Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study

PURPOSE

It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI.

DESIGN

Multicenter prospective international cohort study.

SETTING

Fourteen university hospitals in Spain and the United Kingdom.

PARTICIPANTS

We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37).

CONCLUSIONS

Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

Ultra Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung

PURPOSE/OBJECTIVE(S)

Definitive radiation treatment (RT) for extranodal marginal zone lymphoma (ENMZL) of mucosal associated lymphoid tissue historically involves treatment to 24-30 Gy. There is increasing data supporting the use of ultra-low dose RT as part of a response-adapted approach in the treatment of orbital and gastric ENMZL. With this approach, patients receive initial treatment with 4 Gy, and additional RT is considered for those with persistent or locally progressive disease. However limited data to date assesses the efficacy of 4 Gy in the management of ENMZL of the lung.

MATERIALS/METHODS

We performed an IRB-approved retrospective review of 17 patients with ENMZL of the lung treated with 4 Gy between 7/2015 and 12/2022 with response assessed after RT. Clinical/treatment characteristics, response, and toxicity were extracted from medical records. Statistics were performed using Mann-Whitney U and Fisher's Exact Test.

RESULTS

Eight patients (47%) were female, 15 (88%) white, and 1 (6%) Hispanic. Median age at RT was 66 (interquartile range (IQR) 59-77). All had disease limited to the lung at diagnosis and 15 had stage IE disease. Four patients (24%) were diagnosed incidentally on screening/surveillance imaging in the absence of symptoms. Sixteen patients received 4 Gy in 2 fractions, while one patient received a single fraction of 4 Gy. Median SUVmax prior to RT was 4.5 (IQR 3.2-7.2). Median planning target volume (PTV) was 74 cc (IQR 47-130cc). Six patients (35%) had respiratory symptoms prior to RT, which improved or resolved in 3 (50%). A larger PTV was associated with improvement in symptoms following RT with a median PTV of 266 cc (IQR 171-402) in those who experienced improvement vs. 64 cc (IQR 42-100) in those who did not (p = 0.032). One patient experienced toxicity following RT with pleuritic chest pain, which resolved with corticosteroids. At a median follow-up of 15 months following RT (IQR 7-43 months), the overall response rate (ORR) was 100% (CR, n = 15; PR, n = 2). Fourteen patients had follow-up PET/CT, of whom 13 had a complete metabolic response (CMR) at a median of 3 months following RT (IQR 3-5 months). Two additional patients had a complete response (CR) on CT while one had a partial response on CT. Achieving a CR was not associated with SUV prior to RT (p = 0.50) or PTV size (p = 0.62). In patients with stage IE disease, the ORR rate was 100% and there have been no distant failures to date. Fifteen of 17 patients were alive at last follow-up; two passed away of unrelated causes (one from Alzheimer's disease and one from recurrent squamous cell carcinoma).

CONCLUSION

Ultra-low dose radiation of 4 Gy is associated with excellent local control in the management of ENMZL of the lung and is very well tolerated. Four Gy was effective for local control and symptom palliation even for larger tumors and is an effective initial therapy as part of a response-adapted approach even in limited stage patients.

External validation of Fetal Medicine Foundation competing-risks model for midgestation prediction of small-for-gestational-age neonates in Spanish population

OBJECTIVE

To examine the external validity of the new Fetal Medicine Foundation (FMF) competing-risks model for prediction in midgestation of small-for-gestational-age (SGA) neonates.

METHODS

This was a single-center prospective cohort study of 25 484 women with a singleton pregnancy undergoing routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation. The FMF competing-risks model for the prediction of SGA combining maternal factors and midgestation estimated fetal weight by ultrasound scan (EFW) and uterine artery pulsatility index (UtA-PI) was used to calculate risks for different cut-offs of birth-weight percentile and gestational age at delivery. The predictive performance was evaluated in terms of discrimination and calibration.

