Scholarly Articles
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Item type: Item , Access status: Open Access , Prevalence and Impact of Traumatic Life Events among Black and White Family Members of Intensive Care Unit Patients.(Annals of the American Thoracic Society, 2025-11) Ashana, Deepshikha Charan; Hart, Joanna L; Johnson, Kimberly S; Briggs, Ernestine C; Parish, Alice; Olsen, Maren K; Jaggers, Jennie; Tiver, Greer A; Summer, Amy; Ramadurai, Deepa; Madamidola, Nicholas; Syed, Bassam; Purbeck, Carrie A; Ramos, Katherine; Bah, Muhammed S; Cox, Christopher ERationale: Lifetime trauma is common and may affect interactions with the healthcare system. Objectives: To measure the prevalence of lifetime trauma and its association with family-clinician interpersonal outcomes in the intensive care unit (ICU). Methods: A cross-sectional study was conducted in nine ICUs in one urban and one suburban-rural health system. Participants were Black or White surrogate decision makers for mechanically ventilated patients. Independent variables were the number of lifetime traumatic events measured using the Life Stressor Checklist-Revised (LSC-R) and, secondarily and separately, discrimination-related traumatic stress symptoms. The primary outcome was family-reported conflict with ICU clinicians about treatment decisions. Secondary outcomes were family-reported quality of clinician communication and therapeutic alliance. Results: Among 141 family members (median age, 52.7 yr [interquartile range, 41.9-62.0 yr]; n = 100 women [70.9%]; n = 85 White [60.3%]; n = 56 Black [39.7%]), the median number of lifetime traumatic events was 6.0 (interquartile range, 4.0-9.0). Lifetime trauma was significantly but nonlinearly associated with family-clinician conflict (odds ratio [OR], 1.44 [95% confidence interval (CI), 1.09-1.90] for LSC-R scores of 0-7.5; OR, 0.75 [95% CI, 0.55-1.02] for LSC-R scores of 7.5-16; P = 0.03). Discrimination-related stress symptoms were also associated with conflict (OR, 1.04 [95% CI, 1.003-1.07]; P = 0.03). Interactions between the independent variables and family member race were not significant, suggesting the effects of lifetime trauma and discrimination-related traumatic stress on family-clinician conflict were similar for Black and White caregivers. Conclusions: Lifetime trauma is common among families of critically ill patients and is associated with negative experiences of critical care. Trauma-informed care may reduce family- clinician conflict and improve other measures of family experience.Item type: Item , Access status: Open Access , Radiographic and Clinical Outcomes of First Tarsometatarsal Joint Arthrodesis With a Biplanar Locking Plate System Versus the Modified Lapidus Technique With Crossed-Screw Fixation: A Retrospective Multicenter Comparison.(HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 2026-02) Fletcher, Amanda N; Droz, Lindsey G; Fuller, Robert; Rajan, Lavan; Zhu, Jiaqi; Easley, Mark E; Nunley, James A; Cody, Elizabeth ABackground: Hallux valgus (HV) is recognized as a triplanar deformity. A biplanar locking plate (BLP) system corrects this deformity through first tarsometatarsal joint (TMTJ) arthrodesis, with specialized reduction tools and cutting guides. Yet the optimal surgical technique and fixation construct for first TMTJ arthrodesis remains controversial. Purpose: We sought to compare the BLP system with a modified Lapidus (ML) technique with crossed-screw fixation in terms of radiographic outcomes, complications, and reoperations. Methods: In this retrospective multicenter study, we identified a series of consecutive patients who underwent first TMTJ arthrodesis for HV with either the ML procedure at institution A or the BLP system at institution B. Patients 18 years of age with a minimum of 6 months of postoperative radiographs were included. There were 130 patients, 65 in each group, including 121 women (93.8%) with a median age of 58 years and mean radiographic follow-up of 7.1 months. Data included preoperative and postoperative HV angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP), plus complications and reoperations. Statistical testing included Mann-Whitney U, Wilcoxon signed rank, Fisher exact, McNemar, and multivariable regression. Results: After adjusting for confounding variables, the BLP system was associated with significantly greater improvements in postoperative IMA and HVA but not TSP. There were no significant differences in rates of complications (ML: 18.4%; BLP: 9.2%) or reoperations (ML: 4.6%; BLP: 7.7%). Conclusion: This retrospective multicenter review found that the BLP system was associated with greater improvement in radiographic HV parameters compared with the ML procedure using crossed-screw fixation. Clinical significance is unclear as complication and reoperation rates were similar between groups. Further study in this regard is warranted.Item type: Item , Access status: Open Access , Adaptation and Implementation of Self-System Therapy for Older Adults with Advanced Lung Cancer: Pilot Trial Results(Cancers) Ramos, Katherine; Ayaz, Aliza; Riley, Jennie; Faircloth, Kaylee; Porter, Laura S; Strauman, Timothy JBackground/Objectives: Advanced lung cancer is a highly distressing disease that negatively impacts older adults. Supportive care interventions designed for this population are scarce and often inaccessible due to competing demands and transportation access. We adapted and refined an evidence-based treatment, Self-System Therapy (SST), to address the unmet needs of older adults with advanced cancer. Methods: Guided by principles of implementation science, we conducted patient interviews, focus groups, and user testing to refine our new SST for the lung cancer (SST-LC) protocol. We then conducted a single-arm pilot trial (clinicaltrials.gov NCT04057196) for patients aged 65+ and above with Stage III or IV lung cancer (N = 30). Benchmarks for acceptability, feasibility, and preliminary changes in outcome measures were assessed. Results: Our study met the desired recruitment goals and demonstrated high treatment adherence rates (89%) and satisfaction rates (85%), indicating that SST-LC was feasible and well-received. Participants also showed reductions in distress and depression, and improvements in emotional and functional well-being from baseline to post-intervention, with effects mostly maintained at follow-up. Physical well-being, social well-being, and quality of life showed smaller, non-significant changes. Feedback from participants also suggested that SST enhanced their resilience and ability to cope with cancer-related challenges, but also indicated a preference for fewer sessions. Conclusions: SST for older adults living with advanced lung cancer is feasible and acceptable. Moreover, this supportive care intervention shows promise in addressing psychological distress, emotional well-being, and functional well-being in older adults. Future research will include testing the efficacy of SST in a larger randomized controlled trial.Item type: Item , Access status: Open Access , A virtual program to teach pain coping skills to dyads of caregivers and Veterans with dementia or mild cognitive impairment: Preliminary quantitative and qualitative findings(Palliative and Supportive Care, 2026) Weiner, Debra K; Engel, Ina; Hamm, Megan; Cardamone, Coleen; Rossi, Michelle I; Perera, Subashan; Ramos, Katherine; Porter, Laura SAbstract Objectives To evaluate the feasibility and preliminary efficacy of a clinical program designed to teach informal caregivers of older Veterans with pain and mild-to-moderate dementia or mild cognitive impairment (MCI), pain management, pain coping and pain communication skills. Methods Twenty caregivers of older Veterans with pain and dementia or MCI and the Veterans themselves participated in a 5-session program taught by trained Veterans Affairs (VA) clinicians. All sessions were conducted remotely using video-technology, with caregivers and Veterans. Two sessions were conducted with individual Veteran-caregiver dyads, and three sessions were conducted with caregiver groups. Caregivers and Veterans completed baseline and post-intervention measures. Qualitative interviews of 10 caregivers who completed the program were also conducted and focused on identifying themes related to caregiving for their loved ones with pain and dementia and related to participating in the program. Results The program was well received and almost all caregivers identified videoconferencing as the preferred venue for participating in such a program. They most valued learning about dementia and participating with other caregivers. Pre-post analyses revealed significant improvements in perceived caregiving competence and self-efficacy for managing pain. Challenges encountered included scheduling related to caregivers’ multiple competing responsibilities and lack of familiarity with tele-conferencing technology. Significance of results Patients with pain and mild to moderate dementia or MCI have been relatively ignored in current literature. Our preliminary findings suggest that a program delivered by trained healthcare professionals to caregivers and Veterans using tele-conferencing could benefit caregivers.Item type: Item , Access status: Open Access , Transaurality: On Listening to SOPHIE Against Queer Theory(Contemporary Music Review) Blackburn, Anton LItem type: Item , Access status: Open Access , Complex Effects of B-Vitamin Combinations on Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials over Three Decades.(Nutrients, 2026-03) Ren, Ruodi; Yang, Andrew; Chow, Allison; Wang, Kunkun; Wang, Shan; Leo, Christopher; Lu, Yun; Li, MengyanBackground and Purpose: The effects of B-vitamin combinations on the prevention of cardiovascular diseases, such as myocardial infarction (MI) and stroke, remain controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) over three decades to evaluate the association between B-vitamin combinations and mortality and arterial thrombotic outcomes. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for RCTs with minimal duration over 24 months published between January 1996 and November 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects models were used in this meta-analysis to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Results: Thirteen randomized trials enrolling 68,363 participants across both primary and secondary prevention populations were included. B-vitamin combinations were associated with a nonsignificant reduction in stroke and 3-point major adverse cardiovascular events (MACE) (stroke: RR 0.91, 95% CI 0.81-1.04; MACE: RR 0.93, 95% CI 0.86-1.01). No significant effects were observed for all-cause mortality (RR 1.01, 95% CI 0.96-1.06), cardiovascular mortality (RR 0.97, 95% CI 0.88-1.07), or MI (RR 0.97, 95% CI 0.91-1.03). In primary prevention populations, B-vitamin combinations were associated with significant reductions in stroke (RR 0.79, 95% CI 0.68-0.93) and MACE (RR 0.80, 95% CI 0.69-0.92). A modest reduction in MACE was also observed in secondary prevention populations (RR 0.91, 95% CI 0.83-0.99). Between-study heterogeneity was minimal to low for ischemic outcomes, supporting the robustness of these estimates, whereas substantial heterogeneity was observed for mortality outcomes in secondary prevention populations. Conclusions: The evidence is limited by heterogeneity in trial populations, vitamin formulations and doses, and outcome definitions, with substantial between-study inconsistency for mortality outcomes and imprecision in subgroup estimates derived from a small number of contributing trials. Overall, B-vitamin combinations do not confer consistent benefit for major cardiovascular outcomes but may reduce stroke and MACE in selected primary prevention populations, suggesting that baseline cardiovascular risk and regional folic acid fortification modify treatment effects and should guide future trial design and clinical use.Item type: Item , Access status: Open Access , Advancement of the implementation of evidence-based therapies for cardiovascular-kidney-metabolic conditions: A multi-stakeholder perspective.(American heart journal, 2025-08) Osude, Nkiru; Spall, Harriette Van; Bosworth, Hayden; Krychtiuk, Konstantin; Spertus, John; Fatoba, Samuel; Fleisher, Lee; Fry, Edward; Green, Jennifer; Greene, Stephen; Ho, Michael; Jackman, Jennifer; Leopold, Jane; Magwire, Melissa; McGuire, Darren; Mensah, George; Tuttle, Katherine R; Willey, Vincent; Pagidipati, Neha; Granger, ChristopherCardiovascular disease remains the leading cause of mortality and healthcare expenditures in the United States. It is also a major contributor to premature mortality, years lived with disability, and rising healthcare costs around the world. Despite the availability of proven therapies and interventions that could vastly decrease the burden of cardiovascular disease and cardiometabolic conditions, their implementation is poor, with generally less than half of patients being treated with the most effective therapies. Implementation science offers promise in bridging this gap and mitigating disparities. However, even though small studies have shown that there are effective methods to improve the implementation of evidence-based therapies, these methods have not been scaled to make an impact at the level of health systems or nationally. A coordinated, multi-stakeholder approach is essential to identify barriers to implementation on a broad scale and, more critically, to develop and deploy practical solutions. The Duke Clinical Research Institute conducted an Implementation Summit entitled "Scalability, Spread, and Sustainability" to explore strategies for advancing the uptake of evidence-based interventions for cardiometabolic diseases in healthcare in the United States. This manuscript presents the participants' multi-stakeholder perspective on the steps necessary to improve the implementation of evidence-based therapies in cardiometabolic disease. Key recommendations include focused efforts on evidence generation around broad implementation strategies, dissemination of the evidence generated, uptake of evidence into usual care settings, and investment in training the current and next generations of leaders in implementation.Item type: Item , Access status: Open Access , Development of an Item Bank to Measure Medication Adherence: Systematic Review (Preprint)(2020-04-07) Kwan, Yu Heng; Oo, Livia Jia Yi; Loh, Dionne Hui Fang; Phang, Jie Kie; Weng, Si Dun; Blalock, Dan V; Chew, Eng Hui; Yap, Kai Zhen; Tan, Corrinne Yong Koon; Yoon, Sungwon; Fong, Warren; Østbye, Truls; Low, Lian Leng; Bosworth, Hayden Barry; Thumboo, JulianBACKGROUNDMedication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer‐adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress.
