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Young Investigators & Clinical Investigators A1 Efficacy of the combination of bortezomib and dexamethasone in systemic AL amyloidosis W. Lamm1, W. Willenbacher2, N. Zojer3, E. Müldür3, H. Ludwig3, A. Lang4, B. Schauer-Stalzer1, C. Zielinski1, J. Drach1 1Division

of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria 2Department of Internal Medicine V (Hematology and Oncology), Center of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria 3First Department of Medicine, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria 4Department of Internal Medicine E, Landeskrankenhaus Feldkirch, Feldkirch, Austria

AL amyloidosis (AL) is characterized by misfolding of structurally unstable light chains that form deposits in various organs. Novel agents like bortezomib (B) have shown initial promising results in patients with AL. In this retrospective analysis, we studied the efficacy and tolerability of B plus dexamethasone (BD) in 26 patients with histologically proven AL. All patients received B at a standard dose of 1.3 mg/m2 (days 1, 4, 8, 11, q = 21) in combination with dexamethasone (8–20 mg administered on the day of B and the day after). Routine clinical and laboratory parameters were obtained on a monthly basis. Median age of patients was 57 years, 17 patients (68%) received BD as their first line treatment. The majority of patients had an ECOG performance status of < 2. Twelve patients (48%) had only one organ involved. Organs most frequently involved were kidneys (100%) and heart (28%). A haematological response was observed in 14 patients (56%), CR in 8 patients (31%). Median overall survival (OS) was 18.7 months. Median progression free survival (PFS) was 5 months. Of note, achievement of haematological CR was associated with a significantly prolonged PFS and OS (p = 0.000 and p = 0.024, respectively). Grade 3 and 4 toxicities were rare. Grade 1/2 toxicities observed at higher frequencies included neurotoxicity (24%), hypotension (16%), oedema (16%), and fatigue (12%). Our results confirm the activity of BD in patients with AL (haematological response rate 56% including a 31% CR rate).

A2 Management of acquired severe aplastic anaemia in children: a single center experience over 30 years C. Urban, H. Lackner, P. Sovinz, M. Benesch, A. Nebl, S. Schmidt, W. Schwinger Division of Pediatric Hemato-Oncology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria

Background: For children suffering from acquired severe aplastic anaemia (SAA), stem cell transplantation (SCT) from a matched sibling donor (MSD) is the treatment of choice. Children without MSD receive immunosuppressive therapy (IST) and alternative donor SCT in the case of insufficient response to IST. Methods: From 1978 to 2009, 26 patients (m:f = 11:15; median age 11.65 years) were diagnosed with acquired SAA. Potential causes were hepatitis (6), infectious agents (8), drugs (2), pregnancy (1), unspecific febrile illnesses (5); no identifiable cause (4). Primary MSD-SCT after conditioning with cyclophosphamide ±ALG/ATG was performed in 10 patients. Sixteen patients received IST consisting of ATG, methylprednisolone and cyclosporine A. Results: After SCT, 9/10 patients survive for a median of 12.7 years; one patient died 3.5 years after SCT of pulmonary hypertension; 1 patient developed limited chronic GVHD. After IST, 7/16 (43%) patients achieved stable complete remission, 2 partial remission, 2 did not respond; 5 patients relapsed. Five patients received an alternative-donor-SCT (MUD: 4; mother: 1) after TLI-based (n = 2) or fludarabinebased conditioning regimes (n = 3) with CD34+ selected PBSC (n = 3), CD3/19 depleted PBSC (n = 1) or a combination of both (n = 1); no GVHD was noted. 15/16 patients survive for a median follow-up of 6.5 years; one patient died of hepatic failure 19.4 years after diagnosis. Conclusions: Ninety-two percent of patients with acquired SAA survive after IST and/or SCT. Primary MSD-SCT remains the best treatment option. Following IST, 5/19 patients received alternative donor SCT. For these patients the goal is to use non-radiotherapy based reduced intensity conditioning with high numbers of CD34+ cells and CD3– depletion to reduce toxicity and GvHD.

A3 Treatment responses and adverse events in nilotinib-treated patients with CML: a single center experience C. Sillaber, S. Herndlhofer, K. Gleixner, H. Agis, P. Valent1 Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria

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Tyrosine kinase inhibitors (TKI) have revolutionized therapy in chronic myeloid leukaemia (CML). Although most patients respond well to imatinib (IM), resistance or intolerance may occur. For these patients, two second-line BCR/ ABL TKI are available, nilotinib (NI) and dasatinib (DA). Between December 2006 and January 2010, we treated 24 patients with CML (TKI-resistant or patients who lost or did not achieve a major molecular response, MMolR, n = 17, intolerant patients, n = 6, freshly diagnosed CML, n = 1) with NI (Tasigna®) at 2 × 400 mg daily (resistant/intolerant) or 2 × 300 mg daily (freshly diagnosed). Eight patients had previously failed DA-therapy, in two of these patients the BCR/ABL mutation F317L was detectable. After a median observation time of 16.3 months, 14/24 patients (58.3%) achieved a MMolR (BCR/ABL < 20.1% by IS) and 12/14 (85.7%) had a CCyR. Two patients who switched from IM to NI remained in MMolR. In 7 patients, no MMolR but durable haematological responses, often with normal blood counts, were obtained, including those two patients with BCR/ABL F317L. Side effects were mild and tolerable in most cases. Adverse events included clinically asymptomatic increases in unconjugated bilirubin or amylase/lipase, skin erythema, and folliculitis. No severe cardiac, pulmonary or gastrointestinal side effects were recorded. However, two patients with IM-resistant CML developed rapidly progressive peripheral arterial occlusive disease (PAOD) during NI-therapy. Together, our data confirm superior antileukemic effects of NI in TKI-resistant/intolerant CML. Our study also confirms that NI is a well-tolerated drug in most patients. Whether NI may predispose for PAOD remains to be elucidated.

A4 D-dimer levels predict overall survival in cancer patients C. Ay1, D. Dunkler2, R. Vormittag1, P. Quehenberger3, R. Pirker4, O. Wagner3, C. Zielinski3, I. Pabinger1 1Division

of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria 2Section for Clinical Biometrics, Center for Medical Statistic, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria 3Division of Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria 4Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria

Background: Procoagulant changes in the haemostatic system and activation of haemostasis are frequently observed in cancer patients, even in the absence of venous thromboembolism (VTE). Moreover, coagulation activation, in particular thrombin generation and fibrin formation, has been implicated in tumour progression, invasion, angiogenesis and metastatic spread. D-dimer is produced when cross-linked fibrin is degraded by plasmin and reflects the activation of coagulation and fibrinolysis. Recently, high D-dimer levels were reported to predict the occurrence of VTE in cancer patients.

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Aim: The aim of the current study was to assess the prognostic value of D-dimer levels in cancer patients included in the ongoing prospective observational Vienna Cancer and Thrombosis Study (CATS), which was initiated in 2003 to identify predictive parameters for cancer-associated VTE. Methods: The CATS includes patients with newly diagnosed cancer or progression of disease after remission. Patients are followed over 2 years at regular intervals until occurrence of symptomatic VTE or death. D-dimer levels were measured with a D-Dimer latex agglutination assay. Kaplan Meier and Cox regression analyses were applied for statistical calculation. Results: Data from 873 patients with solid tumours or haematological malignancies (394 females/479 males, median age [IQR]: 62 [53–68] yrs) were available for survival analyses. Patients were followed for a median observation time of 731 days and 357 (40.1%) patients died during follow-up. The probability of overall survival for patients with D-Dimer levels in the 1st, 2nd, 3rd and 4th quartile were 88%, 82%, 66% and 53% after 1 year and 80%, 66%, 50% and 30% after 2 years, respectively (p < 20.001). The hazard ratio (HR) of D-dimer for mortality was 1.5 (95% CI: 1.4–1.6, p < 20.001) per double increase of D-dimer and remained similarly increased in multivariable analysis, which included age, sex and metastatic spread. Conclusion: High levels of D-dimer independently predict mortality risk in patients with cancer.

A5 Metaanalysis of survival outcomes in first-line bevacizumab R. Bartsch1,2, C. De Vries2, M. Foedermayr1, U. Pluschnig2, M. Huber1, Z. Bago-Horvath3, M. Girschikofsky1, G. Steger2, P. Dubsky4, M.-M. Gnant4, C. Zielinski2, R. Ziebermayr1 1Medical

Department I (Center for Hematology, Hemostaseology, Medical Oncology), Hospital Elisabethinen, Linz, Austria 2Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria 3Department of Pathology, Medical University of Vienna, Vienna, Austria 4Department of Surgery, Medical University of Vienna, Vienna, Austria

Background: Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF) approved for first-line use in metastatic breast cancer. Three studies indicated improved progression-free survival, while they were not powered individually to demonstrate survival advantage. Therefore, we conducted a meta-analysis of available survival data. Methods: Three randomized phase III studies of firstline bevacizumab were identified. E2100 and AVADO compared taxane-based chemotherapy to a combination of taxane plus bevacizumab; RIBBON-1 was a four-arm trial evaluating the impact of bevacizumab to either capecitabine memo Suppl 1/10

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or a pooled cohort receiving anthracyclines or taxanes. Those groups were independently powered and analyzed in parallel and therefore independently included into the meta-analysis. Applying fixed-effect and random-effect models, we conducted a meta-analysis of survival data using Meta-AnalysisV2 (BioStat, Englewood, NJ, USA). Results: A total of 2447 patients were treated in three trials. 248 in AVADO arm B received bevacizumab 7.5 mg/kg and were excluded. Under the fixed-effect and random-effect models, the point estimate and 95% confidence interval for the combined studies is 0.902 (Peto odds ratio), 0.760–1.070, p = 0.235, showing a non-significant trend towards improved overall survival with the addition of bevacizumab to first-line chemotherapy. Funnel plot diagram revealed no sign of publication bias. Conclusions: This meta-analysis conducted with updated data could not demonstrate significantly improved survival with the addition of bevacizumab to chemotherapy. This might result from a high number of patients crossing over to second-line bevacizumab upon progression, or short followup in AVADO and RIBBON-1. Analysis of final data therefore must be awaited.

unserem Kollektiv nicht vertretene T790M) als resistent bzw. schlecht auf Gefitinib ansprechend. Dass nicht alle Sequenzvariationen Mutationen sind, die mit der Tumorgenese in Zusammenhang stehen, wird anhand der bei einer Probe detektierten Variante L858P diskutiert. Mittels Bestimmung eines häufigen SNP in Exon 20 an Laser-microdissezierten kleinen Teilarealen wurde gezeigt, dass Verluste eines Allels (Loss of Heterozygosity) in Teilbereichen eines Tumors auftreten können, somit der Tumor genetisch inhomogen sein kann.

A7 Induktionschemotherapie gefolgt von Radioimmuntherapie bei fortgeschrittenen HNO-Tumoren: Ergebnisse der Österreichischen multizentrischen Studie F. Keil1, K. Kapp2, H. Samonigg3, A. DeVries4, A. Lang4, R. Greil5, G. Kornek2 1Department

A6 EGFR-Mutationen bei Non-mucinösen Adenocarcinomen der Lunge – ein Praxisbericht W. Kranewitter1, I. Huemer1, H.-C. Bösmüller2, G. Webersinke1 1Labor

für Molekularbiologie und Tumorzytogenetik, I. Interne Abteilung, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Österreich 2Institut für Klinische Pathologie, Krankenhaus der Bermherzigen Schwestern Linz, Linz, Österreich

Grundlagen: Non-mucinöse Adenocarcinome (NMA) der Lunge mit Mutationen im EGF-Rezeptor (EGFR) zeigen ein besseres Ansprechen auf EGFR-Inhibitoren wie Gefitinib und Erlotinib. Mutationen im EGFR-Gen werden daher als prädiktive Marker insbesondere vor einer Therapie mit Gefitinib bestimmt. Wir berichten über erste Erfahrungen mit der Routinebestimmung von EGFR-Mutationen aus NMA der Lunge. Methodik: Aus FFPE-Schnitten von NMA-Proben wurde genomische DNA präpariert und Exons 18–21 des EGFR mittels Dideoxy-Sequenzierung auf Mutationen untersucht. Zur Validierung der Methode wurden die Ergebnisse der Sequenzierung bei 26 Proben mit einem kommerziellen RealTime-PCR Testkit (Terascreen) verglichen und vollständige Übereinstimmung festgestellt. Ergebnisse und Schlussfolgerungen: In 96 Proben wurden 16 Mutationen (16,7%) detektiert. Die Mutationsrate betrug bei Frauen 24% (12 von 50 Proben mutiert) und bei Männern 8,7% (4 von 46 Proben mutiert). 9 Mutationen waren Deletionen in Exon 19, gefolgt von 4 Mutationen in Exon 21 (ausschließlich die Punktmutation L858R), sowie von 3 Insertionen/Duplikationen in Exon 20. Letztere gelten (wie die in memo Suppl 1/10

für Hämato/Onkologie, LKH Leoben, Österreich für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich 3Klinische Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich 4Strahlentherapie (Onkologie), LKH Feldkirch, Österreich 5III. Medizinische Universitätsklinik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich 2Universitätsklinik

