Division Of Oncology Research Articles

Assessing the frequency of anemia evaluations in patients who are transfusion-dependent in an academic hematology and oncology practice.

e24104 Background: There is a high rate of anemia present in cancer patients and anemia is also a common referral to a hematologist. Symptomatic anemia can significantly impair an individual’s functional status so identifying its cause is essential for improving quality of life. Correction of nutritional deficiencies, like iron, B12, and folate deficiency can improve hemoglobin counts, prevent recurrent PRBC transfusions, and can often resolve the anemia. In a busy academic hematology oncology practice, we hypothesize that it is easy to overlook performing a basic nutritional evaluation especially in the setting of other causes for anemia such as chemotherapy, hemolysis, blood loss, chronic kidney disease, and other disorders. We aim to evaluate the frequency of anemia workup in the hematology and oncology division at our academic institution. Methods: We conducted a retrospective study of all hematology oncology patients seen in our clinic who received a blood transfusion in 2021. All patients were 18 years old or order and received at least one-unit PRBC transfusion as an outpatient. One “transfusion event” was defined as any number of PRBC transfusions on a single day and any subsequent transfusions within a 90-day periods. A single patient, therefore, can have multiple distinct transfusion events. We analyzed whether patients received a “basic” anemia evaluation, defined as checking ferritin, iron saturation, B12, and folate levels within 3 months before or after the first transfusion, and whether a discrepancy in practice patterns exists between different hematology oncology subspecialties. Results: At the interim analysis, we identified 368 transfusion events for 275 patients. Those events were ordered by providers (physician, nurse practitioner, or physician assistant) in the following subspecialties: oncology (n = 20), malignant hematology (n = 18), classical hematology (n = 3), and fellow-in-training (n = 5). A basic anemia workup was missing in 58% (84 of 146), 27% (49 of 183), 23% (8 of 35), 40% (2 of 5) in the above groups respectively. For patients with macrocytic anemia defined as mean corpuscular volume (MCV) > 100 fL, 48% (38 of 79) did not have B12 or folate levels checked within 3 months before or after a transfusion event. For patients with MCV < 80 fL, 47% (14 of 30) did not have ferritin or iron saturation checked within 3 months before or after a transfusion event. Conclusions: We observed a high percentage of cancer and non-malignant hematology patients who did not receive a basic anemia evaluation within three months before or three months after a blood transfusion. A higher percentage of patients with solid tumors patients who required PRBC transfusions did not receive a basic anemia evaluation in a timely manner. Our study identified an area of quality improvement and need for intervention that can easily be overlooked in a busy academic hematology oncology practice.

The Pelvic Surgeon

Journal of Gynecologic SurgeryVol. 39, No. 3 EditorialFree AccessThe Pelvic SurgeonMitchel S. HoffmanMitchel S. Hoffman—Mitchel S. Hoffman, MD, Editor-in-Chief Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.MCC GYN Program, Moffitt Cancer Center, Tampa, Florida, USA.Search for more papers by this authorPublished Online:1 Jun 2023https://doi.org/10.1089/gyn.2023.0035AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail At the turn of the 20th century, a number of advances made surgery much safer for patients. These were: antisepsis; anesthesia; and eventual introduction of antibiotics and blood banking. Formal surgical training in the United States began in the early part of that century. Expertise in gynecologic surgery in the United States also arose from and in tandem with general surgery. The American Board of Obstetrics and Gynecology was established in 1930 as departments of obstetrics and gynecology continued to develop and expand their training programs. Eventually, training in gynecologic surgery became distinct from that of general surgery. Surgical specialization (including gynecologic) followed, a trend that continues in parallel with advances in medical knowledge and complexity.The pelvis is a confined space where portions of the urinary, genital, and intestinal tracts become intimately associated. For that reason, diseases and other abnormalities in the pelvis may involve multiple organ systems and other neurovascular structures. Therefore, urology, gynecology, and colorectal surgery may all be involved in procedures within the confines of the pelvis. As pelvic diseases and abnormalities cross organ systems and disciplines, so must their surgical management.There are ranges of expertise within each pelvic surgical discipline and, while a multidisciplinary approach may be required at times, the gynecologic surgeon must be able to manage the treatment of extended pelvic disease or related pelvic disorders. In some instances, the various surgical disciplines have developed specialty-specific methodology for managing similar conditions. For the reasons described, pelvic surgery by its very nature is multidisciplinary.Two articles in the current issue address gynecologic surgical management of disease extension or related disorders. Drs. Simone Fertel (MD) and Katie Propst (MD), from the University of South Florida Morsani College of Medicine, in Tampa, FL, USA, discuss the historical background of assessment and management of fecal incontinence and the surgical treatment options for patients who suffer with this condition. The Mayo Clinic's (Rochester, MN, USA) gynecologic oncology division investigated specific procedures that might be associated with postoperative complications occurring with ovarian cancer cytoreductive surgery, and identified the contribution of some nongynecologic procedures. Most importantly, surgery must always be done by appropriately trained and skilled individuals. There is a critical consequence arising from the issues that face surgical training competency, particularly as it affects general gynecologic surgery. General gynecologic surgery especially is in danger of becoming boxed into an increasingly narrower scope of capability. Our specialty must train individuals to be pelvic surgeons. I would be most interested in hearing from you, the readers of this journal, regarding your thoughts on the future of general gynecologic surgery. The best format for doing this would be a Letter to the Editor.FiguresReferencesRelatedDetails Volume 39Issue 3Jun 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Mitchel S. Hoffman.The Pelvic Surgeon.Journal of Gynecologic Surgery.Jun 2023.107-107.http://doi.org/10.1089/gyn.2023.0035Published in Volume: 39 Issue 3: June 1, 2023PDF download

