Clinical characteristics of 36 non-survivors with COVID-19 in Wuhan, China

SummaryBackgroundAlthough the outbreak of Coronavirus disease 2019 (COVID-19) has caused over 2200 deaths in China, there was no study about death yet. We aimed to describe the clinical characteristics of non-survivors with COVID-19.MethodsFor this retrospective, single-center study, we included 36 non-survivors with COVID-19 in the Fifth Hospital of Wuhan. Cases were confirmed by real-time RT-PCR between Jan 21 and Feb 10, 2020 according to the recommended protocol. The epidemiological, demographic, clinical, laboratory, radiological and treatment data were collected and analyzed. Outcomes were followed up until Feb 14, 2020. This study was approved by the ethics commissions of the Fifth Hospital of Wuhan, with a waiver of informed consent due to a public health outbreak investigation.FindingsWe included 36 patients who died from COVID-19. The mean age of the patients was 69.22 years (SD 9.64, range 50-90). 25(69.44%) patients were males, and 11 (30.56%) female. 26 (72.22%) patients had chronic diseases, mainly including hypertension, cardiovascular disease and diabetes. Patients had common clinical symptoms of fever (34 [94.44%] patients), cough (28 [77.78%] patients), shortness of breath (21 [58.33%] patients), and fatigue (17 [47.22%] patient). Chest computed tomographic scans showed that 31 (96.88%) patients had bilateral pneumonia. Lymphopenia (lymphocyte count, 0.67□×□109/L [SD, 0.33]) occurred in 24 patients (70.59%), decreased albumin (30.18, [SD, 4.76]) in 25 patients (80.65%), elevated D-dimer (8.64 [IQR, 2.39-20]) in 27 patients (100%), and elevated lactate dehydrogenase (502.5 U/L [IQR, 410-629]) in 26 patients (100%). Nearly all of the patients have elevated CRP (106.3 mg/L [IQR, 60.83-225.3]), PCT (0.61 ng/ml [IQR, 0.16-2.10]) and IL-6 (100.6 pg/ml [IQR, 51.51-919.5]). Most patients received antiviral therapy and antibiotic therapy, and more than half of patients received glucocorticoid therapy (25 [69.44%]). All the patients had acute respiratory distress syndrome (ARDS). The median time from onset to ARDS was 11 days. One (2.78%) patient presented with acute renal injury. The median time from onset to death was 17 days.InterpretationLots of patients died from COVID-19 till now. The median survival time of these non-survivors from onset to death was about 2 weeks. Most patients were older males with comorbidities. They finally progressed to ARDS. The median time from onset to ARDS was 11 days. Gradually decreased lymphocytes and increased inflammation biomarkers were common, and need to be monitored in the routine treatment.FundingThere is no any funder involved in this study.Research in contextEvidence before this studySARS-CoV-2 has been spreading in China as well as in other countries. We searched PubMed for articles published up to Feb 15, 2020. Serveral articles that describe the epidemiological and clinical characteristics of general COVID-19 patients. However, special reports about dead cases of COVID-19 were limited but warranted, considering the large amount of confirmed cases, which is still increasingAdded value of this studyWe retrospectively analysed specific clinical information of 36 non-survivors infected with SARS-CoV-2 in this single-centered study. Most patients were older males with comorbidities. Gradually decreased lymphocytes and increased inflammation biomarkers were found in these patients. They finally progressed to ARDS. The median time from onset to ARDS was 11 days. The mean survival time in our cohort of COVID-19 non-survivors was about 2 weeks.Implications of all the available evidenceLots of patients died from COVID-19 till now. The median survival time of these non-survivors from onset to death was about 2 weeks. Most patients were older males with comorbidities. They finally progressed to ARDS. Early detection and intervention of patients are especially important which can delay the development from mild to severe cases.

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Treatment of advanced colorectal and gastric adenocarcinomas with 5-fluorouracil and high-dose folinic acid.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.5.685 ◽

1986 ◽

Vol 4 (5) ◽

pp. 685-696 ◽

Cited By ~ 249

Author(s):

D Machover ◽

E Goldschmidt ◽

P Chollet ◽

G Metzger ◽

J Zittoun ◽

...

