scholarly journals Rare Lymphoma Cases: Online Education Significantly Improves Hematologist/Oncologist Ability to Personalize Treatment

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-12
Author(s):  
Lauren Willis ◽  
Tristin Abair ◽  
Sara R. Fagerlie
Keyword(s):  
Marginal Zone ◽  
Marginal Zone Lymphoma ◽  
Educational Activity ◽  
Activity Participation ◽  
Educational Impact ◽  
Imaging Results ◽  
Mantle Cell ◽  
The Impact ◽  
Post Assessment ◽  
Case Based

Background: Mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL) are rare types of non-Hodgkin lymphoma (NHL). While MZL is generally indolent, MCL often has a more aggressive clinical course and many patients progress after initial treatment. This study was conducted to determine if an online, case-based continuing medical education (CME) intervention could improve skills of hematologists/oncologists (hem/oncs) to personalize treatment for patients with relapsed/refractory (R/R) MCL or R/R MZL. Methods: The format was an online CME-certified text-based activity composed of 2 patient cases with interactive questions on the diagnosis and treatment of rare types of NHL. Evidence-based educational feedback was provided following each response. Three case-based questions were repeated immediately after activity participation and learners had to select treatment for patients based on prior treatment history, imaging results, and lab values. Question 1, 2, and 3 tested hem/oncs ability to select treatment for a patient with R/R MZL, R/R MCL, and R/R MCL, respectively. Additionally, 1 self-efficacy question was also repeated immediately after activity participation. These questions assessed the impact of the education in the form of a repeated pairs pre-assessment/post-assessment study design in which each participant served as his/her own control. Using data from the assessment completers, percentages of correct responses to pre- and post-assessment questions were compared. A chi-square test was used to assess statistical significance of the educational impact, where P < .05 was considered statistically significant. Cramer's V was used to estimate the magnitude of change in the total number of correct responses between the compared test scores, where V >0.26 indicates an extensive educational impact. The activity launched online on January 9, 2020 and data reported were collected through July 9, 2020. Results: At the time of data collection 203 hem/oncs had completed the activity. Of these 104 (57%) were community-based practitioners. Education had an extensive impact (V =.424) and significantly improved hem/oncs competence to select personalized treatment for patients with these rare types of NHL (Figure 1). Table 1 shows the case summary, questions, and answer choices. Conclusions: This online, interactive, case-based CME-certified educational activity led to statistically significant improvements in the clinical competence of hematologists/oncologists regarding personalizing treatment selection for patients with R/R mantle cell or marginal zone lymphoma. The results indicate that unique educational methodologies and platforms, which are available on-demand, can be effective tools for advancing clinical decision making. Additional studies are needed to assess whether improved aptitude translates to improved performance during clinical practice. Acknowledgements: This CME activity was supported by an independent educational grant from Celgene Corporation and Pharmacyclics, Inc. Reference: https://www.medscape.org/viewarticle/923424 Figure 1 Disclosures No relevant conflicts of interest to declare.

scholarly journals Challenges in Treating Tardive Dyskinesia: Assessing the Impact of Virtual Medical Education

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 165-165
Author(s):  
Amanda Glazar ◽  
Cecilia Peterson ◽  
Michael Lemon ◽  
Chirag Shah ◽  
Prakash Masand
Keyword(s):  
Medical Education ◽  
Tardive Dyskinesia ◽  
Treatment Options ◽  
Respiratory Muscles ◽  
Educational Activity ◽  
Activity Participation ◽  
Chi Square ◽  
Practice Performance ◽  
New Treatments ◽  
The Impact

