MO040LONG-TERM FOLLOW-UP OF IGA NEPHROPATHY PATIENTS AT HIGH RISK OF PROGRESSION ACCORDING TO THE THERAPEUTIC APPROACH EMPLOYED: A MULTICENTER RETROSPECTIVE STUDY OF 947 PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Federico Alberici ◽  
Ivano Baragetti ◽  
Francesca Ferrario ◽  
Serena Ponti ◽  
Chiara Salviani ◽  
...  
Keyword(s):  
High Risk ◽  
Therapeutic Approach ◽  
Immunosuppressive Drugs ◽  
Free Survival ◽  
Risk Of Progression ◽  
Time Average ◽  
Group 2 ◽  
Group 1

Abstract Background and Aims IgA-nephropathy (IgA-N) is a frequent cause of CKD and ESRD. The optimal therapeutic approach and the role of glucocorticoids and immunosuppression is still debated. Aim of this study was to perform a survey across several Italian centers focusing on the long-term outcome of patients with IgA-N at high risk of progression stratified according to the therapeutic approach employed. Method All the consecutive patients affected by biopsy proven IgA-N, proteinuria >1g/day and a follow-up longer than 24 months have been collected across 48 centers. The population has been divided in three groups according to the therapeutic approach: group-1 received ACEi or ARBs alone, group-2 a six months course of glucocorticoids while group-3 glucocorticoids and immunosuppressive drugs. Primary endpoints have been ESRD free-survival, halving of the eGFR free-survival and rate of non-responders (NR, proteinuria >1 g/day). Secondary endpoints have been assessment of the prognostic role of the time average proteinuria (TAP) as well as of the time average slope of proteinuria (TASP) and rate of severe adverse events (SAEs). Results 947 patients have been included and followed for a median time of 60 months (IQR 24-96). Baseline eGFR and proteinuria in the three groups have been respectively 68.1 (95%CI 63.9-72.4)-67.8 (95%CI 65.3-70.3)-63.3 (95%CI 58.5-68.1) ml/min/1.73m2 (p=0.191) and 2.38 (95%CI 2-2.77)-2.65 (95%CI 2.49-2.82)-3.26 (95%CI 2.89-3.64) g/day (p<0.001). Respectively 76/586 (13%) and 28/167 (17%) of the patients in group-2 and 3 required re-treatment with glucocorticoids alone or in combination with immunosuppressive drugs after a median of 24 months from the first cycle. ESRD free-survival has been longer in the group-2 (p=0.004) (figure, panel A); at subgroup analysis this was restricted to the patients with a eGFR<50 ml/min (p=0.004) (figure, panel B) while only a trend was observed in the ones with eGFR ≥50 ml/min (p=0.0631). The halving of the eGFR free-survival has been longer in group-2 only when limiting the analyses to the subgroup with eGFR<50 ml/min (p=0.026) (figure, panel C). The proportion of NR has been significantly lower in group-2 compared to group-1 throughout the first 36 months of follow-up (figure, panel D); of note being NR during the first 36 months increased the risk of developing ESRD during the follow-up (OR 4 95%CI 2.2-7.3, p<0.0001). The TAP and TASP of the first 24 months have been higher in the patients developing ESRD (respectively, mean 2.48 95%CI 2.14-2.82 and 0.81 95%CI 0.70-0.92) compared to the other patients (mean 1.12 95%CI 1.2-1.32 and 0.59 95%CI 0.56-0.61) (p<0.0001 for both comparisons). Of note the 24 months TASP of group-2 was lower compared to group-1 (respectively mean 0.56 95%CI 0.54-0.59 and 0.79 95%CI 0.71-0.87) (p<0.0001). The rate of patients experiencing SAEs during the first 6 months of therapy in the three groups has been respectively 2%, 7% and 16%; of these withdrawn of the therapeutic approach employed has been necessary in 67%, 21% and 48%. During the whole follow-up the number of SAEs per 100 patients/years has been respectively 1.9-2.7 and 2.5 in the 3 groups. Conclusion In this large multicenter retrospective survey, the use of glucocorticoids in patients with IgA-N at high risk of progression has been associated to longer ESRD free-survival, longer time to the halving of the eGFR in the subgroup with eGFR <50 ml/min, lower rate of non-response during the first 36 months of follow-up as well as lower TASP during the first 24 months. The overall rate of SAEs has been low but higher in the group receiving glucocorticoids alone or in combination with immunosuppressors.

