Evaluation of Disease Risk Comorbidity Index after Allogeneic Stem Cell Transplantation in a Cohort with Patients Undergoing Transplantation with In Vitro Partially T Cell Depleted Grafts.

Outcomes of hematopoietic stem cell transplantation (HSCT) are influenced by comorbidities, disease type, and status at transplantation. Several prognostic scores can be used, such as the disease risk index (DRI) or the hematopoietic cell transplantation-specific comorbidity index (HCT-CI). Recently, a new prognostic tool, the disease risk comorbidity index (DRCI), combining the DRI and the HCT-CI, was published. The DRCI determines 6 patient groups (very low risk [VLR], low risk [LR], intermediate risk 1 [IR-1], intermediate risk 2 [IR-2], high risk [HiR], and very high risk [VHR]) with a significant predictive value for overall survival (OS), disease-free survival (DFS), relapse incidence (RI), and graft-versus-host disease-free/relapse-free survival (GRFS). However, the DRCI has not been evaluated for patients allografted with partially in vitro T cell depleted (pTDEP) grafts. In our center, we offer pTDEP to reduce graft-versus-host disease for patients in complete remission at transplant time. In this retrospective study, we investigated the DRCI in 404 adult patients (including 37.6% pTDEP) undergoing a first HSCT for hematological malignancies from 2008 to 2018. Because of the small number of patients in LR, VLR and LR were combined for analysis. In the entire cohort, 2-year OS was 84.4% (95% CI, 71.6% to 97.2%) for LR, 61.6% (54.8% to 68.4%) for IR-1, 45.7% (33.3% to 58.1%) for IR-2, 31% (19.4% to 42.6%) for HiR, and 30.9% (14.5% to 47.3%) for VHR (P < .001). In addition, the DRCI was predictive of DFS, RI, and GRFS but not of nonrelapsed mortality and graft-versus-host disease. Our study confirms similar results with the original publication but gives less accurate prognosis information than the DRI and HCT-CI when used separately. In conclusion, the DRCI does not seem to offer more relevant information than the DRI and HCT-CI to help physicians and patients for the HSCT decision.

Improved localization of implanted subdural electrode contacts on magnetic resonance imaging with an elastic image fusion algorithm in an invasive electroencephalography recording.

BACKGROUND: Accurate projection of implanted subdural electrode contacts in presurgical evaluation of pharmacoresistant epilepsy cases by invasive electroencephalography is highly relevant. Linear fusion of computed tomography and magnetic resonance images may display the contacts in the wrong position as a result of brain shift effects. OBJECTIVE: A retrospective study in 5 patients with pharmacoresistant epilepsy was performed to evaluate whether an elastic image fusion algorithm can provide a more accurate projection of the electrode contacts on the preimplantation magnetic resonance images compared with linear fusion. METHODS: An automated elastic image fusion algorithm (AEF), a guided elastic image fusion algorithm (GEF), and a standard linear fusion algorithm were used on preoperative magnetic resonance images and postimplantation computed tomography scans. Vertical correction of virtual contact positions, total virtual contact shift, corrections of midline shift, and brain shifts caused by pneumocephalus were measured. RESULTS: Both AEF and GEF worked well with all 5 cases. An average midline shift of 1.7 mm (SD, 1.25 mm) was corrected to 0.4 mm (SD, 0.8 mm) after AEF and to 0.0 mm (SD, 0 mm) after GEF. Median virtual distances between contacts and cortical surface were corrected by a significant amount, from 2.3 mm after linear fusion algorithm to 0.0 mm after AEF and GEF (P < .001). Mean total relative corrections of 3.1 mm (SD, 1.85 mm) after AEF and 3.0 mm (SD, 1.77 mm) after GEF were achieved. The tested version of GEF did not achieve a satisfying virtual correction of pneumocephalus. CONCLUSION: The technique provided a clear improvement in fusion of preimplantation and postimplantation scans, although the accuracy is difficult to evaluate.