Präliminäre Ergebnisse der österreichischen Multicenter-Studie bei fortgeschrittenen HNO-Tumoren: Bei fortgeschrittenen nicht operablen HNO-Tumoren haben sich neben der Radiochemotherapie die Radioimmuntherapie sowie die Induktionschemotherapie mit Taxanen gefolgt von Strahlentherapie etabliert. In unserer multizentrischen österreichischen Studie haben wir diese zwei Therapiekonzepte verknüpft. Auf eine taxanhältige Induktionstherapie folgte eine Radioimmuntherapie. Primärer Endpunkt der Studie ist die Analyse der locoregionären Kontrolle nach einem Jahr. Sekundäre Endpunkte: Bewertung akuter Toxizität, Spättoxizität sowie progressionsfreies Überleben nach 2 und 5 Jahren. Zur Zeit haben sämtliche 50 Patienten die Studie abgeschlossen. Toxizität:Während der Induktionschemotherapie wurden 20% Neutropenien Grad IV sowie 4% febrile Neutropenien gesehen. Neutropenien Grad III wurden bei 24% der Patienten beobachtet, Diarrhoe Grad III 20%, febrile Neutropenie Grad III 8%. Vier Patienten konnten die Induktionschemotherapie nicht abschließen. Ein Patient verstarb während der Induktionschemotherapie an einer Candidasepsis, drei Patienten hatten die Therapie abgebrochen. Somit konnten 46 Patienten der Radioimmuntherapie zugeführt werden. Von diesen konnten 44 Patienten die Therapie beenden. In der Radioimmuntherapie traten bzgl. Toxizitäten Grad IV: Mukositis zu 11%, Dermatitis 11%, Xerostomie 9%, Dysphagie 9% Grad IV der behandelten Patienten. Responbse: 12 Monate nach Studienstart sind 38 Patienten noch am Leben. 25 mit einer kompletten Remission, 4 mit einer partiellen Remission, 9 mit Progressive Disease. Weitere 5 Patienten waren an

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der Progression der Grunderkrankung verstorben und ein Patient war im Follow-up verloren gegangen. Von den 50 Patienten ist somit 1 Patient während der Induktion verstorben, 5 Patienten waren nicht beurteilbar(Compliance-Mangel, Screeningfehler etc.) und 5 Patienten waren im Rahmen ihrer Grunderkrankung nach der Radioimmuntherapie verstorben. Die Compliance während der Therapie war sehr gut. Insgesamt konnten von den 50 eingeschlossenen Patienten 44 die Radioimmuntherapie abschließen.

A8 Gefitinib in routine treatment of non-small cell lung cancer (NSCLC): results in 79 consecutive patients from three institutions A. Pircher1, E. Ulsperger2, R. Hack3, H. Jamnig3, G. Pall4, W. Hilbe1, M. Fiegl1

A9 Improved prognostic information in CLL by metaphase cytogenetics E. Krömer-Holzinger1, G. Neumann1, S. Koskela1, M. König1, E. Kitzweger2, R. Ruckser2, M. Korger3, T. Lion1 1Labdia,

1Department

Children’s Cancer Research Institute, St. Anna Children’s Hospital, Vienna, Austria 2Danube Hospital, Vienna, Austria 3Hospital Barmherzige Brüder, Eisenstadt, Austria

Background: Gefitinib is an oral EGFR tyrosine kinase inhibitor (TKI) and was recently approved for the treatment of EGFR mutated NSCLC patients. Previously, gefitinib could be given in pretreated patients within an expanded access programme (EAP) in 2002–2006. We retrospectively analyzed 79 patients with advanced non-small cell lung cancer treated with gefitinib in the EAP in Austria. Methods: 47/79 (60%) are male; median age at the start of gefitinib was 65 years (range, 35–83); 14/58 informative patients (24%) were never-smokers; 56/79 patients (71%), had adenocarcinoma, including 7 BAC; gefitinib was applied in 4%, 34%, 41%, and 22% as 1st, 2nd, 3rd, and 4th–6th line of therapy, respectively. Results: All patients were evaluable for response (“best response”). Partial remission (PR) was observed in 8 patients (10%), stable disease (SD) in 32%, i.e., disease control was achieved in 42%. Remarkably, gefitinib was more efficacious in women (PR 19%, SD 47%). Because gefitinib was most frequently administered in third-line therapy (n = 32), timeto-event analysis was performed only in this cohort: progression-free survival (PFS) was 4.3 months, significantly longer in women (9.1 months) than in men (2.1 months, p = 0.01 log rank-test). In never-smokers (n = 5), PFS was 9.1 months. In the group of third-line gefitinib patients, overall survival (OS) was 8.0 months (female 9.5 months vs. male 5.1 months, p = 0.10). Toxicities typical for EGFR TKIs were observed (mainly diarrhoea, skin rash). Detailed analysis will be presented at the meeting. Conclusions: Gefitinib resulted in a clinical benefit in a remarkable proportion of patients, and the outcome in the

Background: Genetic analysis in CLL is routinely done by interphase FISH (iFISH) using a DNA-probe panel covering chromosome regions known to be frequently involved in numerical or structural abnormalities. The application of conventional metaphase cytogenetics was problematic for a long time due to the characteristically low mitotic index of CLL cells. However, in the last few years improved culture techniques were developed that allow routine application of conventional metaphase cytogenetics in CLL thus providing important additional information on chromosome aberrations not detectable by standard iFISH. Methods: Mononuclear cells from blood or bone marrow samples were cultivated in the presence of the immunostimulatory CpG-oligonucleotide DSP30 and Interleukin-2 (IL-2) for 72 hours. Metaphase preparation and staining were done according to standard protocols and chromosome banding analysis was performed on at least 20 metaphases per case. In parallel a standard panel of DNA-probes for the most important recurrent aberrations with prognostic impact i.e. –13/13q–, +12, del(11q13), t(14q32) and del(17p13) was used for interphase FISH analysis. Results: Metaphase and interphase cytogenetics were performed in 25 consecutive CLL cases. Clonal anomalies were detected in 23 (92%) and 20 patients (80%) by iFISH and chromosome banding analysis, respectively. In 14 cases (61%) additional genetic changes not detected by FISH analysis were identified by conventional cytogenetics. A complex karyotype (> 3 aberrations) was found in only one patient by iFISH but in 8 cases (32%) by metaphase cytogenetics. In one patient with normal iFISH results the presence of a clonal rearrangement (translocation) was revealed by chromosome analysis. Parallel application of both methods thus uncovered genetic aberrations in 24 of 25 cases (96%). Conclusions: Our data confirm the efficiency of the specific stimulation by DSP30 and IL-2 for metaphase generation in CLL. Conventional cytogenetics using this technique can provide essential complementary information on chromosome abnormalities with prognostic impact. Recent studies

of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria 2Department of Internal Medicine V, Hietzing Hospital, Vienna, Austria 3Department of Pneumology, Natters Hospital, Natters, Austria 4Department of Internal Medicine I, General Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria

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whole cohort and in subgroups (women, never-smokers) was well comparable with that in published studies. Thus, our survey confirms efficacy of gefitinib in the routine setting. It is our ongoing effort to document the impact of novel therapies and its side effects as a tool of quality control. This project is supported by the “Verein für Tumorforschung”.

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demonstrated a significant correlation of translocations and complex aberrations with shorter treatment-free as well as overall survival. The detection of clonal chromosome abnormalities not amenable to identification by the standard iFISH probes therefore seems to be of great relevance for more accurate assessment of prognosis and treatment response in CLL.

A10 VLA-4 and CD38 in chronic lymphocytic leukemia – more than prognostic markers? G. Brachtl, T. Girbl, U. Denk, J. D. Pinon, R. Greil, T. N. Hartmann Laboratory of Immunological and Molecular Cancer Research (LIMCR), IIIrd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Paracelsus Private Medical University, Salzburg, Austria

VLA-4 (CD49d/CD29) and CD38 are prognostic markers in chronic lymphocytic leukemia (CLL). Although they independently predict the clinical outcome of the disease, a strong association of their expression can be found. We hypothesized that they act together in CLL homing. First, by analyzing the expression in 124 CLL patients, we confirmed that VLA-4 and CD38 risk groups were highly associated in our patient cohort. In bone marrow (BM) aspirates of low risk CLL patients, CD38 and VLA-4 expression was significantly increased compared to the peripheral blood pool, whereas in aspirates of high risk patients, VLA-4 but not CD38 expression was increased. Expression of the proliferation marker Ki-67 was enriched in the CD38+ and VLA-4+ subpopulation within individual BM samples. In vivo adoptive transfer assays of human CLL cells into immunodeficient mice revealed that CLL cells from high risk patients, expressing VLA-4 and CD38, were capable of homing to BM in a VLA-4 and Gai protein dependent manner. Further experiments using rare patient samples with either VLA-4+/CD38– or VLA-4–/CD38+ CLL cells confirmed the predominate role of VLA-4 over CD38 in BM homing. Pretreatment with anti-CD38 antibodies but not F(ab)2 fragments of the same antibody significantly reduced the number of human cells detected in BM. Also, CD38 blockage did not affect migration of CLL cells towards the BM chemokine CXCL12 or CXCL12-induced VLA-4 activation under shear flow conditions. In summary, albeit both molecules mark a CLL subpopulation with high migratory capacity, CD38 contribution to BM homing seems to be inferior to VLA-4.

A11 The dynamics of CD38 expression in CLL cells over time G. Brachtl1, T. Melchardt1, A. Egle1, T. N. Hartmann1, I. Tinhofer2, R. Greil1 memo Suppl 1/10

1Laboratory

of Immunological and Molecular Cancer Research (LIMCR), IIIrd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Paracelsus Private Medical University, Salzburg, Austria 2Translational Radiobiology and Radiooncology Research Laboratory, Clinical Department for Radiotherapy (CCM/ CVK), Charité University of Berlin, Berlin, Germany

Different prognostic markers determine disease outcome in chronic lymphocytic leukemia (CLL), including CD38 expression. In this study we investigated the stability of CD38 expression on CLL cells in 275 patients over time and correlated it to disease progression. One hundred and ten CLL patients were sampled at least four times with a minimum of 6 months between the first and the last examination. CD38 expression was a very stable risk parameter. Only 9.1% of the patients changed their risk group over time, all from the CD38 high risk to the low risk group. We also found a correlation between CD38 expression and the patient’s treatment status. Therefore we excluded samples collected during and up to 6 months after treatment, and samples from patients in complete remission. Interestingly, there was still a great dynamic in CD38 expression over time within each risk group. The dynamics of CD38 expression was described mathematically as the standard deviation of CD38 expression (as a measure of variance) divided by the time the patient was under observation, in order to discriminate between short and long term changes. Strikingly, patients with a high dynamic in their CD38 expression had a significantly shorter time-totreatment than those with a stable CD38 expression, independent of the CD38 risk group. Although CD38 is a very stable prognostic marker in CLL, the percentage of CD38-expressing CLL cells in some patients varies greatly. Because CD38 has been associated with CLL cell proliferation, CD38 expression dynamics may reflect a more active and thus more aggressive tumour clone.

A12 Genetic engineered T- and NK cells together as a combinatorial approach to break tumour tolerance targeting erbB2/HER2 J. Rudzki1, H. Rumpold2, G. Gastl1, D. Wolf1 1Department

of Internal Medicine V (Hematology and Oncology), Center of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria, 2Hospital Barmherzige Schwestern, Linz, Austria

Background: Advances in molecular immunology have introduced opportunities for the development of cellularbased therapies for the treatment of cancer. Transgenic T cells expressing a chimeric antigen receptor (CAR) act in a MHC-I independent manner. Apparently, the fact that CAR-tg (CAR transgenic) CTLs are clinically not as potent as expected emphasizes the need for devising new innovative concepts to break tumour tolerance. The primary aim of this project is to generate more complex immunotherapeutic strategies using

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CAR-tg immune cells in a combinatorial approach, as each single cell population has been shown to be of limited value for cancer immunosurveillance. Results: High efficient transduction of human cell lines (Jurkat, K562) was obtained by using a control vector (pCCL_g_egfp) and the major target vector (pCCL_g_CAR) (i.e. egfp: 87% in Jurkat; 96% in K562; CAR: 84% in Jurkat; 97% in K562). Unselected primary human T cells (83% CD4+ and 17% CD8+ T cells) expressed the CAR in approximately 50% of the cells when transduced with the pCCL_g_CAR. Positive cells were subsequently enriched by MACS, thus enabling a specific lysis of approximately 45% of HER2-expressing mamma carcinoma cells (MCF7-HER2) after short-term in vitro expansion. Conclusions: Current experiments are performed to generate highly enriched CAR-transgenic T cell subpopulations (i.e. CD4 and CD8 T cells) as well as novel NK-CARs comprising new costimulatory domains (NKG2D/DAP10, NKG2D/h2B4) targeting HER2. It is the final goal of this project to generate CAR-tg lymphocyte subpopulations to target HER2 expressing tumours using a combination of these cell fractions.

