A61 PRE-ALLOGENIC STEM CELL TRANSPLANT CLINICAL FACTORS AND THEIR ASSOCIATION WITH CHRONIC GRAFT VERSUS HOST DISEASE - A RISK FACTOR ANALYSIS FOR CHRONIC GVHD PREDICTION

Background

Allogeneic stem cell transplant is the only curative treatment for some hematological malignancies but is associated with significant toxicities and morbidities. The main long-term complication that is associated with decreased quality of life is chronic graft versus host disease (cGVHD) which can affect any organ system in the body. When clinicians are faced with the decision of transplanting patients many considerations must be taken into place. Unfortunately, despite counseling patients regarding possible toxicities and morbidities resulting from the allogeneic stem cell transplant including GVHD, we are unable to give accurate risks of cGVHD, especially organ-specific cGVHD, which might otherwise deter patients and clinicians from undertaking the transplant depending on their priorities that determine their quality of life.

Aims

We sought to ascertain which prognostic factors could predict gastrointestinal (GI)/liver specific cGVHD.

Methods

We conducted a retrospective case-control study including a consecutive sample of patients from a single specialty clinic from 2012–2017. Patients with biopsy proven GI/liver cGVHD based on pathology or determined by expert opinion reports were classified as cases and patients who underwent allogenic stem cell transplant without GI symptoms or liver enzyme elevations were controls. Data extracted included: age, gender, chemotherapeutics, donor status (related or unrelated), recipient and donor blood type, stem cell dose (x10⁶ cells), complete blood count and differential, and electrolytes. Logistic regression was used to analyze clinical factors associated with GI/liver specific cGVHD.

Results

Our chart review retrieved 66 patients without GI/liver specific cGVHD and 55 patients that experienced GI/ liver cGVHD. The mean [SD] age of the sample was 50 [14] years and most of the participants in the study were men (59%). The most common cancer was acute myeloid leukemia. Univariate analysis revealed that male gender and stem cell dose were associated with GI/liver cGVHD. After adjusting for potential confounders, history of any acute GVHD demonstrated a statistically significant association with GI/liver cGVHD (adjusted OR [aOR]=2.7; 95% confidence interval=1.0–1.3; p=0.049), while male gender (aOR=2.7; 95% confidence interval=1.2–6.2; p=0.02) and stem cell dose (aOR=1.2; 95% confidence interval=1.0–1.3; p=0.037) remained statistically significant. The combination of these three clinical factors demonstrated fair discrimination (area under the curve=0.69). Other clinical factors were not significantly associated with GI/liver cGVHD.

Conclusions

Male gender, previous episode of acute GVHD, and stem cell dose were strongly associated with gastrointestinal (GI)/ liver cGVHD among patients who receive allogeneic stem cell transplants.

Funding Agencies

None

An overview of the latest outlook of sulfamate derivatives as anticancer candidates (2020-2024)

Considering the emergence of new anticancer drugs, in this review we emphasized and highlighted the recent reports and advances related to sulfamate-incorporating compounds with potential anticancer activity during the last 5 years (2020-2024). Additionally, we discussed their structure-activity relationship, clarifying their potent bioactivity as anticancer agents. Sulfamate derivatives hold promise as effective therapeutic candidates against cancer. By targeting biological targets associated with the development of cancer, such as steroid sulfatases (STS), carbonic anhydrases (CAs), microtubules, NEDD8-activating enzyme, small ubiquitin-like modifiers (SUMO)-activating enzyme (SAE), cyclin-dependent kinases (CDKs), breast cancer susceptibility gene 1 (BRCA1), and so on, this can furnish small molecules as anticancer lead candidates serving the drug discovery field. For example, compound 2, an STS inhibitor, demonstrated superior activity compared to its reference, irosustat, by fivefold. In addition, compound 21, an SAE, is under phase I clinical trials. Continued research into sulfamate derivatives holds potential for the development of novel therapeutic agents targeting various diseases.

A93 IMPROVING INPATIENT ENDOSCOPY PROCEDURAL THROUGHPUT: A QUALITY IMPROVEMENT INITIATIVE AT AN ACADEMIC MEDICAL CENTER

Background

Currently, due to pandemic-related supply and personnel constraints, increased strain is being placed on inpatient endoscopic services. At our academic center, inpatient procedural throughput/efficiency is only 65%, which is leading to excess procedures being completed on-call or on weekends.

Purpose

Our quality improvement study attempted to improve throughput of the inpatient endoscopy suite by 1 additional procedure completed per day, over a period of 12 months of study.

