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Yamaguchi T, Akiyoshi T, Fukunaga Y, Sakamoto T, Mukai T, Hiyoshi Y, Nagasaki T, Taguchi S, Chino A, Shinozaki E, Yamaguchi K, Konishi T. Adding Induction Chemotherapy Before Chemoradiotherapy with Total Mesorectal Excision and Selective Lateral Lymph Node Dissection for Patients with Poor-Risk, Locally Advanced, Mid-to-Low Rectal Cancer May Improve Oncologic Outcomes: A Propensity Score-Matched Analysis. Ann Surg Oncol 2023; 30:4716-4724. [PMID: 37032405 DOI: 10.1245/s10434-023-13458-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND This study aimed to investigate whether the addition of induction chemotherapy before chemoradiotherapy (CRT) and total mesorectal excision (TME) with selective lateral lymph node dissection improves disease-free survival for patients with poor-risk, mid-to-low rectal cancer. METHODS The authors' institutional prospective database was queried for consecutive patients with clinical stage II or III, primary, poor-risk, mid-to-low rectal cancer who received neoadjuvant treatment followed by TME from 2004 to 2019. The outcomes for the patients who received induction chemotherapy before neoadjuvant CRT (induction-CRT group) were compared (via log-rank tests) with those for a propensity score-matched cohort of patients who received neoadjuvant CRT without induction chemotherapy (CRT group). RESULTS From 715 eligible patients, the study selected two matched cohorts with 130 patients each. The median follow-up duration was 5.4 years for the CRT group and 4.1 years for the induction-CRT group. The induction-CRT group had significantly higher rates of 3-year disease-free survival (83.5 % vs 71.4 %; p = 0.015), distant metastasis-free survival (84.3 % vs 75.2 %; p = 0.049), and local recurrence-free survival (98.4 % vs 94.4 %; p = 0.048) than the CRT group. The pathologically complete response rate also was higher in the induction-CRT group than in the CRT group (26.2 % vs 10.0 %; p < 0.001). Postoperative major complications (Clavien-Dindo classification ≥III) did not differ significantly between the two groups (12.3 % vs 10.8 %; p = 0.698). CONCLUSIONS The addition of induction chemotherapy to neoadjuvant CRT appeared to improve oncologic outcomes significantly, including disease-free survival, for the patients with poor-risk, mid-to-low rectal cancer who underwent TME using selective lateral lymph node dissection.
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Affiliation(s)
- Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Senzo Taguchi
- Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Chino
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Shinozaki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Yamaguchi T, Akiyoshi T, Fukunaga Y, Sakamoto T, Mukai T, Hiyoshi Y, Nagasaki T, Taguchi S, Chino A, Shinozaki E, Yamaguchi K, Konishi T. ASO Visual Abstract: Adding Induction Chemotherapy Before Chemoradiotherapy with Total Mesorectal Excision and Selective Lateral Lymph Node Dissection in Patients with Poor-Risk, Locally Advanced, Mid-to-Low Rectal Cancer May Improve Oncological Outcomes-A Propensity Score-Matched Analysis. Ann Surg Oncol 2023; 30:4727-4728. [PMID: 37118614 DOI: 10.1245/s10434-023-13481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Senzo Taguchi
- Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Chino
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Shinozaki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Short NJ, Ong F, Ravandi F, Nogueras-Gonzalez G, Kadia TM, Daver N, DiNardo CD, Konopleva M, Borthakur G, Oran B, Al-Atrash G, Mehta R, Jabbour EJ, Yilmaz M, Issa GC, Maiti A, Champlin RE, Kantarjian H, Shpall EJ, Popat U. Impact of type of induction therapy on outcomes in older adults with AML after allogeneic stem cell transplantation. Blood Adv 2023; 7:3573-3581. [PMID: 37104058 PMCID: PMC10368841 DOI: 10.1182/bloodadvances.2022009632] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
Although venetoclax-based lower-intensity regimens have greatly improved outcomes for older adults with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy, the optimal induction for older patients with newly diagnosed AML who are suitable candidates for hematopoietic stem cell transplant (HSCT) is controversial. We retrospectively analyzed the post HSCT outcomes of 127 patients ≥60 years of age who received induction therapy at our institution with intensive chemotherapy (IC; n = 44), lower-intensity therapy (LIT) without venetoclax (n = 29), or LIT with venetoclax (n = 54) and who underwent allogeneic HSCT in the first remission. The 2-year relapse-free survival (RFS) was 60% with LIT with venetoclax vs 54% with IC, and 41% with LIT without venetoclax; the 2-year overall survival (OS) was 72% LIT with venetoclax vs 58% with IC, and 41% with LIT without venetoclax. The benefit of LIT with venetoclax induction was greatest in patients with adverse-risk AML (2-year OS: 74%, 46%, and 29%, respectively). Induction with LIT, with or without venetoclax, was associated with the lowest rate of nonrelapse mortality (NRM) (2-year NRM: 17% vs 27% with IC; P = .04). Using multivariate analysis, the type of induction therapy did not significantly affect any of the post HSCT outcomes evaluated; hematopoietic cell transplantation-specific comorbidity index was the only factor that independently predicted RFS and OS. LIT plus venetoclax followed by HSCT is a feasible treatment strategy in older, fit, HSCT-eligible patients with newly diagnosed AML and may be particularly beneficial for those with adverse-risk disease.
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Affiliation(s)
- Nicholas J. Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Faustine Ong
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Tapan M. Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney D. DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Betul Oran
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gheath Al-Atrash
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias J. Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Musa Yilmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abhishek Maiti
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard E Champlin
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uday Popat
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
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Yu J, Yang K, Cheng YJ, Shen JL, Ouyang W, Zhang W, Zhang JH, Xie CH. [Impact of the depth of remission by induction chemotherapy on the prognosis of limited stage small cell lung cancer]. Zhonghua Zhong Liu Za Zhi 2023; 45:621-626. [PMID: 37462019 DOI: 10.3760/cma.j.cn112152-20220107-00019] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Objective: To evaluate the effect of depth of remission of induction chemotherapy on the overall prognosis of limited stage small cell lung cancer (L-SCLC). Methods: The study was a retrospective, L-SCLC patients who contained complete imaging data and underwent consecutive standardized treatments at the Department of Thoracic Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University between January 2013 and June 2021 were included. To delineate the volume of tumor before and after induction chemotherapy and to calculate the depth of remission caused by the induced chemotherapy. The time receiver operating characteristic (timeROC) method was used to determine the optimal predictors for prognosis, multi-factor analysis using Cox risk proportional model. Results: A total of 104 patients were included in this study. The median PFS and OS of this cohort were 13.7 months and 20.9 months, respectively. It was observed by timeROC analysis that residual tumor volume after induction chemotherapy had the optimal predictive value of PFS at 1 year (AUC=0.86, 95% CI: 0.78~0.94) and OS at 2 years (AUC=0.76, 95% CI: 0.65~0.87). Multivariate analysis showed residual tumor volume after induction chemotherapy was the independent prognostic factor to PFS (HR=1.006, 95% CI: 1.003~1.009, P<0.01) and OS (HR=1.009, 95% CI: 1.005~1.012, P<0.001). For those whose residual tumor volume remitted to less than 10 cm(3) after induction chemotherapy, the favorable long-term outcomes could be achieved, regardless of their initial tumor load. Conclusion: The depth of remission of induction chemotherapy could be a promising prognostic predictor to the L-SCLC and provide the individualized treatment guidance.
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Affiliation(s)
- J Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
| | - K Yang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
| | - Y J Cheng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
| | - J L Shen
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
| | - W Ouyang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
| | - W Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
| | - J H Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
| | - C H Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Key Laboratory of Tumor Biological Behavior, Hubei Cancer Clinical Study Center, Wuhan 430071, China
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Jaime-Pérez JC, Ramos-Dávila EM, Meléndez-Flores JD, González-Treviño M, Gómez-Almaguer D. Assessing the Efficacy of Mitoxantrone and Doxorubicin as Frontline Anthracyclines During Induction Therapy of Newly Diagnosed Acute Promyelocytic Leukemia. Hematol Oncol Stem Cell Ther 2023; 17:13-20. [PMID: 37581460 DOI: 10.56875/2589-0646.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/12/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Therapeutic advances in acute promyelocytic leukemia (APL) have transformed it into today's most curable form of leukemia. However, recommended agents, including arsenic trioxide, idarubicin, or daunorubicin, are not easily available in low-middle-income countries, where outcomes remain suboptimal. We aimed to assess the efficacy and safety of more accessible anthracyclines. METHODS We conducted a retrospective cohort study including sixty-one patients diagnosed with APL over a 15-year period. Patients received low-dose all-trans retinoic acid (ATRA, 25 mg/m2) with mitoxantrone or doxorubicin as an induction to remission therapy. Groups were compared using the χ2 and Student's t-tests. Kaplan-Meier analysis was used for survival analyses. RESULTS Thirty (49.18%) patients received mitoxantrone, and 31 (50.82%) received doxorubicin. The median follow-up was 24.6 months (1-146). Twenty-eight (93.3%) patients achieved complete remission (CR) in the mitoxantrone group and 28 (87.1%) in the doxorubicin group (p=0.103), and the median time to CR was 40 and 31 days, respectively. Mitoxantrone had a 6.7% early mortality rate and a 16.7% relapse rate compared with doxorubicin (3.2% and 32.3%, respectively). No differences were found in survival (p = 0.795), hospitalization days (p = 0.261), or adverse events (p = 0.554). CONCLUSIONS Using mitoxantrone or doxorubicin as induction therapy in newly diagnosed APL is a safe and adequate alternative with comparable outcomes to first-line agents in scenarios where the latter might not be readily available, such as in low-middle-income countries.
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Affiliation(s)
- José C Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Eugenia M Ramos-Dávila
- Department of Hematology, Internal Medicine Division, Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús D Meléndez-Flores
- Department of Hematology, Internal Medicine Division, Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mariana González-Treviño
- Department of Hematology, Internal Medicine Division, Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Zheng H, Zhou P, Wang J, Yu Y, Zhou R, Lin Q, Wu S. Prognostic effect of residual plasma Epstein-Barr viral DNA after induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma. Cancer Med 2023; 12:14979-14987. [PMID: 37212447 PMCID: PMC10417187 DOI: 10.1002/cam4.6132] [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] [Received: 02/10/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND To assess the prognostic effect of plasma Epstein-Barr virus (EBV) DNA load after induction chemotherapy (postIC -EBV DNA) on survival outcomes in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). METHODS Patients who were diagnosed with LA-NPC between August 2017 and October 2021 were included. The chi-squared test, receiver operating characteristic, Kaplan-Meier survival analysis, and Cox proportional hazard model were used for statistical analysis. RESULTS We included 172 patients with EBV DNA-positive LA-NPC in this study. There were 35.5% (n = 61) of patients had plasma residual EBV DNA after induction chemotherapy (IC). Patients with higher EBV DNA before IC (p < 0.001) and advanced nodal stage (p = 0.031) were significantly related to a higher rate of residual postIC -EBV DNA. Patients with detectable postIC -EBV DNA had inferior 3-year locoregional relapse-free survival (LRFS) (86.7% vs. 96.9%, p = 0.020), distant metastasis-free survival (DMFS) (76.8% vs. 94.2%, p < 0.001), disease-free survival (DFS) (68.2% vs. 91.1%, p < 0.001), and overall survival (OS) (87.8% vs. 97.9%, p = 0.044) compared to those with undetectable postIC -EBV DNA. The multivariate prognostic analyses showed that detectable postIC -EBV DNA was the independent prognostic factor related to LRFS (p = 0.032), DMFS (p = 0.010), and DFS (p = 0.004) than those with undetectable postIC -EBV DNA. Pretreatment EBV DNA load had no prognostic effect in the multivariate analyses. CONCLUSIONS The monitoring of plasma postIC -EBV DNA has improved prognostication in LA-NPC. Our findings suggest that postIC -EBV DNA may be a robust indicator to identify the optimal candidate for intensive treatment.
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Affiliation(s)
- Hua Zheng
- Department of Radiation OncologyXiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncologythe First Affiliated Hospital of Xiamen UniversitySchool of Medicine, Xiamen UniversityXiamenPeople's Republic of China
| | - Ping Zhou
- Department of Radiation OncologyXiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncologythe First Affiliated Hospital of Xiamen UniversitySchool of Medicine, Xiamen UniversityXiamenPeople's Republic of China
| | - Jun Wang
- Department of Head and Neck OncologyDepartment of Radiation Oncology, Cancer CenterState Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduPeople's Republic of China
| | - Yi‐Feng Yu
- Department of Radiation OncologyXiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncologythe First Affiliated Hospital of Xiamen UniversitySchool of Medicine, Xiamen UniversityXiamenPeople's Republic of China
| | - Rui Zhou
- Department of Radiation OncologyXiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncologythe First Affiliated Hospital of Xiamen UniversitySchool of Medicine, Xiamen UniversityXiamenPeople's Republic of China
| | - Qin Lin
- Department of Radiation OncologyXiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncologythe First Affiliated Hospital of Xiamen UniversitySchool of Medicine, Xiamen UniversityXiamenPeople's Republic of China
| | - San‐Gang Wu
- Department of Radiation OncologyXiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncologythe First Affiliated Hospital of Xiamen UniversitySchool of Medicine, Xiamen UniversityXiamenPeople's Republic of China
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Al-Jabri R, Afif W. In moderately to severely active UC, etrasimod increased remission at 12 and 52 wk but increased adverse events. Ann Intern Med 2023; 176:JC82. [PMID: 37399559 DOI: 10.7326/j23-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
SOURCE CITATION Sandborn WJ, Vermeire S, Peyrin-Biroulet L, et al. Etrasimod as induction and maintenance therapy for ulcerative colitis (ELEVATE): two randomised, double-blind, placebo-controlled, phase 3 studies. Lancet. 2023;401:1159-1171. 36871574.
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Affiliation(s)
- Reem Al-Jabri
- McGill University Health Center, Montreal, Quebec, Canada (R.A., W.A.)
| | - Waqqas Afif
- McGill University Health Center, Montreal, Quebec, Canada (R.A., W.A.)
