Waldenström macroglobulinemia (WM) is a rare lymphoplasmacytic lymphoma which may predispose individuals to development of secondary malignancies (SMs). The Surveillance, Epidemiology, and End Results (SEER) database is a comprehensive registry of cancer patients in the United States reporting on a wide set of demographic variables. Using the SEER-18 dataset, analyzing patients from 2000 to 2018, we aimed to assess the incidence of SMs in WM patients. Patient characteristics such as gender, age, race, and latency were identified, and respective standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated to compare to the general population. Of the 4,112 eligible WM patients identified, SMs were reported in 699 (17%) patients. The overall risk of developing SM, second primary malignancy, and secondary hematological malignancy was significantly higher in WM patients compared to the general population. Our findings show that WM patients had a 53% higher risk of SMs relative to the general population, and an AER of 102.69 per 10,000. Although the exact mechanism is unclear, the risk of SM development may be due to genetic predisposition, immune dysregulation, or treatment-induced immune suppression.

PurposeTo investigate the benefits of cochlear implantation in adults with single-sided deafness (SSD) and asymmetric hearing loss (AHL). Study designProspective within-subjects repeated-measures. SettingTwo tertiary cochlear implant centers. PatientsFourteen adults with severe-to-profound sensorineural hearing loss in the worse hearing ear and up to moderate SNHL in the better hearing ear. InterventionCochlear implantation in the worse hearing ear. Main outcome measuresConsonant-nucleus-consonant (CNC) test, AzBio sentence test in noise, and lateralization testing were conducted preoperatively and at 3-, 6-, and 12-months post-activation. Patient-related outcomes were measured using the Speech, Spatial, and Qualities of Hearing Scale and Glasgow Benefit Inventory. Tinnitus Handicap Inventory was administered to subjects with tinnitus. ResultsMean length of hearing loss in the worse hearing ear was 3.5 years. The mean CNC change scores from baseline were 54.8, 55.9, and 58.9 percentage points at 3-, 6-, and 12-months (p < 0.001). AzBio sentence test in noise demonstrated improved scores in all spatial configurations, although statistically significant in S0N0 (speech front, noise front) only. Lateralization testing showed significant improvement of 22.9, 24.5, and 24.0 percentage points at 3-, 6-, and 12 months post-activation (p = 0.002). All patient-related outcome measures revealed significant improvement. ConclusionThis study demonstrates improved speech perception in noise, sound lateralization, quality of life, and reduction in tinnitus perception in adults with SSD/AHL who undergo cochlear implantation. Our results add to the growing body of evidence that cochlear implant should be offered to this population.

To evaluate the impact of Transcendental Meditation® (TM®) practice on the multidimensional well-being of nurse clinicians affected by the COVID-19 pandemic. The health of clinical nurses has substantial impact on both the availability of a nursing workforce and the quality and safety of patient care. TM improved health and coping strategies across many populations. Clinical nurses were recruited from 3 Magnet®-designated hospitals during the COVID-19 pandemic. Well-being outcomes included flourishing, burnout, anxiety, and posttraumatic stress disorder. Participants were randomized following completion of baseline surveys into immediate (intervention) or delayed (control) TM instruction. Surveys were repeated at 1 and 3 months following baseline survey or TM instruction. Repeated-measures analysis of variance compared differences in groups over time. Across the 3 sites, there were 104 clinical nurse participants. Repeated-measures analysis of variance showed significant medium to large effects in improvement over time in well-being measures for the intervention group. TM improved multidimensional well-being of clinical nurses by reducing posttraumatic stress disorder, anxiety, and burnout and improving flourishing. TM is easy to practice anywhere. The benefits are immediate and cumulative. Organizations and individual nurses can use TM to support clinical nurses in the difficult and meaningful work of patient care, especially in challenging times. Future studies may consider the feasibility of integrating TM into clinical shifts and evaluating its impact on patient and organizational outcomes.

