Cycles Of Chemotherapy Research Articles

7617 Two Cases of Severe Beta-hCG-Mediated Hyperthyroidism with Gestational Trophoblastic Disease

Abstract Disclosure: A. Morvant: None. M. Mashayekhi: None. Introduction: Hyperthyroidism is most commonly caused by Graves’ disease and toxic nodules and affects 2.5% of the world’s population. Hyperthyroidism due to elevations in beta-hCG (b-hCG), which has thyroid-stimulating activity due to homology with TSH, is a rare process that requires high clinical suspicion. We present two cases of hyperthyroidism caused by severely elevated b-hCG due to gestational trophoblastic disease (GTD), with rapid resolution of hyperthyroidism after treatment of the underlying conditions. Clinical Cases Case 1: A 35-year-old at 28-weeks gestation presented with dyspnea, palpitations, and 6-pound weight loss over the prior month. Labs revealed b-hCG 5.2 million (0-5 mIU/mL), TSH <0.015 (0.35-3.6 mcU/mL), and free T4 2.42 (0.7-1.37 ng/dL). Imaging revealed extensive pulmonary lesions concerning for metastatic disease and a 2.4 cm ovarian mass. Due to worsening respiratory distress and the need to start chemotherapy urgently, she underwent Cesarean section to deliver the viable infant and take out the ovarian mass. Pathology confirmed choriocarcinoma. Methimazole was started post-operatively, and she started chemotherapy. Labs after cycle one of chemotherapy showed b-hCG 1.3 million, TSH <0.015, and free T4 1.46. The methimazole dose was decreased and ultimately stopped as free T4 levels decreased with subsequent chemotherapy cycles. After three cycles, labs showed b-hCG 4,652, TSH 1.55, and free T4 0.68. She was discharged without thyroid-targeting therapy. Case 2: A 33-year-old woman at 12-weeks gestation presented with nausea, vomiting, and 10-pound weight loss over 1 month. Labs showed TSH <0.015, free T4 2.39, and total T3 351 (58-160 ng/dL), which were thought to be due to hyperemesis gravidarum. Two months later she presented with vaginal bleeding and imaging showed an enlarged placenta with a moth-eaten appearance and theca lutein cysts concerning for partial molar pregnancy. Beta-hCG level was 3.3 million, TSH <0.015, free T4 1.76, and total T3 289. She underwent dilation and evacuation and pathology confirmed partial hydatidiform mole. Beta-hCG level decreased to 1.8 million and free T4 normalized after surgery, with b-hCG 3,300, normal TSH, and normal total T3 one month later. Conclusion: These cases highlight the importance of considering possible GTD when evaluating a patient with hyperthyroidism, particularly in women of childbearing age and cases of early pregnancy when the degree of hyperthyroidism seems out of proportion to that expected. Clinicians should consider checking a b-hCG level in consultation with an obstetrician when indicated. Treatment is aimed at the GTD and can yield rapid resolution of hyperthyroidism.

Measurable residual disease monitoring in AML with FLT3-ITD treated with intensive chemotherapy plus midostaurin

AbstractMeasurable residual disease (MRD) monitoring in acute myeloid leukemia (AML) with an FLT3 internal tandem duplication (FLT3-ITDpos]) has been hampered by the broad heterogeneity of ITD mutations. Using our recently developed FLT3-ITD paired-end next-generation sequencing (NGS)–based MRD assay with a limit of detection of 10−4 to 10−5, we evaluated the prognostic impact of MRD at different time points in 157 patients with FLT3-ITDpos AML who were enrolled in the AMLSG16-10 trial and who were treated with a combination of intensive chemotherapy and midostaurin, followed by midostaurin maintenance. Achievement of MRD negativity (MRDneg) after 2 cycles of chemotherapy (Cy2), which was observed in 111 of 142 (78%) patients, was predictive of superior 4-year rates of cumulative incidence of relapse (CIR) (4y-CIR; 26% vs 46%; P = .001) and overall survival (OS) (4y-OS; 70% vs 44%; P = .012). This survival advantage was also seen among patients who underwent allogeneic hematopoietic-cell transplantation during first complete remission (4y-CIR, 14% vs 39%; P = .001; 4y-OS, 71% vs 49%; P = .029). Multivariate models for CIR and OS after Cy2 revealed FLT3-ITD MRDneg as the only consistent favorable variable for CIR (hazard ratio [HR], 0.29; P = .006) and OS (HR, 0.39; P = .018). An NPM1 co-mutation correlated with a deeper molecular response as reflected by stronger MRD reduction and a higher rate of FLT3-ITD MRDneg after Cy2. During follow-up, conversion from MRDneg to MRDpos was a strong, independent factor for inferior CIR (HR, 16.64; P < .001) and OS (HR, 4.05; P < .001). NGS-based FLT3-ITD MRD monitoring allows for the identification of patients at high risk for relapse and death following treatment with intensive chemotherapy and midostaurin. Using NGS-based technology, FLT3-ITD emerges as a novel, highly clinically relevant target for MRD monitoring. This trial was registered at www.ClinicalTrials.gov as #NCT01477606.

