Induction Chemotherapy Research Articles

Comparative analysis of induction chemotherapy followed by chemoradiotherapy and concurrent chemoradiation therapy efficacy in patients with locally advanced head and neck squamous cell cancer

Treatment strategy of advanced unresectable head and neck squamous cell cancer (HNSCC) is limited to induction chemotherapy (ICT) followed by (chemo) radiotherapy (cRT) and concurrent chemoradiotherapy (CCRT). However, the role of ICT remains controversial considering the lack of overall survival benefit.The aim: to evaluate the role of induction chemotherapy in the treatment of locally advanced HNSCC.Methods: We performed a retrospective clinical study that included patients (pts) with unresectable stage III–IVa cancer of larynx, oropharynx and hypopharynx.Results: A total of 176 pts were enrolled, 84 (48 %) received CCRT with cisplatin or carboplatin and 92 (52 %) — ICT followed by cRT. Groups were well balanced by sex, tumor site, T-stage, while in group of ICT there was a significant prevalence of younger pts (p = 0.004) and pts with stage N2–3 (p = 0,03).The objective response rates (ORR) were 76 % (42 / 55) in CCRT arm (including 53 % (12 / 62) of complete responses) and 72 % (56 / 78) in ICT arm with complete response rate of 15 % (12 / 78). The ORR in ICT arm increased after the completion of CCRT up to 82 % with 53 % (33 / 62) of complete responses. The difference was not statistically significant (p = 0,7).With a median follow-up duration of 8.7 months median progression-free survival (mPFS) was 7.6 and 9.4 months (Hazard ratio (HR) 0.67, 95 % CI 0.43–1.04); 6month OS was 65.7 % and 92.8 % in CCRT and ICT groups, respectively (HR 0.51, 95 % CI 0.30–0.85, р < 0.01).Propensity score matching analysis proved the 6month OS in the ICT + cRT group to be significantly longer than in CCRT group — 97.7 % vs 66.8 %, respectively (HR = 0.28, 95 % CI 0.13–0.62, p < 0.01).Conclusions: ICT + сRT resulted in improvement of PFS and OS compared to CCRT in pts with locally advanced HNSCC.

Palliative Care Needs in Adult Patients with Acute Leukemia: A Prospective Observational Study.

Background: Acute leukemia (AL) affects patients' well-being and inflicts substantial symptom burden. We evaluated palliative care needs and symptom burden in adult patients with AL from diagnosis through fourth week of induction chemotherapy. Methods: Newly diagnosed adult patients with AL scheduled for curative-intent treatments, prospectively completed Functional Assessment of Cancer Therapy-Leukemia questionnaire at diagnosis and postinduction therapy. Subscale scores identified domains with major needs, with lower scores signifying higher needs, while Leu-subscale assessed leukemia-specific symptom burden. Results: One hundred patients were enrolled. Upon diagnosis and four weeks into induction phase, respectively, patients exhibited the lowest scores in physical (17 ± 8.75; 16 ± 11; p < 0.05), functional (16.5 ± 10.75; 11 ± 12.2; p < 0.05), and leukemia-specific (43 ± 16.75; 41.48 ± 11.68; p > 0.05) domains. Predominant symptoms were "getting tired easily" (91%) at diagnosis and "unable to do usual activities" (92.3%) after induction. Conclusion: Patients with AL demonstrated substantial physical, functional, and leukemia-specific symptom needs at diagnosis, which intensified postinduction, highlighting the necessity for palliative care integration from diagnosis.

