MedStar Franklin Square Medical Center, a member of MedStar Health, is a hospital located in the Rosedale area of eastern Baltimore County, Maryland. It is the third largest hospital in Maryland; with more than 3,500 employees, it is one of the largest employers in Baltimore County.The building is found along Franklin Square Drive, next to the campus of Community College of Baltimore County - Essex, and is used for the clinical training of allied health programs at the college.
Background Patients with relapsed or refractory (R/R) follicular lymphoma (FL) after two or more prior lines of therapy can now be treated with mechanistically distinct modalities, including CD19-directed chimeric antigen receptor (CAR) T-cell therapy, CD20×CD3 bispecific antibodies, and a Bruton tyrosine kinase inhibitor plus anti-CD20 combination. Head-to-head data are lacking, and sequencing decisions are made with limited comparative evidence. We benchmarked durability outcomes across pivotal trials using reconstructed individual patient data (rIPD) derived from published Kaplan-Meier (KM) curves. Methods KM curves and numbers-at-risk tables from pivotal prospective studies in ≥2-line R/R FL were digitized and rIPD-reconstructed using a validated algorithm: axicabtagene ciloleucel (ZUMA-5), tisagenlecleucel (ELARA), lisocabtagene maraleucel (TRANSCEND FL), mosunetuzumab, epcoritamab (EPCORE NHL-1), and zanubrutinib plus obinutuzumab versus obinutuzumab (ROSEWOOD). Prespecified durability endpoints were landmark progression-free survival (PFS) at 12 and 24 months and restricted mean survival time to 24 months (RMST24). Overall survival (OS) landmarks were summarized where follow-up permitted. ROSEWOOD served as an internal validity check using a Cox model fit to reconstructed data. Results At 24 months, landmark PFS was 65.4% (95% confidence interval (CI) 52.0-82.4) for liso-cel, 62.0% (50.2-76.6) for axi-cel, 53.8% (45.2-63.9) for zanubrutinib plus obinutuzumab, 49.3% (39.3-61.7) for mosunetuzumab, 43.7% (31.3-61.1) for epcoritamab, and 24.7% (14.9-40.9) for obinutuzumab monotherapy. Twelve-month PFS ranged from 81.8% (74.5-89.8) with liso-cel and 77.9% (69.4-87.5) with axi-cel to 61.6% (53.6-70.8), 60.4% (50.8-72.0), and 59.1% (50.5-69.1) for zanubrutinib plus obinutuzumab, mosunetuzumab, and epcoritamab, respectively; tisagenlecleucel showed 12-month PFS of 68.3% (57.2-81.6) with shorter follow-up (maximum 18.2 months). PFS RMST24 estimates were 19.5 months for liso-cel, 18.6 for axi-cel, 16.5 for zanubrutinib plus obinutuzumab, 16.2 for mosunetuzumab, 14.8 for epcoritamab, and 11.9 for obinutuzumab. OS at 24 months was high across regimens (mosunetuzumab 87.3%, liso-cel 84.6%, axi-cel 82.8%, zanubrutinib plus obinutuzumab 77.3%, and epcoritamab 67.6%). In ROSEWOOD, reconstructed data reproduced the published PFS benefit for zanubrutinib plus obinutuzumab (hazard ratio (HR) 0.48, 95% CI 0.32-0.71; p < 0.001) with a weaker OS signal (HR 0.61, 0.35-1.07; p = 0.08). Conclusions In this rIPD-based durability benchmark for ≥2-line R/R FL, the estimated landmark PFS and RMST24 values varied across regimens, with numerically higher point estimates for the CAR T-cell therapies and the zanubrutinib plus obinutuzumab combination and numerically lower estimates for the bispecific antibodies and the obinutuzumab control; CIs overlapped substantially, and 24-month OS estimates were broadly similar across regimens. Because the source trials enrolled materially different populations, these side-by-side estimates are descriptive benchmarks and should not be read as head-to-head comparisons of efficacy. Faithful internal reproduction of the randomized ROSEWOOD effect supports reconstruction fidelity. The analysis provides a transparent, durability-focused reference framework to support sequencing discussions and hypothesis generation, not comparative effectiveness conclusions.
Drug-induced compartment syndrome is a rare, limb- and life-threatening condition. This etiology of compartment syndrome can often be distinguished from other causes by the presence of severe rhabdomyolysis. We report a rare case of gabapentin-induced rhabdomyolysis complicated by acute lower extremity compartment syndrome that required emergent four-compartment fasciotomy. Increased awareness of this rare but serious adverse effect of a commonly prescribed medication is warranted.
