Publications by authors named "Hamza Hashmi"

24 Publications

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Carfilzomib-Based 3-Drug Regimens for Newly Diagnosed Multiple Myeloma-All That Glitters Is Not Gold.

JAMA Oncol 2021 Apr 1. Epub 2021 Apr 1.

Hematology, Oncology, Blood & Marrow Transplantation, Multiple Myeloma Program, Taussig Cancer Center, Cleveland Clinic, Ohio.

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http://dx.doi.org/10.1001/jamaoncol.2021.0174DOI Listing
April 2021

Incidence and Management of Effusions Before and After CD19-Directed Chimeric Antigen Receptor (CAR) T Cell Therapy in Large B Cell Lymphoma.

Transplant Cell Ther 2021 Mar 27;27(3):242.e1-242.e6. Epub 2020 Dec 27.

Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. Electronic address:

In patients with lymphoma, third-space fluid accumulations may develop or worsen during cytokine release syndrome (CRS) associated with chimeric antigen receptor (CAR) T cell therapy. Pre-existing symptomatic pleural effusions were excluded by the ZUMA-1 trial of axicabtagene ciloleucel for large B cell lymphoma (LBCL) and variants. The incidence and management of effusions during CAR T cell therapy for LBCL are unknown. We performed a single-center retrospective study evaluating 148 patients receiving CD19-directed CAR T cell therapy for LBCL between May 2015 and September 2019. We retrospectively identified patients who had radiographic pleural, pericardial, or peritoneal effusions that were present prior to the time of CAR T infusion (pre-CAR T) or that newly developed during the first 30 days after CAR T-cell infusion (post-CAR T). Of 148 patients, 19 patients had a pre-CAR T effusion, 17 patients without pre-existing effusion developed a new infusion after CAR T, and 112 patients had no effusions. Comparing pre-CAR T effusions to new effusions post-CAR T, pre-CAR T effusions were more often malignant (84% versus 12%), persistent beyond 30 days (95% versus 18%), and required interventional drainage after CAR T infusion (79% versus 0%). Compared to patients with no effusion, patients with pre-CAR T therapy effusions had a higher frequency of high-risk baseline characteristics, such as bulky disease and high International Prognostic Index. Similarly, patients with pre-CAR T therapy effusions had a higher rate of toxicity with grade 3 or higher CRS occurring in 32% of patients. On multivariate analysis adjusting for age, Eastern Cooperative Oncology Group status, bulky disease, albumin, and lactate dehydrogenase, a pre-CAR T therapy effusion was associated with reduced overall survival (hazard ratio, 2.34; 95% confidence interval, 1.09 to 5.03; P = .03). Moreover, there was higher non-relapse mortality (11% versus 1%; P = .005). Post-CAR T effusions were not associated with significant difference in survival. Effusions commonly complicate CAR T cell therapy for lymphoma. Malignant effusions that occur prior to CAR T therapy are frequently persistent and require therapeutic intervention, and patients have a higher rate of toxicity and death. Effusions that newly occur after CAR T therapy can generally be managed medically and tend not to persist.
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http://dx.doi.org/10.1016/j.jtct.2020.12.025DOI Listing
March 2021

Carfilzomib-induced atypical haemolytic uraemic syndrome: a diagnostic challenge and therapeutic success.

BMJ Case Rep 2021 Feb 26;14(2). Epub 2021 Feb 26.

Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida, USA

Haemolytic uraemic syndrome (HUS) is a thrombotic microangiopathy (TMA) that presents with renal insufficiency, thrombocytopaenia and microangiopathic haemolytic anaemia. Typical HUS is associated with Shiga toxin while atypical HUS (aHUS) is due to overactivation of the alternative complement pathway. aHUS has numerous causes, including drugs, with rare reports of carfilzomib, a proteasome inhibitor used in multiple myeloma, as causative agent. Cases vary in presentation, presenting a diagnostic challenge. Historically, TMAs were treated with plasma exchange. aHUS, however, is considered refractory to plasma exchange and best treated with eculizumab, a monoclonal antibody targeting C5, a terminal complement protein. We report a patient with history of multiple myeloma who presented with headaches, elevated blood pressure, petechiae, ecchymosis and haemolytic anaemia. His condition was determined to be carfilzomib-induced aHUS and he was successfully treated with eculizumab. Early detection and treatment of drug-induced aHUS is vital in reducing morbidity and mortality related to the condition.
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http://dx.doi.org/10.1136/bcr-2020-239091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919563PMC
February 2021

Role of hematopoietic cell transplantation in relapsed acute promyelocytic leukemia.

