Overview of STEPPS

2016 ◽  
pp. 1-28
Author(s):  
Nancee S. Blum ◽  
Don St. John ◽  
Bruce Pfohl ◽  
Donald W. Black
Keyword(s):  
Group Treatment ◽  
Adjunctive Treatment ◽  
Common Language ◽  
University Of Iowa ◽  
Behavioral Skills ◽  
The University ◽  
User Friendly ◽  
Evidence Based Programs ◽  
And Training

This chapter provides an overview of Systems Training for Emotional Predictability and Problem Solving (STEPPS), a manualized, cognitive-behavioral, skills-based group treatment program, originally developed as an adjunctive treatment for outpatients with borderline personality disorder. STEPPS was developed at the University of Iowa in 1995 in response to patient and provider needs. A detailed manual was developed and training workshops are conducted nationally and internationally. The systems component is unique to the program and refers to providing the client’s support system, (i.e., family members, friends, and key professionals) with an understanding of the STEPPS approach, a common language to communicate clearly about BPD, and ways to reinforce the skills that patients are acquiring. The program has been implemented worldwide and is included in SAMSHA’s NREPP list of evidence-based programs. The program is user-friendly and easily learned and delivered by therapists. A follow-up program, STAIRWAYS, is also described.

scholarly journals COVID-19 Conversion after Exposure in a Semiprivate Room at a Tertiary Care Center in Iowa, July–December 2020

2021 ◽  
Vol 1 (S1) ◽  
pp. s20-s21
Author(s):  
Alexandra Trannel ◽  
Takaaki Kobayashi ◽  
Oluchi Abosi ◽  
Kyle Jenn ◽  
Holly Meacham ◽  
...  
Keyword(s):  
Exposure Time ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
University Of Iowa ◽  
Subsequent Conversion ◽  
Risk Of Exposure ◽  
Polymerase Chain ◽  
The University

Background: Hospital semiprivate rooms may lead to coronavirus disease 2019 (COVID-19) patient exposures. We investigated the risk of COVID-19 patient-to-patient exposure in semiprivate rooms and the subsequent risk of acquiring COVID-19. Methods: The University of Iowa Hospitals & Clinics is an 811-bed tertiary care center. Overall, 16% of patient days are spent in semiprivate rooms. Most patients do not wear masks while in semiprivate rooms. Active COVID-19 surveillance included admission and every 5 days nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) testing. We identified inpatients with COVID-19 who were in semiprivate rooms during their infectious periods during July–December 2020. Testing was repeated 24 hours after the first positive test. Cycle threshold (Ct) values of the two tests (average Ct <30), SARS-CoV-2 serology results, clinical assessment, and COVID-19 history were used to determine patient infectiousness. Roommates were considered exposed if in the same semiprivate room with an infectious patient. Exposed patients were notified, quarantined (private room), and follow-up testing was arranged (median seven days). Conversion was defined as having a negative test followed by a subsequent positive within 14 days after exposure. We calculated the risk of exposure: number of infectious patients in semiprivate rooms/number of semiprivate patient-days (hospitalization days in semiprivate rooms). Results: There were 16,427 semiprivate patient days during July–December 2020. We identified 43 COVID-19 inpatients who roommates during their infectious periods. Most infectious patients (77%) were male; the median age was 67 years; and 22 (51%) were symptomatic. Most were detected during active surveillance: admission testing (51%) and serial testing (28%). There were 57 exposed roommates. The risk of exposure was 3 of 1,000 semiprivate patient days. In total, 16 roommates (28%) did not complete follow-up testing. Of 41 exposed patients with follow-up data, 8 (20%) converted following their exposure. Median time to conversion was 5 days. The risk of exposure and subsequent conversion was 0.7 of 1,000 semiprivate patient days. Median Ct value of the source patient was 20 for those who converted and 23 for those who did not convert. Median exposure time was 45 hours (range, 3–73) for those who converted and 12 hours (range, 1–75) for those who did not convert. Conclusions: The overall risk of exposure in semiprivate rooms was low. The conversion rate was comparable to that reported for household exposures. Lower Ct values and lengthier exposures may be associated with conversion. Active COVID-19 surveillance helps early detection and decreases exposure time.Funding: NoDisclosures: None

