scholarly journals Tumour Relapse Prediction Using Multiparametric MR Data Recorded during Follow-Up of GBM Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Adrian Ion-Margineanu ◽  
Sofie Van Cauter ◽  
Diana M. Sima ◽  
Frederik Maes ◽  
Stefaan W. Van Gool ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Random Forests ◽  
Feature Vector ◽  
Tumour Progression ◽  
Ensemble Classifiers ◽  
Radiological Criteria ◽  
Time Points ◽  
Relapse Prediction ◽  
Time Point

Purpose. We have focused on finding a classifier that best discriminates between tumour progression and regression based on multiparametric MR data retrieved from follow-up GBM patients.Materials and Methods. Multiparametric MR data consisting of conventional and advanced MRI (perfusion, diffusion, and spectroscopy) were acquired from 29 GBM patients treated with adjuvant therapy after surgery over a period of several months. A 27-feature vector was built for each time point, although not all features could be obtained at all time points due to missing data or quality issues. We tested classifiers using LOPO method on complete and imputed data. We measure the performance by computing BER for each time point and wBER for all time points.Results. If we train random forests, LogitBoost, or RobustBoost on data with complete features, we can differentiate between tumour progression and regression with 100% accuracy, one time point (i.e., about 1 month) earlier than the date when doctors had put a label (progressive or responsive) according to established radiological criteria. We obtain the same result when training the same classifiers solely on complete perfusion data.Conclusions. Our findings suggest that ensemble classifiers (i.e., random forests and boost classifiers) show promising results in predicting tumour progression earlier than established radiological criteria and should be further investigated.

Prognostic Value of Minimal Residual Disease (MRD) Detection in Adult Acute Lymphoblastic Leukemia (ALL) – HYPER-CVAD Protocol

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4870-4870
Author(s):  
Nikolaos Tsagarakis ◽  
Nektaria Kentrou ◽  
Mirsini Pergaminou ◽  
Theodore Marinakis ◽  
Stefanos I Papadhimitriou ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Induction Therapy ◽  
Treatment Time ◽  
Lymphoblastic Leukemia ◽  
Treatment Protocol ◽  
Disease Free Survival ◽  
Consolidation Therapy ◽  
Time Points ◽  
Time Point

Abstract Objective: HYPER-CVAD is an intensive treatment protocol of short duration, for ALL and other lymphoid neoplasms. It is consisted of 8 alternating cycles (parts A and B): in part A (cycles 1, 3, 5, 7) fractionated doses of cyclophosphamide, vincristine, doxorubicin and dexamethazone are administrated, while in part B (cycles 2, 4, 6, 8) high doses of methotrexate and aracytin. The two first cycles compose the induction therapy, while the next 6 cycles constitute the consolidation therapy, followed by two years of maintenance therapy. Protection of CNS is achieved with intradorsal injections, whereas in Ph+ ALL patients, imatinib is also administered. The aim of this study was the clinical evaluation of MRD detection in adult patients with ALL, during chemotherapy with HYPER-CVAD. Patients/Methods: During the period 1999–2008, 30 patients were hospitalized in our hospital for ALL and were treated with HYPER-CVAD therapeutic protocol. Among them, 14/30 (46,7%) were males and 16/30 (53,3%) females (median age 43,5 years, range 16–70). Median follow-up time was 12,8 months (range 0,5–100). ALL of T-origin had 8/30 patients and of B-origin, 22/30 (1 B1-EGIL/pro-B, 17 B2-EGIL/B-common, 4 B3-EGIL/pre-B). Caryotypic analysis and FISH was done in all patients (7/30 bcr/abl+). According to classical prognostic markers of ALL: 21/30 were classified as high, 4/30 as medium and 5/30 low risk, respectively. MRD presence was detected in bone marrow samples, with flow cytometric panels, at three particular treatment time-points: completion of induction therapy (T1), completion of consolidation therapy (T2) and at the end of maintenance therapy (T3). Overall survival (OS) and disease free survival (DFS) were investigated, especially in relation to the influence of MRD presence in (OS) and (DFS), respectively. For statistical analysis, Kaplan-Meier was used. Results: At treatment time-point (T1), MRD was detected in 10/28 (35,7%) patients, at time-point (T2) in 7/23 (30,4%) and at treatment-point (T3) in 9/17 (52,94%). The influence of MRD detection in (OS) was statistically significant (p<0,05) at (T2) and (T3), while in (DFS) the detection of MRD presence in any of the standardized treatment time-points resulted in decreased DFS (T1/p<0,05, T2 and T3/p<0,001). Conclusions: Our results suggest that MRD detection during therapy of adult ALL is a negative prognostic indicator for (OS) and (DFS), the independency of which has to be confirmed after prolonged follow-up time and increased number of cases.