A-015 Changes of sST2 and NT-proBNP levels predict early cardiovascular toxicity in breast cancer patients treated with anthracycline-containing chemotherapy

Abstract Background Cardiovascular biomarkers play a crucial role in monitoring the risk for cancer therapy-related cardiovascular toxicity, but their changes and values at the early stage of chemotherapy are still inadequate, especially for some new biomarkers.The purpose of this study was to examine changes in cardiovascular biomarkers and evaluate the prognostic values for cardiovascular toxicity in patients with breast cancer treated with anthracycline-containing chemotherapy. Methods In a prospective cohort of 73 patients treated with anthracycline-containing chemotherapy, soluble ST2 (sST2), high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), Myoglobin (Myo), Creatine kinase isoenzyme MB (CK-MB) and heart-fatty acid binding protein (H-FABP) were measured at baseline, during every chemotherapy cycle (C1-C6, about every month).Cardiovascular toxicity was defined as cancer therapy-related arrhythmias, which was differentiated into bradycardia,tachycardia or atrial fibrillation. According to whether arrhythmia occurred, patients were divided into two groups (healthy group and arrhythmias group), and the basic clinical characteristics were collected and compared among the two groups. Logistic regression analyses and receiver operating characteristic (ROC) curves were conducted to investigate the relationship between the changes in biomarkers and anthracycline-induced cardiotoxicity. Results sST2 levels increased significantly from baseline to C1 (P&amp;lt;0.01). NT-proBNP decreased from baseline to C1, C5 (P&amp;lt; 0.01). Logistic regression analysis showed a greater risk of cardiovascular toxicity was associated with greater interval increase in sST2 from baseline to C1(ΔsST2) (OR:1.27; 95% CI:1.03 to1.56; P= 0.024) and interval decline in NT-proBNP from baseline to C1(ΔNT-proBNP) was associated with cardiovascular toxicity (OR: 0.83; 95% CI: 0.70 to 0.98; P= 0.029). ROC curves showed that ΔsST2, ΔNT-proBNP and ΔsST2+ΔNT-proBNP had good predictive value for cardiovascular toxicity (areas under the curves were 0.631, 0.633, and 0.735, respectively, P&amp;lt;0.05). Conclusions Early changes in sST2 and NT-proBNP levels offer additive information in early cardiovascular toxicity risk prediction in patients with breast cancer who receive anthracycline-containing chemotherapy.

PDOC-10 LIMITATIONS IN POST OPERATIVE- ADJUVANT CARE OF PATIENTS WITH BRAIN TUMOURS-A CASE OF SUPRATENTORIAL MEDULLOBLASTOMA IN A PAEDIATRIC PATIENT

Abstract OBJECTIVE To highlight the challenges and limitations in accessing post-operative adjuvant care of patients with brain tumours in Zimbabwe and implications on patient outcomes and to discuss potential strategies to overcome these challenges. METHODS This is a case report on a 6 year old patient with a supratentorial medulloblastoma to demonstrate the challenges encountered on accessing post-operative adjuvant care at a Central hospital in Harare. RESULTS The patient had a near total resection of the tumour done and was managed in the Intensive care unit for 1 week. HE was discharged to the general ward for another week and eventually referred to the paediatric oncologists after a histological diagnosis of a supratentorial medulloblastoma was made. Patient received cycles of chemotherapy but failed to raise money for adjuvant radiotherapy. Patient returned 5 months later with the tumour having recurred. CONCLUSION Limitations in post-operative adjuvant care may have a negative impact on the overall patient outcomes, in this case lack of access to radiotherapy. Medulloblastomas are responsive to radiotherapy and their prognosis improves significantly with a combination of surgical resection and radiotherapy. Addressing these limitations at different levels involving government and non-governmental organizations helps in mitigating inaccessibility of radiotherapy to radio-sensitive brain tumours patients after surgical resection. This case report brings out the urgent need to implement cheaper and sustainable options to address challenges in post-operative adjuvant care in order to get good patient outcomes.

