PS01.167: MUMELE STUDY: MULTICENTER STUDY ON INCIDENCE OF MEDIASTINAL LEAKS AFTER ESOPHAGECTOMY

Abstract Background Mediastinal anastomotic leak (ML) represent one of the most feared complication of esophageal resection. The incidence of ML, and of the associated mortality rate and the treatment strategy are variously reported. A standard strategy for diagnosis and treatment is difficult to establish Methods In order to evaluate the incidence, predictive factors, treatment and mortality of ML in 7 Italian surgical centers with interest in esophageal surgery (5 high volume centers) a retrospective study including all esophagectomies (E) with intrathoracic esophagogastric anastomosis performed in a 3 year period (2014–2017), was planned. ML were defined according to the classification proposed by the Esophagectomy Complications Consensus Group. Results The data of 501 E were collected. Overall incidence of ML was 11.8%. Surgical approach significantly influenced the rate of ML: leakage rate was highest for totally minimally invasive (TMIE) and lowest for hybrid esophagectomy (HE) (respectively 20 and 9%). No other predictive factor was found. Overall 30 and 90 day (d) mortality rate (M) were respectively 1,4% and 3,2%; 30 and 90 d M for leaks were respectively 5% and 15,3%; 90 d M for TMIE and HE were 5,9% and 1,8% respectively. Endoscopy was the first line treatment in 49% of leaks, with a need for retreatment in 17,2% of cases. Surgery was needed globally in 44,1% of ML. Endoscopic treatment appeared to have the lowest M (6,9%). Removal of the gastric tube with stoma formation was necessary in 8 cases (13.6%). Conclusion The incidence of mediastinal leaks after esophagectomy in the MUMELE study is high mainly in TMIE group. General and specific (leak) mortality rate is however low. Early ‘aggressive’ treatment of severe leaks is mandatory, with no hesitation to redo surgery if first attempt of conservative management fails. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Perioperative complications of esophagectomy - prevention, diagnosis and management

Acta chirurgica iugoslavica ◽

10.2298/aci1701027s ◽

2017 ◽

Vol 64 (1) ◽

pp. 27-38

Author(s):

Dejan Stojakov ◽

Predrag Sabljak ◽

Bratislav Spica ◽

Dejan Velickovic ◽

Vladimir Sljukic ◽

...

Keyword(s):

Mortality Rate ◽

Perioperative Complications ◽

Rapid Development ◽

Postoperative Mortality ◽

High Volume ◽

Esophageal Resection ◽

Vocal Cord Palsy ◽

Pulmonary Complications ◽

High Rate ◽

Septic Complications

Esophageal resection with reconstruction is complex surgical procedure with high rate of postoperative morbidity, with decreasing mortality rate during last decades, particularly in high-volume hospitals. Numerous preoperative, intraoperative and postoperative factors have contribute to incidence and type of complications. Intraoperative haemorrhage and tracheobronchial lesions could be avoid by good surgical judgement and operative technique. Pulmonary complications are often, with multifactorial etiology, and they are the main cause of postoperative mortality after esophagectomy. Dehiscence of esophageal anastomosis could be fatal, and only high index of suspicion and early diagnosis lead to successful treatment. In majority of such cases conservative measures are successful, however, conduit necrosis is indication for surgical reoperation. Vocal cord palsy due to intraoperative injury of recurrent laryngeal nerves is not rare and increases pulmonary complications rate. New onset of arrhythmia could be associate with other surgical complications. Postesophagectomy chylothorax is life-threatening complication due to rapid development of immunosuppression and septic complications, and early ligation of thoracic duct is often mandatory. Intrathoracic herniation of intrabdominal viscera is rare, and ischemic spinal cord lesions are very rare after esophagectomy. Majority of perioperative complications could be prevented or solved, decreasing mortality rate of esophagectomy.

Download Full-text

Bendamustine In Combination With Rituximab As First-Line Treatment For Indolent Non-Hodgkin Lymphoma: Retrospective Analysis Of An Spanish Registry

Blood ◽

10.1182/blood.v122.21.5094.5094 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5094-5094 ◽

Cited By ~ 1

Author(s):

Silvia Solorzano ◽

Carmen Martinez-Chamorro ◽

Carlos Panizo ◽

Cristina Quero ◽

Guillermo Deben ◽

...

