Venous thromboembolism (VTE) is a leading cause of death among outpatient chemotherapy patients. However the VTE preventive measures for outpatients are not widely advocated. We did a meta-analysis to evaluate the outpatient VTE prevention's effectiveness and safety. We searched electronic databases until the end of December 2012 and reviewed the abstracts and manuscripts following the PRISMA guidelines. Occurrence of first VTE event was the efficacy outcome. The safety end point was major bleeding. We calculated Q statistic and a homogeneity formal test. The odds ratio (OR) estimates were pooled by using the Mantel–Haenszel fixed-effects method in the absence of heterogeneity. Data were analyzed using the R META package). We identified 1,485 articles and reviewed 37 articles based on initial screening. The number of patients included in 11 selected trials was 7,805. The odds of VTE was lower in the prophylaxis group (OR 0.56; 95 % CI 0.45–0.71) and improved when heparin-based prevention was analyzed (OR 0.53; 95 % CI 0.41–0.70). We found strong prevention among patients with lung cancer (OR 0.46; 95 % CI 0.29–0.74) and pancreatic cancer (OR 0.33; 95 % CI 0.16–0.67). Major bleeding events were frequent in the intervention group (OR 1.65; 95 % CI 1.12–2.44). Thromboprophylaxis reduced VTE episodes. The VTE events were reduced by 47 % in heparin-based prophylaxis trials compared to placebo. The patients receiving heparin-based prophylaxis had a 60 % increase in bleeding events. Improving risk stratification tools to personalize prevention strategies may enhance the VTE prevention applicability in cancer patients.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and usually occur in the stomach and the small intestine. The pancreas is an extremely rare primary site for GISTs and there are 25 reported cases of pancreatic GIST with most being treated with surgical resection. We describe a 52-year-old African-American female who was diagnosed with limited stage small cell carcinoma in November 2009 and treated with concurrent cisplatin/etoposide chemotherapy and radiation. She subsequently achieved complete remission. Two years later she was diagnosed with localized pancreatic GIST by endoscopic ultrasonography guided fine needle aspiration. We treated her with a tyrosine kinase inhibitor (TKI) imatinib 400 mg oral dose daily as she declined surgery. Her disease is stable based on computed tomography imaging scans 40 months after diagnosis without any metastasis. To the best of our knowledge, our case is the second case of localized pancreatic GIST treated with TKI monotherapy.

Background The overall prognosis for most acute myeloid leukemia (AML) patients remains poor with only 50-55% of patients achieving durable remission. The majority of adult patients (pts) who do achieve remission, will ultimately need allogeneic stem cell transplant (allo-SCT) to achieve long term survival. Treatment of AML requires intensive therapy, transfusion support, antimicrobials, and repeated admissions to the hospital. Limited data is available comparing epidemiology and treatment according to the distance from patient residence to treatment center. Oklahoma University Health Sciences Center (OUHSC) is the major tertiary center for Oklahoma residents to receive treatment for AML. Few patients receive AML treatment from distant states or oversea areas. We describe a retrospective analysis of adult pts with AML treated at our institution evaluating impact on distance from center. Methods From January 2000 to June 2011,we identified a total of 269 patients with 217 meeting inclusion criteria for the study. We then performed an analysis of variance (ANOVA) on the relationship between distance to treatment center (in miles) and relapse rate or remission rates. Kaplan-Meier method was used to estimate survival rates. Age and cytogenetics were identified as the major confounders. A Cox Proportional Hazards model on overall survival (OS) was implemented using the independent variables age category ( ≤60 and > 60), cytogenetic risk status (groups were divided into favorable, intermediate and unfavorable risks), and distance to treatment center. Statistical analysis was performed using SAS 9.2 software (SAS Institute Inc.). Fisher’s exact test was used to compare patients in the different groups. Results Of the 217 pts (52.2% Males, 47.8% Females) included in the study, 81.5% were white, 9.0% African American, and 6.2% Native American. Median age at diagnosis was 51.0 years. Median distance to treatment center was 62 miles (range: 0-420). Distance of residence to treatment center was significantly related to complete remission rates, with patients living at longer distances having lower chances of achieving complete remission( p = 0.03). Distance from residence to treatment center however was not related to the risk of having relapsed disease (p = 0.22). A Cox proportional hazard model was performed including distance to travel, age and cytogenetic risks (unfavorable versus intermediate or favorable) and revealed that all three variables are associated with a trend towards shorter overall survival (p <0.1). Conclusions In this present study, we have identified that distance from residence to treatment center as a risk factor for achieving lower complete remission rate with no significant effect on the risk of relapse. There was a trend toward lower overall survival for those who live at longer distance from center. Further analysis of this dataset will identify the impact of other pretreatment variables on the distance to treatment center by performing a multivariate analysis. Larger studies are needed to further explore the impact of distance to treatment center on outcome in patients with AML. Disclosures: No relevant conflicts of interest to declare.

