Royal Perth Hospital (RPH) is a 450-bed adult and teaching hospital located on the northeastern edge of the central business district of Perth, Western Australia.
To document the occurrence of radiation-induced vasculopathy as a delayed complication in the treatment of head and neck cancers. We present the case history and review the imaging findings in a 51-year-old man with a history of nasopharyngeal cancer, treated with radiotherapy 10 years prior to admission, who presented with a stroke syndrome. The pathophysiology, clinical and imaging features, and development of collateral pathways due to radiation-induced vasculopathy are discussed. The patient had occlusion of the right and left common carotid arteries, as well as of the left internal carotid artery and the right subclavian artery. The proximally occluded vessels ended in tapered “stumps”. CT angiography with Maximum Intensity Projection (MIP) and 3D Volume Rendering Technique (VRT) displayed the collateralisation of the occluded arteries via the thyrocervical trunks and ascending cervical arteries. Radiation therapy for head and neck cancer is associated with a significantly increased incidence of radiation-induced vasculopathy and cerebrovascular ischaemic events. Carotid stump syndrome should be considered as a rare but serious cause of recurrent stroke and stroke-like symptoms
OBJECTIVES:To compare incidence, risk factors and outcomes for interstitial lung disease (ILD) between patients with SLE and controls. METHODS:We performed a population-level cohort study using state-wide longitudinal hospital data from Western Australia (WA) for patients with SLE (n = 1854, median age 40 years, 86% female) and matched hospitalized controls (n = 12107, median age 40 years, 88% female) over the period 1985-2014. We estimated ILD incidence rate (IR), determined independent risk factors for ILD using multivariate logistic regression and assessed outcomes including mortality rate (MR) and cause of death. Results presented as median, frequency, IR or MR per 1000 person years (PY) with 95% CIs and IR or MR ratios (IRR or MRR). RESULTS:ILD occurred in 3.8% of SLE patients with a higher IR in SLE than the controls (3.11, 95% CI 2.44-3.91 vs 0.12, 95% CI 0.08-0.16; IRR 26.8) that was stable over time. Time to ILD from index was shorter in SLE and risk factors for ILD included older age, smoking and serositis. SLE-ILD patients experienced higher MRs (MR 52.0, 95% CI 37.0-71.1) than both SLE patients without ILD (MR 17.7, 95% CI 16.0-19.6; MRR 2.94) and controls with ILD (MR 22.8, 95% CI 12.1-38.9; MRR 2.28). ILD decreased survival for SLE and control cohorts and respiratory causes of death predominated in both the ILD groups. CONCLUSION:ILD occurred more frequently in SLE than the controls with older age, smoking and serositis as risk factors. As SLE-ILD adversely impacts prognosis with increased mortality, greater awareness and earlier management is warranted.
Ultra-low-field (ULF) point-of-care (PoC) Magnetic Resonance Imaging (MRI) offers a promising pathway to improve accessibility in medical imaging due to its portability and lower cost. However, the diagnostic utility of ULF MRI is currently limited by lower image quality, particularly in signal-to-noise ratio, resolution, and contrast. To address this, we introduce SynPoC, a generative diffusion model designed to enhance ULF MRI by synthesizing high-field MRI-like images. SynPoC employs a conditional adversarial diffusion framework that leverages both noise and contrast-specific features to model inter-field representations. We evaluated SynPoC across a multi-site dataset of 180 participants, including both healthy individuals and patients with a variety of brain conditions. The enhanced images exhibited improved anatomical clarity and structural alignment with corresponding high-field MRI, as supported by quantitative and volumetric analyses. Our model demonstrates promise for image quality enhancement and research applications; however, as with other generative approaches, there is a non-zero risk of hallucinated or misleading features, particularly near low-SNR boundaries and fine structures. We therefore provide synchronized slice-by-slice comparison videos (3T, PoC, SynPoC) to aid reader inspection and emphasize that SynPoC is not intended for diagnostic decision-making without additional safeguards and validation. Further validation is warranted before diagnostic use.
Abstract Janus kinase inhibitors (JAKi) are standard of care for patients with myelofibrosis (MF) but can be associated with treatment-limiting cytopenias and do not modify underlying disease. Novel treatments targeting other clinically relevant pathways are needed. Inhibitors of bromodomain (BD) and extraterminal domain (BET) proteins are a promising class of drugs that have demonstrated the ability to modulate key pathways involved in inflammation, fibrosis, and apoptosis. ABBV-744 is a novel small molecule that targets the BDII of BET proteins and has previously been shown to be well tolerated when administered daily at doses of 120 and 180 mg to patients with acute myeloid leukemia. We report the outcomes of a multicenter, open-label phase 1b study of ABBV-744 in patients with MF who received ≥1 previous lines of therapy, including a JAKi. The primary objective was safety, including dose-limiting toxicities (DLTs). Secondary end points included a reduction in spleen volume of ≥35% (SVR35), ≥50% reduction in total symptom score (TSS50), objective response rate, and pharmacokinetics. All 21 patients experienced at least 1 treatment-emergent adverse event, and 11 patients experienced a DLT. The most common events leading to DLTs were thrombocytopenia (33%) and anemia (24%). SVR35 was attained in 24% of patients at week 12 and 33% at week 24. TSS50 was reported for 29% of patients at 12 weeks and 19% at week 24. These outcomes are noteworthy in this heavily pretreated population considering the advanced disease state and limited treatment options for this patient population. This trial was registered at www.clinicaltrials.gov as NCT04454658.