Real-world behavioral restrictional practices of cancer patients (pts).

6592 Background: Quality of life (QoL) assessments do not measure pts’ ability to maintain normal daily activities during cancer therapy. Misbeliefs might promote avoidance of activities perceived as dangerous, compromising pts QoL. We examined the daily practices of actively treated pts with cancer. Methods: A locally validated questionnaire at the Tel-Aviv Sourasky Oncology Division was distributed internationally using the Belong.life social and professional digital health platform. We examined real-world pts reported practices, provided voluntarily and anonymously. The survey consisted of 15 questions, including demographic, clinical, behavioral parameters and sources guiding and supporting pts practices. Independent clinical and demographic variables were analyzed. Statistical analysis was performed, and a multivariate logistic regression was conducted to identify factors predicting restrictive behaviors. Results: The study population comprised 1,395 pts receiving active cancer therapy, reporting their outcomes from the Belong digital platform. Most respondents were from the United States (1082, 77.70%) and Israel (223, 16%), over the age of 40 (1309,93.8%),and female (987, 70.75%). Most common tumor types were breast (394,28.24%) and gastrointestinal cancers (199,14.26%). The majority of pts (1,005,72.88%) reported on at least 1 adopted limitation in daily activities, and 305 (21.86%) maintained more than half of these constraints. Daily life restrictions included avoiding sun exposure (779, 57.83%), international travel (417, 33.33%), indoor public places (malls, etc) (431, 33.13%), hair dyeing (271, 22.72%), domestic tourism (284, 21.93%), contact with friends and family (231, 17.69%), children and grandchildren (202, 16.33%), outdoor public spaces (190, 14.62%), and contact with pets (135, 10.41%). Multiple sources were implicated by the pts as guiding their behavior, with the most common being health-care professionals (951, 65.95%), followed by both non-medical authorities and health-care team (320, 22.19%), and non-medical advisors, including internet, pts forums, partners, friends, and family (171, 11.86%) Pts who maintained strict (≥50% of the limitations) and less strict restrictions, demonstrated no significant association between country of origin (p = 0.118), and education level (p = 0.3591). A significant association was noted between younger age (p = 0.0014), female sex (p = 0.0141) and primary cancer site (p < 0.0001), and the adoption of strict restrictions. Conclusions: The majority of pts reported compromised daily activities, which are likely attributed to misconceptions about therapy and disease, deleteriously impacting QoL, therefore, impeding their ability to continue to conduct a complete and meaningful life. These findings require development of tools examining patients’ real-daily life activity as an additional endpoint in clinical trials.

