Impact of baseline and interim quantitative PET parameters on outcomes of classical Hodgkin Lymphoma.

Currently, analysis of interim PET (iPET) according to the Deauville score (DS) is the most important predictive factor in Hodgkin lymphoma (HL); however, there is room for improvement in its prognostic power. This study aimed to evaluate the prognostic value of quantitative PET analysis (maximum standard uptake value [SUVmax], total metabolic tumor volume [TMTV] and total lesion glicolysis [TLG]) at baseline (PET0) and iPET in a retrospective cohort of newly diagnosed classical HL. For positive iPET (+ iPET), the reduction of quantitative parameters in relation to PET0 (ΔSUVmax, ΔTMTV and ΔTLG) was calculated. Between 2011 and 2017, 234 patients treated with ABVD were analyzed. Median age was 30 years-old, 59% had advanced stage disease, 57% a bulky mass and 25% a + iPET (DS 4-5). At baseline, high TLG was associated with an increased cumulative incidence of failure (CIF) (p = 0.032) while neither SUVmax, TMTV or TLG were associated with overall survival (OS) or progression-free survival (PFS). In multivariate analysis, only iPET was associated with CIF (p < 0.001). Among ΔSUVmax, ΔTMTV and ΔTLG, only a ΔSUVmax ≥ 68.8 was significant for PFS (HR: 0.31, CI95%: 0.11-0.86, p = 0.024). A subset of patients with improved PFS amongst + iPET was identified by the quantitative (ΔSUVmax ≥ 68.8%) analysis. In this real-world Brazilian cohort, with prevalent high-risk patients, quantitative analysis of PET0 did not demonstrate to be prognostic, while a dynamic approach incorporating the ΔSUVmax to + iPET succeeded in refining a subset with better prognosis. These findings warrant validation in larger series and indicate that not all patients with + iPET might need treatment intensification.

Real-world Imatinib Mesylate Treatment in Patients with Chronic Myeloid Leukemia: The Importance of Molecular Monitoring and the Early Molecular Response.

INTRODUCTION: Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder characterized by the Philadelphia (Ph) chromosome. After the introduction of imatinib mesylate (IM) in 2000, the natural history of the disease changed. Data on the treatment of CML with IM are from randomized clinical trials. Establishing whether these results can be reproduced or if caution is needed when extrapolating data to the general population with CML is essential. OBJECTIVES: To evaluate the molecular response (MR) in patients with chronic-phase CML (CML-CP) not included in clinical studies and correlate them with the responses obtained in clinical trials. METHODS: Between January 2007 and January 2017, 227 patients newly diagnosed with CML-CP treated with IM as first-line treatment were included. This study is an observational, retrospective, and single-center study. RESULTS: At a median follow-up time of 7.3 years, 60.3% of the 227 patients who started IM were still on IM. Early molecular response (EMR) at 3 and 6 months was achieved by 74.2% and 65%, respectively. The median time to a MMR was nine months. The MR4.0 and MR4.5 were 67.2% and 51.1%, respectively. The overall survival (OS), progression-free survival (PFS), and event-free survival (EFS) of the patients who exclusively used IM were 91%, 91%, and 85.1%, respectively. CONCLUSION: The results presented are similar to those described in prospective and randomized trials, demonstrating that the outcomes are reproducible in the real world. EMR at 3 and 6 months reflects better long-term responses, including higher rates of deeper molecular responses. Considering treatment costs, the absence of literature evidence of an impact on overall survival demonstrated by first-line second-generation tyrosine kinase inhibitors (TKIs), and the global OS of 85.8%, imatinib mesylate (IM) is still an excellent therapeutic option.

Consolidative mediastinal radiotherapy for advanced-stage classical Hodgkin lymphoma with bulky disease in patients who achieve complete response after chemotherapy in PET-CT era.

Background: The role of consolidation mediastinal radiotherapy (RT) for mediastinal bulky disease in advanced-stage classical Hodgkin lymphoma (cHL) is controversial in the positron emission tomography/computed tomography (PET-CT) era. Materials and methods: We reviewed the medical charts of patients with advanced-stage (clinical stage IIX-IVX) cHL and mediastinal bulky that achieved a complete response after first line chemotherapy treatment between August 2010 and December 2020 and compared the results of those who received with those who did not receive consolidation mediastinal RT. Inclusion criteria required PET-CT imaging for staging and response assessment. Results: We included 115 patients; 91 received mediastinal RT and 24 did not. Patient's characteristics were balanced between the two groups. The median age in patients that received and did not receive mediastinal RT was 28 years and 24.5 years, respectively. Median International Prognostic Score among patients that received and did not receive mediastinal RT was 2 and 2.5, respectively. Disease free survival (DFS) was statistically better in patients that received mediastinal RT (p = 0.013). Two-year DFS for patients that received and did not receive mediastinal RT was 95.2% [95% confidence interval (95% CI): 87.6-98.2%] and 76.4% (95% CI: 52.2-89.4%), respectively. Overall survival (OS) was not different between the two groups (p = 0.617). In multivariate analysis, not receiving mediastinal radiotherapy and only achieving partial response (vs. complete response) after 2 cycles of chemotherapy were factors predictive of lower DFS. Conclusion: DFS, but not OS, was superior in patients that received mediastinal RT.

