Long-Term Bonding Efficacy of CAD/CAM Hybrid Restorative Materials and Universal Adhesives

OBJECTIVES

In-office and lab milled prostheses are the staple for indirect restorations. It is therefore critical to determine their long-term bonding durability.

METHODS

CAD/ CAM blocks of two classes of restorative materials: 1) a nano-ceramic reinforced polymer matrix (NCPM) and, 2) a polymer-infiltrated ceramic network (PICN) were bonded using four different universal adhesives (UA) and silane systems. A lithium disilicate glassceramic (LDS) was used as a reference. The blocks were bisected and bonded with different UA/resin-cement pairs. Bonded blocks were then cut into 1.0x1.0x12.0 mm bar specimens for microtensile bond testing. Half the bars were subjected to bond strength testing immediately and the other half after aging by 50,000 thermal cycles between 5°C and 55°C. ANOVA and post-hoc tests were used to compare mean bond strength among groups.

RESULTS

NCPM presented consistently high bond strength regardless of bonding techniques, while the bond strength of PICN and LDS were lower when bonded with UA relative to traditional silanes. The more hydrophilic UA produced higher bond strengths.

DISCUSSION

Glass-ceramics exhibited lower bond strength with UA than the conventional etch-rinse-silane techniques. However, UAs preserved bonding interface in the long-term.

SIGNIFICANCE

NCPM displayed superior bond strength relative to PICN and LDS regardless of the type of adhesives and bonding techniques.

Patient Satisfaction and Accuracy of Partial Denture Frameworks Fabricated using Conventional and Digital Techniques

This case report compares a conventional and a digital workflow for manufacturing metal frameworks for maxillary and mandibular removable partial dentures (RPDs). Two sets of maxillary and mandible RPDs were produced. The metal framework of one set of RPDs was produced conventionally using the lost wax casting technique. Intraoralscanning and computer-aided designing (CAD) were used to fabricate the metal frameworks of the other set of RPDs using direct metal laser sintering (DMLS) technology. The accuracy of fit of the two sets of RPDs was evaluated after 3 months using replica models. Patient satisfaction was assessed. Two years later, the fit accuracy of the DMLS prosthesis and patient satisfaction were re-evaluated. The accuracy of fit in the maxillary RPD with the DLMS manufactured metal framework showed better results in all areas except areas of rests (457 vs. 421 μm) and the major connector (850 vs. 512 μm). The mandibular RPD with DLMS manufactured metal framework showed only in the areas of the reciprocal arm and major connector better fit accuracy compared to the conventional RPD. The patient satisfaction with the DLMS manufactured RPDs was rated equally to the conventional one. The use of digital technologies in manufacturing RPDs seems promising regarding accuracy and patient satisfaction.

Effect of Thickness and Translucency on Color Change and Masking Ability of Ceramic Materials used for Laminate Veneers

This study evaluated the effect of the thickness and translucency of lithium disilicatebased glass ceramics on resin composite substrates on color change and masking effect. Laminate veneers were fabricated using IPS e.max CAD (A1) blocks with two different light transmittance values (High translucent [HT], Low translucent [LT]). Slices of two different thicknesses (0.3 mm, 0.5 mm) were obtained (n=10) and laminate veneers were cemented on the resin composite substrates of two different shades (A2, A3.5). The color change (ΔE values) was evaluated with the CIELab color system using a spectrophotometer, while the masking effect was calculated. The data were analyzed using independent-samples t-test and two-way analysis of variance. The ceramic thickness and translucency had a significant effect on final color and masking. When HT was used, and the laminate veneer thickness decreased (0.3 mm), the masking effect in ΔE values were lower (p⟨0.05). The ΔE values (⟩3.7) were clinically unacceptable. With the increase in thickness, translucency of porcelain laminate veneers decreases showing better color masking ability. Veneer thickness seems to be more effective on the restoration's masking ability than the shade of the substrate and translucency. Cinically, in case a 0.5-mm or thinner laminate veneer is planned, tooth color, resin cement and ceramic type should be considered.

Evaluation of Clinical Periodontal Parameters of Abutment Teeth Supporting Distal-Extension Base Removable Partial Dentures: A Cross-sectional Study

To assess the clinical periodontal status of abutment teeth in regards of different design components of distal-extension removable partial dentures. Subjects (N=100) with acrylic or cobalt-chromium distal-extension removable partial dentures were enrolled and their periodontal parameters plaque and gingival indices [PI, GI], probing depths [PD], clinical attachment loss [CAL] and a mobility index [MI] evaluated. Denture base type, major connector, occlusal rests position, design of direct retainers, retention, stability and denture wearing habits were further evaluated. Acrylic RPDs were associated with higher mean±SE PI [1.70±0.74], GI [1.76±0.55], PD scores [2.47±1.02 mm] and CAL values [4.46±2.11 mm] compared to CO-CR RPDs [p⟨0.05]. For abutments, the PI [1.6±0.83], GI [1.72±0.57], PD [2.32±1.03] and CAL [4.26±2.08] were higher than their non-abutments counterparts [p⟨0.05]. CAL scores were found to be significantly higher for mandibular abutments compared to maxillary ones [P=0.002]. The highest PI [1.83±1.10] and GI [2.00±0.00] scores were associated with lingual bars and horse-shoe connectors, respectively. Full palatal coverage and lingual plates were associated with the highest PD [2.80±0.48] and CAL [4.70±0.37] scores. Acrylic RPDs, type of major connector, wrought wire clasps and distal occlusal rests may be considered as risk factors for periodontal disease progression in distal-extension removable partial denture wearers.

Comparative Evaluation of Apically Extruded Debris During Root Canal Preparation Using Three Different File Systems Applied Under 2.5% Sodium Hypochlorite or 2% CHX Irrigation

The chemomechanical cleaning of the root canal system is performed using manual and rotary files. This study aimed to compare the effect of ProTaper, Reciproc and HyFlex rotary files considering 2.5% sodium hypochlorite and 2% chlorhexidine (CHX) as irrigating solutions on apical extrusion of intracanal debris. Single-canal mandibular premolars (N=165) were evaluated. The teeth were divided into 6 experimental groups (N=25) for root canal instrumentation using 3 file systems, (Reciproc, HyFlex and ProTaper) and two irrigation solutions, namely 2.5% sodium hypochlorite or 2% CHX. Fifteen teeth were also assigned into three control groups (n=5) with saline as irrigation solution. Eppendorf tubes were weighed and the teeth were placed inside. The canals were instrumented and the tubes weighed to determine the dry weight of extruded debris. Data were analyzed using one-way ANOVA and Bonferroni test (α=0.05). The mean amount of extruded debris using the sodium hypochlorite solution was significantly higher than other irrigating solutions (p⟨0.001). The mean amount of extruded debris using the Reciproc file system was significantly higher compared to ProTaper and HyFlex (p⟨0.001). The use of the sodium hypochlorite solution, single-file systems and reciprocal movement are associated with higher debris extrusion and might be associated with higher risk of postoperative pain.

Phase 3 SELENE study: ibrutinib plus BR/R-CHOP in previously treated patients with follicular or marginal zone lymphoma

The phase 3 SELENE study evaluated ibrutinib + chemoimmunotherapy (CIT; bendamustine and rituximab [BR]; or rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP]) for patients with relapsed/refractory (R/R) follicular lymphoma (FL) or marginal zone lymphoma (MZL). Adult patients who had received ≥1 prior line of CIT were randomized 1:1 to oral ibrutinib (560 mg) or placebo daily, plus 6 cycles of BR/R-CHOP. The primary end point was investigator-assessed progression-free survival (PFS). Overall, 403 patients were randomized to ibrutinib + CIT (n = 202) or placebo + CIT (n = 201). Most patients received BR (90.3%) and had FL (86.1%). With a median follow-up of 84 months, median PFS was 40.5 months in the ibrutinib + CIT arm and 23.8 months in the placebo + CIT arm (hazard ratio [HR], 0.806; 95% confidence interval [CI], 0.626-1.037; P = .0922). Median overall survival was not reached in either arm (HR, 0.980; 95% CI, 0.686-1.400). Grade ≥3 treatment-emergent adverse events (TEAEs) were reported in 85.6% and 75.4% of patients in the ibrutinib + CIT and placebo + CIT arms, respectively. In each arm, 13 patients had TEAEs leading to death. The addition of ibrutinib to CIT did not significantly improve PFS compared with placebo + CIT. The safety profile was consistent with known profiles of ibrutinib and CIT. This trial was registered at www.clinicaltrials.gov as #NCT01974440.

