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Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.

To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.

The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.

Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.

No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.

“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.

“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.

Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.

chestphysician@frontlinemedcom.com

Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.

To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.

The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.

Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.

No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.

“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.

“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.

Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.

chestphysician@frontlinemedcom.com

Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.

To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.

The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.

Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.

No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.

“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.

“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.

Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.

chestphysician@frontlinemedcom.com

As far as the influenza virus is concerned, the new year started in the same way as the old one ended: with almost half of the states at the highest level of flu activity, according to the Centers for Disease Control and Prevention.

For the week ending Jan. 6, 2018, there were 23 states – including California, Illinois, and Texas – at level 10 on the CDC’s 1-10 scale for influenza-like illness (ILI) activity, which was up from 22 for the last full week of 2017. Joining the 23 states in the “high” range were New Jersey and Ohio at level 9 and Colorado at level 8, the CDC’s influenza division reported Jan. 12.

rfranki@frontlinemedcom.com

As far as the influenza virus is concerned, the new year started in the same way as the old one ended: with almost half of the states at the highest level of flu activity, according to the Centers for Disease Control and Prevention.

For the week ending Jan. 6, 2018, there were 23 states – including California, Illinois, and Texas – at level 10 on the CDC’s 1-10 scale for influenza-like illness (ILI) activity, which was up from 22 for the last full week of 2017. Joining the 23 states in the “high” range were New Jersey and Ohio at level 9 and Colorado at level 8, the CDC’s influenza division reported Jan. 12.

rfranki@frontlinemedcom.com

As far as the influenza virus is concerned, the new year started in the same way as the old one ended: with almost half of the states at the highest level of flu activity, according to the Centers for Disease Control and Prevention.

For the week ending Jan. 6, 2018, there were 23 states – including California, Illinois, and Texas – at level 10 on the CDC’s 1-10 scale for influenza-like illness (ILI) activity, which was up from 22 for the last full week of 2017. Joining the 23 states in the “high” range were New Jersey and Ohio at level 9 and Colorado at level 8, the CDC’s influenza division reported Jan. 12.

rfranki@frontlinemedcom.com

“Psychiatric risk that reached into the next generation” is what researchers from Uppsala University and Helsinki University found when they conducted a study of adults whose mothers had been evacuated as children from Finland during World War II.

Between 1941 and 1945, nearly 50,000 Finnish children were evacuated from their homes and placed with Swedish foster families. However, at the same time, many Finnish families kept their children at home. All the children experienced the stresses of war but the evacuees also had to learn a new language, adapt to new family situations, and then re-adapt when they went back to Finland. The researchers linked records from more than 46,000 siblings born between 1933 and 1944 with those of their offspring, more than 93,000 individuals born after 1950. Of those, nearly 3,000 were offspring of parents who had been evacuated to Sweden as children and more than 90,000 were offspring of parents who remained in Finland during the war.

Former-evacuee women and their daughters had the highest risk of being hospitalized for mood disorders, such as depression and bipolar disorders. In fact, evacuees’ daughters had more than 4 times the risk of hospitalization for a mood disorder compared with that of the daughters of mothers who had stayed at home regardless of whether their mothers were hospitalized for a mood disorder.

The researchers did not find any increase in psychiatric hospitalizations for the sons or daughters of men who had been evacuated as children. They could not determine why the daughters of female evacuees had a higher risk of mental illness. Possible explanations include changes in the evacuees’ parenting behavior stemming from their childhood experiences or chemical changes in gene expression, the researchers say. They cite earlier research that showed Holocaust survivors have passed on to their children higher levels of methyl groups bound to the gene FKBP5, which may alter the production of cortisol.

“Psychiatric risk that reached into the next generation” is what researchers from Uppsala University and Helsinki University found when they conducted a study of adults whose mothers had been evacuated as children from Finland during World War II.

Between 1941 and 1945, nearly 50,000 Finnish children were evacuated from their homes and placed with Swedish foster families. However, at the same time, many Finnish families kept their children at home. All the children experienced the stresses of war but the evacuees also had to learn a new language, adapt to new family situations, and then re-adapt when they went back to Finland. The researchers linked records from more than 46,000 siblings born between 1933 and 1944 with those of their offspring, more than 93,000 individuals born after 1950. Of those, nearly 3,000 were offspring of parents who had been evacuated to Sweden as children and more than 90,000 were offspring of parents who remained in Finland during the war.

Former-evacuee women and their daughters had the highest risk of being hospitalized for mood disorders, such as depression and bipolar disorders. In fact, evacuees’ daughters had more than 4 times the risk of hospitalization for a mood disorder compared with that of the daughters of mothers who had stayed at home regardless of whether their mothers were hospitalized for a mood disorder.

