scholarly journals Therapeutic Anticoagulation Impacts MR Morphologic Recurrence Patterns in Glioblastoma—A Matched-Pair Analysis

2022 ◽  
Vol 11 (2) ◽  
pp. 422
Author(s):  
Daniel Dubinski ◽  
Sae-Yeon Won ◽  
Bedjan Behmanesh ◽  
Max Dosch ◽  
Viktoria Puchinin ◽  
...  

Background: Glioblastoma (GBM) patients are at particularly high risk for thrombotic complications. In the event of a postoperative pulmonary embolism, therapeutic anticoagulation (tAC) is indispensable. The impact of therapeutic anticoagulation on recurrence pattern in GBM is currently unknown. Methods: We conducted a matched-pair cohort analysis of 57 GBM patients with or without tAC that were matched for age, sex, gross total resection and MGMT methylation status in a ratio of 1:2. Patients’ characteristics and clinical course were evaluated using medical charts. MRI characteristics were evaluated by two independent authors blinded to the AC status. Results: The morphologic MRI appearance in first GBM recurrence showed a significantly higher presence of multifocal, midline crossing and sharp demarcated GBM recurrence patterns in patients with therapeutic tAC compared to the matched control group. Although statistically non-significant, the therapeutic tAC cohort showed increased survival. Conclusion: Therapeutic anticoagulation induced significant morphologic changes in GBM recurrences. The underlying pathophysiology is discussed in this article but remains to be further elucidated.

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii186-ii186
Author(s):  
O’Dell Patrick ◽  
H Nickols ◽  
R LaRocca ◽  
K Sinicrope ◽  
D Sun ◽  
...  

Abstract BACKGROUND Patients who have recurrent glioblastoma have limited treatment options. We conducted a retrospective review of patients with recurrent glioblastoma treated with standard initial radiation and temozolomide with tumor treating fields to investigate whether reirradiation using radiosurgery would be associated with improved outcomes. METHODS We reviewed the records of 54 consecutively treated patients with recurrent glioblastoma with ECOG 0 or 1 at recurrence and conducted Kaplan-Meier analysis with Log-rank testing to determine significance between groups. RESULTS We identified 24 patients who were treated without radiation therapy (control) while 30 patients underwent re-irradiation using radiosurgery (ReSRS) with a median total dose of 25Gy in five fractions. All patients had completed standard initial therapy, and there was no difference in the time to recurrence between the two groups (10 months for control, 15 months for ReSRS, [P = 0.17, HR for progression 0.65 (95% CI 0.38-1.13)]. A larger proportion of patients in the control arm (54%) had subtotal or gross total resection of the recurrence compared with the ReSRS group (44%, P < 0.05). The majority of patients had recurrence confirmed with biopsy (18/22 in control group, 25/31 in the ReSRS group). MGMT methylation status did not differ between control vs ReSRS (29% vs. 27%). ReSRS was associated with improved median survival from the time of first recurrence of 11.6 months versus 3.8 months in the control arm [P< 0.0001, HR for death 0.33 (95% CI 0.18-0.6)]. CONCLUSIONS In a group of patients with high performance status diagnosed with recurrent glioblastoma, reirradiation with stereotactic radiosurgery was associated with nearly one year median survival after recurrence. Additional analyses are warranted to determine the impact of concurrent systemic therapies with irradiation and underlying tumor or patient factors to predict outcomes.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1206-1206
Author(s):  
Satoshi Takahashi ◽  
Jun Ooi ◽  
Nobuhiro Tsukada ◽  
Seiko Kato ◽  
Aki Sato ◽  
...  