scholarly journals The Pulmonary Sequalae in Discharged Patients With COVID-19:A Short-term Observational Study

2020 ◽  
Author(s):  
Dehan Liu ◽  
Wanshu Zhang ◽  
Feng Pan ◽  
Lin Li ◽  
Lian Yang ◽  
...  
Keyword(s):  
Chest Ct ◽  
Ct Scans ◽  
Optimal Time ◽  
Imaging Features ◽  
Short Term ◽  
Lung Lesions ◽  
Cumulative Percentage ◽  
Time Points ◽  
Time Point

Abstract Background: A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia were discharged from hospitals in Wuhan, China. We aimed to determine the cumulative percentage of complete radiological resolution at each time point, to explore the relevant affecting factors, and to describe the chest CT findings at different time points after hospital discharge.Methods: Patients with COVID-19 pneumonia confirmed by RT-PCR who were discharged consecutively from the hospital between 5 February 2020 and 10 March 2020 and who underwent serial chest CT scans on schedule were enrolled. The radiological characteristics of all patients were collected and analysed. The total CT score was the sum of non-GGO involvement determined at discharge. Afterwards, all patients underwent chest CT scans during the 1st, 2nd, and 3rd weeks after discharge. Imaging features and distributions were analysed across different time points.Results: A total of 149 patients who completed all CT scans were evaluated; there were 67 (45.0%) men and 82 (55.0%) women, with a median age of 43 years old (IQR 36-56). The cumulative percentage of complete radiological resolution was 8.1% (12 patients), 41.6% (62), 50.3% (75), and 53% (79) at discharge and during the 1st, 2nd, and 3rd weeks after discharge, respectively. Patients ≤44 years old showed a significantly higher cumulative percentage of complete radiological resolution than patients >44 years old at the 3-week follow-up. The predominant patterns of abnormalities observed at discharge were ground-glass opacity (GGO) (65 [43.6%]), fibrous stripe (45 [30.2%]), and thickening of the adjacent pleura (16 [10.7%]). Lung lesions showed obvious resolution from 2 to 3 weeks after discharge, especially in terms of GGO and fibrous stripe. “Tinted” sign and bronchovascular bundle distortion as two special features were discovered during the evolution.Conclusion: Lung lesions in COVID-19 pneumonia patients can be absorbed completely during short-term follow-up with no sequelae. Three weeks after discharge might be the optimal time point for early radiological estimation.

Minimal Residual Disease (MRD) in Childhood Acute Lymphoblastic Leukemia (ALL). Correlation with Prognostic Factors and Outcome

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4848-4848
Author(s):  
Anna Paisiou ◽  
Georgios Paterakis ◽  
Nikolaos Tsagarakis ◽  
Nektaria Kentrou ◽  
Vassilios Papadakis ◽  
...  
Keyword(s):  
High Risk ◽  
Treatment Time ◽  
Residual Disease ◽  
Childhood All ◽  
Time Points ◽  
Standardized Treatment ◽  
Group A ◽  
Group B ◽  
Time Point

