The syndrome of chronic recurrent multifocal osteomyelitis and congenital dyserythropoietic anaemia. Report of a new family and a review

A new autosomal recessive syndrome of chronic recurrent multifocal osteomyelitis (CRMO) and congenital dyserythropoietic anaemia (CDA) with microcytosis has recently been described in four children (two sibships) of one consangineous Arab family. In this report, we describe the clinical features and course of the syndrome of CRMO and CDA in two additional patients (one sibship) from another consanguineous Arab family and review the literature. The two patients (brother and sister), the products of a consanguineous marriage, developed the syndrome at an early age of 3 weeks and 2 months respectively. The diagnosis of CRMO was confirmed by radiological and technetium isotope bone scans. Bone marrow studies confirmed the diagnosis of CDA. Peripheral blood films showed hypochromia and microcytosis. The sites involved by CRMO were periarticular, mainly around the elbow, knee, wrist and small joints of the hand. The brother is now 21 years old and the sister 3.5 years old and CRMO is still active with frequent relapses. The brother developed flexion deformities at the age of 13 years. Both patients failed to thrive; weight and height were below the 5th percentile.

CONCLUSION

This is the second report of the syndrome of chronic recurrent multifocal osteomyelitis and microcytic congenital dyserythropoietic anaemia, confirming it as a clinical entity, inherited as an autosomal recessive trait. The disease is characterised by an early onset, long clinical course of remissions and relapses, and seems to be different from the sporadic form of chronic recurrent multifocal osteomyelitis.

Middle East observational study in metastatic soft tissue sarcoma: an epidemiological study on the treatment patterns (MOON)

PURPOSE

Soft tissue sarcomas (STS) are a heterogeneous group of rare mesenchymal neoplasms, accounting for < 1% of all newly diagnosed malignancies. These tumors can occur in almost any anatomic site though they most frequently occur in the extremities. The objective of the study was to describe the epidemiology, treatment paradigm, and real-world outcomes in the clinical management of metastatic STS (mSTS) in the Middle East and North Africa (MEA) region.

METHODS

MOON was an observational, multicenter, retrospective patient chart review study which included 200 patients with mSTS in the final analysis. The primary objective of the study is exploratory, so it is presented using descriptive statistics.

RESULTS

At the time of presentation, 62.0% patients had metastatic disease, 27.5% had received only their primary diagnosis and 10.0% had experienced a local recurrence. The most frequent STS localizations were lower extremities (74%), trunk (28.5%) and upper extremities (10.5%). Primary tumor was staged as T2b in the majority (60%) of patients. Surgical treatment was performed most often for the primary disease, whereas radiation therapy and chemotherapy were predominantly administered with palliative intent. A total of 38 patients received treatment with pazopanib. Thirteen adverse events (AEs) were attributed to pazopanib in eight patients.

CONCLUSION

Adult patients treated for STS have al most equal gender ratio and mostly are middle aged. The majority of patients have metastatic disease and disease progression, and half of the patients died from the disease during the period of evaluation. This study obtained real-life data on the clinical management of STS in MEA countries which could be shared with the medical community.

Prospective evaluation of current RAS mutation testing practices in newly diagnosed metastatic colorectal cancer: Middle East and North Africa Registry (MORE-RAS) Study

e16141

Background: RAS testing is essential for treatment selection in metastatic colorectal cancer (mCRC), as anti-EGFR treatment is indicated only in patients with wild-type (WT) RAS. MORE-RAS was a multicenter, multicountry, observational, ambispective (retrospective + prospective) study designed to evaluate RAS mutation status among patients with mCRC in the Middle East and North Africa (MENA) region. Results of the retrospective study over a prior 2-year period have been previously presented. Here, we report on the prospective evaluation of testing practices in newly diagnosed patients from the same centers. Methods: Five countries (Algeria, Egypt, KSA, Kuwait, Lebanon) enrolled patients between Dec 2014 and Feb 2019. Patients with a new diagnosis of histologically proven mCRC, at least 1 measurable lesion per RECIST criteria, and tissue availability for biomarker analysis were included; those with co-existing malignancies or life expectancy < 6 months were excluded. The primary endpoint was evaluation of the rate of RAS mutation in newly diagnosed patients. Follow-up was for 2 years. Results: 500 patients (mean age 54.6 years; 58% female) were included; 96.4% had Stage 4 disease. Primary tumor sites were sigmoidal colon: 33.4%; rectum: 29.6%; ascending colon: 18.4%; descending colon: 11.4%; transverse colon: 5.2%; and unknown: 1.4%. Most frequent sites of metastasis were liver: 43.4%, lung: 16.0%, and peritoneum: 10.1%. Overall, 407 pts (81.4%; 95% CI, 78%–85%) received prescription for RAS testing. RAS WT was found in 58.4% and mutant in 41.6%; the test was inconclusive in 1 pt. Non-prescription was attributed to test unavailability and medical or financial reasons. The distribution of mutations was KRAS: 85%, NRAS: 4.9%, and not available: 10.1%. Predictors of RAS testing prescription were older age, primary tumor localization in ascending colon, and high tumor grade. Knowledge of RAS status resulted in the addition of bevacizumab or anti-EGFR therapy in 20.4% and 21.2% of pts, respectively at Visit 1 (baseline). Conclusions: RAS testing is now routinely prescribed for newly diagnosed mCRC in the MENA region and can change therapy patterns. The RAS mutation rate in this region differs from that in Western countries.

