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Background Preoperative malnourishment has been consistently associated with poor outcomes after radical cystectomy and other major abdominal surgeries. Most enhanced recovery after surgery (ERAS) studies have examined preoperative nutrition and its relationship to outcomes after gastrointestinal surgery. Although numerous studies have demonstrated the benefits of using an ERAS protocol, this study in unique in comparing 2 ERAS protocols, with and without a nutrition component. Methods A formalized preoperative nutrition protocol (PNP) recommending use of preoperative immunonutrition and carbohydrate drink was introduced in June 2018. A total of 78 consecutive patients who drank both beverages were compared with 92 historical controls. Multivariable logistic regression analyses were sequentially performed to determine if preoperative nutrition was associated with binary outcome variables (30-day complication, infectious complication, and readmission within 30 days). Results The preoperative nutrition group and control group were statistically similar in distribution of age, sex, American Society of Anesthesiologists physical status classification, clinical stage, and body mass index. Return of bowel function was found to occur earlier in the preoperative nutrition group than in the control group (3.12 vs 3.74 days; relative risk, 0.82; CI, 0.73-0.93; P = .0029). Complications within 30 days were similar in both groups (63.6% vs 55.4%; P = 0.36). Infectious complications (42.9% vs 37%; P = .53) and readmission within 30 days (22.1% vs 15.2%; P = .34) were also similar in both groups. Conclusions Use of a PNP including immunonutrition and carbohydrate drink may be associated with earlier return of bowel function after radical cystectomy.

Summary A clearer understanding of the tumor immune microenvironment (TIME) in metastatic clear cell renal cell carcinoma (ccRCC) may help to inform precision treatment strategies. We sought to identify clinically meaningful TIME signatures in ccRCC. We studied tumors from 39 patients with metastatic ccRCC using quantitative multiplexed immunofluorescence and relevant immune marker panels. Cell densities were analyzed in three regions of interest (ROIs): tumor core, tumor–stroma interface and stroma. Patients were stratified into low- and high-marker density groups using median values as thresholds. Log-rank and Cox regression analyses while controlling for clinical variables were used to compare survival outcomes to patterns of immune cell distributions. There were significant associations with increased macrophage (CD68+CD163+CD206+) density and poor outcomes across multiple ROIs in primary and metastatic tumors. In primary tumors, T-bet+ T helper type 1 (Th1) cell density was highest at the tumor–stromal interface (P = 0·0021), and increased co-expression of CD3 and T-bet was associated with improved overall survival (P = 0·015) and survival after immunotherapy (P = 0·014). In metastatic tumor samples, decreased forkhead box protein 3 (FoxP3)+ T regulatory cell density correlated with improved survival after immunotherapy (P = 0·016). Increased macrophage markers and decreased Th1 T cell markers within the TIME correlated with poor overall survival and treatment outcomes. Immune markers such as FoxP3 showed consistent levels across the TIME, whereas others, such as T-bet, demonstrated significant variance across the distinct ROIs. These findings suggest that TIME profiling outside the tumor core may identify clinically relevant associations for patients with metastatic ccRCC.

Introduction Mycophenolate mofetil (MMF) dose/kg can influence clinical outcomes of allogeneic hematopoietic cell transplantation (HCT) including acute graft-versus-host disease (GVHD) (Harnicar BBMT 2015; Bejanyan BBMT 2018). When used for GVHD prophylaxis in conjunction with post-transplant cyclophosphamide (PTCy), MMF is generally dosed at 15 mg/kg three times daily (capped at a maximum of 3 g/day) and combined with either tacrolimus or sirolimus. Thus, many adults receive the maximum dose and a variable dose/kg of MMF. Objectives We sought to investigate the impact of MMF dose/kg on clinical outcomes of HCT in the setting of PTCy-based GVHD prophylaxis, where the effect of MMF dose/kg is unknown. Methods Included are 112 consecutive adult patients with hematologic malignancies who received myeloablative (n=70) or reduced intensity (n=42) HCT at the Moffitt Cancer Center between 2012-2018 with T-cell replete peripheral blood stem cells (n=94) or bone marrow (n=18). GVHD prophylaxis consisted of PTCy/MMF and either tacrolimus (n=57) or sirolimus (n=55). MMF dose relative to patient actual body weight (mg/kg/day), was stratified by tertiles into low ( 40 mg/kg/day, n=36). Results The median age at transplant was 57.8 (range: 21-75) years. Median follow-up was 12 months (range: 0.3-39). Donors were haploidentical related (n=74), mismatched unrelated (n=26), and matched related/unrelated (n=12). MMF dose groups had similar characteristics, except the low dose group having a higher proportion of males (p Conclusion In patients receiving PTCy based GVHD prophylaxis, MMF dose/kg had no significant effect on GVHD. However, lower MMF dose/kg was associated with worse DFS. This study suggests that