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Cyclophosphamide or chlorambucil therapy is indicated in idiopathic membranous nephropathy with strong risk factors for progression

Impact of low disease activity, remission, and complete remission on flares following tapering of corticosteroids and immunosuppressive therapy in patients with systemic lupus erythematous: a multinational cohort study.

Pemphigus in Elderly Adults: Clinical Presentation, Treatment, and Prognosis

Role of FDG-PET As Prognostic Indicator in Patients with Follicular Lymphoma(FL) After Immunochemotherapy Induction. A Retrospective Study From the Fondazione Italiana Linfomi

Mobilization of PML/RAR negative peripheral blood stem cells with a combination of G-CSF and CXCR4 blockade in relapsed acute promyelocytic leukemia pre-treated with arsenic trioxide

Allogeneic hematopoietic stem-cell transplantation (HSCT) from HLA-identical siblings can be used to treat children with acute lymphoblastic leukemia (ALL). However, a significant proportion of patients with ALL who undergo HSCT relapse. For this reason, we prospectively evaluated a preparative regimen that included total body irradiation (TBI), thiotepa (TT), and cyclophosphamide (CY) in patients with high-risk ALL in first complete remission (CR) and in children with ALL in second CR. Forty children (median age, 9 years; range, 1 to 18 years) with ALL in first or second CR who underwent allogeneic HSCT from HLA-identical siblings were conditioned with a combination of fractionated TBI, TT (10 mg/kg), and CY (120 mg/kg over 2 days). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine administered intravenously at a dose of 1 to 3 mg/kg/d for the first 21 days and subsequently orally at a dose of 6 mg/kg/d. All assessable patients were engrafted, with a median time of 11 and 24 days for neutrophil and platelet recovery, respectively. The preparative regimen was well tolerated. Only one patient died as a result of regimen-related causes. Eight patients relapsed at a median time of 8 months after transplantation (range, 3 to 9 months), and this determined a cumulative probability of relapse of 23%. Twenty-six of 40 patients (65%) are alive and in complete hematologic remission, with a median observation time of 36 months (range, 14 to 57 months), which results in a disease-free survival (DFS) at 3 years of 65%. The 13 patients who underwent transplantation in first CR had a DFS of 85%, whereas the 27 patients who underwent HSCT in second CR had a DFS of 56%. These data suggest that TT is an effective cytotoxic drug that can be safely added to the classical TBI-CY regimen. Because of its cell cycle-independent action, good CNS diffusion, and limited extramedullary toxicity, TT may contribute to increasing the percentage of children with ALL who are successfully cured with allogeneic BMT.

The management of patients with a radiographic complete response after chemotherapy remains controversial. The current study assesses the outcome for a modern, unselected patient population with disseminated testicular cancer with particular emphasis on those achieving a radiographic complete remission to combination chemotherapy. All patients with disseminated nonseminoma seen between 1999 and 2007 at the British Columbia Cancer Agency (BCCA) as well as through the Oregon Testis Cancer Program were retrospectively reviewed. A total of 276 patients treated with combination chemotherapy were identified. A radiographic complete remission (CR) was defined as disappearance of all metastatic lesions or minimal residual tissue <or= 1 cm. One hundred sixty-one patients achieved a CR. Results for the total population and CR subset were as follows: International Germ Cell Cancer Consensus Group stage good/intermediate/poor 84%/5%/11% (CR subset, 94%/3%/3%), presence of teratoma in the primary tumor 40% (CR subset, 55%), relapses 13%, death from disease 3% (CR subset, 6% and 0%, respectively). Two of the total 10 relapses in the CR group occurred beyond 2 years. Eight of the 10 relapses in the CR group were treated surgically for teratoma alone, whereas two required salvage chemotherapy. Disease-specific survival for the CR group was 100% after a median follow-up of 52 months (range, 3 to 135 months). Modern risk-adapted systemic chemotherapy with or without surgery for current populations of patients with disseminated testicular nonseminoma results in superb outcomes. Patients with disseminated germ cell tumors who obtain a complete serologic remission and no or minimal radiographic residual can be safely observed without adjunctive regional surgery.

Ibrutinib Plus Rituximab (IR) Followed By Short Course R-Hypercvad/MTX in Patients (age ≤ 65 years) with Previously Untreated Mantle Cell Lymphoma - Phase-II Window-1 Clinical Trial

Background and Aims Previous research supports that reductions in proteinuria are associated with a lower risk of progression to kidney failure (KF) in patients with FSGS. The phase 3 DUPLEX trial examined the efficacy of SPAR, a non-immunosuppressive, dual endothelin angiotensin receptor antagonist (DEARA), vs IRB in patients with FSGS and showed that SPAR led to sustained proteinuria reduction. Expanding on earlier findings from this study, we investigated the comparative effects of SPAR vs IRB on varying low proteinuria targets, including complete and partial remission of proteinuria, and the effect of remission on progression to KF in DUPLEX. Method DUPLEX (NCT03493685) was a randomized, double-blind, phase 3 study evaluating the efficacy and safety of SPAR vs IRB in patients with FSGS (without secondary causes). Patients received SPAR (n = 184) or IRB (n = 187) for 108 weeks at target doses of 800 mg/d and 300 mg/d, respectively. Study endpoints were defined as follows: (i) partial remission of proteinuria, urine protein-to-creatinine ratio (UPCR) of ≤1.5 g/g and a &amp;gt;40% reduction from baseline; (ii) complete remission of proteinuria, UPCR of &amp;lt;0.3 g/g; and (iii) KF, estimated glomerular filtration rate of &amp;lt;15 mL/min/1.73 m2 or kidney replacement therapy. We investigated the impact of SPAR vs IRB on achieving partial and complete remission and varying levels of proteinuria reduction (UPCR of &amp;lt;0.5, 1.0, or 1.5 g/g) at any time during the 108-week double-blind treatment period. Post hoc analyses using pooled data from all treatment groups examined the risk of KF among patients who achieved partial or complete remission of proteinuria vs those who did not. Results Patients achieved all proteinuria thresholds earlier and more frequently with SPAR vs IRB. The median time to partial remission was 14.1 weeks with SPAR vs 109.0 weeks with IRB, with 64.7% of patients achieving partial remission at any time with SPAR vs 43.9% with IRB. Additional results are shown in the Table 1. Irrespective of treatment arm, patients who achieved partial or complete remission at any time during the 108-week study period were less likely to reach KF than those who did not (Fig. 1). Among patients who achieved partial remission, 3.0% reached KF vs 15.9% who did not. Among patients who achieved complete remission, 2.1% reached KF vs 9.9% who did not. SPAR was generally well tolerated, with no new safety concerns. Conclusion Clinically meaningful low proteinuria thresholds and partial and complete remission definitions were achieved earlier and more often with SPAR vs IRB. In DUPLEX, the risk of KF was lower among patients who achieved partial or complete remission of proteinuria vs those who did not. Taken together, results support the nephroprotective benefit of SPAR in patients with FSGS.

M2042 Survival in Refractory Coeliac Disease with Aberrant T-Cells After Cladribine Therapy: Evaluation of a Single Center Experience

AimTo determine the factors that affected the complete clinical remission of oral lichen planus (OLP) treated with topical corticosteroids.Material and methodsWe retrospectively evaluated the charts of patients diagnosed as OLP. Age, sex, current medical conditions, medications, type of OLP, Thongprasom score, pain level assessed by a numeric rating scale (NRS), Candida infection, topical steroid treatment preparation, duration of treatment until the first complete clinical remission, and follow-up duration were assessed as variables.ResultsIn total 100 patients, after complete remission, 22 patients reported a relapse within 1.5–45 months, with a mean of 15.6 ± 13.2 months. Age, duration, gingiva and vestibule area, hypertension, dyslipidemia, Thongprasom score, preparation and topical corticosteroid potency were factors affecting the remission. Multivariate logistic regression analysis revealed that the patients’ age and duration of treatment were significant factors after adjusted for age, sex, and independent factors with a P-value < 0.1 in the univariate analysis. The likelihood of having incomplete remission of the OLP lesion increased by 7.9% for every year increase in age and increased by 2.3% for every month of treatment.ConclusionsThere are many different factors between the complete remission and incomplete remission groups. However, age and duration of treatment were significant factors affecting the remission of OLP.

The authors recently pointed out an epidemiological relation between specific anti-Chlamydia pneumoniae antibodies and peripartum cardiomyopathy in Niamey (Republic of Niger). In this work, they studied the prognosis value of such specific antibodies. The serological status for specific IgG, IgA and IgM anti-C. pneumoniae antibodies of 50 African women (age, mean+/-SD = 30.2 +/- 7 years) hospitalized in Niamey, with peripartum cardiomyopathy, was determined at the time of diagnosis. The diagnosis was categorized as 'complete remission' (13 patients, age = 29.3 +/- 6.5 years, observation delay = 27 months), 'incomplete remission' (27 patients, age = 30.7 +/- 7.6 years, observation delay = 14 months) and 'deceased' (10 patients, age = 30.3 +/- 6.2 years, observation delay = 13 months). The control group comprised 27 African women (age = 25.2 +/- 4.6 years), living in the same area. The Mann-Whitney and Fisher's exact tests were used for the statistical comparison. The dilution of IgG specific anti-C. pneumoniae antibodies was higher (P = 0.047) in the 'incomplete remission' compared with 'complete remission'. The dilution of IgA specific anti-C. pneumoniae antibodies was higher (P = 0.033) in the patients with a severe evolution ('deceased' + 'incomplete remission') compared with 'complete remission'. There was no significant difference between patients in 'complete remission' compared with 'controls'. At the time of peripartum cardiomyopathy diagnosis the specific IgG and IgA anti-C. pneumoniae antibodies are of prognosis value: a high dilution is more often associated with a poor prognosis. This is the first identified prognosis factor during the precocious evolution of peripartum cardiomyopathy.