A13 Deregulated microRNAs reflect molecular features of anaplastic large cell lymphoma F. Hamacher1, D. Laimer4, M. Scheideler5, Z.Trajanoski5, G. Egger4, M. Hassler4, C. Thallinger4, A. Schmatz4, S. T. Turner3, L. Kenner2,4, R. Greil1, O. Merkel1 1Laboratory

of Immunological and Molecular Cancer Research (LIMCR), IIIrd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Paracelsus Private Medical University, Salzburg, Austria 2Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria 3Division of Molecular Histopathology, Cambridge, UK 4Department of Pathology, Medical University of Vienna, Vienna, Austria 5Institute for Genomics and Bioinformatics, University of Technology, Graz, Austria

Anaplastic large cell lymphoma (ALCL) is an aggressive non-Hodgkin T-cell lymphoma. About 46 % of ALCL patients bear a chromosomal translocation that fuses the nucleophosmin (NPM) gene to the anaplastic lymphoma kinase (ALK) resulting in constitutive ALK activation. The WHO classification of ALK+ and ALK– ALCL as two different disease entities is based mainly on the different clinical course i.e. worse prognosis of ALK patients. However, the genetic reasons for this difference remain unclear. Comprehensive miRNA profiling in ALK+ and ALK– ALCL cell lines, a murine ALCL model and primary tumour tissue revealed deregulation of a specific set of miRNAs comprising miR-20b, miR-22, miR-29a,b,c, miR101, miR-125b and miR-150. miRNAs are small RNA molecules (18–22 nt) that have been demonstrated to influence

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processes such as apoptosis, cell proliferation and senescence. Moreover, 6 miRNAs were identified (miR-17, miR-20a, miR20b, miR-93 and miR-106, miR-886-3p) that could discriminate ALK+ from ALK– ALCL. Interestingly, 5/6 miRNAs belong to the oncogenic myc regulated miR17-92 cluster. Over-expression of the severely down-regulated miR-101 resulted in reduced proliferation in 2 ALK+ ALCL cell lines. One of the validated targets of miR-101 is the mTOR protein. Hence, mice engrafted with murine NPM-ALK cell lines were treated with the mTOR inhibitor CCI-779 causing severely reduced tumour growth. These results stress the importance of the mTOR and myc pathway in ALK+ ALCL, and identify a miRNA signature that is able to differentiate ALK+ from ALK– ALCL. Most importantly, the deregulated miRNAs will help to identify novel therapeutic avenues for this disease.

A14 Expression of hepatocyte growth factor (HGF) in leukemic cells in CML: cellular distribution and role of the BCR/ABL oncogene S. Cerny-Reiterer1, K. J. Aichberger1, H. Herrmann2, L. Müllauer3, M. Mayerhofer4, C. Sillaber1, P. Valent1,2 1Division

of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 2Ludwig Boltzmann Cluster Oncology, Vienna, Austria 3Institute of Pathology, Medical University of Vienna, Vienna, Austria 4Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria

Chronic myeloid leukemia (CML) is a myeloproliferative disease in which BCR/ABL leads to enhanced survival of leukemic cells. Several different angiogenic molecules including VEGF have been implicated in the pathogenesis of CML. Hepatocyte growth factor (HGF) is a key mediator of vascularization in normal and neoplastic tissues. In this study, the cellular distribution and mechanism of expression of HGF in CML were examined. As assessed by immunostaining of bone marrow (BM) sections and isolated blood and BM cells, HGF was found to be expressed in a subset of leukemic cells in all patients. HGF mRNA levels were found to vary from patient to patient without a clear correlation to the phase of disease. In consecutive experiments, we were able to show that basophils are the primary source of HGF in CML. In particular, highly enriched sorted CD203c+ CML basophils were found to express HGF mRNA as well as the HGF protein. HGF was also detectable in the basophil-committed CML cell line KU812, but not in K562 cells or in basophil-depleted primary cell fractions. We next examined whether HGF expression in CML cells depends on BCR/ABL using Ba/F3 cells with doxycycline-inducible expression of BCR/ABL. However, BCR/ ABL failed to induce expression of HGF in Ba/F3 cells. Moreover, imatinib failed to inhibit HGF expression in KU812 cells. Together, our data suggest that HGF is a BCR/ABL-independent basophil-derived mediator in CML. Basophils and basophil-derived mediators may play a more active role in memo Suppl 1/10

Abstracts

disease biology and progression in CML than has been assumed so far.

A15 CD34+/CD38- CML progenitor cells express Siglec-3/CD33 and are responsive to the CD33 – targeting drug Mylotarg® H. Herrmann1, S. Cerny-Reiterer2, K. Blatt2, S. Herndlhofer2, H. Agis2, W. Rabitsch3, W. Sperr2, C. Sillaber2, V. Peter1,2 1Ludwig

Boltzmann Cluster Oncology, Vienna, Austria of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 3Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 2Division

Siglec-3 (CD33) is an established therapeutic target in acute myeloid leukemia (AML). We and others have shown that CD33 is expressed on AML stem cells. Here, we describe that leukemic stem cells in patients with chronic myeloid leukemia (CML) display high levels of CD33. As assessed by multi-colour flow cytometry, CD34+/CD38–/CD123+ CML cells expressed 5–10 fold higher levels of CD33 compared to normal CD34+/CD38– bone marrow stem cells. In chronic phase (CP) CML, CD33 was expressed homogeneously on most or all CD34+/CD38 stem cells. In patients with accelerated (AP) or myeloid blast phase (BP), CML stem cells also co-expressed CD33, but the levels of CD33 varied from donor to donor, and in one patient, most CML stem cells appeared to be CD33-negative. In two CML patients, CD34+/CD38 cells were sorted to homogeneity (>98%) and found to contain CD33 mRNA in qPCR analysis. As assessed by 3H-thymidine uptake, GO produced growth inhibition in leukemic cells in all patients tested (CP, n = 7; AP, n = 2). The effects of GO on leukemic cell growth were dose-dependent with IC50 values ranging between 1 and 50 ng/ml. In one patient with imatinib-resistant CML in BP, we were also able to determine the effects of GO on survival of leukemic stem cells. As assessed by Annexin-V-staining, GO induced apoptosis in CD34+/ CD38 CML stem cells. In conclusion, CD33 is expressed abundantly on CD34+/CD38 stem cells in CML. Whether GO can be employed to eradicate residual leukemic stem cells in CML CP patients remains at present unknown.

A16 The Aurora-kinase inhibitor AS703569 produces growth inhibition and apoptosis in CML cells bearing wt BCR/ABL or various imatinib-resistant BCR/ABL mutants K. Gleixner1, H. Herrmann2, B. Peter1,3, K. Blatt1, K. Schuch4, W. F. Pickl Winfried4, S. M. Sarno5, C. Sillaber1, P. Valent1,2 memo Suppl 1/10

1Division

of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 2Ludwig Boltzmann Cluster Oncology, Vienna, Vienna, Austria 3Department of Small Animals and Horses, Clinic for Internal Medicine and Infectious Diseases, University of Veterinary Medicine Vienna, Vienna, Austria 4Institute of Immunology, Medical University of Vienna, Vienna, Austria 5Translational Oncology, EMD Serono Research Institute Inc., Rockland, MA, USA

Imatinib resistance is a major clinical problem and challenge in chronic myeloid leukemia (CML). In most patients, drug-resistant mutants of BCR/ABL are detectable. Although several of these mutants still are responsive to second generation BCR/ABL-kinase inhibitors such as nilotinib or dasatinib, drug responses are often short-lived. In addition, the BCR/ABL mutant T315I confers resistance against all conventional BCR/ABL-inhibitors including nilotinib and dasatinib. More recent data suggest that several Aurora kinase inhibitors (AuK) block BCR/ABL T315I. We examined the growth-inhibitory effects of the AuK AS703569 (Merck-Serono, Darmstadt, Germany) on CML cells. As assessed by 3H-thymidine-uptake, AS703569 was found to inhibit the proliferation of imatinib-sensitive and imatinib-resistant K562 cells, primary CML cells in all donors tested (n = 4) as well as Ba/F3 cells harbouring various imatinib-resistant mutants of BCR/ABL (E255K, Y253F, H396P and T315I). The effects of AS703569 on BCR/ABL-transformed cells were dose-dependent with IC50 values ranging 10–100 nM in K562 cells, 10–1000 nM in primary CML cells, and 1–100 nM in Ba/ F3 cells exhibiting BCR/ABL mutants. Growth-inhibitory effects of AS703569 on CML cells were accompanied by signs of DNA-endoreduplication and apoptosis suggesting the involvement of multiple mechanisms and drug actions. To confirm drug effects on BCR/ABL, Western blot experiments using anti-pCrkL were performed and revealed that AS703569 blocks BCR/ABL activity at 1 μM in both K562 cells and Ba/F3 cells harbouring BCR/ABL T315I. In addition, AS703569 was found to block Aurora kinase A phosphorylation in K562 cells. In summary, our data show that the novel AuK AS703569 produces growth inhibition and apoptosis in BCR/ABL-transformed cells including those harbouring imatinib-resistant BCR/ABL mutants. Whether AS703569 also produces antiCML effects in patients with advanced CML remains at present unknown.

A17 Identification of Polo-like kinase-1 (Plk-1) as a novel molecular target in neoplastic mast cells in advanced systemic mastocytosis B. Peter1,2, K. V. Gleixner1, S. Cerny-Reiterer1, H. Herrmann1,3, E. Hadzijusufovic1,2, V. Ferenc1, V. Winter1, K. Schuch3, M. Willmann2, W. F. Pickl3, P. Valent1,4

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1Division

of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 2Department of Companion Animals and Horses, Clinic for Internal Medicine and Infectious Diseases, University of Veterinary Medicine Vienna, Vienna, Austria, 3Institute of Immunology, Medical University of Vienna, Vienna, Austria 4Ludwig Boltzmann Cluster Oncology, Vienna, Austria

Systemic mastocytosis (SM) is a myeloid neoplasm characterized by abnormal accumulation of mast cells (MC) in internal organs. In most patients, the D816V-mutated variant of KIT is detectable. In aggressive SM (ASM) or mast cell leukemia (MCL) the response to conventional drugs is poor and the prognosis is grave. Therefore current research is attempting to identify novel drug targets in neoplastic MC. Polo-like kinase 1 (Plk-1) is a serine/threonine kinase that plays an essential role in mitosis and has recently been introduced as a new target in myeloid leukemias. We analyzed the expression and function of Plk-1 in neoplastic MC. As assessed by immunostaining, primary neoplastic MC were found to display phosphorylated Plk-1 (pPlk-1) in all patients. Moreover, the MCL line HMC-1 was found to exhibit Plk-1 mRNA as well as pPlk-1. Targeting of Plk-1 in HMC-1 cells by siRNA resulted in apoptosis. Correspondingly, as assessed by 3H-thymidine uptake, the Plk-1targeting drug BI 2536 was found to inhibit proliferation in HMC-1 cells (IC50 5–10 nM) and in the canine mastocytoma cell line C2 (IC50 10–50 nM). The effect of BI 2536 was seen in HMC-1.1 cells harbouring KIT G560V and in HMC-1.2 cells exhibiting KIT G560V as well as KIT D816V. The growth-inhibitory effects of BI 2536 on MC were found to be associated with mitotic arrest and G2-M cell cycle arrest as well as apoptosis. We also found that BI 2536 synergizes with the KIT-targeting drug midostaurin/PKC412 in counteracting growth of HMC-1 cells, C2 cells, and primary neoplastic MC. In conclusion, Plk-1 is expressed in neoplastic MC in SM and may represent a new interesting target in advanced SM.

A18 Effects of glucocorticoids on dasatinibmediated enhancement of histamine release in IgE receptor cross-linked basophils H. Herrmann1,2, K. Blatt1, K. Marth3, V. Winter1, R. Valenta3, P. Valent1,2 1Division

of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria, 2Ludwig Boltzmann Cluster Oncology, Vienna, Austria, 3Division of Immunopathology, Center of Physiology and Pathophysiology, Medical University of Vienna, Vienna, Austria

Dasatinib is a novel multi-kinase inhibitor that blocks several tyrosine kinases including BCR/ABL. Apart from its well-known anti-leukemic activity, the drug produces several side effects including pleural effusion. We have recently

8

shown that low doses of dasatinib (< 20.1 μM) promote IgE-dependent secretion of histamine in blood basophils, especially in allergic individuals, whereas at 1 μM, dasatinib blocks IgE-mediated histamine secretion. In the current study, we evaluated the effects of dexamethasone, prednisolone, and hydrocortisone on IgE-dependent histamine release in basophils exposed to low doses of dasatinib. Normal basophils (n = 5) or basophils derived from allergic donors sensitized against Bet v 1 and/or Phl p 5 (n = 5) were preincubated with glucocorticosteroids for 24 hours and then exposed to anti-IgE (0.001–10 μg/ml) or allergen (Bet v 1 or Phl p 5; dose range: 0.0001–1 μg/ml) with or without low-dose dasatinib (0.025 μM). Then, basophils were examined for histamine release and/or expression of CD63 and CD203c by flow cytometry. All three glucocorticosteroids were found to counteract histamine release provoked by anti-IgE or allergen in the presence or absence of low-dose dasatinib in non-allergic or allergic individuals. Even in patients with maximum histamine release, the glucocorticosteroids were found to counteract dasatinib-induced enhancement of histamine release. The inhibitory effects of the glucocorticosteroids on histamine release were dose-dependent. In addition, all three glucocorticoids were found to decrease anti-IgEinduced upregulation of CD63 and CD203c in the presence or absence of low-dose dasatinib. Glucocorticosteroids may be an effective therapy to counteract co-inflammatory effects of low-dose dasatinib in IgE-receptor cross-linked basophils.

