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1.
New Armenian Medical Journal ; 16(2):14-24, 2022.
Article in English | EMBASE | ID: covidwho-2067786

ABSTRACT

Researches aimed at finding effective means of pathogenic therapy for this viral infection are extremely relevant. Researches of the last three years have established that some human pathogenic coronaviruses - MERS, SARS-CoV and SARS-CoV-2, contain aliphatic polyamines in their structure, which participate in the packaging of genetic material (DNA, RNA), as well as the nucleocapsid. Virus-host cell interactions also provide adhesion processes on the surface of the cytoplasmic membrane of target cells. In the intra-cellular space, aliphatic polyamines actively affect the translation and replication processes of the genetic material and necessary proteins of the virus itself, as well as the formation of daughter viruses. Long-term persistence in the SARS-CoV-2 infected organism is largely due to the absorption of polyamines by corona-virus localized in target cells of the blood and parenchymatous organs. Unfortunately, the above new facts did not serve as a prerequisite for finding effective means of pathogenetic therapy for COVID-19, based on the inhibition of polyamine-dependent processes that ensure long-term persistence of SARS-CoV-2 in the infected organism. We are talking about specific drugs such as alpha-difluoromethylornithine and its ana-logues, which are successfully used in oncology in the complex treatment of malignant neoplasms with the aim of lowering the level of aliphatic polyamines in the affected areas of malignantly transformed organs. We recommend the use of polyamine-free and polyamine-deficient diets for COVID-19 for the first time. In the planned study, we will present tables with food products of animal and vegetable origin, characterized by extremely low content and/or absence of aliphatic polyamines in them. At the same time, food products with a high content of aliphatic polyamines should be excluded from the general list of products recommended for COVID-19 patients. We also recommend the use of a polyamine-deficient diet (with a preventive purpose) during the COVID-19 pandemic to a wide contingent of practically healthy individuals, convalescents, medical staff of specialized infectious disease clinics, as well as family members of SARS-CoV-2 infected patients. Copyright © 2022, Yerevan State Medical University. All rights reserved.

2.
Middle East Journal of Cancer ; 13(4):648-656, 2022.
Article in English | EMBASE | ID: covidwho-2067589

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) emerged in December 2019 in China and exhibited as a highly contagious viral infection which led to a high level of mortality and morbidity. It is followed by a great deal of complications, such as serious psychological disorders. There are a few studies evaluating the psychological status of COVID-19 on the patients with cancer in Iran. Method: This was a cross-sectional study carried out on 94 patients with cancer who referred to Haft-e-Tir hospital for radiotherapy and chemotherapy from 20 April to 15 may, 2020. The data collection tool was the impact of events scale-revised (IES-R). Results: The prevalence of anxiety disorders and obsessive compulsive disorder based on past psychiatric history in the patients was 11.7% and 2.1%, respectively. The results revealed that age was significantly related to avoidance dimension score (B =-0. 209, 95% CI:-0.084 to-0.335). Regarding hyper arousal dimension score, the results were as follows: rural residency (B = 5.091, 95% CI: 0.610 to 9.573), past psychiatric history (PPH) (B = 8.312, 95% CI: 4.314 to 12.310), and radiotherapy (B =-2.976, 95% CI:-5.878 to-0.074) had a statistically significant relationship with the hyper arousal dimension score. Conclusion: The patients with cancer had a severe form of COVID-19. Individuals with cancer who had a previous psychiatric history are more vulnerable to post-traumatic stress disorder symptoms after trauma.

3.
Acta Haematologica Polonica ; 53(4):273-276, 2022.
Article in English | EMBASE | ID: covidwho-2067065

ABSTRACT

Introduction: As more data is collected, hematologists will be able to gain more insight into the impact of coronavirus disease 2019 (COVID-19) on pediatric patients with hematological malignancies. Material(s) and Method(s): We analysed 21 cases of COVID-19 in pediatric patients with onco-hematological diseases treated in the Western Ukrainian Pediatric Medical Center from March 2020 through May 2021. The majority of patients (71.4%) were diagnosed with acute lymphoblastic leukemia. All patients from the analyzed cohort had an asymptomatic, mild or moderate course of coronavirus-19 infection. The most common symptoms of COVID-19 were fever, cough, gastrointestinal symptoms, and dermatitis. Severe severe acute respiratory syndrome coronavirus 2 increased the risk of liver toxicity and venous thrombosis. Result(s) and Conclusion(s): Our analysis showed that pediatric patients with hematological malignancies need the same treatment approach for COVID-19 as for other infective complications. Copyright © 2022.

