This clinical case report describes the simultaneous development of an acute myocardial infarction, stroke, and a massive pulmonary thromboembolism in a 44-year-old patienta carrier of the thrombophilia gene polymorphisms: MTHFR C677T, A1298C, PAI-1 4G/5G, ITGA2 C807T. Multifocal thrombosis was probably due to the initial congenital deficiency of anticoagulants, accompanied by a decrease in antithrombin III and protein C, against the background of their critical consumption in cascade thrombosis, in combination with the carrier of polymorphisms of moderate and low thrombogenic risk. This case is unique in that there is usually a tendency toward clinical thrombosis when the level of antithrombin III is less than 70%. Such patients develop thrombosis at a younger age, and by the age of 35-40 years usually have a verified diagnosis of extremely high-risk hereditary thrombophilia. In this case, multifocal thrombosis was accompanied by critically low values of anticoagulants: antithrombin III -3.4%, and protein C -36.8%. The patient had suffered from epilepsy since childhood and took anticonvulsant drugs that increase the deficit of active folic acid and can lead to hyperhomocysteinemia, which in this case, against the background of an innate decrease in the activity of methyltetrahydrofolate reductase, could have aggravated the situation.

almost overlapped beyond their anatomical sites. The miPD-L1-positive cases showed significantly better OS compared to the negative cases in both gastric and intestinal DLBCL (P=0.0430 and P=0.0115). DEL was found in 11 gastric (9%) and 6 intestinal cases (12%), with significantly worse OS than the others in each anatomical group (P=0.0012 and P=0.0008, respectively). Among patients with complete remission, 21 (16%) of 134 gastric and 6 (17%) of 36 intestinal DLBCL patients had recurrence. Differences in survival, calculated from recurrence, were significant between gastric DLBCL patients with and without POD24 (P=0.0427), but did not work in prognostic delineation of intestinal cases (P=0.563). Multivariate analysis revealed that advanced Lugano stage (P<0.001), DEL (P<0.001), and miPD-L1 negativity (<20%, P=0.027), but not intestinal site (P=0.171), were significant prognostic factors for OS of giDLBCL. Conclusion:The anatomical site of disease did not influence outcome in giDLBCL in the rituximab era. Lugano stage, PD-L1 expression on microenvironment immune cells, and MYC/BCL2 co-expression provide therapeutic guidance for patients with giDLBCL.

Russian Federation; 4 Therapy, Clinical Hospital by V.M. Buyanova, Moscow, Russian Federation; 5 Radiology, Clinical Hospital by V.M. Buyanova, Moscow, Russian Federation Currently the association between hepatitis C virus and DLBCL widely accepted. The result of evidence from epidemiological and clinical studies carried out in the last decades. The majority of studies are ABSTRACT 439 related to antiviral therapy (AT) consisting of interferon (IFN) and ribavirin (RBV). New antiviral regimes without interferon allowed to obtain a high percentage of cure of patients from viral infection. There were limited data about efficacy of the new direct-acting antiviral agents (DAAs) in the treatment of patients DLBCL+HCV. The research objective is to analyze clinical, laboratory, morphological parameters and treatment results in patients with DLBCL+HCV who received DAA together with chemotherapy. Our study included 16 patients with DLBCL+HCV, who received DAA and immunohypotherapy (R-CHOP) from 2016 to 2019 at National Medical Research Center of Oncology named after N. N. Blokhin and Russian National Research Medical University named after N.I. Pirogov. The median age of patients was 48 years (32-75). Man/ woman ratio of was 10/6. All 16 patients had III-IV stages. Bsymptoms were present in 50% (8) of patients. Bulk disease occurred in 62%(10) of patients. Histological variants: 3 patients had GCB type DLCBCL, 13 patients -non-GCB type DLBCL. Spleen lesion was present in 37%(6) patients, bone marrow -in 31% (5) of patients, liver lesion -in 37%(6) of patients. Hb≤14,0g/dl were found in 37% (6) and platelets ≤100x10 9 /l in 25%(4) of patients. Before the treatment:increase level of LDH ≥450 IU/l was in 81%(13) of patients, ALT ≥40 (7) of patients, and albumin ≤35g/l in 37% (6) of patients. HCV RNA were detect in blood of all patients. In all patients the viral RNA was more then 1.6x10 6 IU/l. The 1st genotype of the virus was found in 63%(10) of patients. Before immunochemotherapy all patients received DAA therapy, according on the virus genotype. After 30 days of DAA therapy virology remission obtained in 94%(15) of patients. The level of ALT≤40 IU/l decreased at 81%(13) patients, AST ≤40 IU/l-62%(10) patients. DAA conducted during 4-6 months together with immunochemotherapy. The total response (ORR) of R-CHOP+DAA therapy was 50%. The 2-year survival without progression of the disease (PFS) was 25%. Median follow-up was 24 months. 56% of patients had a relapse of lymphoma. Median of OS was 20 months. Median DFS was 11 months. Conclusion: DAAs therapy makes it possible to complete the therapy program without complications for all patients with DLBCL + HCV. Safety, rapidity and efficacy of DAA in obtaining a virological response, as well as a good profile of tolerance DAA therapy can be used in combination with chemotherapy. Objective: To examine the efficacy of haploidentical stem-cell transplantation (haplo-SCT) for patients with refractory relapsed(R/R) aggressive non-Hodgkin lymphoma (NHL) by comparing with those who con...

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