A19 Effects of 5-azacytidine and 5-aza2′deoxycytidine/decitabine on growth and survival in neoplastic mast cells V. Winter1, H. Herrmann1,2, E. Hadzijusufovic1,4, K. Blatt1, B. Peter1,3, K. Schuch3, S. Cerny-Reiterer1, I. Mirkina2, H. Karlic2,5, W. Pickl3, P. Valent1,2 1Division

of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 2Ludwig Boltzmann Cluster Oncology, Vienna, Austria 3Institute of Immunology, Medical University of Vienna, Vienna, Austria 4Department of Companion Animals and Horses, Clinic for Internal Medicine and Infectious Diseases, University of Veterinary Medicine Vienna, Vienna, Austria 5Hanusch Hospital, Vienna, Austria

Aggressive systemic mastocytosis (ASM) and mast cell leukemia (MCL) are advanced bone marrow neoplasms with a poor prognosis. In these patients, neoplastic mast cells (MC) usually are resistant against anti-cancer drugs. Demethylating agents reportedly exert beneficial effects in a group of patients with myelodysplastic syndromes. We examined the effects of two demethylating agents, 5-azacytidine and 5-aza2′deoxycytidine (decitabine) on the growth and survival (apoptosis) of neoplastic MC and the human MC line HMC-1. Two HMC-1 subclones were used, HMC-1.1 lacking KIT D816V and HMC-1.2 exhibiting KIT D816V. Both demethylatmemo Suppl 1/10

Abstracts

ing agents induced apoptosis in HMC-1.1 and HMC-1.2 cells in a dose-dependent manner (ED50: 10–20 μM). In normal cultured MC and normal bone marrow cells, no substantial effects of 5-azacytidine or decitabine were observed. Druginduced apoptosis in HMC-1 cells was accompanied by increased expression of FAS/CD95 and decreased expression of KIT/CD117. Unexpectedly, as assessed by 3H-thymidine uptake, only decitabine inhibited the proliferation of HMC-1 cells at pharmacological drug-concentrations (IC50: 1–5 μM), whereas no effect was seen with 5-azacytidine (>20 μM). Moreover, only decitabine, but not 5-azacytidine, was found to induce a G2/M arrest in neoplastic MC. We were also able to confirm growth-inhibitory effects of decitabine on primary neoplastic cells obtained from a patient with KIT D816V+ SM associated with CMML. Together, our data show that 5-azacytidine and decitabine exert differential effects on growth and apoptosis in neoplastic MC. Whether epigenetic drugs produce anti-neoplastic effects in vivo in patients with ASM/ MCL remains to be determined in clinical trials. P01 see p. 10.

P02 First results from the Austrian project analyzing retrospectively “real-world” treatments of patients with myelodysplastic syndromes (REALM) G. Aschauer1, R. Greil2, W. Linkesch3, M. Pfeilstöcker4, R. Stauder5, J. Thaler6, M. Fiegl7, M. Fridrik8, M. Girschikofsky9, F. Keil10, A. L. Petzer1 1Department

of Internal Medicine I, Hematology and Medical Oncology, Hospital Barmherzige Schwestern Linz, Linz, Austria 2Laboratory of Immunological and Molecular Cancer Research, IIIrd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology of the Paracelsus Medical University, Salzburg, Austria 3Division of Hematology and Stem Cell Transplantation, Deaprtment of Internal Medicine, Medical University of Graz, Graz, Austria 4Third Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria 5Department of Internal Medicine V (Hematology and Oncology), Center of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria 6Department of Internal Medicine IV, Kreuzschwestern Clinic, Wels, Austria 7Department of Internal Oncology, Hospital Natter, Austria 8Department of Hematology and Oncology, General Hospital Linz, Austria 9Medical Department I (Center for Hematology, Hemostaseology, Medical Oncology), Hospital Elisabethinen, Linz, Austria 10Department of Hematology and Oncology, Hospital Leoben, Austria

Several studies have demonstrated that lenalidomide is effective in patients with myelodysplastic syndromes (MDS), especially in patients harbouring a deletion 5q. This has led to memo Suppl 1/10

an approval of lenalidomide for patients with MDS in the United States of America but not in Europe. Nevertheless, based on the impressive results of lenalidomide in various studies, it is already used by many haematologists in Europe including Austria. We have analyzed our disease registry concerning the use of this new drug in “real-world” treatment option setting. In this retrospective analysis, 50 patients were identified in 18 different Austrian hospitals. This represents approximately 45% of all MDS patients treated with lenalidomide in the observation period in Austria. Out of these 50 patients, 33 were females and 17 males. The median age of this cohort was 74 years (range: 42–88 years). In total, 23 patients had a 5q-syndrome, 5 patients had MDS with isolated 5q deletion with >5% blasts in the bone marrow including 1 patient with AML, 6 patients had MDS with deletion 5q- and additional cytogenetic aberrations, 16 patients had other MDS entities according to the WHO classification. In median this cohort received 4.5 cycles of lenalidomide. In contrast, patients with a 5q-syndrome received a median of 10 cycles. Prescribed daily doses of lenalidomide for 21 days in a 4 weeks cycle were: 10 mg (27 patients), 5 mg (20 patients), 2.5 mg (1 patient), 15 mg (1 patient) and 20 mg (1 patient). Dose interruptions due to possibly treatment-related adverse events (in the majority of cases cytopenias) were necessarily performed in only 15 patients. Out of the 46 patients that were evaluable according to the IPSS, 16 patients were at low, 8 patients intermediate – 1, 16 patients intermediate – 2 and 3 patients at high risk. The ECOG performance status was “0” in 30%, “1” in 43%, “2” in 21% and “3” in 6% of the patients. In total 36 patients were evaluable regarding transfusion independence. In this respect, 64% of patients responded to lenalidomide. A comparable amount responded in the 5q-syndrome group (66%). Patients with MDS with isolated 5q deletion as single aberration showed a response rate in 80% (4 out of 5 patients). More detailed data will be presented at the meeting.

P03 Bendamustin – eine neue Therapieoption beim relapsierten/refraktären Myelom S. Machherndl-Spandl, M. Binder, A. Weltermann, H. Kasparu Krankenhaus der Elisabethinen, Linz, Austria

Grundlagen: Neue Substanzen haben die Prognose des Multiplen Myeloms verbessert. Dazu gehört auch das HybridAlkylans Bendamustin in Kombination mit Kortikoid beim Multiplen Myelom in der Erstlinientherapie. Erfahrungen zur Therapie mit Bendamustin beim relapsierten/refraktären Patienten sind kaum vorhanden. Methodik: Wir haben bei 15 Patienten (10 w/5 m) retrospektiv die Effektivität und Sicherheit von Bendamustin untersucht. Sie wurden zwischen Jänner 2008 und April 2009 bei Rezidiv bzw. Progression der Erkrankung mit Bendamustin 90 mg/m2 Tag 1+2 in Kombination mit Kortikoid behandelt. Im Median lag das Alter bei 65 (49–78) Jahre, die Erkrankungsdauer bei 56 (11–117) Monate und die Anzahl der Vortherapien bei 4 (2–9); 11 Patienten hatten zuvor eine autologe und 1

9

Abstracts

Patient eine allogene Stammzelltransplantation erhalten. Bei Behandlungsbeginn wiesen 6 Patienten eine hämatopoietische Insuffizienz auf. Ergebnisse: Insgesamt wurden bei 15 Patienten 73 (1–14) Zyklen verabreicht. Neun Patienten (60%) zeigten eine Reduktion des Paraproteins, bei 4/9 Patienten war diese mehr als 50% vom Ausgangswert. Drei Patienten (20%) erreichten eine Stabilisierung der Erkrankung, zwei Patienten (13%) waren therapierefraktär und bei einem Patienten wurde die Therapie vorzeitig wegen inakzeptabler Toxizität (Diarrhoe Grad 3) nach einem Zyklus abgebrochen. Das maximale Ansprechen wurde im Median nach 3 (2–7) Zyklen erreicht. Die mediane Zeit bis zum Therapieversagen betrug 6 (3–17) Monate. Hauptnebenwirkung waren schwere Infektionen, bedingt durch die Hämatotoxizität: 4 von 5 Patienten verstarben im Zuge einer Sepsis oder Pneumonie. Nicht hämatologische Nebenwirkungen waren selten (1× Diarrhoe Grad 3, 1× Hypertonie Grad 2, 1× N. mammae). Eine vorbestehende Polyneuropathie wurde nicht verschlechtert. Schlussfolgerungen: Auch für mehrfach vorbehandelte Patienten scheint Bendamustin in Kombination mit Kortikoid eine gute Therapieoption darzustellen. Hauptnebenwirkung sind schwere Infektionen. Prospektiv randomisierte Studien vor allem in Kombination mit anderen Substanzen sind erforderlich.

Results: sFLCa showed a significant advantage in detecting endpoints. By using PPM, 40% of events would have been missed. A median of 13% of the applied therapies proven to be ineffective could have been stopped or altered earlier on. While the use of sFLCi and sFLCD resulted in comparable rates of false positive and negative results in comparison to PPM, sFLCQ is more sensitive to confounding effects. sFLCA detected relapses with a median of 3 months prior to PPM, therapeutic effectiveness with a median of 2 therapy cycles earlier than PPM and therapeutic failure 1 cycle earlier. Conclusions: sFLCa (sFLCi and sFLCD) is an advantageous tool for monitoring myeloma and therapeutic effectiveness.

P04 Register für seltene myeloische und myelodysplastisch/myeloproliferative Erkrankungen – erste Auswertung eigener Daten S. Burgstaller1, D. Zauner2, M. Pötscher2, B. Mayrbäurl1, T. Kühr1, J. Thaler1 1IV.

Interne Abteilung, Klinikum Wels, Wels, Österreich Trial Unit Wels, Wels, Österreich

2Clinical

Haematologic Malignancy P01 Serum free light chain analysis (sFLCa) compared to conventional paraprotein measurements: Usefulness for clinical decision-making E. Willenbacher, S. Gasser, G. Gastl, W. Willenbacher Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria

Background: sFLCA is a tool to monitor myeloma. Either the ratio (FLCQ), the absolute value of the involved one (FLCi) or the difference of involved and uninvolved one (FLCD) is used. To analyze whether results from sFLCA would potentially have been translated into altered clinical decision-making compared to classical paraprotein measurements (PPM), we analyzed all measurements between MAR 03 and OKT 08. Methods: Clinical endpoints were antecedent diagnosis of relapse or remission, as well as therapeutic failure or effectiveness. Furthermore, false positive and negative results as well as time differences between different tests reactivity were analyzed. Patients, assays and treatment lines: 187 out of 235 patients were eligible. 3202 sFLCA and 2583 PPM were performed (range 2–89, median 12) and correlated to 167 treatment lines.

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Myeloische Erkrankungen mit PDGFRA–, PDGFRB– und FGFR1-Rearrangements sowie die Gruppe der myelodysplastisch/myeloproliferativen Neoplasien (CMML, aCML) sind sehr selten. Über den Verlauf sowie die Therapie dieser Erkrankungen sind nur wenige aktuelle Daten in der Literatur verfügbar. Ziel dieser retrospektiven/prospektiven Erhebung ist, die Häufigkeit, den Verlauf und die eingesetzten Therapien auf nationaler Ebene zu erfassen. Diese Auswertung beinhaltet vorerst die an der eigenen Abteilung seit 2000 diagnostizierten Erkrankungen. Geplant ist eine Ausweitung der Datenerfassung auf die größten Zentren in ganz Österreich. Seit 2000 sind an unserer Abteilung insgesamt 17 Patienten mit seltenen myeloischen und myelodysplastisch/myeloproliferativen Erkrankungen erfasst. Bei 8 dieser Patienten wurde eine chronisch myelomonozytäre Leukämie diagnostiziert, bei 4 wurde die Erkrankung als MDS/MPN unklassifizierbar und bei 3 als atypische BCR-ABL negative CML klassifiziert. Das mediane Alter der Patienten betrug 77 Jahre. Eine zytogenetische Untersuchung wurde bei 16 Patienten durchgeführt, wobei sich bei 14 Patienten ein normaler Karyotyp zeigte. Bei einem Patienten wurde eine del5q31 sowie eine Monosomie 7 nachgewiesen, bei einem weiteren Patienten zeigte sich eine t(5;15) (q33;q22), wobei auf molekularbiologischer Ebene das BP53PDGFRB Fusionsgen erstmalig nachgewiesen werden konnte. Bei einem Patienten mit einer CMML konnte eine JAK2 V617F Mutation nachgewiesen werden. Therapeutisch wurde bei 9 von 17 Patienten Hydroxyurea, low dose Ara-C, 5-Azazcitidine, Lenalidomid, Interferon alpha, Busulfan, Mercaptopurin, Imatinib sowie bei einem Patienten eine allogene Stammzelltransplantation eingesetzt, 8 Patienten erhielten keine Therapie. Überlebenskurven wurden mit Hilfe der Kaplan– Meier Methode erstellt und zeigten für die beschriebene Patientenpopulation ein medianes Überleben von 75,5 Wochen, welches mit den Angaben in der Literatur korreliert. memo Suppl 1/10

Abstracts

P05 First annual report of the Austrian CML registry St. Schmidt1, D. Wolf1, J. Thaler2, S. Burgstaller2, W. Linkesch3, A. Petzer4, M. A. Fridrik5, A. Lang 6, H. Agis7, P. Valent7, O. Krieger8, A. Walder9, P. Korger10, E. Schlögl10, on behalf of further ASHO-CML 1Department

of Internal Medicine V (Hematology and Oncology), Center of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria 2Klinikum Wels – Grieskirchen, Wels, Austria 3Division of Hematology, Medical University of Graz, Austria 4Hospital Barmherzige Schwestern, Linz, Austria 5General Hospital Linz, Linz, Austria 6Hospital Feldkirch, Feldkirch, Austria 7Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria 8Hospital Elisabethinen, Linz, Austria 9Hospital Lienz, Lienz, Austria 10Hospital Barmherzigen Brüder, Eisenstadt, Austria

The Austrian Chronic Myeloid Leukemia (CML) registry monitors individual disease courses, treatments applied, clinical outcome and side effects of CML patients on a nationwide basis to provide data on the “real-life” situation and to complement the information and interpretation gained from the selected patient population observed in clinical trials. This report summarizes the Austrian CML registry data as of March 2009. A total of 179 patients have been registered with a median number of 1012 follow-up visits and median observation duration of 20 months. At diagnosis most patients (n = 151) were in chronic phase (early, late, and secondary), whereas only 4 were in advanced phase. A total of 137 patients were treated with tyrosine kinase inhibitors (TKIs), of which 14 received first and second generation TKIs sequentially. Other treatment modalities included chemotherapy or interferon and stem cell transplantation (SCT). Cumulative incidence rates for complete haematological responses (CHR) were 91.6% and 94.4% at 12 and 24 months, respectively, compared to cumulative incidence rates of complete cytogenetical response rates of 64% and 80% at these time points. A total of 5 patients progressed from chronic phase to accelerated (n = 4) and blastic phase (n = 2) while receiving imatinib standard dose. Estimated overall survival (OS) rate at 60 months was 90% and progression free survival (PFS) according to European Leukaemia Net (ELN) failure definition was 58%.

