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Kobushi H, Saida S, Umeda K, Iwai A, Kozuki K, Kubota H, Tanaka K, Obu S, Uchihara Y, Tasaka K, Kato I, Hiramatsu H, Takita J. High-dose carboplatin-irinotecan-temozolomide is an effective salvage chemotherapy for relapsed or refractory neuroblastoma. Pediatr Blood Cancer 2023; 70:e30331. [PMID: 37066594 DOI: 10.1002/pbc.30331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/19/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
There is no clear consensus on the most effective treatment for relapsed/refractory high-risk neuroblastoma (NB). We retrospectively assessed seven NB patients with relapsed/refractory disease who received high-dose carboplatin-irinotecan-temozolomide (HD-CIT). Five of seven patients showed favorable therapeutic response (complete remission or partial remission). Regarding toxicity, the cytopenia period tended to prolong when more than three cycles were repeated, but nonhematological toxicities were controllable with general supportive care. Due to its antitumor efficacy and well-tolerated nonhematologic toxicity, HD-CIT is a promising salvage chemotherapy for relapsed/refractory NB. However, it is important to pay attention to the exacerbation of hematological toxicity when repeating the regimen.
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Affiliation(s)
- Hirokazu Kobushi
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Saida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsutsugu Umeda
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Iwai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kagehiro Kozuki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirohito Kubota
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kuniaki Tanaka
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Obu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinori Uchihara
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiji Tasaka
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Kato
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidefumi Hiramatsu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Patel J, Gao X, Wang H. An Update on Clinical Trials and Potential Therapeutic Strategies in T-Cell Acute Lymphoblastic Leukemia. Int J Mol Sci 2023; 24:7201. [PMID: 37108359 PMCID: PMC10139433 DOI: 10.3390/ijms24087201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Current therapies for T-cell acute leukemia are based on risk stratification and have greatly improved the survival rate for patients, but mortality rates remain high owing to relapsed disease, therapy resistance, or treatment-related toxicities/infection. Patients with relapsed disease continue to have poor outcomes. In the past few years, newer agents have been investigated to optimize upfront therapies for higher-risk patients in the hopes of decreasing relapse rates. This review summarizes the progress of chemo/targeted therapies using Nelarabine/Bortezomib/CDK4/6 inhibitors for T-ALL in clinical trials and novel strategies to target NOTCH-induced T-ALL. We also outline immunotherapy clinical trials using monoclonal/bispecific T-cell engaging antibodies, anti-PD1/anti-PDL1 checkpoint inhibitors, and CAR-T for T-ALL therapy. Overall, pre-clinical studies and clinical trials showed that applying monoclonal antibodies or CAR-T for relapsed/refractory T-ALL therapy is promising. The combination of target therapy and immunotherapy may be a novel strategy for T-ALL treatment.
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Affiliation(s)
- Janisha Patel
- Department of Cell and Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA; (J.P.); (X.G.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Pediatric Hematology/Oncology, Medical University of South Carolina-Shawn Jenkins Children’s Hospital, Charleston, SC 29425, USA
| | - Xueliang Gao
- Department of Cell and Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA; (J.P.); (X.G.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Haizhen Wang
- Department of Cell and Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA; (J.P.); (X.G.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
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Canzi P, Berrettini S, Albera A, Barbara M, Bruschini L, Canale A, Carlotto E, Covelli E, Cuda D, Dispenza F, Falcioni M, Forli F, Franchella S, Gaini L, Gallina S, Laborai A, Lapenna R, Lazzerini F, Malpede S, Mandalà M, Minervini D, Pasanisi E, Ricci G, Viberti F, Zanetti D, Zanoletti E, Benazzo M. Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders. Acta Otorhinolaryngol Ital 2023; 43:S67-S75. [PMID: 37698103 PMCID: PMC10159642 DOI: 10.14639/0392-100x-suppl.1-43-2023-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Objective To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combination with subtotal petrosectomy. Patients' details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results 55 patients were included with a mean follow-up time of 44 months. Cholesteatoma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients.
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Affiliation(s)
- Pietro Canzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Andrea Albera
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Andrea Canale
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Elena Carlotto
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Domenico Cuda
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Francesco Dispenza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone’’, University of Palermo, Palermo, Italy
| | - Maurizio Falcioni
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Francesca Forli
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Sebastiano Franchella
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Lorenzo Gaini
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Salvatore Gallina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone’’, University of Palermo, Palermo, Italy
| | - Andrea Laborai
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Ruggero Lapenna
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
| | - Francesco Lazzerini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Stefano Malpede
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Domenico Minervini
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Pasanisi
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
| | - Francesca Viberti
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Zanetti
- Audiology Unit, Department of Specialistic Surgical Sciences Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan, Italy
- Department of Clinical Sciences and Community Health University of Milan, Milan, Italy
| | - Elisabetta Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Marco Benazzo
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Tang WJ, Li Y, Zheng YH, Zhang L, Niu T. [Progress in Chimeric Antigen Receptor-Modified Natural Killer Cells for Multiple Myeloma]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2023; 45:290-297. [PMID: 37157078 DOI: 10.3881/j.issn.1000-503x.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Although the development of novel drugs has significantly improved the survival of patients with multiple myeloma (MM) over the past decades,the lack of effective therapeutic options for relapsed and refractory MM results in poor prognosis.The chimeric antigen receptor (CAR) T-cell therapy has achieved considerable progress in relapsed and refractory MM.Nevertheless,this therapy still has limitations such as cytokine release syndrome,neurotoxicity,and off-target effects.Natural killer (NK) cells,as a critical component of the innate immune system,play an essential role in tumor immunosurveillance.Therefore,CAR-modified NK (CAR-NK) cells are put forward as a therapeutic option for MM.The available studies have suggested that multiple targets can be used as specific therapeutic targets for CAR-NK cell therapy and confirmed their antitumor effects in MM cell lines and animal models.This review summarizes the anti-tumor mechanisms,biological characteristics,and dysfunction of NK cells in the MM tumor microenvironment,as well as the basic and clinical research progress of CAR-NK cells in treating MM.
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Affiliation(s)
- Wen-Jiao Tang
- Department of Hematology,Institute of Hematology,West China Hospital,Sichuan University,Chengdu 610041,China
| | - Yan Li
- Department of Hematology,Institute of Hematology,West China Hospital,Sichuan University,Chengdu 610041,China
| | - Yu-Huan Zheng
- Department of Hematology,Institute of Hematology,West China Hospital,Sichuan University,Chengdu 610041,China
| | - Li Zhang
- Department of Hematology,Institute of Hematology,West China Hospital,Sichuan University,Chengdu 610041,China
| | - Ting Niu
- Department of Hematology,Institute of Hematology,West China Hospital,Sichuan University,Chengdu 610041,China
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Landon-Cardinal O, Guillaume-Jugnot P, Toquet S, Sbeih N, Rigolet A, Champtiaux N, Dorgham K, Gorochov G, Meyer A, Anquetil C, Barete S, Benveniste O, Allenbach Y. JAK inhibitors for the treatment of adult dermatomyositis: A pilot study. J Am Acad Dermatol 2023; 88:924-926. [PMID: 36356704 DOI: 10.1016/j.jaad.2022.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Océane Landon-Cardinal
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France; Department of Medicine, Université de Montréal, Division of Rheumatology and Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Perrine Guillaume-Jugnot
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France
| | - Ségolène Toquet
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France
| | - Nabiha Sbeih
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France
| | - Nicolas Champtiaux
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France
| | - Karim Dorgham
- Sorbonne Université, Inserm, Centre d'immunologie et des maladies infectieuses-Paris (CIMI-PARIS), Département d'Immunologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Guy Gorochov
- Sorbonne Université, Inserm, Centre d'immunologie et des maladies infectieuses-Paris (CIMI-PARIS), Département d'Immunologie, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Meyer
- Service de physiologie et d'explorations fonctionnelles musculaires, Service de rhumatologie et Centre de références des maladies autoimmunes rares, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Céline Anquetil
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France
| | - Stéphane Barete
- Department of Dermatology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U974, Sorbonne Université, Paris 6, Paris, France.
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Liu X, Wang X, Shen L, Wang B, Li L, Dai X. Uniportal video-assisted thoracoscopic (VATS) subtotal parietal pleurectomy for refractory tuberculous pneumothorax: Five case-reports. Medicine (Baltimore) 2023; 102:e33082. [PMID: 36862879 PMCID: PMC9981438 DOI: 10.1097/md.0000000000033082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE This study explored the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) paretal pleurectomy in patients suffering from complex tuberculous pneumothorax. These cases were reported and summarized to present the experience of the authors with this procedure. METHODS The clinical data of a total of 5 patients with refractory tuberculous pneumothorax having undergone subtotal parietal pleurectomy by uniportal VATS in our institution were hereby collected from November 2021 to February 2022, and regular follow-up was conducted after surgery. RESULTS Parietal pleurectomy via VATS was successfully performed in all these 5 patients, among which, 4 received bullectomy at the same time, with no conversion to open surgery. Among the 4 cases of full lung expansion who were suffering from recurrent tuberculous pneumothorax, the preoperative chest drain duration ranged from 6 days to 12 days; the operation time, from 120 minutes to 165 minutes; intraoperative blood loss, from 100 mL to 200 mL; the drainage volume, from 570 mL to 2000 mL 72 hours after operation; and chest tube duration, from 5 days to 10 days. One rifampicin-resistant case had satisfactory postoperative lung expansion, but left a cavity, the operation time of which was 225 minutes; intraoperative blood loss, 300 mL; the drainage volume, 1820 mL 72 hours after operation; and chest tube duration, 40 days. The follow-up time ranged from 6 months to 9 months, and no recurrence was noted. CONCLUSION Parietal pleurectomy with preservation of the top pleura via VATS is a safe and satisfactorily effective procedure for patients with refractory tuberculous pneumothorax.
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Affiliation(s)
- Xiaoyu Liu
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, China
| | - Xuan Wang
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, China
| | - Lei Shen
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, China
| | - Bing Wang
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, China
| | - Li Li
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, China
| | - Xiyong Dai
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, China
- * Correspondence: Xiyong Dai, Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan 430030, Hubei, China (e-mail: )
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107
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Yao G, Huang J, Zhang Q, Hu D, Yuan F, Han G. Excellent response of refractory triple-negative breast cancer to sintilimab plus chemotherapy: a case report. Immunotherapy 2023; 15:221-228. [PMID: 36789554 DOI: 10.2217/imt-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is the most aggressive subtype of breast cancer with a high propensity for invasion and a high incidence of lymph node metastasis. Systemic chemotherapy is considered the primary treatment for patients with TNBC; however, immune checkpoint inhibitors in addition to chemotherapy have been associated with better outcomes. Sintilimab, an anti-PD-1 antibody, was developed in China. Herein, the authors report a 49-year-old woman diagnosed with TNBC with extensive lung and sternal metastases. Treatment with sintilimab plus paclitaxel and carboplatin was found highly effective after failure of first-line chemotherapy. This combinational therapy can be considered for the treatment of TNBC after necessary investigations and clinical trials.
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Affiliation(s)
- Guojun Yao
- Radiotherapy Center of Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Junping Huang
- Oncology department of HuBei Jianghan Oilfield General Hospital, China
| | - Qu Zhang
- Radiotherapy Center of Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Desheng Hu
- Radiotherapy Center of Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Feng Yuan
- Breast Cancer Center of Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Guang Han
- Radiotherapy Center of Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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108
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Abstract
Angioedema is an acute disorder that affects mucous membranes and the deepest layers of the skin along with underlying tissue, marked by rapid swelling, large welts, and pain. There are 3 major subtypes of angioedema: mast-cell mediated, bradykinin-mediated, and multifactorial or unclear mechanism subtype. The most common subtype of bradykinin-mediated angioedema is ACE-inhibitor induced, which disproportionately affects African-Americans. It is most often self-limiting and usually responds to the withdrawal of the offending agent. The prolonged duration of angioedema is uncommon in the absence of a persistent stimulus, though it is more likely when there is an abnormality of the metabolic pathways, such as in hereditary angioedema or other gene polymorphisms affecting the complement system. We present a case of severe angioedema that persisted for over a month and required a tracheostomy to manage the airway.
