bluuebunny/crossref_metadata_2025_split huggingface dataset:
Celiac disease and chemotherapy
Authors: Robinson S. I. , Murray J. , McWilliams R. R. 
Published: March 2020

19561 Background: Diarrhea is a common side effect of chemotherapy (CT). At times, often unpredictably, patients develop profound diarrhea during CT. Though the clinical diagnosis of celiac disease (CD) is relatively rare, (1/ 2000), the serologic prevalence is much higher (1/ 133), suggesting a large number of undiagnosed cases. Latent CD may be unmasked by stressors, such as CT. We hypothesized that undiagnosed CD may account for some cases of severe diarrhea from CT. Methods: We performed a retrospective chart review at the Mayo Clinic (1980–2006) for patients with diagnoses of cancer and CD that received CT at our center. CD cases were confirmed by biopsy (n= 25) or serologic studies. Data analyzed included severe (grade ≥ 3,) diarrhea while on CT, site of primary cancer, diagnosis of CD prior to or after CT, and specific CT agents received. Results: We identified 27 patients with CD and cancer (12 lymphoma, 6 gastrointestinal, 2 leukemia, 2 breast, 1 brain, bladder, lung, uterine, sarcoma) who received CT at our center. Fifteen were diagnosed with CD prior to receiving CT and 12 after, with the former group presumably on a gluten-free diet. One patient was excluded for lack of clinical data. Five of remaining 14 patients (35%) managed for their CD prior to CT had diarrhea, though 4 of these 5 had only mild diarrhea (gr. 1). One patient suffered gr. 3 diarrhea, though was reported to be poorly compliant with his diet. Three patients received treatment with 5- fluorouracil (5FU), and 2 had gr. 1 diarrhea. Five of the 12 patients (42%) with celiac disease undiagnosed prior to CT were reported to have diarrhea during treatment (3 gr. 4; 2 gr. 1). Of those receiving 5FU, 3 out of 4 had severe (gr. 4) diarrhea. The small numbers of patients precluded meaningful statistical analysis. Conclusion: Patients with known CD compliant with a gluten-free diet tolerated CT well. However, in a subset of undiagnosed patients, severe diarrhea developed during CT, most notably with 5FU-based regimens. We propose that when patients have diarrhea disproportionate to other effects, CD should be considered. Also, in malignancies with a high incidence of CD such as lymphoma and small bowel cancer, underlying CD should be considered before CT is given. No significant financial relationships to disclose.
Phase II trial of pegylated liposomal doxorubicin-cyclophosphamide combination as first-line chemotherapy in elderly metastatic breast cancer patients
Authors: Dufour P. R. , Rousseau F. , Meyer N. , Delozier T. , Serin D. , Nabet M. , Djafari L. , Kurtz J. 
Published: March 2020

19565 Background: Although the majority of metastatic breast cancer (MBC) patients (pts) responds to endocrine therapy, treatment failure is a concern, as well as front-line therapy for pts with ER/PR negative disease.The combination of anthracyclines (A) and cyclophosphamide (C) is active in younger pts, but cardiac toxicity of A in elderly MBC pts has to be considered. Pegylated liposomal doxorubicin (PLD) (Caelyx®) is active in MBC and has much less cardiotoxicity than A, and we present the preliminary data of the PLD/C in elderly MBC pts. Methods: This was a multicentric phase II trial. Inclusion criteria included: pts aged between 65 and 75, histologically proven measurable MBC, ECOG PS 0–1, LVEF = 50%, first-line chemotherapy for MBC. Prior adjuvant chemotherapy was allowed if stopped for = 6 or 12 months without and with anthracyclines, respectively. Endocrine therapy either in the adjuvant or metastatic setting had to be stopped for = 1 month. All pts gave a written informed consent. The treatment schedule was : PLD 40mg/m2 and C 500mg/m2 d1 every 4 weeks. Efficacy as well as response duration and tolerance were the primary and secondary end-points, respectively. Results: 35 patients were enrolled (Median age 71.3, range 65.6–75.9). A total of 166 cycles have been administered. The median number of cycles was 6 (range 1–9). No toxic death was reported, one patient died of diabetes mellitus decompensation. No congestive heart failure or decrease in LVEF was reported, although 1 pt experience grade 3 dyspnea and stopped treatment. Other (gr3–4) NCI-CTC toxicity included: neutropenia in 7 (gr3) and 3 (gr4) pts; gr3 mucositis (4). No febrile neutropenia was reported. Grade 3 hand-foot syndrome occurred in 1 pt, whereas treatment was stopped due to a generalized rash in 1 pt. An objective response (CR + PR) was achieved in 10 (28,6%) pts (1 CR and 8 PR), and a disease control in 24 (68.6%) with a progression free survival of 8.8 months and a median survival of 20.4 months Conclusions: The LPD-C combination is active in elderly MBC pts, with an acceptable toxicity profile. No significant financial relationships to disclose.
Pegfilgrastim can be effectively administered the same day as chemotherapy to prevent neutropenia-related complications
Authors: Gupta N. K. , Thorpe S. , Vanderhoff P. , Gomez S. , Stiltner M. , Alvares D. , Lee D. , Chandler T. , Connelly S. , Clark A. , Bohnen R. 
Published: March 2020

