Posttransplant lymphoproliferative disorder (PTLD) is the second most common malignancy in thoracic transplant recipients and is associated with poor survival. Accurate risk prediction is essential for prevention and management. Adult (≥18 years) heart, lung, and heart-lung transplant recipients were extracted from the Scientific Registry of Transplant (SRTR) and the United Network of Organ Sharing (UNOS) databases. A total of 160 donor and recipient pretransplant variables, including demographics, laboratory tests, induction therapy, and human leukocyte antigens (HLA), were analyzed. Risk scores were developed using the FasterRisk algorithm and compared with statistical and machine learning models. Among 89,139 thoracic recipients, the model achieved cross-validated areas under the curve of 0.776, 0.711, and 0.689 for 1, 3, and 5 year PTLD risk prediction, respectively. Steroid induction and previous malignancy were associated with an increased PTLD risk. Younger age (18-27 years at 1 year; 18-23 years at 5 years) was also linked to higher risk. In contrast, positive Epstein-Barr virus (EBV) status, heart transplantation (compared with lung or combined heart-lung), African American ethnicity, and basiliximab induction were associated with a lower risk. The proposed risk scores enhance understanding of PTLD risk factors and enable individualized prediction during the first 5 years after thoracic transplantation.

Second Transurethral Resection of Bladder Tumor Can Be Safely Omitted in Selected Patients with T1 Non-muscle-invasive Bladder Cancer: Results from the Prospective HuNIRe Trial.

Background: Primary central nervous system lymphoma (PCNSL) is a rare extranodal lymphoma characterized by a poor prognosis due to high relapse rates and a lack of standardized treatment. This study aimed to evaluate the impact of induction/consolidation therapy on long-term survival and to provide extended follow-up data. Methods: In this retrospective analysis, 140 immunocompetent patients with diffuse large B-cell PCNSL (DLBCL-PCNSL) treated at two centers between 2014 and 2024 were enrolled. Treatment efficacy was assessed based on baseline characteristics, therapeutic regimens, and treatment response. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method, and prognostic factors were identified using multivariate Cox proportional hazards regression models. Results: With a median follow-up of 5.3 years (range: 0.1–11.0 years), the 2- and 5-year PFS rates were 50.4% (95% CI: 42.1–60.2) and 34.1% (95% CI: 25.5–45.0), respectively, while the corresponding OS rates were 85.3% (95% CI: 79.4–91.6) and 60.8% (95% CI: 52.0–71.1). No survival plateau was observed. Among patients, 94% received methotrexate-based induction therapy: 94 received rituximab–methotrexate–temozolomide (R-MT) and 17 received MT alone, with 2-year PFS rates of 57.7% and 39.7%, respectively. Overall, 75% of patients achieved remission (CR/CRu/PR) after induction, and among these, 55% underwent consolidation therapy, predominantly autologous stem cell transplantation (ASCT, 90%) or whole-brain radiotherapy (10%). Patients receiving ASCT exhibited superior survival outcomes compared to those who did not. Conclusions: R-MT induction combined with ASCT consolidation is associated with improved survival in PCNSL, although relapse risk remains substantial. Outcomes remain poor in refractory subgroups, highlighting the need for novel therapeutic strategies.

ABSTRACT Background and Aims Achieving endoscopic response (ER), defined as a > 50% reduction from baseline in Simple Endoscopic Score for Crohn's disease (SES‐CD) score, following induction therapy for Crohn's disease (CD) has been linked to improved 1‐year outcomes. We evaluated the impact of ER at the end of maintenance (EOM) on long‐term clinical outcomes. Methods Data from a Phase 3 randomized trial (IM‐UNITI, ustekinumab) and a Phase 2 trial (GALAXI 1, guselkumab and ustekinumab) were analyzed using multivariable statistical methods. The relationship between ER at the EOM (Week 48) and outcomes at Week 96, including clinical remission, hospitalization, and surgery, was assessed. Results Endoscopic and clinical remission data at the EOM were available for 461 patients. ER at EOM was significantly associated with higher odds of clinical remission (odds ratio [OR] = 1.91; p < 0.05) at Week 96. ER was also linked to reduced inflammatory burden, with higher odds of C‐reactive protein normalization (OR = 2.19; p < 0.005). Forty‐one patients were hospitalized or required surgery during the long‐term extension, with higher event rates among those without ER at the EOM ( p = 0.1237). Conclusions ER after 48 weeks of maintenance therapy was associated with a greater likelihood of clinical remission and improved quality of life at 1 year. Data also suggest lower hospitalization and surgery rates for those who achieve ER. Larger studies are needed to substantiate long‐term reductions in hospitalizations and surgeries.

