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Objective: To analyze the clinical manifestations, diagnostic methods and treatment process of the patients with non-Hodgkin's lymphoma complicated with human coronavirus(HCoV)-HKU1 pneumonia and improve the clinical medical staff's awareness of the disease, and to reduce the occurrence of clinical adverse events. Method(s): The clinical data of a patient with non-Hodgkin's lymphoma complicated with HCoV-HKU1 pneumonia with hot flashes and night sweats, dry cough and dry throat as the main clinical features who were hospitalized in the hospital in January 2021 were analyzed, and the relevant literatures were reviewed and the clinical manifestations and diagnosis of HCoV-HKU1 were analyzed. Result(s): The female patient was admitted to the hospital due to diagnosed non-Hodgkin's lymphoma for more than 2 months. The physical examination results showed Karnofsky score was 90 points;there was no palpable enlargement of systemic superfical lymph nodes;mild tenderness in the right lower abdomen, no rebound tenderness, and slightly thicker breath sounds in both lungs were found, and a few moist rales were heard in both lower lungs. The chest CT results showed diffuse exudative foci in both lungs, and the number of white blood cells in the urine analysis was 158 muL-1;next generation sequencing technique(NGS) was used the detect the bronchoalveolar lavage fluid, and HCoV-HKU1 pneumonia was diagnosed. At admission, the patient had symptoms such as dull pain in the right lower abdomen, nighttime cough, and night sweats;antiviral treatment with oseltamivir was ineffective. After treatment with Compound Sulfamethoxazole Tablets and Lianhua Qingwen Granules, the respiratory symptoms of the patient disappeared. The re-examination chest CT results showed the exudation was absorbed. Conclusion(s): The clinical symptoms of the patients with non-Hodgkin's lymphoma complicated with HCoV-HKU1 pneumonia are non-specific. When the diffuse shadow changes in the lungs are found in clinic, and the new coronavirus nucleic acid test is negative, attention should still be paid to the possibility of other HCoV infections. The NGS can efficiently screen the infectious pathogens, which is beneficial to guide the diagnosis and treatment of pulmonary infectious diseases more accurately.Copyright © 2023 Jilin University Press. All rights reserved.
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Objectives: Treatment of severe respiratory distress syndrome (ARDS) due to COVID-19 by veno-venous extracorporeal membrane oxygenation (VV-ECMO) had a mortality of up to 70% in Germany. Many patients with COVID-19 need VV-ECMO support longer than 28 days (long-term VV-ECMO). Evidence on mortality, complications during intensive care, functional status after discharge and mortality-predictors for patients supported with long-term VV-ECMO is lacking. Method(s): Retrospective study of 137 consecutive patients treated with VV-ECMO for ARDS due to COVID-19 at University Hospital Regensburg from March 2020 to March 2022. Result(s): 38% (n=52;87% male) of patients needed longterm VV-ECMO support. In these, SOFA score (median [IQR]) at ECMO initiation was 9 [8-11], age 58.2 [50.6- 62.5] years, PaO2/FiO2-ratio 67 [52-88] mmHg, pCO262 [52-74] mmHg, Murray-Score 3.3 [3.0-3.6] and PEEP 15 [13 - 16] cmH2O. Duration of long-term support was 45 [35-65] days. 26 (50%) patients were discharged from the ICU. Only one patient died after hospital discharge. At VVECMO initiation, baseline characteristics did not differ between deceased and survivors. Complications were frequent (acute kidney injury: 31/52, renal replacement therapy: 14/52, pulmonary embolism: 21/52, intracranial hemorrhage 8/52, major bleeding 34/52 and secondary sclerosing cholangitis: 5/52) and more frequent in the deceased. Karnofsky index (normal 100) after rehabilitation was 70 [57.5-82.5]. Twelve of the 18 patients discharged from rehabilitation had a satisfactory quality of life according to their own subjective assessment. Four patients required nursing support. Mortality-predictors within the first 30 days on VV-ECMO only observed in those who deceased later, were: Bilirubin >5mg/dl for > 7 days, pulmonary compliance <10ml/mbar for >14 days, and repeated serum concentrations of interleukin 8 >150ng/L. Conclusion(s): Long-term extracorporeal lung support in patients with COVID-19 resulted in 50 % survival and subsequently lead to a satisfactory quality of life and functionality in the majority of patients. It should preferably be performed in experienced centers because of a high incidence of complications. Several findings during the early course were associated with late mortality but need validation in large prospective studies.
