ABSTRACT
Primary CNS lymphoma is a rare condition, with annual incidence of about 1400 cases in the US. Patients with aggressive systemic lymphomas also have high incidence of CNS involvement, with poor overall prognosis. Use of high dose methotrexate based therapies has substantially altered the outlook for these patients. We present the outcomes data of patients with primary CNS lymphoma and those with secondary CNS involvement treated with high dose methotrexate from a single, FACT accredited academic transplant center. We reviewed patients treated at our center over a 42 month period between Jan 2017- June 2020. There were 19 patients with primary CNS lymphoma and 24 with secondary CNS involvement who received high dose methotrexate. There were equal number of men and women, and were mostly Caucasian. Median age at diagnosis was 60 years. Majority were HIV negative (95%). 3 of the 19 patients had EBV infection at the time of diagnosis. Majority had performance status of ECOG 1 (range: 0-4). 1 patient had CNS lymphoma in the post transplant setting (had bilateral lung transplant). 2 out of 19 patients had concurrent solid organ malignancies. 17 patients (90 %) had newly diagnosed primary CNS lymphoma. 2 patients (10 %) had relapsed disease. Patients received a median of 6 induction treatments (range 1-12). Majority of patients (17/19) received high dose methotrexate with rituximab. 1 patient received only high dose methotrexate. 1 patient received methotrexate, procarbazine, rituximab and vincristine (R MPV). 5 patients (26%) progressed during induction. There were 7 deaths (37 %) during induction phase. Majority of the deaths occured early during induction. Majority had partial response. 1 patient had complete response. No patient has received stem cell transplant. There were no chemotherapy delays due to COVID 19. No patient with primary CNS lymphoma was hospitalized or died due to COVID 19. 1 patient elected to defer chemotherapy due to fear of contracting COVID 19 in the hospital. No patient received the full,planned doses of high dose methotrexate during induction. Dose reductions were due to poor performance status or impaired renal function. Consolidation was mainly with high dose methotrexate. Those progressing received whole brain radiation, Ara C, or best supportive care. The PFS and OS are being evaluated at the time of this submission. There were 24 patients with secondary CNS involvement. 12 had concurrent systemic and CNS involvement. 12 patients had history of systemic lymphoma but with CNS only relapse. There were equal males and females. Median age at diagnosis was 64 years. (range 33-81). They had good performance status, with majority having PS of ECOG 1 (range 1-3). Majority were caucasian. There were 4 patients (17%) with EBV infection. 2 patients (8 %) had HIV. They received a median of 2 high dose methotrexate inductions (range: 1-10). 4 patients (17%) eventually received stem cell transplants. PFS, survival data are being evaluated at the time of this submission. In general, high dose methotrexate was well tolerated in both primary CNS lymphoma and systemic lymphoma with CNS involvement. Stem cell transplants are still being done infrequently for these patients. Disclosures: Finn:Jazz Pharmaceuticals:Speakers Bureau;Celgene:Speakers Bureau;Seattle Genetics:Speakers Bureau.
ABSTRACT
COVID-19 is a newly diagnosed entity that has been identified for about 6 months. With the US now being theprevalent nation affected, we aimed to identify factors that were relevant to survival and hematologic events inCOVID patients. Our group had primarily been assessing COVID-19-confirmed patients as per PCR at OchsnerMedical Center in Louisiana;we primarily studied patients who were admitted between January 2020 to May 2020.Main events that are currently being studied include factors such as mortality, length of stay, and bleeding orthrombotic events. Secondary endpoints included factors such as influence on blood type and also amount oftransfusions required by these patients. Our overall analysis of 1,773 patients yielded a number of 60 patients whomwe were able to identify as having an active cancer diagnosis. This disproportionate number of patients may berelated to factors such as reluctance to visit the hospital among cancer patients, a phenomenon noted similarly inCardiology, where the number of admissions for cardiac causes had declined suddenly during this pandemictimeline. One half of our population was African American and included an even proportion of males and females.The age range of patients was between 35-93 years. The most common malignancies that were noted to co-occur with COVID-19 in our population seemed to be lung, prostate, and hematologic malignancies. Although finalanalyses regarding mortality are to be completed, the proportion of patients who had died with a diagnosis of cancer was around 50% per collection of our current data. Twenty three out of 60 (38%) patients required bloodtransfusions. In comparison to other reports that had reported bleeding events and thrombotic events, our reportrevealed a much lower rate of bleeding events (5/60) and thrombotic events (5/60). We plan to repeat our analysisto assess for any confounders in identifying these events, as noted, since some earlier literature had reportedbetween one quarter to two thirds of patients having a thrombotic event. Our analysis also looks at other descriptivevariables such as use of anticoagulant and antiplatelet agents, absolute counts of neutrophils and lymphocytes, platelets, and coagulation markers. Also, our assessment includes a study in assessment of any delays noted inchemotherapy dates for these patients.