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Affiliation(s)
- Thomas M Irwin
- 145762University of Kansas Cancer Center, Melanoma Project, Westwood, KS, USA
| | | | | | - William Spence Bodenhamer
- Departments of History of Medicine & Internal Medicine (Palliative Care), 12251University of Kansas School of Medicine, Kansas City, KS, USA
| | - Carla C Keirns
- Departments of History of Medicine & Internal Medicine (Palliative Care), 12251University of Kansas School of Medicine, Kansas City, KS, USA
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109
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Fokkens WJ, Mullol J, Kennedy D, Philpott C, Seccia V, Kern RC, Coste A, Sousa AR, Howarth PH, Benson VS, Mayer B, Yancey SW, Chan R, Gane SB. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): In-depth sinus surgery analysis. Allergy 2023; 78:812-821. [PMID: 35822924 DOI: 10.1111/all.15434] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) often require repeat sinus surgery. Mepolizumab reduced the need for sinus surgery in the SYNAPSE trial; this analysis sought to provide a more in-depth assessment of surgery endpoints in SYNAPSE. METHODS SYNAPSE was a double-blind Phase III trial (NCT03085797) in adults with recurrent, refractory, severe, CRSwNP eligible for repeat sinus surgery despite standard of care treatments and previous surgery. Patients were randomized (1:1) to mepolizumab 100 mg subcutaneously or placebo, plus standard of care, every 4 weeks for 52 weeks. Time to first inclusion on a waiting list for sinus surgery and time to first actual sinus surgery (both up to week 52) were assessed; the latter endpoint was also analyzed post hoc according to time since last sinus surgery before study screening and baseline blood eosinophil count. RESULTS Among 407 patients (mepolizumab: 206; placebo: 201), mepolizumab versus placebo reduced the risk of being included on a waiting list for sinus surgery (week 52 Kaplan-Meier probability estimate [95% confidence interval]: 13.9% [9.8%, 19.5%] vs. 28.5% [22.7%, 35.4%]). Mepolizumab versus placebo reduced the risk of sinus surgery irrespective of time (<3 vs ≥3 years) since patients' last sinus surgery prior to study screening (hazard ratios [95% confidence intervals] 0.28 [0.09, 0.84] and 0.50 [0.26, 0.98], respectively) and baseline blood eosinophil count. CONCLUSIONS Mepolizumab reduced the risk of further sinus surgery in patients with recurrent, refractory, severe CRSwNP, irrespective of the patient baseline characteristics assessed.
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Affiliation(s)
- Wytske J Fokkens
- Department of Otolaryngology, University of Amsterdam, Amsterdam, Netherlands
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - David Kennedy
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Waveney Ear Nose and Throat Service, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Veronica Seccia
- ENT Unit, Department of Neuroscience, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Robert C Kern
- Department of Medicine and Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - André Coste
- Service d'ORL et de Chirurgie Cervico-faciale Centre, Hospitalier Intercommunal de Creteil, et APHP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Universite Paris-Est Creteil, Creteil, France
| | - Ana R Sousa
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Peter H Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK.,Global Respiratory Franchise, GSK House, Brentford, Middlesex, UK
| | - Victoria S Benson
- Epidemiology, Value Evidence and Outcomes, GSK House, Brentford, Middlesex, UK
| | - Bhabita Mayer
- Clinical Statistics, GSK House, Brentford, Middlesex, UK
| | - Steve W Yancey
- Respiratory Medical Franchise, GSK, Research Triangle Park, North Carolina, USA
| | - Robert Chan
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Simon B Gane
- Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Ear Institute, University College London, London, UK
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Maouche N, Srinivasan A, Leary H, Collings F, Tseu B, Vallance GD, Ramasamy K, Kothari J. Daratumumab Monotherapy for Heavily Pre-treated and Refractory Myeloma: Results from a UK Multicentre Real World Cohort. J Oncol Pharm Pract 2023; 29:299-304. [PMID: 34939868 DOI: 10.1177/10781552211067780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Daratumumab is the first anti-CD38 targeting monoclonal antibody approved as monotherapy in multiply relapsed myeloma patients who progressed following prior treatment with proteasome inhibitors (PIs) and immunomodulatory agents (IMiDs). We present real world data on the efficacy of single agent daratumumab in a cohort of 55 multiply relapsed patients treated in the UK.The median age was 72 years, the majority (96%) received ≥ 3 previous lines of treatment; 54.5% were PI-refractory, 76.4% were IMiD-refractory and 47.2% were double refractory; 20% of patients had high-risk (HR) disease.The overall response rate was 49%. After a median follow up of 9.2 months, the median progression-free survival (PFS) for the total cohort was 5.1 months. Patients who achieved a partial response or better (≥PR) demonstrated a significantly longer PFS compared to those with <PR; 9.8 versus 2.7 months, p < 0.001. Double-refractory patients had an inferior PFS compared to single-refractory patients; 2.7 versus 7.4 months, p = 0.084. High-risk disease was associated with significantly shorter PFS compared to standard-risk (SR); 2.3 versus 6.7 months, p = 0.001. The median overall survival (OS) was 15.9 months. Despite a relatively short PFS seen in the double-refractory and high-risk patients; a favourable median overall survival of 12.9 months was achieved in these groups. Patients who achieved ≥PR, those with a previous objective response to PIs or IMiDs and those with SR disease, all benefited from a significantly longer OS which was not reached. A clear benefit in survival is encouraging in this setting of unmet clinical need and limited treatment options.
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Affiliation(s)
- Nadjoua Maouche
- Department of Pharmacy, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anandagopal Srinivasan
- Department of Haematology, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Heather Leary
- Department of Haematology, 5489Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Freya Collings
- Department of Haematology, 7766Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Bing Tseu
- Department of Haematology, 1174Buckinghamshire Healthcare NHS Trust, Bucks, UK
| | - Grant D Vallance
- Department of Haematology, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karthik Ramasamy
- Department of Haematology, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jaimal Kothari
- Department of Haematology, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Abstract
INTRODUCTION Recently, treatments for myasthenia gravis (MG) have progressed significantly. Symptoms of some patients with refractory MG are not relieved by conventional therapies, and such patients might benefit from novel biological treatments that are being developed. AREAS COVERED We review several novel biological therapies for MG, such as complement inhibitors, neonatal Fc receptor inhibitors, anti-B cell drugs, and IL-6 receptor inhibitors. We also report the modes of action, efficacy, safety, and tolerability of these drugs. EXPERT OPINION Several biological therapies have been developed for MG, and these biologics are promising agents for treating refractory MG. Establishing biomarkers and accumulating evidence of therapeutic response is required to provide the most appropriate biological treatment for each patient.
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Affiliation(s)
- Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Chainani-Wu N, Gopal-Murthy V, Wu A, Marinkovich MP. Localized CO 2 laser treatment of a recalcitrant oral ulceration in pemphigus vulgaris. Clin Adv Periodontics 2023; 13:38-41. [PMID: 35649436 DOI: 10.1002/cap.10210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/22/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Recalcitrant oral lesions of pemphigus vulgaris (PV), an autoimmune blistering disease, can result in significant discomfort, difficulty in eating, and maintaining oral hygiene. Increasing the dosage of systemic medications to control such localized lesions results in an increased risk of adverse effects. CASE PRESENTATION We describe a male patient diagnosed at age 51 with PV by oral biopsy that included a direct immunofluorescence examination. After further baseline laboratory testing, he was started on prednisone and mycophenolate. These medications were slowly tapered with adjustments guided by clinical signs. Mycophenolate was replaced with intravenous immunoglobulin monthly infusions due to adverse effects about 2 years after initiation. During the 4.5-year follow-up period after diagnosis, his oral and skin lesions were well-controlled apart from minor transient flares. However, a painful ulcerated lesion on the facial gingiva between #11 and 12 was nonresponsive, even with the use of topical clobetasol in trays. A carbon dioxide (CO2 ) laser was used to vaporize the recalcitrant lesion under local anesthesia. The procedure resulted in complete healing of ulceration with no recurrence until the most recent examination, 2 years postlaser surgery. CONCLUSION Adjunctive procedures that can facilitate a decrease in the cumulative dosage of corticosteroids and immunosuppressants have great value in the management of PV. CO2 laser vaporization is safe, with minimal morbidity and no long-term side effects. It should be considered an adjunctive treatment option for the management of recalcitrant lesions in patients with oral PV. KEY POINTS Why is this case new information? To our knowledge, this is the second report on the use of a CO2 laser in the treatment of recalcitrant oral lesions of PV and the first report with a documented long-term resolution of the treated lesions. What are the keys to the successful management of this case? A localized recalcitrant lesion was treated with this approach. All other mucosal and cutaneous sites were well controlled on the patient's systemic medication regimen. What are the primary limitations to success in this case? This approach is only relevant for the management of recalcitrant lesions in patients whose disease activity is otherwise well controlled. The availability of specialized equipment and trained clinicians is necessary.
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Affiliation(s)
- Nita Chainani-Wu
- Private Practice in Oral Medicine, Mountain View, California, USA
| | - Vinitha Gopal-Murthy
- International Dentist Program, University of the Pacific, San Francisco, California, USA
| | - Aadi Wu
- Living Wisdom School, Palo Alto, California, USA
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113
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Alhaj Moustafa M. Timing of CAR-T therapy in follicular lymphoma. Expert Rev Anticancer Ther 2023; 23:347-349. [PMID: 36825538 DOI: 10.1080/14737140.2023.2185222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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114
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Muthiah N, Mallela AN, Vodovotz L, Sharma N, Akwayena E, Pan E, Welch W, Ibrahim GM, Abel TJ. Development of a clinical model to predict vagus nerve stimulation response in pediatric patients with drug-resistant epilepsy. J Neurosurg Pediatr 2023; 31:476-483. [PMID: 36805960 DOI: 10.3171/2023.1.peds22312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/13/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Epilepsy impacts 470,000 children in the United States. For patients with drug-resistant epilepsy (DRE) and unresectable seizure foci, vagus nerve stimulation (VNS) is a treatment option. Predicting response to VNS has been historically challenging. The objective of this study was to create a clinical VNS prediction tool for use in an outpatient setting. METHODS The authors performed an 11-year retrospective cohort analysis with 1-year follow-up. Patients < 21 years of age with DRE who underwent VNS (n = 365) were included. Logistic regressions were performed to assess clinical factors associated with VNS response (≥ 50% seizure frequency reduction after 1 year); 70% and 30% of the sample were used to train and validate the multivariable model, respectively. A prediction score was subsequently developed. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS Variables associated with VNS response were < 4-year epilepsy duration before VNS (p = 0.008) and focal motor seizures (p = 0.037). The variables included in the clinical prediction score were epilepsy duration before VNS, age at seizure onset, number of pre-VNS antiseizure medications, if VNS was the patient's first therapeutic epilepsy surgery, and predominant seizure semiology. The final AUCs were 0.7013 for the "fitted" sample and 0.6159 for the "validation" sample. CONCLUSIONS The authors developed a clinical model to predict VNS response in a large sample of pediatric patients treated with VNS. Despite the large sample size, clinical variables alone were not able to accurately predict VNS response. This score may be useful after further validation, although its predictive ability underscores the need for more robust biomarkers to predict treatment response.