scholarly journals New risk model is able to identify patients with a low risk of progression in systemic sclerosis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001524
Author(s):  
Nina Marijn van Leeuwen ◽  
Marc Maurits ◽  
Sophie Liem ◽  
Jacopo Ciaffi ◽  
Nina Ajmone Marsan ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systemic Sclerosis ◽  
High Risk ◽  
Disease Progression ◽  
Risk Model ◽  
Immunosuppressive Drugs ◽  
Low Risk ◽  
Expert Assessment ◽  
Risk Of Progression

ObjectivesTo develop a prediction model to guide annual assessment of systemic sclerosis (SSc) patients tailored in accordance to disease activity.MethodsA machine learning approach was used to develop a model that can identify patients without disease progression. SSc patients included in the prospective Leiden SSc cohort and fulfilling the ACR/EULAR 2013 criteria were included. Disease progression was defined as progression in ≥1 organ system, and/or start of immunosuppression or death. Using elastic-net-regularisation, and including 90 independent clinical variables (100% complete), we trained the model on 75% and validated it on 25% of the patients, optimising on negative predictive value (NPV) to minimise the likelihood of missing progression. Probability cutoffs were identified for low and high risk for disease progression by expert assessment.ResultsOf the 492 SSc patients (follow-up range: 2–10 years), disease progression during follow-up was observed in 52% (median time 4.9 years). Performance of the model in the test set showed an AUC-ROC of 0.66. Probability score cutoffs were defined: low risk for disease progression (<0.197, NPV:1.0; 29% of patients), intermediate risk (0.197–0.223, NPV:0.82; 27%) and high risk (>0.223, NPV:0.78; 44%). The relevant variables for the model were: previous use of cyclophosphamide or corticosteroids, start with immunosuppressive drugs, previous gastrointestinal progression, previous cardiovascular event, pulmonary arterial hypertension, modified Rodnan Skin Score, creatine kinase and diffusing capacity for carbon monoxide.ConclusionOur machine-learning-assisted model for progression enabled us to classify 29% of SSc patients as ‘low risk’. In this group, annual assessment programmes could be less extensive than indicated by international guidelines.

Survival of Patients with High-Risk Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

2021 ◽  
Vol 104 (6) ◽  
pp. 895-901
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
First Year ◽  
Pulmonary Arterial ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) with uncorrected left-to-right shunts. Currently, no consensus guideline exists on the management of PAH-CHD in children, especially those who do not meet operability criteria. Objective: To compare survival between three groups of high-risk PAH-CHD, group 1: total correction including both surgical and percutaneous intervention, group 2: palliative treatment, and group 3: conservative with medical treatment group. Materials and Methods: All pediatric patients with PAH-CHD that underwent cardiac catheterization between January 1, 2008 and December 31, 2017 were retrospectively reviewed. Inclusion criteria were high risk PAH-CHD patients who had pulmonary vascular resistance (PVR) greater than 6 Wood unit·m² and PVR-to-SVR ratio greater than 0.3 evaluated in room air. Exclusion criteria were younger than three months of age, severe left side heart disease with pulmonary capillary wedge pressure greater than 15 mmHg, obstructive total pulmonary venous return, and single ventricle physiology. The Kaplan-Meier analysis was performed from the date of PAH diagnosis to the date of all-cause mortality or to censored date at last follow-up. Results: Seventy-six patients with a median age at diagnosis of 27.5 months (IQR 14.5 to 69.0 months) were included in this study. The patients were divided into three subgroups and included 38 patients (50.0%) in group 1, six patients (7.9%) in group 2, and 32 patients (42.1%) in group 3. The median follow-up time was 554 days (IQR 103 to 2,133 days). The overall mortality was 21.7%. One-year survival in patients with simple lesion in group 1 and 3 were 79.5% and 87.5% and patients with complex lesions in group 1, 2, and 3 were 93.8%, 83.3%, and 73.1%, respectively. The results showed that most mortalities occurred in the first year. There were no statistically significant differences in survival among difference types of treatment (log rank test, p=0.522). Conclusion: The mortality of high-risk PAH-CHD patients were not different among those who underwent corrective surgery, palliative, or conservative treatment. The mortality was high in the first year after PAH diagnosis and remain stable afterward. Management decision for an individual with high-risk PAH-CHD patients requires comprehensive clinical assessment to balance the risks and benefits before making individualized clinical judgment. Keywords: Pulmonary hypertension; Congenital heart disease; High-risk patients