AbstractIntroductionTardive Dyskinesia (TD) refers to abnormal, involuntary, choreoathetoid movements of the tongue, lips, face, trunk, and extremities and is associated with long-term exposure to dopamine-blocking agents, such as antipsychotic medications. Once established, these movements usually persist. The movements are disfiguring and can bring unwanted attention to affected individuals. When severe, especially if the respiratory muscles are affected, the movements can be disabling, limit activity, and reduce quality of life. The prevalence is 7.2% in individuals on newer antipsychotics who have never been exposed to older neuroleptics. Until recently, there were no effective treatments for TD. In recent years, many new treatments have been investigated for the treatment of TD, including valbenazine, deutetrabenazine, and branched chain amino acids. Valbenazine first, followed by deutetrabenazine are FDA approved to treat TD. A virtual broadcast was developed to assess the ability of continuing medical education (CME) to improve awareness of the recognition and treatment of TD among psychiatrists.MethodsThe virtual broadcast (May 9, 2020) consisted of a two-hour, live-streamed discussion between two expert faculty. Impact of the educational activity was assessed by comparing psychiatrists’ responses to four identical questions presented before and directly after activity participation. A follow-up survey was sent to all participants six-weeks post-activity to measure performance in practice changes. A chi-square test was used to identify significant differences between pre- and post-assessment responses. Cohen’s d was used to calculate the effect size of the virtual broadcast.ResultsActivity participation resulted in a noticeable educational effect among psychiatrists (n=621; d=6.12, P<.001). The following areas showed significant (P<0.05) pre- vs post-educational improvements: recognition of movements in patients with TD, rate of TD in SGA exposed patients, treatment options for TD (on and off-label), and treatment of TD using VMAT inhibitors. Additionally, 54% of psychiatrists reported a change in practice performance as a result of the education received in the activity, including utilization of a standard scale to evaluate movement disorders and educate patients and family members about potential for TD, how to recognize symptoms, and when to treat.ConclusionsThe results indicated that a CME-certified two-hour virtual broadcast was effective at improving knowledge among psychiatrists for the recognition and treatment of TD. This knowledge also resulted in positive changes in practice performance post-activity. Future education should continue to address best practices in the diagnosis, treatment and management of patients with TD, as there remains an increased need for tailored CME among psychiatrists.FundingNeurocrine Biosciences, Inc.

scholarly journals Composite splenic marginal zone lymphoma and mantle cell lymphoma with p53 deletion and tetraploidization

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
David Azoulay ◽  
Eugene Dementiev ◽  
Luba Trakhtenbrot ◽  
Netanel Horowitz ◽  
Tamar Tadmor ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Marginal Zone ◽  
Cell Lymphoma ◽  
Marginal Zone Lymphoma ◽  
Splenic Marginal Zone Lymphoma ◽  
Mantle Cell

The PIG-A Gene Is Hypermutable in Lymphoid Neoplasms.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2395-2395
Author(s):  
Kimberly DiTata ◽  
David J. Araten
Keyword(s):  
T Cell ◽  
Cell Survival ◽  
Genomic Instability ◽  
Mutation Rate ◽  
Marginal Zone ◽  
Cell Lymphoma ◽  
Marginal Zone Lymphoma ◽  
Cell Divisions ◽  
Flow Cytometric ◽  
Mantle Cell

