Citations

SummaryPre‐existing central nervous system (CNS) involvement may influence referral for autologous haematopoietic cell transplantation (AHCT) for patients with non‐Hodgkin lymphoma (NHL). The outcomes of 151 adult patients with NHL with prior secondary CNS involvement (CNS+) receiving an AHCT were compared to 4688 patients without prior CNS lymphoma (CNS−). There were significant baseline differences between the cohorts. CNS+ patients were more likely to be younger, have lower performance scores, higher age‐adjusted international prognostic index scores, more advanced disease stage at diagnosis, more aggressive histology, more sites of extranodal disease, and a shorter interval between diagnosis and AHCT. However, no statistically significant differences were identified between the two groups by analysis of progression‐free survival (PFS) and overall survival (OS) at 5 years. A matched pair comparison of the CNS+ group with a subset of CNS− patients matched on propensity score also showed no differences in outcomes. Patients with active CNS lymphoma at the time of AHCT (n = 55) had a higher relapse rate and diminished PFS and OS compared with patients whose CNS lymphoma was in remission (n = 96) at the time of AHCT. CNS+ patients can achieve excellent long‐term outcomes with AHCT. Active CNS lymphoma at transplant confers a worse prognosis.

Mini‐AbstractWe present a case of a 25‐year‐old man with aortic regurgitation secondary to infective endocarditis. A preoperative transesophageal echocardiography demonstrated an abnormal aortic valve with possible vegetation or torn leaflet with severe aortic regurgitation, markedly dilated left coronary arteries, and a fistulous communication between the circumflex artery and the coronary sinus. The aortic valve was repaired and the coronary sinus arteriovenous fistula was ligated. At 1‐year follow‐up, there was no evidence of recurrent arteriovenous fistula or aortic regurgitation.

Mini‐AbstractWe present a case of a 76‐year‐old woman with new‐onset atrial flutter who underwent transesophageal echocardiography, which demonstrated a large left atrial mass consistent with myxoma and a “shimmering” mobile mass on the aortic side of the right coronary cusp, with fronds consistent with a papillary fibroelastoma. Such concurrent primary cardiac tumors of different histology are a rare occurence.

Abstract The best conditioning regimen before allogeneic transplantation for high-risk diffuse large B-cell lymphoma (DLBCL) remains to be clarified. We analyzed data from 396 recipients of allotransplants for DLBCL receiving myeloablative (MAC; n = 165), reduced intensity (RIC; n = 143), or nonmyeloablative conditioning (NMAC; n = 88) regimens. Acute and chronic GVHD rates were similar across the groups. Five-year nonrelapse mortality (NRM) was higher in MAC than RIC and NMAC (56% vs 47% vs 36%; P = .007). Five-year relapse/progression was lower in MAC than in RIC/NMAC (26% vs 38% vs 40%; P = .031). Five-year progression-free survival (15%-25%) and overall survival (18%-26%) did not differ significantly between the cohorts. In multivariate analysis, NMAC and more recent transplant year were associated with lower NRM, whereas a lower Karnofsky performance score (< 90), prior relapse resistant to therapy, and use of unrelated donors were associated with higher NRM. NMAC transplants, no prior use of rituximab, and prior relapse resistant to therapy were associated with a greater risk of relapse/progression. In conclusion, allotransplantation with RIC or NMAC induces long-term progression-free survival in selected DLBCL patients with a lower risk of NRM but with higher risk of lymphoma progression or relapse.

Prostate cancer is the most common solid tumor in American men and is screened for using prostate-specific antigen (PSA) tests. We report on a nonstationary partially observable Markov decision process (POMDP) for prostate biopsy referral decisions. The core states are the patients' prostate cancer related health states, and PSA test results are the observations. Transition probabilities and rewards are inferred from the Mayo Clinic Radical Prostatectomy Registry and the medical literature. The objective of our model is to maximize expected quality-adjusted life years. We solve the POMDP model to obtain an age and belief (probability of having prostate cancer) dependent optimal biopsy referral policy. We also prove a number of structural properties including the existence of a control-limit type policy for the biopsy referral decision. Our empirical results demonstrate a nondecreasing belief threshold in age, and we provide sufficient conditions under which PSA screening should be discontinued for older patients. Finally, the benefits of screening under the optimal biopsy referral policy are estimated, and sensitivity analysis is used to prioritize the model parameters that would benefit from additional data collection.

Abstract Combinations of bortezomib (V) and dexamethasone (D) with either lenalidomide (R) or cyclophosphamide (C) have shown significant efficacy. This randomized phase 2 trial evaluated VDC, VDR, and VDCR in previously untreated multiple myeloma (MM). Patients received V 1.3 mg/m2 (days 1, 4, 8, 11) and D 40 mg (days 1, 8, 15), with either C 500 mg/m2 (days 1, 8) and R 15 mg (days 1-14; VDCR), R 25 mg (days 1-14; VDR), C 500 mg/m2 (days 1, 8; VDC) or C 500 mg/m2 (days 1, 8, 15; VDC-mod) in 3-week cycles (maximum 8 cycles), followed by maintenance with V 1.3 mg/m2 (days 1, 8, 15, 22) for four 6-week cycles (all arms) ≥ very good partial response was seen in 58%, 51%, 41%, and 53% (complete response rate of 25%, 24%, 22%, and 47%) of patients (VDCR, VDR, VCD, and VCD-mod, respectively); the corresponding 1-year progression-free survival was 86%, 83%, 93%, and 100%, respectively. Common adverse events included hematologic toxicities, peripheral neuropathy, fatigue, and gastrointestinal disturbances. All regimens were highly active and well tolerated in previously untreated MM, and, based on this trial, VDR and VCD-mod are preferred for clinical practice and further comparative testing. No substantial advantage was noted with VDCR over the 3-drug combinations. This trial is registered at www.clinicaltrials.gov (NCT00507442).