Abstract Aim: The aim of this study was the prospective evaluation of MRD during childhood ALL therapy and its correlation with specific prognostic criteria of ALL-BFM 95 protocol and with patient outcome. Patients/Methods: 127 children (49 girls) with ALL were studied during the period 1999–2008. The median age at diagnosis was 9,32 years (range, 0,6–16,48). All patients were diagnosed in the same center and treated uniformly with the ALL-BFM 95 protocol, modified in two therapeutic branches, medium and high risk, as we have published previously. We used three or five colours’ flow cytometric panels for MRD quantification at sequential standardized treatment time-points: at day 15 of induction (T1), at day 33 (T2) of induction, before consolidation (T3), before re-induction (T4), before maintenance (T5), at maintenance completion (T6). Additionally for the high risk patients, 6 more determinations before each consolidation treatment cycle were performed. The median follow-up time was 48,4 months (range, 1,7–110,3). For statistical analysis, descriptive statistics and Kaplan-Meier were used. Results: Immunophenotypical analysis resulted in 119 patients with ALL of B-origin and 8 of T-origin. Median WBC at diagnosis was 10×109/lt, while extra-BM infiltration was found in 9 children. According to ALL-BFM 95 protocol’s criteria: 40 patients were fulfilling the criteria of the standard risk (SR), 61 of medium (MR) and 26 of high risk (HR), respectively, and therapeutically were divided into two groups: A (101 patients, SR+MR) and B (26 patients, HR). MRD was detected in: 59/123 patients at treatment time-point (T1) (39/59 from group A, of which 26/39 with high MRD levels, and 20/59 from group B, all with high MRD levels). In time-point (T2), disease was detected in 19/124: 5/19 from group A (3/5 high MRD levels), 14/19 from group B (11/14 high MRD levels). At treatment-point (T3), 3/127 had detectable disease (all from group B). None of the patients of group A had minimal residual disease at the following time-points, while only 2 patients of group B had persistent presence of MRD. In total, 14/127 children relapsed (4/SR, 2/MR, 8/HR), with significant levels of MRD in 7 (6/7 HR) and 4 (all HR) patients, at time-point (T1) and (T2), respectively. Among all, 114 children survived (CR1: 110, CR2: 4), while 13 children died (9/disease, 4/therapy-related toxicity). Conclusions: Our results suggest that MRD detection in continuous standardized treatment time-points of childhood ALL correlates with shorter disease free (DFS) and overall survival (OS), however in our cohort there was no sufficient evidence of MRD independency as prognostic factor (cox-regression analysis) compared to the classical prognostic criteria of the ALL-BFM 95. The enlargement of the group of patients and the expansion of the follow-up period will lead to more reliable conclusions.

scholarly journals Participant retention in trauma intensive care unit (ICU) follow-up studies: a post-hoc analysis of a previous scoping review

2020 ◽  
Vol 5 (1) ◽  
pp. e000584
Author(s):  
Himanshu Rawal ◽  
Daniel L Young ◽  
Roozbeh Nikooie ◽  
Awsse H Al Ani ◽  
Lisa Aronson Friedman ◽  
...  
Keyword(s):  
Intensive Care ◽  
Scoping Review ◽  
Retention Rates ◽  
Time Points ◽  
Related Data ◽  
Follow Up Studies ◽  
Participant Retention ◽  
Post Hoc ◽  
Time Point

BackgroundThe study aimed to synthesize participant retention-related data for longitudinal follow-up studies of survivors from trauma intensive care units (ICUs).MethodsWithin a published scoping review evaluating ICU patient outcomes after hospital discharge, two screeners independently searched for trauma ICU survivorship studies.ResultsThere were 11 trauma ICU follow-up studies, all of which were cohort studies. Twelve months (range: 1–60 months) was the most frequent follow-up time point for assessment (63% of studies). Retention rates ranged from 54% to 94% across time points and could not be calculated for two studies (18%). Pooled retention rates at 3, 6, and 12 months were 75%, 81%, and 81%, respectively. Mean patient age (OR 0.85 per 1-year increase, 95% CI 0.73 to 0.99, p=0.036), percent of men (OR 1.07, 95% CI 1.04 to 1.10, p=0.002), and publication year (OR 0.89 per 1-year increase, 95% CI 0.82 to 0.95, p=0.007) were associated with retention rates. Early (3-month) versus later (6-month, 12-month) follow-up time point was not associated with retention rates.DiscussionPooled retention rates were >75%, at 3-month, 6-month, and 12-month time points, with wide variability across studies and time points. There was little consistency with reporting participant retention methodology and related data. More detailed reporting guidelines, with better author adherence, will help improve reporting of participant retention data. Utilization of existing research resources may help improve participant retention.Level of evidenceLevel III: meta-analyses (post-hoc analyses) of a prior scoping review.

scholarly journals The Adherence to MRD Time Points Is a Significantly Prognostic Predictor in an MRD-Directed Therapy for Childhood Acute Lymphoblastic Leukemia in Taiwan

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3813-3813
Author(s):  
Hsi-Che Liu ◽  
Ting-Chi Yeh ◽  
Tang-Her Jaing ◽  
Shih-Hsiang Chen ◽  
Chih-Cheng Hsiao ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Treatment Outcomes ◽  
Lymphoblastic Leukemia ◽  
Childhood All ◽  
Prognostic Predictor ◽  
Time Points ◽  
Cns Relapse ◽  
Total Therapy ◽  
Time Point

