Classical Hodgkin Lymphoma: Clinicopathologic Features,Prognostic Factors,and Outcomes From a 28-Year Single Institutional Experience

IntroductionClassical Hodgkin lymphoma (cHL) is a curable malignancy, with a complete remission rate of approximately 90%. However, relapse remains a significant cause of mortality. Prognostic factors are useful in guiding therapy. This is a large, single-institution study defining the clinicopathologic features, prognostic factors, and treatment outcomes of patients with cHL.Patients and MethodsWe reviewed 727 patients with cHL treated at H. Lee Moffitt Cancer Center and Research Institute from 1990 to 2017. Data on demographics, laboratory studies, and disease statuses were collected from the institutional database and electronic medical records. Statistical analyses, overall survival (OS), progression-free survival (PFS), and multivariate analyses were performed.ResultsThe median age was 35 years. Fifty-four percent of patients were men; 45.6% had advanced stage disease; 82% were treated with ABVD (doxorubicin hydrochloride [adriamycin], bleomycin sulfate, vincristine, and dacarbazine) as frontline therapy; and 70% achieved complete response. The median PFS after first-line treatment was 16.8 years. The median OS of patients with early stage and advanced stage cHL was 19 and 12.9 years, respectively. Poor prognostic factors for OS included older age, advanced stage disease, presence of B symptoms, and a higher International Prognostic Score.ConclusionDespite high cure rates, cHL accounted for the cause of death in 47% of patients who died during follow-up. Prognostic factors, such as age, stage at diagnosis, International Prognostic Score, and B symptoms, are helpful to guide treatment. Outcomes observed in this study are comparable with those reported in previously published studies.     

肺部肿瘤大分割放疗伽玛刀、IMRT和VMAT计划剂量学分析

目的探讨肺部肿瘤大分割放疗患者伽玛刀、固定野调强放疗(Intensity Modulated Radiation Therapy,IMRT)和容积调强放疗(Volumetric Modulated Arc Therapy,VMAT)计划的剂量学差异,分析三种立体定向治疗方式在肺部肿瘤治疗上的优势和不足。方法选取2018年至2020年在海军第九七一医院接受放疗的肺转移瘤患者20例,利用计划系统对20例患者分别制定伽玛刀、IMRT和VMAT治疗计划,通过剂量体积直方图分析靶区及危及器官的剂量、体积等相关参数并做统计学分析,比较三种治疗计划的剂量学差异。结果患侧肺及全肺V₅、V₁₀、V₁₅、V₂₀、V₂₅、V₃₀,伽玛刀低于IMRT和VMAT(P<0.05);IMRT比VMAT的V₁₀、V₁₅小(P<0.05),而V₂₅、V₃₀则略高于VMAT,差异无统计学意义(P>0.05)。三种治疗方式的患肺平均剂量D_mean基本相同(P>0.05);全肺平均剂量D_mean,伽玛刀与IMRT无明显差异(P=0.106),但伽玛刀比VMAT略低(P=0.025)。采用伽玛刀治疗,心脏V₂₀、V₃₀、V₄₀整体好于基于加速器的IMRT和VMAT,除了与VMAT相比V₄₀差异较小(P=0.086)外,其他差异均有统计学意义(P<0.05)。伽玛刀心脏平均剂量D_mean低于IMRT(P=0.007),其他各组无明显差别(P>0.05)。伽玛刀治疗的脊髓最大剂量低于IMRT(P<0.05),而IMRT和VMAT则相差不大(P=0.411)。伽玛刀、IMRT和VMAT三者的食管D_mean依次增高(P<0.05);最大剂量D_max伽玛刀明显低于VMAT(P=0.029),而伽玛刀与IMRT以及IMRT与VMAT则没有明显差别(P>0.05)。IMRT的适形指数好于伽玛刀和VMAT(P<0.05);而伽玛刀和VMAT则无明显差别(P=0.866)。伽玛刀的不均匀指数明显高于IMRT和VMAT(P<0.05),VMAT略高于IMRT(P=0.008)。采用伽玛刀治疗的靶区D_max和D_mean明显高于IMRT和VMAT(P<0.05),VMAT则略高于IMRT(P<0.05)。结论伽玛刀靶区剂量分布最不均匀,适形度稍差,但能更好的保护周围正常肺组织和其他危及器官,对较小的肺叶内肿瘤尤其适合;IMRT用于体部立体定向放射治疗(Stereotactic Body Radiation Therapy,SBRT)比VMAT降低了肺内低剂量辐射的范围,但是高剂量辐射范围稍大;VMAT在用于肺叶内肿瘤SBRT时应该慎重。     

