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

Abstracts Clinical Lymphoma, Myeloma & Leukemia October 2022 S284 (Philadelphia chromosome). The presence of blasts in the lymph node (LN) is enough for a diagnosis of blast-phase CML. Objecti v e: The case study herein is a very rare presentation. D esig n : A case report of a 53-year-old Egyptian male patient who presented in 2020 with night fever and sweats. Setti n g: Oncology Center Mansoura University. Patie n t: Examination revealed firm, non-tender, generalized cervical and bilateral axillary lymphadenopathy. The patient’s abdominal examination revealed moderate, firm, and non- tender splenomegaly. Complete blood count: white blood cell count 239 k/µL, normocytic normochromic anemia with hemoglobin 11 g/dL, and platelet count 321 k/µL. Differential leukocyte count revealed blasts (1%), myelocytes (12%), metamyelocytes (25%), polymorphonuclear leukocytes (50%), eosinophils (2%), basophils (3%), and lymphocytes (2%). Bone marrow (BM) examination was hypercellular; 7 0% of the total BM cellularity was replaced by myeloid series highlighted by myeloperoxidase, and few blasts (<1%) were CD34 + , suggesting chronic-phase CML. I n ter v e n tio n s: BCR- ABL1 gene rearrangement by Q RT-PCR was 65.9% IS. The patient started imatinib 400 mg/d. LNs were suspicious, and excisional biopsy showed multiple fatty nodules ~3.5×3 cm; the cut section was firm, grayish white, partially effaced, and replaced by infiltrate of myeloid series (MPO + , CD3 − , CD30 − , and CD 7 9a) with a high Ki6 7 proliferation index. LN infiltration suggested a CML blastic crisis despite the fact that repeated BM aspirate samples revealed no increase in blasts. However, the new BM biopsy (BMB) revealed that most of the cellularity was replaced by myeloid series with CD11 7 + (15%) and CD34 + . Mai n Outco m e Measures: Acute leukemia risk assessment revealed FLT3 − and inv(16) + , and FISH analysis indicated t(9:22). The patient was refractory to ICT and imatinib and was shifted to salvage. Results: Complete remission was confirmed by PET/CT scan and BMB; however, he did not achieve a molecular response (Q RT-PCR for BCR-ABL1 15% IS). He was switched to dasatinib with consolidation chemotherapy, and HLA matching was done for results. Co n clusio n s: This case report highlights the importance of a rare CML presentation with extramedullary infiltrates. A myeloid sarcoma should be excluded before setting the treatment plan. Keywords: CML, blastic crisis, sarcoma, case CML-030 Do Patients With CML-CP in MMR Still Have a Hope to Receive Nilotinib (Tasigna) While Fasting During Ramadan? An Unanswered Question Mohamed Maher MD, Abdelhamid Fouad MD, Mariam ElHaddad MD, Mohamed Samra MD, Raafat Abdelfatah MD, Hossam Kamel MD National Cancer Institute, Cairo, Egypt Co n text: The introduction of tyrosine kinase inhibitors has offered much in terms of overall survival for patients with chronic myeloid leukemia (CML). In ENESTnd, nilotinib 300 mg twice daily (BID) demonstrated superior efficacy versus imatinib in patients with newly diagnosed CML in chronic phase (CML-CP), including a significant reduction of progression to accelerated phase or blast crisis (AP/BC). The mode of administration of nilotinib— on an empty stomach, without food consumption for at least 2 h before the dose and at least 1 hr after—represents a significant obstacle during Ramadan fasting, which lasts for about 14 h. Objecti v e: To assess the effect of modification of the dosing interval of nilotinib on major molecular response (MMR) during Ramadan fasting. D esig n : Thirty patients diagnosed with CML-CP in MMR for at least 2 years were retrospectively assessed after receiving nilotinib 300 mg BID as first-line treatment with a 9 h interval to allow for Ramadan fasting. The patients had no history of AP/BC transformation. Patie n ts or Other Participa n ts: Patients diagnosed with CML-CP in MMR for at least 2 years, ECOG performance  2. All patients were aged 45 years or younger. I n ter v e n tio n s: RT-PCR for BCR-ABL done 2 weeks after the end of Ramadan. Mai n Outco m e Measures: To assess MMR. Results: Twenty-eight patients (93.3%) showed a persistence state of MMR, whereas only 2 patients showed one log rise in BCR-ABL expression. Co n clusio n s: Achievement of MMR became a major goal when treating patients with CML-CP. Ramadan fasting is one of the five pillars of Islam and is considered a mandatory religious duty; thus, several attempts were made to allow for Ramadan fasting for such patients. Our study revealed that modification of the dosing interval of nilotinib did not significantly affect MMR. Keywords: CML, CP, MMR, RT PCR CML-046 Dose Modification Dynamics of Ponatinib in Patients With Chronic- Phase Chronic Myeloid Leukemia From the PACE and OPTIC Trials Jane Apperley MD 1 , Hagop Kantarjian MD 2 , Michael Deininger MD, PhD 3 , Elisabetta Abruzzese MD, PhD 4 , Jorge Cortes MD 5 , Charles Chuah MD 6 , Daniel J. DeAngelo MD, PhD 7 , John DiPersio MD, PhD 8 , Andreas Hochhaus MD 9 , Jeffrey H. Lipton MD, PhD 10 , Frank Nicolini MD, PhD, HDR 11 , Javier Pinilla- Ibarz MD, PhD 12 , Delphine Rea MD, PhD 13 , Gianantonio Rosti MD 14 , Philippe Rousselot MD, PhD 15 , Michael Mauro MD 16 , Neil Shah MD, PhD 17 , Moshe Talpaz MD 18 , Alexander Vorog MD 19 , Xiaowei Ren PhD 19 , Elias Jabbour MD 2 1 Imperial College London, London, United Kingdom. 2 The University of Texas MD Anderson Cancer Center, Houston, USA. 3 Versiti Blood Research Institute, Milwaukee, USA. 4 S. Eugenio Hospital, Tor Vergata University, Rome, Italy. 5 Georgia Cancer Center, Augusta, USA. 6 Singapore General Hospital, Duke-NUS Medical School, Singapore, Singapore. 7 Dana-Farber Cancer Institute, Boston, USA. 8 Washington University School of Medicine, St. Louis, USA. 9 Universitätsklinikum Jena, Jena, Germany. 10 Princess Margaret Cancer Centre, Toronto, Canada. 11 Centre Léon Bérard, Lyon, France. 12 H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA. 13 Hôpital Saint-Louis, Paris, France. 14 IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy. 15 Hospital Mignot University de Versailles Saint-Quentin-en-Yvelines, Paris, France. 16 Memorial Sloan Kettering, New York, USA. 17 University of California San Francisco, San Francisco, USA. 18 Comprehensive