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Affiliation(s)
| | - Arka N Mallela
- 1Department of Neurological Surgery, University of Pittsburgh
| | - Lena Vodovotz
- 1Department of Neurological Surgery, University of Pittsburgh
| | - Nikhil Sharma
- 1Department of Neurological Surgery, University of Pittsburgh
| | - Emefa Akwayena
- 1Department of Neurological Surgery, University of Pittsburgh
| | - Evelyn Pan
- 1Department of Neurological Surgery, University of Pittsburgh
| | - William Welch
- 2Department of Pediatrics, Division of Child Neurology, University of Pittsburgh, Pennsylvania
| | - George M Ibrahim
- 3Department of Surgery, Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada; and
| | - Taylor J Abel
- 1Department of Neurological Surgery, University of Pittsburgh.,4Department of Bioengineering, University of Pittsburgh, Pennsylvania
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Swierkosz-Lenart K, Dos Santos JFA, Elowe J, Clair AH, Bally JF, Riquier F, Bloch J, Draganski B, Clerc MT, Pozuelo Moyano B, von Gunten A, Mallet L. Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients. Front Psychiatry 2023; 14:1065812. [PMID: 36873207 PMCID: PMC9978117 DOI: 10.3389/fpsyt.2023.1065812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Even though obsessive compulsive disorder (OCD) is one of the ten most disabling diseases according to the WHO, only 30-40% of patients suffering from OCD seek specialized treatment. The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases. The use of neuromodulation techniques, especially Deep Brain Stimulation, is highly promising for these clinical pictures and knowledge in this domain is constantly evolving. The aim of this paper is to provide a summary of the current knowledge about OCD treatment, while also discussing the more recent proposals for defining resistance.
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Affiliation(s)
- Kevin Swierkosz-Lenart
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | | | - Julien Elowe
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, West Sector, Prangins, Switzerland
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, North Sector, Yverdon-les-Bains, Switzerland
| | - Anne-Hélène Clair
- Sorbonne University, UPMC Paris 06 University, INSERM, CNRS, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Julien F. Bally
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Françoise Riquier
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jocelyne Bloch
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging (LREN), Department of Clinical Neurosciences, Centre for Research in Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Marie-Thérèse Clerc
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Beatriz Pozuelo Moyano
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Armin von Gunten
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Luc Mallet
- Department of Mental Health and Psychiatry, Geneva University Hospital, Geneva, Switzerland
- Univ Paris-Est Créteil, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d’Addictologie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
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El-Hajj Fuleihan G, Clines GA, Hu MI, Marcocci C, Murad MH, Piggott T, Van Poznak C, Wu JY, Drake MT. Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2023; 108:507-528. [PMID: 36545746 DOI: 10.1210/clinem/dgac621] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypercalcemia of malignancy (HCM) is the most common metabolic complication of malignancies, but its incidence may be declining due to potent chemotherapeutic agents. The high mortality associated with HCM has declined markedly due to the introduction of increasingly effective chemotherapeutic drugs. Despite the widespread availability of efficacious medications to treat HCM, evidence-based recommendations to manage this debilitating condition are lacking. OBJECTIVE To develop guidelines for the treatment of adults with HCM. METHODS A multidisciplinary panel of clinical experts, together with experts in systematic literature review, identified and prioritized 8 clinical questions related to the treatment of HCM in adult patients. The systematic reviews (SRs) queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. An independent SR was conducted in parallel to assess patients' and physicians' values and preferences, costs, resources needed, acceptability, feasibility, equity, and other domains relevant to the Evidence-to-Decision framework as well as to enable judgements and recommendations. RESULTS The panel recommends (strong recommendation) in adults with HCM treatment with denosumab (Dmab) or an intravenous (IV) bisphosphonate (BP). The following recommendations were based on low certainty of the evidence. The panel suggests (conditional recommendation) (1) in adults with HCM, the use of Dmab rather than an IV BP; (2) in adults with severe HCM, a combination of calcitonin and an IV BP or Dmab therapy as initial treatment; and (3) in adults with refractory/recurrent HCM despite treatment with BP, the use of Dmab. The panel suggests (conditional recommendation) the addition of an IV BP or Dmab in adult patients with hypercalcemia due to tumors associated with high calcitriol levels who are already receiving glucocorticoid therapy but continue to have severe or symptomatic HCM. The panel suggests (conditional recommendation) in adult patients with hypercalcemia due to parathyroid carcinoma, treatment with either a calcimimetic or an antiresorptive (IV BP or Dmab). The panel judges the treatments as probably accessible and feasible for most recommendations but noted variability in costs, resources required, and their impact on equity. CONCLUSIONS The panel's recommendations are based on currently available evidence considering the most important outcomes in HCM to patients and key stakeholders. Treatment of the primary malignancy is instrumental for controlling hypercalcemia and preventing its recurrence. The recommendations provide a framework for the medical management of adults with HCM and incorporate important decisional and contextual factors. The guidelines underscore current knowledge gaps that can be used to establish future research agendas.
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Affiliation(s)
| | - Gregory A Clines
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56100, Italy
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
- MacGRADE Centre, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Department of Family Medicine, Queens University, Kingston, ON, K7L 3G2, Canada
- Peterborough Public Health, Peterborough, ON, K9J 2R8, Canada
| | - Catherine Van Poznak
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joy Y Wu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Drake
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Espiñeira I, Alzate D, Araos J, Pellegrino F, Tunesi M, Jensen M, Donati PA. Propofol versus sodium thiopentone for the treatment of status epilepticus and refractory status epilepticus in dogs. N Z Vet J 2023; 71:128-132. [PMID: 36688794 DOI: 10.1080/00480169.2023.2172089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS To compare the effect on mortality and length of hospital stay of propofol with that of sodium thiopentone for the management of dogs with status epilepticus (SE) and refractory status epilepticus (RSE). METHODS In this cohort study, medical records of a veterinary referral clinic in Argentina were retrospectively searched for dogs that were hospitalised and required induction of therapeutic coma (TC) with either propofol or sodium thiopentone for the management of SE or RSE of any cause. A logistic regression model was performed to evaluate the association between the type of anaesthetic used and in-hospital mortality adjusting for the type of epilepsy (idiopathic, structural, or reactive). Kaplan-Meier estimated survival curves for the length of hospital stay by the type of anaesthetic drug were compared using the log-rank test (deaths were considered censored events). Cox proportional hazards regression was used to estimate hazard ratios for time to hospital discharge, unadjusted and adjusted for type of epilepsy. RESULTS A total of 24 dogs with SE were included in the study: eight treated with propofol and 16 treated with sodium thiopentone. Four dogs treated with propofol (proportion = 0.50; 95% CI = 0.15-0.84), and eight treated with sodium thiopentone (proportion = 0.50; 95% CI = 0.50-0.74) died during hospitalisation. The median hospitalisation time was 43 (IQR 24-56) hours for dogs that were treated with propofol and 72 (IQR 64-96) hours for dogs that were treated with sodium thiopentone. There was no evidence of a difference in the median duration of TC in dogs treated with propofol (12 (IQR 8-24) hours) or with sodium thiopentone (12 (IQR 7.5-20) hours; p = 0.946). In the logistic regression model, no evidence of association between the anaesthetic protocol for the management of RSE and in-hospital mortality, adjusted for the type of epilepsy, was found (OR 1.09 (95% CI = 0.17-6.87); p = 0.925). Cox regression analysis revealed a difference in the time to hospital discharge, adjusted by the type of epilepsy, between treatment groups (HR = 0.05 (95% CI = 0.01-0.54); p = 0.013). CONCLUSIONS AND CLINICAL RELEVANCE The time spent in hospital before discharge was longer in dogs with RSE treated with sodium thiopentone compared to those treated with propofol. However, as the sample size was very small, the results obtained in the present study should be analysed with caution. Further studies including a greater number of dogs are required.
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Affiliation(s)
- I Espiñeira
- UCICOOP, Buenos Aires, Argentina.,Small Animal Clinic, Faculty of Veterinary Sciences, University of Buenos Aires, Buenos Aires, Argentina
| | - D Alzate
- Canines and Felines Animal Hospital, Medellín, Colombia
| | - J Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - F Pellegrino
- Department of Anatomy, Faculty of Veterinary Sciences, University of Buenos Aires, Buenos Aires, Argentina
| | - M Tunesi
- UCICOOP, Buenos Aires, Argentina
| | - M Jensen
- UCICOOP, Buenos Aires, Argentina
| | - P A Donati
- UCICOOP, Buenos Aires, Argentina.,Department of Anaesthesiology and Algiology, Faculty of Veterinary Sciences, University of Buenos Aires, Buenos Aires, Argentina
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Kogure M, Takase E, Fusamoto A, Sato K, Tsuchihashi Y, Nakanishi H, Ikeda T, Kuchibiro T, Hirai Y, Kanai K. Treatment of refractory localized pulmonary nocardiosis caused by Nocardia mexicana with a combination of medication and surgery. Respirol Case Rep 2023; 11:e01098. [PMID: 36789173 PMCID: PMC9909781 DOI: 10.1002/rcr2.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Pulmonary nocardiosis is a rare disease that is often difficult to cure because of its tendency to recur. Here, we report a case of refractory localized pulmonary nocardiosis caused by Nocardia mexicana. A 60-year-old Japanese woman had recurring pulmonary nocardiosis four times previously and each time she was treated with antibiotics for a sufficient duration; nevertheless, the disease continued to recur, probably because of resistance to antibiotics. As a fifth treatment, we performed middle lobe resection and pre- and post-operative antimicrobial therapy for 6 months. The combination of medication and surgery was useful for treating refractory localized pulmonary nocardiosis.
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Affiliation(s)
- Miwako Kogure
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Eri Takase
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Aya Fusamoto
- Department of Breast and General Thoracic SurgeryNaga Municipal HospitalKinokawaWakayamaJapan
| | - Koichi Sato
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Yukiko Tsuchihashi
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Hirotaka Nakanishi
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Takeshi Ikeda
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Tomokazu Kuchibiro
- Department of Clinical LaboratoryNaga Municipal HospitalKinokawaWakayamaJapan
| | - Yoshimitsu Hirai
- Department of Breast and General Thoracic SurgeryNaga Municipal HospitalKinokawaWakayamaJapan
| | - Kuninobu Kanai
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
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Kang L, Liu Y, Luo Z, Zhou Y, Chen B, Yin G, Xie Q. Systematic review and meta-analysis of the current literature on tocilizumab in patients with refractory Takayasu arteritis. Front Immunol 2023; 14:1084558. [PMID: 36845158 PMCID: PMC9945188 DOI: 10.3389/fimmu.2023.1084558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Objective To present the pooled quantitative evidence of baseline characteristics and clinical outcomes of tocilizumab (TCZ) in patients with refractory Takayasu arteritis (TAK). Methods A comprehensive systematic review and meta-analysis was performed on all available studies retrieved from the MEDLINE, Embase, and Cochrane databases, using TCZ in patients with refractory TAK. We applied the commands metan and metaprop_one in Stata Software to pool overall estimates of continuous data and binomial data, respectively. A random-effects model was recruited for analysis. Results Nineteen studies with 466 patients were included in this meta-analysis. The mean age at implementation of TCZ was 34.32 years. Female sex and Numano Type V were the most prominent baseline characteristics. During the 12-month follow-up when receiving TCZ treatment, pooled CRP was 1.17 mg/L (95% confidence interval [CI] -0.18-2.52), pooled ESR was 3.54 mm/h (95% CI 0.51-6.58), and pooled glucocorticoid dose was 6.26 mg/d (95% CI 4.24-8.27). Approximately 76% (95% CI 58-87%) of patients achieved a decrease in glucocorticoid dosage. Meanwhile, patients with TAK had a remission rate of 79% (95% CI 69-86%), a relapse rate of 17% (95% CI 5-45%), an imaging progress rate of 16% (95% CI 9-27%), and a retention rate of 68% (95% CI 50-82%). Adverse events occurred in 16% (95% CI 5-39%) of patients, and infection was the most common adverse event, with a rate of 12% (95% CI 5-28%). Conclusion TCZ treatment can provide favorable outcomes in terms of inflammatory markers, steroid-sparing effects, clinical response, drug retention and minimizing adverse effects for patients with refractory TAK.
