QoL in these patients. Regardless of physical fitness status, however, the presence of pain and impaired psychological health remain independent drivers of fatigue and diminished QoL. Research involving exercise programmes designed to improve physical strength and fitness combined with effective pain management and psychological support are needed to provide the evidence base for much needed rehabilitative interventions. Disclosures Yong: Autolus Ltd: Equity Ownership, Patents & Royalties: APRIL based chimeric antigen receptor; Janssen: Research Funding.