Clin Transplant 2020 09 11;34(9):e14009. Epub 2020 Aug 11.

Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, Florida, USA.

The use of all trans-retinoic acid and arsenic trioxide combination as the induction regimen for acute promyelocytic leukemia (APL) has revolutionized the management and outcomes of this disease. Modern risk-adapted frontline therapy has provided excellent therapeutic results. However, significant numbers of APL patients relapse after frontline therapy, and the optimal management strategy for relapsed APL, specifically the role and type of hematopoietic cell transplantation (HCT) are still to be defined. Both autologous and allogeneic HCTs are associated with durable remission and prolonged survival when utilized in appropriate disease settings. Once remission has been achieved, consolidation with autologous HCT for APL patients with negative minimal residual disease (MRD) status, and with allogeneic HCT for APL patients with positive MRD status appear to offer the best long-term outcomes. In this article, we provide a comprehensive review of existing literature on the efficacy of HCT in treatment of relapse/refractory APL and we discuss the appropriate use of this modality.
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http://dx.doi.org/10.1111/ctr.14009DOI Listing
September 2020

Twice-daily intravenous bolus tacrolimus infusion: A safe and effective regimen for graft-versus-host disease prophylaxis.

Hematol Oncol Stem Cell Ther 2020 Dec 8;13(4):232-237. Epub 2020 May 8.

Division of Hematology Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.

Objective/background: Among patients undergoing allogeneic hematopoietic cell transplant, continuous intravenous (IV) tacrolimus infusion is frequently used for graft-versus-host disease (GvHD) prophylaxis. Twice-daily intermittent IV tacrolimus dosing may confer safety and convenience benefits.

Methods: We performed a retrospective chart review of 66 patients who received twice-daily IV bolus tacrolimus for GvHD prophylaxis. The primary end point of the study was safety, as measured by renal toxicity. The secondary end points included mean tacrolimus serum concentrations, incidence of grades II-IV acute GvHD, electrolyte abnormalities, hyperglycemia, hypertension, and neurologic toxicity.

Results: There was acceptable, possibly favorable, incidence of renal toxicity (42%) and no significant difference in grades II-IV GvHD (37%), compared with published data. Mean tacrolimus blood concentrations were not affected by occurrence of renal toxicity.

Conclusion: We conclude that administration of IV tacrolimus twice daily over 4 h may be safe and effective in preventing GvHD in allogeneic hematopoietic cell transplant.
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http://dx.doi.org/10.1016/j.hemonc.2020.03.002DOI Listing
December 2020

Clinical Outcomes Using Mycophenolate and Tacrolimus for Graft-versus-Host Disease Prophylaxis in Patients Undergoing Allogeneic Stem Cell Transplant: A Single Institution Experience.

Cureus 2020 Feb 5;12(2):e6893. Epub 2020 Feb 5.

Division of Blood and Marrow Transplant, University of Louisville, Louisville, USA.

For recipients of allogeneic hematopoietic stem cell transplant (HSCT), mycophenolate mofetil (MMF) plus tacrolimus combination is mostly used in reduced-intensity (RIC), and nonmyeloablative conditioning (NMAC) whereas methotrexate and tacrolimus combination is preferred in myeloablative conditioning (MAC). We present single institution outcomes in patients undergoing allogeneic HSCT with both MAC and NMAC/RIC regimen using MMF and tacrolimus for graft-versus-host disease (GVHD) prophylaxis. Data from all adult patients who underwent allogeneic HSCT from 2007 to 2017 was collected from Data Back to Centers web-based application of Center for International Blood and Marrow Transplant Research (CIBMTR). A total of 150 patients were included with the mean age of 46.9 years. For the patients who received MAC (n=109), the cumulative incidence of grade II-IV acute GVHD at day 100 was 37%, grade II-IV acute GVHD at one year was 51%, and chronic GVHD at one year was 38%. For the patients who received NMAC/RIC (n=41), the cumulative incidence of grade II-IV acute GVHD at day 100 was 31%, grade II-IV acute GVHD at one year was 28%, and chronic GVHD at one year was 36%. This institutional analysis shows that the combination of MMF and tacrolimus yields acceptable outcomes for the prevention of acute and chronic GVHD.
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http://dx.doi.org/10.7759/cureus.6893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058400PMC
February 2020

The VR-DCEP regimen rescues mobilization failures and controls refractory disease in multiple myeloma.

