Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 155
Filter
1.
Therapeutic Advances in Urology ; 14:12-13, 2022.
Article in English | EMBASE | ID: covidwho-2195428

ABSTRACT

Purpose: We aimed to evaluate the role of plasma fibrinogen and D-dimer as prognostic biomarkers in patients with non-muscle-invasive bladder cancer (NMIBC). Method(s): A prospective study that included 35 patients (30 males) with newly diagnosed NMIBC who underwent complete transurethral resection between September 2020 and December 2021. Patients with history of thromboembolic event or anticoagulant intake or active infection, patients with deranged hepatorenal functions, inflammatory bowel disease, refractory hypertension, or diagnosed with Covid-19 infection within 1 month before surgery or routine follow-up were excluded. Follow-up was done as per NCCN guidelines. Fibrinogen and D-dimer levels were measured within 7 days of surgery or follow-up and analyzed for recurrence-free survival (RFS) and progression-free survival (PFS). Cox regression analyses were adopted to assess the influence of these two parameters on RFS and PFS. Result(s): The mean age was 53.9 years with a median follow-up of 9 months. The cut-off values of fibrinogen and D-dimer were 402.5 mg/dl and 0.55 mug/ml, respectively. Kaplan-Meier analysis demonstrated that high fibrinogen and D-dimer levels were significantly related to poor RFS (p < 0.001) and PFS (p < 0.001). On multivariate analysis, only fibrinogen and D-dimer retained their significance for RFS (p = 0.026 and 0.014, respectively) and PFS (p = 0.027 and 0.042, respectively) but not tumor size. High levels of fibrinogen and D-dimer were also present in patients who had recurrence or progression at follow-up visits compared to the rest of the patients. Conclusion(s): High levels of fibrinogen and D-dimer may indicate worse prognosis in patients with NMIBC, suggesting that these two can be used as prognostic biomarkers.

2.
Critical Care Medicine ; 51(1 Supplement):182, 2023.
Article in English | EMBASE | ID: covidwho-2190528

ABSTRACT

INTRODUCTION: SARS-CoV-2 (COVID-19) has continued to be a public health emergency, affecting almost 450 million people worldwide, with a disproportionate significant disease burden in the elderly community. Our objective is to provide population specific prognostic markers upon description of demographic factors, clinical characteristics, diagnostic variables, treatment characteristics and outcome variables in critically ill geriatric patients with acute hypoxic respiratory failure due to COVID-19 infection. METHOD(S): This is a retrospective chart review of 165 patients admitted to a single institution's medical and cardiovascular intensive care unit between the dates of March 01, 2020 and December 31, 2020. Inclusion criteria was patients age greater than or equal to 65 years, documented positive COVID-19 polymerase chain reaction test result and a diagnosis of acute hypoxic respiratory failure. Our primary end point evaluated the rate of mortality in relation to multiple variables during intensive care unit admission. RESULT(S): Of 165 patients, 45 patients were excluded. Of the remaining 120 patients, 41 were females and 79 were males. Four independent risk factors are significantly associated with higher odds of mortality for the concerned population: presence of solid tumor (AOR: 0.002, 95% CI: < 0.001, 0.31), maximum value of PaCO2 (AOR: 1.094, 95% CI: 1.029, 1.163), Charlson comorbidity index (AOR: 2.962, 95% CI: 1.59, 5.52), and use of diuretics (AOR: 0.015, 95% CI: < 0.001, 0.49). CONCLUSION(S): It was to our surprise that the mortality rate among those intubated was not statistically significant. However, it has been shown in prior research, which is in alignment with our results, that mechanical ventilation does not necessarily result in increased mortality. Certain factors were found to be poor prognostic markers during intensive care unit admission, which may predict a higher rate of mortality in those patient populations.

3.
Open Forum Infectious Diseases ; 9(Supplement 2):S192-S193, 2022.
Article in English | EMBASE | ID: covidwho-2189605

ABSTRACT

Background. Till May 2022 there were 1.06 million of COVID-19 cases and 9108 deaths caused by COVID-19 disease registered in Lithuania. The objective of the study was to evaluate prognostic factors for in-hospital mortality of patients with severe COVID-19 disease. Methods. COVID-19 positive adult patients hospitalized in Vilnius University Hospital Santaros Klinikos, Lithuania, were included in the cohort study between March 2020 and December 2021. Medical history, vital signs were collected, laboratory tests, chest X-ray were performed. Severe COVID-19 disease was defined as pneumonia with objective respiratory failure symptoms. ROC curve was used to evaluate prognostic value of a laboratory test, multivariable logistic regression was used to determine the prognostic factors for in-hospital lethal outcome. p-value < 0.05 was considered significant. Results. Severe COVID-19 disease was diagnosed for 291 participants, 21 (7.2%) of them died. Hematological, lung diseases and cancer were more common among patients who died compared to those who recovered (Table 1). Patients who died were older, more frequently had confusion (25.0% vs 5.2%, p=0.001), tachypnea (57.1% vs 26.7%, p=0.003), and dyspnea (81.0% vs 54.1%, p=0.017), their time median from symptoms onset to admission was shorter (2.5 (IQR 0-7) vs 7 (IQR 4-9) days, p< 0.001) compared those who recovered. On admission, patients who died had lower lymphocytes count, higher neutrophiles count and higher concentration of aspartate aminotransferase (AST), lactate, creatinine and urea compared to those who recovered. The best prognostic features for lethal outcome possessed neutrophiles count, AST, lactate, creatinine and urea (Figure 1). Optimal cut-off values were calculated and included into multivariable regression model. Multivariable regression revealed that hematological diseases (OR 8.68;95% CI 1.46-51.40, p=0.017), initial AST > 32.9 U/l (OR 13.57;95% CI 1.46-125.94, p=0.022), lactate > 1.46 mmol/l (OR 4.87;95% CI 1.03-22.86, p=0.045) were associated with in-hospital mortality of patients with severe COVID-19 adjusted for age. Conclusion. Hematological diseases, elevated AST and lactate are significant prognostic factors for in-hospital mortality of patients with severe COVID-19 disease at earlier stages of disease.