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Seelen LWF, Floortje van Oosten A, Brada LJH, Groot VP, Daamen LA, Walma MS, van der Lek BF, Liem MSL, Patijn GA, Stommel MWJ, van Dam RM, Koerkamp BG, Busch OR, de Hingh IHJT, van Eijck CHJ, Besselink MG, Burkhart RA, Borel Rinkes IHM, Wolfgang CL, Molenaar IQ, He J, van Santvoort HC. Early Recurrence After Resection of Locally Advanced Pancreatic Cancer Following Induction Therapy: An International Multicenter Study. Ann Surg 2023; 278:118-126. [PMID: 35950757 DOI: 10.1097/sla.0000000000005666] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To establish an evidence-based cutoff and predictors for early recurrence in patients with resected locally advanced pancreatic cancer (LAPC). BACKGROUND It is unclear how many and which patients develop early recurrence after LAPC resection. Surgery in these patients is probably of little benefit. METHODS We analyzed all consecutive patients undergoing resection of LAPC after induction chemotherapy who were included in prospective databases in The Netherlands (2015-2019) and the Johns Hopkins Hospital (2016-2018). The optimal definition for "early recurrence" was determined by the post-recurrence survival (PRS). Patients were compared for overall survival (OS). Predictors for early recurrence were evaluated using logistic regression analysis. RESULTS Overall, 168 patients were included. After a median follow-up of 28 months, recurrence was observed in 118 patients (70.2%). The optimal cutoff for recurrence-free survival to differentiate between early (n=52) and late recurrence (n=66) was 6 months ( P <0.001). OS was 8.4 months [95% confidence interval (CI): 7.3-9.6] in the early recurrence group (n=52) versus 31.1 months (95% CI: 25.7-36.4) in the late/no recurrence group (n=116) ( P <0.001). A preoperative predictor for early recurrence was postinduction therapy carbohydrate antigen (CA) 19-9≥100 U/mL [odds ratio (OR)=4.15, 95% CI: 1.75-9.84, P =0.001]. Postoperative predictors were poor tumor differentiation (OR=4.67, 95% CI: 1.83-11.90, P =0.001) and no adjuvant chemotherapy (OR=6.04, 95% CI: 2.43-16.55, P <0.001). CONCLUSIONS Early recurrence was observed in one third of patients after LAPC resection and was associated with poor survival. Patients with post-induction therapy CA 19-9 ≥100 U/mL, poor tumor differentiation and no adjuvant therapy were especially at risk. This information is valuable for patient counseling before and after resection of LAPC.
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Affiliation(s)
- Leonard W F Seelen
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Anne Floortje van Oosten
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lilly J H Brada
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Vincent P Groot
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Lois A Daamen
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Marieke S Walma
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Bastiaan F van der Lek
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Mike S L Liem
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gijs A Patijn
- Department of Surgery, Isala Clinics, Zwolle, The Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | | | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Richard A Burkhart
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Inne H M Borel Rinkes
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | | | - Izaak Quintus Molenaar
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Jin He
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hjalmar C van Santvoort
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
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Ohmoto A, Fuji S. Clinical status of induction therapy incorporating a hypomethylating agent for newly diagnosed adult acute myeloid leukemia compared to the standard 7+3 regimen. Expert Rev Hematol 2023; 16:761-771. [PMID: 37670667 DOI: 10.1080/17474086.2023.2256472] [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] [Received: 05/27/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Cytarabine and anthracycline combination therapy (7 + 3 regimen) is the standard care for induction chemotherapy in adult patients with acute myeloid leukemia (AML). Although this intensive regimen achieves a high response rate, it is highly toxic, especially in elderly or frail patients. Hypomethylating agents approved initially for high-risk myelodysplastic syndrome had longer survival times than conventional care in elderly patients with newly diagnosed AML. AREAS COVERED We summarize the latest information regarding induction therapy using hypomethylating agents (azacitidine and decitabine) for newly diagnosed AML. EXPERT OPINION For untreated patients ineligible for an intensive regimen, a phase III trial exhibited the survival benefit of adding the highly selective BCL2 inhibitor venetoclax to azacitidine. The National Comprehensive Cancer Network guidelines recommend azacitidine or decitabine plus venetoclax as an option for patients with poor-risk AML, including those with TP53 mutations and AML with the cytogenetic features of myelodysplastic syndrome. Future studies should evaluate positioning this combination as an induction therapy for younger patients eligible for hematopoietic stem cell transplantation. Without randomized trials, propensity score matching analysis suggested a comparable prognosis between azacitidine combination and intensive chemotherapy. Considering the feasibility of a doublet regimen incorporating azacitidine, a triplet regimen should be examined.
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Affiliation(s)
- Akihiro Ohmoto
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
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Jain S, Dhir V. Correspondence on 'Five-year treat-to-target outcomes after methotrexate induction therapy with or without other csDMARDs and temporary glucocorticoids for rheumatoid arthritis in the CareRA trial'. Ann Rheum Dis 2023; 82:e162. [PMID: 34193404 DOI: 10.1136/annrheumdis-2021-220816] [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: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Hershenfeld SA, Atenafu EG, Chan S, Gupta V, Maze D, Schuh A, Sibai H, Yee K, Schimmer AD. Impact of Geographical Distance from Quaternary Treatment Center on Clinical Trial Participation, Intensive Induction Chemotherapy, and Outcomes in Patients with Newly Diagnosed Acute Myeloid Leukemia. Acta Haematol 2023; 146:366-372. [PMID: 37315549 DOI: 10.1159/000531484] [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] [Received: 03/15/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Care for patients with acute myeloid leukemia (AML) is centralized in the Ontario single-payer public healthcare system, with intensive induction chemotherapy and clinical trials only offered at specialized cancer centers with large catchment areas. METHODS We therefore conducted a retrospective single-center review of all AML patients assessed at a large specialized cancer center in Ontario, Canada. RESULTS Between 2012 and 2017, 1,310 patients were assessed by our center for upfront AML therapy. The median distance was 33.1 km, with 29% of patients living more than 50 km away from the center. There was no significant difference in probability of intensive induction chemotherapy or clinical trial by distance from center, both in univariate and multivariable analysis adjusting for age, sex, cytogenetics and molecular testing, and performance status. There was no significant difference in overall survival by distance from center on univariate and multivariable analysis. CONCLUSION In conclusion, geographic distance from treatment center does not appear to impact choice of upfront therapy, participation in clinical trials, or clinical outcomes in this study of newly diagnosed patients with AML treated in a single-payer environment.
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Affiliation(s)
| | - Eshetu G Atenafu
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
| | - Steven Chan
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
| | - Vikas Gupta
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
| | - Dawn Maze
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
| | - Andre Schuh
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
| | - Hassan Sibai
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
| | - Karen Yee
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
| | - Arron D Schimmer
- Princess Margaret Cancer Center, University Health Network, ON, Toronto, Canada
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Zhao Q, Dong A, Cui C, Ou Q, Ruan G, Zhou J, Tian L, Liu L, Ma H, Li H. MRI-Based Metastatic Nodal Number and Associated Nomogram Improve Stratification of Nasopharyngeal Carcinoma Patients: Potential Indications for Individual Induction Chemotherapy. J Magn Reson Imaging 2023; 57:1790-1802. [PMID: 36169976 DOI: 10.1002/jmri.28435] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 01/12/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Metastatic lymph nodal number (LNN) is associated with the survival of nasopharyngeal carcinoma (NPC); however, counting multiple nodes is cumbersome. PURPOSE To explore LNN threshold and evaluate its use in risk stratification and induction chemotherapy (IC) indication. STUDY TYPE Retrospective. POPULATION A total of 792 radiotherapy-treated NPC patients (N classification: N0 182, N1 438, N2 113, N3 59; training group: 396, validation group: 396; receiving IC: 390). FIELD STRENGTH/SEQUENCE T1-, T2- and postcontrast T1-weighted fast spin echo MRI at 1.5 or 3.0 T. ASSESSMENT Nomogram with (model B) or without (model A) LNN was constructed to evaluate the 5-year overall (OS), distant metastasis-free (DMFS), and progression-free survival (PFS) for the group as a whole and N1 stage subgroup. High- and low-risk groups were divided (above vs below LNN- or model B-threshold); their response to IC was evaluated among advanced patients in stage III/IV. STATISTICAL TESTS Maximally selected rank, univariate and multivariable Cox analysis identified the optimal LNN threshold and other variables. Harrell's concordance index (C-index) and 2-fold cross-validation evaluated discriminative ability of models. Matched-pair analysis compared survival outcomes of adding IC or not. A P value < 0.05 was considered statistically significant. RESULTS Median follow-up duration was 62.1 months. LNN ≥ 4 was independently associated with decreased 5-year DMFS, OS, and PFS in entire patients or N1 subgroup. Compared to model A, model B (adding LNN, LNN ≥ 4 vs <4) presented superior C-indexes in the training (0.755 vs 0.727) and validation groups (0.676 vs 0.642) for discriminating DMFS. High-risk patients benefited from IC with improved post-IC response and OS, but low-risk patients did not (P = 0.785 and 0.690, respectively). CONCLUSIONS LNN ≥ 4 is an independent risk stratification factor of worse survival in entire or N1 staging NPC patients. LNN ≥ 4 or the associated nomogram has potential to identify high-risk patients requiring IC. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: 4.
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Affiliation(s)
- Qin Zhao
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Annan Dong
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Chunyan Cui
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Qiaowen Ou
- Department of Clinical Nutrition, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China
| | - Guangying Ruan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Jian Zhou
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Li Tian
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
- Department of Radiology, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Huali Ma
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
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Yang M, Lu X, Xin L, Luo J, Diao S, Jia Z, Cheng G, Zeng L, Zhang L. Comparative effectiveness and safety of antibiotic prophylaxis during induction chemotherapy in children with acute leukaemia: a systematic review and meta-analysis. J Hosp Infect 2023; 136:20-29. [PMID: 36921630 DOI: 10.1016/j.jhin.2023.03.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Bacterial infections are common during induction therapy in children and adolescents with acute leukaemia and may cause infection-related mortality. AIM To determine the efficacy and safety of prophylactic antibiotics in paediatric patients with acute leukaemia receiving induction chemotherapy. METHODS From three English databases and four Chinese databases, we searched for randomized controlled trials (RCTs) and cohort studies that compared prophylactic antibiotics to placebo, no prophylaxis, or that compared one antibiotic versus another in paediatric patients with acute leukaemia undergoing induction chemotherapy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias using Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale, and the certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). FINDINGS Two RCTs and ten cohort studies were finally included. For children with acute lymphoblastic leukaemia, antibiotic prophylaxis, including levofloxacin, sulfamethoxazole-trimethoprim, or other antibiotics, probably reduced bacteraemia (risk ratio (RR): 0.44; 95% confidence interval (CI): 0.33-0.60; moderate certainty) without significantly increasing Clostridioides difficile infection (CDI) or invasive fungal infection. Levofloxacin reduced the CDI rate (RR: 0.08; 95% CI: 0.01-0.62; high certainty). Ciprofloxacin prophylaxis probably reduced infection-related mortality (RR: 0.12; 95% CI: 0.01-0.97; moderate certainty). In children with acute myeloid leukaemia, ciprofloxacin plus vancomycin may reduce febrile neutropenia (RR: 0.79; 95% CI: 0.66-0.94; low certainty). Individual studies indicated that prophylaxis increased antibiotic exposure but reduced non-preventive antibiotic exposure. CONCLUSION In children with acute leukaemia undergoing induction therapy, antibiotic prophylaxis may improve the bacterial infection and mortality.
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Affiliation(s)
- M Yang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - X Lu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Paediatric Haematology and Oncology, West China Second Hospital, Sichuan University, Chengdu, China
| | - L Xin
- Department of Clinical Pharmacy, The Affiliated Hospital of Yunnan University, Kunming, China
| | - J Luo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - S Diao
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Z Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - G Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - L Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| | - L Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Petit C, Lee A, Ma J, Lacas B, Ng WT, Chan ATC, Hong RL, Chen MY, Chen L, Li WF, Huang PY, Tan T, Ngan RKC, Zhu G, Mai HQ, Hui EP, Fountzilas G, Zhang L, Carmel A, Kwong DLW, Moon J, Bourhis J, Auperin A, Pignon JP, Blanchard P. Role of chemotherapy in patients with nasopharynx carcinoma treated with radiotherapy (MAC-NPC): an updated individual patient data network meta-analysis. Lancet Oncol 2023; 24:611-623. [PMID: 37269842 DOI: 10.1016/s1470-2045(23)00163-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The meta-analysis of chemotherapy for nasopharynx carcinoma (MAC-NPC) collaborative group previously showed that the addition of adjuvant chemotherapy to concomitant chemoradiotherapy had the highest survival benefit of the studied treatment regimens in nasopharyngeal carcinoma. Due to the publication of new trials on induction chemotherapy, we updated the network meta-analysis. METHODS For this individual patient data network meta-analysis, trials of radiotherapy with or without chemotherapy in patients with non-metastatic nasopharyngeal carcinoma that completed accrual before Dec 31, 2016, were identified and updated individual patient data were obtained. Both general databases (eg, PubMed and Web of Science) and Chinese medical literature databases were searched. Overall survival was the primary endpoint. A frequentist network meta-analysis approach with a two-step random effect stratified by trial based on hazard ratio Peto estimator was used. Global Cochran Q statistic was used to assess homogeneity and consistency, and p score to rank treatments, with higher scores indicating higher benefit therapies. Treatments were grouped into the following categories: radiotherapy alone, induction chemotherapy followed by radiotherapy, induction chemotherapy without taxanes followed by chemoradiotherapy, induction chemotherapy with taxanes followed by chemoradiotherapy, chemoradiotherapy, chemoradiotherapy followed by adjuvant chemotherapy, and radiotherapy followed by adjuvant chemotherapy. This study is registered with PROSPERO, CRD42016042524. FINDINGS The network comprised 28 trials and included 8214 patients (6133 [74·7%] were men, 2073 [25·2%] were women, and eight [0·1%] had missing data) enrolled between Jan 1, 1988, and Dec 31, 2016. Median follow-up was 7·6 years (IQR 6·2-13·3). There was no evidence of heterogeneity (p=0·18), and inconsistency was borderline (p=0·10). The three treatments with the highest benefit for overall survival were induction chemotherapy with taxanes followed by chemoradiotherapy (hazard ratio 0·75; 95% CI 0·59-0·96; p score 92%), induction chemotherapy without taxanes followed by chemoradiotherapy (0·81; 0·69-0·95; p score 87%), and chemoradiotherapy followed by adjuvant chemotherapy (0·88; 0·75-1·04; p score 72%), compared with concomitant chemoradiotherapy (p score 46%). INTERPRETATION The inclusion of new trials modified the conclusion of the previous network meta-analysis. In this updated network meta-analysis, the addition of either induction chemotherapy or adjuvant chemotherapy to chemoradiotherapy improved overall survival over chemoradiotherapy alone in nasopharyngeal carcinoma. FUNDING Institut National du Cancer and Ligue Nationale Contre le Cancer.
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Affiliation(s)
- Claire Petit
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Anne Lee
- Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Benjamin Lacas
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Wai Tong Ng
- Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ruey-Long Hong
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | | | - Lei Chen
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Fei Li
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Pei-Yu Huang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | | | - Roger K C Ngan
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Guopei Zhu
- Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - George Fountzilas
- Aristotle University of Thessaloniki, Thessaloniki, Greece; Hellenic Cooperative Oncology Group, Athens, Greece; German Oncology Center, Limassol, Cyprus
| | - Li Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Alexandra Carmel
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Dora L W Kwong
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - James Moon
- Southwest Oncology Group Statistics and Data Management Center, Seattle, WA, USA
| | - Jean Bourhis
- Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne Auperin
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Jean-Pierre Pignon
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France.
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115
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Ecker BL, Tao AJ, Janssen QP, Walch HS, Court CM, Balachandran VP, Crane CH, D’Angelica MI, Drebin JA, Kingham TP, Soares KC, Iacobuzio-Donahue CA, Vakiani E, Gonen M, O’Reilly EM, Varghese AM, Jarnagin WR, Wei AC. Genomic Biomarkers Associated with Response to Induction Chemotherapy in Patients with Localized Pancreatic Ductal Adenocarcinoma. Clin Cancer Res 2023; 29:1368-1374. [PMID: 36795432 PMCID: PMC10073273 DOI: 10.1158/1078-0432.ccr-22-3089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/06/2022] [Revised: 11/30/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE There is increasing use of neoadjuvant chemotherapy in the management of localized pancreatic ductal adenocarcinoma (PDAC), yet there are few validated biomarkers to guide therapy selection. We aimed to determine whether somatic genomic biomarkers predict response to induction FOLFIRINOX or gemcitabine/nab-paclitaxel. EXPERIMENTAL DESIGN This single-institution cohort study included consecutive patients (N = 322) with localized PDAC (2011-2020) who received at least one cycle of FOLFIRINOX (N = 271) or gemcitabine/nab-paclitaxel (N = 51) as initial treatment. We assessed somatic alterations in four driver genes (KRAS, TP53, CDKN2A, and SMAD4) by targeted next-generation sequencing, and determined associations between these alterations and (1) rate of metastatic progression during induction chemotherapy, (2) surgical resection, and (3) complete/major pathologic response. RESULTS The alteration rates in driver genes KRAS, TP53, CDKN2A, and SMAD4 were 87.0%, 65.5%, 26.7%, and 19.9%, respectively. For patients receiving first-line FOLFIRINOX, SMAD4 alterations were uniquely associated with metastatic progression (30.0% vs. 14.5%; P = 0.009) and decreased rate of surgical resection (37.1% vs. 66.7%; P < 0.001). For patients receiving induction gemcitabine/nab-paclitaxel, alterations in SMAD4 were not associated with metastatic progression (14.3% vs. 16.2%; P = 0.866) nor decreased rate of surgical resection (33.3% vs. 41.9%; P = 0.605). Major pathologic response was rare (6.3%) and not associated with type of chemotherapy regimen. CONCLUSIONS SMAD4 alterations were associated with more frequent development of metastasis and lower probability of reaching surgical resection during neoadjuvant FOLFIRINOX but not gemcitabine/nab-paclitaxel. Confirmation in a larger, diverse patient cohort will be important before prospective evaluation of SMAD4 as a genomic biomarker to guide treatment selection.
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Affiliation(s)
- Brett L. Ecker
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alice J. Tao
- Weill Cornell Medical College, New York, NY, USA
| | - Quisette P. Janssen
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Henry S. Walch
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colin M. Court
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P. Balachandran
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- David M. Rubenstein Center for Pancreatic Cancer Research, New York, NY, USA
| | - Christopher H. Crane
- David M. Rubenstein Center for Pancreatic Cancer Research, New York, NY, USA
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I. D’Angelica
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A. Drebin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T. Peter Kingham
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C. Soares
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine A. Iacobuzio-Donahue
- David M. Rubenstein Center for Pancreatic Cancer Research, New York, NY, USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eileen M. O’Reilly
- Weill Cornell Medical College, New York, NY, USA
- David M. Rubenstein Center for Pancreatic Cancer Research, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna M. Varghese
- Weill Cornell Medical College, New York, NY, USA
- David M. Rubenstein Center for Pancreatic Cancer Research, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R. Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C. Wei
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Wang N, Zhao L, Zhang D, Kong F. Efficacy and safety of anlotinib as maintenance therapy after induction chemotherapy in extensive-stage small-cell lung cancer. Anticancer Drugs 2023; 34:558-562. [PMID: 36728981 DOI: 10.1097/cad.0000000000001488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anlotinib has been approved as the third-line or beyond treatment regimen for patients with extensive-stage small-cell lung cancer (ES-SCLC). However, it is indistinct whether there are survival benefits of anlotinib in the maintenance therapy of ES-SCLC. Therefore, this study aims to evaluate the efficacy and safety of anlotinib monotherapy as maintenance therapy after induction chemotherapy for patients with ES-SCLC. The median progression-free survival (mPFS) was considered to be the pivotal symbol as the primary endpoint. The median overall survival (mOS) and safety were recognized as the second endpoints. Eligible patients in stable status after first-line chemotherapy would subsequently accept oral anlotinib (12 mg/d, d1-d14, every 21 days as a course). The maintenance method was continued until disease progression or unmanageable toxicity occurred. The mPFS was 7.7 months (95% CI, 7.20-8.20 months) and the mOS was 11.0 months (95% CI, 9.19-12.82 months), respectively. The most common treatment-related adverse events were hypertension ( n = 9; 64.3%), fatigue ( n = 6; 42.9%), followed by decreased appetite ( n = 5; 35.7%), nausea ( n = 5; 35.7%), weight decrease ( n = 4; 28.6%), and rash ( n = 4; 28.6%). There were no patients who required dose reduction because of severe adverse events. Anlotinib achieved prospective efficacy and manageable safety in the maintenance treatment of ES-SCLC. These above outcomes demonstrated that anlotinib was a tolerable and potent maintenance treatment option after induction chemotherapy in ES-SCLC.
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Affiliation(s)
- Na Wang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lu Zhao
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dou Zhang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Fanming Kong
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Chbihi M, Eveillard LA, Riller Q, Brousse R, Berthaud R, Quartier P, Salomon R, Charbit M, Avramescu M, Biebuyck N, Dehoux L, Garcelon N, Duong-Van-Huyen JP, Bader-Meunier B, Boyer O. Induction therapy for pediatric onset class IV lupus nephritis: Mycophenolate Mofetil versus Cyclophosphamide. J Nephrol 2023; 36:829-839. [PMID: 36208405 DOI: 10.1007/s40620-022-01438-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Class IV lupus nephritis (LN) is one of the most frequent and severe types of involvement in pediatric systemic lupus erythematosus. Gold standard treatment consists of intravenous (i.v.) Cyclophosphamide (CYC) associated with corticosteroids. Recent studies in adults have shown similar efficacy of oral Mycophenolate Mofetil (MMF) with fewer adverse events. Our aim was to compare the efficacy and tolerance of CYC and MMF as induction therapy in children with class IV LN. METHODS We conducted a retrospective study of children diagnosed with class IV LN who started oral MMF or i.v. CYC treatment at Necker Enfants Malades Hospital (Paris, France). RESULTS The study included 33 patients, 17 treated with oral MMF (51%) and 16 with i.v. CYC (48%). The characteristics at treatment induction did not significantly differ between the two groups except for the neurological involvement, that was only present in the CYC group. Complete remission was obtained in 9/17 (53%) children treated with MMF versus 10/16 (71%) treated with CYC (p = 0.46). Relapse was observed in 59% of patients receiving MMF versus 50% receiving CYC (p = 0.87), after a median of 3.4 years and 4.7 years after the beginning of treatment, respectively (p = 0.41). During the 6.5 years of follow-up, we observed no significant difference regarding the number of treatment-related adverse events between the two groups (p = 0.48). CONCLUSION We report similar efficacy and tolerance of MMF or CYC as induction therapy of class IV LN in children. However, the long-term adverse events such as infertility could not be systematically evaluated in this retrospective pediatric study. Overall, however, considering the long-term safety profile reported in the literature, we suggest that MMF may be used as first-line induction therapy in LN.
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Affiliation(s)
- Marwa Chbihi
- Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France.
| | - Laurye-Anne Eveillard
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Quentin Riller
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Paris Cité University, Imagine Institute, Paris, France
| | - Romain Brousse
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Romain Berthaud
- Pediatric Nephrology, MARHEA Reference Center, Paris Cité University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France
| | - Rémi Salomon
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Marina Charbit
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Marina Avramescu
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Nathalie Biebuyck
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Laurène Dehoux
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Nicolas Garcelon
- Inserm U1163, Imagine Institute, Paris Center University, Paris, France
- Inserm, Cordeliers Research Center, U1138, team 22, Paris Cité University, Paris, France
| | - Jean-Paul Duong-Van-Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Brigitte Bader-Meunier
- Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France
| | - Olivia Boyer
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
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Mohamadou I, Matignon M, Malard S, Lombardi Y, Buob D, Moktefi A, Jamme M, Ouali N, Rafat C, François H, Petit-Hoang C, Rondeau E, Mesnard L, Grimbert P, Taupin JL, Luque Y. Additional Benefits of Rituximab and Plasma Exchange on Top of Standard Induction Therapy in Kidney Transplant Recipients With a Negative CDC Crossmatch but High Preformed Donor Specific Antibody Titer. Transpl Int 2023; 36:10844. [PMID: 37056357 PMCID: PMC10088221 DOI: 10.3389/ti.2023.10844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
Optimal induction strategy in highly sensitized kidney transplant recipients (KTRs) is still a matter of debate. The place of therapies, such as plasma exchange and rituximab, with potential side effects and high cost, is not clearly established. We compared two induction strategies with (intensive) or without (standard) rituximab and plasma exchange in KTRs with high levels of preformed DSA transplanted between 2012 and 2019. Sixty KTRs with a mean age of 52.2 ± 12.2 years were included, 36 receiving standard and 24 intensive induction. Mean fluorescence intensity of immunodominant DSA in the cohort was 8,903 ± 5,469 pre-transplantation and similar in both groups. DSA level decrease was similar at 3 and 12 months after transplantation in the two groups. An intensive induction strategy was not associated with better graft or patient survival, nor more infectious complications. The proportion of patients with rejection during the first year was similar (33% in each group), but rejection occurred later in the intensive group (211 ± 188 days, vs. 79 ± 158 days in the standard group, p < 0.01). Our study suggests that an intensive induction therapy including rituximab and plasma exchanges in highly sensitized kidney recipients is not associated with better graft survival but may delay biopsy-proven rejection.
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Affiliation(s)
- Inna Mohamadou
- Service de Transplantation Rénale, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
- INSERM U1155 Des Maladies Rénales Rares Aux Maladies Fréquentes, Remodelage Et Réparation, Paris, France
- *Correspondence: Inna Mohamadou,
| | - Marie Matignon
- Service de Néphrologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Stéphanie Malard
- Laboratoire d’Immunologie et d’Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Yannis Lombardi
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - David Buob
- Sorbonne Université, Paris, France
- INSERM U1155 Des Maladies Rénales Rares Aux Maladies Fréquentes, Remodelage Et Réparation, Paris, France
- Anatomie Pathologique, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Pairs, France
| | - Anissa Moktefi
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Département de Pathologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris, Créteil, France
| | - Matthieu Jamme
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Nacera Ouali
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Cedric Rafat
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Hélène François
- Sorbonne Université, Paris, France
- INSERM U1155 Des Maladies Rénales Rares Aux Maladies Fréquentes, Remodelage Et Réparation, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Camille Petit-Hoang
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Eric Rondeau
- Sorbonne Université, Paris, France
- INSERM U1155 Des Maladies Rénales Rares Aux Maladies Fréquentes, Remodelage Et Réparation, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Laurent Mesnard
- Sorbonne Université, Paris, France
- INSERM U1155 Des Maladies Rénales Rares Aux Maladies Fréquentes, Remodelage Et Réparation, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Philippe Grimbert
- Service de Néphrologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Jean-Luc Taupin
- Laboratoire d’Immunologie et d’Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Yosu Luque
- Sorbonne Université, Paris, France
- INSERM U1155 Des Maladies Rénales Rares Aux Maladies Fréquentes, Remodelage Et Réparation, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
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Bergen ES, Pilla L, Auclin E, Ilhan-Mutlu A, Prager GW, Pietrantonio F, Antista M, Ghelardi F, Basile D, Aprile G, Longarini R, Hautefeuille V, Tougeron D, Artru P, Mabro M, Drouillard A, Roth G, Ben Abdelghani M, Clement I, Toullec C, Mineur L, Guimbaud R, Taieb J, Zaanan A. Optimal treatment strategy after first-line induction therapy in advanced HER2-positive oeso-gastric adenocarcinoma-a retrospective, international, multicentric AGEO study. Gastric Cancer 2023; 26:425-437. [PMID: 36881202 DOI: 10.1007/s10120-023-01374-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The optimal treatment strategy after first-line induction therapy in advanced HER2-positive oeso-gastric adenocarcinoma (OGA) remains challenging. METHODS Patients treated with trastuzumab (T) plus platinum salts and fluoropyrimidine (F) as first-line chemotherapy between 2010 and 2020 for HER2-positive advanced OGA at 17 academic care centers in France, Italy, and Austria were included. The primary objective was the comparison of F + T vs T alone as maintenance regimen in terms of progression-free survival (PFS) and overall survival (OS) after a platinum-based chemotherapy induction + T. As secondary objective, PFS and OS between patients treated with reintroduction of initial chemotherapy or standard second-line chemotherapy at progression were assessed. RESULTS Among the 157 patients included, 86 (55%) received F + T and 71 (45%) T alone as a maintenance regimen after a median of 4 months of induction chemotherapy. Median PFS from start of maintenance therapy was 5.1 months in both groups (95% CI 4.2-7.7 for F + T and 95% CI 3.7-7.5 for T alone; p = 0.60) and median OS was 15.2 (95% CI 10.9-19.1) and 17.0 months (95% CI 15.5-21.6) for F + T and T alone, respectively (p = 0.40). Of 112/157 patients (71%) receiving systemic therapy after progression under maintenance, 26/112 (23%) were treated with a reintroduction of initial chemotherapy + T and 86/112 (77%) with a standard second-line regimen. Here, median OS was significantly longer with the reintroduction (13.8 (95% CI 12.1-19.9) vs 9.0 months (95% CI 7.1-11.9); p = 0.007) as confirmed by multivariate analysis (HR 0.49; 95% CI 0.28-0.85; p = 0.01). CONCLUSION No additional benefit of adding F to T monotherapy as a maintenance treatment could be observed. Reintroduction of initial therapy at first progression may be a feasible approach to preserve later treatment lines.