Distinct inflammatory profiles linked to cardiovascular disease risk in HIV infection: implications for the design of preventive and therapeutic interventions.

aDivision of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY bDivision of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA. Correspondence to Jeffrey Laurence, MD, Division of Hematology & Medical Oncology, Weill Cornell Medical College, New York, NY 10065, USA. E-mail: [email protected] or Dean L. Winslow, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 84305, USA. E-mail: [email protected] Received 16 December, 2022 Accepted 26 December, 2022

Erratum: Assessing Protein Interactions in Live-Cells with FRET-Sensitized Emission.

An erratum was issued for:Assessing Protein Interactions in Live-Cells with FRET-Sensitized Emission. The Authors section was updated from: György Vámosi1 Sarah Miller2 Molika Sinha2 Gabor Mocsár1 Malte Renz2 1Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen 2Gynecologic Oncology Division, Stanford University School of Medicine to: György Vámosi1 Sarah Miller2 Molika Sinha2 Maria Kristha Fernandez2 Gabor Mocsár1 Malte Renz2 1Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen 2Gynecologic Oncology Division, Stanford University School of Medicine.

Lung cancer in middle and southern Morocco.

Determining risk factors associated with a fatal disease such as lung cancer (LC) remains an important key to understanding the factors related to its development and therefore using the correct emergent or accessible treatments. For that, we sought to highlight by describing, and analysing, the risk factors related to LC survival, reflecting the actual situation in Morocco. We included 987 LC patients diagnosed from 2015 to 2021 at the Medical Oncology Department at the Mohammed VI University Hospital of Marrakech. An overview of the LC situation was described, and analysed, to determine the risk factors related to survival. The independent prognostic factors were determined using Cox Proportional Hazards Regression Analysis. To create a distinction between different risks group in the survival curve, stratification was done, respectively, within sex, age, histology type, treatments and radiation therapy. We finally included 862 patients with 15 parameters among the 27 extracted, all meeting the inclusion criteria. 89.1% of the patients were male (n = 768) and 10.9% were female (n = 94), of whom 83.5% had a history of tobacco smoking (n = 720). The median survival of both sexes was 716 (5-2,167) days. The average age at diagnosis was 60 years. Five hundred and thirty-four patients presented with advanced stage. Patients above 66 years were the more diagnosed category with adenocarcinoma at T4N2M1c pathological category, and endocrinal comorbidity, in addition to pleurisy syndrome. Moreover, family history was found to be a bad prognostic factor. Interestingly, smoking status was not a bad contributor to survival. Age at diagnosis, histology subtype, performance status, haemoglobin, numbers of cures of the first-line chemotherapy, radiotherapy, anaemia and treatments were identified as risk factors related to survival. We established a descriptive and analytical overview of the current LC epidemiology situation in the oncology division of Mohammed VI University Hospital in a non-industrialised state taking into account smoking status.

Apixaban for extended postoperative thromboprophylaxis in gynecologic oncology patients undergoing laparotomy

IntroductionVenous thromboembolic events represent the second most frequent cause of mortality in cancer patients. Recent literature shows that direct oral anticoagulants (DOAC) are at least as effective and safe as low molecular weight heparin for postoperative thromboprophylaxis. However, this practice has not been broadly adopted in gynecologic oncology. The aim of this study was to evaluate clinical effectiveness and safety of apixaban for extended thromboprophylaxis in comparison to enoxaparin after laparotomies for gynecologic oncology patients. MethodsThe Gynecologic Oncology Division at a large tertiary center transitioned from enoxaparin 40 mg daily to apixaban 2.5 mg BID for 28 days after laparotomies for gynecologic malignancies in November 2020. This real-world study compared patients post-transition (November 2020 to July 2021 (n = 112)) to a historical cohort (January to November 2020 (n = 144)), using the institutional National Surgical Quality Improvement Program (NSQIP) database. All Canadian gynecologic oncology centers were surveyed to assess postoperative DOAC utilization. ResultsPatient characteristics were similar between groups. No difference was found between total venous thromboembolism rates (4% vs. 3%, p = 0.49). No difference was found in postoperative readmission (5% vs. 6%, p = 0.50). Of the 7 readmissions in the enoxaparin group, one was due to bleeding requiring transfusion; there were no readmissions for bleeding in the apixaban group. No patient required a reoperation for bleeding. Thirteen percent of the 20 Canadian centers have transitioned to extended apixaban thromboprophylaxis. ConclusionsApixaban for 28-day postoperative thromboprophylaxis was found to be an effective and safe alternative to enoxaparin after laparotomies in a real-world cohort of gynecologic oncology patients.