P1031The impact of the duration of atrial fibrillation persistence for arrhythmia free survival in patients undergoing catheter ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Furukawa ◽  
T Yamada ◽  
T Morita ◽  
S Tamaki ◽  
M Kawasaki ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Outcome Data ◽  
Free Survival ◽  
Group 4 ◽  
Kaplan Meier ◽  
Group 3 ◽  
Group 2 ◽  
Af Recurrence ◽  
Group 1

Abstract Background Catheter ablation (CA) for atrial fibrillation (AF) is a curable treatment option. However, AF recurrence after CA remains an important problem. Although the success rate has been improved after catheter ablation (CA) in patients with paroxysmal AF (PAF), outcome data after CA for persistent AF (PeAF) are highly variable. Previous studies showed the PeAF is one of independent predictors for AF recurrence in comparison to PAF. However, there are little information available on the prognostic significance of AF duration after CA for AF. The aim of this study is to evaluate the impact of AF duration on long-term outcomes of AF ablation in patients with PeAF compared with PAF. Methods We enrolled 778 consecutive patients, who were referred our institution between August 2015 and December 2017 for undergoing the first time CA for AF. We divided 5 groups (Group 1; PAF (n=442), Group 2; PeAF duration ≤6 months (n=198), Group 3; PeAF duration of 6 months to 2 years (n=87), Group 4; PeAF duration of 2–5 years (n=30) and Group 5; PeAF duration ≥5 years (n=21)). All patients followed up for at least 1 year. Outcome data on recurrence of AF after ablation were collected. Results There were no significant differences in baseline clinical characteristics before CA among 5 groups, except for the prevalence of congestive heart failure, left atrial diameter and left ventricular ejection fraction. During a mean follow-up period of 511±298 days, 217 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (31% vs 20%, p=0.002) and in group 4 compared to group 3 (83% vs 30%, p<0.0001). However, AF recurrence was no significantly differences between groups 2 and 3 (31% vs 30%, p=0.76) and between groups 4 and 5 (83% vs 81%, p=0.45). Of 217 patients with AF recurrence, 154 patients had undergone multiple procedures. After last procedures, during a mean follow-up period of 546±279 days, 61 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (10% vs 3%, P=0.0005) and in group 4 compared with group 3 (35% vs 10%, p=0.0001). However, AF recurrence was no significantly difference between groups 2 and 3 (10% vs 10%, p=0.91) and between groups 4 and 5 (47% vs 35%, p=0.47). AF Free Survival Curve Conclusion Although patients with PeAF within 2 years had significantly higher AF recurrence compared to PAF, AF ablation might still be a good contributor as the first line approach to improve outcomes in patient with PeAF within 2 years.

Role of Anticoagulation in Patients with Inferior Vena Cava Filter but with No Risk Factor or History of DVT/PE

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4317-4317
Author(s):  
Mustapha A. Khalife ◽  
Vrushali S. Dabak ◽  
Marwa Hammoud ◽  
Karim Arnaout
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
History Of ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Abstract Abstract 4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Role of the Psychooncology Team in the Multidisciplinary Team Management of Breast Cancer Patients - From Diagnosis to After Treatment: A Qualitative Study at MISR Cancer Center