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Affiliation(s)
- Elisabeth S Bergen
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance publique - Hôpitaux de Paris, SIRIC CARPEM, Université Paris Cité, 20, Rue Leblanc, 75908, Cedex 15, Paris, France
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Lorenzo Pilla
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance publique - Hôpitaux de Paris, SIRIC CARPEM, Université Paris Cité, 20, Rue Leblanc, 75908, Cedex 15, Paris, France
| | - Edouard Auclin
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aysegül Ilhan-Mutlu
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Gerald W Prager
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Antista
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Ghelardi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Debora Basile
- Department of Medical Oncology, San Giovanni Di Dio Hospital, Crotone, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, AULSS8 Berica, Vicenza, Italy
| | - Raffaella Longarini
- Division of Medical Oncology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900, Monza, Italy
| | - Vincent Hautefeuille
- Department of Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France
| | - David Tougeron
- Department of Hepatogastroenterology, Poitiers University Hospital, Poitiers, France
| | - Pascal Artru
- Department of Gastroenterology, Jean Mermoz Hospital, Lyon, France
| | - May Mabro
- Department of Oncology, Foch Hospital, Suresnes, France
| | - Antoine Drouillard
- Hepato-Gastroenterology Department, University Hospital François-Mitterrand, Dijon, France
| | - Gael Roth
- Univ. Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes / Institute for Advanced Biosciences, CNRS, UMR 5309-INSERM U1209, Grenoble, France
| | | | - Inès Clement
- Gastroenterology and Digestive Oncology Department, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France
| | - Clemence Toullec
- Gastrointestinal Oncology Unit, Institut du Cancer, Avignon Provence, France
| | - Laurent Mineur
- Gastrointestinal Oncology Unit, Institut du Cancer, Avignon Provence, France
| | - Rosine Guimbaud
- Digestive Medical Oncology Unit, Toulouse University Hospital, Toulouse, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance publique - Hôpitaux de Paris, SIRIC CARPEM, Université Paris Cité, 20, Rue Leblanc, 75908, Cedex 15, Paris, France
- Centre de Recherche des Cordeliers, INSERM UMRS1138, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe Labellisée Ligue Nationale Contre le Cancer, CNRS SNC 5096, 75006, Paris, France
| | - Aziz Zaanan
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance publique - Hôpitaux de Paris, SIRIC CARPEM, Université Paris Cité, 20, Rue Leblanc, 75908, Cedex 15, Paris, France.
- Centre de Recherche des Cordeliers, INSERM UMRS1138, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe Labellisée Ligue Nationale Contre le Cancer, CNRS SNC 5096, 75006, Paris, France.
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Horiuchi Y. Letter to the Editor: Proposal for Th1-Induction Therapy for Atopic Dermatitis: A Possibility for the Use of the Varicella Zoster Virus Vaccine. Viral Immunol 2023; 36:149-150. [PMID: 36716265 DOI: 10.1089/vim.2022.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Chhabra S, Callander N, Watts NL, Costa LJ, Thapa B, Kaufman JL, Laubach J, Sborov DW, Reeves B, Rodriguez C, Chari A, Silbermann R, Anderson LD, Bal S, Dhakal B, Nathwani N, Shah N, Medvedova E, Bumma N, Holstein SA, Costello C, Jakubowiak A, Wildes TM, Schmidt T, Orlowski RZ, Shain KH, Cowan AJ, Dholaria B, Cornell RF, Jerkins JH, Pei H, Cortoos A, Patel S, Lin TS, Usmani SZ, Richardson PG, Voorhees PM. Stem Cell Mobilization Yields with Daratumumab- and Lenalidomide-Containing Quadruplet Induction Therapy in Newly Diagnosed Multiple Myeloma: Findings from the MASTER and GRIFFIN Trials. Transplant Cell Ther 2023; 29:174.e1-174.e10. [PMID: 36494017 DOI: 10.1016/j.jtct.2022.11.029] [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] [Received: 08/29/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
For eligible patients with newly diagnosed multiple myeloma (NDMM), standard of care includes induction therapy followed by autologous stem cell transplantation (ASCT). Daratumumab as monotherapy and in combination treatment is approved across multiple lines of therapy for multiple myeloma (MM), and lenalidomide is an effective and commonly used agent for induction and maintenance therapy in MM. However, there is concern that lenalidomide and daratumumab given as induction therapy might impair mobilization of stem cells for ASCT. Therefore, we assessed stem cell mobilization in patients following frontline induction therapy in the MASTER and GRIFFIN phase 2 clinical studies by examining stem cell mobilization yields, apheresis attempts, and engraftment outcomes for patients from each study. Adult transplantation-eligible patients with NDMM received induction therapy consisting of daratumumab plus carfilzomib/lenalidomide/dexamethasone (D-KRd) for four 28-day cycles in the single-arm MASTER trial or lenalidomide/bortezomib/dexamethasone (RVd) with or without daratumumab (D) for four 21-day cycles in the randomized GRIFFIN trial, followed by stem cell mobilization and ASCT in both studies. Institutional practice differed regarding plerixafor use for stem cell mobilization; the strategies were upfront (ie, planned plerixafor use) or rescue (ie, plerixafor use only after mobilization parameters indicated failure with granulocyte colony-stimulating factor [G-CSF] alone). Descriptive analyses were used to summarize patient characteristics, stem cell mobilization yields, and engraftment outcomes. In MASTER, 116 D-KRd recipients underwent stem cell mobilization and collection at a median of 24 days after completing induction therapy. In GRIFFIN, 175 patients (D-RVd, n = 95; RVd, n = 80) underwent mobilization at a median of 27 days after completing D-RVd induction therapy and 24 days after completing RVd induction therapy. Among those who underwent mobilization and collection, 7% (8 of 116) of D-KRd recipients, 2% (2 of 95) of D-RVd recipients, and 6% (5 of 80) of RVd recipients did not meet the center-specific minimally required CD34+ cell yield in the first mobilization attempt; however, nearly all collected sufficient stem cells for ASCT on remobilization. Among patients who underwent mobilization, plerixafor use, either upfront or as a rescue strategy, was higher in patients receiving D-KRd (97%; 112 of 116) and D-RVd (72%; 68 of 95) compared with those receiving RVd (55%; 44 of 80). The median total CD34+ cell collection was 6.0 × 106/kg (range, 2.2 to 13.9 × 106/kg) after D-KRd induction, 8.3 × 106/kg (range, 2.6 to 33.0 × 106/kg) after D-RVd induction, and 9.4 × 106/kg (range, 4.1 to 28.7 × 106/kg) after RVd induction; the median days for collection were 2, 2, and 1, respectively. Among patients who underwent mobilization, 98% (114 of 116) of D-KRd patients, 99% (94 of 95) of D-RVd patients, and 98% (78 of 80) of RVd patients underwent ASCT using median CD34+ cell doses of 3.2 × 106/kg, 4.2 × 106/kg, and 4.8 × 106/kg, respectively. The median time to neutrophil recovery was 12 days in all 3 treatment groups across the 2 trials. Because both trials used different criteria to define platelet recovery, data on platelet engraftment using the same criteria are not available. Four cycles of daratumumab- and lenalidomide-based quadruplet induction therapy had a minimal impact on stem cell mobilization and allowed predictable stem cell harvesting and engraftment in all patients who underwent ASCT. Upfront plerixafor strategy may be considered, but many patients were successfully collected with the use of G-CSF alone or rescue plerixafor.
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Affiliation(s)
| | | | - Nicole L Watts
- University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Luciano J Costa
- University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Bicky Thapa
- Medical College of Wisconsin, Division of Hematology/Oncology, Department of Medicine, Milwaukee, Wisconsin
| | | | - Jacob Laubach
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, Massachusetts
| | - Douglas W Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Brandi Reeves
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Larry D Anderson
- Myeloma, Waldenstrom's and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Susan Bal
- University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Binod Dhakal
- Medical College of Wisconsin, Division of Hematology/Oncology, Department of Medicine, Milwaukee, Wisconsin
| | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Nina Shah
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Eva Medvedova
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Sarah A Holstein
- Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Caitlin Costello
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | | | - Tanya M Wildes
- Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Timothy Schmidt
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth H Shain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, Washington
| | | | | | - James H Jerkins
- Medical College of Wisconsin, Division of Hematology/Oncology, Department of Medicine, Milwaukee, Wisconsin
| | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, New Jersey
| | | | | | - Thomas S Lin
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul G Richardson
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, Massachusetts
| | - Peter M Voorhees
- Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, North Carolina
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El-Reshaid K, Al-Bader S, Madda J. The Beneficial Effect of Three-month Induction Therapy with High-dose Prednisone and Mycophenolate Mofetil Followed by Maintenance Therapy in Acute Non-crescentic Nephritis Associated with Immunoglobulin A Deposition Disease in Adults. Saudi J Kidney Dis Transpl 2023; 34:161-166. [PMID: 38146726 DOI: 10.4103/1319-2442.391895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
The data available on immunoglobulin A (IgA) deposition disease indicate an inherited predisposition to the disease with autoimmune triggering. Hence, we prospectively evaluated the role of a new autoimmune regimen in the treatment of severe nephrotic or nephritic flares associated with noncrescentic nephritis in adult patients. Thirty-six patients were included, and the regimen consisted of an initial 3-month induction phase of prednisone and mycophenolate mofetil (MMF), followed by a maintenance phase of MMF alone for 21 months. Complete remission (CR) (normalization of creatinine clearance [CrCl] and a decrease in protein output to <500 mg/day) was achieved in 29 of 36 patients, and a partial response (no further decline in CrCl and a decrease in proteinuria to <50%) was seen in seven patients. CrCl was maintained in patients with CR but was mildly reduced in partially responsive ones. Our study showed the short- and longterm safety and efficacy of this autoimmune regimen directed toward the autoimmune triggering factors in severe forms of noncrescentic IgA nephritis.
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Affiliation(s)
- Kamel El-Reshaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Shaikha Al-Bader
- Department of Medicine, Nephrology Unit, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - John Madda
- Department of Pathology, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
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Yu N, Ye S, Yang Z, Chen Z, Zhang C. Disseminated Cunninghamella elegans Infection Diagnosed by mNGS During Induction Therapy in a Child With Intermediate-risk Acute Lymphoblastic Leukemia: A Case Report and Review of Literature. J Pediatr Hematol Oncol 2023; 45:e266-e271. [PMID: 36730964 DOI: 10.1097/mph.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/17/2022] [Indexed: 02/04/2023]
Abstract
We described a 14-year-old girl with acute lymphoblastic leukemia who developed disseminated mucormycosis during induction therapy. Disseminated Cunninghamella elegans infection was confirmed by histopathology, microbiological culture, and metagenomic next-generation sequencing analysis of skin tissue, blood, and cerebrospinal fluid. Subsequently, the patient received a combination of liposomal amphotericin B, posaconazole, and caspofungin for antifungal treatment, but eventually died because of severe fungal pneumonia, respiratory failure, and septic shock. Moreover, case reports of pulmonary mucormycosis in children published since 1959 were reviewed. In summary, metagenomic next-generation sequencing is an effective diagnostic method for Cunninghamella with high speed and sensitivity.
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Affiliation(s)
- Nan Yu
- Department of PICU, National Clinical Research Center for Child Health, the Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Kong KA, Thorp BD, Sheth SH. The Role of Induction Therapy for Sinonasal Cancers. Curr Treat Options Oncol 2023; 24:162-169. [PMID: 36696082 DOI: 10.1007/s11864-022-01046-z] [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] [Accepted: 12/05/2022] [Indexed: 01/26/2023]
Abstract
OPINION STATEMENT The role of induction chemotherapy in sinonasal cancers is promising; however, prospective studies with higher grades of evidence are needed. With the currently available literature, the authors would advocate for the use of induction chemotherapy (IC) in locally advanced sinonasal squamous cell carcinoma (T3-T4) for organ preservation and potentially for improved survival outcomes. In sinonasal undifferentiated carcinoma (SNUC), IC should be considered in all patients given its tendency for aggressive invasion and poor outcomes. In SNUC, response to IC may direct the modality of definitive treatment to follow. In responders (partial or complete), chemoradiation therapy should be strongly considered. In non-responders or in those with progression of disease, surgical therapy is favored. For esthesioneuroblastoma, surgical resection with negative margins and adjuvant radiation therapy remains the gold standard. However, IC may be considered for locally advanced disease especially with orbital invasion or in recurrent/distant disease. There is no definite indication for IC in sinonasal adenoid cystic carcinoma or sinonasal adenocarcinoma. Recommendations are summarized in Table 1.
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Affiliation(s)
- Keonho A Kong
- Department of Otolaryngology/Head & Neck Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Brian D Thorp
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, Chapel Hill, USA
| | - Siddharth H Sheth
- Division of Oncology, Department of Medicine, University of North Carolina, Houpt Building, 3rd Floor, 170 Manning Drive, CB# 7305, Chapel Hill, NC, 27599, USA.