Bone Marrow Transplant 2020 07 8;55(7):1451-1453. Epub 2019 Nov 8.

Division of Hematology and Blood & Marrow Transplant, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY, USA.

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http://dx.doi.org/10.1038/s41409-019-0735-6DOI Listing
July 2020

Skin nodules in a young patient with HIV/AIDS.

BMJ Case Rep 2019 Sep 18;12(9). Epub 2019 Sep 18.

Department of Internal Medicine, University of Louisville, Louisville, KY, USA.

AIDS-related Kaposi sarcoma (KS) is a malignancy seen in patients with HIV/AIDS that results from unrestrained human herpesvirus 8 infection. It can have an atypical presentation and an aggressive clinical course in patients with uncontrolled HIV infection. We present an interesting case of AIDS-related KS with an atypical initial presentation with skin nodules and debilitating lymphoedema. Patient was successfully managed with supportive measures, antiretroviral therapy and systemic chemotherapy.
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http://dx.doi.org/10.1136/bcr-2019-231096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754643PMC
September 2019

Acquired factor X deficiency in a patient with multiple myeloma: a rare case highlighting the significance of comprehensive evaluation and the need for antimyeloma therapy for bleeding diathesis.

BMJ Case Rep 2019 Sep 16;12(9). Epub 2019 Sep 16.

Division of Medical Oncology and Hematology, University of Louisville, Louisville, Kentucky, USA.

Factor X deficiency is a rare bleeding disorder that can be associated with life-threatening bleeding events. Factor X deficiency can either be inherited or acquired. Acquired cases of factor X deficiency can be seen in patients with plasma cell dyscrasias as well as amyloidosis. Coagulopathy, with clinically relevant bleeding events, although rare, is not an unusual phenomenon for patients with systemic amyloidosis. However, clinically relevant bleeding in patients with symptomatic multiple myeloma, without associated amyloidosis, has not been reported in literature before. We present a rare case of multiple myeloma without concomitant amyloidosis that presented with life-threatening bleeding from acquired deficiency of factor X and responded remarkably to treatment for underlying multiple myeloma. This case not only highlights the diagnostic workup required in patients with factor X deficiency but also provides the principles of management of acquired coagulopathy in plasma cell dyscrasias.
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http://dx.doi.org/10.1136/bcr-2019-230249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754647PMC
September 2019

Haemophagocytic lymphohistiocytosis has variable time to onset following CD19 chimeric antigen receptor T cell therapy.

Br J Haematol 2019 10 13;187(2):e35-e38. Epub 2019 Aug 13.

Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA.

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http://dx.doi.org/10.1111/bjh.16155DOI Listing
October 2019

Rare case of Bing-Neel syndrome treated successfully with ibrutinib.

BMJ Case Rep 2019 Jun 25;12(6). Epub 2019 Jun 25.

Blood and Marrow Transplant, University of Louisville School of Medicine, Louisville, Kentucky, USA.

Waldenstrom's macroglobulinaemia (WM) is a lymphoproliferative disorder of the B cell origin. It is characterised by the presence of IgM paraprotein in the serum and lymphoplasmacytic lymphoma cells in the bone marrow with extranodal involvement relatively uncommon. Bing-Neel syndrome (BNS) is a neurological complication of WM that results from infiltration of the central nervous system by malignant lymphoplasmacytic cells. We present an interesting case of BNS that responded remarkably to ibrutinib monotherapy.
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http://dx.doi.org/10.1136/bcr-2019-230067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605891PMC
June 2019

Diffuse Hyperpigmentation in a Patient With an Axillary Mass.

JAMA Oncol 2019 May 23. Epub 2019 May 23.

Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky.

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http://dx.doi.org/10.1001/jamaoncol.2019.0524DOI Listing
May 2019

Debilitating Metastatic Spindle Cell Carcinoma of the Breast.

Cureus 2019 Jan 10;11(1):e3864. Epub 2019 Jan 10.

Internal Medicine, University of Louisville School of Medicine, Louisville, USA.

