Risk Factors For Relapse Research Articles

Club foot management in the Bafoussam Baptist Healthcare center (BBHC), Cameroon: Treatment outcomes and the associated factors of relapse with the Ponseti’s technique

Background: Clubfoot is a birth defect found in about 1000 live births yearly in Cameroon and its treatment is often associated with relapses. The objective of this study was to evaluate treatment outcomes with the Ponseti’s technique and factors associated with relapses. Methods: We conducted a 5-year retrospective study on clubfoot children at the Bafoussam Baptist Healthcare Center (BBHC). Data on age, sex, birth setting, previous treatment, pirani scoring, number of casts and follow-ups, bracing and relapse were recorded in case report forms. Data were analyzed with SPSS: 25 software; bivariate analysis was performed to determine factors associated with relapse. Results: This study enrolled 78 clubfoot children with median age, 12 months (IQR1,24), 44 (56.4%) had undergone previous treatment elsewhere. The mean Pirani score before treatment was 4.9 [±SD: 0.9] for the left foot (LF), and 4.9 [±SD: 1] for the right (RF). The average number of casts performed was 6.5 [±SD: 1.5]. Tenotomy of the Achilles tendon was performed in 54 (69.2%) children. The mean final Pirani score was 0.9 [±SD: 0.5] for the LF and 0.8 [±SD: 0.6] for the RF. Only 5 (6.4%) cases did not wear Iowa braces and loss of sight rate was 1.3% (1/78). The relapse rate was 9.1% (7 /77). Treatment requiring >8 casts was associated with relapse (aOR: 10.35; CI [1.05-101.55]; P=0.04). Conclusion: The Ponseti’s technique is effective in the treatment of CTEV in the West region of Cameroon. Treatment requiring more than 8 cats is a risk factor for relapse.

Long-Term Pharmacological and Psychosocial Outcomes of Adolescent-Onset Epilepsy: A Single-Center Experience

Purpose: Despite the high incidence of epilepsy during adolescence, little attention has been paid to the outcomes and prognosis of adolescent-onset epilepsy. The aim of this study was to investigate the long-term pharmacological and psychosocial outcomes of adolescent-onset epilepsy.Methods: From 1993 to 2019, the electronic medical records of adolescent-onset epilepsy patients were retrieved from Asan Medical Center Children’s Hospital. Seizure outcomes were evaluated based on the seizure-free period at last contact. Possible predictors of remission, relapse, and intractability were investigated. Neuropsychiatric comorbidities, socioeconomic status, and transition outcomes were also assessed. Results: In total, 137 patients were enrolled in this study. The median age at diagnosis of epilepsy was 14 years and the mean duration of therapy was 13.0 years. During follow-up, 93 patients (67.9%) achieved terminal remission, of which 27 cases (19.7%) resolved. Relapse after withdrawal of medication occurred in 74 patients (54.0%), and the presence of electroencephalographic abnormalities (odds ratio [OR], 8.23; 95% confidence interval [CI], 1.39 to 48.87; P=0.020), poor adherence (OR, 4.84; 95% CI, 2.13 to 11.02; P=0.000), and history of febrile seizures (OR, 4.10; 95% CI, 1.21 to 13.93; P=0.024) were risk factors for relapse. Neurodevelopmental and psychological comorbidities were documented in 17 (12.4%) and 12 (8.8%) patients, respectively. Thirty-six (26.3%) patients transferred to adult clinics, at a mean age of 21.9 years. Conclusion: This study showed overall favorable seizure outcomes with a high rate of remission, but with frequent relapse after withdrawal.

Treatment outcomes for acute T-lymphoblastic leukemias/lymphomas: data from the ALL-2016 multicenter prospective randomized trial

