tbuckley/cabot-search huggingface dataset:
Hypersensitivity to platinum salts according to BRCA status in ovarian cancer: Retrospective analysis of clinical outcomes.
Authors: Gaia Giannone, Giulia Scotto, Ugo De Giorgi, Alberto Farolfi, Dionyssios Katsaros, Fulvio Borella, Annamaria Ferrero, Michela Villa, Valentina Tuninetti, Eleonora Ghisoni, Margherita Turinetto, Laura Zavallone, Massimo Aglietta, Barbara Pasini, Massimo Di Maio, Giorgio Valabrega
Journal: Journal of Clinical Oncology (2020)

6053 Background: Hypersensitivity reactions (HSRs) to platinum salts are an important issue in the treatment of ovarian cancer (OC) patients (pts). Few data suggest that, along with number of previous cycles, germline BRCA mutations could be a risk factor. We aimed at evaluating the incidence and severity of HSRs to platinum salts in a large group of OC pts with known BRCA status and correlated them with drug exposure time. Methods: Between March 2003 and September 2019, 432 pts with a diagnosis of OC and a known BRCA status, were recorded in our 5 Institutions and retrospectively analyzed. The following data were collected: histology, BRCA status, type of surgery and first line therapy, number of total lines and cycles received, line and cycle of HSR onset, symptoms, history of other allergies and if desensitization was attempted. We graded the severity of HSRs according to CTCAE v5.0. We calculated the total duration of exposure to platinum salts, summing up the duration of all platinum lines received by the pts. Results: Four hundred nine of 432 (94.7%) pts were treated with at least one platinum-based line of therapy and were eligible for the analysis. Among them, 314 pts were BRCA wild type (BRCAwt) (76.8%) and 95 were BRCA mutated (BRCAmut) (23.2%). There was no statistical difference in number of prior lines of therapy [median 1 (2-6) for BRCA wt and 2 (1-6) for BRCAmut pts (p = 0.194)] and duration of exposure to platinum [median 126 (42 – 893) and 197 (42 – 896) days for BRCAwt and BRCAmut pts, respectively (p = 0.145)]. Incidence of any grade HSRs was 29 / 314 (9.2%) among BRCAwt pts vs. 17/ 95 (17.9%) among BRCAmut pts (Odds ratio [OR] 0.47, 95% CI 0.24 – 0.89, p= 0.019). All recorded HSRs to platinum salts were related to carboplatin. We observed a numerically higher incidence of Grade 3-4 HSRs in BRCAmut pts (5.1% in BRCAwt vs. 10.5% in BRCAmut cohort, OR 0.46, 95% CI 0.20 – 1.04, p = 0.057). The risk to develop HSRs increases with duration of exposure to platinum, particularly in BRCAmut pts. The cumulative incidence of any grade HSRs was 20.6% vs. 23.3% after 12 months and 38.4% vs. 59.7% after 18 months in BRCAwt and BRCAmut pts, respectively (Hazard Ratio [HR] 1.72, 95% CI 0.94 – 3.12, p = 0.073). The cumulative incidence of severe HSRs was 10.9% vs. 15.7% after 12 months and 26.5% vs. 41.0% after 18 months in BRCAwt and BRCAmut pts, respectively (HR 1.88, 95% CI 0.85 – 4.16, p = 0.11). Conclusions: In BRCAmut OC pts, there is a significantly higher incidence of HSRs to carboplatin, that seems not justified by longer drug exposure only.
Next-generation sequencing of tissue and liquid rebiopsy favors post-progression outcomes of <i><i>EGFR</i></i> T790M-positive NSCLC patients treated with osimertinib.
Authors: Jiangtao Cheng, YiHui Yao, Yu-Er Gao, Shi-Ling Zhang, Hua-Jun Chen, Zhen Wang, Hong-Hong Yan, Qing Zhou, Hai-Yan Tu, Xu-Chao Zhang, Jian Su, Zhi Xie, Yi-Long Wu, Jin-Ji Yang
Journal: Journal of Clinical Oncology (2020)