4.
European Heart Journal, Supplement ; 24(Supplement K):K223, 2022.
Article in English | EMBASE | ID: covidwho-2188688

ABSTRACT

Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. Etiology is one of the main factors determining patient's prognosis. However, in most cases the pericardial effusion, even if large, remains of unknown origin. Pectus excavatum (PEX) is a common deformity of the chest wall in which the inferior part of the sternum and the cartilage are displaced posteriorly. PEX is present within the first year of life in most affected children, more frequently in boys than girls. The chest deformity in PEX may lead to compression of the right-sided cavities between the sternum and the vertebral column impacting right ventricular anatomy and rendering cardiac assessment by echocardiography very difficult. The diagnosis of pericardial effusion is generally confirmed by echocardiography but determining its etiology may be difficult. Although many cases are idiopathic, a careful review of the patient's medical history, physical examination, and laboratory tests can reveal the etiology in most patients. The most common causes of pericardial effusion are infections, malignant tumors, connective tissue diseases, pericardial injury syndrome, myocardial pericardial disease, uremia. In the last years, an association between idiopathic pericardial effusion and PEX has been hypnotized. We report the cases of 2 athletes, 15 and 18 years old, who came to our attention for post COVID19 infection evaluation as indicated by ministerial "Return to Play" protocol. Physical examination was negative for any signs/symptoms. Resting ECG showed normal sinus rhythm. Stress test was performed and resulted negative for signs and symptoms of reduced coronary reserve and arrhythmias. The echocardiographic evaluation showed moderate-severe pericardial effusion, 20 mm and 18 mm, in the absence of hemodynamic alteration. Blood tests were performed (including CRP, ESR, blood count, D-Dimer, IL-6, uricemia) and resulted normal. CardioRM confirmed the presence of severe effusion without signs of hemodynamic impairment/instability. Holter-ECG, performed during training session, resulted negative for arrhythmic events. Athletes were followed up with six-monthly echocardiographic, HolterECG and stress test evaluations, with unchanged entity of the pericardial effusion and any arrythmia or symptoms at serial controls. Chronic pericardial effusion without active pericardial inflammation may represent a diagnostic and therapeutic challenge, especially in the later years as COVID-19 disease and vaccination may be associated with pericardial injury. In the last years, PEX has been associated with the finding of pericardial effusion. Although of interest, caution should be used before labeling indiscriminately a pericardial effusion as due to PEX, especially when clinical insights suggesting alternative diagnosis are present, such as neoplasm or tuberculosis, or when any signs of hemodynamic instability are present. On the contrary, when an otherwise idiopathic pericardial effusion is occasionally identified in a patient with PEX, both the patient and the referring physician may be reassured of the benign association of these two clinical entities, in the proper clinical setting..

5.
British Journal of Surgery ; 109(Supplement 9):ix69, 2022.
Article in English | EMBASE | ID: covidwho-2188339

ABSTRACT

Background: Lymph node yield following oesophagogastric (OG) cancer resection remains a valuable prognosticator of overall patient survival. It is also a quality indicator of histopathological assessment and a surrogate marker of surgical technique. The Royal College of Pathologists' state a minimum lymph node yield of 15 per specimen should obtained in 100% of cases where a radical OG resection has been undertaken. It is well known that the COVID-19 pandemic placed immense strain on NHS services. This study aimed to evaluate its effect on lymph node yield reporting following major OG resection in a large volume tertiary unit. Method(s): Retrospective National OG Cancer Audit (NOGCA) metrics were collected. Histological data including total lymph node yield and positive node status were extracted from patient records. Patient data was categorised into two study periods;pre-pandemic (March 2018-Feb 2020) and pandemic (March 2020- Feb 2022) following the first UK national lockdown. Comparative analysis between the two study periods was performed and for lymph node yield >15 per specimen a X2 statistic calculated. Result(s): In the pre COVID period a total of 280 (excluding GIST) resections were performed, 75% (210) oesophagectomies v. 25% (70) gastrectomies. The median age was 69 (range 25-90, males= 189 v. females =91). In the post pandemic period a total of 188 resections were performed, 72% (135) oesophagectomies v. 28% (53) gastrectomies. The median age was 69 (38-87, males = 142 v. female= 46). Lymph node yield was available for 275 resections in pre-pandemic study period, with a median nodal yield of 20 (5-61). In the pandemic study period lymph node yield data was available for 180 patients, median 19.5 (0-69). The minimum nodal yield (>15) was obtained in 80.7% of resection specimens pre-pandemic v. 68.9% in the pandemic study period (p= 0.00382). Conclusion(s): Our study demonstrates a higher rate of inadequate nodes examined in the post pandemic study period. Despite staffing pressures, efforts should be made to improve number of nodes examined to provide robust prognostic data.

6.
British Journal of Surgery ; 109(Supplement 9):ix28-ix29, 2022.
Article in English | EMBASE | ID: covidwho-2188323

ABSTRACT

Background: The advent of the COVID-19 pandemic in 2020 led to staff redeployment and prioritization of urgent care services. Cancer services were impacted by staff and resource diversion. Cancer diagnoses fell by 33% due to reduction in surveillance, diagnosis, and screening. Upper gastro-intestinal cancers (UGI) include cancers of the esophagus, stomach, small intestine, pancreas, liver, and gall bladder. These cancers progress insidiously, present at late stages and are challenging to treat. Delayed diagnosis significantly reduces the scope of treatment options available and therefore impacts the prognosis of the patient. A Public Health England Report in 2021 showed a reduction in tumor resection surgeries in UGI cancers between March to May 2020 and December to February 2021. The backlog of surgical cancer management is ongoing as the pandemic evolves and NHS service provisions adapt. It is important to understand the effects of COVID-19 on diagnosis, staging and treatment of UGI cancers in order to improve service provision in the ensuing years. Method(s): This was a cross-sectional study conducted at Barking, Havering and Redbridge NHS Trust from January to June 2019, 2020 and 2021. Data for 316 study participants was sourced from the Somerset Cancer Database and supplemented with data from electronic patient care records. Six months of data was compared in 2019 (pre-pandemic), 2020 (mid-pandemic including the first lockdown) and 2021. The data was analysed as raw proportions and percentages. Result(s): The number of UGI cancers diagnosed was lowest in 2020 during the height of the pandemic compared to 2019 and 2021. The most common cancer in all three years was pancreatic. Pancreatic cancer was also the most common emergency cancer presentation. The highest proportion of stage IV cancers presented in 2021 (67%). The proportion of cases that resulted in palliative care management increased from 2019 to 2021 (67% and 70% respectively). 53% of all patients came from neighbourhoods that fell within 50% of the most deprived areas nationally. Conclusion(s): The COVID-19 pandemic has had variable impacts on the presentation and management of UGI cancers at the BHRUT NHS Trust. This study exhibits local trends and percentages following suit from Public Health England's National Cancer Registration and Analysis Service data for trend-based discussion. Further research within London NHS Trusts is encouraged to understand the full impact of COVID-19 on surgical cancer services in the NHS.

