scholarly journals RADT-37. THE IMPACT OF POSTOPERATIVE RADIATION THERAPY (PORT) AND EXTENT OF SURGERY ON CLINICAL OUTCOMES OF ATYPICAL MENINGIOMA (AM): A META-ANALYSIS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii189-ii189
Author(s):  
Philip Haddad ◽  
Furqan Akhtar ◽  
Kevin Gallagher
Keyword(s):  
Clinical Outcomes ◽  
Comparative Studies ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Subtotal Resection ◽  
Recurrence Rates ◽  
Postoperative Radiation Therapy ◽  
Extent Of Surgery ◽  
The Impact

Abstract BACKGROUND Although meningiomas are among the most prevalent types of brain tumors, AMs account for around 4% of all meningiomas. AMs tend to be more aggressive with relatively higher rates of recurrence and mortality. Gross total resection (GTR) has been the standard of care when possible. However, GTR itself is not always enough to prevent the recurrence of AMs. The role of PORT remains controversial in AM as the comparative studies to support its use have provided conflicting RESULTS: The purpose of this meta-analysis is to evaluate the impact of PORT on clinical outcomes according to the extent of resection in AMs. METHODS A review of the medical literature was conducted using online databases. Inclusion criteria consisted of AM diagnosis, English language, Simpson graded resections, and comparative studies reporting recurrence rates (RcR), Progression-Free Survival (PFS), and Overall Survival (OS) with hazard ratios (HR) or Kaplan-Meier curves. A meta-analysis was conducted using an inverse variance method with a random-effects model. RESULTS Twenty-two comparative studies with a total of 5,129 patients were included and analyzed. When GTR was attained, PORT was associated with improved RcR (HR =0.72, 95%CI:0.59-0.86) and PFS (HR=0.77, 95%CI:0.65-0.90), but not OS (HR=0.93, 95%CI:0.83-1.04). When subtotal resection (STR) was attained, PORT was associated with improved PFS (HR=0.35, 95%CI:0.26-0.48) as well as OS (HR=0.70, 95%CI:0.54-0.89). The extent of surgery also impacted AM outcomes as GTR demonstrated superior PFS (HR=0.45, 95%CI:0.31-0.65) and OS (HR=0.30, 95%CI:0.13-0.72). CONCLUSIONS This is the first meta-analysis to show that PORT is associated with PFS benefit in AMs with GTR and STR. Moreover, PORT significantly improved OS of AMs that underwent STR but had no impact on OS when GTR was achieved. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of PORT in this patient population.

Postoperative radiation therapy (PORT) impact on clinical outcomes of resected atypical meningioma: A meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2570-2570
Author(s):  
Kevin M. Gallagher ◽  
furqan akhtar ◽  
Philip A. Haddad
Keyword(s):  
Clinical Outcomes ◽  
Comparative Studies ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Subtotal Resection ◽  
Recurrence Rates ◽  
Postoperative Radiation Therapy ◽  
The Impact

2570 Background: Although meningiomas are among the most prevalent types of brain tumors, atypical meningiomas (AM) account for around 4% of all meningiomas. AMs tend to be more aggressive with relatively higher rates of recurrence and mortality. Gross total resection (GTR) has been the standard of care when possible. However, GTR itself is not always enough to prevent recurrence of AMs. The role of PORT remains controversial in AM as the comparative studies to support its use have provided conflicting results. The purpose of this meta-analysis is to evaluate the impact of PORT on clinical outcomes in resected AMs. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of (i) AM diagnosis, (ii) English language, (iii) Simpson graded resections, and (iv) comparative studies reporting recurrence rates (RcR), Progression Free Survival (PFS), and Overall Survival (OS) with hazard ratios (HR) or Kaplan-Meier curves. A meta-analysis was conducted using an inverse variance method with random-effects model. Results: Twenty-two comparative studies with a total of 5,129 patients were included and analyzed. When GTR was attained, PORT was associated with improved RcR (HR = 0.72, 95%CI:0.59-0.86) and PFS (HR = 0.77, 95%CI:0.65-0.90), but not OS (HR = 0.93, 95%CI:0.83-1.04). When subtotal resection (STR) was attained, PORT was associated with improved PFS (HR = 0.35, 95%CI:0.26-0.48) as well as OS (HR = 0.70, 95%CI:0.54-0.89). Conclusions: This is the first meta-analysis to show that PORT is associated with PFS benefit in AMs with GTR and STR. Moreover, PORT significantly improved OS of AMs that underwent STR but had no impact on OS when GTR was achieved. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of PORT in this patient population.