e21563 Background: Osimertinib is standard of care for patients with advanced non–small-cell lung cancer (NSCLC) carrying acquired epidermal growth factor receptor ( EGFR) T790M mutation. However, few studies have been conducted to investigate the impact of rebiopsy on clinical outcomes after resistance to osimertinib. We evaluated whether next-generation sequencing (NGS) of tissue and liquid rebiopsy could favor post-progression outcomes of T790M-positive advanced NSCLC patients treated with osimertinib. Methods: Immediately just after resistance to second- or further-line osimertinib, advanced NSCLC patients with acquired EGFR T790M mutation were retrospectively divided into the NGS and non-NGS groups according to whether they underwent NGS of tissue or liquid rebiopsy. The co-primary endpoints were post-progression survival (PPS) defined as the time from osimertinib resistance to subsequent-line treatment resistance, and post-progression overall survival (pOS) defined as from osimertinib resistance to death or end of the last follow-up. Multivariable analyses were done using Cox proportional hazards regression model and log-rank test. Results: Between January 2017 and July 2019, 89 patients (62 vs. 27 for the NGS and non-NGS groups respectively) were eligible for final analyses. In the NGS group, 3.2% (2/62) underwent tissue rebiopsy only, 29.0% (18/62)only had liquid rebiopsy, and 66.8% (42/62)with both tissue and liquid rebiopsy.The NGS group received more targeted or combined therapy after resistance to osimertinib (62.9% vs. 40.8%, P= 0.053). The NGS group was significantly superior to the non-NGS group in the co-primary endpoints. The median PPS was 6.1 vs. 2.7 months (hazard ratio [HR], 0.49; 95%CI, 0.30 to 0.80; 2-sided log-rank P= 0.004). Meanwhile, the median pOS was 11.7 vs. 6.8 months (HR, 0.50; 95%CI, 0.29 to 0.85, 2-sided log-rank P= 0.009). Conclusions: Providing more opportunities for individualized treatment, NGS of tissue and liquid rebiopsy favors post-progression outcomes of EGFR T790M-positive advanced NSCLC patients treated with osimertinib.
Cost-utility analysis of surveillance strategies for soft tissue sarcoma recurrence.
Authors: Bonny Chau, Marita Zimmermann, Michael Wagner, Lee D. Cranmer
Journal: Journal of Clinical Oncology (2020)

11565 Background: Soft tissue sarcomas (STS) are uncommon malignancies with significant biological and clinical variation. After primary curative therapy, patients enter a program of surveillance for recurrence with periodic chest x-rays (CXR) or computed tomography (CT). We compared costs and health outcomes of CXR and CT at a range of frequencies and durations of follow-up. Methods: We used a Markov model to simulate a cohort of 10,000 STS patients through their surveillance experience for lung metastasis after completion of definitive treatment for stage II or III primary disease. Health states in the model were no evidence of disease, recurrence, and death. We assessed the method of chest imaging, duration of follow-up, and interval (every 3 months or 6 months) of surveillance in the first 3 years. Cost effectiveness was assessed for each screening modality and screening frequency. Recurrence probabilities, utilities, treatment costs, and other parameters were from previously published data. Outcomes were costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER). Results: The initial evaluation comparing screening every 3 months for 3 years, every 6 months for years 4 and 5, and annually from years 6 to 10 resulted in 632,264 QALYs and $1,038,351,481 costs for CT, compared to 631,834 QALYs and $746,019,937 for CXR, resulting in an ICER of $679,322/QALY. In comparing screening intervals, less frequent screening intervals of every 6 months compared to every 3 months for the first three years using CT resulted in an ICER of $690,527/QALY and for CXR, the ICER was $271,423/QALY. In comparing screening duration between 6 years and 10 years of follow-up, strategies with longer follow-up resulted in slightly higher QALYs in each of the comparison scenarios, at a much higher cost. Conclusions: In our evaluation, more frequent screening the first 3 years and longer duration of surveillance resulted in higher QALYs in both screening modalities. However, in the comparisons the ICERs exceed common willingness to pay thresholds of $150,000/QALY gained; CXR is the more cost-effective imaging modality. Limitation of this model includes the simplification of disease progression and heterogeneity in STS.
Survey of challenges in access to diagnostics and treatment for neuroendocrine tumor (NET) patients (SCAN): Awareness of specialized techniques and latest interventions.
Authors: Mark McDonnell, Dirk Van Genechten, Teodora Kolarova, Dermot O'Toole, Harjit Singh, Jie Chen, James R. Howe, Simron Singh, Catherine Bouvier, Christine Rodien-Louw, Simone Leyden, Sugandha Dureja
Journal: Journal of Clinical Oncology (2020)

