The evolution of mature cystic teratomas of the ovary into squamous cell carcinoma: two case reports and review of the literature.

Mature Cystic Teratomas (MCT) of the ovary or Dermoid Cysts are common benign tumours found in 10-20% of women. However, 0.2-2% of those cysts underwent malignant transformation. Squamous Cell Carcinoma (SCC) is the most frequent histological type reported in the literature.As 2021, there are limited reports of malignant tumours arising from MCT with no guidelines related to the management of these atypical cases. Herein, we describe two cases of MCT that evolved into SCC with different stages and prognosis and we review the current literature to date highlighting the potential risk of malignant transformation of these considered benign cysts and the need for strong evidence protocols for staging and treatment of this atypical entity.IMPACT STATEMENTWhat is already known on this subject? Mature Cystic Teratomas are found in 10-20% of women. However, a malignant behavior is observed in 2% of cases.What do the results of this study add? Our paper will describe two cases of malignant transformation of dermoid cyst in an effort to highlight the possible malignant risk of this entity and the need for specific management guidelines.What are the implications of these findings for clinical practice and/or further research? The prognosis of this converted cyst is very poor. By elaborating a standard management protocol for this tumour and operating every large cyst (>10 cm) in postmenopausal women, we may prevent this event.

Humoral and cellular responses after a third dose of SARS-CoV-2 BNT162b2 vaccine in patients with lymphoid malignancies.

Patients with hematological malignancies have impaired immune response after two doses of BNT162b2 (Pfizer/BioNTech) vaccine against SARS-CoV-2. Here, in this observational study (registration number HDH F20210324145532), we measure SARS-CoV-2 anti-Spike antibodies, neutralizing antibodies and T-cell responses after immune stimulation with a third dose (D3) of the same vaccine in patients with chronic lymphocytic leukemia (n = 13), B cell non-Hodgkin lymphoma (n = 14), and multiple myeloma (n = 16)). No unexpected novel side effects are reported. Among 25 patients with positive anti-S titers before D3, 23 (92%) patients increase their anti-S and neutralizing antibody titer after D3. All 18 (42%) initially seronegative patients remain negative. D3 increases the median IFN-γ secretion in the whole cohort and induces IFN-γ secretion in a fraction of seronegative patients. Our data thus support the use of a third vaccine dose amongst patients with lymphoid malignancies, even though some of them will still have vaccine failure.

Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position article.

Taking into account higher risk of severe coronavirus disease 2019 or death among patients with cancer, as well as impaired immunogenicity after anti-SARS-CoV-2 vaccines, in addition to waning immunity, booster dosing appears mandatory in this patient population. This review sought to provide reasonable evidence so as to assist oncologists in their daily practice, helping them decide when an anti-SARS-Cov2 antibody (Ab) dosage should be scheduled after a full two-dose vaccination and, if necessary, propose an early third dose (D3). Such D3 could apply to non-responder patients with anti-Spike (S) Abs titres <40 binding Ab unit (BAU)/mL. For lowresponder patients with anti-S Ab titres between 40 BAU/mL and 100/260 BAU/mL (suggested area of uncertainty), an early D3 may similarly be proposed. Nevertheless, this D3 could be administered in a less urgent manner, taking into account associated comorbidities and regional epidemic incidence rates. This latter strategy may comprise a monthly dosage of anti-S titres so as to better assess the kinetics of waning immunity. For responder patients with anti-S titres above 260 BAU/mL, we suggest to follow the recommendations outlined for the general population. Given this context, patients with anti-S titres above 1000 BAU/mL should be given the possibility to undergo anti-S titre control after three months, designed to assess rapid humoral waning immunity. We strongly recommend that patients with cancer be included into observational serological monitoring studies or clinical trials that are dedicated to severe immunocompromised patients without any humoral seroconversion after D3.

Current perspectives for SARS-CoV-2 vaccination efficacy improvement in patients with active treatment against cancer.

A higher risk of death from coronavirus disease 19 has been shown for patients with solid cancers or haematological malignancies (HM). Thanks to the accelerated development of anti-SARS-SoV-2 vaccines in less than a year since the start of the global pandemic, patients with cancer were quickly prioritised in early 2021 for vaccination, however dependent on the very unequal availability at the global level. Impaired immunogenicity of SARS-CoV-2 mRNA vaccines in immunocompromised patients was rapidly reported as early as April 2021, although the vaccination fortunately appears to be generally effective without increasing the spacing. Worryingly, the humoral response of the SARS-CoV-2 vaccination is, however, considered insufficient in patients followed for HM, in particular when they are on anti-CD20 treatment. Thus, improving vaccination coverage by strengthening immune stimulation should be evaluated in patients under active treatment against cancer. Here, we discuss three different approaches: a third dose of early vaccine (repeated immune stimulation), heterologous prime-boost vaccination (multimodal immune stimulation) and a double-dose strategy (maximisation of immune response). Dedicated therapeutic trials, currently almost non-existent, seem rapidly necessary.