CLINICOPATHOLOGICAL CHARACTERISTICS OF INVASIVE BREAST CARCINOMA ON PDL-1 IMMUNOHISTOCHEMICAL EXPRESSION IN H. ADAM MALIK HOSPITAL MEDAN

Abstract
 Background: Immune biologic markers that can predict clinical response to anti-PD-1/PD-L1 therapy are needed to identify and validate tumor immunotherapy studies. High PD-L1 expression is associated with increased clinical response in patients with various types of cancer treated with inhibitors of the PD-1/PD-L1 pathway. The researcher wanted to see the clinicopathological characteristics of invasive breast carcinoma according to the immunohistochemical expression of PD-L1.
 Methods: This study is a descriptive study with a cross-sectional, retrospective approach by looking at secondary data from the medical records of the Department of Surgery, Oncology Division, Haji Adam Malik Hospital from January 1, 2019, to December 31, 2021.
 Results: Immunohistochemical expression of PD-L1 was positive in 76.6% of invasive breast carcinomas and negative in 23.3% of invasive breast carcinomas. Immunohistochemical expression of PD-L1 was positive in non-specific IBCs that predominated in every molecular subgroup of breast carcinoma.
 Discussion: Tumours can show positive or negative PD-L1 expression through several biological processes with different functional significance, namely the genetic mechanism of constitutive or oncogene-induced PD-L1 expression, PD-L1 expression induced in T cells, and absence of PD-L1 expression. Due to the absence of T cells and genetic events that block the expression of PD-L1 despite T cell infiltration.

Editorial introductions.

Editorial introductions.

The use of Instagram by gynecologic oncology providers as a patient education tool for patients at high-risk of gynecologic cancer

Social media outlets have increased in popularity within the last decade and are influencing the ways in which patients interact with the healthcare system. The objective of this study is to examine the presence of gynecologic oncology divisions on Instagram and to analyze the content of their posts. Secondary objectives included examining and analyzing the use of Instagram as a tool for patient education among people at increased genetic risk of gynecologic cancers. Seventy-one NCI-Designated Cancer Centers, their gynecologic oncology divisions and hereditary gynecologic cancer related posts were searched on Instagram. Content was reviewed and authorship was analyzed. Of the 71 NCI-designated Cancer Centers, 29 (40.8 %) had Instagram accounts, whereas, four (6 %) gynecologic oncology divisions had Instagram accounts. The search of the seven most common gynecologic oncology genetic terms yielded 126,750 posts with the majority under BRCA1(n = 56,900) and BRCA2 (n = 45,000) followed by Lynch syndrome (n = 14,700) and hereditary breast and ovarian cancer (n = 8,900). In terms of authorship, 93 (66 %) of all top 140 posts were written by patients, 20 (14.2 %) were written by health care providers and 27 (19.3 %) were written by “other.” This study highlights the lack of presence of divisions of gynecologic oncology at NCI-designated Cancer Centers on Instagram but does demonstrate the existence of active discussion on hereditary gynecologic cancers on Instagram by patients.

What Are the Functional and Surgical Outcomes of Tibial Turnup-plasty for Salvage in Patients With Chronic Lower Extremity Infection?