Keyword(s):

Conflicts Of Interest ◽

Bone Marrow Involvement ◽

Common Adverse Event ◽

Hematological Toxicity ◽

Line Treatment ◽

Compassionate Use ◽

First Line ◽

Bulky Disease ◽

Grade 3 ◽

First Line Treatment

Abstract Introduction Indolent lymphomas represent 40% of all subtypes of non-Hodking's lymphoma, of which follicular lymphoma (FL) is the most frequent. Bendamustine is a dual alkylating agent with demonstrated high efficacy and low toxicity profile in reported clinical trials. We present the preliminary results from the experience of Spanish compassionate use registry of this agent as first-line treatment for indolent lymphoma. Methods Retrospective multicenter analysis of patients with indolent non-Hodgkin lymphomas (iNHL) treated as frontline with Bendamustine plus Rituximab (BR) in compassionate use. Clinical efficacy was evaluated according to Cheson criteria (2007) and toxicity according to CTCAE v3.0 scale. This study has been approved by local ethical committees. Results Patients’ characteristics: There are 96 patients registered (9 centers), with the following diagnoses: FL: 62 (64.5%), marginal zone 24 (25%), Waldenström macroglobulinemia 7 (7.3%) and mantle NHL 3 (3.1%). The main clinical features of the series are: 45% males, median age 64 years (range 36-84), 87.1% ECOG≤ 1, 63% Ann Arbor stage IV, 50.5% high risk FLIPI and 43.7% CIRS ≥ 4. Extranodal involvement was present in 79.1% of the patients, bone marrow involvement in 52% and 11 patients (11.9%) had bulky disease. Treatment consisted in 6 cycles of BR (B-90 mg/m2 D1-2, R-375mg/m2 D1) in 95% patients. Median number of cycles administrated was 6 (range 1-8). G-CSF support was administered in 16.1% of cycles. Response and Safety: Overall response rate was 95%, with 65.5 % CR, 13.1% uCR and 16.4% PR in the 61 evaluable patients. Progression was documented in 4.9% of patients. Three exitus ocurred due to aspergillosis, progression and other not related with LNH. Median follow-up period was 14 months (3-47). In general, treatment was well tolerated; over 461 cycles registered, the most common adverse event was hematological toxicity with grade 3-4 neutropenia in 10.4%, grade 3-4 leucocitopenia in 6.9% and grade 3-4 anemia in 1.9% of the cycles. Other toxicities included all grades infections in 3.2% of patients, gastrointestinal in 3.4%, asthenia in 3.2%, chills in 1.1%, and mucositis 0.4%. Only 9 hospitalizations due to febrile neutropenia were reported. Conclusion Bendamustine plus rituximab was an effective and well tolerated regimen for newly diagnosed patients with indolent NHL. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism：a single-centre study in China

10.21203/rs.3.rs-51212/v2 ◽

2020 ◽

Author(s):

Wang Qimin ◽

Chen Liangwan ◽

Chen Daozhong ◽

Qiu Hanfan ◽

Huang Zhongyao ◽

...

Keyword(s):

Mortality Rate ◽

Right Ventricle ◽

Line Treatment ◽

First Line ◽

Single Centre ◽

Right Ventricle Function ◽

Systemic Thrombolysis ◽

Acute Pe ◽

First Line Treatment ◽

Ventricle Function

Abstract Background: Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods: A retrospective review of patients who underwent SPE for acute PE was conducted .Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular functionResults: Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2±48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping . Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days).Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups .There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions: SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups . SPE should play the same role as ST in algorithmic acute PE treatment.

Download Full-text

Real World Treatment Outcomes of Multiple Myeloma in Korea

Blood ◽

10.1182/blood.v128.22.2367.2367 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2367-2367

Author(s):

Ja Min Byun ◽

Sung-Soo Yoon ◽

Dong-Yeop Shin ◽

Youngil Koh ◽

Inho Kim ◽

...