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Uchida M, Mochizuki E, Ishida S, Ozawa N, Yonemitsu H, Ochiai H, Nakamura H, Kawashiri T, Kato K, Egashira N, Akashi K, Ieiri I. Usefulness of a Medication Instruction Sheet for Patients Receiving Cytarabine and Idarubicin Induction Therapy for Acute Myeloid Leukemia. In Vivo 2023; 37:924-932. [PMID: 36881060 PMCID: PMC10026641 DOI: 10.21873/invivo.13164] [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] [Received: 01/01/2023] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM To monitor adverse events rapidly and accurately during combination chemotherapy, we established an innovative medication instruction sheet (MIS) including cytarabine and idarubicin induction therapy. However, it is unclear whether this MIS allows for the accurate prediction of adverse events and their onset timing in a clinically significant manner. We therefore evaluated the clinical usefulness of our MIS for monitoring adverse events. PATIENTS AND METHODS Patients who received cytarabine and idarubicin induction therapy for acute myeloid leukemia (AML) at the Department of Hematology, Kyushu University Hospital between January 2013 and February 2022 were included. The real-world clinical data were compared to the MIS to determine the accuracy of the MIS for predicting the onset and duration of adverse events in patients with AML during induction chemotherapy. RESULTS Thirty-nine patients with AML were included in this study. Overall, 294 adverse events were noted, all of which were predicted items in the MIS. Among the 192 non-hematological adverse events, 131 (68.2%) occurred during a similar period as that listed in the MIS, whereas among the 102 hematological adverse events, 98 (96.1%) appeared earlier than expected. For the non-hematological events, the onset and duration of elevated aspartate aminotransferase levels and nausea/vomiting coincided well with those listed in the MIS, whereas the predictive accuracy for rashes was the lowest. CONCLUSION Hematological toxicity was not predicted because of the bone marrow failure associated with AML. Our MIS was useful for rapidly monitoring non-hematological adverse events in patients with AML receiving cytarabine and idarubicin induction therapy.
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Affiliation(s)
- Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan;
| | - Erika Mochizuki
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Shigeru Ishida
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Nana Ozawa
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroko Yonemitsu
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Hideki Ochiai
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Hanae Nakamura
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Takehiro Kawashiri
- Department of Clinical Pharmacy and Pharmaceutical Care, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Nobuaki Egashira
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ichiro Ieiri
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
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Tang H, Yang D, Luo G, He J, Yi G, Chen Z, Li H, Luo Q, Huang N, Luo H. Durable response of tislelizumab plus cisplatin, nab-paclitaxel followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: A case report. Medicine (Baltimore) 2023; 102:e32924. [PMID: 36800614 PMCID: PMC9936014 DOI: 10.1097/md.0000000000032924] [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: 02/19/2023] Open
Abstract
RATIONALE Limited patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) have achieved complete response (CR) from induction chemotherapy (IC). Neoadjuvant immunotherapy combined with chemotherapy has marked therapeutic effects in some locoregionally advanced solid tumors. However, its efficacy and safety of NPC have not been reported so far. The rapid response of neoadjuvant tislelizumab combined with chemotherapy on LA-NPC may be associated with long-term survival benefit. PATIENT CONCERNS A 57-year-old male patient presented with a 2-month history of bloody nasal discharge and right neck mass for 2 weeks. DIAGNOSIS The patient was eventually diagnosed with nasopharyngeal nonkeratinizing undifferentiated cell carcinoma (stage IVA). INTERVENTIONS The patient received tislelizumab combined with nanoparticle albumin-bound paclitaxel (nab-paclitaxel) nab-paclitaxel plus cisplatin for 4 cycles, followed by cisplatin-based concurrent chemoradiotherapy (CCRT). OUTCOMES A partial response (PR) was achieved after 2 cycles of tislelizumab and nab-paclitaxel plus cisplatin, and CR was achieved after 4 cycles of neoadjuvant treatment. The duration of response lasted 24 months, and the patient was still in CR as of November 2022. The patient had no serious adverse event (AEs) during the treatment. LESSONS This case report showed that tislelizumab combined with cisplatin plus nab-paclitaxel followed CCRT for treatment of patients with LA-NPC may receive a fast and durable response with a manageable safety profile and long-term survival.
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Affiliation(s)
- Haifeng Tang
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Donghong Yang
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Guoqing Luo
- Department of Otorhinolaryngology Head and Neck Surgery at the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Jiaqi He
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Guihua Yi
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zihong Chen
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Haiwen Li
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qianbing Luo
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Ningxin Huang
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Haiqing Luo
- Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- * Correspondence: Haiqing Luo, Specialty of Head and Neck Oncology at Cancer Hospital of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China (e-mail: )
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Abou-Jaoudé M, Akiki D, Moussawi A, Abou-Jaoudé W. The impact of induction therapy in low-immunological risk kidney transplant recipients regardless of HLA matching. Transpl Immunol 2023; 76:101773. [PMID: 36526105 DOI: 10.1016/j.trim.2022.101773] [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] [Received: 07/14/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Induction agents have proved to reduce the rate of acute rejection (AR) in kidney transplant recipients (KTRs) without improving long-term graft and patient survival (PS). OBJECTIVE This study evaluates the utility of induction therapy in low immunological risk KTRs regardless of donor-to-recipient HLA matching. METHODS We retrospectively reviewed the records of 218 patients undergoing kidney transplantation (KT). These patients were divided into two groups according to the usage of induction therapy: 82 did not receive any induction therapy (Group I), and 136 patients received either Anti-IL2 receptor antibodies or anti-thymocyte globulin (Group II). All patients had panel reactive antibody (PRA) < 20% and absence of donor-specific antibodies (DSA). The difference in outcomes were assessed at different intervals following KT. RESULTS The rate of bacterial infections at one year (p-value = 0.032) and the frequency of CMV disease (p-value = 0.044) were significantly higher in Group II (with induction therapy). The duration of hospital stay, the rate and severity of acute rejection, the occurrence of delayed graft function, the rate and type of surgical complications at one year, and the graft function and survival at one and three years were similar between the two groups (p-value = NS). In addition, the financial burden is much less in Group I (without induction therapy), reducing the total cost of the transplant procedure. CONCLUSION We conclude that induction therapy in low-immunological risk kidney transplant patients is not a must regardless of donor-to-recipient HLA matching. Therefore, induction therapy did not yield significant health results, but had negative financial consequences.
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Affiliation(s)
- Maroun Abou-Jaoudé
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; Department of Surgery, Middle East Institute of Health, Bsalim, Lebanon; Department of Surgery, Saint-George Hospital-UMC, Beirut, Lebanon.
| | - Dany Akiki
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Ali Moussawi
- Department of Nephrology, Middle East Institute of Health, Bsalim, Lebanon
| | - Walid Abou-Jaoudé
- Department of Nephrology, Middle East Institute of Health, Bsalim, Lebanon
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Zhou M, Zhang Q, Ren XY, An FR, Wang ZT, Wang HP, Liu LL, Zhai ZM, Dong Y, Tao QS. Impact of rhG-CSF on Clinical Efficacy and Immune Cell Subsets after Initial Induction Chemotherapy in AML. Clin Lab 2023; 69. [PMID: 36787571 DOI: 10.7754/clin.lab.2022.220436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The impact of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in acute myeloid leukemia (AML) is still controversial. The purpose of this study is to explore the impact of rhG-CSF administration on clinical efficacy and immune cell subsets after initial induction chemotherapy in AML. METHODS The clinical efficacy and immune cell subsets were compared in the newly diagnosed patients with AML according to whether rhG-CSF was used after initial induction chemotherapy. Next, rhG-CSF stimulation experi-ments on leukemia cell lines and primary leukemia blasts were performed in vitro. RESULTS There was no statistical difference between control group and rhG-CSF therapy group in complete remission rate and relapse free survival. The duration of agranulocytosis was significantly shortened in rhG-CSF therapy group compared with control group. The percentage of circulating monocytic myeloid-derived suppressor cells (M-MDSCs) and regulatory T cells (Tregs) were significantly increased after the administration of rhG-CSF. Furthermore, it was found that rhG-CSF did not promote the proliferation of leukemia cell lines and primary leukemia blasts, but increased the proportion of M-MDSCs and Tregs in vitro. CONCLUSIONS Administration of rhG-CSF after initial induction therapy of AML does not affect the clinical remission and relapse rate, but reduces the duration of agranulocytosis and increases the proportion of M-MDSCs and Tregs.
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Jiang D, Cao J, Guo L, Chen Y, Yuan G, Huang J. Induction chemotherapy with sequential nimotuzumab plus concurrent chemoradiotherapy in advanced nasopharyngeal carcinoma: A retrospective real-world study. Medicine (Baltimore) 2023; 102:e32732. [PMID: 36705354 PMCID: PMC9876024 DOI: 10.1097/md.0000000000032732] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Many locally advanced nasopharyngeal carcinoma patients develop local recurrence or distant metastasis. Our retrospective real-world study aims to evaluate the efficacy and safety of curative sequential approach with induction chemotherapy followed by concurrent chemoradiation + nimotuzumab as first-line therapy in advanced nasopharyngeal carcinoma. From 2015 to 2021, the clinic data of 117 patients with advanced nasopharyngeal carcinoma (stage III-IV a) who were treated in the Affiliated Hospital of Guangdong Medical University were retrospectively reviewed. Fifty-four patients in observation group received taxanes, cisplatin, and 5-fluorouracil/taxanes and cisplatin induction chemotherapy and nimotuzumab (200 mg, weekly) combined with concurrent chemo-radiotherapy (cisplatin: 40 mg/m2 weekly; intensity-modulated radiation therapy); 63 patients in control group received same therapy without nimotuzumab. There was no significant difference in patients' characteristic baseline between 2 groups (P > .05). The complete response rate and objective response rate of the observational group was significantly higher than control group (46.30% vs 17.64%, P = .01; 96.30% vs 82.54%, P = .02). The median follow-up time was 24.77 (3.53-65.97) months. Both of the median progress free survival time and overall survival time were not reached. The 5-year progression-free survival rate of observation group was greater than control group (84.40% vs 63.70%, hazard ratios 0.365, 95% confidence intervals 0.147-0.909, P = .03). The 5-year overall survival rate of observation group and control group were 91.70% and 84.60%, respectively (P = .20). None of the patients withdrew from the study due to adverse events. Nimotuzumab combined with concurrent chemoradiotherapy as first-line therapy in advanced nasopharyngeal carcinoma can improve objective response rate and 5-year progress free survival rate with good safety profile.
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Affiliation(s)
- Danxian Jiang
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinxin Cao
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Linying Guo
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yonghua Chen
- Department of Pathology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ge Yuan
- Department of Radiotherapy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jing Huang
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- * Correspondence: Jing Huang, Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, No. 57 South Renmin Avenue, Xiashan District, Zhanjiang 524001, China (e-mail: )
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Canali A, Vergnolle I, Bertoli S, Largeaud L, Nicolau ML, Rieu JB, Tavitian S, Huguet F, Picard M, Bories P, Vial JP, Lechevalier N, Béné MC, Luquet I, Mansat-De Mas V, Delabesse E, Récher C, Vergez F. Prognostic Impact of Unsupervised Early Assessment of Bulk and Leukemic Stem Cell Measurable Residual Disease in Acute Myeloid Leukemia. Clin Cancer Res 2023; 29:134-142. [PMID: 36318706 DOI: 10.1158/1078-0432.ccr-22-2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/24/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Acute myeloid leukemias (AML) are clonal diseases that develop from leukemic stem cells (LSC) that carry an independent prognostic impact on the initial response to induction chemotherapy, demonstrating the clinical relevance of LSC abundance in AML. In 2018, the European LeukemiaNet published recommendations for the detection of measurable residual disease (Bulk MRD) and suggested the exploration of LSC MRD and the use of multiparametric displays. EXPERIMENTAL DESIGN We evaluated the performance of unsupervised clustering for the post-induction assessment of bulk and LSC MRD in 155 patients with AML who received intensive conventional chemotherapy treatment. RESULTS The median overall survival (OS) for Bulk+ MRD patients was 16.7 months and was not reached for negative patients (HR, 3.82; P < 0.0001). The median OS of LSC+ MRD patients was 25.0 months and not reached for negative patients (HR, 2.84; P = 0.001). Interestingly, 1-year (y) and 3-y OS were 60% and 39% in Bulk+, 91% and 52% in Bulk-LSC+ and 92% and 88% in Bulk-LSC-. CONCLUSIONS In this study, we confirm the prognostic impact of post-induction multiparametric flow cytometry Bulk MRD in patients with AML. Focusing on LSCs, we identified a group of patients with negative Bulk MRD but positive LSC MRD (25.8% of our cohort) with an intermediate prognosis, demonstrating the interest of MRD analysis focusing on leukemic chemoresistant subpopulations.
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Affiliation(s)
- Alban Canali
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Inès Vergnolle
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Sarah Bertoli
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - Laetitia Largeaud
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - Marie-Laure Nicolau
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Jean-Baptiste Rieu
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Suzanne Tavitian
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Françoise Huguet
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Muriel Picard
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Pierre Bories
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Jean Philippe Vial
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Nicolas Lechevalier
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Marie Christine Béné
- Laboratoire d'Hématologie, CHU de Nantes, Nantes, CRCI²NA INSERM UMR1307, CNRS UMR 6075, France
| | - Isabelle Luquet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Véronique Mansat-De Mas
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - Eric Delabesse
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - Christian Récher
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - François Vergez
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
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Wang B, Wen X, Zhang R, Zhu G, Wu Y, Zhang Y, Lin W, Yu J, Fan J, Li J, Yang J, Qin M, Zheng H. Homoharringtonine-Based Induction Therapy Reduces the Recurrence Rate of Pediatric Acute Myeloid Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation. Cell Transplant 2023; 32:9636897231183559. [PMID: 37470325 PMCID: PMC10363872 DOI: 10.1177/09636897231183559] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/21/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective treatment for acute myeloid leukemia (AML). Pediatric patients with AML who relapse after HSCT have an extremely poor prognosis. We performed a retrospective study of pediatric patients diagnosed with AML from August 2015 to October 2019 who were treated with HSCT. Kaplan-Meier analyses were used to evaluate overall survival (OS), event-free survival (EFS), and cumulative recurrence rate (CRR). Cox regression analysis was used to determine the association between the baseline characteristics and relapse. A total of 37 pediatric patients met the inclusion criteria. Twenty-eight (75.7%) patients survived, and 9 (24.3%) patients died. The OS rates of AML patients treated with HSCT were 89.2% ± 5.1%, 75.7% ± 7.1%, and 75.7% ± 7.1% at 1, 3, and 5 years, respectively, and the CRRs were 11.4% ± 5.4%, 24.7% ± 7.7%, and 33.1% ± 10.4% at 1, 3, and 5 years after HSCT, respectively; four of nine children who relapsed after transplantation died. Induction with etoposide rather than homoharringtonine and fungal infections could be high-risk factors for recurrence after transplantation. The association between homoharringtonine-based induction therapy and a low recurrence rate persisted after adjusting for age, sex, risk stratification, fusion genes, and fungal infections. This study clarifies the clinical features and poor prognosis of post-transplant relapse in pediatric AML and indicates the urgent need for effective therapy for patients who relapse after HSCT.