Is the gemcitabin-cisplatin combination the optimal induction chemotherapy for non-Asian patients with nasopharyngeal carcinoma (NPC)? Insights from a cohort in north-eastern Morocco

Is the gemcitabin-cisplatin combination the optimal induction chemotherapy for non-Asian patients with nasopharyngeal carcinoma (NPC)? Insights from a cohort in north-eastern Morocco

Toxicity and Safety of Induction Chemotherapy in Locally Advanced Oropharynx, Hypopharynx and Larynx: Non-Randomized Study Comparing DCF and Immunochemotherapy (ICT) with PF-Pembrolizumab

Введение. Стандартный режим индукционной химиотерапии по схеме DCF характеризуется высокой частотой объективного ответа у пациентов с распространенными опухолями головы и шеи. Высокая токсичность режима ограничивает возможность его применения. Проспективное нерандомизированное исследование оценивает эффективность и безопасность иммунохимиотерапии (ИХТ) в качестве индукции. Цель. В этой работе представлены данные сравнения безопасности режима DCF и PF — пембролизумаб, а также риски отказа или незавершения последующей химиолучевой терапии (ХЛТ). Методы. В проспективное нерандомизированное исследование II фазы включались пациенты с III-IV стадией плоскоклеточного местнораспространенного рака ротоглотки, гортани, гортаноглотки в случае положительной экспрессии PD-L1 в опухоли (CPS&gt;=1). Пациентам проводились 3 цикла ИХТ пембролизумабом, цисплатином и 5-фторурацилом с последующим проведением ХЛТ. Группа контроля была оценена ретроспективно. В неё включались пациенты, которые в этот же период времени получали режим DCF (доцетаксел + цисплатин + 5-фторурацил) с последующим проведением ХЛТ. Результаты. В период с апреля 2022 г. по июль 2024 г. включено 120 пациентов для проведения ИХТ. Контрольная группа включила данные по 115 пациентам. Частота нежелательных явлений 3-5 степени составила 30 % и 30,4 % для группы ИХТ и группы DCF (p = 1,00). На этапе индукционной терапии отмечено 6 случаев смерти (5,2 %) в группе DCF, в группе пембролизумаб-PF летальных случаев на этапе индукционной терапии не было (р = 0,01). Высокая доза цисплатина в группе ИХТ ассоциирована с более значимой тенденцией к снижению скорости клубочковой фильтрации (СКФ), в сравнении с группой DCF. Медиана снижения составила СКФ 10,5 %. Во всех случаях снижение СКФ не привело к необходимости проведения гемодиализа. В группе ИХТ 4 пациентам (3,3 %) не проведена лучевая терапия в связи с общим ухудшением здоровья на фоне индукционной терапии, в группе DCF — 12 пациентам (10 %), p = 0,06. Заключение. Индукционный режим PF-пембролизумаб обладает приемлемым профилем токсичности. Дальнейшее изучение эффективности ИХТ представляется актуальной задачей. Исследование зарегистрировано на портале clinicaltrials.gov (номер NCT05551767).

New Combination Regimens vs. Fludarabine, Cytarabine, and Idarubicin in the Treatment of Intermediate- or Low-Risk Nucleophosmin-1-Mutated Acute Myeloid Leukemia: A Retrospective Analysis from 7 Italian Centers

Background: Nucleophosmin-1 (NPM1) mutation accounts for 30% of acute myeloid leukemia (AML) cases and defines either low- or intermediate-risk AML, depending on FLT3-ITD mutation. New combination regimens (NCRs), adding midostaurin and gemtuzumab ozogamicin (GO) to the 3 + 7 scheme, are commonly used, though there are no data that compare NCRs with intensive induction chemotherapy. Methods: To evaluate the efficacy and safety of NCRs and FLAI in NPM1+ AML, we retrospectively analyzed 125 patients treated with FLAI (n = 53) or NCRs (n = 72) at seven Italian Centers. Results: The median age was 61 years and 51/125 (41%) were FLT3-ITD+. The complete remission (CR) rate was 77%, slightly better with NCRs (83% vs. 68%; p = 0.054). NCRs yielded a superior median overall survival (OS) (not reached (NR) vs. 27.3 months; p = 0.002), though the median event-free survival (EFS) was similar (NR vs. 20.5 months; p = 0.07). In low-risk AML, CR was higher in NCRs (94% vs. 72%, p = 0.02), as were median OS (NR vs. 41.6 months; p = 0.0002) and EFS (NR vs. 17.8 months; p = 0.0085). In intermediate-risk AML (FLT3-ITD+), there were no differences in CR (60% vs. 71%; p = 0.5), OS (p = 0.27), or EFS (p = 0.86); only allogeneic transplantation improved OS (NR vs. 13.4 months; p = 0.005), regardless of induction regimen. The safety profile was similar, except for delayed platelet recovery with FLAI (22 vs. 18 days; p = 0.0024) and higher-grade II–IV gastrointestinal toxicity with NCRs (43% vs. 18.8%; p = 0.0066). Conclusions: Our data suggest the superiority of NCRs over FLAI in low-risk patients, while all outcomes were comparable in intermediate-risk patients, a setting in which only transplants positively impacted on survival.

