Treatment and outcome of intracranial ependymoma after first relapse in AIEOP 2 nd protocol

2021 ◽  
Author(s):  
Maura Massimino ◽  
Francesco Barretta ◽  
Piergiorgio Modena ◽  
Pascal Johann ◽  
Paolo Ferroli ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Local Relapse ◽  
Salvage Treatment ◽  
Dose Fractionation ◽  
Molecular Subgroup ◽  
Intracranial Ependymoma ◽  
First Relapse ◽  
Multivariable Analyses ◽  
The Impact

Abstract Background More than 40% of patients with intracranial ependymoma need a salvage treatment within 5 years after diagnosis, and no standard treatment is available as yet. We report the outcome after first relapse of 64 patients treated within the 2 nd AIEOP protocol. Methods We considered relapse sites and treatments ,i.e. various combinations of complete/incomplete surgery, if followed by standard or hypo-fractionated radiation(RT) ± chemotherapy(CT). Molecular analyses were available for 38/64 samples obtained at first diagnosis. Of the 64 cases, 55 were suitable for subsequent analyses. Results The median follow-up was 147 months after diagnosis, 84 after first relapse, 5-year EFS/OS were 26.2%/30.8% (median EFS/OS 13/32 months) after relapse. For patients with a local relapse(LR), the 5-year cumulative incidence of second LRs was 51.6%, with a 5-year event-specific probability of being LR-free of 40.0%. Tumor site/grade, need for shunting, age above/below 3 years, molecular subgroup at diagnosis, had no influence on outcomes. Due to variation in the RT dose/fractionation used and the subgroup sizes it was not possible to assess the impact of the different RT modalities. Multivariable analyses identified completion of surgery, absence of symptoms at relapse, and female sex as prognostically favorable. Tumors with a 1q gain carried a higher cumulative incidence of dissemination after first relapse. Conclusions Survival after recurrence was significantly influenced by symptoms and completeness of surgery. Only a homogeneous protocol with well posed, randomized questions could clarify the numerous issues, orient salvage treatment and ameliorate prognosis for this group of patients.

461Modulation of ischemic and bleeding risk by peripheral artery disease after an acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Cespon Fernandez ◽  
S Raposeiras Roubin ◽  
E Abu-Assi ◽  
S Manzano-Fernandez ◽  
F Dascenzo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Cumulative Incidence ◽  
Bleeding Risk ◽  
Peripheral Artery ◽  
Data Set ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
The Impact

Abstract Introduction Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with acute coronary syndrome (ACS). With this study from real-life patients, we try to analyze the balance between ischemic and bleeding risk during treatment with dual antiplatelet therapy (DAPT) after an ACS according to the presence or not of PAD. Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without PAD. The impact of prior PAD in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,600 have PAD (6.1%). Patients with PAD were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with PAD in comparison with the rest of the population (8.2% vs 22.8%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. After propensity-score matching, we obtained two matched groups of 1,591 patients. Patients with PAD showed a significant higher risk of both AMI (sHR 2.17, 95% CI 1.51–3.10, p<0.001) and MB (sHR 1.51, 95% CI 1.07–2.12, p=0.018), in comparison with those without PAD. The cumulative incidence of AMI was 63.9 and 29.8 per 1,000 patients/year in patients with and without PAD, respectively. The cumulative incidence of MB was 55.9 and 37.6 per 1,000 patients/year in patients with and without PAD, respectively. The rate difference per 1,000 patient-years for AMI between patients with and without PAD was +34.1 (95% CI 30.1–38.1), and for MB +18.3 (16.1–20.4). The net balance between ischemic and bleeding events comparing patients with and without PAD was positive (+15.8 per 1,000 patients/year, 95% CI 9.7–22.0). Conclusions PAD was associated with higher ischemic and bleeding risk after hospital discharge for ACS treated with DAPT. However, the balance between ischemic and bleeding risk was positive for patients with PAD in comparison with patients without PAD. As summary, ACS patients with PAD had an ischemic risk greater than the bleeding risk.