OBJECTIVEWe aim to develop an item bank to measure general medication adherence.
METHODSUsing the preferred reporting items for systematic review and meta-analysis (PRISMA), articles published before October 2019 were retrieved from PubMed, Embase, CINAHL, the Cochrane Library, and Web of Science. Items from existing PROMs were classified and selected (“binned” and “winnowed”) according to standards published by the Patient-Reported Outcomes Measurement Information System (PROMIS) Cooperative Group.
RESULTSA total of 126 unique PROMs were identified from 213 studies in 48 countries. Items from the literature review (47 PROMs with 579 items for which permission has been obtained) underwent binning and winnowing. This resulted in 421 candidate items (77 extent of adherence and 344 reasons for adherence).
CONCLUSIONSWe developed an item bank for measuring general medication adherence using items from validated PROMs. This will allow researchers to create new PROMs from selected items and provide the foundation to develop CATs.
Item type: Item , Access status: Open Access , Acceptability and Feasibility of a Multicomponent Intervention to Improve Acute Myocardial Infarction Care in Northern Tanzania: the MIMIC Pilot Trial.(medRxiv, 2024-12-16) Hertz, Julian T; Sakita, Francis M; Haukila, Kelvin F; Shayo, Pankrasi S; Shayo, Frida M; Willy, Joyce; Lameck, Godfrey; Kisanga, Emmanuel; Bosworth, Hayden B; Bettger, Janet P; Rahim, Faraan OBACKGROUND: The Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC) was developed to increase uptake of evidence-based care for acute myocardial infarction in Tanzania. MIMIC consists of five components: triage cards, pocket cards, an online training module, patient educational pamphlets, and clinical champions. Our aim was to determine the acceptability and feasibility of this intervention among emergency department (ED) providers in Tanzania. METHODS: During a one-year pilot of the MIMIC intervention at the Kilimanjaro Christian Medical Centre in northern Tanzania, ED physicians and nurses were approached and invited to complete a survey eliciting their perspectives on MIMIC. The survey included the four-item Acceptability of Intervention Measurement (AIM) and four-item Feasibility of Intervention Measurement (FIM) tools. Mean AIM and FIM scores were generated by assigning scores of 1-5 for each response (1= strongly disagree, 2 = disagree, 3= neutral, 4= agree, 5= strongly agree), and dividing by four. RESULTS: Sixty-four participants were enrolled, including 27 (42%) physicians and 37 (58%) nurses. The mean AIM score was 4.82 (sd = 0.31) out of a maximum possible score of 5. The mean FIM score was 4.61 (sd 0.47). Of participants, 63 (98%) reported using the pocket cards and 54 (84%) reported completing the training module, which took a mean of 16.5 (sd 13.3) minutes to complete. Of 36 nurses who worked in triage, all (100%) reported using the MIMIC triage cards. CONCLUSIONS: The MIMIC intervention is highly acceptable and feasible in a northern Tanzanian ED. Use of a co-design approach in the development of the MIMIC intervention likely increased the acceptability and feasibility the intervention to staff. Additional study is needed to determine the effectiveness of this intervention on clinical care processes and patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04563546 ; registered on September 21 st , 2020; https://clinicaltrials.gov/study/NCT04563546.Item type: Item , Access status: Open Access , Addressing Disability Bias in Neuroprognostication(Pediatrics, 2026-04-01) Lin, Grant L; Barton, Sarah Jean; Tate, TylerItem type: Item , Access status: Open Access , Responding Faithfully to Women’s Pain: Practicing the Stations of the Cross(Christian Bioethics, 2023-12-01) Barton, SJThis essay explores the contemporary experiences of women who live with pain, given the complex responses they encounter within Western medical systems, including pervasive stigma, bias, clinician disbelief, and poor health outcomes. In response to these realities, as highlighted within recent literature and exemplified in a first-person account provided by the paper’s author, this essay explores the Christian practice of the Stations of the Cross as a faithful response to women living with pain. The Stations provide a distinctive Christian practice that invites women living with pain, as well as their clinicians and loved ones, into faithful care marked by prayer, solidarity, and hospitable listening. Practicing the Stations provides one faithful response that Christian clinicians and those who live with pain might engage in the clinic and beyond.Item type: Item , Access status: Open Access , Virtual care nurse triage protocols cost-effectively reduce dermatologist burnout.