The researchers did not find any increase in psychiatric hospitalizations for the sons or daughters of men who had been evacuated as children. They could not determine why the daughters of female evacuees had a higher risk of mental illness. Possible explanations include changes in the evacuees’ parenting behavior stemming from their childhood experiences or chemical changes in gene expression, the researchers say. They cite earlier research that showed Holocaust survivors have passed on to their children higher levels of methyl groups bound to the gene FKBP5, which may alter the production of cortisol.

“Psychiatric risk that reached into the next generation” is what researchers from Uppsala University and Helsinki University found when they conducted a study of adults whose mothers had been evacuated as children from Finland during World War II.

Between 1941 and 1945, nearly 50,000 Finnish children were evacuated from their homes and placed with Swedish foster families. However, at the same time, many Finnish families kept their children at home. All the children experienced the stresses of war but the evacuees also had to learn a new language, adapt to new family situations, and then re-adapt when they went back to Finland. The researchers linked records from more than 46,000 siblings born between 1933 and 1944 with those of their offspring, more than 93,000 individuals born after 1950. Of those, nearly 3,000 were offspring of parents who had been evacuated to Sweden as children and more than 90,000 were offspring of parents who remained in Finland during the war.

Former-evacuee women and their daughters had the highest risk of being hospitalized for mood disorders, such as depression and bipolar disorders. In fact, evacuees’ daughters had more than 4 times the risk of hospitalization for a mood disorder compared with that of the daughters of mothers who had stayed at home regardless of whether their mothers were hospitalized for a mood disorder.

The researchers did not find any increase in psychiatric hospitalizations for the sons or daughters of men who had been evacuated as children. They could not determine why the daughters of female evacuees had a higher risk of mental illness. Possible explanations include changes in the evacuees’ parenting behavior stemming from their childhood experiences or chemical changes in gene expression, the researchers say. They cite earlier research that showed Holocaust survivors have passed on to their children higher levels of methyl groups bound to the gene FKBP5, which may alter the production of cortisol.

In 2015, nearly 40,000 people were diagnosed with HIV infection. Half of those had been living with HIV for at least 3 years. One-quarter had been infected for ≥ 7 years.

But now HIV is being diagnosed sooner than before after infection. The estimated median time from infection to diagnosis in 2015 was 3 years compared with 3 years and 7 months in 2011, according to a CDC Vital Signs report.

Estimated median time from infection to diagnosis ranged from 5 years for heterosexual men to 2 and one-half for heterosexual women and women who inject drugs. The median time was 4 years for Asian Americans, 3 years for African Americans and Latinos, and 2 years for whites.

The percentage of people at high risk for HIV who report getting a test the previous year also has risen. Despite that progress, though, the CDC says “too few are tested.”

In 2015, nearly 40,000 people were diagnosed with HIV infection. Half of those had been living with HIV for at least 3 years. One-quarter had been infected for ≥ 7 years.

But now HIV is being diagnosed sooner than before after infection. The estimated median time from infection to diagnosis in 2015 was 3 years compared with 3 years and 7 months in 2011, according to a CDC Vital Signs report.

Estimated median time from infection to diagnosis ranged from 5 years for heterosexual men to 2 and one-half for heterosexual women and women who inject drugs. The median time was 4 years for Asian Americans, 3 years for African Americans and Latinos, and 2 years for whites.

The percentage of people at high risk for HIV who report getting a test the previous year also has risen. Despite that progress, though, the CDC says “too few are tested.”

In 2015, nearly 40,000 people were diagnosed with HIV infection. Half of those had been living with HIV for at least 3 years. One-quarter had been infected for ≥ 7 years.

But now HIV is being diagnosed sooner than before after infection. The estimated median time from infection to diagnosis in 2015 was 3 years compared with 3 years and 7 months in 2011, according to a CDC Vital Signs report.

Estimated median time from infection to diagnosis ranged from 5 years for heterosexual men to 2 and one-half for heterosexual women and women who inject drugs. The median time was 4 years for Asian Americans, 3 years for African Americans and Latinos, and 2 years for whites.

The percentage of people at high risk for HIV who report getting a test the previous year also has risen. Despite that progress, though, the CDC says “too few are tested.”

A clinical trial to test a new, potentially more convenient HIV prophylaxis for women is starting in Africa. It is a long-acting form of the investigational drug cabotegravir and could give sexually active women a choice of biomedical HIV prevention tools for the first time, similar to the choices available for contraception, says Sinead Delany-Moretiwe, PhD, chair of the protocol.

The trial, HPTN 084, will enroll about 3,200 women aged 18 to 45 years at 20 sites in 7 countries. The women will be randomly assigned to either cabotegravir and a placebo pill or Truvada, which is a combination of emtricitabine and tenofovir disoproxil fumarate. Truvada, currently the only drug licensed for HIV pre-exposure prophylaxis, must be taken every day to achieve and maintain protective drug concentrations. The women will start with 2 cabotegravir injections 4 weeks apart, then receive injections once every 8 weeks for an average of 2.6 years. After completing the injections, participants will be offered 48 weeks of PrEP with daily oral Truvada.

The NIAID is sponsoring the phase 3 clinical trial and cofunding it in a unique partnership with ViiV Healthcare (which is providing the study medications with Gilead Sciences) and the Bill & Melinda Gates Foundation.

Participants will receive HIV prevention counseling, condoms and lubricant, and counseling to support adherence to the daily pill. Anyone who becomes HIV infected during the trial will stop receiving the study products and be referred to local medical providers for care and treatment.

The study also will evaluate how women experience long-acting injectable cabotegravir, the researchers say. They are hoping to get a better understanding of the types of safe and effective HIV prevention that also fit best in women’s lives.

A clinical trial to test a new, potentially more convenient HIV prophylaxis for women is starting in Africa. It is a long-acting form of the investigational drug cabotegravir and could give sexually active women a choice of biomedical HIV prevention tools for the first time, similar to the choices available for contraception, says Sinead Delany-Moretiwe, PhD, chair of the protocol.

The trial, HPTN 084, will enroll about 3,200 women aged 18 to 45 years at 20 sites in 7 countries. The women will be randomly assigned to either cabotegravir and a placebo pill or Truvada, which is a combination of emtricitabine and tenofovir disoproxil fumarate. Truvada, currently the only drug licensed for HIV pre-exposure prophylaxis, must be taken every day to achieve and maintain protective drug concentrations. The women will start with 2 cabotegravir injections 4 weeks apart, then receive injections once every 8 weeks for an average of 2.6 years. After completing the injections, participants will be offered 48 weeks of PrEP with daily oral Truvada.

The NIAID is sponsoring the phase 3 clinical trial and cofunding it in a unique partnership with ViiV Healthcare (which is providing the study medications with Gilead Sciences) and the Bill & Melinda Gates Foundation.

Participants will receive HIV prevention counseling, condoms and lubricant, and counseling to support adherence to the daily pill. Anyone who becomes HIV infected during the trial will stop receiving the study products and be referred to local medical providers for care and treatment.

The study also will evaluate how women experience long-acting injectable cabotegravir, the researchers say. They are hoping to get a better understanding of the types of safe and effective HIV prevention that also fit best in women’s lives.

A clinical trial to test a new, potentially more convenient HIV prophylaxis for women is starting in Africa. It is a long-acting form of the investigational drug cabotegravir and could give sexually active women a choice of biomedical HIV prevention tools for the first time, similar to the choices available for contraception, says Sinead Delany-Moretiwe, PhD, chair of the protocol.

The trial, HPTN 084, will enroll about 3,200 women aged 18 to 45 years at 20 sites in 7 countries. The women will be randomly assigned to either cabotegravir and a placebo pill or Truvada, which is a combination of emtricitabine and tenofovir disoproxil fumarate. Truvada, currently the only drug licensed for HIV pre-exposure prophylaxis, must be taken every day to achieve and maintain protective drug concentrations. The women will start with 2 cabotegravir injections 4 weeks apart, then receive injections once every 8 weeks for an average of 2.6 years. After completing the injections, participants will be offered 48 weeks of PrEP with daily oral Truvada.

The NIAID is sponsoring the phase 3 clinical trial and cofunding it in a unique partnership with ViiV Healthcare (which is providing the study medications with Gilead Sciences) and the Bill & Melinda Gates Foundation.

Participants will receive HIV prevention counseling, condoms and lubricant, and counseling to support adherence to the daily pill. Anyone who becomes HIV infected during the trial will stop receiving the study products and be referred to local medical providers for care and treatment.

The study also will evaluate how women experience long-acting injectable cabotegravir, the researchers say. They are hoping to get a better understanding of the types of safe and effective HIV prevention that also fit best in women’s lives.

ATLANTA – The use of immune checkpoint blockade is increasingly becoming standard therapy in Hodgkin lymphoma, but this approach has so far garnered mixed results in non-Hodgkin lymphoma, Stephen Ansell, MD, PhD, said at the annual meeting of the American Society of Hematology.

In an interview, Dr. Ansell, professor of medicine and chair of the lymphoma group at the Mayo Clinic, Rochester, Minn., said responses have been variable with promising results from immune checkpoint inhibitors in primary mediastinal large B-cell lymphoma, some NK/T-cell lymphomas, and primary CNS lymphoma. However, responses have been modest in low-grade lymphoma.

Dr. Ansell, who chaired a session at ASH 2017 on immunotherapy’s expanding role in non-Hodgkin lymphoma, said one of the major challenges of using immune checkpoint blockade in non-Hodgkin lymphoma is the complicated biology. For example, there are a lot of regulatory T cells that actually inhibit the immune response, and many of the T cells that are present within the tumor have an exhausted phenotype and are poorly functioning. Additionally, some of the cytokines that would seem to be stimulating the immune system can, over time, slowly produce T-cell exhaustion.

