The Outcome of Autologous Hematopoietic Cell Transplantation in Elderly Patients with Aggressive Non-Hodgkin Lymphoma

Introduction: High-dose chemotherapy followed by autologous hematopoietic cell transplantation (AHCT) may provide survival benefit in patients with non-hodgkin lymphoma (NHL). Retrospective analyses suggest that the benefit of HDT extends to elderly patients with NHL, which is an important finding considering that the median age at diagnosis is 67 years (range: 65-74) for NHL in United States, using 2010-2014 US SEER data. We aimed to define the efficacy and toxicity of AHCT in patients >60 years with NHL. Patients and Methods: From January 2005 through January 2021, data from 36 patients with aggressive NHL above 60 years of age who were eligible for AHCT according to geriatric assessment (GA) were evaluated. Their diagnoses were as following; 21 diffuse large B cell lymphoma (primary refractory or relapsed disease), 11 mantle cell lymphoma (first complete remission), 2 follicular lymphoma, 1 peripheral T cell lymphoma and 1 anaplastic large cell lymphoma. We compared the toxicity profile and outcome between the research group: patient aged 60 years and above and the control group: patient <60 years. Results: All of the patients were stage III or IV at diagnosis; ten out of 36 elderly patients had active disease at the time of AHCT. The median follow-up was 20.5 months (range, 1-60 mos). Prior to transplantation majority (85%) of the elderly patients received BEAM protocol as conditioning treatment. Bone marrow stem cell was used in only 1 patient None of the patient had mobilization failure, the median peripheral CD34 level was 5.24x10 6/kg. Forty-eight percent of the patients experienced grade 3-4 mucositis and 77% of the patients had microbiology-documented infection. Sixty-two percent of the patients had diarrhea with median duration of 8 days (range, 5-20 days). Renal toxicity was occurred in 7 (27%) patients while hepatic toxicity in 1(10%) patients. Median time to neutrophil recovery was 10 days (range, 8-18 days) and platelet recovery 11 days (range, 10-32 days). Overall response was obtained from all patients (23% CR). At the time of data collection, 7 patients (19.4%) of patients' ≥ 60 years have deceased. Relapse (n=3) was the main course of death. The probability of 4-year progression free survival (PFS) and estimated overall survival (OS) in elderly patients were 44.4% and 39.4%, respectively. Conclusion: Based on this single center study, AHCT is safe and efficacious in the treatment of elderly lymphoma patients. We emphasize the need for further research in order to determine the risk-benefit threshold for stem cell transplantation based on age coupled with comorbidity and fragility. Disclosures Özcan: Bayer: Research Funding; Archigen: Research Funding; Amgen: Honoraria, Other: Travel/Accommodations/Expenses; Janssen: Other: Travel/Accommodations/Expenses, Research Funding; Roche: Other: Travel/Accommodations/Expenses, Research Funding; Celgene: Research Funding; MSD: Research Funding; Abbvie: Other: Travel/Accommodations/Expenses, Research Funding; AstraZeneca: Research Funding; Takeda: Honoraria, Other: Travel/Accommodations/Expenses, Research Funding; Pfizer: Research Funding; BMS: Other: Travel/Accommodations/Expenses; Jazz: Other: Travel/Accommodations/Expenses; Sanofi: Other: Travel/Accommodations/Expenses; Abdi Ibrahim: Other: Travel/Accommodations/Expenses. Beksac: Amgen,Celgene,Janssen,Takeda,Oncopeptides,Sanofi: Consultancy, Speakers Bureau.

A pilot study of clinical cell therapy for patients with vascular dementia

Background:Vascular dementia (VD) is a series of clinical and neurophysiological manifestations caused by cerebrovascular disease. As the human lifespan increases, the number of people affected by age-related dementia is growing at an alarming pace, but no proved therapeutic methods can stop it from getting worse.Objective:To investigate the neurorestorative effects of injecting olfactory ensheathing cells (OECs), Schwann cells (SCs), and olfactory receptor neurons (ORNs) into olfactory sub-mucosa in VD patients.Methods:A pilot study of double-blind randomized controlled cell therapies was conducted in VD patients (n = 5). Cells were injected into the patients’ olfactory sub-mucosa. Two patients received OEC treatment, one received SC treatment, one ORN treatment, and one OEC combined with ORN. Mental state and cognitive function were observed before treatment and 1, 3, 6, and 12 months after treatment. magnetic resonance imaging (MRI) or computed tomography (CT) was performed before treatment and 12 months after treatment.Results:The directional function score on the Mini-Mental Status Examination (MMSE) in the patient who received SC treatment had increased slightly 1 and 3 months after treatment. The scores for orientation, attention, delayed verbal recall, and repetition increased in the ORN group patient 1 month after treatment. The orientation and repetition scores of the ORN group patient continued to increase 3 months after treatment. The scores for attention, delayed verbal recall, and phase 3 command decreased in the OEC and the OEC + ORN group patients after treatment assessment Scores on the Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating (CDR) scale also improved in the ORN group patient. Clinical and MRI or CT examinations did not find any side effects from the cell therapy or transplanting procedure.Conclusion:All of the cell transplantations were found to be safe. ORN was shown to be a promising therapy for VD patients. Phase II clinical trials of ORN, SC, and OEC therapy are required to verify their effects on VD symptoms, especially ORNs.

