ABSTRACT
Between 2011 and 2012, a phase II trial evaluated the use of the RiBVD (Rituximab, Bendamustine, Velcade and Dexamethasone) combination as first-line treatment for mantle cell lymphoma (MCL) patients aged over 65. We have now re-examined the classic prognostic factors, adding an assessment of the mutation status of TP53. Patients (n=74; median age 73 years) were treated with the RiBVD combination. Median Progression Free Survival (mPFS) was 79 months, and median Overall Survival (mOS) was 111 months. TP53 mutation status was available for 54/74 (73%) patients. TP53 mutations (TP53mt) were found in 12 patients (22.2%). In multivariate analysis, among the prognostic factors (PF) evaluated, only TP53mt and an albumin level below 3.6 g/dL (Alb<3.6 g/dL) were independently associated with a shorter mPFS. A hazard ratio (HR) of 3.16 (1.3-9.9, p=0.014) was obtained for TP53mt versus TP53wt, and 3.6 (1.39-9.5, p=0.009) for Alb<3.6 g/dL vs Alb≥3.6 g/dL. In terms of mOS, multivariate analysis identified three PFs: TP53mt (HR: 5.9 (1.77-19.5, p=0.004)), Alb<3.6 g/dL (HR: 5.2 (1.46-18.5, p=0.011)), and ECOG=2 (HR: 3.7 (1.31-10.6, p=0.014)). Finally, a score combining TP53 status and albumin level distinguished three populations based on the presence of 0, 1, or 2 PF. For these populations, mPFS was 7.8 years, 28 months and 2.5 months, respectively. Our prolonged follow-up confirmed the efficacy of the RiBVD regimen, comparing it favorably to other regimens. TP53mt and hypoalbuminemia emerge as strong PF that can be easily integrated into prognostic scores for older adult patients with MCL.
ABSTRACT
OBJECTIVE: To estimate the prevalence of topographical memory impairment following posterior cerebral artery infarctions (PCAI) and define its anatomical correlations. METHODS: We recruited 15 patients (mean duration of 4 months postinfarct). We administered 2 sets of experimental tests to assess topographical memory: one set included 5 computerized tasks (CompT) and the other set consisted of one ecological topographical orientation test (EcolT) that included 4 tasks (i.e., map drawing, picture recognition and ordering, backward path). Fifteen healthy participants served as controls. Patients and controls underwent a volumetric T1 MRI brain scan. Brain lesions in patients were segmented, normalized, and correlated with performance. RESULTS: Topographical memory impairments were evidenced in patients with PCAI using both group and individual analyses (50%), with more severe outcomes in patients with PCAI in the right hemisphere. CompT and EcolT were highly correlated, but the ecological test was more sensitive in revealing topographical memory impairments. Voxel-based lesion-symptom mapping demonstrated that 2 regions located in the cuneus and the calcarine sulcus correlated significantly with behavioral performance. CONCLUSIONS: Topographical memory disorders following PCAI are reported in 50% of the patient population. Our results demonstrate the importance of developing and using dedicated batteries of topographical memory tests, in particular real-life tests, to identify such deficits.