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Affiliation(s)
- Limei Kang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Liu
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongling Luo
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yueyuan Zhou
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Geng Yin
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Qibing Xie, ; Geng Yin,
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Qibing Xie, ; Geng Yin,
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Wieczorek A, Zaniewska-Tekieli A, Ehlert K, Pawinska-Wasikowska K, Balwierz W, Lode H. Dinutuximab beta combined with chemotherapy in patients with relapsed or refractory neuroblastoma. Front Oncol 2023; 13:1082771. [PMID: 36816982 PMCID: PMC9936065 DOI: 10.3389/fonc.2023.1082771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Prognosis in children with refractory and relapsed high-risk neuroblastoma is poor. Only a minority of patients obtain remission when treated with second-line chemotherapy regimens. Chemotherapy combined with anti-GD2 antibodies has previously been shown to increase response and survival rates. We retrospectively analyzed a cohort of 25 patients with relapsed or refractory high-risk neuroblastoma who were treated with irinotecan/temozolomide chemotherapy in combination with the anti-GD2 antibody dinutuximab beta. The therapy resulted in an objective response rate of 64%, with 32% of patients achieving a complete response. Response to treatment was observed in patients with refractory disease (n=5) and those with first (n=12) or consecutive (n=8) relapses, including patients with progressing disease. In four patients, best response was achieved after more than 5 cycles, suggesting that some patients may benefit from prolonged chemotherapy and dinutuximab beta treatment. Fourteen of our 25 patients had previously received dinutuximab beta, four of whom achieved complete response and six partial response (objective response rate 71%). The therapy was well tolerated, even in heavily pre-treated patients and those who had previously received dinutuximab beta treatment. Toxicities were comparable to those previously reported for the individual therapies, and no discontinuations due to toxicities occurred. Combination of chemotherapy with dinutuximab beta is a promising treatment option for patients with relapsed or refractory high-risk neuroblastoma and should be further explored in clinical studies.
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Affiliation(s)
- Aleksandra Wieczorek
- Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland,Pediatric Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland,*Correspondence: Aleksandra Wieczorek,
| | - Anna Zaniewska-Tekieli
- Pediatric Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Karoline Ehlert
- Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Katarzyna Pawinska-Wasikowska
- Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland,Pediatric Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Walentyna Balwierz
- Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland,Pediatric Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Holger Lode
- Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
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121
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Goursaud L, Berthon C, Quesnel B. Successful bridging to cell therapy for relapsed/ refractory acute lymphoblastic leukaemia with a combination of venetoclax and PEG-asparaginase. Br J Haematol 2023; 200:e37-e39. [PMID: 36470305 DOI: 10.1111/bjh.18595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Laure Goursaud
- CHU Lille, Service des Maladies du Sang, Lille, France.,CNRS, Inserm, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Celine Berthon
- CHU Lille, Service des Maladies du Sang, Lille, France.,CNRS, Inserm, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Bruno Quesnel
- CHU Lille, Service des Maladies du Sang, Lille, France.,CNRS, Inserm, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,Univ. Lille, Lille, France
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Shargian L, Amit O, Bernstine H, Gurion R, Gafter-Gvili A, Rozovski U, Pasvolsky O, Perets G, Horowitz NA, Halloun J, Perry C, Avivi I, Raanani P, Yeshurun M, Ram R. The role of additional chemotherapy prior to autologous HCT in patients with relapse/ refractory DLBCL in partial remission-A retrospective multicenter study. Eur J Haematol 2023; 110:149-156. [PMID: 36251268 PMCID: PMC10092282 DOI: 10.1111/ejh.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the role of additional chemotherapy before autologous hematopoietic cell transplantation (HCT) in patients with relapse/refractory diffuse large B-cell lymphoma (DLBCL) who achieve partial remission following first salvage therapy. METHODS We conducted a multicenter retrospective study of all adult patients with DLBCL who underwent HCT between 2008 and 2020 and achieved partial response (PR) after the first salvage and were either referred directly to HCT (n = 47) or received additional salvage therapy before HCT (n = 22). RESULTS Post-HCT CR rate and progression-free survival were comparable between the two groups (66% vs. 68%, p = .86 and median not reached vs. 10.2 months [95% confidence interval, CI 7.1-12.3], p = .27, respectively). Median overall survival (OS) and estimated 3-year OS favored patients who were directly referred to HCT (105.8 [95% CI 63-148] months vs. 14.5 [95% CI 0-44] months, p = .035, and 65% [95% CI 51%-75%] vs. 40% [95% CI 21%-53%], p = .035, respectively). In Cox regression model, while International Prognostic Index and primary refractory versus relapse disease did not impact OS, allocation to a second salvage regimen and older age were both associated with inferior survival (hazard ratio [HR] = 2.57 95% CI 1.1-5.8, p = .023 and HR = 1.04 95% CI 0.99-1.2, p = .064, respectively). CONCLUSIONS Referring patients with chemotherapy-sensitive disease in PR directly to HCT is associated with better OS compared to those receiving additional lines of treatment.
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Affiliation(s)
- Liat Shargian
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Odelia Amit
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Hematology, Sourasky Medical Center, Tel-Aviv, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nuclear Medicine, Rabin Medical Center, Petah-Tikva, Israel
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Gafter-Gvili
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Galit Perets
- Department of Hematology and Bone Marrow Transplantation, Soroka Medical center and Faculty of Medicine, Beer Sheva, Israel
| | - Netanel A Horowitz
- Department of Hematology and BMT, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Chava Perry
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Hematology, Sourasky Medical Center, Tel-Aviv, Israel
| | - Irit Avivi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Hematology, Sourasky Medical Center, Tel-Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Ram
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Hematology, Sourasky Medical Center, Tel-Aviv, Israel
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Varughese P, Smith R, Xue M, Dorrow N, Hogea C, Maiese EM, Buckingham T. Real-world treatment patterns and outcomes of triple-class treated patients with multiple myeloma in the United States. Expert Rev Hematol 2023; 16:65-74. [PMID: 36579455 DOI: 10.1080/17474086.2023.2154648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Although multiple myeloma (MM) survival has improved following the introduction of proteosome inhibitors, immunomodulatory drugs, and anti-CD38 therapies, patients become refractory to these agents. Real-world outcomes of triple-class exposed patients are limited and were investigated in this study. METHODS The Integra Connect Database was used to assess the treatment patterns of triple-class exposed patients with relapsed/refractory MM (RRMM) (January 2016-December 2019). RESULTS During this period, patients (N = 501) reached triple exposure in a median of three lines of therapy (LOTs) over 995 days. A new LOT was started in a median of 18 (1-691) days after triple exposure; 71% of the patients started a new LOT within 30 days. Throughout the follow-up period, 8% of the patients had a therapy gap greater than 90 days. Following triple exposure, 103/501 patients (21%) received only triple-class agents in subsequent LOTs, while 24 (4.8%) patients received only non-triple-class agents. The median apparent survival from initiation of first therapy after triple exposure was 308 days. CONCLUSION These results indicate that recycling of triple-class agents after previous exposure is widespread and prognosis in the RRMM population remains poor, highlighting the continuing unmet need for new agents with novel mechanisms to improve patient outcomes.
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Affiliation(s)
| | | | - Mei Xue
- IntegraConnect, West Palm Beach, FL, USA
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Zhao YW, Liu S, Qin H, Sun JB, Su M, Yu GJ, Zhou J, Gao F, Wang RY, Zhao T, Zhao GS. Efficacy and safety of CalliSpheres drug-eluting beads for bronchial arterial chemoembolization for refractory non-small-cell lung cancer and its impact on quality of life: A multicenter prospective study. Front Oncol 2023; 13:1110917. [PMID: 37124525 PMCID: PMC10141642 DOI: 10.3389/fonc.2023.1110917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Objective This study aimed to prospectively observe the efficacy and safety of CalliSpheres drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) for refractory non-small-cell lung cancer (NSCLC). Methods The interventional therapy plan was as follows: 300-500 μm CalliSpheres drug-loaded microspheres were loaded with epirubicin, and then slow embolization of tumor supplying artery was performed after microcatheter superselection. Chest enhanced computed tomography and related hematological examination were reviewed after 2 months of DEB-BACE, and the tumor response after the first interventional therapy was evaluated using modified response evaluation criteria in solid tumors. The overall survival (OS) of patients was determined, and the quality of life and the incidence rate of adverse reactions were observed. Results From January 2019 to January 2021, 43 patients with refractory NSCLC were enrolled. The patients were followed up until June 2022. All 43 patients underwent DEB-BACE 1.79 ± 0.69 times on average. The 3-, 6-, 12-, and 24-month survival rates were 100%, 86.0%, 41.9%, and 11.8%, respectively. The median OS was 11.5 months. After the first interventional treatment, cough and wheezing significantly improved in 31 patients, hemoptysis was effectively controlled in 12 patients, and superior vena cava compression disappeared in 2 patients after 2 times of treatment. The general health status of the patients after treatment significantly improved compared with that before treatment, including the improvement in physical and emotional functions. Fatigue, nausea and vomiting, dyspnea, and insomnia improved significantly after treatment. No serious adverse events, such as spinal cord injury and cerebral embolism, were observed during the perioperative period. The main adverse reaction after DEB-BACE was chest pain (13/43, grade 1) followed by fever (10/43, grade 1-2), which was significantly relieved within 3-5 days after symptomatic treatment. Other adverse reactions included irritating cough, nausea and vomiting, and bone marrow suppression, and the incidence was less than 20%. Conclusions DEB-BACE was effective and safe in treating refractory NSCLC, which could significantly improve patients' quality of life and was worthy of clinical promotion and application.
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Affiliation(s)
- Yu Wei Zhao
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
| | - Song Liu
- Cancer Interventional Center, Linyi Cancer Hospital, Linyi, Shandong, China
| | - Hao Qin
- Department of Emergency Surgery, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
| | - Jin Bo Sun
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Mao Su
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Guang Ji Yu
- Cancer Interventional Center, Linyi Cancer Hospital, Linyi, Shandong, China
| | - Jun Zhou
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Fei Gao
- Cancer Interventional Center, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ruo Yu Wang
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
- *Correspondence: Guang Sheng Zhao, ; Tong Zhao, ; Ruo Yu Wang,
| | - Tong Zhao
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
- *Correspondence: Guang Sheng Zhao, ; Tong Zhao, ; Ruo Yu Wang,
| | - Guang Sheng Zhao
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- *Correspondence: Guang Sheng Zhao, ; Tong Zhao, ; Ruo Yu Wang,
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125
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Seng MS, Meierhofer AC, Lim FL, Soh SY, Hwang WYK. A Review of CAR-T Therapy in Pediatric and Young Adult B-Lineage Acute Leukemia: Clinical Perspectives in Singapore. Onco Targets Ther 2023; 16:165-176. [PMID: 36941828 PMCID: PMC10024535 DOI: 10.2147/ott.s271373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/07/2023] [Indexed: 03/15/2023] Open
Abstract
Approximately 10-15% of pediatric B-cell acute lymphoblastic leukemia (B-ALL) are high risk at diagnosis or relapsed/ refractory. Prior to the availability of chimeric antigen receptor T-cell (CAR-T) in Singapore and the region, the treatment options for these paediatric and young adults are conventional salvage chemotherapy or chemo-immunotherapy regimens as a bridge to allogeneic total body irradiation-based hematopoietic stem cell transplantation (allo-HSCT). This results in significant acute and long-term toxicities, with suboptimal survival outcomes. Finding a curative salvage therapy with fewer long-term toxicities would translate to improved quality-adjusted life years in these children and young adults. In this review, we focus on the burden of relapsed/refractory pediatric B-ALL, the limitations of current strategies, the emerging paradigms for the role of CAR-T in r/r B-ALL, our local perspectives on the health economics and future direction of CAR-T therapies in pediatric patients.