RESULTS

The validation cohort was significantly different in composition compared with the FMF cohort in which the model was developed. In the validation cohort, at a 10% false-positive rate (FPR), maternal factors, EFW and UtA-PI yielded detection rates of 69.6%, 38.7% and 31.7% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks' gestation, respectively. The respective values for SGA < 3rd percentile were 75.7%, 48.2% and 38.1%. Detection rates in the validation cohort were similar to those reported in the FMF study for SGA with delivery at < 32 weeks but lower for SGA with delivery at < 37 and ≥ 37 weeks. Predictive performance in the validation cohort was similar to that reported in a subgroup of the FMF cohort consisting of nulliparous and Caucasian women. Detection rates in the validation cohort at a 15% FPR were 77.4%, 50.0% and 41.5% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks, respectively, which were similar to the respective values reported in the FMF study at a 10% FPR. The model had satisfactory calibration.

CONCLUSION

The new competing-risks model for midgestation prediction of SGA developed by the FMF performs well in a large independent Spanish population. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Evidence of decoupling of surface and bulk states in Dirac semimetal Cd3As2

Dirac semimetals have attracted a great deal of current interests due to their potential applications in topological quantum computing, low-energy electronic devices, and single photon detection in the microwave frequency range. Herein are results from analyzing the low magnetic (B) field weak-antilocalization behaviors in a Dirac semimetal Cd₃As₂thin flake device. At high temperatures, the phase coherence lengthl_ϕfirst increases with decreasing temperature (T) and follows a power law dependence ofl_ϕ∝T^-0.4. Below ∼3 K,l_ϕtends to saturate to a value of ∼180 nm. Another fitting parameterα, which is associated with independent transport channels, displays a logarithmic temperature dependence forT > 3 K, but also tends to saturate below ∼3 K. The saturation value, ∼1.45, is very close to 1.5, indicating three independent electron transport channels, which we interpret as due to decoupling of both the top and bottom surfaces as well as the bulk. This result, to our knowledge, provides first evidence that the surfaces and bulk states can become decoupled in electronic transport in Dirac semimetal Cd₃As₂.

A compact x-ray diffraction system for dynamic compression experiments on pulsed-power generators

Pulsed-power generators can produce well-controlled continuous ramp compression of condensed matter for high-pressure equation-of-state studies using the magnetic loading technique. X-ray diffraction (XRD) data from dynamically compressed samples provide direct measurements of the elastic compression of the crystal lattice, onset of plastic flow, strength-strain rate dependence, structural phase transitions, and density of crystal defects, such as dislocations. Here, we present a cost-effective, compact, pulsed x-ray source for XRD measurements on pulsed-power-driven ramp-loaded samples. This combination of magnetically driven ramp compression of materials with a single, short-pulse XRD diagnostic will be a powerful capability for the dynamic materials' community to investigate in situ dynamic phase transitions critical to equation of states. We present results using this new diagnostic to evaluate lattice compression in Zr and Al and to capture signatures of phase transitions in CdS.

Molecular dynamics discovery of an extraordinary ionic migration mechanism in dislocation-containing TlBr crystals

MD simulation of dislocation migration under an electrical field.

π and 4π Josephson Effects Mediated by a Dirac Semimetal

Cd_{3}As_{2} is a three-dimensional topological Dirac semimetal with connected Fermi-arc surface states. It has been suggested that topological superconductivity can be achieved in the nontrivial surface states of topological materials by utilizing the superconductor proximity effect. Here we report observations of both π and 4π periodic supercurrents in aluminum-Cd_{3}As_{2}-aluminum Josephson junctions. The π period is manifested by both the magnetic-field dependence of the critical supercurrent and the appearance of half-integer Shapiro steps in the ac Josephson effect. Our macroscopic theory suggests that the π period arises from interference between the induced bulk superconductivity and the induced Fermi-arc surface superconductivity. The 4π period is manifested by the missing first Shapiro steps and is expected for topological superconductivity.

Patients with classical Hodgkin lymphoma experiencing disease progression after treatment with brentuximab vedotin have poor outcomes

BACKGROUND

Brentuximab vedotin (BV) is a key therapeutic agent for patients with relapsed/refractory classical Hodgkin lymphoma (cHL). The outcomes of patients experiencing disease progression after BV are poorly described.

PATIENTS AND METHODS

We reviewed our institutional database to identify patients with cHL treated with BV who were either refractory to treatment or experienced disease relapse. We collected clinicopathologic features, treatment details at progression and outcome.

