Different subtypes of acute myelogenous leukemia have distinct clinical presentations and courses. The specific clinical and molecular aspects of these leukemias have helped modify and create specific strategies for their management. We observed an increased incidence of pulmonary complications in patients with acute myelomonocytic leukemias (AMML) with inversion of chromosome 16 [inv(16)] irrespective of the presence of hyperleukocytosis. We reviewed patient records available over a period of 12 years at The Cleveland Clinic Foundation of patients with AMML with inv(16) and compared the incidence of pulmonary complications to a matched control group of patients with AMML but without inv(16). We found an increased incidence of pulmonary complications in the AMML with inv(16)group when compared to the control group. Two of these patients demonstrated brochiolitis obliterans with organizing pneumonia (BOOP) on lung biopsy. No specific etiology for the pulmonary complications was identified. These findings represent the first observation of an association between WHO-AMML with inv(16) [FAB-AML M4 with inv(16)] with a pulmonary syndrome at presentation. BOOP should be suspected in these cases. A larger prospective study to evaluate this association is warranted.

This combination of gemcitabine (Gemzar) and rHuIFN-alpha2b has significant hematologic toxicity despite low doses of each agent. Further investigation of this combination using this schedule is not recommended.

BACKGROUND Loeys-Dietz syndrome (LDS) is a rare autosomal dominant syndrome characterized by heterozygous mutations causing multisystemic alterations. It was recently described in 2005, and today at least six different subtypes have been identified. Classically presenting with aortic root enlargement or aneurysms and craniofacial and skeletal abnormalities, with specific arterial tortuosity at any site. The differential diagnosis of LDS includes atypical Marfan syndrome, vascular Ehlers-Danlos syndrome, Shprintzen-Goldberg craniosynostosis, and familial aortic aneurysm and dissection syndrome. CASE SUMMARY We present a case study of a 35-year-old female who came to the emergency department due to lower gastrointestinal bleeding and severe abdominal pain. Computed tomography revealed vascular tortuosity in almost every abdominal vein. CONCLUSION This case report will help us analyze the infrequent presentation of LDS type 4 and the numerous complications that it implies, underlying the importance of publishing more cases in order to expand our knowledge and offer better treatment for these patients. Differential diagnosis, clinical presentation and treatment options for this syndrome are discussed in this article.

Introduction: Breast cancer represents the most frequently neoplasm diagnosed in women. Early breast cancer (EBC) occurs in 36-50% of cases, with recurrence rates of more than 20% at 10 years in our country. Adjuvant chemotherapy reduces recurrence rates in high-risk patients. Oncotype Dx® values ​​the expression of 21 genes associated with recurrence. This study describes the characteristics of a third-level center population and its association with the risk of recurrence over a period of 10 years. Methods: A retrospective review of medical records of patients with early stage IA-IIB, hormone receptors (HR +) and HER2- breast cancer treated in our institution from January 2008 to December 2018 was conducted. Clinicopathological characteristics and Oncotype Dx® recurrence score (RS) were collected and a descriptive statistical analysis of the general variables was performed. Results: We included 136 patients with EBA clinical stage (IA-IIB), HR +/ HER2-, N0-1. Median age at diagnosis was 55.03 years (30-80), the most frequent histology in the general population was invasive ductal carcinoma (88.23%), 68.38% presented in stage IA. Patients were classified into recurrence risks according to the original description of the 21-gen expression test, 72 patients (53%) were classified as low risk (LR), 49 patients (36%) at intermediate risk (IR) and 15 (11%) patients at high risk (HR) of recurrence. For LR patients, mean age at diagnosis was 55.5 years (30-80), for HR patients the mean age was 51.9 years (32-79). Estrogen receptors (ER) were present in all patients. Progesterone receptors were positive in 97.2% of patients with LR and only in 69% in HR. 32% of LR patients expressed Ki-67 levels greater than 15% compared to HR (80%). Lymph node status was positive in 11.1% of LR patients, 30.6% for IR and 20% for RH, tumor size was >20mm (T2) in 18% of LR patients and 26.6% in the HR group. Lymphovascular invasion (LVI) was present in 25% of LR patients while for HR it was positive in 60%, similar findings were found for perineural invasion (PNI) with 20.8% present in LR and 33.3% in the HR group. Nuclear grade was higher in the HR group (20% grade 3) compared to that of LR (5.5%). When reclassifying the risk categories using the cut-off values ​​in TAILORx trial, the population distribution was modified, with a notable increase in the population in IR with 86 (63.2%) patients in this group, 28 patients in the LR group (20.5%) and 22 patients (16.1%) in HR. Conclusions: We reported the clinicopathological characteristics of a Mexican population and its distribution according to Oncotype Dx® risk groups. A higher rate of proliferation was observed by Ki-67 in the HR group, as well as a lower age of presentation, higher rates of LVI and PNI, and a higher nuclear grade. This findings agree with those reported in the literature. The update in the cut-off values ​​for the risk categories in TAILORx resulted in an increase in the proportion of patients at intermediate and high risk. Citation Format: Geovani Amador-García, Elina Alexandra Rodriguez-Meléndez, José Fabián Martínez-Herrera, Raúl Alejandro Andrade-Moreno, Eduardo Reyes-Sánchez, Daniela Vázquez-Juárez, Lorena López-Zepeda, Álvaro Padilla-Rodríguez, Guillermo Manuel Olivares-Beltrán, Alberto Villalobos-Prieto, Álvaro Aguayo-González, Fernando Pérez-Zincer, Christian Patricio Camacho-Limas, José Miguel Lázaro-León, Juan Alberto Serrano-Olvera, Raquel Gerson-Cwilich. Correlation between clinicopathological characteristics and oncotype Dx recurrence score (RS) in early breast cancer. Experience in a Mexican population [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-12.