Impact of radiation (RT) regimen on palliative procedures (PP) for patients with resectable locally advanced esophageal cancer treated with exclusive chemoradiation (CRT) or preoperative chemoradiation (CRT+S): results from a phase III trial of the Federation Francophone de Cancerologie Digestive (FFCD 9102)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4531-4531
Author(s):  
G. Crehange ◽  
F. Bonnetain ◽  
S. Seng ◽  
T. N'guyen ◽  
X. Mirabel ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Locally Advanced ◽  
Length Of Hospital Stay ◽  
Local Relapse ◽  
Phase Iii ◽  
Dysphagia Score ◽  
Cancérologie Digestive ◽  
The Impact ◽  
Locally Advanced Esophageal Cancer

4531 Background: The FFCD 9102 trial demonstrated that CRT is an alternative to CRT+S for responding patients. We investigated the type of PP in the follow-up (FU) period, according to the RT scheme: protracted (P-RT) vs. split course (SC-RT). Methods: Resectable T3 N0–1 M0 thoracic esophageal carcinoma were included. First sequence : 2 cycles of cisplatin and 5-FU (day (d)1 - d22) combined with RT. Two schemes of RT were allowed: P-RT (46 Gy / 4.5 weeks (w), 2 Gy / f) or SC-RT (2 one-week courses of 15 Gy, 3 Gy / f). For CRT, the same chemotherapy was given on d43, d64 and d92 combined with 20 Gy / 2w (P-RT) or 15 Gy / 1w (SC-RT). Responding patients after the first sequence were randomized between CRT and CRT+S. The impact of SC-RT vs. P-RT on PP in the FU period was explored using a Mann-Whitney test. Results: From February 1993 to December 2000, 451 pts were registered and 446 were eligible. P-RT: 161 pts, SC-RT: 285 pts. After a median FU of 47.4 months, 2-year overall survival and local relapse-free survival were for P-RT vs. SC-RT: 37.1% vs. 30.5% (p = 0.25) and 76.7% vs. 56.8% (p = 0.002), respectively. P-RT vs. SC-RT: mean length of hospital stay: 48 d vs. 60.5 d (p= 0.0003). Mean number of dilatation sessions: 0.56 vs. 0.66 (p= 0.43). Mean number of stents: 0.21 vs. 0.34 (p= 0.03). Mean number of any PP: 1.01 vs. 1.50 (p= 0.001). Mean dysphagia grade: 2.99 vs. 3.12 (p= 0.21). In the CRT+S-group, P-RT vs. SC-RT: mean length of hospital stay 55.0d vs. 68.7d (p =0.051). Mean number of dilatation sessions: 0.74 vs. 0.74 (p= 0.77). Mean number of stents: 0.09 vs. 0.18 (p= 0.44). Mean number of PP: 1.00 vs. 1.37 (p= 0.054). In the CRT-group, P-RT vs. SC-RT, mean length of hospital stay: 42.6d vs 54.0d (p= 0.053). Mean number of dilatation sessions : 0.38 vs. 0.67 (p= 0.12). Mean number of stents: 0.31 vs. 0.50 (p= 0.03). Mean number of PP: 0.83 vs. 1.86 (p= 0.0005). Conclusions: Stents, rate of PP and length of hospital stay were significantly increased with SC-RT. Dysphagia score was similar between SC-RT and P-RT at last FU. No significant financial relationships to disclose.

scholarly journals Chemoimmunotherapy for Patients with Chronic Lymphocytic Leukemia: MD Anderson Experience Beyond FCR300

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2047-2047 ◽  
Author(s):  
Dai Chihara ◽  
Philip A Thompson ◽  
Hagop M. Kantarjian ◽  
Susan M. O'Brien ◽  
Alessandra Ferrajoli ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Research Funding ◽  
Risk Model ◽  
Lymphocytic Leukemia ◽  
Cox Proportional Hazards Model ◽  
High Dose ◽  
First Line ◽  
Ighv Gene ◽  
The Impact

