6589 Background: IBM Watson for Oncology (WFO) was trained by Memorial Sloan Kettering and is a cognitive computing system that uses natural language processing to ingest patient data in structured and unstructured formats. The system provides physicians with treatment options that are derived from established guidelines, the medical literature, and training from patient cases. In this study, we assessed the degree of concordance between treatment recommendations proposed by WFO and oncologists at Bumrungrad International Hospital (BIH). BIH is a 580-bed multispecialty hospital in Bangkok, Thailand. Methods: Data from breast, colorectal, gastric, and lung cancer patients treated at BIH were entered into WFO in 2015 and 2016. Retrospective cases were entered after a treatment plan had been determined, and prospective cases were entered during patients’ treatment planning sessions. WFO recommendations were provided in 3 categories: “Recommended”, “For Consideration”, and “Not Recommended.” Concordance was analyzed by comparing the decisions made by the oncologists to those proposed by WFO. Concordance was achieved when the oncologist’s treatment suggestion was in the “Recommended” or “For Consideration” categories given by WFO. Results: A total of 211 cases were assessed, 92 were retrospective and 119 were prospective. The overall concordance rate was 83%; 89% for colorectal, 91% for lung, 76% for breast, and 78% for gastric cancer. Similar concordance rates were observed when retrospective and prospective cases were analyzed separately. Discordance was attributable in part to local oncologists’ preferences for non-U.S. guidelines for certain cancers, especially gastric cancer. Conclusions: There was a high degree of concordance between WFO treatment options and the decisions made by local oncologists. Similar results were recently reported in a breast cancer concordance study conducted using WFO in India (San Antonio Breast Cancer Symposium 2016, Somashekhar et al). WFO’s capabilities as a cognitive decision support tool can be further improved by incorporating regional guidelines. Future work will analyze reasons for discordance such as cost, insurance requirements, and patient and physician preference.

Objective IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. Methods This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH’s institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. Results Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. Conclusion This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.

The combination of sorafenib and gemcitabine in advanced hepatocellular carcinoma is generally well tolerated and has modest clinical efficacy. The median OS is up to 1 year. However, well-designed randomized controlled trials with a sorafenib alone comparator arm are needed to confirm this finding.

Briz et al 1 described a method to detect maternal cell contamination of cord blood. They used PCR amplification of genomic hypervariable regions followed by run on agarose gels stained with ethidium bromide and visualised under UV transillumination. In our opinion, the method used by Briz et al, although simple and inexpensive, has a low sensitivity to identify maternal cells in cord blood samples. The sensitivity reported was between 0.5 and 1% with a contamination incidence of 1.25% (one contaminated of 80 cord blood samples). Sociè et al 2 reported the same sensitivity levels using minisatellite PCR amplification followed by Southern blotting and radioactive detection. In this way the authors identified one contaminated cord blood sample out of 47. Later on, the same group reported a more sensitive technique to identify maternal DNA contamination. 3 They described a PCR amplification of the polymorphic TPO sequence followed by Southern blotting and radioactive detection with a sensitivity of 0.01%.A sensitivity as high as this can also be obtained through techniques which do not need radioactivity. 4 In our experience, we achieved a sensitivity of 0.04% with a contamination incidence of 18% (11 contaminated of 60 cord blood samples). 5 We used a PCR amplification of genomic hypervariable regions, followed by chemiluminescent detection.Many other papers dealing with this subject 2-8 have been published with a variable contamination incidence depending on the technique used.In our opinion it would be more important to establish at what level the maternal cell contamination may exert a clinically relevant effect, if the maternal contamination is due to metabolically active cells, which kind of cells are involved, what is the number of maternal cells acceptable in a cord blood transplantation and what is the possible correlation between GVHD and maternal contamination. We underline the importance of correlating the contamination data with clinical results. This could be achieved with retrospective studies on cord blood transplanted patients who experienced GVHD and with an analysis of the maternal contamination entity using a standard method with a defined sensitivity. Otherwise, the conclusions drawn on the contamination rate can be misleading. Anaphylactoid reaction to granulocyte colonystimulating factor used in mobilization of peripheral blood stem cellWith wider use of the hematopoietic growth factors in both allogeneic and autologous stem cell transplantation, several unusual complications such as splenic rupture and anaphylWe suggest that a workshop should be set up to analyse the problem of maternal cell contamination in cord blood samples and to establish an appropriate standard method to detect maternal contamination. F PoliCentro actic reaction have been reported. [1][2][3][4][5][6][7] We report a case of severe anaphylactoid reaction after intravenous administration of rhG-CSF and the successful use of rhGM-CSF.A 52-year-old Caucasian female presented with a right axillary mass. Biopsy confirmed the ...

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