A Case of Retroperitoneal Synovial Sarcoma in Pregnancy Treated with Antepartum Doxorubicin plus Ifosfamide Chemotherapy

We report a case of a 25-year-old pregnant woman diagnosed with a large, unresectable retroperitoneal synovial sarcoma. Successful neoadjuvant treatment with doxorubicin plus ifosfamide prepartum and continuing postpartum resulted in significant disease response allowing for later tumor resection. Following the first prepartum chemotherapy cycle, a decreased amniotic fluid index was noted, representing a potential complication of chemotherapy. Induction of labor was performed at 33 weeks gestation with excellent outcome in the newborn. This case highlights the complex medical decision-making process in the setting of cancer diagnosed during pregnancy, balancing oncologic and obstetric concerns, and to our knowledge is only the second reported case of synovial sarcoma treated with neoadjuvant cytotoxic chemotherapy in the antepartum period.

Efficacy and safety assessment of prolonged maintenance with subcutaneous rituximab in patients with relapsed or refractory indolent non-Hodgkin lymphoma: results of the Phase III MabCute study

Rituximab plus chemotherapy induction followed by rituximab maintenance for up to 2 years confers long-term progression-free survival (PFS) benefit in patients with indolent non-Hodgkin lymphoma. It is not known whether further prolonged maintenance with rituximab provides additional benefit. The phase III MabCute study enrolled 692 patients with relapsed or refractory indolent non-Hodgkin lymphoma. Patients who responded to induction with rituximab plus chemotherapy and were still responding after up to 2 years’ initial maintenance with subcutaneous rituximab were randomized to extended maintenance with subcutaneous rituximab (n=138) or observation only (n=138). The primary endpoint of investigator-assessed PFS in the randomized population was un-addressed by the end of study because of an insufficient number of events (129 events were needed for 80% power at 5% significance if approximately 330 patients were randomized). In total, there were 46 PFS events, 19 and 27 in the rituximab and observation arms, respectively (P=0.410 by stratified log rank test; hazard ratio 0.76 [95% confidence interval: 0.37–1.53]). Median PFS was not reached in either randomized arm. There were no new safety signals; however, adverse events were seen slightly more frequently with rituximab than with observation during extended maintenance. Maintenance for up to 2 years with rituximab after response to initial induction therefore remains the standard of care in patients with relapsed or refractory indolent non-Hodgkin lymphoma.

Coexistence of blaTEM, blaCTX, blaKPC, blaNDM, blaSIM e blaOXA-48 in polymicrobial bloodstream isolates from a patient with acute myeloid leukemia

Background: Bloodstream infections are among the most frequent and serious complications in patients with haematological malignancies. Case presentation: A patient diagnosed with acute myeloid leukemia was admitted to the hospital for chemotherapy induction, developed several episodes of febrile neutropenia. Had bloodstream infection with at least four strains of Gram-negative bacteria, including Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumanii. The majority showed resistance to ampicillin, cefepime, ceftriaxone, ciprofloxacin and sulfamethoxazole/trimethoprim. blaTEM and blaSIM were detected in P. aeruginosa, blaTEM, blaCTX and blaOXA-48 in E. coli, blaCTX, blaKPC, blaNDM, blaSIM and blaOXA-48 in K. pneumoniae and blaOXA-48 in A. baumannii. Conclusions: The patient was treated with meropenem for 10 days, without progressing from fever episodes, evolved to death.

Von Willebrand Factor:Antigen And Adamts-13 Level, But Not Soluble P-Selectin, Are Risk Factors For The First Asymptomatic Deep Vein Thrombosis In Cancer Patients Undergoing Chemotherapy

METHODS: We measured sP-selectin, vWF:Ag and ADAMTS-13 levels at baseline RESULTS: Forty patients with cancer were included in the study, all were recuited before their first chemotherapy induction. vWF:Ag and ADAMTS-13 were significantly associated with cancer chemotherapy accounting to increased RR for first asymptomatic DVT in the logistic regression model.CONCLUSIONS: Further research is needed to determine whether incorporating vWF:Ag and ADAMTS-13 levels wil find use in everyday clinical practice. Once validated, these results may specify particular cancer patients to be treated with prophylactic anticoagulant.

