The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
R Patel ◽  
CL Kemp ◽  
M Hafejee ◽  
N Peckham ◽  
...  
Keyword(s):  
Scoping Review ◽  
High Volume ◽  
Cardiovascular Outcomes ◽  
High Dose ◽  
Funding Sources ◽  
Review Protocol ◽  
The Mean ◽  
The Impact ◽  
Over Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.

scholarly journals The Underrepresentation of Females in Studies Assessing the Impact of High-Dose Exercise on Cardiovascular Outcomes: a Scoping Review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Roshan Patel ◽  
Caitlin L. Kemp ◽  
Muneebah Hafejee ◽  
Nicholas Peckham ◽  
Vageesh Jain ◽  
...  
Keyword(s):  
Scoping Review ◽  
Cardiovascular Effects ◽  
Cardiovascular Outcomes ◽  
High Dose ◽  
Inclusion Criteria ◽  
Scoping Reviews ◽  
The Mean ◽  
Exercise Induced ◽  
Meta Analyses ◽  
The Impact

AbstractHigh-dose exercise-induced cardiac outcomes may vary between sexes. However, many studies investigating the cardiovascular effects of high-dose exercise have excluded or under-recruited females. This scoping review aimed to describe the recruitment of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and describe how this has changed over time. This scoping review followed the protocol outlined by Arksey and O’Malley and is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. The OVID and EMBASE databases were searched for studies that assessed the effects of high-dose exercise on cardiovascular outcomes. Both professional and nonprofessional groups were included. The review found 2973 studies, and 250 met the inclusion criteria including cumulatively 17,548,843 subjects. Over half the studies (n = 127) excluded females entirely, and only 8 (3.2%) studies recruited all-female participants. The overall mean percentage of females recruited was 18.2%. The mean percentage was 14.5% in studies conducted before 2011 and 21.8% in studies conducted after 2011. Females are an underrepresented group in studies assessing the cardiovascular outcomes related to high-dose exercise. As cardiovascular outcomes vary between sexes, translating findings from a largely male-based evidence may not be appropriate. Future investigators should aim to establish and overcome barriers to female recruitment.

scholarly journals Impact of the COVID-19 pandemic on electrophysiological procedures at a national referral center

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Cueva-Parra ◽  
G Munoz-Benavides ◽  
W Ortiz-Solis ◽  
J Gomez-Flores ◽  
MF Marquez ◽  
...  
Keyword(s):  
Electronic Devices ◽  
Referral Center ◽  
Funding Sources ◽  
Cardiac Implantable Electronic Devices ◽  
Electrophysiological Studies ◽  
Electrophysiological Procedures ◽  
The Impact ◽  
Large Groups ◽  
Made In ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background - Introduction: The COVID-19 pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide. Objectives Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center.  Methods We made a retrospective review of our data base and we compared procedures made in the last 3 years since 2017 to 2019 with the procedures made in the 2020. We divide the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures (which included implants, revisions, changes, upgrades and extractions) and electrophysiological studies and ablations (which included conventional and complex procedures). Other types of procedures were no included. Results There was a significant reduction in all procedures, the average of procedures performed in the last 3 previous years was 467 (there were 479 in 2017, 411 in 2018 and 511 in 2019), while in 2020 we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures performed in our center. There was no statistical difference regarding the CIED related procedures, the average of procedures of the last 3 previous years was 174 (there were 186 in 2017, 148 in 2018 and 188 in 2019), and in 2020 we performed 189 procedures, this value is near to the average of the last 3 previous years and very close to the value of the 2019 (p = 0.46). Regarding the electrophysiological studies and ablations, the average of procedures of the last 3 previous years was 293 (there were 293 in 2017, 263 in 2018 and 323 in 2019), while in 2020 we performed only 129 procedures, considerably decreasing compared to the previous years (p < 0.01). The reduction in the electrophysiological studies and ablations was 55.97%. The most affected months were April, May and June. Conclusions The COVID-19 pandemic considerably affected the number of electrophysiological procedures in our center, reducing it by 33.4% compared to the previous years. The reduction of procedures fundamentally affected the electrophysiological studies and ablations, reducing them by 55.97%. The number of CIED related procedures were no affected. Electrophysiological procedures Procedures2017201820192017-2019 average2020CIED related procedures186148188174189Electrophysiological studies and ablations293263323293129Total479411511467319Comparative table of the electrophysiological procedures performed in our center in recent years.Abstract Figure. Comparison of the procedures.

