Ibrutinib in mantle cell lymphoma: a real-world retrospective multi-center analysis of 77 patients treated in the Czech Republic

Ibrutinib revolutionized therapy for relapsed/refractory (R/R) mantle cell lymphoma (MCL). Real-world data on the outcome of unselected patients are still limited. We analyzed 77 R/R MCL patients receiving ibrutinib with at least one prior systemic anti-lymphoma therapy. After a median follow-up of 14.0 months, 56 patients relapsed/progressed, and 45 died. The overall response rate was 66%, with 31% of complete metabolic remissions on PET/CT. The median progression-free and overall survival (OS) rates were 10.3 and 23.1 months, respectively. The median OS from ibrutinib failure was 3.7 months. High proliferation rate by Ki67 (≥ 30%) and two or more previous therapy lines both negatively correlated with outcome (HR = 2.2, p = 0.04, and HR = 2.06, p = 0.08, respectively). Female gender borderline correlated with better outcome (HR = 0.53, p = 0.08). In multivariate analysis, Ki67 and response to ibrutinib both correlated with OS (p < 0.05). Importantly, ibrutinib appeared to better control nodal and extranodal lymphoma than bone marrow (BM) involvement. From 20 patients with detectable BM infiltration (before ibrutinib initiation) achieving complete (n = 13) or partial (n = 7) metabolic remission, none achieved remission in BM. We confirmed good efficacy of ibrutinib in unselected heavily pre-treated MCL patients. Our findings support the use of a combination of ibrutinib and rituximab in patients with BM involvement.

[Further development of regional early care-Many roads lead to Rome : Developmental stages of four established rheumatological early care concepts in different regions of Germany]

In order to shorten the prognostically relevant waiting time until diagnosis and initiation of appropriate treatment in inflammatory rheumatic diseases, rheumatological centers in many regions across Germany have established and continuously developed specific early care concepts. Evaluated models from Altötting·Burghausen, Berlin Buch, Düsseldorf and Heidelberg and their developmental stages as a response to internal and external challenges are presented in this overview. The transparent publication of the developmental steps and the exchange of experiences aim at promoting new early care concepts in other regions and continuing the joint dialogue for improvement of the early detection and quality of care of inflammatory rheumatic diseases in Germany.

AB0752 HOW DOES TIME TO DIAGNOSIS AND GENDER AFFECT TREATMENT OUTCOMES IN PATIENTS WITH ANKYLOSING SPONDYLITIS OR PSORIATIC ARTHRITIS? – REAL WORLD DATA FROM THE GERMAN AQUILA STUDY WITH SECUKINUMAB

Background

In both, ankylosing spondylitis (AS) and psoriatic arthritis (PsA), women typically have a longer delay in diagnosis.1,2 There is scientific evidence that prognosis for AS and PsA improves when diagnosed early. The German non-interventional study AQUILA provides real-world data on the influence of time to diagnosis and gender on treatment outcomes under secukinumab, a fully human monoclonal antibody that selectively inhibits interleukin-17A.

Objectives

The aims of this interim analysis are to describe selected baseline (BL) demographics of AS and PsA patients (pts) and to evaluate the impact of time to diagnosis and gender on secukinumab treatment outcomes, such as disease activity and global functioning and health.

Methods

AQUILA is an ongoing, multi-center, non-interventional study including up to 3000 pts with AS or PsA. Pts were observed from BL up to week (w) 52 according to clinical routine. Real-world data were assessed prospectively and analyzed as observed. Validated questionnaires were used to collect data on disease activity (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI), global functioning and health (Assessment of SpondyloArthritis-Health Index, ASAS-HI) in AS, and skin and joint-related disease activity (Psoriasis Area and Severity Index, PASI; tender/swollen joint counts, TJC/SJC) and impact of disease (Psoriatic Arthritis Impact of Disease - 12 items, PsAID-12 score) in PsA pts. This interim analysis focused on the subgroups of male and female AS and PsA pts stratified by time to diagnosis after disease onset (˂1 year [y] and ≥1y for early and late diagnosis, respectively).

Results

At BL, 609 AS and 1145 PsA pts were included with information on time to diagnosis (Table 1); only 18.7% of AS and 25.8% of PsA pts were diagnosed within one year. Of interest, both female AS and PsA pts as well as male PsA pts with increased BMI tended to be diagnosed later (Table 1). Regarding BASDAI scores, male AS pts diagnosed late had increased disease activity at BL and throughout the study (Figure 1A); female AS pts diagnosed late showed reduced total treatment effect with increasing time to diagnosis (Figure 1B). Similarly, both male and female AS pts diagnosed late had slightly increased ASAS-HI at BL and throughout the study (Table 1). For PsA pts, there was no difference in skin- (PASI, Figure 1C/D) and joint-related (Figure 1E/F) disease activity with respect to time to diagnosis. Furthermore, there was no difference in PsAID scores (data not shown) between early- and late-diagnosed PsA pts.

Table 1.

Overview of selected BL characteristics in AS and PsA pts stratified by time to diagnosis

AS (N=609)Time to diagnosis ˂1 year (n=114)Time to diagnosis ≥1 year (n=495)Male (n=63)Female (n=51)Male (n=301)Female (n=194)Age, years43.146.345.947.7BMI27.725.927.327.8BASDAI4.75.05.35.2ASAS-HI6.78.07.48.2PsA (N=1145)Time to diagnosis ˂1 year (n=295)Time to diagnosis ≥1 year (n=850)Male (n=126)Female (n=169)Male (n=363)Female (n=487)Age, years50.151.852.353.1BMI28.729.429.328.8PASI6.56.27.07.2PsAID4.65.24.85.3TJC/SJC5.9/3.37.3/3.27.0/3.77.3/3.8

All variables given as mean

Figure 1.

Disease activity in early- and late-diagnosed AS and PsA pts

Conclusion

In a real-world setting, secukinumab improved disease activity and global functioning in both AS and PsA pts. Both, male and female AS pts had a higher treatment response when diagnosed early. Interestingly, delay in diagnosis appeared to be BMI-dependent in female AS pts and PsA pts of both genders. However, in contrast to AS, treatment response of early- and late-diagnosed PsA pts did not differ in the further course.

References

[1]Rusman, T., van Bentum, R.E. & van der Horst-Bruinsma, I.E. Rheumatology59, iv38-iv46 (2020). 2. Passia, E., et al. OP0057. Annals of the Rheumatic Diseases79, 38-39 (2020).

Disclosure of Interests

Karolina Benesova Speakers bureau: Abbvie, BMS, Gilead/Galapagos, Janssen, Lilly, Medac, MSD, Novartis, Roche, Viatris, Consultant of: Gilead/Galapagos, Novartis, Grant/research support from: Abbvie, Novartis, Oliver Hansen Grant/research support from: Novartis, Uta Kiltz Consultant of: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Jan Brandt-Juergens Consultant of: Abbvie, Affibody, BMS, Gilead, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Peter Kästner Consultant of: Chugai, Novartis, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, UCB, Grant/research support from: AbbVie, Chugai, Novartis, UCB, Pfizer, Daniel Peterlik Employee of: Novartis, Christina Budden Employee of: Novartis, Annika Boas Employee of: Novartis, Stefanie Welle Employee of: Novartis, Hans-Peter Tony Consultant of: AbbVie, Astra-Zeneca, BMS, Chugai, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi

Peripheral T-Cell Lymphomas Involving the Central Nervous System: A Report From the Czech Lymphoma Study Group Registry

Introduction

We analyzed the incidence, risk factors of central nervous system (CNS) relapse, and outcome of CNS involvement in patients with peripheral T-cell lymphomas (PTCL) from the Czech Lymphoma Study Group Registry NiHiL (Clinical Trial gov. NCT03199066).

Materials and Methods

Out of 1,040 patients with PTCL, we identified 29 patients (2.79%) with CNS involvement: 2 patients with primary CNS T cell lymphoma, 11 patients with CNS and systemic disease at diagnosis, and 16 patients (1.54%) at CNS relapse. The most common histology with CNS disease was PTCL, not otherwise specified. Progression-free survival (PFS) was defined as the time interval from diagnosis to progression or death. PFS-2 was defined as the interval from the date of a new relapse until the next relapse.

Results

Patients with testicular involvement received intrathecal prophylaxis with methotrexate. High-dose methotrexate-based treatment was administered in 44.8% of patients with CNS disease. Median follow-up was 71.3 months. The difference between the median PFS of 1,027 patients without initial CNS disease (32.6 months) and 11 patients with initial CNS and systemic disease (4.8 months) was significant (p = 0.04). The difference between the median PFS2 in CNS relapses (10.1 months) and 493 relapses outside of CNS (9.1 months) was not significant (p = 0.6). Risk factors for CNS relapses included the following: involvement of more than one extranodal site (p = 0.008), soft tissue involvement (p = 0.003), testicular involvement (p = 0.046), and the presence of B symptoms (p = 0.035). The difference between the median OS of 1,027 patients without initial CNS disease (46.0 months) and 11 patients with initial CNS and systemic disease (18.2 months) was significant (p = 0.02). The median OS2 in CNS relapses was 11.8 months and that in relapses outside of CNS was 21.3 months. CNS involvement was not associated with a significantly worse OS compared to relapsed/refractory patients without CNS involvement (p = 0.1).

Conclusions

The incidence of CNS disease at the time of diagnosis and at relapse in PTCL is low and usually associated with other systemic involvement. The prognosis of PTCL with initial CNS involvement is significantly worse when compared to patients without CNS disease at diagnosis. The outcome of CNS relapse is comparable with relapsed PTCL outside of CNS. The optimal treatment is not defined yet.

Polatuzumab vedotin plus bendamustine and rituximab in patients with relapsed/refractory diffuse large B-cell lymphoma in the real world

OBJECTIVES

Polatuzumab vedotin with bendamustine and rituximab (Pola-BR) was approved for treatment of transplant-ineligible patients with relapsed/refractory DLBCL (R/R DLBCL). However, the number of patients treated in the GO29365 trial including the extension cohort was limited, and more data evaluating the efficacy of this treatment regimen is needed.

METHODS

We analyzed 21 patients with R/R DLBCL to determine real-life efficacy and safety of Pola-BR regimen. Data of all patients entered the database of the NiHiL project (NCT03199066).

RESULTS

Median overall survival was 8.7 months, and progression-free survival 3.8 months. The overall response rate was 33%. Grade 3-4 neutropenia was detected in 29%, thrombocytopenia in 38%, anemia in 19%, infections in 24% cases, and peripheral neuropathy in 5%. Discontinuation of treatment was caused by progression in 50%, adverse events in 31%, and intended bridging to CAR-T therapy in 19%.

CONCLUSION

Although the outcome of patients is worse than in GO29365 trial, the use of Pola-BR regimen in the real world demonstrates tolerable toxicity profile and efficacy in transplant-ineligible patients with R/R DLBCL. Moreover, this regimen might represent a perspective option as a bridge to CAR-T therapy.

The diagnostic performance of whole-body MRI in the staging of lymphomas in adult patients compared to PET/CT and enhanced reference standard-systematic review and meta-analysis

BACKGROUND

Morphology highlighted by diffusion weighted imaging (DWI) is the basis of whole-body MRI (wbMRI). The aim of this study was to analyze current knowledge on the diagnostic performance of wbMRI in the pretreatment staging of patients with lymphoma.

METHODS

A search for original articles reporting the diagnostic performance (sensitivity, specificity) of pretreatment (first staging or staging in relapsed patients after complete remission) wbMRI in nodal and extranodal involvement by extracranial lymphoma and the agreement of stage by the Cotswolds-modified Ann Arbor classification in adult patients compared to the reference standard (PET/CT or enhanced reference standard) was conducted in PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov.

RESULTS

Altogether 15 studies with 519 patients were included in the meta-analysis. The pooled sensitivity and specificity for nodal involvement were 0.93 (95% CI: 0.90 to 0.96) and 0.99 (95% CI: 0.98 to 1.00). For nodal staging, most studies used the size criterion of 10 mm in the short diameter (n=10) and the absence of prominent fatty hilum (n=4). Restricted diffusion on diffusion-weighted imaging as a sign of nodal involvement was either not used (n=5), used for detection (n=4), semi-quantitatively (n=4), or quantitatively (n=1). Only one study (7) relied solely on restricted diffusion as the main criterion for nodal involvement. The pooled sensitivity and specificity for extranodal involvement were 0.89 (95% CI: 0.79 to 0.98) and 0.99 (95% CI: 0.99 to 1.00). Seven studies considered diffuse splenic involvement when its long or vertical axis was greater than 13 cm regardless of the patient's physiognomy. The pooled agreement in staging (Cohen's kappa) was almost perfect (0.90, 95% CI: 0.84 to 0.95).

DISCUSSION

The sensitivity and specificity of wbMRI in the assessment of the nodal and extranodal involvement by lymphoma is high. The agreement of wbMRI with the reference standard is almost perfect.

POS0472 COMPARATIVE METABOLOMIC ANALYSIS OF SERUM SAMPLES FROM PATIENTS WITH COINCIDENTAL RHEUMATOLOGICAL AND MALIGNANT DISEASES

Background:

Rheumatic and musculoskeletal diseases (RMDs) and malignancies are both caused by a dysfunctional immune system and the probability of their coincidence in one individual is rising due to advances in cancer treatment and demographic changes. However, the lack of understanding of the complex interrelationship of both conditions often leads to undertreatment and high level of suffering in affected patients. Herein, the MalheuR project breaks new ground by systematic analysis of concomitant malignant and rheumatic diseases and closes the knowledge gaps on the clinical and molecular level.

Objectives:

To enable early diagnosis of concomitant malignancy and/or identification of patients at risk in the future, changes in serum metabolome were explored in order to create a diagnostic classification model.

Methods:

Serum samples from patients with concomitant RMD and cancer or obligate precancerous lesions (n=78, breast cancer (23), melanoma (14), MGUS (12), prostate cancer (8) and others (21)) were collected as a pilot study within the MalheuR project, a registry-based study initiated in 2018 at the university hospital Heidelberg, Germany. The following groups were defined by the underlying RMD: rheumatoid arthritis (n=42), psoriasis arthritis (n=23), spondylarthritis (n=9) and systemic lupus erythematosus (n=4). RMD patients without any malignancies were used as controls (n=280: 122 RA, 81 PsA, 46 SpA, 31 SLE).

Samples were analyzed by 1H NMR spectroscopy. For all samples, regular 1H acquisition with presaturation and Carr-Purcell-Meiboom-Gill (CPMG) spectra were acquired using a 600 MHz Bruker NMR spectrometer. Spectra were processed with TopSpin using 0.2 Hz of line broadening and manual phasing. Molar concentrations of 26 metabolites were acquired by integration of NMR spectra. With GraphPad Prism, univariate and ANOVA statistical analysis was performed to find significant differences between each malignant group and their control group as well as between all four malignant groups.

