Background Guidelines recommend that hospitalized patients newly diagnosed with HF be referred to an outpatient HF clinic (HFC) within 2 weeks of discharge. Our study aims were (i) to assess the current literary landscape on the impact of patient sex on HFC referral and outcomes and (ii) to provide a qualitative overview of possible considerations for the impact of sex on referral patterns and HF characteristics including aetiology, symptom severity, investigations undertaken and pharmacologic therapy. Methods and resultsWe conducted a scoping review using the Arksey and O'Malley framework and searched Medline, EMBASE, PsychINFO, Cochrane Library, Ageline databases and grey literature. Eligible articles included index HF hospitalizations or presentations to the Emergency Department (ED), a description of the HFC referral of patients not previously followed by an HF specialist and sex-specific analysis. Of the 11 372 potential studies, 8 met the inclusion criteria. These studies reported on a total of 11 484 participants, with sample sizes ranging between 168 and 3909 (25.6%-50.7% female). The included studies were divided into two groups: (i) those outlining the referral process to an HFC and (ii) studies which include patients newly enrolled in an HFC. Of the studies in Group 1, males (51%-82.4%) were more frequently referred to an HFC compared with females (29%-78.1%). Studies in Group 2 enrolled a higher proportion of males (62%-74% vs. 26%-38%). One study identified independent predictors of HFC referral which included male sex, younger age, and the presence of systolic dysfunction, the latter two more often found in males. Two studies, one from each group reported a higher mortality amongst males compared with females, whereas another study from Group 2 reported a higher hospitalization rate amongst females following HFC assessment. Conclusions Males were more likely than females to be referred to HFCs after hospitalization and visits to the Emergency Department, however heterogeneity across studies precluded a robust assessment of sex-based differences in outcomes. This highlights the need for more comprehensive longitudinal data on HF patients discharged from the acute care setting to better understand the role of sex on patient outcomes.

BACKGROUND In the past 20 years, autologous hematopoietic stem cell transplantation (ASCT) has opened new avenues in the treatment of patients with severe, treatment-resistant autoimmune diseases with the aim of resetting the patient's immune system. Over the years, this has led to increased safety and efficacy of the procedure however it is still associated with morbidity and mortality. We evaluated the complications and toxicities associated with ASCT for autoimmune diseases at The Ottawa Hospital. METHODS Using the Ottawa stem cell transplant database, consecutive patients undergoing ASCT for autoimmune diseases were identified between 1999 and 2017. Through retrospective chart review, infectious complications, toxicities, length of hospital stay and survival outcomes were extracted. RESULTS Ninety patients underwent ASCT for an autoimmune disease at The Ottawa Hospital between 1999 and 2017 (median age 35 years, range 19-65 and 61% female). Of the 90 patients transplanted, 75 (83.3%) had a neurologic disease (53 with multiple sclerosis, 8 with myasthenia gravis, 5 with chronic inflammatory demyelinating polyneuropathy, 4 with neuromyelitis optica, and 5 with stiff person syndrome), 10 (11.1%) had a rheumatological disease (7 scleroderma and 3 rheumatoid arthritis), 4 (4.4%) ad Crohn's disease and 1 (1.1%) had immune thrombocytopenia. The median follow-up time in this study was 3.2 years from date of ASCT (range 0-15.75 years). The median length of stay in hospital was 30 days (range 12-215). The median engraftment time was 10 days for neutrophil recovery and 15 days for platelet recovery. The first 100 days following ASCT included 97 episodes of bacterial infections (28-bacteremia, 8-pneumonia, 29-UTI, 9-C. difficile colitis, 5-neutropenic enterocolitis, 12-skin infections, 4-line infections and 2 sinus/pharyngeal infections), 39 viral reactivations or infections (10-CMV, 7-BK, 2-adenovirus, 2-polyomavirus, 6-EBV, 4-HSV, 4-VZV and 4-respiratory viruses), and 7 episodes of fungal infection (4-mucocutaneous candidiasis, 1-candidemia, 1-yeast on urine culture and 1-C. lusitaneae from sputum). There were 9 patients (10%) that developed acute kidney injury, of which 3 recovered without hemodialysis, 1 recovered with temporary hemodialysis, and 2 required permanent hemodialysis. Ten patients (11.1%) developed liver dysfunction, all of which resolved. There were 17 episodes of hemorrhagic cystitis (5-BK, 2-adenovirus, 2-polyoma virus, 1-CMV, 3 tested negative for viruses, and 4 were untested). The 100-day transplant-related mortality was 2.3% and the overall survival plateaued at 93.5% beyond 2 years (95% CI at 2 years 84.9-97.2%). Two patients developed a secondary malignancy (metastatic adenocarcinoma in a scleroderma patient and acute leukemia in a multiple sclerosis patient that had received mitoxantrone). Five patients have died; 4 from organ toxicity (pulmonary hemorrhage at day -3 in a scleroderma patient, veno-occlusive disease at day 62 in a multiple sclerosis patient, heart failure at day 116 in a scleroderma patient, and bronchiolitis obliterans at day 415 in a neuromyelitis optica patient) and 1 from metastatic adenocarcinoma and advanced scleroderma. CONCLUSION This study confirms that the morbidity and mortality of ASCT for patients with autoimmune disease is similar to that for other patient groups undergoing ASCT. Patient selection should take this into consideration. Disclosures No relevant conflicts of interest to declare.