7.
European Journal of Cancer ; 175(Supplement 1):S94, 2022.
Article in English | EMBASE | ID: covidwho-2184664

ABSTRACT

Background: Among women, breast cancer (BC) is the most frequently diagnosed cancer and is ranked as the leading cause of cancer death. Given that aging is one of the strongest risk factors for the development of breast cancer, older adults (65+) are disproportionately affected. At the same time, more than half of older cancer patients are considered frail or pre-frail and are at increased risk of adverse outcomes including treatment intolerance, as well as morbidity, and mortality. Frailty is thus recognized as an important metric to guide decision-making in geriatric oncology. This study characterizes the use of frailty measurements in observational studies on older women with breast cancer. Material(s) and Method(s): MEDLINE, EMBASE, and Cochrane Library were systematically queried to identify observational studies (cohort, casecontrol, cross-sectional) on older women with breast cancer which evaluate survival or mortality before or after treatment, published from 2017-2022. Studies were managed using Covidence software and assessed for inclusion with predefined criteria by independent reviewers. Data was extracted with respect to the characteristics of the studies. Frailty measurements were identified, the proportion of studies using frailty measurements was calculated, and the prevalence of frailty among BC patients was determined. Result(s): A total of 9823 studies were screened on title and after deduplication. Based on specified criteria, 217 full text studies were assessed for eligibility, 71 of which were excluded, mainly due to incorrect target population with respect to age, or incorrect outcome assessment. Overall, 146 studies were included. Preliminary results revealed that frailty status was not considered in all identified observational studies. Among studies that measured frailty, a relevant proportion of female BC patients were considered frail. Detailed results will be shown at the conference. Conclusion(s): Despite having significant prognostic importance, the use of frailty measurements is not a compulsory practice in observational studies on breast cancer in older women. Additionally, although multiple frailty screening tools have been developed, there is no gold standard measurement used to detect frailty. As a result of such heterogeneity in clinical practice, an established definition of frailty remains elusive. Efforts to create a unified definition and gold standard may improve targeted care and health outcomes for older breast cancer patients. No conflict of interest. Copyright © 2022 Elsevier Ltd. All rights reserved

8.
Hematology, Transfusion and Cell Therapy ; 44(Supplement 2):S202, 2022.
Article in English | EMBASE | ID: covidwho-2179128

ABSTRACT

The structural changes involving the long arm of chromosome 3 at bands 3q21 and 3q26.2 in the form of inversion are named paracentric inversion inv(3)(q21q26.2) and in myeloid neoplasms have long been recognized, but are rare. The 3q21q26 syndrome usually occurs in a high-risk myelodysplastic syndrome (MDS) or the setting of acute myeloid leukemia (AML) and is most commonly reported as inv(3)(q21q26.2). Myeloid neoplasms with inv(3) are rare disorders with an incidence of 1% in MDS and AML. Thus, this report aims to show a patient with MDS and high platelets count who presented inv(3)(q21q26.2). A 72-year-old woman looked for medical attention due to fatigue and weakness. The patient reported a history of smoking for 41 years and denied any exposure to toxic agents. At physical examination, only pale was detected. A complete blood count revealed hemoglobin 7g/dL, MCV = 94 fL, leukocytes 5,600/mm3, neutrophils 2,242/mm3 and thrombocytosis with a platelet count of 514,000/mm3. Bone marrow aspirate showed dyserythropoiesis in 30% of cells and 6,5% blasts. The bone marrow cytogenetic analysis showed 46,XX,inv(3)(q21q26.2)[16]/46,XX[4]. The diagnosis of MDS with excess blasts - 1 was established according to the 2016 World Health Organization classification and International Prognostic Scoring System was very high. While waiting for beginning treatment, the patient died of respiratory failure due to COVID-19. Myelodysplastic syndrome with inv(3)(q21q26.2) is a rare aggressive disorder that occurs in less than 1% of all MDS cases and has been associated with a poor outcome: chemoresistance, high risk of leukemic transformation and short survival. Our case showed thrombocytosis with a platelet count of 514,000/mm3. The incidence of thrombocytosis in MDS has been reported in 8% of cases with platelets > 400 x109/L. The major report which evaluated thrombocytosis in MDS studied 2,042 cases, detecting high platelets count in 5% of cases (102/2,042). It appears that thrombocytosis does not adequately capture the aggressive nature of inv(3)(q21q26.2) in MDS but still plays an important role in the pathogenesis of this heterogeneous and dynamic disease. Our patient reported herein showed dyserythropoiesis in 30% of cells and 6,5% blasts, but nothing was detected regarding megakaryocytic lineage. Our patient died very soon after diagnosis due to viral infection. Thrombocytosis is an unusual clinical feature in MDS associated with inv(3)(q21q26.2) and the unfavorable prognosis of inv(3) is independent of thrombocytosis. Copyright © 2022

9.
Hematology, Transfusion and Cell Therapy ; 44(Supplement 2):S167, 2022.
Article in English | EMBASE | ID: covidwho-2179123

ABSTRACT

Objective: About 70% of cases of Acute Lymphoblastic Leukemia (ALL) affect children aged 1- 4 years. The incidence increases slightly again in adults over 50 years, characterizing a poor prognosis. According to data from the National Cancer Institute, for the year 2020 leukemias present in men as the fifth most frequent neoplasm in the Northeast Region with a risk of 8.20/100,000 inhabitants, occupying the fifth position. In the case of women, the risk in the Northeast region is 4.42/100,000 inhabitants and ranks tenth. This study aimed to identify the molecular and epidemiological profile of adult patients with ALL in the state of Ceara. Methodology: Sample collection was performed in patients with ALL treated at the General Hospital of Fortaleza (GHF), considered the main and largest hematology outpatient clinic in the metropolitan region of Fortaleza, as well as the State of Ceara. All patients participating in this study read and signed the informed consent form. Patients with other types of leukemias or other hematological diseases were excluded. This study was approved by the Research Ethics Committee of the Federal University of Ceara under protocol no. 38680520.9.0000.5054. Result(s): From July 2021 to July 2022, 25 patients with ALL were treated, of whom 9 are women and 16 are men. The mean age observed was 42.5 years. 44% of patients live in the capital (Fortaleza), while the other 56% of patients live in rural areas. Through immunophenotyping it was possible to verify that there were 22 patients (88%) compatible with ALL-B presenting CD19, CD10, CD45, CD38, CD22, CD79a, CD34, CD81 and CD58 as the main markers, while only 3 patients (12%) were compatible with ALL-T, expressing mainly CD3, CD45, CD5, CD7, CD2, CD11c and CD1a. Eleven patients (44%) had abnormal and complex karyotypes. Five patients had the BCR-ABL p190 mutation and two had the E2A-PBX1 mutation. A total of 9 patients died due to septic shock, COVID-19, or refractoriness to treatment. Discussion(s): The literature indicates a new peak of ALL cases after 50 years of age, however the highest incidence observed in the study participants was between 30 and 50 years. Studies indicate that immunophenotyping findings in patients with ALL B line are almost always CD19, CD79a, CD10, CD20 and CD22 positive, while T-strain ALL usually present CD7, CD3, CD1a and CD10 as the main markers, corroborating what was observed in the results. In addition, depending on the alteration observed in the karyotype, it may confer poor or good prognosis to the patient. The BCR-ABL1 and E2A-PBX1 mergers, for example, are alterations that give worse prognosis to patients and, therefore, may be targeted for treatment in an attempt to improve the survival of these patients. TEL-AML1 fusion, on the other hand, represents a good prognosis, being more incident in pediatric ALL. Conclusion(s): Epidemiological data from this preliminary study indicate that in the state of Ceara ALL is more common in male patients aged 30-50 years living in rural regions. In addition, the use of targeted therapies for patients with abnormal karyotypes as well as the adoption of stricter measures to prevent hospital infections may increase patient survival. Copyright © 2022