Survival Among Patients Treated with Total Mesorectal Excision or Selective Watch-and-Wait After Total Neoadjuvant Therapy: A Pooled Analysis of the CAO/ARO/AIO-12 and OPRA Randomized Phase II Trials.

Prospective data comparing watch-and-wait (WW) to mandatory total mesorectal excision (TME) in patients with locally advanced rectal cancer (LARC) remains limited, as randomized control trials assessing these two treatment approaches are considered impractical. This pooled analysis of the CAO/ARO/AIO-12 and OPRA trials analyzes survival outcomes among LARC patients managed with either a selective WW or mandatory TME strategy following total neoadjuvant therapy (TNT). The CAO/ARO/AIO-12 and OPRA trials were multicenter, phase II trials that randomized patients with stage II/III rectal cancer to receive either induction or consolidation chemotherapy as part of TNT. All patients in the CAO/ARO/AIO-12 trial underwent TME within six weeks of completing TNT. The OPRA trial allowed patients with a complete or near-complete response to enter WW while those with an incomplete response proceeded to TME. The primary endpoint of the present pooled analysis was disease-free survival (DFS). Secondary endpoints included distant recurrence-free survival (DRFS), local recurrence-free survival (LRFS) and overall survival (OS). This pooled analysis included 628 patients (n=304 CAO/ARO/AIO-12; n=324 OPRA). Median follow-up was 3.6 (IQR 1.13) and 5.1 (IQR 2.2) years, respectively. Patients in the CAO/ARO/AIO-12 trial were more likely to have cT3/4 and cN positive disease while patients in the OPRA trial had tumors closer to the anal verge. Compliance to TNT and rates of grade 3+ adverse events were similar between studies. There were no differences in DFS, DRFS, LRFS or OS based on treatment strategy or TNT treatment arm. This pooled analysis demonstrated equivalent oncologic outcomes between patients treated with mandatory TME and selective WW strategies following TNT. These results strengthen available evidence indicating that WW is a safe treatment option for patients with an excellent response to neoadjuvant therapy.

A Comprehensive Approach to Neoadjuvant Treatment of Locally Advanced Rectal Cancer.

At the end of the past century, the introduction of Total Mesorectal Excision (TME), preceded by either short-course radiotherapy (SCRT) or chemoradiation (CRT), established the new standard of care for locally advanced rectal cancer (LARC). Recently, significant advancements were achieved for both dMMR/MSI and pMMR/MSS LARC patients. For the 2-3% of dMMR/MSI LARCs, ablative immunotherapy emerged as a curative approach, offering the possibility of avoiding chemotherapy (CT), radiotherapy, and surgery altogether. In pMMR/MSS LARCs, the intensification of preoperative treatments with Total Neoadjuvant Treatment (TNT) afforded three outcomes: (a) a reduction of distant metastases, positively impacting on survival endpoints, (b) a significant increase of complete clinical response (cCR) rate, paving the way for non-operative management (NOM), and (c) the selective omission of radiotherapy following induction CT. The choice of the most appropriate therapeutic strategy can only be made through the shared decision-making process between physician and patient based on risk stratification and patient preferences.

Comparison of TPF and PF induction chemotherapy combined with cisplatin concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: A systematic review and meta-analysis.