Results:

Mean disease duration was 11.8 ±10.5 years for cancer and 12.8±10.8 years for RMDs since diagnosis. 1.4% received cancer treatment (6.4% of malignancy group), 69.3% csDMARDs, 42.3% b/tsDMARDs and 46.4% glucocorticoids at the time of sample collection.

Most metabolites tested were significantly lower in the malignancy groups versus associated controls: Concentrations of amino acids V and L were significantly reduced in all malignancy samples. Additionally, T, D, N, Q, E, A, I were altered in RA, SpA and PsA, changes in G were seen in RA, PsA and SLE and P was altered in RA and PsA only. Furthermore, lower concentrations of short chain fatty acids and tricarboxylic acid cycle intermediates were present in the malignancy groups. In no case was a metabolite concentration significantly higher in the malignancy group than in the associated control. When comparing the metabolome within the four malignancy groups, only the concentrations of creatine, threonine and isoleucine were found higher in RA patients with malignancy.

Conclusion:

Significant differences between the metabolomic fingerprints of RMD patients with and without malignancies could be observed. These changes might be characteristic for cancer burden, as in most cases the underlying RMD was not relevant when comparing the concentrations between the malignancy groups. Our results may promote understanding of the interrelationships of both disease entities as well as prove useful as biomarkers for diagnostic and therapeutic purposes.

Acknowledgements:

Grant/research support from medical faculty (Olympia Morata Programme) and foundations commission (Herbert Daus estate) of University of Heidelberg

Disclosure of Interests:

None declared

POS0293 TRheuMa REGISTRY PROVIDES FIRST EVIDENCE OF DIFFERENT COURSE OF RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS AND TUMOUR RESPONSE RATES DEPENDING ON THE TUMOUR ENTITY

Background:

Rheumatic immune-related adverse events (irAE) are associated with a better tumour response to immune checkpoint inhibitors (ICI). In contrast to other irAEs, their potentially chronic course may require long-term immunosuppressive treatment.

Objectives:

Our registry-based study analyses real-world data on the characteristics and outcome of rheumatic irAEs and underlying malignancy. Herein, we present first evidence that these parameters and the optimal clinical management may differ depending on the tumour entity.

Methods:

The TRheuMa registry is a prospective long-term observational study of a patient cohort suffering from rheumatic side effects of cancer therapies with focus on ICI. It is part of the MalheuR project initiated in July 2018 at the University Hospital Heidelberg to explore interrelations of malignancies and RMDs.

Results:

64 patients were recruited due to a rheumatic irAE under ICI treatment (nivolumab n=30, pembrolizumab n=33, ipilimumab n=12, PD-L1i n=5, ipi/nivo n=10) with a follow-up of up to 30 months. Of these, 47% had NSCLC and 41% melanoma. In local cohorts of patients receiving ICI, 4% of NSCLC (n total=888) and 13% of melanoma (n total=195) developed a rheumatic irAE. 7% of NSCLC and 23% of melanoma patients experienced a flare of a pre-existing RMD. De novo irAE mostly resembled phenotypes of spondyloarthritis both in NSCLC (43%) as well as in melanoma patients (33%). CRP levels were increased in 83% of NSCLC and 71% of melanoma patients. Almost all irAE patients showed autoantibody negativity and signs of inflammation in ultrasound examination (96%). Comparison of best responses to treatment in patients with and without rheumatic irAE in melanoma and without any irAE in NSCLC patients were as following: Complete remission (CR) in 48% vs. 4% of melanoma patients and partial remission (PR) in 68% vs. 41% of NSCLC patients. In accordance with our severity-based treatment algorithm, 25% of the melanoma patients in CR and 16% of the NSCLC patients in PR needed add-on DMARDs for sufficient irAE-treatment. ICI-treatment was discontinued in 7 cases (17% NSCLC, 8% melanoma)

Conclusion:

Prospective real-world data from the TRheuMa-registry provide first evidence that rheumatic irAE have distinct characteristics depending on the underlying malignancy. Oncological outcome was better with rheumatic irAE than in their absence and this effect was more pronounced in melanoma patients despite a larger use of immunosuppressants for irAE-treatment.

Disclosure of Interests:

Leonore Diekmann: None declared, Lea Daniello: None declared, Julia Kunz: None declared, Jan Leipe Consultant of: Pfizer; Novartis; Honoraria (self), Abbvie; Astra Zeneca; BMS; Celgene; Hospira; Janssen-Cilag; Gilead; LEO Pharma; Lilly; MSD; Roche; Sanofi; UCB., Grant/research support from: Research grant/Funding (self): Pfizer; Novartis; Honoraria (self), Hanns-Martin Lorenz Consultant of: Abbvie; BMS; MSD; Pfizer; Celgene; Roche; Chugai; Medac; GSK; Honoraria (self), Novartis; UCB; Janssen-Cilag; Astra Zeneca; Lilly, Grant/research support from: Research grant/Funding (institution): Abbvie; BMS; MSD; Pfizer; Celgene; Roche; Chugai; Medac; GSK; Honoraria (self), Research grant/Funding (institution), Novartis; UCB; Janssen-Cilag; Astra Zeneca; Lilly; Research grant/Funding (institution): Baxter; SOBI; Biogen; Actelion; Mundipharma; Bayer Vital; Octapharm; Sanofi; Hexal; Thermo Fischer; Shire., Jessica Hassel Consultant of: MDS; Honoraria (self): Roche; Novartis; Pierre Fabre., Grant/research support from: BMS; Honoraria (self), Karin Jordan Consultant of: Advisory/Consultancy: Amgen; Merck; MSD; Riemser; Helsinn; Tesaro; Kreussler; Voluntis; Pfizer; Pomme-med; Hexal., Petros Christopoulos Consultant of: advisory board/lecture fees from AstraZeneca, Boehringer Ingelheim, Chugai, Novartis, Pfizer, Roche, Takeda., Grant/research support from: research funding from AstraZeneca, Novartis, Roche, Takeda, Karolina Benesova Grant/research support from: Foundations and Awards” commission of the University of Heidelberg: University of Heidelberg; AbbVie; Novartis; Rheumaliga Baden-Württemberg e.V

Prediction of serum NGAL levels using comorbidity AHEAD score and two-year prognosis in stable chronic heart failure patients (FAR NHL registry)

Background

Neutrophil gelatinase-associated lipocalin (NGAL) is marker of renal function and is strongly associated with presence of comorbidities. AHEAD comorbidity score is commonly used to predict survival in acute heart failure patients and could predict events even in chronic heart failure.

Methods

547 stable patients with chronic heart failure patients with left ventricular ejection fraction &lt;50% were included in FARmacology and NeuroHumoraL activation (FAR NHL) registry. Three cardiological centres from The Czech Republic with speciality in heart failure were participating.

Results

Median age was 66 years, 80.3% were men. The etiology of heart failure was in 54% ischemic heart disease, in 40% dilatated cardiomyopathy, in 0.5% hypertrophic cardiomyopathy. 60% of patients were in NYHA class II.

In the first two years of follow-up, 74 events (13.5%) occurred, including all-cause death, left ventricle assist device implantation or orthotopic heart transplantation.

The AHEAD comorbidity score (Atrial fibrillation, low Haemoglobin level &lt;120 g/L in female or &lt;130 g/L in male, Elderly &gt;70 years; Abnormal renal parameters with creatinine &gt;130 μmol/L, Diabetes mellitus; 1 point for each comorbidity present) was set in this registry. Patients with AHEAD 0–1 survived without event in 89.2%, AHEAD 2–3 in 82.4% and AHEAD 4–5 only in 63.5% (p&lt;0.001; pairwise comparison 0.034, &lt;0.001, 0.021).

