Outcomes of adults with lymphoma treated with nonmyeloablative TLI-ATG and radiation boost to high risk or residual disease before allogeneic hematopoietic cell transplant.

We evaluated the impact on survival of antithymocyte globulin conditioning (TLI-ATG) with radiation (RT) boost to high risk or residual disease before allogeneic hematopoietic cell transplant (allo-HCT) for adults with lymphoma (excluding mycosis fungoides and low-grade NHL other than SLL/CLL). Of 251 evaluable patients, 36 received an RT boost within 3 months of allo-HCT at our institution from 2001 to 2016. At the time of TLI-ATG, patients who received boost vs no boost had a lower rate of CR (11% vs 47%, p = 0.0003), higher rates of bulky disease (22% vs 4%, p < 0.0001), extranodal disease (39% vs 5%, p < 0.0001), and positive PET (75% vs 28%, p < 0.00001). In the boost group, the median (range) largest axial lesion diameter was 5.2 cm (1.8-22.3). Median follow-up was 50.2 months (range: 1-196). There was no significant difference in OS, time to recurrence, or time to graft failure with vs without boost. A trend toward higher percent donor CD3+ chimerism was seen with vs without boost (p = 0.0819). The worst boost-related toxicity was grade 2 dermatitis. RT boost may help successfully mitigate the risk of high risk or clinically evident residual disease in adults with lymphoma undergoing allo-HCT.

Intra-abdominal obesity and metabolic risk factors: a study of young adults.

OBJECTIVE: To assess the relative importance of the extent and regional distribution of fat for metabolic risk factors in young adults. DESIGN: Cross-sectional study of findings from a hospital-based case-control study. SUBJECTS: A total of 46 adult Danish Caucasian patients (40 men and six women, aged 34-54 y). Of these, 22 had had non fatal acute myocardial infarction before 41 y of age and 24 were age- and gender-matched controls without coronary heart disease. MEASUREMENTS: Four measurements of fat: body mass index (BMI, kg/m(2)), body fat percentage measured using a dual energy X-ray absorptiometry (DEXA) scanner, waist/hip circumference ratio (WHR), and intra-abdominal adipose tissue area measured using computed tomography (CT) scanning, and eight metabolic risk factors: systolic and diastolic blood pressure, HbA(1c) percentage, fasting concentrations of capillary whole blood glucose, high-density lipoprotein (HDL) cholesterol, serum triglyceride, plasma plasminogen activator inhibitor 1 (PAI-1), and urinary albumin:creatinine excretion ratio. RESULTS: Of 46 participants, 10 were obese (BMI >30 kg/m(2)), 12 were abdominally obese (WHR >0.90 for men and >0.85 for women), and 20 were intra-abdominally obese (intra-abdominal adipose tissue area >135 cm(2)). Men had a higher intra-abdominal adipose tissue area than women (P=0.0053, Mann-Whitney U-test). In multiple regression analyses of the four fat variables, only intra-abdominal adipose tissue area significantly predicted the levels of six metabolic risk factors: systolic blood pressure, diastolic blood pressure, fasting concentrations of capillary whole blood glucose, serum HDL cholesterol, serum triglyceride, and PAI-1. The intra-abdominal adipose tissue area had a linear relation with the six metabolic risk factors. CONCLUSIONS: For young individuals, intra-abdominal fat is the important component of the body fat for six of the eight metabolic risk factors. Intra-abdominal fat might contribute to that most patients with acute myocardial infarction at a young age are men.

Smoking and other major coronary risk factors and acute myocardial infarction before 41 years of age: two Danish case-control studies.

OBJECTIVE: The aim of two case-control studies of adults younger than 41 years of age was to assess how the major coronary risk factors, family history of acute myocardial infarction (AMI), obesity, hypertension and hypercholesterolemia add to the risk of AMI from self-reported current smoking (smoking). DESIGN: An evaluation study included 35 patients and 70 individually matched controls. RESULTS: The risk from smoking increased less than linearly and the risk from serum cholesterol concentration (cholesterol) increased linearly. In multiple conditional logistic regression analyses, smoking as a discrete variable and cholesterol as a continuous variable were significant coronary risk factors. In a final logistic regression model, the odds ratio was 6.4 (95% confidence interval (CI) 1.7-24.1) for smoking and 1.6 (CI 1.1-2.3) for each mmol/L cholesterol. A risk score summarizing the combined risk of the major coronary risk factors did not add to the final logistic regression model (p = 0.56). A validation study included 79 patients and 64 matching control patients. CONCLUSION: The major coronary risk factors were similar for the cases/patients and the two control groups in the two studies. Therefore, the final logistic regression model may reflect a general pattern in Denmark. Primary prevention in individuals less than 41 years of age should focus on smoking and cholesterol instead of the summarizing risk score.