Nonmyeloablative Allogeneic Stem Cell Transplantation With Postcyclophosphamide in a Case of Acute Lymphoblastic Leukemia Complicated by Ventricular Septal Defect.

Impact of induction agent selection on rejection, allograft function, and survival in kidney transplant recipients.

Abstract Background Anthracyclines are very efficient in acute lymphoblastic leukemia (ALL) treatment resulting in promising survival rates. Anthracycline related cardiotoxicity has been detected by the diastolic and systolic cardiac impairment in the follow-up of adult oncological patients and childhood cancer survivors. The data for children on echocardiographic detection of early anthracycline induced diastolic dysfunction is lacking. Purpose We aim to present preliminary results of the study on left ventricle diastolic function evaluation among children treated for acute lymphoblastic leukemia before initiation of anthracycline treatment and after induction and intensification of the therapy. Methods For this prospective study, consecutive pediatric patients diagnosed with ALL were enrolled. Transthoracic echocardiography was conducted following diagnosis and prior to the initiation of anthracycline therapy (first assessment), and after the completion of induction and intensification therapy (second assessment)(fig 1). All studies were performed on the same echocardiographic machine and were obtained from at least 2 cardiac cycles. The echocardiography included conventional 2D diastolic function assessment with tissue doppler imaging and the left atrial (LA) strain. Interobserver reliability of the data was assessed by two echocardiographers. Results The preliminary study group included 25 children (13 females, 12 males) aged between 1-16 years (mean age 5,8±3,7years). All of the children were diagnosed with ALL type C and were treated with the same treatment protocol. Mean dosage of anthracycline equivalent was 107,4±45 mg/m2(min. 26.4 - max 216.0 mg/m2), 7 children received >120 mg/m2 and 1 child >200mg/m2 of anthracycline equivalent. Mean time between the first and second assessment was 214±42 days(~7 months). Diastolic left ventricle function assessed by the E/A ratio, deceleration time, tissue Doppler and left atrial volume index (LAVI) was not significantly different between the first and the second assessment (table 1). However, the LA conduit strain at end diastole (LAScd ED)(-36.6 ± 16.0 vs -25.8 ± 12.0, p=0.028) as well as at atrial contraction(LAScd AC)(-33.4 ± 14.1 vs -23.1 ± 10.9, p=0.016) were significantly reduced after the anthracycline therapy. Other left atrial strain parameters including LA strain during reservoir at end diastole(LASr ED) and at atrial contraction(LASr AC), in the contraction phase at end diastole(LASct ED) and at atrial contraction(LASct AC) did not differ significantly between the assessments. The systolic function of the left ventricle were within norms at both measurements(table 1). Conclusions Early anthracycline induced LV diastolic dysfunction may not be detectable by the conventional echocardiographic methods in children treated for ALL. Subclinical dysfunction may be identified by close echocardiographic monitoring with the left atrial strain.

Background This study aimed to compare reproductive and obstetric outcomes between frozen embryo transfer (FET) cycles using letrozole combined with human menopausal gonadotropin (HMG) for ovulation induction (OI) and hormone replacement therapy (HRT) for endometrial preparation. Methods A retrospective cohort study was conducted on 1,880 FET cycles from 2016 to 2024. Cycles were stratified into the OI group ( n = 902) and HRT group ( n = 978) based on the endometrial preparation protocol. The primary outcome was live birth rate (LBR). Secondary outcomes included clinical pregnancy rate (CPR) and obstetric complications. Exploratory subgroup analyses were performed based on ovulatory status (normal ovulation vs. ovulation disorders) and age (<35 years vs. ≥35 years). Results After adjustment for confounders, no statistically significant difference was observed in the primary outcome of LBR between the OI and HRT groups (OR = 1.145, 95% CI: 0.932–1.407; P = 0.198). Similarly, there was no significant difference in the secondary outcome of CPR (OR = 1.149, 95% CI: 0.944–1.398; P = 0.167). Analysis of other secondary outcomes revealed that the OI protocol was associated with a lower risk of cesarean section (OR = 0.619, 95% CI: 0.432–0.887; P = 0.009) and gestational diabetes mellitus (GDM) (OR = 0.339, 95% CI: 0.117–0.981; P = 0.046). Exploratory subgroup analyses suggested potential variations: In women with ovulation disorders, OI was associated with a higher CPR (OR = 1.624, 95% CI: 1.081–2.440; P = 0.020) and a lower preterm birth rate (OR = 0.682, 95% CI: 0.408–0.562; P = 0.023). In women ≥35 years, OI was associated with a markedly lower risk of GDM (OR = 0.038, 95% CI: 0.002–0.707; P = 0.028) and a non-significant trend toward higher LBR (OR = 1.521, 95% CI: 0.967–2.393; P = 0.07). In women <35 years, the OI cycle was associated with a lower cesarean section rate (OR = 641, 95% CI: 0.426–0.996; P = 0.034). Conclusions Adjusted analysis revealed comparable LBR between the OI and HRT protocols. The OI protocol was associated with a lower risk of cesarean section and GDM in the overall population, with exploratory subgroup analyses suggesting potential differential effects in specific patient groups. These findings warrant prospective validation.