Molecular-targeted agents such as lenvatinib and sorafenib have been approved to treat hepatocellular carcinoma (HCC). However, the choice between these two agents in the primary treatment for advanced HCC is still under debate with conflicting results. We sought to evaluate the efficacy of lenvatinib and sorafenib in patients with HCC. We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until February 10, 2023. The primary outcome of this meta-analysis was overall survival (OS). The secondary outcomes were progression-free survival (PFS), time to progression, objective response rate (ORR), and disease control rate (DCR). A total of 13 studies with 3705 patients (1635 on lenvatinib and 2070 on sorafenib) were included in our analysis. The mean age of the patients in both groups was comparable (66.81 vs 65.9 years). Pooled analysis of primary outcomes showed that, compared with sorafenib, lenvatinib was associated with significantly better OS in patients treated with these drugs (HR 0.82, 95% CI: 0.69-0.97, P = 0.02). Pooled analysis also showed that PFS (HR 0.67, 95% CI: 0.57-0.78, P < 0.00001) and time to progression (HR 0.49, 95% CI: 0.31-0.79; P = 0.004) were significantly better in the lenvatinib group compared to the sorafenib group. It also showed that the lenvatinib group had significantly better ORR (odds ratio [OR] 5.43, 95% CI: 3.71-7.97; P < 0.00001) and DCR (OR 2.35, 95% CI: 1.75-3.16; P < 00001) than the sorafenib group. Our study shows that lenvatinib is superior to sorafenib regarding OS and PFS in patients with advanced HCC.

Introduction Solitary plasmacytoma refers to a rare form of mature B-cell malignancy that can present either extraosseous i.e., solitary extramedullary plasmacytoma (SEP), or the more common type, intraosseous i.e., solitary bone plasmacytoma (SBP). According to the National Comprehensive Care Network, the primary treatment of solitary plasmacytoma is radiotherapy with 40-50 Gy to the involved field +/- surgery (if the patient is unstable or has symptoms indicative of neurological compression), or chemotherapy (if the patient has bulky disease defined as ≥5 cm or unresponsive to radiotherapy). This systematic review aimed to assess relapse predictors of solitary plasmacytoma following definitive treatment. Methods A systematic review was conducted in adherence to the PRISMA guidelines with a pre-specified study protocol registered on PROSPERO (CRD42023432422). A literature search was performed utilizing Medline, ScienceDirect, Google Scholar, Cochrane, and Clinicaltrials.gov, on April 15, 2023. The MeSH terms “plasmacytoma”, “recurrence”, “relapse”, “prognosis”, and “treatment” were used. The inclusion criteria were defined as retrospective, randomized, or non-randomized controlled studies published in English that include patients with solitary plasmacytomas of any site, who received radiotherapy, chemotherapy, and/or surgery, and have outcomes of overall survival, progression-free/relapsed-free survival (PFS/RFS), and time to progression to multiple myeloma. Results After meeting the inclusion criteria, twenty-seven studies were included. Among 1412 patients,1034 (73%) SBP, 427 (30%) SEP, and 844 (60%) males were studied. Most articles were published in the USA (15%), followed by Italy (11%) and France (11%). Several overlapping predictors of relapse were observed (Table 1), with younger age (age &amp;lt;60) and tumor size &amp;lt;5 cm the most common significant better prognostic factors; mentioned in 10 (37%) and 7 (26%) studies, respectively. Interestingly, SBP tumor type was associated with worse prognosis in 3 (11%) studies, while SEP tumor type had mixed prognostic association; worse prognostic association in 4 (15%), and better in 3 (11%) studies. Less common negative prognostic indicators included immunoparesis at diagnosis, occult marrow disease, positive serum M protein, persistent M spike, positive serum B2 microglobulin, positive Bence Jones protein, and positive urinary monoclonal light chains. Radiotherapy exhibited a better prognosis alone, with surgery, and with chemotherapy. In addition, a higher radiation dose (&amp;gt;40 Gy) was associated with better prognosis, supported by another study that showed a worse prognosis with a lower radiation dose (&amp;lt;50 Gy). Four studies did not demonstrate a statistically significant prognostic factor. Conclusion Tumor size and age appear to be the most common significant prognostic indicators for solitary plasmacytoma when indexed to outcomes of OS, PFS, MMFS, and median time to MM progression. Several other prognostic indicators have been reported but require further research to ascertain their strength of association and possibly direct future screening and management.

