Localized early-stage extra-nodal marginal zone lymphoma (MZL) presents with heterogeneous organ involvement and is treated with various modalities, including resection, radiotherapy, and systemic ...therapy. We report the long-term outcome of a large cohort of extra-nodal MZL and assess the impact of patient and disease characteristics, organ site, and treatment strategy on disease control and survival.
We identified 487 consecutive patients with stage IE or IIE MZL referred between 1992 and 2012 to Memorial Sloan Kettering Cancer Center. Pathology was reviewed by hematopathologists at our institution. Patient and disease factors as well as treatment types were analyzed for association with relapse-free survival, overall survival, and cumulative incidence of relapse.
Median follow-up after treatment was 4.7 years. Five-year relapse-free survival and overall survival were 60% and 89%, respectively. Cumulative incidence of disease-specific death at 5 years was 1.3%. Radiotherapy alone was the initial treatment in 50% of patients, followed by surgical resection (30%), observation (8%), immunotherapy (4%), and chemotherapy (2%). Initial treatment type, primary disease site, and number of involved sites were significant factors in multivariable analysis of relapse (all P < 0.05). When compared with stomach, MZL originating in other disease sites (HR > 2.0, P ≤ 0.001), except for thyroid, had higher risk of relapse. Strategies such as antibiotics or topical therapies were associated with higher risk of relapse when compared with radiation therapy (P < 0.001). Crude rate of transformation to pathologically confirmed large-cell lymphoma was 2% (11 patients).
Overall and cause-specific survival are high in early-stage extra-nodal MZL. Curative-intent treatment led to fewer relapses and reduced the need for salvage. Stomach cases had lower risk of relapse than other anatomic primary sites. This study supports the use of local therapies to treat stage IE and IIE MZL.
Background: We previously correlated non-Hodgkin's lymphoma (NHL) histology with 18fluoro-2-deoxyglucose–positron emission tomography (FDG–PET) intensity: a standardized uptake value (SUV) >10 ...predicted aggressive lymphoma with >80% certainty and an SUV >13, with >90% certainty. Patients and methods: To evaluate SUV in transformed lymphoma, we identified all FDG–PET scans for NHL at Memorial Sloan-Kettering Cancer 1999–2007 with (i) biopsy-proven transformation, (ii) no therapy 60 days before PET scan and (iii) FDG–PET scans no more than 60 days before or 90 days after transformation. Results: In 5 of 40 patients, the biopsy site was excised before PET; in two, only marrow was biopsied. In the remaining 33 patients, the SUV of the biopsy site ranged from 3 to 38, mean 14, median 12. Eighteen of 33 biopsies (55%) had an SUV >10 and 16 (48%) >13. The highest SUV in a transformed lymphoma PET scan (SUVstudy-max) ranged from 3.2 to 40, mean 15, median 12. Twenty-five of 40 patients (63%) presented with an SUVstudy-max >10 and 20 (50%) >13. Conclusions: Like de novo aggressive lymphomas, the majority of transformations have a high SUVstudy-max for a given pretreatment staging study, although many do not have very high values. Transformation should be suspected in indolent lymphoma with high SUVs on FDG–PET. Biopsies should be directed to the site of greatest FDG avidity.
Patients with the most common aggressive AIDS-related non-Hodgkin lymphomas can expect improved outcomes approaching those of immunocompetent patients in the contemporary era. When treated with ...appropriate antilymphoma therapy, these improvements apply to every subgroup of patients, including those with low CD4 counts and high-risk disease.
We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades.
We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression-free survival, and overall survival (OS) in different eras: pre-cART (1989–1995), early cART (1996–2000), recent cART (2001–2004), and contemporary cART era (2005–2010).
Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm3) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era.
Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDS-related lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.
Many living organisms contain biominerals and composites with finely tuned properties, reflecting a remarkable level of control over the nucleation, growth and shape of the constituent crystals. ...Peptides and proteins play an important role in achieving this control. But the general view that organic molecules affect mineralization through stereochemical recognition, where geometrical and chemical constraints dictate their binding to a mineral, seems difficult to reconcile with a mechanistic understanding, where crystallization is controlled by thermodynamic and kinetic factors. Indeed, traditional crystal growth models emphasize the inhibiting effect of so-called 'modifiers' on surface-step growth, rather than stereochemical matching to newly expressed crystal facets. Here we report in situ atomic force microscope observations and molecular modelling studies of calcite growth in the presence of chiral amino acids that reconcile these two seemingly divergent views. We find that enantiomer-specific binding of the amino acids to those surface-step edges that offer the best geometric and chemical fit changes the step-edge free energies, which in turn results in macroscopic crystal shape modifications. Our results emphasize that the mechanism underlying crystal modification through organic molecules is best understood by considering both stereochemical recognition and the effects of binding on the interfacial energies of the growing crystal.
Minimal residual disease (MRD) monitoring has been used to identify early molecular relapse and predict clinical relapse in mantle cell lymphoma (MCL). Few published data exist in MCL on the ...performance of next-generation sequencing–based assay of immunoglobulin gene rearrangements for MRD assessment.
In a prospective clinical trial (NCT01484093) with intensive induction chemotherapy and autologous stem-cell transplantation, posttreatment peripheral blood samples were collected from 16 MCL patients and analyzed with an earlier version of the Adaptive Biotechnologies MRD assay.