e16708 Background: SCAN measured global readiness to provide diagnostics and treatments for NET patients in terms of awareness, availability, quality and affordability. This analysis focused on patient and healthcare professional (HCP) awareness of NET diagnostics and treatments. Methods: During Sept-Nov 2019, NET patients and HCPs completed an online survey (available in 14 languages). Results: There were 2795 respondents from 68 countries across 6 continents (2359 patients/carers; 436 HCPs). Primary NETs were most often gastroenteropancreatic NETs (GEP NET; 71% [1408/1983]), particularly small intestinal (35% [690/1983]) or pancreatic (20% [402/1983]). Biopsy was the most well-known diagnostic option in the overall NET patient group (82% [1917/2325]), the GEP NET patient subgroup (83% [1156/1395]) and HCPs (94% [411/435]), followed by CT (all patients: 81% [1874/2325]; GEP NET: 80% [1118/1395]; HCPs: 86% [376/435]). More HCPs were aware of specialized diagnostics, such as 68 Ga-DOTA PET CT (HCP 81% [353/435]) and chromogranin A (CgA; 79% [344/435]), than patients (all: 68% [1574/2325] &amp; 62% [1451/2325], respectively; GEP NET: 69% [962/1395] &amp; 67% [936/1395]). The vast majority of all patients (87% [1983/2275]), GEP NET patients (89% [1215/1363]) and HCPs (91% [392/431]) knew surgery was a treatment option. Somastatin analogues were recognised as a treatment option by 90% of HCPs (387/431), but only 75% of GEP NET patients (1019/1363) and 70% of all NET patients (1599/2275). Nearly a quarter of HCPs (22% [95/431]) and one-third of patients (all: 33% [755/2275]; GEP NET: 30% [409/1363]) had not heard of peptide receptor radionuclide therapy (PRRT). The majority of patients (all: 88% [2007/2273]; GEP NET: 89% [1213/1370]) and HCPs (93% [396/425]) were aware of conventional imaging, such as CT/MRI/ultrasound, being used for ongoing monitoring of NETs. Approximately a third of all NET patients and a quarter of HCPs were unware CgA (patients: 32% [723/2273]; HCPs: 22% [94/425]) or 68 Ga-DOTA PET CT (patients: 29% [670/2273]; HCPs: 24% [102/425]) were ongoing monitoring tools. Similarly, CgA and 68 Ga-DOTA PET CT were not recognized by 27% of GEP NET patients (364/1370 &amp; 371/1370, respectively). Conclusions: Increased awareness of NET diagnostics and treatments, particularly newer, more specialized tools, amongst both HCPs and patients is required to ensure continued advancements and improvements in the global standard of care for NETs.
浮肿-腹泻-腹胀
Authors: 姚子明, 沈敏, 曾学军
Journal: BMJ (2012)

患者男性,45岁,因浮肿3年余、腹泻2年、加重伴腹胀2个月于2011年9月收入本院.患者2008年2月无明显诱因出现双下肢轻度可凹性水肿,晨轻暮重,伴下肢乏力,无发热、盗汗,无咳嗽咯痰、胸闷心悸、尿量减少、尿色异常及尿中泡沫增多. 关键词：蛋白丢失性肠病
498名新婚妇女紧急避孕知识宣传教育效果及意愿的调查分析
Authors: 刘学伟, 赵学英, 管嬿, 王杏芹, 翟艳荣
Journal: BMJ (2005)

对新婚妇女进行紧急避孕知识教育干预,对照组给予常规节育避孕教育,宣传教育组(宣教组)分发有关紧急避孕知识的宣传手册并给予专业咨询.结果显示,干预后宣教组的247例紧急避孕知识水平和使用紧急避孕法意愿均高于对照组的251例(P＜0.01),新婚妇女认为最理想的服务机构是妇幼保健院、大医院妇产科等.提示新婚妇女对紧急避孕知识有较高的需求和可接受性,宣教效果明显.各级医疗机构应大力宣传紧急避孕知识并提供及时有效的指导与服务。
Response Criteria for Intratumoral Immunotherapy in Solid Tumors: itRECIST
Authors: Gregory V. Goldmacher, Anuradha D. Khilnani, Robert H. I. Andtbacka, Jason J. Luke, F. Stephen Hodi, Aurelien Marabelle, Kevin Harrington, Andrea Perrone, Archie Tse, David C. Madoff, Lawrence H. Schwartz
Journal: Journal of Clinical Oncology (2020)