Spindle cell carcinoma of the breast is a rare malignancy. If diagnosed and treated in a timely manner, it is generally associated with a good prognosis. Herein, we have presented an interesting case of metastatic spindle cell carcinoma of breast origin, with extensive metastasis and an unusually aggressive disease course. We also discussed refractory hypoglycemia as a fatal complication of highly metabolically active malignancy. Lastly, we briefly explored the importance of seeking medical attention for early detection and treatment and the need to address psychosocial barriers that influence breast cancer screening.
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http://dx.doi.org/10.7759/cureus.3864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414181PMC
January 2019

Trigeminal Amyloidoma: Case Report and Review of Literature.

Cureus 2018 Dec 28;10(12):e3795. Epub 2018 Dec 28.

Internal Medicine, Saint Francis Hospital and Medical Center, Grand Island, USA.

Amyloid is an abnormal insoluble protein that can deposit in extracellular space. It can involve nearly any organ system and may manifest as a systemic process or focal lesion (amyloidoma). We present a rare case of localized amyloidosis with trigeminal nerve being the only site of involvement and no evidence of systemic disease. We also review literature relevant to trigeminal amyloidoma and make recommendations for diagnosis and treatment.
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http://dx.doi.org/10.7759/cureus.3795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402733PMC
December 2018

Treatment of Multiple Myeloma in Elderly Patients: A Review of Literature and Practice Guidelines.

Cureus 2018 Dec 1;10(12):e3669. Epub 2018 Dec 1.

Oncology, University of Louisville School of Medicine, Louisville, USA.

Multiple myeloma (MM) is a clonal disorder of malignant plasma cells that comprises approximately 10% of hematologic malignancies. With median age of 66 at the time of presentation, multiple myeloma is predominantly a disease of the elderly. The availability of new combination regimens and the enhanced safety of autologous hematopoietic stem cell transplant has increased the treatment options for elderly patients with multiple myeloma. We provide a summary of data supporting the current management of elderly patients with newly diagnosed multiple myeloma.
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http://dx.doi.org/10.7759/cureus.3669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364954PMC
December 2018

Rescue therapy for acute idiopathic thrombocytopenic purpura unresponsive to conventional treatment.

BMJ Case Rep 2019 Jan 14;12(1). Epub 2019 Jan 14.

Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA.

A 61-year-old woman with chronic lymphocytic leukaemia, with Richter's transformation to a diffuse, large, B-cell lymphoma, treated with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone and in complete remission, presented to the hospital after her platelets were found to be 2×10³/µL in outpatient laboratory studies. She initially underwent a platelet transfusion without improvement. This was followed by 4 days of high-dose dexamethasone and intravenous immunoglobulin, which again yielded no meaningful effect. Even a single-dose rituximab failed to achieve a platelet increase after 5 days of monitoring. The patient was then given 2 mg of intravenous vincristine along with a high-dose of dexamethasone and IVIG and demonstrated substantial recovery in platelets to >50×10³/µL within 48 hours. This case study provides an overview of the current management strategies for idiopathic thrombocytopenic purpura that is unresponsive to conventional medical therapy and particularly sheds light on their therapeutic benefits and potential adverse effects.
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http://dx.doi.org/10.1136/bcr-2018-227717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340572PMC
January 2019

Choosing the appropriate salvage therapy for B-cell non-Hodgkin lymphoma.

Expert Opin Pharmacother 2018 10 10;19(15):1631-1634. Epub 2018 Sep 10.

c Division of Hematology, The James Cancer Hospital and Solove Research Institute , The Ohio State University , Columbus , OH , USA.

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http://dx.doi.org/10.1080/14656566.2018.1518430DOI Listing
October 2018

A Rare Case of Erdheim-Chester Disease (Non-Langerhans Cell Histiocytosis) with Concurrent Langerhans Cell Histiocytosis: A Diagnostic and Therapeutic Challenge.

Case Rep Hematol 2018 16;2018:7865325. Epub 2018 May 16.