Determining a real-world definition of percutaneous tibial nerve stimulation induction therapy in Medicare beneficiaries with overactive bladder.

Surgical treatment of pancreatic tumors invading the celiac axis is increasingly performed following induction therapy. This generally consists of a pancreatosplenectomy with celiac axis resection. When performed without revascularization, it is classified as IA.1 This video presents a 52-year-old patient with no medical history, in whom a pancreatic body mass was incidentally discovered. Imaging revealed a locally advanced lesion involving the celiac axis, contacting the superior mesenteric artery and the portal-mesenteric confluence. Biopsies were noncontributory, CA 19-9 was normal, and the staging workup was negative. After multidisciplinary discussion, induction therapy was recommended. The patient received 12 courses of FOLFIRINOX followed by 50.4Gy radiochemotherapy with capecitabine. In the absence of progression, surgical resection was undertaken. Preoperative hepatic and left gastric artery embolization was performed to promote collateral circulation and reduce postoperative morbidity.2,3 A distal splenopancreatectomy with celiac axis resection, full isolation of the superior mesenteric artery, and lateral resection of the portal-mesenteric axis including the splenic vein origin were performed. Venous reconstruction was achieved using a peritoneal patch. The procedure was uneventful, and postoperative recovery was uncomplicated. Locally advanced pancreatic body tumors involving the celiac trunk and/or superior mesenteric artery may be suitable for resection after optimal neoadjuvant therapy and preoperative vascular conditioning. Such complex procedures require a multidisciplinary approach and should be performed in specialized pancreatic surgery centers with interventional radiology expertise in selective embolization.

Background and Clinical Significance: Acute promyelocytic leukemia (APL) is a rapidly progressive subtype of acute myeloid leukemia defined by PML::RARA fusion and characterized by life-threatening coagulopathy. Because the disease typically follows an aggressive course, immediate treatment is essential once APL is suspected. This case report describes an atypical de novo presentation marked by indolent progression rather than the expected aggressive trajectory. Case Presentation: A 37-year-old female exhibited gradually declining white blood cell and neutrophil counts over the course of a year, followed by unexplained pancytopenia with severe neutropenia (0.1 × 109/L). Evaluation for nutritional deficiencies and autoimmune disease was unrevealing aside from a positive ANA without clinical features of autoimmunity. Bone-marrow biopsy demonstrated morphologic and flow cytometric findings suggestive of APL, low-level t(15;17), PML::RARA fusion, and concomitant TP53 loss and ETV6 mutation. Despite the indolent clinical presentation and low disease burden, the molecular and cytogenetic findings confirmed the diagnosis of classical APL with TP53 loss and ETV6 mutation. Induction therapy with all-trans-retinoic acid and arsenic trioxide resulted in hematologic remission. Conclusions: This case highlights an unusually indolent form of de novo APL not previously documented in the literature, expanding the recognized clinical spectrum of the disease. The findings emphasize the importance of still considering severe diagnoses, such as APL, when presentations deviate from classical patterns. Atypical clinical trajectories should prompt careful assessment of marrow morphology and immunophenotypic features. Continued characterization of such cases may refine diagnostic criteria and direct individualized approaches to therapy.

