Faculty Bibliography

Background. Injection drug use is a significant and growing public health concern in New York State (NYS). Infectious endocarditis (IE) is a serious complication of injection drug use, and is associated with significant morbidity and mortality, prolonged hospitalizations, and high healthcare costs. Methods. Data was extracted from the Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP)'s New York State Inpatient Database (SID) to determine incidence of IE in New York between 2000-2014. The HCUP-SID database includes inpatient discharge records from hospitals across the state regardless of payer and contains information on inpatient healthcare utilization. Regional incidence was then calculated using population values from the 2010 regional census. Cost of hospitalization was derived from the HCUP using the cost to charge ratio (CCR) file to estimate the cost of inpatient hospital stays. Results. During the study interval the number of statewide substance use-associated IE cases fluctuated between a low of 262 cases in 2000, and a high of 362 cases in 2007. Approximately 70-80% of the patients with substance use-associated IE in NYS in this study were insured through public programs (Medicare or Medicaid). In-hospital mortality from substance use-associated IE appears to be decreasing slightly, however, there is an accompanying increase in hospital costs, in part due to long average length of hospital stays between 13 and 18 days. The mean cost of hospitalization rose notably from $51,934 to $134,325 over the course of our study. Over 10% of hospitalizations culminated in patient directed discharges. Over the study period New York City's incidence rates appeared to decrease while other region's incidence rates appeared to increase, specifically in the Capital District, Central New York, and Southern Tier regions. Trends in substance use associated infectious endocarditis in NYS This figure shows trends in endocarditis in the study period. It shows a rise in cases in substance use associated endocarditis in NYS in less urban areas. Conclusion. Between 2000 and 2014 the rates of substance use-associated infective endocarditis in NYS fluctuated but remained fairly constant. Despite the relatively constant statewide rates, there was important regional variation, including decreasing incidence rates of SUIE in New York City and rising incidence rates in non-New York City counties

BACKGROUND:Large granular lymphocytic leukemia is a rare lymphocytic neoplasm that can pose a treatment challenge in patients with severe neutropenia in whom conventional therapies fail. We report one of the first cases in which allogeneic stem cell therapy was used as treatment for large granular lymphocytic leukemia. We report and discuss the case of a 42-year-old white Caucasian female who, despite multiple therapies including methotrexate, cyclophosphamide, prednisone, cyclosporine, and pentostatin, continued to show severe neutropenia and recurrent infections. The patient was treated successfully and cured by allogeneic stem cell transplant without any major complications. CONCLUSIONS:The significant importance of this case report is the introduction of a new treatment algorithm for challenging cases of T-cell large granular lymphocytic leukemia in which standard care fails. We hope that this case report will raise awareness of the potential benefits of allogeneic stem cell transplant in the treatment of aggressive forms of T-cell large granular lymphocytic leukemia.

Patients with one form of cancer are at increased risk for another, and this is true for lung cancer, where synchronous primary lung cancers are an increasing multifaceted challenge.^1,2 Here, we present the case of a middle age woman who was found to have bilateral lung masses. Biopsy and subsequent testing revealed unique synchronous lung adenocarcinomas, each with unique genetic signatures. Despite having two unique tumors, she was found to have CHEK2 mutations in both tumors and in germline testing. Because of this extensive testing that showed unique tumors, she was ultimately diagnosed with stage IIIb and IA2 lung cancers, and this changed her treatment options. Consideration of unique primary tumors leads to thorough diagnostics, which changed this patient's diagnosis, prognosis, and treatment. We hope this case raises awareness for multiple primary tumors, as well as CHEK2 as an important oncogene.

Pancreatic cancer is a highly lethal disease, where the mortality closely matches increasing incidence. Pancreatic ductal adenocarcinoma (PDAC) is the most common histologic type that tends to metastasize early in tumor progression. For metastatic PDAC, gemcitabine had been the mainstay treatment for the past three decades. The treatment landscape has changed since 2010, and current first-line chemotherapy includes triplet drugs like FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin), and doublet agents like nab-paclitaxel and gemcitabine. Nanoliposomal encapsulated irinotecan (nal-IRI) was developed as a novel formulation to improve drug delivery, effectiveness, and limit toxicities. Nal-IRI, in combination with leucovorin-modulated fluorouracil (5-FU/LV), was found in a large randomized phase III clinical trial (NAPOLI-1) to significantly improve overall survival in patients who progressed on gemcitabine-based therapy. This review will focus on the value of using nal-IRI, toxicities, recent clinical experiences, and tools to improve patient outcomes in this setting.