Cancer Mortality in Psychiatric Patients: The IOWA Record-Linkage Study

1987 ◽  
Vol 16 (3) ◽  
pp. 189-197 ◽  
Author(s):  
Donald W. Black ◽  
George Winokur
Keyword(s):  
Record Linkage ◽  
Excess Mortality ◽  
Psychiatric Patients ◽  
Relevant Literature ◽  
Linkage Study ◽  
Significant Excess ◽  
University Of Iowa ◽  
Organic Mental Disorders ◽  
The University

Of 5,412 patients admitted to the University of Iowa Psychiatric Hospital over a ten-year period, forty-six died of cancer during follow-up, which did not differ significantly from expected. Significant excess mortality from cancer was present within the first two years of follow-up. At risk during this period were women and patients with organic mental disorders. A review of relevant literature is presented.

The IPI Predicts Outcome in Patients with Diffuse Large B-Cell Lymphoma (DLBCL) Treated with Immunochemotherapy: A Report of the University of Iowa/Mayo Clinic SPORE

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1279-1279
Author(s):  
Thomas M. Habermann ◽  
B.K. Link ◽  
M.J. Maurer ◽  
J.E. Wooldridge ◽  
S.M. Geyer ◽  
...  
Keyword(s):  
Strong Predictor ◽  
Predictive Ability ◽  
B Cell Lymphoma ◽  
University Of Iowa ◽  
History Of ◽  
Observational Cohort ◽  
Factor Index ◽  
The Difference ◽  
The University

Abstract The International Prognostic Factor Index (IPI) predicts survival in DLBCL in patients treated with chemotherapy. The Revised IPI (R-IPI) has been reported to be a simpler and more accurate predictor of outcome in patients treated with immunochemotherapy (rituximab and anthracycline-based chemotherapy). We evaluated the predictive value of the IPI and the R-IPI in an observational cohort of unselected patients treated with R-CHOP. Consecutive, newly diagnosed patients age 18 years and older with DLBCL were prospectively offered enrollment into our Lymphoma SPORE Registry. Pathology was centrally reviewed, and composite lymphomas and history of concurrent or prior cancers were excluded. All patients were actively followed for progression free progression (PFS) and overall survival (OS). Here we report on patients enrolled from 9/2002 – 6/2006. 229 patients with a median age of 62 years (range 20–93) were evaluated. 56% were >60 years of age, 16% had a performance score ≥2, 54% had an elevated LDH, 19% had >1 extranodal site, and 51% were stage III/IV. During follow-up, there were 63 progressions (28%) and 45 deaths (20%), and the median follow-up time for living patients was 34 months (range 6–61 months). As shown in the table and figure, the IPI and R-IPI were predictive for both PFS and OS (all p<0.001). The predictive ability of the IPI as measured by 3-year concordance index was stronger for the IPI (0.71) compared to the R-IPI (0.67) and the bootstrap 95% confidence interval for the difference (0.01, 0.08) indicates that this difference was statistically significant. While all factors in the IPI were statistically significant (p<0.05) predictors of OS individually, when included in a multivariate model, an elevated LDH (HR=1.5; p = 0.32) and >1 extranodal sites (HR=1.0; p = 0.96) were no longer significant; similar results were obtained for PFS. The IPI remains a strong predictor of PFS and OS in the immunochemotherapy era. Figure Figure Group % Pats 3 Y PFS HR 95% CI 3 Y OS HR 95% CI Standard IPI Low (0,1) 41% 87% 1.0 ref 93% 1.0 ref Low-Int (2) 22% 62% 3.1 (1.4, 6.8) 74% 4.2 (1.6, 11.1) High-Int (3) 21% 60% 3.1 (1.4, 6.8) 77% 3.4 (1.2, 9.7) High (4,5) 15% 39% 7.2 (3.4, 15.2) 47% 10.2 (4.0, 26.5) R-IPI Very good (0) 11% 96% 1.0 ref 100% 1.0 ref Good (1,2) 53% 74% 6.2 (0.8, 46.0) 84% - - Poor (3–5) 36% 52% 13.5 (1.8, 98.9) 65% - -

Rates and Outcomes of Follicular Lymphoma Transformation in the Rituximab Era: A Report From the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1546-1546
Author(s):  
Brian K Link ◽  
Matthew J Maurer ◽  
Grzegorz S. Nowakowski ◽  
Stephen M Ansell ◽  
William R Macon ◽  
...  
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
Mayo Clinic ◽  
Cell Lymphoma ◽  
Management Strategies ◽  
B Cell Lymphoma ◽  
Newly Diagnosed ◽  
University Of Iowa ◽  
The University