4.
Intensiv- und Notfallbehandlung ; 47(3):156-161, 2022.
Article in German | EMBASE | ID: covidwho-2067042

ABSTRACT

Background: Lung ultrasound is an im-portant tool for distinguishing between causes and therapies of cardiorespiratory diseases in emergency departments (ED). Aim and method: Based on a case report, the importance of point-of-care ultrasound (POCUS) in the context of emergency di-agnostics and intensive care therapy will be illustrated. Case report: A 78-year-old male presented to the ED with dyspnea und weakness. A double mRNA-Covid vaccination was completed 3 months before. His medical history revealed multiple myeloma. Using POCUS, a severe Covid-19 pneumonia could be suspected, and at the same time other differential diagnoses were ruled out. PCR confirmed a SARS-CoV-2 infection. The patient was admitted to our intensive care unit with severe Covid-19 pneumonia fol-lowed by a complicated and ultimately le-thal course. Conclusion(s): In immunocompro-mised patients, there is still a high risk of a severe and complex course despite vaccina-tion. POCUS allows evaluation of probable Covid-19 pneumonia and rapid exclusion of possible differential diagnoses. Copyright © 2022 Dustri-Verlag Dr. K. Feistle.

5.
Turkiye Klinikleri Journal of Medical Sciences ; 42(3):171-177, 2022.
Article in English | EMBASE | ID: covidwho-2067036

ABSTRACT

Objective: In the period of the coronavirus disease-19 (COVID-19) pandemic, upper gastrointestinal endoscopy was either postponed or canceled, except for emergencies, due to the high risk of transmission. Our study aimed to evaluate the effect of the COVID-19 pandemic on patients with upper gastrointestinal bleeding presenting to the emergency department and to compare it with the data before the pandemic. Material(s) and Method(s): In this single-center, retrospective study, patients were divided into 2 groups: pre-COVID-19 (pre-C) (March 2019-March 2020) and post-COVID-19 (post-C) (March 2020-March 2021). Patients who presented to the emergency department with upper gastrointestinal bleeding during these periods and underwent endoscopic examination were included in the study. Result(s): Endoscopy for upper gastrointestinal bleeding was urgently performed in 125 patients in the pre-C period and in 89 (29% decrease) patients in the post-C period. The Glasgow-Blatchford Score was higher in the pre-C period (p=0.02). Peptic ulcers were the most common cause of bleeding in both groups. High-risk peptic ulcer (forrest 1a/1b/2a/2b), and malignancy were observed more frequently in the post-C period (p=0.003, p=0.04;respectively). Endoscopic combined treatment rate was higher in the post-C group (p<0.001). Re-bleeding ratios were similar for both the groups (p=0.48). Conclusion(s): During the post-C period, the number of upper gastrointestinal bleeding cases admitted to the emergency department decreased significantly. However, the rate of high-risk peptic ulcer and malignancy in the etiology of upper gastrointestinal bleeding increased in the post-C period. Copyright © 2022 by Turkiye Klinikleri.

6.
Open Access Macedonian Journal of Medical Sciences ; 10:1832-1834, 2022.
Article in English | EMBASE | ID: covidwho-2066701

ABSTRACT

BACKGROUND: During our past 18 months, we must be faced with the current COVID-19 pandemic era with much uncertainty in the continuation of multimodality treatment of the gastrointestinal cancer patients. Especially in this immunocompromised group with the history of previous chemotherapy treatment, these patients have an increased risk of COVID-19 transmission. Many studies have been reported about the current recommendation for gastrointestinal cancer patients during this pandemic, but there might be a lack of evidence about the safety of vaccination for the gastrointestinal cancer patients. AIM: Since the vaccination has been approved by our government medical support, we would evaluate the safety of the COVID-19 vaccination program in gastrointestinal cancer patients. METHODS: All gastrointestinal cancer patients who have been already diagnosed with cancer will be included in this study. The vaccine-related sign symptoms will be recorded and evaluated. The chemotherapy schedule was not been interrupted following the vaccination. The patient who refused to receive the second vaccination dose will be excluded from this study. RESULTS: Thirty-two patients were included in this study (our past 6-month evaluation from February till August 2021), colorectal adenocarcinoma was the most common gastrointestinal cancer according to organ-specific (25 patients), the others were gastric adenocarcinoma, pancreatic adenocarcinoma, and small bowel gastrointestinal stromal tumor. Both of them already received two doses of COVID-19 vaccine during this period, we reported there was no side effect related to these and the chemotherapy cycle has not been interrupted during vaccination. All of the patients could be tolerated it well and did not refuse to continue the treatment. CONCLUSION: There were no significant signs and symptoms of vaccine-related side effects on gastrointestinal cancer patients. COVID-19 vaccination during this pandemic and following the chemotherapy schedule on any kind of gastrointestinal cancer patients was safe and could be suggested as a routine protocol.