Keyword(s):

Multiple Myeloma ◽

Treatment Outcomes ◽

Conflicts Of Interest ◽

Poor Performance Status ◽

Solitary Plasmacytoma ◽

Line Treatment ◽

First Line ◽

Predictive Values ◽

Conventional Cytogenetics ◽

First Line Treatment

Abstract Once believed to be a homogeneous disease entity, multiple myeloma now represents epitome of heterogeneous genomic evolution and mutational profiles. Various groups have reported different risk stratification methodologies based on cytogenetic data, especially the fluorescent in situ hybridization (FISH) results. Reflecting the racial disparities, Oh et al. have previous described prognostic model specific to Koreans using a nationwide registry. However their main focus has been on conventional cytogenetics. We sought to analyze the predictive and prognostic value of FISH on top of conventional cytogenetics from a large cohort of Korean multiple myeloma patients. From a single tertiary academic center, 1006 newly diagnosed MM patients were retrospectively identified during the period of January 2005 to June 2015. Adult patients, defined as 18 years old or older were included, while cases with smoldering myeloma, monoclonal gammopathy, solitary plasmacytoma and plasmoblastic leukemia were excluded in the first place. After excluding additional 441 patients for insufficient data, a total of 565 patients with complete set of molecular information were evaluated. Progression free survival (PFS) was defined as the duration from the start of first line treatment to disease progression or death, and data available up to June 2016 were used. On a different note, Korea has an unique public medical insurance system that is mandatory and covers approximately 98% of the overall Korean population Although the insurance covers comprehensive aspects of healthcare, the range of coverage is restricted. In this study, autologous stem cell transplantation (autoSCT) eligible patients were defined as those under the age of 65 years according to such insurance coverage restrictions. For the same reason, first line treatment were diverse according to the patient's financial standings. The median age was 63 years (18-92 years), and there were 309 males (54.7%). As for MM subtype, IgG type was 49.0%, IgA type 18.1%, and light chain type 28.8%. The proportion of patients at ISS stage III was 32.2%, and 45.8% had poor performance status (ECOG 2 or more). Overall, the median line of treatment was 2 (range 1-16) and 42.7% of the patients underwent autoSCT. The patients who actually underwent autoSCT had significantly better PFS compared to those who did not (not reached vs 18 months, P <0.001). The median PFS for each first line chemotherapy regimen are listed in Table. For autoSCT ineligible patients, novel agents such as lenalidomide and carfilzomib were more frequently used and this translated into surprisingly long median survival of 51 months. FISH results showed p53 deletion in 9.1% (27/296), 13q14 deletion in 36.0% (174/484), IgH rearrangement in 47.6% (231/485), and 1q21 amplification in 40.0% (193/483) of cases. Those with p53 had the worst prognosis with median PFS at 13 months, and its presence significantly altered overall PFS (P=0.002). This phenomenon was observed both in autoSCT eligible group (PFS for p53 deletion present 20 months vs not present 77 months, P<0.001), and in ineligible group (PFS for p53 deletion present 7 months vs not present 24 months, P<0.001). The presence of p53 was associated with reduced bortezomib sensitivity (P=0.003), but not thalidomide. On the other hand, the presence of 13q14 deletion was not significant for PFS in autoSCT eligible group (P=0.726), but was significant in ineligible group (P=0.023). The presence of 13q14 was associated with reduced sensitivity to MP/VAD regimen (P=0.005). The presence of 1q21 did not have survival implications or treatment predictive values. Likewise, IgH rearragements did not affect PFS and were not useful for individualizing therapy. MM patients in Korea presents a unique set of population associated with different survival benefits per therapy compared with other ethnicities. Since FISH data can be readily used to predict the treatment outcomes of particular agents, a panel markers specific to Korean race should ensue to establish risk-adaptive therapeutic approaches for equitable distribution of limited medical resources. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01364-z ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Wang QiMin ◽

Chen LiangWan ◽

Chen DaoZhong ◽

Qiu HanFan ◽

Huang ZhongYao ◽

...