Keyword(s):

Survival Time ◽

Folinic Acid ◽

Disease Progression ◽

Median Time ◽

Gastric Adenocarcinoma ◽

Median Survival ◽

Median Survival Time ◽

Single Agent ◽

High Dose ◽

Gastric Adenocarcinomas

We report the results of an expanded trial of 5-fluorouracil (5-FU) combined with high-dose folinic acid for treatment of patients with advanced colorectal or advanced gastric adenocarcinoma. In each treatment course, the patients received both 5-FU (340 to 400 mg/m2/d by intravenous (IV) infusion for a period of 15 minutes) and folinic acid (200 mg/m2/d by IV bolus) for 5 consecutive days, with a 21-day interval between courses. Eighty-six patients with colorectal carcinoma were evaluated. The combined complete and partial response rates were 39% for 54 patients who did not receive prior chemotherapy and 22% for 32 patients who had previously received chemotherapy. Four patients who were previously resistant to 5-FU attained objective responses. The median time to disease progression for the 28 responders was 10 months. The median survival time of responders was 19.5 months, and the probability of their being alive at 2 years was 40%. Of 27 patients with gastric adenocarcinoma, 13 (48%) responded to therapy. Their median time to disease progression was 5.5 months. The median survival time of responders was 11 months, and their probability of being alive at 15 months was 30%. Toxicity was within acceptable limits. Toxic effects included stomatitis, diarrhea, conjunctivitis, skin rash, and mild myeloid hypoplasia. In a separate study, plasma concentrations of L-folates greater than 10(-5) mol/L were achieved after a rapid single IV injection of 200 mg/m2 of folinic acid. Comparisons of our results with those reported in previous studies on 5-FU administered as a single agent suggest that, in advanced colorectal and gastric adenocarcinoma, folinic acid administered in high doses enhances the effectiveness of 5-FU administered concomitantly. Furthermore, some colorectal tumors that were previously resistant to 5-FU become sensitive to this drug. The survival of the patients who responded to therapy was markedly improved over that observed in reported series of untreated patients with advanced colorectal and gastric adenocarcinomas.

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Deficiency of Either Carboxypeptidase B2 or Carboxypeptidase N Exacerbated Disease Activity in a Mouse Model of Hemolytic Uremic Syndrome

Blood ◽

10.1182/blood.v128.22.3758.3758 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3758-3758

Author(s):

Lawrence L. Leung ◽

Zhifei Shao ◽

Toshihiko Nishimura ◽

Qin Zhou ◽

Laura Gigliello ◽

...

Keyword(s):