3141Background: The approval of intratumoral (IT) immunotherapy for metastatic melanoma and the active development of numerous novel IT drugs have created a need for standardized evaluation of resp...
Impact of clinical and pathological variables on stage I non-small cell lung cancer outcomes.
Authors: Matthew C Lee, Dimitre C Stefanov, Mallorie B Angert, Erica C Cohn, Nina Kohn, Michael J Esposito, Nagashree Seetharamu
Journal: Journal of Clinical Oncology (2020)

e21071 Background: Stage I patients (pts) have 5-year survival ranging 50-75% suggesting heterogeneity within. While American Joint Committee on Cancer 8 th edition upstages tumors with visceral pleural invasion (VPI) to IB, other histological features namely lymphovascular invasion (LVI), micropapillary pattern (MIP), spread through airspace (STAS) &amp; neuroendocrine differentiation (NE) may also affect prognosis. This retrospective single institution study evaluated influence of these factors along with pt variables age, gender, smoking, Charleston comorbidity index (CCI) &amp; chemotherapy (CT) on recurrence &amp; mortality. Methods: 351 resected stage I cases from 2015-2019 were included. Data was summarized as means (standard deviation/SD) or percentages. Association between variables &amp; outcomes (measured from diagnosis till event or last visit if no event) were investigated using Univariate &amp; Multiple Cox proportional hazards models. Survival curves were compared using the Log-Rank test when the assumption for the proportional hazards was not satisfied. All predictors were included in the multiple Cox regression models based on their clinical importance. P &lt; 0.05 was considered statistically significant. SAS 9.4 (SAS Institute, Cary, NC) was used for the analysis. Results: Mean age was 69.62 years (9.83). Majority were female (57.3%), smokers (76.9%), &amp; had adenocarcinoma (AC) (78.6%). 39% had COPD &amp; mean CCI was 6.3 (1.74). 193 (55%) pts had lobectomy or larger procedure while 158 (45%) had sub-lobar resection. 45 (12.8%) pts received CT. Recurrence &amp; death occurred in 33 (9.4%) &amp; 15 (4.3%) pts respectively. Univariate models indicated higher recurrence risk with NE (HR = 4.18 95% CI 1.47-11.9, p = 0.0075), LVI (HR = 2.68, 95% CI 1.03-6.94, p = 0.0423), COPD (HR = 3.28 95% CI 1.56-6.9, p = 0.0017), age (HR = 1.05 95% CI 1.01-1.09, p = 0.0212), &amp; CCI (HR = 1.57 95% CI 1.35-1.83, p &lt; .0001). CT was also associated with increased recurrence risk (HR = 8.61, 95% CI 4.28-17.33, p &lt; .0001). Multivariable model for recurrence retained significance for CT &amp; CCI. Age (HR = 1.07 95% CI 1.01-1.14, p = 0.0312), CCI (HR = 1.27 95 % CI 1.02-1.59, p = 0.0347) were associated with mortality in univariate models. Multivariate analysis for mortality wasn’t feasible due to few events. Conclusions: Histological features other than VPI may be associated with recurrence. Pts who received CT had increased recurrence but they possibly had multiple risk factors or other adverse features not assessed here. Limitations included retrospective nature, limited sample size &amp; small number of events.
Current status of hyper-triglyceridemia in community residents of Beijing
Authors: Gui-lian Wang, Yi-hong Sun, Yuan-yuan Fu, Da-yi Hu
Journal: BMJ (2009)