Total Body Irradiation Versus Chemotherapy Conditioning in Pediatric Acute Lymphoblastic Leukemia Patients Undergoing Hematopoietic Stem Cell Transplant: A Systematic Review and Meta-Analysis

Allogeneic hematopoietic stem cell transplant (HSCT) is indicated in pediatric patients with acute lymphoblastic leukemia (ALL) who have relapsed or are at a very high risk of relapse during first complete remission. Two types of myeloablative conditioning are employed before allogeneic HSCT: total body irradiation (TBI)-based regimens and chemotherapy (CHT) alone. This study compares the efficacy and safety of TBI-based regimens and CHT-based conditioning in pediatric, adolescent, and young adult patients with ALL (0-24 years old). TBI-based and CHT-conditioning regimens were evaluated in 4262 and 1367 patients, respectively, from 15 studies. Compared to CHT alone, TBI-based regimens were associated with better overall survival (OS), relative risk (RR) 1.21, better event-free survival (RR 1.34), and a reduced risk of relapse (RR 0.69). Both approaches had comparable risk of acute graft-versus-host disease (GVHD), grades 3 to 4 acute GVHD, chronic GVHD, and nonrelapse mortality (NRM). In the subgroup analysis for patients in first complete remission, TBI-based regimens and CHT alone had comparable OS and NRM. Our results demonstrate the superiority of TBI-based regimens compared to CHT alone in pediatric patients with ALL.     

The prognostic significance of left atrial appendage peak flow velocity in the recurrence of persistent atrial fibrillation following first radiofrequency catheter ablation

BackgroundAtrial fibrillation (AF) relapse following radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (PeAF) continues to be a concern. This study establishes a connection between left atrial appendage peak flow velocity (LAAV) and recurrence of AF in individuals having PeAF following first RFCA.MethodsWe retrospectively studied 164 successive PeAF patients who had first RFCA between January 2018 and December 2019. Before the ablation, the LAAV was recorded using transesophageal echocardiography (TEE). The demographic and clinical data of the individuals were gathered. Participants were monitored at regular intervals to monitor for recurrence of AF. We employed Cox proportional hazards regression to determine if LAAV, as well as other clinical indicators, were predictive of AF recurrence in follow-up.ResultsIn this study, AF relapse was seen in 43 patients (26.2%) following a median follow-up of 15 [interquartile range (IQR): 12–18] months. It was shown that the LAAV was decreased in individuals who had recurrences of AF (0.36±0.05 vs. 0.45±0.17 m/s, P=0.004). Using Kaplan-Meier analysis, it was discovered that the low LAAV (0.37 m/s) group had a poorer event-free survival rate compared to the high LAAV (>0.37 m/s) group (17.6 vs. 21.2 months, log-rank P=0.002) group. Based on the results of the multivariate Cox regression analysis, a LAAV of fewer than 0.37 m/s [hazard ratio (HR): 2.32; 95% confidence interval (CI): 1.177–4.227; P=0.014] was shown to be an independent predictor of AF recurrence following RFCA.ConclusionsA low LAAV is associated with AF relapse, and it is a predictor of AF relapse following the first RFCA for PeAF. This discovery may be useful in the optimization of treatment strategies and the care of patients with PeAF.     

Correction: “Changes in the medical burden of pyogenic and tuberculous spondylitis between 2007 and 2016: A nationwide cohort study”

BackgroundThis nationwide study aimed to compare the medical burdens of pyogenic spondylitis (PS) and tuberculous spondylitis (TS) between 2007 and 2016 in Korea.MethodsWe used a national database managed by the National Health Insurance Service (NHIS) with data from the years 2007 and 2016. A total of 9655 newly diagnosed patients with PS or TS were correspondingly enrolled in the PS or TS group. Chi square test analyses were used to compare the PS and TS groups.ResultsThe overall incidence of infectious spondylitis during the study period was 9655 persons. The PS and TS groups consisted of 7305 and 2350 cases, respectively. Individual medical costs in the PS group (USD 10,049 ± 94 vs. USD 16,672 ± 17,729, P < 0.001) and the TS group (USD 4882 ± 6869 vs. USD 8531 ± 10,709, P < 0.001) both increased. The total medical cost for the PS group increased significantly between 2007 and 2016 in Korea (USD 24,428,560 vs. USD 81,044,196, P < 0.001). In contrast, the total medical cost for the TS group decreased between 2007 and 2016 in Korea (USD 8,573,038 vs. USD 4,879,520, P < 0.001).ConclusionThis nationwide study shows that the total medical cost of PS has increased and that the total medical cost of TS has decreased between 2007 and 2016 in Korea.     