“Sort of like too much of a good thing ends up being a bad thing,” he said.

These are the issues that are fueling research today, Dr. Ansell said. Going forward he said he expects to see more combination approaches to therapy, such as using an agonistic positive signal plus the blocking of an inhibitory signal with chemotherapy.

Dr. Ansell reported that Mayo Clinic receives clinical trial support from Merck, Bristol-Myers Squibb, Seattle Genetics, Trillium, and Affimed.

mschneider@frontlinemedcom.com

ATLANTA – The use of immune checkpoint blockade is increasingly becoming standard therapy in Hodgkin lymphoma, but this approach has so far garnered mixed results in non-Hodgkin lymphoma, Stephen Ansell, MD, PhD, said at the annual meeting of the American Society of Hematology.

In an interview, Dr. Ansell, professor of medicine and chair of the lymphoma group at the Mayo Clinic, Rochester, Minn., said responses have been variable with promising results from immune checkpoint inhibitors in primary mediastinal large B-cell lymphoma, some NK/T-cell lymphomas, and primary CNS lymphoma. However, responses have been modest in low-grade lymphoma.

Dr. Ansell, who chaired a session at ASH 2017 on immunotherapy’s expanding role in non-Hodgkin lymphoma, said one of the major challenges of using immune checkpoint blockade in non-Hodgkin lymphoma is the complicated biology. For example, there are a lot of regulatory T cells that actually inhibit the immune response, and many of the T cells that are present within the tumor have an exhausted phenotype and are poorly functioning. Additionally, some of the cytokines that would seem to be stimulating the immune system can, over time, slowly produce T-cell exhaustion.

“Sort of like too much of a good thing ends up being a bad thing,” he said.

These are the issues that are fueling research today, Dr. Ansell said. Going forward he said he expects to see more combination approaches to therapy, such as using an agonistic positive signal plus the blocking of an inhibitory signal with chemotherapy.

Dr. Ansell reported that Mayo Clinic receives clinical trial support from Merck, Bristol-Myers Squibb, Seattle Genetics, Trillium, and Affimed.

mschneider@frontlinemedcom.com

ATLANTA – The use of immune checkpoint blockade is increasingly becoming standard therapy in Hodgkin lymphoma, but this approach has so far garnered mixed results in non-Hodgkin lymphoma, Stephen Ansell, MD, PhD, said at the annual meeting of the American Society of Hematology.

In an interview, Dr. Ansell, professor of medicine and chair of the lymphoma group at the Mayo Clinic, Rochester, Minn., said responses have been variable with promising results from immune checkpoint inhibitors in primary mediastinal large B-cell lymphoma, some NK/T-cell lymphomas, and primary CNS lymphoma. However, responses have been modest in low-grade lymphoma.

Dr. Ansell, who chaired a session at ASH 2017 on immunotherapy’s expanding role in non-Hodgkin lymphoma, said one of the major challenges of using immune checkpoint blockade in non-Hodgkin lymphoma is the complicated biology. For example, there are a lot of regulatory T cells that actually inhibit the immune response, and many of the T cells that are present within the tumor have an exhausted phenotype and are poorly functioning. Additionally, some of the cytokines that would seem to be stimulating the immune system can, over time, slowly produce T-cell exhaustion.

“Sort of like too much of a good thing ends up being a bad thing,” he said.

These are the issues that are fueling research today, Dr. Ansell said. Going forward he said he expects to see more combination approaches to therapy, such as using an agonistic positive signal plus the blocking of an inhibitory signal with chemotherapy.

Dr. Ansell reported that Mayo Clinic receives clinical trial support from Merck, Bristol-Myers Squibb, Seattle Genetics, Trillium, and Affimed.

mschneider@frontlinemedcom.com

Adding rituximab and bortezomib to a moderate-intensity chemotherapy regimen and following it up with maintenance rituximab produced high response rates and “excellent” survival outcomes for adults with previously untreated mantle cell lymphoma (MCL), investigators reported in long-term follow-up of a small study.

The objective response rate (ORR) among 30 patients with MCL treated with VcR-CVAD – bortezomib (Velcade), rituximab, and hyperCVAD (hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) followed by rituximab maintenance – was 90%, including a high proportion of complete responses (CR) or unconfirmed complete responses.

After a median follow-up of 7.8 years, the rates of 6-year progression-free and overall survival (PFS and OS) were 53% and 70%, respectively, with patients older and younger than 60 years having equally good outcomes, according to Julie E. Chang, MD, of the Wisconsin Institute of Medical Research in Madison, and her colleagues.