Keyword(s):

Pulmonary Embolism ◽

Mortality Rate ◽

Line Treatment ◽

First Line ◽

Single Centre ◽

Right Ventricle Function ◽

Systemic Thrombolysis ◽

Acute Pe ◽

First Line Treatment ◽

Ventricle Function

Abstract Background Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods A retrospective review of patients who underwent SPE for acute PE was conducted.Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular function. Results Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2 ± 48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping. Ventilatory support time was 78 h (range, 40–336 h), intensive care unit stay was 7 days (range, 3–13 days), and hospital stay was 16 days (range, 12–23 days). Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups.There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups. SPE should play the same role as ST in algorithmic acute PE treatment.

Download Full-text

Non Hodgkin Lymphoma: Experience of a Referral Hospital.

Blood ◽

10.1182/blood.v114.22.4774.4774 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4774-4774

Author(s):

Humberto Castellanos-Sinco ◽

Silvia Rivas-Vera ◽

Victoria E. Ferrer Argote ◽

Carlos Martínez-Murillo ◽

Christian Omar Ramos Peñafiel

Keyword(s):

Conflicts Of Interest ◽

B Cell Lymphoma ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Chop Regimen ◽

Free Survival ◽

Non Hodgkin Lymphoma ◽

Global Trend ◽

First Line Treatment

Abstract Abstract 4774 Introduction Non-Hodgkin lymphomas corresponds a heterogeneous group of neoplasms deriving of lymphocytes, in development countries represents a great cause of morbility and mortality. The General Hospital of Mexico is a referral centre localized in Mexico City, whose first cause of primary hematology attention in NHL. Material and methods Is an observational, descriptive and retrospective study, based on medical records of patients treated between 1992-2009. Objectives Determine the response, overall survival (OS) and event free survival (EFS) (progression, death or last visit) associated with treatment by CHOP as first line treatment without rituximab and four cycles of DEP as a second line treatment (dexamethasone 40 mg/m2 IV daily, days 1-4, VP-16 300 mg/m2 IV daily, days 1-2 and cysplatin 100 mg/m2 IV day 1), in cycles of 21 days each one. Results In a period of 17 years, 303 of 632 patients were eligible. The average age was 52 years, with male:female relation 1:1.1. Thirty four percent of the sample were older 60 years. The most frequent NHL was diffuse large B cell lymphoma (DLBCL) (N=146 treated), 60% were IPI low plus intermediate low; the most frequent indolent NHL were follicular lymphoma (N=20 treated), 71% were FLIPI low plus intermediate. The resting 94 cases were treated with CHOP, too. Conclusion The global trend is the addition of rituximab to all of CHOP-based regimens. In our country, because the economics limitations, the use of rituximab is low. The CHOP regimen remains the first line treatment; and the second line treatments are based on the experience of the institutional protocols. DEP is the institutional protocol for second line treatment and their response, OS and EFS are comparable to more expensive protocols (ESHAP, DHAP). Concluding that DEP is a low toxic and cheaper second line regimen and this could be an alternative for development countries. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Early Response (ER) Is a Prognostic Marker for PFS in CLL Treated by Fludarabine Containing Regimens.

Blood ◽

10.1182/blood.v114.22.2377.2377 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2377-2377

Author(s):

Elena Stadnik ◽

Galina Salogub ◽

Yulia Alekseeva ◽

Natalija Lazorko ◽

Eugene Nikitin ◽

...

Keyword(s):