RESULTS

One hundred patients met inclusion criteria, with a median age of 32 years (range 18-84) at progression after BV. The median number of treatments before BV was 3 (range 0-9); 71 had prior autologous stem cell transplant. The overall response rate (ORR) to BV was 57%, and the median duration of BV therapy was 3 months (range 1-25). After disease progression post-BV, the most common treatment strategies were investigational agents (n = 30), gemcitabine (n = 15) and bendamustine (n = 12). The cumulative ORR to therapy was 33% (complete response 15%). After a median follow-up of 25 months (range 1-74), the median progression-free (PFS) and overall survival (OS) were 3.5 and 25.2 months, respectively. In multivariate analysis, no factors analyzed were predictive of PFS; age at progression >45 years and serum albumin <40 g/l at disease progression were associated with increased risk of death. Among patients who achieved response to therapy, allogeneic stem cell transplantation was associated with a non-significant trend toward superior OS (P = 0.11).

CONCLUSIONS

Patients with BV-resistant cHL have poor outcomes. These data serve as a reference for newer agents active in BV-resistant disease.

Factors influencing outcome in advanced stage, low-grade follicular lymphoma treated at MD Anderson Cancer Center in the rituximab era

BACKGROUND

The optimal initial therapy of follicular lymphoma (FL) remains unclear. The aims of this study were to compare primary treatment strategies and assess the impact of maintenance rituximab and patterns of treatment failure.

PATIENTS AND METHODS

We retrospectively analyzed patients with treatment-naive advanced stage, grade 1-2 FL treated at our center from 2004 to 2014. We included 356 patients treated on clinical trials or standard of care with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP, n = 119); R-CHOP with maintenance (R-CHOP + M, n = 65); bendamustine/rituximab (BR, n = 45); BR with maintenance (BR + M, n = 35); R(2) (n = 94). We compared baseline characteristics, progression-free survival (PFS), overall survival (OS) and analyzed prognostic factors using univariate and multivariate analysis adjusted for treatment.

RESULTS

After a median follow-up of 4 years (range 0.2-15.0), the 3-year PFS was 60% [95% confidence interval (CI) 51% to 69%] for R-CHOP, 72% (59% to 82%) for R-CHOP + M, 63% (42% to 78%) for BR, 97% (80% to 100%) for BR + M and 87% (78% to 93%) for R(2). Patients treated with R-chemotherapy had more high-risk features than patients treated with R(2) but, by adjusted multivariate analysis, treatment with R(2) [hazard ratio (HR) 0.39 (0.17-0.89), P = 0.02] was associated with a superior PFS. Eastern Cooperative Oncology Group Performance status of one or more predicted inferior OS. Among patients treated with R-chemotherapy, maintenance was associated with the superior PFS [HR 0.38 (95% CI 0.21-0.68)]. By adjusted multivariate analysis, disease progression within 2 years [HR 5.1 (95% CI 1.57-16.83)] and histologic transformation (HT) [HR 11.05 (95% CI 2.84-42.93)] increased risk of death.

CONCLUSION

Induction therapy with R(2) may result in disease control which is comparable with R-chemotherapy. Early disease progression and HT are predictive of inferior survival.

Role of the oxidizing agent to complete the synthesis of strontium aluminate based phosphors by the combustion method

Well-controlled fuel/oxidizing agent ratio allows to synthesize nanostructured strontium aluminates lamellar particles with high luminescence properties.

Abstract P3-08-15: Improving survivors’ quality of care through use of self-reported satisfaction data

Background: Despite numerous initiatives to improve the quality and safety of care for the growing number of cancer survivors, little empirical evidence is available about survivor satisfaction with post-treatment care or whether their information needs are met. Our specific aim was to conduct a comparative evaluation of 2 cohorts of survivors to determine their satisfaction with services provided in a breast survivorship clinic.

Methods: We compared satisfaction in 2 separate cohorts of women who completed their curative treatment. Eligibility criteria for both groups included being a woman diagnosed with breast cancer and transitioned to “long-term survivor” status by their primary oncologist. Women were then grouped into no-visit, those who had never been to a breast survivorship clinic or completed-visit, survivors who had completed a visit to the survivorship clinic. Data was collected for the no-visit group in 2009, when the breast survivorship clinic was initially launched. Data collection for the comparative or completed-visit cohort is ongoing.

The instrument consisted of 6 items reflecting 2 subscales: satisfaction and information needs. The first subscale focused on satisfaction with their visit, time spent with provider, and management of emotional distress. The second sub-scale focused on information received related to disease surveillance, late effects, health promotion, and social services. Survivors in both groups received the questionnaire upon their clinic arrival and completed it during their visit. Descriptive statistics were used to summarize all responses. All data were de-identified.

Results: The no-visit cohort consisted of 81 breast cancer survivors who had never been seen in any type of survivorship clinic. Responses indicating that the survivors strongly agreed with an item were reported as follows: 79.5% satisfied with their visit, 77.3% information received, and 77.8% adequate time with provider. Of survivors who reported they were experiencing emotional distress, 50% strongly agreed that the clinicians in the clinic did all possible to address their distress, such as making referrals to the clinic social worker or to community-based mental health services. Bone health, cancer education, recurrence, and screening were the educational topics most requested. Final data collection and analysis for the comparative cohort, completed-visit, will be concluded by August 2013.

Discussion: The no-visit cohort reported high satisfaction with survivorship care and information before they were seen in any type of institutional survivorship clinic. This finding could be a bias resulting from satisfaction with care received as a patient in active treatment. Results however, also suggest survivors of breast cancer who had not been seen in a survivorship clinic were aware of the type of specialized care or education needed to maintain their health after curative treatment. Further evaluation and research is needed to determine how satisfaction and unmet educational needs can be used to optimize outcomes for our growing population of cancer survivors.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-15.

Mycophenolate mofetil and tacrolimus reduce mortality after deceased donor kidney transplantation

A study of mortality in renal transplantation recipients showed that the combination of mycophenolate mofetil (MMF) and tacrolimus (TaC) reduced the mortality rate. We studied 1045 consecutive adult deceased donor kidney transplant recipients from 1986-2001, where follow-up to 2011 was a minimum of 10 years, to analyze the impact of these immunosuppressive drugs on patient survival. Cox multivariate analysis showed that treatment with MMF and the use of TaC instead of cyclosporine reduced the risk of death by 43%. In conclusion, both immunosuppressive drugs reduced the risk of death of patients receiving from renal transplants deceased donors.

Low-hazard metallography of moisture-sensitive electrochemical cells

A low-hazard approach is presented to prepare metallographic cross-sections of moisture-sensitive battery components. The approach is tailored for evaluation of thermal (molten salt) batteries composed of thin pressed-powder pellets, but has general applicability to other battery electrochemistries. Solution-cast polystyrene is used to encapsulate cells before embedding in epoxy. Nonaqueous grinding and polishing are performed in an industrial dry room to increase throughput. Lapping oil is used as a lubricant throughout grinding. Hexane is used as the solvent throughout processing; occupational exposure levels are well below the limits. Light optical and scanning electron microscopy on cross-sections are used to analyse a thermal battery cell. Spatially resolved X-ray diffraction on oblique angle cut cells complement the metallographic analysis.

Direct-Write Precision Resistors for Ceramic Packages

A direct-write approach to fabricate high precision resistors is reported. Special attention is paid to the effect of print thickness on the resistance value of buried resistors after a low temperature co-firing process. The results show that the direct-write approach provides a superior line definition and thickness control over a traditional screen printing process. Microstructural analysis indicates that there is an interdiffused layer developed between the resistor material and the low temperature co-fired ceramic substrate. These observations are consistent with electrical measurements which show that resistance increases as the effective cross-sectional area is reduced. The resistance data show that the standard deviations for resistors printed on a 6” × 6” area are 5% and 15% for the direct-write and the screen-printed patterns, respectively.

Vincristine sulfate liposomes injection (Marqibo) in heavily pretreated patients with refractory aggressive non-Hodgkin lymphoma: report of the pivotal phase 2 study

BACKGROUND

Marqibo, a sphingosomal/cholesterol encapsulation of vincristine sulfate has targeted, increased, and sustained delivery of vincristine to tumor tissues. A phase 2, open-label, single-arm, and multinational study evaluated the efficacy and tolerability of Marqibo as a single agent in patients with multiply relapsed or refractory aggressive non-Hodgkin lymphoma (NHL).