Primary central nervous system T-cell lymphoma: An analysis from the surveillance,epidemiology, and end results program

BackgroundPrimary central nervous system T-cell lymphoma (PCNSTCL) is a rare neoplasm with few data regarding its common features and survival characteristics.ObjectiveTo explore the Surveillance, Epidemiology, and End Results 18 (SEER 18) database to determine the epidemiology of PCNSTCL.MethodsThe SEER 18 registry database was queried to identify patients diagnosed with PCNSTCL from 1973 to 2014 and extract their information. Age-specific rates and Kaplan-Meier overall survival (OS) were calculated. A Cox proportional hazards model was applied to investigate relationships between various demographic/treatment variables and OS.ResultsThe age-specific incidence rates were higher in the older population (≥60 years). Among 59 PCNSTCL cases from the SEER 18, the mean age at presentation was 55.8 years (SD, ±17.95), with a male predominance (1.36:1.00). The median follow-up was 8 months, and the median OS was 8 months (SE, ±4.162). The 1-, 3-, and 5-year OS was 46.3% [95% CI, 33.4%–59.2%], 32.8% [20.3%–45.3%], and 32.8% [20.3%–45.3%], respectively. Seventeen of the 59 patients survived at last follow-up. Patients < 60 years had a greater 3-year OS compared with patients ≥ 60 years (52.6% [33.6%–71.6%] vs 13.9% [1.4%–26.4%]. Multivariate analysis has demonstrated that only age at diagnosis (≥60/<60 years) exhibited a significant relationship with OS (HR, 3.495 [1.688–7.235]; p = 0.001). Sex (female/male) was observed to have a doubted trend towards significance (HR, 0.487 [0.231–1.030]; p = 0.060).ConclusionsPCNSTCL is generally of poor prognosis but younger age at diagnosis (<60 years) predicts a better prognosis.     

Monitor selection according to the defect location in the medial femoral condyle flap,

BackgroundMedial femoral condyle(MFC) flap is frequently used in hand reconstruction, but like other buried flaps, MFC is not easy to monitor and follow.In this study, we present our adipofascial and periosteal tissue technical modifications and results for MFC free flap monitoring and compare different monitoring methods.MethodsTwenty one patients with wrist bone or metacarpal defect reconstructed with MFC flap were included in the study. Adipofascial tissue in wrist defect and periosteal tissue in metacarpal defect were selected as MFC flap's monitor. Patient characteristics, type of injury, flap size, early or late-period complications, flap elevation time,satisfaction scale, visual analogue scale (VAS) and postoperative X-ray view were noted.ResultsThere were 3 female and 18 male patients in the study. The mean age of the patients was 50.8 (38–68). The elevation times of flaps with adipofascial and periosteal monitors were 48 and 53.3 min, respectively. The satisfaction scale averages for the adipofascial and periosteal monitor groups were 3.5 and 3.54, respectively. The VAS scores of the adipofascial and periosteal monitor groups were 2.9 and 3.9, respectively. The flap sizes with periosteal and adipofascial monitors were 10.48 cm³ and 1.36 cm³, respectively. There was no statistically significant difference between flap elevation, VAS, and satisfaction scale (>0.05). There was a statistically significant difference in flap sizes. (<0.05)ConclusionMFC free flap is frequently used in wrist and metacarpal reconstruction. Monitor selection according to the defect area positively affects the prognosis of the flap in the postoperative period.     

Interleukin-2 maintains the survival of interleukin-17+ gamma/delta T cells in inflammation and autoimmune diseases

There is increasing appreciation of the critical pathogenic role of IL-17 in inflammation and autoimmune diseases, which could be produced from both adaptive Th17 cells and innate γδ T cells. Existing evidences suggest that IL-2 is important for in vivo accumulation of IL-17⁺ γδ T cells, leaving the mechanisms still elusive. Herein, using lupus-prone MRL/lpr mice, we demonstrated that splenic γδ T cells were potent IL-17 producers at the onset of lupus, which could be diminished by in vivo IL-2 neutralization. Additional in vivo results showed that neutralization of IL-2 also significantly deleted the IL-17-producing γδ T cells in ovalbumin (OVA) /CFA-immunized B6 mice. Using splenic γδ T cells from OVA/CFA-immunized B6 mice, we further demonstrated that IL-2 could induce IL-17 production alone or together with IL-1β or IL-23 or anti-TCRγδ. Mechanism studies demonstrated that IL-2 could support the survival of γδ T cells, rather than induce the proliferation. Through specific pharmacologic inhibitor, we demonstrated that IL-2 could maintain that RORγt expression of γδ T cells in a STAT5-dependent manner. Collectively, this study suggested that the interplay between IL and 2 and other pro-inflammatory cytokines could trigger the rapid IL-17 production from innate γδ T cells, thus to orchestrate an inflammatory response before the development of adaptive Th17 cells.