Prevention and management of secondary central nervous system lymphoma

Secondary central nervous system (CNS) lymphoma (SCNSL) is defined by the involvement of the CNS, either at the time of initial diagnosis of systemic lymphoma or in the setting of relapse, and can be either isolated or with synchronous systemic disease. The risk of CNS involvement in patients with diffuse large B-cell lymphoma is approximately 5%; however, certain clinical and biological features have been associated with a risk of up to 15%. There has been growing interest in improving the definition of patients at increased risk of CNS relapse, as well as identifying effective prophylactic strategies to prevent it. SCNSL often occurs within months of the initial diagnosis of lymphoma, suggesting the presence of occult disease at diagnosis in many cases. The differing presentations of SCNSL create the therapeutic challenge of controlling both the systemic disease and the CNS disease, which uniquely requires agents that penetrate the blood-brain barrier. Outcomes are generally poor with a median overall survival of approximately 6 months in retrospective series, particularly in those patients presenting with SCNSL after prior therapy. Prospective studies of intensive chemotherapy regimens containing high-dose methotrexate, followed by hematopoietic stem cell transplantation have shown the most favorable outcomes, especially for patients receiving thiotepa-based conditioning regimens. However, a proportion of patients will not respond to induction therapies or will subsequently relapse, indicating the need for more effective treatment strategies. In this review we focus on the identification of high-risk patients, prophylactic strategies and recent treatment approaches for SCNSL. The incorporation of novel agents in immunochemotherapy deserves further study in prospective trials

Toward a feminist housing commons? Conceptualising care - (as) - work in collaborative housing

This article conceptualizes care-(as)-work in collaborative housing and addresses current debates on the potential of cohousing to embody a feminist commons. A focus on purpose-built cohousing projects in the UK enables us to focus on the values present in the initial phases of collective design and on the ongoing negotiations and mediation that take place through social interactions, resident-led self-management, and formal and informal mutual support. Our analysis is based on in-depth interviews and focus group discussions with two communities in England. Our contribution focuses on two aspects of care-(as)-work: how difficult emotions related to cohousing maintenance work are minimized for the good of the common and how such work is differentially embodied. Returning to cohousing’s transformational capacities as a feminist commons, we show that while boundaries of care in commoning are critical to residents, they are inherently blurry, performative and gendered

‘A Slow Build-Up of a History of Kindness’: Exploring the Potential of Community-Led Housing in Alleviating Loneliness

This article explores the potential of community-led housing (CLH) in combatting loneliness, and represents a mixed-methods research project carried out from just before the beginning of the pandemic, through 2020. Methods comprised a nationwide quantitative online survey of members of CLH groups (N = 221 respondents from England and Wales), followed by five case studies of communities representing a range of different CLH models. This qualitative element comprised participant observation, and semi-structured interviews at each group. The article also considers data from a smaller research project carried out by the same team in July 2020, that aimed to capture the experience of the pandemic for CLH groups, and comprising an online questionnaire followed by 18 semi-structured interviews. We conclude that members of CLH projects are measurably less lonely than those with comparable levels of social connection in wider society, and that such benefits are achieved through combinations of multiple different elements that include physical design, social design and through social processes. Notably, not all aspects of communities that contribute positively are a result of explicit intentionality, albeit the concept is considered key to at least one of the models

Redesign of a Large Lecture Course Into a Small-Group Learning Course

Objective. To describe the redesign of a large self-care course previously delivered in a traditional lecture format to a small-group case-based course

Multicentre retrospective study of intravascular large B‐cell lymphoma treated at academic institutions within the United States

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149677/1/bjh15923.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149677/2/bjh15923_am.pd

Asian-variant intravascular lymphoma in the African race

Intravascular Large B-cell lymphoma (IVLBCL) is an exceptionally rare form of non-Hodgkin lymphoma (NHL) distinguished by the preferential growth of neoplastic cells within blood vessel lumen. Challenging to detect and deemed disseminated at diagnosis, this condition is characterized by a highly aggressive, inconspicuous course with a high mortality rate. We describe the case of a 48 year-old African-American female presenting with a two month history of low-grade fevers and malaise. Laboratory data was notable for anemia, thrombocytopenia, elevated liver function tests, and hematuria. An extensive work-up for infectious, rheumatologic and malignant causes was negative. Her symptoms progressed and within two weeks, she was admitted for disseminated intravascular coagulation (DIC). Her course was complicated by diffuse pulmonary hemorrhage and ultimately, care was withdrawn. Autopsy identified widespread CD-20 positive intravascular large B-cell lymphoma with significant hepatosplenic involvement, characteristic of the Asian variant IVLBCL. This case uniquely highlights development of the Asian variant IVLBVL in a previously undescribed race. Identified by its intraluminal vascular growth pattern, IVLBCL generally spares lymphatic channels. Diagnosis and differentiation of this condition from other hematological malignancies via skin, visceral and bone marrow biopsy is imperative as anthracycline-containing chemotherapies may significantly improve clinical outcomes. This article outlines the common presentation, natural course, and treatment options of IVLBCL, along with the histopathology, immunohistochemistry, and chromosomal aberrations common to this condition

Fellowships in Community Pharmacy Research: Experiences of Five Schools and Colleges of Pharmacy

Objective To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. Setting: Five schools and colleges of pharmacy in the United States. Practice description: Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Practice innovation: Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. Evaluation: Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Results: Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. Conclusion: Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice