Introduction: The role of serum albumin as a prognostic factor has been well established in various medical conditions including some hematologic malignancies such as multiple myeloma and myelodysplastic syndromes . In this retrospective analysis, we examined the prognostic value of serum albumin at diagnosis prior to any therapy in a cohort of patients with acute myeloid leukemia (AML) irrespective of treatment modality. Methods: Data were collected retrospectively in a cohort of 257 AML patients who received treatment between 2002 to 2019. The cohort included patients who received conventional 7+3 induction, patients who were not candidates for induction receiving lower intensity chemotherapy +/- targeted drug, and patients who were placed on clinical trials. Patients under the age of 17 were excluded, as well as patients who received their initial diagnosis and induction at an outside hospital whose initial laboratory data for albumin were not available. We excluded patients who were not identified as Caucasian or African American in our final analysis. 46 patients were lost to follow up before 6-months and were excluded from all analysis. Analysis were performed with Epi Info software. Our patients were dichotomized by serum albumin ≥3.5 (normal albumin) and <3.5 (hypoalbuminemia [HA]). Chi-square test was performed for univariate analysis of categorical variables and logistic regression was performed for multivariable analysis. Results: Of the 211 patients, the median age was 59.4 years (17 - 83.4) with 1:1 male to female ratio. 171 patients survived to 6 months and were included in our analysis. There was no significant age difference between normal albumin and HA groups (median age 59 and 59.7 respectively, p=0.854). There was an equal distribution of patients with HA with respect to sex (33.0% male and 36.9% female, p=0.560). With regards to race, more African Americans were found to have hypoalbuminemia compared to Caucasians (46% African Americans vs. 30% Caucasians, p=0.027). Patients with HA had an overall survival rate of 72.2% at 6 months while those with normal albumin levels had a survival rate of 85.1% (p=0.027). Multivariate logistic regression analysis including age, race, sex and albumin levels showed that age, sex and albumin levels were statistically significant independent predictors of survival at 6 months [Table 1]. Patients with albumin ≥3.5 were significantly more likely to survive controlling for age, race, and sex (OR=2.16, p=0.044). Multivariate analysis additionally showed that age was inversely associated with survival at 6-months (p=0.003) and males were more likely to survive than females (p=0.034). Though African Americans were shown to have a higher incidence of HA in univariate analysis, race was not an independent predictor for survival in the multivariate analysis when controlling for age, sex, and albumin level. Conclusions: In this cohort of AML patients, we found that hypoalbuminemia is an independent predictor survival. Serum albumin <3.5 was associated with a significantly decreased overall survival at 6-months. Age and sex were additional independent predictors of 6-month survival. This data suggests that hypoalbuminemia, defined as albumin <3.5, has prognostic utility in AML patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Background: Patients who are diagnosed with hematologic malignant diseases (HMD) almost invariably receive placement of central venous catheters (CVCs), whether temporary or permanent. These catheters are used for administration of various chemotherapies, antibiotics and even nutrition. Although the patients with HMD are immunocompromised, prophylactic use of antibiotics among these patients, especially related to CVC placement, remains controversial. This retrospective analysis evaluates the rates of development of neutropenic fever in patients with HMD with CVCs receiving prophylactic antibiotics. Methods: Data were collected retrospectively in a cohort of 268 patients with HMD who received treatment at our academic institution between 2002 to 2019. Demographic and other related data was abstracted and descriptive analysis was performed using Epi-Info - 7 software. Results: Of the 268 patients with HMD, 175 patients (65.3%) received prophylactic antibiotics and among these patients, 180 (67.2%) had a permanent CVC and 109 (40.7%) had a temporary CVC. Comparatively, 93 patients (34.7%) did not receive prophylactic antibiotics and among these individuals, 64 (68.8%) had a permanent CVC and 34 (36.6%) had a temporary CVC. In patients with a permanent central line, 84.3% of patients receiving prophylactic antibiotics developed neutropenic fever while 85% of those who did not receive prophylactic antibiotic also developed neutropenic fever. Among the individuals with a temporary CVC, 79.7% of patients receiving prophylactic antibiotics developed neutropenic fever and 65.4% of patients who were not receiving prophylactic antibiotics also developed neutropenic fever. None of the differences were statistically significant (p=0.8990 and p=0.1547 respectively). Conclusion: In this cohort of HMD patients, the rate of neutropenic fever development in patients with central venous access receiving prophylactic antibiotic was not significantly different compared to the rate of neutropenic fever development in patients with central venous access who did not receive any prophylactic antibiotic. This data suggests that there does not appear to be a significant clinical utility for prophylactic antibiotics in the prevention of neutropenic fever in patients with HMD who have central venous catheters in place. Further studies analyzing the impact of prophylactic antibiotics on true infections as an etiology for neutropenic fevers in patients with HMD and central venous catheters is warranted. Disclosures No relevant conflicts of interest to declare.