Tibial turnup-plasty is a rarely performed surgical option for large bone defects of the distal or entire femur and can serve as an alternative to hip disarticulation or high above-knee amputation. It entails pedicled transport of the ipsilateral tibia with or without the proximal hindfoot for use as a vascularized autograft. It is rotated 180° in the coronal or sagittal plane to the remaining proximal femur or pelvis, augmenting the functional length of the thigh. Prior reports consist of small case series with heterogeneous surgical techniques. Patient-reported outcome measures after the procedure have not been reported, and ambulatory status after the procedure is also unknown. (1) What proportion of patients underwent reoperation after tibial turnup-plasty? (2) What is the ambulatory status and what proportion of patients used a prosthesis after tibial turnup-plasty? (3) What are the Patient-Reported Outcome Measurement Information System (PROMIS) Global-10 mental and physical function scores after tibial turnup-plasty? A retrospective analysis was performed of 11 patients who underwent tibial turnup-plasty between 2003 and 2021 by a single orthopaedic oncology division in collaboration with a reconstructive plastic surgery team. Nine patients were men, with a median age of 55 years (range 34 to 75 years). All had chronic infections after arthroplasty or oncologic reconstructions, with a median number of 13 surgeries before turnup-plasty. All were considered to have no other surgical options other than hip disarticulation or high transfemoral amputation. All patients who were offered this possibility accepted it. Data of interest included patient demographics and comorbidities, surgical history that led to limb compromise, medical and surgical perioperative complications, date of prosthesis fitting, and functional capacity at the most recent follow-up interval based on ambulatory status and PROMIS Global-10 mental and physical function scores. The statistical analysis was descriptive. The median number of reoperations after turnup-plasty was one (range 0 to 11). Of the six patients who underwent at least one reoperation, indications for surgery included wound infection (four patients), nonunion of the osteosynthesis site (two), heterotopic ossification (one), tumor recurrence (one), and flap hypoperfusion treated with local tissue revision (one). One patient underwent conversion to external hemipelvectomy for tumor recurrence. Ten of the 11 patients were ambulatory at the final follow-up interval with standard above-knee amputation prostheses. Two ambulated unassisted, four used a single crutch or cane, and four used two crutches or a walker. Of the nine patients for whom scores were available, the median PROMIS Global-10 physical and mental health scores were 48 (range 30 to 68) and 53 (range 41 to 68), both within the standard deviation of the population mean of 50. The tibial turnup-plasty is a complex surgical option for patients with large bone defects of the femur for whom there are no alternative surgeries capable of producing residual extremities with acceptable functional length. This should be viewed as a procedure of last resort to avoid a hip disarticulation or a high transfemoral amputation in patients who have typically undergone numerous prior operations. Although ambulation with a prosthesis within 1 year can be expected, almost all patients will require an assistive device to do so, and reoperations are frequent. Level IV, therapeutic study.

Abstract A083: Higher incidence of rare ovarian tumors in West Africa

Abstract There is considerable regional variation in the incidences of ovarian cancer (OC); Europe and North America have the highest rate of 10.1 and 8.7 per 100,000 respectively whereas Japan and developing countries present with lowest incidences. Recent studies showed that West and East Africa women have high proportion of non-epithelial ovarian cancer, 30% and 39.5% from West and East Africa women respectively compared to 14%, 12%, 3% and 4.12% from US Born Black, Caribbean Born Black, US Born white and Alberta women, respectively. Africa women with epithelial ovarian cancer (EOC) presented at a lower age group; median age of 52.5 years compared with 59 years and above for the other group of women. The objective of the study was to evaluate a large cohort of OC tumors from West Africa, Nigeria to determine the patients’ demographics, the diagnostic accuracy and the tumor histotypes with the aim at identifying opportunities to improve the OC diagnosis in Africa and long-term goal of reduction in mortality and morbidity associated with the disease condition. This is a multi-centered retrospective study of OC involving 19 tertiary health institutions in West Africa, Nigeria over a period of 3 years (2017-2019). The histological records were accessed with the retrieval of patients’ demographics, original diagnosis and formalin fixed paraffin embedded (FFPE) tissue blocks of the corresponding patients. The FFPEs were sent to the collaborating institution, Division of Gynecological Oncology, Miller School of Medicine, University of Miami, Florida for further diagnostic appraisal. All FFPEs were sectioned, stained with hematoxylin and eosin (H&E) and reviewed by two pathologists. Immunohistochemistry (IHC) was performed on cases in which the morphology features were not diagnostic. A total of 422 FFPE ovarian tissue blocks were reviewed, corresponding to 377 patients. 238 (63.1%) of the cases fulfilled criteria for inclusion such as documentation of original diagnosis, presence of tumor on the slides, and interpretable morphologic features. 95 (39.9%) cases had some changes in their diagnosis. 5 cases (2.1%) had a complete change from malignant tumor to benign or borderline. IHC was required to perform differential diagnosis in 42 (44.2%) while the remaining 55 (56.8%) cases were made after histological secondary review. Epithelial ovarian cancer was 48.3% (115) of cases while non-epithelial ovarian cancer cases were 41 (36.4%) and other malignancies such as sarcoma, metastasis and hematological neoplasm accounted for the remaining 60 (25.2%) with 35 (58.3%) of the cases being metastatic tumors to the ovary. Our findings confirmed that West African women have a lower percentage of EOC compared to East Africa and North America women. We further demonstrated that secondary review of surgical pathology cases in a sub-specialized academic center and the use of ancillary techniques such as IHC may improve the diagnosis accuracy of OC in a low resource country. There would be need to incorporate this into the management of OC in low resource countries. Citation Format: Ayodele Joshua Omotoso. Higher incidence of rare ovarian tumors in West Africa [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A083.