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Affiliation(s)
- Bin Wang
- Transplantation Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiaojia Wen
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ruidong Zhang
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Guanghua Zhu
- Transplantation Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ying Wu
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuanyuan Zhang
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wei Lin
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jiaole Yu
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jia Fan
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jing Li
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jun Yang
- Transplantation Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Maoquan Qin
- Transplantation Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Huyong Zheng
- Leukemia Department, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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Saha A, Wadsley J, Sirohi B, Goody R, Anthony A, Perumal K, Ulahanan D, Collinson F. Can Concurrent Chemoradiotherapy Add Meaningful Benefit in Addition to Induction Chemotherapy in the Management of Borderline Resectable and Locally Advanced Pancreatic Cancer?: A Systematic Review. Pancreas 2023; 52:e7-e20. [PMID: 37378896 DOI: 10.1097/mpa.0000000000002215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES The role of concomitant chemoradiotherapy or radiotherapy (RT) after induction chemotherapy (IC) in borderline resectable and locally advanced pancreatic ductal adenocarcinoma is debatable. This systematic review aimed to explore this. METHODS We searched PubMed, MEDLINE, EMBASE, and Cochrane database. Studies were selected reporting outcomes on resection rate, R0 resection, pathological response, radiological response, progression-free survival, overall survival, local control, morbidity, and mortality. RESULTS The search resulted in 6635 articles. After 2 rounds of screening, 34 publications were selected. We found 3 randomized controlled studies and 1 prospective cohort study, and the rest were retrospective studies. There is consistent evidence that addition of concomitant chemoradiotherapy or RT after IC improves pathological response and local control. There are conflicting results in terms of other outcomes. CONCLUSIONS Concomitant chemoradiotherapy or RT after IC improves local control and pathological response in borderline resectable and locally advanced pancreatic ductal adenocarcinoma. The role of modern RT in improving other outcome requires further research.
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Affiliation(s)
- Animesh Saha
- From the Department of Radiation Oncology, Apollo Multispecilty Hospitals, Kolkata, India
| | - Jonathan Wadsley
- Department of Clinical Oncology, Weston Park Cancer Centre, Sheffield, United Kingdom
| | - Bhawna Sirohi
- Department of Medical Oncology, Apollo Proton Cancer Centre, Chennai, India
| | | | - Alan Anthony
- Medical Oncology, Leeds Cancer Center, Leeds, United Kingdom
| | | | - Danny Ulahanan
- Medical Oncology, Leeds Cancer Center, Leeds, United Kingdom
| | - Fiona Collinson
- Medical Oncology, Leeds Cancer Center, Leeds, United Kingdom
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Tsukada N, Oda Y, Nomura M, Kasuya Y, Takei T, Sato K, Ogura M, Kikuchi T, Abe Y, Suzuki K, Ishida T. [A retrospective analysis of 124 patients with multiple myeloma who received up-front autologous hematopoietic cell transplantation following triplet induction therapy]. Rinsho Ketsueki 2023; 64:1397-1403. [PMID: 38072424 DOI: 10.11406/rinketsu.64.1397] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The IFM/DFCI group reported that VRD induction followed by up-front autologous peripheral blood stem cell transplantation (ASCT) and maintenance therapy led to median PFS of 50 months, which established up-front ASCT as the standard of care even in the era of novel agents. We conducted a retrospective analysis on outcomes of patients who received triplet induction therapy followed by up-front ASCT at our institution. A total of 124 patients received ASCT between November 2016 and December 2021 at Japanese Red Cross Medical Center. Patient characteristics, treatment response before and after ASCT, and PFS and OS were retrospectively analyzed. VRD-based induction therapy was used for 94%. Among 118 evaluable patients, 116 (98%) received either consolidation and/or maintenance therapy. Best responses were ≥CR 77% and ≥VGPR 94%, respectively. Sixty-eight out of 104 patients achieved MRD-negativity by multiparameter FCM (<10-5). Five-year estimated PFS and OS were 54.7% and 80.2%, respectively. Age ≥65, high-risk cytogenetic abnormalities, and
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Affiliation(s)
| | - Yuki Oda
- Department of Hematology, Japanese Red Cross Medical Center
| | - Moe Nomura
- Department of Hematology, Japanese Red Cross Medical Center
| | - Yuki Kasuya
- Department of Hematology, Japanese Red Cross Medical Center
| | - Tomomi Takei
- Department of Hematology, Japanese Red Cross Medical Center
| | - Kota Sato
- Department of Hematology, Japanese Red Cross Medical Center
| | - Mizuki Ogura
- Department of Hematology, Japanese Red Cross Medical Center
| | - Taku Kikuchi
- Department of Hematology, Japanese Red Cross Medical Center
| | - Yu Abe
- Department of Hematology, Japanese Red Cross Medical Center
| | - Kenshi Suzuki
- Department of Hematology, Japanese Red Cross Medical Center
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center
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Fitoussi O, Roche JB, Riviere J, Wallerand H, Poulain JE, Gordien P, Galland S, Henriques B, Dupin C, Vincent M, Kuratle T, Saffarini M, Ramos-Pascual S. Accuracy of FDG-PET/CT for Response Evaluation of Muscle-Invasive Bladder Cancer following Neoadjuvant or Induction Chemotherapy. Urol Int 2023; 107:239-245. [PMID: 36657430 DOI: 10.1159/000528524] [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] [Received: 08/03/2022] [Accepted: 11/08/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The aim of the study was to confirm the diagnostic accuracy of a second FDG-PET/CT following neoadjuvant or induction chemotherapy (NAIC) prior to radical cystectomy for patients with localized muscle-invasive bladder cancer (MIBC). METHODS Retrospective review of 62 consecutive patients with MIBC, that had a first FDG-PET/CT between April 2016 and September 2021. Patients then underwent NAIC, followed by a second FDG-PET/CT and radical cystectomy. Patients with no hypermetabolism in the bladder and lymph nodes on the second FDG-PET/CT were considered metabolic complete responders, while patients with no evidence of residual disease on histopathology were considered pathologic complete responders. The accuracy of the second FDG-PET/CT to distinguish complete responders from patients with residual disease was calculated, with histopathology as gold standard. RESULTS Of 62 patients, 1 was lost to follow-up, 5 died before radical cystectomy, 5 had delay >2 months between the second FDG-PET/CT and radical cystectomy, and 6 did not undergo radical cystectomy and instead underwent alternative treatment. The study cohort comprised 45 patients, 39 males and 6 females, with an age of 66 ± 6 years. In comparison to histopathology, FDG-PET/CT provided (i) sensitivity of 95% and specificity of 42%, for the overall disease; (ii) sensitivity of 100% and specificity of 36%, for the primary tumor only; and (iii) sensitivity of 97% and specificity of 30%, for the lymph nodes only. CONCLUSION FDG-PET/CT has over 95% sensitivity for distinguishing complete responders from patients with residual disease. Thus, FDG-PET/CT can be used for early response evaluation following NAIC to identify patients that did not completely respond to chemotherapy and may require alternative treatment pathways.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Camille Dupin
- Laboratoire de Cytologie et d'anatomie pathologique CAP, Le Bouscat, France
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Chen Q, Shen L, Li S. Tumor volume reduction after induction chemotherapy with gemcitabine plus cisplatin in nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2022; 280:2497-2509. [PMID: 36572820 DOI: 10.1007/s00405-022-07809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the tumor volume reduction after induction chemotherapy (IC) with gemcitabine plus cisplatin (GP) and to build prediction models for tumor volume reduction in nasopharyngeal carcinoma (NPC). METHODS NPC patients who received GP IC were retrospectively enrolled. The gross tumor volume of the nasopharynx and lymph nodes (GTVnx and GTVnd) were contoured before and after IC. Univariate and multivariate analyses were performed to identify associated factors. Nomogram models were constructed to predict the possibility of tumor volume reduction. RESULTS A total of 192 patients were enrolled. The mean relative volume reduction for GTVnx and GTVnd was 29.66% and 31.75%, respectively. The volume reduction of GTVnx and GTVnd had a weak association (r = 0.229, p < 0.001). For GTVnx volume reduction, pre-treatment neutrophil count (p = 0.043), lymphocyte count (p = 0.026), LDH level (p = 0.005), and BMI (p = 0.020) were independently associated factors. For GTVnd volume reduction, pre-treatment EBV-DNA (p = 0.029), GTVnd volume (p < 0.001), eosinophil count (p = 0.043), NLR (p = 0.039), LDH level (p = 0.026), and serum potassium level (p = 0.027) were independently associated factors. For the GTVnx nomogram model, areas under the receiver-operating characteristic curve (AUC) were 0.702 and 0.698 for the training and validation cohorts, respectively. For the GTVnd nomogram model, the AUC was 0.872 and 0.758 for the training and validation cohorts, respectively. CONCLUSIONS Tumor volumes reduce significantly after GP induction chemotherapy. Nomogram models for predicting the possibility of tumor volume reduction are built.
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Affiliation(s)
- Qian Chen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Shan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China.
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136
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Liu JR, Gu JL, Huang BH, Kuang LF, Chen ML, Zou WY, Zheng D, Wang HH, Xu DR, Li J. [New agents-based induction chemotherapy followed by autologous stem cell transplantation and maintenance treatment strategy for multiple myeloma: a single center retrospective study of 300 cases]. Zhonghua Xue Ye Xue Za Zhi 2022; 43:1003-1009. [PMID: 36709105 PMCID: PMC9939329 DOI: 10.3760/cma.j.issn.0253-2727.2022.12.005] [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] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 01/30/2023]
Abstract
Objective: To examine the survival and influential factors of an integrated approach of novel agents, autologous hematopoietic stem cell (auto-HSCT) , and maintenance therapy in patients with multiple myeloma (MM) patients from a single center over the past 15 years. Methods: In our center, 300 MM patients who received an integrated strategy of new agents, auto-HSCT, and maintenance therapy over 15 years were retrospectively and prospectively analyzed. Results: The complete remission rates (CR) and ≥very good partial remission rates (VGPR) following induction therapy, transplantation, and maintenance therapy were respectively 35.3% and 55.2% , 72.4% and 80.0% , 89.2% , and 93.4% . When compared to patients receiving double-drug induction, the ≥VGPR and ORR of patients receiving triple-drug induction were improved. No difference existed in CR, ≥VGPR, and ORR between the PAD (bortezomib + liposome doxorubicin+ dexamethasone) and RAD (lenalidomide + liposome doxorubicin + dexamethasone) regimens, but the benefits speed differed. The negative rate of flow minimal residual disease following induction, transplantation, and maintenance was 18.8% (54 cases) , 41.4% (109 cases) , and 58.7% (142 cases) , respectively. The median time to progress (TTP) was 78.7 months and the median overall survival (OS) was 109 months. The median TTP for RISS-Ⅰ-Ⅲ patients were 111.8 months, 77.4 months, and 30.6 months, and the median OS was 118.8 months, 91.4 months, and 48.5 months, respectively. At various points during treatment, the TTP and OS of patients obtaining CR and MRD negative were longer than those of patients who did not obtain CR and MRD negative. TTP was noticeably shorter in high-risk cytogenetic patients compared to standard-risk patients even when CR was acquired during induction. There was no difference in TTP between patients with high-risk cytogenetics and those with standard-risk cytogenetics if MRD negative was acquired during induction. According to a multivariate analysis, the R-ISS stage was a poor predictor of TTP and OS at various treatment intervals. Therapeutic effectiveness was a newly independent prognostic factor following treatment. Conclusion: A median survival of almost 10 years is possible for MM patients who receive an integrated strategy of induction regimens followed by auto-HSCT and maintenance therapy, which significantly improves prognosis. However, this approach did not significantly benefit high-risk cytogenetic MM patients.
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Affiliation(s)
- J R Liu
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - J L Gu
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - B H Huang
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - L F Kuang
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - M L Chen
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - W Y Zou
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - D Zheng
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - H H Wang
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - D R Xu
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - J Li
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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Nath K, Shekarkhand T, Salcedo M, Derkach A, Rueda S, Chansakul A, Hulcrantz M, Korde N, Shah UA, Tan C, Chung DJ, Lahoud OB, Hassoun H, Lesokhin AM, Landau HJ, Shah G, Scordo M, Giralt SA, Usmani SZ, Roshal M, Landgren O, Mailankody S. A short course of daratumumab in patients with multiple myeloma and minimal residual disease after induction therapy. Leuk Lymphoma 2022; 63:3488-3492. [PMID: 36282633 DOI: 10.1080/10428194.2022.2131417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Karthik Nath
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tala Shekarkhand
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Salcedo
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andriy Derkach
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Siobhan Rueda
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Aisara Chansakul
- Emergency Department, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Malin Hulcrantz
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neha Korde
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi A Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlyn Tan
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar B Lahoud
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M Lesokhin
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather J Landau
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan Shah
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio A Giralt
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saad Z Usmani
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sham Mailankody
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Lontos K, Tsagianni A, Agha M, Raptis A, Hou JZ, Farah R, Redner RL, Im A, Dorritie KA, Sehgal A, Rossetti J, Aggarwal N, Saul M, Gooding W, Boyiadzis M. A nomogram using cytogenetics, TP53, and NPM1 mutational status can predict responses to induction chemotherapy in AML. Leuk Lymphoma 2022; 63:3257-3260. [PMID: 36075047 PMCID: PMC9771947 DOI: 10.1080/10428194.2022.2118532] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 01/12/2023]
Affiliation(s)
| | | | - Mounzer Agha
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Anastasios Raptis
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Jing-Zhou Hou
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Rafic Farah
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Robert L Redner
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Annie Im
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Alison Sehgal
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - James Rossetti
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Nidhi Aggarwal
- Department of Pathology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Melissa Saul
- Department of Medicine, University of Pittsburgh, PA, USA
| | - William Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Michael Boyiadzis
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
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Mastromattei S, Todisco T, Chioma L, Ubertini G, Pattumelli MG, Fintini D, Cappa M. Efficacy of short-term induction therapy with low-dose testosterone as a diagnostic tool in the workup of delayed growth and puberty in boys. J Endocrinol Invest 2022; 45:2377-2384. [PMID: 35900653 DOI: 10.1007/s40618-022-01879-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Constitutional delay of growth and puberty (CDGP) represents the most frequent cause of delayed puberty in males, sharing some clinical features with growth hormone deficiency (GHD) and isolated hypogonadotropic hypogonadism (IHH). Short-term induction therapy (SIT) has been approved for the induction of puberty in CDGP. We aim to investigate the efficacy of SIT with transcutaneous testosterone gel (TTG) or intramuscular testosterone therapy (IMTT) in a cohort of CDGP subjects, compared to clinical observation. Furthermore, we aim to evaluate the role of SIT as a diagnostic tool to differentiate CDGP from GHD and IHH subjects. METHODS The retrospective study included 246 male subjects with delayed puberty. The study population was divided into three groups: TTG, IMTT, and control group (CNT). RESULTS At 6 months observation, height velocity (HV) was significantly increased in both treated groups compared to CNT group, particularly higher in TTG than IMTT group. A significant testicular enlargement was revealed in both CNT and TTG group compared to IMTT group. Furthermore, LH value was significantly greater in TTG compared to IMTT group. IGF-1 values after SIT rose significantly in both treated groups compared to CNT group. Moreover, almost all GH provocative tests performed after SIT showed a normal GH response. CONCLUSION SIT with TTG appears to be more effective to induce growth spurt, better tolerated and with a more physiological effect on pubertal induction compared to IMTT in CDGP population. Finally, TTG might be a useful tool in the diagnostic work up to discriminate CDGP from GHD or IHH.