Backgrounds and Purposes Minimal residual disease (MRD) monitoring has been proved to be the most important prognostic predictor in childhood acute lymphoblastic leukemia (ALL). The nationwide TPOG-ALL-2013 protocol (TPOG-2013), adapted from the St. Jude Total Therapy XV Study and Total Therapy XVI Study, was launched since January 2013. This is the first MRD-directed protocol for treatment of childhood ALL in Taiwan. Here, we report the improved treatment outcomes and the impacts of adherence to MRD time points. Patients and Methods Totally, 402 patients aged between 1-18 years and diagnosed before December 31, 2018, who had MRD monitoring at the major central laboratory (Chang Gung Memorial Hospital-Linkou), were enrolled with the last follow-up on June 30, 2019. According to TPOG-2013, two MRD measurements were scheduled on days 15-19 of induction (MRD1 time point, TP1) and days 35-42, end of induction (MRD2 time point, TP2) to make the definitive risk stratification to guide subsequent therapy. The methodologies of MRD measurement included multicolor flow cytometry for leukemia-associated immunophenotypes (LAIP) (82.3% of TPOG-2013 cohort), qPCR assay for clonally rearranged antigen-receptor genes (Ig/TCR) if no LAIP (12.5%). Since January 2018, reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR) was applied to patients carrying fusion transcripts (5.2%) of TCF3-PBX1, ETV6-RUNX1, BCR-ABL1, KMT2A-AFF1 (AF4) and KMT2A-MLLT3. The clinical features and outcomes of patients treated with TPOG-2013 were compared with those of 1,300 patients treated with the previous TPOG-ALL-2002 protocol (TPOG-2002), which did not integrate the MRD monitoring. Results The median follow-up time of the 402 patients of TPOG-2013 cohort was 32.5 months (range, 1.0-79.2 months). There were no significant differences in gender, age, WBC counts, and lineage at diagnosis between the patients treated with TPOG-2002 and TPOG-2013. However, based on the MRD data, the percentages of patients assigned to each risk group of TPOG-2013 was statistically differed from those of TPOG-2002 (P< 0.0001). The 5-year event-free survival (EFS) (% ± SE) was significantly improved from 78.1 ± 1.2 of TPOG-2002 to 85.4 ± 2.5 of TPOG-2013 (P< 0.0001). Further, the cumulative incidences (% ± SE) of isolated CNS relapse and any CNS relapse significantly decreased from 4.0 ± 0.5 to 0.3 ± 0.3 (P= 0.001) and from 5.8 ± 0.7 to 1.2 ± 0.9 (P= 0.001), respectively. The issue of non-adherence to MRD monitoring emerged since the implementation of MRD-directed TPOG-2013. For further analysis, 321 (80%) patients with exact adherence (EA) to both TPs were assigned as MRD EA group; 80 (20%) patients who were non-adherence (NA) to either one of TPs as MRD NA group; and one patient died between the two TPs was excluded for the comparative outcome analysis. The rate of non-adherence decreased significantly from 26.5% in 2013 to 2.4% in 2018. The major causes of non-adherence for both TPs were delaying MRD monitoring due to neutropenic fever and documented infections. In MRD EA group, 12.5% of patients were upgraded to higher-risk treatment groups based on their MRD results. The MRD NA group had older age (≥ 10 years), lower standard-risk and lower incidence of ETV6-RUNX1 compared with MRD EA group. There were significant differences in outcomes between MRD EA and MRD NA groups: the 5-year EFS were 89.4 ± 2.4 and 71.9 ± 7.4, respectively (P= 0.0005), overall survival (OS) were 90.9 ± 2.1 and 75.6 ± 5.8, respectively (P= 0.0003), and the cumulative incidence of isolated CNS relapse were 0 and 1.4 ± 1.3, respectively (P= 0.048) (Figure 1). In multivariate analysis, older age (≥ 10 years), higher WBC count (≥ 50 × 109/L) at diagnosis and MRD non-adherence were independent predictors for inferior EFS. In addition to these three factors, a higher-risk classification also predicted an inferior OS (Figure 2). Conclusions Contemporary MRD-directed therapy has improved the treatment outcomes of childhood ALL in Taiwan. The adherence to MRD time points remains a significantly prognostic predictor in the era of MRD-guided treatment. Disclosures No relevant conflicts of interest to declare.