Abstract Background: Novel, targeted therapies, such as ibrutinib, have transformed outcomes for patients with relapsed CLL and for older and unfit patients in the first-line setting. However, chemoimmunotherapy (CIT) remains the standard-of-care in fit patients. We reported that a subgroup of patients with IGHV mutated CLL experience prolonged PFS and potential cure after first-line CIT withfludarabine, cyclophosphamide and rituximab (FCR). However, FISH data was not available for this cohort of patients. Accurate knowledge of which patients are likely to experience prolonged PFS after FCR is essential to better select patients who may benefit from CIT in the era of novel therapies. Patients and Methods: We analyzed 492 patients who were treated on six clinical trials of first-line CIT between 2004 and 2015. Treatments were FCR, (n=277) FCR with high dose rituximab (n=65), FCR plusmitoxantrone (n=30), FCR plusalemtuzumab (n=60) and FCR with GM-CSF (n=60). Progression-free survival (PFS) and overall survival (OS) were calculated and pretreatment characteristics were evaluated for association with survival outcomes using a Cox Proportional Hazards model. Cumulative incidence was calculated by competing risk (death without event) regression analysis. Results: The median age of patients was 59 (range 28-84). Sixty-seven percent of the patients were male, 33% of the patients had mutated IGHV gene. Thirty percent of patients had del(13q), 19% had Trisomy12, 21% had del(11q), 8% had del(17p) and 21% were negative by FISH. Fifty-nine percent of patients received six cycles of CIT. With a median follow up duration of 6.2 years, the median PFS and OS were 6.3 years and not reached, respectively. Recently reported risk model by Rossi and colleagues using IGHV mutation status and FISH results (Blood 2015) discriminated PFS very well; 5-year PFS for low risk {mutated without del(11q)}, intermediate risk {unmutated or del(11q)} and high risk group {del(17p)} were 81%, 45% and 22%, respectively. Of note, there was a plateau in PFS after 8 years in patients with mutated IGHV gene, with 10-year PFS of 63% (Figure A). There was a significantly improved OS after relapse by the time. Three-year OS in patients who started salvage chemotherapy in 2004 to 2012 and 2012 to 2016 were 59% and 83%, respectively, suggesting the impact of improved salvage treatment options, particularly B cell signaling pathway inhibitors (Figure B). Five-year cumulative incidence of Richter transformation (RT) and AML/MDS was 4.8% and 4.2%, respectively (Figure C, D). There was a difference in onset for these two complications; 52% of RT occurred within 2 years, while 62% of AML/MDS occurred in 2-4 years after CIT. Overall, 110 patients (22.4%) died during the follow-up; the three major causes of death were CLL progression (4.9%), Richter transformation (3.7%) and AML/MDS (3.3%). Conclusion: Patients with mutated IGHV gene and who do not have del(11q) or del(17p) have favorable outcomes and demonstrate a plateau on the PFS curve, consistent with prior studies. Effective salvage therapy has improved outcomes at relapse, but the development of RT and AML/MDS remain major causes of mortality in CLL patients. Given favorable outcomes for patients with mutated IGHV gene treated with FCR, further studies are warranted to identify predictors of non-response among the mutated patients, risk factors for development of AML/MDS and RT and whether choice of first-line therapy can modulate this risk. Disclosures Thompson: Pharmacyclics: Consultancy, Honoraria. O'Brien:Janssen: Consultancy, Honoraria; Pharmacyclics, LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding. Jain:Servier: Consultancy, Honoraria; Novimmune: Consultancy, Honoraria; Incyte: Research Funding; Celgene: Research Funding; ADC Therapeutics: Consultancy, Honoraria, Research Funding; Genentech: Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Seattle Genetics: Research Funding; Novartis: Consultancy, Honoraria; Abbvie: Research Funding; Pharmacyclics: Consultancy, Honoraria, Research Funding; BMS: Research Funding; Infinity: Research Funding. Wierda:Abbvie: Research Funding; Novartis: Research Funding; Acerta: Research Funding; Gilead: Research Funding; Genentech: Research Funding.

