Hodgkin's disease is a rare malignancy that affects approximately 7,500 patients per year in the U.S., leading to an estimated 1,400 deaths. The relapse rate for this disease varies from around 5% for early-stage disease to 35% for patients with advanced disease. Patients who relapse after chemotherapy have about a 20% cure rate with conventional salvage chemotherapy. Two randomized phase III studies have shown an improved failure-free survival rate with high-dose chemotherapy and autologous stem cell support compared with conventional chemotherapy in re- CASE PRESENTATIONMr. T is a 50-year-old African-American male with a past medical history significant for type 2 diabetes mellitus. In January 2002, he presented to the emergency room with complaints of fever, chills, right groin pain, and a 25-pound weight loss over the last several months. Initial laboratory evaluation revealed an elevated white cell count of 11,800, hemoglobin of 11.7 g/dl, hematocrit of 35.8, platelet count of 406,000, and an elevated blood sugar of 516 mg/dl. A chest radiograph revealed right paratracheal lymphadenopathy and a patchy density overlying the left upper lung field. A computed tomography (CT) scan of the chest, abdomen, and pelvis showed enlarged lymph nodes in the mediastinum and the prevascular, right paratracheal, subcarinal, left axillary, left subclavian, azygoesophageal recess, and inguinal and bilateral iliac regions. A biopsy of the enlarged right cervical lymph node revealed fibrofatty connective tissue. A mediastinoscopy with biopsy was performed, and the pathology revealed mixed cellularity-type Hodgkin's lymphoma (Fig. 1). A gallium scan was positive in the mediastinal, left axillary, and right inguinal nodes. A bone marrow biopsy revealed Hodgkin's lymphoma, and the patient was considered to have clinical-stage IVB disease (Fig. 2). He underwent treatment with adriamycin, bleomycin, vincristine, and dacarbazine (ABVD) chemotherapy for four cycles. Restaging gallium scan was negative for nodal uptake, and a CT scan showed significant decrease in the lymphadenopathy. After four additional cycles of ABVD, repeat staging revealed new gallium-avid disease in the right paratracheal region, with stable disease upon CT scan. Repeat bone marrow biopsy was negative. The patient was considered to have refractory disease and underwent salvage therapy with rituximab, ifosfamide, carboplatin, and etoposide. After two cycles, he had a negative gallium

Following initial graft rejection, a second attempt at allogeneic immunotherapy is often contemplated, but data on the success is limited. We therefore report on 11 patients with hematologic malignancies, renal cell cancer or marrow failure who underwent a second reduced-intensity regimen for primary or secondary graft failure. Nine of the 11 patients initially engrafted with the second attempt including two of four who used the same donor. One of the patients engrafted after the third attempt using a different donor and conditioning regimen. There were two treatment-related deaths. Four patients died from progressive disease 1-9 months after the second transplant. Two patients are still in recovery phase less than 1 year from the second transplant. Long-term remission is possible and three patients are alive in complete remission.

The epidermal growth factor receptor (EGFR) is a promising target in the treatment of advanced stage non-small-cell lung cancer (NSCLC). Currently erlotinib and gefitinib are approved by the US Food and Drug Administration, whereas cetuximab is being studied for use in NSCLC. Erlotinib has shown a survival advantage in patients with advanced NSCLC. Further studies have identified female sex, nonsmokers, Asian race, good performance status, and adenocarcinoma histology as predictors of patient response to these agents. A genetic mutation in EGFR has also been correlated with an increase in response.

74 Background: Immunotherapy is a type of cancer treatment that uses an individual’s immune system to fight cancer. Most clinical trials involving immunotherapy have been done on healthy patients, thus excluding many hospitalized patients. Many oncologists feel there are less significant toxicities to immunotherapy and thus may give them to sicker patients. This may delay discussions regarding goals of care and contribute to increased costs at end of life. This exploratory study focuses specifically on the use of immune checkpoint inhibitors in hospitalized patients to determine outcomes of patients treated in the inpatient setting. Methods: This is a retrospective chart-review study. Data on patients from the Hartford Healthcare system was extracted from EPIC. Patients were eligible if they had received at least one dose of a PD1 or PDL1 inhibitor (pembrolizumab, nivolumab, atezolizumab) during a hospital stay. The number of doses received in total, side effects, as well as discharge status was also recorded. Results: A total of 74 patients received at least one dose of a PD1 or PDL1 inhibitor during a hospital stay. 46% of the total patients treated either died in the hospital (16.2%) or were discharged to hospice (29.3%). 54 percent of patients were discharged with a plan to continue with therapy. For the subgroup of the 27 patients whose treatment was initiated in the hospital, 48% of them received only one cycle of treatment and 74% received less than 4 treatments total. The average number of cycles was 5.3. The percentage of patients who died in the hospital was 11.1% and the percentage of patients discharged to hospice was 33.3%. 55.5% were successfully discharged with a plan to continue with therapy. Conclusions: For patients who receive immunotherapy in the hospital setting there is a questionable benefit with more than 45% dying in the hospital or being discharged to hospice. Further evaluation can be done looking at increasing the cost, delaying palliative care, and patient/family satisfaction with their end of life care by giving immunotherapy in the hospital. A new quality measure looking at time from last immunotherapy to hospice enrollment or death may need to be followed in the future due to these poor outcomes in the hospitalized setting. [Table: see text]