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Affiliation(s)
- Michaela S Seng
- Department of Paediatric Hematology and Oncology, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Francesca L Lim
- Duke-NUS Medical School, Singapore
- Department of Hematology, Singapore General Hospital, Singapore
| | - Shui Yen Soh
- Department of Paediatric Hematology and Oncology, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - William Y K Hwang
- Duke-NUS Medical School, Singapore
- Department of Hematology, Singapore General Hospital, Singapore
- National Cancer Centre Singapore, Singapore
- Correspondence: William YK Hwang, Department of Haematology, Singapore General Hospital, 31 Third Hospital Ave, 168753, Singapore, Tel +65 62223322, Email
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Arabpour E, Khoshdel S, Akhgarzad A, Abdi M, Tabatabaie N, Alijanzadeh D, Abdehagh M. Baclofen as a therapeutic option for gastroesophageal reflux disease: A systematic review of clinical trials. Front Med (Lausanne) 2023; 10:997440. [PMID: 36873860 PMCID: PMC9981648 DOI: 10.3389/fmed.2023.997440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
Background The main components of gastroesophageal reflux disease (GERD) management include a combination of medications and lifestyle modifications; Nevertheless, based on the severity of symptoms and their response to medications, other treatments could be considered. Baclofen has been demonstrated in studies to relieve GERD symptoms. The current study aimed to precisely address the effects of baclofen on the treatment of GERD and its characteristics. Methods A systematic search was carried out in Pubmed/Medline, Cochrane CENTRAL, Scopus, Google Scholar, Web of Science, and clinicaltrials.gov up to December 10, 2021. The search terms included baclofen, GABA agonists, GERD, and reflux. Results We selected 26 papers that matched the inclusion criteria after examining 727 records. Studies were classified into four categories based on the study population and reported outcomes: (1) adults, (2) children, (3) patients with gastroesophageal reflux-induced chronic cough, (4) hiatal hernia patients. The results revealed that baclofen can significantly improve reflux symptoms and pH-monitoring and manometry findings to different degrees in all four mentioned categories; although its effect on pH-monitoring parameters seems less significant than the other parameters. Mild neurological and mental status deterioration were the most reported side effects. However, side effects occurred in a portion of less than 5% of short-term users and nearly 20% of long-term users. Conclusion In PPI-resistant patients, a trial of adding baclofen to the PPI may be helpful. Baclofen therapies may be more beneficial for symptomatic GERD patients who also report concurrent conditions including alcohol use disorder, non-acid reflux, or obesity. Systematic review registration https://clinicaltrials.gov/.
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Affiliation(s)
- Erfan Arabpour
- Department of Gastroenterology and Hepatology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Khoshdel
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akhgarzad
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadamin Abdi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Tabatabaie
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dorsa Alijanzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdehagh
- Department of Gastroenterology and Hepatology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Edwards RJ, Parboo M, Edwards J, Boyce G. Trichomoniasis refractory to 5-nitroimidazole therapy in Trinidad. Trop Doct 2023; 53:143-145. [PMID: 36214266 DOI: 10.1177/00494755221131370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Trichomoniasis is the most common non-viral sexually transmitted infection (STI) occurring worldwide and the majority of infected persons (70-85%) have mild or no genital symptoms. Symptoms in women may include a vaginal discharge which may be associated with vulval irritation and most infections can be effectively treated with metronidazole 500mg bd for seven days. Trichomoniasis unresponsive to 5-nitroimidazole therapy is uncommon but results in substantial therapeutic challenges, especially in resource limited countries. We present such a case which was eventually treated with a low-cost intravaginal combination of boric acid and clotrimazole cream.
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Affiliation(s)
- Robert Jeffrey Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad.,Department of Paraclinical Sciences, University of the West Indies, St Augustine, Trinidad
| | - Miriam Parboo
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Jonathan Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Gregory Boyce
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
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Miller SD, Lozano-Ortega G, Mutebi A, Briggs O, Sail K, Elliott B, Kalsekar A. Systematic review of outcomes and patient heterogeneity in relapsed or refractory diffuse large B-cell lymphoma. J Comp Eff Res 2023; 12:e220146. [PMID: 36417238 PMCID: PMC10288944 DOI: 10.2217/cer-2022-0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Aim: To evaluate trials of systemic therapies in transplant-ineligible or -experienced, relapsed/refractory diffuse large-B cell lymphoma and the impact of patient characteristics on overall response rate (ORR). Patients & methods: Systematically reviewed multiple databases through 22 July 2021. Analyzed variations in patient characteristics and their relationship with ORR across trials. Results: Among 17 included trials, key patient characteristics varied substantially: primary refractory (0-69%), refractory to last line of therapy (LOT) (12-100%), ≥2 prior LOTs (14-100%), ≥3 prior LOTs (0-64%), IPI ≥3 (23-73%), tumor stage III/IV (50-90%) and median age (56-74 years). ORRs varied substantially (25-83%), correlating with these characteristics. Conclusion: Differences in patient characteristics significantly contribute to the variability in ORR across these trials and should be considered when contextualizing efficacy data.
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Affiliation(s)
- Sally D Miller
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC V6A 1A4, Canada
| | | | - Alex Mutebi
- Genmab, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
| | - Owanate Briggs
- Genmab, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
| | - Kavita Sail
- AbbVie, 1 N. Waukegan Road, Chicago, IL 60064, USA
| | - Brian Elliott
- Genmab, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
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Ivarola P, Pociecha J, Princich J, Bartuluchi M, Caraballo R. [Benefit of surgery in a case of negative motor focal epileptic seizures secondary to parietal cortical dysplasia]. Medicina (B Aires) 2023; 83:1013-1017. [PMID: 38117725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Focal atonic seizures are recognized rarely as ictal phenomena, they can correspond to both generalized epilepsy and focal epilepsy. The areas of the brain involved in the management of this type of seizure are: the negative motor area and the primary motor and primary somatosensory cortices, although the neurophysiology that generates them is still unclear. We present the case of a patient with focal atonic seizures in the left upper limb, refractory to drug treatment. Neuroimaging was performed, a parietal cortical lesion was diagnosed. A scalp Video EEG and then a Stereo EEG was performed, defining the epileptogenic area and its relationship with eloquent areas. Surgical resection of the lesion was performed, achieving complete seizure control.
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Affiliation(s)
- Paula Ivarola
- Servicio de Neurología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. E-mail:
| | - Juan Pociecha
- Servicio de Neurología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Juan Princich
- Servicio de Diagnóstico por Imágenes, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Marcelo Bartuluchi
- Servicio de Neurocirugía, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Roberto Caraballo
- Servicio de Neurología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Garavatti E, Yamamoto E, Collins K, Selden N, Bushlin I. Surgical Resection of Focal Cortical Dysplasia in a Neonate with Novel TSC1 Mutation Leading to Resolution of Refractory Seizures: Case Report. Child Neurol Open 2023; 10:2329048X231219223. [PMID: 38107744 PMCID: PMC10722926 DOI: 10.1177/2329048x231219223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
We describe a neonate presenting on first day of life with refractory seizures secondary to a single, large area of focal cortical dysplasia (FCD) who underwent surgical resection at age 3 weeks leading to resolution of seizure activity and dramatic improvement in developmental trajectory. Surgical intervention for epilepsy is infrequently offered for neonates, often reserved only for those with catastrophic presentations. This case demonstrates that surgical intervention can be safe and efficacious in neonates for pharmaco-resistant seizures associated with a focal lesion. Rapid whole exome sequencing in this case yielded a germline novel de novo TSC1 mutation, leading to a genetic diagnosis of tuberous sclerosis complex (TSC). Our patient demonstrates an atypical neonatal presentation of TSC. Limited data is available for those with isolated FCD in TSC; this is the first reported case in a neonate.
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Affiliation(s)
- Emily Garavatti
- Neurodevelopmental Disabilities, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Erin Yamamoto
- Neurosurgery, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Kelly Collins
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA
| | - Nathan Selden
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA
| | - Ittai Bushlin
- Department of Pediatric Neurology, Oregon Health & Science University, Portland, OR, USA
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Iqbal A, Sharma C, Bora RL, Phukan A. Efficacy and safety of biosimilar romiplostim in Indian patients with chronic immune thrombocytopenia: A multicentric retrospective study. INDIAN J PATHOL MICR 2023; 66:96-100. [PMID: 36656218 DOI: 10.4103/ijpm.ijpm_1034_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Context and Aims To evaluate the efficacy and safety of biosimilar romiplostim in Indian patients with immune thrombocytopenic purpura (ITP). Settings and Design Multicentre, retrospective observational study. Methods and Material Patients with chronic ITP who received biosimilar romiplostim from July 2019 to March 2020 across 3 major hospitals in Guwahati, India, were included. The study outcomes were the platelet response (platelet count > 50 × 109/L), time to first response, number of dose-limiting events, and the median effective dose. Statistical Analysis Used Descriptive. Results Of 32 patients included in this analysis, majority (59.4%) were females. The mean (SD) age was 40.37 (15.79) years, and mean age at ITP diagnosis was 38.53 years. The median number of romiplostim doses were 27.5 (range: 10-42) over a period of 10 months; median romiplostim dose used was 4.2 μg/kg (range: 2.8-5 μg/kg). Platelet response was achieved as early as after one week in 9 (28.12%) patients, which continued to increase to 24 (75%) patients after the second, 30 (93.75%) patients after the third and all 32 (100%) patients after four weeks of romiplostim administration. The median platelet count was 161 × 109/L. Dose reduction was done in a total of 21 patients. Thrombocytosis (46.88%), elevated liver enzymes (15.63%) and myalgia (15.63%) were the most common adverse events. Conclusions Biosimilar romiplostim was effective in achieving and maintaining platelet response without any new safety concerns in Indian adult patients with chronic ITP. The median effective dose of romiplostim required in our patients was lower as compared with the standard prescribed dose.
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Affiliation(s)
- Asif Iqbal
- Health City Hospital, Guwahati, Assam, India
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Sener S, Batu ED, Sari S, Kasap Cuceoglu M, Yildiz AE, Talim B, Aydingoz U, Ozen S, Haliloglu G. A Child with Refractory and Relapsing Anti-3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Myopathy: Case-Based Review. J Neuromuscul Dis 2023; 10:279-291. [PMID: 36617789 DOI: 10.3233/jnd-221557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVE Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) myopathy is rare in children. Here, we present a boy with relapsing refractory anti-HMGCR myopathy along with a systematic literature review. CASE REPORT 17-year-old boy with five years of muscle weakness, rash, high creatinine kinase (CK) levels, and muscle biopsy compatible with inflammatory myopathy was diagnosed with juvenile dermatomyositis. He was treated with corticosteroids, intravenous immunoglobulin (IVIG), and methotrexate. His muscle weakness improved with this treatment although never completely resolved. CK levels decreased from ∼15000 U/L to ∼3000 U/L. At the age of 15, muscle weakness relapsed after an upper respiratory tract infection; pulse corticosteroid treatment was administered. The re-evaluated muscle biopsy showed a necrotizing pattern and the HMGCR antibody was positive confirming anti-HMGCR myopathy when he was 16. The diagnostic delay was 50 months. Disease activity was monitored by Medical Research Council score, MRI and functional tests. Despite corticosteroids, methotrexate, IVIG, cyclosporine A, and rituximab therapies, muscle weakness improved only slightly during the first three months and remained stable afterwards.Results of the Literature Search:We identified 16 articles describing 50 children (76% female) with anti-HMGCR myopathy by reviewing the English literature up to March 1st, 2022. Proximal muscle weakness was the most common clinical symptom (70.8%). Corticosteroids (84.8%), IVIG (58.7%), and methotrexate (56.5%) were preferred in most cases. Complete remission was achieved in nine patients (28.1%). CONCLUSION Diagnosis and management of children with anti-HMGCR myopathy are challenging. Complete remission is achieved in only one third of these patients. Imaging biomarkers may aid treatment.
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Affiliation(s)
- Seher Sener
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Sari
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Adalet Elcin Yildiz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Beril Talim
- Division of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ustun Aydingoz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Goknur Haliloglu
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Liu Y, Wang F. Failure of double filtration plasmapheresis to treat severe pemphigus vulgaris: A case report. J Clin Apher 2022. [PMID: 36579441 DOI: 10.1002/jca.22036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/05/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022]
Abstract
Pemphigus vulgaris (PV) is a chronic, mucocutaneous, autoimmune bullous disease. Double filtration plasmapheresis (DFPP) may be effective when PV fails to be controlled by conventional corticosteroid treatment. The patient was a 64-year-old man with erythema, blisters, and erosions on his head, face, mouth, trunk, limbs, and scrotum for over a month. He was diagnosed with severe PV, and the original rash area continued to expand after treatment with systemic corticosteroids, immunosuppressants, and intravenous immunoglobulin, with massive exudate and ≥5 new blisters and macules still occurring daily. Subsequently, the patient completed three sessions of DFPP. After the first DFPP, the original erosion surface exudate was significantly reduced and gradually healed. After the second DFPP, the erosion area and exudate increased compared with the previous one. After the third DFPP, the rash did not improve further and had a tendency to continue to progress. During the entire three sessions of DFPP, the patient had new blisters and bullae on his limbs every day. The Nikolsky's sign of the limbs turned negative at the initial stage, and then the trunk and limbs Nikolsky's sign became positive again. The titer of autoantibodies did not decrease significantly after the plasmapheresis. The patient eventually died of secondary lung infection and septic shock. The efficacy of DFPP in this patient with refractory severe PV was poor.