scholarly journals Statistical cures and other fallacies

2012 ◽  
Vol 18 (4) ◽  
pp. 387-390 ◽  
Author(s):  
Gary R Cutter
Keyword(s):  
Wishful Thinking ◽  
Percentage Change ◽  
Regression To The Mean ◽  
The Common ◽  
The Mean ◽  
Regression Towards The Mean ◽  
The Impact ◽  
Relapse Rates ◽  
Over Time

Relapse rates and thus the impact of therapies have been decreasing. Why they decline and the impact on our ability to understand which treatments are better require more than simple math. The objective of this review is to discuss the impact of regression to the mean, changes in outcome effects and how we compare outcomes over time and among studies. This paper provides discourse on the topics of regression to the mean, some examples of the pitfalls of changes and some difficulties in the interpretation of the common percentage change in outcomes. The results show that we can often be deceived by what we think we see and they also demonstrate how such confusion evolves in the literature. This article aims to caution against the over-interpretation of changes from baseline, which are helped along by regression towards the mean and other factors. Furthermore, how we interpret changes from baseline requires care and not wishful thinking, coupled with careful digestion of seemingly reasonable explications of results.

scholarly journals Prenatal Diet in Relation to Sleep Health of Offspring During Adolescence: Evidence From the ELEMENT Study

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 833-833
Author(s):  
Astrid Zamora ◽  
Karen Peterson ◽  
Martha Maria Téllez-Rojo ◽  
Alejandra Cantoral ◽  
Peter Song ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Maternal Diet ◽  
Principal Component ◽  
Female Offspring ◽  
Sleep Health ◽  
Diet Patterns ◽  
Funding Sources ◽  
Us Epa ◽  
The Mean ◽  
The Impact

Abstract Objectives Maternal diet during gestation has been linked to sex-specific differences in infant sleep; however, the impact on sleep into adolescence is unknown. We sought to examine the relationship between maternal diet patterns and sex-stratified offspring sleep health during adolescence among a Mexico City cohort. Methods Data from 309 mother-adolescent dyads were analyzed. Prenatal diet patterns were formed by principal component analysis derived from a food frequency questionnaire collected over the third trimester. Sleep variables were derived from 7-day actigraphy data from adolescents aged 9–17 years. Linear regression was employed to examine sex-stratified associations between tertiles of the diet patterns with adolescent sleep, adjusting for confounding factors. Results Three diet patterns included: the Prudent Diet (PD), high in lean proteins and vegetables; the Transitioning Mexican Diet (TMD) high in Mexican and “Westernized” foods; and the High Meat & Fat Diet (HMFD), high in meats and high-fat dairy products. The mean (SD) offspring age was 15.1 (1.9) years, and 52.4% of the sample was female. The mean (SD) sleep duration was 8.4 (1.4) h/night. Adjusted analyses showed an association between PD adherence and earlier sleep midpoint among female offspring, the offspring of mothers in the highest tertile of PD had a 0.70 h (95% CI: −1.2, −0.20; p = 0.01) earlier sleep midpoint (p, trend = 0.01). Additional associations were detected between TMD prenatal adherence with shorter sleep duration and earlier sleep midpoint among both sexes. For example, female and male offspring of mothers in the highest tertile of TMD had 0.80 h (95% CI: −85.0, −10.6; p = 0.01) (p, trend = 0.0043) and 0.54 h (95% CI: −66.1, 1.3) (p, trend = 0.03) shorter sleep duration, respectively. HMFD prenatal adherence was associated with less fragmented sleep in a non-linear manner among females and was non-linearly associated with an earlier sleep midpoint among males. Conclusions Sex-stratified analyses demonstrated that findings were more robust between multiple diet patterns and shorter sleep, earlier sleep timing, and less fragmented sleep among female offspring, thus indicating that maternal diet during pregnancy may impact female offspring's sleep health in adolescence. Funding Sources US EPA, NIEHS, NHLBI, and the National Institute of Public Health/Ministry of Health of Mexico.