Background . The effectiveness of therapy for acute T-lymphoblastic leukemia (T-ALL) and T-lymphoblastic lymphoma (T-LBL) has significantly improved over the past decades, including through the implementation of hematopoietic stem cell transplantation (HSCT). The Russian multicenter ALL-2009 study (ClinicalTrials.gov NCT01193933) showed that performing autologous HSCT (auto-HSCT) in patients with T-ALL/LBL improves long-term results. However, the study was non-randomized and the need for auto-HSCT in clinical practice requires careful study. Aim . To assess the significance of auto-HSCT in patients with T-ALL/LBL in the framework of ALL-2016 multicenter, prospective, randomized study (ClinicalTrials.gov NCT03462095). Materials and methods . The study included 109 adult patients with T-ALL/LBL (m:f 82:27). Median age was 31 (18– 52) years. T-ALL was diagnosed in 88 (81 %) patients, T-LBL in 21 (19 %) patients. All patients are treated according to the ALL-2016 protocol. Using the web platform, upon completion of induction therapy (+70 days), all T-ALL/LBL patients who achieved clinical and hematological remission were randomized to the auto-HSCT arm or chemotherapy alone (CT). Centralized monitoring of minimal residual disease (MRD) in bone marrow samples was performed by multicolor flow cytometry at the control points according to the ALL-2016 protocol. Statistical analysis was performed using SAS 9.4. Results . 87 patients with T-ALL/LBL were randomized: 44 to the auto-HSCT arm and 43 to the CT arm. Further analysis included 25 patients who underwent auto-HSCT and 36 patients receiving only CT. Three-year relapse-free survival in T-ALL is estimated at 62 % (auto-HSCT) vs. 81 % (CT) (p = 0.3422), and in T-LBL – 67 % (auto-HSCT) vs. 79 % (CT) (p = 0.59). MRD persistence on the +70 th day of therapy according to the ALL-2016 protocol was determined in 40 % of patients (autoHSCT) and in 67 % (CT) (p = 0.057). In a multivariate analysis, it was determined that T-ALL from early T-cell precursor (ETP-variant) and MRD persistence after the end of II phase induction are the main risk factors for relapse in the treatment according to the ALL-2016 protocol. Conclusion . Performing auto-HSCT both in patients with T-ALL and T-LBL, and with MRD persistence on day +70 according to the ALL-2016 protocol did not improve long-term results. The development of new programs for the treatment of patients with MRD persistence, as well as the ETP variant of T-ALL, is of current interest.

Predictors of relapse in Takayasu arteritis

BackgroundTakayasu arteritis (TAK) is a large-vessel vasculitis with high relapse rate. Longitudinal studies identifying risk factors of relapse are limited. We aimed to analyze the associated factors and develop a risk prediction model for relapse. MethodsWe analyzed the associated factors for relapse in a prospective cohort of 549 TAK patients from the Chinese Registry of Systemic Vasculitis cohort between June 2014 and December 2021 using univariate and multivariate Cox regression analyses. We also developed a prediction model for relapse, and stratified patients into low-, medium-, and high-risk groups. Discrimination and calibration were measured using C-index and calibration plots. ResultsAt a median follow-up of 44 (IQR 26–62) months, 276 (50.3%) patients experienced relapses. History of relapse (HR 2.78 [2.14–3.60]), disease duration <24 months (HR 1.78 [1.37–2.32]), history of cerebrovascular events (HR 1.55 [1.12–2.16]), aneurysm (HR 1.49 [1.10–2.04], ascending aorta or aortic arch involvement (HR 1.37 [1.05–1.79]), elevated high-sensitivity C-reactive protein level (HR 1.34 [1.03–1.73]), elevated white blood cell count (HR 1.32 [1.03–1.69]), and the number of involved arteries ≥6 (HR 1.31 [1.00–1.72]) at baseline independently increased the risk of relapse and were included in the prediction model. The C-index of the prediction model was 0.70 (95% CI 0.67–0.74). Predictions correlated with observed outcomes on the calibration plots. Compared to the low-risk group, both medium and high-risk groups had a significantly higher relapse risk. ConclusionsDisease relapse is common in TAK patients. This prediction model may help to identify high-risk patients for relapse and assist clinical decision-making.

Impact of minimal residual disease on relapse in childhood acute lymphoblastic leukemia: Lessons learnt from a tertiary cancer center in India

Prognostic predictive value of end of induction minimal residual disease (EOI-MRD) is well established in acute lymphoblastic leukemia (ALL). We evaluated the factors likely to affect EOI-MRD positivity (>0.01%) by flow cytometry and relapse in different BFM-95 (Berlin–Frankfurt–Munich) risk groups among children and adolescents. In this retrospective study, data of 223 newly diagnosed patients with ALL was analyzed. Association between demographic and pretreatment characteristics with EOI-MRD was assessed. Risk factors for relapse were analyzed using univariate and multivariate Cox regression. Proportion of the SR (standard risk), MR (moderate risk), and HR (high risk) patients was 18.8%, 60.9%, 20.3%, respectively. Positive EOI-MRD among these risk groups was observed in 11.9%, 18.3%, and 55.5% patients respectively (p value <.01%). MRD positivity was more likely to be associated with older age (>10 years) and BFM-HR patients (p value .0008 and <.0001). Thirty-four (15.2%) patients relapsed in the whole cohort. On univariate analysis, statistically significant factors for RFS (relapse-free survival) included hyperleukocytosis, high-risk cytogenetics, NCI (National Cancer Institute) high risk, poor day-8 prednisolone response, BFM–HR and positive EOI-MRD status. Of all these only EOI-MRD retained its impact by multivariate analysis. Positive EOI-MRD significantly predicted relapse in BFM-MR with 5-year RFS of 88.0% and 68.4% (p value .02). Five-year RFS of EOI-MRD negative and positive groups were 86.4% and 65.5%, respectively (p value .004). EOI-MRD is a powerful tool to predict relapse in children and adolescent with ALL especially in BFM-MR. Application of MRD in HR patients needs to be redefined in conjunction with other variables.

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

Acne Vulgaris Relapse in Sudanese Patients Treated with Oral Isotretinoin: Rate and Predictive Factors.

Acne vulgaris is a skin disorder primarily affecting teenagers and young adults. Acne relapse is the main drawback of oral isotretinoin (OI), which is the golden therapy for severe acne. This study aimed to assess the rate and predictive factors of acne relapse among Sudanese patients using OI. A cross-sectional study was conducted in a dermatology and venereology clinic-Sudan, using a self-administered questionnaire and data collection sheet. Patients using OI for acne treatment were enrolled in the study. Chi-square test and logistic regression analysis were used to evaluate the association between variables. P-value <0.05 was considered statistically significant. 225 acne patients (mean age: 26.0±4.2 years, females: 88.9%) were included in this study. OI daily dose ranged from 0.25 to 1 mg/kg/day, with frequent daily doses of 40-49 mg (57.3%) over 3-6 months (81.8%). Around one-third of patients (36%) received maintenance therapy after completion of OI course. At a 2-year follow-up, approximately 36% of patients experienced acne relapse that commonly occurred within 6-18 months after the last OI therapy. Early discontinuation of OI was a positive predictor of acne relapse which was 3.99 times greater in patients who had early discontinued OI than those completing the planned OI course (OR=3.99; p=0.002). OI cumulative doses of 120-139 mg/kg and 140-159 mg/kg were negative predictors of acne relapse (OR=0.23; p=0.001 and OR=0.15; p=0.02, respectively). Most patients (94.2%) received prescription OI, and 76.4% of women were advised to use contraceptives. About 69% of patients practiced skin care. About one-third of patients experienced acne relapse. Early discontinuation and low cumulative doses of OI are the main risk factors for acne relapse. Long-term therapy of OI, with cumulative doses of 120-159 mg/kg, would be beneficial to reduce acne relapse.

Role of transgenerational transmission of trauma in development of schizophrenia: A case report of a patient whose parents survived genocide in Srebrenica

IntroductionDevelopmental predisposition to schizophrenia can be a consequence of early experienced traumas. Transgenerational trauma is process in which traumatic experience of one generation is passed on to the next generation.ObjectivesTo show connection between transgenerational transmission of trauma and development of schizophrenia.MethodsPsychiatric interview, psychological testing.ResultsPatient G.E. age 29, admitted to Psychiatry Clinic due to altered behavior, aggressiveness and presence of delusions and hallucinations. First mental problems in form of a catatonic stupor appeared 6 years ago. Patient has history of earlier abuse of psychoactive substances. A drug test performed at admission was negative. Patient was born in Srebrenica in 1993, he escaped to Tuzla with his mother in July 1995, while father survived escaping on foot. Patient is a first child from his father’s second marriage. The father’s first wife and two minor children were shot by Bosnian Serbs in early 1992. Patient was born a year and a half after death of his siblings and was named after his half-sister. Patient’s father consumed alcohol after the war and was aggressive towards children. In the last two years, patient had frequent hallucinations, he told his parents that voices were telling him to kill his mother and told his father that his children were still alive. Diagnostic processing was performed and diagnosis of schizophrenia was stated. During hospitalization, patient was treated with olanzapine and low doses of haloperidol, along with haloperidol decanoate, which resulted in significant reduction of productive psychotic symptoms. A partial remission is achieved, negative schizophrenic symptoms and cognitive impairments verified by psychological instruments remain.ConclusionsCase report emphasize transgenerational transmission of trauma: father‘s untreated trauma, alcohol dependency and abuse of the patient in childhood. These findings are important for treatment and therapeutic considerations. Mentalizing is a possible mediator between childhood abuse and negative symptoms. Parental bonding was explored within high expressed emotions theory as a risk factor for relapse to psychosis, especially the “affectionless control” in the parental (mainly father‘s) bonding style. Studies also stated that psychotic patients often show insecure attachment representations. Possible pathway for further analysis could be discussed: a cold parental bonding style leading to experienced emotional neglect and attachment avoidance might be reflected in lower capacity to mentalize. To improve the mentalization capacity, it would be essential to establish a sustainable therapeutic treatment frame.Disclosure of InterestNone Declared

