scholarly journals Comparison of Demographics, Treatment Patterns and Outcomes Among Primary Central Nervous System Lymphoma (PCNSL) Patients Treated at a Safety-Net Hospital Versus a Tertiary Academic Institution within the Same Healthcare System

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-12
Author(s):  
Akshat M Patel ◽  
Omer M Ali ◽  
Radhika Kainthla ◽  
Syed M Rizvi ◽  
Farrukh T Awan ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Performance Status ◽  
Safety Net ◽  
Treatment Patterns ◽  
Survival Outcomes ◽  
Consolidation Treatment ◽  
Academic Center ◽  
Receive Induction Chemotherapy ◽  
Safety Net Hospital ◽  
To Receive

Introduction: Primary CNS lymphomas (PCNSL) are rare, aggressive, extra-nodal, non-Hodgkin lymphomas confined to the CNS. Other than high-dose methotrexate (MTX) based induction regimens, there are no established standards-of-care for managing PCNSL. Treatment practices across institutions vary regionally and globally. At safety-net hospitals, there are often access issues, delays in seeking medical care, and limited treatment options due to insurance barriers and other prohibitive costs. This study compares the demographics, treatment patterns, and survival outcomes among PCNSL patients treated at a safety-net hospital versus a tertiary academic institution within the same healthcare system. Methods: Medical records of 94 patients who were treated for PCNSL from 2007-2020, at either a public safety-net hospital (n=34) or an academic tertiary-care center (n=60), both serving the same metroplex, were analyzed. Demographics, Memorial Sloan-Kettering Cancer Center (MSKCC) prognostic class, International Extranodal Study Group (IELSG) score, induction and consolidation treatment modalities used, and survival outcomes were compared between the 2 groups. Categorical variables and response rates were compared using Fisher's exact test. Continuous variables were compared using Mann-Whitney U test. Survival functions for overall- and progression-free survival (OS and PFS) were estimated by the Kaplan-Meier method and compared using a log-rank test. Cox proportional hazards regression was used for multivariate analysis. Results: Baseline characteristics of the study population is shown in Table 1. Compared to the tertiary academic center, patients at the safety-net hospital were significantly younger, had better Karnofsky performance status (KPS) and MSKCC prognostic class, and were more commonly Black or Hispanic, male, and HIV positive. Median follow-up was 39.4 months for surviving patients and 13.1 months for all patients. Induction regimens used were either chemotherapy (n = 74) or palliative whole brain radiation therapy (WBRT) (n = 16). Chemotherapy regimens were predominantly MTX-based (71/74, 95.9%). Safety-net patients were significantly less likely to receive induction chemotherapy (67.6% vs 85%, p = 0.004). Overall response to chemo-based induction was 70.3%. There was no significant difference in response rate to chemo-based induction between safety-net and academic center patients (73.9% vs 68.6%, p = 0.786). Patients who had a good response to induction chemotherapy (n = 52) were either given consolidative WBRT (n =11), autologous stem cell transplant (ASCT) (n = 14), chemotherapy (n = 17), or no further treatment (n = 10). When comparing safety-net and academic center patients, hospital location did not significantly affect whether patients received consolidation therapy (82.4% vs. 80%, p = 0.735). Safety-net hospital patients were significantly less likely to receive ASCT (0% vs. 40%, p = 0.001) and had higher rates of consolidative WBRT (41.2% vs 11.4%, p = 0.03). OS (71.7% vs. 51.1%, p = 0.218) and PFS (54.9% vs. 57.4%, p = 0.967) were not significantly different between safety-net and tertiary academic hospitals when adjusted for age and KPS. In a subset analysis, excluding patients who only received palliative care, there also were no differences in OS (68.9% vs 55.2%, p = 0.309) and PFS (50.3% vs 57.4%, p = 0.719) between hospitals (Figure 1). Patients who received consolidation treatment had significantly higher OS (84.8% vs 34.0%) and PFS (77.0% vs 30.3%), after adjusting for age and KPS (p = 0.001 for both). There were no significant differences between type of consolidation strategy employed for OS (p = 0.801) or PFS (p = 0.899). Conclusions: Safety-net patients with PCNSL were less likely to receive induction chemotherapy and could not receive ASCT as consolidation due to insurance barriers. Despite these differences in patterns of treatment, they had similar outcomes in terms of OS and PFS, even after adjusting for age and performance status. Consolidation treatments improved outcomes and it is critical to ensure eligible patients receive them, though the optimal type of consolidation remains unknown. This study is limited by the small sample size and retrospective analysis. Research to unearth the biologic heterogeneity of PCNSL and develop predictive biomarkers will be critical to personalize and optimize management strategies for these patients. Disclosures Awan: Genentech: Consultancy; MEI Pharma: Consultancy; Janssen: Consultancy; Astrazeneca: Consultancy; Celgene: Consultancy; Blueprint medicines: Consultancy; Sunesis: Consultancy; Karyopharm: Consultancy; Pharmacyclics: Consultancy; Gilead Sciences: Consultancy; Kite Pharma: Consultancy; Dava Oncology: Consultancy; Abbvie: Consultancy. Desai:Boston Scientific: Consultancy, Other: Trial Finding.