NCOG-04. THE IMPACT OF PROPHYLAXIS CHEMOTHERAPY ON CENTRAL NERVOUS SYSTEM (CNS) RELAPSES OF HIGH RISK DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL): A NETWORK META-ANALYSIS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi152-vi153
Author(s):  
Philip Haddad ◽  
Dalia Hammoud ◽  
Kevin Gallagher
Keyword(s):  
High Risk ◽  
Comparative Studies ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Recurrence Rates ◽  
Cns Prophylaxis ◽  
The Impact

Abstract BACKGROUND CNS relapses with DLBCL tend to be uncommon. The risk increases with certain DLBCL types and certain identified risk features. There is no consensus regarding the optimal approach to CNS prophylaxis for high-risk DLBCL patients. While some favor prophylaxis with high-dose systemic therapy or intrathecal chemotherapy (IT), some experts advocate combining both approaches. In the absence of randomized trials, the role of chemotherapy prophylaxis remains controversial in DLBCL with contradictory comparative studies. The purpose of this meta-analysis is to evaluate the impact of CNS prophylaxis approaches on the clinical outcomes of high-risk DLBCL. METHODS A review of the medical literature was conducted using online databases. Inclusion criteria consisted of DLBCL diagnosis, English language, IT or high-dose systemic prophylactic chemotherapy, and comparative studies reporting CNS recurrence rates. A frequentist and Bayesian network meta-analysis were conducted using the netmeta package and random-effects model. RESULTS Twenty-one comparative studies with a total of 11,507 patients were included and analyzed. The relative risk (RR) of CNS recurrence was not statistically different between IT prophylaxis, high-dose chemotherapy, and no prophylaxis. However, the combination of IT prophylaxis and high-dose chemotherapy was found to be significantly associated with a reduced RR of CNS recurrence when compared to IT prophylaxis (RR 0.28, 95%CI 0.13-0.58), high-dose chemotherapy (RR 0.34, 95%CI 0.14-0.80), and no prophylaxis (RR 0.41, 95%CI 0.19-0.87). CONCLUSIONS This network meta-analysis is the first to compare the different CNS prophylactic approaches. It indicates that IT prophylaxis and high-dose chemotherapy each were not better than no prophylaxis. However, the combination of IT prophylaxis with high-dose chemotherapy was significantly superior to each approach alone as well as no prophylaxis. In the absence of randomized clinical trials, this network meta-analysis represents the most compelling data supporting the use of CNS prophylaxis in patients with high-risk DLBCL.

scholarly journals The Impact of Rituximab on the Clinical Outcomes of Primary Central Nervous System Lymphoma (PCNSL) When Added to Combination Chemotherapy: A Comprehensive Meta-Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-12
Author(s):  
Philip A Haddad ◽  
Dalia Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Outcomes ◽  
Comparative Studies ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Phase Ii Trials ◽  
The Impact

