Brüton’s tyrosine kinase (BTK) inhibitors have significantly advanced treatment options for patients with B-cell malignancies; however, side effects with these agents are not uncommon, and a multidisciplinary approach is necessary for monitoring and managing adverse events such as bleeding, hypertension, and atrial fibrillation. In the treatment of patients on BTK inhibitors, maintaining communication between patients and all providers is essential, particularly concerning the use of any concurrent medications or supplements, as is educating patients on identifying early risk factors and reporting any signs or symptoms of toxicities. Ongoing clinical studies with both covalent and noncovalent BTK inhibitors are expected to further increase the understanding of these toxicities while improving the efficacy and safety of this class of medications.
Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain (Charcot's triad). Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone.
Background. The objective of our study was to ascertain racial/ethnic disparities in Asian/Pacific Islanders (API) for non-small-cell lung cancer (NSCLC) clinicopathologic features and survival outcomes based on various tumor characteristics and treatment modalities. Method. SEER database identified invasive NSCLC cases from 2004 to 2010. Variables included American Joint Committee on Cancer (AJCC) stage 7, tumor grade, tumor size, histology, age, marital status, radiation, surgery, and reason for no surgery. The Kruskall-Wallis test and the Z test were used to examine differences between races/ethnicities and the referent, non-Hispanic white (NHW). Multivariate Cox proportional analyses were used to establish the weight of the prognostic significance contributing to disease-specific survival (DSS) in each AJCC stage. Result. Improved DSS was seen in API across stage I (HR: 0.78), stage II (HR: 0.79), and stage IV (HR: 0.86), respectively, compared to the referent NHW (P < 0.01). Prognosis was improved by being married, being female gender, AIS histology, and birth outside the US (P < 0.01). Conclusion. We have demonstrated improved survival among API in early stage and stage IV NSCLC. Further research is necessary to clarify the role of lifestyle and tumor biology for these differences.
e22559 Background: Soft tissue and bone sarcoma (STS/BS) are heterogeneous and difficult to treat malignancies. Recent advances in molecular testing improved our understanding of the disease biology. Methods: Retrospective data on non-GIST sarcoma cases were analyzed using next genomic sequencing (NGS) (MiSeq on 47 genes, NextSeq on 592 genes), immunohistochemistry (IHC), fusion transcript detection and copy number alterations (CNA) by Caris Life Sciences between July 2010 and November 2018 at Karmanos Cancer Institute. Targetable aberrations (TA) were identified by searching available literature on therapeutics tested in clinical trials. Results: Demographic data on 64 patients were analyzed; median age 56 (21-87y) and a 1:1 gender ratio. Most frequent histologies include Leimyosarcoma (LMS) 15.3% (n = 10) and Undifferentiated Pleomorphic Sarcoma (UPS) 12.5% (n = 8). Genetic aberrations occurred in 78% of cases, with a cumulative 302 aberrations and a mean 4.7 TA (1-11)/case. Frequent aberrations by methodologies include a) IHC: TOP2A 64.3% (n = 36), MGMT 53.9% (n = 28), TUBB3 49% (n = 24); b) NGS: TP53 37.8% (n = 17); c) CNA: CDK4 and MDM2 at 9.3% (n = 4) respectively; d) fusion transcript: NOTCH2 fusion (n = 1), p < 0.05. All cases were MSI stable. TA constituted 37.1% (n = 112) of the identified aberrations in the cohort and existed in 89.1% (n = 57) cases with a mean of 3.08 TA/case, p < 0.05. Frequent TA other than TOP2A, TP53, MGMT by histologies included a) LMS: RRM1 28.6% (n = 4), PI3KCA and ER/PR at 14.3% (n = 1) each respectively; b) UPS: TUBB3 50% (n = 4), PD-1 25% (n = 2); c) Sarcoma NOS: CDK4 28.6% (n = 2), TS 28.6% (n = 2), C-MET and EGFR at 14.3% (n = 1) each respectively; d) Well Differentiated/Dedifferentiated Liposarcoma: CDK4, MDM2 and PD-1 at 20% (n = 1) each respectively. Conclusions: Incorporating genomic profiling has helped personalize treatment to include clinical trial enrollment. Further drug development and prospective studies are required in this population.
Background: Chronic obstructive pulmonary disease (COPD) is one of leading cause of morbidity and mortality worldwide. Exacerbations of COPD is considered as second most common cause of admission in the UK. The recognition that high flow oxygen therapy in susceptible patients during exacerbations of COPD can lead to hypercapnia and also that respiratory acidosis is usually associated with a worse outcome has led to a rise in arterial blood gas (ABG) sampling to measure the values of pH, PaCO2, PaO2 and HCO3. Objectives: Objective was to study the correlation of ABG with VBG in in terms of pH, pCO2 and HCO in patients presenting with exacerbation of COPD. Methodology: Ninety two patients with acute exacerbation of COPD were included. Samples for ABG and VBG were taken simultaneously and analyzed using blood gas analyzer. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20. Results: Ninety two patients were included. Mean age was 47.50+8.27 years and 87% were male. Regarding correlation between ABGs and VBGs, it was seen that Pearson's correlation for pH was 0.81 with p value of 0.05. A strong correlation was found for PCO of ABGs and VBGs i.e. 0.88 with a p value of < 0.01. Conclusion: There was strong correlation between pH, PCO and HCO of ABGs and VBGs.
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are essentially different manifestations of the same disease that are similarly managed. A number of molecular and cytogenetic variables with prognostic implications have been identified. Undetectable minimal residual disease at the end of treatment with chemoimmunotherapy or venetoclax-based combination regimens is an independent predictor of improved survival among patients with previously untreated or relapsed/refractory CLL/SLL. The selection of treatment is based on the disease stage, presence or absence of del(17p) or TP53 mutation, immunoglobulin heavy chain variable region mutation status, patient age, performance status, comorbid conditions, and the agent’s toxicity profile. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with CLL/SLL.
516 Background: Second primary cancers are a major concern for young adult colorectal cancer (CRC) survivors. The impact of treatment with radiation on the risk for second solid and hematological malignancies, as well as the typical latency period before development of a second cancer, requires elucidation. Methods: The Surveillance Epidemiology and End Results (SEER) database was used to detect CRC cases in young adults (aged 20-40 years) diagnosed up to 12/31/2011. The Standardized Incidence Ratio (SIR) was calculated as the ratio of observed to expected cases of second primary malignancy based on incidence data in the general United States population. The latency exclusion period from the date of diagnosis was 5 years. We investigated the possible effect of radiation therapy on risk for a second cancer, and established the typical latency period after initial diagnosis (5-10 years and >10 years). Results: A total of 9,537 cases of CRC in young adults were available for analysis. Radiation was administered in 1,823 (19.1%) patients. Second primary cancers occurred in 798 cases, 754 (94.5%) solid tumors and 44 (5.5%) hematological malignancies respectively. In the latency period 5-10 years after initial diagnosis, “All Solid Tumors” (SIR: 1.85, p<0.05) and female genital tumors (SIR: 3.52, p<0.05) were increased. In the latency period >10 years after initial diagnosis, an increased risk of developing pancreatic cancer (SIR: 1.90, p<0.05) and female genital tumors (SIR: 1.77, p<0.05) was observed. In patients who received radiation the only significantly increased risk was for “All Solid Tumors” (SIR: 1.42, p<0.05). No significant increase in second hematological malignancies was observed in the entire cohort, including cases that received radiation. Conclusions: An increased risk of second primary female genital tumors was seen in both the 5-10 years and >10 years latency periods. Pancreatic cancer risk was increased specifically in the >10 years latency period. Radiation treatment did not pose an increased risk for any specific second primary cancers. Interestingly, young adult CRC survivors did not have an increased risk for hematological malignancies compared to the general population.