Heart Rate Variability in Adults With Substance Use Disorder: A Comprehensive Narrative Review.

Heart rate variability (HRV) is an indicator of autonomic abnormalities. However, little is known about the role of HRV related to substance use behavior and the association between the changes in HRV and signs of relapse in substance use. The purpose of this study was to review the existing literature on autonomic response to substance use (i.e., opioids, cocaine, and methamphetamine) measured by HRV and its outcomes related to the risk factors of relapse. A systematic search of the literature was conducted using PubMed, PsychINFO, and Ovid Medline databases. The study includes full-text articles published in English from 2010 to 2020, using measures of HRV in human subjects who use substances. A total of 14 studies were reviewed. Studies included outpatients with a prescription or nonprescription opioid misuse behavior with a primary diagnosis being chronic pain or substance use disorder (SUD). Significantly decreased resting HRV was found in substance users compared to healthy controls. Lower resting HRV has been significantly associated with stress, craving, and greater symptom severities in individuals with SUD and other substance dependence. HRV indices can be potential measures of homeostatic imbalance and self-regulation flexibility. HRV may be a useful tool for monitoring early indication of relapse so that relapse prevention measures can be implemented in a timely manner. Future studies in substance use may benefit from examining HRV in relations to substance use and relapse signs and symptoms in a larger population to guide future relapse prevention strategies.

Effectiveness and quality of life improvement in young adult schizophrenia patients treated with Abilify Maintena

IntroductionTreating young patients with schizophrenia is a challenge, as these patients have much to gain from controlled pharmacotherapy and even more to lose with a possible relapse. Treating patients with long-acting injectable antipsychotics avoids the issue of non-compliance, the biggest risk factor for relapse, while also improving the quality of life. Receiving a drug once-a-month can provide greater flexibility and convenience to our patients.ObjectivesAim of the paper is to assess the efficacy and quality of life in monthly dosing of long-acting injectable antipsychotic in young adult schizophrenia patients.MethodsThe research included 7 patients aged 19 to 25 years who were diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients were assessed eight times over two years using the following clinical scales: Positive and Negative Syndrome Scale, Clinical Global Impression – Severity and Improvement Scale, Treatment Satisfaction Questionnaire for Medication (TSQM-9) and Quality of Life Scale (QOLS).ResultsAll treated patients achieved remission. There was a statistically significant improvement in measured scales in all patients. There were no side-effects reported during the study period, with no relapse or new hospitalizationsConclusionsThe monthly formulation of aripiprazole has proven to be effective and safe in our study and has great potential to improve patient quality of life as well.Disclosure of InterestNone Declared

Immune thrombotic thrombocytopenic purpura: Spotlight on long-term outcomes and survivorship.

Advances in diagnosis and treatment have dramatically improved survival of acute immune thrombotic thrombocytopenic purpura (iTTP) and iTTP has evolved from an acute fatal condition to a chronic relapsing disorder. In addition to the risk of iTTP relapse, iTTP survivors are at risk of multiple adverse health outcomes including higher than expected rates of all-cause mortality, increased rates of stroke and other cardiovascular disease, and higher rates of morbidities such as obesity, hypertension, and autoimmune disorders. iTTP survivors also report neurocognitive impairment, depression, and reduced quality of life. Women with iTTP are at risk for recurrent iTTP, preeclampsia, and other maternal and fetal complications in subsequent pregnancies. ADAMTS13 activity during clinical remission has emerged as an important targetable risk factor for iTTP relapse and other outcomes including stroke and all-cause mortality. This review summarizes current literature regarding the epidemiology and potential mechanisms for adverse long-term sequelae of iTTP, outlines current best practices in iTTP survivorship care, and highlights a research agenda to improve long-term iTTP outcomes.