METHODS

Eligible patients had relapsed or refractory de novo or transformed aggressive NHL and prior treatment with at least 2 multiagent chemotherapy regimens. Marqibo was administered at 2 mg/m2, every 2 weeks, for a maximum of 12 cycles or until toxicity or disease progression.

RESULTS

One hundred and nineteen patients were enrolled and treated on trial. Ninety-six had histological confirmed de novo (N=89) or transformed (N=7) aggressive NHL. Median number of cycles was 4 (median dose/cycle 4 mg). Overall response (CR and complete response unconfirmed and PR) was 25% (95% confidence interval [CI], 17, 35), CR and complete response unconfirmed confirmed by external reviewers was 5%. Median overall survival was 6.6 months (Kaplan-Meier estimate, 95% CI, 4.7, 9.8). Grade 3 of 4 neurotoxicity occurred in 32% of patients. All patients had prior neurotoxic agents, and 85% had baseline residual neuropathy symptoms (grades 1-2) from prior treatment.

CONCLUSIONS

Marqibo is an active agent in patients with heavily pretreated aggressive NHL, and tolerated at approximately twice the dose intensity of standard vincristine. Its activity supports further investigation as a substitution for vincristine in combination treatment of lymphoid disorders.

Evaluation of brain natriuretic peptide (BNP), troponin levels, and left ventricular ejection fraction (LVEF) in older adults with diffuse large B cell lymphoma (DLBCL)

e19506

Background: Troponin and BNP are markers that rise acutely during myocardial injury and cardiac dysfunction, respectively. Doxorubicin (Dox) is an effective drug for treatment of DLBCL, in the regimen RCHOP (Coiffier, et.al. NEJM, 2002). Dox has risk of myocardial toxicity, which is higher in older patients (pts). Pegylated liposomal doxorubicin (D) has greater cardiac safety yet similar efficacy to Dox in breast cancer. D replaced Dox in RCHOP (DRCOP) in a phase II study in patients >60 yrs of age, with troponin and BNP levels pre and post-treatment to see if they would predict a fall in LVEF secondary to DRCOP. Methods: DRCOP is: Rituximab 375 mg/m2 IV day (d) 1; D 40 mg/m2 IV d 1; cyclophosphamide 750 mg/m2 IV d 1; vincristine 2 mg IV d 1 total dose; prednisone 100 mg/d p.o. d 1–5. Eligibility criteria: > 60 years; untreated DLBCL; Ann Arbor stage II-IV; baseline LVEF ≥ 50%. Consult at baseline by Cardiologist required, and at follow-up as indicated. The Wilcoxon rank sign test was used to compare baseline BNP with subsequent BNP. A linear mixed model was used to assess the effect of time on troponin at baseline, midpoint and endpoint. All tests were two-sided and p-values of 0.05 or less were considered statistically significant.. Statistical analysis was carried out using SAS version 9 (SAS Institute, Cary, NC). Results: 60 patients are enrolled; only one patient has developed systolic dysfunction, (LVEF to <50%). Conclusions: DLBLC older patients Older adults with DLBCL treated with DRCOP maintain preserved LVEF and troponin levels, suggesting less cardiotoxicity. There is a significant rise in BNP without clinical cardiac dysfunction. This is a new observation that merits further study.

[Table: see text]

No significant financial relationships to disclose.

Hepatosplenic gamma-delta T-cell lymphoma: clinicopathological features and treatment

BACKGROUND

Hepatosplenic T-cell lymphoma (HSTCL) is a rare peripheral T-cell lymphoma; treatment with standard anthracycline-containing chemotherapy regimens has been disappointing, and an optimal treatment strategy for this patient population has not yet been determined.

METHODS

We identified 15 cases of pathologically confirmed HSTCL in the institution's database. Clinical characteristics and treatment results were reviewed.

RESULTS

Complete responses (CRs) were achieved in 7 of 14 patients who received chemotherapy. Achievement of CR was followed by hematopoietic stem-cell transplantation in three patients. Median duration of CR was 8 months (range 2 to 32+ months) with four patients currently alive and in CR at 5, 8, 12, and 32 months, respectively. Median overall survival (OS) was 11 months (range 2 to 36+ months). Patients who achieved a CR had a median OS of 13 months, compared with 7.5 months in patients who did not achieve a CR. Risk factors associated with worse outcome included male gender, failure to achieve a CR, history of immunocompromise, and absence of a T-cell receptor gene rearrangement in the gamma chain.

