The management of chronic lymphocytic leukemia (CLL) in older patients requires careful balancing of therapeutic efficacy with the risks of treatment intolerance. Frailty assessment is increasingly recognized as a critical determinant of clinical outcomes, but its specific role in guiding therapy with second-generation Bruton tyrosine kinase inhibitors remains poorly defined. We conducted a prospective, multicenter investigation of 326 consecutive CLL patients aged 65 years or older who received zanubrutinib across 52 Italian centers, aiming to evaluate whether the Clinical Frailty Scale (CFS) could predict treatment discontinuation in real-world practice. The cohort was characterized by advanced age (median 78.1 years, range 65.1-94.5), with over half of the patients presenting with Binet stage C disease. Two-thirds were treated in the frontline setting, while the remainder received zanubrutinib as salvage therapy. After a median follow-up of 8 months, 48 patients (14.7%) discontinued treatment, most commonly due to toxicity or disease progression. Receiver operating characteristic curve analysis identified a CFS of 3 as the optimal threshold for predicting discontinuation, with an area under the curve of 0.65 (95% CI 0.56-0.73, p < 0.001). At 12 months, the discontinuation rate was significantly higher among patients with a CFS > 3 (29.2%) compared with those with a CFS ≤ 3 (8.8%) (p < 0.001); among conventional prognostic variables, only relapsed/refractory disease demonstrated an independent association with TTD. These findings highlight the CFS as a simple yet powerful clinical tool that provides incremental prognostic information beyond standard disease-related factors. Incorporating frailty assessment into treatment planning may enhance patient selection and optimize therapeutic strategies for elderly CLL patients in daily practice.
BACKGROUND:To provide an updated and detailed overview of the current use of platelet-rich plasma (PRP) penile injections in men affected by Peyronie's disease (PD). METHODS:A comprehensive search in PubMed, Scopus, and Web of Science, was performed for prospective and retrospective, single cohort or comparative studies published in form of full-text articles or conference abstracts, evaluating safety and efficacy of PRP for PD treatment. Primary outcome consisted in the reduction of penile curvature. Sexual function and adverse/side effects were also investigated. Qualitative and quantitative data syntheses were provided. RESULTS:Overall, 15 records were included: four studies focused on PRP alone, two randomized clinical trials tested PRP versus placebo, and the remainder assessed the combination of PRP with external shock wave therapy, manual penile modelling, vacuum erection device therapy, percutaneous needle tunneling, phosphodiesterase type-5 inhibitors or hyaluronic acid. Patient numbers ranged between 10 and 159 according to studies, with 685 patients receiving PRP alone or in combination (median age 56.2 years). Despite the heterogeneity in study design, protocol of administration, dose of PRP, and follow-up duration, all studies independently reported a statistically significant improvement in penile curvature and sexual outcomes, without major adverse/side effects. A linear mixed-effects model was fitted to estimate the change in penile curvature over time across studies, with results suggesting that the effect of PRP on reducing penile curvature tends to improve over time, was enhanced by greater initial treatment intensity, and negatively influenced by patient age. CONCLUSIONS:PRP penile injections for PD treatment have shown encouraging results in preliminary studies. Patient numbers and the short-term follow-up may limit the generalizability of these observations. High-quality, large-scale, and standardized controlled trials are needed before starting to recommend its use in clinical practice.
Recently, the EAU guidelines presented the EAU guidelines bot to assist urologists in the reading of the guidelines; however, up to date, no external validation is available. The aim of our study is to assess the accuracy, completeness, and clarity of the guideline’s bot in testicular cancer. A total of 36 questions based on the EAU testicular cancer guidelines recommendations were developed. Each question was systematically presented to the EAU guidelines bot and the responses were independently assessed by two expert urologists to assess the accuracy, completeness, and clarity. A 5-point Likert scale was used as a score, and in case of discrepancies, a third urologist was queried. Accuracy, completeness, and clarity were assessed per chapter and per grade of recommendation. All questions and answers were recorded in an Excel file. Overall, 36 questions were developed. In terms of accuracy, 36/36 (100
Cardiac sarcoidosis is a rare but potentially life-threatening condition characterized by the formation of non-caseating granulomas in the myocardium. Clinical manifestations range from asymptomatic forms to atrioventricular blocks, ventricular arrhythmias, heart failure, and sudden cardiac death. Diagnostic work-up requires a multimodality approach combining advanced imaging, clinical criteria, and, when possible, histological confirmation. Immunosuppressive therapy remains the cornerstone of treatment, aimed at suppressing myocardial inflammation and preventing irreversible damage. Risk stratification for sudden cardiac death is crucial, and cardiac implantable electronic devices play a key role in selected patients. This review, structured in ten clinical questions, provides an overview of the epidemiology, clinical presentation, diagnostic criteria, differential diagnosis, therapeutic strategies, and risk stratification of cardiac sarcoidosis, in light of the most recent international guidelines and consensus documents.