The standard of care for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) is induction chemotherapy (ICT) followed by concurrent chemoradiation (CCRT). However, the ideal ICT regimen for LA-NPC remains unclear. We conducted a meta-analysis to evaluate the survival outcomes, responses, and incidences of toxicities between taxane, cisplatin and fluorouracil (TPF) and cisplatin and fluorouracil (PF) ICT regimens plus CCRT in LA-NPC. A systematic review and meta-analysis of the literature was conducted to compare the efficacy and safety of TPF versus PF followed by CCRT with cisplatin every 3 weeks or weekly cisplatin and intensity-modulated radiotherapy in LA-NPC. Three studies with 2482 patients met the inclusion criteria. ICT with the TPF regimen plus CCRT resulted in a significantly improved progression-free survival (hazard ratios [HR] 0.84 [95% CI 0.73-0.96], P = .01), overall survival (HR 0.83 [95% CI 0.71-0.97], P = .02), and 3-year locoregional recurrence-free survival (risk ratios [RR] 1.03 [95% CI 1.01-1.06], P = .009) compared with the PF regimen plus CCRT in LA-NPC. However, distant metastasis-free survival was not statistically significant (P = .07). The incidence of grade 3 or 4 neutropenia (RR 2.08 [95% CI 1.84-2.36]) and diarrhea (RR 1.94 [95% CI 1.07-3.52]) during ICT was higher in the TPF group than in the PF group. In terms of progression-free survival, overall survival, locoregional recurrence-free survival, in the era of intensity-modulated radiotherapy, the TPF plus CCRT with cisplatin is superior to PF plus CCRT with cisplatin in LA-NPC. Thus, the TPF plus CCRT regimen appears to be a reasonable treatment option, and further confirmation by prospective studies is needed.

The efficacy and safety of induction chemotherapy combined with sintilimab followed by concurrent chemoradiotherapy plus sintilimab sequencing maintaining with sintilimab for patients with unresectable locally advanced esophageal squamous cell carcinoma

PurposeTo evaluate the efficacy and safety of induction chemotherapy combined with programmed death protein 1 (PD-1) inhibitor (sintilimab) followed by concurrent chemoradiotherapy (CCRT) plus sintilimab, and subsequent maintenance with sintilimab (IC-ICCRT-IO) for patients with unresectable locally advanced esophageal squamous cell carcinoma (ESCC) in a retrospective study.MethodsData from patients with histologically confirmed, locally advanced, inoperable ESCC who received IC-ICCRT-IO were retrospectively analyzed. Treatment effects were evaluated after 2 cycles of induction therapy and after CCRT by contrast-enhanced CT scans and esophagograms, followed by subsequent evaluations every 3 months post-treatment. The primary endpoints included progression-free survival (PFS) and PFS rates at 6, 12, and 18 months. Secondary endpoints involved overall response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. The influence of the expression level of programmed death ligand-1 (PD-L1) as well as neutrophil-to-lymphocyte ratio (NLR) on efficacy of the IC-ICCRT-IO was analyzed.ResultsIn total, 29 eligible patients were enrolled and analyzed. The median follow-up time was 20.5 months. The median PFS was not reached; the 6-, 12-, and 18-month PFS rates were 100.0%, 93.1%, and 82.8%, respectively. The median OS was not reached, and the 6-, 12-, and 18-month OS rates were all 100.0%. The ORR and DCR were 89.7% and 100.0%. Adverse events (AEs) were manageable, with grade 3 or higher AEs observed in 48.2% of patients, primarily nonimmune-related and clinically manageable. Hematologic toxicity was predominant. Two patients developed grade 3 immune-related rash, and two patients developed grade 3 radiation pneumonitis, all of whom were managed with appropriate symptomatic treatment. No significant differences in survival outcomes were observed with respect to PD-L1 and NLR.ConclusionOur results indicated that the IC-ICCRT-IO regimen for unresectable locally advanced ESCC provided a survival benefit with manageable safety profile. More prospective clinical studies should be warranted.Trial registration2024-04-22, No. QYFY WZLL 28,684, retrospectively registered.