Immunophenotypical Sequential MRD Assessment in AML for Prediction of Relapse and Definition of Putative Future Intervention Time Points.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3012-3012
Author(s):  
Nicole Feller ◽  
Peter C. Huijgens ◽  
Angele Kelder ◽  
Guus Westra ◽  
Gert Ossenkoppele ◽  
...  
Keyword(s):  
Residual Disease ◽  
Treatment Strategies ◽  
Sampling Period ◽  
High Dose Chemotherapy ◽  
Post Treatment ◽  
High Dose ◽  
Time Points ◽  
Definition Of ◽  
Time Point

Abstract Immunophenotypical assessment of minimal residual disease (MRD) has been shown by us (Feller et al, Leukemia18:1380, 2004) and others (San Miguel et al., Blood98: 1746, 2001, Venditti et al., Blood96: 3948, 2000) to be predictive for clinical outcome in AML both in patients treated with standard chemotherapy (SD) and high dose chemotherapy followed by autologous (AutoTQ) or allogeneic (AlloTQ) transplantation. Directly after consolidation therapy using a cut-off of 0.11% in the high MRD group the risk of relapse was 7.2 fold than in the low MRD group (Feller et al., 2004). Using that cut-off level, in the present study another important issue, i.e. sequential MRD assessments after end of treatment were done to i) prove consistancy of low MRD% in patients that remain in CR, ii) prove the ability to predict relapse using increase of MRD% and iii) assess the minimally required inter-sampling period to make MRD assessment clinically useful. To enable such 124 samples of 33 patients (&lt;60 years) were included: 16 after SD, 8 after AutoTQ and 9 after AlloTQ. All time points refer to post-treatment periods, time point zero reflecting end of therapy. Of 16 patients studied after SD, 15 had MRD &lt;0.11%. Of these, 12 are in CR with a median follow-up of 30.5 (range 9–46) months. In these 12 patients MRD remained consistently &lt;0.11 %, (mean of 3 sequential MRD assessments per patient). Of these 15 patients 3 relapsed after 9, 9 and 26 months, but in these cases the last time point of MRD assessment (still &lt;0.11%) unfortunately was at least 6 months before relapse. One patient who started with MRD&gt;0.11 relapsed within 2 months after that MRD assessment. Of 8 patients studied after AutoTQ, 6 had MRD &lt;0.11%. Of these, 4 are in CR with a follow-up of 6, 15, 40 and 72 months. Again, MRD remained consistently &lt;0.11% (mean of 3 assessments per patient). Of these 6 patients 2 relapsed after 13 and 43 months, with relapse predictable using 3 months assessment intervals. Two patients had &gt;0.11% MRD and relapsed after 5 and 11 months and within 3 months after the last MRD assessment, with no previous sign of forthcoming increase. Of 9 patients studied after AlloTQ, 2 had MRD &lt;0.11%; thet are still in remission after 47 and 53 months. Again, MRD remained consistently &lt;0.11 % (6 and 7 MRD assessments in these 2 patients). Of these 9 patients 2 relapsed too fast to have the opportunity to assess MRD. In addition, 5/9 had MRD &gt;0.11%, of whom 2/5 relapsed after 6 and 7 months which was 4 and 2 months resp., after their last MRD assessment, with no previous sign of forthcoming increase. A remarkable phenomenon was observed in the other 3/5 patients: a large drop in MRD% down to detection level (0.01%) occurred 3–10 months after end of therapy. 2 of these 3 patients are still in CR (at 11 and 33 months), 1/3 relapsed after 26 months, 5 months after last MRD assessment with no previous sign of increase. The unique decrease of MRD% may be speculated to result from graft versus leukemia effects. These results show: 1) consistently low MRD% in sequential MRD assessments during persisting CR; 2) increases of MRD% which consistently predict relapse; 3) a minimally required inter-sampling period of 3 months for patients with MRD &lt;0.11% and probably &lt;3 months for patients with MRD&gt;0.11%; 4) a strong decrease of MRD in part of the allogeneically transplanted patients. Results show the feasibility of sequential post-treatment MRD assessment that ultimately will contribute to design of post-treatment strategies in AML.

scholarly journals PC3 - 219 Evaluation of delayed FDG-PET in differentiating progressive disease from post-treatment radiation effect in brain tumors

