The role of cytarabine-based induction and autologous stem cell transplantation (ASCT) in front-line treatment of younger patients with mantle cell lymphoma (MCL) is well established, however the utility of intensive approaches in older patients remains unclear. This retrospective study compared first line treatment outcomes in patients aged 60 years or more, treated at six tertiary centres between 2000–2015. 70 patients included had a median age of 69 (60–91) and most (94%) demonstrated advanced stage disease. Treatment regimens included: R-CHOP-like (n = 39), alternating R-CHOP/R-DHAC (n = 10), R-HyperCVAD/R-MA (n = 7), R-CHOP/Cytarabine (Nordic Protocol) (n = 10) and other (n = 4). 16 patients underwent an ASCT. The median follow-up for surviving patients was 37 months. Compared to R-CHOP-like therapies, cytarabine-based regimens were associated with an improved overall response rate (ORR) of 70% vs 33% (p < 0.001) and overall survival (OS) (HR 0.541, [0.292–1.001], p = 0.05). No difference in efficacy between different cytarabine-based regimens was detected, but R-HyperCVAD/R-MA was associated with increased hospitalisation and transfusion requirements. Patients undergoing ASCT demonstrated an improved median OS (HR 0.108 [0.015–0.796], p = 0.029) but were significantly younger. These results reaffirm the use of cytarabine in MCL for selected patients aged over 60. Such regimens should be strongly considered for this population in frontline therapy.

Patients with acute leukemia frequently develop catheter-related thrombosis (CRT) despite concurrent thrombocytopenia. The incidence, treatment and outcomes of this complication are poorly documented. We undertook this study to determine the incidence of CRT in patients with acute leukemia and assess the safety and effectiveness of a treatment strategy using a platelet-adjusted low molecular weight heparin (LMWH) dosing protocol. Patients (18 years and older) with newly diagnosed acute leukemia from January 2014 to December 2015 who received central venous catheters were included. The clinical data were reviewed up to 12 months from acute leukemia diagnosis to capture objectively documented CRT events. The outcome events including recurrent venous thromboembolism (VTE), bleeding events, infectious or mechanical complications, and death were reported up to 3 months from the time of CRT diagnosis. The incidence of CRT among 214 patients was 10.7% (23 patients) in the first 12 months after acute leukemia diagnosis. Among 18 patients who were treated with anticoagulation, 14 (78%) received reduced LMWH dosing due to concurrent thrombocytopenia. There were no recurrent VTE episodes, but 3 patients experienced bleeding events while on anticoagulation. Fifteen patients (83%) completed a minimum of 3 months anticoagulation. Twelve patients (52%) experienced an infectious complication, which was the main reason for catheter removal. Deaths occurred in 2 patients, related to underlying acute leukemia during 3 months period following CRT. Symptomatic CRT is frequent in patients with acute leukemia. Platelet-adjusted LMWH dosing may be effective and well tolerated despite thrombocytopenia.

Background Bone marrow biopsy (BMB) is an accepted investigation in fever of unknown origin (FUO) to uncover haematological malignancies, such as lymphoma, and sometimes infections. With the advance in imaging modalities, such as 18‐fluoro‐2‐deoxyglucose positron emission tomography (FDG‐PET) to identify the focus of lymphoma, BMB may not contribute to the diagnosis when there are no other clinical features to suggest an underlying haematological disease. Aim To investigate the utility of BMB in determining the cause of FUO, when there are no other indications for BMB. Methods Medical records of adult patients who had BMB performed for FUO or febrile illness from 1 January 2005 to 31 December 2014 in four metropolitan tertiary hospitals in Melbourne, Australia were reviewed. Patients with other concurrent indications for BMB, known human immunodeficiency virus infection and previously diagnosed connective tissue diseases were excluded. Results Seventy‐three patients were included in the study. Fifty‐one patients had a final diagnosis for fever (systemic inflammatory diseases, infective, malignancy or other) while 22 patients had no diagnoses. In only 10 patients (13.7%) did BMB contribute to the diagnosis, finding either malignancy or granulomata. However, all these diagnoses could have been made without BMB. Two patients with diffuse large B‐cell lymphoma had normal BMB. FDG‐PET was helpful in making a diagnosis in eight (25%) out of 32 patients. Conclusion Performing BMB in patients with FUO and no other haematological abnormalities is of very limited value, and other investigations, such as FDG‐PET, may be more likely to help establish a definitive diagnosis.