(Dermatology online journal, 2025-11) Seely, Mason; Faraz, Khushnood; Atkins, Margaret-Anne; Lancaster, La'Vonne; Bradsher, Michelle; Greene, Emily; Jamison, Megan; Nicholas, Matilda; Marano, Anne LItem type: Item , Access status: Open Access , Patient-Centered Culturally Tailored Diet for Hospitalized Patients With Type 2 Diabetes Mellitus(Nutrition Today, 2025-07-01) Holmes, H; Waldrop, JB; Reynolds, SS; Lam, DType 2 diabetes mellitus management is largely influenced by dietary practices. The American Diabetes Association recommends considering patient culture when developing dietary recommendations. In this pilot evidence-based practice change initiative, patient educational sessions were initiated in the hospital setting that incorporated a patient-centered, culturally tailored diet. To evaluate the impact of the educational sessions, the patients completed the Patient-Centered Culturally Tailored Diet Questionnaire and constructed a meal on a 9-inch plate. A total of 11 patients participated in the pilot project. Patients’ dietary practices improved after the intervention, as evidenced by an increase in their Patient-Centered Culturally Tailored Diet Questionnaire scores. Furthermore, most of the patients were able to successfully design a menu using a 9-inch plate. Patients felt motivated to implement changes in their diet, which could be related to their acute crisis and hospitalization. Some expressed the opinion adhering to the dietary practice was challenging, whereas others embraced the challenge and remained motivated to make lifestyle changes.Item type: Item , Access status: Open Access , Appropriate Use of Statistical Analysis in DNP Projects(Journal for Nurse Practitioners, 2025-10-01) Reynolds, S; Waldrop, JB; Dunlap, JJItem type: Item , Access status: Open Access , Faculty perceptions of AI-versus human-summarized narrative exit survey data across three nursing programs.(Nurse education in practice, 2026-01) Reynolds, Staci S; Kauschinger, Elaine D; Cadavero, Allen; Conrad, Stefanie; McMillian-Bohler, Jacquelyn M; Webb, MichelleAim
The purpose of this study was to compare faculty perceptions of the quality of artificial intelligence (AI)-generated versus human-generated summaries of narrative exit survey data to assess the feasibility of AI integration into program evaluation processes.Background
Generative AI tools are increasingly used in higher education to streamline data analysis. In nursing education, student evaluations offer rich insights but are time-consuming to summarize. AI tools like Microsoft Copilot offer potential efficiencies but raise concerns about reliability, bias and the preservation of reflective pedagogy and student voice.Design
A cross-sectional, descriptive pilot study design was used.Methods
Five faculty members independently rated summaries generated by Microsoft Copilot and by human analysis using a 7-point Likert scale. Ratings were based on accuracy, clarity, bias and relevance.Results
Quality ratings of the AI-generated summaries were higher (mean=5.9) compared with the human-generated summaries (mean=5.0).Conclusions
This pilot project suggests integrating AI as a supportive tool rather than a replacement for human review. The overall intent was to assist faculty in improving efficiency in program evaluations by using AI, in conjunction with human review, to maintain fidelity to the student voices and context.Item type: Item , Access status: Open Access , Teaching DNP Students Evidence-Based Practice and Quality Improvement.(The American journal of nursing, 2026-02) Waldrop, Julee; Milner, Kerry A; Reynolds, Staci S; Fineout-Overholt, Ellen; Dunlap, Jayne JenningsIt's time to eliminate inaccurate language and clarify competencies.Item type: Item , Access status: Open Access , 19-Year-Old Male with Headaches and a Possible Seizure(Brain Pathology, 2017-07-05) Nasrallah, MacLean P; Nasrallah, Ilya M; Prelack, Marisa S; Johnson, Margaret O; Lewis, Travis B; Rubenstein, Michael; Minturn, Jane E; Desai, Arati; Marcotte, Paul; Santi, Mariarita; Martinez-Lage, MariaItem type: Item , Access status: Open Access , Utilization of Hospice Services in a Population of Patients With Huntington's Disease.