Distinctive Facial Cues Predict Leadership Rank and Selection.

Facial appearance correlates with leadership, both in terms of who is chosen (leader selection) and how they do (leader success). Leadership theories suggest that exceptional individuals acquire positions as leaders. Exceptional traits can differ between domains, however, and so the qualities valued in leaders in one occupation may not match those valued among leaders in another. To test this, we compared the relationship between facial appearance and leadership across two domains: law firms and mafia families. Perceptions of power correlated with leadership among law executives whereas social skill correlated with leadership in organized crime. Critically, these traits were distinctive within their respective groups. Furthermore, an experimental test showed that the relative frequency of facial traits in a group can render them either an asset or liability. Perceived leadership ability is therefore enhanced by characteristics that appear unique among individuals who satisfy the basic criteria for their group.

First-line therapy for chronic lymphocytic leukemia in patients older than 79 years is feasible and achieves good results: A FILO retrospective study.

The mean age at diagnosis of chronic lymphocytic leukemia (CLL) is 72 years, with 22.8% of patients being older than 80 years. However, the elderly are underrepresented in clinical studies of CLL. We performed a retrospective study of CLL patients aged 80 years or older at the initiation of first-line therapy in hospitals affiliated with the French intergroup on CLL (French Innovative Leukemia Organization) between 2003 and 2013. Here, we describe the clinical and biological characteristics, treatment, and outcomes for 201 patients. The median age of the cohort was 83.2 years (80-92 years). The median Cumulative Index Rating Scale comorbidity score was 5 and the median creatinine clearance was 48 mL/min (Cockcroft-Gault formula). At treatment initiation, Binet stage was A (26.4%), B (27.9%), or C (40.3%). Therapy consisted mainly of chlorambucil (65.7%), bendamustine (10.5%), and rituximab (44.3%) as follows: chlorambucil alone (45.3%) or immunochemotherapy (48.3%) with rituximab + chlorambucil (22.7%), rituximab + bendamustine (10.4%), or rituximab + cyclophosphamide + dexamethasone (5.5%). The overall response rate was 66.2% with 31.8% clinical complete remission. The median overall and progression-free survival from treatment initiation was 53.7 and 18.3 months, respectively. These results suggest that treatment is feasible in this age group, even with immunochemotherapy. Thus, prospective trials should target this population and oncogeriatric evaluation and new targeted therapies should be part of such future trials.

Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients.

Central nervous system involvement (CNSi) is a rare and poorly reported complication of chronic lymphocytic leukaemia (CLL). Establishing cause and effect between the CLL and the neurological symptoms remains challenging. We have analysed a retrospective cohort of 30 CLL patients with CNSi, documented by lymphocytic infiltration either by flow cytometry of the cerebrospinal fluid (CSF; n = 29) or CNS biopsy (n = 1). Neurological symptoms were heterogeneous. At the time of CNSi, less than half of the patients had a progressive CLL and 20 had never been treated for CLL. Initial treatment with fludarabine-based immuno-chemotherapy, with or without intra-CSF therapy, led to durable response in eight out of nine untreated patients. In contrast, 50% patients receiving various prior treatments needed additional therapy within a median of 4 months (1-16). Ibrutinib led to complete response in 4/4 heavily pre-treated patients. From CNSi, 5-year overall survival was 72% and 48% for treatment-naïve and previously treated patients respectively (P = 0·06); 5-year progression-free survival (PFS) was 43% and 0% (P = 0·125). 17p deletion was significantly associated with poor PFS (P = 0·006). CNSi may be the only sign of progression of CLL and should be considered an initiation criterion of systemic treatment. Prognosis seemed to be related to CLL characteristics rather than to CNSi itself.

Subtle Increases in BMI within a Healthy Weight Range Still Reduce Womens Employment Chances in the Service Sector.

Using mixed design analysis of variance (ANOVA), this paper investigates the effects of a subtle simulated increase in adiposity on women's employment chances in the service sector. Employing a unique simulation of altering individuals' BMIs and the literature on "aesthetic labour", the study suggests that, especially for women, being heavier, but still within a healthy BMI, deleteriously impacts on hireability ratings. The paper explores the gendered dimension of this prejudice by asking whether female employees at the upper end of a healthy BMI range are likely to be viewed more negatively than their overtly overweight male counterparts. The paper concludes by considering the implications of these findings.

Predicting Firm Success From the Facial Appearance of Chief Executive Officers of Non-Profit Organizations.

