Number Of Previous Treatments Research Articles

Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam

BackgroundOpioid relapse, one of the common and severe problems during methadone maintenance treatment, can give rise to poor treatment outcomes. This study measured the opioid relapse rate and its associated factors among methadone maintenance patients in Vietnam.MethodsInformation about the demographic characteristics and social support of 655 patients was collected through direct interviews. Medical records were used to gather data on treatment characteristics. Relapse was determined via urine opioid test results.ResultsThe overall relapse rate of patients during treatment was 13.1%. According to the multivariate logistic regression model, living in mountainous areas (adjusted odds ratio (aOR) = 3.63, 95% CI 1.90–7.46) and long duration of drug use in the past (aOR = 1.06, 95% CI 1.03–1.09) were associated with an increase in the odds of opioid relapse. By contrast, living with many family members (aOR = 0.69, 95% CI 0.55–0.85), having longer treatment time (aOR = 0.80, 95% CI 0.73–0.87), and completely adhering to treatment (aOR = 0.38, 95% CI 0.23–0.64) were protective for opioid relapse. As per the univariate analyses, the odds of opioid relapse declined by 25% for each increase of one close friend or relative (OR = 0.75, 95% CI 0.66–0.86). Regarding social support (range score: 0–100), each additional increase of one score was associated with a 1% decrease in the odds of opioid relapse (OR = 0.99, 95% CI 0.98–0.99). Patient sex, education level, occupation type, patient’s monthly income, family’s monthly income, the number of previous treatments, daily methadone dose, comorbidity, and received antiretroviral therapy were not associated with opioid relapse among patients (p > 0.05).ConclusionsResidence, the role of family and social support, and treatment adherence should be paid more attention to guarantee and enhance the success of methadone maintenance treatment.

P-057 Does sperm cryopreservation affect the clinical outcome? A retrospective study in an oocyte donation program

Abstract Study question Does sperm cryopreservation have a negative impact on pregnancy and live birth rate (LBR)? Summary answer The use of frozen sperm does not affect pregnancy rates and LBR significantly compared to fresh sperm. What is known already The use of frozen sperm, especially in oocyte donation cycles, is a common strategy in organizing a couple’s treatment. By now, contradictory data has been published concerning the impact of fresh sperm versus frozen on pregnancy and LBR. There is data indicating reduction of the LBR with the use of frozen sperm in a donation program, while in other studies no significant difference between fresh and frozen sperm was observed in the LBR. Study design, size, duration This is a retrospective cohort study conducted in Embryolab Fertility Clinic, Greece, from January 2019 to March 2020. Only oocyte donation cycles were included in the study. On the day of donor's oocyte retrieval ICSI was performed, either with fresh (group A) or frozen sperm (group B)All embryos were cultured to blastocyst stage, assessed for their development, vitrified and two were transferred post warming on a subsequent HRT cycle. Participants/materials, setting, methods For the present study, 135 cases were analyzed: in 28 cases fresh sperm was used, while frozen sperm was used in 107 cases[pd1] . The mean men’s age was 44.4 years, while all oocyte-donors were below 35 years old. The main outcome measure was LBR, while fertilization rate, blastulation rate as well as positive β-HCG were also analyzed. All patients with uterine factor, severe male factor or surgically obtained sperm were excluded from the study. Main results and the role of chance There was no significant difference between LBR of fresh vs frozen sperm (53.57% ±50.78 vs 50.47% ±50.23, p=0.086). Although positive β-CG reached a higher percentage in fresh sperm samples, there was no significant difference between two groups (85.71% ±35.63 in fresh vs 77.78% ±41.76 in frozen sperm, p=0.857). Similarly, both blastulation rate (68.93% ±25.22 in fresh vs 67.97% ± 28.72 in frozen sperm, p=0.873) and fertilization rate (85.36% ±16.92 in fresh vs 83.27% ±17.01 in frozen sperm, p=0.565) did not differ significantly between fresh and frozen sperm samples. [pd1] Regression analysis adjusting for relevant confounders (endometrial thickness the day of the embryo transfer, BMI, donor’s age) showed no association between LBR and sperm type (fresh vs cryopreserved). Limitations, reasons for caution This is a retrospective study, including sperm samples irrespectively to quality parameters (sperm count, motility, morphology). The number of previous treatments per couple was not included in the study. Wider implications of the findings The outcome of the study indicates that the use of frozen sperm is a viable choice in a donation program, as it does not induce any negative effects in LBR. However, specific subgroups might benefit from fresh sperm especially when the sperm parameters are low. Trial registration number N/A

Level of adherence to acne treatment and associated factors in patients with acne in Yaoundé, Cameroon (sub-Saharan Africa)