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 114s-114s
Author(s):  
I. Sallam ◽  
G. Amira ◽  
A. Youssri
Keyword(s):  
Breast Cancer ◽  
Qualitative Study ◽  
Cancer Center ◽  
Team Management ◽  
Breast Cancer Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: According to the cultural and socioeconomic factors, breast cancer patients (BCP) experienced a relatively low health-related quality of life (Qol) during the journey of breast cancer treatment, that influence patient adaptation to the situation from diagnosis to after treatment. And the further effect on either starting the treatment or its continuation. This merited conducting a qualitative study to explore the importance of the psychooncological approach to BCP and the impact on commencing and continuation of treatment and follow-up. Aim: To describe the impact and importance of the psychooncology team in the cancer center and the effect of their approach on the BCP's Qol. Methods: The study involved 114 interviewed participants, excluding patients with wide variety of chronic illnesses, only 91 patients are the focused study group. Of which 11 patients group (1) refused to join the psychooncological approach due to cultural, and socioeconomic issues, and 80 patients group (2) joined and followed up by the team. Both groups are regularly surveyed. Qualitative and quantitative measurements were used. Data were collected as follows, at time of diagnosis, after surgery and after chemo-radiation therapies from group (1) and for group (2) after the psychooncology team management and care. Developing the psychooncology team for the cancer center. 2 psychooncologists, 5 psychoeducating nurses and a group therapy sessions at a world standard levels of care with ethics committee approvals, and caring for patients' privacy. Close follow-up and evaluation of the performance and Qol of our BCP, raising the awareness about psychoeducation and psychological approach importance for BCP that would help them cope with daily life challenges to improve Qol. Results: Category Group N. Diagnosis related depression N. Surgery related depression N. Treatment related depression Free of depression Group (1) No= 11 3 (27%) 2 (18%) 5 (45%) 1 (10%) Group (2) No= 80 12 (15%) 9 (11.3%) 23 (28.7%) 36 (45%) Conclusion: Results indicate that the most critical depressing points is at time of diagnosis and chemo-radiation therapy. Group (2) has positive indication and alternation on the level of Qol and a significant improvement on level of depression when compared with group (1). This study highlighted the importance of psychooncology team in BCPs' survivorship. It also brings to attention the important role of the government, health policy makers and health plans toward enriching all cancer centers with the psychooncology team. To maximize health and health care for BCP.

Combined treatment image guided-intensity modulated radiotherapy (IG-IMRT) plus high-dose rate brachytherapy (HDR) and hormonotherapy (HT) as treatment for high-risk prostate cancer: Five-year result of a phase II study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15571-15571
Author(s):  
B. Guix ◽  
J. Bartrina ◽  
I. Henriquez ◽  
R. Serrate ◽  
P. Palombo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Dose Rate ◽  
Late Effects ◽  
High Dose Rate ◽  
High Dose ◽  
Group 2 ◽  
Grade 3 ◽  
Group 1

15571 Background: To report early and late toxicity and preliminary biochemical outcome in 345 patients with high-risk (Gleason >=7; PSA>20 or T2c-T3) clinically localized prostate cancer treated with combined high-dose-rate brachytherapy and IMRT (IMRT-HDR) to the prostate and seminal vesicles with 24–36 months of hormononal treatment (goserelin+bicalutamide) (HT). Methods: Between 12/1999 and 10/2003, 345 patients with PSA>20, Gleason score>6 and/or T2c-T3 N0 M0 prostate cancer were treated with IG-IMRT followed by HDR implant to the prostate and HT. Patients were randomly assigned to receive HT for 24 (group 1, 172 patients) or 36 months (group 2, 173 patients). Acute and late toxicities were scored by the EORTC/RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. PSA failure was defined as nadir +2.0 ng/ml. Results: All patients completed treatment. One patient included in the group 1 and none of the group 2 experienced grade 3 rectal toxicity (rectal ulcer). Seven patients in each group (4.0%) developed acute Grade 2 urinary symptoms, and none experienced urinary retention. No patient (0%) developed Grade 4 rectal complications or grade 3 or 4 urinary complications. With a median follow-up of 44 months, the 5-year actuarial PSA relapse-free survival rates for the whole group of patients was 95.7 %. No statistical differences between group 1 and 2 patients were found. Conclusions: High-dose IG-IMRT+HDR and HT was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute and late rectal and urinary complications were significantly low, compared with what has been observed with high-dose conventional, 3D-conformal or IMRT-only. Short-term PSA control rates seem to be at least comparable to those achieved with 3D-EBRT or IMRT. Both treatment regimes were very effective. Longer follow-up is needed to know if better PSA control rate are achieved with longer HT. No significant financial relationships to disclose.