19571 Background: Pegfilgrastim has been proven to reduce neutropenia-related complications of chemotherapy. However, the administration of pegfilgrastim 24 hours after chemotherapy treatment often poses an inconvenience for the patients and care givers. Methods: A retrospective chart review of the patients who received pegfilgrastim the same day as chemotherapy was done at a rural oncology practice, where some patients travel more than 100 miles each way for treatment. Incidence of febrile neutropenia (FN), defined as ANC = 500 and temperature =101° F; hospitalization for FN; dose-delay; dose-reduction (= 15% reduction in the planned dose); ANC recovery (ANC=1,500 on the day of next treatment), Grade III/IV neutropenia one week after chemotherapy and empiric use of prophylactic antibiotics was recorded. Results: Between 11/05 and 11/06, 243 doses of pegfilgrastim were given the same day as chemotherapy to 48 patients. M/F=14/34; Age(median): 61.2 yrs (range: 27–88 yrs).The diagnoses were NSCLC=13 (Stage II, III, IV: 2, 2 and 9, respectively); Breast Ca=11 (stage II, III, IV: 4, 6 and 1, respectively); Diffuse large B-cell lymphoma (DLBCL)= 6 (stage III, IV: 4, 2); Follicular lymphoma=3 (stage IV: 3); SCLC=3 (stage IV: 3); Ovarian Ca=2 (stage III, IV: 1, 1); and others=10. Twenty five different chemotherapy regimens were administered (Q3 wk. regimens: 19, Q2 wk. regimens: 4 and others=2). No patient had FN or hospitalization for FN. ANC recovery was sub- optimal twice (ANC of 880 and 1,010 on the day of next treatment). Dose was delayed only once due to neutropenia (ANC=880), patient with ANC of 1,010 received treatment as scheduled. Three patients needed dose-reduction of more than 15% (all had DLBCL). Grade III/IV neutropenia after one week of treatment (CBC was available after 235 treatments) was observed in 52 (0.2%) patients, 23 patients had had AC and 25 patients had had CHOP. Empiric prophylactic antibiotics were not given to any patient. Conclusions: Pegfilgrastim can be effectively given the same day as chemotherapy to ameliorate neutropenia-related complications. Same-day administration of pegfilgrastim could improve the quality of life of patients and may reduce the health care costs. Large prospective trials should be done to address this issue. No significant financial relationships to disclose.
Predictors of outcome and treatment decisions of older patients with stage III non-small cell lung cancer
Authors: Luong D. D. , Poon D. , Gao G. , Boulware D. , Simon G. , Extermann M. 
Published: March 2020