Impact of water restriction periods on carcass traits and meat quality of feedlot lambs in the Brazilian semi-arid region.

Water restriction periods were evaluated in crossbred lambs (n = 32) distributed in one of four treatments: without water restriction, water restriction for 24, 48 and 72 h. The water restriction for 72 h reduced the water and dry matter intakes, body weight at slaughter and hot and cold carcass yields. Water restriction did not affect the weight of the carcass cuts and the chemical composition of the meat. The fatty acid EPA increased and DHA reduced with increasing water restriction period. There was an increasing linear effect for meat shear force, with less force (30.5 N/cm2) for sheep meat without water restriction and higher force (45.8 N/cm2) for those with water restriction for 72 h. The period of 24 h of water restriction was the one that promoted the highest similarities in the characteristics assessed to those in animals receiving water ad libitum. Therefore, water restriction periods should not exceed 24 h for feedlot animals in situations of severe water shortage.

Two successful pregnancies in a woman with chronic myeloid leukemia exposed to nilotinib during the first trimester of her second pregnancy: case study.

The occurrence of chronic myeloid leukemia in pregnancy is rare and its management poses a clinical challenge for physicians treating these patients. We report a 30-year-old woman with chronic myeloid leukemia who became pregnant twice successfully. Philadelphia-positive CML in its chronic phase was diagnosed at 16 weeks of her first gestation. At that time, she received no treatment throughout her pregnancy. At 38 weeks of gestation, a normal infant was delivered by cesarean section. At six weeks postpartum, the patient underwent imatinib mesylate therapy but she could not tolerate the treatment. The treatment was then changed to nilotinib at 400 mg orally b.i.d. Two years later, she became pregnant again while she was on nilotinib 200 mg b.i.d. The unplanned pregnancy was identified during her 7.4 weeks of gestation. Because the patient elected to continue her pregnancy, nilotinib was stopped immediately, and no further treatment was given until delivery. Neither obstetrical complications nor structural malformations in neonates in both pregnancies were observed. Both babies' growth and development have been normal. Although this experience is limited to a single patient, the success of this patient demonstrates that the management of chronic myeloid leukemia in pregnant women may be individualized based on the relative risks and benefits of the patient and fetus.

Distribuição dos valores pressóricos e prevalência de hipertensão arterial em jovens de escolas do ensino médio em Sorocaba, SP / Blood pressure distribuition and hypertension prevalence in high school students of Sorocaba, Brazil

Objetivo :A hipertensão arterial, assintomática e desconhecida pela maioria dos seus portadores, é importante fator de risco para complicações cardiovasculares e renais. A prevenção primária e a detecção precoce da doença são as formas mais efetivas de evitar tais complicações. Métodos: Estudantes de Medicina foram preparados para realizar palestras a alunos do ensino médio sobre hipertensão arterial e outros riscos cardiovasculares associados, aplicar questionário epidemiológico e aferir a pressão arterial (PA) em amostra de 633 alunos. Resultados: A média da idade foi 17,4± 1,9 anos (SD); 5O,1 por cento eram homens; 76,2 por cento caucasianos, 22,8 por cento negros ou mulatos, 0,9 por cento orientais e 13,7 por cento fumantes. Foram encontrados índice de massa corporal (IMC) entre 25 e 30 Kg/m2 em 9,9por cento e IMC>30 Kg/M2 em 1,4por cento. PA sistólica elevada (> 1 40 mmhg) foi verificada em 9,6 por cento, PA diastólica elevada (>menor que 90 mmhg) em 9,3por cento; 14,2por cento tinham PA sistólica e/ou diastólica elevadas. Outros 16,1 por cento tinham PA na faixa "limítrofe". A hipertensão arterial foi mais prevalente nos homens (2 1,5 por cento) que nas mulheres (7 por cento), p<0,000 1, não havendo diferença entre negros ou mulatos (16,4 pro cento) e caucasianos (13,7 por cento). Encontramos correlação positiva entre PA sistólica e IMC (r=0,341 1, p<0,0001), bem como entre PA diastólica e IMC (r=0,3133, p<0,0001). Não observamos relação entre o fumo ou a inatividade física e prevalência de hipertensão. Conclusão: Embora seja preciso reavaliar a PA individualmente, preocupa a alta prevalência de hipertensão arterial nesta idade, intimamente relacionada ao sobrepeso. Há necessidade de se estabelecer instrumentos de avaliação precoce do risco cardiovascular e promover orientação preventiva para estes jovens.