Suitable Diagnosis and Treatment of Esophageal Ruptures in Cases of Non-Boerhaave Syndrome: A Comparison With Boerhaave Syndrome

Boerhaave syndrome (BS) is frequently reported in cases of esophageal perforation; however, there are relatively few studies on non–Boerhaave syndrome (nBS). This study clarifies the appropriate diagnosis and treatment for patients with nBS among those with esophageal ruptures. Twelve patients with esophageal ruptures who underwent surgery at our department over 14 years were classified into 2 groups: 4 in the nBS group and 8 in the BS group. Patient characteristics, surgical methods, surgical outcomes, and complications were compared between the groups. The chief complaints varied between the groups. The nBS group had significantly higher preoperative C-reactive protein ( P = .007) and required 5 days (median) from onset to surgery. Moreover, the perforation diameter was significantly smaller in the nBS group than in the BS group ( P = .013). Suturing of the perforation site was performed during the initial surgery in 8 BS group patients (100%) and 1 nBS group patient (25%; P = .018). Only drainage was performed during the initial surgery for 3 nBS group patients (75%). The complications did not significantly differ between the groups ( P = 1.000), and no deaths were reported. The chief complaints of patients with nBS are diverse, and esophageal perforation should be cited as a differential diagnosis even in the absence of vomiting or chest pain symptoms. In the initial surgery for patients with nBS, the perforation site does not necessarily need to be closed. It is treatable by second-stage surgery or by natural closing.

Prospective Randomized Evaluation of High Power during CLOSE-guided Pulmonary Vein Isolation: The POWER-AF Study

Background - CLOSE-guided atrial fibrillation (AF) ablation is based on contiguous (inter-tag distance ≤6mm), optimized (Ablation Index (AI) >550 anteriorly and >400 posteriorly) point-by-point radiofrequency (RF) lesions. The optimal RF power remains unknown. Methods - The POWER-AF study is a prospective, randomized controlled monocentric study including patients with paroxysmal AF, planned for first CLOSE-guided PVI using a contact force RF catheter (Thermocool SmartTouch®, Biosense Webster Inc., Irvine, CA, USA). A total of 100 patients were randomized into two groups (1:1). The control group received AF ablation using the standard CLOSE protocol (35W), while in the experimental group PVI was performed using high power (45W). Endoscopic evaluation was performed in patients with intraesophageal temperature rise >38.5°C. Results -The resulting sample size was 96 (48+48) patients. In the high power group, shorter procedure time (80min vs. 102min, p<0.001), shorter total RF application time [16min vs. 26min (p<0.001)] and RF time per application [26 vs. 37s anteriorly, p<0.001 and 13 vs. 17s posteriorly, p<0.001] were observed. Endoscopic evaluation (performed in 19/48 vs. 25/48 patients respectively, p=0.31) showed an ulcerative perforation in a high power group patient (treated by endoscopic stenting and normalization after ~4months) and a superficial ulcerative lesion in a control group patient (conservative treatment). Both occurred following excessive AI applications (up to 460 and 480 resp.) with excessive contact force (30g on average, with peaks up to 50g). Six-months AF recurrence was not significantly different (10% in High Power vs. 8% in Control, p=0.74). Conclusions -This randomized controlled study shows that a 45W RF-power CLOSE-protocol in paroxysmal AF patients significantly increases the global procedural efficiency with similar mid-term efficacy. However, our study showed a narrower safety margin and a limited increased efficiency at the posterior wall using high power. This advocates against the use of high power in the region neighboring theesophagus.

A fatal, rare case of bilateral, upper, lower limbs and abdominal gangrene associated with brucellosis

Brucellosis distributed worldwide is a classical zoonotic disease. Complications associated with gangrene are quite uncommon and may or might not occur during the course of the disease. Here, we report a pediatric age group patient who presented with fever and gangrene over the upper and lower limbs and abdomen associated with brucellosis.