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Background: The use of cryopreservation for stem cell grafts for both autologous stem cell and allogeneic cord blood transplant has been utilized for years. For other allogeneic stem cell transplant sources, the use of fresh collected grafts has been preferred due to concerns that cryopreservation may result in impaired graft function. With the onset of the COVID-19 pandemic a shift was made at our institution to exclusive use of cryopreservation Methods: In this retrospective single-center analysis a total of 133 patients undergoing allogeneic stem cell transplant at the University of Minnesota between 1/2018-6/2021 for a variety of malignancies were included, with 62 patients receiving fresh stem cell product and 71 patients receiving frozen stem cell product. Univariate statistical analysis was performed. Result(s): There was no significant difference between the two groups with regards to product type, sex, age, diagnosis (acute leukemia vs other), disease risk index, conditioning regimen, Karnofsky score, co-morbidity index, or cell dose (Table 1). Donor type was notably different between the two groups (p<0.01): matched sibling grafts were more commonly used for fresh products than frozen (85% vs. 35%), while matched unrelated donors were used more frequently for frozen than for fresh products (54% vs. 6%). Use of frozen product was associated with delayed neutrophil and platelet engraftment compared to fresh (median days to engraftment 15 vs 12 for neutrophils, 23 vs 17 for platelets, p<0.01 for both). Two-year relapse rates were significantly lower for frozen products (4%) than fresh (24%) (Table 2). This may be partially attributable to differences in follow up between the groups, as fresh products had a total of 910 days of follow up vs 432 for frozen products (P<0.0001). The difference in follow up remained statistically significant if the data was censored at 730 days (P<0.0001). Of note, the use of frozen products was associated with a lower rate of chronic graft-versus-host disease at one year post-transplant (p<0.01). There was no significant difference in the rates of acute GVHD between the groups. There were significant differences in GVHD prophylaxis regimens between the fresh and frozen groups (p<0.01). (Figure Presented)Two-year overall survival did not differ between groups (p=0.96). Conclusion(s): Use of cryopreserved stem cell products is associated with similar efficacy and outcomes as those seen with the use of fresh stem cell products. Although the data presented here suggest novel finding of decreased risk of relapse and chronic GVHD with the use of frozen stem cell products, additional follow up may abrogate these differences. Regardless, the logistical benefits of cryopreservation make this an attractive option for continued use in allogeneic transplants and our data presented here suggests that cryopreserved products remain an appropriate option for allogeneic stem cell transplant.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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Background: Despite the transformative potential of chimeric antigen receptor T (CAR-T) therapy, more tools to assist with identifying patients with increased likelihood of benefitting from this therapy will be helpful, particularly given the logistical complexity and socio-economic demands for CAR-T relative to other therapies. Health care resource restriction during the COVID-19 pandemic highlights the need for these tools. We present a simple survival score that uses 3 readily available clinical labs: platelet (plt), absolute lymphocyte count (ALC), and Lactate dehydrogenase (LDH), to predict the risk of dying within 6 months of CAR-T therapy in patients with aggressive lymphoma. Method(s): We conducted a retrospective chart review of patients with aggressive non-Hodgkin lymphoma (NHL) who received FDA-approved CAR-T between Jan 2018 to Jan 2022 at Mayo Clinic Rochester.(Table Presented)Results: Among a total of 110 pts who received CAR-T, 27 (25%) pts died within the first 6 months post CAR-T infusion (OS <= 6 months). Disease progression was the main cause of death (18/25, 72%), followed by infection (4/25, 16%), CAR-T related (HLH/MAS, 2/25, 8%), second primary malignancy (1/25, 4%) and unknown (2/25, 8%).Baseline demographics were comparable between the OS>6months and <=6months groups (Table 1). Patients' ECOG, Karnofsky performance status and 11 labs at the time of evaluation for CAR-T therapy (initial eligibility assessment, prior to leukapheresis) were compared between those who died from any cause within 6 months of CAR-T infusion and those who did not. Hemoglobin, plt, ALC, absolute monocyte count, CRP, ferritin, and LDH were selected as clinically and/or statistically significant variables for multivariate testing. Multivariate regression with boot-strap testing identified plt, ALC, and LDH as the most predictive variables with 80.9+/-11.7% accuracy for predicting death within 6 months of CAR-T infusion. Patients were scored 0-3 using these 3 labs, with 1 point assigned for plt <= 100 X109/L, ALC <= 0.4 X109/L, or LDH > 222 U/L (upper limit of normal). OS by this survival score is shown in Figure 1.