Background: Acne is a chronic inflammatory disease of the pilosebaceous follicle. The aim of this study was to assess the level of adherence to acne treatment and to identify factors associated with adherence to therapy in patients with acne. Materials and Methods: This was a descriptive, analytical, cross-sectional study conducted from January to April 2017 in three hospitals in Yaoundé. We included patients followed for acne for at least one month. The sampling was consecutive and exhaustive. Adherence to treatment was assessed according to the Morisky score. Data was analyzed with Microsoft Excel 2013 and the SPSS software, version 23. We employed the ANOVA test to find associations between the different variables. p values below 0.05 were considered statistically significant. Results: A total of 113 patients were selected, with a mean age of 26.0 ? 6.4 years. The mean Morisky score was 5.6 ? 1.9. Adherence to treatment was low, medium, and high in 58 (51%), 31 (28%), and 24 (21%) patients, respectively. The factors associated with low adherence were the presence of relapses, a psychological history, the number of previous treatments above two, and the duration of treatment above three months. Conclusion: Adherence to acne treatment was low in over half of the patients. In our context, the presence of relapse, a psychological history, the number of previous treatments above two, and the duration of treatment above three months were associated with low adherence to therapy.

P17.04.B Combination of Trofosfamide and Etoposide in Recurrent Glioma

Abstract Background Disease relapse almost inevitably occurs in patients with adult-type diffuse glioma. Standard of care treatment options at tumor relapse are still not well defined. Frequently used drugs for adult-type diffuse glioma recurrence include lomustine (CCNU) and bevacizumab. Few studies indicate that the combination of trofosfamide/etoposide, given their high lipid solubility with good blood-brain barrier penetrance, may be feasible in pediatric glioblastoma patients. In this retrospective analysis, we determined tolerability and feasibility of combined trofosfamide/etoposide treatment at disease recurrence of patients with adult-type diffuse glioma. Material and Methods We collected clinicopathological data from adult patients with adult-type diffuse glioma treated with the combination of trofosfamide/etoposide at the Division of Clinical Neurooncology at the University Hospital Essen. Only those patients were considered eligible who received trofosfamide/etoposide treatment for more than four weeks (one course). Trofosfamide (100mg/m2/day) and Etoposide (25mg/m2/day) was administered orally in a “one week on, one week off” scheme. A cohort of patients receiving empiric treatment at the investigators’ discretion balanced for tumor entity and canonical prognostic factors (number of previous treatments, MGMT promoter methylation, IDH mutation status, KPS, age, extent of resection) served as control. We collected toxicity data as it pertained to CTCAE (Common Terminology Criteria for Adverse Events, version 5.0) and survival data to explore putative efficacy. Results A total of 33 patients were eligible for this analysis. In the IDH wild-type glioblastoma (n=18) subgroup, median progression-free survival (3.8 months versus 2.9 months, HR: 2.09, 95% CI: 1.010-4.312, p=0.0227; PFS-6: 39% versus 6%) and median overall survival (10.4 months versus 5.7 months, HR: 3.05, 95% CI: 1.393-6.655, p=0.0008) were significantly prolonged as compared to the control cohort. In a multivariable Cox regression analysis, treatment with trofosfamide/etoposide emerged as statistically significant prognostic marker regarding progression-free survival and overall survival. We observed high-grade adverse events (CTCAE grade≥III ) in 21 (64%) of all recurrent glioma patients with hematotoxicity comprising most adverse events (n=18, 86%). Lymphopenia was by far the most observed hematotoxic adverse event (n=13, 62%). Among non-hematologic high-grade adverse events was transaminase elevation (n=3, 14%). Conclusion This study provides first indication that the combination of trofosfamide/etoposide is safe in patients with adult-type diffuse gliomas and may be associated with prolonged survival in adult patients with recurrent IDH wildtype glioblastoma. Our data provide a reasonable rationale for follow-up of a larger cohort in a prospective controlled trial.

Comparison of dimethyl fumarate and interferon outcomes in an MS cohort

BackgroundTo compare the effectiveness of dimethyl fumarate (DMF) with subcutaneous interferon beta-1a (IFNβ-1a) in controlling disease activity in patients with relapsing–remitting Multiple Sclerosis (MS).MethodsClinical and imaging data from patients treated with either IFNβ-1a or DMF for at least one year were reviewed. The proportion of patients with at least one clinical relapse within 3–15 months after treatment onset, the proportion of patients with new T2 or gadolinium-enhancing lesions, and the proportion of subjects who achieved no evidence of disease activity (NEDA) status were assessed.ResultsThree hundred sixteen (98 on IFNβ-1a, 218 on DMF) subjects were included. Baseline demographics were comparable between groups except for age, disease duration, and the number of previous treatments being higher and relapse rate in the prior year being lower in the DMF-treated group. The proportion of patients having a clinical relapse (24.5% vs. 9.6%; OR = 3.04; P < 0.001) or a new MRI lesion (28.6% vs. 8.7%; OR = 4.19, P < 0.001) at 15 months were higher on IFNβ-1a. 79.9% of the patients achieved NEDA status at 15 months on DMF (vs. 51.1% for IFNβ-1a; OR = 0.26, P < 0.001). Further adjustment for demographics, disease characteristics, treatment and relapse history, and subgroup analyses confirmed these findings.ConclusionDMF was associated with less clinical and radiological disease activity compared to IFNβ-1a.