7.
ARS Medica Tomitana ; 27(1):50-57, 2021.
Article in English | EMBASE | ID: covidwho-2065355

ABSTRACT

It was found that oncological patients are4 to 8 times more likely of developing severe forms of COVID-19 infection than other patients, so mortality is higher in patients with gyneco-logical cancer. Due to this pandemic, reported delays in diagnosis and treatment of genital cancer and changes in disease management, may influence the natural history of neoplasm. This fact adds more stress and fear for patients with neoplasms. Adequate protective measures are essen-tial for SARS CoV2 infection avoidance and lead to changes in healthcare professionals clinical practice. Prioritization is important, but direct personal interactions should be limited. However, gynecological tumors surgery, chemotherapy, and radiotherapy should continue as high priority practices, without essential modification. The conclusion is that COVID-19 pandemic has affect-ed many guides for management of diseases, especially oncological. Adaptations in clinical prac-tice may avoid viral infection and reduce mortality and severe complications. Copyright © 2021 Dragos-Eugen Georgescu et al., published by Sciendo.

8.
American Journal of Transplantation ; 22(Supplement 3):876-877, 2022.
Article in English | EMBASE | ID: covidwho-2063505

ABSTRACT

Purpose: Solid organ transplant recipients (SOTRs) are at an elevated risk of developing non-melanoma skin cancers. Routine dermatologic surveillance has been shown to improve skin cancer outcomes in SOTRs. However, the COVID-19 pandemic has had a profound impact on delivery of care. Among the general population, recent studies have found an increase in the number of teledermatology visits despite an overall decrease in dermatology visits, a decline in treatment adherence, and a stated preference for in-person care. The impact of the ongoing pandemic on dermatologic care in SOTRs, a high-risk population, remains largely unexplored. We sought to compare rates of usage of dermatology in-person and telemedicine services and new skin cancer diagnoses among SOTRs before and during the first wave of the COVID-19 pandemic in Los Angeles, CA. Method(s): A retrospective study was performed on patients who received solid organ transplants at Keck Hospital of USC between 2013-2018. The number of visits to our dermatology department during two 17-month time periods was counted: 1) prepandemic, October 2018-March 2020 and 2) peri-pandemic, April 2020-September 2021. Each visit was categorized based on 1) general dermatology vs. Mohs surgery or follow-up and 2) in-person vs. telemedicine. Lastly, the number of new skin cancer diagnoses during these two time periods was counted. Result(s): Among a total of 1569 SOTRs, 154 patients had at least 1 dermatology visit in the pre-COVID 19 pandemic period, compared to 135 in the peri-pandemic period (p=0.241). While there was no significant decline in the mean number of general dermatology in-person visits per patient (p=0.266), there was a significant increase in general telemedicine visits during the same timeframe (p=0.026). Lastly, 11 new skin cancer diagnoses were made pre-pandemic, compared to 13 peri-pandemic (p=0.270). Conclusion(s): Our findings suggest our high-risk population of SOTRs did not experience significant disruption to routine delivery of dermatologic care during the first wave of the COVID-19 pandemic. Like prior studies, we found an increased reliance on teledermatology services, however without a concomitant decline in access to in-person care. Furthermore, the similar pre- and peri-pandemic rates of new skin cancer diagnoses do not raise concern for a future surge in skin cancer morbidity and mortality. By continuing to investigate the usage of dermatology services by SOTRs during the ongoing pandemic, we hope to address barriers to dermatologic care and prevent a rise in skin cancer morbidity and mortality. (Table Presented).

9.
American Journal of Transplantation ; 22(Supplement 3):528, 2022.
Article in English | EMBASE | ID: covidwho-2063394

ABSTRACT

Purpose: Alcohol use after liver transplant is associated with higher rates of graft loss and increased mortality;however, there is limited data regarding the factors that influence biochemically confirmed relapse. We aimed to evaluate the association between social determinants of health (SDOH) and biochemical alcohol relapse in patients who have been transplanted for alcohol-associated liver disease (ALD). Method(s): This single-center, retrospective cohort study examined patients with ALD who were transplanted between 2018-2021. The primary outcome was biochemical alcohol relapse as measured by systematic phosphatidylethanol (PEth) testing. SDOH including race, ethnicity, income, employment, social support, education level, public vs private health insurance, mental health comorbidities, and comorbid illicit substance use were assessed for their association with the outcome using logistic regression analyses. Additionally, temporal trends in biochemical relapse related to the Covid-19 pandemic were evaluated using a cut point of April 2020 to differentiate between pre-pandemic and pandemic groups. Result(s): Seventy-five patients were transplanted for ALD over the study period, of whom 71 had biochemical PEth measurements (95%). Of these 71 patients, 21% were female with a mean (+/-SD) age of 52.9 (+/-10.4) years and 49% of the study population identified as Hispanic ethnicity. At the time of transplant listing, 73% were unemployed, 65% had public insurance, and 62% were married or had a stable co-companion. Over 64 person-years of follow up, 10 (15%) patients had biochemical relapse after transplant. Older age was protective OR=0.94 (95% CI 0.88-0.99;p=0.05), while non-Hispanic white race OR=6.29 (95% CI 1.22-32.51;p=0.03), and prior illicit substance use OR=4.2 (95% CI 1.05-16.90;p=0.04) were associated with an increased risk of relapse. Patients identifying as non-Hispanic white had non-significant trends toward lower household income, decreased social support, and higher rates of comorbid mental illness. Severe acute alcohol hepatitis, time from last drink to listing, SIPAT and AUDIT score were not associated with increased risk of relapse. The risk of relapse increased during the Covid-19 pandemic from 4.3% pre-Covid-19 to 18.8% during Covid-19 with a trend towards statistical significance OR=5.1 (95% CI 0.60-42.8;p=0.13). Conclusion(s): Non-Hispanic white race, younger age, and illicit substance use were associated with increased rates of biochemical alcohol relapse and may be explained by SDOH;however, conventional metrics including >6 months from last drink to listing and lower SIPAT score were not predictive of biochemical relapse.