Abstract In neoplasms, the presence of chromosomal abnormalities and point mutations is suggestive of genomic instability, but could also be a consequence of selection. While genomic instability may increase the chances that a malignant population acquires adaptive mutations, extremely high mutation rates may not be compatible with cell survival. To investigate the role of genomic instability in lymphoid neoplasms, we have applied a new method for the quantification of the human mutation rate, using the PIG-A gene as a sentinel. PIG-A is essential for the biosynthesis of glycosylphosphatidylinositol (GPI) and is mutated in blood cells of patients with Paroxysmal Nocturnal Hemoglobinuria. A broad range of mutations can produce the GPI (−) phenotype, and because PIG-A is on the X-chromosome, the effect of a single mutation is detectable. Since a host of proteins require GPI for attachment to the cell surface, rare mutants are readily detected by flow cytometry. We have previously shown that PIG-A mutations arise spontaneously in normal donors, and we determined that the mutation rate in normal B cell lines ranges from 2 to 29 per 107 cell divisions. Here we analyzed cell lines derived from: a transformed low grade lymphoma harboring a t(14;18) translocation; a mantle cell lymphoma harboring a t(11;14) translocation; a marginal zone lymphoma; and T cell ALL. Cells were first stained with an antibody specific for CD59 (a representative GPI-linked protein) and pre-existing GPI (−) cells were eliminated from the population by flow cytometric sorting, by gating on the upper 50th percentile of the distribution curve. The collected GPI (+) cells were then returned to culture and the number of cell divisions (d) determined by cell counts. After 3–4 weeks, the frequency (f) of new mutants arising in culture was determined by flow cytometric analysis of a large number of cells (median 2.3 x 106). Cells were stained simultaneously with antibodies specific for at least 3 GPI-linked proteins (e.g. CD48, CD52, CD55, and CD59) as well as a transmembrane protein (e.g. HLA-DR or CD45) to identify live cells. FLAER and proaerolysin-- which bind to GPI-- were used to confirm the phenotype. The frequency of mutants was determined by the number of GPI(−) cells divided by the number of GPI(+) cells analyzed, and the mutation rate (μ) was calculated with the formula μ = f ÷ d. We demonstrated a high mutation rate in 3 out of the 4 cells lines: 1750 x 10−7 (transformed lymphoma), 335 x 10−7 (mantle cell lymphoma), 112 x 10−7 (T cell ALL). Of note, the mutation rate was normal (4 x 10−7) in the marginal zone lymphoma—consistent with this being an indolent neoplasm. These data support the hypothesis that an elevated mutation rate is part and parcel of aggressive neoplasms and demonstrate that a 2-log elevation in this parameter is compatible with cell survival. With this model, it may be possible to predict the development of mutations that confer chemotherapy drug resistance.

Phase 2 study of suberoylanilide hydroxamic acid (SAHA) in relapsed or refractory indolent non-Hodgkin lymphoma: A California Cancer Consortium study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18515-18515 ◽  
Author(s):  
M. Kirschbaum ◽  
J. Zain ◽  
L. Popplewell ◽  
V. Pullarkat ◽  
N. Obadike ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Hydroxamic Acid ◽  
Marginal Zone ◽  
Ct Scanning ◽  
Complete Response ◽  
Marginal Zone Lymphoma ◽  
Clinical Activity ◽  
Rapid Progression ◽  
Non Hodgkin Lymphoma ◽  
Mantle Cell

18515 Background: The indolent (follicular, marginal zone and mantle cell) lymphomas tend to recur with decreasing intervals of remission post standard chemotherapy. Vorinostat (SAHA, Zolinza), an orally administered hydroxamic acid histone deacetylase inhibitor with activity against class I and II deactylases, with preclinical and clinical activity against various forms of lymphoma, is being studied in patients with relapsed or refractory indolent lymphoma. Methods: Patients with relapsed or refractory follicular, marginal zone, or mantle cell lymphoma are eligible. Vorinostat is dosed at 200 mg po twice daily for 14 consecutive days on a 21 day cycle. CT scanning and marrow biopsy is performed after every three cycles. Patients may have received up to four prior chemotherapy regimens including Zevalin or Bexxar; previous transplant is allowed. Results: 15 patients (9 female, 6 male) have been enrolled thus far. Median age is 64 (40- 78) years One patient was found to have coexisting DLBCL and was removed from study. Four patients were taken off study due to progression, three stopped due to toxicity (fatigue in a 73 yo woman who had stable to improved marginal zone lymphoma after 10 cycles, fatigue and atrial fibrillation in a 65 yo man after 7 cycles, diarrhea in a 78 year old woman after 2 cycles). Complete Response (CR) in a patient with follicular lymphoma was attained after 9 cycles, this CR persists now for eight months at the time of abstract submission off therapy. A partial response (PR) was seen in a 40 yo man with lymphoma progression despite multiple rounds of therapy, with rapidly expanding masses just prior to starting vorinostat, the largest of which was 16x12.3 cm. This lesion currently measures 7.2x4.6 cm, with disappearance of many other sites; patient continues on vorinostat. Three of the patients with continued stable disease beyond 9 cycles have marginal zone lymphoma, while the two responders (CR or PR) have follicular lymphoma. A patient with PET resolution and decreases in two of the involved sites stopping after 10 cycles due to fatigue, developed rapid progression three months after stopping vorinostat. Conclusions: Vorinostat demonstrates preliminary activity against follicular and marginal zone lymphoma. No significant financial relationships to disclose.