O-065 The effect of double vitrification on embryo reproductive potential and clinical outcome

Abstract Study question Do double-vitrified embryos have impaired implantation potential compared to embryos vitrified once? Summary answer Double-vitrified embryos demonstrated significantly lower percentages of positive β-HCG, clinical pregnancy (CPR) and live birth (LBR) compared to embryos vitrified once. What is known already Since vitrification became a core player in ART, many clinics adopted a freeze-all strategy, including vitrification of more than one embryo per vitrification device. Nowadays, the guidelines’ suggestion for single embryo transfers often results in a surplus of good quality embryos post warming which are re-vitrified to avoid embryo wastage. Thus, transfers of double-vitrified embryos have been performed worldwide, leading to successful pregnancies. It remains yet to be answered whether embryos after double vitrification exhibit the same reproductive performance as embryos vitrified once. By now, limited studies including various cryopreservation methods show relatively conflicting results. Study design, size, duration This retrospective cohort study was conducted in Embryolab Fertility Clinic, Greece. Assisted reproductive cycles included in the study were performed from January 2015 to December 2020. Both PGT cycles and cryopreserved oocyte cycles were excluded. The mean women age was 32.8 years old (±5.9) in the study group and 33 (±5.9) in the control group. There was no variation in the cryopreservation methods used, since all embryos were cryopreserved by the same vitrification protocol. Participants/materials, setting, methods For the present study, 233 embryo transfers of 334 double-vitrified embryos (309 blastocysts/25 cleavage embryos) and 172 transfers of 260 embryos vitrified once (246 blastocysts/14 cleavage) were analyzed to explore the impact of double vitrification on positive β-HCG, CPR, LBR and miscarriage rate. Moreover, the performance of embryos that were cultured for at least 24 hours before re-vitrification was compared to embryos warmed and re-vitrified on the same day, for the same parameters mentioned above. Main results and the role of chance All embryos survived vitrification (100% survival rate) in both study and control group. An alpha level of .05 was used for all statistical tests. Results showed that positive β-HCG percentage was significantly lower in the double vitrification group (45.1% for double -vitrified embryos -study group-, 57.0% for embryos vitrified once -control group-, p=.02), as well as CPR (28.3% in study group - 42.4% in control group, p=.003) and LBR (26.6% in study group - 40.4% in control group, p=.004). The miscarriage rate did not significantly differ between two groups (35% in study group - 25% in control group, p=.121). Moreover, positive β-HCG percentage was significantly higher in transfers with embryos that were cultured at least 24 hours before re-vitrification (group A: 48.9%), compared to embryos that were warmed and re-vitrified on the same day (group B: 30.6%, p=.02). Interestingly, although CPR (31% in group A, 18.4% in group B, p=.08), LBR (29.4% in group A, 16.3% in group B, p=.06) and miscarriage rate (35.6% in group A, 33% in group B, p=.87) were not significantly different between these groups, there was a tendency for rates to be higher in group A compared to group B. Limitations, reasons for caution This is a retrospective study, including transfers of embryos of different stage (day 2 – day 5). However, the control group was matched to the study group, in terms of embryo stage. The number of previous treatments per couple was not included in the study. Wider implications of the findings Although double-vitrified embryos can lead to successful pregnancies, our results showed an adverse effect of double vitrification on embryo reproductive potential. To avoid lower pregnancy rates, culture of embryos until day 5 and cryopreservation of one embryo per vitrification device should be considered. Trial registration number not applicabe

Role of radium-223 discontinuation due to adverse events in castration-resistant prostate cancer patients. A retrospective monocentric analysis.