P3843Ischemic-bleeding balance according to history of prior bleeding in patients with acute coronary syndrome during treatment with dual antiplatelet therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Dominguez Erquicia ◽  
S Raposeiras Roubin ◽  
E Abu-Assi ◽  
F D'Ascenzo ◽  
S Manzano Fernandez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Cumulative Incidence ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Short Term ◽  
History Of ◽  
The Impact

Abstract Introduction ESC guidelines recommend short-term dual antiplatelet therapy (DAPT) in patients with high bleeding risk. In this sense, patients with prior admissions by bleeding are considered of high-risk of bleeding. With our study, we aimed to show the ischemic-bleeding profile of patients with prior bleeding in comparison with those without prior bleeding during treatment with DAPT. Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without prior admission by bleeding. The impact of prior prior bleeding in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction, whereas for bleeding risk we have considered major bleeding defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,105 have PAD (4.2%). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), 640 had myocardial infarction (2.5%) and 685 had major bleeding (2.6%). After propensity-score matching, we obtained two matched groups of 1,101 patients. In comparison with patients without prior bleeding, those with prior bleeding had higher risk of major bleeding (sHR 2.03, 95% CI 1.33–3.11, p=0.001) with similar risk of myocardial infarction (sHR 0.98, 95% CI 0.61–1.59, p=0.945), in comparison with those without PAD. The cumulative incidence of myocardial infarction was 31 and 32 per 1,000 patients/year in patients with and without prior bleeding, respectively. The cumulative incidence of major bleeding was 63 and 29 per 1,000 patients/year in patients with and without prior bleeding, respectively. The difference between myocardial infarction rate and major bleeding rate was −32 and +3 per 1,000 patient-years in patients with and without prior bleeding (Figure). Conclusions Patients with ACS and prior history of bleeding have a significant increment of bleeding risk during treatment with DAPT. In these patients, short-term DAPT (6 months) should be recommended.

Risk of depression following prostate cancer work-up: A nationwide study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5061-5061
Author(s):  
Anne Sofie Friberg ◽  
Klaus Brasso ◽  
Elisabeth Wreford Andersen ◽  
Signe Benzon Larsen ◽  
John Thomas Helgstrand ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cumulative Incidence ◽  
Treatment Modalities ◽  
Income Quintile ◽  
Increased Risk ◽  
Diagnostic Work ◽  
The Impact ◽  
Work Up ◽  
Diagnostic Work Up

5061 Background: Little is known about the psychological impact of undergoing evaluation for prostate cancer (PCa). We investigated the risk of developing a depression following PCa work-up with benign and malignant findings, respectively, compared with cancer-free men. Methods: A nationwide cohort of men who underwent prostate needle biopsies in Denmark from 1997–2011 was identified through the Danish Prostate Cancer Registry. Primary outcome was indication of moderate to severe depression defined as hospital contact for depression or first redemption of a prescribed antidepressant. For comparison, we selected a minimum of five age-matched cancer-free men per man who had undergone PCa specific diagnostic work-up. We excluded men with other cancer, major psychiatric disorder or use of antidepressants up to three years before study entry. Information on outcome and covariates (age, period, cohabitation status, income quintile and comorbidity) were retrieved from National Danish registries. We illustrated the risk of depression by cumulative incidence functions. Data were analyzed using Cox models adjusted for possible confounders. Results: We identified 54,766 men who underwent work-up including transrectal biopsies of the prostate, among these, 21,419 biopsy sets were benign and 33,347 men were diagnosed with PCa. We found an increasing cumulative incidence of depression in all groups. However, men diagnosed with PCa had a significantly higher risk throughout up to 18 years of follow-up. The adjusted hazard ratio (HR) of depression in men diagnosed with PCa was increased throughout follow-up with the highest risk in the two years following diagnosis (HR 2.77, 95% CI 2.66–2.87). After undergoing biopsies, men with benign results had an increased risk of depression (HR 1.22, 95% CI 1.14–1.31) in the first two years compared with cancer-free men; hereafter, we found no difference. Conclusions: We found an increased risk of depression in men following diagnostic work-up for PCa compared with a matched background population. In men diagnosed with PCa, the risk remained increased throughout the study period. Future studies are needed to further analyze the impact of stage and treatment modalities.

scholarly journals Macrovascular Complications in Patients with Diabetes Mellitus: Incidence and Impact on Survival in Kazakhstan

2021 ◽  
Author(s):  
Antonio Sarría-Santamera ◽  
Binur Orazumbekova ◽  
Tilektes Maulenkul ◽  
Alessandro Salustri ◽  
Natalya Glushkova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Hospital Admission ◽  
Cumulative Incidence ◽  
Hospital Admissions ◽  
Macrovascular Complications ◽  
Diabetic Patients ◽  
Lower Survival ◽  
Patients With Diabetes ◽  
The Impact

Abstract Background and aim: Diabetic patients are at an increased risk for the development of macrovascular complications such as acute myocardial infarction (AMI), stroke and lower-limb amputations (LLA). This study aimed to explore a. the incidence of hospital admission for macrovascular complications (AMI, stroke, and LLA); b. to assess the impact of hospital admission on survival in a large population with diabetes mellitus living in Kazakhstan. Materials and methods: Retrospective observational study using a nationwide anonymized electronic database of 98.469 hospitalized diabetic patients from Kazakhstan between November 2013 and December 2019. The incidence of hospital admissions for AMI, stroke and LLA were obtained to calculate their all-time cumulative incidence, and survival rate at follow-up. Results: The all-time cumulative incidence of hospital admissions was 1.30% for AMI, 1.94% for stroke and 2.94% for LLA. The incidence of macrovascular complications was statistically significantly higher in males compared to females (p-value<0.05). 29.03% of diabetic patients with AMI, 25.16% with stroke and 29.80% with LLA died during the follow-up period. Individuals with AMI had 3.58 (95% CI 3.20; 4.01) times, with stroke 3.86 (95% CI 3.52; 4.24) times and with LLA 3.63 (95% CI 3.38; 3.88) times higher hazard of 6-year death compared to diabetic patients free of these complications. The stratified survival analysis by sex indicated the lower survival in women than in men, and the lower survival in older age groups. Conclusion: The results from this study shows that cumulative incidence of AMI and stroke among diabetic patients admitted in the hospitals in Kazakhstan between 2013-2019 years was similar to the estimates from other countries, but the incidence of LLA was significantly higher in Kazakhstan. Patients with diabetes mellitus (DM) in Kazakhstan are at high risk of excess mortality if they suffer from macro-vascular complications. More research is required to explore the reasons for the high incidence of those complications, in order to propose systematic solutions for lowering the incidence and improve survival.

SAT0256 THE ROLE OF FAST-TRACK ULTRASOUND IN PREVENTING EARLY COMPLICATIONS AND RELAPSES IN GIANT CELL ARTERITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1071.1-1071
Author(s):  
P. Delvino ◽  
S. Monti ◽  
A. Bartoletti ◽  
E. Bellis ◽  
F. Brandolino ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Fast Track ◽  
Clinical Signs ◽  
Conventional Group ◽  
High Dose ◽  
First Relapse ◽  
The Impact