The Evolving AML Genomic Landscape: Therapeutic Implications

Improved understanding of the genomic and molecular landscape of acute myeloid leukemia (AML) has resulted in a significant evolution of our understanding of AML biology and allows refined prognostication for those receiving standard combination chemotherapy induction. This dramatic increase in knowledge preceded, and was somewhat responsible for, at least some of eight new FDA drug approvals for AML. This review discusses the impact of genomics on clinical care of AML patients and highlights newly approved FDA drugs. Despite these recent clinical advances, however, the outcome for most patients diagnosed with AML remains dire. Thus, we describe here some of the challenges identified with treating AML including off-target toxicity, drug transporters, clonal heterogeneity, and adaptive resistance, and some of the most promising opportunities for improved therapy.

Impact of coadministration of apigenin and bone marrow stromal cells on damaged ovaries due to chemotherapy in rat: An experimental study

Background: Apigenin is a plant-derived flavonoid with antioxidative and antiapoptotic effects. Bone marrow stromal cells (BMSCs) are a type of mesenchymal stem cells (MSCs) that may recover damaged ovaries. It seems that apigenin may promote the differentiation of MSCs. Objective: The aim of this study was to investigate the effect of coadministration of apigenin and BMSCs on the function, structure, and apoptosis of the damaged ovaries after creating a chemotherapy model with cyclophosphamide in rat. Materials and Methods: For chemotherapy induction and ovary destruction, cyclophosphamide was injected intraperitoneally to 40 female Wistar rats (weighing 180–200 gr, 10 wk old) for 14 days. Then, the rats were randomly divided into four groups (n = 10/each): control, apigenin, BMSCs and coadministration of apigenin and BMSCs. Injection of apigenin was performed intraperitoneally and BMSC transplantation was performed locally in the ovaries. The level of anti-mullerian hormone serum by ELISA kit, the number of oocytes by superovulation, the number of ovarian follicles in different stages by H&E staining, and the expression of ovarian Bcl-2 and Bax proteins by western blot were assessed after four wk. Results: The results of serum anti-mullerian hormone level, number of oocytes and follicles, and Bcl-2/Bax expression ratio showed that coadministration of apigenin and BMSCs significantly recovered the ovarian function, structure, and apoptosis compared to the control, BMSC, and apigenin groups (p < 0.001). Conclusion: The results suggest that the effect of coadministration of apigenin and BMSCs is maybe more effective than the effect of their administrations individually on the recovery of damaged ovaries following the chemotherapy with cyclophosphamide in rats. Key words: Apigenin, Bone marrow stromal cells, Chemotherapy, Ovary, Regeneration.

Update in pediatric nasopharyngeal undifferentiated carcinoma

Many of the principles established in adults with undifferentiated nasopharyngeal carcinoma (NPC) apply to children, adolescents and young adults. However, NPC in young patients should be distinguished from the adult form by several points. This review focuses mainly on differences between adult and pediatric NPC. The role of biology and genetics in pediatric NPC is discussed. Systemic treatment modalities including type of chemotherapy induction, timing of treatment, role of immunotherapy as adjuvant treatment, or in relapsing/ metastatic diseases are reported. Radiation modalities (doses, techniques…) in children are also reviewed. Long-term effects including secondary cancers are finally be discussed in this young NPC population.

Effects of COJEC induction on neuroblastoma patient-derived xenografts (PDX).

e21503 Background: Neuroblastoma (NB) is a solid pediatric tumor that causes 15% of childhood cancer deaths. High-risk patients have 50 to 70% mortality after 5 years. Currently, the standard way to treat high risk patients is COJEC induction followed by surgery, chemotherapy with stem cell transplants, irradiation and immunotherapy. This intense treatment has significantly increased overall survival, but mortality is still high, survivors are prone to relapse and treatment resistance is a major clinical problem. COJEC induction consists in the cycled administration of the chemotherapeutics Cisplatin, Vincristine, Etoposide, Cyclophosphamide and Carboplatin. These drugs have been long used in the clinic, but a comprehensive preclinical study combining all of them had not been done. The aim of this project was to establish a PDX model for chemotherapy induction in high-risk NB and investigate tumor characteristics and response upon treatment. Methods: NB cells from previously developed high-risk PDX models were injected subcutaneously in nude mice. When tumors reached an appropriate size, they were treated with either a COJEC-like protocol or single agent induction with high dose cisplatin. After treatment, tumors were analyzed by immunohistochemistry, chromosomal copy number analysis and RNA sequencing. Results: Most mice responded well to COJEC induction and 8/10 tumors were reduced. Within the reduced tumors, 4 were subjected to total resection and relapsed after several weeks, mimicking the clinical situation. Cisplatin treatment alone led to no significant tumor reduction and 6/10 tumors were highly resistant. Thus, as for humans, multidrug induction is more successful in reducing tumor size but presents an uneven response with high relapse rate. The responsive tumors show a higher degree of cellular differentiation when compared to resistant tumors. Cisplatin treated tumors have accumulation of chromosomal aberrations when compared to controls, and subclonal dynamics are enhanced in resistant tumors. Conclusions: We established a PDX model for chemotherapy induction in high-risk NB. The results mimic clinical findings seen in high-risk NB patients. The model is useful to understand the mechanisms of treatment resistance and for the testing of novel therapies against high-risk NB.