Method

An interprofessional team of gastroenterology fellows, attending physicians, nurses and nurse managers was created to investigate throughput concerns. Baseline data was collected via direct observation and completion of a time study over a period of 1-2 months.

Subsequently, a process flow diagram was completed. A combination of root cause analysis tools (ie. Stakeholder interviews, Pareto chart and Driver Diagram were then utilized to identify areas for improvement. A delay in procedural start time was identified as a strong culprit for reduced patient throughput. Potential interventions proposed included: early physician handover start time, constructing a standardized patient procedure list, and improving timeliness of patient transfer to the endoscopy suite.

Result(s)

Stakeholder Interview(s): Completed via Anonymous Survey/Google Forms:

See

https://docs.google.com/forms/d/e/1FAIpQLSe-PDL31ClU8g-BChdBoBYhPoBhGBZVmlToTTZJnYKlEHz-GQ/viewform?usp=sf_link

Concerns:

- Inpatient procedure list not consistently being completed prior to starting endoscopy

- Physician handover in the morning can cause significant delays in starting inpatient endoscopy

- Concern patient/porter transfer related delays

Conclusion(s)

Our current data identifies that the most effective intervention included developing a standardized procedure list and mandating the first case is an EGD, minimizing delay due to inadequate bowel preparation. Concordantly, arranging timely patient transfer to the endoscopy suite, thereby minimizing delays due to patient portering services, was also found to be effective. Our average procedural time for completion of an EGD and associated recovery is approximately 25-30 minutes. After multiple interventions/PDSA cycles we obtained a more optimized procedural suite start time of 08:22 am, on average, which resulted in the completion of an additional procedure and increased the throughput of our endoscopy unit.

Please acknowledge all funding agencies by checking the applicable boxes below

None

Disclosure of Interest

None Declared

A100 ORAL VANCOMYCIN THERAPY FOR CLOSTRIDIOIDES DIFFICILE INFECTION AND RISK OF INFECTION WITH GRAM-NEGATIVE ORGANISMS

Background

Vancomycin is the recommended first-line therapy for mild to severe Clostridioides difficile infection (CDI). However, oral vancomycin is associated with disruption of the indigenous microbiota, predisposing patients to overgrowth of endogenous pathogens such as vancomycin-resistant enterococci.

Aims

The primary objective of the study is to examine the effect of the treatment regimens of CDI on the risk of infection with gram-negative organisms in adult patients treated for CDI.

Methods

A retrospective cohort study of 319 adult patients treated for CDI at Hamilton Health Sciences in the year 2015. A multivariate logistic regression analysis was performed to determine if oral vancomycin-based therapy is associated with an increased risk of infection with gram-negative organisms after adjustment for other factors.

Results

Eighty-one patients were excluded because of recurrent episodes of CDI within the same year or missing information. 238 patients were included in the final analysis. 48 (20.2%) patients had positive culture for gram-negative organisms after onset of CDI. Urine was the most common source for gram-negative organisms (39/48, 81.3%) followed by blood (8/48,16.7%). The most common isolated gram-negative organisms were Escherichia coli (18/48, 37.5%) and Klebsiella pneumonia (9/48, 18.8%).

The most common CDI treatment regimens were metronidazole monotherapy (137/238, 57.6%), vancomycin monotherapy (13/238, 5.5%), and combination therapy (88/238, 37.0%). Among patients who were treated with metronidazole monotherapy, vancomycin monotherapy, and combination therapy, 30(30/137, 21.9%), 3 (3/13,23.1%), and 15 (15/88, 17.1%) had positive culture for gram-negative organisms, respectively (P= 0.6).

Ninety-seven (97/238,40.8%) patients had severe CDI, 40 (40/97, 41.2%) were treated with metronidazole monotherapy, 5(5/97, 5.2%) with vancomycin monotherapy, and 52 (52/97, 53.6%) with combination therapy. 26 (26/141,18.4%) and 22 (22/97, 22.7%) had positive culture for gram-negative organisms among patients with non-severe and severe CDI, receptively (P= 0.7). In the multivariate analysis, neither type of CDI treatment regimen (P=0.2, 95% CI 0.30–1.31) nor CDI severity (P=0.4, 95% CI 0.67–2.69) was associated an increased risk of infection with gram-negative organisms after CDI onset.

Conclusions

Contrary to the reported literature, we did not find that oral vancomycin-based CDI treatment was associated with increased risk of infection with gram-negative organisms.

Funding Agencies

None