Also levels of NGAL are higher when comorbidities from AHEAD score are present: Atrial fibrillation (62 vs. 50 ng/mL; p&lt;0.001), Haemoglobin level (Spearman's rank correlation coefficient −0.240; p&lt;0.001), Eldery (Spearman's coefficient 0.425; p&lt;0.001), Abnormal creatinine level (Spearman's coefficient 0.528; p&lt;0.001), Diabetes mellitus (57 vs. 51 ng/mL; p=0.006).

NGAL levels are singificantly higher in patients with higher AHEAD score. Mean level of NGAL in AHEAD 0–1 (N=320) is 51 ng/mL, in AHEAD 2–3 (N=190) is 78 ng/mL and in AHEAD 4–5 (N=37) is 142 ng/mL (Kruskal-Wallis test p&lt;0.001, pairwise comparision all &lt;0.001).

Conclusion

In stable chronic heart failure registry FAR NHL, comorbidity score AHEAD can predict events. Serum NGAL level is significantly higher when AHEAD score comorbidities are present: Atrial fibrillation, low Haemoglobin, Eldery, Abnormal renal function and Diabetes mellitus.

Funding Acknowledgement

Type of funding source: None

The interval between progression and therapy initiation is the key prognostic parameter in relapsing diffuse large B cell lymphoma: analysis from the Czech Lymphoma Study Group database (NIHIL)

Relapsing diffuse large B cell lymphomas (rDLBCL) represent a heterogeneous disease. This heterogeneity should be recognized and reflected, because it can deform the interpretation of clinical trial results. DLBCL patients with the first relapse and without CNS involvement were identified in the Czech Lymphoma Study Group (CLSG) database. Interval-to-therapy (ITT) was defined as the time between the first manifestation of rDLBCL and the start of any treatment. The overall survival (OS) of different ITT cohorts (< 7 vs. 7-21 vs. > 21 days) was compared. In total, 587 rDLBCLs (51.8% males) progressed with a median of 12.8 months (range 1.6 to 152.3) since the initial diagnosis (2000-2017). At the time of relapse, the median age was 67 years (range 22-95). First-line therapy was administered in 99.3% of the patients; CHOP and anti-CD20 were given to 69.2% and 84.7% of the patients, respectively. The salvage immune/chemotherapy was administered in 88.1% of the patients (39.2% platinum-based regimen). The median ITT was 20 days (range 1-851), but 23.2% of patients initiated therapy within 7 days. The 5-year OS was 17.4% (range 10-24.5%) vs. 20.5% (range 13.5-27.4%) vs. 42.2% (range 35.5-48.8%) for ITT < 7 vs. 7-21 vs. > 21 days (p < 0.001). ITT was associated with B symptoms (p 0.004), ECOG (p < 0.001), stage (p 0.002), bulky disease (p 0.005), elevated LDH (p < 0.001), and IPI (p < 0.001). The ITT mirrors the real clinical behavior of rDLBCL. There are patients (ITT < 7 days) with aggressive disease and a poor outcome. Conversely, there are rDLBCLs with ITT ≥ 21 days who survive for a long time.

AB1021 CHARACTERISTICS AND MANAGEMENT OF RHEUMATIC MANIFESTATION UNDER ESTROGEN RECEPTOR-TARGETING CANCER THERAPIES, DATA FROM A PROSPECTIVE REGISTRY

Background:

The knowledge about interdependencies between rheumatic manifestations and malignancies is limited. Further, reliable data on the occurrence of rheumatic symptoms as side effects of specific cancer therapies beyond checkpointinhibitor-induced immune-related adverse events are sparse. In this regard, although arthralgia under estrogen receptor-targeting therapies (aromatase inhibitors and the estrogen receptor modulator tamoxifen) has been frequently reported in oncological clinical trials and case reports, prospective data including an assessment of rheumatic manifestations by rheumatologists are lacking.

Objectives:

To contribute to a better understanding of interdependencies between rheumatic manifestations and cancer/ estrogen blockade and potentially improve the management of both entities, pilot data were analysed.

Methods:

Data on characteristics and treatment of rheumatic manifestations and cancer as well as their timely association were systematically, prospectively collected and analysed in the MalheuR (´malignancy and rheumatic disease´) registry, a long-term, observational study designed to study patients suffering from concomitant rheumatic disease and malignancy and/or premalignant lesions.

Results:

We identified 11 patients with rheumatic manifestations under estrogen receptor-targeting therapies (3 anastrozol, 4 letrozol, 8 tamoxifen) as part of breast cancer treatment. In addition to breast cancer one patient had a lymphoma 3 years after and another patient had a non-small cell lung cancer 2 years before breast cancer diagnosis. The patients had different cancer stages (5 IA, 3 IIA, 1 IIB, and 1 IVA). Their mean age at cancer diagnosis was 60.4 ± 11.6 years and all patients are females. The time interval between diagnosis of cancer and onset of systemic/ rheumatic symptoms was 49.5 ± 34.0 months. Of interest, the time interval between onset of rheumatic symptoms and first assessment by a rheumatologist was 16.9 ± 22.3 months. The following systemic and rheumatic symptoms were reported: arthralgia in 10, arthritis in 8 (small joints in 5, large joints in 3 affected), morning stiffness (>30 min) in 7, IBP in 1, myalgia in 7, sicca symptoms in 2, fever in 1 (new-onset FMF with heterozygous M694U mutation), class IV glomerulonephritis and polyserositis in 1 (with new-onset SLE) patient(s). Disease burden at baseline was rather high with a mean VAS pain of 65 (±12.9)/100. Laboratory analyses revealed an increased CRP in 6/11 (55%) with a mean of 10.3 ± 8.2 mg/l (<5). Autoantibody positivity was observed for ANAs in 5/10 (50%, titers ranging from 1:80 to 1:160), anti-dsDNA in 1, rheumatoid factor in only 1/10 (10%) patients, none was anti-CCP positive. Before consulting a rheumatologist, patients were treated with NSAR 3/11 (27%), 10/11 systemic glucocorticoids (91%) with an initial dose of 17.5 ± 19.5 mg and intra-articular glucocorticoids 1/11 (9%). Rheumatological assessment lead to initiation of csDMARDs (3/11 MTX, 1/11 SSZ, 1/11 HCQ, 1/11 AZA (later MMF/ rituximab in the SLE patient) 1/11 colchicine) as corticosteroid-sparing agents with good response in the majority of patients.

Conclusion:

Our data demonstrate heterogeneous rheumatic manifestations, partially with severe manifestations beyond arthralgia, so far not reported by oncological studies including follow-up, which might suggest an underreporting. Furthermore, despite close monitoring in tumor aftercare, our data show a considerable delay in referral to a rheumatologist and initiation of suitable treatment. The prospective design of the MalheuR registry enables future validation of our pilot data.