scholarly journals Primary Central Nervous System Lymphoma: A Real-World Comparison of Therapy Access and Outcomes by Hospital Setting

2021 ◽  
Author(s):  
Akshat Maneesh Patel ◽  
Omer Ali ◽  
Radhika Kainthla ◽  
Syed M. Rizvi ◽  
Farrukh T. Awan ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Public Safety ◽  
Central Nervous System Lymphoma ◽  
Safety Net ◽  
Treatment Patterns ◽  
Survival Outcomes ◽  
Academic Center ◽  
Safety Net Hospital ◽  
To Receive

Abstract Purpose: Primary central nervous system lymphoma (PCNSL) is an aggressive disease with many tools for management that may be subject to resource barriers. This study compares the treatment patterns and survival outcomes among PCNSL patients treated at a safety-net hospital versus a tertiary academic institution.Methods:We retrospectively reviewed records of PCNSL patients from 2007-2020 (n = 95) at a public safety-net hospital (n = 33) and a private academic center (n = 62) staffed by the same university. Demographics, treatment patterns, and outcomes were analyzed.Results:Compared to the tertiary academic center, patients at the safety-net hospital were significantly younger, more commonly Black or Hispanic, and had a higher proportion of presenting patients with HIV. The safety-net hospital cohort was significantly less likely to receive induction chemotherapy (67% vs 86%, p = 0.003) than those at the academic center. Safety-net hospital patients were significantly less likely to receive autologous stem cell transplant (ASCT) consolidation (0% vs. 44%, p = 0.001) and had higher rates of consolidative WBRT (35% vs 15%, p = 0.001). Younger age and receiving consolidation were associated with improved progression-free survival (PFS, p = 0.001) and overall survival (OS, p = 0.001). Hospital location had no statistical effect on PFS (p = 0.725) or OS (p = 0.226) on age-adjusted analysis. Conclusions:Our study showed significant treatment differences between a public safety-net hospital and an academic cancer center reflecting access disparities. Despite variable treatment patterns, survival outcomes were not different. Further research is needed to determine optimal treatments for an orphan disease like PCNSL and it will be essential to advocate for equitable access in resource-limited settings.