Abstract Abstract 1546 Background: Follicular lymphoma (FL) is an incurable disease with an undefined optimal management strategy. Global priorities in goals of care are avoidance of death and transformation to aggressive subtypes. Retrospective series, – most including patients diagnosed before ubiquitous rituximab use, - describe diverse rates of transformation with a common consensus of 3% per year, and with a median survival post transformation of less than 2 years. This study sought to characterize transformation events in a prospective observational series begun after diffusion of early rituximab use in FL. Methods: Newly diagnosed FL patients were prospectively enrolled in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource (MER) from 2002–2009. Clinical data were abstracted from medical records using a standard protocol. Patients were actively followed for retreatment, transformation, and death. Inclusion criteria for this analysis were initial diagnosis of grade I-IIIa FL. Exclusion criteria for this cohort include composite diffuse large B-cell lymphoma (DLBCL), FL grade IIIb, or evidence of clinical or pathological transformation at the time of FL diagnosis. Transformation was defined as refractory/recurrent disease with either a) biopsy confirmed subtype of FLIIIb, DLBCL or higher grade B-cell lymphoma; or b) clinical indication of transformation (sudden rise in LDH, rapid discordant localized nodal growth, new involvement of unusual extranodal sites, new B symptoms or hypercalcemia). Risk of transformation was analyzed via time to transformation using a death as a competing risk. Time to transformation was defined as the date of initial FL diagnosis to date of transformation. Overall survival was defined as the date of initial diagnosis to date of death or last known follow-up for patients still alive. Results: There were 631 newly diagnosed grade I-IIIa FL patients with a median age at enrollment of 60 years (range 23–93). 54% were male. The most common types of initial therapy were observation (33%), rituximab (R) monotherapy (12%), alkylator based chemotherapy +/− R (22%), and anthracycline based chemotherapy +/− R (20%). At a median follow-up of 60 months (range 11–110), 79 patients had died, 311 patients had an event (death, progression, or retreatment), and 60 patients (9.5%) had transformed. Transformation was biopsy proven in 48 of the 60 patients (80%). The overall transformation rate at 5 years (TX5) was 10.7% (95% CI: 8.3%–13.8%) (Figure 1). Time to transformation was associated with a FLIPI score of 3–5 (HR=2.37, 95% CI 1.28–4.39, p=0.006), but was not significantly associated with other standard clinical characteristics. Risk of transformation was different in the common initial treatment groups with the highest rate in patients who were initially observed (TX5=14.4%) and lowest rate in patients who initially received R monotherapy (TX5=3.2%)(p=0.058). Outcome after transformation was inferior to MER subjects with de-novo diagnosed DLBCL (p<0.0001). The median overall survival from date of transformation was 44 months (95% CI: 22-NA). Survival after transformation was superior in patients who transformed greater than 18 months after FL diagnosis compared to patients who transformed earlier (5 yr OS =70% vs 20%) (p=7 ×10−5), and for those initially observed (median unreached) versus those patients who were initially treated with alkylator or anthracycline based chemotherapy (median survival of 11 months)( p=0.016). Conclusions: Follicular transformation rates in this modern large prospective observational study are similar to risk of death without transformation and slightly lower at 5 years than most previous reports. Post-transformation prognosis is substantially better than described in older series. These observed differences may be a function of the prospective nature of the study design, modern management strategies, or patient selection factors. Initial management strategies may influence the risk of transformation. Marked survival differences following early vs. late transformation suggest that these may be different biologic events. Disclosures: Link: Genentech: Consultancy, Research Funding; Celgene: Consultancy; Millenium: Consultancy. Johnston:Novartis: Consultancy.

scholarly journals Hybrid Dialog

2010 ◽  
pp. 314-331 ◽  
Author(s):  
Tobias Zimmermann ◽  
Karen-Lynn Bucher ◽  
Daniel Hurtado
Keyword(s):  
Online Learning ◽  
Behavioral Skills ◽  
Web Based ◽  
Hybrid Course ◽  
Learning Platform ◽  
Large Lecture ◽  
Learning Success ◽  
University Of Zurich ◽  
The University ◽  
And Training

Attendance at classical lectures usually leads to rather poor learning success. A wide variety of studies show that while lectures are as effective as any other method for transmitting information, they are inferior in many other dimensions. Lectures are not as effective as discussion methods in promoting thought and they are ineffective at teaching behavioral skills and subject-related values as well as at awakening interest in a subject. Still ex-cathedra teaching is a favored way to cope with a high student-to-teacher ratio. To solve this conflict between organizational and pedagogical requirements, a group of researchers at the Institute of Teacher Education at the University of Zurich has developed a hybrid course setting using an online learning platform. Their setting incorporates a dialog among students within a large lecture class. Furthermore a feedback loop enables the lecturer to continuously adjust the content of the lecture to the learning process of the students. In this article, the authors first present the structure of this setting and then illustrate how to implement it by the web-based open source learning management system OLAT (Online Learning and Training). Based on their research, they focus on key components for the success of their hybrid dialog. They show how individual and group learning can be fostered with corresponding assignments, assessments, and assigned roles such as moderators. Thus, the authors will define their position that the challenge of a large lecture class can be met while successfully implementing social learning and process-oriented assessments of academic achievement.

Three-Year Experience of Treating Recurrent Respiratory Papilloma with Interferon

1987 ◽  
Vol 96 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Rodney P. Lusk ◽  
Brian F. McCabe ◽  
Janis H. Mixon
Keyword(s):  
Severe Disease ◽  
Human Leukocyte ◽  
Interferon Α ◽  
University Of Iowa ◽  
Poor Patient Compliance ◽  
Ifn Treatment ◽  
Human Leukocyte Interferon ◽  
The University ◽  
Lost To Follow Up

This paper presents the 3-year follow-up of the original 19 patients with recurrent respiratory papilloma treated with exogenous alpha human leukocyte interferon (α-IFN) at the University of Iowa. Two patients were dropped from the study because of poor patient compliance, and one was lost to follow-up. After approximately 1 year of α-IFN treatment, five patients were clear, and the rest continued to have disease: Seven mild, two moderate, and two severe. A second course of α-IFN was administered to eight patients, all of whom had a decrease in the volume of the papilloma. The reduction in anatomic distribution was variable. During the observation period all patients either cleared (50%), improved (25%), or continued with severe disease (25%). In summary, the response of recurrent respiratory papilloma to α-IFN therapy is dramatic in some patients and slight in others.

scholarly journals COVID-19 Modifications for Remote Teleassessment and Teletraining of a Complementary Alternative Medicine Intervention for People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial

10.2196/18415 ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. e18415 ◽  
Author(s):  
Byron Lai ◽  
Chia-Ying Chiu ◽  
Emily Pounds ◽  
Tracy Tracy ◽  
Tapan Mehta ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Blood Pressure ◽  
Alternative Medicine ◽  
Sensitivity Analyses ◽  
Complementary Alternative Medicine ◽  
Patient Centered ◽  
Study Results ◽  
The University ◽  
And Training

Background Access to comprehensive exercise and rehabilitation services for people with multiple sclerosis (MS) remains a major challenge, especially in rural, low-income areas. Hence, the Tele-Exercise and Multiple Sclerosis (TEAMS) study aims to provide patient-centered, coordinated care by implementing a 12-week complementary and alternative medicine (CAM) intervention for adults with MS. However, due to the societal impact of coronavirus disease (COVID-19) in mid-March 2020, the University of Alabama at Birmingham announced a limited business model halting all nonessential research requiring on-site visits, which includes the TEAMS study. Objective In compliance with the shelter-in-place policy and quarantine guidance, a modified testing and training protocol was developed to allow participants to continue the study. Methods The modified protocol, which replaces on-site data collection and training procedures, includes a teleassessment package (computer tablet, blood pressure cuff, hand dynamometer, mini disc cone, measuring tape, an 8” step, and a large-print 8” × 11” paper with ruler metrics and wall-safe tape) and a virtual meeting platform for synchronous interactive training between the therapist and the participant. The teleassessment measures include resting blood pressure and heart rate, grip strength, Five Times Sit to Stand, Timed Up & Go, and the Berg Balance Scale. The teletraining component includes 20 sessions of synchronous training sessions of dual tasking, yoga, and Pilates exercises designed and customized for a range of functional levels. Teletraining lasts 12 weeks and participants are instructed to continue exercising for a posttraining period of 9 months. Results The protocol modifications were supported with supplemental funding (from the Patient-Centered Outcomes Research Institute) and approved by the University Institutional Review Board for Human Use. At the time nonessential research visits were halted by the university, there were 759 people enrolled and baseline tested, accounting for 92.5% of our baseline testing completion target (N=820). Specifically, 325 participants completed the 12-week intervention and follow-up testing visits, and 289 participants needed to complete either the intervention or follow-up assessments. A modified analysis plan will include sensitivity analyses to ensure the robustness of the study results in the presence of uncertainty and protocol deviations. Study results are projected to be published in 2021. Conclusions This modified remote teleassessment/teletraining protocol will impact a large number of participants with MS who would otherwise have been discontinued from the study. Trial Registration ClinicalTrials.gov NCT03117881; https://clinicaltrials.gov/ct2/show/NCT03117881 International Registered Report Identifier (IRRID) DERR1-10.2196/18415