Disclosure of Interests:

Alina Dr. Patroi Consultant of: Advisory board Novartis, Leonore Diekmann: None declared, Hanns-Martin Lorenz Grant/research support from: Consultancy and/or speaker fees and/or travel reimbursements: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly. Scientific support and/or educational seminars and/or clinical studies: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly, Baxter, SOBI, Biogen, Actelion, Bayer Vital, Shire, Octapharm, Sanofi, Hexal, Mundipharm, Thermo Fisher., Consultant of: see above, Bernhard. Kraemer: None declared, Karolina Benesova Grant/research support from: Study grants for SCREENED study by Abbvie, Novartis and Rheumaliga Baden-Württemberg, Consultant of: One-time participation in Novartis advisory board., Jan Leipe Grant/research support from: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Consultant of: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Speakers bureau: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB

SAT0578 RHEUMAL REGISTRY PROVIDES FIRST INSIGHTS INTO MUTUAL INTERDEPENDENCIES BETWEEN RHEUMATIC AND MUSCULOSKELETAL DISEASES AND MALIGNANCIES

Background:

Knowledge about interdependencies between rheumatic and musculoskeletal diseases (RMDs) and malignancies is limited on the clinical and molecular level. Particularly, valid prospective data on the timely association of malignancies in patients with RMDs and treatment of the latter are sparse.

Objectives:

Due to the heterogeneous patient population, a registry-based study has been conducted in order to provide insights into mutual interdependencies and novel evidence for suitable clinical management of patients with concomitant RMD and malignancies.

Methods:

The RheuMal registry is a long-term, open-end observational study designed to address the specific situation of patients suffering from concomitant RMD and concomitant malignancy and/or premalignant conditions. The RheuMal registry is one of the three subregistries of the MalheuR project, a registry-based study initiated in July 2018 at the at the university hospital Heidelberg, Germany.

Results:

Data from the RheuMal registry (n=404) show an earlier onset of gender-specific cancers and malignant melanoma in RMD patients compared to data from the German Cancer Registry Data of the Robert-Koch-Institute: compared to the reference population, in RMD patients breast cancer (n=32) occurred 5.3 years and prostate cancer (n=16) 3.3 years earlier. Onset of malignant melanoma was 2.4 years earlier in females (n=9) and 1.1 years in males (n=7) with concomitant RMD. The mean latency between the initial diagnosis of the RMD and the later occurring malignant condition was 10.2 years. The diagnosis of the malignancy frequently led to a change or interruption of disease-modifying antirheumatic therapy in RMDs.

Conclusion:

The RheuMal registry offers first insights into interdependencies between RMDs and malignancies based on demographic data, disease characteristics, clinical management and outcome as well as correlation of specific diagnoses and therapies. The earlier onset of gender-specific cancers and malignant melanoma suggests differences in the epidemiology and course of the malignant disease in RMD patients compared to a healthy reference population, suggesting interdependency between the two disease entities. Future research will focus on further understanding of this interdependency und the underlying molecular mechanisms.

Disclosure of Interests:

Karolina Benesova Grant/research support from: Study grants for SCREENED study by Abbvie, Novartis and Rheumaliga Baden-Württemberg, Consultant of: One-time participation in Novartis advisory board., Leonore Diekmann: None declared, Maria Czaja: None declared, Karin Jordan Consultant of: Consultancy and/or speaker fees: MSD, Merck, Amgen, Hexal, Riemser, Helsinn, Tesaro, Kreussler, Voluntis, Pfizer, Pomme-med., Jan Leipe Grant/research support from: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Consultant of: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Speakers bureau: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Hanns-Martin Lorenz Grant/research support from: Consultancy and/or speaker fees and/or travel reimbursements: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly. Scientific support and/or educational seminars and/or clinical studies: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly, Baxter, SOBI, Biogen, Actelion, Bayer Vital, Shire, Octapharm, Sanofi, Hexal, Mundipharm, Thermo Fisher., Consultant of: see above

AB1147 SCREENED – HIGH REMISSION RATES UNDERLINE THE BENEFIT OF SCREENING CONSULTATION MODELS FOR EARLY RECOGNITION AND TREATMENT OF RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background:

Early recognition and treatment of rheumatic and musculoskeletal diseases (RMDs) is of critical importance for the individual outcome. However, nationwide health care structures in Germany do not facilitate early access to initial rheumatologic evaluation. Furthermore, waiting times of several months due to substantial capacity constrains in regional rheumatology care services compromise the prognostically relevant “window of opportunity” for subsequent sustained remission. To promote early detection of RMDs, the Division of Rheumatology at the University hospital Heidelberg, Germany has launched a unique screening consultation model that offers early access to rheumatologic evaluation on regional level.

Objectives:

The registry-based study SCREENED (“Screen for early diagnosis”) has been initiated to monitor the outcome of patients that were diagnosed with an RMD at the screening clinic and to assess the costs and benefits of this consultation model for the regional quality of care.

Methods:

The screening consultation model has been launched in two phases: in the first phase (02/2016 - 01/2018), a screening clinic open to all patients without previous rheumatologic evaluation with appointments according to the registration order has been established through rearrangement of available capacities. In contrast to regular appointments, the screening clinic took place in shorter consultation time frames and without additional diagnostic procedures. In the second phase (02/2018 - 01/2020), in order to manage and prioritize access to rheumatologic care at our division more efficiently, prior to appointment allocation (not only) to the screening clinic all new patient registrations became subject to a preselection procedure based on the evaluation of an anamnesis questionnaire, medical reports and laboratory findings by an experienced rheumatologist. Furthermore, SCREENED project has been launched for scientific evaluation of both phases of the consultation model.

Results:

The screening consultation model achieved a significant reduction in waiting times to few weeks compared to six months for a regular appointment. In the first phase, the screening clinic had a high sensitivity of 94.3% and an improvable specificity of 31.1%. In the retrospective cohort, high remission rates have been observed over all RMD entities (120/206 = 58.3% patients based on physicians’ assessment in the follow-up after screening clinic) and in rheumatoid arthritis (RA) in particular (38/61 = 62.3% and 33/55 = 60% patients with DAS28 score < 2,6 after 12 and 24 months respectively). Remission was usually reached within a year after the first appointment (9.5 ± 6.7 months), however, a trend to higher remission rates in patients with shorter illness duration was obvious. In RA patients, csDMARDs have been initiated in a third of patients immediately at diagnosis in the screening clinic and in another third within six months after the first appointment. After 12 months, > 80% have received csDMARDs, while only 14.2% needed b/tsDMARDs in the follow-up over 24 months.

Conclusion:

High sensitivity and significant reduction in waiting times for initial rheumatologic evaluation in the screening clinic pave the way for early recognition and treatment of RMDs. Subsequently, high remission rates in the follow-up were reached. In RA, a high proportion of patients only required csDMARDs to achieve sustained remission. A correspondingly small proportion of patients necessitating b/tsDMARD in the follow-up points towards a significant health economic benefit of the early rheumatologic intervention in the screening consultation model.

Disclosure of Interests:

Karolina Benesova Grant/research support from: Study grants for SCREENED study by Abbvie, Novartis and Rheumaliga Baden-Württemberg, Consultant of: One-time participation in Novartis advisory board., Vivienne Lion Grant/research support from: Grant/research support from: Study grants for SCREENED study by Abbvie, Novartis and Rheumaliga Baden-Württemberg, Oliver Hansen Grant/research support from: Grant/research support from: Study grants for SCREENED study by Abbvie, Novartis and Rheumaliga Baden-Württemberg, Hanns-Martin Lorenz Grant/research support from: Consultancy and/or speaker fees and/or travel reimbursements: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly. Scientific support and/or educational seminars and/or clinical studies: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly, Baxter, SOBI, Biogen, Actelion, Bayer Vital, Shire, Octapharm, Sanofi, Hexal, Mundipharm, Thermo Fisher., Consultant of: see above

OP0270 TRHEUMA REGISTRY EXPLORES CHARACTERISTICS AND SUITABLE DIAGNOSTIC AND THERAPEUTIC MANAGEMENT OF RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS (IRAES)

Background:

Reports of rheumatic immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors (ICPi) have recently attracted new attention to the complex interrelations of malignancies andrheumatic and musculoskeletal diseases (RMDs). Since those two entities represent two sides of a dysregulated immune response, further research on rheumatic irAEs and mechanisms underlying the better tumor response rates in irAE-affected patients may contribute to a better understanding of the different pathophysiology characterizing tumor and rheumatic disease.

Objectives:

Given the heterogeneity of the patient population with rheumatic irAEs, a registry-based study has been conducted to provide first evidence regarding characteristics of rheumatic irAEs and further insights into the optimal diagnostic and therapeutic management of rheumatic irAEs.

Methods:

The TRheuMa registry is a long-term, open-end observational study of a patient cohort suffering from rheumatic symptoms as a result of ICPi or other cancer therapies. The TRheuMa registry is one of the three subregistries of the MalheuR project, a registry-based study initiated in July 2018 at the at the university hospital Heidelberg to explore interrelations of malignancies and RMDs.

Results:

Over 18 months, 52 of 63 patients in the TRheuMa registry were recruited with a rheumatic irAE under ICPi treatment (pembrolizumab n=21, nivolumab n=28, ipilimumab n=11, durvalumab n=1, atezolizumab n=2, avelumab n=1, history of >1 ICPi n=11). Of the 52 patients, 22 (42.3%) had non-small cell lung cancer and 23 (44.2%) had a melanoma. Eight (15.3%) patients experienced a flare of a preexisting RMD under ICPi treatment. The remaining 44 patients withde novoirAEs were characterized by rheumatoid arthritis-like (20.5%) or polymyalgia rheumatica-like (18.1%) and psoriatic or other spondyloarthritis-like phenotypes (50.0%). However, laboratory findings differed from classical RMDs with elevated CRP-levels in 73.1% particularly in psoriatic arthritis-like, but not necessarily in polymyalgia rheumatica-like irAEs. On the contrary, autoantibody positivity was very rare. The majority of patients (78.8%) showed signs of inflammation upon ultrasound examination.

Based on the severity of signs and symptoms as well as treatment response, we developed a therapeutic algorithm for rheumatic irAEs: non-steroidal anti-inflammatory drugs and/or low dosed glucocorticoids (≤10mg prednisone equivalent) as first treatment step were sufficient for 75% patients, whereas 17.3% required higher dosed glucocorticoids and 11.5% patients required further treatment with a cs- or bDMARD. In two cases ICPi-treatment was discontinued on patients’ request due to the pain and functional impairment caused by the rheumatic irAE, although a satisfactory symptom control was reached in the further course.

Complete remission of cancer was observed in 43.5% of melanoma patients, 66.7% experienced additional severe irAEs in other organ systems.

Conclusion:

Overall, data from the TRheuMa-registry show that rheumatic irAEs mostly resemble classical RMDs, however show distinct characteristics. Our diagnostic and therapeutic management of rheumatic irAEs demonstrated efficacy in the majority of patients. These findings contribute to the further understanding of rheumatic irAEs and malignancies. Future research agenda includes a correlation of irAE severity with tumor response.

Disclosure of Interests:

Karolina Benesova Grant/research support from: Study grants for SCREENED study by Abbvie, Novartis and Rheumaliga Baden-Württemberg, Consultant of: One-time participation in Novartis advisory board., Leonore Diekmann: None declared, Hanns-Martin Lorenz Grant/research support from: Consultancy and/or speaker fees and/or travel reimbursements: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly. Scientific support and/or educational seminars and/or clinical studies: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly, Baxter, SOBI, Biogen, Actelion, Bayer Vital, Shire, Octapharm, Sanofi, Hexal, Mundipharm, Thermo Fisher., Consultant of: see above, Karin Jordan Consultant of: Consultancy and/or speaker fees: MSD, Merck, Amgen, Hexal, Riemser, Helsinn, Tesaro, Kreussler, Voluntis, Pfizer, Pomme-med., Jan Leipe Grant/research support from: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Consultant of: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Speakers bureau: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB

[Side effects of novel cancer immunotherapies]

Systemic treatment with immune checkpoint inhibitors (ICI) has revolutionized the treatment of hematological and oncological diseases in recent years. The mechanism of action hinges on enhancing the natural ability of the immune system to eliminate malignant cells. The most important substances in this arena include inhibitors of PD‑1, PD-L1 and CTLA‑4. As a consequence, the spectrum of treatment-associated adverse reactions is shifting away from classical cytotoxic effects (e.g. pancytopenia and polyneuropathy) towards novel entities of immune-mediated complex diseases. These so-called immune-related adverse events (irAEs) can involve any organ system and mimic known classical autoimmune conditions. Timely recognition of irAEs is the key for rapid initiation of a suitable treatment and is especially challenging in the clinical routine as it requires an intensive interdisciplinary management. Nephrologists are particularly confronted with this kind of problem due to the highly interdisciplinary nature of their work. This article summarizes the broad spectrum of currently known renal and more frequently occuring non-renal forms of irAEs and aims to prime the reader on diagnostic and therapeutic options.

[Early recognition and screening consultation: a necessary way to improve early detection and treatment in rheumatology? : Overview of the early recognition and screening consultation models for rheumatic and musculoskeletal diseases in Germany]

In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.

1418Adverse effects of spironolactone in long-term treatment of resistant arterial hypertension

Background

Spironolactone is recommended as a fourth line antihypertensive drug by current hypertension guidelines. This drug had relatively few adverse effects in short term clinical trials, but data about their occurrence during long-term treatment of resistant hypertension are scarce.

Purpose

To evaluate the occurrence and type of adverse effects of spironolactone during long-term treatment and their possible clinical and laboratory predictors.

Methods

We prospectively followed 274 patients with resistant arterial hypertension who started treatment with spironolactone between September 2007 and December 2016. The duration of spironolactone use, its dose, the incidence of adverse events, blood pressure, and laboratory findings were recorded at baseline and during the last clinical examination.

Results

Patients were followed for an average of 35 (± 29) months, the mean dose of spironolactone was 27.5 mg/day. Adverse effects occurred in 72 patients (26.3%) and in 61 (84.7%) lead to discontinuation of spironolactone. The most common adverse reactions were gynaecomastia (30.6%), hyperkalaemia (30.6%) and symptomatic hypotension (26.4%). The mean duration of spironolactone treatment before their occurrence was 25 (± 27) months. According to the Kaplan-Meier curve, the median for the incidence of adverse events would be 97 months (91.5–102.5 months), i.e. 50% of patients could be treated with no adverse events for more than 8 years. Adverse events were more common in the elderly (hazard ratio – HR 1.38, P=0.007), patients with higher baseline serum creatinine (HR 1.12, P=0.035) and patients taking angiotensin receptor blockers (HR 1.65, P=0.040).

Kaplan-Meier estimate – adverse events

Conclusion

During long-term treatment of resistant hypertension with spironolactone, more than a quarter of patients experience adverse reactions that usually require discontinuation of spironolactone.

Acknowledgement/Funding

Supported by the grants of Palacký University in Olomouc Nr. IGA_LF_2016_038 and IGA_LF_2017_029.

P1657Hyperuricaemia treatment in acute heart failure patients does not improve their long-term prognosis: a propensity score matched analysis from the AHEAD registry

Background

Hyperuricaemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricaemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients.

Methods and results

The prospective acute heart failure registry (AHEAD) was used to select 3,160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricaemia was defined as UA ≥500μmol/l and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricaemia, with treated hyperuricaemia and with untreated hyperuricaemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricaemia, unlike those with hyperuricaemia, had a higher left ventricular ejection fraction, a better renal function and higher haemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with ACEIs/ARBs and/or beta-blockers. In a primary analysis, the patients without hyperuricaemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricaemia had a similar five-year survival rate as those with untreated hyperuricaemia (42.0% vs 39.7%, p=0.362) whereas those with treated hyperuricaemia had a poorer prognosis (32.4% survival rate; p=0.006 vs non-hyperuricaemia group and p=0.073 vs untreated group).

Conclusion

Hyperuricaemia was associated with an unfavourable cardiovascular risk profile in HF patients. Treatment of hyperuricaemia with low doses of allopurinol did not improve the longterm prognosis of HF patients.

Acknowledgement/Funding

Ministry of Health CZ 65269705 and MUNI/A/1250/2017

The quality of life following allogeneic hematopoietic stem cell transplantation - a multicenter retrospective study

Although allogeneic haematopoietic stem cell transplantation (allo-HSCT) offers a unique curative potential, it may be connected with high treatment-related morbidity and mortality. Besides many organ complications, allo-HSCT may significantly affect quality of life (QOL).

PATIENTS AND METHODS

Between January 2011 and December 2012, five hundred and ninety patients (pts) from 6 transplant centers in the Czech Republic filled in the questionnaire for the quantitative measurement of QOL using Functional Assessment of Cancer Therapy-General (FACT-G) version 4. Study cohort characteristics were as follows: 325 males, 340 pts received myeloablative conditioning, 383 pts received PBPC, representation of diagnoses; acute leukemia (n=270), bone marrow failure (n=36), chronic myeloid leukemia (n=74), myelodysplastic/myeloproliferative syndrom (n=110), lymphoproliferative disease (n=93). The median age at allo-HSCT was 43 years (range: 1.7 - 71.0), the median time from allo-HSCT to questionnaire completing was 3.8 years (range: - 0.2 - 21.6). The earliest allo-HSCT was performed in November 1989, the last in September 2012. In this retrospective study, we investigated the impact of various factors on the QOL after allo-HSCT: age, gender, diagnosis, type of conditioning, time from diagnosis to allo-HSCT, disease stage, graft type, donor type, time from allo-HSCT to questionnaire completing, GVHD, relapse. Only data from patients who were more than 3 months after allo-HSCT were used for the multivariate analysis. The overall results of the total FACT-G score (median=85.0; range: 29-108) as well as the results of each specific dimension - PWB (median=23.0; range: 5-28), SWB (median=24.0; range: 7-28), EWB (median= 19.0; range: 4-24), FWB (mean=21.0; range: 2-28) showed a value in the highest quartile of the possible evaluation. In multivariate analysis, an inferior QOL score was reported for patients with aGVHD (p=0.002), cGVHD (p<0.001), QOL decreased with increasing age (p=0.048) and increased with time elapsed since allo-HSCT (p<0.001).Allogeneic HSCT represents an important intervention into the overall integrity of the organism. In particular, the development of GVHD can cause very serious organ, but also mental problems which can significantly reduce the QOL. The QOL is steadily increasing with increasing interval from allo-HSCT but improvement and disappearance of these complications may take many years, and sometimes these effects may probably persist permanently.

The incidence of biopsy-proven transformation in follicular lymphoma in the rituximab era. A retrospective analysis from the Czech Lymphoma Study Group (CLSG) database

The aim of this study is to assess the incidence, risk factors, and outcome of biopsy-proven transformation in follicular lymphoma (FL) patients in the rituximab era. Transformation was analyzed in 1233 patients with initially diagnosed FL grades 1-3A, identified between 2002 and 2012 in the prospectively maintained Czech Lymphoma Study Group database. Only patients with histologically proven transformation (HT) were included. HT occurred in 58 cases at a median of 3.0 years from the initial FL diagnosis; the HT rate was 4% at 5 years. Transformation occurred most frequently at the first relapse (84% patients). Median OS from the HT was 2.5 years (95% CI 0.4-4.6) and 6-year OS with HT was shorter compared to all FLs (60 vs. 83.9%; 95% CI). A bulky tumor (≥ 10 cm), increased lactate dehydrogenase, age ≥ 60 years, and International Prognostic Index (intermediate/high risk), but not Follicular Lymphoma International Prognostic Index, were associated with transformation (p < 0.05). In the first line, 70% of patients received rituximab (including 36% rituximab maintenance), 57% CHOP-like regimens, and 2.6% of patients were treated with fludarabine-based therapy, whereas 11% of patients were watched only. The patients treated with R-CHOP in the first line (n = 591) showed the transformation rate at 5 years of 4.23% (95% CI 2.52-5.93); subsequent rituximab maintenance (n = 276) vs. observation (n = 153) was associated with a lower transformation rate (p.033; HR 3.29; CI 1.10-9.82). The transformation rate seems to be lower than in previous series, which may be influenced by broad use of rituximab, but prognosis of HT developed during therapy continues to be poor.

Change in Quality of Life Measured over Time in Czech Women with Breast Cancer

BACKGROUND

This study examined the impact of breast cancer on quality of life (QOL) of Czech women by comparing the QOL of breast cancer patients with that of age-matched healthy controls.

METHODS

The sample consisted of 74 breast cancer patients who filled in self-assessment questionnaires retrospectively before treatment and at the time of the study. In addition, 73 healthy controls completed the same battery of questionnaires. QOL was assessed using the Rand 36-Item Health Survey, the Life Satisfaction Questionnaire, and the Czech research version of Functional Assessment of Breast Cancer Therapy. The Wilcoxon paired test and Mann-Whitney U test were used for data analysis.

RESULTS

A statistically significant decline in QOL in breast cancer patients was found for the following components: Physical Functioning (p = 0.021), Role Functioning-Physical (p < 0.001), Bodily Pain (p = 0.001), General Health (p = 0.031), Role Functioning-Emotional (p = 0.023), and Physical Well-being (p = 0.001). The only significant increase over time was observed in Social/Family Well-being (p = 0.024). For most of the components, patients showed a statistically significant lower QOL than that of healthy controls. A recent diagnosis, advanced disease stage, more comorbidities, a higher BMI, and other sociodemographic characteristics were associated with a higher incidence of a lower QOL over time.

CONCLUSION

Perceived QOL decreased over time in breast cancer patients mainly in components such as physical and emotional functioning, bodily pain, and general health, with several risk factors strongly influencing this change. The QOL of patients was lower than that of the non-cancer population, indicating that subsequent care should be improved to minimize the adverse effects that breast cancer has on QOL.

Screening of Psychological Distress 4.5 Years after Diagnosis in Breast Cancer Patients Compared to Healthy Population

BACKGROUND

Survival rate of breast cancer patients has improved significantly in recent years. Cancer diagnosis represents a great psychological distress for patients which may not stem solely from the disease itself. Patients may experience higher distress even several years after treatment.

PATIENTS AND METHODS

The study was carried out at the Department of Obstetrics and Gynecology and Department of Internal Medicine, Haematology and Oncology, Faculty Hospital Brno. Results of 85 patients at 4.5 years after diagnosis of breast cancer compared to 72 healthy controls are presented in this paper. The data were collected in the form of semi-structured interviews, from the patients medical records and by Symp-tom Check List-90.

RESULTS

The overall rate of psychological distress (GSI) 4.5 years after breast cancer dia-gnosis does not differ significantly (p = 0.703) from the healthy population. Also, we did not find any statistically significant relationship between the observed factors and the level of psychological distress in breast cancer patients.