Basal Cell Carcinoma in Xeroderma Pigmentosa: Reduced CD1a Expression as a Sensitive Predictor of Recurrence.

Xeroderma pigmentosa (XP) is a rare genetic disorder that is characterized by defective DNA repair after ultraviolet induced damage with a great tendency for recurrent cutaneous malignancies including basal cell carcinoma (BCC). BCC is frequently linked to impaired local immune response with a major role played by Langerhans cells (LCs). The current study aims at investigating LCs in BCC specimens of XP and non-XP patients, in a trial to study its possible impact on tumor recurrence. It included 48 retrospective cases of primary facial BCC (18 for XP patients and 30 for non-XP controls). Each group was subdivided, based on the 5 years follow-up data, into recurrent and non-recurrent BCC groups. LCs were assessed immunohistochemically using the sensitive marker; CD1a. Results showed significantly reduced LCs count (intratumoral, peritumoral, and in perilesional epidermis) in XP patients compared with non-XP controls ( P ˂0.001 for all). Intratumoral ( P =0.008), peritumoral ( P =0.005), and perilesional epidermal ( P =0.02) LCs mean values were significantly lower in recurrent versus non-recurrent BCC specimens. Also, within each group (XP and controls), LCs were of significantly lower means in recurrent versus non-recurrent cases ( P ≤0.001 for all). Regarding recurrent BCC cases, peritumoral LCs showed a significant positive correlation with 1ry BCC duration ( P =0.05). Also, intratumoral and peritumoral LCs correlated positively with BCC relapse interval ( P =0.04 for both). Among non-XP controls, periocular tumors had the least LCs count (22.00±3.56), whereas tumors located in the rest of the face had the greatest count (29.00±0.00) ( P =0.02). Sensitivity and specificity of LCs to predict BCC recurrence in XP patients reached 100% in intartumoral area and perilesional epidermis when cutoff points were less than 9.5 and 20.5, respectively. In conclusion; reduced LC count in primary BCC specimens of XP patients and also in normal subjects could help to predict its recurrence. Thus, it might be identified as a risk factor for relapse to apply new strict therapeutic and preventive measures. This presents new avenue for the immunosurveillance against skin cancer relapse. However, being the first study to investigate that link in XP patients recommends further research to confirm.

Clinical-pathological characteristics and management of fusocellular tumors. Our experience

Introduction: Fucocellular tumors encompass a spectrum of very rare entities. Prognostic factors for the risk of relapse and overall survival such as tumor size, surgical margin, histological strain, and stromal growth are described. Materials and methods: Observational, analytical and cross-sectional study, which studied patients with a diagnosis of fusocellular tumor, treated in the Breast Pathology Service of the Marie Curie Municipal Oncology Hospital (HOMC) of Buenos Aires during the period 2003 to 2022. Quantitative variables were used and analyzed with measures of central tendency. For the comparison of these variables, the Chi 2/Fisher exact test was used. Results: A total of 58 patients with diagnosis of spindle-cell lesions were recruited, including Filode tumors, sarcomas, hamartomas, adenomyoepithelioma, aggressive fibromatosis, gigantocellular granuloma, fusocellular lesion. Conclusion: It was observed that early age (&lt;40 years) is not a risk factor for relapse, with an increase in this index in patients with tumor size &gt; 5 cm. The percentage of relapses was not modified when conservative surgeries vs mastectomies were compared.

Management of the odontogenic keratocysts from diagnosis to treatment: an algorithm derived from the comparison of a single institution experience and literature review

BackgroundThe aim of this study is to define an algorithm for the management of odontogenic keratocysts (OKCs) in order to reduce the recurrence rate (RR), morbidity and to analyse relapse risk factors. Material and MethodsThis article is a 10-years retrospective study on 67 patients treated for odontogenic keratocysts with different surgical options established on clinical and radiological evaluations. Recurrence free survival (RFS) and relapse risk factors were analysed with Kaplan-Meier method and log-rank tests, with a confidence interval set at 95 %. A literature research was performed using PubMed to find the most relevant and recent papers about the argument. ResultsFifty-five subjects were included: 38 out of 55 patients presented the disease only once, while the others 17 patients presented at least one relapse. The total amount of histological examined lesions and relative surgical procedures was 75. More aggressive treatments showed lower recurrence rate but higher morbidity; more conservative ones had better functional and aesthetic outcomes but higher recurrence rate. Considering the literature, conservative treatments plus adjuvant procedures can reduce the RR. The recurrence rate was estimated to be 25.3 % with a median time to relapse of 24 months. Multilocularity resulted a negative prognostic factor significantly associated with recurrence free survival (p = 0.048). ConclusionAccording to our results and to the literature, we propose a management algorithm from diagnosis to treatment of the OKCs based on dimensions and internal arrangement of lesions, type (primary lesion or recurrence), presence of bony erosions, noble structure/teeth involvement. Multilocularity represented a statistically significant risk factor for relapse.