Introduction: Historically, CNS lymphomas have been associated with a very poor prognosis High-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has been investigated in patients with primary central nervous system lymphoma (PCNSL) and secondary central nervous system lymphoma (SCNSL) with promising results in small recent small prospective phase 1/2 results and retrospective series. We hypothesized that the use of R-BuMelTt (rituximab, busulfan, melphalan, thiotepa) conditioning regimen with ASCT regimen will be effective for both patients with PCNSL and SCNSL as used in previously reported promising data by Oh et al 2016 for patients with SCNSL with higher remission and survival rates. Patients and Methods: A retrospective analysis was performed of 6 consecutive patients who had undergone R-BuMelTt conditioning regimen with ASCT for 3 patients with PCNSL and 3 patients with SCNSL from December 2017 to March 2020. The median age of this patient population was 62 years at the time of ASCT. The induction chemotherapy regimen used for patients with SCNSL was R-CHOMP except one patient who received DHAP, and for patients with PCNSL MATRix regimen was used. The median duration of chemotherapy cycles was 4, and all of them had achieved remission prior to transplant based on PET/CT scan/MRI scan. All patients were planned to undergo ASCT using the Conditioning Regimen of Rituximab 375 mg/m2 on Day-7, Thiotepa 250 mg/m2 on Day-6,-5, Busulfan 3.2 mg/kg on Day-4,-3,-2 and Melphalan 100 mg/m2 on Day-1. Supportive cares measures were given at treating physician's discretion. Results: Patients received a median cell dose of 4.4x106 CD34+cells/kg (range: 2.5-5.7), had neutrophil engraftment at 11.5 days (range:9-13), platelet recovery was achieved on days 11,15 and 16 for three patients but was delayed at 27, 46, 89 days for 3 patients. Infectious complications were common with documented bacteremia in in 3 out of 6 patients, 2 patients with c. difficile infection and with significant platelet support due to thrombocytopenia. At a median follow up of 24.5 months (range: 6-30 months), 5 out of 6 patients had complete metabolic response on radiological imaging with PET/CT in conjunction with MRI head. One of the patients with SCNSL died after transplant due to CNS relapse 223 days post ASCT giving an overall survival of 66.6%. Amongst the 2 patients with SCNSL that survived there was no relapse after 30 month follow-up. None of the patients with PCNSL died or relapsed during or after transplant therefore having a 100% overall survival. Although this is a small retrospective study, our results are comparable to current literature. Toxicities included nausea/vomiting, diarrhea, mucositis with 5/6 patients requiring TPN. Also busulfan PK levels were not done. Conclusions: R-BuMelTt regimen can be used successfully as conditioning regimen for ASCT for patients with PCNSL and SCNSL, however with increased hematological toxicity, most notably delayed platelet engraftment. The rate of progression free and overall survival is promising with short median follow up of 24 months. Disclosures Lam: Janssen: Honoraria, Speakers Bureau; Roche: Honoraria, Speakers Bureau.

Background: Respiratory syncytial virus (RSV) is one of the most commonly encountered respiratory viruses among patients who have been diagnosed with a hematological malignancy or a hematopoietic stem cell transplantation (HSCT). In immunocompromised patients including HSCT recipients, RSV can progress to a more severe lower respiratory infection (LRI), often complicated by respiratory failure leading to increased morbidity and mortality. Little is known about the best management strategy in this immunocompromised group and strategies to manage RSV is challenging. Data on aerosolized ribavirin to treat RSV infections in HSCT recipients come from small, retrospective studies with heterogeneous treatment combinations but nevertheless, have shown to prevent poor outcomes. There is very little data on oral ribavirin treatment but the retrospective data so far has been promising. Aim: To evaluate the effectiveness of oral ribavirin in HSCT patients with RSV infection at our centre in London, Ontario. Methods: Eighteen HSCT patients with RSV were analyzed retrospectively. In 2012, there were 5 patients treated with supportive care alone. After 2012, there were 13 patients treated with oral ribavirin. RSV diagnosis was established by polymerase chain reaction assay via nasopharyngeal swabs. Oral ribavirin was initiated at 15 mg/kg/day in three divided doses for 7-10 days with possibility of extension in persistently symptomatic patients. An immunodeficiency scoring index (ISI) was used to classify patients as low, moderate, or high risk for progression to lower respiratory infection (LRI) or death. Findings: An outbreak of RSV occurred in our oncology unit in early 2012 where 5 HSCT patients ((3 autologous HSCT and 2 allogeneic HSCT patients) contracted RSV infection as well. No definitive treatment options were available during this period and patients were managed with supportive care alone. 4/5 HSCT patients died of RSV infection leading into an 80% mortality rate. This experience led to the development of a protocol for the HSCT patients focusing on prevention of nosocomial transmission, early PCR testing and treatment with oral ribavirin for those confirmed with RSV infection and signs of pneumonia or LRI. Since 2012, 13 HSCT patients (4 autologous HSCT patients and 9 allogeneic HSCT patients) were diagnosed with RSV infection and promptly treated with oral ribavirin. The median treatment duration was 10 days (range: 7-12). All patients treated with oral ribavirin survived the infection. Oral ribavirin was well tolerated with minor adverse effects. Conclusion: We found that HSCT patients with lower respiratory RSV infections can be successfully managed by use of prevention strategies and oral ribavirin. Although, our experience reflects a small sample size, the protocol was associated with decreased mortality compared to patients who received supportive care alone. Our experience supports the use of oral ribavirin for the early treatment of HSCT patients with RSV associated LRI and may be an alternative to aerosolized RBV. But ongoing review of our experience with this protocol is necessary and large prospective studies are needed to determine the optimal therapy in this patient group. Disclosures No relevant conflicts of interest to declare.