COMPARISON OF PERCENTAGE PERIPHERAL BLOOD LYMPHOBLAST PROLIFERATION AND APOPTOSIS IN PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA BEFORE AND AFTER CHEMOTHERAPY INDUCTION PHASE (Perbandingan Persentase Proliferasi dan Apoptosis Limfoblas di Darah Tepi di Pasien Leukemia Limfoblastik Akut Anak Sebelum dan Sesudah Kemoterapi Tahap Induksi)

Leukemia Limfoblastik Akut (LLA) adalah penyakit neoplasma yang dihasilkan dari perpindahan somatik multistep progenitorlimfoid di sumsum tulang, ditandai maturation arrest, proliferasi tidak terkendali seri limfoid serta penumpukan limfoblas di sumsumtulang dan darah tepi. Kelainan terkait aktivitas proliferasi sel berkaitan dengan kendali apoptosis. Penelitian ini bertujuan mengetahuiperbandingan persentase proliferasi dan apoptosis limfoblas di darah tepi pasien LLA anak sebelum dan sesudah kemoterapi tahapinduksi. Subjek penelitian sebesar 12 pasien LLA anak kasus baru yang diperiksa sebelum dan sesudah kemoterapi tahap induksi. Jenispenelitian ini cohort prospektif tanpa pembanding. Pemeriksaan proliferasi limfoblas dilakukan menggunakan spesimen darah tepisedangkan pengecatannya menggunakan reagen PI/RNase. Pemeriksaan apoptosis limfoblas dilakukan menggunakan spesimen darahtepi sedangkan pengecatannya menggunakan reagen FITC Annexin V. Pembacaan proliferasi dan apoptosis limfoblas menggunakan alatBD FACSCallibur dengan metode flow cytometry. Rerata persentase proliferasi dan apoptosis limfoblas sebelum kemoterapi tahap induksi7,84%±7,50 dan 11,50%±8,60 sesudah kemoterapi tahap induksi 3,2%±1,89 dan 13,42%±8,10. Persentase proliferasi limfoblas didarah tepi sesudah pemberian kemoterapi tahap induksi terdapat penurunan bermakna, sedangkan pemeriksaan apoptosis limfoblasdidapatkan peningkatan yang tidak bermakna. Persentase proliferasi limfoblas di darah tepi sesudah kemoterapi tahap induksi terdapatpenurunan bermakna, sehingga dapat dipergunakan sebagai peramal keberhasilan pengobatan pasien LLA anak. Pemeriksaan apoptosislimfoblas tidak terdapat perbedaan bermakna sebelum dan sesudah kemoterapi tahap induksi. Perlu penelitian lebih lanjut untukmenganalisis hasil yang didapat.

MOTHER’S FIRST EXPERIENCE IN ASSISTING CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA WHO IS UNDERGOING CHEMOTHERAPY

Introduction. Acute Limfoblastic Leukemia (ALL) is a malignant disease which mostly found in children. The main treatment of ALL is chemotherapy for a long time, so it affects their mother life as the primary caretaker. This research aimed to explore, understand, and give the meaning of mother’s fi rst experience in assisting children with ALL that was undergoing chemotherapy: the induction phase. Method. This research was a qualitative research by using phenomenological. Six participants were taken by using purposive sampling that participated in interview. In-depthinterviews and fi eld note were used to collect data. The result of the interview was transcribed verbatimly and analyzed by Collaizi method. Results. There was six main themes that found in this research including:1) undergoing emotional response, 2) undergoing physical impaired, 3) seeking information, 4) undergoing a spiritual experience, 5) undergoingan economic burden, and 6) the importance of support. Discussion. It suggests that nurses provided nursing care to mother that assisting the children in chemotherapy at the fi rst time like giving intervention concerned emotional problem, physical, and spiritual. It also gives earlier information for mother about chemotherapy.Keywords: mother’s fi rst experiences, chemotherapy, induction phase, acute lymphoblastic leukemia’s children