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Affiliation(s)
- S Mastromattei
- Endocrinology Unit, University Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, P.zza Sant'Onofrio 4, 00165, Rome, Italy
| | - T Todisco
- Endocrinology Unit, University Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, P.zza Sant'Onofrio 4, 00165, Rome, Italy
| | - L Chioma
- Endocrinology Unit, University Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, P.zza Sant'Onofrio 4, 00165, Rome, Italy.
| | - G Ubertini
- Endocrinology Unit, University Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, P.zza Sant'Onofrio 4, 00165, Rome, Italy
| | - M G Pattumelli
- Endocrinology Unit, University Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, P.zza Sant'Onofrio 4, 00165, Rome, Italy
| | - D Fintini
- Endocrinology Unit, University Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, P.zza Sant'Onofrio 4, 00165, Rome, Italy
| | - M Cappa
- Endocrinology Unit, University Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, P.zza Sant'Onofrio 4, 00165, Rome, Italy
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Chawla S, Loevner L, Mohan S, Lin A, Sehgal CM, Poptani H. Dynamic contrast-enhanced MRI and Doppler sonography in patients with squamous cell carcinoma of head and neck treated with induction chemotherapy. J Clin Ultrasound 2022; 50:1353-1359. [PMID: 36205388 DOI: 10.1002/jcu.23361] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
In view of the inherent limitations associated with performing dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in clinical settings, current study was designed to provide a proof of principle that Doppler sonography and DCE-MRI derived perfusion parameters yield similar hemodynamic information from metastatic lymph nodes in squamous cell carcinomas of head and neck (HNSCCs). Strong positive correlations between volume fraction of plasma space in tissues (Vp ) and blood volume (r = 0.72, p = 0.02) and between Vp and %area perfused (r = 0.65, p = 0.04) were observed. Additionally, a moderate positive correlation trending towards significance was obtained between volume transfer constant (Ktrans ) and %area perfused (r = 0.49, p = 0.09).
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurie Loevner
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chandra M Sehgal
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harish Poptani
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Puéchal X, Iudici M, Perrodeau E, Bonnotte B, Lifermann F, Le Gallou T, Karras A, Blanchard-Delaunay C, Quéméneur T, Aouba A, Aumaître O, Cottin V, Hamidou M, Ruivard M, Cohen P, Mouthon L, Guillevin L, Ravaud P, Porcher R, Terrier B. Rituximab vs Cyclophosphamide Induction Therapy for Patients With Granulomatosis With Polyangiitis. JAMA Netw Open 2022; 5:e2243799. [PMID: 36441554 PMCID: PMC9706346 DOI: 10.1001/jamanetworkopen.2022.43799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Results of randomized clinical trials have demonstrated rituximab's noninferiority to cyclophosphamide as induction therapy for antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV), with neither treatment having a specific advantage for granulomatosis with polyangiitis (GPA). However, post hoc analysis results have suggested that rituximab might be more effective than cyclophosphamide in inducing remission in patients with proteinase 3-positive AAV. OBJECTIVE To compare the effectiveness of rituximab and cyclophosphamide in inducing GPA remission in a large population of unselected patients. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used multicenter target trial emulation observational data from 32 French hospitals in the French Vasculitis Study Group Registry. Groups were determined according to treatments received, without any intervention from the investigators. Inverse probability of treatment weighting was used to correct for baseline imbalance between groups. Participants included patients with newly diagnosed or relapsing GPA who satisfied American College of Rheumatology classification criteria and/or Chapel Hill Consensus Conference nomenclature. Data were analyzed from October 1, 2021, to May 31, 2022. EXPOSURES At least 1 infusion of rituximab or cyclophosphamide for induction therapy between April 1, 2008, and April 1, 2018. MAIN OUTCOMES AND MEASURES The primary outcome was remission rate at month 6 (±2 months), with remission defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 and prednisone dose of 10 mg/d or less. The BVAS is a validated tool for small-vessel vasculitis and used to assess the level of disease activity, with a numerical weight attached to each involved organ system. The BVAS has a range of 0 to 63 points; a score of 0 indicates no disease activity. Subgroup analyses included the primary outcome for patients with a new diagnosis, for most recently treated patients, and for patients with myeloperoxidase-ANCA positivity. RESULTS Among 194 patients with GPA included in the analysis (mean [SD] age, 54 [15] years; 110 men [56.7%]), 165 (85.1%) had a new diagnosis, and 147 of 182 with data available (80.8%) had proteinase 3-ANCA positivity. Sixty-one patients received rituximab and 133 received cyclophosphamide for induction therapy. In the weighted analysis, the primary outcome was reached for 73.1% of patients receiving rituximab vs 40.1% receiving cyclophosphamide (relative risk [RR], 1.82 [95% CI, 1.22-2.73]; risk difference, 33.0% [95% CI, 12.2%-53.8%]; E value for RR, 3.05). Similar results were observed in the subgroup of patients with newly diagnosed GPA and those with a more recent treatment. In the subset of 27 patients with myeloperoxidase-ANCA-positive GPA, 8 of 10 rituximab recipients and 8 of 17 cyclophosphamide recipients met the primary end point (unweighted RR, 1.73 [95% CI, 0.96-3.11]). CONCLUSIONS AND RELEVANCE In this comparativeness effectiveness study using clinical data, rituximab induction therapy for GPA was more frequently associated with remission than cyclophosphamide. These results inform clinical decision-making concerning the choice of remission induction therapy for this subset of patients with AAV.
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Affiliation(s)
- Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | - Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
- Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Geneva, Switzerland
| | | | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, François Mitterrand University Hospital, Dijon, France
| | - François Lifermann
- Department of Internal Medicine, Centre Hospitalier Côte-d’Argent, Dax, France
| | - Thomas Le Gallou
- Department of Internal Medicine and Clinical Immunology, Rennes-Sud University Hospital, Rennes, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | | | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, Centre Hospitalier, Valenciennes, France
| | - Achille Aouba
- Department of Internal Medicine, Côte-de-Nacre University Hospital, Caen, France
| | - Olivier Aumaître
- Department of Internal Medicine, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Vincent Cottin
- National Referral Center for Rare Pulmonary Diseases, Louis-Pradel Hospital, Claude-Bernard University Lyon 1, Lyon, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Marc Ruivard
- Department of Internal Medicine, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | | | | | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
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Cai Z, Chen D, Qiu W, Liang C, Huang Y, Zhou J, Zhan Z, Xiang Y, Guo X, Lv X. Concurrent chemoradiotherapy combined with nimotuzumab in stage III–IVa nasopharyngeal carcinoma: a retrospective analysis. J Cancer Res Clin Oncol 2022; 149:2327-2344. [PMID: 36289067 DOI: 10.1007/s00432-022-04355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The efficacy and safety of nimotuzumab (NTZ) added to concurrent chemoradiotherapy (CCRT) were investigated in patients with stage III-IVa nasopharyngeal carcinoma (NPC). METHODS Patients with stage III-IVa NPC treated with CCRT, with or without NTZ, were screened between January 2015 and December 2017. We compared patients' overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) between different therapeutic regimens. Propensity score matching (PSM) was applied to reduce the selection bias. Nomogram models were developed to predict the survival of CCRT with or without NTZ. RESULTS Four hundred and twenty-six patients were included after PSM, with 213 patients in each regimen. Compared with NPC patients receiving CCRT alone, patients who received NTZ plus CCRT treatment had significantly better OS (5 year OS, 76.1 vs. 72.3%, P = 0.004), PFS (5 year PFS, 73.2 vs. 69.0%, P = 0.002), and LRFS (5 year LRFS, 73.2 vs. 69.0%, P = 0.028). A multivariate Cox regression analysis demonstrated that, compared with receiving CCRT alone, NTZ plus CCRT was an independently positive factor for OS, PFS, and LRFS. No significant difference was observed in the major toxicities between the two treatments (all P > 0.05). In addition, the nomogram presented good accuracy for predicting the prognosis of NPC patients. CONCLUSION CCRT combined with NTZ presented favorable clinical outcomes for stage III-IVa NPC patients with good tolerance and similar toxicity compared to CCRT alone. A prospective, randomized clinical trial is essential to validate the current findings.
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Affiliation(s)
- Zhuochen Cai
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Dongni Chen
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510089, Guangdong, People's Republic of China
| | - Wenze Qiu
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, No 78, Hengzhigang Road, Yuexiu District, Guangzhou, 510095, Guangdong, People's Republic of China
| | - Chixiong Liang
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yingying Huang
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jiayu Zhou
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zejiang Zhan
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yanqun Xiang
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiang Guo
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Xing Lv
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.
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Castaneda-Avila MA, Suárez Ramos T, Torres-Cintrón CR, Cotto-Santana LA, Tortolero-Luna G, Ortiz-Ortiz KJ. Induction Therapy and Survival for Acute Myeloid Leukemia in Hispanic Adults from Puerto Rico. Clin Lymphoma Myeloma Leuk 2022; 22:e922-e930. [PMID: 35853812 DOI: 10.1016/j.clml.2022.06.007] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is the most common type of leukemia in adults. There are no previous studies evaluating AML treatment patterns in Puerto Rico. We describe the first-line therapy patterns and survival of patients diagnosed with AML in Puerto Rico using the Puerto Rico Central Cancer Registry Health Insurance Linkage Database (2011-2015). METHODS We describe patient characteristics according to intensive, non-intensive, and non-treatment status. We used Cox proportional hazard models to evaluate the factors associated with the risk of death stratified by intensive and non-intensive therapy. For this study, 385 patients with AML were included. RESULTS The mean age was 67 years old and 50.1% were female. Nearly half of AML patients (46.8%) received intensive treatment, 23.6% received non-intensive treatment, and 26.2% did not receive treatment. The overall 3-year survival rate was 17.9%. Among those who received intensive therapy, the risk of death among females was lower than males (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.44-0.93). Patients 60 years or older who received intensive treatment had a higher risk of death than younger patients (HR: 1.67, 95% CI: 1.09-2.55). Patients with poor/adverse risk receiving intensive (HR: 3.43, 95% CI: 1.76-6.69) or non-intensive (HR: 4.32, 95% CI: 1.66-11.28) treatment had a higher risk of death than patients with a favorable risk category. CONCLUSION Our findings are the first step to monitor the quality of care of patients with AML in Puerto Rico, particularly related to the administration of appropriate induction therapies, which is one of the most important predictors of AML survival.
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Affiliation(s)
- Maira A Castaneda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Tonatiuh Suárez Ramos
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | | | - Guillermo Tortolero-Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
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Xu WY, Wang F, Liu L, Ren XH, Liu PP, Zhang H, Zheng L, Zhang SS, Xu YR, Guo ZX. [Clinical Analysis of Elderly Patients with AML/High-Risk MDS]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2022; 30:1311-1317. [PMID: 36208228 DOI: 10.19746/j.cnki.issn.1009-2137.2022.05.002] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To analyze the clinical features of acute myeloid leukemia (AML)/high-risk myelodysplastic syndrome (MDS) patients aged over 60 years old. METHODS The clinical data of 61 elderly newly diagnosed patients with AML and high-risk MDS who submitted to the Department of Hematology/Oncology of the First Affiliated Hospital of Tsinghua University from January 2009 to April 16, 2021 were retrospectively analyzed. These patients were divided into chemotherapy group (45 cases) and supportive treatment group (16 cases). The overall survival (OS) was analyzed by Kaplan-Meier method, and the prognostic factors of survival were analyzed by multivariate Cox regression. RESULTS After 2 cycles of induction chemotherapy, the complete remission (CR) rate was 37.8% (17/45), and overall response rate was 62.2% (28/45) in the chemotherapy group. The median OS in the chemotherapy group and supportive treatment group was 11.3 (0.07-43) and 1.6 (0.33-7.72) months, respectively (P<0.001). The median OS in patients who reached CR or did not reach after 1 cycle of induction chemotherapy was 19.8 (10-30.63) and 8.17 (0.07-43) months, respectively (P<0.05), while after 2 cycles was 22.7 (4.2-43) and 7.26 (0.07-26) months, respectively (P<0.001). Univariate analysis showed that age > 80 years old, CCI score > 2, PS score > 2 and supportive treatment were the adverse prognostic factors for OS. Further multivariate analysis suggested that chemotherapy was the only independent prognostic factor for OS (HR=0.140, 95%CI: 0.048-0.409, P<0.001). In the chemotherapy group, univariate analysis showed that CCI score > 2 and failure to reach CR after induction chemotherapy were poor prognostic factors. Multivariate analysis showed that CCI score > 2 (HR=0.139, 95%CI: 0.050-0.384, P<0.001) and failure to achieve CR after induction chemotherapy (HR=0.103, 95%CI: 0.041-0.259, P<0.001) were the adverse prognostic factors for OS. The patients were tolerant to side-effect of chemotherapy. CONCLUSION Appropriate chemotherapy can prolong the survival of elderly patients with AML and high-risk MDS.
