A 44-year-old male with Ph+ chronic myeloid leukaemia (CML) underwent histoidentical allogeneic bone marrow transplantation 18 months after initial diagnosis. He received pretransplant conditioning with busulphan and cyclophosphamide (Bucy). GVHD prophylaxis consisted of methotrexate, cyclosporine (CsA) and methylprednisolone. On day +50, he developed a microangiopathic haemolytic anaemia with indirect bilirubinaemia, 10% fragmented red cells (FC) and an elevated LDH (1213 U/l: normal range 100-185 U/l). Clinical symptoms consisted of edema and hypertension. The patient was not febrile and had no neurological changes. A clinical diagnosis of severe (grade 4) multifactorial (acute GVHD, CMV infection and cyclosporine) BMT-TM was made. He responded following 19 plasma exchanges with replacement with fresh frozen plasma.

Introduction: the second neoplasm, are pathologies described during the post transplant evolution, often associated to immunosuppression. The post transplant lymphoproliferative syndromes, habitually associated to viruses are the most frequent. The BMT is a procedure clearly different from the rest of the transplants, and this difference would also be observed on the incidence and type of tumor in its evolution. The incidence of second malignancies after BMT is low, and is related to the use of chemotherapy, particulary alkylating. agents radiotheraphy and immunosuppression. Objective: To analyze the incidence and characteristics of second neoplasm of the patients undergoing BMT in our Institute. Results: Between 06/93 and 04/05 over a total of 416 transplants, 132 Allogenic and 284 Autologous, 6 cases of second tumor in variable intervals post procedure were stated. Table 1. The data reflects an incidence of second neoplasias of 1,4% (6/416). None of then received radiotherapy in conditioning. No lymphoproliferative syndrome was observed; 2 cases of acute leukemias; being the rest solid tumors with expected evolutions for each pathology. Table 1 Case Disease Conditioning BMT 2nd Tumor Time betwen BMT-Tumor Evolution 1 MM L-PAM AUTO Lung Cancer 120 months Dead 2 CML BuCy ALLO Colon Cancer 72 months Dead 3 MDS BuCy ALLO Merckel cells tumor 60 months Dead 4 NHL CBV AUTO AML 65 months Dead 5 NHL CBV AUTO Bladder Cancer 58 months Alive 26 months 6 NHL CBV AUTO AML 4 months Dead

e10214th International Congress on Infectious Diseases (ICID) Abstracts demic. The last of these is called Swine flue (influenza A H1N1), which since its inception has caused great alarm, high morbidity and mortality especially in pregnant women. This is a sample of the features of the disease in Dominican Republic.Dominican Republic is a tropical country located in the Caribbean that receive substantial annual number of tourists, which makes influenza outbreaks throughout the year: both seasonal peaks in the northern and southern hemisphere.Methods: The Epidemiology National Program starts a surveillance since the epidemic arise at level 5, at epidemiological week 16.Diagnosis confirmation was made with rt-PCR for A H1N1 to all symptomatic respiratory cases.Results: Until the 40th epidemiology week, we have 2,664 suspicious cases, 997 (37%) hospitalized, 441 confirmed cases, from this 191 (45%) hospitalized, and 22 (5%) death, 76 (17%) cases were pregnant women with 16% mortality.Clinical manifestations were: fever (94%), cough (89%), nasal congestion (76%), headache (71%), muscle pain (67%), sore throat (60%), dyspnoea (45%), nausea (25%), rales (21%), vomiting (18%) and diarrhoea (11%).Pregnancy was one of the more important risk factor associated with mortality.Necropsy findings where: edema, hemorrhage and necrosis in lung tissues, frequently associate with intravascular thrombosis.High mortality was cause due a delay in search of medical attention and no suspected diagnosis from health cares personel.Conclusion: It must be increased the Primary Care Services to obtain an early diagnosis of the disease, and began the antiviral treatment in high risk populations, when this pathology is suspected, mostly in pregnant women.

Ahmad et al presented their experience with four VADrefractory patients under autologous transplantation program who were salvaged with VAD plus thalidomide.

4582 Introduction: Introduction of imatinib mesylate has changed the approach towards bone marrow transplantation in Chronic Myeloid Leukemia (CML). Historically considered as a curative therapeutic option, with a probability of disease free survival ranging from 40 to 60%. Its indicated use has been restricted to patients with treatment failure to prior tyrosin-kinase inhibitors or blast crisis. Objective: To assess the outcome of patients with CML who undergo BMT Materials and methods: 66 patients who underwent allogeneic BMT between the years 1994 and 2011 in two health care facilities were analyzed. 63 (93%) were performed between 1994 and 2005. At the time of transplantation, patient status was: 56 patients in 1st Chronic Phase and 10 in advanced phases. Fourteen patients received Unrelated Donor BMT and 37 had Related Donor BMT. Transplant risk was assessed, based on the European Bone Marrow Transplantation (EBMT) score (sc). The conditioning regimens which were used included: for patients in chronic phase, cyclophosphamide (Cy) and busulfan (Bu) and for patients in accelerated phase etoposide (VP 16) was added to the previous regimen, and for unrelated donors BuCy + ATG or alentuzumab was used. Prophylaxis for Graft vs Host Disease (GVHD) was performed with a two-drug regimen (cyclosporine, methotrexate), with or without methylprednisone. Result: 66 patients were recorded (28 female/38 male), with a mean age of 35 years at the time of transplantation (range 8–55). The source of Stem Cell was bone marrow in 60 patients and peripheral blood in 6 patients. 43% of patients developed GVHD: (29 patients) according to clinical criteria established by the European Cooperative Group. Overall Survival (OS) was 50% with a mean follow-up of 48 months. Analyzed according to the EBMT risk score, OS was 64% in the 0–2 score group and 31% in patients with a 3–5 score. Procedure-related mortality was 16%, and the most frequent causes included: hepatic veno-occlusive disease, infections, GVHD, and graft failure. Conclusions: BMT in patients with CML has been substantially reduced since the introduction of tyrosin-kinase inhibitors. In our experience, this shows its healing potential with an extended follow-up and a prolonged survival. Disclosures: No relevant conflicts of interest to declare.