Introduction SARS-CoV-2 induced coagulopathy has been associated with increased risk of arterial and venous thromboembolism. Literature demonstrates that incidence of thromboembolism has varied widely throughout the COVID-19 pandemic, with many reports preceding emergence of Delta and Omicron variants. This study aimed to characterize the incidence of arterial and venous thromboembolic events among patients hospitalized with acute SARS-CoV-2 infection during Wuhan, Delta, Omicron, or Omicron BA.x waves. To our knowledge, this study debuts variant specific analyses to shed some light on reported substantive differences pooled across SARS-CoV-2 variants regarding host response, clinical course, and outcomes. Intensity of pathophysiologic anomalies may have been associated with macro- and micro-circulatory clotting. Therefore, we hypothesized variant idiosyncratic host responses would be evoked and aimed to link our patient's demographics and comorbidity patterns with risk of thromboembolism. Methods This is a retrospective study including patients with laboratory confirmed SARS-CoV-2 infection who underwent index hospitalization during Wuhan (March 14, 2020- June 18, 2021), Delta (June 19, 2021- December 18, 2021), Omicron (December 19-March 30, 2022) or Omicron BA.x (March 31, 2022 - April 14, 2023) variant waves at an 820-bed academic public health trust hospital in Florida. Demographics, laboratory at presentation, ICD-10-CM-based comorbidity, SARS-CoV-2 directed treatment and administrative data were extracted under IRB exemption from electronic medical records. Generalized regression with adaptive LASSO identified variables associated with embolism in at least one variant wave controlling for extant dysrhythmia, chronic anticoagulation therapy, and COVID-19 directed treatment. Prespecified 2-way ANOVA examined interactions between intra- vs. inter-variant waves but was ruled out due to strong imbalances in variation. Thus, only within-variant contrasts were performed. Continuous data summarized with mean [±SD] were compared using an ANOVA test adjusting p-value for parametric vs. non-parametric distribution. Discrete data summarized as proportions were compared with chi-squared test. A p&amp;lt;.05 was considered significant. Results We studied 6490 patients consecutively discharged across Wuhan (n=2249), Delta (n=1196), Omicron (n=953) and Omicron BA.x (n=2092) variants with respective embolic event(s) of 3%, 2%, 2%, and 4%. Table 1 summarizes demographics, anthropometric, comorbidities and laboratory biomarkers obtained within 24h of hospitalization across variants. Table 2 presents clinical course and outcomes. Discussion Incidence of embolic events was isomorphically distributed among waves tending to affect older males harboring hypertension, neurologic disease, and/or heart failure. D-dimer levels at presentation significantly distinguished risk of thromboembolism with Wuhan, Delta, or Omicron, but not Omicron BA.x variant infection. Indeed, Omicron BA.x infection was associated with numerically lower ICU visits, mechanical ventilation requirement, hospital LOS and mortality. Elevated D-dimer consistently has been associated with excess risk of progression to severe illness and mortality (Milenkovic M et al., 2022), mostly via pooled results across SARS-CoV variant waves. Some have suggested that D-dimer guided anticoagulation management improves outcomes in patients with COVID-19 (Ronderos Botero DM et al., 2023). Deeper phenotyping of patients infected with Omicron BA.x variants may reveal unique prothrombotic features driving what appears to be a less severe hypercoagulable state.

