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The applicability of prognostic models under rituximab-dose-adjusted EPOCH (R-DA-EPOCH) in primary mediastinal large b-cell lymphoma (PMLBCL) : a comparison with R-CHOP

Sun, 01 Jan 2023 00:00:00 GMT

Title: The applicability of prognostic models under rituximab-dose-adjusted EPOCH (R-DA-EPOCH) in primary mediastinal large b-cell lymphoma (PMLBCL) : a comparison with R-CHOP Authors: Vassilakopoulos, Theodoros; Ferhanoglu, B.; Horowitz, Na; Apostolidis, J.; Mellios, Z.; Piperidou, Alexia; Kaynar, L.; Zektser, M.; Giotas, Asterios; Symeonidis, A.; Kalpadakis, C.; Agathocleous, A.; Akay, Om; Sayyed, A.; Atalar, Sc; Katodritou, E.; Leonidopoulou, T.; Papageorgiou, Sg.; Tadmor, T.; Gutwein, O.; Karakatsanis, S.; Ganzel, C.; Karianakis, G.; Isenberg, G. Y.; Gainaru, G.; Vrakidou, E.; Palassopoulou, M.; Ozgur, M.; Siakantaris, Marina; Paydas, S.; Tsirigotis, P.; Tsirogianni, M.; Hatzimichael, E.; Tugular, Tf.; Assimakopoulos, Jv; Ligdi, L.; Liaskas, A.; Lefaki, Maria Aikaterini; Labropoulou, P.; Kopsaftopoulou, A.; Verrou, E,; Kanellias, M.; Zikos, P.; Koumarianou, A.; Gafter- Gvili, A.; Angelopoulou, Mk; Karmiris, T.; Gurion, R. Abstract: Abstract Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical; Background: The rarity of PMLBCL has prevented the development of dedicated, powerful and validated prognostic systems. The International Prognostic Index (IPI) and its age-adjusted variant are of questionable value under R-CHOP±radiotherapy (RT). Recently, we published two potential prognostic systems for PMLBCL: The first combined the presence of extranodal disease (stage IV or simply extranodal extension; E/IV) with elevated LDH exceeding twice the upper normal limit (LDH>2x) (E/IV-LDH2x model). The second combined E/IV with bulky disease ≥10 cm (E/IV-bulk). The potentially improved outcomes with R-da-EPOCH render the identification of powerful prognostic factors even harder and the applicability of prognostic models questionable.; Aims: To assess the applicability of the E/IV-LDH2x and E/IV-bulk prognostic models in the setting of PMLBCL treated with R-da-EPOCH and minimal use of RT in a multinational real-life setting.; Methods: In Hellenic, Israeli, Turkish, Saudi, Maltese and Cypriot Centers, 258 patients (<65 years) with PMLBCL were treated under the R-da-EPOCH program. Consolidative RT was given at the treating physician’s discretion in a minority of patients (~15%) usually based on PET/CT results. Full data regarding the E/IV-LDH2x and E/IV-bulk models were available in 253 and 244 patients respectively. Survival data were compared numerically with a previously published Hellenic-Cypriot series of 332 PMLBCL patients (≤65 years old) treated with R-CHOP (Vassilakopoulos et al. Oncologist; 2021;26:597-609).; Results: The 5-year Freedom From Progression (FFP) after R-da-EPOCH was 84.7%. However, 5 patients developed therapy-related (t-)AML at 10.5-24 months from treatment initiation, while in 1st remission. The 5-year Lymphoma-Specific Survival (LSS) was 91.7%. Protocol violations were common (53%), mainly consisting of insufficient dose escalation despite the absence of prohibitive toxicity. As shown in the table, the distribution of patients with 0,1 or 2 adverse factors in the E/IV-LDH2x and E/IV-bulk were almost identical in the R-CHOP- and the R-da-EPOCH-treated populations despite the diverse ethnic origin. With less marked differences between the prognostic subgroups and less events, the prognostic models produced statistically significant results of lower magnitude after R-da-EPOCH compared to R-CHOP. Interestingly, patients with no adverse factors by either model had virtually identical 5-year FFP (88-90%) and LSS (96% for the E/IV-LDH2x and 98-99% for the E/IV-bulk model) irrespectively of treatment with R-CHOP or R-da-EPOCH. The use of RT was much more frequent with R-CHOP (data to be precisely presented in the Meeting). Patients with 1 risk factor had 7-12% better FFP in absolute terms and 4-8% better LSS with R-da-EPOCH compared to R-CHOP. Patients with 2 risk factors had 11-15% better FFP but virtually no difference in LSS when treated with R-da-EPOCH.; Summary/Conclusion: Prognostic models derived from R-CHOP-treated populations are also applicable under R-da-EPOCH, although less discriminative. This comparative study suggests that R-CHOP may be sufficient in patients with no adverse factors but the need of RT remains an open question. Patients with one or multiple adverse factors appear to do better than with R-CHOP. A final analysis of ~290 R-da-EPOCH patients will be presented. The application of the above prognostic models might facilitate the selection of optimal R-da-EPOCH candidates with the hope to avoid severe toxicity, including t-AML.

