Clinical Lymphoma, Myeloma & Leukemia, Vol.22, Suppl.2 - October 2022

Abstracts Clinical Lymphoma, Myeloma & Leukemia October 2022 S198 2019. EOI MRD negative rates were 7 0.1% compared with 51. 7 % in a historical cohort treated with chemotherapy. On longer follow up (median follow up 38months), 3-year EFS and OS rates were 7 5.6% (95% CI 62.3-91.9%), and 7 5.6% (95% CI 62.3-91.9%) respectively. 3-year rates of EFS based on post-induction (week 4) MRD status was 55.6% (31-99. 7 %) in MRD positive group compared with 86.1% ( 7 2. 7 -100%) in MRD negative group. 3-year rates of OS based on EOI MRD status was 55.6% (31-99. 7 %) in MRD positive group compared with 86.1% ( 7 2. 7 -100%) in MRD negative group. The median OS for patients who attained CR was not reached versus 8 months in patients who fail to achieve CR. Co n clusio n s: On longer follow-up, the activity of the combination of bortezomib and rituximab is maintained without any new safety concerns. EOI MRD positivity and lack of complete remission post- induction are strong predictors of poor outcomes. Keywords: ALL, bortezomib and rituximab, B-acute lymphoblastic leukemia, Phase II ALL-243 Cytomegalovirus Reactivation in Adult Acute Lymphoblastic Leukemia Patients during POMP Maintenance Chemotherapy: Do We Underestimate the Dormant Virus? Layal Al Mahmasani MD, Elio Jabra MD, Nour Moukalled MD, Jean El Cheikh MD, Ali Bazarbachi MD, Iman Abou Dalle MD American University of Beirut, Beirut, Lebanon Co n text: Cytomegalovirus (CMV) is a common herpes virus that infects around 60-100% of adults and is one of the most common pathogens involved in infectious complications post-hematopoietic stem cell transplantation (HSCT). Infections with the CMV can cause complications such as pneumonia, retinitis, and enterocolitis. Studies have shown that HSCT patients are at higher risk for CMV reactivation leading to disease and have high morbidity and mortality rates. Nevertheless, CMV infections have been reported in non- transplant patients, especially in the pediatric population. There are several case reports that highlight the complications of CMV in non- transplant acute lymphoblastic leukemia (ALL) pediatric patients. Very few cases of CMV infections have been reported in non- transplanted adult ALL patients during maintenance chemotherapy. Objecti v e: To report a case series on adult ALL, non-transplant patients with CMV disease. D esig n : We report four adult patients who were diagnosed with ALL, achieved complete remission after induction chemotherapy without HSCT, and then developed CMV disease during their maintenance chemotherapy treatment with mercaptopurine, vincristine, methotrexate, and prednisone (POMP) at the American University of Beirut Medical Center (AUBMC), Lebanon. Results: Four cases of ALL patients (all were males, age range from 20 to 7 3 years) are reported. Patient 1 presented with sequential vision loss in the 5th month of POMP treatment. Patient 2 presented with fever and diarrhea in the 2nd month of POMP treatment. Patient 3 presented with fever, diarrhea, and respiratory distress in the 11th month of POMP treatment. Patient 4 presented with respiratory distress in the 8th month of POMP treatment. Three patients cleared CMV viremia after first-line treatment with either ganciclovir or valganciclovir, whereas one patient required second-line treatment with Ganciclovir, Foscarnet, and intravenous immune globulin. Co n clusio n s: Our observations and a review of the literature suggest this is a rare entity with potentially high morbidity. The majority of patients develop asymptomatic viremia before manifestations of end-organ damage. Clinicians shall be aware of this entity, especially in patients who are at high risk for developing CMV reactivation and diseases such as those with positive serology and prolonged lymphopenia, which is commonly encountered during the maintenance treatment. Keywords: ALL, case, acute lymphoblastic leukemia, cytomegalovirus, maintenance treatment, immunosuppression ALL-257 Detection of Deletion in the IKZF1 Gene and the NOTCH1 Signaling Pathway in Patients With T-Cell Acute Lymphoblastic Leukemia: Data of the RALL Study Group Anastasia N. Vasileva MD 1 , Olga A. Aleshina PhD 1 , Andrey B. Sudarikov MD, PhD 1 , Bella V. Biderman MD, PhD 1 , Galina A. Isinova MD, PhD 1 , Ekaterina S. Kotova MD 1 , Elena N. Parovichnikova MD, PhD 1 1 National Research Center for Hematology, Moscow, Russian Federation Backgrou n d: Mutation in the NOTCH1 is the most frequent event in patients with T-acute lymphoblastic leukemia (ALL). This mutation is associated with a favorable prognosis. Deletion of the IKZF1 gene, occurring in patients with T-ALL in about 10% of cases, is a prognostically unfavorable anomaly. Ai m : To evaluate the survival of patients withT-ALL depending on the immunophenotype, as well as to analyze the frequency of occurrence of anomalies in the NOTCH1 and IKZF1 genes. Materials a n d Methods: The analysis included 91 patients with T-ALL/LBL receiving therapy according to the ALL-2016 protocol. The immunophenotype was determined by flow cytofluorimetry. Anomalies in the IKZF1 and NOTCH1 were investigated by fragment analysis according to Caye A, et al and Campregher PV, et al in 25 and 29 patients, respectively. Results: From December 2016 to June 2021, 91 patients with T-ALL were included in the ALL-2016 protocol (64 men and 2 7 women, median 32 years: 6-TIV, 11-ETP-ALL, 32-TI/II, 42-TIII). 3-year overall survival in the ETP group was 28%, TI/II-50%, TIII- 7 3% and TIV-83%. Molecular anomalies in NOTCH1 were analyzed by fragment analysis in 29 patients (1-undifferentiated variant, 8-ETP-ALL, 9-TIII, 10-TIII, 1-TIV), in IKZF1 genes in 25 patients (1-undifferentiated variant, 5-ETP-ALL, 8-TIII, 10- TIII, 1-TIV). None of the patients had deletions in the IKZF1 . Anomalies in the NOTCH1 were detected in 19 (65.5%) patients (4-ETP-ALL, 7 -TII, 7 -TIII, 1-TIV). At the same time, 15 of them (51%) had NOTCH1 deletions, 4 (14%) had insertions. 5 patients without abnormalities in the NOTCH1 (50%) died as a result of a resistant or relapse, 5 patients are alive in remission. In the group of