Clinical Performance of Minimally Invasive Monolithic Ultratranslucent Zirconia Veneers: A Case Series up to Five Years of Follow-up

There is a lack of reports in the literature on the long-term clinical performance of ultratranslucent zirconia, especially considering its use in manufacturing monolithic veneers. The purpose of this case series is to describe the aesthetic treatment steps of three patients with minimally invasive ultratranslucent zirconia veneers and to report the clinical findings up to five years. Three patients (woman: 2, man: 1; mean age: 30 years) unsatisfied with their dental aesthetics sought dental treatment. The treatment plan involved cementing ultratranslucent zirconia veneers. Air-abrasion was performed on the internal surface of zirconia with alumina particles coated by silica (silicatization), followed by silane and adhesive applications for the adhesive cementation. All veneers were adhesively cemented to enamel with resin cement (Variolink Esthetic, Ivoclar). The patients were clinically evaluated annually considering the Ryge modified/ California Dental Association criteria. After a mean follow-up of 4.33 years (4-5 years), a survival rate of 100% was detected for the 28 minimally invasive ultratranslucent zirconia veneers cemented in the 3 patients. There were no absolute failures such as debonding, veneer fracture, or secondary caries. Superficial marginal discoloration was observed in one element (maxillary left lateral incisor) of one patient. Ultratranslucent zirconia is a viable option for manufacturing veneers due to its excellent clinical performance and longevity. However, further long-term clinical studies are essential to consolidate this material as an option for esthetic restorations.

Cusatuzumab plus azacitidine in newly diagnosed acute myeloid leukaemia ineligible for intensive chemotherapy (CULMINATE): part one of a randomised, phase 2, dose optimisation study

BACKGROUND

Cusatuzumab, a high-affinity anti-CD70 antibody, has shown preliminary activity as a treatment for acute myeloid leukaemia when combined with azacitidine. We aimed to determine the optimum dose for future trials of cusatuzumab in combination with azacitidine in patients with previously untreated acute myeloid leukaemia who are not eligible for intensive chemotherapy.

METHODS

In this randomised, phase 2, open-label, dose-optimisation study we enrolled adult patients aged 18 years or older with newly diagnosed acute myeloid leukaemia not eligible for intensive chemotherapy, and with Eastern Cooperative Oncology Group scores of 0-2, from 40 hospitals and centres across seven countries. In part one of the trial, participants were randomly allocated 1:1 to 10 mg/kg or 20 mg/kg intravenous cusatuzumab on days 3 and 17, combined with subcutaneous or intravenous azacitidine 75 mg/m2 on days 1-7 in 28-day cycles. The primary efficacy outcome was the rate of complete remission in the intention-to-treat group. The two dose cohorts were evaluated independently without between-cohort statistical comparison. Safety analyses were performed in all patients who received one dose of study drug. Part two of the trial was planned to be a single-arm expansion to evaluate cusatuzumab plus azacitidine at the cusatuzumab dose level selected in part one (primary hypothesis ≥35% rate of complete remission vs null hypothesis of 20%); however, changes in the acute myeloid leukaemia treatment landscape during this trial made it unlikely that enrolment to part two of the study would be clinically feasible, so the study stopped at the end of part one. The trial was registered at ClinicalTrials.gov, NCT04023526.

FINDINGS

103 patients were enrolled between Aug 30, 2019, and Feb 25, 2020, and randomly assigned to either cusatuzumab 10 mg/kg (n=51) or 20 mg/kg (n=52). Median follow-up was 7·2 months (IQR 10·7 months). 57 of 103 (55%) patients were male and 46 (45%) patients were female, 78 (76%) were White, one (1%) was Asian, and 24 (23%) did not report their race. In the 10 mg/kg group, complete remission rate was 12% (six of 51 patients; 95% CI 6-23) and in the 20 mg/kg group was 27% (14 of 52; 17-40). Grade 3 or worse treatment-emergent adverse events (TEAEs) were similar between the cusatuzumab 10 mg/kg (n=51) and 20 mg/kg (n=51) cohorts and included thrombocytopenia (24 patients [47%] vs 29 [57%]), anaemia (24 [47%] vs 17 [33%]), and neutropenia (20 [39%] in both cohorts). Serious TEAEs were also similar in the two cohorts (44 [86%] vs 40 [78%]). Treatment-related TEAEs leading to death were reported in both groups (three patients [6%] in the 10 mg/kg group vs one patient [2%] in the 20 mg/kg group); the reported causes of death were pneumonia (n=2) and septic shock (n=2).

INTERPRETATION

Although part one of this study was not designed to formally compare the two dose cohorts for efficacy, the totality of clinical data for cusatuzumab studies performed to date indicate that cusatuzumab 20 mg/kg plus azacitidine represents the optimal dose for further studies. A phase 1b study investigating the triple combination of cusatuzumab with venetoclax and azacitidine is underway (NCT04150887).

FUNDING

Janssen Research & Development and argenx.

EPA Consensus Project Paper: Anterior Full or Partial Coverage Single Tooth Restorations - A Systematic Review of Survival and Complication Rates

INTRODUCTION

The aim of this systematic review was to assess the literature reporting on the failure rates, survival rates and complication rates and patient reported outcome measures (PROMs) of anterior full (FC) or partial (PC) coverage single tooth restorations after a mean observation period of at least 3 years.

METHODS

Systematic search was conducted using the electronic databases: MEDLINE, EMBASE and Cochrane library. Data regarding survival (restoration failure) and complication rates and PROMs were extracted and presented descriptively.

RESULTS

Altogether 42 studies were included in the analysis (28 with FC, 12 with PC and 2 with both types of restorations). For FC restorations the estimated annual failure rate was 0.72 (95%CI: 0.33-1.57), resulting in a 5-year survival rate of 96.4% (95%CI: 92.4-98.3). For PC restorations, the estimated annual failure rate was 0.62 (95%CI: 0.27-1.46), resulting in a 5-year survival rate of 96.9% (95%CI: 93.0-98.7). There was no significant difference between the groups regarding survival or technical complications, while significantly fewer biological complications were observed with PC compared to FC restorations (test for subgroup differences, p=0.01).

CONCLUSIONS

FC and PC restorations showed high 5-year survival rates but the teeth restored with FC restorations may be more prone to biological complications.

Clinical longevity of intracoronal restorations made of gold, lithium disilicate, leucite, and indirect resin composite: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis is to assess the comparative clinical success and survival of intracoronal indirect restorations using gold, lithium disilicate, leucite, and indirect composite materials.

MATERIAL AND METHODS

This systematic review and meta-analysis were conducted following the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. The protocol for this study was registered in PROSPERO (registration number: CRD42021233185). A comprehensive literature search was conducted across various databases and sources, including PubMed/Medline, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and gray literature. A total of 7826 articles were screened on title and abstract. Articles were not excluded based on the vitality of teeth, the language of the study, or the observation period. The risk difference was utilized for the analyses, and a random-effects model was applied. All analyses were conducted with a 95% confidence interval (95% CI). The calculated risk differences were derived from the combined data on restoration survival and failures obtained from each individual article. The presence of heterogeneity was assessed using the I2 statistic, and if present, the heterogeneity of the data in the articles was evaluated using the non-parametric chi-squared statistic (p < 0.05).

RESULTS

A total of 12 eligible studies were selected, which included 946 restorations evaluated over a minimum observation period of 1 year and a maximum observation period of 7 years. Results of the meta-analysis indicated that intracoronal indirect resin composite restorations have an 18% higher rate of failure when compared to intracoronal gold restorations over 5-7 years of clinical service (risk difference =  - 0.18 [95% CI: - 0.27, - 0.09]; p = .0002; I2 = 0%). The meta-analysis examining the disparity in survival rates between intracoronal gold and leucite restorations could not be carried out due to methodological differences in the studies.

CONCLUSIONS

According to the currently available evidence, medium-quality data indicates that lithium disilicate and indirect composite materials demonstrate comparable survival rates in short-term follow-up. Furthermore, intracoronal gold restorations showed significantly higher survival rates, making them a preferred option over intracoronal indirect resin-composite restorations. Besides that, the analysis revealed no statistically significant difference in survival rates between leucite and indirect composite restorations. The short observation period, limited number of eligible articles, and low sample size of the included studies were significant limitations.

CLINICAL SIGNIFICANCE

Bearing in mind the limitations of the reviewed literature, this systematic review and meta-analysis help clinicians make evidence-based decisions on how to restore biomechanically compromised posterior teeth.

Pembrolizumab in relapsed or refractory primary mediastinal large B-cell lymphoma: final analysis of KEYNOTE-170

Previous analyses of the phase 2 KEYNOTE-170 (NCT02576990) study demonstrated effective antitumor activity and acceptable safety of pembrolizumab 200 mg given every 3 weeks for up to 35 cycles (∼2 years) in patients with relapsed/refractory (R/R) primary mediastinal B-cell lymphoma (PMBCL) whose disease progressed after or who were ineligible for autologous stem cell transplantation. The end points included objective response rate (ORR), progression-free survival (PFS), and duration of response (DOR) according to the investigator per 2007 Response Criteria; overall survival (OS); and safety. In this final analysis, median duration of follow-up was 48.7 months (range, 41.2-56.2). The ORR was 41.5% (complete response, 20.8%; partial response, 20.8%). The median DOR was not reached; no patients who achieved a complete response progressed at the data cutoff. The median PFS was 4.3 months; the 4-year PFS rate was 33.0%. The median OS was 22.3 months; the 4-year OS rate was 45.3%. At the data cutoff, 30 patients (56.6%) had any-grade treatment-related adverse events (AEs); the most common were neutropenia, asthenia, and hypothyroidism. Grade 3/4 treatment-related AEs occurred in 22.6% of the patients; no grade 5 AEs occurred. After 4 years of follow-up, pembrolizumab continued to provide durable responses, with promising trends for long-term survival and acceptable safety in R/R PMBCL.