2016 ◽  
Vol 43 (S4) ◽  
pp. S23-S23
Author(s):  
R.A. Harrison ◽  
A. Masood ◽  
O. Mawlawi ◽  
D. Schellingerhout ◽  
B.A. Chasen ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Fdg Pet ◽  
Progressive Disease ◽  
Radiation Effect ◽  
Post Treatment ◽  
Delayed Imaging ◽  
Time Points ◽  
Delayed Time ◽  
Time Point

Traditional and advanced magnetic resonance imaging techniques are often unable to differentiate progressive central nervous system neoplasm from post-treatment radiation effect (PTRE). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with delayed imaging has been shown to increase the specificity of PET imaging for cerebral neoplasm in small studies. We sought to further evaluate the potential diagnostic benefits of delayed imaging at 5 hours versus standard imaging at 1 hour to differentiate progressive disease (PD) from PTRE in patients with primary or metastatic brain tumors treated with radiation therapy.Ten patients with primary (n=4) and metastatic (n=6) brain tumors were identified, with diagnostic confirmation of PD or PTRE provided by pathology or>3 month clinical and radiographic follow-up. Maximum standard uptake values (SUV) were calculated for suspicious areas of abnormal contrast enhancement (lesion) and compared to contralateral normal appearing brain (background) at both early and delayed time points. Seven patients were classified as having PD and 3 as having PTRE based pathology or clinical/radiographic follow up. The average lesion to background ratio (L/B) at the early time point (1.16+0.50) was significantly different than L/B for the later time point (1.72+1.10), p=0.030. The mean L/B for PD was 2.17+1.01 at the later time point compared to 0.65+0.06 for PTRE (p=0.010). For the earlier time point, L/B for PD was 1.40+0.42, compared to the L/B for PTRE which was 0.61+0.10 (p=0.003).L/B ratios at early and delayed time points successfully differentiated between patients with PD and PTRE, with significantly greater L/B ratios seen at delayed time points. These initial results are promising and further investigation is underway to evaluate the contribution of delayed imaging in differentiating PD from PTRE.

scholarly journals Phacoemulsification combined with micropulse cyclodiode laser in glaucoma patients: efficacy and safety

Eye ◽  
2021 ◽  
Author(s):  
Arij Daas ◽  
Thomas Sherman ◽  
Lina Danieliute ◽  
Saurabh Goyal ◽  
Andrew Amon ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Case Note ◽  
Efficacy And Safety ◽  
Retrospective Case ◽  
Safety And Efficacy ◽  
Time Points ◽  
Transscleral Cyclophotocoagulation ◽  
Case Note Review ◽  
Time Point

Abstract Objective To evaluate the safety and efficacy of phacoemulsification combined with Micropulse transscleral cyclophotocoagulation (MP-TSCPC) in glaucoma patients. Methods This is a retrospective case-note review. The participants were adult patients with diagnoses of glaucoma and cataract who required a further reduction in IOP or a reduction in the number of glaucoma drops. All consecutive patients who underwent cataract surgery (CS) combined with MP-TSCPC laser between October 2018 and July 2019 were included in the study. The effect on visual acuity (VA), intraocular pressure (IOP) and number of anti-glaucoma drops were evaluated at 6 and 12 months in addition to any complications that occurred during any time point of the study. Results 42 eyes were included in the study. Mean IOP was reduced from 19.5 ± 5.4 mmHg by 22.5% to 15.1 ± 4.6 at 6 months post-operatively and by 19.5% to 15 ± 6.6 mm Hg at 12 months (p < 0.001 at both time points). The number of anti-glaucoma medications also reduced significantly from 2.8 ± 1.3 to 1.6 ± 1.2 at 6 months and to 2.2 ± 1.3 at 12 months (p < 0.001 at both time points). The success rate was 56% at 6 months and 54% at 12 months. 54.7% of our patients who completed 12 months follow up had an improvement or unchanged vision at the last visits. Conclusion This is the first study evaluating the effect of cataract surgery combined with MP-TSCPC in glaucoma patients. We demonstrated that this led to a reduction in IOP and the number of anti-glaucoma medications at 6 and 12-month postoperatively. The majority of patients had either stable or better vision at 12 months follow-up.

scholarly journals MRD Status Did Not Correspond to the Relapse Incidence within One Year of Follow-up By Non-Intensive but Non-Interruptive Approach: The First Interim Results of the Russian Prospective Multicenter RALL-2016 Trial for Ph-Negative Adult ALL