10.
Hematology, Transfusion and Cell Therapy ; 44(Supplement 2):S166-S167, 2022.
Article in English | EMBASE | ID: covidwho-2179122

ABSTRACT

Objective: Acute myeloid leukemia (AML) is the second most common leukemia in adults and older patients represent most cases. The states of the Northeast of the country have stood out in the frequency of leukemia cases, and the frequencies are higher than the rate of 35% compared to other neoplasms, especially in the metropolitan regions of Fortaleza. In the State of Ceara, the number of cases of leukemia expected for the year 2020 is 6.17 cases/100,000 inhabitants in men and 4.29 cases/100,000 inhabitants in women. In view of this information, the aim of this study was to identify the molecular and epidemiological profile of patients with AML in the state of Ceara. Methodology: Sample collection was performed in patients with AML treated at the General Hospital of Fortaleza, considered the main and largest hematology outpatient clinic in the metropolitan region of Fortaleza, as well as the State of Ceara. All patients participating in this study read and signed the informed consent form. Patients with other types of leukemias or other hematological diseases were excluded. This study was approved by the Research Ethics Committee of the Federal University of Ceara under protocol no. 38680520.9.0000.5054. Result(s): From July 2021 to July 2022, 31 patients with AML were treated, of which 8 are women and 23 are men. The mean age observed was 50.4 years. 54.8% of patients live in the capital, while the other 45.2% of patients live in rural areas. Through immunophenotyping it was possible to verify that the main markers presented by LMA patients were CD33, CD13, CD117, CD45, MPO, CD34, CD64, HLA-DR, CD11c, CD11b e CD38. Thirteen patients (42%) had abnormal and complex karyotypes, of which six died. Five patients (16,1%) had the t(15;17)(q24;q21.3) corresponding to the PML-RARA fusion. Six patients (19,3%) had the FLT3 mutation that confers a poorer prognosis. During the clinical follow up, a total of 16 patients died due to septic shock, COVID-19, or refractoriness to treatment. Discussion(s): The incidence of cases of adults over 50 years of age with AML was 58%, as it corroborates the expected incidence of cases regarding the age described in the literature. Studies indicate that immunophenotyping is critical to the differential diagnosis among AML subtypes. AML is defined by the mainly expression of the markers MPO, CD117, CD13, CD33, HLA-DR and CD38, corroborating what was observed in the results. In addition, depending on the alteration observed in the karyotype, it may confer poor or good prognosis to the patient. The PML-RARA merger, for example, is known as M3 AML or acute promyelocytic leukemia (APL), a subtype of AML with a better prognosis for patients. The FLT3 mutation is present in 1 in 3 patients with AML. The presence of this altered gene may mean a worse prognosis and a greater possibility of recurrence but allows a specific and differentiated treatment. Conclusion(s): Epidemiological data from this preliminary study indicate that in the state of Ceara AML is more common in male patients aged 50-80 years. In addition, the use of targeted therapies for patients with abnormal karyotypes as well as the adoption of stricter measures to prevent hospital infections may increase patient survival. Copyright © 2022

11.
Hematology, Transfusion and Cell Therapy ; 44(Supplement 2):S134, 2022.
Article in English | EMBASE | ID: covidwho-2179117

ABSTRACT

Introduction: Central nervous system (CNS) infiltration in chronic lymphocytic leukemia (CLL) is a rare presentation of CLL that can potentially have disastrous complications. Reported prognosis is poor. The objective of this study is to report a series of cases of CLL with CNS infiltration. Method(s): This is a case-series of a Brazilian CLL registry (Registro Brasileiro de Leucemia Linfocitica Cronica). We included patients with CLL and CNS infiltration. This is a descriptive study. Result(s): A total of 10 (0.28%) in 3610 patients were identified with confirmed (80%) or suspected (20%) CNS infiltration. Median age at CLL diagnosis was 57.5 y/o (range: 50 - 76). Three (30%) patients were diagnosed with CNS infiltration concomitantly with the CLL diagnosis, while others (70%) were diagnosed at a median of 41 months of CLL diagnosis (range: 11 to 119 months). Only three (30%) patients had been previously treated for CLL. Most common symptoms of CNS infiltration were convulsion (30%), altered mental status (30%), headaches (30%), ophthalmologic (30%), and urinary incontinence (20%). Amnesia, asthenia, vomiting, hemiparesis, cervicalgia, and dizziness were also present (one patient each). Of the patients with confirmed CNS infiltration, diagnoses were performed through liquor exam (all patients) and biopsy (one patient). Of the two patients with suspected CNS infiltration, one achieved complete response and the other, partial clinical response, following instituted CLL-directed therapy with (1 patient) or without (1 patient) intrathecal chemotherapy. Of the other 8 patients, 3 achieved complete response, 2 failed treatments, 1 was not evaluated and 2 had missing information. Of all patients, 5 are alive, 3 died of sepsis, multiorgan failure following CNS methotrexate-related toxicity, and COVID, and 2 had missing information. Discussion(s): Our results show that the prognosis of CNS infiltration in CLL can be relatively good, with at least 50% of patients alive at 1 year. However, a series of 18 patients published by Strati et al has shown a poorer outcome, with half of the patients dead at 1 year. Although all patients were diagnosed by liquor exam, that same study reported a low specificity for liquor exam in CLL (42%) due to the frequent presence of leukemic cells in the cerebrospinal fluid in other conditions. Establishing CNS CLL as the cause of the symptoms can be difficult, since up to 70% of patients with CLL have CNS infiltration in autopsy studies, and our results may be superestimated. In summary, CNS infiltration in CLL is a rare event, and further studies are needed to address prognosis and management. Copyright © 2022

