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עמוד בית
Thu, 22.02.24

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October 2022
Miri Zektser MD, Anat Rabinovich MD, Uri Grinbaum MD, Tzvi Porges MD, Aya Gozlan MD, Anna Gourevitch MD, Kayed Al-Athamen MD, Orit Barrett MD, Ido Peles MD, Tehila Kaisman-Elbaz MD, Etai Levi MD

Background: Primary central nervous system lymphoma (PCNSL) is a rare aggressive non-Hodgkin's lymphoma. There are limited data on the management of PCNSL outside of clinical trials.

Objectives: To report experience with three main high-dose methotrexate (HDMTX)-based protocols for PCNSL treatment at one medical center.

Methods: We conducted a retrospective review of the medical records of patients diagnosed with PCNSL who were treated at Soroka Medical Center between 2007 and 2019.

Results: The study included 36 patients, median age 64.9 years; 33 patients received a HDMTX backbone induction therapy, 21 (58.3%) received consolidation treatment in addition. In the entire cohort, 25 patients (75.7%) achieved complete remission (CR, CRu-unconfirmed), with mean progression-free survival (PFS) 32 ± 6.9 months and median overall survival (OS) 59.6 ± 12.4 months. More aggressive regiment such as combination of rituximab, HDMTX, cytarabine and thiotepa had better responses 5 (100%) CR, but also a higher incidence of side effects such as neutropenic fever 5 (100%). In subgroup analysis by age (younger vs. older than 60 years), the PFS was 24.2 vs. 9.3 months, and OS was 64.1 vs. 19.4 months, respectively.

Conclusions: A difference in CR and PFS favored a more aggressive protocol, but the toxicity of the multiagent combinations was significantly higher. The prognosis in younger was better than in older patients, with higher rates of CR, PFS, and OS, although not statistically significant. Overall treatment outcomes are encouraging; however, there is a real need for an adaptive approach for older patients and balancing among the effectiveness and side effects.

October 2021
Orr Yahal MD, Yael Halavy MD, Asaf Vivante MD, Noah Gruber MD, Irit Tirosh MD, and Omer Bar-Yosef MD
July 2017
Carlo Salvarani MD, Robert D. Brown Jr MD MPH and Gene G. Hunder MD
October 2016
Saar Anis MD, Amir Sharabi MD PhD, Yair Mina MD, Ainat Klein MD, Emanuela Cagnano MD, Ori Elkayam MD and Tanya Gurevich MD
April 2016
Luca Cantarini MD PhD, Maria L. Stromillo MD, Antonio Vitale MD, Giuseppe Lopalco MD, Giacomo Emmi MD PhD, Elena Silvestri MD, Antonio Federico MD, Mauro Galeazzi MD, Florenzo Iannone MD PhD and Nicola De Stefano MD PhD

Behçet's disease (BD) is a multi-systemic disorder of unknown etiology characterized by relapsing oral-genital ulcers, uveitis, and involvement of the articular, gastrointestinal, neurologic, and vascular systems. The choice of treatment is based on the severity of systemic involvement, clinical presentation and the site affected, and includes corticosteroids, azathioprine, interferon, cyclophosphamide, methotrexate or tumor necrosis factor-alpha and interleukin-1 blockers. We present a case series of four refractory BD patients successfully treated with intravenous immunoglobulins (IVIG). All patients fulfilled International Study Group criteria. The patients’ mean age was 38.75 ± 12.09 years and mean disease duration 10.25 ± 8.5 years. Human leukocyte antigen B51 was positive in two of four patients. In addition to oral aphthosis, all patients suffered from genital ulcers and cutaneous BD-related manifestations; central nervous system involvement and arthralgia were found in two patients. Peripheral nervous system, gastrointestinal and eye involvement occurred in 25% of cases. In all patients, previously treated according to EULAR recommendations without reaching satisfactory results, IVIG induced immediate and sustained response over time without incurring any side effects. We propose IVIG administration as an additional effective and safe treatment option in patients with severe and resistant BD.

July 2013
G. Yaniv, G. Twig, O. Mozes, G. Greenberg, C. Hoffmann and Y. Shoenfeld
 Systemic lupus erythematosus (SLE) is a complex autoimmune disorder involving multiple organs. One of the main sites of SLE morbidity is the central nervous system (CNS), specifically the brain. In this article we review several imaging modalities used for CNS examination in SLE patients. These modalities are categorized as morphological and functional. Special attention is given to magnetic resonance imaging (MRI) and its specific sequences such as diffusion-weighted imaging (DWI), diffuse tensor imaging (DTI) and magnetic resonance spectroscopy (MRS). These modalities allow us to better understand CNS involvement in SLE patients, its pathophysiology and consequences.

 

September 2009
July 2009
N. Agmon-Levin, B. Gilburd, S. Kivity, B.S. Porat Katz, I. Flitman-Katzevman, N. Shoenfeld, D. Paran, P. Langevitz and Y. Shoenfeld

Background: Anti-ribosomal-P antibodies have been associated with central nervous manifestations of systemic lupus erythematosus. However, inconsistencies in their prevalence and clinical correlations have become an obstacle to their use as a diagnostic marker of the disease. This lack of consistency might stem from several factors, such as the lag period between clinical manifestations and the time blood was drawn, or the different methods used for antibodies detection.

Objectives: To evaluate three different enzyme-linked immunosorbent assay tests for the detection of anti-Rib-P Abs[1] in patients with SLE[2] and normal controls.

Methods: Sera from 50 SLE outpatients and 50 healthy subjects were tested with three ELISA[3] kits: Kit-1, which uses synthetic peptide comprising the 22 C-terminal amino-acids; Kit-2, which uses native human ribosomal proteins (P0, P1, P2); and Kit-3, which is coated with affinity-purified human ribosomal proteins. ELISA studies were performed according to the manufacturers' instructions.

Results: The prevalence of anti-Rib-P Abs in SLE patients and controls was 30% vs. 0%, 17% vs. 21%, and 30% vs. 14% in kits 1-3 respectively. Anti-Rib-P Abs detected by Kit-1 correlated with the SLEDAI score (SLE Disease Activity Index). No correlation between prior CNS[4] manifestations and anti-Rib-P Abs was observed.

Conclusions: A significant difference was documented between the ELISA kits used for the detection of anti-Rib-P Abs. A correlation was found between these antibodies (evaluated by Kit-1) and concurrent SLEDAI scores, in contrast to the lack of correlation with previous CNS manifestations. This supports the notion of "active serology" that is evaluated at the same time manifestations are present, as well as the need for standardization of laboratory assays in the future that enable a better assessment of anti-Rib-P Abs presence and clinical correlation. 



 




[1] anti-Rib-P Abs = anti-ribosomal-P antibodies

[2] SLE = systemic lupus erythematosus

[3] ELISA = enzyme-linked immunosorbent assay

[4] CNS = central nervous system

 



 
April 2009
S. Kivity, O.D. Ortega-Hernandez and Y. Shoenfeld
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