VcR-CVAD is a moderate-intensity regimen with a favorable toxicity profile that allowed tolerability even in an older population, the investigators noted. “An important lesson illustrated by VcR-CVAD is that long-term remissions are achievable in some patients without intensive inductions or consolidation,” they wrote in Clinical Lymphoma, Myeloma & Leukemia.

The investigators previously reported that after a median follow-up of 42 months, the 3-year PFS and OS were 63% and 86%, respectively, and that these outcomes were comparable to those reported with more intensive regimens (Br J Haematol. 2011 Oct;155[2]:190-7).

Wikimedia Commons/TexasPathologistMSW/CC-ASA 4.0 International

hematologynews@frontlinemedcom.com

SOURCE: Chang J et al. Clin Lymphoma Myeloma Leuk. 2018 Jan;18(1):e61-e67. doi: 10.1016/j.clml.2017.10.006.

Adding rituximab and bortezomib to a moderate-intensity chemotherapy regimen and following it up with maintenance rituximab produced high response rates and “excellent” survival outcomes for adults with previously untreated mantle cell lymphoma (MCL), investigators reported in long-term follow-up of a small study.

The objective response rate (ORR) among 30 patients with MCL treated with VcR-CVAD – bortezomib (Velcade), rituximab, and hyperCVAD (hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) followed by rituximab maintenance – was 90%, including a high proportion of complete responses (CR) or unconfirmed complete responses.

After a median follow-up of 7.8 years, the rates of 6-year progression-free and overall survival (PFS and OS) were 53% and 70%, respectively, with patients older and younger than 60 years having equally good outcomes, according to Julie E. Chang, MD, of the Wisconsin Institute of Medical Research in Madison, and her colleagues.

VcR-CVAD is a moderate-intensity regimen with a favorable toxicity profile that allowed tolerability even in an older population, the investigators noted. “An important lesson illustrated by VcR-CVAD is that long-term remissions are achievable in some patients without intensive inductions or consolidation,” they wrote in Clinical Lymphoma, Myeloma & Leukemia.

The investigators previously reported that after a median follow-up of 42 months, the 3-year PFS and OS were 63% and 86%, respectively, and that these outcomes were comparable to those reported with more intensive regimens (Br J Haematol. 2011 Oct;155[2]:190-7).

Wikimedia Commons/TexasPathologistMSW/CC-ASA 4.0 International

hematologynews@frontlinemedcom.com

SOURCE: Chang J et al. Clin Lymphoma Myeloma Leuk. 2018 Jan;18(1):e61-e67. doi: 10.1016/j.clml.2017.10.006.

Adding rituximab and bortezomib to a moderate-intensity chemotherapy regimen and following it up with maintenance rituximab produced high response rates and “excellent” survival outcomes for adults with previously untreated mantle cell lymphoma (MCL), investigators reported in long-term follow-up of a small study.

The objective response rate (ORR) among 30 patients with MCL treated with VcR-CVAD – bortezomib (Velcade), rituximab, and hyperCVAD (hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) followed by rituximab maintenance – was 90%, including a high proportion of complete responses (CR) or unconfirmed complete responses.

After a median follow-up of 7.8 years, the rates of 6-year progression-free and overall survival (PFS and OS) were 53% and 70%, respectively, with patients older and younger than 60 years having equally good outcomes, according to Julie E. Chang, MD, of the Wisconsin Institute of Medical Research in Madison, and her colleagues.

VcR-CVAD is a moderate-intensity regimen with a favorable toxicity profile that allowed tolerability even in an older population, the investigators noted. “An important lesson illustrated by VcR-CVAD is that long-term remissions are achievable in some patients without intensive inductions or consolidation,” they wrote in Clinical Lymphoma, Myeloma & Leukemia.

The investigators previously reported that after a median follow-up of 42 months, the 3-year PFS and OS were 63% and 86%, respectively, and that these outcomes were comparable to those reported with more intensive regimens (Br J Haematol. 2011 Oct;155[2]:190-7).

Wikimedia Commons/TexasPathologistMSW/CC-ASA 4.0 International

hematologynews@frontlinemedcom.com

SOURCE: Chang J et al. Clin Lymphoma Myeloma Leuk. 2018 Jan;18(1):e61-e67. doi: 10.1016/j.clml.2017.10.006.

The administration of inhaled budesonide to extremely preterm infants did not increase the risk of neurodevelopmental disability, but did increase mortality, in a study by Dirk Bassler, MD, of the University of Zürich and his associates.

An older study led by Dr. Bassler and published in the New England Journal of Medicine showed that inhaled budesonide significantly reduced the incidence of bronchopulmonary dysplasia, which has been linked to higher mortality and chronic respiratory and cardiovascular impairment (N Engl J Med. 2015;373:1497-506).