scholarly journals Substance Use Among Patients Receiving Out- and Inpatient Dependence Care: a Prospective Norwegian Cohort Study From 2016 to 2020

2021 ◽  
Author(s):  
Jørn Henrik Vold ◽  
Fatemeh Chalabianloo ◽  
Christer F. Aas ◽  
Else-Marie Løberg ◽  
Kjell Arne Johansson ◽  
...  
Keyword(s):  
Substance Use ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Severity Index ◽  
Future Research ◽  
Opioid Agonist ◽  
Low Threshold ◽  
The Mean ◽  
The Impact ◽  
Over Time

Abstract BackgroundContinuous use of amphetamines, alcohol, benzodiazepines, cannabis, cocaine, or opioids contributes to health impairments, increased morbidity, and overdose deaths among patients with substance use disorders (SUDs). This study evaluates the impact of inpatient detoxification, specialized opioid agonist therapy (OAT), and low-threshold municipality care on substance use over time. MethodsWe used data from a cohort of SUD patients in Norway through health assessments of self-reported substance use and sociodemographic and clinical factors. A total of 881 substance use measurements, including type and amount of substances, were assessed from 708 SUD patients in 2016-2020. Substance use for individual and total substances was calculated, creating a substance use severity index (SUSI) ranging from zero (no use) to one (daily use). We defined baseline as the first substance use measurement when the measurements were listed chronologically. Time was defined as years from baseline. We used a linear mixed model to analyze associations between the SUSI and inpatient detoxification, specialized OAT compared with low-threshold municipality care, as well as the factors like injecting substance use, gender, and age, presented with coefficients and 95% confidence intervals (CI).ResultsNeither inpatient detoxification (mean SUSI change: 0.01, -0.03;0.04) nor specialized OAT (0.03, -0.09;0.14) compared with low-threshold municipality care were associated with changes in substance use over time. Patients who were over 60 years of age (mean SUSI difference: -0.06, -0.13;0.00) had a lower SUSI than those under 30 years of age, while patients who injected substances had a higher SUSI than those who did not inject substances (0.18, 0.15;0.20) at baseline. The mean SUSI for the individual substances were 0.50 (standard deviation (SD): 0.38) for cannabis, 0.40 (0.37) for benzodiazepines, 0.33 (0.34) for amphetamines and cocaine, 0.31 (0.29) for alcohol, and 0.22 (0.31) for opioids at baseline. The mean SUSI of all substances was 0.35 (0.20). Conclusion The present study demonstrates that neither inpatient detoxification nor specialized OAT compared to low-threshold municipality care were associated with changes in substance use over time. Future research needs to evaluate the impact on substance use and healthy survival of multiple health care interventions to this patient group.

scholarly journals Unravelling the impact of COVID-19 on mental health: A scoping review on traumatogenic events using the phases of response to disaster model

2021 ◽  
pp. 218-236
Author(s):  
den Cruyce Nele Van
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Disaster Response ◽  
Mental Health Problems ◽  
Economic Status ◽  
Psychological Needs ◽  
Vulnerable Groups ◽  
Cross Sectional ◽  
The Impact ◽  
Over Time