(Figure Presented)Discussion: Due to the curative potential of CAR-T, patients with broader characteristics than those treated on registration studies have been treated in standard of care practice. While an estimated 5%-10% risk of CAR-T associated deaths in the first 3 months is seen across all patients in clinical trials, predictors for early death after CAR-T in real-world patient populations can provide additional context for pts and providers when selecting treatment. This survival score is important proof of concept that a simple model using readily accessible clinical labs at the time of CAR-T evaluation could provide additional context to help with additional clinical decision-making. Multicenter prospective studies will help define and validate the definitive survival scoring system.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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Introduction: The purpose of this study was to evaluate the functional status and ongoing respiratory symptoms of patients who have been discharged home, who were admitted to the intensive care unit (ICU) with severe COVID-19 disease. Long term complications post critical illness, such as post intensive care syndrome (PICS), are well-recognised [1], however, little data exists specific to COVID-19 ICU survivors. Method(s): Local ethics committee approval was secured. Participants were recruited using the electronic intensive care chart database. All patients, from March 2020 to November 2021, who survived Covid-19 were included. Researchers conducted phone interviews with participants and completed three questionnaires;Katz Index of Independent Living Questionnaire, Karnofsky Performance Status Scale and the American Thoracic Society (ATS) Respiratory Disease Questionnaire. Data was input and analysed using excel and stored on a password encrypted computer. Result(s): Database search revealed 61 patients available, 33 of 61 patients were included. 20 (61%) were male, 13 (39%) were female. Mean age was 58, with a range of 25-81. Mean length of ICU stay was 15 days, with a range of 1-74 days. 15 (45%) patients were intubated. Most common Katz score (range 1-6) was the highest score of 6 in 23 (70%) patients. Most common Karnofsky score (range 10-100) was 60 in 11 (33%) patients, with 31 (94%) scoring < 100. The most frequent ATS shortness of breath (SOB) grade (range 0-4) was 3 in 10 (9%) patients, with 23 (70%) patients scoring > 0. 14 (42%) patients had an ongoing cough, 11 (33%) patients had a wheeze and 0 (0%) patients were on home oxygen therapy. Conclusion(s): This study highlights in the majority of patients who survived severe Covid-19 disease to discharge home, there were serious ongoing limitations to their functional status and exercise tolerance, however, they remained independent of basic activities of daily living.
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1. Describe the association of functional status and symptom severity for 10 common symptoms among patients who receive palliative care consultation. 2. Consider the interaction of functional status and different symptoms when managing symptoms of patients who receive palliative care consultations. The interaction of functional status and individual symptoms has never been comprehensively investigated in palliative care (PC) populations. Therefore, we studied the relationship between the Karnofsky Performance Status (KPS) and the prevalence and severity of 10 common symptoms among hospitalized patients at the time of PC consult. Weretrospectively analyzed data from a registry of PC consults across five hospitals within the Mount Sinai Health System between January 1, 2020, and December 31, 2021. Demographics and ICD-10 codes were extracted from electronic medical and billing records. During consult, PC clinicians assessed functional status using the KPS at the time of consult (0%-100%) and symptom burden using the 10-item Edmonton Symptom Assessment Scale (ESAS), which rates each symptom