Patient-physician agreement on the content of CHD prevention discussions: Patient-physician agreement on discussions

Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care

Harnessing the immune system through programmed death-1 blockade in the management of Hodgkin lymphoma

Melody B Oncale, Hossein Maymani, Loretta J Nastoupil Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Abstract: Immunotherapy is a rapidly evolving therapeutic option in the treatment of lymphoma. Neoplastic cells evade immune recognition through the programmed death (PD)-1/PD-ligand immune checkpoint pathway. Several novel agents have been developed to restore the immune system’s ability to recognize and destroy cancer cells. Nivolumab and pembrolizumab are two anti-PD-1 antibodies that have demonstrated success in the treatment of refractory Hodgkin lymphoma. Harnessing the immune system’s ability to target neoplastic cells, ideally without the use of cytotoxic chemotherapeutic agents, is one way in which these novel agents are changing the therapeutic landscape in the treatment of lymphomas. Here, we review the emerging data regarding checkpoint inhibitors in the management of Hodgkin lymphoma, the unique adverse effects encountered with the use of these agents, and a practical approach to the management of these adverse effects. Additionally, we discuss upcoming trials that will further assess the promising future developments of checkpoint inhibition in the treatment of not only Hodgkin lymphoma but also other B cell lymphomas and myeloma. These agents offer immense promise of a future where many lymphomas can be treated without the toxic effects of chemotherapeutic agents. Keywords: Hodgkin lymphoma, programmed death-1, nivolumab, pembrolizumab, lymphom

The role of activity, scan duration and patient's body mass index in the optimization of FDG imaging protocols on a TOF-PET/CT scanner

BACKGROUND: Time-of-flight (TOF) PET technology determines a reduction in the noise and improves the reconstructed image quality in low count acquisitions, such as in overweight patients, allowing a reduction of administered activity and/or imaging time. However, international guidelines and recommendations on the 18F-fluoro-2-deoxyglucose (FDG) activity administration scheme are old or only partially account for TOF technology and advanced reconstruction modalities. The aim of this study was to optimize FDG whole-body studies on a TOF-PET/CT scanner by using a multivariate approach to quantify how physical figures of merit related to image quality change with acquisition/reconstruction/patient-dependent parameters in a phantom experiment.METHODS: The NEMA-IQ phantom was used to evaluate contrast recovery coefficient (CRC), background variability (BV) and contrast-to-noise ratio (CNR) as a function of changing emission scan duration (ESD), activity concentration (AC), target internal diameter (ID), target-background activity ratio (TBR) and body mass index (BMI). The phantom was filled with an average concentration of 5.3kBq/ml of FDG solution and the spheres with TBR of 21.2, 8.8 and 5.0 in 3 different sessions. Images were acquired at varying background activity concentration from 5.1 to 1.3kBq/ml, and images were reconstructed for ESD of 30-151s per bed position with and without point spread function (PSF) correction. The parameters were all considered in a single analysis using multiple linear regression methods.RESULTS: As expected, CRC depended only on sphere ID and on PSF application, while BV depended on sphere ID, ESD, AC and BMI of the phantom, in order of decreasing relevance. Noteworthy, ESD and AC resulted as the most significant predictors of CNR variability with a similar relevance, followed by the BMI of the patient and TBR of the lesion.CONCLUSIONS: AC and ESD proved to be effective tools in modulating CNR. ESD could be increased rather than AC to improve image quality in overweight/obese patients to fulfil ALARA principles

Comparison of Outcomes of Allogeneic Hematopoietic Cell Transplantation for Multiple Myeloma Using Three Different Conditioning Regimens.

Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy for patients with multiple myeloma, as it provides a graft-versus-myeloma effect alongside a myeloma-free graft. Although reduced-intensity conditioning regimens decrease nonrelapse mortality (NRM), there is a paucity of data with regard to the ideal conditioning regimen in myeloma. We conducted a retrospective comparison of 3 different preparative regimens used for allo-HCT for multiple myeloma at our institution in recent clinical trials: busulfan/fludarabine (BuFlu), fludarabine/melphalan 100 mg/m2 (FM100), and fludarabine/melphalan 140 mg/m2 (FM140). NRM, progression-free survival (PFS) at 3 years, and overall survival (OS) at 3 years were the primary endpoints. Secondary endpoints included time to engraftment, and the incidence of grades II through IV acute graft-versus-host disease and chronic graft-versus-host disease. A total of 73 patients received allo-HCT with these regimens. NRM at 3 years was seen in 3 (21%), 5 (28%), and 6 (24%) patients in the BuFlu, FM100, and FM140 groups, respectively. Three-year PFS in the BuFlu, FM100, and FM140 groups was 16% (hazard ratio [HR], 1.2; 95% confidence interval [CI], 0.6 to 2.1), 26% (HR, 0.6; 95% CI, 0.3 to 1.2), and 11% (reference), respectively. Three-year OS in the BuFlu, FM100, and FM140 groups was 39% (HR, 1.1; 95% CI, 0.5 to 2.2), 43% (HR, 0.7; 95% CI, 0.3 to 1.4), and 32% (reference), respectively. High-risk cytogenetics and relapsed disease prior to allo-HCT were found to be independent predictors of inferior OS on multivariate analysis, with a HR of 2.1 (P = .02) and 2.6 (P = .004), respectively. In contrast, the preparative regimen did not emerge as a predictor of PFS or OS. Durable clinical remission can be achieved in 11% to 25% of patients with multiple myeloma with the use of allo-HCT without any significant difference in the safety or efficacy of the conditioning regimen. High-risk cytogenetics and relapsed disease prior to transplant were associated with inferior PFS and OS