19574 Background: In treating Stage III non-small cell lung cancer in the elderly, oncologists often empirically adjust treatment without clear guidelines. Identifying patient characteristics that impact prognosis will aid in creating better treatment algorithms in this patient population. Methods: A retrospective analysis was done on older patients (age > 70) treated for Stage III NSCLC (excluding “wet” IIIB) at the H. Lee Moffitt Cancer. Cox multivariate analysis identified variables impacting progression free survival, overall survival, treatment chosen, treatment interruptions, and hospitalizations. Correlation and regression tree analysis (CART) was performed to create potential decision making models. Results: 213 patients were evaluable. Multivariate analysis identified ECOG performance status (hazard ratio = 1.52, p = 0.005) and nodal status (HR = 1.36, p = 0.001) as negatively associated with PFS while BMI (HR = 0.96, p = 0.02) was positively associated. ECOG performance status (HR = 2.26, p < 0.0001), nodal status (HR = 1.18, p = 0.08), and CIRS3 (having a comorbidity classified as severity 3; HR = 1.33, p = 0.02) were negatively associated with OS. BMI (HR = 0.95, p = 0.002) and CIRSmean (mean CIRS-G severity score; HR 0.61, p = 0.01) were positively associated with OS. These variables were also identified as the most significant splitters, along with smoking status and pulmonary function, in CART analyses. Trees using PFS and OS as outcomes were created with receiver operating curves (ROC) ranging from 0.64–0.75. A CART analysis targeting treatment modality chosen had ROCs ranging from 0.49–0.78. Conclusions: Our multivariate analysis found ECOG performance status, nodal status, and severe medical comorbidity as negatively associated with survival. Unexpectedly, BMI (at initial treatment), independent of weight loss, was found to be positively associated. Also, the splitter variables identified by CART analysis were very similar to the general multivariate model, but the weights differed in the various analyses and subgroups of patients. The CART analyses suggest that we can create decision making models with a range of applicability comparable to those commonly considered useful for clinical guidelines, i.e. about 60% of straightforward application. No significant financial relationships to disclose.
Increased toxicity associated with delayed clearance of methothrexate (MTX) in patients with lymphoma receiving high-dose MTX
Authors: Huen A. , Romaguera J. E. , Fayad L. E. , Teegala S. R. , Ji Y. , Vadhan-Raj S. 
Published: March 2020

19578 Background: High response rates have been observed with the rituximab (R), cyclophosphamide, vincristine, doxorubicin, and dexamethasone (R-HyperCVAD) alternating R-MTX and cytarabine(AraC) regimen in patients with mantle cell lymphoma (MCL). Delayed MTX clearance, related to high dose MTX (1gm/m2) used in this regimen, is an important problem since the common practice is to monitor patients in the hospital for leucovorin rescue, hydration and urine alkalinization to avoid potential toxicity. It is unclear, however, if moderate delay in clearance is associated with increased toxicity. Methods: In this retrospective cohort study, we analyzed toxicity data from pts with MCL who received R-MTX (1gm/m2 given intravenously over 24 hours)/Ara-C as part of the R-HyperCVAD regimen. Delayed MTX clearance was defined as serum MTX level ≥ 0.1 μmol/L at 48 hours after end of infusion. Results: 112 patients received a total of 232 cycles of the (R)MTX/Ara-C regimen. The median age was 61 years (range, 40–80) with 37% of patients over 65 years. Of the 228 evaluable cycles, 80 cycles (35 %) had delayed MTX clearance. Median time to clearance of MTX in the delayed clearance group was 72 hours post treatment (range 72–336 hours). Serum MTX levels at 48 hours from MTX completion in the delayed group ranged from 0.1 to 3.55 micromol/L. The cycles with delayed MTX clearance were associated with more toxicity than cycles with non-delayed clearance as shown in the table below. *(out of 143 evaluable cycles) Conclusions: These findings indicate that patients with delayed MTX clearance at 48 hours are at increased risk for myelosuppression and renal toxicity. These findings suggest future evaluation of the role of Carboxypeptidase (CPDG2), a novel enzyme that cleaves MTX into inactive metabolite, for early intervention in patients with an evidence of delayed clearance at 48 hours to reduce hospitalization and prevent subsequent complications. [Table: see text] No significant financial relationships to disclose.
Emergence of quinolone-resistant Escherichia coli at a comprehensive cancer center
Authors: Rolston K. V. , Coyle E. , Prince R. 
Published: March 2020

19623 Background: Quinolone prophylaxis is recommended in high-risk neutropenic patients. Although effective in reducing the frequency of febrile episodes and documented gram-negative infections, this approach can lead to the emergence of resistant organisms. Surveillance studies looking for changes in resistance patterns at institutions that care for high-risk patients are also recommended. Methods: Our institution has participated in the meropenem yearly susceptibility test information collection (MYSTIC) program since 2000. The susceptibility of E. coli isolates from our cancer patients to quinolones (ciprofloxacin and levofloxacin) and broad-spectrum agents often used in empiric antimicrobial regimens in such patients, was determined. These studies were conducted by JMI Laboratories, Iowa, USA, and combined results as well as results of each participating institution were provided. CLSI designated breakpoints for susceptibility were used. Ribotyping and PFGE studies were performed on recent isolates. Results: Table 1 documents the declining susceptibility of E. coli isolates to the quinolones. In 2006 only 40.7% were quinolone susceptible compared to 84.2% in 2000 (p = 0.0032). All E. coli isolates remain susceptible to the carbapenems (meropenem, imipenem, ertapenem) and 95.5% remain susceptible to cefepime, ceftazidime, piperacillin-tazobactam, and the aminoglycosides. Twenty-one resistant E. coli isolates underwent ribotyping. Fourteen isolates showed identical ribotype and similar PFGE patterns suggesting the presence of an endemic clone. The other 7 isolates showed variability in their molecular patterns. Conclusions: Quinolone resistance among E. coli strains isolated from cancer patients has increased substantially. Fortunately these isolates remain susceptible to most broad-spectrum beta-lactams and aminoglycosides. Effective infection control methods need to be implemented and enforced in order to reduce the spread of these organisms in high risk patients. No significant financial relationships to disclose. [Table: see text]
What can we do for gastrointestinal cancer patients with poor performance status (PS)?
Authors: Shitara K. , Munakata M. , Muto O. , Kasai M. , Sakata Y. 
Published: March 2020

