Jasmine H Francis1, David H Abramson2, Marie-Claire Gaillard3, Brian P Marr2, Maja Beck-Popovic4, Francis L Munier3. 1. Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill-Cornell Medical Center, New York, New York. Electronic address: francij1@mskcc.org. 2. Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill-Cornell Medical Center, New York, New York. 3. Jules-Gonin Eye Hospital, Lausanne, Switzerland. 4. Pediatric Hematology Oncology Unit, University Hospital CHUV, Lausanne, Switzerland.
Abstract
PURPOSE: To evaluate the clinical characteristics of the 3 classifications of vitreous seeds in retinoblastoma-dust (class 1), spheres (class 2), and clouds (class 3)-and their responses to intravitreal melphalan. DESIGN: Retrospective, bi-institutional cohort study. PARTICIPANTS: A total of 87 patient eyes received 475 intravitreal injections of melphalan (median dose, 30 μg) given weekly, a median of 5 times (range, 1-12 times). METHODS: At presentation, the vitreous seeds were classified into 3 groups: dust, spheres, and clouds. Indirect ophthalmoscopy, fundus photography, ultrasonography, and ultrasonic biomicroscopy were used to evaluate clinical response to weekly intravitreal melphalan injections and time to regression of vitreous seeds. Kaplan-Meier estimates of time to regression and ocular survival, patient survival, and event-free survival (EFS) were calculated and then compared using the Mantel-Cox test of curve. MAIN OUTCOME MEASURES: Time to regression of vitreous seeds, patient survival, ocular survival, and EFS. RESULTS: The difference in time to regression was significantly different for the 3 seed classes (P < 0.0001): the median time to regression was 0.6, 1.7, and 7.7 months for dust, spheres, and clouds, respectively. Eyes with dust received significantly fewer injections and a lower median and cumulative dose of melphalan, whereas eyes with clouds received significantly more injections and a higher median and cumulative dose of melphalan. Overall, the 2-year Kaplan-Meier estimates for ocular survival, patient survival, and EFS (related to target seeds) were 90.4% (95% confidence interval [CI], 79.7-95.6), 100%, and 98.5% (95% CI, 90-99.7), respectively. CONCLUSIONS: The regression and response of vitreous seeds to intravitreal melphalan are different for each seed classification. The vitreous seed classification can be predictive of time to regression, number, median dose, and cumulative dose of intravitreal melphalan injections required.
PURPOSE: To evaluate the clinical characteristics of the 3 classifications of vitreous seeds in retinoblastoma-dust (class 1), spheres (class 2), and clouds (class 3)-and their responses to intravitreal melphalan. DESIGN: Retrospective, bi-institutional cohort study. PARTICIPANTS: A total of 87 patient eyes received 475 intravitreal injections of melphalan (median dose, 30 μg) given weekly, a median of 5 times (range, 1-12 times). METHODS: At presentation, the vitreous seeds were classified into 3 groups: dust, spheres, and clouds. Indirect ophthalmoscopy, fundus photography, ultrasonography, and ultrasonic biomicroscopy were used to evaluate clinical response to weekly intravitreal melphalan injections and time to regression of vitreous seeds. Kaplan-Meier estimates of time to regression and ocular survival, patient survival, and event-free survival (EFS) were calculated and then compared using the Mantel-Cox test of curve. MAIN OUTCOME MEASURES: Time to regression of vitreous seeds, patient survival, ocular survival, and EFS. RESULTS: The difference in time to regression was significantly different for the 3 seed classes (P < 0.0001): the median time to regression was 0.6, 1.7, and 7.7 months for dust, spheres, and clouds, respectively. Eyes with dust received significantly fewer injections and a lower median and cumulative dose of melphalan, whereas eyes with clouds received significantly more injections and a higher median and cumulative dose of melphalan. Overall, the 2-year Kaplan-Meier estimates for ocular survival, patient survival, and EFS (related to target seeds) were 90.4% (95% confidence interval [CI], 79.7-95.6), 100%, and 98.5% (95% CI, 90-99.7), respectively. CONCLUSIONS: The regression and response of vitreous seeds to intravitreal melphalan are different for each seed classification. The vitreous seed classification can be predictive of time to regression, number, median dose, and cumulative dose of intravitreal melphalan injections required.
Authors: David H Abramson; Armida W M Fabius; Jasmine H Francis; Brian P Marr; Ira J Dunkel; Scott E Brodie; Anna Escuder; Y Pierre Gobin Journal: Ophthalmic Genet Date: 2017-01-17 Impact factor: 1.803
Authors: Matthew D Karl; Jasmine H Francis; Saipriya Iyer; Brian Marr; David H Abramson Journal: J Pediatr Ophthalmol Strabismus Date: 2017-01-17 Impact factor: 1.402
Authors: Jesse L Berry; Francis L Munier; Brenda L Gallie; Ashley Polski; Sona Shah; Carol L Shields; Dan S Gombos; Kathleen Ruchalski; Christina Stathopoulos; Rachana Shah; Rima Jubran; Jonathan W Kim; Prithvi Mruthyunjaya; Brian P Marr; Matthew W Wilson; Rachel C Brennan; Guillermo L Chantada; Murali M Chintagumpala; A Linn Murphree Journal: Pediatr Blood Cancer Date: 2021-02-23 Impact factor: 3.167
Authors: Helen Dimaras; Timothy W Corson; David Cobrinik; Abby White; Junyang Zhao; Francis L Munier; David H Abramson; Carol L Shields; Guillermo L Chantada; Festus Njuguna; Brenda L Gallie Journal: Nat Rev Dis Primers Date: 2015-08-27 Impact factor: 52.329