Division of Blood and Marrow Transplant, University of Louisville, Louisville, KY, USA.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocyte disorder most commonly characterized by multifocal osteosclerotic lesions of the long bones demonstrating sheets of foamy histiocyte infiltrates on biopsy with or without histiocytic infiltration of extraskeletal tissues. ECD can be difficult to diagnose since it is a very rare disease that can affect many organ systems. Diagnosis is based on the pathologic evaluation of involved tissue interpreted within the clinical context. Patients who have the BRAF V600E mutation are treated first line with vemurafenib. For those without the mutation with symptomatic ECD, conventional or PEGylated interferon alpha is recommended. For patients who are either intolerant or nonresponsive to interferon alpha, systemic chemotherapy with or without corticosteroids can be used. We present a rare case of Erdheim-Chester disease with concurrent Langerhans cell histiocytosis which occurs in only one fifth of the cases and often presents as a diagnostic and therapeutic challenge.
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http://dx.doi.org/10.1155/2018/7865325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977054PMC
May 2018

Hypertrophic cardiomyopathy with a large apical ventricular aneurysm and mural thrombus.

Glob Cardiol Sci Pract 2018 Mar 14;2018(1). Epub 2018 Mar 14.

Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan.

Hypertrophic cardiomyopathy (HCM) is characterized by increased left ventricular wall thickness in the absence of any other identifiable cause of thickness. It predisposes the patient to increased risk of sudden cardiac death (SCD) due to fatal arrhythmias. Approximately 2% of the HCM patients have left ventricular apical aneurysm. CMR imaging is better in identifying this apical aneurysm as compared to echocardiogram. This apical aneurysm, which can be akinetic or dyskinetic, increases the risk of disease-related adverse events as compared to general HCM. These adverse disease-related events include SCD, thromboembolism, and symptoms of heart failure. We report a rare case of hypertrophic cardiomyopathy in association with Williams-Beuren Syndrome. On CMR imaging, patient was found to have a large apical aneurysm and mid-ventricular obstruction with underlying thrombus. He was started on oral anticoagulation, and ICD was recommended.
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http://dx.doi.org/10.21542/gcsp.2018.9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857068PMC
March 2018

Primary Effusion Lymphoma without an Effusion: A Rare Case of Solid Extracavitary Variant of Primary Effusion Lymphoma in an HIV-Positive Patient.

Case Rep Hematol 2018 28;2018:9368451. Epub 2018 Jan 28.

Division of Blood and Marrow Transplant, University of Louisville, Louisville, KY, USA.

Primary effusion lymphoma (PEL) is a unique form of non-Hodgkin lymphoma, usually seen in severely immunocompromised, HIV-positive patients. PEL is related to human herpesvirus-8 (HHV-8) infection, and it usually presents as a lymphomatous body cavity effusion in the absence of a solid tumor mass. There have been very few case reports of HIV-positive patients with HHV-8-positive solid tissue lymphomas not associated with an effusion (a solid variant of PEL). In the absence of effusion, establishing an accurate diagnosis can be challenging, and a careful review of morphology, immunophenotype, and presence of HHV-8 is necessary to differentiate from other subtypes of non-Hodgkin lymphoma. Treatment involves intensive chemotherapy, and prognosis is usually poor. We present a rare case of a PEL variant in an HIV-positive patient who presented with extensive lymphadenopathy without any associated effusions.
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http://dx.doi.org/10.1155/2018/9368451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829335PMC
January 2018

Opportunities to improve clinical summaries for patients at hospital discharge.

BMJ Qual Saf 2017 05 6;26(5):372-380. Epub 2016 May 6.

Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.

Background: Clinical summaries are electronic health record (EHR)-generated documents given to hospitalised patients during the discharge process to review their hospital stays and inform postdischarge care. Presently, it is unclear whether clinical summaries include relevant content or whether healthcare organisations configure their EHRs to generate content in a way that promotes patient self-management after hospital discharge. We assessed clinical summaries in three relevant domains: (1) content; (2) organisation; and (3) readability, understandability and actionability.

Methods: Two authors performed independent retrospective chart reviews of 100 clinical summaries generated at two Michigan hospitals using different EHR vendors for patients discharged 1 April -30 June 2014. We developed an audit tool based on the Meaningful Use view-download-transmit objective and the Society of Hospital Medicine Discharge Checklist (content); the Institute of Medicine recommendations for distributing easy-to-understand print material (organisation); and five readability formulas and the Patient Education Materials Assessment Tool (readability, understandability and actionability).