Left ventricular global longitudinal strain alteration in young patient and correlation with post-COVID syndrome (TUN END COV Study)

Background

Several protocols are in study to understand mechanisms of these persistent symptoms of COVID-19. The conventional echocardiography can be a good tool to detect abnormalities in the cardiovascular system induced by long COVID-19.

Objective

Correlation between echocardiographic parameters and symptoms of long COVID and the spontaneous evolution at one month of follow-up.

Patients and methods

A prospective multicentric study including a total of 630 patients diagnosed with COVID-19, 2 weeks to one month after recovering from COVID-19. Young patients without any medical history other than recent SARS-CoV2 infection are selected. A meticulous interrogation and clinical examination as well as an echocardiography are performed in all of patients. In addition to symptoms, we assessed echocardiographic parameters including initial left ventricular global longitudinal strain (initial SLG: SLGi) and after one month (SLG control: SLGc).

Results

Mean SLGi was −18.1 ± 2.4 in study group (−19.6 ± 1.5; P < 0.001). Forty-two patients (52.5%) had initially altered strain versus 38 patients (47.5%) with normal strain. The threshold value for SLG in our study has been established using ROC curve which was −17.95% with sensibility (52.5%) and specificity (83.7%). we found a statistically significative correlation between the initial alteration of SLG and persistent symptoms in multivariate test: dyspnea (P < 0.002); chest pain (P = 0.031). At one month of follow-up, 87.5% of patients improved their SLG. And there was a correlation between control GS value (mean SLGc was −18.91 ± 3.33; P = 0.002) associated with a marked improvement in symptoms (P = 0.001).

Conclusion

We reported here an original case series of SLG alteration induced by SARS-CoV2 infection that is correlated with the presence of chest pain and dyspnea. However, this affection seems to be spontaneously significantly reversible and associated with significant clinical improvement.

Final result for SAFIA trial for neoadjuvant palbociclib in patients with operable luminal breast cancer responding to fulvestrant

596

Background: Luminal, human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC) encompasses the most common subtype of breast malignancies. Neoadjuvant strategies of operable BC are primarily based upon chemotherapy (CT), while neoadjuvant hormone therapy (NAHT) has not been well studied in the Middle East and North Africa (MENA) region. However, these tumors might respond poorly to neoadjuvant CT with significant side effects, emphasizing the need to identify patients who could be candidates for NAHT. Methods: The SAFIA trial is a prospective multicentre, international, double-blind, neoadjuvant phase-III trial using upfront 21-gene Oncotype DX Breast Recurrence Score assay (RS) <31) to select operable Luminal HER2-negative patients for induction hormonal therapy with Fulvestrant 500 mg +/– Goserelin (F/G) before randomizing responding patients to F/G + Palbociclib (Cyclin-Dependent Kinase 4/6 inhibitor / CDK 4/6) versus F/G + Placebo. The primary endpoint of this study was the complete pathologic response (pCR) rate. Results: A total of 354 patients were enrolled, leading to 277 patients treated with induction F/G. Of these, 253 responding patients were randomized to F/G fulvestrant with palbociclib or Placebo. Two hundred and thirty patients were evaluable for pathologic response. No statistically significant differences were identified in terms of pCR rates between F/G with palbociclib or placebo: 2% versus 7%, respectively. According to the radiologic responses post- induction F/G, the hormone sensitivity rate was 89.8%, while the clinical benefit of 8–9 months of neoadjuvant F/G was 96%. Safety in the MENA population was acceptable with a grade 3-4 neutropenia rate of 25% in the F/G plus palbociclib arm. The feasibility of performing the 21-gene breast recurrence score assay on core biopsy specimens was optimal in 96.4% of cases. Conclusions: The addition of palbociclib to neoadjuvant F/G did not show any additional benefit in terms of pathologic response, including pCR in neoadjuvant therapy of Luminal HER2-negative BC responding to induction F/G. The use of an upfront 21-gene assay appeared feasible on biopsy specimens, and the identification of tumors with RS<31 allowed to select endocrine sensitive patients, leading ultimately to a 96% clinical benefit with 8–9 months of F/G neoadjuvant therapy. Clinical trial information: NCT03447132. [Table: see text]