as none, mild, moderate, or severe. The association of KPS and ESAS symptom severity was assessed using ordinal logistic regression models, adjusting for age, gender, Elixhauser comorbidity index, and the underlying serious illness (cancer, sepsis, dementia, COVID-19). The study population included 6,065 patients (mean age 70±16 years, 50.9% male). The most frequent underlying serious illnesses were sepsis (36.6%), cancer (32.9%), and dementia (22.8%). In regression analysis, KPS was significantly associated with symptom severity for all ESAS symptoms (p<0.001). However, symptoms separated into two different groups. Drowsiness (β=-0.85), inactivity (β=-0.71), dyspnea (β=-0.21), anorexia (β=-0.19), and agitation (β=-0.06) were negatively associated with KPS (ie, lower functional status was associated with more severe symptoms), whereas nausea (β=0.2), anxiety (β=0.15), physical discomfort (β=0.13), depression (β=0.13), and constipation (β=0.06) were positively associated with KPS (ie, lower functional status was associated with milder symptoms). These associations remained statistically significant after adjusting for baseline characteristics. While some symptoms were more severe, other symptoms were less severe among patients with poor functional status. This observation can inform symptom management and warrants further investigation. [ FROM AUTHOR] Copyright of Journal of Pain & Symptom Management is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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OBJECTIVE: Patients with end-stage respiratory failure after severe coronavirus disease 2019 (COVID-19) infection may benefit from lung transplant; however, data on transplant outcomes and the impact of prolonged circulatory support before transplant in these patients are limited. METHODS: We assessed survival, postoperative complications, and the impact of pretransplant extracorporeal membrane oxygenation (ECMO) in patients undergoing lung transplant in the United States from August 2020 through March 2022 using records validated by United Network for Organ Sharing experts and extracted from the United Network for Organ Sharing database. RESULTS: In 305 patients with COVID-19-related respiratory failure and validated data, survival for up to 1-year posttransplant did not differ between 188 patients with COVID-19-related acute respiratory distress syndrome and 117 patients with post-COVID-19 pulmonary fibrosis (P = .8). Pretransplant ECMO support (median 66 days) was required in 191 patients (63%), and venovenous ECMO was used in 91.2% of patients. One-, 6-, and 12-month survival was not significantly different between patients requiring ECMO and patients without ECMO (95.8% vs 99.1%, 93.1% vs 96.4%, 84.8% vs 90.9%, P = .2) In addition, 1-year survival was similar in recipients requiring ECMO for COVID-19 lung failure and recipients requiring ECMO for non-COVID-19 restrictive lung failure (84.8% vs 78.0%, P = .1). CONCLUSIONS: These findings suggest that lung transplant in patients with COVID-19 respiratory failure yields acceptable 1-year outcomes. Despite an often more complex postoperative course, prolonged ECMO pretransplant in well-selected patients was associated with adequate clinical and functional status.
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BACKGROUND: The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill COVID-19 patients admitted to a COVID-19 center in Lugano (Switzerland). METHODS: A retrospective analysis on consecutive patients discharged alive from ICU with COVID-19 ARDS was performed based on a follow-up one year after hospital discharge; ADLs were assessed through the Barthel index (BI) and the Karnofsky Performance Status (KPS) scale. The primary objective was to assess differences in ADLs at hospital discharge (acute ADLs) and one-year follow-up (chronic ADLs). The secondary objective was to explore any correlations between ADLs and multiple measures at admission and during the ICU stay. RESULTS: A total of 38 consecutive patients were admitted to the ICU; a t-test analysis between acute and chronic ADLs through BI showed a significant improvement at one year post discharge (t = -5.211, p < 0.0001); similarly, every single task of BI showed the same results (p < 0.0001 for each task of BI). The mean KPS was 86.47 (SD 20.9) at hospital discharge and 99.6 at 1 year post discharge (p = 0.02). Thirteen (34%) patients deceased during the first 28 days in the ICU; no patient died after hospital discharge. CONCLUSIONS: Based on BI and KPS, patients reached complete functional recovery of ADLs one year after critical COVID-19.