Immediate and Late Repair of Microhybrid Resin Composites: Effect of Silane Coupling Agent, Universal Adhesives and Photo Polymerization

This study investigated the effect of silane coupling agent and universal adhesive application on repair bond strength of resin-based composite after bur grinding. Microhybrid resin composite (Charisma Smart) blocks (N=80; 8x8x4 mm3) were prepared, aged (37°C; 1 month), roughened, etched and randomly divided into two groups. Silane was applied to half of the groups (Porcelain Primer, Bisco), before one of the following universal primers/adhesives was applied: a) Scotchbond Universal (3M), b) All-Bond Universal (Bisco), c) G-Premio Bond (GC), and d) Clearfil SE Bond (Kuraray). In each adhesive group half of the group was photo-polymerized. The blocks were repaired with the same size resin composite and segmented into beams. Half of the beams were subjected to micro-tensile bond test (1 mm/min), while the other half was aged (37°C; 6 months) prior to testing. Failure modes were analyzed using Scanning Electron Microscopy (SEM). Data were analyzed using repeated measures of ANOVA, Tukey's post-hoc, and paired t-tests (alpha=0.05). The silane application did not affect the repair bond strength regardless of photo-polymerization of the adhesive resin. The repair bond strength decreased significantly after 6 months when adhesive resin was not photopolymerized (p⟨0.05). Photo-polymerizing universal adhesives might ensure higher repair bond strength and its maintenance after aging.

Clinical survival and performance of premolars restored with direct or indirect cusp-replacing resin composite restorations with a mean follow-up of 14 years

OBJECTIVES

The objective is to evaluate the long-term clinical survival and performance of direct and indirect resin composite restorations replacing cusps in vital upper premolars.

METHODS

Between 2001 and 2007, 176 upper premolars in 157 patients were restored with 92 direct and 84 indirect resin composite restorations as part of an RCT. Inclusion criteria were fracture of the buccal or palatal cusp of vital upper premolars along with a class II cavity or restoration in the same tooth.

RESULTS

Forty patients having 23 direct and 22 indirect composite restorations respectively, were lost to follow-up (25.6%). The cumulative Kaplan-Meier survival rates were 63.6% (mean observation time: 15.3 years, SE 5.6%) with an AFR of 2.4% for direct restorations and 54.5% (mean observation time: 13.9 years, SE: 6.4%) with an AFR of 3.3% for indirect restorations. The Cox regression analysis revealed a statistically significant influence of the patient's age at placement on the survival of the restoration (HR 1.036, p = 0.024), the variables gender, type of upper premolar, type of restoration, and which cusp involved in the restoration had no statistically significant influence. Direct composite restorations failed predominantly due to tooth fracture, indirect restorations primarily by adhesive failure (p < 0.05).

SIGNIFICANCE

There was no statistically significant difference in survival rates between direct and indirect composite cusp-replacing restorations. Both direct and indirect resin composite cusp-replacing restorations are suitable options to restore compromised premolars. The longer treatment time and higher costs for the indirect restoration argue in favor of the direct technique.

Evaluation of New Alkasite Based Restorative Material for Restoring Non- Carious Cervical Lesions- Randomized Controlled Clinical Trial

Two different restoration materials, an alkasite-based resin composite and a resinmodified glass ionomer cement were used to assess restoration of non-carious cervical dental lesions. This split mouth randomized controlled trial included 40 patients. After randomization both sides of the dental arch were restored with either an alkasite-based (Cention N, Ivoclar Vivadent) or a resin-modified glass ionomer cement (Voco GmbH) restoration. The placed fillings were evaluated by blinded additional operators 1, 6 months and 1 year after to the USPHS criteria (retention, marginal integrity and discoloration, anatomical form and secondary caries). Data were analyzed using Kendall's Coefficient of Concordance test and Chi-square tests using SPSS software (SPSS Inc., Version 20) (P=0.05). As for retention and anatomic form both materials performed similar after one month. However, the retention and anatomic form for alkasite based restorative Cention showed significantly better results after 6 months (p=0.013/p=0.003) and one year (p=0.026/p=0.008). The resin modified glass ionomer restoration showed higher discoloration after 6 months (p=0.025) and one year (p=0.018), while Cention performed better regarding marginal integrity at all time intervals. No secondary caries occurred. Alkasite based restorative materials displayed superior technical, mechanical and aesthetical performance in a follow-up period of one year and can therefore be recommended as an alternative to resin-modified glass ionomer cements.

Eltrombopag for the Treatment of Poor Graft Function Following Haematopoietic Cell Transplantation: Real-Life Data

Background

Eltrombopag has an off-label indication for haematopoietic cell transplantation in patients experiencing delayed thrombocyte recovery and/or thrombocytopaenia.

Aims

To present our centre’s experience of using this agent not only for post- haematopoietic cell transplantation thrombocytopaenia but also for poor graft functioning in the post-haematopoietic cell transplantation setting.

Study Design

Retrospective cross-sectional study.

Methods

Thirty-nine patients who had persistent cytopaenia following haematopoietic cell transplantation and treated with eltrombopag at our centre between October 2011 and December 2021 were retrospectively identified. During this period, 9 (23.1%) and 30 (76.9%) patients who underwent allogeneic transplantations, respectively, received eltrombopag.

Results

The female-to-male ratio was 12:27, and the median transplant age was 49 (18-70) years. Eight (20.5%) patients had isolated thrombocytopaenia, 19 (49.4%) had bi-lineage cytopaenia and 12 (30.1%) had pancytopaenia. Patients received a median of 50 mg/day (25-150 mg/day) of eltrombopagfor a median duration of 82 (24-386) days. Nine (23.1%) patients had autologous haematopoietic cell transplantation, and 30 (76.9%) had allogeneic haematopoietic cell transplantation (14 unrelated, 9 sibling and 7 haploidentical). The median donor age was 32 (20-67) years. The median follow-up was 16.4 (1.8-84.3) months. The median pre-treatment platelet count was 11x10⁹/l (1-23), which increased to 41x10⁹/l (6-150). The median platelet count increment was 29.5x10⁹/l (p = 0.001). The pre-treatment median neutrophil count was 1.19x10⁹/l (0.39-5.1), which increased to 2.35 x10⁹/l (0.1-5.33) (p = 0.05), and the pre-treatment median haemoglobin was 8.3 (6.2-14) g/dl, which increased to 10 (6.2-14) g/dl (p = 0.001) with eltrombopag. No eltrombopag-related hepatotoxicity occurred; however, 1 (2.6%) patient failed to continue treatment because of two consecutive episodes of deep venous thrombosis. Six (15.4%) patients were unresponsive to eltrombopag and dependent on blood product transfusions. After a median time of 82 days, 61.5% of the patients discontinued eltrombopag successfully.

Conclusion

The results confirmed that eltrombopag could provide a rapid, sustained response in patients with poor graft functioning after haematopoietic cell transplantation. This finding is essential given the high rate of non-relapse mortality caused by poor graft functioning after haematopoietic cell transplantation.

Investigation of phenotypic and genotypic characteristics of isolated Vibrio anguillarum strains in rainbow trout cage farms in Kahramanmaraş city of Turkey

Bu çalışma, Kahramanmaraş, Türkiye bölgesindeki kafes çiftliklerinde kültürlenen gökkuşağı alabalığındaki Vibrio anguillarum suşlarının fenotipik ve genotipik özelliklerinin izolasyonu ve incelenmesi ile ilgilidir . Bu amaç için, karaciğer, dalak, böbrek ve bağırsak örnekleri fenotipik özelliklerini ve biyokimyasal kimlik incelemek üzere Haziran 2014 farklı kafes çiftliklerinde yaklaşık 250-300 g ağırlığında alabalık farklı gökkuşağı alınmıştır V. anguillarum , Biolog Sistemi, gökkuşağı alabalığından alınan örneklerden elde edilen saf vibrio suşlarına uygulandı. 20 V. anguillarumu doğrulamak için spesifik bir primer ile polimeraz zincir reaksiyon tekniği kullanıldıfenotipik ve biyokimyasal özelliklere göre belirlenen suşlar. Daha sonra, bunların hepsinin V. anguillarum olduğu doğrulandı . Örneklerden elde edilen V. anguillarum suşlarının sekans analizi gerçekleştirildi ve daha sonra bunların karşılık gelen verileri yorumlandı. Bu çalışmanın sonucunda V. anguillarum bakterileri iki farklı alabalık kafesi çiftliğinde tespit edilmiştir. V. anguillarum'un tanımlanma süresi kültür yöntemi ile üç hafta sürerken , kısa sürede PCR tekniği ile yapıldı. 