19629 Background: The prognosis of advanced gastrointestinal cancer patients, especially those with poor PS, is generally dismal. Needless to say, such patients are ineligible for participation in clinical studies. However, there are many patients with poor PS who wish to receive chemotherapy. Methods: From June 2000 to October 2006, a total of 508 patients with advanced cancer, including 304 gastrointestinal cancer patients, were treated by chemotherapy in our hospital. Of these, 110 gastrointestinal cancer patients (gastric=35, colorectal=30, pancreatic=26, biliary tract=11, esophageal=8) had poor PS (ECOG PS 3 = 68 patients, PS 4 = 42 patients). In 103 patients with at least one measurable lesion, a partial response according to RECIST criteria was obtained in 13 patients (12.6%). In 60 patients with ascites (47 patients), pleural effusion (25 patients), or both (12 patients), 11 of the patients (18.3%) achieved decreased fluid accumulation. A decline in tumor markers (>25%) was observed in 28 patients. Improvement in PS was seen in 13 patients (11.8%). As a result, 35 patients (31.8 %, including 9 patients with PS 4) achieved a tumor response, a decrease in accumulated fluid, or a decline in tumor markers, which resulted in a survival benefit compared to the other 75 patients without effect (6.4 months vs. 2.3 months, p<0.001). Alleviation of some symptoms was observed in 28 out of 98 symptomatic patients (30.4%). A better response and/or a decline in tumor markers significantly correlated with alleviation of symptoms (p<0.001). No treatment related death was seen. Conclusions: With regard to response rate, chemotherapy was rarely effective for patients with advanced gastrointestinal cancer with poor PS. However, more than a few patients gained a certain survival benefit and alleviation of symptoms. Thus, chemotherapy may be warranted in cases of patients with advanced gastrointestinal cancer who wish to receive chemotherapy despite the low possibility of response. No significant financial relationships to disclose.
Invasive healthcare-associated (HA) environmental fungal infections (EFI) in pediatric oncology (ONC) patients (PTS) are an ever-present risk
Authors: Cox J. , Metcalf P. , Seigel J. , Winick N. 
Published: March 2020

19631 To reduce the risk of HA EFI, our ICUs, onc inpatient and stem cell transplant (SCT) units are centrally HEPA filtered and portable HEPA filters are used in each onc outpatient clinic room. Anticipating demolition and then construction of a new, adjacent hospital tower, infection control (IC) verified (Feb 2006) that all windows were completely sealed, provided valet parking remote to the construction and N95 respirators to be worn in all areas except the HEPA filtered locations for immunosuppressed pts to reduce exposure to construction dust; a known risk factor for HA EFI. Eleven new cases of possible HA EFI were diagnosed in 2006: 3 part of a Jan-Feb cluster related to a new construction elevator and malfunction of a door to the outside and 8 clustered July-Oct after demolition and construction began in April. This compares with only 4 cases in 2005. The primary diagnoses in 2006 were AML (6), ALL (4), and hemophagocytic lymphohistiocytosis (1) versus AML (2) and SCT (2) in 2005. Pts with AML and SCT received antifungal prophylaxis or were receiving antifungal therapy at the time of EFI diagnosis. Different isolates were identified including Aspergillus (numerous species), Scedosporium, Fusarium, and Rhizopus; sites of infection included paranasal sinuses (5), pulmonary (6), skin (2) and GI tract (1). 3 of 11 pts died; all required long term antifungal therapy, and most required altered chemotherapy. 4 of 8 pts in the Jul-Oct cluster had been in rooms later found to have faulty window caulking caused by severe weather conditions in Mar 2006. Our data suggest that despite implementation of measures to prevent HA EFI, new sources of outside air and construction dust likely led to an increase in HA EFI. The absence of HA EFI in SCT pts in 2006 may be attributed to the positive pressurization of the SCT unit, location of the unit facing away from the construction site and the antifungal prophylaxis used. The variety of fungi also support outside air as a source. After the faulty caulking was identified and repaired, no further HA EFI occurred; a case-control study is underway to identify important risk factors. Vigilance for potential new sources of contaminated air is required on units with high risk patients. No significant financial relationships to disclose.
Invasive respiratory Aspergillosis is a treatable disease with early diagnosis and aggressive therapy
Authors: Cakir F. B. , Cakir E. , Berrak S. G. , Uyan Z. S. , Beker D. B. , Karakoc F. , Canpolat C. , Dagli E. 
Published: March 2020