Background:Giant Cell Arteritis (GCA) is the most common form of primary systemic vasculitis, mainly affecting adults over 50 years old. Permanent visual loss (PVL) is one of the most feared complications, occurring in about 20% of cases, typically prior to initiation of high-dose glucocorticoid (GC) therapy. Color-duplex sonography (CDS) of temporal arteries (TAs) and large vessels (LVs) is recognized as a first-line diagnostic tool for patients with suspected GCA. A fast track approach (FTA), incorporating CDS has been associated to a significant reduction of PVL in two retrospective studies1,2.Objectives:To assess the impact of FTA on PVL and risk of relapses during follow-up compared to conventional care prior to the introduction of the FTA in our rheumatology clinic.Methods:Patients with new-onset GCA evaluated in our department from January 1998 to September 2019 were included in the study. The FTA approach for GCA was implemented since October 2016. The diagnosis of GCA was based on positive TAs and/or LVs CDS and/or a positive TA biopsy and clinical signs and symptoms of GCA. All patients were clinically examined by the same rheumatologist who performed the CDS. PVL was defined as total visual impairment in one or both eyes. Data on baseline clinical features and later outcomes were collected.Results:153 patients were included: 115 females (75.2%), mean age at diagnosis 71.6±8.2 years. Of these, 112 patients (73%) were evaluated conventionally and 41 (27%) with FTA. Patients in the FTA group were older (P=0.0002), presented more frequently with polymyalgia rheumatica symptoms, weight loss, jaw or tongue claudication and scalp tenderness (P<0.05 for all comparisons). The median duration of follow-up in the FTA group was shorter compared with the conventional group (1.5 vs 5.8 years). PVL occurred in 22 (19.6%) patients in the conventional group compared to 5 patient (12.2%) in the FTA, leading to a reduction of 37.9% in the relative risk of PVL with the FTA approach. Cumulative incidence of relapses and time to first relapse did not change after FTA introduction (P>0.05) (Fig. 1).Conclusion:The application of a FTA in GCA resulted in a significant reduction of PVL. However, the relapse rate did not seem to be influenced by the FTA, highlighting the need to implement further management strategies, besides earlier diagnosis and prompt initiation of GC, that would impact the course of the disease during long-term follow-upReferences:[1]Patil P, Williams M, Maw WW et al. Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study. Clin Exp Rheumatol 2015;33(Suppl 89):S-103-6.[2]Diamantopoulos AP, Haugeberg G, Lindland A, Myklebust G. The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis? Rheumatology 2016;55:66_70.Fig. 1.Time to first relapse in patients with GCA and evaluated with a FTA compared to conventionally approached patients.Disclosure of Interests:None declared

A Study on the Prognosis of Patients Relapsing after Autologous Stem Cell Transplantation (auto-SCT) for Follicular Lymphoma (FL): The Impact of Remission Duration.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3064-3064
Author(s):  
Julia Stumm ◽  
Jens Dreyhaupt ◽  
Martin Kornacker ◽  
Manfred Hensel ◽  
Michael Kneba ◽  
...  
Keyword(s):  
Cox Regression ◽  
Treatment Time ◽  
Salvage Treatment ◽  
Prognostic Impact ◽  
Post Transplant ◽  
Kaplan Meier ◽  
Cox Analysis ◽  
Time To Relapse ◽  
The Impact

Abstract Although auto-SCT has been in use for treatment of advanced FL since many years, little is known about the course of those who relapse after this procedure. Because these patients may be candidates for aggressive salvage approaches, we sought to study the outcome of patients with FL relapsing after auto-SCT with particular focus on factors predicting for survival. Methods: Relapse cases were identified retrospectively from 244 patients autografted for FL between August 1990 and November 2002 in 3 institutions. Overall survival after relapse (OS) was calculated according to Kaplan-Meier and analyzed for the prognostic impact of pre-relapse variables as well as of post-relapse salvage treatment by univariate log rank comparisons and Cox regression analyses. Results: With a median follow-up of 88 (5–186) months post auto-SCT, 104 relapses occurred, corresponding to a 10-year relapse probability of 0.47 (95%CI 0.4–0.53). Median age of relapsed patients was 48 (22–65) years. FLIPI score at diagnosis was low in 18%, intermediate in 58%, and high in 24%. In 51%, auto-SCT had been given as part of first-line treatment, and 45% had been in complete remission at auto-SCT. Myeloablation included total body irradiation (TBI) in 57% of the cases. Median time from auto-SCT to relapse was 19 (2–128) months, with only 2 relapses occurring later than 6 years post transplant. Transformed FL was present in 14% of those 87 patients who had relapse histology available. Rituximab-containing salvage therapy was given to 50% of the patients after relapse. With 45 (1–139) months of follow-up, median OS after relapse was 100 months. Log rank comparisons identified auto-SCT as part of salvage treatment, time to relapse <12 months, and salvage without rituximab as factors adversely influencing OS, while all other variables listed above had no impact. Cox analysis considering sex, age, salvage auto-SCT, TBI, time to relapse, and rituximab salvage confirmed a possible adverse impact of time to relapse <12 months (hazard ratio 2.58 (95%CI 0.99–6.82); p 0.055) but none of the other covariates on OS. Conclusions: The prognosis of patients relapsing after auto-SCT for FL is surprisingly good. However, those whose disease recurs within the first post-transplant year tend to have a dismal outcome and might benefit from experimental salvage approaches, such as allogeneic SCT.

Impact of Routine Surveillance Imaging on the Outcome of Patients with Relapsed Hodgkin Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1558-1558 ◽  
Author(s):  
Basciano A. Basciano ◽  
Craig Moskowitz ◽  
Andrew D. Zelenetz
Keyword(s):  
Hodgkin Lymphoma ◽  
Prognostic Model ◽  
Conflicts Of Interest ◽  
Risk Group ◽  
Initial Therapy ◽  
High Dose ◽  
Surveillance Imaging ◽  
First Relapse ◽  
The Impact

Abstract Abstract 1558 Poster Board I-581 Purpose To determine the role of asymptomatic post-remission surveillance imaging in the diagnosis of first relapse and its impact on outcomes in patients with Hodgkin lymphoma (HL). Patients and Methods The impact of surveillance imaging on diagnosis of first relapse and outcomes was determined by analysis of a defined patient population with relapsed HL who underwent high dose therapy followed by autologous stem cell rescue (HDT/ASCR). We retrospectively identified 114 patients from the HDT/ASCR database with biopsy-confirmed, relapsed HL; 94 patients had adequate data and follow-up for inclusion in the analysis. Details of surveillance imaging were obtained including: frequency; type; indication; and results of post-remission imaging. The indication for imaging was classified as asymptomatic surveillance (AS) or clinically indicated (CI; i.e. to investigate symptoms or physical examination findings). We have previously reported a validated prognostic model for relapsed HL that found time from initial therapy, presence of B symptoms at relapse and extra-nodal disease at relapse to be adverse factors (Moskowitz et al. Blood 97:616). We determined the prognostic risk group (PRG) (low [L] 0-1 factor, intermediate [I] 2 factors, high risk [H] 3 factors) for all patients. Overall and failure-free survivals were determined using the methods of Kaplan and Meier. Results Patient characteristics included: median age 32 years; PRG L: 65%, I: 31%, H: 4%; AS 36 (38%), CI 58 (62%). The median follow-up for surviving patients was 7.4 years. The PRG (L, I/H) correlated to outcome, validating its applicability in this patient cohort: FFS at 5 years was 64.8% and 49.4% respectively, p=0.045. PRGs were evenly distributed between the AS and CI groups: L: 64% v 66%; I/H: 36% v 37% p=0.48. The FFS at 5 years for patients in the AS and CI groups was 58.4% and 59.3% respectively, p=0.9; similar there was no difference in 5 year OS, AS 62.4% and CI 73.3% p=0.6. Within a given risk group (L or I/H) patients in the AS group did not have a superior outcome compared to the CI group. Conclusion AS does not identify a group of patients with first relapse of HL with a more favorable risk profile according the MSKCC prognostic model. While nearly 40% of patients were identified with relapse as a consequence of AS imaging, this did not identify a group of patients with relapsed HL with improved outcomes compared to patients who had CI imaging. If these results are confirmed in a prospective study, AS may be safely eliminated in HL after remission to reduce cost and long-term risk of the diagnostic imaging. Disclosures No relevant conflicts of interest to declare.