Use of empegfilgrastim for primary prevention of febrile neutropenia in patients receiving myelosuppressive therapy. Experience of the Arkhangelsk Clinical Oncological Dispensary

Background. Granulocyte colony-stimulating factors (G-CSFs) are used in oncology practice for prevention of febrile neutropenia caused by cytotoxic chemotherapy. Despite the proven safety of G-CSFs use in randomized clinical trials and in real clinical practice, clinicians have questions about the tolerability of this group of drugs.Aim. To demonstrate the safety profile of a long-acting G-CSF produced in Russia which was used to prevent febrile neutropenia and maintain dose intensity of drug therapy in patients with various solid tumors undergoing chemotherapy at the Arkhangelsk Clinical Oncological Dispensary.Materials and methods. The retrospective analysis included patients with a confirmed diagnosis of malignant neoplasm who received various chemotherapy regimens that required the inclusion of G-CSF. For primary prevention of febrile neutropenia, patients were prescribed empegfilgrastim (Extimia®) at a dose of 7.5 mg subcutaneously once per course of chemotherapy.Results. Data of 151 patients were analyzed for the period from July 2021 to April 2023. The average age was 57 years (28–75). The group of elderly patients (over 65 years) consisted of 38 (25 %) patients. The majority of patients were diagnosed with breast cancer (56 (37 %) patients) and gastric cancer (37 (25 %) patients). The number of empegfilgrastim injections over the entire observation period was 773. Adverse reactions associated with the use of empegfilgrastim were registered in 13 (8.6 %) patients, the most common of which was grade 1–2 leukocytosis according to the CTCAE v.5 classification. One patient developed a serious adverse reaction: grade 4 neutropenia according to the CTCAE v.5 classification. A subgroup of patients with metastatic pancreatic cancer treated with FOLFIRINOX was analyzed separately to assess the relative dose intensity of the chemotherapy courses. Nine patients with metastatic pancreatic cancer received FOLFIRINOX therapy with a median of 8 (5–12) courses. A total of 69 chemotherapy cycles were administered to 9 patients with a median of 7.5 (2–13) cycles. The relative dose intensity of the chemotherapy courses was 83.71 ± 19.33.Conclusion. Empegfilgrastim has shown a favorable safety and tolerability profile in patients with various solid tumors in real-world clinical practice including the highly toxic FOLFIRINOX regimen.

Long-Term Survival Outcomes With First-Line Nivolumab Plus Ipilimumab–Based Treatment in Patients With Metastatic NSCLC and Tumor Programmed Death-Ligand 1 Lower Than 1%: A Pooled Analysis

IntroductionNivolumab plus ipilimumab–based treatment regimens have shown long-term, durable efficacy benefits in patients with metastatic NSCLC. Here we report clinical outcomes from a pooled analysis of patients with metastatic NSCLC and tumor programmed death-ligand 1 (PD-L1) lower than 1% treated with first-line nivolumab plus ipilimumab with or without two cycles of chemotherapy versus up to four cycles of chemotherapy in the randomized phase 3 CheckMate 227 and CheckMate 9LA studies. MethodsPatients were aged 18 years or older and had stage IV/recurrent NSCLC with no sensitizing EGFR/ALK alterations. Assessments included overall survival (OS), progression-free survival (PFS), objective response rate, duration of response, and safety. ResultsIn patients with tumor PD-L1 lower than 1% in the nivolumab plus ipilimumab with or without chemotherapy (n = 322) versus chemotherapy (n = 315) arms, median OS was 17.4 versus 11.3 months, respectively, (hazard ratio [HR] = 0.64, 95% confidence interval [CI]: 0.54–0.76; 5-y OS rate, 20% versus 7%) at a median follow-up of 73.7 months. The OS benefit was observed across key subgroups, including difficult-to-treat populations such as those with baseline brain metastases (HR = 0.44, 95% CI: 0.26–0.75) or squamous NSCLC (HR = 0.51, 95% CI: 0.36–0.72). In the overall pooled population, the median PFS was 5.4 versus 4.9 months (HR = 0.72, 95% CI: 0.60–0.87; 5-y PFS rate, 9% versus 2%), the objective response rate was 29% versus 22%, and the median duration of response was 18.0 versus 4.6 months. No new safety signals were observed. ConclusionNivolumab plus ipilimumab with or without chemotherapy provides a long-term, durable clinical benefit in patients with metastatic NSCLC and tumor PD-L1 lower than 1%, supporting the use of this strategy as a first-line treatment option in this population with high unmet need. Clinical Trial Registrations: NCT02477826, NCT03215706

Hepatitis B and/or C virus reactivation in patients receiving chemotherapy: An observational study