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5185-5185
Author(s):  
Olga A. Gavrilina ◽  
Elena N. Parovichnikova ◽  
Vera V. Troitskaya ◽  
Galina A. Baskhaeva ◽  
Andrey N. Sokolov ◽  
...  
Keyword(s):  
Basic Research ◽  
Nijmegen Breakage Syndrome ◽  
High Dose ◽  
Time Points ◽  
Consolidation Phase ◽  
Intensive Approach ◽  
One Year ◽  
Basic Research Grant ◽  
Time Point

Abstract Introduction RALL-2009 study (NCT01193933) has demonstrated that non-intensive but non-interruptive treatment with fewer allo-HSCT is rather effective in adult Ph-negative ALL pts aged 18-55 yy, producing more than 50% OS at 8-years [Parovichnikova, EHA E836, 2017]. In this study we have shown that only age, initial WBC >30*109/l and t(4;11) became the factors of poor prognosis for BCP-ALL and none of the factors - for T-ALL. MRD was not measured in this study. Since Dec 2016 we started a new RALL-2016 (NCT03462095) protocol based on the same principle but modified according to the conclusions drawn from RALL-2009. Aim. To evaluate the first interim results of MRD monitoring and 1-year probability of relapse regarding MRD status in Ph-negative ALL treated by RALL-2016 protocol. Materials and patients. Taking in consideration the major pitfalls of RALL-2009 (high CR rate, early CNS relapses in T-ALL, selection bias for autologous HSCT in T-cell ALL, absence of MRD testing) a new study was developed. One day high-dose MTX block and one-day high-dose ARA-C block are eliminated and substituted by 2 months of non-intensive and non-interruptive treatment, L-asparaginase is scheduled for 1 year of treatment instead of 2,5 y, 15 intrathecal injections are increased up to 21 during consolidation phase, CR T-ALL patients are brought to randomization after the informed consent: auto-HSCT vs no auto-HSCT, - with further similar maintenance. All primary bone marrow samples are collected and tested for cytogenetic and molecular markers, all included pts are MRD monitored by flow cytometry in a centralized lab at 3-time points (days +70,+133,+190). Since Dec2016 till July 2018, 86 adult Ph-negative ALL pts from 11 centers (10 regions of Russia) were included in theRALL-2016 protocol: median age 33 y (18-54), m/f 54/32, BCP-ALL was diagnosed in 48 (56%), T-ALL/LBL - in 35 (40,5%), biphenotypic ALL -3 (3,5%). Results. CR rate in 76 available for the analysis patients was 80% (n=61), induction death occurred in 12% (n=9) and refractory ALL was registered in 8% (n=6). There were no deaths in CR so far. 2 allo-HSCT were performed (1 MUD and 1 haplo) for BCP-ALL with MRD persistence and T-ALL associated with Nijmegen breakage syndrome, respectively. 26 T-ALL patients after CR achievement were randomized for chemo (n=13) or for auto-HSCT (n=13). Up to now 7 of randomized T-ALL patients were transplanted at a median of 6 mo of CR. OS for the whole cohort constituted 68% at 18 months, relapse probability - 8,7%. MRD at the 1st time point (+70 day) was measured in 54 pts, at the 2nd time point (+133 day) - in 43 pts and at the 3rd time point (+190 day) - in 36 pts. MRD-positivity was detected in 15 pts (28%) at day+70 (BCP-ALL=11 out of 32 pts, T-ALL=4 out of 22), at day +133 - in 8 pts (19%) (BCP-ALL=7 out of 30 pts, T-ALL=1 out of 13), at day +190 - in 2 pts (5%) (both BCP-ALL). MRD clearance was much better in T-ALL patients, as it was demonstrated by other studies earlier [Bruggemen, Goekbuget]. But we have to mention that regardless our non-intensive approach, the portion of MRD-positive patients was similar at the same time points as in the other studies applying highly intensive protocol. We did not reveal any differences in early (within 1-year) relapse probability according to MRD status, though we have to assume that the study is small and the period of follow is too short. Conclusion Our data demonstrate that non-intensive but non-interruptive approach is as effective as more intensive protocols providing very similar MRD clearance in Ph-negative ALL. MRD is declining better in T-ALL patients comparing to BCP-ALL. And no correspondence was noticed between the MRD-positivity and relapse probability at the 18 mo of follow-up. Figure. Figure. Disclosures Kulikov: Russian Foundation for Basic Research grant 18-015-00399 A: Research Funding.