Abstract 13007: Myocardial Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Medium-term Follow-up in a Large Prospective Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tam T Doan ◽  
Carlos Bonilla-Ramirez ◽  
Shagun Sachdeva ◽  
J. Kevin Wilkes ◽  
Dana L Reaves-O’neal ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Myocardial Ischemia ◽  
Right Coronary Artery ◽  
Low Risk ◽  
Medium Term ◽  
Coronary Cta ◽  
Group 2 ◽  
Group 1

Introduction: Anomalous aortic origin of a right coronary artery (AAORCA) may lead to myocardial ischemia (ISCH) and sudden death in the young. Current guidelines deem asymptomatic patients (pts) low-risk if normal exercise stress test (EST). Hypothesis: The frequency of ISCH in AAORCA pts is seen more commonly on stress perfusion imaging (sPI) compared to EST. Method: Pts <21 yrs with AAORCA were prospectively enrolled and managed following a standardized approach (12/2012-04/2020). Coronary CTA was used to define details of AAORCA. EST and sPI were performed in pts >7 yrs and in younger pts if concern for ISCH. sPI included nuclear imaging initially and dobutamine stress cardiac MRI since 06/2014. High-risk features included intramural length (IML), abnormal ostium, symptoms or evidence of myocardial ISCH. Shared decision-making directed medical/surgical management. Results: Of 220 pts (male 135, 61%) enrolled at median age of 12 [IQR 6-15] yrs, 168 (76%) had no/non-exertional symptoms (Group-1) and 52 (24%) had exertional chest pain/syncope (Group-2). Coronary CTA was available in 180 and EST in 164 pts. EST was positive in 2/164 (1%), both had positive sPI. Of 162 negative EST, inducible ISCH was seen in 10/96 (10%) in Group-1 and 8/42 (19%) in Group-2. No difference in IML was noted between pts with/without ISCH (5.7±2.4 vs 6.0±2.1 mm, p=0.6). Surgery was indicated in 67 (30%) pts with high-risk features, not indicated in 143 (65%), and 10 (5%) are undergoing evaluation. In 51 operated pts (38 unroofing; 13 translocation), 3 await post-operative assessment, 48 on normal physical activities; median follow-up of 4.6 [IQR 2.3-6.3] yrs. All patients were alive at last follow-up; median of 2.9 [IQR 1.2-5.1] yrs. Conclusions: AAORCA pts can present with reversible ISCH on sPI regardless of symptoms or IML. EST may be a poor predictor of ISCH and caution should be given to determine low-risk. Most high-risk patients return to exercise and remain well at medium-term follow-up.

scholarly journals Mitotane levels predict the outcome of patients with adrenocortical carcinoma treated adjuvantly following radical resection

2013 ◽  
Vol 169 (3) ◽  
pp. 263-270 ◽  
Author(s):  
M Terzolo ◽  
A E Baudin ◽  
A Ardito ◽  
M Kroiss ◽  
S Leboulleux ◽  
...  
Keyword(s):  
Adrenocortical Carcinoma ◽  
Plasma Concentrations ◽  
Multivariable Analysis ◽  
Radical Resection ◽  
Free Survival ◽  
Risk Of Death ◽  
Radical Removal ◽  
Group 2 ◽  
Group 1

ContextMitotane plasma concentrations ≥14 mg/l have been shown to predict tumor response and better survival in patients with advanced adrenocortical carcinoma (ACC). A correlation between mitotane concentrations and patient outcome has not been demonstrated in an adjuvant setting.ObjectiveTo compare recurrence-free survival (RFS) in patients who reached and maintained mitotane concentrations ≥14 mg/l vs patients who did not.Design and settingRetrospective analysis at six referral European centers.PatientsPatients with ACC who were radically resected between 1995 and 2009 and were treated adjuvantly with mitotane targeting concentrations of 14–20 mg/l.Main outcome measuresRFS (primary) and overall survival (secondary).ResultsOf the 122 patients included, 63 patients (52%) reached and maintained during a median follow-up of 36 months the target mitotane concentrations (group 1) and 59 patients (48%) did not (group 2). ACC recurrence was observed in 22 patients of group 1 (35%) and 36 patients in group 2 (61%). In multivariable analysis, the maintenance of target mitotane concentrations was associated with a significantly prolonged RFS (hazard ratio (HR) of recurrence: 0.418, 0.22–0.79; P=0.007), while the risk of death was not significantly altered (HR: 0.59, 0.26–1.34; P=0.20). Grades 3–4 toxicity was observed in 11 patients (9%) and was managed with temporary mitotane discontinuation. None of the patients discontinued mitotane definitively for toxicity.ConclusionsMitotane concentrations ≥14 mg/l predict response to adjuvant treatment being associated with a prolonged RFS. A monitored adjuvant mitotane treatment may benefit patients after radical removal of ACC.

scholarly journals The results of allogeneic hematopoietic stem cell transplantation from a matched unrelated and haploidentical donors in children with high-risk infant leukemia in first and second remissions