10.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P51-P52, 2022.
Article in English | EMBASE | ID: covidwho-2064493

ABSTRACT

Introduction: The COVID-19 pandemic has led to an increased burden being placed on our health care system. In this study, we aim to expand upon the impact of COVID-19 on a head and neck cancer population by examining the number of patients presenting to a university emergency department with an initial presentation of head and neck cancer during the pandemic and immediately before it. Method(s): A retrospective analysis of medical records of patients presenting to the emergency department (ED) at Baylor University Medical Center (BUMC) who received a diagnosis of head and neck cancer (HNC) either in the ED or in the admission immediately after was performed for a 6-month pre- COVID-19 time period (September 2019-February 2020) and a 6-month post-COVID-19 time period (April 2020-September 2020). Data analysis of patient presentation and final diagnosis was performed. Analysis of total ED encounters at BUMC per month over both time periods was also performed. Result(s): A chart review of 892 patients found 217 HNCrelated admissions in the pre-COVID-19 period and 228 in the post. In the pre-COVID-19 period, 9 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 4.1% of HNC-related admissions. In the post-COVID-19 period, 14 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 6.1% of HNCrelated admissions. In the pre-COVID-19 period, 1.9 per 10,000 ED visits resulted in a diagnosis of HNC. Comparatively, in the post-COVID-19 period, 3.8 per 10,000 ED visits resulted in a diagnosis of HNC. There was a sharp increase in ED-related HNC diagnoses in May of 2020, with 6.9 per 10,000 ED visits resulting in a diagnosis of HNC. Of ED-related HNC diagnoses, 75% made in May of 2020 were stage IV at the time of diagnosis. Conclusion(s): There has been a significant increase in the amount of primary HNC diagnoses made in the ED or upon subsequent admission since the start of the COVID-19 pandemic. HNC diagnosed at ED presentation or upon subsequent admission are more likely to be late stage, highlighting delays in care secondary to the COVID-19 pandemic.

11.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P23, 2022.
Article in English | EMBASE | ID: covidwho-2064484

ABSTRACT

Introduction: Since the onset of the COVID-19 pandemic, telemedicine has become an increasingly utilized resource in all fields of medicine, allowing greater access to and efficiency of medical care. This study seeks to quantify the average reduction in cost to patients and carbon footprint attributable to telemedicine for endocrine cancer care. Method(s): This retrospective cohort study includes telemedicine visits for in-state patients from April 1, 2020, to June 20, 2021, at the endocrine oncology clinic of a single National Cancer Institute-designated comprehensive cancer center. The primary outcome is cost savings of endocrine cancer care with use of telemedicine. This includes 2 components: (1) direct costs of travel (round-trip distance of car travel) and (2) loss of productivity due to the clinic visit (loss of income from travel and in-office visit time). The secondary outcome is reduction of carbon footprint (kg CO2 emissions) with use of telemedicine. Result(s): There were 3171 telemedicine visits for 2921 patients conducted within the designated time frame. Telemedicine was associated with total savings of 494,895 round-trip travel miles for patients (9734 hours total drive time). An additional 3613 hours were saved in accounting for time to park, enter the building, and wait. Telemedicine resulted in an average savings of $145/visit for patients under 65 years old and $111/visit for patients greater than 65 years old. Additionally, telemedicine reduced the carbon footprint by an average of 46.18 kg CO2 emissions per visit. Conclusion(s): As the costs of medical care continue to rise, further implementation of telemedicine may result in significant savings for patients. This study found that telemedicine is associated with reduction in financial burden caused by both travel and time costs. Additionally, implementation of telemedicine may significantly reduce the carbon footprint of endocrine cancer care. These data need to be interpreted in the context of clinical efficacy of the telemedicine visit, which will require additional study of clinical impact, patient satisfaction, and oncological outcomes.