Clinical Evaluation of Low-shrinkage Bioactive Material Giomer Versus Nanohybrid Resin Composite Restorations: A Two-year Prospective Controlled Clinical Trial

This study evaluated the clinical performance of low-shrinkage bioactive resin composite compared with a conventional nanohybrid resin composite. A total of 35 patients (18 males, 17 females; mean age: 29±9 years old) received, randomly, 35 pairs of fillings restored with either low-shrinkage bioactive material employing Giomer filler technology (Beautifil II LS, Shofu Inc, Kyoto, Japan) or conventional nanohybrid resin composite (Clearfil Majesty Posterior, Kuraray, Japan) in Class I and Class II cavities. Two operators made all the restorations using the corresponding adhesive resins: FL-Bond II (Shofu Inc) and Clearfil SE Bond (Kuraray), according to each manufacturer's instructions. Two calibrated operators evaluated the restorations two weeks after placement (baseline), at six months, and at one and two years using FDI criteria (Scores 1-5). Data were analyzed using the McNemar test (α=0.05). Mean observation time was 27.4 ± 4.1 months (min=20.8; max=33.7). In both groups, according to FDI criteria, the restorations were mostly rated with best scores (Score 1 or 2) for biological, functional, and optical parameters. For one filling in the group restored with nanohybrid resin composite, a small and localized secondary caries lesion was observed and monitored at the one- and two-year follow-ups. One restoration in the low-shrinkage Giomer restorative group was accepted as a failure due to retention loss. Over the two-year follow-up, both the Giomer and the nanohybrid resin composite restorations' performance was clinically acceptable.

Two-Year Survival of Ceramic Endocrowns and Partial Coverage Ceramic Restorations with Fiber Post: A 2-Year Double-Blind Randomized Clinical Trial

PURPOSE

This double-blind randomized clinical trial (RCT) aimed to evaluate the 2-year survival rates of endocrowns and partial coverage ceramic restorations (PCCR) with fiber posts.

MATERIAL AND METHODS

Forty (40) participants fulfilled the elegibility criteria, and they were randomly allocated in 2 groups: Endocrown or PCCR+post. The survival rates were assessed based on USPHS modified and radiographic examinations. A Chi-square test was used to assess the distribution of characteristics between groups. Kaplan-Meier and Log-rank tests were used to estimate the survival rate. To evaluate the association between survival of the restorations and the explanatory variables, the Multivariate Cox regression model was used. Only variables presenting p⟨0.20 were maintained in final model (α= 0.05).

RESULTS

The highest 2-year survival rates were recorded for the Endocrown group (100%), whereas the PCCR+post group exhibited the lowest performance (66.7%). Most of the restoration failures was due to lack of marginal adaption, fracture, and recurrent caries. Cox Regression unadjusted analysis showed that only type of restoration presented a significant effect (p⟨0.20). Thus, adjusted analysis was not performed.

CONCLUSIONS

Endocrowns appear to be a promising conservative restorative option and to be feasible and reliable approach restoring endodontically.

Implant-Supported Extra-Orally Cemented Monolithic Zirconia Crowns: A Prospective Controlled Clinical Study up to 18 Months in Function

This study evaluated the clinical performance of implant supported, extra-orally cemented, monolithic zirconia crowns after a follow-up to 18 months. Thirty-one patients with 50 posterior dental implants were consecutively selected for this study. A total of 50 crowns were cemented onto titanium abutments extra-orally and then screwed to the implants with the required torque intra-orally. The patients were followed at 12 months and 18 months after placement of restorations. During the follow-up period, all restorations were evaluated according to following technical parameters: implant failure, crown fracture, screw loosening, loss of retention due to decementation, fracture of antagonist tooth or restoration. Data were analyzed using Kaplan Meier method. One implant and its corresponding crown was lost during the follow-up period, yielding a 18 months survival rate of 98%. During the study, 2 complication events were observed, including one screw loosening and one veneering porcelain chipping in an antagonist bilayered zirconia restoration. The overall success rate of the observed prosthesis was 96%. According to the results of this study, the extra-orally cemented, monolithic zirconia crowns resulted in a favorable short-term outcome for posterior implant supported restorations within this short observation time.

Water as Veneering Modeling Liquid Affects Microhardness of Glassy Matrix Veneering Ceramic

PURPOSE/AIM

To evaluate the effect of different veneering liquids used for modeling on microhardness, fracture toughness and biaxial flexural strength of a glass-veneering ceramic.

MATERIAL AND METHODS

The manufacturer recommended modeling liquid (ML), distilled water (DW), isopropyl alcohol (IA), 0.5% (P05), 1% (P1), and 2% (P2) polyethylene glycol solutions were mixed with feldspathic ceramic powder to form disc-shaped samples (n=20, 15 mm × 1.2 mm). After sintering, samples were mirror-polished and subjected to Vickers indentation (n=5) for measurement of microhardness and fracture toughness. The remaining 15 samples from each group were subjected to biaxial flexural strength. Data were subjected to one-way ANOVA and Weibull analysis.

RESULTS

The microhardness was affected by veneering liquid (p=0.002): DW promoted higher microhardness values than ML and IA. Fracture toughness (p=0.301) and flexural strength (p=0.930) were not affected by the veneering liquid but Weibull parameters were affected. All groups presented surface pores under high magnification.

CONCLUSION

Even though the use of DW led to higher values of surface microhardness than the ML, all obtained values are inside the range of enamel microhardness values reported in the literature. Such parameters may affect antagonist wear and should be reported in clinical trials.

Clinical Performance of Complete-Arch Implant- Supported Rehabilitations Using Monolithic Lithium Disilicate Restorations Bonded to CAD/CAM Titanium and Zirconia Frameworks up to 5 Years

This clinical study evaluated the survival of monolithic lithium disilicate (ML) (IPS Emax, Ivoclar Vivadent) restorations bonded to complete-arch CAD/CAM made titanium or zirconia frameworks. Between August 2007 and December 2009, 15 patients (7 female, 8 male; mean age: 56.8 years old) received 30 implant-supported screw-retained rehabilitations with ML restorations cemented to CAD/CAM made titanium (T) (n=6) or zirconia (Z) frameworks (n=24) adhesively (Multilink Automix, RelyX Unicem) and followed up until December 2015. The evaluation protocol involved technical failures (chipping, debonding or fracture of crown/framework, screw loosening), Californian Dental Association (CDA) quality criteria (Romeo: Excellent; Sierra: Acceptable; Tango: Retrievable; Victor: Not acceptable) and biological failures (mucositis, peri-implantitis). Mean observation time was 60.3 months. No implants were lost, and all the prostheses were in situ. Four mechanical failures occurred in the form of minor chipping (n=3 in ML-Z, n=1 in ML-T) and major fracture in ML crown (n=1 in ML-Z). Romeo scores (N=370) decreased until final observation (N=347) and 23 Sierra scores were given to the restorations. Mucositis was observed in 3 patients and peri-implantitis in one patient. Complete-arch implant-borne FDPs made of monolithic lithium disilicate bonded to titanium or zirconia frameworks could be a promising alternative.

Ibrutinib plus Bendamustine and Rituximab in Untreated Mantle-Cell Lymphoma

BACKGROUND

Ibrutinib, a Bruton's tyrosine kinase inhibitor, may have clinical benefit when administered in combination with bendamustine and rituximab and followed by rituximab maintenance therapy in older patients with untreated mantle-cell lymphoma.

METHODS

We randomly assigned patients 65 years of age or older to receive ibrutinib (560 mg, administered orally once daily until disease progression or unacceptable toxic effects) or placebo, plus six cycles of bendamustine (90 mg per square meter of body-surface area) and rituximab (375 mg per square meter). Patients with an objective response (complete or partial response) received rituximab maintenance therapy, administered every 8 weeks for up to 12 additional doses. The primary end point was progression-free survival as assessed by the investigators. Overall survival and safety were also assessed.

RESULTS

Among 523 patients, 261 were randomly assigned to receive ibrutinib and 262 to receive placebo. At a median follow-up of 84.7 months, the median progression-free survival was 80.6 months in the ibrutinib group and 52.9 months in the placebo group (hazard ratio for disease progression or death, 0.75; 95% confidence interval, 0.59 to 0.96; P = 0.01). The percentage of patients with a complete response was 65.5% in the ibrutinib group and 57.6% in the placebo group (P = 0.06). Overall survival was similar in the two groups. The incidence of grade 3 or 4 adverse events during treatment was 81.5% in the ibrutinib group and 77.3% in the placebo group.

CONCLUSIONS

Ibrutinib treatment in combination with standard chemoimmunotherapy significantly prolonged progression-free survival. The safety profile of the combined therapy was consistent with the known profiles of the individual drugs. (Funded by Janssen Research and Development and Pharmacyclics; SHINE ClinicalTrials.gov number, NCT01776840.).

Longevity of Direct Resin Composite Restorations in Maxillary Anterior Crown Fractures: A 4-year Clinical Evaluation

OBJECTIVES

To investigate the longevity of direct composites for Class IV restorations and the possible reasons of failure.

METHODS AND MATERIALS

The longevity of 168 Class IV restorations in 50 adult patients was evaluated, in terms of modified United States Public Health Service criteria, for 4 years. Restorations were performed using a monochromatic layered microhybrid, resinbased composite (RBC) (Essentia, Universal Shade, GC Corporation, Japan; n=76) and polychromatic layered micro/nanohybrid (MD and LE shades, Essentia, GC Corporation, Japan; n=92) RBCs, by a single operator.

RESULTS

The majority of the teeth (n=156) remained acceptable at the end of 4 years, and the overall survival (OS) rate was considered as 92.86%. Survival rates for the monochromatic layering technique (MLT) and polychromatic layering technique (PLT) were 90.8% and 94.6%, respectively. Mean survival was 46 months for MLT and 47 months for PLT, indicating no significant difference (p=0.343). Fracture of the restoration was the most common reason for failure (4.2% out of 7.1% of general failures) for both the layering techniques.