Objective To investigate blood level of triglyceride(TG)in community residents of urban and rural Beijing.Methods A total of 10 054 community residents were recruited by cluster samphng for investigation using questionnaire,as well as physical examinations and fasting plasma TG determination for diagnosing hypertriglyceridemia,during June to August,2007.Results Median of plasma level of TG of the participants was 1.17 mmol/L,ranging(0.81-1.78)mmoVL Totally,1234 people were diagnosed as borderline hypertriglyceridemia and 15 12 as hypertriglycefidemia.with prevalence of 12.27%and 15.04%,respectively.There was no significant difference in plasma level ofTG between men andwomen[1.16(0.80-1.84)mmol/L vs.1.18(0.81-1.75)mmol/L,P:0.187].Age-adjusted prevalence of borderline hypertriglyceridemia and hypertriglyeeridemia was higher in men than those in women(11.60% vs.10.90%and 20.32% vs.10.88%,respectively),and the same results were obrained in those less than 50 years old,however,reveraw outcomes were got in those more than 50 years old.Plasma level of TG,as well as prevalence of hypertriglyceridemia,were higher in those living in urban areas than those in rural areas[1.31(0.89-1.95)mmol/L vs.1.05(0.73-1.58)mmol/L].Awareness,proportion of people with hyperglycefidemia under treatment and proportion of those with TG under coutrol were 13.95%.35.92%and 38.51%,respectively.Standardized prevalence of borderline hyperglycefidemia and hyperglycefidemia were higher in those with coronary heart disease than those without it(24.79% vs.11.22%and 25.31% vs.15.35%,respectively).Conclusions Awareness,proportion of treatment and proportion of those under control for hyperglyceridemia were all lower in community residents of Beijing.Education and monitoring on hyperglyeeridemia should especially be strengthened for urban residents,women aged more than 50 years,and these with coronary heart disease.

Key words: 
Hyportriglyceridemia; Cross-sectional studies; Qestionnaires
鼻内镜下治疗鼻出血的体会
Authors: 王锦文
Journal: BMJ (2007)

应用鼻内镜技术对79例患者反复鼻出血的病因进行仔细检查,给予不同的止血方法治疗,治疗后均可达到止血.随访6～12个月,平均8.5个月.治愈率达97%,疗效显著.提示应用鼻内镜手术技术治疗鼻出血视野清晰、定位准确、止血效果好。
糖尿病合并急性冠状动脉综合征患者出院后的治疗
Authors: 秦明照
Journal: BMJ (2008)

急性冠状动脉综合征(acute coronary syndrome,ACS)是一大类包含不同临床特征、临床危险性及预后的临床症候群,其共同的病理机制是冠状动脉粥样硬化易损斑块破裂和糜烂并发血栓形成、血管痉挛及微血管栓塞等多因素作用下,导致病变血管不同程度的阻塞,引起急性或亚急性心肌供氧减少。
按系统整体论理念抢救一起毒蕈中毒事件的体会
Authors: 王景山, 韩佩孚, 王景文, 王志清, 刘兴海, 孙桂芹
Journal: BMJ (2005)

2003年9月,我市发生一起毒蕈(毒蘑菇)中毒事件,先后30人出现中毒症状,我院收治重症患者10人,其中4人死亡.本次抢救工作中,我们以全科医学理论中的系统整体论为指导,收效良好,得到了患者、家庭、社会、政府等方面的认可,现总结如下。
急腹症的影像学诊断(二)
Authors: 徐辉, 谢敬霞
Journal: BMJ (2011)

(急腹症的影像学诊断(一)见本卷第6期第454页) 三、肠套叠 肠套叠指肠管向远端或近端的肠腔内套入.大多数婴儿肠套叠属于急性原发性,腹腔内无任何器质性病变因素.由肠壁器质性病变而引发的肠套叠多见于成人,可由憩室、息肉或肿瘤等所致.套叠处由内向外分别称内筒、中筒及外筒.内筒与中筒合称套人部,外筒又称套鞘.中筒与外筒的返折部称套叠颈部,中筒与内筒的返折部称套叠头部.颈部与套鞘的痉挛可致套入的系膜发生狭窄,肠壁可由淤血发展为缺血,最终导致坏死与穿孔。
Endoscopic retrograde cholangiopancreatography (ERCP) findings to predict survival in patients with metastatic pancreatic adenocarcinoma.
Authors: Vishwajith Sridharan, Neha Shafique, Elijah Darnell, Thomas Wang, Yasmin Hernandez-Barco, Maximilian Weniger, Motaz Qadan, Carlos Fernandez Del-Castillo, Brenna Casey, Kumar Krishnan
Journal: Journal of Clinical Oncology (2020)