12.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P176, 2022.
Article in English | EMBASE | ID: covidwho-2064423

ABSTRACT

Introduction: Access to high-quality, comprehensive, subspecialty care is challenging in rural health care settings under ideal circumstances. In the clinically restricted environment created by the SARS-CoV-2 pandemic, this has been even more problematic. The regional distribution of a broad patient demographic across multiple tertiary care centers within a large rural health care system presents unique challenges. Here we describe our system platform for the management of a large population of thyroid patients across an expansive rural health system during the pandemic. Method(s): This retrospective review was approved by our institutional review board. Patients undergoing surgical management of thyroid and parathyroid disease were identified using a system electronic medical record via Current Procedural Terminology codes. Applications essential for management of these patients included implementation of an endocrine database, utilization of a multidisciplinary thyroid cancer tumor board, and coordination of regional patient access through the Geisinger System Program for Thyroid and Parathyroid Disorders. Result(s): We identified 930 endocrine surgical cases at our institution managed over the past 3 years. A total of 281 patients have been reviewed thus far. A total of 185 thyroid surgeries were performed on 173 patients. Final pathology was benign in 99 (53.5%) patients;77 (41.6%) were welldifferentiated thyroid carcinomas. The average elapsed days from fine needle aspiration biopsy to surgery was 54.8 (with those >100 days excluded). Average elapsed days from biopsy to surgery in patients with molecular testing was 61.5 days compared with 49.9 days for those without molecular testing. These 2 averages were significantly different from each other (P=.02) but not from the overall average. Conclusion(s): In this presentation, the effective management of a large population of thyroid patients is demonstrated through the utilization of several critical clinical applications. We propose a care delivery scheme for the evaluation and management of thyroid patients utilizing multiple clinical access points together with a multidisciplinary program for endocrine disease management.

13.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P201, 2022.
Article in English | EMBASE | ID: covidwho-2064416

ABSTRACT

Introduction: Access to specialty care is challenging in rural health environments, and this has been compounded by the COVID-19 pandemic. Routes to establishing care for head and neck cancer patients are especially important. We sought to quantify our referral patterns and processes to identify opportunities for optimization. Method(s): Retrospective review was performed of patients with initial head and neck tumor board presentation between January 1, 2020, through December 31, 2021. Assessed time points were date of referral, biopsy, pathological diagnosis, imaging order, imaging obtained, and initial presentation at head and neck tumor board. Result(s): A total of 429 patients were included. Squamous cell carcinoma (n=350, 81.6%) made up the majority, and most common primary sites were oropharynx (27.4%), oral cavity (20.3%), larynx (16.9%), and cutaneous (16.5%). At time of referral, 37.6% of patients had biopsy proven diagnosis. Average time to tumor board was 22 days, and significantly greater in those undiagnosed at referral (29 vs 14 days). Distance to provider did not correlate with time to tumor board. The period since the onset of the COVID crisis did not appear to affect access to care once in our system. However, there was evidence that patients presented with advanced locoregional disease during COVID-19. Conclusion(s): This study creates an approach to map access to care, evaluating critical time points and opportunities to expedite multiple steps that initiate therapy for head and neck cancer. There are both external (rural geography and the COVID-19 pandemic) and internal aspects that may pose barriers to access. Identification of these barriers allows for improved timely access to care in this susceptible population.

14.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P197, 2022.
Article in English | EMBASE | ID: covidwho-2064415

ABSTRACT

Introduction: The head and neck cancer (HNC) disease and treatment process creates highly visible disfigurement and a fundamental impact on vital functions in this anatomical region, which can lead to an emotionally traumatic illness experience. These factors make HNC patients vulnerable to significant change in quality of life (QOL). There has been little research regarding the psychosocial effects of the coronavirus disease 2019 (COVID-19) pandemic on this group, and we want to explore how their QOL has changed in this unique situation. Method(s): This is a retrospective study identifying 400 patients with newly diagnosed HNC in the time period of March 2015 to March 2021 who completed the University of Washington Quality of Life Questionnaire (UW-QOL), collected as part of routine clinical care at our institution. Patients diagnosed between March 2015 and December 2019 were classified in the pre-COVID-19 group, while those diagnosed between March 2020 and March 2021 were classified in the COVID-19 group. Only patients with newly diagnosed HNC who completed the UW-QOL were included. Patients with a diagnosis of skin, thyroid, and sinonasal cancer;those who were unwilling or unable to take part in the study;and those with recurrent HNC were excluded. Result(s): A total of 353 participants who met criteria were included. Patients diagnosed with HNC during the COVID-19 pandemic had significantly decreased scores in the chewing and speech sections of the UW-QOL (P<.01 and P<.05, respectively). More patients ranked a decreased mood as a point of concern in the COVID-19 group (29.82% vs 26.45%). There were no significant differences in global QOL scores between groups. Conclusion(s): HNC patients experienced a similar overall QOL prior to and during the COVID-19 pandemic. However, some domains of HNC-specific QOL were negatively affected during the COVID-19 pandemic. Patients had more concerns about their mood during the pandemic compared with before the pandemic. The results of this study may be used to inform patient treatment and patient education as well as to alleviate pandemic-related concerns for this vulnerable population.