Single-arm Cohort Study on the Effects of the COVID-19 Pandemic on the Radiation Treatment of Cancer Patients Referred to the Radiation Oncology Division of a Tertiary Hospital

Single-arm Cohort Study on the Effects of the COVID-19 Pandemic on the Radiation Treatment of Cancer Patients Referred to the Radiation Oncology Division of a Tertiary Hospital

Exploring the epigenetics of the TME

Roisin McGuigan, Editor, Immuno-Oncology Insights, speaks to Jesús M Paramio, Head of the Molecular and Translational Oncology Division CIEMAT & Head of the Cell and Molecular Oncology Group, Institute of Biomedical Investigation University Hospital “12 de octubre” Madrid, SpainWhat role do epigenetic modifications play in creating an immunosuppressive tumor microenvironment (TME), and how can further understanding of these epigenetic modifications help to better predict or enhance response to immuno-oncology (I–O) agents? In this interview, Jesús M Paramio, Head of the Molecular and Translational Oncology Division, CIEMAT, discusses his work in bladder cancer, the importance of interdisciplinary research, and the complex epigenetic factors at play within the TME.Dr Jesús M Paramio studied Biology at the University Autonoma of Madrid and specialized in Biochemistry and Molecular Biology (1979-84). He got a PhD in Biochemistry and Molecular Biology at the same University in 1992. He then moved to University of Dundee to work in the group of Prof EB Lane in close collaboration with Prof DP Lane and returned to CIEMAT in 1996, where he started new projects on epidermal differentiation, carcinogenesis and cell cycle using transgenic mouse models. In 2000, Jesús went to NIDCR/NIH to study signal transduction processes in epidermal differentiation and carcinogenesis. He then returned to CIEMAT to establish his own group focused on molecular and translational oncology with particular focus on transgenic mouse models and genomic analyses. In 2011, he also started a collaboration with a group of oncologists, pathologists, and urologist to study genitourinary (mainly bladder) cancer, including patient samples in his own studies. In 2014, formed a joint group between CIEMAT and University Hospital 12 de Octubre located at the Hospital and started collaboration with some Pharma companies. His current work is focused on molecular and translational characterization of bladder cancer, including some academic or industry supported clinical trials, although still does some work on other cancer types (head and neck, lung, kidney, ovarian, etc.). Most of his work is focused on aspects of epigenetic plasticity, immunotherapy and personalized medicine approaches.

43 Implementation of a standard same day discharge protocol for minimally invasive hysterectomies in the division of gynecologic oncology: a quality improvement project

43 Implementation of a standard same day discharge protocol for minimally invasive hysterectomies in the division of gynecologic oncology: a quality improvement project

Thrombocytopenia As a Risk Factor for Developing Febrile Neutropenia in Patients with DLBCL Receiving R-CHOP Chemotherapy