19632 Background: Invasive respiratory aspergillosis (IRA) is a fulminant infection in immunocompromised hosts. This study aims to evaluate the effectiveness of early screening of patients and the outcome of them during febrile neutropenia (FNP) episodes. Methods: Between 2003 and 2006, 212 FNP episodes were evaluated and the cases who are still febrile at their fifth FNP treatment were screened with computerized tomography (CT) of sinus, thorax and and other relevant sites. Results: Fungal infection rate was 15%, while IRA was detected in 22 patients. Thirteen of these patients were male. Fifteen patients had hematological malignancies, 6 had solid tumors and one patient had combined immunodeficiency and hemophagocytic lymphohistiocytosis. All patients had absolute neutrophil count of zero for 5 to 30 days (median 11.5 days). IRA cases were classified as definite (n:3), probable (n:7) and possible (n:12) according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. Amphotericin B was administered emprically to all cases and continued as a single agent in 7 patients. Variable modifications with caspofungin, voriconazole or itraconazole were done in 11, 9 and 2 patients, respectively. At present, 7 patients are disease-free after completion of treatment, 6 patients are still on antifungal therapy, 4 patients were lost despite antifungal therapy and 5 patients died of underlying disease while in remission or with stabile disease for a median of 339 days (range: 13–1027 days). Therefore, our remission rate and overall survival rates are 83% and 60% respectively. Conclusions: Contrary to the previous reports, we suggest that IRA is a treatable disease with early diagnosis and aggressive antifungal therapy and it is worthwhile to screen FNP patients who are resistant to wide-spectrum antibiotics with CT for early intervention. No significant financial relationships to disclose.
Symptom profile and clinical characteristics of metastases in metastatic renal cell carcinoma
Authors: Sawhney R. , Kabbinavar F. , Pantuck A. , Klatte T. , Zomorodian N. , Belldegrun A. 
Published: March 2020

19638 Background: In the US, 39,000 new cases of renal cell carcinoma (RCC) will be diagnosed and 13,000 people will die of RCC, in 2006(1). While incidence has increased 126% since 1950 (2,3), little information is available regarding prevalence of symptoms & signs or metastases in patients presenting with metastatic RCC. Significance of such information is high as patients will be living longer, in this emerging era of targeted therapies for RCC. Method: Data were taken from prospective database of 1818 patients evaluated at UCLA with histologically confirmed RCC. From this 631 patients were identified with metastatic disease & surveyed at diagnosis. Data was obtained on matching variables, that included age, gender, ethnicity, smoking status, comorbidities, performance status, symptoms, site of metastasis & therapy. Results: 449 (71%) men, 182 (29%) women, were evaluated. Weight loss, hematuria, fatigue, flank pain, cough and musculoskeletal pains were the five most prevalent symptoms and signs. Of these patients, 557 (88%) were symptomatic with atleast one or more symptom on presentation and their presence lead to a diagnosis in 565 (90%) patients. In only 55 (8%) patients was metastatic RCC diagnosed incidentally. Most common metastatic site were the lungs 461 (73%), bones 200 (32%), followed by adrenals, non regional lymph nodes and soft tissue.Conclusion: In a large survey of metastatic RCC patients, weight loss, hematuria, fatigue, flank pain, cough and musculoskeletal pains were the five most prevalent symptoms and signs. Presence of atleast one or more of the above mentioned signs and symptoms led to a diagnosis in 90% of patients. Involvement of lungs and bones was most common at presentation. We believe that a better understanding of symptom and signs in patients with metastatic RCC, will lead to the development of better symptom assessment strategies, as well as early and thus cost-effective interventions. Especially in an era of increased disease control with targeted therapies. No significant financial relationships to disclose. [Table: see text]