Background Intraoperative radiation therapy has shown potential in early-stage breast cancer treatment. The single-arm, prospective, multi-institution ExBRT trial was designed to improve the quality of evidence in patients treated with lumpectomy and intraoperative electronic brachytherapy (IORT). Methods Women at least 40 years with single lesion invasive ductal carcinoma (IDC) or ductal carcinoma in situ (DCIS) no larger than 3 cm, cN0, treated with lumpectomy and IORT per protocol, were followed for ipsilateral breast tumor recurrence (IBTR), serious adverse events (SAEs), breast cancer-related and overall survival. Results At median 5-year follow-up, IBTR was diagnosed in 42(3.50%) of 1199 subjects, with a Kaplan-Meier probability of 4.21% (95%CI 2.86, 5.55). IBTR-related risk analyses identified age younger than 50 years, high-grade DCIS, Grade 3 IDC and endocrine therapy (ET) non-compliance to increase IBTR risk. SAEs were low at 1.4%. Breast cancer-related survival had a median 5-year Kaplan-Meier probability of 99.90% (95%CI 99.70, 100), with 1 breast cancer-related death. There were 46 unrelated deaths for an overall survival probability of 94.30% (95%CI 92.67, 95.95). Conclusions Patients treated with lumpectomy and IORT, delivered conveniently in a single setting, demonstrated low IBTR with minimal toxicity and excellent breast cancer-related and overall survival. This compared favorably to published early-stage breast cancer radiation omission and de-escalation radiotherapy results. Synopsis A single-arm, prospective, multi-institution research study (ExBRT trial) assessing IORT safety and efficacy immediately following lumpectomy using disposable balloon electronic brachytherapy. IORT, with a 4.21% Kaplan-Meier IBTR probability at median 5-year follow-up, is a convenient, less toxic treatment with results similar to early-stage breast cancer radiation omission and de-escalation radiotherapy results.
Injection drug use is an established risk factor for invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA). People who inject drugs (PWID) who are admitted to the hospital for severe infections are typically initiated on empiric intravenous (IV) vancomycin for MRSA coverage. However, it can be difficult to perform vancomycin therapeutic drug monitoring and achieve pharmacokinetic targets in this patient population. Thus, in some cases, patients are anecdotally transitioned to alternative antibiotics that can be administered less frequently and are not subject to therapeutic drug monitoring, such as IV daptomycin. We performed a retrospective, dual-center study evaluating antibiotic practices in adult PWID admitted with MRSA bacteremia between September 1, 2019 and September 1, 2024 who received IV vancomycin for at least 48 hours. The primary objective was the incidence of switching from vancomycin to daptomycin. Secondary objectives included the timing of antibiotic modification, time to blood culture clearance, and other factors associated with the switch. A total of 63 patients met eligibility criteria and were included in the analysis. The transition from vancomycin to daptomycin occurred in 32 (50.8%) patients after a median of 5.0 days (IQR 4.0 – 10.0) on empiric vancomycin. The median daptomycin dose administered was 8.0 mg/kg (IQR 7.6 – 8.3) daily. Overall time from initiation of antibiotics with MRSA activity to blood culture clearance was 3.0 days (IQR 2.0 – 4.0). Blood culture clearance occurred after a median of 2.0 days on daptomycin (IQR 1.0 to 2.0). Of the patients transitioned to daptomycin, the most common reasons for switch were ease of discharge to a facility for once daily administration and lack of need for therapeutic drug monitoring. Approximately half of the included patients were transitioned from vancomycin to daptomycin for treatment of MRSA bacteremia. This is consistent with concerns in clinical practice relating to safety, efficacy, and monitoring of vancomycin in this patient population. Given how commonly this occurs, these findings suggest it may be beneficial for institutions to develop guidelines for the treatment of MRSA bacteremia in PWID. Amanda Binkley, PharmD, BCIDP, AAHIVP, Shionogi: Advisor/Consultant Katherine Mersinger, PharmD, Melinta Therapeutics: Honoraria
Primary breast lymphomas account for less than 1% of all non-Hodgkin lymphomas and 0.04-0.5% of all malignant breast neoplasms. We report a case of breast extranodal marginal zone lymphoma (EMZL) in a 60-year-old woman with chronic hepatitis C virus (HCV) infection. After comprehensive evaluation excluded other known etiologies, chronic HCV infection emerged as the most plausible contributing factor. Epidemiologic and biological evidence supports an association between HCV and B-cell non-Hodgkin lymphomas, particularly marginal zone lymphomas. Our case adds to the limited literature suggesting that HCV should be considered as a potential etiological factor in breast EMZL. We discuss the emerging role of direct-acting antiviral (DAA) therapy in HCV-associated indolent lymphomas and its implications for management.