Radium 223 (Ra-223) was approved for the treatment of metastatic castration resistant prostate cancer (mCRPC) patients with bone-only disease, following demonstration of significant improvement in overall survival (OS). To date, there are no validated prognostic factors useful in predicting outcome of mCRPC patients treated with Ra-223. Our retrospective study aims to evaluate the prognostic role of treatment discontinuation due to adverse events in mCRPC patients treated with Ra-223, and to identify which factors correlate with the toxicity onset. We performed a retrospective analysis of all consecutive mCRPC patients treated with Ra-223 from September 2013 to December 2019 at our institute. Patients were divided in 2 groups according to the reason of Ra-223 therapy discontinuation: toxicity versus other causes. Outcome measures were progression-free survival (PFS) and OS. In the overall population (75 patients) median PFS and OS were 5.46 months and 11.15 months respectively. Patients who discontinued treatment due to toxicity had a lower median PFS (3.49 vs 5.89 months, HR: 1.88, 95% CI: 1.14-3.12, p = 0.014) and OS (8.59 vs 14.7 months HR: 3.33, 95% CI: 1.85-6.01, p < 0.001) than patients who discontinued therapy due to other causes. The risk of Ra-223 discontinuation due to toxicity correlates with the number of previous treatments (p = 0.002), previous chemotherapy treatment (p = 0.039), baseline LDH (p = 0.012), Hb (p = 0.021) and platelet-to-lymphocyte ratio (p = 0.024). Discontinuation due to toxicity is associated with worse outcomes in mCRPC patients treated with Ra-223. To reduce the risk of developing toxicities that may compromise treatment efficacy, Ra-223 should be used early in mCRPC patients.

Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting

BackgroundTreatment decision for recurrent symptomatic brain metastases (BM) is challenging with scarce data regarding surgical resection. We therefore evaluated the efficacy of surgery for pretreated, recurrent BM in a comprehensive multidisciplinary treatment setting.MethodsIn a retrospective single center study, patients were analyzed, who underwent surgical resection of recurrent BM between 2007 and 2019. Intracranial event-free survival (EFS) and overall survival (OS) were evaluated by Kaplan-Maier and Cox regression analysis.ResultsWe included 107 patients with different primary tumor entities and individual previous treatment for BM. Primary tumors comprised non-small cell lung cancer (NSCLC) (37.4%), breast cancer (19.6%), melanoma (13.1%), gastro-intestinal cancer (10.3%) and other, rare entities (19.6%). The number of previous treatments of BM ranged from one to four; the adjuvant treatment modalities comprised: none, focal or whole brain radiotherapy, brachytherapy and radiosurgery. The median pre-operative Karnofsky Performance Score (KPS) was 70% (range 40–100) and improved to 80% (range 0-100) after surgery. The complication rate was 26.2% and two patients died during the perioperative period. Sixty-seven (62.6%) patients received postoperative local radio-oncologic and/or systemic therapy. Median postoperative EFS and OS were 7.1 (95%CI 5.8–8.2) and 11.1 (95%CI 8.4–13.6) months, respectively. The clinical status (postoperative KPS ≥ 70 (HR 0.27 95%CI 0.16–0.46; p < 0.001) remained the only independent factor for survival in multivariate analysis.ConclusionsSurgical resection of recurrent BM may improve the clinical status and thus OS but is associated with a high complication rate; therefore a very careful patient selection is crucial.

Study of the Visceral Adipose Tissue in a Cohort of Patients with Moderate-Severe Psoriasis Treated with Biological Therapy.

IntroductionVisceral adipose tissue (VAT) has a greater relationship with the genesis of the metabolic syndrome and the pathology associated with obesity.MethodsA cross-sectional study of patients with moderate-severe psoriasis in the Psoriasis Unit of the San Cecilio University Hospital in Granada in the period July 1, 2020 – December 31, 2020, was performed. All the patients (n = 110) were receiving biological therapy to control the disease. The variables measured included age, sex, time since diagnosis, weight, height, body mass index (BMI), visceral and total fat, and severity parameters. The visceral fat index was evaluated using a bioimpedance scale, considering a cut-off point for a healthy level < 12.ResultsOur sample consisted of 110 patients with a mean age of 47.47 years, with a clear predominance of males (61.7% of patients). After testing for normality using the Kolmogorov-Smirnov test, the Mann-Whitney U test for nonparametric data for independent samples was used, which revealed significant differences between the number of previous treatments and visceral fat (U = −2.235, P = 0.025). No statistically significant differences were found when correlating total fat or visceral fat with BMI.ConclusionsThe results presented lead us to consider if the levels of VAT could be a factor that contributes to some extent to therapeutic refractoriness. The determination of VAT using bioimpedance scales in patients with moderate-severe psoriasis is a valuable method to measure VAT.

The outcomes of three buccal mucosal graft urethroplasty techniques in women with urethral stricture disease.