2020 ◽  
Vol 19 (2) ◽  
pp. 30-37
Author(s):  
O. V. Paina ◽  
Z. Z. Rakhmanova ◽  
P. V. Kozhokar ◽  
A. S. Frolova ◽  
L. A. Tsvetkova ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Hemopoietic Stem Cell ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Group 2 ◽  
Group 1

Aсute myeloid leukemia (AML) in children aged 0–2 years and aсute lymphoid leukemia (ALL) up to 1 year (i.e., infants) frequently characterize high risk and poor prognosis. Аllogeneic hemopoietic stem cell transplantation (аllo-HCST) is a main curative but toxic option for these patients, and choice of allogeneic donor may be one of the important factor for long-term survival. Aim. To evaluate overall survival (OS), relapse free survival (RFS), transplant related mortality (TRM), "graft versus host" disease free/relapse free survival (GRFS) in infant with acute leukemia underwent allo-HCST from MUD vs haplodonor at 1st or 2nd remission. The study was approved by the Independent Ethics Committee and the Scientific Council of the I.P. Pavlov First Saint Petersburg State Medical University. 34 children with infant acute leukemia: 23 pts with AML (68%) and 11 – with ALL (32%) – underwent allo-HSCT from MUD vs haplo at 1st or 2nd remission between 2004–2018 were analyzed. Median age at allo-HCST – 22 months (6 months – 5 y.o.). HSCT was performed from MUD in 19 (56%) pts (group 1), haplo – 15 (44%) pts (group 2). Myeloablative conditioning received 29 (85%) pts. Reduced intensity conditioning received 5 (15%) pts. Posttransplant cyclophosphomyde (PtCy) was used in 10 (53%) pts in the group 1 and 14 (93%) pts. in the group 2 (p = 0.043). Engraftment was identified in 18 pts (95%) of group 1 and 12 pts (80%) of group 2 (p = 0.28). At the median follow up 3.5 years OS is 79% in the group 1 аnd 73% in the group 2 (p = 0.68). RFS is 79% in the group 1 аnd 67% in the group 2 (p = 0.41). GRFS is 39% in the group 1 аnd 47% in the group 2 (p = 0.5). TRM occurred in 2 pts (11%) of group 1 (due to infectious and toxicity) and no one of the group 2 (p = 0.2). Haplo-HSCT with PtCy is a good alternative to MUD with high efficacy and acceptable toxicity in children with infant acute leukemia at 1st or 2nd remission.

Prognostic role of apolipoprotein and lactate dehydrogenase levels in resectable colorectal cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15541-e15541
Author(s):  
Yifei Ma ◽  
Ping Lu ◽  
Xinjun Liang ◽  
Shaozhong Wei
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Lactate Dehydrogenase ◽  
Cox Regression ◽  
Prognostic Role ◽  
Free Survival ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

e15541 Background: Apolipoprotein b (apob), apolipoprotein a1 (apoa1), and lactate dehydrogenase (LDH) levels are circulating biomarkers that relate to tumor inflammation. This study aimed to evaluate the prognostic role of apob/apoa1 and LDH in resectable colorectal cancer (CRC). Methods: 513 patients of colorectal cancer (CRC) from Hubei cancer hospital were included finally, and we collected the pre-operative laboratory results within a week before surgery. We combined the two indicators and divided them into three groups (group 1: apob/apoa1-LDH low; group 2: apob/apoa1 or LDH high; group 3: apob/apoa1-LDH high). Kaplan-Meier survival analysis, univariate COX regression and multivariate COX regression were used to assess the prognoses of colorectal cancer patients. Results: The median follow-up was 35 months. Our study found that the prognosis of group 1 was better than group 2 in both overall survival (88.2% vs. 75.4% vs. 61.9%) (P≤0.001) and diseases-free survival (77.4% vs. 64.7% vs. 42.8%) (P≤0.001), and group 3 was the worst. By multivariate analysis, the new predictive marker obtained by combining apob/apoa1 and LDH could independently predict outcomes in CRC [overall survival: (HR: 1.487; 95% CI, 1.074-2.061); diseases-free survival (HR: 1.381; 95% CI, 1.045-1.827)]. Conclusions: New marker based on apob/apoa1 and LDH is useful for predicting the prognosis of patients with CRC. However, more research is needed in the future.

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