Abstract Abstract 1206 Poster Board I-228 [Study purpose] With the increased number of cord blood transplantation (CBT) for adults, more human leukocyte antigen (HLA)-mismatched grafts are selected as alternative donor. In Japan, we have performed more than 5,500 CBT and almost two-third of them has been using 2-loci HLA-mismatched grafts. Slow engraftment and high risk of graft failure should be solved to improve the clinical results. In general, the degree of HLA disparity is known to be associated with risks of poor graft function and of graft-versus-host disease (GVHD). On the other hand, those risks of transplant-related complications are not equivalent even in the donor-recipient pairs who have same number of mismatched HLA antigens. There might be “haplotype matching effect” because novel undetected major histocompatiblility antigen (MHC) resident variation encoded on HLA haplotypes and those mismatching could be responsible for post-transplant risks. In this study, we have analyzed the impact of HLA haplotype matching in HLA-mismatched CBT using the same method in the single institute. [Patients and Methods] We studied the clinical outcomes of 149 consecutive adult patients who received unrelated CBT between August 1998 and June 2009 in the institute of medical Science, University of Tokyo. Patients received previous allogeneic tranplants were excluded from this study. All patients received myeloablative regimens including 12 Gy of total body irradiation, cyclosporine plus short term methotraxate for GVHD prophylaxis and almost the same supportive care. By low-resolution typing method for HLA-A, -B and –DR loci, 9 patients received matched grafts, 46 received 1 antigen-mismatched and 94 received 2 antigens-mismatched grafts in the host-versus-graft (HvG) direction. In the graft-versus-host (GvH) direction, 7 patients received matched grafts, 51 received 1 antigen-mismatched and 91 received 2 antigens-mismatched grafts. When we looked at the maximum number of mismatched antigens for both directions, 38 patients received 1 antigen-mismatched and 111 received 2 antigens-mismatched grafts respectively, but there was no matched pair. Common haplotypes in Japanese population were referred from the 11th International Histocompatibility Workshop and other previous reports. Median numbers of leukocytes and CD34+ progenitor cells before freezing of cord blood grafts were 2.4×107/kg and 0.9×105/kg, respectively. Median follow-up was 39 months. We evaluated the impact of haplotype matching on cumulative incidences of hematopoietic recovery, of GVHD, of relapse and of non-relapse mortality (NRM) using the Pepe and Mori's test. Estimates of overall survival were calculated using the Kaplan-Meier method and analyzed by the log-rank test. [Results] Thirty (11 of 38 one antigen-mismatched and 19 of 111 two antigens-mismatched) among all 149 pairs were defined as the haplotype-matched pairs sharing same haplotypes in both grafts and recipients. The age, sex, cytomegalovirus serological status, diagnosis, risk of the disease at the transplant, numbers of total nucleated cells and CD34+ cells at the cryopreserved were not significantly different between both groups with and without matched haplotypes. Among the 1 antigen-mismatched pairs in the HvG direction, early engraftment of neutrophil after CBT occurred in haplotype-matched group compared with control group (median: 20.5 days versus 23 days, P=0.01). The haplotype matched group had better platelet engraftment in the 1 antigen-mismatched pairs (cumulative incidence on day 120: 86% versus 62%; median: 41 days versus 53 days), but this is not significant (P=0.29). Such correlation between engraftment and haplotype matching was not observed in 2 antigens-mismatched pairs. The cumulative incidences of grades II to IV acute GVHD were not significantly different between haplotype matched and control groups, however, those of grades III and IV in patients with matched-haplotype tended to be lower among 1 antigen-mismatched pairs in GvH direction (P=0.10) and were significantly lower among 2 antigens-mismatched pairs (P=0.02). Those haplotype matching effects were not observed in survival rates, cumulative incidences of relapse and NRM among any HLA mismatched pairs. [Conclusion] Those data suggest that untyped variation carried on the HLA haplotytpe might be better to be matched and the haplotype matching might effect on better engraftment and lower risk of sever acute GVHD after HLA-mismatched CBT. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1762-1762
Author(s):  
ZiYi Lim ◽  
Dragana Milojkovic ◽  
Laurence Pearce ◽  
Michelle Kenyon ◽  
Aloysius Ho ◽  
...  