(Journal of Pain and Symptom Management, 2018-02) Johnson, Margaret O; Frank, Samuel; Mendlik, Matthew; Casarett, DavidCONTEXT:Although the early and middle stages of Huntington's disease (HD) and its complications have been well described, less is known about the course of late-stage illness. In particular, little is known about the population of patients who enroll in hospice. OBJECTIVES:Our goal is to describe the characteristics of patients with HD who enrolled in hospice. METHODS:This is a retrospective cohort study of electronic medical record data from 12 not-for-profit hospices in the United States from 2008 to 2012. RESULTS:Of the 164,032 patients admitted to these hospices, 101 (0.06%) had a primary diagnosis of HD. Their median age was 57 (IQR 48-65) and 53 (52.5%) were women. Most patients were cared for by a spouse (n = 36, 36.6%) or adult child (n = 20, 19.8%). At the time of admission, most patients were living either at home (n = 39, 38.6%) or in a nursing home (n = 41, 40.6%). All were either bedbound or could ambulate only with assistance. The most common symptom reported during enrollment in hospice was pain (n = 34, 33.7%) followed by anxiety (n = 30, 29.7%), nausea (n = 18, 17.8%), and dyspnea (n = 10, 9.9%). Patients had a median length of stay in hospice of 42 days, which was significantly longer than that of other hospice patients in the sample (17 days), P < 0.001. Of the 101 patients who were admitted to hospice, 73 died, 11 were still enrolled at the time of data analysis, and 17 left hospice either because they no longer met eligibility criteria (n = 14, 13.7%) or because they decided to seek treatment for other medical conditions (n = 3, 3.0%). Of the 73 patients who died while on hospice, most died either in a nursing home (n = 29; 40%) or a hospital (n = 27; 37%). Seventeen patients (23%) died at home. No patient that started in a facility died at home. CONCLUSION:Patients with HD are admitted to hospice at a younger age compared with other patients (57 vs. 76 years old) but have a significant symptom burden and limited functional status. Although hospice care emphasizes the importance of helping patients to remain in their homes, only a minority of these patients were able to die at home.Item type: Item , Access status: Open Access , Performance of a nomogram for IDH-wild-type glioblastoma patient survival in an elderly cohort.(Neuro Oncology Advances, 2019-12-20) Shen, Erica; Johnson, Margaret O; Lee, Jessica W; Lipp, Eric S; Randazzo, Dina M; Desjardins, Annick; McLendon, Roger E; Friedman, Henry S; Ashley, David M; Kirkpatrick, John P; Peters, Katherine B; Walsh, Kyle MItem type: Item , Access status: Open Access , Patterns of relapse after successful completion of initial therapy in primary central nervous system lymphoma: a case series.(Journal of neuro-oncology, 2020-04) Patel, Mallika P; Kirkpatrick, John P; Johnson, Margaret O; Healy, Patrick; Herndon, James E; Lipp, Eric S; Miller, Elizabeth S; Desjardins, Annick; Randazzo, Dina; Friedman, Henry S; Ashley, David M; Peters, Katherine BPurpose
Primary central nervous system lymphoma (PCNSL) is a subtype of non-Hodgkin's lymphoma that involves the brain, spinal cord, or leptomeninges, without evidence of systemic disease. This rare disease accounts for ~ 3% of all primary central nervous system (CNS) tumors. Methotrexate-based regimens are the standard of care for this disease with overall survival rates ranging from 14 to 55 months. Relapse after apparent complete remission can occur. We sought to understand the outcomes of patients who relapsed.Methods
This is an IRB-approved investigation of patients treated at our institution between 12/31/2004 and 10/12/2016. We retrospectively identified all cases of PCNSL as part of a database registry and evaluated these cases for demographic information, absence or presence of relapse, location of relapse, treatment regimens, and median relapse-free survival.Results
This analysis identified 44 patients with a pathologically confirmed diagnosis of PCNSL. Mean age at diagnosis was 63.1 years (range 20-86, SD = 13.2 years). Of the 44 patients, 28 patients successfully completed an initial treatment regimen without recurrence or toxicity that required a change in therapy. Relapse occurred in 11 patients with the location of relapse being in the CNS only (n = 5), vitreous fluid only (n = 1), outside CNS only (n = 3), or a combination of CNS and outside of the CNS (n = 2). Sites of relapse outside of the CNS included testes (n = 1), lung (n = 1), adrenal gland (n = 1), kidney/adrenal gland (n = 1), and retroperitoneum (n = 1). Median relapse-free survival after successful completion of therapy was 6.7 years (95% CI 1.1, 12.6).Conclusion
After successful initial treatment, PCNSL has a propensity to relapse, and this relapse can occur both inside and outside of the CNS. Vigilant monitoring of off-treatment patients with a history of PCNSL is necessary to guide early diagnosis of relapse and to initiate aggressive treatment.