The purpose of this paper is to present the outcomes of three buccal mucosal graft (BMG) urethroplasty techniques in female patients with urethral strictures. We included all patients who had BMG urethroplasty for female urethral strictures (FUS) disease between January 2015 and June 2020. Patient age, comorbidities, stricture etiology, stricture length, the number of previous treatments, preoperative and postoperative uroflowmetry data, postvoid residual volumes, and the operation and postoperative course details were documented. A total of 34 patients were included in this study. There were 8 patients in vaginal-sparing inlay BMG, 12 for ventral onlay BMG, and 14 for Aybek-Zumrutbas (AZ) technique groups. The mean age of the study population was 56.1 years. The length of urethral strictures varied between one and 4.5 cm. All patients had a previous history of endoscopic treatment or dilatations. The preoperative mean maximal flow rate (Qmax) was 6.9 ml/s. The median postoperative follow-up time was 24.6 months. Twelve months after surgery, the mean Qmax was 25 (range: 14-32) ml/s. There were no significant complications in any patients. The success rates were 83.3% for ventral onlay BMG, 87.5% for vaginal-sparing, and 100% for AZ technique. All three BMG urethroplasty techniques applied in this study had a success rate of over 80% in a median follow-up of approximately 2 years. In females, urethroplasty with BMG provided high rates of cure, and the recently described two techniques (vaginal-sparing inlay BMG, and AZ technique) showed promise in FUS treatment.

Outcome of NPM1 Mutated Acute Myeloid Leukemia (AML) Treated with Hypomethylating Agents (HMAs): A Report on 71 Cases

Background: NPM1 mutation is seen in 25 - 30 % of AML, and its incidence does not decrease with older age. While NPM1 mutation is associated with better prognosis in AML patients treated with intensive chemotherapy (IC), it is unknown if it also confers a good prognosis to patients unfit for IC who are treated with HMA.Methods: 71 AML patients with mutated NPM1 treated by HMA from 2007 to 2016 in 8 European and 1 US centers were retrospectively analyzed. 48 (68%) received azacitidine (AZA), 16 (22%) received decitabine (DAC), and 7 (10%) guadecitabine (SGI 110).All patients were tested for NPM1 and FLT3 mutations.Results: M/F was 25/46; median age was 75 years (36-85), 76% being 65 or older. 34 patients, considered unfit for IC, received HMA as first line treatment, and 37 after primary or secondary IC failure. Median WBC count at HMA onset was 5.3 x109/L (1.5 - 83). Sixty patients (84%) had normal cytogenetics, 6 had intermediate prognosis abnormalities, one had a complex karyotype, and two had missing data. In addition to NPM1 mutation, 26 patients (37%) had FLT3-ITD, one FLT3-TKD, and 10 (14%) had IDH1 or IDH2 mutation.The median number of HMA cycles received was 4. The overall response rate (ORR) was 35.1% (n=25), including 16 (22.5%) CR, 5 (7%) CRi, and 4 (5.6%) PR. The number of previous treatments before HMA, the type of HMA used, and baseline WBC had no impact on ORR. The ORR was 45.5% and 27% respectively in patients receiving HMA as first line or subsequent treatment (p=0.137); 45% and 27% respectively in mutated and non-mutated FLT3 (p= 0.302); 20% and 38.3% respectively in mutated and non-mutated IDH1/2 patients (p= 0.314). Among the 26 FLT3-ITD patients, 11 received concomitant therapy with sorafenib, without any impact on ORR or survival (OS), compared to FLT3-ITD patients who did not receive sorafenib (p= 0.73).Median OS was 280 days, 1 year OS was 17% and only one patient was alive after 2 years, but he died at 24.5 months. We failed to identify any prognostic markers for OS including whether HMA was administered as first line or subsequent treatment (median 289 vs 269 days, p= 0.90), and FLT3-ITD status (median 217 days vs 312 in FLT3-ITD negative, p=0.44). OS was significantly longer in responders (median 553 days vs 123 days, p<10-4). Four of the 6 patients in whom marrow NPM1 MRD was performed achieved a >3log reduction after six cycles of treatment, but 3 of them relapsed within less than six months, while one was alive in CR 12 months after the onset of HMA.We compared patients of the present series with 92 NPM1 unmutated AML patients previously treated upfront with AZA by our group (Desoutter, Leukemia, 2016). In this cohort, median age was 74 years, 69% had unfavorable cytogenetics, and 63% TP53 mutation. Despite a different molecular profile, there was no OS difference in patients with mutated or non-mutated NPM1 (median 280 vs 291 days, p= 0.53, respectively). This finding was also true when the analysis was restricted to NPM1 mutated patients treated with HMA as first line therapy (Figure 1, p=0.48)Conclusion: This is to our knowledge the first study reporting the efficacy of HMA in NPM1 mutated AML. Contrary to what is observed with conventional AML chemotherapy, HMA do not seem to improve the outcome of NPM1 mutated compared to unmutated AML cases, and are unable to provide long term remissions. Thus, in elderly AML patients, presence of a NPM1 mutation could contribute to decide the administration of intensive chemotherapy rather than a HMA, when possible. [Display omitted] DisclosuresRecher:Novartis, Celgene, Jazz, Sunesis, Amgen: Consultancy; Celgene, Sunesis, Amgen, Novartis: Research Funding. Fenaux:Astex: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Astex: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

Prognostic Value of 2-Deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography after Autologous Hematopoietic Stem Cell Transplantation in Lymphoma Using Deauville Scores.

