Objective. To evaluate the impact of tumor burden, as measured by whole-body metabolic tumor volume (MTV) from 18-F-fluorodeoxyglucose PET-CT imaging, on treatment outcomes in patients with relapsed/refractory non-Hodgkin lymphomas (NHL) treated with locally produced CAR T-cell therapy. Material and methods. Metabolic volume was retrospectively investigated in 20 patients with NHL who underwent baseline pre-treatment PET-CT and received CAR T-cell therapy at N.N. Alexandrov National Cancer Center of Belarus. Results. Semi-automatically segmented (SUV>4) MTV and weight-standardized MTV (sMTV) were calculated. The median MTV and sMTV were 99.4 mL and 1.6 mL/kg, respectively. Receiver operating characteristic analysis showed AUC for MTV 0.875 and for sMTV 0.901. Using a receiver operating characteristic curve-based sMTV cutoff of 4 mL/kg, 1-year progression-free survival (PFS) was 17.9% for high MTV versus 90.9% for low sMTV (p = 0.01), and 1-year overall survival (OS) was 17.9% and 100%, respectively (p <0.01). No statistically significant association between MTV and toxicity severity was found. Conclusion. Our data provide additional evidence for the predictive power of MTV on efficacy outcomes in patients with R/R NHL treated with CAR T-cell therapy. Specifically, sMTV discriminates high versus low tumor burden and predicts PFS and OS outcomes. Furthermore, these data indicate that efforts to reduce pretreatment tumor burden may improve longitudinal clinical outcomes.
Modern thymus surgery cannot be imagined without videoendoscopic technologies. Thymus surgeries are performed using multiport, single-port, subxiphoidal approaches, as well as with the participation of robotic systems. This report presents an original method of videothoracoscopic thymectomy, the peculiarity of which lies in the sequence of stages of the operation. According to the technique, before the isolation of the thymus gland in combination with mediastinal tissue, mobilization and ligation of the thymic veins are performed. The described technique is aimed at preventing a massive release of autoantibodies to nicotinic acetylcholine receptors into the bloodstream and preventing the development of postoperative myasthenic crisis.
The report presents a clinical case of partial erythrocyte aplasia that developed as an autoimmune syndrome of giant thymoma. Manifestation of the disease included persistent and progressive aplasia of the erythrocyte lineage of the bone marrow against the background of long-term growth of the anterior mediastinal thymoma. The reason for surgical treatment was the phenomena of compression syndrome, complicating the patient's eating and breathing. Despite the radical removal of the tumor and improvement of the general condition of the patient, remission of erythrocyte aplasia was not achieved. Literature data demonstrating pathogenetic features of the course of a rare thymus-associated autoimmune syndrome, including the features of postoperative support, are presented.