Abstract Introduction: Patients (pts) with soft tissue plasmacytomas noncontiguous with bone (true extramedullary disease [EMD]) have poor outcomes with standard therapies shown by low overall response rates (ORRs), which are not durable. Talquetamab (Tal; anti-GPRC5D×CD3) and teclistamab (Tec; anti-BCMA×CD3) are first-in-class bispecific antibodies (BsAbs) approved as monotherapies for triple-class exposed (TCE) relapsed/refractory multiple myeloma (RRMM). Primary analysis from the RedirecTT-1 (NCT04586426) dedicated phase 2 EMD cohort (March 2025 data cut; median follow-up [mFU] 12.6 mo) showed Tal + Tec elicited an ORR of 78.9% (assessed by independent review committee) and a 12-mo progression-free survival (PFS) of 61.0%. Here, we report updated efficacy, using investigator assessment, and safety results from the phase 2 RedirecTT-1 EMD cohort with Tal + Tec. Importantly, we report EMD location and a novel analysis of tumor burden as a prognostic indicator of ORR. Methods: Pts had TCE RRMM and true EMD defined as ≥1 nonradiated soft tissue plasmacytoma noncontiguous with bone ≥2 cm in 1 dimension (with or without paramedullary plasmacytomas). Nonsecretory/oligosecretory disease was permitted. Prior CAR-T and non-BCMA/-GPRC5D BsAb therapies were permitted. Pts received Tal 0.8 mg/kg + Tec 3.0 mg/kg Q2W, preceded by step-up doses, with a permitted switch to monthly dosing at investigator's discretion after cycle 6 or after cycle 4 with confirmed ≥VGPR. Response was assessed per IMWG; EMD response was assessed by PET-CT or MRI whole-body scans. Tumor burden was assessed by total EMD tumor volume. Results: As of July 2025, 90 pts received Tal + Tec, with a median follow-up of 16.3 mo (range 0.5–23.7). Baseline characteristics were as previously reported; 39% had nonsecretory/oligosecretory disease, 20% had prior anti-BCMA CAR-T therapy, and 9% had prior BsAb therapy (all anti-FcRH5). The median number of plasmacytomas was 2 (range 1–7); 17 (18.9%), 29 (32.2%), and 74 (82.2%) pts, respectively, had ≥1 nodal, organ, or soft tissue EMD, while 11 (12.2%) also had ≥1 additional paramedullary plasmacytoma. Of 268 EMDs across all pts, 95 (35.4%) were nodal EMD, 77 (28.7%) were organ EMD (most commonly liver), and 64 (23.9%) were soft tissue EMD; 32 (11.9%) were paramedullary. Baseline EMD tumor volume was <25 cm2in 43 (47.8%) pts, 25–50 cm2 in 21 (23.3%) pts, and >50 cm2 in 26 (28.9%) pts. Per investigator assessment, ORR (95% CI) was 77.8% (67.8–85.9); 50.0% had a ≥CR. Median duration of response (DOR) was not estimable (NE; 12-mo DOR rate, 60.1%), 12-mo PFS was 55.6%, and median overall survival (OS) was NE (12-mo OS rate 73.8%). ORR was 90.7% (77.9–97.4; ≥CR 60.5%) in pts with EMD tumor volume <25 cm2, 66.7% (43.0–85.4; ≥CR 52.4%) for 25–50 cm2, and 65.4% (44.3–82.8; ≥CR 30.8%) for >50 cm2. Common adverse events (AEs) included CRS (77.8%; no grade [gr] 3/4) and neutropenia (72.2%; gr 3/4 62.2%). Taste changes (78.9%), non-rash skin AEs (68.9%), and nail AEs (55.6%) were all gr 1/2, and rash AEs (30.0%) were mostly gr 1/2. ICANS occurred in 11 (12.2%) pts (gr 3, 1.1%; gr 4, 1.1%). Infections occurred in 72 (80.0%) pts (gr 3/4 40.0%), most commonly upper respiratory tract infection (26.7%; gr 3/4 5.6%); IVIG was highly recommended to prevent and manage hypogammaglobulinemia and infection. Ten (11.1%) pts discontinued Tal + Tec due to treatment-emergent AEs (4 pts due to infections and 6 due to gr 5 AEs). Two pts discontinued Tal only due to AEs. In total, 11 (12.2%) pts had gr 5 AEs (6 due to infections), 6 of which were deemed to be drug related by investigators. Data will be updated with an additional 4 mo of follow-up for the presentation. Conclusions: With longer follow-up in pts with TCE RRMM with true EMD regardless of baseline tumor characteristics, Tal + Tec efficacy exceeded all approved therapies, including T-cell redirecting and cellular therapies, noting limitations of cross-study comparisons. Lower total EMD tumor volume was associated with a higher ORR but low pt numbers in each group and lack of statistical testing limits robust interpretation. The safety profile of Tal + Tec was generally consistent with each monotherapy; AEs were not exacerbated with the combination. These data continue to highlight the clinical benefit of the novel combination of Tal + Tec in pts with true EMD, a population with high disease burden and significant unmet need.