Treatment related mortality (TRM) for AML pts managed at a non-transplant, safety net hospital.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18092-e18092
Author(s):  
Krishna Goparaju ◽  
Timothy E. O'Brien
Keyword(s):  
Induction Chemotherapy ◽  
Performance Status ◽  
Healthcare Delivery ◽  
Safety Net ◽  
Induction Treatment ◽  
Poor Performance Status ◽  
Molecular Testing ◽  
Equal Distribution ◽  
Poor Risk ◽  
Safety Net Hospital

e18092 Background: Induction treatment for AML is associated with severe, life threatening toxicities. An accepted criterion for TRM is the 4 week mortality rate. A recent 18 yr study of AML pts treated with 3+7 induction regimens at SWOG institutions revealed an overall TRM at 4 weeks of 11%. Management of AML pts at non-transplant centers is controversial due to concerns over lower volumes, possibly leading to excess TRM. Over a 15-year period TRM was evaluated at a safety net, non-transplant center and compared to a national benchmark. Adherence to national guidelines for diagnostic testing was also assessed. Methods: MetroHealth Medical Center is a safety net hospital with a mission statement requiring all pts to be seen regardless of their ability to pay. Using tumor registry data, all cases of AML from 2001- 2016 were identified. Demographic data, 4 week TRM and compliance with standard diagnostic evaluation per NCCN guidelines were assessed.. Results: 67 cases were identified; average age was 59 (25-89), with equal distribution in gender. 73% were Caucasian, 18% African American, 4.5% Asian and 4.5% Hispanic. All but one (who went into hospice) had standard diagnostic tests sent (flow cytometry, cytogenetics and, for those with normal karyotyping, all had molecular testing for FLT-3 ITD, NPM-1, CEPBA and c-kit). Of the 67 patients, 5 received azacitadine, 2 received decitabine and 12 did not get treated due to co-morbidities and/or poor performance status. 48 patients received induction chemotherapy, of which 5 had APL appropriate therapies and the rest (43) received 3+7 induction regimens. For these 48 pts the 4 week mortality was 10%. Of those who received induction chemotherapy, 27% had favorable, 23% intermediate and 50% had poor risk molecular studies. Conclusions: A 15 yr review of outcomes during AML induction at a non-transplant, safety net institution revealed a TRM rate similar to a national benchmark, in spite of a relatively high percentage of poor risk cases. There was also good adherence to national diagnostic standards. Given the potential changes in the US healthcare delivery system which may result in more pts being seen at safety net institutions, these findings may have implications for future allocation of care.

Abstract 18: Patient-administered Home Inotrope Therapy: A Proof of Concept

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Wally A Omar ◽  
Chris Mathew ◽  
Kavita Bhavan ◽  
Sandeep R Das ◽  
Jose A Joglar
Keyword(s):  
Heart Failure ◽  
Infusion Pump ◽  
Cost Savings ◽  
Safety Net ◽  
Therapy Program ◽  
Advanced Therapies ◽  
Safety Net Hospital ◽  
End Stage ◽  
The Cost ◽  
To Receive

Background: Palliative use of continuous IV inotrope therapy has shown to improve quality of life and reduce hospital readmissions for patients with end-stage heart failure (HF) who are otherwise ineligible to receive advanced therapies. Administration of home inotrope therapy generally requires a hospice or home-health agency, placing this option out of reach for patients who lack funding. As such, underinsured patients are relegated to the difficult choice of either remaining in the hospital to receive IV inotropes, or going home without the therapy for as long as their symptoms allow. To address this issue at our large county safety-net hospital, we developed and implemented a patient self-administered home inotrope therapy program. Methods: A multidisciplinary team of physicians, pharmacists, nurses, and social workers was assembled to pilot the program. Eligible patients were provided with a peripherally inserted central venous catheter (PICC) and a portable infusion pump. They were then instructed on proper use of the pump, medication administration, medication bag changes, and IV line care using a nursing teach-back technique. After proper understanding was demonstrated, patients were discharged home with weekly follow up in heart failure clinic for PICC-care and medication exchanges. Results: During the initial 12 months of the program, 5 patients were deemed eligible for enrollment. Total hospitalized days for these patients was 277 (mean = 55.4 days) in the one year prior to enrollment and 12 (mean = 2.4 days) while enrolled for a cumulative period of 288 days (Figure 1). One patient was able to secure funding for advanced therapies, two patients died while enrolled, and two patients are currently enrolled and alive. Discussion: A self-administered home IV inotrope therapy program is a feasible alternative for palliation in unfunded patients with end-stage HF who are otherwise not candidates for advanced therapies, allowing for more days at home in the end of life. Thus far, the cost impact of the program has been mitigated by the cost savings for inpatient hospitalizations. Studies to assess patient-centered outcomes, and overall cost savings are ongoing.

Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center

2019 ◽  
Vol 129 (4) ◽  
pp. 369-375
Author(s):  
Caitlin Bertelsen ◽  
Janet S. Choi ◽  
Anna Jackanich ◽  
Marshall Ge ◽  
Gordon H. Sun ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Tertiary Care ◽  
Surgical Care ◽  
Safety Net ◽  
Clinic Visit ◽  
Level Of Evidence ◽  
Sociodemographic Differences ◽  
Academic Center ◽  
Safety Net Hospital ◽  
Type Of Surgery

Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c

Impact of the Closure of a Large, Urban Safety-Net Hospital on a Neighboring Academic Center: A Philadelphia Case Study

2020 ◽  
Vol 17 (9) ◽  
pp. 1123-1129
Author(s):  
Sarah I. Kamel ◽  
Adam C. Zoga ◽  
Frederick Randolph ◽  
Vijay M. Rao ◽  
Vishal Desai
Keyword(s):  
Safety Net ◽  
Academic Center ◽  
Safety Net Hospital ◽  
Urban Safety

Calcium and magnesium infusions for prevention of oxaliplatin-induced peripheral neuropathy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 387-387
Author(s):  
M. Bupathi ◽  
G. Mahmud ◽  
J. Kovar ◽  
E. Wang ◽  
T. E. O'Brien
Keyword(s):  
Peripheral Neuropathy ◽  
Cumulative Dose ◽  
Medical Center ◽  
Demographic Data ◽  
Performance Status ◽  
Safety Net ◽  
Control Group ◽  
Minority Population ◽  
Tumor Type ◽  
Safety Net Hospital

387 Background: Oxaliplatin plays an important role in chemotherapy regimens for colorectal and other GI malignancies. Debilitating peripheral neuropathy (PN) often develops with use of this drug. One study (Grothey A et al, ASCO 2009, abst #4025) has shown that pre- and post-oxaliplatin infusions with calcium (Ca) and magnesium (Mg) may reduce this toxicity. To confirm this in an unselected indigent minority population, a retrospective review was performed comparing development of PN in oxaliplatin exposed patients treated with or without Ca/Mg. Methods: Records of patients who received oxaliplatin from 1/2008 to 12/2009 at MetroHealth Medical Center, a large safety net hospital in Cleveland, OH, were reviewed. 47 patients received Ca/Mg + oxaliplatin and 46 oxaliplatin alone. Data collected included age, race, gender, insurance status, performance status, tumor type, stage, concomitant diseases (DM and EtOH), number of cycles and cumulative dose of oxaliplatin. PN was determined using the Common Terminology Criteria of Adverse Events (CTCAE) version 3.0. Patients were followed 6 months after completion of oxaliplatin. Results: Demographic data was similar between the two groups. Colorectal cancer compromised 77% of the treatment group and 85% of control group. Patients who received Ca/Mg had significantly less PN in all three grades (1-3) compared with the control group (grade 1 89.4% vs. 71.7%, grade II 10.6% vs. 19.6%, grade 3 0% vs. 8.7%, respectively). The cumulative dose of oxaliplatin did not differ between the two groups (Ca/Mg median 1,143 range 260-2,169; control median 1,425 range 137-2,635). The combined total grades 2 and 3 in both the treatment and control (10.6% vs. 28.3%, p = 0.038) favored use of Ca/Mg. Conclusions: This small, retrospective study confirms that Ca/Mg infusions reduce the incidence of clinically significant (grade 2/3) PN in pts receiving oxaliplatin. No significant financial relationships to disclose.