scholarly journals A clinical analysis of two indolent lymphoma entities: mantle cell lymphoma and marginal zone lymphoma (including the mucosa-associated lymphoid tissue and monocytoid B-cell subcategories): a Southwest Oncology Group study

Blood ◽  
1995 ◽  
Vol 85 (4) ◽  
pp. 1075-1082 ◽  
Author(s):  
RI Fisher ◽  
S Dahlberg ◽  
BN Nathwani ◽  
PM Banks ◽  
TP Miller ◽  
...  
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
Marginal Zone ◽  
Cell Lymphoma ◽  
Marginal Zone Lymphoma ◽  
Indolent Lymphoma ◽  
Free Survival ◽  
Mantle Cell ◽  
Monocytoid B Cell ◽  
Working Formulation

The objectives of this study were (1) to determine the clinical presentation and natural history associated with two newly recognized pathologic entities termed mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL), including the mucosa-associated lymphoid tissue (MALT) and monocytoid B-cell subcategories, and (2) to determine whether these entities differ clinically from the other relatively indolent non- Hodgkin's lymphomas with which they have been previously classified. We reviewed the conventional pathology and clinical course of 376 patients who had no prior therapy; had stage III/IV disease; were classified as Working Formulation categories A, B, C, D, or E; and received cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) on Southwest Oncology Group (SWOG) studies no. 7204, 7426, or 7713. All slides were reviewed by the three pathologists who reached a consensus diagnosis. Age, sex, performance status, bone marrow and/or gastrointestinal involvement, failure-free survival, and overall survival were compared among all the categories. We found that (1) MCL and MZL each represent approximately 10% of stage III or IV patients previously classified as Working Formulation categories A through E and treated with CHOP on SWOG clinical trials; (2) the failure-free survival and overall survival of patients with MZL is the same as that of patients with Working Formulation categories A through E, but the failure-free survival and overall survival of the monocytoid B-cell patients were higher than that of the MALT lymphoma patients (P = .009 and .007, respectively); and (3) the failure-free survival and overall survival of patients with MCL is significantly worse than that of patients with Working Formulation categories A through E (P = .0002 and .0001, respectively). In conclusion, patients with advanced stage MALT lymphomas may have a more aggressive course than previously recognized. Patients with MCL do not have an indolent lymphoma and are candidates for innovative therapy.

scholarly journals 2527. Improving Care for Adolescents Living with HIV: Evaluating the Impact of Case-Based Education

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S878-S879
Author(s):  
Simi Thomas Hurst ◽  
Don Blatherwick
Keyword(s):  
Online Education ◽  
Positive Impact ◽  
Pediatric Hiv ◽  
Evidence Based ◽  
Multiple Choice Questions ◽  
Living With Hiv ◽  
The Impact ◽  
Post Assessment ◽  
Assessment Questions ◽  
Case Based