Obesity in Survivors of Childhood Hematopoietic Stem Cell Transplantation.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2130-2130
Author(s):  
Theodore B. Moore ◽  
Leanne Streja ◽  
Pamela Kempert ◽  
Alan Ikeda ◽  
Kristen Venick ◽  
...  
Keyword(s):  
Stem Cell ◽  
Survival Rate ◽  
Hematopoietic Stem Cell ◽  
P Value ◽  
Obese Patients ◽  
Hematopoietic Stem ◽  
Time Points ◽  
Post Transplant ◽  
Time Point

Abstract Background: Obesity is an increasing problem in the United States, and a leading cause of morbidity and mortality. In recent years, survivors of certain malignancies such as childhood acute lymphoblastic leukemia (ALL) have demonstrated an increased incidence of obesity than their corresponding age group in the general population. We retrospectively evaluated the pediatric hematopoietic stem cell transplant (HSCT) population at our institution for the incidence of overweight/obese patients, as well as any factors that might be associated. Patients and Methods: We conducted a retrospective analysis of medical records of pediatric HSCT patients treated between 1990 and 2005 at the Mattel Children’s Hospital at UCLA. Data was collected on 297 patients including body mass index (BMI), diagnosis, treatment, post-transplant disease and infection, survival. We excluded patients from our analysis that had observations from only one time point or insufficient follow-up BMI data for analysis. The remaining cohort consisted of 195 patients whose demographic and clinical data are presented below. Age, height and weight were measured at baseline and approximately at 100 day and 1year time intervals until 5 years post-transplant. The average age was 8.4 years (95% CI: 7.6, 9.3), about two-thirds of the patients were male and the predominant ethnicities were Caucasian (42.8%) and Hispanic (32.5%). The majority of patients had ALL as a diagnosis (43.6%), 1 or 2 remissions (90.4%), no prior transplant history (83.6%), a related donor (65.4%), a bone marrow stem cell source (77.3%), no antigen mismatch (80.5%), and 0 or 1 hospitalization during the 5 year post-transplant period (69.5%). BMI (measured in kg/m2) and BMI percentiles (BMI%) were calculated for all time points. Calculation of BMI% relied on the WHO growth chart for patients 0–5 yrs old, and the CDC chart for patients greater than 5 yrs old. We constructed the following BMI-related variables for all time points: overweight = BMI% ≥95th percentile for patients ≤20 yrs or BMI ≥30 kg/m2 overweight = BMI% ≥95th percentile or BMI ≥30 kg/m2 for patients over 20 yrs), underweight = BMI% ≤5th percentile for patients ≤20 yrs or BMI ≤18.5 kg/m2 for patients over 20 yrs, We focused on baseline and last time point measures for these variables and also determined if a patient was ever obese, ever overweight, or ever underweight at any point during the 5-year time period. We also computed the change in BMI between time points and from baseline, and categorized the patients as either having a decrease in BMI&gt;1.5 kg/m2, change in BMI ≤1.5, or increase in BMI&gt;1.5 kg/m2 Results: At baseline and during a 5-year follow up period, our HSCT patients became substantially more overweight than the general pediatric population with initially 17.4% of patients exceeding the 95th percentile at baseline and 34% ultimately exceeding this percentile post transplant. Length of hospital stay was moderately associated with obesity (P-value = 0.037), with a longer stay on average having a stronger association with obesity than shorter stays (where a longer stay was on average 49±30 days in comparison to 40±22 days for the shorter stay). A diagnosis of ALL and graft vs. host disease were moderately associated with whether a patient became overweight during the study (Fisher’s exact test P-values = 0.036 and 0.075 respectively). Patients who experienced stability in their BMI had significantly higher survival rates than patients whose BMI significantly changed (71.2% vs 44.9%; log rank P-value = 0.01). We also found that obesity at the last time point was significantly associated with decreased survival (log rank P-value = 0.004), with patients who were obese at the last time point having a 2-year survival rate of 38% (95% CI: 23.9, 60.4) and patients who were not obese having a 2-year survival rate of 64.2% (95% CI: 56.3, 73.3). While demographic, treatment and illness, infection, and other BMI related variables were considered, they were not significant. Conclusion: An increased incidence of overweight and obese patients where observed in our pediatric post-transplant population, nearly doubling from baseline. Additional studies into interventions are warranted.

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