15.
American Journal of Transplantation ; 22(Supplement 3):598-599, 2022.
Article in English | EMBASE | ID: covidwho-2063361

ABSTRACT

Purpose: Therapies for COVID-19 in immunocompromised (IC) patients (pts), including transplant (tx) pts, are limited. We describe our experience with ALVR109, an allogeneic, partially HLA-matched T-cell product, given through emergency investigational new drug (eIND) application to 4 consecutive IC pts with protracted COVID-19. Method(s): To measure SARS-CoV-2 viral loads, SARS-2 RNA was quantified by RT-PCR (N gene) in plasma and saliva. ALVR109 was manufactured for Allovir at Baylor College of Medicine. Result(s): Between May and October 2021, ALVR109 was given to 4 IC pts with COVID-19 (details in Table 1). 2 pts had lymphoma (1 post auto-tx) and 2 had lung tx. All pts had SARS-CoV-2 RNA detected in plasma (viremia) in the weeks leading up to ALVR109 administration. Infusions (20-40 million cells (MC) per dose) were well-tolerated with no adverse events. Prior to ALVR109, pts 1 and 3 had progressive COVID-19 and ongoing SARS-CoV-2 viremia despite monoclonal antibodies (mABs) and remdesivir. Following ALVR109 administration both patients had a decrease in viremia with marked clinical improvement in pt 1, but both eventually died from their underlying disease. Viral loads (plasma/saliva) and functional scores for pt 1 are shown in the figure. Autopsy of pt 3 showed no evidence of SARS-CoV-2 infection by lung in-situ hybridization (ISH). Pts 2 and 4 received ALVR109 as adjunctive therapy to mABs and remdesivir;viremia continued to decline following ALVR109 and both pts survived and were discharged home. Conclusion(s): This initial experience suggests a potential role of ALVR109 in the treatment of IC and tx pts with COVID-19. SARS-CoV-2-specific T-cells appear to be safe and may control viremia in IC pts. Larger studies are needed to confirm this observation, define the best candidates for ALVR109, and determine optimal timing of administration. (Table Presented).

16.
Neuro-Oncology ; 24(Supplement 2):ii88-ii89, 2022.
Article in English | EMBASE | ID: covidwho-2062942

ABSTRACT

BACKGROUND: A novel therapeutic approach using molecularly targeted radiation is currently in development for patients with recurrent GBM. Many tumor types, including GBM, overexpress the L-type amino transporter 1 (LAT-1)4, which is able to internalize the small-molecule amino acid derivative, 4-L-[131I] iodo-phenylalanine (131I-IPA). In preclinical research, combining 131I-IPA with external radiation therapy (XRT) yielded addi- tive cytotoxic effects. Tumoral accumulation of 131I-IPA was confirmed in a proof-of-principle study using single doses of 2-7 GBq 131I-IPA as a monotherapy or in combination with XRT in patients with recurrent GBM. The objective of the IPAX-1 study was to evaluate the safety, tolerability, dosing schedule, and preliminary efficacy of 131I-IPA in combination with secondline radiotherapy in patients with recurrent GBM. METHOD(S): IPAX-1 is a multi-center, open-label, single-arm, dose-finding phase 1/2 study. Key inclusion criteria: 1. Confirmed histological diagnosis of GBM with evidence of first recurrence 2. History of GBM standard therapy 3. >= 6 months since end of first-line XRT 4. Pathologically increased amino acid tumor uptake shown by molecular imaging 5. Current indication for repeat radiation 6. Gross tumour volume of up to 4.8 cm diameter. Treatment: In phase 1 of the study patients received intravenous 131I-IPA at a dose level of 2 GBq administered in one of three different dosing regimens: single dose group with 2 GBq before radiation, 3 (f)-fractionated-parallel group: 3 x 0.67 GBq during XRT and 3 (f)-fractionated-sequential group: 0.67 GBq x 1 -> XRT -> 0.67 GBq x 2. XRT is delivered in 18 fractions of 2 Gy each. RESULT(S): 10 patients were randomized;one patient with Covid related death was withdrawn from analysis. Survival from start of TLX101 therapy showed mPFS2 of 4.33 M (95% -CI 4.18 - 4.48), PFS-6: 18 % and mOS2 of 15.97 M (95% -CI 2.9 - 29.1) at data lock 09/2021. Updated results will be presented at the meeting. CONCLUSION(S): There were no clinically relevant laboratory changes over time. Urinalysis, vital signs, and ECG did not show any clinically relevant changes from baseline. There were no notable differences in safety and tolerability between groups. Injections of single or fractionated doses of 131I-IPA containing a total activity of 2 GBq in combination with XRT in patients with recurrent GBM were safe and well tolerated. Survival data look promising;extension cohort will be treated in a phase II study in Linz;phase 1/2 study in first line setting is planned.