Outcomes of “real world” treatment for metastatic renal cell carcinoma (mRCC).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 406-406
Author(s):  
Michael Roger Harrison ◽  
Daniel J. George ◽  
Mark S. Walker ◽  
Lori L. Hudson ◽  
Connie Chen ◽  
...  
Keyword(s):  
Real World ◽  
Cox Regression ◽  
Performance Status ◽  
Treatment Options ◽  
Current Treatment ◽  
Treatment Patterns ◽  
Impaired Performance ◽  
Academic Center ◽  
Chart Abstraction ◽  
Metastatic Sites

406 Background: Targeted therapies have expanded treatment options for mRCC. Using a joint community/academic center database, we determined outcomes for “real world” mRCC patients (pts) in order to understand current treatment patterns and their effectiveness. Methods: A retrospective cohort dataset included all identified adult mRCC pts receiving care in Duke University Health System and 11 community oncology practices, diagnosed and alive since Jan. 2007, and not enrolled in a trial. Standardized chart abstraction supplemented the electronic medical record. Demographics, comorbidities, tumor characteristics, treatment patterns and outcomes were recorded. Pts were grouped by exposure sequence (TKI [sorafenib, sunitinib or pazopanib], mTOR [temsirolimus or everolimus], TKI/mTOR, etc.) for 9 sequences. Outcomes analysis for overall survival (OS) included Cox regression. Results: The cohort included 385 pts, 64 yrs old (±10.1), 66% male, 72% Caucasian; 64% had clear cell histology (25% unknown). Median OS was: mTOR (N=33; 5.4 mo), mTOR/TKI (N=11; 9.3 mo), TKI/mTOR (N=33; 13.7 mo), TKI (N=108; 21.1 mo), TKI/mTOR/TKI (N=18; 29.8 mo), TKI/TKI/mTOR (N=11; 33.1 mo), Other (N=40; 38.2 mo), TKI/TKI (N=32; 42.9 mo), No Therapy (N=99; not reached). “Other” pts received a combination or a non-TKI, non-mTOR monotherapy in the 1st three exposures. “No Therapy” pts had received no systemic therapy as of data analysis; most were alive and censored. Pts in the mTOR only sequence had trends toward worse disease at baseline with more metastatic sites (median 2.0; p=.067) and impaired performance status (18%; p=NS). When significant covariates were controlled, OS (vs. No Therapy) was poorest for pts receiving mTOR only (Hazard Ratio[HR]=2.3) and best for pts receiving TKI/TKI (HR=0.50). Significant risks were evident with liver metastasis (HR=1.7) and impaired performance status (HR=3.1). Conclusions: In the real world setting pts receiving mTOR as the 1st treatment exposure had worse OS, likely because pts with more aggressive disease were preferentially treated with mTOR. Outcomes were consistent with contemporary trials; however, several sequences (e.g. TKI/TKI, No Therapy) had surprisingly long OS, which requires further evaluation.

scholarly journals Willingness of Patients from an Urban Safety-Net Dermatology Clinic to Receive a COVID-19 Vaccine

2021 ◽  
Vol 5 (6) ◽  
pp. 649-655
Author(s):  
Hannah Mumber ◽  
Daniela Del Campo ◽  
Manuel Alvarado ◽  
Jacqueline Watchmaker
Keyword(s):  
Vaccine Development ◽  
Safety Net ◽  
Survey Study ◽  
Cross Sectional ◽  
Dermatology Clinic ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Flu Vaccine ◽  
Caucasian Patients ◽  
To Receive