e13053 Background: Breast cancer was the second most common malignant tumor diagnosed in 2018 worldwide, and the main cause of cancer death in women. In Mexico is the leading cause of cancer deaths, the most common molecular subtypes is HR+/HER2- (63%). The addition of iCDK 4/6 can enhance the benefit seen with endocrine therapy (ET) alone. In this work we will describe the experience in a “real world” model, of two tertiary-level hospitals in Mexico, with the use of iCDK 4/6 in a period of 3 years. Methods: Retrospective review of medical records of all consecutive pts with histological diagnosis of metastatic breast cancer HR+/HER2- and iCDK 4/6 treatment at our Institutions from July 2016 to January 2019. Clinical and pathological variables at diagnosis were recorded. Progression free survival was estimated using Kaplan-Meier method and survival distributions were compared using the Log-rank test. To assess association variables and progression we use Chi square. Results: 65 pts were treated, all with iCDK 4/6 in combination with ET, either aromatase inhibitor or irreversible estrogen receptor antagonist. 62 with palbociclib and 3 with ribociclib; Median age was 53 y/o (IQR 42-63), ECOG 0-1 (92.3%), 80% was metastatic recurrent disease, 92% of these patients received endocrine adjuvant treatment. Median estrogen receptor percentage was 90 (IQR 61-92), progesterone 50 (9-83), KI67 20 (10-30). The metastatic sites were bone (64.6%), liver (41.5%), nodal (33.8%), lung (21.5%), CNS (3.1%) and others (18.5%). 26 pts (40%) received iCDK 4/6 in the first line, 21 (32.3%) in the second line, and 27% in subsequent lines. Any grade of toxicity was presented in 44 pts (67.7%), Most common toxicities were neutropenia (63%), fatigue (16.9%), anemia (9.2%), grade 3-4 toxicities were presented in 21.5% and 17 pts (26.2%) required any dose adjustment. At the cut-off date, 28 pts (43.1%) had disease progression, median time to progression for the 65 pts was 10 months (1-84). OR for first line treatment vs subsequent lines was 0.14 (0.04-0.47, 95%, p = 0.001). OR for pulmonary metastases were 4.21 (1.15-15.31, 95%, p = 0.03), for other sites of metastasis were NS. Conclusions: Our outcomes suggest that the PFS is better when iCDK 4/6 are used as a first line treatment. Pulmonary metastases are may associated with poorly outcomes. In low- and middle-income countries, efforts should be focused on early therapy with iCDK 4/6.