Post-transplant immunotherapy with donor-lymphocyte infusion and novel agents to upgrade partial into complete and molecular remission in allografted patients with multiple myeloma

Research BackgroundB lymphocyte-mediated adaptive immunity is pivotal in the pathogenesis of membranous nephropathy (MN). This study evaluated the efficacy and safety of zuberitamab, a novel anti-CD20 monoclonal antibody, in primary membranous nephropathy (PMN).Research MethodsWe retrospectively analyzed 25 patients with PMN treated with zuberitamab (zuberitamab group). Using 1:1 propensity score matching, we selected a comparable control cohort of 25 PMN patients who received rituximab during the same period (RTX group). The primary endpoint was the 12-month overall remission rate (CR + PR).Research ResultsAll 25 patients (100.0%) in the zuberitamab group achieved clinical remission (CR 80.0%) at 12-month, with 11 patients achieving complete immunological remission. Compared to the RTX group, the complete remission (CR) rate was significantly higher (80.0% vs 32.0%, P<0.01). Kaplan-Meier analysis demonstrated a higher complete remission rate (log-rank P<0.001; HR = 4.187, 95% CI [2.285-7.672]). Zuberitamab induced progressive urine protein-to-creatinine ratio (uPCR) reduction (all P<0.001) and sustained albumin improvement (3-month: P<0.05; 6/9/12-month: P<0.001). Peripheral blood CD19+ B-cell counts decreased to < 5 cells/μl at 6-month among the 22 patients with complete follow-up data, and remained consistently low throughout follow-up. No severe adverse events were observed in either group.ConclusionZuberitamab may be a promising treatment option for PMN, demonstrating a high complete remission rate and sustained proteinuria reduction in this study. Large-scale prospective studies are warranted to confirm these findings.

In the present paper, we evaluate tolerability, outcome and prognostic factors in patients with poor prognosis non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) when uniformly treated with BCNU, etoposide, cytarabine and melphalan (BEAM) and autologous stem cell transplant (ASCT). On hundred and forty-eight patients with NHL (n = 112) or HD (n = 36) received BEAM followed by infusion of bone marrow (n = 55), peripheral blood stem cells (n = 79) or both (n = 14). Twenty-eight patients had low-grade lymphoma (LGL), 68 intermediate- and 16 high-grade lymphoma (IGL). Within the NHL group, 21 patients were in 2nd or subsequent complete remission (CR) at transplant, 34 had sensitive disease and 11 resistant disease; 46 patients were transplanted in 1st CR due to the presence of > or = 2 adverse prognostic features at diagnosis or to a slow CR. Of the HD patients at transplant 17 had active disease, 16 were in > or = 2 CR and three in 1st CR. The overall percentage of toxic deaths was 5.4%, while in the group of patients transplanted with PBSC it was only 1.3%. NHL patients: 78% were in CR following ASCT, including 25 out of 45 patients (56%) who were transplanted with active disease. Only two of the 11 patients transplanted with resistant disease achieved CR. Incidence of overall survival (OS) and disease-free survival (DFS) at 3 years was 65 and 75%, respectively. As far as histology was concerned, OS was significantly better for patients with LGL in comparison with IGL (88 vs 56%) (P = 0.002). DFS was significantly higher for patients transplanted in first CR or first partial remission (PR) than it was for those transplanted in a later CR or PR (86 vs 53%) (P = 0.02). Multivariate analysis for OS showed that histology, bulky disease, poor performance status at transplant and achievement of CR were independent prognostic factors. In addition, a high number of infused MNC was associated with poor DFS. HD patients: 30 (83%) were in CR after transplantation, with 25 maintaining CR at the end of the study. Only one of the four patients transplanted with resistant disease reached CR. Incidence of OS and DFS at 3 years was 78 and 81%. DFS was similar for patients transplanted with early or late relapse (95 and 93%). With multivariate analysis, the only independent variable for OS was CR after transplant. In conclusion, the present results demonstrate the efficacy and low toxicity of the BEAM regimen in high-risk lymphoma patients with sensitive disease. Other strategies should be investigated for patients with refractory lymphoma.