Background: Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is currently the standard of care for diffuse large B-cell lymphoma (DLBCL). Although heterogeneous, approximately 60 % of patients are cured while 10% of patient's refractory to initial chemotherapy. These outcomes are highly dependent on the dose intensity of chemotherapy received with poor outcomes associated with reduced dose intensity. Febrile neutropenia is one of the most common adverse events experienced leading to dose delays and interruptions. Therefore, we planned to evaluate the incidence of febrile neutropenia, its influence on delaying chemotherapy doses, and the need for subsequent growth factor support. We also planned to identify risk factors for the development of febrile neutropenia after the initiation of chemotherapy. Methods: We conducted a single-center retrospective study including adults with newly diagnosed DLBCL initiating R-CHOP-21 chemotherapy without growth factor support between dates January 2016 to February 2021 at the University of Alabama at Birmingham. We extracted baseline clinical and demographic variables (age, sex, race, stage, bulky disease > 7.5 cm, number of extranodal sites, osseous or bone marrow involvement, presence of B-symptoms, ECOG score, height, weight) and laboratory variables (absolute lymphocyte count, absolute neutrophil count, absolute monocyte count, platelets, lactate dehydrogenase, albumin, and creatinine) within 7 days of initiating treatment. The outcome variable was the development of febrile neutropenia during treatment. We used a multivariate regression model to identify risk factors for the development of febrile neutropenia adjusted for demographic and laboratory covariates listed above. Collinearity amongst variables was evaluated and highly correlated variables were excluded. The hypothesis testing was two-sided, and the level of significance was chosen as 0.05. Results: Of the 257 patients with a diagnosis of DLBCL, 149 patients met the inclusion criteria and were included in our cohort. The median age at diagnosis was 60 yrs (IQR 50 - 68) with 61% male and 77% white. Stage I/II was present in 33% of patients with bulky disease in 32% pts and 17% with involvement of the bone or bone marrow at diagnosis. The ECOG PS was less than 2 in 82% of patients with only 17% of patients endorsing B symptoms prior to treatment. Delays in treatment by more than 3 days were seen in 49 pts (32%) and 32 pts(21%) had delays of more than 7 days. Treatment discontinuation due to toxicity or death was seen in 19 pts (13%). Febrile neutropenia was experienced by 17 pts (11%) requiring subsequent growth factor support in 8 pts and leading to subsequent delays in treatment in all but one patient. Increasing platelet count (Odds Ratio, OR 0.91; 95%CI 0.84 - 0.98; p value 0.02) was associated with a decreased risk of developing febrile neutropenia during treatment. Conclusions: R-CHOP chemotherapy is generally well-tolerated, however, febrile neutropenia remains the most-common toxicity occurring in approximately 11% of patients and leads to associated treatment delays. Lower platelet count prior to initiation of chemotherapy was identified as a risk factor for developing febrile neutropenia adjusted for other known variables of bone marrow function. Therefore, future predictive models of febrile neutropenia in DLBCL should include baseline platelet count as a feature. Affiliations: 1. The Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX 2. Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 3. Mays Cancer Center, UT San Antonio, San Antonio, TX 4. Division of Hematology and Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Using Whole Exome Sequencing to Identify the Pathogenic Variant of F7 C.681+1 G>t As a Potential Cause of Severe Bleeding Clinic Presentation in a Newborn Baby

Ching-Tien Peng1, 2, 3 Chien-Yu Lin4 Yin-Ting Chen1 1.Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, 40447, Taiwan 2.Department of Biotechnology, Asia University, Taichung, 40447, Taiwan 3.Divisions of Pediatrics, China Medical University Hsinchu Hospital, Zhubei City, Hsinchu County, 30272, Taiwan. 4.Divisions of Laboratory Medicine, China Medical University Hsinchu Hospital, Zhubei City, Hsinchu County, 30272, Taiwan. Objective: The clinical manifestations of Factor VII deficiency vary, most cases remain asymptomatic or mild, and cases with severe clinical presentation are rarely reported. It is a rare hereditary hemorrhagic disorder passed on through autosomal recessive inheritance. We present a 2-day-old male infant with large cephalohematoma and intracranial hemorrhage, who was diagnosed using whole exome sequencing with Factor VII deficiency. Materials and Methods: Whole exome sequencing and Sanger sequencing were used to verify related variants. Other routine blood coagulation and factor activity tests were conducted by Divisions of Laboratory Medicine, China Medical University Hospital, Taiwan. Results: A 2-day-old male newborn was identified to develop left intracranial hemorrhage with unknown causes. The laboratory coagulation factor test results indicated a prolonged prothrombin time and normal activated partial thromboplastin time. The test results for Fibrinogen (279.9 mg/dL) and Factor activity analysis, included Factor VIII (85.6%), Factor V (49.3%), Factor VII (<1.0%), Factor IX (81.3%), and Factor X (42.7%). The results for VWF activity and antigen are normal. Subsequently, whole exome sequencing was used to conduct genetic tests, which revealed the homozygote mutation at F7 c.681+1 G>T (NM_000131). Further variant tests on the family members suggested that the father, mother, and older sister had heterozygote mutation at the same site. Conclusions: We used next-generation sequencing, which uses array-based sequencing to process reactions in parallel and enables the simultaneous investigation of multiple genes at a manageable cost, to identify the variants. While there is still little research on whether there is a relationship between different gene mutations and clinical presentations. The sequencing results revealed homozygote mutation at F7 c.681+1 G>T (NM_000131). The pathogenicity level was indicated to be "Highly pathogenic" in the ClinVar archive. Studies have reported the association of such mutation with severe hemorrhage disorders. Therefore, the present study offers critical empirical insights in that it applies to clinical practice in a clinical setting and identifies a pathogenic variant. We will present the hypothesis mechanism at the ASH meetings.