Purpose In the present study, we mainly aimed to evaluate the prognostic value of 2-deoxy-2-[18F]fluoro-D-glucose ([18F]F-FDG) positron emission tomography (PET)/computed tomography (CT) after autologous stem cell transplantation (ASCT) in lymphoma. Procedures. A total of 76 lymphoma patients who benefited from [18F]F-FDG PET-CT (within 3 months and 3–6 months) after ASCT in our institution between April 2010 and December 2019 were enrolled in this retrospective study. These abovementioned patients were divided into two groups based on the Deauville criteria. The Kaplan–Meier method was used in survival analysis, and the log-rank method was adopted in comparison. Prognostic factor analysis was performed by the Cox regression model. Results Positive post-ASCT [18F]F-FDG PET-CT was associated with lower progression-free survival (PFS) and overall survival (OS) (p = 0.001 and p = 0.022, respectively). Univariate analysis showed the post-ASCT PET-CT result was the only independent factor associated with PFS (p = 0.002). Both the number of previous treatments and post-ASCT PET-CT result had a different impact on OS (p = 0.040 and p = 0.028, respectively). Multivariate analysis showed the post-ASCT PET-CT result was the only independent factor associated with OS (p = 0.028). The results showed no significant change from the abovementioned results when DS < 3 was defined as the negative result. For patients who had a PET-CT scan within 3–6 months after ASCT, the negative PET-CT group had a better prognosis including PFS and OS (p = 0.009 and p = 0.025, respectively). However, among the patients receiving PET-CT within 3 months, the result was not statistically significant (p = 0.064 and p = 0.445, respectively). Conclusion Collectively, we found that the post-ASCT [18F]F-FDG PET-CT was a strong indicator for PFS and OS, and a time window of 3–6 months was appropriate for post-ASCT [18F]F-FDG PET-CT. Trial registration number: ChiCTR2100042745.

Corona Virus Infectious Disease 19 (COVID-19) in Various Reviews

Rationale. Discrepancies between tests for drug-resistant tuberculosis infections are becoming more common as diagnostic tools become more varied. These discrepancies may partly causes the longer time to diagnose tuberculosis that leads to delay of treatment. Objectives. The main objective was to investigate discrepancies between GeneXpert (MTB/RIF) and drug-susceptibility test in diagnosing tuberculosis drug resistance and which factors were associated with those discrepancies. Other purpose was to measure the proportion of different types of drug-resistant tuberculosis and to identify the factors affecting the occurrence of multi-drug resistant tuberculosis in Indonesia. Methods. This was a cross-sectional study. Demographic data and clinical characteristics of patients were collected from eTB Manager of Persahabatan General Hospital from January 2015 to December 2017. We did descriptive analysis of patient characteristics, resistance pattern, and treatment outcomes. Association of patient characteristics with tests discrepancies and occurrence of multi-drug resistant tuberculosis were further analyzed. Measurements and Main Results. Discrepancy of GeneXpert (MTB/RIF) and drug-susceptibility test were found in 48 cases (7%). Factors that significantly influenced the emergence of a discrepancy were number of previous treatments (p=0.009) and use of different sputum samples (p

Impact of depression on adherence to lenalidomide plus low-dose dexamethasone in patients with relapsed or refractory myeloma.

While continued lenalidomide and low-dose dexamethasone (Rd) treatment could improve survival outcomes for multiple myeloma (MM), the association of depression on the adherence to Rd regimen in myeloma patients has never been studied even though depression is a common symptom among MM patients. This study aims to evaluate the impact of depression prior to Rd treatment on adherence to the treatment among patients with MM. This multicenter cohort study was conducted from January 2015 to October 2018 at five tertiary hospitals in Korea. Patients who completed fewer than 4cycles, 4-11cycles, and more than 12cycles were categorized as the poor adherence group (PAG), moderate adherence group (MAG), and good adherence group (GAG), respectively. Among141 patients, 41.8% of them had depression before beginning Rd treatment and 46% of participants were in the GAG. Compared with patients in the GAG (30.3%), patients in the PAG were more likely to have depression at baseline (90.0%) and had the higher distress scores (6.35 vs. 4.28, P < 0.01). Presence of depression prior to Rd treatment was significantly associated with poor adherence (IRR = 6.67, 95% CI = 1.45, 30.61) after adjusting for age, sex, education, ECOG, ISS stage, number of previous treatments, and disease status prior to Rd treatment. Patients with depression had a substantially high risk of poor adherence compared to patients without depression. Given that Rd treatment is mainly offered by outpatient clinics, active interventions to reduce depression should be considered for MM patients prior to Rd treatment.

Identification of an Optimal Population for Allogeneic Hematopoietic Stem Cell Transplantation in Patients With Mature T and NK Cell Neoplasms.

The prognosis of mature T and natural killer (NK) cell neoplasms still remains dismal, despite the advancements in the understanding of the heterogeneous features of these diseases. As allogeneic stem cell transplantation (alloSCT) is an attractive salvage option for relapsed/refractory patients, we conducted this study to identify those who might benefit the most from alloSCT. This was a retrospective, single-center, longitudinal cohort study of patients who received alloSCT between December 2019 and January 2000. The median relapse-free survival and overall survival were 4.4 and 10.0 months, respectively. Disease control status at alloSCT and number of previous treatments were associated with survival outcomes. The conditioning intensity did not significantly alter survival. AlloSCT offers a cure chance for selected relapsed or refractory T and NK cell neoplasms, especially when used early and the disease is well controlled prior to transplantation.

Identification of occult cerebral microbleeds in adults with immune thrombocytopenia

AbstractManagement of symptoms and prevention of life-threatening hemorrhage in immune thrombocytopenia (ITP) must be balanced against adverse effects of therapies. Because current treatment guidelines based on platelet count are confounded by variable bleeding phenotypes, there is a need to identify new objective markers of disease severity for treatment stratification. In this cross-sectional prospective study of 49 patients with ITP and nadir platelet counts <30 × 109/L and 18 aged-matched healthy controls, we used susceptibility-weighted magnetic resonance imaging to detect cerebral microbleeds (CMBs) as a marker of occult hemorrhage. CMBs were detected using a semiautomated method and correlated with clinical metadata using multivariate regression analysis. No CMBs were detected in health controls. In contrast, lobar CMBs were identified in 43% (21 of 49) of patients with ITP; prevalence increased with decreasing nadir platelet count (0/4, ≥15 × 109/L; 2/9, 10-14 × 109/L; 4/11, 5-9 × 109/L; 15/25 <5 × 109/L) and was associated with longer disease duration (P = 7 × 10−6), lower nadir platelet count (P = .005), lower platelet count at time of neuroimaging (P = .029), and higher organ bleeding scores (P = .028). Mucosal and skin bleeding scores, number of previous treatments, age, and sex were not associated with CMBs. Occult cerebral microhemorrhage is common in patients with moderate to severe ITP. Strong associations with ITP duration may reflect CMB accrual over time or more refractory disease. Further longitudinal studies in children and adults will allow greater understanding of the natural history and clinical and prognostic significance of CMBs.

AVAIL-T: A Phase 2a Trial of Avelumab, and Anti-PD-L1 Antibody, in Relapsed and Refractory Peripheral T-Cell Lymphoma (PTCL)

AVAIL-T: A Phase 2a Trial of Avelumab, and Anti-PD-L1 Antibody, in Relapsed and Refractory Peripheral T-Cell Lymphoma (PTCL)

The ovarian reserve as measured by the anti-Müllerian hormone is not diminished in patients with rheumatoid arthritis compared to the healthy population

Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory arthritis, affecting 0.5-1% worldwide population and predominates in females. Altered fertility has been reported due to a decrease in ovarian reserve secondary to sustained inflammation. The anti-Müllerian Hormone (AMH) is currently the most reliable biomarker of ovarian reserve. However, few and contradictory studies have been reported to analyse the relationship between fertility in RA female patients and AMH. The aim of present study is to determine the AMH serum concentrations in a long-standing RA patient group and control group. We also sought to determine the correlation between AMH serum levels and disease activity measured by different parameters and the effect of biological DMARDs. Serum AMH levels were measured in 60 women with long-standing RA aged 20-50 y.o. and compared to 59 healthy women. AMH was assessed by an electrochemiluminescence immunoassay method (ECLIA, Roche Diagnostics) and a large data set of clinical and molecular data was annotated. Demographic parameters, RA disease activity measured by DAS28 score and inflammatory biomarkers such as ESR, CRP, lymphocyte CD4+, CD8+, NK cells, IL-10 and IL-6 were determined. A comprehensive gynaecological self-administered questionnaire was given. Serum AMH levels were age-correlated. Differences between groups were calculated using Student's t-test or Mann-Whitney U-test for continuous variables and Fisher's exact test for categorical variables. Multivariate analysis was conducted by the partial correlation coefficient. Linear regression analysis was performed to study the effect of different variables on proportional AMH change. p-values <0.005 were considered significant. The median age was similar in AR and control groups (37.4±6.23 vs. 37.3±6.27 p=0.937). Mean disease duration was 8.37±5.36 years. The number of previous treatments was <3 in 71.7% of patients and ≥3 in 28.3%. Disease activity measured by DAS28 was 2.89± 1.54. The age-adjusted mean serum concentration of AMH was 1.27 ng/ml [IQR 0.42; 2.24] in RA patients and 1.31 ng/ml [IQR 0.46; 3.09] in controls (p=0.608). Neither disease activity (p=0.862), nor current or previous bDMARDs treatments (p=0.871) were associated with AMH levels. However, a negative linear correlation was observed between AMH and IL-10 levels (p=0.033). Our study shows that ovarian reserve determined by AMH serum levels is not reduced in rheumatoid arthritis patients compared with healthy controls. In our series, AMH levels were not affected by disease activity, however, a significant correlation was observed between AMH and IL-10 levels. These results support the role of cytokines profile in the female reproductive system and will focus further investigations in this critical area, mainly once biological DMARDs have been recommended in RA pregnant patients.

HL-150: Brentuximab Vedotin and Bendamustine Combination Therapy as Salvage for Relapsed-Refractory Hodgkin Lymphoma: A Real-World Single-Center Experience

Context Despite high cure rates with standard treatment, 30% patients with Hodgkin lymphoma develop relapsed or refractory (R/R) disease. Salvage therapy followed by consolidation autologous hematopoietic cell transplantation (AHCT) is the standard of care. Brentuximab vedotin (BV) is a novel anti-CD30 monoclonal antibody-drug conjugate, and approved in R/R CD30+ lymphomas, after failure of two prior lines of treatment and in post-transplant setting. BV in combination with bendamustine (Be) has been tested in the salvage setting with promising results. [1,2,3] Objective To determine the activity and safety of combination BV-Be salvage therapy in patients with R/R classical Hodgkin lymphoma (cHL). Design Single-center, retrospective, observational study. Patients or other participants Chart review of patients diagnosed with R/R cHL who received BV-Be salvage treatment, between March 2011-December 2019. BV at 1.8 mg/kg (day 1) and Be at 90 mg/sqm (days 1, 2); q21-day cycle. Main outcome measures Response rates, toxicity, PFS, and OS calculated using the Kaplan–Meier method and log-rank test. Results 20 patients diagnosed with R/R cHL received BV+Be salvage therapy. Primary refractory disease (n=3), relapsed disease [n=17 (first relapse=2, second=10, later=05)]. 03 patients post-AHCT and 01 was post Allogeneic HCT (AlloHCT). The median number of previous treatments was 02 (01-04). The median number of BV-Be cycles was 03 (01-06). Nearly 67% doses administered as out-patient. All patients were evaluable for efficacy. The CR and OR rates were 65% and 80%, respectively. 55% of responding patients proceeded to AHCT and 27% underwent AlloHCT. Median follow-up of 16 months (5-45). Median PFS 25 months (95%CI: 23-29), and 2-year OS 70%. Significantly longer PFS and OS observed in patients attaining a major clinical response to treatment and in those who received HCT. Fourteen (70%) patients experienced severe (G > 2) toxicity which were neutropenia (70%), gastrointestinal (30%), peripheral sensory neuropathy (10%), and infection (15%). Two patients expired during treatment, one with disease progression and other with neutropenic sepsis. Conclusions BV-Be is an effective, well-tolerated salvage treatment for patients with R/R cHL as a bridge to consolidation with HCT, and can be administered as an outpatient.

Female buccal mucosa graft urethroplasty: a new modified ventral onlay "AZ" technique.

To present the surgical details and the outcomes of our modified ventral onlay buccal mucosal graft (BMG) urethroplasty technique in female patients with urethral strictures. We included the first seven female patients who had BMG urethroplasty between January 2015 and April 2019 and had at least 6months of follow-up. Patient age, stricture length, comorbidities, number of previous treatments, pre- and postoperative uroflowmetry data, and post-void residual volumes were recorded. The mean patient age was 56.7 (44-80) years. The mean stricture length was 3.1 (2-4) cm. The mean postoperative follow-up time was 23 (7-48) months. The preoperative mean maximal flow rate (Qmax) was 5.1 (3.2-9.5) ml/s and post-void residual urine volume (PVR) was 84.4 (37-158) ml. At the 3rd month after surgery, mean Qmax was 31.8 (24.7-36.2) ml/s, and PVR volume was 7.1 (0-16) ml. Three patients had the postoperative 2-year follow-up, and 12th and 24th month mean Qmax values were 28 (23.6-33.2) ml/s and 28.5 (24.1-31.1) ml/s, respectively. The mean operation time was 63.8 (55-113) min. We did not observe any infection, vaginal erosion, urinary incontinence, or oral discomfort due to graft harvesting postoperatively. Female urethroplasty provides high cure rates and should be performed in case of recurrent FUS. The early and medium-term results of our modified new technique indicated that it might be used as a simple alternative to current techniques. In all of our patients, it significantly increased the flow rate and reduced PVR without any significant complications.