CONCLUSION

A better understanding of the pathophysiology of HSTCL and new therapeutic strategies are needed.

Predictive value for survival of a risk model of two serological markers, beta-2-microglobulin (B2M) and lactic dehydrogenase (LDH), in diffuse large cell lymphoma (DLCL)

10599

Background: The International Prognostic Index (IPI), the standard tumor risk model in patients (pts) with diffuse large cell lymphoma (DLCL), has 5 factors (age, LDH, performance status, extra nodal sites, and stage). We previously proposed a simpler two-factor model, based on LDH and B2M (JCO10;1989). B2M is a component of HLA class I antigens, expressed in lymphocytes, and a known prognostic indicator in some lymphoid malignancies. The benefits of this model are: objective measures; lab method widely available; simplicity; biologic marker. Methods: We applied the model to a large cohort of DLCL patients with prospective baseline B2M, and treated with doxorubicin-based (chemo) regimens, with and without rituximab. 718 pts with DLCL were sequentially treated at MDACC by IRB approved chemo protocols from 1988–2000. In 2001, rituximab plus chemo (RCHOP) became standard. 311 DLCL pts were sequentially treated with RCHOP from 2001–2005. Cox regression analyses for univariate and multivariate models of IPI factors and B2M were done. Kaplan-Meier survival projections were in three risk categories: low (normal [nl] LDH and B2M); intermediate (either LDH or B2M > nl); or high (LDH and B2M > nl). Results: In both treatment groups, IPI factors and B2M were significant as univariate factors. In the RCHOP group, however, the IPI multivariate model showed age, stage, and extra-nodal sites were not significant risk factors, while B2M and LDH remained highly significant (p<0.01). The 5 year survival projections by risk category were: (*) combines intermediate low and intermediate-high categories Conclusions: This simple two-factor model predicts risk for patients with DLCL, treated with or without rituximab, comparably to the IPI. B2M should be considered an important prognostic indicator in DLCL, particularly in rituximab treated patients. Exploratory analyses to revise the IPI model are indicated.

[Table: see text]

No significant financial relationships to disclose.

R-HCVAD/R-MTX-ARAC is an effective regimen for untreated diffuse large B-cell lymphoma (DLBCL) with aggressive features: M. D. Anderson experience in 40 patients

8058

Background: R-HCVAD (rituximab-cyclphosphamide, vincristine, dexamethasone, doxorubicin) alternating with R-MTX-ARAC (rituximab, methotrexate-cytarabine) is a chemoimmunotherapy regimen with activity in ALL, mantle cell, and Burkitt’s lymphomas (BL). Histological differentiation between BL, atypical BL, and DLBCL with high-grade features can be difficult. We thus have treated patients with DLBCL with high-grade histological features and/or poor-risk IPI with R-HCVAD. Methods: Forty consecutive patients with information collected prospectively in the NCCN database, treated between 7/2002 and 10/05 at M.D Anderson Cancer Center, and who received at least one cycle are included in this cohort analysis. Characteristics: 18 (45%) male; 18 (45%) HI and High IPI; 25 (62.5%) ↑LDH; 26 (65%) with Stage III/IV; 2 (5%) with PS>1; 8 (20%) with >60 years; 25 (62%) a Ki-67 >90%. Four patients received less than 4 cycles of treatment. Results: ORR was of 100%, with 95% CR/CRu. With a median follow-up of 26 months, 6 patients failed: 1 died in CR of pulmonary embolism while on treatment; 1 patient who achieved CR, had PD before the end of treatment; 1 achieved a PR and was transplanted (is alive in remission); 1 achieved a PR and progressed died of disease; and 2 relapsed (one is in remission after an ASCT). Four patients have died: 3 of disease, 1 of pulmonary embolism. The 3-year OS is 88% (95% CI 77%-99%); 3-year FFS is 71% (95% CI 47%-95%). The 3-year FFS for patients with L/LI risk (3-failures of 22 pts) was 78% (95% CI 52%-100%); and for patients with HI/H IPI (3 failures of 18 pts) 65% (95% CI 27%-100%). Conclusions: R-HCVAD/R-MTC-ARAC is a very active regimen for DLBCL of high grade. Toxicity was mostly hematological. We are currently doing a prospective randomized phase II study comparing this regimen to standard R-CHOP in patients with poor-risk IPI scores.

