Mobarek D

Purpose: To identify DEL amongst veteran patients with diffuse large B cell lymphoma (DLBCL) and its outcome.

Background: Molecular profile determines prognosis in DLBCL. Activated B-cell (ABC), a subtype of DLBCL, is associated with poor outcome compared to germinal center Bcell (GCB). Poor response to standard chemotherapy is seen with double-hit lymphomas as detected by FISH (5% -10% of DLBCL) and DELs that express both MYC and BCL-2 as detected by immunohistochemistry (IHC) (cutoffs—30% MYC, 40% BCL-2), with a median overall survival of <12 months.

Methods: Sixty-nine DLBCL patients diagnosed at DC VAMC from 1/1996-4/2016 were identified utilizing cancer registry. IHC stains were reviewed for CD3, CD10, CD20, BCL-2, BCL-6, C-MYC, MUM-1, MIB1, and p53. DLBCL were sub-classified as GCB and ABC based on CD10, BCL6 and MUM1 stains. Demographic data, diagnosis, treatment and outcome in terms of relapse and death are analyzed and will be presented at the meeting.

Results: Of the 69 DLBCL cases, only 37 met inclusion criteria; 32 were excluded due to unavailable blocks (20, mostly sent to outside institutions), tissue exhaustion with incomplete IHC data (6), T-cell rich B cell lymphoma (5) and pending (1). 20 cases are GCB and 17 ABC. All cases are CD20 positive with high mib1. MYC is positive in 17 cases (46%) and 15 of them double positive for BCL-2 (40%).

Implications/Future Directions: DLBCL veterans at the DC VAMC have a high percentage of double expressors when compared to the literature. It will be important to examine clinical data, treatment, and outcome to develop better treatment guidelines for double-expressor DLBCL. Future studies are in plan to compare double hit lymphomas to double expressors.

Purpose: To identify DEL amongst veteran patients with diffuse large B cell lymphoma (DLBCL) and its outcome.

Background: Molecular profile determines prognosis in DLBCL. Activated B-cell (ABC), a subtype of DLBCL, is associated with poor outcome compared to germinal center Bcell (GCB). Poor response to standard chemotherapy is seen with double-hit lymphomas as detected by FISH (5% -10% of DLBCL) and DELs that express both MYC and BCL-2 as detected by immunohistochemistry (IHC) (cutoffs—30% MYC, 40% BCL-2), with a median overall survival of <12 months.

Methods: Sixty-nine DLBCL patients diagnosed at DC VAMC from 1/1996-4/2016 were identified utilizing cancer registry. IHC stains were reviewed for CD3, CD10, CD20, BCL-2, BCL-6, C-MYC, MUM-1, MIB1, and p53. DLBCL were sub-classified as GCB and ABC based on CD10, BCL6 and MUM1 stains. Demographic data, diagnosis, treatment and outcome in terms of relapse and death are analyzed and will be presented at the meeting.

Results: Of the 69 DLBCL cases, only 37 met inclusion criteria; 32 were excluded due to unavailable blocks (20, mostly sent to outside institutions), tissue exhaustion with incomplete IHC data (6), T-cell rich B cell lymphoma (5) and pending (1). 20 cases are GCB and 17 ABC. All cases are CD20 positive with high mib1. MYC is positive in 17 cases (46%) and 15 of them double positive for BCL-2 (40%).

Implications/Future Directions: DLBCL veterans at the DC VAMC have a high percentage of double expressors when compared to the literature. It will be important to examine clinical data, treatment, and outcome to develop better treatment guidelines for double-expressor DLBCL. Future studies are in plan to compare double hit lymphomas to double expressors.

Purpose: To identify DEL amongst veteran patients with diffuse large B cell lymphoma (DLBCL) and its outcome.

Background: Molecular profile determines prognosis in DLBCL. Activated B-cell (ABC), a subtype of DLBCL, is associated with poor outcome compared to germinal center Bcell (GCB). Poor response to standard chemotherapy is seen with double-hit lymphomas as detected by FISH (5% -10% of DLBCL) and DELs that express both MYC and BCL-2 as detected by immunohistochemistry (IHC) (cutoffs—30% MYC, 40% BCL-2), with a median overall survival of <12 months.

Methods: Sixty-nine DLBCL patients diagnosed at DC VAMC from 1/1996-4/2016 were identified utilizing cancer registry. IHC stains were reviewed for CD3, CD10, CD20, BCL-2, BCL-6, C-MYC, MUM-1, MIB1, and p53. DLBCL were sub-classified as GCB and ABC based on CD10, BCL6 and MUM1 stains. Demographic data, diagnosis, treatment and outcome in terms of relapse and death are analyzed and will be presented at the meeting.

Results: Of the 69 DLBCL cases, only 37 met inclusion criteria; 32 were excluded due to unavailable blocks (20, mostly sent to outside institutions), tissue exhaustion with incomplete IHC data (6), T-cell rich B cell lymphoma (5) and pending (1). 20 cases are GCB and 17 ABC. All cases are CD20 positive with high mib1. MYC is positive in 17 cases (46%) and 15 of them double positive for BCL-2 (40%).

Implications/Future Directions: DLBCL veterans at the DC VAMC have a high percentage of double expressors when compared to the literature. It will be important to examine clinical data, treatment, and outcome to develop better treatment guidelines for double-expressor DLBCL. Future studies are in plan to compare double hit lymphomas to double expressors.

Background: Cancer and chemotherapy are both associated with an increased risk of thrombosis. Venous thromboembolism (VTE) is the leading cause of death in cancer patients. Inferior vena cava (IVC) filter use is recommended in patients with VTE and contraindication to anticoagulation (AC) or recurrent VTE despite treatment. The use of IVC filters in cancer patients outside the Veterans Affairs Medical Center (VAMC) has been described; no such study exists within the VAMC.