12.
Annals of Oncology ; 33(Supplement 8):S1424-S1425, 2022.
Article in English | EMBASE | ID: covidwho-2176295

ABSTRACT

Background: The oncology landscape is rapidly evolving towards more personalized treatment with the use of molecular-driven therapies. Thus, genomic information has become an integral component of clinical decision-making. This study aims to analyze tumor tissue samples of high-grade serous ovarian cancer (HGSOC) to understand if genomic changes in gene mutation frequencies between primary and relapsing tumors occur and can influence the detection of actionable gene alterations. Method(s): A retrospective study approved by local Ethics Committee was conducted on OC patients treated at Fondazione Policlinico Universitario A. Gemelli, IRCCS. All subjects provided informed written consent for genetic analysis and study participation. FFPE specimens were analyzed by Foundation One CDx, which applies NGS across 324 genes known to be drivers of solid tumors, by sequencing the coding regions of 309 cancer-related genes plus introns from 36 genes. Z-test was used to analyze the mutation frequencies between primary and relapsing tumors. Result(s): 261 patients underwent Foundation Medicine testing. Out of 216 HGSOC, 151 tests were performed on primary lesion, 43 at 1st/2nd recurrence, and 22 at >3 recurrences. Statistically significant changes in BRCA1-2 frequencies were found between primitive lesions and recurrence (p=0.0013). A lower frequency in TP53 (p=0.0013) and a higher frequency of NF1 (p=0.028) and TERC (p=0.027) mutations were shown in tissue collected at recurrence compared to primary lesion. Selective chemotherapy pressure and natural enrichment of better prognosis patients at recurrence may explain the discrepancies between primary and secondary tumors. Conclusion(s): These data suggest the opportunity to re-characterize the molecular profiling of the tumors at the time of recurrence to identify potentially actionable alterations to guide treatment. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: V. Salutari: Financial Interests, Personal and Institutional, Advisory Board: AstraZeneca, Clovis, GSK, Tesaro, MSD, Roche, PharmaMar, Eisai. G. Scambia: Financial Interests, Personal, Invited Speaker: Johnson & Johnson, AstraZeneca & MSD, Olympus Europa, Baxter Healthcare, Intuitive Surgical Inc., GlaxoSmithKline;Financial Interests, Personal, Expert Testimony, Trainer: Covidien AG (Medtronic company);Financial Interests, Institutional, Invited Speaker, 'IsoMSLN' in Ovarian Cancer and Malignant Pleural Mesothelioma: Kiromic;Financial Interests, Institutional, Invited Speaker, Roll-over study for patients who have completed a previous cancer study with olaparib and who the investigator believes can benefit from continued treatment - ROSY-O: AstraZeneca;Financial Interests, Institutional, Invited Speaker, CATCH-R: Roll-over study to provide continuous access to clinical therapy with rucaparib: Clovis Oncology;Financial Interests, Institutional, Invited Speaker, Phase III, multicenter, placebo-controlled clinical study comparing chemo-immunotherapy (paclitaxel-carboplatin-oregovomab) versus chemotherapy (paclitaxel-carboplatin-placebo) in patients with advanced epithelial ovarian, tubal cancer of fallopian or peritoneal (FLORA-5): Oncoquest Pharmaceuticals Inc.;Financial Interests, Institutional, Invited Speaker, Phase IIb randomized, open-label, active comparator, parallel-group, multicenter study designed to evaluate the efficacy and safety of three different doses of the P2X3 receptor antagonist (BAY 1817080) versus placebo and Elagolix 150 mg in women with symptomatic endometriosis: Bayer AG;Financial Interests, Institutional, Invited Speaker, Usability of ITE transducers for sending electric fields for tumor treatment (TTFields): Novocure Ltd.;Financial Interests, Institutional, Invited Speaker, Phase III, multicentre, open-label extension trial to evaluate long-term safety and efficacy in patients with advanced cancers currently undergoing treatment or in follow-up in a pembrolizumab trial: Merck. D. Lorusso: Financial Interests, Persona , Advisory Board, Participation in Advisory Boards and Invited Speaker: GSK, Clovis Oncology, PharmaMar;Financial Interests, Personal, Advisory Board, Participation in Advisory Boards and Invited Speakers: AstraZeneca, MSD;Financial Interests, Personal, Other, Consultancy: PharmaMar, Amgen, AstraZeneca, Clovis Oncology, GSK, MSD, Immunogen, Genmab, Seagen;Financial Interests, Personal, Advisory Board, Participation in Advisory Boards: Merck Serono;Financial Interests, Personal, Advisory Board, Invited member of advisory board: Seagen, Immunogen, Genmab, Oncoinvest, Corcept, Sutro;Financial Interests, Institutional, Funding, Grant for founding academic trial: MSD, Clovis Oncology, PharmaMar;Financial Interests, Institutional, Funding, Grant for founding academic trial: GSK;Financial Interests, Institutional, Invited Speaker, ENGOT trial with institutional support for coordination: Clovis Oncology;Financial Interests, Institutional, Invited Speaker, ENGOT trial with institutional support for coordination: Genmab, MSD;Financial Interests, Institutional, Funding, Clinical trial/contracted research: AstraZeneca, Clovis Oncology, GSK, MSD, Seagen;Financial Interests, Institutional, Funding, Clinical trials/contracted research: Genmab, Immunogen, Incyte, Novartis, Roche;Non-Financial Interests, Personal, Principal Investigator, PI of several trials, no compensation received: GSK;Non-Financial Interests, Personal, Principal Investigator, PI of several trials. No personal compensation received: AstraZeneca, GenMab;Non-Financial Interests, Personal, Principal Investigator, PI in several trials. No personal compensation received: MSD;Non-Financial Interests, Personal, Principal Investigator, PI of clinical trial. No personal compensation received: immunogen, clovis, Incyte;Non-Financial Interests, Personal, Principal Investigator, PI of clinical trial. No personal compensation receive: Roche;Non-Financial Interests, P rsonal, Member, Board of Directors: GCIG. All other authors have declared no conflicts of interest. Copyright © 2022 European Society for Medical Oncology

13.
Biochimica Clinica ; 46(3):S90, 2022.
Article in English | EMBASE | ID: covidwho-2169624

ABSTRACT

Beside lowering the surface tension at air-liquid interface in the alveoli, the pulmonary surfactant has a pivotal role in triggering the elimination of pathogens or any hazardous materials introduced with breathing. Among the components of the pulmonary surfactant, surfactant protein-D (SP-D) is a low abundant (0.6%) hydrophilic protein that is able to promote pathogens clearance binding highly conserved glycosidic residues on their surface. SP-D also cooperates in the maintenance of lung homeostasis by directly modulating immune system activity. Previous investigations on acute respiratory distress syndrome (ARDS) patients demonstrated a significant increment of SP-D serum level compared with healthy donors. Since in physiological condition SP-D is not permeable to alveoli-capillary membrane and poorly express by other tissues, this enhancement is likely due to an impairment of the pulmonary barrier caused by prolonged inflammation. In view of the above, the present work aims to investigate SP-D as diagnostic and/or prognostic marker for COVID-19. In particular, a retrospective study on a relatively large cohort of patients of Hospital Pio XI of Desio (i.e., 79 mild cases plus 123 severe cases) was conducted to assess differences of the hematic levels of this biomarker among COVID-19 patients and healthy donors and if SP-D serum levels resulted a risk factor for disease severity and mortality. The performed analyses, using an Anova-Mixed model, showed a significant difference in the mean of log SP-D between COVID-19 patients and healthy donors: 150 ng/mL was identified as threshold value to best discriminate the mentioned groups. Significant differences were also found between dead vs survived patients, as well among severe vs non-severe cases. In all cases, SP-D serum levels presented significantly higher values for COVID-19 patients, dead and severe cases.Moreover, further analysis conducted with Logistic Mixed models, highlighted that SP-D, in a model with Age, C-reactive protein and cancer status, resulted the strongest significant risk factor of mortality (model predictive accuracy, AUC=0.826), and in a lesser extent for risk of severity.The overall data suggest that SP-D can be a predictive marker of COVID-19 disease and its outcome.

