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Objective: To determine the rheumatic manifestations associated with hematologic malignancies namely acute and chronic leukemia, Hodgkin's and non-Hodgkin's lymphomas, and multiple myeloma; and the markers correlating with their presence. Methods:Eighty patients with hematologic malignancies (28 leukemia, 28 lymphoma and 24 multiple myelomas) were evaluated and examined for the presence of rheumatic manifestations, clinically, radiologically, and by bone scan. Two groups of controls: clinical and laboratory (80 and 15 healthy individuals from the normal population respectively) were also studied. Routine laboratory tests and bone marrow aspiration were done for all patients, while serum rheumatoid factor (RF), antinuclear antibodies (ANA), creatine phosphokinase (CPK), and serum beta-2 macroglobulin were assessed as a marker for rheumatic manifestations in patients and controls.Results: Rheumatic manifestations were identified in 50 patients with hematologic malignancies (62.5%) and 21 clinical controls (26.3%) (p 0.001, odds ratio=4.7, and 95% confidence interval=2.4-9.2). Arthralgia and low back pain were the most significantly rheumatic manifestations associated with hematological malignancies in comparison with healthy controls (OR=15.4, and OR=3.4 respectively). Serum beta-2 macroglobulin was elevated in 38 patients (47.5%), rheumatoid factor was positive in 30 patients (37.5%), and ANA was found in 19 (23.7%) with a significant difference between patients and laboratory controls. 60 patients (75%) had radiological findings and 19 patients (23.75%) had an increased uptake in bone scan. Serum beta-2 macroglobulin was positively correlated with rheumatic manifestations (r=0.21, p=0.02), osteopenia in x-rays (r=0.24, p=0.03), and increased uptake in bone scan (r=0.41, p< 0.001). Conclusion:Rheumatic manifestations occur in 62.5% of patients with leukemia, lymphoma, and myeloma, significantly more commonly than in age and sex-matched controls. They may precede the other manifestations of malignancy (31.3%), occur during the course of illness (25%) or follow as a complication of chemotherapy (6.3%). Serum beta-2 macroglobulin is a useful laboratory test, being a marker for the presence of rheumatic manifestations and predicting osteopenia in x-rays and increased uptake in bone scan.

4770 BACKGROUND Relapse in the central nervous system (CNS) following initial treatment of diffuse large B-cell lymphoma (DLBCL) is an uncommon but fatal complication. However, the addition of rituximab improves the clinical outcome dramatically in DLBCL patients; its influence on CNS relapse is unproven. Aim This single centre retrospective study was conducted to investigate the incidence of CNS relapse, and to evaluate the impact of adding rituximab to standard CHOP (RCHOP) regimen without CNS prophylaxis in patients at risk of CNS relapse. PATIENTS AND METHODS All patients with DLBCL diagnosed from April 2002 to December 2007 at sunnybrook cancer center were retrospectively identified in the Cancer Database. Patients were included if they were >16 years old, had advanced stage (stage III /IV, or stage I /II with B symptoms, elevated LDH or bulky disease, were treated with RCHOP regimen with curative intent and were free of CNS involvement at diagnosis. CNS relapse was diagnosed by CSF cytology, radiology or clinically. Results A total of 155 patients were newly diagnosed with DLBCL and treated with RCHOP only. 22 pts were excluded, 20 had CNS prophylaxis and 2 pts had CNS involvement. 133 pts were eligible (69 male and 64 female) Median age was 64 (Age'60 was 59.4%). Stage III/IV was 69.9%. LDH was elevated in 59.4%. Bone marrow (BM) involvement and Extra nodal “>2 were 18.05% and 25.6% respectively. EN sites were: (liver 4.5%, Bone 6.8%, Pulmonary 4.5%, kidney 3.01%, cardiac 1.5%, intestine 2.3%, testicular 1.5%). The International Prognostic Index was high-intermediate/high in 55.6%. Pathologically transformed was 12.03% and were transformed from indolent histologies. BCL2 was positive in 65.4%, BCL6 was 48.9%, CD10 was positive in 49.6%, Ki-67 was >80% in 25%. All patients received RCHOP (Median 6 cycles, (range 2-8). Overall response (ORR) was 88.6%, CR/CRU 72.7% with a median follow up 24.6 months (range 2.6-75.5). 28 patients (21.05%) relapsed systemically. Two patients (1.5%) had a CNS relapse 1 brain parenchyma and 1 leptomeningeal one month after systemic relapse. The median time to CNS relapse was 10.4 mos (6.24-14.5 mos). In univariate risk factor analysis (LDH (p=0.8), IPI>3 (p=0.9), No of EN (p=0.9). Actuarial 5 y Overall Survival (OS) was 67.3% (95% CI (57-77%) and progression free Survival (PFS) was 65.7% (95% CI (52.3-78.6%). Conclusion Our data suggest that the addition of rituximab may reduce the risk of CNS relapse for poor risk patients likely through systemic control. Future prospective studies of rituximab-containing chemotherapies with CNS prophylaxis are warranted Disclosures: No relevant conflicts of interest to declare.