Purpose: Descriptive analysis of IVC filters use in cancer patients at the Washington DC VAMC.

Methods: Retrospective study utilizing data from the Washington DC VA Cancer Registry and the electronic health records (EHR). Current Procedural Terminology (CPT) codes for IVC filter placement were used to identify subjects in the cancer registry who received an IVC filter. Demographics, cancer date of diagnosis, VTE date of diagnosis, type of filter, indication, placement date, procedural complications, and AC medication use at time of filter placement were collected. Cancer subjects (n = 6,678) were identified from October 1999 – May 2015 and 64 patients met inclusion criteria.

Data Analysis: Percentages were calculated for the aforementioned data points.

Results: Characteristics of the 64 cancer patients with IVC filter placement include: 100% male, 75% black or African American, 15.6% white, 1.6% Hispanic or Latino, 7.8% unknown. The average age at cancer diagnosis was 65.3 years. Date of cancer diagnosis to VTE diagnosis is currently being analyzed.

VTE diagnosis with an immediate contraindication to AC medication led the list of IVC filter indications (59%). An additional 16% of patients received filters due to subsequent development of AC contraindication. The remaining patients (25%) received filters for prophylaxis, AC failure, or in combination with AC medications. For subjects whose filter type was captured from chart review, 51.8% were given permanent filters versus 48.1% who were given retrievable filters. Overall, there were no complications associated with the procedure.

Implications: Contraindication to immediate AC is the leading indication for IVC filter use in our cancer patients with VTE, consistent with current guidelines. Overall, rates of permanent versus retrievable filter use were similar.

Background: Cancer and chemotherapy are both associated with an increased risk of thrombosis. Venous thromboembolism (VTE) is the leading cause of death in cancer patients. Inferior vena cava (IVC) filter use is recommended in patients with VTE and contraindication to anticoagulation (AC) or recurrent VTE despite treatment. The use of IVC filters in cancer patients outside the Veterans Affairs Medical Center (VAMC) has been described; no such study exists within the VAMC.

Purpose: Descriptive analysis of IVC filters use in cancer patients at the Washington DC VAMC.

Methods: Retrospective study utilizing data from the Washington DC VA Cancer Registry and the electronic health records (EHR). Current Procedural Terminology (CPT) codes for IVC filter placement were used to identify subjects in the cancer registry who received an IVC filter. Demographics, cancer date of diagnosis, VTE date of diagnosis, type of filter, indication, placement date, procedural complications, and AC medication use at time of filter placement were collected. Cancer subjects (n = 6,678) were identified from October 1999 – May 2015 and 64 patients met inclusion criteria.

Data Analysis: Percentages were calculated for the aforementioned data points.

Results: Characteristics of the 64 cancer patients with IVC filter placement include: 100% male, 75% black or African American, 15.6% white, 1.6% Hispanic or Latino, 7.8% unknown. The average age at cancer diagnosis was 65.3 years. Date of cancer diagnosis to VTE diagnosis is currently being analyzed.

VTE diagnosis with an immediate contraindication to AC medication led the list of IVC filter indications (59%). An additional 16% of patients received filters due to subsequent development of AC contraindication. The remaining patients (25%) received filters for prophylaxis, AC failure, or in combination with AC medications. For subjects whose filter type was captured from chart review, 51.8% were given permanent filters versus 48.1% who were given retrievable filters. Overall, there were no complications associated with the procedure.

Implications: Contraindication to immediate AC is the leading indication for IVC filter use in our cancer patients with VTE, consistent with current guidelines. Overall, rates of permanent versus retrievable filter use were similar.

Background: Cancer and chemotherapy are both associated with an increased risk of thrombosis. Venous thromboembolism (VTE) is the leading cause of death in cancer patients. Inferior vena cava (IVC) filter use is recommended in patients with VTE and contraindication to anticoagulation (AC) or recurrent VTE despite treatment. The use of IVC filters in cancer patients outside the Veterans Affairs Medical Center (VAMC) has been described; no such study exists within the VAMC.

Purpose: Descriptive analysis of IVC filters use in cancer patients at the Washington DC VAMC.

Methods: Retrospective study utilizing data from the Washington DC VA Cancer Registry and the electronic health records (EHR). Current Procedural Terminology (CPT) codes for IVC filter placement were used to identify subjects in the cancer registry who received an IVC filter. Demographics, cancer date of diagnosis, VTE date of diagnosis, type of filter, indication, placement date, procedural complications, and AC medication use at time of filter placement were collected. Cancer subjects (n = 6,678) were identified from October 1999 – May 2015 and 64 patients met inclusion criteria.

Data Analysis: Percentages were calculated for the aforementioned data points.

Results: Characteristics of the 64 cancer patients with IVC filter placement include: 100% male, 75% black or African American, 15.6% white, 1.6% Hispanic or Latino, 7.8% unknown. The average age at cancer diagnosis was 65.3 years. Date of cancer diagnosis to VTE diagnosis is currently being analyzed.

VTE diagnosis with an immediate contraindication to AC medication led the list of IVC filter indications (59%). An additional 16% of patients received filters due to subsequent development of AC contraindication. The remaining patients (25%) received filters for prophylaxis, AC failure, or in combination with AC medications. For subjects whose filter type was captured from chart review, 51.8% were given permanent filters versus 48.1% who were given retrievable filters. Overall, there were no complications associated with the procedure.

Implications: Contraindication to immediate AC is the leading indication for IVC filter use in our cancer patients with VTE, consistent with current guidelines. Overall, rates of permanent versus retrievable filter use were similar.