Background/Objectives: Malnutrition is highly prevalent in patients with acute leukemia and is frequently underrecognized at diagnosis. Traditional screening tools based on anthropometry often fail to identify early nutritional deterioration. This study aimed to evaluate the prognostic utility of a comprehensive morphofunctional assessment—including bioelectrical impedance vector analysis (BIVA), handgrip strength (HGS), and muscle ultrasound—conducted at diagnosis and after induction therapy, to evaluate the prognostic association with 12-month mortality. Methods: In this prospective cohort study, 52 adult patients with newly diagnosed acute leukemia were enrolled between November 2022 and November 2024 at two tertiary hospitals in Málaga, Spain. Nutritional status was determined using GLIM criteria. Morphofunctional assessment included BIVA-derived phase angle (PhA), HGS via dynamometry, and rectus femoris ultrasound. A second evaluation was performed prior to haematopoietic stem cell transplantation. Mortality at 12 months was the primary outcome. Logistic regression and ROC analysis were used to assess prognostic associations. Results: At baseline, 65.4% of patients were classified as malnourished. After three months, patients showed significant declines in PhA (−0.55°, p < 0.001), body cell mass (−3.15 kg, p < 0.01), skeletal muscle mass (−1.66 kg, p < 0.01), and rectus femoris cross-sectional area (−0.36 cm2, p = 0.011). Baseline malnutrition (OR = 6.88; 95% CI: 1.17–40.38; p = 0.033) and PhA decline ≥ 0.90° were both independently associated with higher 12-month mortality. Conclusions: Early morphofunctional assessment using GLIM criteria, BIVA, and muscle ultrasound identifies patients at nutritional and functional risk. PhA decline during treatment was associated with higher 12-month mortality, supporting the need for early, personalized nutritional intervention in leukemia care.

Podocyte infolding glomerulopathy is a rare glomerular lesion characterized by microtubular structures and microspheres in the glomerular basement membrane. While most reported cases are associated with autoimmune diseases such as systemic lupus erythematosus, pediatric cases are rarely reported. The patient was a 14-year-old Japanese girl with a 1-year history of proteinuria detected during a school urinary screening program. Five months prior to admission to our department, she was hospitalized at a regional hospital for acute abdominal pain. Although her symptoms resolved spontaneously, a renal biopsy was performed due to the presence of proteinuria, leukopenia and antinuclear antibody positivity. However, the diagnoses of systemic lupus erythematosus was not established at that time owing to negative IgG, IgA, IgM, C3 and C1q on immunofluorescence, negative anti-dsDNA and anti-Smith antibody as well as normal serum C3 and C4 levels. On admission to our department, she was diagnosed with systemic lupus erythematosus and lupus enteritis based on the presence of malar rash, fever, leukopenia, and proteinuria supported by the characteristic findings on abdominal enhanced computed tomography. Reassessment of the initial renal pathology revealed microtubular structures and microspheres within the glomerular basement membrane on electron microscopy, consistent with podocyte infolding glomerulopathy. Induction therapy with methylprednisolone pulse therapy improved her systemic symptoms and proteinuria promptly. This is the first report of podocyte infolding glomerulopathy in a pediatric patient with systemic lupus erythematosus. Clinicians should be aware of this unique glomerular lesion in pediatric-onset systemic lupus erythematosus.

A retrospective study was conducted to analyze changes in the diagnosis, treatment, and prognosis of multiple myeloma (MM) patients in a provincial medical center in the Gannan region and to describe the gradual improvements in these methods. The clinical data of patients with newly diagnosed multiple myeloma (NDMM) at the First Affiliated Hospital of Gannan Medical University from January 1, 2013, to December 31, 2022, were retrospectively collected. Demographic and clinical characteristics, 1st-line treatment and its efficiency, survival, and prognostic factors of patients with MM in the past 10 years were analyzed. A total of 439 patients with NDMM were identified, with a median age of 64 (33–91) years and a male-to-female ratio of approximately 1.26:1. Among the patients, 56.95% were classified as International Staging System stage III. A total of 168 patients (38.27%) underwent fluorescence in situ hybridization, with a positive rate of 68.45%. The proportion of patients who underwent autologous stem cell transplantation was low. The main regimen used for induction therapy was proteasome inhibitor + immunomodulatory drug-based triple chemotherapy. During follow-up, the overall response rate was 72.73%, and the complete response rate was 20.35%. The short-term and long-term overall survival (OS) rates increased annually. The median OS was 1273 days, and the 5-year OS% was 35.70%. Multivariate Cox analysis revealed that age > 65 years; no autologous stem cell transplantation; progression to relapsed and refractory MM; and increased lactate dehydrogenase, β2-microglobulin, and uric acid levels were independent poor prognostic factors affecting OS. In the past decade, the diagnosis of NDMM and treatment methods in the Gannan area have gradually improved. With the popularization of new technologies and the widespread use of standardized treatment regimens containing new drugs, the short-term and long-term survival of MM patients in the Gannan area has significantly improved.