17.
Gesundheitswesen, Supplement ; 84(8-9):806, 2022.
Article in English | EMBASE | ID: covidwho-2062340

ABSTRACT

Einleitung The Covid-19 pandemic resulted in rationing of healthcare resources, including cancer prevention and treatment interventions. However, in many high-income countries, available offers for cancer prevention and treatment remain underutilized, especially among men. Our interdisciplinary research group at Heidelberg University is studying the underlying individual perceptions, attitudes and experiences of age- and gender-specific barriers against cancer-related medical and psychosocial offers available in Germany. Methoden A mixed-methods, sequential explanatory study was designed. Separate online questionnaires were used for cancer patients/survivors to determine barriers for treatment and for non-patients to determine barriers for screening. In the second phase, 15 semi-structured interviews were conducted with 5 participants from each group via selective sampling to record their individual opinions, experiences and expectations of using cancer-related health services. Five further qualitative interviews are planned with healthcare providers. Ergebnisse Overall 292 participants (29% male, 71% female, mean age 48.2y) completed the questionnaire. 39% respondents were cancer patients. 61% population was living in Baden-Württemberg. 85% were married or living with partners. Further inferential statistical analysis will be used to identify important barriers and facilitators separately for the use of cancer screenings and cancer treatment offers. Final results will be analyzed with behavioral and sociocultural theories to gain a deeper understanding of perceived and experienced barriers in accessing cancer care in Germany and to formulate recommendations for prospective targeted approaches and interventions. The results will be also used to develop an interprofessional teaching module in the medical curriculum. Schlussfolgerung These findings will be useful for facilitating knowledge transfer and policy dissemination to increase public awareness about cancer offers and improve participation rates.

18.
Clinical Lymphoma, Myeloma and Leukemia ; 22(Supplement 2):S411, 2022.
Article in English | EMBASE | ID: covidwho-2062040

ABSTRACT

Context: CARTITUDE-2 (NCT04133636) Cohort A is assessing cilta-cel in lenalidomide-refractory patients with progressive MM after 1-3 prior LOT. Objective(s): To present updated results from CARTITUDE-2 Cohort A. Design(s): Phase 2, multicohort study. Patient(s): Lenalidomide-refractory patients with progressive MM after 1-3 prior LOT (PI and IMiD included) and no previous exposure to BCMA-targeting agents. Intervention(s): Single cilta-cel infusion (target dose 0.75x106 CAR+ viable T-cells/kg) after lymphodepletion Main Outcome Measure(s): Primary endpoint was minimal residual disease (MRD) negativity at 10-5. Management strategies were used to reduce risk of movement/neurocognitive adverse events (MNTs). Pharmacokinetics (PK) (Cmax/Tmax of CAR+T-cell transgene levels), cytokine release syndrome (CRS)-related cytokines over time, peak cytokine levels by response/CRS, association of cytokine levels with immune effector cell-associated neurotoxicity syndrome (ICANS), and CAR+T-cell CD4/CD8 ratio by response/CRS/ICANS are being evaluated. Result(s): As of January 2022 (median follow-up [MFU] 17.1 months), 20 patients (65% male;median age 60 years;median 2 prior LOT;95% refractory to last LOT) received cilta-cel. Overall response rate was 95% (90% >=complete response;95% >=very good partial response). Median times to first and best response were 1.0 month and 2.6 months, respectively. All 16 MRD-evaluable patients achieved MRD negativity at 10-5. Median duration of response was not reached. At 12 months, event-free rate was 79% and progression-free survival rate was 75%. 95% of patients had CRS (gr3/4 10%);median time to onset was 7 days and median duration was 3 days. Neurotoxicity was reported in 30% of patients (5 gr1/2;1 gr3/4) and ICANS in 15% (all 3 gr1/2);1 patient had gr2 facial paralysis. No MNTs were observed. 1 death occurred due to COVID-19 (treatment-related), 2 due to progressive disease, and 1 due to sepsis (not treatment-related). Preliminary PK analyses showed peak CAR-T cell expansion at day 10.5;median persistence was 153.5 days. Conclusion(s): At MFU of 17.1 months, a single cilta-cel infusion resulted in deep and durable responses in lenalidomide-refractory MM patients with 1-3 prior LOT. We will present updated PK/cytokine/CAR-T subset analyses and clinical correlation to provide novel insights into biological correlates of efficacy/safety in this population. Copyright © 2022 Elsevier Inc.