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Affiliation(s)
- Yangai Liu
- Department of Dermatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Fei Wang
- Department of Dermatology, Zhong Da Hospital, Southeast University, Nanjing, China
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de Arriba de la Fuente F, Montes Gaisán C, de la Rubia Comos J. How to Manage Patients with Lenalidomide- Refractory Multiple Myeloma. Cancers (Basel) 2022; 15:cancers15010155. [PMID: 36612152 PMCID: PMC9818178 DOI: 10.3390/cancers15010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Although lenalidomide-based combinations, such as lenalidomide plus a proteasome inhibitor or an anti-CD38 monoclonal antibody, improve the overall response rate, progression-free survival, and overall survival of patients with relapsed/refractory multiple myeloma (RRMM), there is a tendency to use these regimens as a frontline treatment. This strategy has led to the development of refractoriness early in the disease course, usually after the patient's first treatment. Since lenalidomide-free regimens have so far shown limited efficacy in lenalidomide-refractory patients, there is an unmet need for other treatment options. In this review, we discuss the therapeutic options available to treat the general population of lenalidomide-refractory patients (mono, double and triple refractory) and the subpopulation of patients with other high-risk features such as renal failure, extramedullary disease, and high-risk cytogenetics. Moreover, new promising individual therapies and the possible impact of immunotherapy in RRMM patients are debated.
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Affiliation(s)
- Felipe de Arriba de la Fuente
- Haematology and Medical Oncology Department, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biomédica (IMIB)-Arrixaca, Universidad de Murcia, 30008 Murcia, Spain
| | - Carmen Montes Gaisán
- Haematology Department, Hospital Universitario Marqués de Valdecilla, 39008 Cantabria, Spain
| | - Javier de la Rubia Comos
- Haematology Department, Hospital Universitario y Politécnico La Fe and Universidad Católica “San Vicente Mártir”, CIBERONC CB16/12/00284, 46001 Valencia, Spain
- Correspondence:
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Olgun N, Cecen E, Ince D, Kizmazoglu D, Baysal B, Onal A, Ozdogan O, Guleryuz H, Cetingoz R, Demiral A, Olguner M, Celik A, Kamer S, Ozer E, Altun Z, Aktas S. Dinutuximab beta plus conventional chemotherapy for relapsed/ refractory high-risk neuroblastoma: A single-center experience. Front Oncol 2022; 12:1041443. [PMID: 36620564 PMCID: PMC9816792 DOI: 10.3389/fonc.2022.1041443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Relapsed/refractory high-risk neuroblastoma has a dismal prognosis. Anti-GD2-mediated chemo-immunotherapy has a notable anti-tumor activity in patients with relapsed/refractory high-risk neuroblastoma. The purpose of this study was to analyze the efficacy and safety of the combination of immunotherapy with dinutuximab beta (DB) and chemotherapy in patients with relapsed/refractory high-risk neuroblastoma. Methods All patients received the Turkish Pediatric Oncology Group NB 2009 national protocol for HR-NB treatment at the time of diagnosis. Salvage treatments were administered after progression or relapse. The patients who could not achieve remission in primary or metastatic sites were included in the study. The most common chemotherapy scheme was irinotecan and temozolomide. DB was administered intravenously for 10 days through continuous infusion with 10 mg/m2 per day. The patients received 2 to 14 successive cycles with duration of 28 days each. Disease assessment was performed after cycles 2, 4, and 6 and every 2 to 3 cycles thereafter. Results Between January 2020 and March 2022, nineteen patients received a total of 125 cycles of DB and chemotherapy. Objective responses were achieved in 12/19 (63%) patients, including complete remission in 6/19 and partial response in 6/19. Stable disease was observed in two patients. The remaining five patients developed bone/bone marrow and soft tissue progression after 2-4 cycles of treatment. The most common Grade ≥3 toxicities were leukopenia, thrombocytopenia, hypertransaminasemia, fever, rash/itching and capillary leak syndrome, respectively. Conclusion Our study results suggest that DB-based chemo-immunotherapy seems to be suitable with encouraging response rates in patients with relapsed/refractory high-risk neuroblastoma.
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Affiliation(s)
- Nur Olgun
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye,*Correspondence: Nur Olgun,
| | - Emre Cecen
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye
| | - Dilek Ince
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye
| | - Deniz Kizmazoglu
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye
| | - Birsen Baysal
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye
| | - Ayse Onal
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye
| | - Ozhan Ozdogan
- Department of Nuclear Medicine, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Handan Guleryuz
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Riza Cetingoz
- Department of Radiation Oncology, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Ayse Demiral
- Department of Radiation Oncology, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University School of Medicine, Izmir, Türkiye
| | - Serra Kamer
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Türkiye
| | - Erdener Ozer
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Zekiye Altun
- Department of Basic Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye
| | - Safiye Aktas
- Department of Basic Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Türkiye
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136
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Wu Z, Teng Y, Wu J, Zhang H, Peng W, Meng C, Tang W, Feng J. Clinical use of HD-MTX monotherapy in a rare case of refractory primary bone diffuse large B-cell lymphoma with long-term survival after local radiotherapy: A case report. Front Med (Lausanne) 2022; 9:989590. [PMID: 36619626 PMCID: PMC9810803 DOI: 10.3389/fmed.2022.989590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Primary bone diffuse large B-cell lymphoma (PB-DLBCL) has been rarely reported because of its low incidence. The optimal treatment plan for patients with relapsed/refractory PB-DLBCL remains controversial. In this study, we present a case of a 57-year-old patient with refractory PB-DLBCL to better understand this disease. The patient developed lumbosacral/low extremity pain. A lumbar magnetic resonance imaging (MRI) revealed skeletal lesions with osteolysis in L4-L5 and S1. With the failure of multi-line chemotherapy, the patient developed paralysis of both lower limbs. 18-Fluorinefluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and MRI showed new lesions in the femoral head, cervical and thoracic vertebrae. We tried to treat the patient with adjuvant radiotherapy and 10 courses of high-dose methotrexate (HD-MTX)-based monotherapy, after which the patient was able to walk and achieved complete remission (CR). To the best of our knowledge, this is the first attempt to use local radiotherapy combined with an HD-MTX regimen successfully for the treatment of refractory PB-DLBCL.
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Affiliation(s)
- Zhiya Wu
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Teng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jianqiu Wu
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Honglu Zhang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Weiwei Peng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Meng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Weiyan Tang
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Weiyan Tang,
| | - Jifeng Feng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,Jifeng Feng,
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137
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Chen LC, Yeung CY, Chang CW, Lee HC, Chan WT, Jiang CB, Chang SW. Blue Rubber Bleb Nevus Syndrome (BRBNS): A Rare Cause of Refractory Anemia in Children. Children (Basel) 2022; 10:children10010003. [PMID: 36670554 PMCID: PMC9856356 DOI: 10.3390/children10010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Refractory anemia is not uncommon in pediatric patients, and anemia caused by gastrointestinal tract bleeding should always be kept in mind. Aside from infection or intestinal malrotation related bleeding, vascular malformation should also be considered. Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder consisting of multiple venous malformations. Lack of experience in pediatric BRBNS might lead to delayed diagnosis or misdiagnosis. Herein, we report a case of an eleven-year-old boy with recurrent pallor appearance and weakness diagnosed with BRBNS. After a thorough examination, he was treated with endoscopic polypectomy, and further iron supplements and folic acid. He is now under regular follow-up at our outpatient department. No complication is noted for six months. BRBNS is a rare venous malformation syndrome that mostly involves skin and the gastrointestinal tract. Multidisciplinary approach should be arranged for diagnosis and management. Up to date, no consensus for BRBNS treatment has been reached. Management usually depends on clinical symptoms and severity of damage of involved organs. The options of treatment include conservative, medical, endoscopic, and surgical management.
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Affiliation(s)
- Liang-Chun Chen
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 242, Taiwan
| | - Chun-Yan Yeung
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hsinchu Municipal MacKay Children’s Hospital, No. 690, Sec. 2, Guangfu Rd., East Dist., Hsinchu City 300044, Taiwan
- Correspondence: ; Fax: +886-3-6110900
| | - Chen-Wang Chang
- Department of Hepatology and Gastroenterology, MacKay Memorial Hospital, Taipei City 104, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Szu-Wen Chang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mackay Memorial Tamshui Branch Hospital, New Taipei City 251, Taiwan
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Sugimoto T, Yamawaki T, Naito H, Ohno N, Giga M, Kono T, Ochi K, Kohriyama T, Nomura E, Maruyama H. [The Myasthenia Gravis Activities of Daily Living score and associated factors to distinguish the refractory phase in generalized myasthenia gravis patients with 5 years or more disease duration]. Rinsho Shinkeigaku 2022; 62:915-921. [PMID: 36450489 DOI: 10.5692/clinicalneurol.cn-001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Associated factors of the Myasthenia Gravis Activities of Daily Living (MG-ADL) score were investigated in 55 patients who had had generalized MG for more than 5 years. In multivariate analysis, correlates of the MG-ADL score at the last follow-up were the total number of fast-acting treatments (FTs) (standardized regression coefficient 0.617,P < 0.001) and Myasthenia Gravis Foundation of America (MGFA) classification (standardized regression coefficient 0.227,P = 0.032) (F = 32.7,P < 0.001). In patients with a score of 5 or more on MG-ADL at the last follow-up, tendency as follows were seen: 1) early-onset (P = 0.002), 2) longer duration (P = 0.014), 3) high frequency of MGFA classification V (P = 0.017), 4) high frequency of the total number of FTs (P < 0.001), and 5) higher dose of prednisolone at the last follow-up (P = 0.003). MGFA V, early-onset without depending on E-L-T classification, or difficulty of reduction for high doses of prednisolone can be the target of novel treatment for MG, and future prospective study will be expected.
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Affiliation(s)
- Takamichi Sugimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University
| | - Takemori Yamawaki
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
- Department of Internal Medicine, Hiroshima Teishin Hospital
| | - Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University
| | - Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Kazuhide Ochi
- Department of Neurology, Hiroshima Prefectural Hospital
| | - Tatsuo Kohriyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University
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Castagna L, Bono R, Tringali S, Sapienza G, Santoro A, Indovina A, Tarantino V, Di Noto L, Maggio A, Patti C. The place of allogeneic stem cell transplantation in aggressive B-cell non-Hodgkin lymphoma in the era of CAR-T-cell therapy. Front Med (Lausanne) 2022; 9:1072192. [PMID: 36561713 PMCID: PMC9763323 DOI: 10.3389/fmed.2022.1072192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Chimeric antigen receptor T (CAR-T) cells are a treatment option for patients with relapse/refractory (R/R) non-Hodgkin lymphoma (NHL), acute lymphoid leukemia and multiple myeloma. To date, diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), follicular lymphoma (FL), and chronic lymphocytic leukemia (CLL) have been successfully treated with CAR-T cells directed against the CD19 antigen. However, when R/R disease persists after several treatment lines, patients with these diseases are often referred to transplantation centres to receive allogeneic stem cell transplantation (ALLO-SCT). ALLO-SCT and CAR-T cells share mechanism of actions, inducing immune effects of T-cells (and other cells after transplantation) against lymphoma cells, but they differ in several other characteristics. These differences justify unique positioning of each therapy within treatment algorithms. In this paper, we analyzed the results obtained after ALLO-SCT and CAR-T-cell therapy in patients with aggressive lymphomas (large B-cell lymphoma and MCL) to identify the ideal scenarios in which these 2 immunological therapies should be employed.
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Affiliation(s)
- Luca Castagna
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, Palermo, Italy,*Correspondence: Luca Castagna
| | - Roberto Bono
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | | | | | - Alessandra Santoro
- Onco-Hematology and Cell Manipulation Laboratory Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | | | - Vittoria Tarantino
- Onco-Hematology Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Laura Di Noto
- Transfusional and Transplantation Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Aurelio Maggio
- Campus of Hematology Franco and Piera Cutino, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Caterina Patti
- Onco-Hematology Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
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Shi Y, Ding W, Gu W, Shen Y, Li H, Zheng Z, Zheng X, Liu Y, Ling Y. Single-cell phenotypic profiling to identify a set of immune cell protein biomarkers for relapsed and refractory diffuse large B cell lymphoma: A single-center study. J Leukoc Biol 2022; 112:1633-1648. [PMID: 36040107 DOI: 10.1002/jlb.6ma0822-720rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 01/04/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common invasive type of non-Hodgkin lymphoma. Cell-of-origin (COO) classification is related to patients' prognoses. Primary drug resistance in treatment for DLBCL has been observed. The specific serum biomarkers in these patients who suffer from relapsed and refractory (R/R)-DLBCL remains unclear. In the current study, using single-cell RNA sequencing (scRNA-seq) and mass cytometry (CyTOF), we determined and verified immune cell biomarkers at the mRNA and protein levels in single-cell resolution from 18 diagnostic PBMC specimens collected from patients with R/R DLBCL. As controls, 5 PBMC specimens from healthy volunteers were obtained. We identified a panel of 35 surface marker genes for the features of R/R DLBCL unique cell cluster by scRNA-seq of 8 R/R DLBCL patient samples and validated its efficiency in an external cohort consisting of 10 R/R DLBCL patients by CyTOF. The cell clustering and dimension reduction were compared among R/R DLBCL samples in CyTOF Space with COO as well as the C-MYC expression designation. Immune cells from each patient occupied unique regions in the 32-dimensional phenotypic space with no apparent clustering of samples into discrete subtypes. Significant heterogeneity observed in subgroups was mainly attributed to individual differences among samples and not to expression differences in a single, homogeneous immune cell subpopulation. The marker panel showed reliability in labeling R/R DLBCL without any influence from COO stratification and C-MYC expression designation. Furthermore, we compared all the markers between R/R DLBCL and normal samples. A total of 12 biomarkers were significantly overexpressed in R/R DLBCL relative to the normal samples. Therefore, we further optimized the diagnostic biomarker panel of R/R DLBCL comprising CD82, CD55, CD36, CD63, CD59, IKZF1, CD69, CD163, CD14, CD226, CD84, and CD31. In summary, we developed a novel set of biomarkers for the diagnoses of patients with R/R DLBCL. Detections procedures at single-cell resolution provide precise biomarkers, which may substantially overcome intertumoral and intratumoral heterogeneity among primary samples. The findings confirmed that each case was unique and may comprise multiple, genetically distinct subclones.
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Affiliation(s)
- Yuan Shi
- Department of hematology laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Weidong Ding
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Weiying Gu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yangling Shen
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Haiqian Li
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhuojun Zheng
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, China.,Institute for Cell Therapy of Soochow University, Changzhou, China
| | - Xiao Zheng
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, China.,Institute for Cell Therapy of Soochow University, Changzhou, China
| | - Yan Liu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yun Ling
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Yang XF, Jia XY, Yu XJ, Cui Z, Zhao MH. Rituximab for the treatment of refractory anti-glomerular basement membrane disease. Ren Fail 2022; 44:1123-1129. [PMID: 35820833 PMCID: PMC9291707 DOI: 10.1080/0886022x.2022.2097405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Anti-glomerular basement membrane (anti-GBM) disease is a rare but severe autoantibody-mediated immune disorder. The typical clinical presentation includes rapidly progressive glomerulonephritis and often concurrent pulmonary hemorrhage. The present study is aimed to investigate the therapeutic effects of rituximab either used alone or with other immunosuppressants. METHODS Eight patients diagnosed with anti-GBM disease and treated with rituximab from 2014 to 2020 were retrospectively reviewed. RESULTS Eight patients included 5 males and 3 females with a median age of 58.5 years. They all presented severe kidney injuries and 1 patient had lung hemorrhage. At diagnosis, the median of serum creatinine was 246 µmol/L (ranging from 91 to 850 µmol/L), with 3 patients requiring dialysis. All of them received corticosteroids and plasmapheresis. Rituximab was given as either standard four weekly doses or one pulse ranging from 100 to 600 mg. After a median follow-up of 34.5 months, kidney function was partially recovered or stabilized in 5/8 (62.5%) patients, free of dialysis. Anti-GBM antibodies remained undetected in all patients during follow-up. No severe adverse effect associated with rituximab was observed. CONCLUSION Rituximab may be an alternative therapy in the treatment of patient with severe or refractory anti-GBM disease.
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Affiliation(s)
- Xue-Fen Yang
- Renal Division, Peking University First Hospital, Beijing, China.,Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, Taiyuan, China
| | - Xiao-Yu Jia
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Juan Yu
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
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142
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Suzuki S, Uzawa A, Murai H. Efgartigimod for generalized myasthenia gravis with or without anti-acetylcholine receptor antibodies: a worldwide and Japanese perspective. Expert Rev Clin Immunol 2022; 18:1207-1215. [PMID: 36227228 DOI: 10.1080/1744666x.2022.2136167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The management of myasthenia gravis (MG) has been improved due to immunotherapy advances, but 20% of individuals with MG are refractory to the conventional therapy, and the need for novel biological drugs remains. AREA COVERED The Japanese clinical guidelines for MG published in May 2022 include the concept that treatment is often lifelong and should aim to maintain a sufficient quality of life and mental health. We provide an overview of the therapeutic strategy for generalized MG in Japan, in comparison with the international consensus. We summarize the clinical efficacy, safety, and tolerability of efgartigimod, the first approved anti-neonatal Fc receptor inhibitor for MG. A phase III study showed that efgartigimod was well-tolerated and efficacious in patients with generalized MG. EXPERT OPINION Efgartigimod is a promising biological drug for patients with moderate to severe generalized MG with or without anti-acetylcholine receptor antibodies in Japan.
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Affiliation(s)
- Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Murai
- Department of Neurology, International University of Health and Welfare, Narita, Japan
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143
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Onishi H, Nouso K, Takaki A, Oyama A, Adachi T, Wada N, Takeuchi Y, Shiraha H, Okada H. History of Transcatheter Arterial Chemoembolization Predicts the Efficacy of Hepatic Arterial Infusion Chemotherapy in Hepatocellular Carcinoma Patients. Acta Med Okayama 2022; 76:695-703. [PMID: 36549772 DOI: 10.18926/amo/64120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study sought to identify factors that are predictive of a therapeutic response to hepatic arterial infusion chemotherapy (HAIC) by focusing on the number of prior transcatheter arterial chemoembolization (TACE) sessions. To determine the parameters predicting a good response to HAIC, we retrospectively analyzed 170 patients with hepatocellular carcinoma (HCC) who received HAIC regimens comprising low-dose cisplatin combined with 5-fluorouracil (LFP) or cisplatin (CDDP) for the first time. In both the LFP and CDDP regimens, the response rates were significantly lower in patients with three or more prior TACE sessions than in those with two or fewer prior TACE sessions (LFP 57% versus 28%; p=0.01, CDDP 27% versus 6%; p=0.01). Multivariable logistic regression analysis revealed that the number of prior TACE sessions (≥ 3) was significantly associated with non-responder status (odds ratio 4.17, 95% Confidence Interval (CI) 1.76-9.86) in addition to the HAIC regimen. Multivariable analysis using the Cox proportional hazards model revealed that a larger number of prior TACE sessions (≥ 3) was a significant risk factor for survival (hazard ratio 1.60, 95% CI 1.12-2.29) in addition to Child-Pugh class, serum alpha-fetoprotein concentration, and maximum diameter of HCC. HCC patients who receive fewer prior TACE sessions (≤ 2) were found to be better responders to HAIC.
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Affiliation(s)
- Hideki Onishi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kazuhiro Nouso
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsushi Oyama
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takuya Adachi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Nozomu Wada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yasuto Takeuchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.,Center for Innovative Clinical Medicine, Okayama University Hospital
| | - Hidenori Shiraha
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Stamatoullas A, Ghesquières H, Feugier P, André M, Le Bras F, Gac AC, Borel C, Gastinne T, Quittet P, Morschhauser F, Ribrag V, Guidez S, Nicolas-Virelizier E, Berriolo-Riedinger A, Vander Borght T, Edeline V, Brice P. Final results of brentuximab vedotin combined with ifosfamide-carboplatin-etoposide in first refractory/relapsed Hodgkin lymphoma: a lymphoma study association phase I/II study. Leuk Lymphoma 2022; 63:3063-3071. [PMID: 35975738 DOI: 10.1080/10428194.2022.2107204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This phase I/II study assessed the combination of brentuximab vedotin (BV) with ifosfamide-carboplatin-etoposide (ICE) as a second-line therapy in refractory/relapsed (R/R) classical Hodgkin lymphoma (cHL) patients. Phase I study was designed to determine the maximum tolerated dose (MTD) of BV (10 patients) and phase II evaluated the rate of complete metabolic response (CMR) after 2 cycles of BV-ICE (42 patients). There were no dose-limiting toxicities (DLT) during phase I recommending BV 1.8 mg/kg for phase II. Twenty-six patients (61.9%) achieved CMR after 2 cycles of BV-ICE and 37 patients (88%) were transplanted. With a median follow-up of 38 months, the 3-year progression free survival (PFS) and overall survival (OS) rate were 64.3% and 100%, respectively. Hematological toxicities (81%) and infections (21%) were the most frequent adverse event encountered BV-ICE regimen is feasible with manageable toxicities and could be an alternative to other salvage treatments. Trial Registration: ClinicalTrials.gov identifier: NCT02686346.
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Affiliation(s)
| | | | | | - Marc André
- Département d'Hématologie, CHU UCL, Namur, Belgique
| | - Fabien Le Bras
- Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France
| | | | - Cécile Borel
- Département d'Hématologie, IUCT Oncopole, Toulouse, France
| | | | | | | | - Vincent Ribrag
- Département of Hématologie, Institut Gustave Roussy, Paris, France
| | - Stephanie Guidez
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | | | | | | | - Véronique Edeline
- Service de Médecine Nucléaire, Institut Curie, Hôpital R Huguenin, Saint-Cloud, France
| | - Pauline Brice
- Département d'Hématologie, Hôpital Saint Louis, APHP Paris, Paris, France
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145
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Xie Q, Zhang X, Cui W, Pang Y. Construction of a Nomogram for Identifying Refractory Mycoplasma pneumoniae Pneumonia Among Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children. J Inflamm Res 2022; 15:6495-6504. [PMID: 36474517 PMCID: PMC9719700 DOI: 10.2147/jir.s387809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/15/2022] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE The individualized prediction of treatment regimens of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) is scarce. The aim of this study was, therefore, to evaluate the relevant data of patients and construct a nomogram for identifying refractory Mycoplasma pneumoniae pneumonia (RMPP) among children continued to be treated with macrolide after the confirmation of MUMPP, providing a reference for the choice of treatment regimen. METHODS We performed a retrospective study involving 162 children who continued to be treated with macrolide (azithromycin) after the confirmation of MUMPP without antibiotic changes between January 2020 and January 2022. We collected data on clinical feature, hospitalization period, treatments, laboratory data, extrapulmonary symptoms, parapneumonic effusion, and connections with other respiratory pathogens. In addition, the independent risk factors for RMPP were determined through univariate and multivariate analyses, and then a nomogram was constructed and validated. RESULTS In this study, the multivariate logistic regression analysis showed that age, leukocyte count, neutrophil proportion, serum procalcitonin, and lactate dehydrogenase were independent risk factors for RMPP. Using the five independent associated factors, the nomogram for identification of RMPP was constructed. Moreover, the area under the ROC curve (AUC) was 0.925 (95% CI: 0.882-0.968) for the nomogram showing excellent discrimination. The calibration curve, close to the 45-degree line, exhibited good calibration of nomogram. CONCLUSION We constructed and validated a visual and user-friendly nomogram for individualized prediction of RMPP risk in children who continued to be treated with macrolide after the confirmation of MUMPP based on five variables. According to the nomogram model, continuation of macrolide should be considered rather than second-line antibiotics including tetracyclines (doxycycline or minocycline) and fluoroquinolones for MUMPP children with low predictive values.