CONCLUSIONS

Under the conditions of this mid-term clinical study, MLT and PLT as well as microhybrid and nanohybrid resin composite materials, showed similar clinical durability. In terms of simplicity, monochromatic layering can be preferred for Class IV restorations, when the right indication criteria are met.

The effects of high intensity-interval training on vaspin, adiponectin and leptin levels in women with polycystic ovary syndrome

AIM

We aimed to investigate the metabolic effects of HIIT exercise on PCOS patients and how it affects adiponectin, vaspin and leptin.

MATERIAL AND METHODS

Twenty women with PCOS were included in the study and were divided into two groups. HIIT program was applied for 10 PCOS and Medium Intensity Continuous Training (MICT) program was applied for other 10 PCOS. At the beginning and at the end of the study, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride(TG), insulin, Adiponectin, Leptin, Vaspin levels of both PCOS groups were evaluated.

RESULTS

When PCOS patients by performed HIIT exercise for 12 weeks, we found that the levels of leptin and vaspin did not change while adiponectin levels increased. Moreover serum levels of insulin, TG, total cholesterol, LDL-C decreased but levels of HDL-C increased.

CONCLUSION

HIIT increased in the adiponectin levels in women with PCOS and provided more weight loss.

The Relevance of Additional Immunohistochemical Markers on the Differential Diagnosis of Small B-Cell Lymphomas: A Case-control Study

Objective:

Clinical and pathological differential diagnosis of small B-cell lymphomas (SBCLs) is still controversial and may be difficult due to their overlapping morphology, phenotype, and differentiation to plasma cells. We aimed to examine the expression of the immune receptor translocation-associated protein 1 (IRTA1), myeloid cell nuclear differentiation antigen (MNDA), lymphoid enhancer-binding factor-1 (LEF1), and stathmin 1 (STMN1) markers in SBCL cases involving different sites that may have plasma cell differentiation.

Materials and Methods:

We studied 154 tissue samples with lymphoma involvement from 116 patients and evaluated the staining distribution of the markers. Expressions were evaluated in 21 chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), 7 follicular lymphoma (FL), 14 nodal marginal zone lymphoma, 17 extranodal marginal zone lymphoma, 55 splenic marginal zone lymphoma, 22 marginal zone lymphoma-not otherwise specified, and 18 lymphoplasmacytic lymphoma/Waldenström macroglobulinemia cases by immunohistochemistry.

Results:

The results confirmed that LEF1 was the most sensitive and specific marker for CLL/SLL and STMN1 was the most sensitive and specific marker for FL (p<0.001). MNDA and IRTA1 were useful markers to distinguish marginal zone lymphomas.

Conclusion:

Our results suggest that LEF1 for CLL/SLL and STMN1 for FL are reliable markers. LEF1, MNDA, STMN1, and IRTA1 are helpful with other routinely used immunohistochemical markers in a diagnostic algorithm considering their limitations.

Clinical Characteristics and Outcome of COVID-19 in Turkish Hematological Malignancy Patients

Objective:

Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.

Materials and Methods:

In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.

Results:

Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.

Conclusion:

Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.

Micro-Computed Tomography Analysis of Fit of Ceramic Inlays Produced with Different CAD Software Programs

PURPOSE

The aim of this study was to evaluate marginal and internal fit of ceramic inlays designed with different computer-aided design software programs.

MATERIALS AND METHODS

11 typodont mandibular first molars were prepared as a ceramic class II mesioocclusal inlay cavity. Teeth were scanned using 3Shape TRIOS Intraoral Dental Scanner. The scan data, which was obtained in the form of a STL file, was designed in three different CAD systems (CEREC, KaVo, and Planmeca). The obtained STL scan data was exported to design inlay using three different CAD systems (CEREC, KaVo, and Planmeca). An independent 5-axis milling unit was used to manufacture the feldspatic inlay restorations. 11 measurements for each teeth were made by using micro-ct to evaluate the marginal and internal fit. One-way ANOVA was used to determine the statistical difference between groups, and Tukey posthoc test was used to determine intra-group differences.

RESULTS

According to repeated ANOVA test results, a statistically significant difference was found between the groups for the variables A, D, and F. There was no statistically significant difference between the groups in linear measurements for other measurement points and volumetric measurements (p⟩0.05).

CONCLUSION

Software programs of different systems affects the marginal and internal fit of inlay restorations.

Accuracy, Reliability and Clinical Implications of Static Compared to Quantifiable Occlusal Indicators

OBJECTIVE

This literature review summarizes the properties, advantages, limitations, and clinical implications of employing static occlusal indicators compared to quantifiable digital occlusal indicators during occlusal adjustments.

METHOD

An electronic database search of dental literature was carried out in PubMed/MEDLINE using the key words Occlusal Indicators, Occlusal Assessment, Static, Reliability, Dynamic, Repeatability, Validity and Clinical Accuracy. A total of 231 papers were isolated, with 129 papers considered for review.

RESULTS

The included papers were grouped by Static and Dynamic Occlusal indicators. The numbers of papers in the Static Group was extremely low (only 20 papers) compared to The Dynamic group (T-Scan: 89; Dental Prescale: 28; Intraoral Scanners:17).

CONCLUSION

Little evidence supports the use of static occlusal indicators due to their high degree of subjectivity required during implementation. However, much scientific evidence supports the use of T-Scan, as it measures relative occlusal forces and timing objectively, accurately, and repeatedly. For the improvement of Occlusal Practice, Subjective Interpretation using Static occlusal indicators should be replaced with digital ones for objective measurements.

CLINICAL RELEVANCE

The computerized occlusal analysis system is well studied and has the capacity to provide precise time and force sequencing information to objectively evaluate occlusal contacts for improved treatment outcome.

Clinical wear and quality assessment of monolithic and lithium disilicate layered zirconia restorations

BACKGROUND

Wear and quality assessments of translucent monolithic zirconia and CAD-on^® restorations were performed.

METHODS

Forty 3-unit posterior fixed partial denture (FPD) in 18 patients (age:18-50 years) were made from translucent monolithic zirconia (tm) (Zenostar T) and zirconia-frameworked, lithium disilicate layered (c) (CAD-on), materials in a split-mouth design. Restorations were digitally fabricated and their internal and marginal adaptations were measured before cementation followed by luting (Multilink Speed). Clinical evaluations were made by modified United States Public Health Service criteria at baseline, 6, 12, and 24-months. Wear of the restorations and the antagonists were digitally evaluated after optical scanning of stone casts at 1st week and 24 m through a software (Cerec 4.4). Statistical analysis was made (analysis of variance, Shapiro-Wilk, Friedman and Wilcoxon tests (SPSS 20)) at α = 0.05 significance level.

RESULTS

At 24 m, all restorations were clinically acceptable. Insignificant differences were found between tm and c restorations (P > 0.05). Mean internal and marginal adaptation of c restorations were significantly better (145 µm (premolar)-174 µm (molar)) than tm (190 µm (premolar)-207 µm (molar)) (P < 0.05). C restorations significantly caused more wear (0.3 ± 0.1 mm) than tm (0.1 ± 0.07 mm) on the antagonistic dentition (P < 0.05).

CONCLUSIONS

Translucent monolithic zirconia restorations caused less wear and antagonist wear than CAD-on restorations. CAD-on restorations exhibited higher internal and marginal adaptation.

Accuracy of Removable Partial Denture Frameworks Fabricated Using Conventional and Digital Technologies

This study analyzed the fit accuracy of the removable partial denture (RPD) metal frameworks produced using digital and conventional manufacturing technologies. Mandibular RPD metal frameworks (N=15, n=3 per group) were fabricated on a representative clinical case. RPDs were fabricated using one of the following manufacturing procedures: a) conventional lost-wax casting technique (C-LW), b) conventional casting of milled sacrificial patterns (C-M), c) conventional casting of printed sacrificial patterns (C-P), d) selective laser melting (SLM), e) direct metal laser sintering (DMLS) technologies. The fit accuracy of RPD frameworks was analyzed by fabricating replicas with silicone registration material and measuring with a digital microscope. A total of 11 sites and 29 areas in the RPD metal frameworks were considered for the accuracy measurements (μm). Data were statistically analyzed using Wilcoxon signed rank and Friedman test (α=0.05). Before finishing and polishing, C-M method presented overall significantly better (P⟨.001) fit accuracy (118 μm) than those of other methods (195-265 μm). After finishing and polishing, C-M method showed overall significantly better (P⟨.033) fit accuracy (205.7 μm) than C-LW and SLM methods (285.7 μm; 249 μm) and comparable fit accuracy to that of C-P and DMLS methods. Accuracy at the minor and major connector areas of RPDs were affected from the manufacturing technologies. Clinical Implications: When accuracy of RPDs are considered, digital technologies tested presented similar results to those of conventional manufacturing method except for minor and major connector areas which necessitates further improvement.

Highlighting the Prognostic Importance of Measurable Residual Disease Among Acute Myeloid Leukemia Risk Factors

Objective:

The optimal timing of measurable residual disease (MRD) evaluation in acute myeloid leukemia (AML) patients has not been well defined yet. We aimed to investigate the impact of MRD in pre- and post-allogeneic hematopoietic stem cell transplantation (AHSCT) periods on prognostic parameters.