Not available.

Background/Objectives: Real-world data on the therapeutic use of FLT3 inhibitors in Turkey remain limited. Therefore, we retrospectively evaluated outcomes from 13 academic centers nationwide, focusing on the multikinase inhibitor midostaurin in patients with newly diagnosed FLT3-mutated acute myeloid leukemia (AML). Methods: We collected comprehensive information regarding treatment efficacy, safety, and tolerability. Results: The overall response rate to intensive chemotherapy (3 + 7) plus midostaurin was 87.7%, with a complete remission rate of 84.2%, consistent with previously reported clinical trial results. Treatment discontinuation due to intolerance or toxicity was low (3.5%). One patient discontinued therapy because of septic shock during induction, and another due to a drug–drug interaction during consolidation. Median overall survival was 21.4 months. Allogeneic stem cell transplantation was performed in first remission in 52.6% of patients. Five patients (8.8%) were refractory to induction therapy, and relapse occurred in 21.1% (12 patients). Conclusions: These findings support the effectiveness and acceptable tolerability of midostaurin in routine clinical practice for FLT3-mutated AML.

Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial.

A 6-month-old boy presented with complaints of irritability, decreased feeding and high-grade intermittent fever for 20 days. He had moderate hepatosplenomegaly. Baseline cultures were negative but urinary Cytomegalovirus polymerase chain reaction was positive. He was started on Inj. Ganciclovir 5 mg/kg/dose twice daily for 14 days. Bone marrow aspiration (BMA) yielded a dry tap. Bone marrow biopsy (BMB) showed marked myelofibrosis with suppressed trilineage hematopoiesis. In view of persistent cytopenia and fever, a repeat BMA was done, revealing 22% blasts. Immunophenotyping by flow cytometry revealed 5.4% blasts with megakaryocytic differentiation. Subsequent cytogenetic analysis revealed Trisomy 8 and 19, with no evidence of Down syndrome. He was started on Down syndrome AML induction therapy followed by Cytarabine-Idarubicin-Etoposide therapy, but ultimately, he succumbed to infection and persistent disease. This case highlights the significance of looking for blasts even in a diluted marrow, so AMKL in a fibrotic marrow will not be missed.

Background: Tap water iontophoresis (TWI) is a well-established second-line treatment for primary focal hyperhidrosis. While its efficacy is proven, data regarding the correlation between session frequency and clinical response, as well as long-term adherence in hospital-based settings, remain limited. Objective: We aimed to evaluate the efficacy and safety of hospital-based TWI and to analyze the relationship between the number of treatment sessions and clinical outcomes. Methods: This retrospective study included 92 patients with primary focal hyperhidrosis treated with TWI. Disease severity was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Clinical response was categorized as “Excellent” (≥2-point HDSS reduction), “Good” (1-point reduction), or “No Response.” Relapse rates and reasons for treatment discontinuation were analyzed over a 6-month follow-up period. Results: The overall objective response rate was 65.2% (46.7% Excellent, 18.5% Good). A significant positive correlation was found between the total number of treatment sessions and the degree of clinical response (r = 0.401, p < 0.001). Patients achieving an “Excellent” response completed a significantly higher median number of sessions compared to non-responders (p = 0.001). However, among responders, the relapse rate was 85% within six months. Logistical difficulties were the most common reason for treatment discontinuation (17.5%). No compensatory hyperhidrosis or severe adverse events were observed. Conclusions: Hospital-based TWI is a safe and highly effective induction therapy, with success rates closely linked to the number of completed sessions. However, the high relapse rate and logistical barriers to adherence suggest that hospital-based protocols should serve primarily as a bridge to home-based maintenance therapy to ensure sustained long-term remission.

Thymoglobulin Induction Therapy in Kidney Transplant Patients Receiving Organs Donated after Cardiac Death in China: A Real-World Patient-Level Pooled Analysis of the T-DCD and Start-DCD Studies.