Background: Viral hepatitis reactivation occurs during various chemotherapy treatments. Patients with high serum titer levels of Hepatitis B virus (HBV) DNA before chemotherapy and those receiving intensive chemotherapy for hematological malignancies are particularly at risk. Aims and Objectives: This study aimed to determine the incidence, predictors, and clinical significance of HBV and hepatitis C virus reactivations during chemotherapy. Materials and Methods: This prospective observational study was conducted at a tertiary care center. Hepatitis B and C virus status was identified before the initiation of cancer treatment. Liver function was monitored in all patients before each cycle of chemotherapy. Patients with deranged liver function were subjected to repeated viral antigen tests and DNA/RNA titer levels. Results: A total of 110 patients were identified as having hepatitis virus reactivation out of 1190 patients. The sites of malignancy were breast, 39.1% (43 patients); colorectal, 11.8% (13 patients); upper gastrointestinal, 10% (11 patients); ovary, 9.1% (10 patients); hematological malignancies, 8.2% (9 patients); lung, 5.6% (6 patients); genitourinary, 4.5% (5 patients); head-and-neck, 4.5% (5 patients); biliary tract, 3.6% (4 patients); brain tumor, 1.8% (2 patients); and others, 1.8% (2 patients). Most of the patients with reactivation received 5-FU/Capecitabine-based chemotherapy 37.3%, (41 patients), taxane plus platinum (10.9%, 12 patients), taxane only (10%, 11 patients), trastuzumab (8.2%, 9 patients), platinum-based (6.4%, 7 patients), tyrosine kinase inhibitors (6.4%, 7 patients), monoclonal antibodies (MABs) (3.6%, 4 patients), anthracyclines (2.7%, 3 patients), immunomodulators (2.7%, 3 patients), and other agents (11.8%, 13 patients). Conclusion: We recommend that Hepatitis B and C virus Screening must me performed before chemotherapy and that non-reactive patients should be vaccinated.

Primary retroperitoneal lymph node dissection for metastatic non-seminomatous germ cell tumours: outcomes and adjuvant chemotherapy.

To compare the outcomes and treatment burden of primary retroperitoneal lymph node dissection (pRPLND) alone versus pRPLND + adjuvant chemotherapy (AC) in patients with pathological stage II (PSII) non-seminomatous germ cell tumours (NSGCT). Retrospective review of the Princess Margaret Cancer Center eTestes cancer database identified patients with PSII NSGCT after pRPLND between 1995 and 2020. The primary outcome was relapse-free survival (RFS). Secondary outcomes included disease-specific survival (DSS), burden of relapse treatment, and factors associated with relapse. A total of 109 PSII patients were included in the study. There were 96 patients treated with pRPLND alone and 13 treated with pRPLND + AC. The median follow-up was 61 months. The 5-year RFS was 72% for the pRPLND-only group vs 92% for the pRPLND + AC group (hazard ratio [HR] 4.372, 95% confidence interval [CI] 0.59-32.36; P = 0.11). Within the pRPLND-only group the 5-year RFS differed by pN stage (pN1 = 94% vs pN2/N3 = 67%, P = 0.03). Despite a higher relapse rate within the pRPLND-only group, the DSS was similar at 5 years (98% pRPLND only vs 100% pRPLND + AC, P = 0.48). Only 24 (25%) of the patients in the pRPLND-only group required any subsequent chemotherapy. Despite achieving similar survival, the cumulative post-RPLND treatment burden was less for the pRPLND-only group than the pRPLND+AC group overall (average 1.23 vs 2.46 cycles of chemotherapy per patient in group). The majority of patients with PSII NSGCT treated with pRPLND alone do not experience a recurrence or require chemotherapy. Despite a lower relapse risk when AC is given, no difference in survival was seen but higher chemotherapy burden was entertained. AC may constitute overtreatment for most patients with PSII NSGCT treated with pRPLND.

Multiple primary malignancies: sequential development of Ewing sarcoma and carcinoid tumor in a single patient

Introduction and importance: Multiple primary malignancies (MPMs) involve two or more distinct primary cancers in one individual, either simultaneously or at different times. The incidence of MPMs is rising due to advancements in cancer detection, improved survival rates, and long-term treatment effects. This case report, likely the first of its kind, highlights a rare instance of a 30-year-old female developing a carcinoid tumor 5 years after Ewing sarcoma, emphasizing the need for vigilant monitoring of cancer survivors. Case presentation: A 30-year-old female with a history of Ewing Sarcoma diagnosed 5 years prior, initially presenting with a vascular, hard mass on her right shoulder, underwent neoadjuvant chemotherapy and surgical excision. She recently presented with high-grade fever, cough, weight loss, and severe chest pain. Imaging and biopsy confirmed a high-grade carcinoid tumor. Histopathology showed positive markers for Synaptophysin, CD56, and Chromogranin, with a Ki-67 index of 30–40%. The patient passed away after one cycle of chemotherapy. Clinical discussion: Diagnosing and managing MPMs is challenging due to the complexity of distinguishing primary tumors from metastases. This case fits the Warren and Gates’ criteria for MPMs. This case confirmed Ewing sarcoma and atypical carcinoid tumor as distinct primary malignancies. Delayed diagnosis worsens outcomes, especially for aggressive atypical carcinoids. This case underscores the importance of thorough diagnostics, long-term follow-up, and improved healthcare infrastructure. Conclusion: This case report emphasizes the importance of a multidisciplinary approach, regular follow-ups, and timely detection for effective management of MPMs.