Background: Disease outbreaks such as the COVID-19 pandemic give rise to high levels of psychological distress in people worldwide. Since this is the first pandemic of its kind, the best available evidence is needed on what psychological needs could be expected during and after the pandemic. Objectives: In this scoping review existing research on traumatogenic events is examined in order to identify the potential impact on mental health of the COVID pandemic. The research findings are organized using the the phases of disaster response model. Results: A total of 34 longitudinal studies, 2 studies with multiple waves of data collection and 92 cross-sectional studies met the inclusion criteria. The studies included in this scoping review could be classified as: 87 studies on COVID-19, 2 on SARS, 19 on wars, 19 on terrorist attacks and 1 on a nuclear accident. Results indicate that stress, anxiety, depressive symptoms, insomnia, denial, anger, grief and fear can be anticipated as common reactions. The longer a pandemic continues, the higher the psychological strain is expected to be. Conclusions: The phases of response to disaster model offers a valid frame to unravel the impact of the pandemic on mental health over time. Specific attention must be given to vulnerable groups, whereby specific risk factors include age, gender, pre-existing mental health problems, healthcare profession, migration background, isolation and low socio economic status. However, these may change over time, and a delayed manifestation of psychosocial problems needs to be considered too. Mental health governance is, therefore, warranted throughout and even up to 6 months after the pandemic.

scholarly journals Protein status of people with phenylketonuria: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049883
Author(s):  
Sarah Firman ◽  
Radha Ramachandran ◽  
Kevin Whelan ◽  
Oliver C Witard ◽  
Majella O’Keeffe
Keyword(s):  
Scoping Review ◽  
Scientific Evidence ◽  
Grey Literature ◽  
The Body ◽  
Future Research ◽  
Advisory Group ◽  
Protein Status ◽  
Ethical Approval ◽  
Review Protocol ◽  
The Impact

IntroductionPhenylketonuria (PKU) is a disorder of protein metabolism resulting in an accumulation of phenylalanine in the body. Dietary management consists of altering the sources of ingested protein to limit phenylalanine intake. Current dietary protein guidelines for PKU are based on limited scientific evidence, thus it remains unclear whether current practice leads to optimal protein status in people with PKU. To date, no attempt has been made to systematically evaluate the protein status of people with PKU, using a combination of validated anthropometric, biochemical and functional measurement tools. Furthermore, factors known to influence protein status in the general population warrant consideration when determining protein status in individuals with PKU, alongside factors unique to PKU such as the type of protein substitute consumed. Understanding the impact of these variables on protein status is crucial to developing a personalised approach to protein recommendations for optimising health and functional outcomes in people with PKU. Therefore, the aim of this scoping review is to examine existing evidence regarding the protein status of people with PKU, and to investigate the nutritional and lifestyle variables that influence protein status.Methods and analysisThis review will be guided by Arksey and O’Malley’s framework, along with guidance from Levac et al, Pawliuk et al and the Joanna Briggs Institute. The following databases will be searched: MEDLINE (Ovid), Embase, CENTRAL, Web of Science and Scopus, alongside grey literature. Identified literature will be assessed by two independent reviewers for inclusion. Descriptive numerical analysis will be performed and a narrative summary will accompany the tabulated results describing how study findings relate to the review questions.Ethics and disseminationThis review protocol does not require ethical approval. Findings will be disseminated through peer-reviewed publication, presented at relevant conferences, and shared with a patient research advisory group to inform discussions on future research.

scholarly journals Patient and public involvement in stroke research: a scoping review protocol

2021 ◽  
Vol 4 ◽  
pp. 118
Author(s):  
Patricia Hall ◽  
Thilo Kroll ◽  
Julianne Hickey ◽  
Diarmuid Stokes ◽  
Olive Lennon
Keyword(s):  
Scoping Review ◽  
Public Involvement ◽  
Data Extraction ◽  
Research Question ◽  
Grey Literature ◽  
Healthcare Research ◽  
Stroke Research ◽  
Health And Social Care ◽  
Review Protocol ◽  
The Impact