A Serial MRI-based Deep Learning Model to Predict Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To develop and evaluate a deep learning-based prognostic model for predicting survival in locoregionally- advanced nasopharyngeal carcinoma (LA-NPC) using serial MRI before and after induction chemotherapy (IC). Materials and Methods This multicenter retrospective study included 1039 LA-NPC patients (779 male, 260 female, mean age 44 [standard deviation: 11]) diagnosed between April 2009 and December 2015. A radiomics- clinical prognostic model (Model RC) was developed using pre-and post-IC MRI and other clinical factors using graph convolutional neural networks (GCN). The concordance index (C-index) was used to evaluate model performance in predicting disease-free survival (DFS). The survival benefits of concurrent chemoradiation therapy (CCRT) were analyzed in model-defined risk groups. Results The C-indexes of Model RC for predicting DFS were significantly higher than those of TNM staging in the internal (0.79 versus 0.53) and external (0.79 versus 0.62, both P < .001) testing cohorts. The 5-year DFS for the Model RC-defined low-risk group was significantly better than that of the high-risk group (90.6% versus 58.9%, P < .001). In high-risk patients, those who received CCRT had a higher 5-year DFS rate than those who did not (58.7% versus 28.6%, P = .03). There was no evidence of a difference in 5-year DFS rate in low-risk patients who did or did not receive CCRT (91.9% versus 81.3%, P = .19). Conclusion Serial MRI before and after IC can effectively predict survival in LA-NPC. The radiomics-clinical prognostic model developed using a GCN-based deep learning method showed good risk discrimination capabilities and may facilitate risk-adaptive therapy. ©RSNA, 2025.

A Nomogram Built on Clinical Factors and CT Attenuation Scores for Predicting Treatment Response of Acute Myeloid Leukemia Patients.

Background: Acute myeloid leukemia (AML) is an aggressive cancer with variable treatment responses. While clinical factors such as age and genetic mutations contribute to prognosis, recent studies suggest that CT attenuation scores may also predict treatment outcomes. This study aims to develop a nomogram combining clinical and CT-based factors to predict treatment response and guide personalized therapy for AML patients. Methods: This retrospective study included 74 newly diagnosed AML patients who underwent unenhanced abdominal CT scans within one week before receiving their first induction chemotherapy. Clinical biomarkers of tumor burden were also collected. Patients were classified into two groups based on treatment response: complete remission (CR; n = 24) and non-complete remission (NCR; n = 50). Multivariable logistic regression was used to identify independent predictors of treatment response. Predictive performance was evaluated using receiver operating characteristic (ROC) curves, and model consistency was assessed through calibration and decision curve analysis (DCA). Results: Significant differences in hemoglobin (Hb), platelets (Plt), and CT attenuation scores were observed between the CR and NCR groups (all p < 0.05). Multivariable logistic regression identified Hb, Plt, and CT attenuation scores as independent predictors of treatment response. A nomogram incorporating these factors demonstrated excellent predictive performance, with an area under the curve (AUC) of 0.912 (95% CI: 0.842-0.983), accuracy of 0.865 (95% CI: 0.765-0.933), sensitivity of 0.880 (95% CI: 0.790-0.970), and specificity of 0.833 (95% CI: 0.684-0.982). The CR nomogram displayed significant clinical value and excellent goodness of fit. Conclusions: The nomogram, which incorporates Hb, Plt, and CT attenuation scores, provides valuable insights into predicting treatment response in AML patients. This model offers strong discriminatory ability and could enhance personalized treatment planning and prognosis prediction for AML.

Rhabdomyosarcoma Surgical Update.

Rhabdomyosarcoma (RMS) tumors arise from mesenchymal tissue and represent half of pediatric sarcomas, which in turn make up 7% of pediatric tumors. Advances in local control therapy of RMS have improved outcomes after surgical resection of the primary tumor, either before or after induction chemotherapy, even in the setting of metastatic disease. The utilization of diagnostic core needle and sentinel node biopsy techniques for lymph node staging are becoming more widely used. Over the past several years, refinement of prognostic factors with adoption of fusion status instead of histology, and optimized risk stratification schemas have been developed to assure appropriate therapy. There have been efforts between North American and European surgical oncology cooperative groups to standardize the care we provide, and yet there are still some philosophical differences to overcome.