No significant financial relationships to disclose.

Noise reduction in ultrasonic NDT using undecimated wavelet transforms

Translation-invariant wavelet processing is applied to grain noise reduction in ultrasonic non-destructive testing of materials. In particular, the undecimated wavelet transform (UWT), which is essentially a discrete wavelet transform (DWT) that avoids decimation, is used. Two different UWT processors have been specifically developed for that purpose, based on two UWT implementation schemes: the "à trous" algorithm and the cycle-spinning scheme. The performance of these two UWT processors is compared with that of a classical DWT processor, by using synthetic grain noise registers and experimental pulse-echo NDT traces. The synthetic ultrasonic traces have been generated by an own-developed frequency-domain model that includes frequency dependence in both material attenuation and scattering. The experimental ultrasonic traces have been obtained by inspecting a piece of carbon-fiber reinforced plastic composite in which we have mechanized artificial flaws. Decomposition level-dependent thresholds, which are suitable for correlated noise, are specifically determined in all cases. Soft thresholding, Daubechies db6 mother wavelet and the three well-known threshold selection rules, Universal, Minimax and SURE, are applied to the different decomposition levels. The performance of the different de-noising procedures for single echo detection has been comparatively evaluated in terms of signal-to-noise ratio enhancement.

Reduced-intensity allogeneic stem cell transplantation in relapsed and refractory Hodgkin's disease: low transplant-related mortality and impact of intensity of conditioning regimen

A total of 40 patients with relapsed/refractory Hodgkin's disease (HD) underwent reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT) from an HLA-identical sibling (n=20) or a matched unrelated donor (n=20). The median age was 31 years (range 18-58). Disease status at allo-SCT was refractory relapse (n=14) or sensitive relapse (n=26). The conditioning regimens were fludarabine-cyclophosphamide+/-antithymocyte globulin (n=14), a less intensive regimen, and fludarabine-melphalan (FM) (n=26), a more intensive one. The two groups had similar prognostic factors. The median time to neutrophil recovery (ie absolute neutrophil count >/=500/microl) was 12 days (range 10-24). The median time to platelet recovery (ie platelet count >/=20 000/microl) was 17 days (range 7-132). Day 100 and cumulative (18-month) transplant-related mortalities (TRMs) were 5 and 22%. Twenty-four patients (60%) are alive (14 in complete remission or complete remission, unconfirmed/uncertain) with a median follow-up of 13 months (4-78). In all, 16 patients expired (TRM n=8, disease progression n=8). FM patients had better overall survival (73 vs 39% at 18 months; P=0.03), and a trend towards better progression-free survival (37 vs 21% at 18 months; P=0.2). RIC allo-SCT is feasible in relapsed/refractory HD patients with a low TRM. The intensity of the preparative regimen affects survival.

Long-term results favor allogeneic over autologous hematopoietic stem cell transplantation in patients with refractory or recurrent indolent non-Hodgkin's lymphoma

BACKGROUND

The aim of this study was to compare the outcomes of high-dose therapy (HDT) and allogeneic versus autologous hematopoietic stem cell transplantation (SCT) in patients with refractory or recurrent indolent non-Hodgkin's lymphoma (NHL).

PATIENTS AND METHODS

From January 1991 to March 2000, 112 patients underwent HDT followed by either autologous (68 patients) or allogeneic (44 patients) SCT for refractory or recurrent indolent NHL. Prior conventional chemotherapy had failed in all patients.