Results: Clinical summaries averaged six pages (range 3-12). Several content elements were universally auto-populated into clinical summaries (eg, medication lists); others were not (eg, care team). Eighty-five per cent of clinical summaries contained discharge instructions, more often generated from third-party sources than manually entered by clinicians. Clinical summaries contained an average of 14 unique messages, including non-clinical elements irrelevant to postdischarge care. Medication list organisation reflected reconciliation mandates, and dosing charts, when present, did not carry column headings over to subsequent pages. Summaries were written at the 8th-12th grade reading level and scored poorly on assessments of understandability and actionability. Inter-rater reliability was strong for most elements in our audit tool.

Conclusions: Our study highlights opportunities to improve clinical summaries for guiding patients' postdischarge care.
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http://dx.doi.org/10.1136/bmjqs-2015-005201DOI Listing
May 2017

Utility of Lower Extremity Doppler in Patients with Lower Extremity Cellulitis: A Need to Change the Practice?

South Med J 2015 Jul;108(7):439-44

From the Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, and Spectrum Health, Grand Rapids, Michigan.

Objectives: Cellulitis and deep vein thrombosis (DVT) in the lower extremities (LE) often have similar presentations: erythema, swelling, and calf tenderness. The overlap of these symptoms often results in physicians ordering unnecessary LE Doppler ultrasounds in patients with LE cellulitis. This practice leads to subjecting patients to unwarranted procedures and results in increased healthcare costs. We aimed to determine the percentage of Doppler ultrasounds performed in patients admitted with LE cellulitis and the prevalence of DVT in that population.

Methods: A retrospective chart review was performed of the patients admitted January 1, 2009 to June 30, 2013 who had a diagnosis of LE cellulitis. The number of Doppler ultrasounds performed and the presence of DVT was recorded. Patients were divided into groups of Doppler ultrasounds with no DVT and Doppler ultrasounds that were positive for DVT to compare the risk factors.

Results: There were 624 patients identified using the International Classification of Diseases, 9th Revision code for LE cellulitis at the time of admission. Slightly more than half of the subjects were men (315/624) and the average age was 61.4 ± 18.8 years (mean ± standard deviation). There were 417 (66.8%) patients who underwent Doppler ultrasound. Only 25 (5.9%) patients had DVT. Multivariate analysis showed that prior cerebrovascular accident, calf swelling, and history of thromboembolism were statistically significant predictors for DVT (P < 0.05).

Conclusions: A concurrent incidence of DVT and LE cellulitis is rare. In the absence of known risk factors of DVT, the yield of LE Doppler is low and Doppler ultrasound is not required as a part of a standard admission evaluation.
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http://dx.doi.org/10.14423/SMJ.0000000000000315DOI Listing
July 2015

Spontaneous Regression of Refractory Diffuse Large B-Cell Lymphoma with Improvement in Immune Status with ART in a Patient with HIV: A Case Report and Literature Review.

Am J Case Rep 2015 Jun 5;16:347-52. Epub 2015 Jun 5.

Department of Hematology/Oncology, Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI, USA.

Background: Diffuse large B-cell lymphoma accounts for the large majority of AIDS-related non-Hodgkin lymphoma. Traditionally, this lymphoma has been treated with CHOP-like regimens with the recent addition of rituximab. We report a unique case where an HIV-infected patient with diffuse large B-cell lymphoma had complete regression of the lymphoma with continued antiretroviral therapy (ART) after chemotherapy was stopped.

Case Report: A 55-year-old man who presented with fatigue and weight loss had initial CT findings of bilateral renal masses during his workup. Biopsy revealed diffuse large B-cell lymphoma and subsequently he was also diagnosed with HIV. He completed 6 cycles of CHOP-like (4 cycles of EPOCH-R and 2 cycles of R-CHOP) first-line therapy with significant dose delays and dose reductions due to severe adverse effects. Chemotherapy was stopped due to physical deconditioning and intolerable adverse effects. He had a FDG-PET/CT showing progression of his disease 8 weeks after completing chemotherapy. He was maintained only on ART after finishing 6 cycles of chemotherapy. With this therapy alone and with improvement in his immune status, his lymphoma regressed completely.

Conclusions: There are very few reported cases in which lymphoma has regressed with treatment of HIV alone, as is regression of diffuse large B-cell lymphoma. This case emphasizes that ART can lead to immune reconstitution of HIV-infected patients and can establish the anti-tumor effect, causing regression of the lymphoma.
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http://dx.doi.org/10.12659/AJCR.892883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467606PMC
June 2015