Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2637-2637
Author(s):  
Tarec Christoffer El-Galaly ◽  
Martin Hutchings ◽  
Karen Juul Mylam ◽  
Peter de Nully Brown ◽  
Anne Bukh ◽  
...  
Keyword(s):  
Pathological Features ◽  
Newly Diagnosed ◽  
Extranodal Involvement ◽  
Pet Ct ◽  
Extranodal Disease ◽  
Group 3 ◽  
Group 2 ◽  
Lymphatic Organs ◽  
Group 1 ◽  
Skeletal Lesions

Abstract Abstract 2637 Background Hodgkin lymphoma (HL) has traditionally been regarded as a disease primarily affecting the lymphatic organs. The introduction of dual modality [18]F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) may challenge this statement as PET/CT reveals more sites of extranodal disease than CT alone. The aim of this study was to characterize the clinico-pathological and prognostic features of newly diagnosed HL patients with PET/CT-ascertained skeletal involvement. Patients and Methods We performed a retrospective analysis of the pre-therapeutic PET/CT results from newly diagnosed HL patients at four Danish university hospitals. Criteria for inclusion in the study were (a) histologically verified HL, (b) age ≥15 years, and (c) PET/CT-based staging. Clinical information was obtained from the Danish Lymphoma Registry (LYFO) supplemented by review of medical records. Imaging reports were reviewed for extent of disease. Patients were divided into three groups according to their pattern of PET/CT-positivity: HL confined to lymphatic organs (lymph nodes, spleen, thymus, Waldeyer's ring) (group 1); HL with focal skeletal PET/CT lesions as the only extranodal involvement (group 2); HL with any extranodal involvement, including skeletal lesions if other extranodal sites were concurrently involved (group 3). Results A total of 454 patients with newly diagnosed HL were included and the median follow-up time was 34 months (range 1–113). Focal skeletal PET/CT lesions were identified in 82 patients (18%). HL was confined to nodal areas in 336 (74%) patients (group 1). Among the 118 (26%) patients with extranodal disease, 39 had focal skeletal PET/CT lesions as their only extranodal manifestation (group 2), while 79 had involvement of other extranodal sites with or without co-existing skeletal lesions (groups 3). Group 1 patients exhibited the most favorable combination of clinico-pathological features, group 3 patients displayed most adverse combination of clinico-pathological features, whereas group 2 was intermediate (Table). In a 1:1 comparison between group 1 and 2 patients, the latter had significantly lower hemoglobin (Hgb) levels, higher erythrocyte sedimentation rates (ESR) and higher occurrence of B-symptoms. The PFS for group 2 patients was similar to that of group 3 patients (p=0.85), but significantly shorter than that of group 1 patients (p<0.001) (Figure). After adjusting for other risk factors in a multivariate Cox model, the presence of focal skeletal PET/CT lesions remained independently associated with shorter PFS (p=0.009). Conclusions PET/CT-based identification of focal skeletal lesions as the only extranodal involvement in patients with newly diagnosed HL is not uncommon. This group of patients frequently presents with systemic symptoms and elevated ESR. In addition, their PFS is inferior to that of patients with nodal HL, but similar to that of HL patients with other types of extranodal disease. Although rarely histologically verified, these focal skeletal lesions are thus likely to represent extranodal manifestations of HL. Disclosures: Hutchings: Takeda/Millennium: Consultancy.

The Relation Between Epicardial Fat Tissue Thickness and TSH Receptor Antibody in Hyperthyroidism