CONCLUSION

Screening investigation showed no difference in the psychological distress in breast cancer patients 4.5 years following diagnosis, compared with the healthy population.

Predicting Vitality Change in Older Breast Cancer Survivors after Primary Treatment--an Approach Based on Using Time-related Difference of Pro-inflammatory Marker C-reactive Protein

BACKROUND

We aimed to determine prognosis of vitality change and functional status of breast cancer survivors after primary oncological treatment using time-related differences of elevated levels of highly sensitive proinflammatory C-reactive protein (CRP).

PATIENTS AND METHODS

The test group consisted of 46 elderly breast cancer survivors (median age was 65 years) who completed Vitality Scale of Short Form 36 (SF-36) after completing treatment and another retrospectively at diagnosis. Data on tumor-related factors, treatment, and outcomes were obtained retrospectively from medical records, and linear regression analysis was performed. CRP was followed at diagnosis and one year after primary treatment. Within the scope of this study, clinically important difference in the Vitality Scale was set at five points of change.

RESULTS

Results showed a statistically significant relationship between CRP change and vitality component of SF-36 change (rs = - 0.350, p = 0.023) in which a decrease in CRP inversely correlated with the quality of life component. The overall change was 1.078 of the vitality scale score (approximately 1 point) for each 1 unit decrease of CRP (1 mg/ L). Association of CRP levels (before and after treatment, its difference between these time points) with age, number of comorbidities and stage of the disease was analyzed and no statistically significant relationship was found in our study.

CONCLUSION

Preliminary results suggested time-related differences in elevated CRP levels as a potentially suitable predictor for change in vitality status for long term, chronic condition for older breast cancer survivors. We suggest the interpretation schema including an understanding that CRP change of 5 mg/ L and more should be considered a potential risk factor for subsequent negative clinical outcomes.

Impact of rituximab maintenance and maintenance schedule on prognosis in first-line treatment of follicular lymphoma. Retrospective analysis from Czech Lymphoma Study Group (CLSG) database

Rituximab maintenance (RM) improves time to progression (PFS) in advanced follicular lymphoma (FL), but the impact of various RM schedules remains unknown. This study performed a retrospective evaluation of RM given for up to 2 years vs observation in 319 untreated FL patients (stage II-IV; grade 1-3A) responding to RCHOP induction and a comparison of two different RM schedules (RM8=eight doses given every 3 months and RM12=12 doses given every 2 months). A total of 183 patients received RM and 136 patients were observed; 5-year PFS was better in the RM arm, 74.1% vs 52.3% (p<0.001), which was projected in 5-year OS 93.8% vs 87.5% (p=0.005). However, 5-year PFS was similar in both the RM8 (n=54) and RM12 (n=56) arms. In the first line, RM significantly prolongs PFS and OS in FL, but different RM schedules bring a similar benefit.

Radiotherapy with rituximab may be better than radiotherapy alone in first-line treatment of early-stage follicular lymphoma: is it time to change the standard strategy?

Early-stage follicular lymphoma (FL) has traditionally been treated with involved-field radiotherapy (RT). Rituximab (R) is a low-toxic, efficient systemic therapy for FL, but there are no data about its clinical impact in early FL. We retrospectively analyzed 93 patients with stage I-II indolent FL treated with RT (n=65) or RT+R (n=14) or R alone (n=14). Median follow-up was 5.0 years for patients with RT, 2.8 years for the RT+R subgroup and 2.5 years for patients treated with R. The complete response rate was 92%, 100% and 86% (not significant) and the median PFS was 3.3 years, not reached and 4.9 years (p=0.035) for the RT, RT+R and R arms, with no impact on overall survival. R combined with RT seems to give better results in terms of global FL control, but longer follow-up and prospective comparison are needed to verify these results.

The Hans algorithm failed to predict outcome in patients with diffuse large B-cell lymphoma treated with rituximab

Diffuse large B-cell lymphoma (DLBCL) consists of at least two biologically and pathogenetically different subtypes, the germinal centre B-cell (GCB) and the activated B cell type (ABC). It has been suggested that immunohistochemistry can discriminate these subtypes as well. The aim of this study was to verify the validity of the most commonly used Hans algorithm in patients with DLBCL treated with anthracycline- based chemotherapy with rituximab. Immunohistochemical staining using standard protocols was performed on formalin fixed paraffin-embedded tissues. CD20, CD5, CD23, BCL2, CD10, BCL6, MUM1 and Ki67 antibodies were applied. Out of 120 examined cases 52 patients were evaluated as GCB type and 68 patients as having non-GCB, out of a set of 99 patients treated with immunochemotherapy 45 patients with GCB and 54 patients with non-GCB DLBCL were identified. In this set of patients, there was no statistically significant difference neither in overall survival (OS) (HR 1.47 95% CI 0.51-2.63; p=0.45) nor in progression free survival (PFS) (HR 1.57, 95 % CI 0.76-3.22; p=0.731) between both groups.

No association between the TP53 codon 72 polymorphism and risk or prognosis of Hodgkin and non-Hodgkin lymphoma

The role of the TP53 gene's R72P polymorphism in non-Hodgkin lymphoma (NHL) has been analyzed in several studies but it has not been studied in Hodgkin lymphoma (HL). We have evaluated the role of R72P in 340 NHL and 298 HL patients. There was no difference in the R72P frequency between analyzed lymphoma cases and 749 controls. We found no association of R72P with the risk of NHL and HL development [OR(ArgPro/ProPro)=0.9 (95% CI 0.7-1.2) and 1.2 (95% CI 0.9-1.5), respectively] or with survival. Our results support the evidence that R72P is not a prognostic factor in Caucasian NHL patients, and they indicate its irrelevance for HL development or prognosis.

Reduced-intensity conditioning for allogeneic stem cell transplantation in patients with chronic myeloid leukemia is associated with better overall survival but inferior disease-free survival when compared with myeloablative conditioning - a retrospective study of the Czech National Hematopoietic Stem Cell Transplantation Registry

Allogeneic stem cell transplantation (AlloSCT) has been currently recommended in the treatment of patients with chronic myeloid leukemia (CML) as a second option after imatinib failure or in selected group of patients with high-risk CML and low risk for transplant-related mortality. The actual role of reduced-intensity conditioning (RIC) before AlloSCT in CML patients has not been yet conclusively established. The Czech National Hematopoietic Stem Cell Transplantation Registry has conducted a retrospective analysis of all patients (n=29) transplanted after RIC from the Registry database containing 295 patients with CML transplanted in the Czech Republic in years 1988-2005 and compared them with patients at comparable age (median age 48.3 and 50.6 years, respectively; p=0.587) transplanted during the same period of time using conventional myeloablative conditioning (n=26). Survival advantage of patients transplanted after RIC has been confirmed by log rank test (p=0.036) despite the fact that the relapse rate was significantly higher in RIC group (44.8% versus 0%). Both groups did not differ significantly in the use of voluntary unrelated donors, type of the grafts and in incidence of acute graft versus host disease (GVHD). However, there were trends for higher risk of CML and higher use of unrelated donors in the myeloablative group while peripheral stem cell grafts and chronic GVHD were observed more frequently in the RIC group. Transplant-related mortality was the leading cause of death in both groups of patients. Our results should be interpreted with caution because they may be influenced by small groups of subjects and also the impact of patients with high EBMT risk score on inferior survival in the myeloablative group cannot be fully eliminated. More retrospective and prospective studies are needed to elucidate the actual role of RIC before AlloSCT for CML.