The DLBCL90 gene-expression assay identifies double-hit lymphomas with high sensitivity in patients from two phase II clinical trials with high-risk diffuse large B-cell lymphoma

Peer reviewe

The Geriatric Prognostic Index: a clinical prediction model for survival of older diffuse large B-cell lymphoma patients treated with standard immunochemotherapy

The International prognostic Index (IPI) is the most widely used clinical prediction model for diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), but may be suboptimal in older patients. We aimed to develop and externally validate a clinical prediction model for older, RCHOP- treated DLBCL patients by examining geriatric assessment and lymphoma-related parameters in real-world cohorts. A population-based training set of 365 R-CHOP-treated DLBCL patients ≥70 years was identified through the Cancer Registry of Norway. The external test set consisted of a population-based cohort of 193 patients. Data on candidate predictors were retrieved from the Cancer Registry and through review of clinical records. Cox regression models for 2-year overall survival were used for model selection. Activities of daily living, the Charlson Comorbidity Index, age, sex, albumin, stage, Eastern Cooperative Oncology Group performance status and lactate dehydrogenase level were identified as independent predictors and combined into a Geriatric Prognostic Index (GPI). The GPI demonstrated good discrimination (optimismcorrected C-index 0.752), and identified low-, intermediate- and high-risk groups with significantly different survivals (2- year overall survival, 94%, 65%, and 25%, respectively). At external validation, the continuous and grouped GPI demonstrated good discrimination (C-index 0.727 and 0.710, respectively) and the GPI groups had significantly different survivals (2-year overall survival 95%, 65%, and 44%, respectively). Both the continuous and grouped GPI showed better discrimination than the IPI, revised-IPI and National Comprehensive Cancer Network (NCCN)-IPI (C-index 0.621, 0.583, and 0.670, respectively). In conclusion, we have developed and externally validated a GPI for older DLBCL patients treated with R-CHOP that outperformed the IPI, revised-IPI and NCCN-IPI. A web-based calculator is available at https://wide.shinyapps. io/GPIcalculator/

Preventing Clinical Leakage of Colonic Anastomoses with A Fibrin-Coated Collagen Patch Sealing - An Experimental Study

Background: Anastomotic leakage remains a major complication following colorectal surgery, with a largely unknown pathophysiology and limited treatment options. Previous clinical studies have revealed that many leakages on colo-rectal anastomoses remain subclinical. Prior attempts at prophylactic mechanical sealing of gastrointestinal anastomoses, i.e., the application of various forms of mesh and fibrin components, have been disappointing. We therefore decided to determine whether a collagen patch coated with fibrin glue components (TachoSil and reg;) is able to seal leaking colonic anastomoses and thereby prevent clinical leakage and peritonitis. Material and methods: Prospective study on 20 pigs operated with experimentally induced defects in colonic anastomoses randomized to sealing vs. no sealing with a collagen patch coated with fibrin glue components. The primary study endpoints were visible leakage at the anastomotic site, death or illness causing sacrifice and fecal peritonitis (local or diffuse). Results: A significant reduction in macroscopic anastomotic leakage in the group of pigs with sealed anastomoses was found (2/10 vs. 9/10, p=0.0055). Furthermore, macroscopic examination of the abdominal cavity (n=20) showed a significant decrease in peritonitis in the sealed vs. non-sealed groups (2 vs. 9, p=0.0055). Additionally, a reduction, although non-significant, in dead and sacrificed animals before the end of the observation period (1 vs. 4) was found in the sealed group. Conclusion: A collagen patch coated with fibrin glue components efficiently seals leaking gastrointestinal anastomoses in pigs. Whether these results may be applied to humans in order to prevent clinical anastomotic dehiscence must be investigated in future randomized clinical studies. [Arch Clin Exp Surg 2014; 3(4.000): 201-206