Abstract The use of IV busulphan (Bu) has reported improved bioavailability with lower variability of plasma levels, and may reduce the incidence of hepatic veno-occlusive disease (HVOD) and lower the transplant related toxicity. We performed a retrospective matched 2:1 case analysis to evaluate the impact of the use of oral vs IV busulphan as part of RIC HSCT on toxicity as well as engraftment. 75 patients received fludarabine (30mg/m2 x 5 days), alemtuzumab (20mg x 5 days) and either oral Bu (4mg/kg x 2 days) (25 patients) or IV Bu (3.2mg/kg x 2 days) (50 patients). 25 patients received IV Bu between Jan 2004 and Jan 2005. Each of these patients was matched for sex, diagnosis, disease stage, donor status and cell source with 2 comparable historical patients receiving oral Bu. There were 42 male and 33 female patients. Median age was 55 years (range:22–72). Median follow-up was 850 days (range: 39–1820) for the oral Bu group and 228 days (range: 38–453) for the IV Bu group. All patients were being treated for myeloid malignancies: AML n=21, MDS/MPD n=45, CML n= 9. There were 33 sibling matched HSCT, 27 matched VUD HSCT and 15 HLA-mismatched VUD HSCT. 63 patients received PBSC and 12 received BM, the median CD34 cell dose was 5.17 x 106/kg (range:1.2–18.5) and 2.49 x 106/kg (range:0.7–4.9) respectively. 28 patients had early disease vs 48 advanced disease (advance disease defined as AML > CR1, CML > CP1, MDS with RAEB or AML with multilineage dysplasia). 5 patients in the oral group and 3 patients in the IV group had a previous allogenic HSCT. No patients had a previous history of hepatic impairment. Median time to neutrophil (>0.5x10^9/kg) and platelet (>20x10^9/kg) regeneration was 12 days and 14 days respectively, with no significant difference between both arms. There was 1 case of primary graft failure and 1 case of HVOD in both arms. Both patients with HVOD had a previous allogeneic HSCT. Myeloid (CD15) engraftment occurred rapidly in both groups with full donor chimerism (>95% donor chimerism) achieved at day+28/day+100/day+180 in 92%/90%/86% IV and 90%/85%/89% oral Bu patients. Lymphoid (CD3) engraftment was delayed in both groups, with full donor chimerism in 28%/26%/37% of IV Bu and 56%/57%/49% of oral Bu patients at day+28/day+100/day+180. 14 patients in the oral Bu group had grade I–III acute graft versus host disease (aGvHD), of which 3 had Gd III aGvHD. In contrast, 4 patients in the IV Bu group developed Gd I–III aGvHD, with 1 patient having Gd III aGvHD. The day +100 treatment related mortality (TRM100) was 8% in both groups. The overall survival (OS), disease free survival (DFS) and relapse incidence at day +200 for the IV vs oral groups was (86% vs 70%, p=0.30), (75% vs 60%, p=0.21), and (18% vs 24%, p=0.36) respectively. In summary, RIC HSCT with both oral and IV busulphan appears to be safe and well tolerated regimen with a low incidence of HVOD and low TRM100. Persisting CD3 mixed donor chimerism is seen in both arms, with a trend to lower incidence of aGvHD with IV Bu (p=0.09) with no significant difference in early relapse, DFS, OS.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2283-2283
Author(s):  
Nadira Durakovic ◽  
Ana Boban ◽  
Mirando Mrsic ◽  
Dubravka Sertic ◽  
Ranka Serventi Seiwerth ◽  
...  

Abstract Infections due to multidrug-resistant (MDR) Gram-negative bacteria have been increasing and they are an important cause of nosocomial morbidity and mortality, especially in immunocompromised patients. In order to determine efficacy and safety of colistin (colistimethate sodium) use in the treatment of MDR Pseudomonas aeruginosa sensitive to colistin, a comparison of renal function, other toxicities, and outcome of therapy was done between a group of patients treated with colistin and patients treated with other antipseudomonas drugs as control group. A group of 26 patients that was hospitalized in our institution between February 2002 and December 2006 and treated with intravenous colistin for an infection caused by MDR P.aeruginosa was compared in a matched-pair analysis to a group of 26 patients treated with other antipseudomonas drugs. Patients were 52% male and 48% female; mean age was 37 years (range 17–63). All of the patients were treated for haematological malignancy, most received intensive chemotherapy regimens (44%), 19% received allogeneic and 31% autologous transplants. Groups of patients did not differ in age, sex, disease, or kind of treatment received. All of the patients in both groups had clinical signs of sepsis; in 69% of patients from colistin group and 84% from control group P.aeruginosa was isolated from blood, and in 27% and 12% it was isolated from skin lesions that had clinical presentation of echtyma gangrenosum, respectively. Patients treated with colistin received 3 MU of colistin every 8 hours for a mean (± SD) duration of 12.5 (± 5.4) days. Due to nature of their disease, and severity of infections, all of the patients received more than two other possibly nephrotoxic drugs; in colistin group 4 other concomitant drugs, on control group 3; most frequently vancomycin, cefepime, amikacine, garamycine and amphotericine B deoxycholate was used. Of 26 patients receiving colistin, 76.9% of patients had the drug discontinued after successful clearance of infection, while in control group 65.4% of patients had the drug discontinued due to same reason. Only one patient had displayed neurological toxicity (Jacksons attack with secondary generalisation), but the drug was not discontinued, dose was modified, patient had no further attacks. There was no statistically significant difference in the level of serum creatinine, creatinine clearance (calculated), or potassium levels between prior to therapy and after treatment discontinuation between groups. One patient treated with colistin developed renal failure and was subjected to continuous venovenous hemodiafiltration; of note is that at the time colistin introduction patient already had impaired renal function. In one patient drug was discontinued due to suspected allergic reaction. No other adverse events of colistin therapy were noted. Colistin is an effective antimicrobial drug for the treatment of severe infections caused by MDR P.aeruginosa in haematological patients. The safety profile observed is acceptable in these severe life-threatening infections, in matched-pair analysis it did not display greater toxicity than other antipseudomonas drugs. Further studies are needed to better address the treatment of MDR P. aeruginosa, naimely the optimal dose and schedule, also route of administration of colistin, as well as drug-to-drug interactions.


2016 ◽  
Vol 117 (6) ◽  
pp. 883-889 ◽  
Author(s):  
Kasper D. Berg ◽  
Frederik B. Thomsen ◽  
Camilla Nerstrøm ◽  
Martin A. Røder ◽  
Peter Iversen ◽  
...  