14.
American Journal of Translational Research ; 14(12):8862-8878, 2022.
Article in English | EMBASE | ID: covidwho-2168562

ABSTRACT

Objectives: Cancer patients are reported to be more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the COVID-19 (the Corona Virus Disease 2019) patients with cancer suffer from certain serious complications. ASGR1 has been recently identified as a novel receptor of SARS-CoV-2 in human cells;however, there are limited studies on ASGR1 in various human cancers. Method(s): This study utilized a comprehensive analysis of COVID-19-related ASGR1 in multiple human cancers based on 18,589 multi-center samples. Using Wilcoxon rank-sum analysis, a difference in ASGR1 expression between cancer and control tissues was detected. Cox regression analysis, Kaplan-Meier curves, and receiver operating characteristic curves were utilized to determine the correlation between ASGR1 expression and the clinical parameters of cancer patients. The immune relevance and potential mechanisms of ASGR1 in various cancers were also investigated. Result(s): Abnormal ASGR1 mRNA expression was observed in 16 of 20 different cancers (e.g., it was upregulated in colon adenocarcinoma but downregulated in cholangiocarcinoma;P < 0.05). ASGR1 was related to prognosis, e.g., overall survival, in 14 cancers (P < 0.05), such as adrenocortical carcinoma. The gene was also found to be a potential marker that can be utilized to distinguish eleven cancers from controls with moderate to high accuracy (e.g., the area under the curve for cholangiocarcinoma = 1.000). ASGR1 expression was related to DNA methyltransferases, mismatch repair genes, immune checkpoints, levels of tumor mutational burden, microsatellite instability, neoantigen count, and immune infiltration levels in certain cancers (P < 0.05). The gene plays a role in multiple cancers by affecting four signaling pathways, such as cytokine-cytokine receptor interaction. Cancer patients with high ASGR1 expression are sensitive to 25 drugs, including ulixertinib. Conclusion(s): SARS-CoV-2-correlated ASGR1 is a novel marker that can be used for treating and identifying multiple human cancers. Copyright © 2022 E-Century Publishing Corporation. All rights reserved.

15.
Anatolian Journal of Cardiology ; 25(Supplement 1):S171-S172, 2021.
Article in English | EMBASE | ID: covidwho-2202556

ABSTRACT

Background and Aim: A novel coronavirus disease 2019 (COVID-19) which was declared a pandemic in March 2020, has spread rapidly around the world and it is still threatening global health. COVID-19 infection may exhibit several clinical manifestations varying from mild respiratory illness to severe pneumonia and acute respiratory distress syndrome (ARDS). Many studies have shown that inflammatory responses play a pivotal role in the severity and prognosis of COVID-19 disease. Galectin-3, a b-galactoside-binding lectin, is a new important player in the pathophysiological processes of inflammation and fibrosis. In this study, we aimed to investigate the relationship between serum Galectin-3 levels at admission and pneumonia severity and inflammatory parameters in COVID-19 patients. Method(s): A total of 68 patients with laboratory, clinical and radiological confirmed COVID-19 were prospectively recruited to the study. The study population was classified into 2 groups as those with severe pneumonia (n=48) and those with mild pneumonia (n=20) based on chest computed tomography images at admission. Ten milliliter of peripheral venous blood were drawn within 24 hours of admission to estimate serum Galectin-3 levels. Patients with chronic renal failure, other inflammatory or rheumatic diseases and/or malignancies, cardiovascular diseases and diabetes mellitus were excluded from the study. We evaluated the relationship between Galectin-3 levels, pneumonia severity and laboratory parameters in COVID-19 patients. Result(s): The demographic and clinical data and laboratory findings of the study population are presented in Table 1. The mean age of the study population was 61.68+/-14.4 years (45 male;23 female). The mean level of Galectin-3 was 29.67+/-16.7 ng/mL. Serum Galectin-3, lactate dehydrogenase (LDH), C-reactive protein (CRP), prohormone B-type natriuretic peptide (pro-BNP), troponin-T, D-dimer and procalcitonin levels, white blood cell (WBC) counts, neutrophil and lymphocyte counts and percentages were significantly different between the groups (Table 1). Serum Galectin-3 levels were found to be higher in severe pneumonia group (p=0.04). In patients with mild pneumonia;Galectin-3 was negatively correlated with neutrophil percentage (r =-0.483 p=0.031) but was positively correlated with lymphocyte percentage and lymphocyte counts (r=0.428, p=0.05;r=0.554, p=0.011, respectively) (Table 2A). However, Galectin-3 was negatively correlated with WBC counts, neutrophil counts and neutrophil percentage (r=-0.317 p=0.028;r=-0.379 p=0.008;r=-0.609 p<0.001, respectively) and positively correlated with lymphocyte percentage (r=0.307;p=0.034) in COVID-19 patients with severe pneumonia (Table 2B). Conclusion(s): In this study, we found a significant relationship between serum Galectin-3 levels and pneumonia severity in COVID-19 patients. Therefore, Galectin-3, a new biomarker of inflammation, may be useful as a prognostic factor in patients with COVID-19.