19.
Chest ; 162(4):A1320, 2022.
Article in English | EMBASE | ID: covidwho-2060986

ABSTRACT

SESSION TITLE: Challenges in Cystic Fibrosis Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Pulmonary involvement in Systemic Lupus Erythematosus (SLE) is seen in 30-50% of patients (most commonly Nonspecific Interstitial Pneumonitis) but cystic lung disease is extremely rare (1). Lymphoid interstitial pneumonia (LIP) is an inflammatory lung disease that is characterized by infiltration of lymphocytes and plasma cells (2), and associated with lung cysts. Oftentimes, it is associated with HIV, lymphoma, and primary Sjogren's Syndrome (SS) (2), however there are rare reports of LIP associated with SLE (1). We present a case of a young male with incidental lung cysts who was found to have a new diagnosis of SLE. CASE PRESENTATION: A 24-year-old male with a past medical history of premature birth at 5 months and prior mild COVID-19 infection presented with 3 weeks of abdominal pain, nausea, vomiting, fever, and unintentional 15-pound weight loss. He endorsed dry mouth, frequent cavities, and a new rash involving his chest, face, and lower extremities. Physical exam was significant for malar rash and dry mucous membranes. Labs revealed pancytopenia, sedimentation rate 61 mm/hour and C-reactive protein 5.54 mg/L. Computed tomography (CT) of the chest showed several thin-walled cysts in all bilateral lung lobes (predominant in right upper lobe) and bilateral axillary lymph nodes [Figure 1]. CT abdomen and pelvis was unremarkable. Autoimmune work-up resulted in a positive antinuclear antibody >1:1280, double stranded DNA antibody elevated at 34, elevated SSA and SSB antibodies (>8.0 and 1.4 respectively), and decreased Complement 3 (59.5 mg/dl) and 4 (10.1 mg/dl) levels. Peripheral smear, right axillary lymph node and bone marrow biopsies were negative for malignancy. He was started on prednisone and Plaquenil with symptomatic improvement. There is high suspicion of LIP given the clinical and radiological findings. He will follow up in clinic to obtain PFTs and schedule a lung biopsy. DISCUSSION: Interstitial lung disease in SLE presents in middle-aged patients at a later part of their disease course, with a female preponderance (2,3). An initial presentation of SLE and secondary SS in a young male and associated cystic lung disease is rare. The suspicion for LIP in association with SLE is high in our patient given variable size and distribution of lung cysts and coexisting secondary Sjogren's syndrome, although no ground glass or nodular opacities were found on CT chest as reported in typical LIP (3). Though this patient has no pulmonary symptoms, cysts/LIP in SLE tend to progress and have a high incidence of developing lymphomas, gammaglobulinemia and amyloidosis (2,3). CONCLUSIONS: It is important to establish a histopathological diagnosis and obtain baseline PFTs to monitor pulmonary disease manifestations. In addition to controlling the primary disease with antirheumatic drugs, steroids have been found to be useful in acute pulmonary flares (2). Reference #1: Maeda R, Isowa N, Miura H, Tokuyasu H. Systemic lupus erythematosus with multiple lung cysts. Interact Cardiovasc Thorac Surg. 2009 Jun;8(6):701-2. doi: 10.1510/icvts.2008.200055. Epub 2009 Mar 12. PMID: 19282324. Reference #2: Yood RA, Steigman DM, Gill LR. Lymphocytic interstitial pneumonitis in a patient with systemic lupus erythematosus. Lupus. 1995 Apr;4(2):161-3. doi: 10.1177/096120339500400217. PMID: 7795624. Reference #3: Filipek MS, Thompson ME, Wang PL, Gosselin MV, L Primack S. Lymphocytic interstitial pneumonitis in a patient with systemic lupus erythematosus: radiographic and high-resolution CT findings. J Thorac Imaging. 2004 Jul;19(3):200-3. doi: 10.1097/01.rti.0000099464.94973.51. PMID: 15273618. DISCLOSURES: No relevant relationships by Matthew Fain No relevant relationships by Christina Fanous No relevant relationships by Rathnavali Katragadda No relevant relationships by CHRISELYN PALMA

20.
Chest ; 162(4):A2594, 2022.
Article in English | EMBASE | ID: covidwho-2060971

ABSTRACT

SESSION TITLE: Late Breaking Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. METHODS: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariate, multivariate, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate, and sPESI. Both lactate and sPESI were included as continuous variables. Our covariates included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. RESULTS: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariate analysis, both sPESI (p=3.4*10

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