No abstract

Introduction While the role of cytarabine-based immunochemotherapy (ICT) and autologous stem cell transplantation (ASCT) in untreated younger patients with MCL is well established, the utility of 'more intense' approaches in older patients is uncertain. Despite a median age at presentation of 60 years or more there are few therapeutic trials focussing on older patients. With the development of targeted agents, the need to define the optimal ICT strategy for comparison is pressing. Methods The primary aim of this study was to compare the safety and efficacy of first line ICT based therapy in patients with MCL aged over 60 years. Treatment and outcome data were collected for patients treated between 2000-2015 across a combined health-care network servicing the south-eastern, south-western and central corridor of the Australian state of Victoria (catchment area >2 million patients encompassing four major academic tertiary referral centers). Eligible patients had MCL diagnosed according to WHO 2008 criteria, confirmed by either fluorescence in situ hybridization for t(11;14) translocation or immunohistochemistry for cyclin D1 expression. Only cases with adequate information, including baseline characteristics, treatment regimens and outcome, were included. Overall survival (OS) and progression free survival (PFS) were modelled using Cox regression. For ICT comparison, patients undergoing ASCT were censored at the time of transplant. Differences in hospitalization and transfusion were analyzed using the Mann-Whitney U test. Results 52 patients met inclusion criteria with a median age of 69 (range 60-91; M/F >3:1), of which 23 patients were >70 years. Most patients had advanced disease on staging, >1 extra-nodal site and an intermediate-high MIPI score. All received rituximab with initial therapy. Treatment regimens included: R-CHOP-like (31), alternating R-CHOP/R-DHAC (10), R-HyperCVAD/R-MA (7) and other (4). Eleven patients underwent ASCT. The median follow up for surviving patients was 40 months. Type of chemotherapy and up-front ASCT were the only variables influencing PFS and OS. Cytarabine-based ICT was associated with an improved median PFS (not reached vs 35 months, HR 0.27 [0.08-0.93], p=0.018) and OS (not reached vs 54 months, HR 0.28 [0.08-0.94], p=0.039) compared to R-CHOP-like regimens. Patients undergoing ASCT were younger (mostly < 70 years) and demonstrated improved median OS (not reached vs 46 months, HR 0.124 [0.017-0.921], p=0.041). No statistically significant difference in efficacy between R-HyperCVAD/R-MA and R-CHOP/R-DHAC could be determined due to low numbers. Both group of patients receiving cytarabine demonstrated durable response over time. However, those receiving R-HyperCVAD/R-MA experienced greater toxicity with increased hospitalisation: median 54 [31-72] v 20 [6-77] days, p=0.023 and transfusion requirements: median 13 [7-24] v 2 [0-5] red cell units, p=0.001; median 6 [2-15] v. 0 [0-1] platelet pools, p=0.001. Conclusion In older patients with previously untreated MCL, cytarabine-based ICT resulted in a significant improvement in OS, with a 72% reduction in the risk of death relative to CHOP-like therapy. Cytarabine-based ICT is highly efficacious and well tolerated and should serve as a benchmark with which to compare targeted therapies. ASCT should also be considered in selected older patients. Table Table. Disclosures Quach: Amgen: Membership on an entity's Board of Directors or advisory committees; Janssen Cilag: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Opat:Roche: Consultancy, Honoraria, Other: Provision of subsidised drugs, Research Funding.