Stem Cell Transplantation in Hodgkin’s Lymphoma Past, Present and FutureAmir Abbas Hedayati Asl
Treatment for HL has improved significantly since the ABVD chemotherapeutic combination was invented over 30 years ago .
Despite using the same ABVD regimen in most patients treated in the first line, we now have a much better understanding of disease biology and the late side effects of therapy, and we have moved toward a personalized, risk-adapted approach.
This approach promises to deliver low toxicities and high cure rates for lower risk patients while reserving aggressive regimens for those high risk patients who really need them.
For the minority of patients who fail first-line therapy, novel drugs like the antibody-drug conjugate BV and immunotherapies with nivolumab and pembrolizumab have produced high response rates and durability of benefit.
Further research is needed to determine whether these novel drugs could make life better for both patients with HL who are undergoing treatment and for the growing cohort of HL survivors.
Lymphoma is the third most common cancer in children <15 years of age.The prognosis for children with newly diagnosed chemosensitive non-Hodgkin’s lymphoma (NHL) and Hodgkin’s disease (HD) has improved significantly.Despite the generally excellent prognosis of children and adolescents with Hodgkin’s lymphoma (HL), approximately 15% of patients relapse. Aggressive chemotherapy followed by autologous bone marrow transplantation has been used with some improvement in survival.
Breast cancer is a malignancy originating from breast tissue. This chapter
distinguishes between early stages, which are potentially curable, and
metastatic breast cancer (MBC), which is usually incurable.
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Stem Cell Transplantation in Hodgkin’s Lymphoma Past, Present and FutureAmir Abbas Hedayati Asl
Treatment for HL has improved significantly since the ABVD chemotherapeutic combination was invented over 30 years ago .
Despite using the same ABVD regimen in most patients treated in the first line, we now have a much better understanding of disease biology and the late side effects of therapy, and we have moved toward a personalized, risk-adapted approach.
This approach promises to deliver low toxicities and high cure rates for lower risk patients while reserving aggressive regimens for those high risk patients who really need them.
For the minority of patients who fail first-line therapy, novel drugs like the antibody-drug conjugate BV and immunotherapies with nivolumab and pembrolizumab have produced high response rates and durability of benefit.
Further research is needed to determine whether these novel drugs could make life better for both patients with HL who are undergoing treatment and for the growing cohort of HL survivors.
Lymphoma is the third most common cancer in children <15 years of age.The prognosis for children with newly diagnosed chemosensitive non-Hodgkin’s lymphoma (NHL) and Hodgkin’s disease (HD) has improved significantly.Despite the generally excellent prognosis of children and adolescents with Hodgkin’s lymphoma (HL), approximately 15% of patients relapse. Aggressive chemotherapy followed by autologous bone marrow transplantation has been used with some improvement in survival.
Breast cancer is a malignancy originating from breast tissue. This chapter
distinguishes between early stages, which are potentially curable, and
metastatic breast cancer (MBC), which is usually incurable.
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. • Highly malignant chemo sensitive
tumor occur in two categories:
• A-non metastatic lesion : usually
confined to uterus in form of invasive
mole and is follow [ 15%] of primary
HM.
• B- metastatic lesion : usually lead to
distant metastasis and is follow [5%]
of primary HM.
3. Incidence and epidemiology :
• Geographical distribution: similar to
that of HM. west [1 :10.000- 1 :70.000
] pregnancy, middle east [ intermediate
position ], Asia [1- 250 - 1-6000].
• Age > in old, parity > in high parity,
socioeconomic > in poor.
• Antecedent pregnancy: HM in [50% -
75%], normal term pregnancy [ 25%],
abortion [ 25%].
• Maternal blood group: > in group A, <
in group O.
4. Pathology of persistent GTT:
Macroscopic appearance:
• Dark hemorrhage tumor mass on
uterine wall, cervix and vagina could
perforate uterine wall or invade blood
vessels leading to metastases.
Choriocarcinoma: completely
disorganized growth with bizarre
forms of cytotrophoblasts and
syncytiotrophoblast, with variable
cellular anaplasia and absence villi.
5. Microscopic appearance:
• Invasive mole: trophoblastic extensive
deep myometrial penetration, may
reach peritoneal covering of uterus or
vagina with necrosis of muscles and
preservation of villous pattern usually
lacking tendancy of widespread
metastasis.
