Staphylococcal Pericarditis Causing Pericardial Tamponade and Concurrent Empyema

Bacterial pericarditis is a rare presentation and is usually due to secondary infection from a hematogenous cause or can occur secondary to trauma, intrathoracic surgery, or due to spread of infection from a contiguous focus via ligaments that anchor the pericardium to its surrounding structures. Its course is fulminant characterized by a high mortality rate from sepsis, tamponade, and constriction. We describe a rare case of Staphylococcus aureus pericarditis with concurrent unilateral empyema. The patient rapidly developed tamponade and was successfully treated with antibiotics and urgent percutaneous pericardial drainage with placement of a temporary catheter. Treatment for bacterial pericarditis typically is 4–6 weeks long. Thoracic surgery should be consulted as soon as possible to determine need for surgical intervention, as fibrin deposition may occur, making percutaneous drainage incomplete and leading to complications of persistent purulent pericarditis or constrictive pericarditis

Staphylococcal Pericarditis Causing Pericardial Tamponade and Concurrent Empyema

Bacterial pericarditis is a rare presentation and is usually due to secondary infection from a hematogenous cause or can occur secondary to trauma, intrathoracic surgery, or due to spread of infection from a contiguous focus via ligaments that anchor the pericardium to its surrounding structures. Its course is fulminant characterized by a high mortality rate from sepsis, tamponade, and constriction. We describe a rare case ofStaphylococcus aureuspericarditis with concurrent unilateral empyema. The patient rapidly developed tamponade and was successfully treated with antibiotics and urgent percutaneous pericardial drainage with placement of a temporary catheter. Treatment for bacterial pericarditis typically is 4–6 weeks long. Thoracic surgery should be consulted as soon as possible to determine need for surgical intervention, as fibrin deposition may occur, making percutaneous drainage incomplete and leading to complications of persistent purulent pericarditis or constrictive pericarditis.</jats:p

Pathologic and clinical outcomes after neoadjuvant modified FOLFIRINOX and gemcitabine and NAB-paclitaxel for pancreatic cancer.

e16236 Background: Surgical resection is the only potentially curative option for pancreatic cancer (PC). Unfortunately, just 15-20% of patients (pts) have resectable disease at the time of diagnosis. Recently, for a variety of reasons, neoadjuvant chemotherapy (NAC) has been widely adopted in both borderline resectable and resectable tumors. Most guidelines recommend either modified FOLFIRINOX (mFOLFIRINOX) or gemcitabine and NAB-paclitaxel (GnP) in this setting. This is largely based on phase II trials and extrapolations from trials in the metastatic setting. Here we investigate the difference in tumor regression score (TRS) and clinical outcomes between these regimens. Methods: We retrospectively collected data from pts who underwent resection of PC after NAC at Ochsner Health between July 2012 and July 2021. Primary objective was TRS on operative pathology as assessed by the reading pathologist. Secondary objectives were progression free survival (PFS) from the date of surgery and overall survival (OS) from the date of diagnosis. TRSs were dichotomized as complete (0)/moderate (1) responses versus (vs) minimal (2)/poor (3) responses. The dichotomized score was assessed using log-binomial regression. Kaplan-Meier survival analysis was utilized to estimate PFS and OS. Survival curves were compared by the log-rank test. Results: We identified 96 pts with PC who had NAC followed by surgical resection. Mean age at diagnosis was 65.7. 55% had borderline resectable and 45% had clearly resectable disease at diagnosis. 74 pts received mFOLFIRINOX and 22 pts received GnP. Pts receiving GnP were more likely to be older (71 vs 64, P = 0.001) and have a worse Eastern Cooperative Oncology Group performance status (PS) (P = 0.019). TRSs were similar between the 2 groups with 58.1% and 59.1% in each group achieving a TRS of 2. 7 pts in the mFOLFIRINOX group had TRS of 0 (CR) while 0 pts in the GnP group had a TRS of 0. When controlling for age and PS, risk ratio for a lower TRS (0/1 vs 2/3) with mFOLFIRINOX vs GnP was 1.22 (0.27 - 5.47). 40% and 36.4% had disease recurrence after mFOLFIRINOX and GnP, respectively. Median PFS and OS were 15.6 and 23.4 months (m) in the mFOLFIRINOX group and 18.9 and 27.6 m in the GnP group (P = 0.996, P = 0.933, respectively). On multivariate analysis, controlling for age and PS, hazard ratios for OS and PFS with mFOLFIRINOX vs GnP were 0.86 (95% CI 0.38–2.18) and 1.17 (95% CI 0.53–2.84), respectively. Conclusions: Our study showed no difference in TRS between mFOLFIRINOX or GnP as NAC, although the small number of pts who received GnP precluded statistical inference. Differences in survival outcomes between the two NAC regimens were not significantly different, and outcomes were comparable to those reported in the phase II SWOG S1505 trial. Large prospective trials comparing these two regimens in terms of efficacy and toxicity will be required to better answer these questions. </jats:p