Values of Serum Ferritin, Folic Acid and Vitamin B12 in Treatment of Multiple Myeloma with Bortezomib Combined with Chemotherapy

To investigate the value of serum ferritin, folic acid and vitamin B12 in the treatment of multiple myeloma (MM) with bortezomib combined with chemotherapy. Clinical data of 40 MM patients admitted to our hospital from January 2020 to August 2022 and 40 hematology outpatients during the same period were reviewed. All MM patients were treated with bortezomib combined with chemotherapy. The diagnostic efficacy of serum ferritin, folic acid and vitamin B12 on MM was analyzed by ROC curve. The changes of serum ferritin, folic acid and vitamin B12 in MM patients before and after treatment were compared. According to the mean values of serum ferritin, folic acid and vitamin B12, patients were divided into high and low expression groups, and the survival of patients between the groups was compared. Before treatment, the levels of serum ferritin and vitamin B12 in MM patients were significantly higher than those in control group, while folic acid was lower (all P <0.001). The area under the curve (AUC) of MM patients diagnosed with ferritin, folic acid and vitamin B12 were 0.928, 0.843 and 0.867, the specificity was 100%, 67.50% and 72.50%, and the sensitivity was 80.00%, 95.00% and 87.50%, respectively. After 4 cycles of chemotherapy, there were 9 cases of complete remission (CR), 19 cases of very good partial remission (VGPR), 6 cases of PR, 4 cases of stable disease (SD) and 2 cases of progression disease (PD) in 40 MM patients. In CR group, ferritin and vitamin B12 decreased but folic acid increased after treatment compared with before treatment (all P < 0.05). The overall survival (OS) rates of patients in low expression group of ferritin and vitamin B12 were significantly higher than those in high expression group (both P < 0.01). The OS rate of patients in high expression group of folic acid was significantly higher than that in low expression group (P < 0.01). Cox regression analysis showed that ferritin was an independent prognostic factor for MM patients (HR=8.850, 95%CI : 2.267-34.553, P =0.002). Serum ferritin, folic acid and vitamin B12 have some auxiliary value in the diagnosis and efficacy evaluation of MM, and ferritin is an independent prognostic factor for MM.

Longitudinal assessment of cancer-related distress during cancer treatment using an electronic health record–based tool and impact of social work intervention.

207 Background: Cancer-related distress affects 35-45% of patients. 2020 ASCO-QOPI standards require baseline and ongoing psychosocial assessments, with interventions as needed. We examined the feasibility and outcomes of integrating the NCCN Distress Thermometer (DT) into the oncology electronic health record (EHR) for distress monitoring. Methods: A flowsheet containing NCCN DT questions was created in Epic EHR (Epic Systems, Verona, WI). Oncology nursing staff administered the electronic DT as part of normal patient ‘rooming’ protocol and alerted providers when distress level was ≥ 4 (DT4). This in turn generated a social work (SW) referral. SW interventions were documented in a SW dashboard. Results: Between May 1 st 2023, and April 30 th 2024, our Epic EHR DT was used to screen 6,270 distinct oncology patients, 1,852 scored &gt;=4. 19.7%, 14.2%, 20.4% and 5.4% of the responses were in the emotional, practical, physical, and familial domains respectively. 447 (24.1%) of these patients were referred to SW. When contacted by SW, worry/anxiety in 37.5%, finance in 34.9% and transportation in 29.4% were the top three concerns. Access to grants, free-care, lodging and gas cards was made available to 37.4%, 14.5%, 20.5% and 13.1% of patients respectively. Additionally, in accordance with QOPI certification requirements, 947 patients with active oncology treatment plans were serially screened during successive cycles of chemotherapy generating 6,330 responses. 398 (42%) of these responses indicated DT4. SW referral was placed in 163 (41%) of patients with DT4. Serial distress monitoring revealed a trend towards improved distress in later cycles of chemotherapy, with DT4 percentage decreasing from 27.7% in cycle 1 to 7.9% in cycle 6. Process improvement efforts informed by this data increased DT use from 42.7% to 50% between May-October 2023 and November 2023-April 2024. Conclusions: Electronic capture of cancer related distress as part of routine care is feasible in a community-based oncology program and resulted in a variety of meaningful SW interventions. Cumulatively, distress caused by emotional, social, and practical problems are more frequent than distress caused by physical problems, underscoring the need for comprehensive cancer care. Distress tends to diminish during successive cycles of chemotherapy, possibly due to lower cancer related morbidity due to therapy, or increased patient familiarity with chemotherapy and improved use of supportive care.