Evaluation of the Toxicity and Outcomes of the Combination of Midostaurin and CLAG-M in Patients With FLT3-Mutated Acute Myeloid Leukemia (AML): A Multicenter Retrospective Analysis.

Addition of midostaurin to standard "7+3" (cytarabine and anthracycline) significantly prolongs overall and event-free survival. At University of Washington/Fred Hutchinson Cancer Center (UW/FHCC), the standard regimen for newly diagnosed (ND) and relapsed/refractory (R/R) AML is cladribine, high-dose cytarabine, GCSF, and mitoxantrone (CLAG-M); midostaurin is added if FLT3-mutated. There is limited data on the use of FLT3-inhibitors with high-dose cytarabine regimens in AML. This study aimed to evaluate the safety and efficacy of the combination of midostaurin with CLAG-M versus midostaurin plus 7+3 in FLT3-mutated AML patients. This is a retrospective, multicenter review including FLT3-mutated AML patients undergoing (re)induction chemotherapy with either CLAG-M or 7+3 at UW/FHCC, Oregon Health & Science University, and Swedish Cancer Institute. The primary outcome was incidence of adverse events. Secondary outcomes included disease response per ELN2017 criteria and 28-day mortality. Excluded were patients on clinical trials or who started midostaurin 30 days after chemotherapy. Eighty patients treated from September 2016 to December 2023 were included; 36 patients received CLAG-M, and 44 patients 7+3. Baseline characteristics were similar across all institutions. Adverse event rates were similar between the 2 cohorts, except diarrhea and bleeding which were more common in the 7+3 cohort. The rate of complete remission (CR) plus CR with incomplete blood count recovery did not significantly differ between the 2 cohorts: CLAG-M, 86% versus 7+3, 70% (P = 0.11). The toxicity profile of CLAG-M combined with midostaurin is comparable with the combination of 7+3 with midostaurin, and induces high remissions rates in adults with FLT3-mutated AML.

Impact of Filgrastim on Mortality During Induction Chemotherapy in Childhood B-Cell Non-Hodgkin Lymphoma

Impact of Filgrastim on Mortality During Induction Chemotherapy in Childhood B-Cell Non-Hodgkin Lymphoma

Outcomes in patients with acute myeloid leukemia older than 70 years within the last 30 years, a single center experience.

As median age of patients with acute myeloid leukemia is 72 years, older patients continue to be a vulnerable cohort representing significant challenges in clinical practice. Patient-specific comorbidities as well as leukemia-specific unfavorable molecular- and cytogenetics confer even poorer outcomes. Treatment of AML therefore needs to be less toxic to prevent harm while lowering or eradicating leukemic burden to prolong survival. In this retrospective analysis we included 365 older AML patients from the Düsseldorf registry who were diagnosed and treated in our department of hematology over a period of 31 years. Most patients were treated with HMA (37.3%) followed by 35.3% of patients who received either low dose chemotherapy or BSC. 9% of patients were treated with induction chemotherapy while 8.5% of patients received a combination of HMA with venetoclax. 4.1% of patients underwent allografting. At the time of last follow up, 35 patients (9.6%) were still alive. Of those patients who were treated with induction chemotherapy or HMA + venetoclax, 18.2% and 29.0% were still alive, whereas 60% of the patients who underwent allogeneic stem cell transplantation were still alive (p < 0.001). Median overall survival of the entire patient population was 6 months. Longest survival was observed in patients who underwent aHSCT with an unreached median overall survival followed by patients who were treated with induction chemotherapy (21 months) or HMA plus venetoclax (11 months). The implementation of HMA + venetoclax and increasing numbers of aHSCT improved prognosis and survival even in older AML patients.

PEG-rhG-CSF versus rhG-CSF in supporting neutrophil recovery after induction chemotherapy for patients with newly diagnosed acute lymphoblastic leukemia.