A multicenter prospective validation study of the 3-cm cut-off in stage I seminoma (S3MI-PT).

TPS435 Background: Testicular germ cell tumors (TGCT) are the most common solid malignancy in men aged 15 to 35, and Seminoma histology can account for up to half of the cases. Since the latest edition of the American Joint Committee on Cancer (AJCC) staging manual (8th edition, 2018), it is recommended that, only in pure Seminoma, the pT1 category should be subdivided according to tumor size: pT1a for tumors &lt; 3 cm or T1b for tumors ≥ 3 cm. This change was based on large retrospective data that suggested almost a doubling of the risk of relapse at 3-years in pT1b versus pT1a, with a Hazard Ratio of 1.87, 95% confidence interval (CI) 1.15-3.06. So far, there has been no prospective validation for these staging changes and there are no known implications of its use in clinical practice. Furthermore, these changes are exclusive for AJCC since the Union for International Cancer Control (UICC), another widely used staging system, did not change from previous editions (i.e., no pT1 subdivision in pure Seminoma). Tumor size was already recognized as a risk factor for relapse (if tumor size &gt; 4 cm) but not formally used for staging before. Of concern, these are mostly young patients, and despite exceptionally good long-term survival rates, in stage I Seminoma, the general estimation of relapse is about 15% but can surpass 30% — therefore accurate prognostic information is particularly important. This study aims to validate the 3 cm cut-off in stage I Seminoma introduced by AJCC 8th edition. Additionally, the study will allow for the evaluation for current trends of adjuvant options (namely surveillance vs active treatment). Methods: S3MI-PT, or Seminoma 3 cm cut-off Prospective Trial, is a multicenter prospective observational validation study that aims to include at least 300 patients (the estimate includes a 10% loss to follow-up rate as TGCT studies are historically difficult to accrue). Eligibility criteria: male patients ≥ 18 years old diagnosed with clinical stage I pure Seminoma histology (pT1N0M0S0), whose orchiectomy must have occurred after January 2018, the AJCC 8th ed. implementation date, who are willing to sign the informed consent. Demographic and clinical data will be collected, that includes, age at diagnosis, tumor size, rete testis invasion, values for TGCT markers, adjuvant treatment options (surveillance or active treatment) and relapse, if applicable. Exclusion criteria: non-pure Seminoma TGCT staged pT2-T4, pN1-N3, M1, S1-3. Primary endpoint is relapse-free survival at 3 years in pT1a versus pT1b, with two-sided P &lt; 0.05 used to determine statistical significance with a 95% CI, by Kaplan-Meier method. S3MI-PT has been approved by the Ethics Committee. The study is actively enrolling, and all individuals and institutions interested in collaborating can do so by request.

Caudate gray matter volumes and risk of relapse in Type A alcohol-dependent patients: A 7-year MRI follow-up study.

Whether alteration in regional brain volumes can be detected in Type A alcoholics both at baseline and after a long follow-up remains to be confirmed. Therefore, we examined volume alterations at baseline, and longitudinal changes in a small follow-up subsample. In total of 26 patients and 24 healthy controls were assessed at baseline using magnetic resonance imaging and voxel-based morphometry, among which 17 patients and 6 controls were re-evaluated 7 years later. At baseline, regional cerebral volumes of patients were compared to controls. At follow-up, three groups were compared: abstainers (n = 11, more than 2 years of abstinence), relapsers (n = 6, <2 years of abstinence), and controls (n = 6). The cross-sectional analyses detected, at both times, higher caudate nuclei volumes bilaterally in relapsers compared to abstainers. In abstainers, the longitudinal analysis indicated recovery of normal gray matter volumes in the middle and inferior frontal gyrus, and in the middle cingulate, while white matter volumes recovery was detected in the corpus callosum and in anterior and superior white matter specific regions. Overall, the present investigation revealed larger caudate nuclei in the relapser AUD patient group both at baseline and at follow-up in the cross-sectional analyses. This finding suggest that a higher caudate volume could be a candidate risk factor of relapse. In patients with specific type A alcohol-dependence, we showed that long-term recovery in fronto-striato-limbic GM and WM volumes occurs during long-term abstinence. These results support the crucial role of frontal circuitry in AUD.