Orthotopic renal autotransplantation: A step forward during postchemotherapy retroperitoneal lymph node dissection for germ cell tumor

ABSTRACT We present the first and a rare case of orthotopic renal auto-transplantation in the management of postchemotherapy residual retroperitoneal mass encasing the left renal vessels but sparing the parenchyma in a 24-year-old patient with Stage IIIC nonseminomatous germ cell tumor after 4 cycles of chemotherapy. Immediate postoperative and 6 months’ follow-up renograms confirmed the maintained glomerular filtration rate of the transplanted kidney with no residual disease. This case report shows the feasibility of renal autotransplantation in carefully selected patients as they are young and have long-term survival.

Holistic nutritional management via epro for patients with cancer undergoing six cycles of chemotherapy

Holistic nutritional management via epro for patients with cancer undergoing six cycles of chemotherapy

High-dose chemotherapy as initial salvage chemotherapy in patients with relapsed or refractory testicular cancer: a systematic review and meta-analysis.

The role of high-dose chemotherapy followed by autologous hematopoietic cell transplantation in the management of patients with relapsed/refractory germ-cell tumors has not been established in prospective studies. Our aim was to estimate the benefits and harm of this treatment in men with relapsed/refractory germ-cell tumors. Electronic databases, conference proceedings, and trial registers until April 30, 2023, were searched. Randomized and non-randomized prospective controlled trials were included. Risk of bias assessments were performed using either RoB2 or ROBINS-I tools. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Time-to-event data were analyzed using the hazard ratio. The primary outcome was overall survival, and a meta-analysis was not conducted to assess it because non-randomized trials were judged to have a critical risk of bias. Categorical data were analyzed using a risk ratio. All results are presented with the corresponding 95% confidence interval. Four out of 3,824 records met the inclusion criteria, and three out of four were used to assess primary and secondary outcomes. Based on the IT94 study (N = 263 participants), single high-dose chemotherapy followed by autologous hematopoietic cell transplantation may have little to no effect on overall survival [hazard ratio (HR) 0.98, 95%CI 0.68 to 1.42; p = 0.916]. Non-randomized trials (N = 43 participants) showed contrasting results, which may be explained by the number of cycles of high-dose chemotherapy administered in each study. Regarding secondary outcomes, information was only provided for event-free survival, response rate, and acute toxicities. Based on prospective data, there is insufficient evidence to support or refute the proposal that high-dose chemotherapy with autologous hematopoietic cell transplantation improves survival in men with relapsed/refractory germ-cell tumors. If this treatment is considered essential, the choice should be made by experienced clinicians at high-volume cancer centers.

Association between Early Minimal Residual Disease Detected by Flow Cytometry and Prognosis in Children with Acute Myeloid Leukemia: A Clinical Retrospective Study

To investigate the prognostic value of minimal residual disease (MRD) detected by multi-parameter flow cytometry (MFC) in pediatric patients with acute myeloid leukemia (AML) after induction chemotherapy. A retrospective study was conducted on 97 pediatric patients initially diagnosed with AML at Wuhan Children's Hospital from August 2015 to December 2022. The study analyzed the results of MRD detection using MFC after the first and second cycles of induction chemotherapy, and its association with prognosis were analyzed. Following the first cycle of induction treatment, 57 of the 97 patients tested positive for MRD (MRD1+ , 58.8%). Subsequently, 19 patients remained MRD positive (MRD2+ , 19.6%) after the second cycle of induction treatment. Kaplan-Meier survival analysis showed that the estimated 3-year overall survival (OS) rate of the 37 (64.9%) MRD1+ patients who underwent transplantation was significantly higher than that of the 20 (35.1%) MRD1+ patients who did not undergo transplantation (84.6% vs 40.0%, P =0.0001). Among the 35 MRD1+ MRD2- patients, the 3-year OS rate of the 25 children who underwent transplantation was higher than that of the 10 children who did not undergo transplantation (87.2% vs 70.0%, P =0.3229). The 3-year OS rate of the 19 MRD1+ MRD2+ patients was lower than that of the 35 MRD1+ MRD2- patients (57.4% vs 81.8%, P =0.059). In the 19 MRD2+ patients, the 3-year OS rate of the 12 children who underwent transplantation was significantly higher than that of the 7 children who did not undergo transplantation (80.8% vs 14.3%, P =0.0007). There was no significant difference in 3-year OS between the 12 MRD1+ MRD2+ patients and 25 MRD1+ MRD2- patients, both treated with transplantation (80.8% vs 87.2%, P =0.8868). In those not treated with transplantation, the 7 MRD1+ MRD2+ patients had a significantly lower 3-year OS compared with the 10 MRD1+ MRD2- patients (14.3% vs 70.7%, P =0.0114). Further multivariate analysis indicated that MRD2 positivity and transplantation were both independent prognostic factors (P =0.031, 0.000), while MRD1 positivity was not significantly associated with the overall prognosis of 97 patients (P =0.902). MRD positivity following the second cycle of induction chemotherapy is an independent risk factor for unfavorable outcomes in children with AML. MRD2 positivity indicates a poorer prognosis and can help to identify the candidates requiring transplantation. MRD2 positivity is not a contraindication for transplantation in pediatric patients, and early transplantation significantly improves the prognosis of high-risk patients.

