12th Congress of the European Hematology ... - Haematologica

1548
QUALITY ANALYSIS OF THE MULTIDISCIPLINAR PROGRAM DESIGNED FOR
THE APLICATION OF RADIOINMUNOTHERAPY IN NON-HODGKIN LYMPHOMA
V. Recasens, 1 A. Rubio-Martinez, 2 M.J. Agustín, 3 T. Baringo, 4
P. Giraldo 5
1 Hospital U Miguel Servet, ZARAGOZA; 2 Haematology Department HU
Miguel Servet, ZARAGOZA; 3 Clinical Pharmacy. HU Miguel Servet,
ZARAGOZA; 4 Nuclear Medicine. HU Miguel Servet, ZARAGOZA; 5 Haematology
Department. HU Miguel Servet, ZARAGOZA, Spain
Introduction. 90Y ibritumomab tiuxetan (90Y-IT) is not only an effective
treatment for refractory follicular non-Hodgkin lymphoma (NHLF),
but also, it is well-tolerated and safe in an outpatient regimen, nevertheless
it requires a coordinating multidisciplinary team who follows a
sequential and organized protocol. Methods. 18 refractory/relapsed
patients with NHLF were treated with 90Y-IT according to protocol,
within September 2005-December 2006, in an university hospital, which
is the referral centre of the remaining haematology departments of the
Aragon. Adult patients with NHLF who met the inclusion criteria were
selected. A sequential schedulle was planned following a programmed
track, the activity and the participation of each member of the group
were registered. -Selection of each patient for the responsible clinical
haematologist- Inform the patient, obtain the Informed consent (IC) and
give the patient warming information regarding post-treatment- After
24hours coordinating meeting within haematology/Nuclear medicine/
Clinical Pharmacy was arranged, at this time, date of treatment as well
as Rituximab application procedures are fixed. The date (days -7 and 0)
and time for the 90Y Ibritumomab tiuxetan infusion is also reserved in
the out patient clinic- Registration in the agenda of Nuclear Medicine and
in the out patient clinic-Graphic calendar performance in which you can
fix the steps and also define at any moment the process tradability.
Weekly patient visits are scheduled until recover the normal haematology
values and at 12 weeks, the response is also assessed. A satisfaction
survey is given to the patients as well as mailbox for suggestion. For the
analysis, the following indicators have been used: compliance % of the
IC, time from indication to treatment, agenda fulfilment grade and drug
application, quality control of 90Y-IT dose, satisfaction survey. Results.
We have had success in the performance of the process. 100% had been
signed the IC. Quality control of dose adjustment 100%. Patient visits
performed in the programmed dates 95%. High grade of patients and
professionals satisfaction. Conclusions. The compliance of the multidisciplinary
operation program has been evaluated, which has been
designed for the use of the radioinmunotherapy in the regular practice
and the established quality indicators compliance.
1549
COST OF TRANSFUSION-DEPENDENT MYELODYSPLASTIC SYNDROMES (MDS)
IN GERMANY
C. Kuehne, 1 T. Mittendorf, 1 M. Völk, 2 R. Lipp, 3 U. Germing, 4 A. Vioni-
Niemeyer, 2 J.M. Graf von der Schulenburg1 1 Leibniz University Hannover, HANNOVER; 2 Celgene GmbH, MUNICH;
3 Innovation Oncology Research &Consulting, HAMBURG; 4 University Düsseldorf,
DÜSSELDORF, Germany
Background. Only few studies assess the health economic burden of
myelodysplastic syndromes (MDS) to payers, society or patients. So far,
in Germany no such cost study has been conducted. The annual incidence
of MDS is estimated to be about 5 in 100,000 persons overall with
a peak of 20-30 in 100,000 persons among over 70 year old. About twothirds
of MDS patients are estimated to also suffer from anaemia and
require red blood cell transfusion, costing approximately €140 per unit.
However, treatment of MDS and its side effects as well as MDS-related
co-morbidities lead to intensive resource use, which increases with duration
of illness. Aims. The objective of this study is to assess the costs of
transfusion-dependent low/intermediate-1 risk MDS in Germany from
a payers’ perspective. Methods. 100 low/intermediate-1 risk transfusiondependent
MDS patients from 6 outpatient facilities and 25 low/intermediate-1
risk transfusion-dependent deletion 5q MDS patients from a
hospital-based MDS registry were identified. Claims data and patient
records of the previous five years are used to collect health care utilization
data of these patients retrospectively. Publicly available tariff books
and remuneration schemes are applied using e.g. EBM 2000+, GOÄ, G-
DRG to evaluate mean costs p.a. in 2006 EUROS. Results. This is an
ongoing study where the collection of data is almost finalized and data
analyses just started. Results will be presented at the conference explain-
12 th Congress of the European Hematology Association
ing cohort characteristics such as age, gender, time since diagnosis, disease
state, co-morbidities and health insurance. The average annual cost
per patient will be shown in total and in detail for the following categories:
inpatient services, outpatient services, oncological and other medication,
transfusion cost, cost according to age groups, and disease states.