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Background: Patients with relapsed/refractory follicular lymphoma (R/R FL) often experience multiple relapses and require various lines of therapy. The ELARA and ZUMA-5 trials demonstrated high response rates along with acceptable safety profiles. We perform a phase 1b/2 single-center clinical trial of autologous point-of-care (POC) academic anti-CD19 chimeric antigen receptor (CAR) T-cells for patients with R/R FL treated with at least 2 lines of systemic therapy (NCT02772198). Aims: To report outcomes of POC CAR T-cell therapy in patients with R/R FL. Methods: Adults with R/R FL underwent a single leukapheresis procedure. Fresh peripheral blood mononuclear cells were isolated, activated, and transduced with a gammaretrovirus encoding for a CD19 CAR (based on an FMC63-derived ScFv, a CD28 costimulatory domain, and a CD3-ζ signaling domain). Lymphodepletion included fludarabine 25 mg/m2 over 3 days (days-4 to-2) and cyclophosphamide 900 mg/m2 once (day-2), followed by infusion of 1×106/kg CAR T-cells in the inpatient setting. Primary endpoints were response (by PET-CT, per Lugano criteria) at day 28, best response, and safety. Secondary endpoints included overall survival, progression-free survival (PFS), and production feasibility. Last follow-up was as of 02/2022. Results: All 19 patients enrolled received CAR T-cell infusion in a median of 11 days (IQR 10-11) after leukapheresis. The median age was 61 years (IQR 52-66). Five (26%) patients had Karnofsky performance status < 90%. Disease stage at enrollment was III-IV in 16 (84%) patients. Two (11%) patients had bulky disease;8 (42%) had LDH > upper limit of normal;and 16 (84%) had Follicular Lymphoma International Prognostic Index ≥ 3. Disease status at enrollment was progressive disease (n=14, 74%), stable disease (n=3, 16%), or partial response (PR;n=2, 11%). Twelve patients (64%) were refractory to last treatment. Disease grade at most recent lymph node biopsy was 1 (n=3, 16%), 2 (n=11, 58%), or 3a (n=5, 26%). The median time from FL diagnosis was 3.9 years (IQR 2.5-4.6). Sixteen (84%) patients had progression of disease within 24 months of initial therapy. The number of prior therapies was ≥ 4 in 6 (32%) patients;and 5 (26%) patients underwent prior autologous transplantation. Grade III-IV cytokine release and immune effector cell-associated neurotoxicity syndromes occurred in 1 (5%) and 4 (21%) patients, respectively. One patient was infected with COVID-19 on the 5th day following cell infusion and was admitted to the intensive care unit. One patient had grade 3 atrial fibrillation. Severe neutropenia (absolute neutrophil count <500/μL), thrombocytopenia (platelets <50K/μL) and anemia (hemoglobin <10g/dl) occurred in 15 (79%), 5 (26%), and 7 (37%) patients, respectively. No bleeding events or death were recorded following cell infusion. Response was evaluated in all patients. Overall response rate on day 28 was 84% (79% complete response [CR]). One patient with PR on day 28 achieved a CR after a year of follow-up. Three patients (16%) continued to progress following CAR infusion. All patients were alive at the last follow-up (median follow-up, 11.5 months [IQR 4-21]). One-year PFS was 74% (95% CI, 53-100). The median duration of response (DOR) was not reached (95% CI, 12.5-not reached). Estimated DOR at 1-year was 89% (95% CI, 71-100). Image: Summary/Conclusion: Point-of-Care anti-CD19 CAR T-cell therapy, performed following a very short production time, induced high CR rate with an acceptable safety profile in a cohort of patients with high-risk R/R FL.