Of the 7 patients whose disease remained in remission, the MRD test remained negative in 5 (71%). Of the 9 patients who experienced relapse, the MRD test was positive at least 3 months before relapse in 6 patients (67%) and positive at the time of relapse in 1 patient (11%). All patients with at least 2 positive MRD tests experienced relapse.
The next-generation sequencing–based MRD assay identified early molecular relapse, and we observed more sensitivity in the cellular (circulating leukocytes) versus acellular (plasma cell-free DNA) compartment. This observation may be due to availability of tumor target or a limitation of the assay.
Limited information exists in mantle cell lymphoma (MCL) on the performance of next-generation sequencing–based assay of immunoglobulin gene rearrangements for minimal residual disease (MRD) assessment. Posttreatment peripheral blood samples were collected from 16 MCL patients and analyzed with the Adaptive Biotechnologies MRD assay, which identified early molecular relapse. We observed more sensitivity in the cellular versus acellular compartment.
Purpose
The objective of this study was to assess the knowledge of dentists, dental hygienists and dental students regarding the Israeli Ministry of Health guidelines for using fluoridated ...toothpaste.
Materials and methods
An anonymous questionnaire was distributed to dentists, dental hygienists, and dental students in their final years at the Hebrew University-Hadassah School of Dental Medicine. Participants were queried regarding their knowledge of Ministry of Health fluoride concentration guidelines in toothpaste by the following age categories: under 2 years, 2–6 years, and above 6 years.
Results
Thirty-two paediatric dentists (specialists and residents), 63 general dentists, 68 dental hygienists, and 69 students responded to the survey. Analysis of survey respondent’s knowledge of Ministry of Health fluoride toothpaste guidelines by age group found that 81%, 75% and 88% of participants selected a fluoride concentration within the recommended range for those under 2 years, 2–6 years and greater than 6 years, respectively. Only 58% of respondents were aware of the recommended fluoride concentration for all three age groups. Among respondents who answered all three questions, there was a significant association between correctly answering the fluoride questions and respondent’s profession (
P
= 0.026), with a larger percentage of paediatric dentist (76%) and dental students (66%) correctly answering all three questions.
Conclusions
Israeli dental practitioners should be educated about the Israeli Ministry of Health fluoride concentrations in toothpaste guidelines. The guidelines should be emphasised at annual meetings and in continuing education courses.
Aim
This survey assessed the attitude of paediatric dental EAPD members toward using “knee-to-knee” positioning for dental examinations and minor procedures in infants and toddlers.
Methods
An ...anonymous electronic online questionnaire was distributed among EAPD members. The survey consisted of 12 questions and assessed demographic characteristics, professional experience and attitudes toward the use of the “knee-to-knee” position.
Results
Of the 162 respondents, 148 (91%) reported using “knee-to-knee” positioning for dental examination. In addition, 97 (63%) reported performing other procedures in the “knee-to-knee” position. Fluoride application and oral hygiene instructions were the most common procedures performed in the “knee-to-knee” position.
Conclusions
Most of the paediatric dentists who responded to this survey reported performing dental examinations in toddlers up to 2 years old using the “knee-to-knee” position. Majority of respondents also used this position to instruct parents regarding oral hygiene and to apply fluoride varnish.
Ultralow density polymers, metals, and ceramic nanofoams are valued for their high strength-to-weight ratio, high surface area, and insulating properties ascribed to their structural geometry. We ...obtain the labrynthine internal structure of a tantalum oxide nanofoam by x-ray diffractive imaging. Finite-element analysis from the structure reveals mechanical properties consistent with bulk samples and with a diffusion-limited cluster aggregation model, while excess mass on the nodes discounts the dangling fragments hypothesis of percolation theory.
Xanthogranuloma of the Eyelid: A Case Report Ramirez Marquez, Estefania; Ayala Rodríguez, Sofía C; De Jesús Rodríguez, Edgar ...
Curēus,
07/2023, Volume:
15, Issue:
7
Journal Article
Peer reviewed
Open access
We report on the case of a Hispanic woman with necrobiotic xanthogranuloma (NBX) whose disease was managed based on her symptoms. She underwent a diagnostic and debulking surgical intervention and ...surveillance for hematologic malignancy. This 56-year-old patient presented with a six-year history of enlarging masses and swelling around her eyes, with intermittent inflammation, associated pain, and occasional redness. Her past medical history was remarkable for asthma and nasal polyps. Upon external examination, she had severe fullness of the upper lids with yellow plaques and palpable masses along them, nontender palpation, the absence of visible erythema, and blepharoptosis in both eyes. The patient presented with bilateral visual field constriction due to mechanical obstruction. An orbital computed tomography scan revealed a dense diffuse lesion involving the pre- and postseptal tissues and invading the orbit of the right eye. A facial magnetic resonance imaging scan revealed infiltration of the postseptal spaces within both orbits. A skin and soft tissue biopsy from the bilateral periorbital regions of both eyes confirmed the diagnosis of NBX. A workup for underlying hematologic malignancies, including plasma cell dyscrasias and lymphoproliferative disorders, was unremarkable. The patient underwent diagnostic and debulking surgery in an attempt to improve her visual function. Subsequently, she was scheduled for ongoing monitoring of her disease progression.
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