Systemic glucocorticoids have been linked to greater risk of neurodevelopmental disability, but only a few studies have examined the effect of inhaled glucocorticoids, such as budesonide, in preterm infants. These studies, including the earlier one by Dr. Bassler and his colleagues, were either small, covered a short period of time or involved late administering of the drug.

In the two studies by Dr. Bassler and his colleagues, 863 preterm infants between 23 weeks’ and just under 28 weeks’ gestation who required any form of positive-pressure respiratory support were randomized to receive inhaled budesonide (two puffs, 200 mcg per puff) or placebo every 12 hours. They began within 24 hours of birth and continued for the first 14 days of life. Following that, patients received 1 puff every 12 hours until they no longer required supplemental oxygen and positive-pressure support, or reached a postmenstrual age of 32 weeks.

The treatment resulted in a significant reduction in bronchopulmonary dysplasia at a postmenstrual age of 36 weeks (28.2% in the budesonide group vs. 37.4%; P = .01), in the older study.

In the new study, which was also published in the New England Journal of Medicine, Dr. Bassler and his associates found higher mortality (19.9% vs. 14.5%; relative risk, 1.37; 95% confidence interval, 1.01-1.86; P = .04) in the group of patients who had received inhaled budesonide. Additionally, at a corrected age of 18-22 months, surviving infants who received inhaled budesonide had a similar risk of neurodevelopmental disability as those patients who took the placebo.

Broadly speaking, 48.1% of infants who received budesonide had a neurodevelopmental disability, compared with 51.4% of infants who received placebo (RR adjusted for gestational age, 0.93; 95% CI, 0.80-1.09; P = .40). The two groups also had no statistically significant differences in their frequencies of cerebral palsy, blindness, hearing loss, or cognitive delay.

“There was no significant difference between the groups in adverse long-term outcomes in our study. However, the fact that fewer infants died in the placebo group than in the budesonide group complicates the interpretation of the treatment of budesonide,” the researchers wrote.

Supported by a grant from the European Union and by Chiesi Farmaceutici. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

SOURCE: N Engl J Med. 2018;378:148-57.

The administration of inhaled budesonide to extremely preterm infants did not increase the risk of neurodevelopmental disability, but did increase mortality, in a study by Dirk Bassler, MD, of the University of Zürich and his associates.

An older study led by Dr. Bassler and published in the New England Journal of Medicine showed that inhaled budesonide significantly reduced the incidence of bronchopulmonary dysplasia, which has been linked to higher mortality and chronic respiratory and cardiovascular impairment (N Engl J Med. 2015;373:1497-506).

Systemic glucocorticoids have been linked to greater risk of neurodevelopmental disability, but only a few studies have examined the effect of inhaled glucocorticoids, such as budesonide, in preterm infants. These studies, including the earlier one by Dr. Bassler and his colleagues, were either small, covered a short period of time or involved late administering of the drug.

In the two studies by Dr. Bassler and his colleagues, 863 preterm infants between 23 weeks’ and just under 28 weeks’ gestation who required any form of positive-pressure respiratory support were randomized to receive inhaled budesonide (two puffs, 200 mcg per puff) or placebo every 12 hours. They began within 24 hours of birth and continued for the first 14 days of life. Following that, patients received 1 puff every 12 hours until they no longer required supplemental oxygen and positive-pressure support, or reached a postmenstrual age of 32 weeks.

The treatment resulted in a significant reduction in bronchopulmonary dysplasia at a postmenstrual age of 36 weeks (28.2% in the budesonide group vs. 37.4%; P = .01), in the older study.

In the new study, which was also published in the New England Journal of Medicine, Dr. Bassler and his associates found higher mortality (19.9% vs. 14.5%; relative risk, 1.37; 95% confidence interval, 1.01-1.86; P = .04) in the group of patients who had received inhaled budesonide. Additionally, at a corrected age of 18-22 months, surviving infants who received inhaled budesonide had a similar risk of neurodevelopmental disability as those patients who took the placebo.

Broadly speaking, 48.1% of infants who received budesonide had a neurodevelopmental disability, compared with 51.4% of infants who received placebo (RR adjusted for gestational age, 0.93; 95% CI, 0.80-1.09; P = .40). The two groups also had no statistically significant differences in their frequencies of cerebral palsy, blindness, hearing loss, or cognitive delay.

“There was no significant difference between the groups in adverse long-term outcomes in our study. However, the fact that fewer infants died in the placebo group than in the budesonide group complicates the interpretation of the treatment of budesonide,” the researchers wrote.

Supported by a grant from the European Union and by Chiesi Farmaceutici. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

SOURCE: N Engl J Med. 2018;378:148-57.

The administration of inhaled budesonide to extremely preterm infants did not increase the risk of neurodevelopmental disability, but did increase mortality, in a study by Dirk Bassler, MD, of the University of Zürich and his associates.

