AB0718 Immune-apheresis in patients with inflammatory myopathies, a case series

Background

Idiopathic inflammatory myopathies (IIM) comprise a heterogenous group of autoimmune diseases characterised by inflammation of muscle and affection of other organs, such as lung or skin. Some cases of IIM non-responsive to conventional treatment with glucocorticoids and DMARDs require treatment escalation. There are only limited data on efficacy and safety of immune-apheresis (IA) in IIM patients.

Objectives

This retrospective cohort study aims to determine whether IA is effective in treating therapy-refractory IIM.

Methods

Patients with active IIM undergoing IA (either plasma-exchange or immunoadsorption) at the Medical University Vienna were included in this explorative study. Patient characteristics and clinical data including serum levels of creatine kinase and concomitant medication were extracted from electronic medical records. As a primary endpoint, efficacy of IA was evaluated four weeks after initiation of IA, calculating absolute and relative change of CK-values as well as changes in steroid dose. Secondary endpoints included absolute and relative changes of CK-values at week 8 and week 12.

Results

From 2000 to 2021 25 IIM patients treated with IA were identified, 24 could be used for further analyses. Patient characteristics at start of IA are displayed in Table 1. Subtypes of IIM included dermatomyositis (DM 54.2%), polymyositis (PM 8.3%), Overlap-Myositis (20.8%), mmune-mediated-necrotising-myositis (IMNM 8.3 %), and antisynthetase syndrome (ASS 8.3 %). The majority of patients received concomitant steroid therapy (87.5 %) and DMARD therapy (62.5 %).

Table 1.

Cohort descriptives:

Population, n (n= female%)24 (n=19;79.2 %)Age at Baseline (years; mean [SD];)42.5 [11.5]Subtyp Myositis (%,n)-Dermatomyositis54.2 % (13)-Polymyositis8.3 % (2)-Overlap-Myositis20.8 % (5)-Immune mediated necrotising myositis8.3 % (2)-Anti-Synthetase-Syndrom8.3 % (2)Immune Apharesis within 4 weeks (number of cycles)mean: 9.54,median: 9.5,[IQR: 8; 11.5]Previous DMARDs (%,n)-Any DMARDs-Mean number of previous DMARDs amongst all 24 patients62.5% (15)-Azathioprin33.3% (8)-Methotrexat45.8% (11)-Rituximab16.7% (4)-Mycophenolat mofetil16.7% (4)-Cyclophosphamid8.3% (2)-Ciclosporin8.3% (2)-(Hydroxy)-Chloroquin20.8% (5)-Etanercept4.2% (1)-Infliximab4.2% (1)Concomitant DMARDs (%,n)-Any DMARDs62.5% (15)-Azathioprin20.8% (5)-Methotrexat20.8% (5)-Rituximab4.2% (1)-Cyclophosphamid4.2% (1)-Ciclosporin4.2% (1)-(Hydroxy)-Chloroquin8.3% (2)Concomitant Steroids % (n)87.5% (21)-Dose prednisone at Baseline (mg/day; median [IQR])25 [12.5; 50] (21)-Dose prednisone at week 4 (mg/day; median [IQR]12.5 [0; 37.5] (22)CK-level at baseline (U/ml; median [IQR])970.5 [157.5; 3795.5]Change in CK-values from baselineAbsolute changeRelative change-to week 4 (n=24)median [IQR] U/ml% [IQR]-to week 8 (n=16)304.5 [28.8;2051]49.1 [22.4; 79.3] %-to week 12 (n=15)648.5 [25.8; 3939.3]70.0 [13.6; 87.7] %559 [-7; 3988]63.8 [-5.8; 98.1] %

Until week 4 significant decrease in CK-values was observed in 21/24 patients (p<0.01; Figure 1), from median 970.5 [157.5; 3795.5] to 347[63; 1010] U/ml. Median [IQR] dose reduction of steroids was 12.5 [0; 12.5] mg/day absolute and 25% [0%, 100%] relative. No differences were observed within patients of different myositis subtypes. One patient died after 4 weeks, in 15 patients IA was maintained until week 12. Significant reduction in CK-values was observed from baseline to week 8 and 12 respectively (141 [78; 460], 111 [57;338]. Median and relative changes from baseline until week 12 are displayed in Table 1.

Figure 1.

Individual response in CK-levels from baseline to week 12

Conclusion

Immune-apheresis seems an effective therapeutic option in refractory IIM, leading to decrease of CK-values and steroid dose.

References

[1]Lundberg IE. Expert Perspective: Management of Refractory Inflammatory Myopathy. Arthritis Rheumatol. 2021 Aug;73(8):1394-1407.

