Hashmi, S.

Background Chronic graft versus host disease (cGVHD) is a complex post-transplant complication resulting in varying degrees of musculoskeletal (MSK) manifestations, including sclerosis-type skin conditions, fasciitis, and osteopenia, avascular necrosis affecting the shoulder, elbow and hands apart from other joints of the body. A large proportion of these can often miss out on the expertise of upper limb therapists. Study Objectives This paper aims to outline upper limb cGVHD manifestations to raise awareness among upper limb physiotherapists and rehabilitation specialists, so that patients can receive more focused, optimal care. Methods An electronic search was conducted across a wide database covering the period from 1990 to 2025. Further manual search used Google Scholar to help identify relevant articles. Boolean operators ‘AND’ and ‘OR’ combined keywords such as chronic graft versus host disease, acute graft versus host disease, allogenic hematopoietic stem cell transplantation, hematopoietic cell transplantation, stem cell transplant, bone marrow transplant, physiotherapy, upper limb specialist, musculoskeletal, fasciitis, and scleroderma. Results A total of 4,393 titles were screened against the pre-set inclusion and exclusion criteria, and only 3 articles were found to be suitable for this narrative review. All 3 articles were case studies of upper limb cGVHD and rehabilitation reporting positive outcomes on patients’ upper and lower limb range of motion, function, and quality of life (QoL). Conclusion cGVHD can cause various MSK issues, especially in the upper limbs. It is important to collaborate with upper limb physiotherapy and occupational therapy experts to improve awareness and patient outcomes.

4606 Background: Preclinical studies have indicated that TP is one of the most useful markers of tumor response to capecitabine; with elevated TP expression resulting in higher intratumor levels of 5-FU. TP level in the tumor may be associated directly with survival and may be up-regulated by XRT. Methods: Twenty patients (pts) who had newly diagnosed locally advanced pancreatic cancer, age ≥ 19 years, ECOG PS 0–2, and adequate organ function received 50.4 Gy XRT with capecitabine 1,600 mg/m2 M-F x 6 wks determined from our phase I study (JCO, Dec 2005). Following capecitabine-XRT, stable and responding pts received capecitabine 2,000mg/m2 x 14 days every 3 wks till progression. Restaging was performed every 9 wks. Tumor specimens were procured with EUS-FNA prior and week 2 after starting capecitabine-XRT to evaluate TP mRNA levels by RT-PCR. Results: TP levels were elevated post-XRT when compared to pre-XRT TP (p= 0.01). Each of the 20 pts had at least one observation of TP. Mean TP level of each pt was obtained by averaging the pre-XRT and post-XRT TP levels. If one value was missing, then the other value was used for the mean TP level. Mean TP level was significantly associated with survival using the Cox proportional hazards model (p= 0.0072). Pts were separated into two groups - those with high baseline TP level and those with lower TP level with a cut off value of 213.85 using median of mean TP level. It was observed that group with higher TP levels had better survival as compared to the group with lower TP levels. However, the survival curves of these two groups crossed over after 18 months. Conclusions: Our study suggests that the higher the TP level in tumor post-XRT, the better the survival. This is most probably due to a higher accumulation of 5-FU in tumor due to up-regulation of TP. Possible explanation for the two groups crossing over after 18 months may include heterogeneity in TP due to a difference in pharmacogenomics or idiosyncratic drug toxicity profile of capecitabine. Further studies of long-term effects of treatment with a larger number of pts are needed to study exact effects of capecitabine and XRT, and to evaluate the differential role of TP with survival. [Table: see text]