The Emergence of Cancer Stem Cells in Early Diagnosed Prostate Cancer

The Emergence of Cancer Stem Cells in Early Diagnosed Prostate Cancer

Telemedicine and gynecologic oncology: caring for patients remotely during a global pandemic

Telemedicine uses technology to deliver medical care remotely and has been shown to provide similar patient satisfaction and care outcomes compared with in-person visits. This study aimed to assess the gynecologic oncology patient telehealth experience. All patients receiving telehealth care between March 23, 2020, to May 14, 2020, from a single institution's gynecologic oncology division were offered postvisit surveys to assess satisfaction. Basic demographic and clinical data were collected and analyzed with descriptive statistics. Patient zip code data were correlated with Community Need Index scores and visualized using heat maps. Of 286 telehealth visits, 112 postvisit surveys (39.2%) were collected. Survey responses demonstrated high patient satisfaction with responders agreeing that privacy was respected (97.3%), diagnosis and treatment options were adequately explained (92%), they could easily ask questions (97.3%), and they established a good rapport with their provider (96.4%). Additional benefits included reduced travel (92.9%), time (83.0%), cost (67.9%), and family interruption (57.1%). Among 11 patients receiving treatment on a clinical trial, 10 (90.9%) were able to continue on trial without disruption. Most responders (87.5%) preferred future visits to occur via telehealth or a mixture of telehealth and in-person visits. No difference in satisfaction was found among patients residing in zip codes associated with higher Community Need Index scores or increased distance from the institution. The use of telemedicine in providing gynecologic oncology care was associated with high patient satisfaction and had the benefits of reduced time, cost, travel, and interruption to family time.

Eribulin in Patients with Liposarcoma and Leiomyosarcoma: A Retrospective Single-Center Experience

Introduction: Soft tissue sarcomas are rare and heterogenous malignancies with a poor prognosis in advanced disease stages. Eribulin is used in metastatic liposarcoma (LPS) patients, who have failed first-line chemotherapy and has been approved for use in patients with LPS in the USA and Europe due to its efficacy in this histological subtype in a phase 3 trial. We have evaluated efficacy and tolerability of eribulin in LPS and leiomyosarcoma (LMS) patients in the routine clinical setting at our department. Methods: In this retrospective single-center analysis, efficacy and safety of eribulin were retrospectively evaluated in advanced LPS and LMS patients at the Division of Oncology, Medical University of Vienna. Results: A total of 32 adult patients treated with eribulin were identified and included in this analysis. Overall response rate was 9.4% for all patients, with one patient with LPS and two patients with LMS showing a partial response. Disease control rate (partial response plus stable disease) for all patients was 50% (LPS: 47.1%; LMS 53.3%). No statistically significant difference in median progression-free survival and overall survival was detected between patients with LPS and LMS (p = 0.807 and p = 0.519, respectively). Patients with LMS (n = 2) had received fewer previous therapy lines than patients with LPS (n = 14) (≤ previous treatment lines, p < 0.001). Toxicity was generally manageable, and grade 3 + 4 events were rare. Conclusion: The activity and tolerability of eribulin in LPS as in well in LMS patients in the routine clinical setting is comparable to outcomes reported in published phase 3 trials.