P06

1Division

of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 2Department for Companion Animals and Horses, Clinic for Internal Medicine and Infectious Diseases, University of Veterinary Medicine Vienna, Austria 3Ludwig Boltzmann Cluster Oncology, Vienna, Austria 4Institute of Immunology, Medical University of Vienna, Vienna, Austria 5Comparative Medicine and Integrative Biology Program, Michigan State University, East Lansing, MI, USA

Advanced mast cell (MC) disorders are characterized by uncontrolled growth of neoplastic MC in various organs, resistance against cytoreductive drugs, and a poor prognosis. In most patients, transforming mutations in the KIT protooncogene are detectable and are considered to contribute to resistance. MC lines are an important model for analyzing drug resistance. We have established a novel canine mastocytoma cell line, NI-1 from a canine patient suffering from mast cell leukemia. NI-1 cells were found to harbour several homozygous KIT mutations including two missense mutations at nucleotides 107 (C to T) and 1187 (A to G), a 12 bp duplication at nucleotide 1263, and a 12 bp deletion at nucleotide 1550. Drug response profiling revealed that NI-1 cells differ markedly from canine mastocytoma C2 cells harbouring an exon 11 KIT mutation, and the human mast cell lines HMC1.1 (exon 11 mutation in KIT) and HMC-1.2 (exon 11 and exon 17 mutation). In contrast to C2 cells, NI-1 cells were found to be largely resistant against the apoptosis-inducing effects of masatinib, sorafenib, and sunitinib. Similarly, in contrast to HMC-1.1 cells, HMC-1.2 cells were found to be largely resistant against masatinib, sorafenib, and sunitinib. Drug resistance was specific for KIT tyrosine kinase blockers in that vorinostat, an HDAC inhibitor, produced growth-inhibitory and apoptosis-inducing effects with comparable IC50 and ED50 values in all MC lines tested. Together, these data provide further evidence that KIT mutations are associated with resistance to KIT-targeting drugs. The novel MC line NI-1 may serve as a valuable tool to investigate the mechanisms of drug resistance in canine mast cell tumours and the role of novel KIT mutations.

P07 The role of the VLA-4 integrin in adhesion and survival of chronic lymphocytic leukaemia (CLL) cells K. Sahakyan1, S. Hofbauer1, G. Brachtl1, T. Girbl1, R. Henschler2, R. Greil1, T. Hartmann1 1Laboratory

KIT mutations predict resistance to sorafenib, sunitinib, and masatinib in neoplastic human and canine mast cells E. Hadzijusufovic1,2, B. Peter1,2, H. Herrmann1,3, K. Schuch4, T. Thaiwong5, V. Yuzbasiyan-Gurkan5, W. Pickl4, M. Willmann2, P. Valent1,3 memo Suppl 1/10

for Immunological and Molecular Cancer Research, 3rd Medical Department for Hematology, Oncology, Hemostaseology, Infectious Diseases and Rheumatology, University Hospital Salzburg, Salzburg, Austria 2Institut für Transfusionsmedizin und Immunhämatology Institute of Transfusion Medicine and Immune Hematology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany

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Abstracts

Abnormalities in cell adhesion molecules like integrins may account for the patterns of intranodal growth, survival, and chemoresistance of malignant cells. The survival of chronic lymphocytic leukemia (CLL) cells depends on their microenvironmental interactions with accessory cells. Cell adhesion via beta1 integrins has been described to mediate drug resistance in several malignant entities and the beta1 integrin VLA-4 was suggested as a novel prognostic marker in CLL. Here, we investigated the role and downstream signalling of VLA-4 mediated adhesion for CLL cell survival. First, we cultured CLL cells in the presence of bone marrow derived stromal cells and observed a coculture-mediated survival benefit, which was dependent on direct cell-cell contact rather than soluble factors and able to compensate fludarabineinduced apoptosis in a VLA-4 dependent manner. VLA-4 positive CLL cells displayed a higher adhesiveness to stroma than VLA-4 negative cells. Further investigating involved beta1 integrin ligands, we found that adherence to VCAM-1 coated on plastic was sufficient to reduce spontaneous in vitro apoptosis of CLL cells. VLA-4 dependent adherence was also observed using retronectin but not fibronectin. Finally, to determine what kind of downstream signal pathways are involved in VLA-4 mediated adhesion, we tested the impact of RhoA kinase inhibitor on adherence and survival of CLL cells. In summary, our data suggest that adhesive interactions via VLA-4 not only result in CLL localization within supportive microenvironmental niches and thus ultimately in the development of chemoresistance but also confer additional direct survival benefits via VLA-4 engagement by the respective ligands.

P08 Chemokine-induced, CD44-dependent interactions of activated CLL cells with hyaluronic acid T. Girbl, T. N. Hartmann, R. Greil Laboratory for Immunological and Molecular Cancer Research, 3rd Medical Department for Hematology, Oncology, Hemostaseology, Infectious Diseases and Rheumatology, University Hospital Salzburg, Salzburg, Austria

Emerging evidence suggests that microenvironmental niches support the survival and proliferation of chronic lymphocytic leukaemia (CLL) cells. Activation of CLL cells by CD4+ CD40L+ T lymphocytes within proliferative centres might hereby support the outgrowth of the malignant clone. The adhesion receptor CD44 is participating in lymphocyte cell activation and mediates migration and tissue retention in many cell types via interaction with the extracellular matrix component hyaluronic acid (HA). As CD44 was reported to predict a poor clinical outcome in CLL, we were interested to dissect the function of the CD44-HA interplay in CLL extravasation and motility by a combination of cytometrical and videomicroscopical adhesion assays. We found that unstimulated CLL cells were neither able to bind soluble HA nor to specifically adhere to immobilized HA, yet, when activated by

12

coculture with a CD40L-transfected fibroblast system, they gained HA-binding capacity in a CD44-dependent manner. Activation of the CLL cells by PMA/ionomycin or BCR crosslinking with anti-IgM antibodies also induced this capacity. Although chemokine-hyaluronic acid mediated interactions were not sufficient to induce rapid tethering of CLL cells under shear flow conditions, the chemokines CXCL12 and CCL21 induced random motility of CLL cells on HA substrates as assessed by time-lapse videomicroscopy. Our data suggest a role of CD44 interactions in the CLL crosstalk with molecular and cellular factors within activating and proliferation-inducing niches.

P09 Antileukemia and antilymphoma activity of Schiff base transition metal complexes A. Hille1, T. Wolf2, P. Schumacher2, I. Ott1, R. Gust1, B. Kircher2 1Institute

of Pharmacy, Freie Universität Berlin, Berlin, Germany 2Department of Internal Medicine V (Hematology and Oncology), Center of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria

Schiff base transition metal complexes exert various biological effects including antifungal, antibacterial and even anti-tumoural activities. Therefore, they are becoming more and more attractive lead structures for the design of cytostatics with a mode of action that differs from that of the frequently administered anticancer agent cisplatin and its second-generation derivatives, which still induce non-tolerable side effects and resistance. Data on antileukemic effects of Schiff base transition metal complexes, however, are limited. The activity of salene (compound 1; N,N´-bis(salicylidene)1,2-phenylenediamine), its iron(II/III) and manganese(II/ III) complexes as well as saldach (compound 2; rac-transN,N´-bis(salicylidene)-1,2-cyclohexanediamine) and its respective iron (II/III) complexes was evaluated against U-937 non-Hodgkin’s lymphoma and the HL-60, SUP-B15 and K-562 leukemia cell lines. The free ligands (complexes 1 and 2) induced in all cell lines, if at all, only marginal, concentrationdependent antiproliferative effects, and did not trigger Cu/Zn SOD release or induce apoptosis. The Schiff base transition metal complexes [FeII(salophene)] and [FeIII(salophene)Cl] blocked cellular proliferation, caused a strong release of Cu/ Zn superoxide dismutase (Cu/Zn SOD) and induced apoptosis. In contrast, the manganese analogues [MnII(salophene)] and [MnIII(salophene)OAc] inhibited cell growth, caused the programmed cell death only at higher concentrations and did not provoke release of Cu/Zn SOD in any of the four cell lines. Weaker cell death-promoting effects were observed when the salophene moiety of [FeII(salophene)] and [FeIII(salophene) Cl] was replaced with saldach, indicating the influence exerted by the ligand structure. In conclusion, Schiff base transition metal complexes induce strong inhibitory effects on human leukemia and lymphoma cells. memo Suppl 1/10

Abstracts

P10 Enzastaurin kills human CLL cells regardless of clinical risk profile, but fails to prolong life in a murine CLL model T. Kocher, J. Pinon, C. Holler, U. Denk, R. Greil, A. Egle Laboratory for Immunological and Molecular Cancer Research (LIMCR), 3rd Medical Department, State Hospital Salzburg and Paracelsus Medical Private University, Salzburg, Austria

The clinical course of B-cell chronic lymphocytic leukaemia (CLL) varies widely among patients depending on several factors that in part relate to the signalling capacity of the B-cell receptor (BCR). This highlights the BCR and components of the BCR signalling machinery as key molecules in CLL pathogenesis, as well as important therapeutic targets. We have recently demonstrated that PKCbeta, a modulator of BCR signal strength, is essential for the development of BCLL. Targeted deletion of PKCbeta in TCL1a transgenic mice completely abolished CLL development. Importantly, loss of even one allele of PKCbeta significantly delayed CLL onset, implying that inhibition of PKCbeta using chemotherapeutic compounds, could translate into a survival benefit in patients. We have used the murine model as well as primary patientderived CLL cells to investigate the efficacy of the PKCbetaselective inhibitor LY317615. HCl (Enzastaurin) in the treatment of CLL. Treatment of patient PBMCs with Enzastaurin led to an induction of Bmf, Noxa, and p21, and a decrease in Mcl-1, resulting in a significantly reduced viability of the B-CLL cells. Moreover, the sensitivity of the B-CLL cells to Enzastaurin was similar in all patient samples tested, regardless of their B-CLL risk group or whether they were co-cultured under protective microenvironmental conditions. However, Enzastaurin treatment of C57BL/6 mice engrafted with tumour cells derived from a TCL1a tg mouse did not lead to an increased overall survival compared to untreated controls. The results point to a rationale for combination of Enzastaurin with Bcl-2 modulating therapies, such as ABT-737.

P11 T cell subset dynamics in the TCL1a transgenic murine model for human B-CLL J. D. Pinon, C. Heyder, T. Kocher, C. Holler, U. Denk, D. Trapin, I. Tinhofer, R. Greil, A. Egle Laboratory for Immunological and Molecular Cancer Research (LIMCR), 3rd Medical Department, State Hospital Salzburg and Paracelsus Medical Private University, Salzburg, Austria

Numerous T cell dysfunctions have been described in B cell chronic lymphocytic leukaemia (CLL) that are believed to contribute to tumour clone maintenance. Among these is the memo Suppl 1/10

difference in the relative distribution of naive and memory T cell subsets within the peripheral blood of patients with mutated and unmutated IgVH genes. We have recently demonstrated that unmutated CLL cases had a significant increase in relative numbers of central and effector memory CD4+ T cells as compared to mutated cases. We now demonstrate that these changes are also modelled in the TCL1a transgenic (tg) mouse model of this disease. Leukaemic TCL1a tg mice have increased absolute numbers of T cells, owing to an expanded CD8+ population. We also observed an increase in the relative numbers of memory and effector T cells predominantly in the CD8+ subset. The shift to more differentiated T cells parallels the incidence of CD19/CD5 hyperplasia in the TCL1a tg mice. Furthermore, transplantation of tumour cells into congenic recipients could direct similar changes in T cell subset distribution in recipient mice. Because memory and effector T cells represent antigen-experienced cells, we used CDR3 spectratyping to determine the degree of clonality of the various T cell families and found more oligo- and monoclonal T cells in the infiltrated organs of leukaemic mice. Our results demonstrate a crosstalk between CLL-like cells and the microenvironment T cells in this murine model that demonstrate the utility of this model for the study of immune dysfunction in CLL.