An older study led by Dr. Bassler and published in the New England Journal of Medicine showed that inhaled budesonide significantly reduced the incidence of bronchopulmonary dysplasia, which has been linked to higher mortality and chronic respiratory and cardiovascular impairment (N Engl J Med. 2015;373:1497-506).

Systemic glucocorticoids have been linked to greater risk of neurodevelopmental disability, but only a few studies have examined the effect of inhaled glucocorticoids, such as budesonide, in preterm infants. These studies, including the earlier one by Dr. Bassler and his colleagues, were either small, covered a short period of time or involved late administering of the drug.

In the two studies by Dr. Bassler and his colleagues, 863 preterm infants between 23 weeks’ and just under 28 weeks’ gestation who required any form of positive-pressure respiratory support were randomized to receive inhaled budesonide (two puffs, 200 mcg per puff) or placebo every 12 hours. They began within 24 hours of birth and continued for the first 14 days of life. Following that, patients received 1 puff every 12 hours until they no longer required supplemental oxygen and positive-pressure support, or reached a postmenstrual age of 32 weeks.

The treatment resulted in a significant reduction in bronchopulmonary dysplasia at a postmenstrual age of 36 weeks (28.2% in the budesonide group vs. 37.4%; P = .01), in the older study.

In the new study, which was also published in the New England Journal of Medicine, Dr. Bassler and his associates found higher mortality (19.9% vs. 14.5%; relative risk, 1.37; 95% confidence interval, 1.01-1.86; P = .04) in the group of patients who had received inhaled budesonide. Additionally, at a corrected age of 18-22 months, surviving infants who received inhaled budesonide had a similar risk of neurodevelopmental disability as those patients who took the placebo.

Broadly speaking, 48.1% of infants who received budesonide had a neurodevelopmental disability, compared with 51.4% of infants who received placebo (RR adjusted for gestational age, 0.93; 95% CI, 0.80-1.09; P = .40). The two groups also had no statistically significant differences in their frequencies of cerebral palsy, blindness, hearing loss, or cognitive delay.

“There was no significant difference between the groups in adverse long-term outcomes in our study. However, the fact that fewer infants died in the placebo group than in the budesonide group complicates the interpretation of the treatment of budesonide,” the researchers wrote.

Supported by a grant from the European Union and by Chiesi Farmaceutici. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

SOURCE: N Engl J Med. 2018;378:148-57.

More veterans are developing diabetes, say researchers from East Tennessee University in Johnson City, Tennessee. The rise is linked to a similar climb in obesity rates.

The researchers analyzed data from 5 cycles of the National Health and Nutrition Examination Survey (NHANES). The survey sample sizes ranged from 472 to 685.

Diabetes prevalence rose from 15.5% in 2005-2006 to 20.5% in 2013-2014, and rose significantly among men, from 16.5% in 2005-2006 to 22% in 2013-2014. Diabetes was most prevalent among veterans who were aged > 65 years, had more than 12 years of education, and had an income below the 100% federal poverty level. Those same subgroups had the highest prevalence of obesity except for the age subgroup. Obesity was more prevalent among veterans aged 45 to 64 years. Hispanic veterans had the highest prevalence of both obesity and diabetes. 

The researchers note that some factors limited the accuracy of the estimated prevalence of diabetes among U.S. veterans when using VA databases. One is that in fiscal year 2014, < 30% of the total veteran population sought VA health care, and > 70% sought care outside the VA system even though some were enrolled.

More veterans are developing diabetes, say researchers from East Tennessee University in Johnson City, Tennessee. The rise is linked to a similar climb in obesity rates.

The researchers analyzed data from 5 cycles of the National Health and Nutrition Examination Survey (NHANES). The survey sample sizes ranged from 472 to 685.

Diabetes prevalence rose from 15.5% in 2005-2006 to 20.5% in 2013-2014, and rose significantly among men, from 16.5% in 2005-2006 to 22% in 2013-2014. Diabetes was most prevalent among veterans who were aged > 65 years, had more than 12 years of education, and had an income below the 100% federal poverty level. Those same subgroups had the highest prevalence of obesity except for the age subgroup. Obesity was more prevalent among veterans aged 45 to 64 years. Hispanic veterans had the highest prevalence of both obesity and diabetes. 

The researchers note that some factors limited the accuracy of the estimated prevalence of diabetes among U.S. veterans when using VA databases. One is that in fiscal year 2014, < 30% of the total veteran population sought VA health care, and > 70% sought care outside the VA system even though some were enrolled.

More veterans are developing diabetes, say researchers from East Tennessee University in Johnson City, Tennessee. The rise is linked to a similar climb in obesity rates.

The researchers analyzed data from 5 cycles of the National Health and Nutrition Examination Survey (NHANES). The survey sample sizes ranged from 472 to 685.