Il-Musbieh : Malta Nursing and Midwifery Journal : issue 112 : September 2026

Tue, 01 Sep 2026 00:00:00 GMT

Title: Il-Musbieh : Malta Nursing and Midwifery Journal : issue 112 : September 2026 Abstract: Table of contents: 1/ Editorial: Thirty Years of MUMN: A Legacy Worth Defending -- 2/ PACE, P. - President's message: MUMN will not tolerate racism, abuse or violence against our members -- 3/ GALEA, C. - Kelmtejn mis-Segretarju Ĝenerali -- 4/ CAMILLERI, J. - Opinjoni: Għaliex niċčelebraw il-Jum Internazzjonali tal-Infermiera? -- 5/ GALEA VELLA, M. - Green Nursing -- 6/ FENECH, P. - Proposti li nixtieq nara fil-qasam tas-sañha bħala fiżjoterapista b'24 sena esperjenza u bħala rappreżentanta tal-Fiżjoterapisti fi ħdan I-MUMN għal dawn I-aħħar 13-il sena -- 7/ Certain historical highlights of the Catholic Church's history on health care -- 8/ CUSCHIERI, S. - Non-suicidal self-injury and mentalisation-based therapy -- 9/ CAMILLERI, J. - SRN No.1: Ethel Gordon Fenwick -- 10/ GRECH, W. - "L-MUMN - Tletin sena ta' storja, hidma u impenn (1996-2026)" -- 11/ European Semester Country Report for Malta 2026 -- 12/ 4 ways to talk to patients about strike action -- 13/ ATTARD, D. - Why Community Matters More Than Ever in Healthcare -- 14/ Vicarious trauma: spotting the signs and taking action -- 15/ ICN calls for urgent action on maldistribution of nurses between hospital vs community settings -- 16/ Perimenopause: "I woke one morning with a gripping anxiety"

The Dental Probe : issue 99 : September 2026

Tue, 01 Sep 2026 00:00:00 GMT

Title: The Dental Probe : issue 99 : September 2026 Authors: Muscat, David Abstract: Table of contents: 1/ MUSCAT, D. - Editorial -- 2/ MELI ATTARD, A. - Mastering posterior restorations: predictability in everyday practice -- 3/ RIZZO, D. - Anterior composite workshop: a hands-on clinical approach -- 4/ MUSCAT, D. - The once only technical system -- 5/ BARUFFALDI, A. - Chairside 3D printing in contemporary restorative dentistry: three clinical workflows from daily practice -- 6/ Zammit Orthodontics - Does orthodontics cause or cure breathing disorders?

The Synapse : the Medical Professionals' Network : volume 24 : issue 2

Wed, 01 Jan 2025 00:00:00 GMT

Title: The Synapse : the Medical Professionals' Network : volume 24 : issue 2 Authors: Friggieri, Jesmond; Ellul, Ian C. Abstract: Table of contents:; 1/ FEARNE, C. - Antimicrobial resistance : a call to action; 2/ OPADIYA, M. A., AHMED, N., UDOH, F. S., BORG, D., & ZAMMIT-VINCENTI, M. - Proportion of surgical patients prescribed VTE prophylaxis upon admission; 3/ CHOUEIRY, P. - Effects of cardiozymTM supplementation on lipid profile and cardiovascular risk in patients at risk for cardiovascular disease : a retrospective chart review; 4/ CUTAJAR, K., & MIFSUD, T. - Speech and language success : early intervention for lasting impact; 5/ SPITERI, P. - Mindfulness : how, and when to start this evidence-based practice; 6/ GAUCI, C., ZRINZO, S., & BELLIZZI, M. - Sacroiliac joint syndrome : multidisciplinary perspective on diagnosis and management; 7/ MUSCAT, J. - The ongoing breast screening debate : time to clear the air; 8/ BORG, J., BRINCAT, D., THEUMA, S., VELLA, J., VELLA, M., BORG, J., & FELICE, A. - CAREOMICS : x and y chromosome typing in the Maltese population : from population genetics to clinical practice; 9/ GRECH, A., FARRUGIA, M., & BALZAN, M. - Centenarians : what can they teach us about lifespan & healthspan?; 10/ AGIUS ANASTASI, A., & VELLA, F. - Bridging perspectives : rehabilitation expectations among healthcare professionals and the general public; 11/ EDWARDS, N. - Plantar fasciitis : radiological findings and evidence-based treatment approaches