To compare the efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) and rhG-CSF in the recovery of neutrophils after induction therapy in ALL patients, PEG-rhG-CSF was injected subcutaneously within 24 ~ 48h after the end of intravenous infusion of daunorubicin/idarubicin during induction chemotherapy. In rhG-CSF group, patients were given rhG-CSF. The main outcome indexes were the incidence and duration of grade 4 chemotherapy-induced-neutropenia (CIN, ANC less than 0.5 × 109/L), the incidence of severe agranulocytosis (ANC less than 0.2 × 109/L). The incidence of grade 4 CIN in the PEG-rhG-CSF group was significantly lower than that in the rhG-CSF group (P = 0.007). There was no significant difference in the incidence of severe neutrophil deficiency and the median time of neutrophil deficiency in PEG-rhG-CSF group and rhG-CSF group. There was no significant difference in day 28 complete response (CR) rate of bone marrow cytology between the two groups (P = 0.985). Compared with rhG-CSF, PEG-rhG-CSF can reduce the incidence of agranulocytosis after induction chemotherapy in newly diagnosed ALL patients, without affecting the efficacy of chemotherapy. Meanwhile, it can reduce the pain of patients, with good safety and tolerance.

Benefit and Harms of Radical Nephroureterectomy as Part of a Multimodal Treatment Strategy for Upper Tract Urothelial Carcinoma Patients Presenting with Clinical Evidence of Regional Lymph Node Metastasis: A Systematic Review and Meta-analysis by the European Association of Urology Guidelines.

Given the uncertainty regarding the role of radical nephroureterectomy (RNU) as part of a multimodal treatment strategy for upper tract urothelial carcinoma (UTUC) patients with cN+ disease, we aimed to perform a systematic review and meta-analysis of the corresponding literature. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we identified 17 observational comparative and noncomparative studies, published between January 2000 and September 2024, evaluating UTUC patients with cTanyN+M0 disease (P) who received RNU as part of a multimodal treatment strategy (I), as compared with any treatment strategy if applicable (C), to assess oncological or postoperative outcomes (O). Meta-analyses were further performed, as appropriate. Overall, 15 studies evaluated the effectiveness of adding chemotherapy to RNU in the perioperative setting without specifying the exact timing of delivery (n=1), in the induction setting (n=14), or in the adjuvant setting (n=5), while two studies evaluated the effectiveness of adding RNU to chemotherapy. Meta-analyses showed that the use of induction chemotherapy plus RNU versus RNU alone was associated with greater odds of pathological downstaging (risk ratio [RR]=3.06; 95% confidence interval [CI]=[2.48-3.77]; p<0.001; I2=0%; p=0.44) and pathological complete nodal response (RR=2.80; 95% CI=[2.03-3.86]; p<0.001; I2=0%; p=0.47) as well as prolonged overall survival (HR=0.52; 95% CI=[0.42-0.64]; p<0.001; I2=14%; p=0.33) without any significant impact on the risk of overall (RR=1.14; 95% CI=[0.79-1.64]; p=0.48; I2=0%; p=0.76) and major (RR=0.48; 95% CI=[0.18-1.24]; p=0.13; I2=0%; p=0.87) postoperative complications. In addition, the use of induction chemotherapy plus RNU versus RNU plus adjuvant chemotherapy (HR=0.58; 95% CI=[0.38-0.89]; p=0.01) or chemotherapy alone (HR=0.49; 95% CI=[0.32-0.76]; p=0.001; I2=46%; p=0.17) was associated with prolonged overall survival. Limitations include the observational design of all included studies. The use of RNU could provide the greatest oncological benefits without any significant harm in selected UTUC patients with fit general condition and resectable cN+ disease responding to induction chemotherapy. In this report, we looked at the outcomes of radical surgery in combination with systemic chemotherapy for upper tract urothelial carcinoma with clinical evidence of dissemination to the surrounding lymph nodes. We observed that the use of radical surgery was associated with the greatest oncological benefits without any increased risk of postoperative complications in patients with fit general condition and resectable disease responding to induction chemotherapy. We conclude that the use of induction chemotherapy plus radical surgery could be the best multimodal treatment strategy for these patients.