Materials and Methods:

Seventy-seven AML patients who underwent AHSCT in complete morphological remission were included. MRD analyses were performed by 10-color MFC and 10^-4 was defined as positive. Relapse risk and survival outcomes were assessed based on pre- and post-AHSCT MRD positivity.

Results:

The median age of the patients was 46 (range: 18-71) years, and 41 (53.2%) were male while 36 (46.8%) were female. The median follow-up after AHSCT was 12.2 months (range: 0.2-73.0). The 2-year overall survival (OS) in the entire cohort was 37.0%, with a significant difference between patients who were MRD-negative and MRD-positive before AHSCT, estimated as 63.0% versus 16.0%, respectively (p=0.005). MRD positivity at +28 days after AHSCT was also associated with significantly inferior 2-year OS when compared to MRD negativity (p=0.03). The risk of relapse at 1 year was 2.4 times higher (95% confidence interval: 1.1-5.6; p=0.04) in the pre-AHSCT MRD-positive group when compared to the MRD-negative group regardless of other transplant-related factors, including pre-AHSCT disease status (i.e., complete remission 1 and 2). Event-free survival (EFS) was significantly shorter in patients who were pre-AHSCT MRD-positive (p=0.016). Post-AHSCT MRD positivity was also related to an increased relapse risk. OS and EFS were significantly inferior among MRD-positive patients at +28 days after AHSCT (p=0.03 and p=0.019).

Conclusion:

Our results indicate the importance of MRD before and after AHSCT independently of other factors.

Copanlisib + rituximab versus rituximab + placebo in patients with relapsed follicular (FL) or marginal zone lymphoma (MZL): Subset analysis from the phase III CHRONOS-3 trial

7510

Background: Rituximab (R) monotherapy is an approved treatment for patients (pts) with relapsed indolent NHL (iNHL) who have a prolonged progression-free and treatment-free interval after last R-based therapy or who are unwilling/unfit to receive chemotherapy. Copanlisib (C) is a PI3K inhibitor approved as monotherapy in pts with relapsed FL who have progressed after ≥2 systemic therapies. The recent Phase III CHRONOS-3 study in pts with relapsed iNHL treated with C+R vs placebo (P)+R (NCT02367040) met its primary endpoint with a significant 48% reduction in the risk of disease progression or death (Matasar et al. AACR 2021). We report here a pre-planned subset analysis in pts with relapsed FL or MZL. Methods: Pts with relapsed iNHL who were progression- and treatment-free for ≥12 months (mo) after last R-based therapy or ≥6 mo if unwilling/unfit to receive chemotherapy were randomized 2:1 to receive C+R or P+R. C 60 mg/P was given i.v. on days 1, 8, and 15 (28-day cycle); R 375 mg/m2 was given i.v. on days 1, 8, 15, and 22 of cycle 1 and on day 1 of cycles 3, 5, 7, and 9. Primary endpoint was centrally assessed progression-free survival (PFS) by Cheson 2014 criteria. Secondary endpoints included objective response rate (ORR), duration of response (DoR), complete response rate (CRR), time to progression (TTP), and treatment-emergent adverse events (TEAEs). All randomized pts were assessed for efficacy; pts were assessed for safety if they received ≥1 dose of C/P or R. The data cut-off date was August 31, 2020. Results: From a total dataset of 458 iNHL pts, 250 pts with FL/MZL (184 FL/66 MZL) were randomized to C+R and 120 (91 FL/29 MZL) to P+R. Median age was 62 years (range 28-91) and the arms were well balanced. With a median follow-up of 18.5 mo, C+R significantly reduced the risk of disease progression/death vs P+R (HR = 0.55 [95% CI 0.40, 0.76]; 1-sided p = 0.0001); median PFS was 22.2 mo (95% CI 19.1, 33.1) vs 15.4 mo (95% CI 11.0, 19.2), respectively. Median TTP was 27.5 mo for C+R vs 15.4 mo for P+R (HR = 0.500; 1-sided p = 0.00001). ORRs were 82.4% (CRR 37.6%) for C+R and 50.8% (CRR 18.3%) for P+R; median DoR was 23.9 mo vs 17.9 mo, respectively. Most common TEAEs (all grades [G]/G3+) in pts with FL/MZL receiving C+R (n = 249) were hyperglycemia (72.7%/59.0%), hypertension (53.8%/43.0% [all G3]), and diarrhea (35.3%/5.6% [all G3]). For pts receiving P+R (n = 116), the most common TEAEs were hyperglycemia (23.3%/7.8% [all G3]), hypertension (19.8%/8.6% [all G3]), neutropenia (18.1%/13.8%), and upper respiratory tract infection (18.1%/0%). Conclusions: C+R demonstrated superior efficacy vs P+R in pts with relapsed FL/MZL and had a manageable safety profile, consistent with C and R as monotherapy. Copanlisib is the first PI3K inhibitor to be safely combined with R in relapsed FL/MZL, representing a potential new therapeutic option. Clinical trial information: NCT02367040.

Adhesion between zirconia and resin cement: A critical evaluation of testing methodologies

This study aimed to analyze different methodologies (tensile, microtensile, shear, microshear, and interfacial toughness) for evaluation of the bond strength between zirconia (Y-TZP) and resin cement. Zirconia ceramic blocks (VITA in-Ceram® YZ, VITA Zahnfabrik, Germany) were obtained, substrate surfaces were air-abraded with aluminum oxide (50 μm) for 10 s (2 bar pressure, distance: 10 mm, angle: 90°). Then, the specimens were washed with distilled water, dried, and coated with Clearfil Ceramic Primer that was actively applied with a microbrush for 20 s. The specimens were then cemented with resin cement under a load of 750 g, followed by photo-polymerization (40 s on each surface). After cementation, the specimens were aged in thermocycling (8000 cycles, 5-55 °C, 30 s for each bath) and subjected to tensile, microtensile, shear, microshear or interfacial toughness tests. All specimens were inspected for failure modes. The microtensile test showed the highest bond value (18.29 N/mm²). The microshear tests showed the highest coefficient of variation (0.59) and highest number of pre-test failures. The interfacial energy to fracture test showed that as the shear stress increased its interaction in the adhesive interface, the coefficient of variation also increased. The bond strength of Y-TZP showed different results according to the methodology, as well as its interfacial energy to fracture varied according to the angulation/type of stress specimen was submitted. The lower the shear stress at the adhesive interface of the mixed tests (interfacial energy to fracture), the lower was the variability of the test.

Assessment of Biomechanical Behavior of Endodontically Treated Premolar Teeth Restored with Novel Endocrown System

OBJECTIVE

Despite the increased popularity of endocrowns, there is no clear consensus considering their effectiveness to restore severely-destructed endodontically treated premolars. This study aimed to assess the biomechanical behavior of endodontically treated maxillary first premolars restored with a novel endocrown system compared to the conventional one.

MATERIALS AND METHODS

Twenty sound human maxillary first premolars were collected. After endodontic treatment, they were divided into 2 groups (n=10) according to the system used for endocrown fabrication. Group C (Control): conventional monolithic IPS e.max CAD endocrowns. Group P: novel bi-layered endocrowns (Pekkton ivory coping veneered with cemented IPS e.max CAD). All specimens were subjected to 10000 thermal cycles followed by 240000 dynamic load cycles. Surviving specimens were subjected to fracture resistance test followed by qualitative analysis using Stereomicroscopy and Scanning Electron Microscopy.

RESULTS

A significantly higher load was observed for Group P (1831.37 ± 240.69 N) than Group C (1433.47 ± 174.39 N) (p ⟨ 0.001). A statistically significant difference was observed considering the failure mode (p = 0.036), with more favorable fractures detected with Group P.

CONCLUSIONS

The tested novel endocrown system improved the biomechanical behavior of the tooth/ restoration complex in the restored endodontically treated maxillary first premolars.

CLINICAL SIGNIFICANCE

The tested novel endocrown system with a PEKK coping veneered with cemented IPS e.max CAD can be considered a promising option for restoration of severely-destructed endodontically treated premolar teeth. It can be considered as a conservative alternative option to the conventional treatment modalities.

Evaluation of Adhesion Protocol for Titanium Base Abutments to Different Ceramic and Hybrid Materials

Scientific evidence regarding conditioning of different ceramic and hybrid materials and their bonding on titanium abutments is lacking. Titanium disks (Tritan) (N=450, n=15) were randomly cemented onto five different ceramic and hybrid materials, namely 1. Zenostar T, 2. Lava Ultimate, 3. IPS e.max CAD, 4. Vita Enamic multicolor and 5. G-ceram using three different cements, Panavia 21, TheraCem and Multilink hybrid abutment. Half of all specimens were thermocycled (5000 cycles, 5-55°C), while the other half were kept dry. Macro shear bond testing was conducted using a universal testing machine. Failure types were classified using a digital microscope. Data was statistically analyzed with three-way ANOVA and Tukey HSD post hoc tests. Both the ceramic (P⟨0.0001) and cement type(P⟨0.0001) significantly affected the shear bond strength(MPa), while thermocycling did not (P⟩0.05). The incidence of cohesive (50.34%) and adhesive failures (49.66%) were not significantly different. As for implant superstructures, when ceramics are bonded to titanium bases, the ceramic and cement type both have an impact on the bond strengths along with the conditioning and bonding protocols for each substrate. An equal affinity of the cements tested to the ceramic, hybrid materials and to titanium can be assumed. Combination of zirconia and TheraCem can be recommended for clinical use.

Evaluation of Smear Layer Removal and Antimicrobial Efficacy of HybenX Against Enterococcus Faecalis Biofilm

To evaluate the antibacterial efficacy of HybenX, an endodontic irrigant against Enterococcus faecalis biofilm and determine its efficacy in removal of smear layer. Forty root canals were inoculated with E. faecalis for three weeks, divided into 4 groups and irrigated with: Group1: 5 ml 2.5% sodium hypochlorite; Group2: 5 ml 2% chlorhexidine gluconate; Group3: 5 ml HybenX; Group4: 5 ml distilled water (control). Dentin shavings were collected and plated on agar plates, followed by colony forming unit (CFU) determination. For smear layer removal examination, 30 single rooted teeth were instrumented and divided into 3 groups and treated with: GroupI: 5 ml of 17% EDTA; GroupII:5 ml of HybenX; and GroupIII: 5 ml of distilled water. Samples were then subjected to SEM examination. All irrigants showed a significant reduction in CFUs compared to the control group (P⟨ .001), but none compared to each other. Regarding smear layer removal in the apical third, EDTA removed smear layer more effectively than HybenX (P = .014). HybenX demonstrated good antimicrobial efficacy against E. faecalis biofilm and removed the smear layer effectively in coronal and middle third of the root canal system. HybenX can be considered as a promising irrigating agent in root canal treatment of infected teeth.

Effect of Thickness and Shade of Resin and Ceramic- Based Hybrid Materials on Color Masking Abilities and Optical Performance of CAD/CAM Materials

Scientific data analysing color masking abilities of chairside CAD/CAM materials is lacking. The purpose of this in-vitro study was to evaluate the thickness and shade influence of three materials on their optical behaviour. Three materials: a) LD: Lithium disilicate glass ceramic (Emax, Ivoclar Vivadent), b) LDS: Lithium-disilicate-strengthened aluminosilicate glass ceramic (N!ce, Straumann) and c) RNC: Resin Nanoceramic (Lava Ultimate, 3M ESPE) were polished in different shades (A1,A2,A3) and thicknesses (0.1- 1.2mm). Specimens (N=108; n=36 per group) (12x12x1mm3) were positioned on resin composite base (Clearfil AP-X, Kuraray) in shade A3. Spectrophotometric measurements were performed and the parameters thickness, shade and material were analysed using three-way ANOVA, and pairwise T-tests (P-values ⟨ 0.05). Both the shade (p⟨0.001) and the interaction of material in correlation to thickness (p⟨0.001) were significant. Shade value A1-A3 comparisons were significant A1 vs. A2 (p=0.045); A2 vs. A3 (p=0.002); A1 vs. A3 (p⟨0.001)). A significant correlation of the material and thickness was observed when comparing LD and LDS (p=0.007) at the thickness of 0.1-0.4 mm. Masking abilities were influenced by material and thickness choice. Reinforced glass ceramics showed the best results in the smallest thickness tested (0.1-0.4 mm). LDS could be considered as an advantageous alternative in minimal-invasive cases.

Relationship between internal accuracy and load-bearing capacity of minimally invasive lithium disilicate occlusal veneers

PURPOSE

To test whether internal accuracy affects the load-bearing capacity of 0.5-mm-thick occlusal veneers made out of milled or heat-pressed lithium disilicate (LS2).

MATERIALS AND METHODS

Extracted human molars (N = 80) were divided into four groups (n = 20 each) depending on the bonding substrate (enamel [E] or dentin [D]) and the fabrication method (milling [CAD] or heat pressing [PRE]) for the occlusal LS2 veneers: (1) E-CAD, (2) D-CAD, (3) E-PRE, or (4) D-PRE. After restoration fabrication, the abutment teeth and the corresponding restorations were scanned and superimposed in order to measure the marginal and internal accuracy. After adhesive cementation, the specimens were thermomechanically aged and thereafter loaded until fracture. The load-bearing capacities (F_max) were measured. F_max and the marginal and internal accuracy between the groups were compared using Kruskal-Wallis test (P < .05) and pairwise group comparisons. In addition, the relationship between F_max and the internal accuracy was analyzed using Spearman rank correlation.

RESULTS

Median F_max values (and first and third quartiles) per group were as follows: 1,495 N (Q1: 932; Q3: 2'318) for E-CAD; 1,575 N (Q1: 1,314; Q3: 1,668) for E-PRE; 1,856 N (Q1: 1,555; Q3: 2,013) for D-CAD; and 1,877 N (Q1: 1,566; Q3: 2,131) for D-PRE. No statistical difference was found between the groups (P = .0981). Overall, the internal accuracy in the areas of the cusp (P < .0007) and fossa (P < .0001) showed significant differences. While no significant differences were detected in the marginal area (P = .3518), a significant correlation with a negative linear relationship was found between the 3D internal accuracy and the F_max values (P = .0007).

CONCLUSION

An increase in the internal accuracy raised the load-bearing capacity of minimally invasive LS2 occlusal veneers. In general, the restorations bonded to dentin in the occlusal regions showed a better accuracy compared to those bonded to enamel.

ROBUST: A Phase III Study of Lenalidomide Plus R-CHOP Versus Placebo Plus R-CHOP in Previously Untreated Patients With ABC-Type Diffuse Large B-Cell Lymphoma

Patients with the activated B-cell-like (ABC) subtype of diffuse large B-cell lymphoma (DLBCL) historically showed inferior survival with standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Phase II studies demonstrated that adding the immunomodulatory agent lenalidomide to R-CHOP improved outcomes in ABC-type DLBCL. The goal of the global, phase III ROBUST study was to compare lenalidomide plus R-CHOP (R2-CHOP) with placebo/R-CHOP in previously untreated, ABC-type DLBCL.

Biomarkers of response to ibrutinib plus nivolumab in relapsed diffuse large B-cell lymphoma, follicular lymphoma, or Richter's transformation

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Biomarkers of response to ibrutinib + nivolumab were analyzed in diffuse large B-cell lymphoma (DLBCL), follicular lymphoma and Richter transformation.

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DLBCL patients with elevated PD-L1 by immunohistochemistry tended to have better response and survival.

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Whole exome sequencing identified gene mutations in alternate B-cell receptor pathways linked to response in DLBCL.

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Enriched pathways by gene expression profiling were related to immune activation in responders and proliferation/replication in nonresponders.

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This preliminary work may help to generate hypotheses on genetically defined subsets of patients most likely to benefit from ibrutinib + nivolumab.

We analyzed potential biomarkers of response to ibrutinib plus nivolumab in biopsies from patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and Richter's transformation (RT) from the LYM1002 phase I/IIa study, using programmed death ligand 1 (PD-L1) immunohistochemistry, whole exome sequencing (WES), and gene expression profiling (GEP). In DLBCL, PD-L1 elevation was more frequent in responders versus nonresponders (5/8 [62.5%] vs. 3/16 [18.8%]; p = 0.065; complete response 37.5% vs. 0%; p = 0.028). Overall response rates for patients with WES and GEP data, respectively, were: DLBCL (38.5% and 29.6%); FL (46.2% and 43.5%); RT (76.5% and 81.3%). In DLBCL, WES analyses demonstrated that mutations in RNF213 (40.0% vs. 6.2%; p = 0.055), KLHL14 (30.0% vs. 0%; p = 0.046), and LRP1B (30.0% vs. 6.2%; p = 0.264) were more frequent in responders. No responders had mutations in EBF1, ADAMTS20, AKAP9, TP53, MYD88, or TNFRSF14, while the frequency of these mutations in nonresponders ranged from 12.5% to 18.8%. In FL and RT, genes with different mutation frequencies in responders versus nonresponders were: BCL2 (75.0% vs. 28.6%; p = 0.047) and ROS1 (0% vs. 50.0%; p = 0.044), respectively. Per GEP, the most upregulated genes in responders were LEF1 and BTLA (overall), and CRTAM (germinal center B-cell–like DLBCL). Enriched pathways were related to immune activation in responders and resistance-associated proliferation/replication in nonresponders. This preliminary work may help to generate hypotheses regarding genetically defined subsets of DLBCL, FL, and RT patients most likely to benefit from ibrutinib plus nivolumab.

Comparison of the Clinical Accuracy of Digital and Conventional Dental Implant Impressions

The aim of this study was to compare the clinical accuracy of digital and conventional dental implant impressions. Two types of implant impressions were made for each case, namely a conventional open-tray impression and a digital implant impression (DII) using a Trios IOS. Master casts were scanned using a D800 laboratory scanner and STL files were retrieved from conventional and digital workflows to be exported for comparison. The distance between center points, angulation, rotation, vertical shift, and surface mismatch of the scan bodies were evaluated and compared between conventional and digital impression techniques. Comparing digital and conventional impression techniques the following factors showed statistically significant differences: distance (73.7±75 μm), angulation (0.42±0.3°), and surface mismatch of scan bodies. The difference in conventional and digital impression techniques as regards to angulation and distance between the implants were associated with distance, angle, and vertical shift differences in scan. The mismatch of the scanned surface of scan bodies was twice higher for the intraoral scanner group. Clinicians should therefore control the implant suprastructures clinically and also using casts (e.g. printed casts) when a digital scan is planned.