A Case of Pulmonary Epithelioid Hemangioendothelioma with Literature Review

Pulmonary epithelioid hemangioendothelioma is a rare vascular tumor and infrequently described in medical literature as case reports and case series. Diagnosis is often incidental with high index of histopathological suspicion from clinical pathologist. The pathological pattern is quite unique with distinct immunohistochemical stains. Up to this day, there is no established standard treatment owing to the scarcity of this tumor. In this case report, we describe a case of pulmonary epithelioid hemangioendothelioma unexpectedly diagnosed with transthoracic needle biopsy, along with a review of the current literature

Strategizing the Treatment Approach to Acute Myeloid Leukemia

For decades acute myeloid leukemia, the primary acute leukemia affecting adults, had limited treatment options. Since 2017, we have seen discovery and development in cytogenetic and molecular classification of acute myeloid leukemia, improved understanding of cell signaling pathways, and development of new treatment for acute myeloid leukemia. These new treatments include novel combinations of agents and therapy targeting molecular alterations improving rates of remission and overall survival. Treatment discovery provides therapeutic opportunity to older patients and populations previously excluded from intense induction chemotherapy. In this review, we discuss the timing of first therapy, non-intense treatment regimens achieving remission, and new targets for directed therapy. We reference key clinical trials to expand our discussion of newly approved agents for acute myeloid leukemia. In this review, we highlight the discovery of treatment strategies to improve patient outcomes and ongoing research in leukemia.</jats:p

A Case of Pulmonary Epithelioid Hemangioendothelioma with Literature Review

Pulmonary epithelioid hemangioendothelioma is a rare vascular tumor and infrequently described in medical literature as case reports and case series. Diagnosis is often incidental with high index of histopathological suspicion from clinical pathologist. The pathological pattern is quite unique with distinct immunohistochemical stains. Up to this day, there is no established standard treatment owing to the scarcity of this tumor. In this case report, we describe a case of pulmonary epithelioid hemangioendothelioma unexpectedly diagnosed with transthoracic needle biopsy, along with a review of the current literature.</jats:p

Implications of ¹⁸F-FDG PET/CT findings before autologous stem cell transplant in patients with multiple myeloma.

e20023 Background: The IMWG recommends using 18F-FDG PET/CT (PET) to monitor response to therapy in multiple myeloma (MM). Prior studies in patients who received chemotherapy before autologous stem cell transplant (ASCT) found that severe FDG uptake on PET was associated with inferior event free survival. However, novel agents and monoclonal antibodies have changed the landscape of MM and chemotherapy is no longer used as initial treatment making the role of PET before ASCT unclear. This study explores findings on pre-ASCT PET that may predict shorter remissions after ASCT. Methods: This was a retrospective cohort study. Patients were included if they had a PET at least 60 days before ASCT between 2014 and 2021. All patients achieved at least a partial response (PR) prior to ASCT. The primary endpoint, PFS was defined as time to progression on labs, imaging or bone marrow biopsy necessitating change in therapy or resulting in death after ASCT. The cytogenetic risk category (CG), number of bone lesions at diagnosis, presence of severe FGD uptake on PET (defined as SUV max ≥ 4.2) and persistence of lesions on PET was recorded. Patients who did not experience the event of interest were censored at their last date of clinic follow up. Hazard ratios (HR) for disease progression were estimated using Cox proportional hazards models. Results: 151 patients were included in our study. All patients underwent induction with a 3-drug regimen containing a proteasome inhibitor (PI) and/or an immunomodulatory agent (IMiD). 32% had high risk CG, 44% had &gt; 3 bone lesions at diagnosis, 24% had severe FDG uptake and 29% had &gt; 3 lesions on pre-ASCT PET. The presence of high-risk CG [HR 2.08 (1.03 – 4.17)] and severe FDG uptake on diagnostic PET [HR 6.43 (2.58 – 16.07)] was associated with more aggressive disease and shorter PFS. Patients with &gt; 3 lesions in their pre-transplant PET had a statistically significant decreased PFS [HR 2.01 (1.02 – 3.96)] compared to those with ≤ 3 lesions. Conclusions: This study found that that persistence of &gt; 3 lesions on pre-ASCT PET were an adverse finding associated with an increased risk of progression. To our knowledge these findings have not previously been shown in patients treated with PIs and IMiDs before ASCT. Significantly shorter PFS was observed in patients with high-risk CG and severe FDG uptake on initial PET, consistent with our knowledge of MM. In addition to established risk factors for aggressive disease, persistence of &gt; 3 bone lesions on PET/CT could be used to identify a high-risk group of patients who may benefit from more intensive surveillance or therapy after ASCT. [Table: see text] </jats:p