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 59
Author(s):  
Henryk Haffer ◽  
Luis Becker ◽  
Michael Putzier ◽  
Mats Wiethölter ◽  
Katharina Ziegeler ◽  
...  

Functional spinopelvic parameters are crucial for describing spinal alignment (SA), but this is susceptible to variation. Anatomically fixed pelvic shape is defined by the parameters pelvic radius (PR), pelvic incidence (PI), and sacral table angle (STA). In patients with lumbosacral transitional vertebrae (LSTV), the spinopelvic alignment may be altered by changes of these parameters and influences of SA. There have been no reports studying the relation between LSTV, four (4 LV) and six (6 LV) lumbar vertebrae, and fixed anatomical spinopelvic parameters. A retrospective analysis of 819 abdomen–pelvis CT scans was performed, identifying 53 patients with LSTV. In a matched-pair analysis, we analyzed the influence of LSTV and the subgroups 4 LV (n = 9) and 6 LV (n = 11) on PR, PI, and STA. LSTV were classified according to Castellvi classification. In patients with 6 LV, measurement points at the superior endplates of S1 and S2 were compared. The prevalence of LSTV was 6.5% (53/819), 6 LV was 1.3% (11/819), and 4 LV was 1.1% (9/819) in our study population. PI significantly increased (p < 0.001), STA significantly decreased (p < 0.001), and PR (p = 0.051) did not differ significantly in the LSTV group (n = 53). Similar findings were observed in the 4 LV subgroup, with an increase in PI (p < 0.021), decrease in STA (p < 0.011), and no significant difference in PR (p < 0.678). The same results were obtained in the 6 LV subgroup at measuring point S2 (true S1) PI (p = 0.010), STA (p = 0.004), and PR (p = 0.859), but not at measuring point S1 (true L6). Patients with LSTV, 4 LV, and 6 LV showed significant differences in PI and STA compared to the matched control group. PR showed no significant differences. The altered spinopelvic anatomy in LSTV patients need to be reflected in preoperative planning rebalancing the sagittal SA.


Author(s):  
Ralph Rogers ◽  
Fadi Shehadeh ◽  
Evangelia Mylona ◽  
Josiah Rich ◽  
Marguerite Neill ◽  
...  

Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods A matched cohort analysis of hospitalized patients with severe COVID-19. The impact of CP treatment on all cause in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on the time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. Overall in-hospital mortality was 14.9%. There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 − 2.20). There was also no significant difference in the overall rate of hospital discharge (rate ratio [RR} 1.28, 95% CI 0.91 − 1.81), but a subgroup analysis of patients 65-years-old or greater who received CP demonstrated a significantly increased hospital discharge rate among these patients (RR 1.86, 95% CI 1.03 − 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions The use of CP in this study was a safe treatment for COVID-19. There was no overall significant reduction of in-hospital mortality or increased rate of hospital discharge associated with the use of CP in this study, although there was a signal for improved outcomes among the elderly. Further adequately powered randomized studies should target this subgroup when assessing the efficacy CP treatment.


2000 ◽  
Vol 7 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Tina U. Cohnert ◽  
Frank Oelert ◽  
Thorsten Wahlers ◽  
Bernhard Gohrbandt ◽  
Ajay Chavan ◽  
...  

Purpose: To investigate whether endovascular stent-grafts implanted during the early phase of an aortic endografting program have advantages over conventional surgical procedures for treatment of infrarenal aortic aneurysm (AAA). Methods: In the first months of an endografting program, 37 patients (36 men; mean age 67.9 ± 7.1 years, range 55 to 86) underwent AAA repair with endovascular implantation of a Vanguard (n = 17) or Talent (n = 20) bifurcated stent-graft. Data collected during the perioperative period and in follow-up were compared retrospectively to a matched group of 37 elective surgical patients. Results: All endograft implantations were completed. Two type I and 6 type II endoleaks (21.6%) were seen postoperatively. Five type II sealed without intervention; 1 type I endoleak was corrected with an additional stent, but 1 type I and 1 type II endoleaks persisted despite attempts with coil embolization. Two (5.4%) endograft patients died during the perioperative period; however, this was not significantly different (p = 0.15) from the control group. In the mean follow-up of 12 ± 6 months for both groups, 1 (2.7%) late conversion was necessary at 2 years for aneurysm expansion in an endograft patient with an unsealed type I endoleak. Conclusions: In our learning curve experience with aortic endografting, postoperative morbidity and mortality were higher in endograft patients compared to conventionally treated controls. Only in the endograft group was reoperation required during follow-up. Careful monitoring with periodic imaging studies is mandatory after endoluminal AAA treatment.


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