Introduction Cancer survivorship addresses attendant challenges beyond treatment, emphasizing outcomes of patient quality of life, costs, emergency services/hospitalization, and mortality. Nekhlyduov L et al., 2019 describe nine domains of cancer survivorship which, although represented distinctly, are interrelated and codependent. Despite the sustained worldwide increase in the burden of cancer in the past decade, there is a paucity of evidence regarding cancer survivorship pertaining to patient needs across the Gulf countries. Methods A systematic review adhering to the PRISMA 2020 guidelines was conducted to assess cancer survivorship across the 6 Gulf countries Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. We utilized search results across Medline, Embase, Cochrane, SciELO, and Web of Science published in English through April 1, 2023. Our search terms were inclusive of the country's names, cancer, survivors, neoplasm, survivorship, and follow-up studies were used. Included articles were then evaluated for nine domains of cancer survivorship outlined by Nekhlyduov L et al., 2019. Results Thirty-one articles were included in the systematic review. Cancer survivorship in the context of hematological malignancy (leukemia, lymphoma, and multiple myeloma) was observed in 48% (n = 15) of studies. Saudi Arabia accounted for most of the published literature, 67.7% (n = 21). Kuwait, Qatar, and Bahrain all reported the least on cancer survivorship, 3.2% (n = 1). Clinical structure, surveillance, and management of physical and psychosocial effects were the most reported domains across the included articles, 87.1% (n = 27), 74.2% (n = 23), and 67.7% (n = 21), respectively. Conversely, the surveillance and management of chronic medical conditions and patient and caregiver experience domains were the least reported,12.9% (n = 4) and 9.7% (n = 3), respectively. The clinical structure domain refers to the type of healthcare delivery environment, cancer survivorship providers' education and training status, availability, and access to needed specialty care, healthcare professionals, health information systems, and opportunities for research participation to patients. The surveillance and management of physical and psychosocial effects domains encompassed assessment of patient symptoms and conditions, referral of recommended evaluation, recommendations of and adherence to appropriate treatment and risk-reducing strategies, and reassessment of symptoms and/or conditions at defined intervals and/or treatment phases. The domain of surveillance and management of chronic medical conditions involves evaluating and treating noncancer comorbidities using disease-specific indications and medical reconciliation. The patient and caregiver experience domain assesses the patient's satisfaction with the healthcare provider, perceived timely access to healthcare and services, and follow-up regarding test results. Conclusion Our findings siren the need for a clear focus on the clinical structure domain. There are significant gaps in both the countries reporting on the topic and the domains of cancer survivorship included in their studies. Importantly, Oman, Kuwait, Qatar, and Bahrain require further cancer survivorship research. Moreover, all the countries need to emphasize domains of surveillance and management of chronic conditions and patient caregiver experience.

Introduction SARS-CoV-2 infection promulgates an immune dysregulation that drives an inflammatory cascade therefore inducingmorbidity and mortality across the COVID-19 presentation spectrum. Hemogram (CBC) derived traits associated with COVID-19 severity have been reported (Meizlish ML et al., 2021, Dhinata KS et al., 2021), but their relative impact across SARS-CoV-2 variants is unclear. We employed sequential machine learning approachesto identify significantly contributing traits with attendant portion of explained variance (EV%) in hospital mortality risk models across predominant SARS-CoV-2 variants. Methods Our retrospective design, analyses and interpretations followed constructs detailed in the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline. Adult patients with laboratory confirmed COVID-19 who underwent index hospitalization during Wuhan/D614G (March 14, 2020- June 18, 2021), Delta (June 19, 2021- December 18, 2021), Omicron (December 19-March 30, 2022) or Omicron BA.x (March 31, 2022 - April 14, 2023) variant waves at an 820-bed academic public health trust hospital in Florida were studied. Demographics, laboratory results (within 24h of presentation), ICD-10-CM-based comorbidity, COVID-19 directed treatment and administrative data were extracted from electronic medical records under IRB exemption. Generalized regression with adaptive LASSO identified hemogram-derived traits significantly associated with mortality in at least one of the variants while controlling for presentation vital signs, age, sex, extant comorbidities and ultimate COVID-19 directed treatment. Boosted Tree modeling computed within-variant proportion contributed by each trait to model's accuracy (R 2) representing EV% of mortality risk. Traits contributing to one or more variants for at least 1% portion of EV were retained in model. A Bonferroni corrected two-tailed p &amp;lt; .0125 was considered significant. Results We included 6490 consecutively discharge patients distributed across Wuhan/D614G (n=2249), Delta (n=1196), Omicron (n=953) and Omicron BA.x (n=2092) variants with respective mortality of 9.3%, 13.0%, 4.4%, and 2.4% (p&amp;lt; .0001). Patient characteristics and on-presentation laboratory medicine clinical traits are in Table 1. Table 2 provides ranked contribution for each of the 7 traits retained in the model with attendant presentation mortality risk accuracy (R 2) across variant waves. Potent synergy can be generated with biomarkers ratios, as seen with Segmented neutrophil/monocyte ratio (SMR) and lymphocyte/monocyte ratio (LMR), compared to studying these variables individually. Conclusion Sequential machine-learning approaches identified differential expression intensity across SARS-CoV-2 variants in presentation hemogram-derived traits associated with hospital mortality risk modeling at index infection. These findings suggest that COVID-19 presentation risk and level of care assessment tools employing hemogram-derived traits may not generalize across pandemic variants. Platelets counts were associated with mortality in Delta, Wuhan/D614G and Omicron variants. Although it was also associated in Omicron Bx.5, the R 2 is lower, this can be explained because in this study the variant of Omicron Bx.5 had the lowest mortality rate. Studies have shown that platelet activation generates a cascade with more thromboxane A2 and platelet thrombofactor A which increases prothrombotic states (Dhinata KS et al., 2021). The absence of eosinophils was seen in Wuhan/D614G and Delta, the cause of which cannot be ascertained. A theory is that the inflammation caused by SARS-CoV-2 infection releases certain cytokines that induce eosinophil apoptosis (Dhinata KS et al., 2021). Immature neutrophils evidenced across variants can be explained by the inflammatory cascade inducing G-CSF and IL-8 production, which induces neutrophil activation (Meizlish ML et al., 2021).Lymphopenia seen throughout variants contributes to an increase in LMR. One presumption is that the SARS-CoV-2 affects T-Lymphocytes through ACE-2 receptor and CD117 spike proteins (Meizlish ML et al., 2021). Overall, our study brings to attention how hemogram-derived traits express differently across SARS-CoV-2 variants, which could guide the stratification of COVID-19 severity and assist in the care of patients before decompensation is noticed.