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Background: Nivolumab (NIVO), a programmed death-1 immune checkpoint inhibitor, has demonstrated clinical efficacy across patients with different tumor types, including clear cell renal cell carcinoma (ccRCC), when administered via IV infusion. As an alternative to IV infusion, subcutaneous (SC) administration alleviates the need for IV ports, thereby lowering the risk of associated complications such as infections and phlebitis. SC formulation also reduces the time for dose preparation and administration, which may decrease overall treatment burden and reduce patient time in the clinic, benefiting patients and healthcare providers and improving overall healthcare resource utilization. SC-administered NIVO consists of NIVO co-formulated with the recombinant human hyaluronidase PH20 enzyme (NIVO + rHuPH20), which aims to increase the dispersion and absorption of NIVO within the SC space. SC NIVO + rHuPH20 was shown to be safe and well tolerated in a phase 1/2 study, warranting further investigation (Lonardi S et al. J Clin Oncol 2021;39(suppl 15):2575). Methods: CheckMate 67T is a multicenter, randomized, open-label, phase 3 study that will evaluate the noninferiority of SC NIVO + rHuPH20 versus IV NIVO in patients with advanced or metastatic ccRCC who have progressed after receiving ≤ 2 prior systemic treatment regimens. Key inclusion criteria are age ≥ 18 years, histologically confirmed advanced or metastatic ccRCC, measurable disease by RECIST v1.1 within 28 days prior to randomization, and a Karnofsky performance status ≥ 70. Key exclusion criteria are untreated symptomatic metastases to the central nervous system, other malignancy, autoimmune diseases, HIV-positive status with AIDS-defining infection within past year or current CD4 count < 350 cells/μL, other serious or uncontrolled disorders including severe, acute SARS-CoV-2 infection, and prior treatment with immune checkpoint inhibitors, other T-cell-targeting antibody drugs, or live attenuated vaccines within 30 days of first study treatment. At least 454 eligible patients will be randomized to receive SC NIVO + rHuPH20 or IV NIVO. The primary objectives are to demonstrate pharmacokinetic (PK) noninferiority of SC NIVO versus IV NIVO, as measured by time-averaged serum concentration over the first 28 days (Cavgd28) and trough serum concentration at steady state (Cminss) (co-primary endpoints). Secondary endpoints include objective response rate by blinded independent central review, additional PK parameters, safety, efficacy, and immunogenicity of SC NIVO and IV NIVO. This study is currently enrolling patients globally.
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Background/aims: A specialist palliative care service evaluation in an acute hospital during the first wave of COVID-19 showed that those from ethnic minority backgrounds, especially women, were referred later. Improvements in treatments, and operational and system-level changes to the palliative care service which were introduced to address this disparity, may have improved access for those from ethnic minorities. Aim: To assess the effectiveness of operational and system-level changes to the hospital specialist palliative care service, by examining care patterns and trends for those with COVID-19. Methods: Retrospective service evaluation comparing patients referred to an acute hospital palliative care service with confirmed COVID-19 infection either at the peak of the first (Mar-Apr 2020, W1) or second (Dec 2020-Feb 2021, W2) wave of the pandemic. Demographic, clinical characteristics, and outcomes data were collected and compared using statistical tests;generalised linear mixed models for modelling of elapsed time from admission to referral;and survival analysis for each wave. Results: Data from 165 patients (W1 = 60, W2 =105) were included. Overall, patients in W1 were referred earlier to palliative care than in W2, particularly in the first 8 days from admission. Receiving dexamethasone, anticoagulants and absence of dementia, hypertension, and fever were associated with longer time to referral. The delay in referral from W1 of Black and Asian patients of 2-4 days, accounting for 22%-44% of the overall time from admission to death, was no longer observable in W2. The Australian-modified Karnofsky Performance Status (HR < 0.92, upper CI < 0.97) and phase of illness (HR > 3, lower CI >2) were good predictors of survival in both waves. Conclusions: The delayed referrals for ethnic minorities were not seen in W2. Actions to integrate palliative care within organisational COVID-19 planning, engaging with minority ethnic groups, and educating the workforce on culturally sensitive approaches to care may have had a positive impact on access to palliative care.