Background: Various demographic, clinical and cytogenetic factors have been shown to affect the outcome of patients with acute myeloid leukemia (AML). Some of these risk factors are well-described with performance status and patient age being principal predictors of early death while cytogenetic and molecular factors allow stratification into prognostic categories. However, several critical factors have not been adequately assessed. Typically AML patients treated with standard induction chemotherapy will have cytopenias requiring intervention. Often the neutropenia is prolonged and results in neutropenic fevers and a high risk of infections. We hereby describe a single institution retrospective analysis at the University of Oklahoma Health Sciences Center (OUHSC) in which we evaluate the effect of duration of days with at risk absolute neutrophil (ANC) and absolute lymphocyte counts (ALC) and the occurrence of neutropenic fever on survival and response rates of AML patients. Methods: This is a retrospective chart review of AML adult patients who were diagnosed and treated at OUHSC between 2000 and 2014 and were undergoing initial induction chemotherapy. Outcomes of interest were overall survival (OS), event free survival (EFS: in case of relapse or death) and complete response (CR). Variables of interest wereneutropenic fever, and duration of decreased ANC and ALC counts (ANC&lt;500, ANC&lt;100, ALC&lt;500, ALC&lt;100). Institution policy did not allow granulocytes colony stimulating factors use because of the interference with bone marrow aspirate results. Nonetheless it was rarely used in few cases of septic shock, so this variable was not included in this analysis. Descriptive and bivariate analyses were conducted to evaluate the variables of interest and the outcomes.Models were used to assess the relationship between the variables of neutropenic fever, duration of decreased counts (ANC&lt;500, ANC&lt;100, ALC&lt;500, ALC&lt;100) and the outcome of interest after adjusting for age, race, gender, risk group andwhite blood count (WBC). Multivariable Cox proportional hazard models were used for OS and EFS and multivariable logistic regression models were used for CR. SAS 9.4 was used for all analyses. An alpha of 0.05 was used. Results: A total of 153 patients were analyzed. Mean age was 50 years, 35.7 % female, 64.3% male. Based on cytogenetics 16.9% were in favorable category, 28.6% in intermediate, 25.3% in unfavorable risk group, and 29.2% unknown. Mean number of weeks with ANC &lt;500 was 3.58 (25 days), ANC &lt;100 was 2.81 (20 days), ALC &lt; 500 was 4.47 (31 days), ANC &lt;100 was 3.24 (23 days). Incidence of neutropenic fever was 86.9%. Total number of positive cultures was 55.2%, of which 78.3% were bacterial, 25.3% fungal and 7.7% viral.After adjustment for age, race, gender, WBC and risk group, both neutropenic fever and duration during which ANC &lt; 100 were associated with worse OS (p value &lt;0.05) while duration of ANC&lt; 500 was not significant (p value &lt; 0.0576). When we considered EFS, the duration where ANC&lt;500, ANC &lt;100, and neutropenic fever occurrence were significant (p value &lt;0.05).The hazard ratio of death is 3.15 for those with neutropenic fever compared to those without.With regard to CR, duration of ANC &lt; 100 was significant (p value 0.0272). The duration of ALC &lt;500 or &lt;100 was not significant for OS nor EFS. Examining duration of neutropenia, for every week with ANC &lt;500, there was a 9% higher hazard ratio of death after adjusting for other covariates. Conclusion: In this single-institution, retrospective study, we identified that the duration of neutropenia along with the presence of neutropenic fever during induction therapy adversely affected OS and EFS. Shorter duration of neutropenia significantly correlated with CR. Duration of days with ALC count &lt;500 was not predictive of OS nor EFS. Larger studies are needed to examine the prognostic significance of neutropenia duration and its relationship to OS and CR. Neutropenia duration during induction chemotherapy may be an important risk factor in making decisions regarding future treatments including allogeneic transplant tolerability and aggressiveness of consolidation chemotherapy.It is important to look at this variable in more intensive induction regimens (using higher dose of cytarabine or adding a nucleoside analogue) as prolonged neutropenia may be a marker of poor general health rather than the induction regimen. Table 1 Table 1. Disclosures No relevant conflicts of interest to declare.

BackgroundBody composition alterations are frequent in patients with cancer or chronic liver disease, but their prognostic value remains unclear in many cancer entities.ObjectiveWe investigated the impact of disease aetiology and body composition after surgery for intrahepatic cholangiocarcinoma (iCCA), a rare and understudied cancer entity in European and North American cohorts.MethodsComputer tomography‐based assessment of body composition at the level of the third lumbar vertebra was performed in 173 patients undergoing curative‐intent liver resection for iCCA at the Department of Surgery, Charité – Universitätsmedizin Berlin. Muscle mass and ‐composition as well as subcutaneous and visceral adipose tissue quantity were determined semi‐automatically. (Secondary) sarcopenia, sarcopenic obesity, myosteatosis, visceral and subcutaneous obesity were correlated to clinicopathological data.ResultsSarcopenia was associated with post‐operative morbidity (intraoperative transfusions [p = 0.027], Clavien–Dindo ≥ IIIb complications [p = 0.030], post‐operative comprehensive complication index, CCI [p < 0.001]). Inferior overall survival was noted in patients with myosteatosis (33 vs. 23 months, p = 0.020).Fifty‐eight patients (34%) had metabolic (dysfunction)‐associated fatty liver disease (MAFLD) and had a significantly higher incidence of sarcopenic (p = 0.006), visceral (p < 0.001) and subcutaneous obesity (p < 0.001). Patients with MAFLD had longer time‐to‐recurrence (median: 38 vs. 12 months, p = 0.025, log‐rank test). Multivariable cox regression analysis confirmed only clinical, and not body, composition parameters (age > 65, fresh frozen plasma transfusions) as independently prognostic for overall survival.ConclusionThis study evidenced a high prevalence of MAFLD in iCCA, suggesting its potential contribution to disease aetiology. Alterations of muscle mass and adipose tissue were more frequent in patients with MAFLD.