2018 ◽  
Vol 6 (01) ◽  
pp. 37-40
Author(s):  
Rıza Altunbaş ◽  
Mehmet Eren ◽  
İbrahim Altıparmak ◽  
Hüseyin Karaaslan ◽  
Tevfik Sabuncu
Keyword(s):  
Tsh Receptor ◽  
Newly Diagnosed ◽  
Fat Tissue ◽  
Tissue Thickness ◽  
Receptor Antibody ◽  
Tsh Receptor Antibody ◽  
Epicardial Fat Tissue ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Although hyperthyroidism may be associated with atherosclerosis, its pathogenesis is not well known. TSH receptor antibody (TRAb) has been shown to be responsible for increased orbital fat tissue in Graves ophthalmopathy. Epicardial fat tissue thickness (EFT) has been found to be increased in case of overt hyperthyroidism. In our study, we aimed to investigate if TRAb is associated with the increased EFT in newly diagnosed hyperthyroidism. Methods Twenty six TRAb positive (group 1) and 26 TRAb negative (group 2) newly diagnosed patients with hyperthyroidism, and 26 healthy control subjects (group 3) were enrolled. EFT was measured by the same cardiologist using an echocardiography device. Serum TRAb levels were measured by the radio-receptor assay and levels above 1.75 IU/L were considered as positive. Results There was no difference among groups in terms of age, gender and body mass index. Although there was no significant difference between group 1 and 2, both group 1 (0.38±0.15 cm) and group 2 (0.4±0.17 cm) had significantly higher EFT levels when compared to group 3 (0.25±0.06 cm) (p=0.004 and p=0.001, respectively). However we did not find any correlation between TRAb and EFT levels. Conclusion The results of our study suggested that EFT was increased in hyperthyroidism and this increasing was not dependent of TRAb level. EFT elevation might be depending directly to the cardiovascular effects of hyperthyroidism.

Clinical efficacy of tumor-treating fields for newly diagnosed glioblastoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 2046-2046
Author(s):  
Yang Liu ◽  
Margie Richardson ◽  
Kwanza Warren ◽  
Myla S. Strawderman ◽  
Nimish Mohile ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Survival Rates ◽  
Extent Of Resection ◽  
Newly Diagnosed ◽  
Cox Models ◽  
Tumor Treating Fields ◽  
Group 3 ◽  
Group 2 ◽  
Group 1 ◽  
Group Comparisons

2046 Background: Recent clinical trials have shown that adding tumor treating fields (TTF) to the Stupp protocol (SP) has increased survival after glioblastoma (GBM) diagnosis. However, whether this regimen improves population-based survival for patients with GBM remains unknown. Methods: We retrospectively identified adult patients with newly diagnosed GBM treated at our institution from January 2000 to July 2017 (n = 438, median age: 63 years).We grouped patients into three time periods for comparison: 2000-2004 (group 1, prior to SP), 2005-2013 (group 2, SP) and 2014-2017 (group 3, adding TTF to SP). The Kaplan-Meier method was used to estimate survival. Statistical analysis included unadjusted group comparisons by Chi-square and Log-rank tests and adjusted group comparisons using logistic and Cox models. Results: Thirty-seven percent (43/117) of patients with GBM in group 3 received TTF with SP therapy; when compared to those who received SP only, these patients had significant improvements in 6-month and 1-year overall survival (OS) rates (100.0% vs. 82.4%, p < 0.01; 86.0% vs. 66.2%, p < 0.05, respectively) (unadjusted for prognostic factors including sex, age, KPS and extent of resection) and an increased trend of median OS (479.0 vs. 448 days, p = 0.269). However, after adjusting for those prognostic factors, we didn’t find a statistically better survival for patients treated with TTF (OR: 6.156, p = 0.097, OR: 2.102, p = 0.185, respectively). Furthermore, multivariate Cox proportion hazards model after adjusting for those prognostic factors showed no significant survival benefits for patients treated with TTF and SP compared to those treated with SP only (HR = 0.797, p = 0.648). In addition, we didn’t find significant increases of 6-month, 1-year survival rates and median OS for patients in group 3 when compared to those in group 2 who had seen increased trends of survival trends when compared to those in group 1. Conclusions: Although adding TTF to SP appeared to benefit patients with GBM, this effect might be due to selection bias, e.g., TTF was offered to those patients with better prognostic factors. Ascertaining the long-term benefits of TTF requires further investigation.

Molecular Imaging in the selection and evaluation of response in patients treated with Radium-223 in six different solid tumors: A single center experience

2020 ◽  
Author(s):  
SEVASTIAN MEDINA-ORNELAS ◽  
FRANCISCO OSVALDO GARCIA-PEREZ ◽  
MIGUEL Alvarez-Avitia ◽  
NORA SOBREVILLA-MORENO ◽  
ZAEL SANTANA-RIOS ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Solid Tumors ◽  
Tumor Burden ◽  
Response To Treatment ◽  
Radium 223 ◽  
Pet Ct ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Objective: Evaluate impact after 223 Ra therapy and 18 F-NaF (sodium fluoride) PET/CT in the selection and evaluation of response in patients treated with 223 Ra in six different solid tumors. Material and Methods: Twenty patients with metastatic castration-resistant prostate cancer (mCRPC), seven metastatic castration-sensitive prostate cancer (mCSPC), three osteosarcoma, two breast cancer, two non-small cell lung cancer (NSCLC), one chondrosarcoma, one chordoma and one patient lung neuroendocrine carcinoma. Three groups of study were defined according total skeletal tumor-burden obtained by 18 F-NaF PET/CT, group 1 <1000cm 3 , group 2 1001–2999cm 3 and group 3 >3000cm 3 VOI´s. A semi-quantitative comparison was performed measuring the SUVmax values of VOIs values in all bone metastases in each patient previous to receive the first cycle of 223 Ra, after 3 and 6 cycles. Results: 30 patients non-progress disease was documented after 24±4 weeks. 8 patients progress disease was presented after three cycles of 223 Ra, two patients with osteosarcoma, four patients with mCRPC, one patient with chondrosarcoma and one patient with NSCLC. Group 1 patients showed better response rates compared to group 3 (p<0.05). Group 2 patients who showed improvement clinical and radiological, had prostate malignancies compared to those in the same group, but non-prostatic malignancies (p<0.05). No significant difference in group 2 patients compared to group 3 (p<0.67). Symptomatic skeletal-related event was observed in 7 patients. Conclusion: 18 F-NaF PET/CT allows to identify patients who show osteoblastic bone activity and discard or confirm progression in the interval PET/CT image, allowing change of treatment, reducing costs. High tumor-burden strongly suggests a poor response to treatment

Incidence, Clinical Features and Outcome of Patients with Differentiation Syndrome in Acute Promyelocytic Leukemia Treated with All-Trans Retinoic Acid (ATRA) Alone Versus ATRA Plus Idarubicin Versus ATRA Plus Arsenic Trioxide.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1044-1044
Author(s):  
Sameer A Parikh ◽  
Hagop Kantarjian ◽  
Farhad Ravandi ◽  
Gautam Borthakur ◽  
Stefan Faderl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Gain ◽  
Promyelocytic Leukemia ◽  
Newly Diagnosed ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Group 3 ◽  
Frontline Therapy ◽  
Group 2 ◽  
Group 1

Abstract Abstract 1044 Poster Board I-66 Background: Differentiation Syndrome (DS) in patients (pts) with acute promyelocytic leukemia (APL) remains a source of significant morbidity and mortality. DS is reported in 2-27% of pts with newly diagnosed APL treated with all-trans retinoic acid (ATRA) alone or in combination with idarubicin (IDA). More recently, arsenic trioxide (ATO) has been used in combination with ATRA as frontline therapy to improve rates of complete remission (CR) and overall survival (OS). It has been postulated that with the use of ATO, the risk of DS may decrease. Aim To describe the incidence, characteristics and outcome of differentiation syndrome with various modalities of ATRA-based therapy used for APL. Methods: We reviewed the records of 167 pts with newly diagnosed APL treated at our institution from 1992-2009 with three regimens: ATRA + IDA (Group 1), liposomal ATRA (Group 2) and ATRA plus ATO (Group 3). Patients in Group 1 (n=52; 1992-1997) received induction with ATRA 45mg/m2 orally daily in two divided doses until CR and IDA 12mg/m2 IV daily for 4 days. Group 2 (n=34; 1997-2000) received liposomal ATRA at 90mg/m2 IV every other day until CR. Patients in Group3 (n=82; 2002-2009) received 45mg/m2 ATRA orally daily in two divided doses, 9mg/m2 gemtuzumab ozogamicin if the WBC count exceeded 30 ×109/L in the first 4 weeks of therapy, ATO 0.15mg/kg/day IV starting on day 10 in 47 patients and on day 1 in 35 patients, and methylprednisolone (50 mg daily for 5 days) to prevent DS. A diagnosis of DS was made by the presence of: dyspnea, unexplained fever, weight gain, peripheral edema, unexplained hypotension, acute renal failure or congestive heart failure, and particularly by a chest radiograph demonstrating interstitial pulmonary infiltrates, or pleuropericardial effusion [Sanz MA, Blood. 2009;113(9):1875-91].Patients with ≥4 features were classified as having severe DS and those with ≤3 mild DS. No single sign or symptom was considered sufficient for diagnosis of DS. Patients with a final diagnosis of pneumonia, sepsis, diffuse alveolar hemorrhage and decompensated heart failure were not considered to have DS. Patients who developed DS ≤7 days of starting therapy with ATRA were classified as “early DS” and others as having “late DS”. Results: Forty one patients (24%) were diagnosed with DS: 14 (27%) in Group 1, 12 (35%) in Group 2, and 15 (18%) in Group 3. Baseline characteristics of patients with DS in each group are shown in Table. Dyspnea, weight gain and pulmonary infiltrates were the most common features of DS in all groups. The median number of days to develop DS after starting ATRA was 3 (1-15) in Group 1, 5 (2-18) in Group 2 and 10 (1-18) in Group 3. ATRA was held in 8 pts (57%) in Group 1, 9 pts (75%) in Group 2, and 8 pts (53%) in Group 3. Intravenous corticosteroids were used for treatment of all patients with DS. CR was achieved in 7 (50%) pts in group 1, 10 (83%) in Group 2 and 14 (93%) in Group 3. The number of patients who died during induction therapy was 6, 2 and 1 in Groups 1, 2 and 3 respectively. There were no deaths directly attributable to DS in any groups. Three-year survival was 65% for pts with DS and 83% for those without DS (p-value: 0.07). Conclusion: The incidence of DS is higher when ATRA alone is used as frontline therapy for APL. With ATRA + ATO (and prophylaxis with corticosteroids) there is a trend for decreased frequency and more delayed occurrence of DS. The severity of DS appears lower for patients not receiving chemotherapy with ATRA. With adequate management, a diagnosis of DS during induction therapy for APL does not influence outcomes independent of therapy. Disclosures: Ravandi: Cephalon: Consultancy, Honoraria.

Combined Ayurveda and Yoga Practices for Newly Diagnosed Type 2 Diabetes Mellitus: A Controlled Trial

2017 ◽  
Vol 25 (1) ◽  
pp. 16-23
Author(s):  
Purnima Datey ◽  
Alex Hankey ◽  
H.R. Nagendra
Keyword(s):  
Type 2 Diabetes ◽  
Blood Sugar ◽  
Controlled Trial ◽  
Newly Diagnosed ◽  
Post Intervention ◽  
Group 3 ◽  
Group 2 ◽  
Male Prisoners ◽  
Group 1

Background: The increasing prevalence of type 2 diabetes in India is a cause for national concern, particularly the spiraling cost burden to the country. As one approach to stop its increase, Yoga medicine has been widely implemented, finding popularity with all social strata. Here, we report a study suggesting that treatment with fresh herbal juices and Yoga can improve the levels of blood glucose and hemoglobin A1c (HbA1c) in people with pre-diabetes. Methods: Study design: 3-arm controlled trial 3 months in duration. Participants: 157 male prisoners with newly diagnosed, high fasting blood sugar (FBS) and postprandial blood sugar (PPBS) levels. Group interventions: (1) Rasahara and Yoga, (2) Yoga, (3) no intervention. Assessments: FBS and PPBS levels were measured every 2 weeks; HbA1c and blood lipids were determined pre- and post-intervention. Results: Significant decreases occurred in the FBS (-21.13 ± 21.16 mg/dl) and PPBS levels (-15.02 ± 14.89 mg/dl) in group 1 (both p < 0.0001) and in the FBS level (20.62 ± 32.68 mg/dl) in group 2 (p = 0.0005), while the increases in group 3 attained significance only for the PPBS level (9.62 ± 21.83 mg/dl) (p = 0.0022). Observed changes in HbA1c were: group 1, -0.044 ± 0.059 mg/dl; group 2, +0.024 ± 0.456 mg/dl (not significant); and group 3, +0.365 ± 0.369 mg/dl (p < 0.0001). Conclusions: This study of Yoga for the treatment of diabetes shows that all male prisoners could benefit from the Yoga prison programs. Addition of Yoga programs to state and federal activities at all levels is now national policy in India. Follow-up studies should be carried out to obtain more robust results.

scholarly journals The Risk of Bladder Cancer in Type 2 Diabetes Mellitus with Combination Therapy of SGLT-2 Inhibitors and Pioglitazone

2021 ◽  
Vol 11 (9) ◽  
pp. 828
Author(s):  
Yan-Rong Li ◽  
Chi-Hung Liu ◽  
Wei-Chiao Sun ◽  
Pei-Yi Fan ◽  
Feng-Hsuan Liu ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Combination Therapy ◽  
Reference Group ◽  
Newly Diagnosed ◽  
Group 4 ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Either sodium-glucose cotransporter-2 (SGLT-2) inhibitors or pioglitazone (Pio) has doubtful issues of bladder cancer, especially for the combination therapy with these two drugs. Our study aimed to investigate the risk of bladder cancer under combination therapy of SGLT-2 inhibitors and Pio. Materials and Methods: We included 97,024 patients with type 2 diabetes mellitus (T2DM) in the Chang Gung Research Database in Taiwan from 1 January 2016 to 31 December 2019. The primary outcome was newly diagnosed bladder cancer after combination therapy with SGLT-2 inhibitors and Pio. Group 1 received both study drugs, group 2 received SGLT-2 inhibitors, group 3 received Pio, and group 4 received non-study drugs (the reference group). The secondary outcome in each group was all-cause mortality. Results: In group 1, no newly diagnosed bladder cancer was detected after a mean 2.8-year follow-up and all-cause mortality decreased significantly (adjusted hazard ratio (AHR), 0.70; 95% confidence interval (CI), 0.54–0.92) in comparison to the reference group (group 4). In group 2 and group 3, no trend of increased bladder cancer was observed (group 2: AHR 0.49, 95% CI 0.05–4.94; group 3: AHR 0.48, 95% CI 0.15–1.58) and it still reduced all-cause mortality (group 2: AHR 0.83, 95% CI 0.70–0.99; group 3: AHR 0.90, 95% CI 0.83–0.99). Conclusions: In T2DM patients without previous or active bladder cancer, the combination therapy of SGLT-2 inhibitors and Pio was not associated with newly diagnosed bladder cancer and had lower all-cause mortality.

The fluciclovine (FACBC) PET/CT site-directed therapy of oligometastatic prostate cancer (Flu-BLAST-PC) trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS5099-TPS5099
Author(s):  
Risa Liang Wong ◽  
Sarah K Holt ◽  
Jing Zeng ◽  
Laura Graham ◽  
Rachel Kang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
The United States ◽  
Abiraterone Acetate ◽  
Ct Imaging ◽  
Definitive Treatment ◽  
Pet Ct ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

TPS5099 Background: Patients with biochemical recurrence (BCR) after local definitive therapy for prostate cancer (PC) represent the largest group of patients alive with PC in the United States. For patients with BCR after both radical prostatectomy and radiation, no further definitive treatment options currently exist as standard of care. FACBC PET/CT is a next-generation imaging modality approved in 2016 for suspected PC recurrence based on elevated PSA levels following prior treatment. FACBC PET/CT allows for earlier detection at lower PSA levels of oligometastatic PC in patients who would otherwise be considered as having micro-metastatic disease. FACBC PET/CT may provide potential targets for site-directed therapy; however, it is unknown whether this approach leads to improvement in clinically relevant outcomes. Methods: Flu-BLAST-PC (ClinicalTrials.gov Identifier: NCT0417543) is a prospective, interventional study enrolling men with PC and BCR who have previously undergone both radical prostatectomy and adjuvant or salvage radiation to the prostatic fossa, with PSA ≥0.5 to < 10 ng/mL, PSA doubling time > 3 to < 18 months, and no radiographically detectable metastases by conventional CT and bone scan imaging. Enrolled patients undergo FACBC PET/CT imaging, and those with no PC metastases detected (Group 1) undergo observation with repeat FACBC PET/CT performed at PSA thresholds of > 2 and > 5 ng/mL, with eligibility for the trial ending at PSA ≥10 ng/mL if FACBC PET/CT remains negative. Those with 1-3 PC regions (defined as radiation fields) detected on FACBC PET/CT (Group 2) undergo site-directed therapy with surgery (e.g. lymphadenectomy) and/or radiation, as well as six months of systemic treatment with androgen deprivation therapy (ADT) and abiraterone acetate with prednisone. Patients with ≥4 PC regions detected on FACBC PET/CT (Group 3) undergo six months of ADT and abiraterone acetate with prednisone without any site-directed therapy. Patients initially in Group 1 who subsequently have PC metastases detected on repeat FACBC PET/CT imaging per protocol join Group 2 or Group 3 based on the number of PC regions involved. Given the long anticipated survival of patients with PC and BCR, the primary endpoint of the study is undetectable PSA ( < 0.2 ng/mL) rate in Group 2 at two years beyond study treatment, with secondary endpoints including the same outcome measure for Group 3, undetectable PSA rate two years after testosterone recovery from ADT in Groups 2 and 3, time to re-initiation of ADT, overall survival, and safety and tolerability. Assuming a null hypothesis of 15% undetectable PSA rate for patients with BCR two years after completing ADT and alternative hypothesis of improvement to 40% in Group 2, planned enrollment is 65 patients in Group 2. This will provide 90% power at the two-sided significance level of 0.05. Five patients have enrolled to date. Clinical trial information: NCT0417543.

Phase 2, open-label study of pembrolizumab in children and young adults with newly diagnosed classical Hodgkin lymphoma (cHL) with slow early response (SER) to frontline chemotherapy: KEYNOTE-667.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS7567-TPS7567
Author(s):  
Christine Mauz-Körholz ◽  
Kara M. Kelly ◽  
Frank G. Keller ◽  
Rod Ramchandren ◽  
Akash Nahar ◽  
...  
Keyword(s):  
Young Adults ◽  
Risk Group ◽  
Response Assessment ◽  
Early Response ◽  
Phase 2 ◽  
Newly Diagnosed ◽  
Deauville Score ◽  
Pet Ct ◽  
Group 2 ◽  
Group 1

TPS7567 Background: High risk for relapse is observed in cHL patients (pts) with SER to initial chemotherapy and organ toxicities may be higher following dose intensification. Methods: The phase 2 KEYNOTE-667 study will enroll 440 pts aged 3 to 17 (children) or 18 to 25 years (young adults) with newly diagnosed, confirmed stage IA, IB, or IIA cHL without bulky disease (Group 1 [low-risk]) or stage IIEB, IIIEA, IIIEB, IIIB, IVA, or IVB cHL (Group 2 [high-risk]); measurable disease; and performance status per Lansky Play-Performance Scale ≥50 (age ≤16 years) or Karnofsky score ≥50 (age >16 years). Pts will receive induction with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD; Group 1) or vincristine, etoposide/etoposide phosphate, prednisone/prednisolone, doxorubicin (OEPA; Group 2) for 2 cycles, then early response assessment by PET/CT/MRI. Pts with rapid early response (Deauville score 1-3) will receive standard therapy. Pts with SER (Deauville score 4-5) will receive consolidation with pembro 2 mg/kg Q3W up to 200 mg (children) or 200 mg Q3W (young adults) plus 2 cycles AVD (Group 1) or 4 cycles cyclophosphamide, vincristine, prednisone/prednisolone, dacarbazine (COPDAC-28; Group 2). PET/CT for late response assessment (LRA) will be performed after consolidation. After LRA, Group 1 pts with SER and Group 2 pts with Deauville score 4-5 will receive radiotherapy (RT). All pts will receive maintenance with pembro Q3W concomitantly with RT. Pembro will continue up to 17 administrations, with an option to stop after 24 weeks due to CR, or until progression, unacceptable toxicity, or withdrawal. The primary endpoint is ORR per Cheson 2007 IWG criteria by group in SER pts. Secondary endpoints are SERs with PET negativity after consolidation, 2-yr event-free survival (EFS), OS, and RT frequency and details by group, RERs with PET negativity after ABVD induction, 3-yr EFS by investigator, and OS by risk group, and serum TARC levels at screening in SERs by risk group. ORR with 95% CI will be estimated by Clopper-Pearson method. EFS and OS will be estimated by Kaplan-Meier method. Safety will be assessed in all treated pts. Clinical trial information: NCT03407144.