P12 IDH1 and IDH2 mutations in patients with therapy-related and secondary AML evolving from myelodysplasia M. Pichler, C. Bodner, K. Hiden, W. Linkesch, H. Sill, A. Wölfler 1Division

of Hematology and Stem Cell Transplantation, Department of Internal Medicine, Medical University of Graz, Graz, Austria

Acute myeloid leukemia (AML) is an aggressive malignancy arising from haematopoietic progenitor cells and often characterized by distinct chromosomal and genetic aberrations. However, in a significant fraction of patients the underlying genetic events are not known. The availability of whole genome sequencing technologies recently led to the identification of a mutation in the isocitrate dehydrogenase gene 1 (IDH1), which results in the replacement of a critical arginine (R) on position 132 and is present in about 5–8% of patients with de novo AML. In addition, this mutation or a corresponding mutation in its homologue IDH2 was found in 5 out of 16 patients (31%) with AML evolving from a chronic myeloproliferative disorder. However, the frequencies of these mutations in patients with other subtypes of AML, such as therapy-related AML (t-AML) or AML evolved from myelodysplastic syndromes (sAML) are not known. By screening 45 patients with t-AML and 18 patients with sAML we found an IDH1 R132C mutation in a patient with t-AML (1/45; 2.2%) and an IDH2 R172K mutation in a patient with acute monoblastic leukemia evolved from chronic myelomonocytic leukemia (1/18; 5.5%). These findings suggest that the frequencies

13

Abstracts

of IDH1/2 mutations in t-AML and AML evolving from myelodysplastic syndromes are comparable to the ones found in de novo AML. An analysis of serial samples of the second patient as well as an expansion of both study populations are currently in progress and extended results will be presented at the meeting.

P13 Dasatinib and nilotinib show synergistic growth-inhibitory effects in CML cells including BCR/ABL T315I-transformed cells K. Gleixner1, K. Schuch2, W. F. Pickl2, C. Sillaber1, P. Valent1,3 1Division

of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria 2Institute of Immunology, Center for Physiology, Pathophysiology and Immunology, Medical University of Vienna, Vienna, Austria 3Ludwig Boltzmann Cluster Oncology, Vienna, Austria

In most patients with chronic myeloid leukemia (CML), complete cytogenetic remission can be achieved with the BCR/ABL tyrosine kinase inhibitor (TKI) imatinib. Unfortunately, however, not all patients are long-term responders. Acquired resistance against imatinib is often caused by BCR/ ABL mutations. In most of these patients, a second generation TKI is prescribed. However, the T315I mutant of BCR/ ABL causes resistance to most TKIs including nilotinib and dasatinib. One approach to overcome drug-resistance in BCR/ABL T315I+ CML may be to apply drug combinations. Recent data suggest that the mechanisms through which dasatinib and nilotinib act on BCR/ABL differ from each other, and that both drugs elicit mild residual activity on most BCR/ ABL mutants including T315I. Moreover, it has been described that both drugs act on multiple additional targets in CML cells. We here show that dasatinib and nilotinib cooperate with each other in producing growth inhibition in BCR/ ABL T315I+ CML cells. Strong cooperative or even synergistic effects were observed in primary T315I+ CML cells in all the 3 patients tested (chronic phase, n = 1; blast phase, n = 2) as well as in Ba/F3 cells exhibiting BCR/ABL T315I. Synergism was demonstrable at pharmacological drug concentrations (< 21 μM) and was also seen in freshly diagnosed CML (wt BCR/ABL) and in all other BCR/ABL mutants tested, suggesting that the drug combination acts suppressive on most, if not all, CML subclones. Synergistic effects of dasatinib and nilotinib may be explained by direct effects on BCR/ABL including residual effects on BCR/ABL T315I, and additional drug targets in CML cells. These in vitro drug combination effects occur at drug concentrations that can be reached in vivo and may thus represent an interesting pharmacological concept in CML.

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Solid Tumours P14 Intrathecal use of liposomal AraC: a retrospective analysis of 37 patients treated between 2006 and 2009 F. Romeder, C. Muß, B. Mlineritsch, R. Greil Laboratory for Immunological and Molecular Cancer Research, 3rd Medical Department for Hematology, Oncology, Hemostaseology, Infectious Diseases and Rheumatology, University Hospital Salzburg, Salzburg, Austria

Background: Involvement of central nervous system in solid tumours is a rare complication, but still goes along with low live expectancy. Patients with cytological or radiological assured carcinomatous or lymphomatous meningeosis receive intrathecal chemotherapeutic agents. In the past years Metotrexate (MTX) got more and more replaced by liposomal cytarabine (LC) as a single use therapy in combination with dexamethasone. It is administered intrathecal (IT) by lumbal puncture every 2 weeks. Clinical trials have shown LC to be safe and non-inferior to MTX concerning to antitumoural effect. Methods: We retrospectively looked at patients in our department, who received intrathecal LC between 2006 and 2009. Results: We identified 37 patients (8 males, 29 females) with a median age of 54 years (range: 22–77). Underlying diagnoses were: Lung cancer (n = 8, 22%), Lymphomas/Leukemia (n = 17, 46%), Breast Cancer (n = 10, 27%) and 2 rare diagnoses (1 ovarian, 1 testicular cancer). Median time to meningeosis was 7.6 months (range: 0–220). There were no significant differences between the several tumour types. Main symptoms were peripheral paresis (n = 13), cephalea (n = 10), central paresis (n = 9) and vertigo (n = 5). Thirty-two of them received LC as first line intrathecal therapy, 5 of them second line after MTX. LC doses were administered totally 167 times, median 4 counts per patient (range: 1–16). Solitary meningeosis was found in 50% of patients, whereas 50 % had additional cerebral and/or medullar manifestations. Cerebral spinal fluid (CSF) was cytologically positive in 32 patients (91.4 %), MRI imaging was positive for meningeosis in 25 pt. (76%). Twenty patients (76%) of 26 who were cytologically evaluable, did respond to LC by spinal fluid diagnosis. In 6 patients (23%, 3 Lung cancer, 2 Breast cancer, 1 Lymphoma) tumour progression was detected despite IT tumour therapy and in 11 patients of 37 (30%) response evaluation by SF was not done. Those 20 patients who did achieve cytological response had a median Time to progression of 5.3 months (range: 2–9.5). In 20 patients (55%) clinical improvement could be reached by IT. As additional treatment 12 patients underwent radiation therapy (WBRT) and IT LC. In none of the cases the treatment had to be discontinued due to significant toxicity. Clinical tolerance was very good with a satisfying handling in an outpatient setting. Conclusions: Our results show, that more than the half of patients had clinical improvement and duration of rememo Suppl 1/10

Abstracts

sponse. Therefore LC should be recommended in therapy of CNS meningeosis. Nevertheless there is a need for prospective controlled trials to analyze the response, toxicity and effect on quality of life of IT-LC vs. conventional IT-therapy.

P15 Quality of Life monitoring in elderly cancer patients A. Zabernigg1, E.-M. Gamper2, J. Giesinger2, G. Kemmler2, K. Gattringer1, B. Holzner2 1Department

of Internal Medicine, Kufstein County Hospital (Teaching Hospital of Innsbruck Medical University), Kufstein, Austria 2Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria

Background: Computerized assessment of Quality of Life (QOL) in elderly cancer patients provides important information on patients’ perceived health states. This information can contribute to medical decision-making and improve symptom management. In addition QOL monitoring can be an essential part of quality assurance with regard to evidencebased medicine in oncology. Methods: Since January 2005 elderly cancer inpatients treated at the Kufstein County Hospital were consecutively included in the QOL monitoring. QOL-assessment (EORTC QLQ-C30) was done using a software tool called CHES (Computer-based Health Evaluation System). Results: A total of 226 cancer patients aged above 65 years were included in the monitoring and assessed 1013 times (51.6% males; mean age 73.3 ± 5.0 years). Main diagnoses were lung cancer (20.9%), haematological malignancies (13.3%) and colorectal cancer (11.6%). On average QOL was assessed 4.48 times per patient, 1013 times in total. The user-friendly software was successfully implemented and tested. The routine QOL assessment was found to be feasible and was well accepted by both physicians and patients. The impact of clinical and sociodemographic variables on QOL in elderly cancer patients was analyzed. Conclusions: The software-generated graphic QOL-profiles were found to be an important tool for screening patients for clinically relevant problems. Computer-based QOL-monitoring contributes to an optimization of treatment (e.g. symptom management and psychosocial interventions) and facilitates data collection for research purposes.

P16

LKH Leoben, Abteilung für Palliativmedizin, Landeskrankenhaus Leoben, Österreich

Im Jahr 2005 wurde am LKH Leoben eine Palliativstation mit 8 Betten in Betrieb genommen, zusätzlich wurde ein Konsiliarteam im Hause sowie eine extramurale Versorgung aufgebaut. Palliativstation: Auf der Palliativstation wurden im Jahr 2008 279 Patienten versorgt. Die durchschnittliche Liegedauer der Patienten betrug 9 Tage und 71% der Patienten konnten wieder nach Hause entlassen werden. Die Lebensqualität der Patienten verbesserte sich signifikant bis zur Entlassung. Der durchschnittlicher Wert des Lebensqualitätsscores nach EORTC QLQ-Pal C15 war bei Aufnahme 3,08 und bei Entlassung mit 4,14 signifikant angestiegen. Konsiliar wurden im Jahr 2008 464 Patienten an anderen Abteilungen durch eine Schwester, einem Sozialarbeiter und einem Arzt, die der Palliativeinheit zugeordnet sind, betreut. Dies entlastet die Palliativstation, da auch an anderen Abteilungen somit insgesamt 460 Palliativpatienten versorgt werden konnten. Mobile extramurale Versorgung: Im Jahr 2008 wurden insgesamt 160 Patienten durch das Mobile Team versorgt. Diese wurden im Jahr insgesamt 1030mal besucht. Die am häufigsten erbrachten Leistungen waren Patientengespräch mit Optimierung oder Verbesserung der Schmerztherapie oder sonstiger supportivtherapeutischer Maßnahmen, gefolgt von Organisation von Hilfsmitteln und Medikamenten vor Ort. Es konnten 308 stationäre Aufnahmen durch das extramurale Team vermieden werden. 50% der geleisteten Stunden wurden durch Hausbesuche aufgewendet, die weiteren 50% durch organisatorische Arbeiten im Hause. Insgesamt entlastet eine Palliativmedizinische Einheit deutlich eine Hämato-Onkologische Abteilung, die sich eher auf die Durchführung von aufwendigen Chemotherapie konzentrieren kann. Weiters verbessert sich signifikante Lebensqualität von palliativen Patienten. Durch ein Konsiliarsystem kann die Palliativversorgung an einem Haus generell deutlich verbessert werden, und eine extramurale Versorgung führt zu einer hohen Patientenzufriedenheit, erspart weitere stationäre Aufnahmen im Zentralkrankenhaus und verbessert auch deutlich die Kommunikation mit den niedergelassenen Ärzten und Zuweisern.

P17 Behandlungsergebnisse nach Therapie des kolorektalen Karzinoms am LKH Bregenz F. Schmid1, H.-G. Stephan1, B. Grießhammer1, A. de Vries2, D. Wohlgenannt1, B. Föger1 1Landeskrankenhaus

Bregenz, Österreich für Radioonkologie, Landeskrankenhaus Feldkirch, Österreich

2Klinik

Was leistet eine Palliativmedizinischen Einheit an einer Hämato-Onkologischen Schwerpunktabteilung bezüglich Lebensqualität und Versorgung Onkologischer Patienten? F. Keil, A. Passini, E. Chorozidis, E. Hayn-Völkl, V. Odelga, M. Lammer memo Suppl 1/10

Grundlagen: Das kolorektale Karzinom ist unabhängig vom Geschlecht der häufigste maligne Tumor in Österreich. Nach operativer Therapie gilt im Stadium III bei Pat. in Europa das FOLFOX4-Protokoll adjuvant als Standard. Beim Rektumkarzinom ist die (neo)adjuvante Radio-Chemotherapie Standard. Beim fortgeschrittenen Kolorektalkarzinom wurde in den zurückliegenden 10 Jahren durch Integration neuer

15

Abstracts

Zytostatika (Irinotecan und Oxaliplatin) und Antikörper (Bevacizumab und Cetuximab) in moderne Therapiealgorithmen eine signifikante Verbesserung der Prognose erzielt; so hat sich die mittlere Überlebenszeit mehr als verdoppelt. Methodik: Von 1995 bis 2006 wurden 433 Pat. mit kolorektalem Karzinom am LKH Bregenz sowohl operativ als auch medikamentös behandelt, die Radiotherapie wurde jeweils an der Klinik für Radioonkologie am LKH Feldkirch durchgeführt. 341 Pat. wurden kurativ mit primär operativer Therapie und gegebenenfalls mit (neo)adjuvanter (Radio) chemotherapie behandelt. 92 Pat. im metastasierten Stadium erhielten primär eine medikamentöse Tumortherapie. Ergebnisse: Bei den primär kurativ behandelten Pat. betrug die 5-Jahres-Überlebensrate im Stadium III näherungsweise 60 % (Schwankungen je nach Subgruppe). Im metastasierten Stadium betrug die mittlere Lebenserwartung mehr als 30 Monate. Subgruppenauswertungen in diesem Patientengut zeigen, dass Anämie, Leukozytose, Erhöhung alkalischer Phosphatase und der Metastasenbefall von 2 oder mehr Organen negative prognostische Faktoren sind, die sich auch in Remissionsdauer und Überlebenszeiten niederschlagen. Schlussfolgerungen: Die Behandlungsergebnisse am LKH Bregenz sind vergleichbar mit den Ergebnissen internationaler Studien. Klinische und laborchemische Daten, bisher bereits ermittelt an Pat.-Kollektiven mit 5-FU-basierter Chemotherapie erlauben einen Hinweis auf die Prognose von Pat. im metastasierten Stadium auch nach Hinzugabe von Antikörpern zur 5-FUbasierten Chemotherapie. Eine Datenbank stellt ein geeignetes Instrument zur Qualitätskontrolle onkologischer Therapien dar.

P18 Association of hypoxia inducible factor 1-alpha gene polymorphisms and colorectal cancer prognosis J. Szkandera1, G. Knechtel1, M. Stotz1, G. Hofmann1, U. Langsenlehner2, P. Krippl3, T. Langsenlehner4, D. Dehchamani5, H. Samonigg1, W. Renner6, A. Gerger1 1Division

of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria 2Internal Outpatient Department, Steiermaerkische Gebietskrankenkasse, Graz, Austria 3Department of Internal Medicine, Regional Hospital of Fuerstenfeld, Fuerstenfeld, Austria 4Clinic of Therapeutic Radiology and Oncology, Medical University Graz, Graz, Austria 5Department of Dentistry and Maxillofacial Surgery, Medical University Graz, Graz, Austria 6Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria

Background: Hypoxia inducible factor 1 (HIF-1) is the key regulator of cellular responses to hypoxia and presumably plays a central role in the control of tumour growth. Recently, two single nucleotide polymorphisms (SNP) in the HIF-1alpha gene, C1772T and G1790A, were shown to cause significantly higher transcriptional activity than the wild-

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type. In this study, we aimed to investigate the effect of these SNPs on the prognosis of colorectal cancer (CRC). Methods: DNA from 336 CRC patients was genotyped for both polymorphisms. The genotypes of each polymorphism were tested for association with disease-free survival (DFS) using univariate and multivariate Cox regression analysis adjusted for known CRC prognostic factors. Results: Genotype frequencies were CC 75.6%, CT 18.8% and TT 1.8% for HIF-1alpha C1772T and GG 93.2%, GA 2.7% and AA 0% for HIF-1alpha G1790A. We observed a statistical significant association between DFS and Karnofsky-Index, tumour size, clinical stage, number of metastatic lymph nodes and application of 5-FU based chemotherapy. However, no association was found between HIF-1alpha C1772T (p = 0.44, RR = 1.19, 95% CI = 0.77–1.83) and HIF-1alpha G1790A (p = 0.89, RR = 0.92, 95% CI = 0.29–2.90) polymorphisms and DFS in univariate and multivariate Cox-regression analysis including known CRC prognostic factors. Conclusions: Our results suggest that HIF-1á C1772T and G1790A polymorphisms are not involved in progression or metastasis of colorectal cancer.

P19 Single nucleotide polymorphisms in the hypoxia-inducible factor 1 gene and colorectal cancer risk G. Knechtel1, J. Szkandera1, M. Stotz1, G. Hofmann1, U. Langsenlehner2, P. Krippl3, H. Samonigg1, W. Renner4, D. Dehchamani5, A. Gerger1 1Division

of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria 2Internal Outpatient Department, Steiermaerkische Gebietskrankenkasse, Graz, Austria 3Department of Internal Medicine, Regional Hospital of Fuerstenfeld, Fuerstenfeld, Austria 4Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria 5Department of Dentistry and Maxillofacial Surgery, Division of Oral and Cranio-Maxillofacial Surgery, Medical University Graz, Graz, Austria

With an incidence of about 300,000 new cases, colorectal cancer (CRC) is the second leading cause of cancer-related death in Europe and the United States. Environmental and genetic factors influence CRC risk. Hypoxia-inducible factor-1 (HIF-1), a heterodimeric protein composed of two subunits, HIF-1 alpha and HIF-1 beta, plays a critical role in oxygen homeostasis and is involved in angiogenesis and cell proliferation. The gene for the HIF-1 alpha subunit (HIF1A) carries two common missense mutations – P582S (rs11549465) and A588T (rs11549467) – which both have been related to increased trans-activation capacity of HIF1A. In our case-control study we investigated the association between these polymorphisms and CRC risk. We investigated 381 patients with histologically confirmed CRC and 2156 control subjects. HIF1A genotypes were determined by exonuclease (TaqMan) assays. HIF1A P582S and A588T genomemo Suppl 1/10

Abstracts

type frequencies were not significantly different between patients (PP 76.4%, PS/SS 20.2%; AA 93.4%; AT/TT 2.9%) and control subjects (PP 82.2%, PP/PS 17.8%, p = 0.147; AA 96.5%, AT/TT 3.5%, p = 0.608). In a multivariate logistic regression analysis including age and sex neither the HIF1A 582S allele (Odds ratio: 1.204; 95% confidence interval: 0.911–1.592; p = 0.193) nor the 588T allele was significantly associated with CRC (Odds ratio: 0.851; 95% confidence interval: 0.444–1.631; p = 0.626). However, in an exploratory analysis, the HIF1A 588T allele was associated with tumour localization (p = 0.016) and tumour size (p = 0.003). We conclude that functional polymorphisms in the HIF1A gene do not modify CRC risk but may be associated with clinic-pathological features of the disease.

pelitinib, canertinib, and BIBW2992. Multiple fractionationexperiments revealed that HCT116 cells are composed of a responsive and a resistant subpopulation. However, expression of CD133 was not invariably associated with resistance against irreversible ErbB blockers, and a CD133 siRNA failed to overcome drug resistance in HCT116 cells. Moreover, gene chip analysis revealed that although several growth-related pathways are expressed differentially, resistance-related genes showed no preferential expression in the CD133+ subfraction. Although the irreversible ErbB blockers inhibited ErbB-phosphorylation and several downstream signalling molecules in all fractions, no major effect on phosphorylation of ERK was seen in drug-resistant cells. Together, these data show that expression of CD133 in HCT116 cells is indicative of a growth advantage but not with resistance against ErbB blockers. Whether the Ras/MEK/ERK pathway is involved in drug resistance is currently under investigation.

P20 Expression of CD133 in HCT116 colon cancer cells is associated with a growth advantage but not with resistance against ErbB blockers Laffer1,

Grunt1,2,

Herrmann1,3,

Wagner2,

S. T. W. H. R. A. Hebar4, E. Selzer1,4, A. Graf5, M. Posch5, M. Bilban1,6, B. Marian1,7, C. C. Zielinski1,2, P. Valent1,3 1Ludwig

Boltzmann Cluster Oncology, Vienna, Austria Division of Oncology, Medical University of Vienna, Vienna, Austria 3Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria 4Department of Radiotherapy, Medical University of Vienna, Vienna, Austria 5Section of Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria 6Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria 7Department of Internal Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria

P21 Proteomic changes in colorectal cancer cell lines in response to sorafenib treatment T. Auer1, G. Gamerith2, B. Sarg3, D. Müller3, H. Zwierzina1, H. Lindner3, J. Loeffler-Ragg1

2Clinical

1Department

Advanced colon cancer is characterized by drug resistance and a poor prognosis. In these patients cancer stem cells (CSC) appear to be largely resistant against various targeted drugs including ErbB-inhibitors. The cell surface antigen prominin (CD133) has recently been identified as a potential marker of colon CSC. We examined the functional role of CD133 in HCT116 colon cancer cells. Unfractionated HCT116 were found to contain two distinct populations, one CD133+ and one CD133-negative fraction. Both subpopulations expressed the RAS mutation 38G > A and displayed an almost identical surface-phenotype, including CD44, CD166/ALCAM, CD326/EpCAM, EGFR/ErbB1, ErbB2, ErbB4, c-MET, and IGFR-1. In long-term culture, CD133+ HCT116 cells were found to outnumber CD133-negative, cells in all experiments, even when sorted ‘CD133-negative cells were examined. Both CD133+ and CD133- HCT116 cells were found to be resistant against various kinase-inhibitors including reversible ErbBinhibitors erlotinib, lapatinib, and gefitinib. However, HCT116 cells were found to respond to irreversible ErbB inhibitors

Background: Sorafenib is an oral, reversible small molecule multikinase inhibitor of several tyrosine- and serine-/ threonine kinases like BRAF, VEGFR 1/2/3, PDGF-b, RET, flt-3, p38 and c-kit. On the basis of positive results in preclinical studies, there are several ongoing phase I/II trials combining sorafenib with conventional therapies in the treatment of colorectal cancer (CRC). However, the molecular effects of this agent on CRC cells are poorly characterized. The identification of molecular biomarkers could be helpful to determine the probability of response to this multikinase inhibitor and to monitor therapy. Analyses of changes in proteome profiles in response to sorafenib treatment could lead to a better understanding of involved pathways and reveal responsive biomarkers. Methods: Two different CRC cell lines (Caco-2 and HRT-18) were treated with various concentrations of sorafenib (range 1.0–15 μM) and dose response curves were obtained by WST-1 cell proliferation assay. Subsequently, differential protein expression analysis between untreated and treated samples (IC50 dose) at time point 48 hours was performed with 2D-DIGE (Difference in Gel Electrophoresis) followed by an identification of the particular proteins of interest by mass spectrometry (ESI-MS).

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of Internal Medicine I (Metabolic Diseases, Pulmology, Infectious Diseases, Endocrinology, Rheumatology and Angiology), Center of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria 2Department of Internal Medicine V (Hematology and Oncology) Center of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria 3Biocentre, Division of Clinical Biochemistry, Medical University of Innsbruck, Innsbruck, Austria

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Abstracts

Results: Differential analysis of protein expression levels elucidated nine concordantly regulated proteins in both cell lines under treatment with sorafenib (average ratio: cut off 1.5). According to the mass spectrometry results, downregulation of the following eight proteins was identified: GART, Septin11, SET, T52DL2, CALM2, S100A9, RPP2, and RPS20. In contrast, the protein ENO1 was found to be upregulated under treatment. Conclusions: Our results show that proteome-based technologies are a suitable tool for improved understanding of the complex molecular response of malignant cells to treatment with anticancer agents such as tyrosine kinase inhibitors. In response to sorafenib we identified nine regulated proteins that have not yet been associated with this agent. All these proteins have known involvement in cancer-related pathways. Their potential as responsive biomarkers has to be clarified in further functional studies.

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P23 Association between polymorphisms in DNA repair genes and the development of severe side effects after radiotherapy in prostate cancer patients E.-M. Thurner1, W. Renner2, G. Hofmann3, A. Gerger3, R. Partl4, U. Langsenlehner5, K. S. Kapp4, T. Langsenlehner4 1Department

1Department

of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria 2Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria 3Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria 4Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria 5Internal Outpatient Department, Steiermaerkische Gebietskrankenkasse, Graz, Austria

Background: The majority of cancer patients treated with anti-angiogenic therapies will relapse because the tumour develops evasive mechanisms of resistance. Soluble angiogenic parameters or functional imaging might indicate resistance to therapy at an earlier date than detected by standard clinical evaluations. This hypothesis generating study intends to detect a profile of parameters which could then be further developed for routine clinical use. Methods: 40 patients treated with anti-VEGF/R therapies suffering from hepatocellular carcinoma (HCC), nonsmall cell lung cancer (NSCLC), renal cell cancer (RCC) and colorectal cancer will be included. Circulating endothelial cells (CECs) and circulating endothelial progenitor cells (CEPs) will be enumerated and VEGF, bFGF, ICAM, sVEGFR-2, SDF1 and Dickkopf 3, measured in consecutive serum and blood samples, will be correlated to functional imaging and clinical outcome. Functional imaging of the blood flow in the tumour tissue will be analyzed by DCE-MRI (dynamic contrast enhanced magnetic resonance imaging). Results: Four patients with RCC and 1 with HCC and 1 with NSCLC have already been included. The study is still ongoing.