6. Clinical feature of persistent GTT:
• a-uterine cramps and bleeding which is
the commonest complaint and is either
internal bleeding due to myometrial
infiltration by tumor and lead to
perforation and hemoperitoneum, or
external bleeding.
• b-offensive vaginal discharge.
• c-cachexia, weakness and pyrexia as
disease advances.
7. • d-not uncommon, patient has no specific
complaint and she diagnosed during
surveillance after molar pregnancy when
one of the indication of chemotherapy is
encountered.
• d-signs and symptoms of metastatic lesion:
metastasis may be local to broad ligament
and paracervical tissues or through blood
stream to the lungs most commonest site
of metastasis [75%] leading to dyspnea
and hemoptysis, vagina next common site
of metastasis [50%] leading to bleeding
nodules, CNS lead to seizure and CVA, liver
metastasis.
8. Investigations of persistent GTT:
• a-HCG: important in the diagnosis and
clinical staging of persistent GTT HCG
should normalize [48 hours after term
delivery], [2 weeks after abortion] and [6-
8 weeks after HM]. So persistent increase
levels of HCG mean persistent GTT.
• b-CXR to detect lung metastasis.
• c-imaging techniques U/S,CT scan, MRI. [
MRI is superior to U/S and CT scan in
evaluating abdominal and pelvic organs
and CNS metastasis.
9. Staging of persistent GTT:
• Numbers of factors identified which
influence prognosis of persistent GTT in
a positive way they are as follows:
• 1-increasing HCG before starting
treatment because it reflect larger
mass.
10. • 2- metastasis and this include :
• a-Site of metastasis worst prognosis
with CNS metastasis because
chemotherapy agents usually do not
cross blood brain barrier, liver
metastasis associated with poor
prognosis because chemotherapy
rapidly detoxified in liver.
• b-Numbers of metastatic lesions the
more the numbers the poor the
prognosis.
11. • 3-size of largest mass: the larger the
mass the poorer the prognosis.
• 4-antecedent pregnancy: worst
prognosis when antecedent
pregnancy is term normal pregnancy,
better prognosis with abortion, best
prognosis when antecedent
pregnancy is H, mole.
• 5-pregnancy – treatment interval:
longer the interval between
pregnancy and chemotherapy the
worse the prognosis.
12. • 6-previous unsuccessful
chemotherapy: associated with poor
prognosis due to drug resistance may
be due to impermeability of
chemotherapy to tumor mass because
of scarring and fibrosis or
accumulating drugs toxicity.
• 7-ABO group : worst prognosis in
blood groups B,AB.
• 8-age poor prognosis if[ > 39 ]and
parity >[ 3 or 4].
13. • Each of the above mentioned prognostic
variables is given a score ranging from [
zero to 30 ] zero if absent and 30 if
present.
• By calculating the score of the patient :
final score
• + [< 50 ]allocated as low risk G.T.T.
• + [ 55-95 ] allocated as medium risk G.T.T.
• + [ >95 ] allocated as high risk G.T.T.
• So staging affect survival rate and choice of
chemotherapy , this based mainly on HCG
levels and metastasis and is not a
pathological classification.
14. Treatment of persistent GTT:
• Optimum result encountered in highly
specialized centers, same policy of
treatment in invasive mole and
metastatic choriocarcinoma .
Treatment modalities:
• Chemotherapy= main stay of
treatment.
• Surgery=certain limited indication.
• Radiotherapy= limited indication.
• Further management and follow up.
15. Chemotherapy of persistent GTT:
• Chemotherapy is indicated in all cases
of persistent GTT. metastatic or non
metastatic forms of tumors are highly
chemosensitive.
• Protocol for chemotherapy agents are
selected according to degree of risk of
patient [ low, medium, high ] which
indicated by her pre treatment
prognostic score. Low risk category
responds to single drug and medium,
high risk category require
combination of drugs.
16. Low risk category:
• Survival rate [100 %] carries best
prognosis responds to single agent
chemotherapy either methotrexate or
actinomycin D
• Methotrexate : it is the drugs of choice
in single chemotherapeutic courses
because its simplicity and low toxicity [
its low toxicity attributed to the
availability of antidote folinic acid which
reduce toxicity and allow use of higher
dose.