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Affiliation(s)
- Wen-Yan Xu
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Fang Wang
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Li Liu
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Xiu-Hong Ren
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Ping-Ping Liu
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Hao Zhang
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Li Zheng
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Song-Song Zhang
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Ya-Ru Xu
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Zhen-Xing Guo
- Department of Hematology & Oncology, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China.E-mail:
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McCaughan GJ, Gandolfi S, Moore JJ, Richardson PG. Lenalidomide, bortezomib and dexamethasone induction therapy for the treatment of newly diagnosed multiple myeloma: a practical review. Br J Haematol 2022; 199:190-204. [PMID: 35796524 PMCID: PMC9796722 DOI: 10.1111/bjh.18295] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023]
Abstract
For patients with newly diagnosed multiple myeloma, survival outcomes continue to improve significantly: however, nearly all patients will relapse following induction treatment. Optimisation of induction therapy is essential to provide longer term disease control and the current standard of care for most patients incorporates an immunomodulatory agent and proteasome inhibitor, most commonly lenalidomide and bortezomib in combination with dexamethasone (RVD), with maintenance until progression. Historically there has been limited access to RVD as an induction strategy outside of the United States; fortunately, there is now increasing access worldwide. This review discusses the rationale for use of RVD as induction therapy and aims to provide guidance in prescribing this regimen in order to optimise efficacy while minimising the toxicities of treatment. We also highlight the increasing evidence for the utility of addition of a monoclonal antibody to the RVD backbone to deepen responses and potentially provide longer disease control.
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Affiliation(s)
- Georgia J. McCaughan
- Department of HaematologySt Vincent's HospitalSydneyAustralia
- University of New South Wales, Medicine and HealthSydneyAustralia
| | - Sara Gandolfi
- Translational Research ProgramUniversity of HelsinkiHelsinkiFinland
- Haematology Research UnitUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - John J. Moore
- Department of HaematologySt Vincent's HospitalSydneyAustralia
- University of New South Wales, Medicine and HealthSydneyAustralia
| | - Paul G. Richardson
- Dana‐Farber Cancer Institute, Jerome Lipper Multiple Myeloma Center, Department of Medical OncologyBostonMassachusettsUSA
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Xu J, Yang Y, Zhong Q, Hou L, Ma H, Zhang Y, Feng L, He S, Lian M, Fang J, Wang R. A Study of Peripheral Blood Parameters to Predict Response to Induction Chemotherapy and Overall Survival in Advanced Laryngeal Squamous Cell Carcinoma. Curr Oncol 2022; 29:6472-6484. [PMID: 36135078 PMCID: PMC9497498 DOI: 10.3390/curroncol29090509] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose: the purpose of this study was to screen peripheral blood parameters and construct models predicting the prognosis and induction chemotherapy (IC) response in locally advanced laryngeal squamous cell carcinoma (LSCC) patients. Methods: A total of 128 stage III/IVa LSCC patients (who required a total laryngectomy) were enrolled in a retrospective study from January 2013 to September 2020 at Beijing Tongren Hospital of Capital Medical University. Among them, 62 patients received IC (IC group), and 66 patients immediately underwent a total laryngectomy (TL) after diagnosis (surgery group). Demographic information and peripheral blood parameters were collected for further analysis. The overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS) were compared between the two groups. The prognosis and survival were also compared between patients with laryngeal function preservation (LFP) and those with TL. Results: The Receiver Operating Characteristic (ROC) curve for IC response in the IC group showed that the AUC of the blood model based on the four peripheral blood parameters of fibrinogen (FIB), platelet (PLT), high-density lipoprotein cholesterol (HDL), and albumin (ALB) was significantly higher than the TNM stage model’s AUC (0.7932 vs. 0.6568). We constructed a nomogram blood model to predict IC response (C-Index = 0.793). Regarding the OS of all patients, an ROC analysis for overall survival, the Kaplan–Meier (K-M) method with a log-rank test, and multivariate analysis indicated age, clinical stage, FIB, and hemoglobin (HGB) were independent prognostic factors for the OS of LSCC patients. The blood–clinical logistic model (AUC = 0.7979) was constructed based on the four prognosis factors, which were superior to the blood (AUC = 0.6867) or clinical models (AUC = 0.7145) alone to predict OS. We constructed a nomogram model based on age, clinical stage, FIB, and HGB to predict OS for LSCC patients (C-Index = 0.792). Besides this, there were no significant differences in OS, PFS, and DSS between IC and surgery groups or LFP and TL groups. Conclusion: Peripheral blood parameters help predict IC response and overall survival. Furthermore, induction chemotherapy significantly improves laryngeal function preservation without lowering the survival prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ru Wang
- Correspondence: (J.F.); (R.W.)
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Lee YC, Huang CY, Lin CH, Cheng BW, Huang SK, Yeh SN, Lee YJ, Ting WH. The effects of estrogen induction therapy on pubertal presentations in turner syndrome patients. Taiwan J Obstet Gynecol 2022; 61:788-793. [PMID: 36088045 DOI: 10.1016/j.tjog.2022.05.014] [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] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In this study, we investigated various pubertal presentations and progressions before and after estrogen induction therapy and the correlations with Turner syndrome karyotypes. MATERIALS AND METHODS We reviewed the medical records of patients with Turner syndrome diagnosed before the age of 18 years between 2000 and 2019. Sixty-six patients were enrolled and distributed into 45,X monosomy group, X chromosome structural abnormalities group and X mosaicism group. The pubertal presentations were classified into spontaneous puberty, arrested puberty and no spontaneous puberty. All patients' karyotypes, pubertal progressions and laboratory data were collected and analyzed. RESULTS The karyotypes were highly correlated with pubertal presentations. No spontaneous puberty was noticed in 58.3% 45,X monosomy patients, 50% patients with X chromosome structural abnormalities had arrested puberty, whereas 70% patients with X mosaicism had spontaneous puberty. Estrogen induction therapy in patients with no spontaneous puberty could induce puberty and the tempo of puberty may approximate to the spontaneous puberty group (median, 2.3 vs. 2.2 years, P = 0.95). In both interventional groups, the FSH level was distinguishable before treatment (median, 65.1 vs. 100.4 mIU/mL, P = 0.02). After long term estrogen therapy, the FSH could be suppressed to similar level in both interventional groups (median, 37.5 vs 34.5 mIU/mL, P = 0.84). Neither LH nor E2 level provided valuable information before and after treatment. CONCLUSION The karyotypes were highly correlated with pubertal presentations at Turner syndrome patients. The integrity of 2nd X chromosome plays an important role. Low dose estrogen could mimic the tempo of puberty even delay induction age at Taiwan. The FSH data could provide predictive information of pubertal induction for both interventional groups.
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Affiliation(s)
- Yi-Chen Lee
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan; Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taitung Mackay Memorial Hospital, Taitung, Taiwan.
| | - Chi-Yu Huang
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chao-Hsu Lin
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
| | - Bi-Wen Cheng
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Shih-Kang Huang
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taitung Mackay Memorial Hospital, Taitung, Taiwan; Department of Pediatrics, Tamsui MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Nin Yeh
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Saint Paul's Hospital, Taoyuan City, Taiwan
| | - Yann-Jinn Lee
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Medical Research, Tamsui MacKay Memorial Hospital, New Taipei City, Taiwan; Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Hsin Ting
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior college of Medicine Nursing and Management, New Taipei City, Taiwan.
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148
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Suarez-Rodriguez V, Loro-Ferrer JF, Rodriguez-Ruiz D. Effect of Myofascial Induction Therapy in Pterygoid Muscles of Woodwinds and String Musicians on Muscular Stiffness of the Upper Trapezius. Med Probl Perform Art 2022; 37:143-150. [PMID: 36053492 DOI: 10.21091/mppa.2022.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Considering the fascial continuity and its biomechanical characteristics, the purpose of this study was to assess the change in muscular stiffness (Dm) of the upper trapezius muscles after the application of myofascial induction therapy (MIT) to the masticatory muscles of musicians. METHODS This was a pre-posttest design involving one treatment. SUBJECTS The total sample was 33 subjects (n = 33). The experimental group comprised 18 violin, viola, and woodwind players, and the control group was comprised of 15 non-musicians. The outcome measures included pre-posttest measurements with tensiomyography of the upper trapezius (muscle stiffness, Dm), and baseline neck disability (Neck Disability Index), and pain (SF-36 questionnaire). The experimental group received MIT for 5 minutes on each side of the lateral pterygoid muscle. The control group assumed a supine position for 10 minutes. RESULTS After the intervention, there was a significant difference in Time per Group (F = 2.896, p = 0.034, ƞ2p = 0.367, and w = 0.755). There were statistically significant differences in pre-post and side-by-side analyses for the Dm of the upper trapezius in the experimental group as well as between the two groups. CONCLUSION MIT of the lateral pterygoids is effective in decreasing upper trapezius stiffness as measured by an increase in the Dm measured by tensiomyography. The greatest change occurred in musicians with a lower percentage of Neck Disability Index at baseline.
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Affiliation(s)
- Vidina Suarez-Rodriguez
- Dep. of Medical and Surgical Sciences, Facultad de Ciencias de la Salud, Campus Universitario de San Cristóbal, 35016 Las Palmas de Gran Canaria, Spain.
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149
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Yuan JJ, Ding JW, Li JW, Hu RH, Gong D, Hu JL, Zhu KB, Liu Y, Ding YH, Wei JW, Zeng JL, Lu ZB, Yin WH, Ai SF, Zha GH, Zhang ZL, Zou R, Zeng L. Nimotuzumab plus induction chemotherapy followed by radiotherapy/concurrent chemoradiotherapy plus nimotuzumab for locally advanced nasopharyngeal carcinoma: protocol of a multicentre, open-label, single-arm, prospective phase II trial. BMJ Open 2022; 12:e051594. [PMID: 36008072 PMCID: PMC9422822 DOI: 10.1136/bmjopen-2021-051594] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
UNLABELLED Epidermal growth factor receptor (EGFR) is a therapeutic target in nasopharyngeal carcinoma (NPC). The optimal combined modality of optimal combined modality of anti--EGFR monoclonal antibodies, induction chemotherapy (ICT), concurrent chemotherapy and radiotherapy for NPC remains poorly defined. None of previous studies have developed subsequent treatment strategies on the basis of stratification according to the efficacy following ICT plus anti-EGFR mAbs. This study aims to increase treatment intensity for patients with poor efficacy of ICT and reduce treatment toxicity for patients with favourable efficacy of ICT by assessing whether the efficacy of this treatment regimen is non-inferior to ICT plus concurrent chemoradiotherapy (historic controls). INTRODUCTION METHODS AND ANALYSIS: Pathology-confirmed WHO type II/III NPC patients at clinical stage III-IVA (eighth American Joint Committee on Cancer/Union for International Cancer Control staging system) will be included in the study. They will receive ICT plus nimotuzumab (NTZ), followed by radiotherapy plus NTZ or concurrent chemoradiotherapy plus NTZ (stratified based on the efficacy of ICT plus NTZ). The primary endpoint is 3-year failure-free survival rate; while the secondary endpoints are 3-year overall survival rate, distant metastasis-free survival rate and locoregional recurrence-free survival rate, and short-term remission rate of tumour and treatment toxicity. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the Second Affiliated Hospital of Nanchang University. Our findings will be disseminated in a peer-reviewed journal. Implementation strategies are in place to ensure privacy and confidentiality of participants. TRIAL REGISTRATION NUMBER ChiCTR2000041139.
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Affiliation(s)
- Jing-Jing Yuan
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Jian-Wu Ding
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
| | - Jin-Wei Li
- Department of Radiotherapy, Ganzhou Cancer Hospital, Ganzhou, China
| | - Rong-Huan Hu
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
| | - Dan Gong
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
| | - Jia-Li Hu
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
| | - Kai-Bin Zhu
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
| | - Yan Liu
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
| | - Yu-Hai Ding
- Department of Oncology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Jia-Wang Wei
- Department of Oncology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Jian-Lun Zeng
- Department of Oncology, Pingxiang People's Hospital, Pingxiang, China
| | - Zhi-Bing Lu
- Department of Oncology, Pingxiang People's Hospital, Pingxiang, China
| | - Wei-Hua Yin
- Department of Oncology, Yichun People's Hospital, Yichun, China
| | - Su-Fen Ai
- Department of Oncology, Yichun People's Hospital, Yichun, China
| | - Guo-Hua Zha
- Department of Oncology, Fuzhou First People's Hospital, Fuzhou, China
| | - Zhi-Lin Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Nanchang University Second Affiliated Hospital, Nanchang, China
| | - Rui Zou
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Lei Zeng
- Department Of Oncology, Nanchang University Second Affiliated Hospital, Nanchang, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
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150
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Ma YR, Zhao T, Ma L, Hu LJ, Duan WB, Jiang H, Huang XJ, Jiang Q. [Variables associated with hematological remission and survival in patients with acute myeloid leukemia after induction failure and relapse]. Zhonghua Xue Ye Xue Za Zhi 2022; 43:644-650. [PMID: 36709148 PMCID: PMC9593012 DOI: 10.3760/cma.j.issn.0253-2727.2022.08.005] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/28/2022]
Abstract
Objective: This study aimed to explore variables associated with remission rate and survival in patients with acute myeloid leukemia (AML) after induction failure and relapse. Methods: Data of 373 consecutive patients with AML were analyzed after induction failure and relapse. Binary logistics and the Cox model regression were used to identify variables associated with remission rate and outcomes. Results: In patients with AML after induction failure and relapse, the total CR+CRi rates were 50.6% and 40.3%, respectively; among those who achieved CR/CRi, the 3-year RFS rates were 34.4% and 30.4%, respectively, and the 3-year overall survival rates were 40.1% and 31.6%, respectively. In the multivariate analyses, using CLAG or FLAG regimen as a re-induction chemotherapy regimen, age <39 years and SWOG low-risk were significantly associated with higher remission rates in patients with induction failure. Male, secondary AML, SWOG high-risk, the interval from the first remission to relapse within 12 months, and bone marrow blasts ≥20% at the time of relapse were significantly associated with lower remission rates in relapsed patients. Transplantation was significantly associated with prolonged relapse-free survival and overall survival in patients achieving hematologic remission; the SWOG low-risk group was significantly associated with longer overall survival in those with induction failure; and achieving CR (not CRi) or having female gender was associated with longer RFS or overall survival in relapsed patients. Conclusion: Reinduction chemotherapy regimen, age, gender, SWOG risk, secondary AML, the interval from the first remission to relapse, and bone marrow blast percentage at the time of relapse were significantly associated with remission rates in the patients with AML after induction failure and relapse. Transplantation, SWOG low-risk, achieving CR, or female gender were associated with longer survivals in those achieving remission.
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Affiliation(s)
- Y R Ma
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - T Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - L Ma
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - L J Hu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - W B Duan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - H Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - X J Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Q Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
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