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BACKGROUND AND AIMS: Haemodialysis (HD) patients tend to be old, have weakened immune systems and suffer from multiple comorbidities, making them particularly prone to infections and death by the Coronavirus disease 2019 (COVID-19). Global vaccination against SARS-CoV2 has been underway, but long-term data in dialysis patients are still scant. We aimed to study the seroconversion with the Pfizer BNT162b2 vaccine in HD patients of 5 Dialysis Centres after the first 2 doses and monitor the immune responses and clinical data during the following 7 months. We also investigated the security of the vaccine. METHOD: We included 404 patients on chronic HD. All patients received 2 shots of the Pfizer BNT162b2 vaccine, separated by 21 days. Serologic tests were run using Quant II IgG anti-Spike SARS-CoV-2 assay by Abbott. Blood was drawn 21 days after the first dose (D22), 21 days after the second dose (D43), 3 and 6 months after the first dose (M3 and M6, respectively). We asked the patients to answer written questionaries about the symptoms reported during the 7 days after each vaccination. RESULTS: 60.6% of our patients were male and the median age was 70 years (min 19, max 97). 26 patients (6.4%) had previously been infected with COVID-19. 6 of them (23.1%) needed hospitalization. At 7 months follow-up, there were 3 new cases and 1 death (the one who died had negative antibody counts at M3). Maximum response to the vaccine was seen at D43, with 97.3% of the patients showing positive antibody titers. At 6 months, 91.5% still had positive antibodies. As is reported in Table 1, the following patients had higher antibody titers at D43 and M6: patients with COVID-19 before the first vaccine, younger patients, patients with higher albumin levels, patients on HDF versus HD. Patients on HDF had higher titers at all moments during the 6 months (Figure 1). Patients with cancer without antineoplasic treatment in the last 6 months showed lower rates of seroconversion at D43: OR: 0.117 [95% confidence interval (95% CI) 0.016-0.863]} and M6 (OR: 0.203, 95% CI 0.049-0.842]. Patients whose levels of C-reactive protein was ≤ 2.8 mg/dL had more probability of seroconversion at D43 (OR: 7.840, 95% CI 1.839-33.419;P < 0.005) as well as those with a higher (better) Karnofsky scale (OR 1.062, 95% CI 1.016-1.110). 43.4% of the patients reported at least one side effect after the first shot and 64.6% after the second shot. A total of 69.1% had at least one-side effect on the first or second shot. All the reported reactions were mild and transitory. CONCLUSION: Patients on HD respond surprisingly well to anti-COVID-19 vaccination and present only mild side effects. Further studies should analyze the impact of HDF on immune responses, since our work suggests that this type of dialysis may have a positive and protective long-term role on this population.
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: Lung transplantation is a potentially lifesaving treatment for severe COVID-19 acute respiratory distress syndrome (ARDS), when optimized medical treatment fails to accomplish lung recovery. However, since the long-term outcomes remain unknown, concerns related to the use of lung transplantation in critically ill COVID-19 patients persist. In the current study, we evaluated consecutive patients that underwent lung transplantation for severe COVID-19 ARDS at our center and compared their post-transplant outcomes with those undergoing transplantation for non-COVID-19 pathology during the concurrent study period. All consecutive patients undergoing lung transplantation between January 2020 to May 2021 were included. The study included two cohorts of patients that underwent transplantation for non-COVID-19 disease (nC19) or refractory COVID-19 ARDS (C19). For additional analysis, we included consecutive patients with severe COVID-19 that required veno-venous extracorporeal membrane oxygenation (ECMO). We found that post-procedure complications and length of stay were significantly greater compared to transplants performed for non-COVID-19 lung diseases during the concurrent study period. Following transplant the COVID-19 cohort demonstrated a more rapid improvement in Karnofsky performance status. At one year, all recipients in COVID-19 cohort were alive with post-transplant survival no different than institutional non-COVID-19 recipients. Furthermore, when compared to propensity-matched recipients from SRTR, post-transplant survival of institutional COVID-19 ARDS patients was non-inferior. There was progressive reduction in the probability of separation from extracorporeal membrane oxygenation (ECMO) with time and ECMO support greater than 30 days was associated with a significantly greater risk of death in patients with COVID-19 ARDS. In those who remained unweanable from ECMO after 30 days, lung transplant was an independent predictor of survival. We conclude that lung transplantation in selected patients with severe COVID-19 ARDS who remain unweanable from extracorporeal life support can result in post-transplant outcomes comparable to recipients with chronic end-stage lung diseases and non-COVID-19 ARDS. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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BACKGROUND: The neurologic assessment in neuro-oncology (NANO) scale was developed as a standardized metric to objectively measure neurologic function in patients with brain tumors and complement radiographic assessment in defining overall outcome. The scale has been incorporated in clinical trials. Early data is suggestive of feasibility and that NANO contributes to overall outcome assessment. However, real-world use of the NANO scale to drive clinical-decision making and the predictive value of the NANO scale to determine overall survival remains unclear in IDH-wt GBM. METHODS: We report on an ongoing study using the NANO scale to evaluate neurologic function in patients with IDH-wt GBM, seen at Dana-Farber Cancer Institute (DFCI). Patient demographics, tumor histology and molecular status, treatment history and progression dates are being captured. NANO score, as collected by a built-in scale in our institutional electronic medical record (EMR), functional status (Karnofsky performance status) and corticosteroid dose are collected at prespecified time points (prior to start of therapy, and during each subsequent MRI visit). Changes in the NANO score will be correlated to overall survival. Statistical analyses including descriptive data analysis and generalized linear models will be performed using R (version 3.4.3). RESULTS: Since June 2020, 50 patients have been enrolled in this study, including 42 (84%) with ≥2 follow up visits. Study accrual was initially impacted by the COVID-19 pandemic, but adaptation to a virtual platform for NANO allowed for improved recruitment and follow up of patients. Study results will be available for discussion at the 2021 SNO conference. CONCLUSIONS: Evaluation of neurologic function by NANO is feasible in a virtual framework in a prospective study in patients with GBM, aided by integration of the scale in our institutional EMR. NANO is able to objectively track neurologic function throughout disease course in IDH-wt GBM.
