BACKGROUND: Avascular necrosis (AVN) is a debilitating condition reported after chronic steroid use. The purpose of this study was to describe the magnitude of risk in individuals who survived ≥1 years after hematopoietic cell transplantation (HCT), and to investigate the role of immunosuppressive agents such as prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and cyclosporine (CSA) in the development of AVN after HCT. METHODS: Using a retrospective study design, the authors followed 1346 eligible patients for the development of AVN. Cumulative incidence was calculated taking into consideration competing risk from death and disease recurrence. Cox proportional regression techniques were used to identify associated risk factors. RESULTS: The median age at HCT was 34 years (range, 7 months‐69 years), and median length of follow‐up for those surviving was 8.2 years. Seventy‐five patients developed AVN of 160 joints. The cumulative incidence of AVN at 10 years was 2.9% after autologous HCT, 5.4% after allogeneic matched related donor HCT, and 15% after unrelated donor HCT (P < .001 compared with autologous HCT recipients). For allogeneic transplant recipients, male sex (relative risk [RR], 2.1; 95% confidence interval [95% CI], 1.1‐4.0); presence of chronic graft‐versus‐host disease (RR, 2.2); and exposure to CSA, FK506, prednisone, and MMF rendered patients at increased risk, especially in patients with a history of exposure to ≥3 drugs (RR, 9.2; 95% CI, 2.42‐35.24). CONCLUSIONS: Future studies examining the pathogenetic mechanism underlying AVN should help develop targeted interventions to prevent this chronic debilitating condition. Cancer 2009. © 2009 American Cancer Society.

Materials and Methods Animals and ethical clearanceAdult male albino rats of Wistar strain were used for the study. Animals were weighing about 220-250g obtained from Rajudyog biotechnology division Maharashtra, India were used. The animal studies were carried out upon institutional animal ethical committee approval. DrugsEtoposide was procured from Dabur India Ltd. Bovine serum albumin, reduced and oxidized GSH, thio barbituaric acid (TBA), butylated hydroxytolune (BHT), L-gammaglutamyl-p-nitroanilidehydrochloride, sodium azide, Dinitro thio benzoic acid (DNTB), NADPH, sodium dithionite, sodium formate were purchased from SRL India. All other chemicals used were of analytical grade. MethodologyAnimals were acclimatized for a period of two-weeks and were then treated. They received standard pellet and water ad libitum. Rats

SUMMARY We report a case of a never-smoker male originally diagnosed with stage IIIb non-small-cell lung cancer that then presented with metastatic disease (EGFR/KRAS wild-type and ALK-positive) confined to the omentum 6 years later. Early metastasis to a variety of internal organs is common in the course of disease. Gastrointestinal metastasis of non-small-cell lung cancer is relatively rare and is typically found in the gastric or small bowel regions. Metastasis to the omentum is commonly seen with certain gynecologic cancer, but has not yet been well documented in pulmonary malignancies. Increasing use of molecular markers has altered the diagnosis, management and possible long-term prognosis of various subcategories of lung cancer. ALK-associated mutations have been found in a small minority of patients and its presence requires the use of novel therapeutics and, possibly, more prolonged surveillance for late metastasis.