Introduction: PCNSL is a rare diffuse large B-cell lymphoma (DLBCL) confined to the central nervous system accounting for approximately 2-5% of all primary brain tumors. Although there is no standard combination of chemotherapy, high-dose methotrexate is considered the backbone of all PCNSL chemotherapy regimens. Rituximab, an anti-CD20 antibody, has been a standard component of non-CNS DLBCL combinations since it improves progression-free (PFS) and overall survival (OS). However, the role of Rituximab in the treatment of PCNSL has been controversial with contradictory results. A meta-analysis conducted in 2019 found no associated survival advantage for Rituximab when added to chemotherapy. However, this meta-analysis was small and included only 2 studies. The purpose of this meta-analysis is to evaluate in a more comprehensive way the impact of Rituximab-based chemotherapy combinations on the clinical outcomes of patients with PCNSL incorporating all available comparative studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of PCNSL diagnosis, English language, and studies reporting OS and PFS with hazard ratios (HR) or Kaplan-Meier curves that compared similar regimens with and without Rituximab. A meta-analysis using an inverse variance method with a random-effects model was conducted. Results: Four comparative studies with a total of 467 patients were included in this meta-analysis. Two of these studies were retrospective comparative studies and two were randomized phase II trials. When added to chemotherapy, Rituximab was found to significantly improve the OS and PFS (HROS 0.75, 95%CI: 0.59-0.96, p=0.02; HRPFS 0.67, 95%CI: 0.53-0.85, p=0.001) with a heterogeneity estimate, I2=0%. Conclusions: This is the first meta-analysis to show that adding Rituximab to chemotherapy is associated with OS and PFS in patients with PCNSL. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the routine use of Rituximab combinations in PCNSL. Disclosures No relevant conflicts of interest to declare.

Early palliative care in haematological patients: a systematic literature review

2020 ◽  
Vol 10 (4) ◽  
pp. 395-403
Author(s):  
Silvia Tanzi ◽  
Francesco Venturelli ◽  
Stefano Luminari ◽  
Franco Domenico Merlo ◽  
Luca Braglia ◽  
...  
Keyword(s):  
Palliative Care ◽  
Comparative Studies ◽  
English Language ◽  
Meta Analysis ◽  
Early Palliative Care ◽  
Study Results ◽  
Registration Number ◽  
Integrated Or ◽  
The Impact

BackgroundEarly palliative care together with standard haematological care for advanced patients is needed worldwide. Little is known about its effect. The aim of the review is to synthesise the evidence on the impact of early palliative care on haematologic cancer patients’ quality of life and resource use.Patients and methodsA systematic review was conducted. The search terms were early palliative care or simultaneous or integrated or concurrent care and haematological or oncohaematological patients. The following databases were searched: PubMed, Embase, Cochrane, CINHAL and Scopus. Additional studies were identified through cross-checking the reference articles. Studies were in the English language, with no restriction for years. Two researchers independently reviewed the titles and abstracts, and one author assessed full articles for eligibility.ResultsA total of 296 studies titles were reviewed. Eight articles were included in the synthesis of the results, two controlled studies provided data on the comparative efficacy of PC interventions, and six one-arm studies were included. Since data pooling and meta-analysis were not possible, only a narrative synthesis of the study results was performed. The quality of the two included comparative studies was low overall. The quality of the six non-comparative studies was high overall, without the possibility of linking the observed results to the implemented interventions.ConclusionsStudies on early palliative care and patients with haematological cancer are scarce and have not been prospectively designed. More research on the specific population target, type and timing of palliative care intervention and standardisation of collected outcomes is required.PROSPERO registration numberCRD42020141322.

scholarly journals The Impact of Chromothripsis on the Clinical Outcomes of Acute Myeloid Leukemia (AML): A Meta-Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-34
Author(s):  
Philip A Haddad ◽  
Dalia Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Clinical Outcomes ◽  
English Language ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
Response Rates ◽  
Kaplan Meier ◽  
Online Databases ◽  
Inverse Variance ◽  
Aggressive Clinical Course ◽  
The Impact