Abstract Background The CDC estimates that 26% of the approximately 50,000 people newly diagnosed with HIV in 2010 were youth 13 to 24 years of age. Older children and adolescents now comprise the largest population cared for at pediatric HIV clinics. Methods To improve HIV/ID specialists’ ability to develop a comprehensive care strategy for adolescents living with HIV, a CME/ABIM MOC/CE certified, case-based, educational program was developed. A series of multiple-choice questions evaluated the application of evidence-based recommendations. A “test then teach” approach elicited cognitive dissonance, with evidence-based feedback provided following each learner response. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (< 0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; > 0.26 extensive effect). The activity launched on a website dedicated to continuous professional development on November 27, 2018. Data for this initial analysis were collected through February 27, 2019. Results To date, 6,755 HCPs (1,714 physicians; 2,795 nurses; 1,076 pharmacists) have participated in the activity. Data from the subset of HIV/ID specialists (n = 87) who answered all pre-/post-assessment questions during the initial study period were analyzed. Following activity participation, significant improvements were observed in the proportion of HIV/ID specialists who answered all assessment questions correctly (5% pre vs. 68% post; P < 0.0001; V = 0.397). Improvements were also observed in several specific areas of assessment (table). Additionally, 43% of HIV/ID specialists indicated they planned to modify their treatment approach among adolescents as a result of participating in the education. Conclusion Participation in this online, interactive, case-based, educational intervention significantly improved HIV/ID specialists’ ability to develop individualized strategies for adolescents living with HIV. These findings highlight the positive impact of well-designed online education. Disclosures All authors: No reported disclosures.

Survival with splenectomy in splenic marginal zone lymphoma: Analysis of the Surveillance, Epidemiology and End Results (SEER) database.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8044-8044
Author(s):  
Adam J. Olszewski
Keyword(s):  
Propensity Score ◽  
Survival Data ◽  
Marginal Zone ◽  
Relative Survival ◽  
Marginal Zone Lymphoma ◽  
Splenic Marginal Zone Lymphoma ◽  
Primary Therapy ◽  
Seer Database ◽  
The Impact

8044 Background: The role of splenectomy as the primary therapy for splenic marginal zone lymphoma has been questioned. We studied relative survival in SMZL and the impact of splenectomy on lymphoma-specific survival (LSS). Methods: SMZL cases (diagnosed in 1993-2008) were derived from the SEER database. Age, sex and race-matched actuarial survival data were summarized. Factors predictive of splenectomy were studied using logistic regression with a subsequent propensity score (PS)-weighted survival analysis. Results: 1071 patients were identified with a median age of 69 years (range, 25-96) and a median follow up of 33 months. 53% were women and 92% were white. 70% of the lymphomas were stage III/IV with B symptoms recorded in 22.3%. 54% of patients underwent splenectomy. The significant factors predictive of surgery included younger age (p<10-14), stage I/II (p<10-15), B-symptoms (p=0.003), no prior malignancy (p=0.002), with significantly lower rates in black patients (OR 0.41, 95%CI 0.21-0.80, p=0.008), on the Pacific Coast (OR 0.62, 95%CI 0.47-0.81, p=0.0004) and with decreasing rates over time (p=0.0002). The actuarial 5-year relative survival was 82.8% (95%CI 77.9-86.7%) with no difference by sex (p=0.79), race or stage. 54% of deaths were related to SMZL with the estimated LSS of 80.8% (95%CI 78-84%). Splenectomy was not associated with improved LSS in propensity score-stratified log-rank test (p=0.60) or in the PS-weighted Cox model (HR=0.93, 95%CI 0.62-1.38, p=0.70). Advancing age (HR 1.05, 95%CI 1.03-1.07, p<10-8) and presence of B-symptoms (HR=1.98, 95%CI 1.30-3.01, p=0.002) were significantly predictive of death from SMZL, with no evidence of improvement in LSS over the years (HR=0.97, 95%CI=0.91-1.03, p=0.34). There was also no detectable impact of splenectomy on survival in patients who ultimately died of SMZL (p=0.83). Conclusions: In this cohort, the largest studied to date, splenectomy did not demonstrate a survival benefit in SMZL. Patients continue to have decreased survival despite advances in other indolent B-cell lymphomas. The role of splenectomy versus chemoimmunotherapy remains to be determined.

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