Idelalisib for the treatment of indolent non-Hodgkin lymphoma

 a review of its clinical potential:



Jacqueline C Barrientos

CLL Research and Treatment Program, Division of Hematology/Oncology, Department of Medicine, Hofstra Northwell School of Medicine, Hofstra University, Lake Success, NY, USA

Abstract: Idelalisib is a first-in-class, oral, selective phosphatidylinositol 3-kinase δ inhibitor that offers a chemotherapy-free option for patients with relapsed or refractory (R/R) indolent non-Hodgkin lymphoma (iNHL). Clinical trials in iNHL have evaluated idelalisib as monotherapy and as combination therapy with rituximab, bendamustine, and rituximab + bendamustine. When administered to heavily pretreated patients with R/R iNHL, idelalisib monotherapy or combination therapy showed durable antitumor activity accompanied by sustained or improved quality-of-life outcomes. Idelalisib has an acceptable safety profile; however, serious or fatal diarrhea/colitis, hepatoxicity, pneumonitis, and intestinal perforation have occurred in treated patients. Selective inhibition of phosphatidylinositol 3-kinase δ with idelalisib is a valuable addition to available treatment options for patients with iNHL, many of whom do not respond to or cannot tolerate chemoimmunotherapy. Two Phase III, randomized, placebo-controlled trials of idelalisib as combination therapy with rituximab or bendamustine + rituximab and a Phase I trial of idelalisib in combination with the Bruton's tyrosine kinase inhibitor ONO/GS-4059 in R/R B-cell malignancies are currently ongoing. A Phase III monotherapy trial in previously treated follicular lymphoma or small lymphocytic lymphoma is planned. The development of other kinase inhibitors for the treatment of iNHL raises the potential for new treatment combinations. Additional research is needed to determine optimal therapy (monotherapy vs combination regimens), treatment sequencing, and long-term management.

Keywords: B-cell receptor, follicular lymphoma, elderly, targeted therapy, kinase inhibitor, phosphatidylinositol 3-kinase

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1WJWrgq
via IFTTT

Enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy

Comparative effects of different enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy: a network meta-analysis:



Zhihong Zhang,^1,2 Yu Zhu,¹ Yun Ling,³ Lijuan Zhang,¹ Hongwei Wan<sup>1



1</sup>Department of Nursing, Shanghai Proton and Heavy Ion Center, ²Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, ³Department of Human Resource, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China



Abstract: Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy were frequently used in the head and neck cancer patients when malnutrition was present. Nevertheless, the evidence was inclusive in terms of the choice and the time of tube placement. The aim of this network meta-analysis was to evaluate the comparative effects of prophylactic percutaneous endoscopic gastrostomy (pPEG), reactive percutaneous endoscopic gastrostomy (rPEG), and NGT in the head and neck cancer patients receiving radiotherapy or chemoradiotherapy. Databases of PubMed, Web of Science, and Elsevier were searched from inception to October 2015. Thirteen studies enrolling 1,631 participants were included in this network meta-analysis. The results indicated that both pPEG and NGT were superior to rPEG in the management of weight loss. pPEG was associated with the least rate of treatment interruption and nutrition-related hospital admission among pPEG, rPEG, and NGT. Meanwhile, there was no difference in tube-related complications. Our study suggested that pPEG might be a better choice in malnutrition management in the head and neck cancer patients undergoing radiotherapy or chemoradiotherapy. However, its effects need to be further investigated in more randomized controlled trials.



Keywords: malnutrition, tube feeding, weight loss, treatment interruption, readmission, complication

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1TtIe1e
via IFTTT

Low-grade nasopharyngeal papillary adenocarcinoma

 a case report and review of the literature:



Xiaoli Wang,^1,2 Hongjiang Yan,¹ Yijun Luo,^1,2 Tingyong Fan<sup>1

1</sup>Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, ²School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China

Abstract: Low-grade nasopharyngeal papillary adenocarcinoma is an extremely rare tumor, with only a limited number of cases reported in the literature. Some published studies have paid more attention to the clinicopathological features of nasopharyngeal adenocarcinoma, while little effort has been made to study the optimal therapeutic strategies. We report about a woman diagnosed with low-grade nasopharyngeal papillary adenocarcinoma. She received the treatment approach that combined transnasal endoscopic surgery to remove the lesion with postoperative radiotherapy for nasal cavity. There was no evidence of recurrence after 4 months of surgery, and further follow-up is being continued. Through this example, we wanted to explore the optimal therapeutic strategies for primary nasopharyngeal adenocarcinomas.

Keywords: nasopharyngeal adenocarcinoma, immunohistochemistry, treatment policy, survival and prognosis

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1WJWOaE
via IFTTT

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)

A changing paradigm in thyroid surgical pathology and implications for thyroid cytopathology:

The change in the diagnosis of noninvasive encapsulated follicular variant papillary thyroid carcinoma to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (ie, not carcinoma) will have significant impact on the risk of malignancy for categories according to The Bethesda System for Reporting Thyroid Cytopathology, and especially for the indeterminate categories.