RESULTS

The two groups were similar with respect to age at transplantation, gender, histological subtypes, number of chemotherapy regimens received before transplantation and International Prognostic Index scores. The median time from diagnosis to transplantation was longer in the autologous than in the allogeneic SCT group (46 versus 27 months, P = 0.002). In the allogeneic SCT group the median follow-up time was 53 months (range 21-113), and the overall survival (OS) and disease-free survival (DFS) rates were 49% and 45%, respectively. After a median follow-up time of 71 months (range 22-109), in the autologous SCT group, the OS and DFS rates were 34% and 17%, respectively. Patients who underwent autologous SCT were more likely to have chemosensitive disease (P <0.001) and were more likely to be in complete remission at the time of transplantation (P = 0.001) than those who underwent allogeneic SCT. However, the probability of disease progression was significantly higher in the autologous SCT group than in the allogeneic SCT group (74% versus 19%, P = 0.003).

CONCLUSIONS

Patients who undergo HDT with allogeneic SCT for refractory or recurrent indolent NHL have lower relapse rates but higher treatment-related mortality rates than patients who undergo autologous SCT. However, with the development of non-myeloablative preparative regimens, which can decrease treatment-related mortality, patients with recurrent indolent NHL should be considered for controlled trials of allogeneic transplantation if they have a human leukocyte antigen-identical donor.

Irinotecan in relapsed or refractory non-Hodgkin's lymphomas. Indications of activity in a phase II trial

Because irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin's lymphomas (NHLs). Irinotecan at 300 mg/m2 i.v. was administered every 21 days with intensive loperamide management of diarrhea. Responders received up to six treatment cycles. Of 44 registered patients, 32 are evaluable for response. Seventeen patients had received one previous regimen, and 15 patients had received two. Disease was refractory to the regimen preceding irinotecan in 12 patients. At baseline, serum lactate dehydrogenase levels were high in 47% (14/30), and beta-2-microglobulin levels were higher than 3.0 mg/L in 29% (8/28) of patients. Responses were seen in 12 of 32 (38%) patients (95% confidence interval [CI] = 21%-56%). Response rates were 43% for seven indolent (95% CI = 10%-82%), 0% for three mantle cell (95% CI = 0%-71%), 44% for 18 relapsed aggressive (95% CI = 22%-69%), and 20% for five refractory aggressive NHLs (95% CI = 1%-72%). Grade 3/4 toxicities included myelosuppression, neutropenic fever, and diarrhea. Irinotecan appears active and relatively well tolerated in patients with relapsed aggressive or indolent NHL. Accrual to this study is continuing for better determination of response rates in all histologic subtypes of NHL.

Primary cutaneous non-Hodgkin's lymphoma with aggressive histology: inferior outcome is associated with peripheral T-cell type and elevated lactate dehydrogenase, but not extent of cutaneous involvement

BACKGROUND

The aim of this study was to explore the association between extent of cutaneous involvement, presenting features and progression-free survival (PFS) in patients with primary cutaneous non-Hodgkin's lymphoma (PCNHL) of aggressive histology.

METHODS

Previously untreated patients with localized or extensive PCNHL of aggressive histology, treated with combination chemotherapy, but excluding lymphoblastic lymphoma and mycosis fungoides and its variants, were reviewed retrospectively.

RESULTS

We identified 53 patients, of whom 52 (35 males, 17 females) were treated with doxorubicin-based regimens. Median age was 52 years (range 25-81 years), and disease was localized and extensive in 37 and 16 patients, respectively. Twenty-four patients had diffuse large B-cell lymphoma, nine had grade 3 follicular lymphoma, 13 had peripheral T-cell lymphoma (PTCL; not otherwise specified) and seven had anaplastic large cell lymphoma (WHO classification). With a median follow-up of 101 months (range 2-237 months) for survivors, the 10-year PFS was 65 +/- 7% and overall survival was 72 +/- 8%. The first failure involved the skin in 33% of B-cell and 91% of relapsing T-cell lymphomas. Univariate analysis revealed that PTCL (P = 0.005), lymphopenia (P = 0.01) and high serum levels of beta(2)-microglobulin (P = 0.0006) and LDH (P = 0.002), but not extent of skin involvement, were associated with inferior PFS. Multivariate analysis revealed that only PTCL and high serum lactate dehydrogenase (LDH) were independently associated with inferior PFS.

CONCLUSIONS

PTCL and elevated serum LDH level, but not extent of cutaneous involvement are associated with inferior PFS in aggressive PCNHL treated with combination chemotherapy.