Adolescent and Young Adult Patients with Vaginal Graft-vs-Host Disease and Hematocolpos Managed with Vaginal Stents: A Case Series.

STUDY OBJECTIVE: Vaginal stenosis can be acquired as a result of vaginal graft-vs-host disease (GVHD) in patients who have undergone hematopoietic stem cell transplant (HSCT). Little data exist to guide the management of vaginal GVHD, particularly in adolescent and young adult patients. The objective of this study was to detail the management of vaginal stenosis with lysis of adhesions and vaginal stent placement in 3 young patients with vaginal GVHD. METHODS: A retrospective chart review was done for 3 patients with vaginal GVHD causing vaginal stenosis with hematometrocolpos. All 3 were treated using vaginal stent placement. Additionally, a literature review was conducted through PubMed and Google Scholar to identify 21 case reports (with a total of 35 patients) of menstrual obstruction due to GVHD. RESULTS: Obstructive vaginal stenosis secondary to vaginal GVHD occurred in our patients at ages 15, 16, and 24 years. Resolution of hematocolpos was obtained with lysis of vaginal adhesions with vaginal stent placement in all patients, with varying regimens of systemic and topical hormones, topical corticosteroids, and dilator therapy. DISCUSSION: Vaginal stenosis secondary to vaginal GVHD should be considered in patients with a history of allogeneic HSCT presenting with amenorrhea, especially those with a diagnosis of primary ovarian insufficiency. The use of vaginal stents, along with postoperative medical and dilator management as appropriate, may prevent re-stenosis, although more information is needed regarding the efficacy of treatments.

Individualized chemotherapy drug dose escalation in dogs with multicentric lymphoma.

BACKGROUND: This study was performed to determine the ability to escalate drug doses in a 15-week CHOP protocol in dogs with multicentric lymphoma. HYPOTHESIS: We hypothesized that at least 50% of dogs could successfully be escalated in at least 1 drug. Secondary aims were to establish objective response rate (ORR), progression-free interval (PFI), and overall survival time (OST). ANIMALS: Thirty dogs with newly diagnosed multicentric lymphoma were prospectively treated with a 15-week CHOP protocol. METHODS: This was a prospective cohort study. Drug doses that did not cause dose-limiting adverse effects (AEs) were increased using a standardized escalation protocol. AEs and response were assessed using VCOG criteria. Serial blood samples were collected after the first dose of each drug for pharmacokinetic analysis. RESULTS: Of the 23 dogs with the opportunity to dose escalate, at least 1 drug was successfully escalated in 18 (78%). Vincristine was successfully escalated to 0.8 mg/m2 or higher in 11 dogs, cyclophosphamide to 300 mg/m2 or higher in 16 dogs, and doxorubicin to 35 mg/m2 or 1.4 mg/kg or higher in 9 dogs. Three of the 23 dogs (13%) were hospitalized at least once because of drug-induced AEs. Neutropenia was the most common dose-limiting toxicosis for all drugs. Peak doxorubicin concentrations were significantly lower in dogs where doxorubicin was successfully escalated. The objective response rate was 100%. The median progression free interval was 171 days. The median overall survival time was 254 days. CONCLUSIONS: Drugs in the CHOP protocol can often be escalated safely with manageable AEs.

Outcome and Metastatic Behavior of Canine Sinonasal Osteosarcoma (2005-2015).

Sinonasal neoplasms in dogs behave locally aggressively, and metastatic disease has not been a common cause of death. The metastatic rate of sinonasal osteosarcoma (OSA) is not well characterized, and reported outcomes of these patients are variable. The purpose of this study is to evaluate the outcome and metastatic behavior of canine sinonasal OSA. Medical records of canine patients diagnosed with sinonasal OSA via histopathology between January 2005 and December 2015 were reviewed. Patients with any form of treatment or no treatment were included. Time to local progression, time to metastasis, and overall survival data were evaluated. Variables that may impact outcome, such as tumor stage and treatment type, were evaluated. Twenty-seven dogs were identified that fit the inclusion criteria. Overall, 30.0% of dogs developed metastasis over the disease course, with a median time to metastasis of 458 days (95% confidence interval [CI] 318-758 days). The median time to local progression was 335 days (95% CI 264-544 days). The overall median survival time was 410 days (95% CI 341-627 days). Regarding metastasis, sinonasal OSA behaves similarly to sinonasal neoplasms of other histologies and dissimilarly to appendicular OSA. The outcome of treated patients appears similar to that of sinonasal tumor patients with other histologies.