Jonathan Q. Trinh

Allogeneic hematopoietic stem cell transplantation (HCT) improves survival of patients with hematologic malignancies. A growing responsibility exists to identify and address long-term morbidity and symptom burden. We investigated metabolic syndrome and symptom burden in adult HCT survivors. We analzyed adults with hematologic disorders who were treated with allogeneic HCT at our institution from June 2018-November 2022. We used standard criteria for metabolic syndrome with body mass index (BMI) as a surrogate for waist circumference. We assessed symptom burden using the National Comprehensive Cancer Network Survivorship Assessment. The Short Physical Performance Battery and Short Blessed Test were used to investigate physical function and cognition, respectively. A total of 152 patients were included. Median age was 61 years, 59% were male, and the most common disorder was acute myeloid leukemia (48%). 64 patients developed metabolic syndrome post-transplant. The most commonly affected symptom domains were fatigue (51%), sleep (45%), and cognitive function (42%). Additionally, 34% and 7% of patients had objectively impaired functional capacity and cognition, respectively. Recipients of allogeneic HCT have a high incidence of metabolic syndrome, symptom burden, and impaired physical function.

Spiradenocarcinomas are rare malignant skin adnexal tumors. We describe a novel case of a patient with an aggressive CDKN2A-mutated spiradenocarcinoma who responded to a CDK4/6 inhibitor. This case highlights the unique nature of spiradenocarcinomas as well as the potential benefit of targeted therapy.

Purpose: The usual workup for patients newly diagnosed with advanced non-small cell lung cancer (NSCLC) occurs in the ambulatory setting. A subset of patients present with acute care needs and receive the diagnosis while hospitalized. Palliative therapies are typically initiated when patients are outpatients, even when diagnoses are made when they are inpatients. Lengthy admission, rehabilitation needs after discharge, and readmissions are possible barriers to timely and adequate outpatient follow-up. The outcomes for these patients diagnosed in the hospital are not well characterized. We hypothesized that patients have been ill-served by current treatment patterns, as reflected by low rates of cancer-directed treatment and poor survival. Patients and methods: We performed a retrospective study of new inpatient diagnoses of metastatic NSCLC at our institution between 1 January 2012 and 1 January 2022. The primary outcome was the proportion of patients ultimately receiving cancer-directed therapy. Other outcomes included time to treatment, use of targeted therapy, palliative care/hospice utilization, and overall survival (OS). Results: Seventy-three patients were included, with a median age of 57 years. Twenty-seven patients (37%) ultimately received systemic therapy with a median time from diagnosis to treatment of 37.5 days. Overall, 5.4% patients died while admitted, 6.8% were discharged to a hospice, 21.9% were discharged to a facility, and 61.6% were discharged home. Only 20 patients (27%) received palliative care consultation. The median OS for our entire population was 2.3 months, with estimated 6-month and 1-year OS rates of 32% and 22%, respectively. Conclusion: Patients with new inpatient diagnoses of metastatic NSCLC have extremely poor outcomes. Current management strategies resulted in few patients starting systemic therapy, yet most of the patients did not receive palliative care or hospice involvement. These findings demonstrate that there is a high unmet need to optimally support and palliate these patients.

Background/Aim: The PACIFIC trial demonstrated improved survival in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with durvalumab following definitive concurrent chemoradiotherapy (CRT). This study sought to explore real-world outcomes with durvalumab consolidation therapy at our institution. Patients and Methods: We retrospectively identified patients diagnosed with stage III NSCLC at our institution from January 2012 to January 2022. We created two cohorts: one who received durvalumab following definitive CRT and a historical one who did not. Primary outcomes of interest included median progression-free survival (PFS) and overall survival (OS). Additionally, we performed subgroup analysis on the durvalumab cohort to explore the associations between survival and time to durvalumab initiation, PD-L1 expression, and neutrophil-to-lymphocyte ratio (NLR). Results: We identified 79 patients with locally advanced NSCLC who were not surgical candidates. Patients treated with durvalumab (n=44) had significantly improved survival compared to the historical cohort (n=35) including a median PFS of 17.4 months versus 8.0 months (p=0.0019) and a median OS of 37.0 months versus 17.0 months (log-rank p-value=0.07, Wilcoxon p-value=0.02). Within the durvalumab group, outcomes did not significantly differ between those who initiated therapy before or after 42 days of finishing CRT, between various PD-L1 expression levels, or between high or low NLR. Conclusion: Patients who received durvalumab as consolidation therapy following definitive CRT demonstrated significantly improved survival compared to a historical cohort who did not receive durvalumab. Furthermore, durvalumab appears to benefit patients regardless of time to initiation, PD-L1 expression, or NLR.

Supplementary Figure 1: Fecal microbiome composition variations across disease statuses by (A) study name, and (B) geographical regions (country). Covariates explaining the variation in the microbiome in cohorts (C) showing that country had the highest explanatory power.

Supplementary Table 1: Number of taxa reads per study.

Supplementary Table 2: DNA extraction methods per study in the CuratedMetagenomeData cohorts.

Supplementary Table 3: Correlations between microbial abundance and activity of host KEGG pathways in early- versus late-onset CRC.