Unusual Presentation of T-cell Large Granular Lymphocytic Leukemia

Large granular lymphocytic (LGL) leukemia is a rare chronic lymphoproliferative disorder that can arise from T- or natural killer-cell lineages. It is an indolent disease that typically occurs in the sixth decade of life. Most cases of T-cell LGL leukemia (T-LGL) are associated with autoimmune disorders. Patients with T-LGL are generally asymptomatic; however, they can present with symptoms related to neutropenia, infections, and autoimmune disorders. Here, we report two cases of T-LGL in which the patients presented with liver dysfunction

Brief Report: Prognostic Relevance of 3q Amplification in Squamous Cell Carcinoma of the Lung

INTRODUCTION: Amplification of 3q is the most common genetic alteration identified in squamous cell carcinoma of the lung (LUSC), with the most frequent amplified region being 3q26 to 3q28. METHODS: In this analysis, we aim to describe the prognostic relevance of 3q amplification by focusing on a minimal common region (MCR) of amplification constituted of 25 genes. We analyzed 511 cases of LUSC from The Cancer Genome Atlas and included 476 in the final analysis. RESULTS: We identified a 25-gene MCR that was amplified in 221 (44.3%) cases and was associated with better disease-specific survival (not reported [NR] versus 9.25 y, 95% confidence interval [CI]: 5.24-NR, log-rank p = 0.011) and a progression-free interval of 8 years (95% CI: 5.1-NR) versus 4.9 years (95% CI: 3.5-NR, log-rank p = 0.020). Multivariable analysis revealed that MCR amplification was associated with improved disease-specific survival and progression-free interval. CONCLUSIONS: Amplification of the 25-gene MCR within 3q was present in 44% of this cohort, consisting mainly of Caucasian patients with early stage LUSC. This analysis strongly indicates the prognostic relevance of the 25-gene MCR within 3q. We are further evaluating its prognostic and predictive relevance in a racially diverse patient population with advanced LUSC

Satisfaction of hem/onc patients with video visits during the COVID-19 pandemic at a tertiary care center in Michigan

Background: In early 2020, the WHO declared the COVID-19 pandemic a public health emergency. Consequently, medical institutions minimized health care services to facilitate social distancing and telemedicine became the forefront of patient-provider interaction. Herein, we present the results of our study that explored patient satisfaction with video visits during the pandemic at a tertiary care center. Methods: A 12-question survey (table) was emailed following a video visit with a Hem/Onc provider carried out between February and December 2020, questions were answered anonymously. The survey also collected patient demographics. The survey evaluated 5 aspects of telemedicine using a five-point graded scale. Results: A total of 1107 patients responded. Median age was 65 years (25-97) with 51.5% over 65, 64% were females and 36% males. Based on zip codes of primary residence and 2015-2019 US Census data, a significant proportion lived in inner-city Detroit, 77.3% were Caucasians, and 15.2% African Americans. Median household income was 66.8K (Michigan’s median is 57K). Regarding access: ease of scheduling appointments, ease of contacting the office and ability to schedule desired appointments, were respectively given positive responses (good, very good, or fair) by 97.61%, 97.32%, and 98.4%. Regarding CP: ability to explain problem, show concern for worries, include patients in decisions, and discussion of treatment plan, were respectively given positive responses by 99.09%, 99.26%, 98.9%, 99.35%. Regarding telemedicine technology: ease of talking to CP, quality of video, and audio connections, were respectively given positive responses by 94.27%, 90.77%, and 91.42%. For the overall visit assessment, 98.58% gave a positive response for the video staff performance. Regarding their comfort level to return to clinic: 78.75% were comfortable and 10.14% were not. Conclusions: Patients reported an overall high level of satisfaction with telemedicine. One area of improvement is the technological aspect. More than 50% were older than 65 years and a significant proportion lived in underserved areas which indicates that telemedicine is easily accessible. Moreover, around 80% were comfortable to return to clinic while 10% were not which highlights the importance of offering both telemedicine and in-person care

Brief Report: Prognostic Relevance of 3q Amplification in Squamous Cell Carcinoma of the Lung

Introduction: Amplification of 3q is the most common genetic alteration identified in squamous cell carcinoma of the lung (LUSC), with the most frequent amplified region being 3q26 to 3q28. Methods: In this analysis, we aim to describe the prognostic relevance of 3q amplification by focusing on a minimal common region (MCR) of amplification constituted of 25 genes. We analyzed 511 cases of LUSC from The Cancer Genome Atlas and included 476 in the final analysis. Results: We identified a 25-gene MCR that was amplified in 221 (44.3%) cases and was associated with better disease-specific survival (not reported [NR] versus 9.25 y, 95% confidence interval [CI]: 5.24–NR, log-rank p = 0.011) and a progression-free interval of 8 years (95% CI: 5.1–NR) versus 4.9 years (95% CI: 3.5–NR, log-rank p = 0.020). Multivariable analysis revealed that MCR amplification was associated with improved disease-specific survival and progression-free interval. Conclusions: Amplification of the 25-gene MCR within 3q was present in 44% of this cohort, consisting mainly of Caucasian patients with early stage LUSC. This analysis strongly indicates the prognostic relevance of the 25-gene MCR within 3q. We are further evaluating its prognostic and predictive relevance in a racially diverse patient population with advanced LUSC

Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma [version 1; peer review: 1 approved, 2 approved with reservations]

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH.  Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement.  Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework.  The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents.  Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi