Search

Circulating tumour DNA (ctDNA) is defined as short DNA sequences shed by tumour cells into the systemic circulation. A promising use of ctDNA includes the detection of minimal residual disease (MRD) and is currently being studied in multiple types of solid tumours. Literature for the use of individualised ctDNA in nasopharyngeal carcinoma (NPC) is not available, although circulating Epstein-Barr virus DNA level is validated as a prognostic factor. We present a man in his 40s diagnosed with stage IV NPC who was started on chemotherapy with cis-platinum and gemcitabine. Serial monitoring of ctDNA completed to aid in detecting MRD after treatment demonstrated initial up-trending values correlating with subsequent imaging findings showing progression. Reinitiation of a different chemotherapy regimen significantly improved the ctDNA level, with corresponding imaging exhibiting a similar response. This case provides insight into the potential use of ctDNA in NPC and the benefit of serial ctDNA monitoring during treatment.

Thrombotic thrombocytopenic purpura (TTP) is a type of thrombotic microangiopathy that is characterized by microangiopathic haemolytic anaemia, consumption thrombocytopenia and organ injury. It is caused by a severe deficiency of ADAMTS13, which can be either congenital or acquired. There is a plethora of things that can cause the acquired form, including medications and infections. Vaccines have also been shown to cause TTP. In the midst of the COVID-19 pandemic, with multiple new vaccines being developed and distributed to the masses, the medical community needs to be aware of adverse events associated with these new vaccines. We present a case of TTP following administration of the Moderna booster vaccine.

Background: Circulating tumor DNA (ctDNA) are short DNA sequences shed by tumor cells into the systemic circulation. Studies have shown potential utility of the test to predict relapse or recurrence following treatment in solid tumors, but sensitivity and specificity have varied widely, ranging from 19-100% and 80-100% respectively, in breast cancer specifically. Moreover, literature describing the utility of monitoring dynamic changes in ctDNA trends is limited. We aim to evaluate the correlation between ctDNA test, both single test as well as dynamic trends in value over time, with imaging findings. Methods: We retrospectively analyzed the medical records of all adult patients diagnosed with breast cancer who underwent ctDNA testing at the hematology-oncology clinic at William Beaumont - Royal Oak and Troy Hospitals, Michigan, from August 2017 to June 2022. Patients who had ctDNA testing done but did not have imaging to correlate it with were excluded from the study. We calculated the sensitivity and specificity of a single positive ctDNA test to detect disease progression or residual disease on imaging. In patients with multiple ctDNA tests, we calculated the sensitivity and specificity of dynamic trends in ctDNA values to detect progression, regression, or absence of disease on imaging. Moreover, we calculated the lead time for positive ctDNA results to detect disease progression compared to imaging. Results: Nineteen patients were included in the study, with 34 total ctDNA test results, each utilized as a separate data point to compare with corresponding imaging findings (Table 1). Ten out of the 19 patients had multiple(>=2) ctDNA test results reported, with a total of 15 pairs of ctDNA values and each pair was analyzed separately as up trending (N=7), down trending (N=4), or persistent negative (N=4) to compare with a corresponding pair of imaging findings (Table 2). The median age at diagnosis was 55 years, and 94.7% were female. At diagnosis, majority of patients (68.4%) had either stage III or IV disease. Our primary endpoint, the correlation of single positive ctDNA result with imaging showing either progression or residual disease, showed a sensitivity and specificity of 100% and 93.3%, respectively. Secondarily, serial ctDNA trend analysis in ten patients revealed both sensitivity and specificity of 100% for up-trending ctDNA values to detect progression, down-trending to detect regression, and persistent negative results to detect absence of disease on imaging, respectively. The positive ctDNA results detected disease progression with a median lead time of 44.5 days compared to imaging. Conclusion: Given the high sensitivity and specificity to detect disease progression and regression in breast cancer patients by single ctDNA results and dynamic ctDNA trends in our study, we conclude that this may be a valid way to reliably monitor for changes in disease status before they become evident in imaging studies. Further clinical studies are required to prove the utility of ctDNA to detect changes in disease status and to guide therapeutic interventions in breast cancer. Table 1. Correlation of single ctDNA result with imaging findings. Table 2. Correlation of dynamic trends in ctDNA values with imaging findings. Citation Format: Ujjwal Karki, Bipin Ghimire, Emma Herrman, Siddhartha Yadav, Mohammad Muhsin Chisti. Detection of progression or regression of breast cancer by circulating tumor DNA (ctDNA) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-07.

Luai Madanat,1 Melinda Sager,1 Daniel O’Connor,1 Bijaya Thapa,1 Nishant Aggarwal,1 Bipin Ghimire,1 Carl Lauter,1– 4 Gabriel N Maine,5,6 Matthew Sims,1,2,4 Alexandra Halalau1,4 1Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA; 2Infectious Diseases, William Beaumont Hospital, Royal Oak, MI, USA; 3Allergy and Immunology, William Beaumont Hospital, Royal Oak, MI, USA; 4Oakland University William Beaumont School of Medicine, Rochester, MI, USA; 5Pathology and Laboratory Medicine, William Beaumont Hospital, Royal Oak, MI, USA; 6Pathology, Oakland University William Beaumont School of Medicine, Rochester, MI, USACorrespondence: Luai Madanat, Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA, Tel +1 248-551-3000, Email Luai.madanat@beaumont.orgBackground: Antibody levels against SARS-CoV-2 can be used as an indicator of recent or past vaccination or infection. However, the prognostic value of antibodies targeting the receptor binding protein (anti-RBD) in hospitalized patients is not widely reported.Purpose: Determine prognostic impact of SARS-CoV-2 antibody quantification at the time of admission on clinical outcomes in hospitalized COVID-19 patients.Methods: We conducted a pilot observational study on patients hospitalized with SARS-CoV-2 infection to determine the prognostic impact of antibody quantitation within the first two days of admission. Anti-nucleocapsid IgG (anti-N) and Anti-RBD levels were measured. Anti-RBD level of 500 AU/mL was used as a cutoff to stratify patients. Spearman’s rank Coefficient (rs) was used to demonstrate association.Results: Of the 26 patients included, those who were vaccinated more frequently tested positive for Anti-RBD (100% vs 46.2%, P = 0.005) with higher median titer level (623 vs 0, P = 0.011) compared to unvaccinated patients. Anti-N positivity was more frequently seen in unvaccinated patients (53.9% vs 7.7%, P = 0.03). Anti-RBD levels > 500 were associated with lower overall hospital length of stay (LOS)(5 vs 10 days, P = 0.046). The analysis employing a Spearman Rank coefficient demonstrated a strong negative correlation between anti-S titer and LOS (rs=− .515, p = 0.007) and a moderate negative correlation with oxygen needs (rs =− .401, p = 0.042).Conclusion: Anti-RBD IgG levels were associated with lower LOS and oxygen needs during hospitalization. Further studies are needed to determine if levels on admission can be used as a prognostic indicator.Keywords: SARS-CoV-2, anti-RBD IgG, anti-nucleocapsid IgG, hospitalized patients, prognosis, outcomes

More than 100,000 Bhutanese refugees have been found homes in third countries. The other side to the story of this successful resettlement programme, however, is the failure to tackle the impact it has had on the remaining camp populations.

We present a case of a woman in her early 60s with multiple myeloma who, while undergoing treatment with cyclophosphamide, bortezomib and dexamethasone (CyBorD), noticed a whitish nodular swelling on the eyelid. This occurred after one cycle of CyBorD and on subsequent treatment, it also involved the contralateral eyelid. The lesions were initially managed with conservative measures by applying warm compresses, but the lesions progressively increased in size. CyBorD was discontinued and topical antibiotics and anti-inflammatories were initiated, resulting in a decrease in size of the lesions. On resolution of symptoms, she was rechallenged with CyBorD, and symptoms did not recur. The temporal relationship between bortezomib and the development of chalazion is based on connection and no association has been proven.