Background: While recent vaccine development has initiated a return to pre-COVID "normalcy" both in the dermatology clinic and worldwide, significant challenges remain regarding the public’s willingness to receive a COVID-19 vaccine. Dermatologists often discuss vaccinations with their patients and aid them in making evidence-based medical decisions. Previous studies have looked at the U.S. population’s willingness to receive a COVID-19 vaccine, but no studies have examined the dermatology patient population from an urban, safety-net hospital. Studies have shown that understanding the target audience is the first step towards increasing vaccine acceptance. Methods: A cross-sectional, telephone-based survey study was administered to 326 patients of an urban, safety-net hospital from July 2020 to August 2020 in order to assess willingness to obtain a COVID-19 vaccine. Results: Our survey study showed that 57.7% of patients with a recent dermatology appointment are willing to receive a COVID-19 vaccine and that safety concerns represent the main reason for patient hesitancy. Patients who do not regularly receive a flu vaccine, non-Caucasian patients, and those who know someone who tested positive for COVID-19 are less willing to receive a COVID-19 vaccine. Patients with a recent dermatology appointment are more willing to receive a COVID-19 vaccine than those who did not have a recent dermatology appointment. Conclusions: Our results provide dermatologists, especially those working in urban safety-net clinics, with key information about the attitude of patients toward the COVID-19 vaccine.

Attempts to Optimise Induction and Consolidation Chemotherapy in Patients with Acute Myeloid Leukaemia: Results of the MRC AML15 Trial.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 484-484 ◽  
Author(s):  
Alan K Burnett ◽  
Robert K Hills ◽  
Donald Milligan ◽  
Ann E. Hunter ◽  
Anthony H. Goldstone ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
De Novo ◽  
Conflicts Of Interest ◽  
White Cell Count ◽  
Performance Status ◽  
Gemtuzumab Ozogamicin ◽  
High Dose ◽  
General Acceptance ◽  
Post Induction ◽  
To Receive

Abstract Abstract 484 On behalf of the NCRI AML Working Group, United Kingdom There is a general acceptance that survival in younger patients (<60 years) with AML has improved over the last 20 years, the majority still fail treatment. While the induction rate is satisfactory at >75% relapse remains a problem. Optimisation of induction and defining the schedule and duration of post-induction chemotherapy remains important even as novel approaches such as antibody directed therapy or small molecule therapy are added. The MRC AML15 compared 3 induction chemotherapy schedules and 4 post induction options. In induction patients were randomised to two course of DA or ADE or FLAG-Ida. In each case patients were also eligible to be randomised to receive Gemtuzumab Ozogamicin (GO) or not, which has been separately reported. In consolidation patients were randomised to MRC schedule (MACE/MidAC) or two courses of High Dose Ara-C and for those randomised to Ara-C to a dose of 3g/m2 or 1.5g/m2. Finally patients could be randomised to receive, or not, a 5th course comprising Ara-C. Between October 2002 and January 2009, 1982 patients were randomised between DA (n=994) and ADE (n=988); up to May 2007, patients could also be randomised to FLAG-Ida; the randomised comparison with ADE recruited 1266 patients (FLAG-Ida n=635, ADE n=631). For part of the trial patients could be randomised to GO or not (306 patients in the DA v ADE and 297 in the FLAG-Ida v ADE comparisons were randomised). The median age of patients in the randomised comparisons was 49 years. Overall the ORR was 85% (CR 80%, CRi 5%) and the OS at 5 years is 43%. The randomisations were balanced for age, sex, performance status, de Novo/secondary disease, cytogenetics, white cell count, and GO allocation. With the exception of a suggestion of greater benefit on ORR with FLAG-Ida among patients given GO, overall outcomes were not affected by GO treatment. In consolidation 1445 patients were randomised between MRC (n=723) and HD Ara-C (n=722). Of the 723 Ara-C patients, 328 were randomised to 3g/m2 and 329 to 1.5g/m2: 227 of the 1619 patients who received 4 courses were randomised for a 5th course with 112 allocated 5 courses. Conclusions: There were no significant differences in the response rate between induction treatments. FLAG-Ida resulted in a reduced relapse rate but this was balanced by increased myelosuppression and deaths in CR resulting in no overall benefit in survival. No survival differences were seen in any of the post induction comparisons, but the MACE/MidAc arm produced more myelosuppression and required more supportive care, and led to increased death in remission. Disclosures: No relevant conflicts of interest to declare.

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