Disclosure of Interests

None declared

Testing for HTLV 1 and HTLV 2 among blood donors in Western Saudi Arabia: prevalence and cost considerations

BACKGROUND

Screening all blood donors for human T-cell lymphotropic viruses 1 and 2 (HTLV 1 and HTLV 2) is mandatory in Saudi Arabia. The aim of this study is to evaluate the results and costs associated with the current testing policy for HTLV 1 and HTLV 2 in blood donors at King Abdulaziz University Hospital (KAUH), Jeddah.

STUDY DESIGNS AND METHODS

Donor-testing results from Blood Transfusion Services at KAUH were reviewed over a 10-year period, from January 2006 through December 2015. All donors were screened using chemiluminescent microparticle immunoassay. Reactive samples were then tested by Western blot for confirmation. Costs associated with testing were calculated.

RESULTS

Data of 107 419 donations in the study period were reviewed. Saudi nationals constituted 51 168 donors (47·6%). Of 107 419 blood donors tested for HTLV 1 and HTLV 2 antibody, and 95 (0·088%) donors were reactive to screening tests. None of the samples found to be reactive to screening tests was positive by Western blot. The average cost of testing was US$ 171 870 per year.

CONCLUSION

No donors were confirmed to have HTLV 1 and HTLV 2 in this cohort exceeding 100 000 donors. We propose changes to the policy mandating universal testing by replacing it with universal leukodepletion coupled with targeted screening to donors coming from endemic area or donors at risk. Such changes are expected to lead to a reduction of testing cost without affecting safety.

Late relapse associated with CEP 17 polysomic breast cancer

20011

Background: The clinicopathologic features associated with chromosome enumeration probe 17 (CEP 17) polysomy by fluorescence in situ hybridization (FISH) are not well defined. CEP 17 polysomy is frequently encountered in assessing Her-2neu amplification, which has become an important adjuvant therapeutic target. One mechanism to increase Her-2neu gene copy is polysomy. In this analysis the prognostic and predictive factors associated with CEP 17 polysomy are compared to similar factors in Her-2neu gene amplification. Methods: All cases of Her-2neu gene amplification and CEP 17 polysomic breast cancers from 2000 to present were abstracted. The polysomy group was defined as at least 3 gene copies and was further subdivided into two groups; 3–4 copies and ≥ 5 copies. This resulted in 193 cases of invasive breast cancer, which became the study cohort. Polysomic status and her-2neu gene amplification was compared to age, estrogen receptor (ER), progesterone receptor (PR), grade, tumor size, cell type, mitotic rate, nodal status, number of positive nodes and relapse. Descriptive statistics were used for categorical variables. The χ2 test was used to compare each clinicopathologic factor. Results: Both the ER and PR status was significantly different in the 3 groups. For the Her-2neu amplified, the polysomic 3–4, and the polysomic ≥ 5, the ER positive status was 53%, 67% and 81%, respectively (p = .012). Histologic grade, tumor size and nodal status were not significantly different between groups. Lobular pathology was present in 15% of the polysomy ≥ 5 group, 8% of the polysomy 3–4 group and 1.7% of the amplified group and this difference was significant (p = .03). Relapse disease status was significantly more frequent in the polysomy ≥ 5 group (18.5%) compared to the amplified group (2.6%) (p = .007). Within the relapsed group the median time to relapse was 4 years for the amplified patients versus 12 years and 10 years for the polysomic patients. Conclusion: The incidence of CEP 17 polysomy varies in the literature from 10–50% depending on definitions. Our study is unique in that we divided the polysomic group into 3–4 copies which can be complicated by proliferative activity versus ≥ 5 copies. A significant association between relapse and polysomic breast cancer is described in our dataset.

No significant financial relationships to disclose.

Results of animal experiments on the transplantability of Cialit preserved human fascia

Results of animal experiments on the transplantability of Cialit preserved fascia are presented. Preserved human fascia was grafted to the area of the forehead of 11 rabbits. Specimens were taken for examination between the 10th and 50th day. The fascia healed normally and was revascularised. Based on the results of these experiments, the method of preserving connective tissue (fascia) in Cialit also appears to be suitable for clinical use in the maxillo-facial region in reconstructive surgery, e.g., in facial palsy.

[Treatment of jaw fractures in the Göttingen minipig]

The Freiburg tension plate was used with Göttingen minipigs not particularly to determine the clinical relevance but rather to facilitate animal experiments with the minipig which are impossible with splints or wire. Our studies showed that the AO-mandibular-DC plates with 45 degrees arrangement of apertures used in the clinical field are also suitable for fragment stabilization with minipigs, even though the masticatory force is considerably greater than with humans. A functionally stable osteosynthesis was achieved in animal experiments, whereby the masticatory function of the minipigs was not disturbed. The fractures healed without complications.

[Studies on maxillary growth in patients with cleft palate]

Breadth, length and height of the maxilla and palate measured on models of children with cleft palate decrease at first in the years after operation. The original measurements of the breadth of the dental arch are exceeded at the age of 8,5 but not the length of the dental arch.