Risk factors for post-transplant relapse and survival in younger adult patients with t(8;21)(q22;q22) acute myeloid leukemia undergoing allogeneic hematopoietic stem cell transplantation: A multicenter retrospective study.

Outcomes of patients with t(8;21)(q22;q22) acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain heterogeneous. To identify the risk factors for relapse and survival after allo-HSCT in t(8;21) AML patients, we retrospectively evaluated the clinical and prognostic information of 142 patients with t(8;21) AML undergoing allo-HSCT between January 2002 and September 2018 at 15 hematology research centers in China. Twenty-nine patients (20%) relapsed after undergoing allo-HSCT. A > 1-log reduction in RUNX1/RUNX1T1-based minimal residual disease (MRD) directly before allo-HSCT and a > 3-log reduction within the first 3 months after allo-HSCT were associated with a significantly lower post-transplant 3-year cumulative incidence of relapse (CIR, 9% vs. 62% and 10% vs. 47%,all P < 0.001), whereas transplantation during the second complete remission (CR2, 39% vs. 17% during CR1, P = 0.022), during relapse (62% vs. 17% during CR1, P < 0.001) and KIT D816 mutations at diagnosis (49% vs. 18%, P = 0.039) were related to a significantly higher 3-year CIR. Multivariate analysis demonstrated that a > 1-log reduction in MRD directly before transplantation (CIR: hazard ratio(HR), 0.21 [0.03-0.71], P = 0.029; overall survival (OS): HR = 0.27 [0.08-0.93], P = 0.038) and a > 3-log reduction in post-transplant MRD within the first 3 months (CIR: HR = 0.25 [0.07-0.89], P = 0.019; OS: HR = 0.38 [0.15-0.96], P = 0.040) were independent favorable prognostic factors, and transplantation during relapse (CIR: HR = 5.55 [1.23-11.56], P = 0.041; OS: HR = 4.07 [1.82-20.12], P = 0.045) were independent adverse prognostic factors for post-transplant relapse and survival in patients with t(8;21) AML. Our study suggests that for patients with t(8;21) AML undergoing allo-HSCT, it would be better to receive transplantation during CR1 with a MRD directly before transplantation achieving at least 1-log reduction. MRD monitoring in the first 3 months after allo-HSCT might be robust in predicting relapse and adverse survival after allo-HSCT.

Prognostic factors in giant cell arteritis associated aortitis with PET/CT and CT angiography at diagnosis

BackgroundPrognosis data on giant-cell arteritis (GCA)-associated aortitis are scarce and heterogeneous. The aim of this study was to compare the relapses of patients with GCA-associated aortitis according to the presence of aortitis on CT-angiography (CTA) and/or on FDG-PET/CT. MethodsThis multicenter study included GCA patients with aortitis at diagnosis; each case underwent both CTA and FDG-PET/CT at diagnosis. A centralized review of image was performed and identified patients with both CTA and FDG-PET/CT positive for aortitis (Ao-CTA+/PET+); patients with positive FDG-PET/CT but negative CTA for aortitis (Ao-CTA-/PET+), and patients solely positive on CTA. ResultsEighty-two patients were included with 62 (77%) of female sex. Mean age was 67±8 years; 64 patients (78%) were in the Ao-CTA+/PET+ group; 17 (22%) in the Ao-CTA-/PET+ group and 1 had aortitis only on CTA. Overall, 51 (62%) patients had at least one relapse during follow-up: 45/64 (70%) in the Ao-CTA+/PET+ group and 5/17 (29%) in the Ao-CTA-/PET+ group (log rank, p = 0.019). In multivariate analysis, aortitis on CTA (Hazard Ratio 2.90, p = 0.03) was associated with an increased risk of relapse. ConclusionPositivity of both CTA and FDG-PET/CT for GCA-related aortitis was associated with an increased risk of relapse. Aortic wall thickening on CTA was a risk factor of relapse compared with isolated aortic wall FDG uptake.

Editors' Note: Frequency of Asymptomatic Optic Nerve Enhancement in a Large Retrospective Cohort of Patients With Aquaporin-4+ NMOSD.