Prognostic Factors ◽

Mutation Analysis ◽

Gold Standard ◽

Conflicts Of Interest ◽

Early Response ◽

Line Treatment ◽

First Line ◽

Statistical Program ◽

First Line Treatment ◽

Better Than

Abstract Abstract 2377 Poster Board II-354 Fludarabine containing regimens has become the gold standard for first-line treatment of CLL. The prognosis for the response is usually done by mutation analysis and cytogenetics. These types of analyses are time consuming and could not be available in general practice. Staging is very easy tool for predicting the response, although it is not a matter of individual prognosis. The aim of the study was to find clinical data predicting the response. As a model, we have evaluated the response after 3 fludarabine containing regimens. Patients and methods 75 patients treated by fludarabin containing regimens (FC and FCR) were included (2002-2008). Staging was performed according to Binet (1977). Stage B and C patients were included. Lymph nodes were evaluated by CT and ultrasound. CD38 was done by CytoFlow (cut off 30%). Mutation analysis was studied by PCR and sequencing with cut off 98%. Early response(ER) was defined as PR and CR after 3 cycles of therapy, others were considered as nER. CR was defined according to NCI criteria. The patients were treated and followed-up by the single team of physicians, there were no losses of follow-us.SPSS - 17 statistical program was used for analysis. Results. In the whole group, median PFS was 25 mons . There were 40 ER pts(33 - PR and 7 - CR).Median PFS in ER patients was 38mons, in other patients (nER) – 17mons (p= 0.0001). After 6 cycles of therapy, the overall response was 100%; CR was 83% and 7% PR I ER pts, in nER- resp- 67%, 23% and 41% ( p < 0,001). Differences of median PFS according to standard prognostic factors is presented in table 1: Thus, ER patients with standard adverse prognostic factors did better than nER with similar prognostic factors. ER patients in comparison to nER had higher median PFS on both FC (28 mons vs 14 mons, p=0.001) and FCR (58 mons vs 18 mons, p=0.018) regimens. Conclusion. The early response (PR and CR) after three fluadarabine containing regimens is a good predictor for PFS. More intensive treatment should be considered for patients without early response. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Bing Neel Syndrome: The French Experience

Blood ◽

10.1182/blood.v124.21.3068.3068 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3068-3068

Author(s):

Laurence Simon ◽

Xavier Leleu ◽

Jehan Dupuis ◽

Therese Aurran ◽

Lauris Gastaud ◽

...

Keyword(s):

Median Time ◽

Systemic Chemotherapy ◽

Conflicts Of Interest ◽

Cauda Equina ◽

Treatment Strategies ◽

High Dose ◽

Line Treatment ◽

First Line ◽

Csf Analysis ◽

First Line Treatment

Abstract Background: Bing-Neel syndrome (BNS) is a rare complication of Waldenström Macroglobulinemia (WM) defined as the direct involvement of central nervous system (CNS) by neoplastic cells. Because of its rarity, few data are currently available in the literature, which is mostly based on case-reports descriptions. The management of these patients is challenging with no consensus about the best treatment strategies to use. Patients and Methods: We retrospectively analyzed 37 patients out of 15 French centers databases, treated for a BNS between 1995 and 2014. Results: At the time of BNS diagnosis, the median age was 64 years. In 13 cases (35%), BNS was the first manifestation of WM. In others cases, median time between WM diagnosis and BNS was 96 months (range 2-300).BNS occurrence was correlated with a systemic progression of WM in 30% of cases. For the others patients with no systemic progression of WM, median time between the end of the last treatment of WM and BNS diagnosis was 30 months (range 10-72). The median IgM level was 11.25 g/L (range 0.35-60.8) at the time of BNS onset. Clinical manifestations: the most frequent symptoms at the time of BNS diagnosis were cognitive impairment (32%), motor or sensory deficits (30% and 16% respectively), pain (16%), cranial nerves involvement (30%), headache (21%), poor performance status (32%) and cauda equina syndrome (18%). The median interval between appearance of neurological symptoms and diagnosis of BNS was 4 months. Cerebrospinal fluid (CSF) analysis showed a lymphocytic meningitis in 81% of cases with a median of 33 cells/mm3 (range 7-3900), all with monoclonal B-cell population when phenotyping was available (except one case). Protein level was elevated in 94% (1,77 g/L in median, range 0,52-7,23). Magnetic resonance imaging (MRI) showed abnormalities in 83% (n=29/35) of cases. Meningeal enhancement was present in 52% of cases with conus medullaris infiltration in half of these patients. Cerebral enhancement was present in 45 % of cases and a normal pressure hydrocephalus in 3 cases. In 17% of cases, MRI was normal. Based on MRI results and CSF analysis, the majority of patients (81%, n=30/37) had an infiltrative form with only 7 patients presenting with a pseudotumoral involvement of brain parenchyma. The diagnosis was made on CSF analysis in the majority of cases (82%, n= 28/34). In four cases the diagnosis required a brain biopsy. First-line treatment comprised systemic chemotherapy in 89% (n=33/37) of cases. Treatment of CNS involvement was based on high-dose chemotherapy in 17 cases (methotrexate and/or aracytine). Intra-thecal chemotherapy was used in 70% of cases, and rituximab in 58% of cases. Autologous stem-cell transplantation (ASCT) in first-line was performed in 4 cases. 4 patients were treated up-front by whole-brain radiotherapy (in combination with systemic chemotherapy by fludarabine, cyclophosphamide and rituximab in 1 case). Outcome: 31 patients were assessable for first-line treatment response: overall response rate (ORR) was 68% (n=21/31) including 7 complete remissions; 7 patients had a progressive disease. 9 patients died. Median follow-up of alive patients was 23 months. At 5 years after BNS diagnosis, 79% of the patients were alive. Conclusion: Up to now, this is the most important retrospective cohort of patients presenting with Bing-Neel syndrome. In more than one third of the cases, BNS was the first manifestation of WM disease. Noteworthy is the late occurrence of some cases, up to 25 years. No correlation was observed between systemic progression of WM and BNS occurrence. BNS should be considered even in the context of a stable WM disease. In order to define the best treatment strategies, collection of additional cases is currently ongoing, and data will be up-dated at time of the meeting. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Cardiovascular Toxicities of Tyrosine Kinase Inhibitor in CML