scholarly journals P115 Quantitative MRI of muscles is different in rheumatoid arthritis patients compared to healthy controls

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Matthew Farrow ◽  
John Biglands ◽  
Steven Tanner ◽  
Elizabeth Hensor ◽  
Maya Buch ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Grip Strength ◽  
Muscle Volume ◽  
Quantitative Mri ◽  
Muscle Pathology ◽  
Healthy Controls ◽  
Newly Diagnosed ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Rheumatoid arthritis (RA) can present with the loss of muscle mass and a decrease in strength and functional capability. Quantitative MRI offers a non-invasive measurement of muscle status which could improve the understanding of muscle pathology in RA. The purpose of this study was to assess whether MRI-based measurements of T2, fat fraction (FF), diffusion tensor imaging and muscle volume can detect differences between the muscles of RA patients and healthy controls in the thigh; and to assess how different stages of the disease present differently. Methods 39 RA patients were recruited, comprised of 3 groups: 13 newly diagnosed treatment naïve (Group 1 - New RA: 10/13 female, mean age 63 years, mean CRP 31.5, mean EMS 71 minutes), 13 in clinical remission DAS28 &lt;2.6 for at least 1 year (Group 2 - Remission RA: 10/13 female, mean age 67 years, mean CRP 12.1, mean disease 74 months, mean EMS 2 minutes), 13 RA with at least 1 year diagnosis, DAS28 &gt;3.2 ± raised CRP/ESR ± DMARD/targeted therapy escalation ± requiring steroid therapy (Group 3 - Resistant RA: 10/13 female, mean age 65, mean CRP 17.4, mean disease 123 months, mean EMS 63 minutes). 13 healthy controls were also recruited. All 4 groups were age and gender matched. MRI of the dominant thigh was performed using a STEAM-EPI imaging sequence to assess diffusion: mean diffusivity (MD) and fractional anisotropy (FA), 2-point Dixon imaging to assess FF and a fat-suppressed turbo-spin echo sequence to measure T2. All participants had knee extension/flexion and grip strength torque measured using isokinetic dynamometer. Results A one-way ANOVA analysis demonstrated significant differences in T2, FF and muscle volume between RA patients and healthy controls, but no difference in MD or FA. There was no significant difference between the RA groups. T2 and FF were higher in RA patients whilst muscle volume was lower. Muscle volume was significantly correlated with early morning stiffness (rs = 0.4, p = 0.001), DAS28 (rs = 0.4, p = 0.001) and grip strength (rs = 0.5, p &lt; 0.001). All RA patients showed weaker strength compared to the healthy controls. Although the patients in remission (group 2) had better results compared to New (group 1) and Resistant RA patients (group 3), they performed worse than the healthy controls in all strength assessments. Conclusion Quantitative MRI can detect changes in the muscles of RA patients, whether they are newly diagnosed, in remission or with persistently active disease. Difference in T2, FF and muscle volume were apparent even at diagnosis, suggesting muscle changes in RA occur early. Despite effective RA therapy, patients in remission show worse MRI parameters and strength compared to healthy individuals. These warrant attention in improving the muscle strength and quality throughout the spectrum of the RA continuum. Disclosures M. Farrow: None. J. Biglands: None. S. Tanner: None. E. Hensor: None. M. Buch: None. P. Emery: None. A. Tan: None.

Prognostic Impact of Extranodal Diffuse Large B-Cell Lymphoma in the Era of Immunochemotherapy and PET/CT Staging

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1630-1630
Author(s):  
Tarec Christoffer El-Galaly ◽  
Diego Villa ◽  
Musa Alzahrani ◽  
Jakob Werner Hansen ◽  
Laurie H. Sehn ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cox Regression ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Newly Diagnosed ◽  
Extranodal Involvement ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Extranodal Disease ◽  
Large B Cell