16.
Indian Journal of Nephrology ; 32(7 Supplement 1):S40-S41, 2022.
Article in English | EMBASE | ID: covidwho-2201604

ABSTRACT

BACKGROUND: Hyperviscosity syndrome (HVS) is an infrequent but life-threatening complication of multiple myeloma (MM) and classically presents with the triad of mucosal bleed neurological and visual disturbances. HVS is typically associated with Immunoglobulin M (IgM) MM and very rarely may complicate IgG MM. Even suspicion of HVS necessitates therapy based on clinical severity rather than the calculated degree of viscosity. While plasmapheresis promptly decreases serum viscosity by 30-50% early initiation of antimyeloma therapy is crucial to prevent rebound phenomena. AIM OF THE STUDY: In this context, we report a case of IgG MM which despite being complicated by HVS had gratifying outcome attributable to early clinical suspicion and consequent prompt therapeutic intervention. METHOD(S): Case report - A 60-year-old lady presented with headache altered sensorium blurring of vision and bleeding from both nostrils of two days duration. She also had breathlessness on exertion and generalized fatigue for one month. Clinical evaluation was remarkable for pallor hypertension (blood pressure - 160/96 mm Hg) tachypnea (respiratory rate - 26/minute) with blood clots in nostrils bleeding from gums dry tongue and skin bruising on the arms. Besides altered mentation neurological evaluation revealed bilateral venous congestion and perivenular flame-shaped hemorrhages on direct ophthalmoscopy. There were no features of heart failure peripheral lymphadenopathy or organomegaly. Her initial blood sampling was difficult as blood was rapidly clogging during sampling itself. After rapid saline infusion, samples could be drawn and processed. Hemogram showed normocytic normochromic anemia (hemoglobin-6.3%g/ dL) thrombocytopenia (platelets -71 000/mm3) and rouleaux formation without hemolysis or blast cells on peripheral blood smear. SARS-CoV-2 PCR was negative. She had reversal of albumin-globulin ratio (total protein -10.6 g/dL;albumin -2.1 g/dL) hypercalcemia (corrected calcium - 14 mg/dL) and raised creatinine of 2.5 mg/dL. Her coagulation profile was essentially normal. Computed tomography images of head chest and abdomen were essentially normal. Further evaluation revealed M-spike (5.3%gm/dL) on serum protein electrophoresis raised IgG (4.69 g/dL) increased kappa light chain (kappa 171 mg/L lambda 24.3 mg/L;ratio -7) on serum-free light chain assay monoclonal band of IgG Kappa on serum immune-fixation electrophoresis. Bone marrow aspiration revealed 60% plasma cells (Figure-1) with sheets of plasma cell on bone marrow biopsy having kappa-restriction on immunohistochemistry thereby confirming multiple myeloma and ruled out remote possibility of lymphoplasmacytic lymphoma-related HVS. In view of presumptive HVS complicating multiple myeloma patient was managed with urgent plasmapheresis and consequently initiated on bortezomib-based anti-myeloma triplet therapy including lenalidomide and dexamethasone (VRd) besides supportive therapy for hypercalcemia and acute kidney injury. After three sessions of plasmapheresis patient showed complete resolution of symptoms of HVS with remarkable change in plasma color (Figure-2). Her acute kidney injury also recovered by day-7, and she went home walking on day-10 of her hospitalization. Two months later she was tolerating her chemotherapy well with complete resolution of hypergammaglobulinemia. Six months later she is in complete remission and is being planned for autologous hematopoietic stem cell transplant. RESULT(S): Discussion - Classical triad of HVS include mucosal bleed, neurological disorders, and visual disturbances.5 Presence of oro-nasal bleed mandates thorough retinal evaluation since hemorrhages may occur without visual symptomatology. Furthermore, clinical signs include hypertension, congestive heart failure5, priapism6, and decreased hearing merit consideration. Structure of protein is an important determinant of viscosity, whereby spherical proteins rotate through plasma and contribute very little and large linear proteins spin end over end and raise viscosity disproportionatel . Likewise, IgM (molecular weight of 950 Kd) has a high axial length-to-width ratio and, therefore, raises plasma viscosity at levels above 5 g/ dL. IgA circulates as a dimer, and results in HVS at levels above 7 g/dL7. HVS complicating IgG MM with IgG circulating as a monomer (molecular weight of 180 Kd) is rare and accounts for less than 5% of cases and requires IgG level usually above 10 g/dL7. Even presumptive suspicion of HVS necessitates therapy based on clinical severity rather than the calculated degree of viscosity as correlation between serum viscosity and clinical manifestation is not precise;nevertheless, symptoms attributable to HVS are rare if serum viscosity is less than 4 centipoise (CP) [normal value -1.5 CP]. With rapid symptomatic relief following plasmapheresis, absence of further therapeutic and prognostic implications and logistic constraints, serum viscosity and Ig G subtyping8 couldn't be estimated in the index case. As IgM is predominantly limited to intravascular space (over 80%), only a single session of plasma exchange (removal of 1-1.5 plasma volume) typically, decrease plasma viscosity by 30% to 50%, and reduce IgM level by 60%9 and is generally sufficient to abate acute symptoms in patients with IgM-related HVS. In contrast, maximum of three sessions of plasmapheresis10 may be needed in IgG-related HVS (due to late and less efficient removal of IgG as it is near equally distributed between the intravascular space and extravascular space) or if the viscosity remains over six CP11. Although International Myeloma Working Group does not specifically identify HVS as myeloma-defining event, clearly its presence warrants Bortezomib-based chemotherapy for rapid decline of Ig levels.5 However, pharmacological treatment should never be considered as an alternative to plasma exchange for immediate hyperviscosity reduction.5 Moreover, patients with HVS tend to have plasma volume expansion;hence, actual anemia may be partially dilutional. Consequential red blood cell transfusion can have negative rheological impact of adding red cells to the circulation and further increase in blood viscosity and worsen HVS.5 Therefore, red blood cell transfusion is recommended only after blood viscosity reduction. Symptomatic HVS consequent to IgG MM with IgG levels below 5 g/dL7 is infrequent and hence reported for its novelty. Moreover, early clinical suspicion of HVS and consequent pre-emptive plasmapheresis (even before completion of work-up of MM) may improve clinical outcome as evident in the index case. CONCLUSION(S): To conclude, neurological dysfunction at presentation of MM with / without mucosal bleed and visual disturbance should caution us toward an albeit infrequent, yet devastating complication of HVS, which is otherwise potentially reversible subject to early clinical suspicion and prompt initiation of appropriate therapy.

17.
Journal for ImmunoTherapy of Cancer ; 10(Supplement 2):A1353, 2022.
Article in English | EMBASE | ID: covidwho-2161959

ABSTRACT

Background Clonal hematopoiesis (CH) is an age-related phenomenon characterized by the overrepresentation of blood cells arising from a single, mutant clone and is detectable in 10-20% of individuals over 70.1 CH has now been implicated in a variety of non-hematological disorders, such as cardiovascular diseases and Covid-19 infections, by exacerbating the innate inflammatory response.2-4 However, the impact of CH in solid tumors and response to immune checkpoint blockade (ICB) is unknown. Methods To assess the prevalence and role of CH in patients with solid tumors, we analyzed publicly available data from the MSKCC-IMPACT study.5, 6 To mechanistically study CH in solid tumors, we established an orthotopic model of pancreatic adenocarcinoma (PDAC) in mice with Tet2+/- CH. CH and WT mice were treated with either ICB (aCTLA-4 + aPD-1) or vehicle control. Single-cell (sc-) RNAseq was performed on tumor infiltrating lymphocytes (n=3/group) while remaining mice were observed for disease progression and overall survival (n=10/group). Results Analyzing CH frequencies in a cohort of patients with solid tumors, we observed that the prevalence of CH was approximately 5 times higher in patients with cancer when compared to healthy age-matched controls. Further, patients with detectable CH clones had significantly worse overall survival (figure 1A). In vivo, sc-RNAseq data revealed that myeloid cells present within the pancreatic tumors of mice with Tet2+/- CH were significantly enriched for both type I and type II interferon (IFN) signaling (figure 1B). Further, these IFN+ myeloid cells were ablated after ICB therapy in Tet2+/+ WT mice but persisted in mice with Tet2+/- CH (figure 1C). PDAC tumors from mice with Tet2+/- CH had approximately half the total number of infiltrating CD8 T cells at baseline when compared to those from Tet2+/+ WT mice. Upon ICB treatment, CD8 effector cells only expanded in the tumors from Tet2+/+ WT mice. Functionally, this translated to more rapidly progressing tumors, resistance to ICB, and reduced overall survival in mice with Tet2+/- CH (figure 1D). Conclusions CH is present in upwards of 30% of patients with solid tumors and is associated with significantly worsened prognosis. Modeling PDAC in the presence of Tet2+/- CH in vivo revealed distinct alterations in the tumor microenvironment that ultimately influenced tumor progression and response to ICB. This proposed research bridges the fields of solid tumor immunology and clonal hematopoiesis to address novel mechanisms of immunotherapy resistance that will span cancer type and, ultimately, improve patient care.