Blood ◽

10.1182/blood-2020-143216 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 6-6

Author(s):

Samip R Master ◽

Richard Preston Mansour

Keyword(s):

Chronic Myeloid Leukemia ◽

Tyrosine Kinase ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Kinase Inhibitor ◽

Conflicts Of Interest ◽

Line Treatment ◽

Front Line ◽

First Line ◽

First Line Treatment

Background: Cardiovascular (CV) toxicity is a known toxicity of tyrosine kinase inhibitors (TKI) used for chronic myeloid leukemia (CML). Imatinib, dasatinib, nilotinib and bosutinib are all approved for first line treatment for CML. We did a retrospective analysis on adverse effects (AE) of TKIs that has been made available to public by the FDA. Methods: The FDA has made the data on AEs of various treatments available to general public through the FDA Adverse Events Reports System (FAERS) public dashboard. We investigated the CV AEs of various TKIs for the years 2017-2019. Results: The percentage of CV AE compared to total AEs reported for Imatinib, Dasatinib, Bosutinib , Nilotinib and Ponatinib were 7.2%, 10.5%, 15.8%, 23.4% and 23.5% respectively. The percentage of CV AE leading to death for Imatinib, Dasatinib, Bosutinib , Nilotinib and Ponatinib were 8.3%, 9.1%, 9.1%, 13.7 % and 18.6% respectively. Conclusions: Out of the reported cases of AEs to TKIs approved for front line CML, nilotinib appears to have more CV AE compared to imatinib, dasatinib and bolutinib. Imatinib appears to have least CV AE out of the total AEs reported Disclosures No relevant conflicts of interest to declare.

Download Full-text

Endocrinological Aspects of Pituitary Adenoma Surgery in Europe

10.21203/rs.3.rs-812484/v1 ◽

2021 ◽

Author(s):

David Netuka ◽

André Grotenhuis ◽

Nicolas Foroglou ◽

Francesco Zenga ◽

Sebastien Froehlich ◽

...

Keyword(s):

High Volume ◽

Pituitary Surgery ◽

Primary Treatment ◽

Line Treatment ◽

First Line ◽

Debulking Surgery ◽

Geographical Regions ◽

Acth Secreting ◽

Shed Light ◽

First Line Treatment

Abstract Purpose:Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to shed light on different endocrinological aspects of hormone-secreting adenomas surgery.Methods: A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, “mainly endoscopic/mainly microscopic practice” and geographical regions. Results: Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1-5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Conclusions:Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.

Download Full-text