Outcome of Patients (pts) with Acute Myeloid Leukemia (AML) Evolving From Myelodysplastic Syndromes (MDS) Post Hypomethyling Agents (HMA) Failure

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3600-3600
Author(s):  
Hady Ghanem ◽  
Hagop M. Kantarjian ◽  
Guillermo Garcia Manero ◽  
Farhad Ravandi ◽  
Jorge E. Cortes ◽  
...  
Keyword(s):  
Median Survival ◽  
Response Rate ◽  
Salvage Chemotherapy ◽  
High Dose ◽  
Platelet Recovery ◽  
Secondary Aml ◽  
First Relapse ◽  
Investigational Agents ◽  
The Impact

Abstract Abstract 3600 Introduction: Outcome of pts with secondary AML evolving from MDS is dismal. HMA are standard of care for pts with MDS. We have previously reported a median survival of 4 months post HMA failure. The impact of salvage chemotherapy on pts with AML evolving from MDS post HMA failure is unknown. Aims: Assess the impact of salvage chemotherapy on pts with AML evolving from MDS post HMA on survival. Methods: We reviewed 64 consecutive pts with AML evolving from MDS and treated at MDACC with HMA in clinical trials between on 1/2003 and 7/2012. Response assessment followed standard criteria. Overall survival (OS) was measured from the time of therapy till the time of death or last follow-up. Results: 64 pts with a median age of 63 years (range, 38–82) were assessed, with 39 % older than 65 years. At the time of MDS diagnosis, 13 (20%) had a high International Prognostic System Score (IPSS), 31 (48%) had an intermediate 2 IPSS score, 16 (25%) had an intermediate-1 risk IPSS score and 1(2%) had a low-risk IPSS. Thirty-seven patients (57%) had complex cytogenetics. Prior to progression into AML, 51 pts (80%) received decitabine based regimen and 13 (20%) received azacitidine based regimen. Responses to HMA were as follows: 18 pts (28%) achieved a complete remisson (CR) and an additional 2 pts (3%) achieved CR with incomplete platelet recovery (CRp), for an overall response rate (ORR) of 31%. After progression to AML, all 64 pts (100%) received at least 1 salvage regimen, 32 (50%) received 2 or more salvage regimens and 12 pts (18%) received 3 more salvage regimens. Twenty-nine pts received high-dose cytarabine (HDAC)-based regimen as first salvage and 5 as second salvage. Thirty-six pts received investigational agents at time of first relapse. Of the 34 pts who received HDAC, 7 (20%) achieved CR. Of the 36 who received investigational agents at first relapse, 8 achieved CR and 1 patient achieved CRp, for an ORR of 25%. 12 pts underwent allogeneic or cord stem transplantation, 5 of them had active disease at time of receiving the transplant, and 7 were in CR: five after HDAC containing regimens, and 2 after other agents. Median duration of response was 27 months (range, 2 to 81) after 1st salvage and 5 months (range, 0 to 74) after 2nd salvage. With a median follow-up of 52 months from transformation into AML, 5 (8%) pts remained alive, 3 of them in CR. The median OS after HMA failure is 6.4 months with a 1-year survival of 23% and a 2-year survival of 8%. Conclusion: The outcome of pts with AML evolving from MDS post HMA failure is poor with a median survival of 6.4 months. Response rate to salvage chemotherapy with HDAC is low (21%). These pts constitute a distinct population from those with secondary AML and should benefit from more innovative approaches. Disclosures: Ravandi: Eisai: Honoraria.

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