scholarly journals Pediatric meningiomas: 65-year experience at a single institution

2017 ◽  
Vol 20 (1) ◽  
pp. 42-50 ◽  
Author(s):  
Andrew J. Grossbach ◽  
Kelly B. Mahaney ◽  
Arnold H. Menezes
Keyword(s):  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Recurrence Rates ◽  
University Of Iowa ◽  
Who Grade ◽  
History Of ◽  
Grade Ii ◽  
The University ◽  
Pediatric Meningiomas

OBJECTIVEMeningiomas are relatively common, typically benign neoplasms in adults; however, they are relatively rare in the pediatric population. Pediatric meningiomas behave very differently from their adult counterparts, tending to have more malignant histological subtypes and recur more frequently. The authors of this paper investigate the risk factors, pathological subtypes, and recurrence rates of pediatric meningiomas.METHODSA retrospective chart review was conducted at the University of Iowa to identify patients 20 years old and younger with meningiomas in the period from 1948 to 2015.RESULTSSixty-seven meningiomas in 39 patients were identified. Eight patients had neurofibromatosis, 2 had a family history of meningioma, and 3 had prior radiation exposure. Twelve (31%) of the 39 patients had WHO Grade II or III lesions, and 15 (38%) had recurrent lesions after resection.CONCLUSIONSPediatric meningiomas should be considered for early treatment and diligent follow-up.

Hybrid Dialog

2012 ◽  
pp. 623-640
Author(s):  
Tobias Zimmermann ◽  
Karen-Lynn Bucher ◽  
Daniel Hurtado
Keyword(s):  
Online Learning ◽  
Behavioral Skills ◽  
Web Based ◽  
Hybrid Course ◽  
Learning Platform ◽  
Large Lecture ◽  
Learning Success ◽  
University Of Zurich ◽  
The University ◽  
And Training

Attendance at classical lectures usually leads to rather poor learning success. A wide variety of studies show that while lectures are as effective as any other method for transmitting information, they are inferior in many other dimensions. Lectures are not as effective as discussion methods in promoting thought and they are ineffective at teaching behavioral skills and subject-related values as well as at awakening interest in a subject. Still ex-cathedra teaching is a favored way to cope with a high student-to-teacher ratio. To solve this conflict between organizational and pedagogical requirements, a group of researchers at the Institute of Teacher Education at the University of Zurich has developed a hybrid course setting using an online learning platform. Their setting incorporates a dialog among students within a large lecture class. Furthermore a feedback loop enables the lecturer to continuously adjust the content of the lecture to the learning process of the students. In this article, the authors first present the structure of this setting and then illustrate how to implement it by the web-based open source learning management system OLAT (Online Learning and Training). Based on their research, they focus on key components for the success of their hybrid dialog. They show how individual and group learning can be fostered with corresponding assignments, assessments, and assigned roles such as moderators. Thus, the authors will define their position that the challenge of a large lecture class can be met while successfully implementing social learning and process-oriented assessments of academic achievement.

scholarly journals Estimates and Timing of Therapy Initiation during the First Decade for Patients with Follicular Lymphoma Who Were Observed at Diagnosis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 7-8
Author(s):  
Arushi Khurana ◽  
Raphael Mwangi ◽  
Stephen M. Ansell ◽  
Thomas M. Habermann ◽  
James R. Cerhan ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Treatment Initiation ◽  
Large Cell ◽  
Tumor Burden ◽  
Advisory Committees ◽  
University Of Iowa ◽  
Therapy Initiation ◽  
The University