Sensitivity analyses will be conducted on the unit cost of medical services,
cost of co-morbidities and resource usage versus remunerated services.
Further, the results will be shown in comparison to published cost
of MDS in other countries.
1550
CORRELATION BETWEEN LDH LEVELS AND MUTATIONAL STATUS OF JAK2 GENE
IN ESSENTIAL THROMOCYTHEMIA
C. Garcia, R.S.C. Sancho-Tello de Carranza, C. Benet Campos,
M.D. Carrera Merino, V. Amigo Garcia, J.R. Mayans Ferrer
Hospital Arnau de Vilanova, VALENCIA, Spain
Background. Essential Thrombocythemia (ET) is a chronic myeloproliferative
disorder (CMPDs) relatively indolent and often asymptomatic,
characterized mainly by a sustained elevation in platelets count (>600 x
109/L), proliferating enlarged and hyperlobated megakaryocytes, and
minimal or absent bone marrow fibrosis. The prevalence in general population
is approximately 30/100.000. The median age at diagnosis is from
65 to 70 years old, but the disease may occur at any age. The clinical feature
is dominated by a predisposition to vascular occlusive events (involving
the cerebrovascular, coronary and peripheral circulation) and haemorrhages.
Recently, a mutation in the Janus Kinase 2 (JAK 2) gene has
been found in a significant number of cases of ET and other CMPDs. In
the majority of ET cases, a 57% of them, the mutation in the JAK 2 gene
can be detected. Data on the JAK 2 mutation status of ET patients cannot
be used at present for prognosis assessment. Correlations between
JAK 2 status and the vascular risk and, eventuality, of clone progression
remains unknown. For the same reasons, a therapeutic approach based
on the positive or negative status JAK 2 of an individual patient does not
present clinical relevance at the moment. However, the presence of a
mutation in an important signalling way as JAK STAT could provide some
key to differentiate between negative and/or positive JAK2 trombocythemias
Aims. The aim of this work was to analyse the presence or not
of the JAK2 mutation by ARMS procedure and its relation with other
haematological and/or bioquimical parameters in ET patients. Methods.
In order to reach this objective, 30 patients fulfilling the criteria of ET have
been studied (sixteen women and fourteen men). The features at diagnosis
as haemoglobin levels, leukocyte differential counts, platelet counts,
LDH, β2 microglobulin, creatinine and uric acid were analyzed. Results and
discussion. Seventeen cases (56.6%) were detected as negative, and 13
(44.4%) were positives for the mutation. After statistical analyses, only
the LDH level was significantly correlated with the mutational status.
The majority of cases JAK 2 negatives presented LDH normal values.
There was not other parameter statistically significant including sex, age,
platelets count, and hematocrit or haemoglobin level. A known fact is that
the increase of LDH is an indicator of tumoral activity. This activity could
explain the difference between positive and negative cases and that could
means more clinical aggressiveness in the JAK-2 positive cases, because
one major activity, of the tumoral clone. Explanation of this fact is unclear
at the moment and further studies are needed in the future to value these
differences.
1551
JAK2 V617F MUTATION AND VEGF LEVELS IN PATIENTS WITH MYELOPROLIFERATIVE
DISORDERS
L. Bourantas, 1 A. Chatzikyriakidou, 2 K. Panteli, 3 M. Bai, 4
D.K. Bourantas, 3 St. Tsiara, 3 I. Georgiou, 2 K.L. Bourantas3 1 University of Ioannina, Greece, IOANNINA; 2 Laboratory of Genetics, Univ.
Hospital, IOANNINA; 3 Depart. of Hematology, Univ. Hospital, IOANNINA;
4 Depart. of Pathology, Univ. Hospital, IOANNINA, Greece
Background. The pathogenesis of bcr/abl negative myeloproliferative
disorders (MPDs) has been recently associated with the V617F somatic
mutation of the Janus (JAK) 2 kinase. This mutation leads to increased
activation of the single transducer and activator of transcription (STAT)
molecules and further, to inhibition of apoptosis and augmented proliferation
of the progenitor myeloid cells. On the other hand, the vascular
endothelial growth factor (VEGF), a promoter of vasolidation and angiogenesis,
is increased in solid tumors and haematology malignancies
including MPDs. Aims-Methods. In this study we investigated the impact
of JAK 2 V617F mutation in the expression of VEGF in patients with
haematologica/the hematology journal | 2007; 92(s1) | 547