Immune-mediated meibomian gland dysfunction and dry eye disease related to trastuzumab emtansine chemotherapy in HER2 breast cancer: A case report

One of the most commonly administered drugs for human epidermal growth factor receptor 2 (HER2) breast cancer is trastuzumab emtansine (TDM-1). Unfortunately, this drug causes ocular surface disease as an adverse effect. This case report describes the diagnosis and management of meibomian gland dysfunction (MGD) and dry eye related to TDM-1 in HER2 a breast cancer patient. Our patient was a 43-year-old female diagnosed with HER2 breast cancer with metastasis to the peritoneum and liver. After a cycle of TDM-1 chemotherapy, she complained of recurrent hordeolum, ocular discomfort, and blurry vision. We initially prescribed topical and oral medications and gradually combined them with hordeolum incision and drainage, in-office meibomian gland expression, and intense pulse light therapy to improve symptoms. Ocular adverse effects due to anticancer agents are not preventable. Ophthalmologists must be aware of them and instigate needed therapy to ensure patients’ compliance with cancer treatment and improve quality of life.

Characteristics of Chemotherapy Treatments for Breast Cancer Patients at Bhayangkara Tk.1 Pudsdokkes Polri Hospital, Jakarta

Background: Breast cancer is a malignant breast tumor that develops in the ductal or lobular epithelium and usually attacks women. Chemotherapy is a cornerstone of breast cancer treatment, particularly for patients with advanced disease or those who are not candidates for surgery or radiation therapy. This research aims to observe the use of chemotherapy drugs for breast cancer patients in terms of chemotherapy regimens and cycles at Bhayangkara Tk.1 Pudsdokkes Polri Hospital. Methods: This study employs descriptive quantitative approaches. Data were gathered retrospectively from medical records of breast cancer patients receiving chemotherapy at Bhayangkara Tk.1 Pudsdokkes Polri Hospital Jakarta from July to December 2021. Results: From 110 patients, 86 (78.18%) patients used the CAF regimen, 18 (16.36%) patients used the AC regimen, and 3 (2.73%) patients used the TAC regimen, while the regimen that did not comply with the guidelines was 2 (1.82%) patients using the combination of paclitaxel and epirubicin, 1 patient utilizing the combination of paclitaxel and doxorubicin. Forty-six (41.82%) patients with the CAF regimen had completed six cycles of chemotherapy with intervals of 3 weeks or 21 days, while only 5 patients (3.63%) completed four cycles of the AC regimen at 3-week or 21-day intervals. At the time of data collection, 11 patients, and 1 patient utilizing the AC regimen. This was because 59 patients had not yet finished the chemotherapy cycle, specifically in the advanced stage. Conclusions: The CAF regimen was the most commonly used chemotherapy regimen, followed by the AC and TAC regimens. This finding aligns with current clinical guidelines for breast cancer treatment. A significant number of patients had not yet completed their chemotherapy cycles, particularly those with advanced-stage breast cancer. This highlights the challenges associated with treating advanced disease and the need for more effective and less toxic treatment options.

Effect of training based on Orem's self-care deficit theory on breast cancer patients' management of chemotherapy-related side effects and self-care behaviors: A randomized controlled trial

PurposeTo examine the effects of training based on Orem's self-care deficit theory on breast cancer patient's physical, social, and psychological well-being and self-care behaviors during chemotherapy. MethodsThis randomized controlled trial was based on a pretest–posttest experimental design. The study sample consisted of 62 breast cancer patients (n = 31 for each of the intervention and control groups) receiving cyclophosphamide–epirubicin or cyclophosphamide–adriamycin treatment in the medical oncology department of a university hospital in Tekirdağ, Turkey. The breast cancer patients in the intervention group received training based on Orem's self-care deficit theory regarding physical, social, and psychological well-being and self-care behaviors during chemotherapy. The researcher conducted two face-to-face follow-ups (during the second and third chemotherapy cycles, 3 weeks apart) and a posttest assessment. Pretest and posttest symptom scores and self-care survey results were compared for both groups. ResultsThe Nightingale Symptom Assessment Scale (N-SAS) first follow-up, second follow-up, and posttest scores showed that the intervention group experienced fewer negative changes in quality of life than the control group based on the physical, social, and psychological subdimension and total scale scores (p < .05). The most positive changes in the intervention group's self-care behaviors were observed for items about caring for and protecting hair, using protective gloves when doing chores, monitoring weight, and limiting social meetings when blood values were low to protect against possible infection. ConclusionTraining based on Orem's self-care deficit theory positively influenced breast cancer patients' management of chemotherapy-related side effects and self-care behaviors. Chemotherapy-related side effects should be evaluated frequently. Moreover, patients' needs should be determined, and training should be tailored to their needs.

Large-cell neuroendocrine carcinoma of the bile duct: Case report of surgical treatment and adjuvant chemotherapy of 2 cases.

Neuroendocrine carcinoma originating from extrahepatic bile duct is very rare, and only a few cases have been reported. Because of its scarcity of incidence, not much is known about the disease but for its aggressiveness and poor prognosis. In this report, we present 2 cases of large cell neuroendocrine carcinoma (LCNEC) originating from extrahepatic bile duct. Case 1: a 60-year-old woman presented with jaundice but no abdominal pain. Case 2: a 67-year-old man also presented with jaundice, along with abdominal discomfort and appetite loss. Case 1: LCNEC with a focal adenocarcinoma component (pT2aN1M0, pStage IIIB). Case 2: LCNEC with a focal adenocarcinoma component (pT1N1M0, pStage IIB). Case 1: the patient underwent left hepatectomy and caudatectomy with hepaticojejunostomy, followed by 6 cycles of adjuvant chemotherapy (etoposide and cisplatin). Case 2: the patient underwent laparoscopic pylorus-preserving pancreatoduodenectomy, followed by 6 cycles of adjuvant chemotherapy (etoposide and cisplatin). Case 1: liver metastasis was detected 6 months postoperatively, and despite multiple chemotherapy regimens, the patient died 24 months post-surgery. Case 2: liver metastasis was detected 23 months postoperatively. The patient is still alive 36 months post-surgery after receiving multiple chemotherapy regimens and radiotherapy. Given the rarity of LCNEC, it is essential to continue collecting and reporting additional case studies to build a more comprehensive understanding of the disease. Although the prognosis for LCNEC is generally poor, the use of a multidisciplinary approach and further research will be critical in developing more effective treatment strategies in the future.

Real-world treatment outcomes for Hodgkin lymphoma in South Africa: a prospective observational study

BackgroundProspective data from sub-Saharan Africa suggests that treatment outcomes for people living with HIV (PWH) with Hodgkin lymphoma (HL) are similar to those without HIV. However, real-world data from high-resource settings and retrospective studies from sub-Saharan Africa, suggest inferior outcomes. We set out to evaluate the real-world treatment outcomes for HL in South Africa to better understand the disparate outcomes.MethodsWe established a prospective, observational cohort of newly diagnosed, adult (≥ 18 years) HL cases recruited from Chris Hani Baragwanath Academic and Netcare Olivedale Hospitals in Johannesburg, South Africa between March 2021 and March 2023. Participants were followed for up to 18 months after enrollment with data censored on December 23rd, 2023. The primary endpoint was 1-year overall survival.ResultsWe enrolled 47 participants with HL including 31 PWH and 16 HIV-negative. Advanced stage disease and B symptoms were common at time of diagnosis irrespective of HIV status. Bone marrow biopsy, performed during the work-up and evaluation of cytopenias, provided the initial diagnosis of HL in 16/31 (52%) PWH. HIV status and bone marrow involvement were associated with early mortality (within 3 months of diagnosis) and a poorer 1-year overall survival from diagnosis (HIV: 55% vs. 88%; p = 0.03; bone marrow involvement: 50% vs. 80%; p = 0.02). Among evaluable participants, those that received at least 6 cycles of chemotherapy and underwent response assessment, there was no difference between those with and without HIV.ConclusionTraditional laboratory markers of poor prognosis including anemia, lymphopenia and hypoalbuminemia were more common among PWH and those with bone marrow involvement and suggest high risk disease. A better understanding of the drivers of these aggressive presentations is warranted to ensure more PWH are able to tolerate chemotherapy.