18.
Clinical and Experimental Obstetrics and Gynecology ; 49(11) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2164627

ABSTRACT

Background: The COVID-19 pandemic had a catastrophic impact on healthcare. Keeping an optimal cancer care routine has been challenging. For cervical cancer (CC) patients external beam radiotherapy (EBRT) and brachytherapy (BT) are key elements for radical treatment. Oncological treatment delays have represented a major issue during the pandemic. Overall treatment time (OTT) is a well-known prognostic factor for CC. Thus, we decided to evaluate radiotherapy timing and modalities, and OTT trends for locally advanced cervical cancer (LACC) patients treated at our center during the Pandemic. Method(s): We retrospectively collected and analyzed data of patients treated for LACC at our Center, (Department of Oncology, Radiation Oncology, S.Anna Hospital, Turin, Italy), during the COVID-19 pandemic. Result(s): Between March 2020 and March 2022, 36 patients were treated. All patients underwent EBRT (median pelvic dose 48 Gray (Gy)). Concurrent chemotherapy (ChT) was administered in 31/36 patients. High Dose Rate (HDR) BT boost was delivered to 32/36 patients. BT schedules adopted were: 28 Gy in 4 fractions (18 cases, 56.2%), 26 Gy in 4 fractions (5 cases, 15.6%), 21 Gy in 3 fractions (4 cases, 12.5%), 18 Gy in 3 fractions (3 cases, 9.3%), 24 Gy in 4 fractions (one case, 3.2%), 12 Gy in 2 fractions plus 11 Gy in 2 fractions (one case, 3.2%). Most of the patients (25/32, 78.1%) received one fraction per week;6 patients (18.1%) 2 fractions per week and one patient 3 fractions per week. Median OTT was 74 days (57-99). The median interval from EBRT to HDR-BT was 14 days (6-54). Four patients tested positive for COVID-19 between EBRT and BT. At a median follow-up of 10.7 months (range 1.8-20.3), a complete response was obtained in 25 patients (69.5%), a partial response in 8 cases (22.2%), and a disease progression in two patients (5.5%). Conclusion(s): in terms of radiotherapy management of LACC, brachytherapy resulted as the most affected by the restrictions due to the pandemic. We adopted different schedules and fractionations to optimize the resources available and to keep providing an optimal care. A be-weekly fractionation emerged as a promising option for LACC during the pandemic, with a good toxicity profile. Copyright: © 2022 The Author(s).

19.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128176

ABSTRACT

Background: Cerebral venous thrombosis (CVT) is a major cause of stroke in young adults. Is more frequent in women, it may appear related to pregnancy or the use of hormonal contraceptives. Its symptoms are nonspecific, often with a normal neurological examination. Its diagnosis is based on imaging tests and in most cases, if treatment is started early, the prognosis may be favorable. Aim(s): Describe the characteristics of CVT in patients that we have had in our clinic. Method(s): We compiled data from patients with CVT followed up in our hemostasis consultation in the last 6 years. Patient data were collected through hospital medical records. Result(s): We have a series of 15 cases, most of them women (73.3%). The average age of the series is 38.6 years (range from newborn to 64 years). The most frequent symptoms were epileptic seizures in 40% and headache in 33.3%. In 45.5% of women, CVT was related to pregnancy or the puerperium, and in 27.3% of the women it was associated with taking oral contraceptives. Thrombophilia (genetic or acquired) has been found to be involved in 33.3% of cases. The remaining cases were associated with breast cancer (1), trauma (1), severe anemia (1), and SARS-CoV vaccines (1). In two cases (13.3%) decompressive neurosurgery was required. In two cases (13,3%), direct oral anticoagulant (apixaban and dabigatran) were used. In 60% of cases anticonvulsant treatment was associated. In 40% of cases, the evolution was very favorable without sequelae, recurrent headache was found in 53,3% of cases. Conclusion(s): CVT is a rare but important cause of stroke in young adults. CVT it is not easy to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations and interpret correct brain imaging. We must keep it in mind to avoid delay in diagnosis and treatment. (Table Presented).

20.
Tumori ; 108(4 Supplement):135-136, 2022.
Article in English | EMBASE | ID: covidwho-2114868

ABSTRACT

Background: Studies evaluating COVID-19 in cancer patients beyond the effects of the infection itself are generally from single institutions, voluntary surveillance registries, or surveys. To extend the limited evidence available, we analyzed both the incidence and one-year mortality of breast cancer (BC) female patients at a population level in Lombardy, the first Italian region affected by the pandemic and the most populous one. Method(s): The regional COVID-19 database, including all SARS-CoV2 cases based on a positive swab result, was integrated with the Regional Health Information System, collecting data from 10 million habitants on primary medical care;hospitalization;pharmaceuticals;and survival status. From the database, we extracted data of newly-diagnosed not previously treated BC patients, including patient characteristics and comorbidities (respiratory insufficiency, diabetes, chronic kidney disease, cerebral vasculopathy, hypertension and cardiovascular disease), BC stage, and treatment. Result(s): The study population consisted of 12912 newlydiagnosed/ not previously treated BC patients, 7349 in 2019 and 5563 in 2020. There were two drops of newly diagnosed cases, one in the first wave (March-May 2020;-37.2%), the other in the second wave (October-December 2020;-15.8%). No major differences were found between characteristics of cases occurring in 2019 and 2020;with the exception of a reduced use of both chemotherapy (86.2% vs 53.4%) and radiotherapy (65.7% vs 42.1%) in 2020. One-year overall survival was 97.6% in 2020 vs 98.3% in 2019, Hazard Ratio [HR] (95% Confidence Interval [95%CI]): 1.51 (1.18-1.93);p=0.0010 at univariate analysis;HR 0.91 (0.71-1.17), p= 0.47, after adjusting for age, stage, BC treatment and comorbidities at multivariable analysis. COVID-19 occurred in 250 of 5563 (4.5%) newly-diagnosed BC cases in 2020. Notably, the time-dependent COVID-19 effect was significantly associated with mortality (multivariable Cox analysis HR 2.25 (1.35-3.74);p=0.0018) even after adjusting for age, stage, treatment and comorbidities. Conclusion(s): Breast cancer incidence and survival were both reduced in 2020, and COVID-19 was an independent predictor of death in BC patients. While follow-up is ongoing to assess long sequelae of COVID-19, these results encourage prevention of infection regardless of BC stage;and at the same time warn against suboptimal treatment and overlooking new diagnoses to ensure a favourable prognostic outcome.

SELECTION OF CITATIONS
SEARCH DETAIL