Bond Strength Durability of Adhesive Cements to Translucent Zirconia: Effect of Surface Conditioning

PURPOSE

To evaluate the influence of airborne particle abrasion, Piranha acid and hot acid etching on bond strength of zirconia with self-adhesive resin cements after aging. Also, the effect of Silano-Pen treatment on the bond strength of zirconia to resin cements.

MATERIALS AND METHODS

Thirty-six zirconia blocks were cut, sintered and divided into three groups (n=12); Airborne particle abrasion, Piranha acid, and hot acid etching were then treated with Silano-Pen. Each zirconia block was bonded to its corresponding composite block utilizing either Panavia SA, TheraCem or Panavia F2.0. 360 micro -tensile test bars were obtained and half of them were subjected to 10000 thermal aging cycles. Each microtensile test bar was subjected to microtensile force until debonding. Scanning Electron Microscopic evaluation was performed.

RESULTS

There was a significant difference between the surface treatments. Hot acid showed the highest mean bond strength and the lowest was Piranha acid. Panavia SA significantly improved the bond strength compared to TheraCem and Panavia F2.0. The interaction between cement and Silano-Pen was non-significant (p=.067). Under SEM analysis, hot acid treatments showed homogenous granular texture with wide distribution of porous network.

CONCLUSIONS

Pre-treatment, resin cement, and aging influences the effectiveness of bonding of zirconia. Silano-Pen after hot acid improved the bonding of zirconia.

In Vitro Static and Fatigue Behavior of Ceramic Occlusal Veneers Using CAD/CAM

To evaluate fracture resistance of occlusal veneers made of glass-ceramic and zirconia with and without fatigue. Occlusal overlays (N=80; n=10 per group) were milled out of CAD/CAM materials, namely: a)LD:Lithium disilicate glass ceramic, b)LDS:Lithium-disilicate- strengthened aluminosilicate glass ceramic, c)ZLT:Zirconium dioxide ceramic and d)ZMT:Zirconium dioxide ceramic. The overlays were cemented on polymeric duplicates, randomly distributed to aging or non-aging conditions and loaded until fracture. Ultimate catastrophic failure strength(Fmax) and Initial crack formation load(Finitial) values were analysed using two-way ANOVA. For Finitial, material type and aging and their interaction resulted in significant values (p =⟨0.001). Finitial mean±SD values ranged from ZMTa (593 N ±205 N) to LDSb (118 N ±42 N). As for Fmax, the material type significantly affected the outcome (p⟨0.001), while aging type did not show an influence (p=0.795). The non-aged Fmax specimens values presented were: LDSa (877 N ±253 N)⟨LDa (2029 N ±412 N)⟨ZLTa (2049 N ±379 N)⟨ZMTa (2144 N ±333 N), LDSa being significantly lower (p⟨0.001). The aged Fmax values were: LDSb (1313 N ±599 N)⟨ ZLTb (1715 N ±453 N)⟨ZMTb (2018 N ±300 N)⟨LDb (2134 N ±289 N). LDS yielded significantly lower Fmax values without and non-significant less favourable results with aging. The mechanical properties following aging and lack of additional firing makes LDS an interesting restorative material for clinical application.

Reliability of Chair-side Monolithic CAD-CAM Generated Lithium Disilicate Single Crowns with Knife- Edge Finish Line: Up to 5-Year Retrospective Analysis of Clinical Performance

This clinical study evaluated the survival of monolithic lithium disilicate (MLD) single crowns. Between January-2010 and January-2015, 87 patients received 122 MLD (IPS e.max CAD) single crowns on natural teeth with knife-edge finish lines that were adhesively bonded (Maxcem Elite). MLD single crowns (N=122) were bonded on 60 molars (maxilla:35, mandible:25), 53 premolars (maxilla:27, mandible:26), 4 canines (maxilla:2, mandible:2), 3 laterals and 2 centrals (maxilla). One crown fracture, one retention loss and one endodontic complication were experienced (survival rate: 97.5%). MLD single crowns could be safely indicated on teeth with knife-edge preparations.

Long-term safety and efficacy of the PI3K inhibitor copanlisib in patients with relapsed or refractory indolent lymphoma: 2-year follow-up of the CHRONOS-1 study

Safety profiles of oral PI3K inhibitors have resulted in US FDA black box warnings regarding fatal/serious toxicities. The approved intravenous PI3K inhibitor copanlisib has low incidence of severe toxicities and no black box warnings, but chronic treatment effects were unknown. We provide an update on safety and efficacy of copanlisib with a minimum 2-year follow-up of the CHRONOS-1 study. A total of 142 patients with histologically confirmed indolent B-cell lymphoma who had relapsed after or were refractory to ≥2 prior treatments received intravenous copanlisib 60 mg on days 1, 8, and 15 (28-day cycle). The primary efficacy endpoint was objective response rate (ORR) after ≥4 cycles (independent assessment). The predominant histology was follicular lymphoma (n = 104). The ORR was 60.6% (seven additional complete responses since primary analysis). Secondary endpoints of median duration of response, progression-free survival, and overall survival were 14.1 months (median follow-up, 16.1 months), 12.5 months (median follow-up, 14.0 months), and 42.6 months (median follow-up, 31.5 months), respectively. Median safety follow-up was 6.7 months; 26% of patients received treatment for >1 year. Common treatment-emergent adverse events (TEAEs) (all grade/grade 3/grade 4) were transient hyperglycemia (50.0%/33.1%/7.0%), diarrhea (35.2%/8.5%/0%), transient hypertension (29.6%/23.9%/0%), and neutropenia (28.9%/9.2%/14.8%). Serious AEs were largely unchanged, with no new cases of pneumonitis (4.2%), diarrhea (2.8%), or grade 5 events. Note, TEAEs showed no evidence for increased incidence or worsening following longer exposure in patients treated >1 year. Long-term follow-up of patients with relapsed/refractory indolent B-cell lymphoma treated with intravenous copanlisib demonstrated durable, enhanced responses without evidence of worsening TEAEs, as reported for orally administered PI3K inhibitors.

Digital Image Correlation and Finite Element Analysis of Bone Strain Generated by Implant-Retained Cantilever Fixed Prosthesis

PURPOSE

The present study evaluated the displacement and strain generated in an implant- supported fixed prosthesis under axial and non-axial loads using two methods.

MATERIALS AND METHODS

Three implants were inserted in a resin block. The Digital Image Correlation (DIC) was used to measure displacement and strain generated on the surface of the resin blocks for the different load applications (500N, 1 image/second). A 3-dimensional model was constructed and a load of 500 N was applied at an axial point and a non-axial point through finite element analysis (FEA).

RESULTS

Both methods gave similar trends for the strains, and both gave slightly higher strains with non-axial loading. FEA predicted higher strain magnitude (±11%) in comparison with DIC, but with the same mechanical behavior. According to ANOVA, the loading influenced the strain concentration. Higher strain was generated for non-axial loading around the implant nearest to the loading.

CONCLUSIONS

For implant-retained cantilever fixed prosthesis, the same load applied in the lever arm induces higher strain in the cervical area of the last implant, which suggests more damaging potential than a load applied at the center of the prosthesis.

Long-term results of brentuximab vedotin in relapsed and refractory Hodgkin lymphoma: multi-center real-life experience

Classical Hodgkin lymphoma (cHL) is considered a curable disease; however, approximately one-third of responders experience disease relapse following first-line therapy. Several studies have shown the efficacy of brentuximab vedotin (BV) in patients with relapsed/refractory HL. We present a retrospective analysis of 58 patients with relapsed/refractory HL treated with BV in a named patient program from 11 centers. The median follow-up duration was 20 (range, 4-84) months. The best overall response rate was 64% (complete response [CR], 31%; partial response [PR], 33%). The 5-year progression-free survival (PFS) and overall survival (OS) rates were 12% (95% confidence interval [CI], 0.05-0.22) and 26% (95% CI, 0.16-0.38), respectively. Among patients who achieved CR, the estimated 5-year PFS and OS rates were 32% (95% CI, 0.13-0.54) and 60% (95% CI, 0.33-0.78), respectively. A total of 26 patients underwent subsequent stem cell transplantation. The 5-year PFS and OS rates for 10 patients who had consolidative stem cell transplantation were 28% and 30%, respectively. Twenty-seven patients required further therapy following BV. At the time of the analysis, 12 patients (21%) were alive. Five patients (9%) had long-term remission after achieving CR with BV monotherapy, with a median PFS of 76 months. Three of them (5%) did not receive any other treatment following BV and their median PFS was 75 months. Our long-term results showed that a small subset of patients with relapsed/refractory cHL may benefit from and even be cured with BV monotherapy.

A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience

OBJECTIVE

The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP).

MATERIALS AND METHODS

A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm³) and defined as complete (platelet count of >100,000/mm³), partial (30,000-100,000/mm³ or doubling of platelet count after treatment), or unresponsive (<30,000/mm³). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed.

RESULTS

The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1^st, 2^nd, 3^rd, 4^th, and 8^th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%).

CONCLUSION

Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.