Background: Observation or "wait and watch" (W/W) strategy remains a viable option in the rituximab era for asymptomatic, stage II-IV, low-tumor burden patients with FL grade 1-2, 3A. Studies to date both in pre and post rituximab era have not shown an overall survival benefit from immediate treatment in such low-risk patients.To improve our understanding and to better counsel FL patients on W/W strategy, we sought to estimate the incidence of treatment initiation at landmark time points in our prospectively observed cohort from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE). We further evaluate the association between the presence of GELF criteria (MER treatment criteria) at diagnosis and initiation of treatment patterns, transformation rates and cause of death in FL patients managed by W/W. Methods: FL patients on W/W strategy were identified from MER of the University of Iowa/Mayo Clinic Lymphoma SPORE. From 2002-2015, consecutive patients with newly diagnosed FL were offered enrollment. Patients were managed per treating physician and followed prospectively. Baseline clinical and pathological data were abstracted using a standard protocol. Cumulative incidence estimates of treatment initiation for follicular lymphoma were calculated using transformation to large cell lymphoma (as the first event) and death due to any cause as competing risks. Transformation was defined based on biopsy-proven disease. Patients were retrospectively considered to meet treatment criteria at diagnosis if they had the presence of any GELF criteria components per available abstracted data in the MER database. Not all GELF criteria were prospectively assessed and captured for all patients, and thus the MER treatment criteria utilized here will be conservative for formal GELF assessment. Results: A total of 401 FL patients were identified in MER on W/W strategy. Baseline characteristics for W/W patients showed a favorable profile such as normal LDH (89%), low and intermediate FLIPI score in 48% and 35% respectively, no B symptoms (97%), low tumor burden (&lt;4 nodal groups) in 72%, and GELF positive vs. negative in 36% and 64% respectively. At a median follow up of 8 years (IQR 5.9-12), 64% initiated treatment for FL only. Cumulative incidence estimates of treatment initiation at sequential time points were calculated from the initiation of observation (Table1&2). At diagnosis, the likelihood of treatment initiation was 15%, 26%, and 42% in the next 1, 2, and 5 years. The incidence of treatment initiation decreased over time as patients remained treatment-free after diagnosis (Figure 1A [blue curve]). Patients that met MER treatment criteria had increased rates of therapy initiation (33.2% vs. 21.9%) in the next two years and untreated transformation to large cell lymphoma [red curve] (8.7% vs. 4.5%) during the next 5 years (Figure 1B). Despite this, the rate of lymphoma related death at 10 years was similar between groups (met treatment criteria = 6.2% vs. 7.1%) (Figure 1C, [green curve]). Discussion: The longer duration of W/W strategy suggests a decreasing need for treatment over time. We provide time point estimates, which would be helpful for counseling patients. Of note, long-term continuous oncologic assessment and follow-up is necessary since approximately 66% of patients in this mature cohort initiated treatment by 8 years median follow up. MER treatment criteria at diagnosis identified patients with higher rates of transformation and therapy initiation in the first two years but did not identify those with worse lymphoma specific survival. Identification of biological differences in patients with early vs. late or no progression is a critical next step in understanding outcomes in W/W patients. Disclosures Ansell: Bristol Myers Squibb: Research Funding; Seattle Genetics: Research Funding; Takeda: Research Funding; AI Therapeutics: Research Funding; Regeneron: Research Funding; Affimed: Research Funding; ADC Therapeutics: Research Funding; Trillium: Research Funding. Cerhan:BMS/Celgene: Research Funding; NanoString: Research Funding. Wang:Incyte: Research Funding; Innocare: Research Funding; Novartis: Research Funding. Witzig:MorphSys: Consultancy; AbbVie: Consultancy; Incyte: Consultancy; Acerta: Research Funding; Karyopharm Therapeutics: Research Funding; Immune Design: Research Funding; Spectrum: Consultancy; Celgene: Consultancy, Research Funding. Maurer:Morphosys: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Nanostring: Research Funding; Kite: Membership on an entity's Board of Directors or advisory committees; Celgene / BMS: Research Funding. Nowakowski:NanoString: Research Funding; Kite: Consultancy; Seattle Genetics: Consultancy; Kymera: Consultancy; Celgene/BMS: Consultancy, Research Funding; MorphoSys: Consultancy, Research Funding; Curis: Consultancy; Ryvu: Consultancy, Membership on an entity's Board of Directors or advisory committees.

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