Introduction: Chromothripsis is a single genomic catastrophic event that can involve one or several chromosomes resulting in chromosomal fragmentation. Genomic instability leading to loss of chromosomes and complex karyotype is known to be associated with resistance to chemotherapy and poor prognosis in AML. While chromothripsis is associated with aggressive clinical course in various cancers, its impact on AML clinical outcomes has not been consistently conclusive. The purpose of this meta-analysis is to evaluate the pooled effect of chromothripsis on the response rates and overall survival of patients with AML. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of AML diagnosis, English language, and studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves that compared AML outcomes with and without chromothripsis. A meta-analysis using an inverse variance method with a random-effects model was conducted. Results: Two comparative studies with a total of 444 patients were included in this meta-analysis. In the presence of chromothripsis OS was adversely impacted (HR 1.78, 95%CI: 1.05-3.01, p=0.03) with a heterogeneity estimate, I2=40%. Moreover, response rates were significantly lower in AML cases with chromothripsis versus those without (19% vs. 62%, p<0.05). Conclusions: This meta-analysis confirms the adverse impact of chromothripsis on response rates and OS of patients with AML. Disclosures No relevant conflicts of interest to declare.

scholarly journals EPID-28. THE IMPACT OF RITUXIMAB COMBINATION CHEMOTHERAPY ON THE CLINICAL OUTCOMES OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): AN UPDATED META-ANALYSIS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii84-ii84
Author(s):  
Philip Haddad ◽  
Dalia Hammoud ◽  
Kevin Gallagher
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Outcomes ◽  
Combination Chemotherapy ◽  
Comparative Studies ◽  
Meta Analysis ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Phase Ii Trials ◽  
The Impact

Abstract BACKGROUND PCNSL is a rare diffuse large B-cell lymphoma (DLBCL) confined to the central nervous system accounting for approximately 2–5% of all primary brain tumors. Although there is no standard combination of chemotherapy, high-dose methotrexate is considered the backbone of all PCNSL chemotherapy regimens. Rituximab, an anti-CD20 antibody, has been a standard component of DLBCL combinations since it improves progression-free (PFS) and overall survival (OS). However, the role of Rituximab in the treatment of PCNSL has been controversial with contradictory RESULTS: A small meta-analysis conducted in 2019 found no associated survival advantage for Rituximab when added to chemotherapy. However, this meta-analysis was small and included only 2 studies. The purpose of this updated meta-analysis is to evaluate in a more comprehensive way the impact of Rituximab combination chemotherapy on the clinical outcomes of patients with PCNSL incorporating all available comparative studies. METHODS A review of the medical literature was conducted using online databases. Inclusion criteria consisted of PCNSL diagnosis, English language, and studies reporting OS and PFS with hazard ratios (HR) or Kaplan-Meier curves that compared similar regimens with and without Rituximab. A meta-analysis using an inverse variance method with a random-effects model was conducted. RESULTS Four comparative studies with a total of 467 patients were included in this meta-analysis. Two of these studies were retrospective comparative studies and two were randomized phase II trials. When added to chemotherapy, Rituximab was found to significantly improve the OS and PFS (HROS 0.75, 95%CI: 0.59–0.96, p=0.02; HRPFS 0.67, 95%CI: 0.53–0.85, p=0.001) with a heterogeneity estimate, I2=0%. CONCLUSIONS This is the first meta-analysis to show that adding Rituximab to chemotherapy is associated with OS and PFS in patients with PCNSL. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the routine use of Rituximab combinations in PCNSL.

scholarly journals Enteral immunonutrition versus enteral nutrition for patients undergoing oesophagectomy: a systematic review and meta-analysis

2020 ◽  
Vol 30 (6) ◽  
pp. 854-862 ◽  
Author(s):  
Xiao-Kun Li ◽  
Hai Zhou ◽  
Yang Xu ◽  
Zhuang-Zhuang Cong ◽  
Wen-Jie Wu ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
English Language ◽  
Early Stage ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
P Value ◽  
Standard Mean Difference ◽  
The Impact