Background: Growing consensus supports public and patient involvement (PPI) in research as the lived experience of patients, family carers and users of health and social care services bring unique insights to healthcare research. The impact and burden of stroke present ongoing challenges for those living with its consequences and could potentially limit PPI activity. This review aims to explore PPI in published stroke research to identify and describe the extent, nature and design of PPI activities, the type/s of studies involved and the profile of PPI participants engaged in stroke research. Methods: This systematic scoping review, guided by the Arksey & O’Malley five step framework, will be reported according to the PRISMA-ScR reporting guidelines. PPI is embedded at each stage of this proposed scoping review from conceptualisation, participation, contribution and collaboration. The Population, Concept, Context (PCC) structure defines the research question which asks - How is PPI in stroke research currently being conducted and how do the study authors report their PPI activities and its impact? A comprehensive range of electronic databases including PubMed, CINAHL, EMBASE, PsychINFO and the Cochrane Database of Systematic Reviews will generate a broad range of studies. Grey literature (e.g. OpenGrey, Leanus) and internationally recognised stroke organisation websites will be searched for additional research reports. Data extraction will adhere to the Joanna Briggs Institute guidelines, with results collated and mapped to the research cycle stage/s. Conclusions: The outlined scoping review protocol will comprehensively identify and map the existing scientific literature that reports PPI in stroke research. Findings will be presented in relation to PPI conceptualisation, participant profiles and activities in stroke research, volume, type and range of approaches. Knowledge gaps and future priorities for PPI in stroke research will be identified.

Abstract P347: The Impact of the Length of the Follow-up on the the Strengths of the Associations Between Cardiovascular Risk Factors and Future Myocardial Infarction, Stroke and Heart Failure

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Lars Lind ◽  
Erik Ingelsson ◽  
Johan Sundström ◽  
Johan ärnlöv
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Outcomes ◽  
Rapid Decline ◽  
The Impact ◽  
Over Time

Objective: The aim of this study was to investigate how the length of the follow-up period influences the strength of the associations between major cardiovascular risk factors and different cardiovascular outcomes (myocardial infarction [MI], stroke and heart failure). Methods: We examined 1826 men aged 50 regarding cardiovascular risk factors in 1970-74. The follow-up time was 33 years. The hazard ratio (HR) was calculated yearly for each risk factor and outcome. During follow-up, 571 cases of MI, 381 cases of stroke and 384 cases of heart failure occurred. Results: Two major patterns were found regarding influence of the follow-up time on the associations between risk factors and the different cardiovascular outcomes. First, a gradual decline in the HR over time was seen for blood pressure in relation to all three outcomes, with the most rapid decline for heart failure and stroke. This pattern was also seen for BMI in relation to MI and heart failure, and for smoking regarding MI and stroke. Second, we observed a gradual increase in HRs to a maximum at 20-25 years, and thereafter a slight decline. This pattern was seen for the apoB/A1 ratio, HDL, and triglycerides, mainly in relation to MI and heart failure. Conclusion: The length of follow-up influenced the associations between traditional risk factors and cardiovascular outcomes in different ways. The collective influence of the risk factors did however show a substantial decline in discrimination over time for the outcomes stroke and heart failure, but not regarding myocardial infarction.

