No abstract

： PcALCL mainly concerns elderly patients. It is a large CD30+ T-cell neoplasm composed of large cells with anaplastic, pleomorphic or immunoblastic morphology, with exclusively cutaneous onset and localization. The clinical course of pcALCL is predominantly indolent. Most elderly patients with lymphoma tend to have a sedentary lifestyle, which has a negative effect on their quality of life (QoL) and on their survival. Several studies indicate that exercise has a positive impact on QoL because it reduces peak oxygen consumption, improves physical capacity, increases self-esteem, reduces accumulated stress and promotes relaxation. Therefore, particularly in indolent lymphomas, it is necessary to indicate a program of physical activity to be practiced systematically. The complete surgical excision and local radiotherapy are the first line gold standard in pcALCL with solitary lesion.

2296 Background: Comorbidity in cancer has been shown to be a major determinant in treatment selection and survival. The most used instrument for measuring comorbidity in Hematology is the Charlson comorbidities index (CCI). It is a list of 19 conditions with weight assigned from 1 to 6, derived from relative risk estimates of a proportional hazard regression model using clinical data. The ACE-27 is a 27 item comorbidity index for patients with cancer and assign weights from 1 to 3 based on the dysfunction grade of each condition. Little is known about the impact of comorbidity in chronic myeloid leukemia (CML). Aims: Our objectives were to evaluate the impact of comorbidity in the outcomes of a cohort of chronic phase chronic myeloid leukemia (CP-CML) patients (pts) treated with imatinib and compare the results from the 2 indexes (CCI and ACE-27). Methods: We conducted a retrospective study in a cohort of patients with CP-CML from a south Brazilian database. All patients received imatinib 400mg as first or second-line therapy. Patient evaluation and response criteria followed the European LeukemiaNet recommendations. Comorbidity conditions were registered at any point during evaluation and CCI and ACE-27 scores were applied to each patient. The outcomes were event-free survival rate (EFS) and imatinib temporary suspension rate. EFS was measured from the start of imatinib to the date of any of the following events while on therapy: death from any cause, loss of complete hematologic response, loss of complete cytogenetic response, discontinuation of therapy for toxicity or lack of efficacy, or progression to accelerated phase or blastic phase. Imatinib suspensions were considered if superior to 20 days. We conducted 3 types of analysis concerning treatment suspension: suspension for any reason (toxicity and nonadherence), suspension only due to toxicity and only due to nonadherence to treatment. Results: We analyzed data from 185 pts with CP-CML diagnosed since 1990. The median age at diagnosis was 48 years (range 4 – 85). The median time from diagnosis to imatinib was 7 months (range 0 – 178) and 29% of pts had more than 12 months lapse. Prior therapy with interferon was used in 70% pts. CCI distribution among pts: score point 0 was assigned to 136 pts, score point 1 to 24 pts, score point 2 to 11 pts, score point 3 – 6 to 13 pts and 1 pt with missing information. ACE-27 distribution among pts: score point 0 was assigned to 92 pts, score point 1 to 51 pts, score point 2 to 21 pts, score point 3 to 19 pts and 2 pts with missing information. The indexes showed a strong correlation (Spearman's coefficient 0,7, P<0,0001). The projected EFS rate at 4 years was 68% after a median follow-up time of 4 years. We found a significant association between both indexes and EFS rate at 4 years. The EFS in each group of ICC was: 73% in score 0 group, 65% in score 1 group, 41% in score 2 group and 36% in score 3 to 6 group (P=0,04, Fig 1). The EFS in each group of ACE-27 was: 80% in score 0 group, 69% in score 1 group, 56% in score 2 group and 33% in score 3 group (P<0,001, Fig 2). A significant association between both indexes and drug temporary suspension rate was also found. For the CCI, 32% of score 0 pts had at least one suspension due to any reason, compared to 41% of pts with score 1, 46% of pts with score 2 and 73% of pts with score 3–6 (P=0,04). Subgroup analysis revealed a significant association between CCI and interruption due to toxicity (P=0,03) and due to nonadherence (P=0,03). For the ACE-27, 32% of score 0 pts had at least one suspension due to any reason, compared to 36% of pts with score 1, 27% of pts with score 2 and 69% of pts with score 3 (P=0,03). Subgroup analysis revealed a significant association between ACE-27 and interruption due to toxicity (P=0,02) but not due to nonadherence (P=0,69). Conclusions: In our population of pts with CP-CML, event-free survival, imatinib toxicity and nonadherence seem to be associated with the presence of comorbidities. Both CCI and ACE-27 can be used in the stratification of patients at risk to have major toxicities, lack of adherence or an event during treatment with imatinib. ACE-27 was a better tool in predicting EFS, in the other way, CCI was superior in predicting nonadherence. Disclosures: No relevant conflicts of interest to declare.