ABSTRACT
Background: Impairment of quality of life (QOL) such as reduced physical fitness and psycho-social dysfunction, is a recognized late effect of HCT, a life-saving procedure. Guided exercise and mindfulness-based stress management (MBSM) programs, delivered alone or in combination, have shown promise in improving patient's QOL mainly in the inpatient setting. Delivery of equitable and effective interventions in outpatient settings is challenging but may be addressed via telecommunication technology, reducing clinic visits and infection transmission. The aim of this study is to examine the feasibility and efficacy of a virtual and home-based program of combined exercise and MBSM via videoconference. Methods: Patients attending our post-HCT outpatient clinic were invited to participate (SVH HREC approval 12/175). Eligibility criteria included aged 18-75 years, >6 months post allogeneic HCT and the basic skills to access the online training and assessment packages. Patients with severe medical and psychological problems were excluded by their clinicians. Consented participants attended an initial in-person introductory session and were provided materials including booklet and audio recordings for skill practice. This was followed by once weekly exercise and MBSM training for 6 weeks via videoconferencing. Assessments were performed pre, and then virtually post training, and at 3, 6 and 12 months. Assessment session included: 6-minute walk test (6-MWT), Modified Bruce Test (MBT), sit-to-stand (STS), hand grip strength (HGS). Subjective measures were Goal Attainment Scale, Karnofsky Score, FACT-BMT, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, and Godin-Shephard Leisure Time Index. Linear mixed-effects model was used for outcome comparisons. This maximum likelihood approach utilizes all acquired data points and manages missing data points by missing at random (MAR) assumption. P values were adjusted using Holm-Sidak method for multiple comparisons. Results: Twenty-four eligible patients responded to the invitation and completed the program (54% male, median age 53 years (33 - 73), median time post-HCT of 37 months (13 - 68), 38% rural/remote). Based on participant feedback surveys at 6 months, this combined modality telehealth program was found to be well-accepted and safe. The 6-MWT scores were significantly higher at 3 and 12 months (M=646.5m, SD=53.34 and M=615.33m, SD= 94.95, respectively;both p < 0.01) compared to baseline (M=566.94, SD=145.22). The MBT, the only test that required participants to attend the clinic was ceased after 3 months as changes in 6-MWT paralleled changes in MBT. STS Test was significantly higher at 3 and 12 months (M=19.53, SD=6.93, p<0.01 and M=19.07 SD= 8.0;both p < 0.05) compared to baseline (M=15.14, SD=6.44). For the upper limb assessment, dominant hand grip was significantly stronger at 3, and 12 months (M=35.09, SD=9.83;p< 0.01) compared to baseline (M=29.07, SD=9.79). A significantly higher FACT-BMT total and FACT-G scores were found at 3 months (M=123.37, SD=15.12 and M=91.23, SD=11.76;p< 0.01) compared to baseline (M=116.44, SD=14.16 and M=88.25, SD=12.52 respectively), and a trend non-significant at 12 months. Conclusion: A 6-week internet and home-based exercise and MBSM programme was an acceptable, safe, and potentially effective intervention for sustained improvement of some QOL outcomes in HCT survivors. The positive findings of this feasibility study provided valuable data for the design of a multicentre RCT that is underway. Disclosures: No relevant conflicts of interest to declare.