Background: Intrinsic radiosensitivity is determined in particular by the cells’ capacity to repair radiation induced DNA damage. Modulation of repair capacity by single nucleotide polymorphisms (SNPs) in genes responsible for DNA damage signalling and repair might affect cell and tissue response to radiation and therefore influence individual radiosensitivity and the risk of radiation-induced toxicities. The aim of the present study was to evaluate the role of SNPs in genes involved in DNA repair for the development of radiation-induced late side effects in prostate cancer patients treated with radiotherapy. Methods: To analyze the role of polymorphisms in DNA repair genes for late toxicity 603 participants from the Austrian PROCAGENE study were included in the present investigation. All patients underwent three-dimensional conformal radiotherapy. Acute and late genitourinary and gastrointestinal toxicity was graded according to standard RTOG criteria. Six functional candidate polymorphisms in XRCC1 (Arg194Trp, Arg280His, and Arg399Gln), XRCC3 (Thr241Met) and ERCC2 (Asp312Asn and Lys751Gln) were selected for analysis and determined by 5′-nuclease (TaqMan) assays. Statistic analysis was done using SPSS 16.0 for Windows. Results: Within a median follow-up time of 35 months, 91 patients (15.7%) developed genitourinary and/or gastrointestinal late toxicity RTOG ≥ 2. In a Kaplan–Meier analysis, carriers of a XRCC1 280His allele were at decreased risk of late toxicity grade ≥ 2 (p = 0.022). In a univariate Cox regression model, the relative risk of carriers of a XRCC1 280His allele for late toxicity ≥ 2 was 0.28 (95% CI: 0.09 – 0.90; p = 0.032), in a multivariate Cox regression model carriage of a XRCC1 280His

Profile of soluble and cellular biomarkers and functional imaging during anti-angiogenic therapies in cancer patients A. Pircher1, N. Leonhartsberger2, I. Graziadei3, M. Schocke4, C. Kremser4, E. Gunsilius1, G. Untergasser1, J. Kern1, G. Gastl1, W. Hilbe1 of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria 2Depatment of Urology, Medical University of Innsbruck, Innsbruck, Austria 3Department of Internal Medicine II, Gastroenterlogy and Hepatology, Medical University of Innsbruck, Austria 4Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

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Conclusions: The present project intends to screen for potential biomarkers and biomarker combinations relevant for anti-angiogenic drugs in different tumour types, which might help clinicians in the future to use these agents more effectively and also more economically. Supported by a OEGHO research grant 2009 and the “Verein für Tumorforschung”.

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Abstracts

allele was associated with a relative risk of 0.27 (95% CI: 0.09 –0.86; p = 0.026). No significant associations were found for the remaining polymorphisms. Conclusions: We conclude that the XRCC1 Arg280His polymorphism may be protective against the development of high-grade late toxicity after radiotherapy in prostate cancer patients. If confirmed in future studies our findings could contribute to the construction of predictive risk models for the occurrence of late radiation-induced toxicity in prostate cancer patients. The increasing knowledge of the influence of polymorphisms on individual radiosensitivity could lead to an individualization of radiotherapy, thereby minimizing radiationinduced toxicity and improving efficacy of radiation therapy.

P24 Evaluation of iron metabolism parameters as predictive factors for response to darbepoetin alpha in cancer patients with chemotherapy-associated anaemia S. Hösel1, S. Stanzer1, M. Eichinger2, J. Horina3, H. Samonigg1, B. Tiran4, B. Obermayer-Pietsch2, T. Bauernhofer1 1Division

of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria 2Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria 3Division of Nephrology and Dialysis, Department of Internal Medicine, Medical University Graz, Graz, Austria 4Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria

Background: In recent studies intravenous iron administration in addition to the treatment with erythropoietin stimulating agents (ESA) of cancer patients with chemotherapy-associated anaemia (CAA) have demonstrated response rates up to 90%. However, iron is a potential growth factor for tumour cells and 40–60% of patients respond to ESA treatment alone. Guidelines for the use of intravenous iron administration in addition to ESA are lacking. Methods: In a retrospective study we evaluate the pretherapeutic serum level of pro-hepcidin, iron, ferritin, tranferrin, soluble transferring receptor (sTfR), and transferrin saturation (TS) as potential predictive markers for response to darbepoetin alpha alone in 105 cancer patients (pts) with CAA. Results: Of 105 pts., 69 were classified as responders and 36 as non-responders to darbepoetin alpha treatment using an increase of haemoglobin level of >1 g/dl within 4 weeks as denominator. Prohepcidin levels were not significantly different in responders versus non-responders (69 ± 24 vs. 74 ± 34 ng/ml, p = 0.87). However, iron levels (54 ± 37 vs. 34 ± 19 μg/dl, p = 0.001), ferritin levels (364 ± 463 vs. 256 ± 308 ng/ml, p = 0.050), and TS (17 ± 11 vs. 11 ± 6%, p = 0.003) were significantly higher in responders compared to non-responders. A trend towards higher sTfR levels was observed in non-responders (p = 0.056). ROC curve analysis revealed that an iron level with a cut off at 38 μg/dl can predict response to darbepoetin alpha treatment with a sensitivity of 61% and a specificity of 69%. memo Suppl 1/10

Conclusions: Our data suggest that in cancer patients with CAA iron levels might be used to predict response to darbepoetin alpha alone.

Cases P25 Peripheral arterial occlusive disease during nilotinib therapy in chronic myeloid leukemia: report of two cases K. Aichberger, S. Herndlhofer, C. Sillaber, P. Valent Medical University of Vienna, Vienna, Austria

The second-generation BCR/ABL tyrosine kinase inhibitor nilotinib (AMN107) is increasingly used for the treatment of patients with imatinib-resistant CML. So far, nilotinib is considered a well-tolerated drug that shows little if any adverse side effects. We here report on two imatinib-resistant/ intolerant CML patients who developed a rapidly progressive and overwhelming peripheral arterial occlusive disease (PAOD) upon treatment with nilotinib. In both patients, no pre-existing PAOD was known. In both patients, PAOD required angioplasty and surgery within a few months. In one patient, additional risk factors predisposing for PAOD were recorded, whereas in the other patient, no risk factors were known. Although the pathogenesis of rapid PAOD-development in these patients remains unknown, several potential mechanisms are discussed and related to cell-specific biochemical markers and targets of nilotinib-therapy. One of the potential targets appears to be KIT and KIT-dependent activation of mast cells, known to produce endogenous heparin and uncomplexed tissue-type plasminogen activator, tPA. In patients treated with nilotinib, this vascular repair system may be altered as mast cell tryptase levels are markedly suppressed in these patients. Notably, in all nilotinib-treated patients examined, tryptase-levels decreased, and in several of our well-responding patients, tryptase levels dropped to undetectable levels. Whether indeed the nilotinib-induced suppression of KIT and thus mast cells can predispose for PAOD remains to be elucidated.

P26 Successful allogeneic stem cell transplantation during respiratory failure and invasive mechanical ventilation: a case report A. Böhm, W. Rabitsch, G. J. Locker, N. Worel, O. Robak, K. F. Laczika, T. Staudinger, A. Bojic Medical University of Vienna, Vienna, Austria

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Abstracts

Allogeneic haematopoietic stem cell transplantation (HSCT) is a curative treatment option for a variety of haematological disorders. However, a number of life threatening adverse events can occur during therapy resulting from treatment-related toxicity, severe infections and graft-versus-host disease. We report on a 64-year-old patient suffering from secondary acute myeloid leukemia (AML) with successful HSCT while on mandatory ventilation. Acute respiratory failure with extensive infiltrates and pleural effusions occurred after reduced intensity conditioning therapy according to the FLAMSA-protocol two days before scheduled HSCT. Following emergency endotracheal intubation the patient was transferred to the intensive care unit (ICU) because the respiratory deterioration stem cell infusion was postponed. After temporary improvement HSCT was performed with one day delay, followed by transient respiratory impairment, as expected, thus probably reflecting pulmonary leukocyte accumulation in the lung. The further ICU course was uneventful. Overall, mandatory ventilation had to be continued for seven days. After successful weaning and extubation the patient was referred to the bone marrow transplantation unit. Following haematopoietic regeneration the patient was discharged in good condition on day 35 after HSCT. One year after transplantation she is still doing well with sustained complete haematological and cytogenetic remission. This case illustrates that intubation and mechanical ventilation not necessarily precludes from HSCT.

P27 Sorafinib as forth-line treatment in a patient with metastatic gastrointestinal stromal tumour: a case report D. Rühlinger, J. Szkandera, M. Pichler, F. Eisner, H. Stöger, T. Bauernhofer Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria

Background: Gastrointestinal stromal tumours (GIST) are commonly characterized by specific mutations in the c-kit receptor and respond to tyrosin kinase inhibitors targeting c-kit. Standard treatment for patients with metastatic GIST is imatinib 400 mg once daily. However, some patients do not respond to standard dose imatinib. Case report: We report on a 50-year-old female patient with a GIST metastatic to liver and peritoneal cavity diagnosed two years after resection of a tumour with a diameter of 6.5 cm located in the jejunum. Standard dose of 400 mg imatinib was initiated as first-line treatment. Progressive disease was demonstrated after 3 months and the dose of imatinib was escalated to 800 mg. In parallel, mutational analysis of the primary tumour was performed revealing a mutation in exon 9. After a brief stabilization of disease for 3 months in response to 800 mg of imatinib the patient progressed again. Sunitinib in a dose of 37.5 mg once daily was started resulting in a minor response for 16 months. As third-line treatment, nilotinib was employed. Nevertheless, the tumour progressed

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rapidly and sorafinib at a dose of 800 mg per day was administered within a named patient programme. Follow-up examinations showed minor response with a response duration of 6 months up to now. As side effects diarrhoea, acrokeratosis of hands and feet, and loss of appetite were observed and the dose of sorafenib was lowered to 600 mg per day. Conclusions: Sorafenib might be used successfully as fourth-line treatment option in patients with progressive metastatic GIST.

P28 Third-line treatment of relapsed small-cell lung cancer with irinotecan and carboplatin: a case report I. Osprian, M. Pichler, H. Samonigg, F. Ploner, T. Bauernhofer Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria

Background: Treatment options for small-cell lung cancer (SCLC) after the failure of second-line treatment with topotecan are limited. Case report: A 67-year-old female patient was diagnosed with extensive SCLC in November 2008. The patient received 5 cycles of cisplatin and etoposid which led to a partial response according to the Response Evaluation Criteria In Solid Tumor guidelines (RECIST). After an observation period of six months, radiological examination showed a progressive primary lung lesion and enlarged mediastinal lymph nodes. As a second-line treatment, monochemotherapy with topotecan weekly was initiated. However, progressive disease was observed after 8 cycles. As a third-line treatment we started with a combination therapy of irinotecan 60 mg/m2 and carboplatin AUC of 2, repeated on day 1, 8, 15 qd 28. After 3 cycles of this regime, follow-up examination demonstrated a partial response according to RECIST. No grade 3 toxicities or grade 4 toxicities were observed in this patient. Conclusions: This 28-day regime of irinotecan and carboplatin was effective and safe in our patient with SCLC as a third-line treatment option after treatment failure to topotecan.

P29 Paraneoplastic limbic encephalitis in a patient with extragonadal chorioncarcinoma – the significance of onconeural antibodies: a case report J. Szkandera1, F. Ploner1, T. Bauernhofer1, A.-K. Kasparek1, F. Payer2, M. Balic1, G. Knechtel1, A. Gerger1, G. Gallè3, H. Samonigg1, G. Hofmann1 1Division

of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria memo Suppl 1/10

Abstracts

2Department

of Neurology, Medical University of Graz, Graz, Austria 3Department of Urology, Medical University of Graz, Graz, Austria

Background: Paraneoplastic limbic or brainstem encephalitis is considered to be an autoimmune mediated disorder of the nervous system associated with different types of cancer, germ cell tumours being one of them. Case report: We report on a 31-year-old patient presenting with eye motility dysfunction, dysarthrophonia, lethargy, depression, slow mentation, disorientation, dysgraphia and retarded motion sequence. Neurological testings, imaging techniques of the brain and blood chemistry tests were not able to find the reason for his disorders. After seven months, further examinations including ultrasound of the abdomen were performed, and a retroperitoneal mass was detected. The biopsy of this mass showed fractions of a choriocarcinoma. The patient underwent curative chemotherapy including cisplatin, etoposide and bleomycin, but although the cancer therapy was successful, the neurological disorders did not improve. Concurrent examination for anti-Ma2 antibodies in serum was positive and therefore confirmed the paraneoplastic origin of the neurological symptoms. Conclusions: Patients with symptoms of limbic or brainstem encephalitis, especially young men, should be tested for anti-Ma2 antibodies in serum to elucidate its paraneoplastic origin. The detection of these antibodies supports the diagnosis of a paraneoplastic syndrome and may lead to the earlier identification of an otherwise hidden extragonadal germ cell tumour.

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P30 Complete remission of ocular adnexal mucosa-associated lymphoid tissue (MALT)-lymphoma after Helicobacter pylori-eradication therapy D. Voskova Department of Internal Medicine III, Oncology, General Hospital Linz, Austria

Primary non-Hodgkin’s lymphoma (NHL) of the orbit is a rare condition, representing 8–10% of extranodal NHL and only 15% of all NHLs. Generally, it has an indolent course. Systemic lymphomatous involvement may be associated in 20% of cases. Ocular adnexal MALT lymphoma (OAML) could be induced by a chronic antigenic stimulation provided by different agents. In some cases, the role of Chlamydia psittaci was hypothesized in the aetiology of OAML. Tumour regression was observed in about 50% patients positive for Chlamydia infection and treated with doxycykline. The role of antibiotics is well defined in MALT-lymphoma of stomach. The biological nature of these tumours is different from orbital lymphomas. We report the case of a 50-year-old male patient with isolated marginal zone B cell lymphoma of the left orbit. Chlamydia psittaci could not be detected. For the treatment of lymphoma, the radiotherapy as standard therapeutic option was recommended. Before starting the radiotherapy, the patient underwent the eradication therapy (omeprazol, clarithromycin and amoxicillin) due to Helicobacter pylori associated gastritis. Control magnetic resonance imaging (MRI) used prior the radiotherapeutic planning did not show any tumour. The eradication therapy for Helicobacter pylori alone led unusually to complete remission of orbital MALT-lymphoma.

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