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Affiliation(s)
- Qiaoyi Xie
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xiaote Zhang
- Department of Otolaryngology Head and Neck Surgery, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
| | - Wei Cui
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yajiao Pang
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
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146
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Wang J, Zhang SX, Chang JS, Cheng T, Jiang XJ, Su QY, Zhang JQ, Luo J, Li XF. Low-dose IL-2 improved clinical symptoms by restoring reduced regulatory T cells in patients with refractory rheumatoid arthritis: A randomized controlled trial. Front Immunol 2022; 13:947341. [PMID: 36524114 PMCID: PMC9744779 DOI: 10.3389/fimmu.2022.947341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Regulatory T cells (Tregs) have been found to play crucial roles in immune tolerance. However, the status of Tregs in refractory rheumatoid arthritis (RA) is still unclear. Moreover, low-dose interleukin-2 (IL-2) has been reported to selectively promote the expansion of Tregs. This study investigated the status of CD4+ Tregs and low-dose IL-2 therapy in patients with refractory RA. Methods The absolute number of CD4+CD25+FOXP3+ Treg (CD4 Treg), CD4+IL17+ T (Th17), and other subsets in peripheral blood (PB) from 41 patients with refractory RA and 40 healthy donors was characterized by flow cytometry combined with an internal microsphere counting standard. Twenty-six patients with refractory RA were treated with daily subcutaneous injections of 0.5 million IU of human IL-2 for five consecutive days. Then, its effects on CD4 Treg and Th17 cells in PB were analyzed. Results A decrease in the absolute number of PB CD4 Tregs rather than the increase in the number of Th17 was found to contribute to an imbalance between Th17 and CD4 Tregs in these patients, suggesting an essential role of CD4 Tregs in sustained high disease activity. Low-dose IL-2 selectively increased the number of CD4 Tregs and rebalanced the ratio of Th17 and CD4 Tregs, leading to increased clinical symptom remission without the observed side effects. Conclusions An absolute decrease of PB CD4 Tregs in patients with refractory RA was associated with continuing disease activation but not the increase of Th17 cells. Low-dose IL-2, a potential therapeutic candidate, restored decreased CD4 Tregs and promoted the rapid remission of patients with refractory RA without overtreatment and the observed side effects. Clinical trial registration http://www.chictr.org.cn/showproj.aspx?proj=13909, identifier ChiCTR-INR-16009546.
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Affiliation(s)
- Jia Wang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
| | - Sheng-Xiao Zhang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
| | - Jia-Song Chang
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China,Department of Physiology, Shanxi Medical University, Taiyuan, China
| | - Ting Cheng
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
| | - Xiao-Jing Jiang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
| | - Qin-Yi Su
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
| | - Jia-Qi Zhang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
| | - Jing Luo
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
| | - Xiao-Feng Li
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China,Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China,*Correspondence: Xiao-Feng Li,
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147
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Díaz-Alberola I, Gutiérrez-Bautista JF, Espuch-Oliver A, García-Aznar JM, Anderson P, Jiménez P, Hidalgo-Tenorio C, López-Nevot MÁ. Incidence, Management Experience and Characteristics of Patients with Giardiasis and Common Variable Immunodeficiency. J Clin Med 2022; 11:jcm11237007. [PMID: 36498582 PMCID: PMC9740678 DOI: 10.3390/jcm11237007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Common variable immunodeficiency (CVID) is an antibody immunodeficiency with a wide variety of clinical and immunological manifestations, and whose genetic cause is found in about 25% of diagnosed cases. Giardia lamblia is one of the main causes of gastrointestinal infections in CVID. 5-Nitroimidazoles are the most used first-line treatment, but nitroimidazole-refractory giardiasis is increasing. Nevertheless, only a few cases of refractory giardiasis in CVID have been reported. This study aimed to determine the incidence of Giardia infection in our CVID cohort, shows our management experience and describes patients' phenotypic features. Clinical data collection, immunological, immunogenetics and microbiology assays were performed, and previous cases of giardiasis in CVID were reviewed. The incidence of symptomatic giardiasis was 12.9%. The main immunological features were undetectable or decreased IgA levels and reduced switched memory B cells. A probable PTEN pathogenic variant was detected in one. Three patients responded to metronidazole but suffered reinfections, and one was a refractory giardiasis eradicated with innovative quinacrine plus paromomycin combination. This work could contribute to the decision-making and therapeutic management of future patients with CVID and giardiasis, highlighting the importance of the early detection and treatment of infections in patients with CVID to ensure a good quality of life.
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Affiliation(s)
- Irene Díaz-Alberola
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Programa de Doctorado en Biomedicina, University of Granada, 10816 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Correspondence:
| | | | - Andrea Espuch-Oliver
- Servicio de Reproducción Asistida, Hospital Universitario de Torrecárdenas, 04009 Almería, Spain
| | | | - Per Anderson
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Departamento Bioquímica, Biología Molecular e Inmunología III, University of Granada, 18071 Granada, Spain
| | - Pilar Jiménez
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Carmen Hidalgo-Tenorio
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - Miguel Ángel López-Nevot
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Departamento Bioquímica, Biología Molecular e Inmunología III, University of Granada, 18071 Granada, Spain
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148
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Iula R, De Novellis D, Trastulli F, Della Pepa R, Fontana R, Carobene A, Di Perna M, D’Ambrosio A, Romano M, Leone A, De Fazio L, Fiumarella A, Gaeta G, Marafioti V, Barbato S, Palmieri S, Rocco S, Serio B, Califano C, Pane F, Ferrara F, Giudice V, Selleri C, Catalano L. Efficacy and safety of belantamab-mafodotin in triple- refractory multiple myeloma patients: A multicentric real-life experience. Front Oncol 2022; 12:1026251. [PMID: 36457484 PMCID: PMC9705330 DOI: 10.3389/fonc.2022.1026251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/24/2022] [Indexed: 07/30/2023] Open
Abstract
Belantamab-mafodotin is an innovative and selective treatment for multi-refractory/relapsed multiple myeloma (MM) patients; however, available real-life experiences on efficacy and safety are limited. In this real-world multicentric retrospective study, we enrolled 28 MM patients treated in four Hematology units of Campania region, Italy, who received a median of six treatment lines prior to belantamab-mafodotin. The overall response rate (ORR) was 40% (complete remission, CR, 11%; very good partial remission, VGPR, 11%; and partial remission, PR, 18%), with a median progression-free survival (PFS) and overall survival (OS) of 3 and 8 months, respectively. One of the most frequent drug-related adverse events was keratopathy observed in nine (32%) patients, leading to therapy discontinuation in only three (11%) of them. Moreover, 22 out of 28 total patients who were treated with at least two administrations achieved an ORR of 50% (CR, 14%; VGPR, 14%; and PR, 22%) with a median PFS and OS of 5 and 11 months, respectively. In conclusion, our multicentric study confirmed efficacy and safety of belantamab-mafodotin in triple-refractory MM patients even in the real-life setting.
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Affiliation(s)
- Rossella Iula
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Danilo De Novellis
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Fabio Trastulli
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Roberta Della Pepa
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Raffaele Fontana
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Angela Carobene
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Maria Di Perna
- Onco-Hematology Unit, “A. Tortora” Hospital, Pagani, Italy
| | - Alessandro D’Ambrosio
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Martina Romano
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Aldo Leone
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Laura De Fazio
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Alfonso Fiumarella
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Gaeta
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Violetta Marafioti
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Serafina Barbato
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Salvatore Palmieri
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Stefano Rocco
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Bianca Serio
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | | | - Fabrizio Pane
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Felicetto Ferrara
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Valentina Giudice
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Lucio Catalano
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
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Abdullah I, AlMojil K, Shehab M. Effectiveness of Dual Biologic or Small Molecule Therapy for Achieving Endoscopic Remission in Refractory Inflammatory Bowel Disease. Diseases 2022; 10:diseases10040102. [PMID: 36412596 PMCID: PMC9680431 DOI: 10.3390/diseases10040102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/06/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic autoimmune disease with relapse-remission courses. A number of patients may present with a refractory disease with partial or no response to treatment. Others may present with extra-intestinal manifestations that makes the treatment with one biologic challenging. Dual target therapy (DTT), combining biologics and/or small molecule drugs, may offer a chance to achieve remission in these cases and improve patients' quality of life despite the limited evidence regarding this approach. We present a case series of refractory inflammatory bowel disease cases managed with DTT. Seven patients with refractory IBD achieved steroid free, clinical, and endoscopic remission by using DTT. These results support that DTT could be an effective approach in selected patients with refractory IBD or with concomitant extra-intestinal manifestations (EIM). Larger studies, ideally randomized controlled trials, are needed to further support the evidence and confirm the efficacy and safety of DTT for IBD.
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Affiliation(s)
- Israa Abdullah
- Department of Pharmacy, Clinical Pharmacy Unit, Kuwait Hospital, Sabah Al-Salem 44001, Kuwait
| | - Khaled AlMojil
- Division of Gastroenterology, Department of Internal Medicine, Mubarak Alkabeer University Hospital, Kuwait University, Jabriya 47060, Kuwait
| | - Mohammad Shehab
- Division of Gastroenterology, Department of Internal Medicine, Mubarak Alkabeer University Hospital, Kuwait University, Jabriya 47060, Kuwait
- Correspondence: ; Tel.: +965-99633181
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Huang SH, Wu YW, Shueng PW, Wang SY, Tsai MC, Liu YH, Chuang WP, Lin HH, Tien HJ, Yeh HP, Hsieh CH. Case report: Stereotactic body radiation therapy with 12 Gy for silencing refractory ventricular tachycardia. Front Cardiovasc Med 2022; 9:973105. [PMID: 36407435 PMCID: PMC9669661 DOI: 10.3389/fcvm.2022.973105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/17/2022] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Encouraging results have been reported for the treatment of ventricular tachycardia (VT) with stereotactic body radiation therapy (SBRT) with 25 Gy. SBRT with 12 Gy for refractory VT was designed to reduce long-term cardiac toxicity. METHODS Stereotactic body radiation therapy-VT simulation, planning, and treatment were performed using standard techniques. A patient was treated with a marginal dose of 12 Gy in a single fraction to the planning target volume (PTV). The goal was for at least ≥ 95% of the PTV to be covered by at least 95% of 12 Gy radiation. RESULTS From April 2021 through June 2022, a patient with refractory VT underwent treatment. The volume for PTV was 65.8 cm3. The mean radiation dose administered to the heart (the heart volume excluding the PTV) was 2.2 Gy. No acute or late toxicity was observed after SBRT. Six months after SBRT, the patient experienced new monomorphic right ventricular outflow tract (RVOT) VT. Interestingly, the substrate of the left ventricular basal to middle posteroseptal wall before SBRT was turned into scar zones with a local voltage < 0.5 mV. Catheter ablation to treat RVOT VT was performed, and the situation remains stable to date. CONCLUSION This study reports the first patient with refractory VT successfully treated with 12.0 Gy SBRT, suggesting that 12 Gy is a potential dose to treat refractory VT. Further investigations and enrollment of more patients are warranted to assess the long-term efficacy and side effects of this treatment.
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Affiliation(s)
- Shan-Hui Huang
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Nuclear Medicine Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Meng-Chieh Tsai
- Division of Radiology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yuan-Hung Liu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electronic Engineering, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Wen-Po Chuang
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Heng-Hsu Lin
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hui-Ju Tien
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsin-Pei Yeh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Hsi Hsieh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Head and Neck Cancer Surveillance and Research Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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