Linfoma não-Hodgkin de cordão espermático Linfoma não-Hodgkin de cordão espermático Linfoma não-Hodgkin de cordão espermático Linfoma não-Hodgkin de cordão espermático Linfoma não-Hodgkin de cordão espermático Non-Hodgkin's lymphoma of the spermatic cord Non-Hodgkin's lymphoma of the spermatic cord Non-Hodgkin's lymphoma of the spermatic cord Non-Hodgkin's lymphoma of the spermatic cord Non-Hodgkin's lymphoma of the spermatic cord MARCELO Este estudo apresenta um novo caso de linfoma de cordão espermático, tratado com orquiectomia radical e quimioterapia adjuvante, com remissão completa da doença. Hoje se encontra com quatros anos e meio de seguimento, sem evidência clínica recidiva, pois os exames de imagem apresentam-se normais. RELATO DO CASO RELATO DO CASO RELATO DO CASO RELATO DO CASO RELATO DO CASOPaciente masculino, branco, 71 anos, procurou o Serviço de Urologia com queixa de abaulamento em região inguinal esquerda, indolor, com seis meses de evolução. Ao exame apresentava massa de consistência endurecida, indolor, localizada no trajeto inguinal esquerdo, aderida ao cordão espermático. Testículos normais à palpação. Negava história familiar de neoplasia.A ultra-sonografia evidenciou massa paratesticular heterogênea, em topografia de cordão espermático, sem envolvimento de testículo ou epidídimo.O paciente foi submetido à operação, com abordagem pela via inguinal esquerda, sendo evidenciada massa endurecida aderida ao cordão espermático com aproximadamente 4,5 cm de diâmetro longitudinal (Figura 1). Procedeu-se à orquiectomia radical com ligadura precoce do cordão espermático. O pós-operatório evoluiu sem intercorrências, tendo recebido alta no primeiro dia de pós-operatório.O estudo anátomo-patológico confirmado por imuno-histoquímica revelou linfoma de funículo espermático, não-hodgkin, linhagem B, difuso e de grandes células (R.E.A.L.) com margens cirúrgicas livres sem envolvimento do testículo ou epidídimo (Figura 2).Realizou-se investigação complementar com biópsia de medula óssea normal e tomografia computadorizada de tórax e abdome que não revelaram alterações.O paciente foi encaminhado para quimioterapia adjuvante que foi realizada com Ciclofosfamida, Doxorrubicina, Vincristina e Prednisona (CHOP) com remissão completa da doença e atualmente encontra-se com quatros anos e meio de seguimento, sem evidência clínica de recidiva e com exames de imagens normais. DISCUSSÃO DISCUSSÃO DISCUSSÃO DISCUSSÃO DISCUSSÃOA revisão dos 14 casos de linfoma primário do funículo espermático relatados na literatura internacional mos- O linfoma primário do funículo espermático acomete homens entre 20 e 89 anos 1,3 e o diagnóstico diferencial é feito com outros tumores benignos ou malignos da região inguino-escrotal, funiculites e criptorquidia 3 . Okabe et al revisando 14 casos verificaram que 12 estavam no estágio I, um no estágio II e um no estágio IV, sendo todos os linfomas não-hodgkin, linhagem B. A ocorrência rara do linfoma do cordão espermático dificulta o seu estudo e o estabelecimento de uma padronização qu...

2300 Introduction: Imatinib mesylate (Gleevec) treatment for Chronic Myelogenous Leukemia (CML) was first introduced in Brazil in 2003, initially used as second line therapy for patients resistant or intolerant to interferon. In 2004 imatinib was adopted as front-line therapy for chronic phase (CP) and clinical experience improving since then. Close monitoring of responses achievement at scheduled time has proven to provide good predictive value for progression and event-free survival. Failure and sub-optimal responses correspond to indications for dose change or therapy switching and the identification of patients at greater risk for such events has a vital role. The aim of this study is to evaluate the impact of temporary imatinib therapy discontinuation on achievement of Major Cytogenetic Response (MCyR) and event-free survival (EFS). Materials and Methods: During the period of 1990 to 2010 a total of 185 patients from 7 CML treatment centers from Rio Grande do Sul, south Brazil, with a confirmed diagnosis of CML (Philadelphia chromosome positive [Ph+]) at CP under imatinib treatment were retrospectively analyzed. A major cytogenetic response was considered complete plus partial cytogenetic responses (Ph+ less than 35%). At least 20 metaphases were analyzed for a cytogenetic response to be evaluable. Temporary treatment discontinuation (TTD) corresponds to 20 days or more off-medication for any reason during the follow-up. Were included patients in imatinib second-line and first-line therapy. Early-imatinib treatment was considered when imatinib started before 12 months from diagnosis and late-imatinib treatment when more then 12 months lapse. EFS was measured from the start of imatinib to the date of any the following events while on therapy: death of any cause, therapy failure, any response loss, disease progression, definitive treatment discontinuation or therapy change. Descriptive statistics and Kaplan-Meier analysis (to estimate event-free survival [EFS]) were performed using SPSS software. Results: The median age at diagnosis was 48 years (range, 4–85 years) median of follow-up was 47 months (range, 7–113 months) and 55% of male sex. Preferential previous treatment was interferon in 70% of the patients and 71% were early-imatinib treatment. TTD was observed in 63/185 patients (34%) and was related to toxicities in 35/63 patients (55%), including hematological and non-hematological. Nonadherence was attributed to the remaining TTD, 28/63 patients (44%). Late-imatinib patients had significant more TTD (62%) than early-imatinib patients (26,2% [p<0,001]). Subgroup analyzes showed that was a significant TTD rate due to toxicity in the late-imatinib patients (p=0,03), but not significant due to nonadherence (p=0,37). Patients who experienced TTD had lower proportion of MCyR at 12 months: only 43% compared to 70% of patients who did not had TTD (p<0,001 [Figure 1]). Finally the TTD had a relevant negative impact on EFS in 5 years. In the group who had TTD EFS was 47,5%, compared with 73% in the group without TTD (p=0,002 Figure 2). Conclusion: In our cohort, patients with TTD were associated with lower rate of MCyR and it may be a risk factor for failure or sub-optimal responses to imatinib therapy. TTD also has a negative effect in terms of EFS in patients under imatinib treatment, possibly related to worsen cytogenetic disease control. The late onset of imatinib therapy correlates with more toxicity leading to treatment interruptions and front-line imatinib therapy should be started as soon as possible. Special attention should be given to patients who presents with side effects of any nature that could preclude the correct use of the medication. Close monitoring and early management of such adverse reactions, frequent assessment of compliance should be warrant as effort to guarantee the best chance for therapy success. Disclosures: No relevant conflicts of interest to declare.