Introduction Multiple myeloma is a hematological malignancy characterized by the uncontrolled proliferation of plasma cells within the bone marrow, with an increasing incidence and mortality in the last decade. Eligibility for stem cell transplantation plays a crucial role in determining the approach to treatment, with transplant eligible patients undergoing triple induction therapy with an immunomodulatory agent, a proteasome inhibitor, and steroid. We aimed to review the recent data on the available treatment options for newly diagnosed multiple myeloma (NDMM) in transplant eligible patients. Methods A scoping review was conducted according to the PRISMA 2020 guidelines utilizing the PubMed and Embase databases. The inclusion criteria was phase II or III clinical trials pertaining to the use of triple and quadruple therapy in NDMM patients, from the year 2010 onwards. A total of 2377 search results were screened, with 510 undergoing full-text screening against the inclusion criteria. Covidence was used to facilitate the screening process (Figure 1). Results Forty studies were included in the analysis. Eleven trials were based on Daratumumab induction. Additionally, two trials each utilized Isatuximab and Carfilzomib-based induction. One trial employed induction therapy containing Elotuzumab, and another utilized Cyclophosphamide. Addition of Daratumumab to the triplet regimen resulted in significant improvements in response rates and depth of responses. CASSIOPEIA trial demonstrated a notable improvement in minimal residual disease (MRD), with VTd treatment yielding 44% MRD, while Dara-VTd regimens achieved 64% MRD. Similarly, complete response (CR) rates increased from 26% to 39%, respectively. GRIFFIN trial revealed a remarkable 55% reduction in the risk of disease progression for patients with Dara-RVd . Moreover, the estimated 48-month progression-free survival (PFS) rate was 87.2% in the Dara-RVd group, compared to 70% in the RVd group. Notably, the median PFS was not reached in either treatment arm. The Lyra trial, which analyzed Dara-CyBorD followed by Dara maintenance, demonstrated a CR rate of 48.7% for transplant patients and 29.8% for non-transplant patients, respectively. Additionally, the MASTER trial revealed that Dara-KRd/autologous hematopoietic cell transplant (AHCT) led to a high rate of MRD negativity, with 80% of patients achieving MRD negativity. The two-year PFS was 87%. Furthermore, the addition of Isatuximab and Carfilzomib to the treatment regimen demonstrated favorable outcomes in terms of MRD and PFS (Table 1). The addition of Elotuzumab did not lead to a significant improvement in outcomes. Moreover, caution is warranted when using Cyclophosphamide, given its less favorable safety profile and limited additional benefit in survival outcomes (MRD: 27% in +Cyclophosphamide arm vs. 35% without), including a temporary decline in health-related quality of life. Conclusion In conclusion, this scoping review underscores the significance of individualized treatment approaches for multiple myeloma based on clinical trial results. Each induction regimen has shown varying levels of efficacy and safety, offering clinicians flexibility to tailor treatments for different patient populations. The results from these trials will serve as valuable benchmarks and inform future research in the quest for improved therapies for NDMM patients.