Diabetes prevalence rose from 15.5% in 2005-2006 to 20.5% in 2013-2014, and rose significantly among men, from 16.5% in 2005-2006 to 22% in 2013-2014. Diabetes was most prevalent among veterans who were aged > 65 years, had more than 12 years of education, and had an income below the 100% federal poverty level. Those same subgroups had the highest prevalence of obesity except for the age subgroup. Obesity was more prevalent among veterans aged 45 to 64 years. Hispanic veterans had the highest prevalence of both obesity and diabetes. 

The researchers note that some factors limited the accuracy of the estimated prevalence of diabetes among U.S. veterans when using VA databases. One is that in fiscal year 2014, < 30% of the total veteran population sought VA health care, and > 70% sought care outside the VA system even though some were enrolled.

Zero Suicide is a key concept of the 2012 National Strategy for Suicide Prevention. It uses a “programmatic approach” to quality improvement, based on the realization that suicidal individuals often fall through the cracks in a “sometimes fragmented and distracted” health care system.

A task force identified 7 essential elements of care for health and behavioral health care systems to adopt, including promoting a “safety-oriented” culture, training a competent and caring workforce, using evidence-based treatments, and providing continuous contact and support. The program represents a commitment to both patient safety and to the safety and support of clinical staff who care for suicidal patients.

The Zero Suicide tool kit includes readings, videos, webinars, and other resources, such as a Mental Health Guide developed by the VA to ensure a “safe and therapeutically enriching environment” and a checklist to review inpatient mental health units for environmental hazards. The tool kit also provides thoughtful supplements, such as hospital care cards to send to patients after discharge and a “caring letter template” that includes caring phrases in the Puyallup language with English translations.

The 8 facilities receiving grants are Apache Behavioral Health Service in Whiteriver, Arizona; Chinle Comprehensive Healthcare Facility in Arizona; Fort Defiance Indian Hospital Board in Arizona; Gallup Indian Medical Center in New Mexico; Lawton Indian Hospital in Oklahoma; Menominee Indian Tribe of Wisconsin in Keshena; Pueblo of Acoma in New Mexico; and Rocky Boy Health Board, Box Elder in Montana.

Zero Suicide is a key concept of the 2012 National Strategy for Suicide Prevention. It uses a “programmatic approach” to quality improvement, based on the realization that suicidal individuals often fall through the cracks in a “sometimes fragmented and distracted” health care system.

A task force identified 7 essential elements of care for health and behavioral health care systems to adopt, including promoting a “safety-oriented” culture, training a competent and caring workforce, using evidence-based treatments, and providing continuous contact and support. The program represents a commitment to both patient safety and to the safety and support of clinical staff who care for suicidal patients.

The Zero Suicide tool kit includes readings, videos, webinars, and other resources, such as a Mental Health Guide developed by the VA to ensure a “safe and therapeutically enriching environment” and a checklist to review inpatient mental health units for environmental hazards. The tool kit also provides thoughtful supplements, such as hospital care cards to send to patients after discharge and a “caring letter template” that includes caring phrases in the Puyallup language with English translations.

The 8 facilities receiving grants are Apache Behavioral Health Service in Whiteriver, Arizona; Chinle Comprehensive Healthcare Facility in Arizona; Fort Defiance Indian Hospital Board in Arizona; Gallup Indian Medical Center in New Mexico; Lawton Indian Hospital in Oklahoma; Menominee Indian Tribe of Wisconsin in Keshena; Pueblo of Acoma in New Mexico; and Rocky Boy Health Board, Box Elder in Montana.

Zero Suicide is a key concept of the 2012 National Strategy for Suicide Prevention. It uses a “programmatic approach” to quality improvement, based on the realization that suicidal individuals often fall through the cracks in a “sometimes fragmented and distracted” health care system.

A task force identified 7 essential elements of care for health and behavioral health care systems to adopt, including promoting a “safety-oriented” culture, training a competent and caring workforce, using evidence-based treatments, and providing continuous contact and support. The program represents a commitment to both patient safety and to the safety and support of clinical staff who care for suicidal patients.

The Zero Suicide tool kit includes readings, videos, webinars, and other resources, such as a Mental Health Guide developed by the VA to ensure a “safe and therapeutically enriching environment” and a checklist to review inpatient mental health units for environmental hazards. The tool kit also provides thoughtful supplements, such as hospital care cards to send to patients after discharge and a “caring letter template” that includes caring phrases in the Puyallup language with English translations.

The 8 facilities receiving grants are Apache Behavioral Health Service in Whiteriver, Arizona; Chinle Comprehensive Healthcare Facility in Arizona; Fort Defiance Indian Hospital Board in Arizona; Gallup Indian Medical Center in New Mexico; Lawton Indian Hospital in Oklahoma; Menominee Indian Tribe of Wisconsin in Keshena; Pueblo of Acoma in New Mexico; and Rocky Boy Health Board, Box Elder in Montana.