In “Frequency of Asymptomatic Optic Nerve Enhancement in a Large Retrospective Cohort of Patients With Aquaporin-4+ NMOSD,” Shah et al. reported that 17% of patients with Aquaporin-4+ NMOSD have asymptomatic optic nerve enhancement, predominantly at the site of prior optic neuritis. They suggested that this could represent intermittent blood-brain barrier breakdown or subclinical optic neuritis. Cao et al. noted that it is unclear whether asymptomatic enhancement is associated with an increased risk of relapse, given silent lesions have both diagnostic and prognostic value in multiple sclerosis. Chen and Shah responded that the number of recurrent attacks was the same for both patients with and without asymptomatic optic nerve enhancement, suggesting this is not a risk factor for relapse. They speculated that the varying prognostic value of enhancement of the optic nerve, as compared with the brain and spinal cord, may be attributed to blood-brain barrier differences, but noted additional studies that include imaging of all 3 parts of the neuroaxis are needed to explore this further. The findings of this study suggest that NMOSD may be a more continuous inflammatory disorder than previously thought. In “Frequency of Asymptomatic Optic Nerve Enhancement in a Large Retrospective Cohort of Patients With Aquaporin-4+ NMOSD,” Shah et al. reported that 17% of patients with Aquaporin-4+ NMOSD have asymptomatic optic nerve enhancement, predominantly at the site of prior optic neuritis. They suggested that this could represent intermittent blood-brain barrier breakdown or subclinical optic neuritis. Cao et al. noted that it is unclear whether asymptomatic enhancement is associated with an increased risk of relapse, given silent lesions have both diagnostic and prognostic value in multiple sclerosis. Chen and Shah responded that the number of recurrent attacks was the same for both patients with and without asymptomatic optic nerve enhancement, suggesting this is not a risk factor for relapse. They speculated that the varying prognostic value of enhancement of the optic nerve, as compared with the brain and spinal cord, may be attributed to blood-brain barrier differences, but noted additional studies that include imaging of all 3 parts of the neuroaxis are needed to explore this further. The findings of this study suggest that NMOSD may be a more continuous inflammatory disorder than previously thought.

Risk factors for early relapse in patients with biliary tract cancers who underwent curative resection: An exploratory subgroup analysis of JCOG1202.

541 Background: Relapse after highly invasive surgery for biliary tract cancers (BTCs), especially in the early postoperative period, causes medical, psychological, social, and economic disadvantages to the patients. However, approximately 30% of patients with curatively resected BTCs experience relapse within the first 12 months. JCOG1202 (UMIN000011688) is a randomized phase III trial conducted in patients with resected BTCs showing the benefit of adjuvant S-1 for overall survival. This study aimed to investigate the risk factors for early relapse of resected BTCs in the JCOG1202 cohort. Methods: Of the 440 patients enrolled in the JCOG1202, 217 patients who received surgery alone (arm A) and 207 patients who received adjuvant S-1 (arm B) were eligible and included in this analysis. Early relapse was defined as relapse or death within 12 months after enrollment. Predictive factors for early relapse were assessed using logistic regression analyses. Results: Postoperative early relapse was observed in 59 (27.2%) and 38 (18.4%) of patients in arm A and arm B, respectively. In multivariable logistic regression analysis for the 424 eligible patients, postoperative CA19-9 levels &gt;37 u/ml (odds ratio (OR): 2.790, 95% confidence interval (CI): 1.262-6.170), poorly differentiation (vs. well-differentiated/papillary) (OR: 4.746, 95% CI:1.927-11.688), moderate differentiation (vs. well-differentiated/papillary) (OR: 1.955, 95% CI:1.071-3.567), lymph node metastases &gt; 4 (vs. 0) (OR: 3.991, 95% CI: 1.674-9.514), lymph node metastases 1-3 (vs. 0) (OR: 2.661, 95% CI: 1.471-4.814), and presence of residual tumor (OR: 2.171, 95% CI: 1.070-4.408) were independent risk factors for early relapse. Importantly, adjuvant S-1 chemotherapy significantly reduced early relapse (OR: 0.491, 95% CI: 0.290-0.833). Similar results were observed in arm B. Conclusions: Postoperative CA19-9 level, tumor differentiation, lymph node metastases, and the residual tumor significantly impact early relapse in patients with curatively resected BTCs. Although adjuvant S-1 chemotherapy was effective in reducing early relapse, similar factors tended to be the risk factors in patients receiving adjuvant S-1 chemotherapy. Patients at high risk of early relapse may need more intensive perioperative therapy. Clinical trial information: UMIN000011688 .