Abstract OBJECTIVES According to retrospective studies, oesophageal carcinoma is the second deadliest gastrointestinal cancer after gastric cancer. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve the inflammatory response of patients undergoing oesophagectomy; however, conclusions across studies remain unclear. We aimed to evaluate the effect of EIN on the clinical and immunological outcomes of patients undergoing oesophagectomy. METHODS Four electronic databases (MEDLINE, Embase, Web of Science and Cochrane Library) were used to search articles in peer-reviewed, English-language journals. The mean difference, relative risk or standard mean difference with 95% confidence interval were calculated. Heterogeneity was assessed by the Cochran’s Q test and I2 statistic combined with the corresponding P-value. The analysis was carried out with RevMan 5.3. RESULTS Six articles were finally included, with a total of 320 patients with oesophageal cancer. The meta-analysis results showed that EIN did not improve clinical outcomes (such as infectious complications, pneumonia, surgical site infection, anastomotic leak and postoperative hospital stay) or immune indices [referring to C-reactive protein, interleukin (IL)-6, IL-8, tumour necrosis factor-α]. Descriptive analysis suggested that EIN also increased the serum concentrations of IgG and the percentage of the B-cell fraction. Thus, its impact on IL-8 and IL-6 remains inconsistent. CONCLUSIONS The early-stage impact of EIN on immunological status in patients undergoing oesophagectomy is still unclear. According to the results of this meta-analysis, whether EIN could improve the clinical outcomes or biological status after oesophagectomy compared to standard enteral nutrition is uncertain. Since the impact of EIN is unclear, current guidelines that strongly advise the use of EIN should be changed, as the utility of EIN is very uncertain. More appropriately powered clinical studies are warranted to confirm its effectiveness.

scholarly journals Effective Central Nervous System (CNS) Prophylaxis Chemotherapy Approach in High Risk Diffuse Large B-Cell Lymphoma (DLBCL): A Network Meta-Analysis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1461-1461
Author(s):  
Philip A Haddad ◽  
Dalia Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
High Risk ◽  
Comparative Studies ◽  
Randomized Clinical Trials ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cns Prophylaxis ◽  
The Impact

Abstract Introduction: CNS relapses with DLBCL tend to be uncommon. The risk increases with certain DLBCL types and certain risk features. There is no consensus regarding the optimal approach to CNS prophylaxis for high-risk DLBCL patients. While some favor prophylaxis with high-dose systemic therapy or intrathecal chemotherapy (IT), some experts advocate combining both approaches. In the absence of randomized trials, the role of CNS chemotherapy prophylaxis remains controversial in DLBCL with contradictory comparative studies. The purpose of this meta-analysis is to evaluate the impact of CNS prophylaxis approaches on the clinical outcomes of high-risk DLBCL. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of DLBCL diagnosis, English language, IT or high-dose systemic prophylactic chemotherapy, and comparative studies reporting CNS recurrence rates. A frequentists and Bayesian network meta-analyses were conducted using the netmeta package and random-effects model. Results: Twenty-one comparative studies with a total of 11,507 patients were included and analyzed. The relative risk (RR) of CNS recurrence was not statistically different between IT prophylaxis, high-dose chemotherapy, and no prophylaxis. However, the combination of IT prophylaxis and high-dose chemotherapy was found to be significantly associated with a reduced RR of CNS recurrence when compared to IT prophylaxis (RR=0.28, 95%CI 0.13-0.58), high-dose chemotherapy (RR=0.34, 95%CI 0.14-0.80), and no prophylaxis (RR=0.41, 95%CI 0.19-0.87). Conclusions: This network meta-analysis is the first to compare the different CNS prophylactic approaches. It indicates that IT prophylaxis and high-dose chemotherapy each were not better than no prophylaxis. However, the combination of IT prophylaxis with high-dose chemotherapy was significantly superior to each approach alone as well as no prophylaxis. In the absence of randomized clinical trials, this network meta-analysis represents the most compelling data supporting the use of CNS prophylaxis in patients with high-risk DLBCL. Disclosures No relevant conflicts of interest to declare.

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