Abstract Background: Extranodal disease is common in diffuse large B-cell lymphoma (DLBCL), and involvement of more than one extranodal site is associated with a worse outcome. 18F-fluorodeoxyglucose PET/CT (PET/CT) is the current state-of-the-art for staging of DLBCL, and has shown to be much more sensitive for the detection of extranodal involvement than a stand-alone CT scan. Therefore, a re-evaluation of the clinical significance of extranodal disease among PET/CT staged DLBCL patients is warranted. Patients and Methods: We retrospectively included patients from Aalborg (2007-2012), Copenhagen (2009-2012), and British Columbia (2011-2012) in the present study. The inclusion criteria were, i) newly diagnosed DLBCL, ii) R-CHOP or R-CHOP like first-line treatment, and iii) PET/CT staging. The written PET/CT files were reviewed for disease stage and extranodal sites of involvement. The relationship between number of involved sites, extranodal locations and outcome were assessed with simple Cox regression analyses. Extranodal locations with p<0.1 in univariate analysis were entered in a multivariable Cox regression analysis together with the following International Prognostic Index (IPI) factors: age > 60 years, elevated LDH, ECOG performance score >1. Results: A total of 444 patients with a median age of 65 years (range 16-90) and a male:female ratio of 1.3 were included in the study. Of these patients 28% (n=98) had Ann Arbor stage I disease, 16% (n=72) stage II disease, 16% (n=71) stage III disease, and 46% stage IV disease (n= 203). LDH was elevated in 51% (n=224), and 17% (n=74) had ECOG performance status >1. B-symptoms were present in 37% (n=164) and 26% (n=114) had a bulky mass =/> 10 cm. With a median follow-up of 2.4 years (range 0.5-6.5) in patients still alive at the time of analysis, the 3-year OS and PFS were 73% and 69%, respectively. Extranodal disease was diagnosed in 286 (64%) of the patients. The anatomic locations of extranodal disease and their relations to outcome are shown in Table I. Figure 1A and B show the PFS and OS curves when patients are grouped according to the number of involved extranodal sites. Patients with one or two extranodal sites of involvement had similar outcome (3-year PFS 68% vs. 70%), whereas all patients with involvement of more than three extranodal sites progressed. Conclusions: Extranodal involvement is diagnosed in more than half of all newly diagnosed DLBCL patients staged with PET/CT. Bone/bone marrow involvement was the most common site and associated with a worse outcome. Thus, detection of these lesions with PET/CT is clinically important. The presence of extranodal disease is generally associated with a worse outcome, but our data suggest that the optimal cut-off for prognostication in PET/CT staged patients may be more than two sites rather than more than one site, as according to the IPI. Abstract 1630 Table1: Extranodal DLBCL and their relationship with outcome in PET/CT staged patients treated with R-CHOP. Empty boxes represent variables not included in multivariate models. Site Frequency, n (%) HR, univariate HR, multivariate PFS OS PFS OS Lung 33 (7%) 1.56, p=0.002 1.46, p=0.26 Not significant Liver 34 (8%) 2.39, p=0.001 2.43, p=0.002 Not significant Not significant Bone/bone marrow (PET/CT) 127 (29%) 2.49, p<0.001 2.53, p<0.001 1.77, p=0.007 1.66, p=0.03 Bone marrow indolent NHL (biopsy) 28 (6%) 0.86, p=0.70 0.94, p=0.87 Bone marrow DLBCL (biopsy) 43 (10%) 2.55, p<0.001 2.66, p<0.001 Not significant Not significant Gastrointestinal 35 (8%) 1.27, p=0.43 1.02, p=0.96 Kidney 13 (3%) 2.10, p=0.06 1.63, p=0.29 Not significant Soft tissue and muscle 46 (10%) 1.18, p=0.58 1.17, p=0.64 Paranasal sinus 15 (3%) 1.57, p=0.28 1.69, p=0.25 Pleural fluid 16 (4%) 2.82, p=0.005 3.23, p=0.003 2.43, p=0.02 2.53, p=0.02 Testicular 13/252 (5%) 2.42, p=0.22 1.81, p=0.41 Female genitals 10/192 (5%) 3.38, p=0.006 3.76, p=0.003 Figure 1A and B: PFS (Figure 1A) and OS (Figure 1B) in patients grouped according to the number of extranodal sites involved: zero (blue), 1 (green), 2 (grey), 3 (purple), >4 (red). Figure 1A and B:. PFS (Figure 1A) and OS (Figure 1B) in patients grouped according to the number of extranodal sites involved: zero (blue), 1 (green), 2 (grey), 3 (purple), >4 (red). Disclosures No relevant conflicts of interest to declare.

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