Roth spots serve as a clue to underlying acute myeloid leukemia

Abstract Acute myeloid leukemia (AML) is one of the causes of Roth spots. Here, we report a female patient in her early 30s of Asian origin presented to our ophthalmology outpatient clinic with chief complaints of decreased visual acuity (VA) in the right eye along with generalized weakness, palpitations, and colored stools. The best corrected VA in the right eye was counting fingers 1 m and 6/6 in the left eye. Fundus examination revealed Roth spots and subhyaloid hemorrhages in the right eye and Roth spots in the left eye. Peripheral smear revealed few blasts, and bone marrow showed 58% blasts, with increased cellularity suggestive of AML. Currently, the patient is on an induction chemotherapy course under oncologist treatment. The presence of Roth spots in the fundus picture may require a complete blood picture examination as they may be present in leukemia also.

Cellular automata modelling of leukaemic stem cell dynamics in acute myeloid leukaemia: insights into predictive outcomes and targeted therapies.

Acute myeloid leukaemia (AML) is a haematologic malignancy with high relapse rates in both adults and children. Leukaemic stem cells (LSCs) are central to leukaemopoiesis, treatment response and relapse and frequently associated with measurable residual disease (MRD). However, the dynamics of LSCs within the AML microenvironment is not fully understood. This study utilized three-dimensional cellular automata (CA) modelling to simulate LSC behaviour and treatment response under induction chemotherapy. Our study revealed: (i) a correlation between LSC persistence post-induction chemotherapy and risk of AML relapse; (ii) MRD negativity based on LSC count may not reliably predict outcomes, supporting clinical evidence that patients with MRD-negative status can still be at risk of relapse; (iii) prolonged persistence of LSCs post-chemotherapy without disruption of normal haematopoiesis, aligning with clinical observations of dormant AML clones; (iv) early LSC dynamics post-induction chemotherapy, characterized by stochastic behaviours and movement velocities, are insufficient predictors of long-term prognosis; and (v) a distinct spatiotemporal organization of LSCs in later phases post-induction chemotherapy is correlated with long-term outcomes. Our modelling results provide a theoretical and clinical framework for AML research, and future clinical data validation could refine the utility of CA modelling for oncological studies.

Intensified total neoadjuvant therapy in patients with locally advanced rectal cancer: long-term results of a prospective phase II study

AimsTo analyze the long-term results of a prospective phase II trial testing intensified total neoadjuvant therapy (TNT) in patients with locally advanced rectal cancer (LARC). Materials and methodsPatients with histologically confirmed LARC adenocarcinoma were enrolled. Intensified TNT consisted of targeted agent (bevacizumab or panitumumab/cetuximab) plus FOLFOXIRI (5-fluorouracil, leucovorin, oxaliplatin and irinotecan) induction chemotherapy followed by intensified (oxaliplatin and 5-fluorouracil) chemoradiotherapy (CRT) and surgical resection. Follow-up data were collected for all patients included in the trial. Survival outcomes were calculated using the Kaplan-Meier method and curves were compared by the log-rank test. ResultsBetween October 2015 and September 2019, 28 LARC patients were enrolled. Follow-up data were available for all included patients. In total, 11 (39.3%) patients had a complete response (CR). At 6.3 years (median follow-up), 5-year OS and DFS were 74.6% and 57.1%, respectively. Five-year OS was 80.8% for CR patients and 70.1% in no-CR patients (p-value 0.07). Those patients with CR after TNT treatment had a 5-year DFS of 81.8% versus 41.2% for those with no-CR (p-value 0.015). ConclusionThe addition of targeted agent to induction FOLFOXIRI and of oxaliplatin to 5-fluorouracil-based CRT, with the doses and intensities as used in this study, resulted in high CR rates. Patients who achieve a CR demonstrate superior DFS compared to patients without CR. Intensified TNT may have the potential to increase survival outcomes. Further research of TNT strategies in LARC is encouraged.