Molecular and Clinical Characteristics of Different Toxicity Rates in Anti-CD19 Chimeric Antigen Receptor T Cells: Real-World Experience.

Commercially available anti-CD19 chimeric antigen receptor T cells (CARΤ cells) have offered long-term survival to a constantly expanding patient population. Given that novel toxicities including cytokine release syndrome (CRS) and neurotoxicity (ICANS) have been observed, we aimed to document the safety and toxicity of this treatment in a real-world study. We enrolled 31 adult patients referred to our center for CAR T therapy. Tisagenlecleucel was infused in 12 patients, axicabtagene ciloleucel in 14, and brexucabtagene autoleucel in 5. Cytokine release syndrome was noted in 26 patients while neurotoxicity was observed in 7. Tocilizumab was administered for CRS in 18 patients, along with short-term, low-dose steroid administration in one patient who developed grade III CRS and, subsequently, grade I ICANS. High-dose steroids, along with anakinra and siltuximab, were administered in only two MCL patients. With a median follow-up time of 13.4 months, nine patients were then in CR. The progression-free (PFS) and overall survival (OS) rates were 41.2% and 88.1% at one year, respectively. MCL diagnosis, which coincides with the administration of brexucabtagene autoleucel, was the only factor to be independently associated with poor OS (p < 0.001); meanwhile, increased LDH independently predicted PFS (p = 0.027).In addition, CRP at day 14 was associated with a poor OS (p = 0.001). Therefore, our real-world experience confirmed that commercial CAR T therapy can be administered with minimal toxicity.

Microwave ablation of a solitary colorectal liver metastasis complicated by stomach perforation and gastrocutaneous fistula - a case report.

BACKGROUND: Organ perforation secondary to thermal ablation is a rare but severe complication that can occur in certain patients, in whom tissue dissection and preservation cannot be adequately achieved. CASE DESCRIPTION: A 69-year-old man presented with a gastrocutaneous fistula 20 days after a microwave ablation of liver metastases from colorectal cancer. Besides skin rash, local tenderness, and gastric content discharge from a wound where the probe had been placed, no other signs or symptoms were present. The patient was treated surgically, and a wedge-shaped gastric resection was performed. His postoperative course was uneventful. After 8 months, the patient underwent the same procedure for local progression of the same lesion, using a pulsed MW antenna and a dedicated hydrodissection needle, without complications. CONCLUSIONS: A gastrocutaneous fistula is a rare complication of microwave ablation. However, adequate hydrodissection can minimize the risk for the development of these complications. Proper treatment of these complications does not preclude repeated usage of microwave ablation in the future.

Laparoscopic repair of large inguinoscrotal hernias with combined use of plug and flat mesh.

BACKGROUND: This study's purpose was to examine the outcomes of the laparoscopic repair of large inguinoscrotal hernias with the combined use of a plug and flat mesh and to compare them to laparoscopic repair with the exclusive use of a flat mesh. CASE SERIES: Fifty male patients with large inguinoscrotal hernias underwent this procedure over two years. Twenty-five patients had a transabdominal preperitoneal (TAPP) hernia repair with the combined use of a plug and flat mesh, and 25 patients had TAPP repair using a flat mesh only. The novelty of this technique lies in the fact that after complete dissection of the hernia sack, a plug mesh is placed reversely, and its top edge is anchored onto the lower edge of the inguinal ligament with a standard fixation device. Next, a flat mesh is fixated, and the two meshes are sutured together with polypropylene sutures to form one combined mesh. One hernia recurrence was recorded during the follow-up period after the combined use of the plug and flat mesh. One patient developed a scrotal hematoma which was treated conservatively. CONCLUSIONS: The laparoscopic repair of large inguinoscrotal hernias with the combined use of a plug and flat mesh is a safe and effective technique with excellent short-term outcomes. It is a simple modification of the standard TAPP procedure. The recurrence rate of large inguinoscrotal hernias is also believed to be reduced. HIPPOKRATIA 2021, 25 (1):38-41.