17. How to give methotrexate ?
• Before starting chemotherapy send for
CBP, LFT, RFT and is given parentrally [iv
– im] excreted in urine so its
contraindicated in renal failure, the
coarse constitutes [8 days] ,
methotrexate given every other day
alternating with folinic acid.
• D1=D3=D5=D7= methotrexate
D2=D4=D6=D8= folinic acid.
18. • HCG should be assessed twice weekly
to ensure that it is regressing
satisfactorily, if HCG is increase or
plateau which mean drugs resistance
and you need to change agent.
• WBC count and platelet count sent for
daily so stop chemotherapy if [WBC
count < 1000], [platelet count
<50.000].
19. • Toxicity of methotrexate may be
encountered
• a-myelosuppression:
thrombocytopenia, granulocytopenia.
• b-mucus membrane: stomatitis,
oesophagitis, vaginitis, conjunctivitis.
• c-skin rush, nephrotoxicity,
hepatotoxicity.
• When 8day course completed give
[7- 14]days rest then start second
course of methotrexate in similar
manner and you need [ 2-4] courses
20. • To reach undetected level of HCG. When
HCG level undetected give[ 2-3]extra
courses of methotrexate because
approximately[ 100.000] trophoblast
cells may escape detected by RIA of HCG.
• actinomycin D: given parenterally in
courses consisting of 5 days , spaced by
[7- 14]days rest repeat courses until you
reach undetectable level of HCG followed
by[ 2-3]extra courses, monitor patient
condition by CBP, LFT, RFT and is given
and monitor patient response by HCG
twice weekly.
21. Medium risk category:
• Overall survival rate [ 95 %], they resist
methotrexate when used as single agent
combination chemotherapy improves
prognosis significantly. The following
agents are added to methotrexate.
• ^Actinomycin, 6 mercaptopurine,
vincristine and cyclophosphamide.
22. High risk category:
• biggest therapeutic challenge,
survival rate [40 – 65% ] they
require seven drugs combination
courses include: alklating agent as
chlorambucil + methotrexate +
Actinomycin D + vincristine and
others, they also require prophylactic
intra thecal methotrexate on each
alternating course to prevent CNS
metastasis, also these drugs
combined in courses spaced by [7-
14]days rest.
23. Surgical treatment of persistent GTT.
• In pre chemotherapy era hysterectomy
was the treatment of choice in persistent
GTT and at that time it may resulted in
favorable outcome with HM or invasive
mole but was totally inadequate for
metastatic choriocarcinoma. Now we are
in the era of chemotherapy,
• success of chemotherapy replaced
hysterectomy favorable pregnancy
outcome is possible after successful
chemotherapy so is best to avoid
hysterectomy and preserve reproductive
function.
24. Surgical treatment is indicated in the following :
• a-drugs resistance focus: diagnosed when
find focus with persistent increase in HCG
despite drugs combination so hysterectomy if
the focus confined to uterus or salvage
surgery e.g lobectomy if the focus confined to
lung or vaginal nodules excision.
• b-uterine perforation: by invasive mole lead to
hemopeirtonium.
• c-heavy uncontrollable uterine bleeding.
• Hysterectomy with preservation of ovaries
because ovarian metastasis is very rare.
25. Radio therapy of persistent GTT.
• persistent GTT not sensitive to radio
therapy, it is of no benefit in
chemotherapy resistance tumor may be
indicated in cases of brain or liver
metastasis who develop hemorrhage into
these metastatic lesions after
chemotherapy.
26. Further management of persistent GTT:
• By quantitative assessment of HCG the
aim of follow up is to diagnose remission
which define as 4 consecutive weekly -ve
HCG assay. And to detect relapse and
majority of relapses occur in the first 12
months of remission, contraception
essential during treatment and during the
first year of remission by barrior methods
then OCCP after normalization of HCG
levels.
27. Follow up scheme
• a-monthly HCG assay in the first year.
• b-twice per a year for 5 years.
• c-once per a year for 5 years.
• Plus follow up previous metastatic lesion
by appropriate tests
• CXR for lung metastasis and MRI for
pelvic, abdominal viscera and CNS.