Results of the Largest Study on Post-Transplant-Lymphoproliferations (PTLDs) of the Central Nervous System (CNS) in the Rituximab Era: A Surprising Overrepresentation of Kidney Transplantations, Key Importance of Methotrexate (Mtx), Cytarabine (AraC) and Radiotherapy (RX) for Long Term Survival and Low Impact of Rituximab (R)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3614-3614 ◽  
Author(s):  
Sylvain Choquet ◽  
Stefan Oertel ◽  
Ioannis Anagnostopoulos ◽  
Hanno Riess ◽  
Madalina Uzunov ◽  
...  
Keyword(s):  
Overall Survival ◽  
University Hospital ◽  
High Dose ◽  
Solid Organ ◽  
Cns Involvement ◽  
Term Survival ◽  
Long Term Survival ◽  
The Mean ◽  
The Impact

Abstract Background: PTLD is a rare and severe complication of solid organ and hematopoetic stem cell transplantation and CNS localizations are well known to be associated with an unfavourable outcome. Published data on PTLD with CNS involvement (CNS-PTLDs) are nearly inexistent and the impact of rituximab is unknown. Methods: We performed a retrospective analysis on CNS-PTLDs in two centres, the Pitié salpêtrière university hospital in Paris, France, and the Charité university hospital in Berlin, Germany, in order to have an homogeneous way to handle these diseases and to avoid biases of large national registers. PTLDs with extra-CNS localization were excluded. While attitudes for diagnosis, staging and initial immunosuppression diminution were identical, one centre largely used intravenous (iv) rituximab and radiotherapy while the other preferred high dose chemotherapy. The Pitié Salpêtrière series of 72 PTLD patients without CNS involvement served as a control population to identify specific disease characteristics of primary CNS-PTLD. Results: 24 patients with CNS-PTLD (median age 55y) have been analyzed and compared to the non-CNS PTLD group (table I). The mean follow-up of patients alive is 5 years. Primary CNS-PTLD are clearly of late onset (mean 1366 days after transplantation) with only 3/24 patients diagnosed within the first year after transplantation. There was a significant overrepresentation of renal allografts in the CNS-PTLD group as compared to PTLDs without CNS involvement, (75% vs 29%). Primary CNS-PTLDs were always of B-cell phenotype and tumors were EBV positive in 88% of cases. Treatment of primary CNS-PTLDs consisted of chemotherapy (CT) alone with high dose (HD) Mtx and/or HD AraC in 8 cases, intrathecal (it) Mtx only in 1 case and it single agent rituximab in 1 case. Rituximab has been used in combination with CT in 2 cases. Radiotherapy (RX) was used at a mean dose of 30 Gy in combination with CT in 6 patients, and in combination with rituximab in 6 patients. The overall survival of patients suffering from primary CNS-PTLD was 180 days, but some patients obtained sustained complete remissions (CR) and 11 survived more than one year [395d – 3965d]. Eight patients are alive at the time of analysis, 9 died of PTLD progression and 2 by early sepsis. The mean DFS is 1456 days. Among the 13 patients obtaining a CR, only one relapsed 6 years after his first PTLD diagnosis in an extra CNS form. Five patients died, 3 by sudden death (d60, d408, d671), one by cerebral toxoplasmosis (d703) and one by sepsis (d91). Among patients with long term survival, 5 have been treated with CT alone, 3 by RX +/− R and 3 with combined CT-RX. The role of rituximab in primary CNS-PTLD is still unclear, as only 4/9 patients treated with rituximab achieved survival, all the more so since it as been always used but once in association. Concusion: Primary CNS-PTLD is a specific entity inside the PTLD family, with a high representation of kidney grafts and EBV positive tumors. As in immunocompetent patients, long survival is possible, especially with HD CT with or without RX. The impact of rituximab seems to be reduced. CNS-PTLD Non CNS PTLD n 24 72 Age (years) 55 47 Sex ratio (M/F) 12/12 49/72 Delay from transplantation 1366 days 830 Kidney transplantation 75% (18/24) 29% Monomorphic/polymorphic 86% (19/22) 68% B phenotype 100% (24/24) 90% EBV positive (tumor) 88% (21/24) 71% ECOG > 2 33% (7/21) 14% (18/70) Overall survival 180 days 372 days Table1: comparison between primary CNS-PTLD and non CNS-PTLD

Sign in / Sign up

Export Citation Format

Share Document