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1TtIeyp
via IFTTT

Follicular dendritic cell tumour/sarcoma

 a commonly misdiagnosed tumour in the thorax Intrathoracic follicular dendritic cell sarcoma:

Abstract

Aims

Follicular dendritic cell sarcoma (FDCS) is a rare tumour reported to occur occasionally in association with the hyaline-vascular type of Castleman's disease (HVCD). Most cases arise in lymph nodes though extranodal presentation is described.

Methods and Results

Clinical, radiological and histological characteristics, including diagnosis on pre-resection material, were assessed in seven intrathoracic cases from five males and two females with a median age of 38 years. Clinical symptoms were related to mass location, six cases presenting within central and/or posterior mediastinal compartments and one within the lungs. PET/CTs demonstrated marked fluoro-deoxy-glucose (FDG) avidity and the prominent vessels traversing the lesions. Four of six cases (67%) were initially misdiagnosed. HVCD was present in three cases. Two cases with high mitotic rates recurred after resection. All were positive for at least one of the follicular dendritic cell markers (CD21, CD35 and CD23). Six of seven cases (86%) show Cyclin D1 expression ranging from 5% to 90%.

Conclusions

FDCS is often misdiagnosed on biopsy and pathologists need to be aware of the tumour to request the relevant immunohistochemistry, especially in masses presenting in the central/posterior mediastinum with high vascularity and SUV levels. Background HVCD appears more common than previously thought.

This article is protected by copyright. All rights reserved.

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1TtIjCb
via IFTTT

Small B-cell lymphoid neoplasms involving the bone marrow and peripheral blood Report on the Bone Marrow

Issues in diagnosis of small B-cell lymphoid neoplasms involving the bone marrow and peripheral blood Report on the Bone Marrow workshop of the XVIIth meeting of the European Association for Haematopathology and the Society for Hematopathology:

Abstract

Small B-cell lymphoid neoplasms are the most common lymphoproliferative disorders involving peripheral blood (PB) and bone marrow (BM). The Bone Marrow Workshop (BMW) organized by the European Bone Marrow Working Group (EBMWG) of the European Association for Haematopathology (EAHP) during the 17^th EAHP Meeting in Istanbul October 2014 was dedicated to discussion of cases illustrating how the recent advances in immunophenotyping, molecular techniques and cytogenetics provide better understanding and classification of these entities. Submitted cases were grouped into following categories:

cases illustrating diagnostic difficulties in chronic lymphocytic leukaemia (CLL).

cases of BM manifestations of small B-cell lymphoid neoplasms other than CLL.

transformation of small B-cell lymphoid neoplasms in the BM.

multiclonality and composite lymphomas in the BM.

This report summarizes presented cases and conclusions of the BMW and provides practical recommendations for classification of the BM manifestations of small B-cell lymphoid neoplasms based on the current state of knowledge.

This article is protected by copyright. All rights reserved.

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1TtIlKa
via IFTTT

Eosinophils and mast cells of the gastrointestinal tract

Histologic analysis of eosinophils and mast cells of the gastrointestinal tract in healthy Canadian children

via Human Pathology

Publication date: August 2016
Source:Human Pathology, Volume 54
Author(s): Elizaveta Chernetsova, Katrina Sullivan, Joseph de Nanassy, Janice Barkey, David Mack, Ahmed Nasr, Dina El Demellawy
Many gastrointestinal (GI) disorders, including GI eosinophilia and inflammatory bowel disease, can be characterized by increased mucosal eosinophils (EOs) or mast cells (MCs). Normal mucosal cellular counts along the GI tract in healthy children have not been established for a Canadian pediatric population. To establish a benchmark reference, we quantified EO and MC from 356 mucosal biopsies of the GI tract obtained during upper and lower endoscopic biopsies of 38 pediatric patients in eastern Ontario. Mean total counts of EO varied for the 11 tissues we examined, from a low of 7.6±6.5/high-power field (HPF) (×40 [×400, 0.55mm²]) in the body of the stomach to a high of 50.3±17.4/HPF in the cecum. The lower GI tract (ileum, cecum, colon, sigmoid, and rectum) generally had higher total EO counts than the upper GI tract (antrum and body of stomach, duodenum, and duodenal cap) (combined average of 32.1±20.6 versus 19.3±15.8, respectively). Similarly, the number of mucosal MC was different in the various regions of the GI tract ranging from 0.04±0.2/HPF in the duodenal cap to 0.9±2.6/HPF in the ileum. Total counts for EO and MC in the lamina propria were not significantly different between sexes when adjusted for multiple testing. EO polarity was absent in many cases, irrespective of the GI region. These numeration and localization of EO and MC will provide normative data for upper and lower endoscopic GI biopsies in the pediatric population of Eastern Ontario.

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1TtIehT
via IFTTT