Recent research has demonstrated that judgments of Chief Executive Officers' (CEOs') faces predict their firms' financial performance, finding that characteristics associated with higher power (e.g., dominance) predict greater profits. Most of these studies have focused on CEOs of profit-based businesses, where the main criterion for success is financial gain. Here, we examined whether facial appearance might predict measures of success in a sample of CEOs of non-profit organizations (NPOs). Indeed, contrary to findings for the CEOs of profit-based businesses, judgments of leadership and power from the faces of CEOs of NPOs negatively correlated with multiple measures of charitable success (Study 1). Moreover, CEOs of NPOs looked less powerful than the CEOs of profit-based businesses (Study 2) and leadership ratings positively associated with warmth-based traits and NPO success when participants knew the faces belonged to CEOs of NPOs (Study 3). CEOs who look less dominant may therefore achieve greater success in leading NPOs, opposite the relationship found for the CEOs of profit-based companies. Thus, the relationship between facial appearance and leadership success varies by organizational context.

Azacitidine-Induced Interstitial Pneumonitis.

Azacitidine is a demethylating and cytotoxic drug for the treatment of adult patients with (1) myelodysplastic syndromes, (2) chronic myelomonocytic leukemia, and (3) acute myeloid leukemia who are not eligible for induction treatment or hematopoietic stem cell transplantation. Widely described in the literature, the main adverse events are hematotoxicity, digestive toxicity, asthenia, cutaneous toxicity, and infections such as neutropenic sepsis and pneumonia. The pivotal phase III comparative and supporting studies did not point out interstitial pneumonitis as a significant adverse event. Rare clinical data from literature report interstitial lung disease secondary to azacitidine administration, which should therefore be considered as a serious potential adverse event. We, herein, report a case of an 86-year-old white woman with acute myeloid leukemia and azacitidine-induced interstitial pneumonitis.

Influence of Perceived Height, Masculinity, and Age on Each Other and on Perceptions of Dominance in Male Faces.

Several studies have examined the individual effects of facial cues to height, masculinity, and age on interpersonal interactions and partner preferences. We know much less about the influence of these traits on each other. We, therefore, examined how facial cues to height, masculinity, and age influence perceptions of each other and found significant overlap. This suggests that studies investigating the effects of one of these traits in isolation may need to account for the influence of the other two traits. Additionally, there is inconsistent evidence on how each of these three facial traits affects dominance. We, therefore, investigated how varying such traits influences perceptions of dominance in male faces. We found that increases in perceived height, masculinity, and age (up to 35 years) all increased facial dominance. Our results may reflect perceptual generalizations from sex differences as men are on average taller, more dominant, and age faster than women. Furthermore, we found that the influences of height and age on perceptions of dominance are mediated by masculinity. These results give us a better understanding of the facial characteristics that convey the appearance of dominance, a trait that is linked to a wealth of real-world outcomes.

Successful re-treatment of a relapsed V600E mutated HCL patient with low-dose vemurafenib.

Hairy cell leukemia (HCL) is a chronic B-cell lymphoproliferative disorder that accounts for 2% of all leukemia. Recent identification of the recurrent V600E BRAF mutation in a majority of HCL patients has led some teams to evaluate the clinical potential of vemurafenib, a BRAF V600 specific inhibitor in a limited number of refractory HCL patients. Recently, we published the case of an HCL patient successfully treated with a low dose of vemurafenib. Eight months after the ending of treatment this patient relapsed. We present here the successful retreatment of this patient with a second line of vemurafenib. Our data suggest for the first time that vemurafenib at the dose of 240 mg once a day could be sufficient to maintain a complete hematological remission after an initial induction treatment with low-dose vemurafenib (2 × 240 mg) daily without inducing major toxicity.

High-dose chemotherapy with carmustine, etoposide, cytarabine and melphalan followed by autologous stem cell transplant is an effective treatment for elderly patients with poor-prognosis lymphoma.

Autologous stem cell transplant (ASCT) after high-dose chemotherapy (HDT) increases overall survival when used in relapsed non-Hodgkin lymphoma (NHL) in patients under 65 years old. Limited experience is available for older patients. We present a retrospective analysis of 73 consecutive patients aged over 65 years treated for aggressive or relapsed lymphoma by HDT with carmustine, etoposide, cytarabine and melphalan (BEAM) at full dosage followed by ASCT. Patient data were obtained from medical charts from two institutions. Median age was 67 years (65-74). Significant comorbidities were present in 24.7% of patients. The median number of days for grade 4 neutropenia was 9 (5-18). The early treatment-related mortality rate (<100 days) was 2.7%. The estimated 2-year progression-free survival and overall survival rates were 67.2% and 78.5%, respectively. In conclusion, the full-dose HDT-ASCT regimen is feasible, safe and efficient in selected patients over 65 years old.

Are nilotinib-associated vascular adverse events an under-estimated problem?

Vascular adverse events have been reported with nilotinib, a tyrosine kinase inhibitor prescribed for chronic myeloid leukaemia. However, few data specify their incidence, or whether they occur in predisposed patients. Hence, we prospectively studied 30 consecutive patients to assess the frequency of such adverse reactions and determine whether the patients presenting with these adverse events bear predisposing factors. From 3 to 73 months after nilotinib initiation, 10 of the 30 patients experienced vascular events. Three patients of these 10 were devoid of any patent cardiovascular risk factor, except for age. This study points out an occurrence more frequent than expected of vascular adverse events associated with nilotinib (> 30% vs. < 1% in summary of product characteristics), and particularly of vascular events of late onset in patients with no pre-existing risk factors.

Impressions of dominance are made relative to others in the visual environment.

Face judgments of dominance play an important role in human social interaction. Perceived facial dominance is thought to indicate physical formidability, as well as resource acquisition and holding potential. Dominance cues in the face affect perceptions of attractiveness, emotional state, and physical strength. Most experimental paradigms test perceptions of facial dominance in individual faces, or they use manipulated versions of the same face in a forced-choice task but in the absence of other faces. Here, we extend this work by assessing whether dominance ratings are absolute or are judged relative to other faces. We presented participants with faces to be rated for dominance (target faces), while also presenting a second face (non-target faces) that was not to be rated. We found that both the masculinity and sex of the non-target face affected dominance ratings of the target face. Masculinized non-target faces decreased the perceived dominance of a target face relative to a feminized non-target face, and displaying a male non-target face decreased perceived dominance of a target face more so than a female non-target face. Perceived dominance of male target faces was affected more by masculinization of male non-target faces than female non-target faces. These results indicate that dominance perceptions can be altered by surrounding faces, demonstrating that facial dominance is judged at least partly relative to other faces.

Hodgkin's Lymphoma in Older Patients: an Orphan Disease?

Hodgkin Lymphoma HL can be cured in the large majority of younger patients, but prognosis for older patients, especially those with advanced-stage disease, has not improved substantially. The percentage of HL patients aged over 60 ranges between 15% and 35%. A minority of them is enrolled into clinical trials. HL in the elderly have some specificities: more frequent male sex, B-symptoms, advanced stage, sub diaphragmatic presentation, higher percentage of mixed cellularity, up to 50% of advanced cases associated to EBV. Very old age (>70) and comorbidities are factor of further worsening prognosis. Like in younger patients, ABVD is the most used protocol, but treatment outcome remains much inferior with more frequent, severe and sometimes specific toxicities. Few prospective studies with specific protocols are available. The main data have been published by the Italian Lymphoma Group with the VEPEMB schedule and the German Hodgkin Study Group with the PVAG regimen. Recently, the Scotland and Newcastle Lymphoma Study Group published the SHIELD program associating a prospective phase 2 trial with VEPEMB and a prospective registration of others patients. Patients over 60y with early-stage disease received three cycles plus radiotherapy and had 81% of 3-year overall survival (OS). Those with advanced-stage disease received six cycles, with 3-year OS of 66%. The role of geriatric and comorbidity assessment in the treatment's choice for HL in the elderly is a major challenge. The combination of loss of activities of daily living combined with the age stratification more or less 70y has been shown as a simple and effective survival model. Hopes come from promising new agents like brentuximab-vedotin (BV) a novel antibody-drug conjugate. The use of TEP to adapt the combination of chemotherapy and radiotherapy according to the metabolic response could also be way for prospective studies.

Recommendations of the SFH (French Society of Haematology) for the diagnosis, treatment and follow-up of hairy cell leukaemia.

Hairy cell leukaemia (HCL) is a rare haematological malignancy, with approximately 175 new incident cases in France. Diagnosis is based on a careful examination of the blood smear and immunophenotyping of the tumour cells, with a panel of four markers being used specifically to screen for hairy cells (CD11c, CD25, CD103 and CD123). In 2011, the V600E mutation of the BRAF gene in exon 15 was identified in HCL; being present in HCL, it is absent in the variant form of HCL (HCL-v) and in splenic red pulp lymphoma (SRPL), two entities related to HCL. The management of patients with HCL has changed in recent years. A poorer response to purine nucleoside analogues (PNAs) is observed in patients with more marked leukocytosis, bulky splenomegaly, an unmutated immunoglobulin variable heavy chain (IgVH) gene profile, use of VH4-34 or with TP53 mutations. We present the recommendations of a group of 11 experts belonging to a number of French hospitals. This group met in November 2013 to examine the criteria for managing patients with HCL. The ideas and proposals of the group are based on a critical analysis of the recommendations already published in the literature and on an analysis of the practices of clinical haematology departments with experience in managing these patients. The first-line treatment uses purine analogues: cladribine or pentostatin. The role of BRAF inhibitors, whether or not combined with MEK inhibitors, is discussed. The panel of French experts proposed recommendations to manage patients with HCL, which can be used in a daily practice.