Introduction: Patients with hematological malignancies are at increased risk of infections which leads to increased morbidity and mortality. Particularly, they are at an increased risk of developing central line associated bloodstream infection (CLABSI) since they frequently require central venous catheters for various essential reasons including chemotherapy, blood transfusions, and parenteral nutrition. Prophylaxis with antibiotics is the key in the management for these patients but is not always effective and sometimes associated with complications. Hence, the main objective of the study is to examine the rate of developing CLABSI in patients with hematological malignancies receiving antimicrobial prophylaxis and in those who did not receive prophylaxis. Methods We conducted a retrospective study involving patients diagnosed with a hematological malignancy admitted to the Augusta University Medical Center from 2002 to 2019. IRB approval was obtained to review the patients' charts. Patients who developed CLABSI are defined as those who had positive blood cultures after central venous catheter had been placed. Percentage of patients who received prophylaxis and those who didn't get antimicrobial prophylaxis were calculated. The difference between the two percentages was examined to determine whether or not it is statistically significant. Results The charts of 268 patients admitted for hematological malignancies were reviewed. Among 173 patients receiving antibiotic prophylaxis (65.0%), 78 (45.1%) developed CLABSI. Among the patients who didn't receive prophylaxis, 64 (68.8%) developed CLABSI. The difference between the two groups was statistically significant (p<0.01), and the relative risk of developing CLABSI in patients who did not receive prophylaxis is 0.57 (95% confidence interval 0.41 - 0.79). Conclusion Patients who had been diagnosed with a hematologic malignancy and admitted at the academic institution from 2002 to 2019 were analyzed for the risk of developing CLABSI that was associated with the use of antibiotic prophylaxis. We found that the non-prophylactic group has statistically significant higher risk of developing CLABSI than the prophylactic group. Thus prophylaxis with antibiotics may play a major role in decreasing the rate of CLABSI in patients admitted with hematological malignancy. Disclosures No relevant conflicts of interest to declare.

Background: Guidelines on the clinical management of certain disease processes assists providers in their decision making and in some cases reduce the amount of further testing/imaging that a patient undergoes. Without evidence based guidelines in place, the medical provider relies on previous experience and their clinical judgement in pursuing additional diagnostic studies. In this observational retrospective descriptive analysis, we reviewed 188 inpatient Acute Myelogenous Leukemia (AML) patients between 2002 and 2019 who post-induction presented with objective abdominal symptoms and/or abnormal gastrointestinal laboratory values, as well as correlating the number of diagnostic imaging performed. Methods: Data was collected retrospectively from an academic medical hospital database for descriptive analysis. Patients included in the study were those diagnosed with AML between April 2002 and October 2019, underwent induction therapy (i.e 7+3 induction with Idarubicin), and who received abdominal imaging ultrasound or computed tomography (US/CT) within 40 days post induction therapy. Patients who underwent induction therapy between April 2002 and December 2010 was one group, January 2011-October 2019 was the other group. Only the first abdominal image performed with each patient within 40 days post induction therapy was included in our analysis. Individuals who were noted to have cholecystectomies, those without clear induction dates and patients under the age of 16 were excluded whether or not they received abdominal imaging. Access to test result databases are password protected. Results from each subject are codified based on their sample ID and are not traceable to any identifiable subject name. Results: 76 individuals had induction therapy initiation dates listed that were within April 2002-December 2010. Of those 76, 16 received abdominal imaging: 12 CT abdomen and 5 abdominal ultrasound. 112 individuals had induction therapy initiation dates listed that were within January 2011 and October 2019. Of those 112, 35 received abdominal imaging: 15 CT abdomen and 20 abdominal ultrasound. Compared to the latter 9 years in regards to imaging performed for abdominal related clinical suspicions, the initial 9 years was observed to have a 51.4% reduction in the number of primary abdominal images (US/CT) performed. The latter 9 year patient population was also noted to have more individuals whose induction dates were listed, therefor included in the analysis; 32.1% larger in size than the first 9 years group. First 9 years: Each CT abdomen was within normal limits. One abdominal ultrasound was concerning for acute acalculous cholecystitis within this group, in which further investigation was warranted i.e ERCP Latter 9 years: One CT abdomen was of concern depicting distension of the gallbladder without evidence of cholelithiasis and also visible pericholecystic fluid likely secondary to ascites. Two abdominal ultrasounds were concerning for sludge however without signs of acute cholecystitis nor acute acalculous cholecystitis. These three results were not clinically significant to warrant further investigation Conclusion: Evidence based guidelines that correlates clinical presentation with the appropriate timing and indication of diagnostic imaging with AML patients is currently not well known in literature. Due to the lack of guidance, the decision to obtain diagnostic imaging may differ from providers leading to inconsistent care and multiple diagnostic imaging that may not be clinically significant. In this observational retrospective study at this institution, what was discovered was the increased overutilization of abdominal medical diagnostic imaging (US/CT) over the years that grossly did not result with findings that required further investigation or adjustment in AML therapeutic management. Disclosures No relevant conflicts of interest to declare.