e16734 Background: Chemotherapy is the primary therapy for patients with metastatic pancreatic ductal adenocarcinoma (PDAC), but response to therapy is variable. Patients with PDAC often develop jaundice and cholangitis and require endoscopic biliary stenting. Here, we investigate the association between ERCP findings, cholangitis, chemotherapy use, and survival in PDAC patients. Methods: We conducted a retrospective chart review of all patients who received metal stents for biliary obstruction with PDAC over a five-year period at the Massachusetts General Hospital. Only patients with metastatic cancer were included. Patients were stratified by whether or not they received chemotherapy, as well as the presence or absence of cholangitis. Associations between chemotherapy use and ERCP findings were investigated. Survival analyses were performed to compare patients by chemotherapy use, presence of cholangitis, and findings at ERCP. Results: A total of 126 patients were included; the average age of patients in our study was 69.9 ± 11.8. The average size of the primary lesion was 38.7 ± 14.4 mm. Sixty-nine percent of patients completed chemotherapy. The average number of stents for all patients was 2.5 ± 2.5, but was significantly higher in patients who experienced cholangitis (3.3 ± 2.8) as expected (p &lt; 0.001). The majority of ERCP reports noted debris or sludge (44%), followed by presence of infiltrating or obstructing tumor (27%), stone (13%), pus or purulence (11%), and blood clot (5%). Patients who did not receive chemotherapy were more likely to have tumor obstruction noted on ERCP compared to those who received chemotherapy (p = 0.024). Patients undergoing chemotherapy were also more likely to have sludge noted on ERCP (p = 0.009) compared to those who did not have chemotherapy. There was no association between chemotherapy use and presence of stones (p = 0.94) or presence of purulence (p = 0.44) noted on ERCP. Among patients who received chemotherapy, those who had sludge or debris noted on their ERCP tended to have better survival compared to those where sludge was not noted on endoscopy (p = 0.038). Conversely, among patients who received chemotherapy, identification of an obstructing tumor on ERCP was prognostic of poorer survival (p = 0.037). Among patients who did not get chemotherapy, there was no survival difference between patients who had sludge or tumor and those who did not. Conclusions: Findings on ERCP may serve as a surrogate for chemotherapy response and be prognostic of survival in metastatic PDAC.
Novel systemic therapies in hard to treat fibrolamellar hepatocellular carcinoma.
Authors: Ariel Gliksberg, Claire O'Grady, Paul Kent
Journal: Journal of Clinical Oncology (2020)

e16653 Background: Fibrolamellar Carcinoma (FLC) is a very rare liver malignancy of young adults without underlying liver disease (0.02 per 100,000 in the US).. Complete resection is the primary therapy, but recurrence rates are still &gt; 50%. Currently there are no established systemic treatments, especially for high-risk disease (unresectable, relapse, progression, or metastatic disease). At our institution triple therapy “TT” with Nivolumab/5FU/Interferon α-2b is our first line, followed by other novel combination therapies such as Gemcitabine/Oxaliplatin/Lenvantinib (GOL) or Nivolumb/Lenvantinib/Quecertin (NLQ). Objective: To evaluate the tolerability and early response of multi-agent systemic therapies in patients with high-risk FLC. Methods: Data from all patients with FLC who received systemic therapies from 5/2018 to 2/2020 was reviewed to assess tolerability, survival and toxicity. Results: Nineteen patients were treated with systemic therapies of which 16 (10F, 6M median age of 19) were evaluable based on follow up scans. Between our 16 patients they had relapsed 28 times, 12 had metastatic disease and 7 had tried 2+ systemic therapies. RECIST 1.1 objective response (CR+PR) and tumor control (CR+PR+SD) are 44% and 69%. Since starting multi-agent therapy, all 6 patients who had previously been treated with monotherapy, have already exceeded their previous longest time to progression. Thirteen patients were treated with “TT” [12.5 median cycles (6-38)]. Three patients were treated with NLQ including 2 who failed TT. Of these, the 1 evaluable patient achieved CR. Two patients were treated with GOL, 1 who failed TT and one who was post liver transplant, both had sustained PR of 6 and 9 months. Subsequently one died and one achieved CR. For the 6 patients who achieved remission before or during therapy, only 1 has relapsed. To date the period of response is already 68% longer than the previous best length of response. There was 1 withdrawal due to grade 3 colitis and 2 dose adjustments. All experienced mild adverse effects, most commonly fever, headache, and hypertension, with 3 patients with grade 3 toxicities. Conclusions: FLC is a devastating disease with patients often relapsing even after successful surgical remission. Currently there is a need for tolerable systemic therapies. Although at our institution, TT is our frontline therapy, there are other combinations of immunochemotherapies that we have used to treat FLC with preliminary success and minimal toxicities. Our early results show that multi-agent systemic therapy in hard-to-treat FLC is worthy of further study.