Mouse Model ◽

Hemolytic Uremic Syndrome ◽

Survival Time ◽

Median Time ◽

Median Survival ◽

Median Survival Time ◽

Conflicts Of Interest ◽

Uremic Syndrome ◽

Carboxypeptidase N ◽

C5a Anaphylatoxin

Abstract Two different basic carboxypeptidases circulate in blood - carboxypeptidase N (CPN) and proCPB2. CPN is constitutively active, while proCPB2 is a zymogen, (also termed thrombin activatable fibrinolysis inhibitor, TAFI), and is activated by the endothelial thrombin/thrombomodulin complex to CPB2. Their kinetics of substrate cleavage are distinct but both can efficiently inactivate the complement anaphylatoxins, C3a and C5a. Hemolytic uremic syndrome (HUS) is caused by Shiga toxin (stx) producing strains of E. coli and is characterized by the triad of hemolysis, thrombocytopenia and uremia. We hypothesized that in a mouse model of HUS, Cpb2-/- and Cpn-/- mice would have prolonged C5a anaphylatoxin activity thus causing disease exacerbation. HUS was induced by stx2 and LPS administration in WT, Cpn-/- and Cpb2-/- mice. In Cpb2-/- mice, median time to death was earlier (60 hours, n=15) than in WT mice (96 hours: n=42, p<0.0001), and had greater kidney and liver damage shown by increases in ALT, AST, BUN and creatinine levels at 48 hours (creatinine Cpb2-/-: 1.01 mg/dL, WT: 0.25 mg/dL; Cpb2-/- control: 0.20 mg/dL and WT control: 0.19 mg/dL; Cpb2-/- p<0.0001 vs. all other groups, n>9). An increase in hemolysis was demonstrated by reduced RBC count and hemoglobin level plus an increase in total bilirubin and LDH. Profound thrombocytopenia (Cpb2-/-: 121,000/μL vs. WT: 217,000/μL; p=ns) developed in both genotypes (control Cpb2-/-: 1,001,000/μL vs. control WT: 1,141,000/μL; p=ns but vs. either Cpb2-/- or WT with HUS, p<0.0001) and thus the HUS clinical triad was present. Histology showed tubular epithelial necrosis in the kidney ante-mortem. Administration of either toxin separately caused milder disease without the characteristics of HUS and with no observed mortality. Induction of the disease depended on co-administration of both toxins. Treatment with anti-murine C5 antibody (0.75 mg every 24 hours from 3 hours before disease initiation) improved survival of both WT and Cpb2-/- mice with a median survival time of 168 hours for both genotypes (n=11, p=0.003 and <0.0001 respectively) and normalized the outcomes between the genotypes. Cpn-/- mice also died sooner (median time to survival 81.5 hours, n=28) than WT mice (96 hours, n=42, p=0.0002). The median survival time between Cpb2-/- and Cpn-/- mice was also significantly different (60 vs. 81.5 hours, p=0.0083). This is a first direct comparison of the role of CPN vs. CPB2 in regulating C5a activity in a disease relevant mouse model. Our study suggests that both CPB2 and CPN protect against HUS by inactivation of C5a with CPB2 having a greater effect than CPN. When Cpb2+/-/Cpn+/- mice are crossed, all expected genotypes are recovered in the expected Mendelian ratios including double deficient Cpb2-/-/Cpn-/- mice. Thus absence of both plasma basic carboxypeptidases is not essential for murine life. We are currently evaluating the Cpb2-/-/Cpn-/- mice in our HUS model. Disclosures No relevant conflicts of interest to declare.

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An Expedited Palliative Radiation Protocol for Lytic or Proliferative Lesions of Appendicular Bone in Dogs

Journal of the American Animal Hospital Association ◽

10.5326/0450024 ◽

2009 ◽

Vol 45 (1) ◽

pp. 24-32 ◽

Cited By ~ 23

Author(s):

Heather M. Knapp-Hoch ◽

Janean Louise Fidel ◽

Rance K. Sellon ◽

Patrick R. Gavin

Keyword(s):

Pain Relief ◽

Survival Time ◽

Median Time ◽

Median Survival ◽

Median Duration ◽

Late Effects ◽

Median Survival Time ◽

Prognostic Indicator ◽

Bone Lesions ◽

Palliative Radiation

Fifty-eight dogs with lytic or proliferative bone lesions were treated with a radiation protocol of two 8-Gy fractions over 2 consecutive days. The protocol was well tolerated, with no increase in early or late effects over previously published protocols. Forty-three (91%) of 47 dogs responded positively to radiation, with a median time of 2 days to onset of pain relief. Median duration of pain relief was 67 days (range 12 to 503 days; mean 99±16 days). Median survival time for all dogs was 136 days (mean 179±18 days). Distal radial location was a positive prognostic indicator for survival (P=0.005).

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Radiotherapy plus the anti-EGFR mAb nimotuzumab or placebo for the treatment of high-grade glioma patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.2515 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 2515-2515

Author(s):

Maria Teresa Solomon ◽

Julio Cesar Selva ◽

Javier Figueredo ◽

Jose Vaquer ◽

Carolina Toledo ◽

...

Keyword(s):

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Drug Exposure ◽

Progression Free Survival ◽

High Grade Glioma ◽

Clinical Activity ◽

High Grade ◽

Double Blind ◽

The Mean

2515 Background: Despite remarkable advances in multimodal therapy, high grade glioma (HGG) patients still face a poor prognosis. EGFR is well validated as a primary contributor of HGG initiation and progression. Nimotuzumab is a humanized monoclonal antibody (mAbs) that recognizes the EGFR extracellular domain. While it has similar preclinical and clinical activity when compared to other anti-EGFR mAbs, it does not induce skin toxicity or hypomagnesemia. Methods: A randomized, double blind, multicentric clinical trial was conducted in 70 anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM) patients that received radiotherapy (RT) plus nimotuzumab or placebo. Patients received 6 weekly doses of nimotuzumab or placebo together with radiotherapy. Treatment was maintained every 3 weeks, until completing 1 year of treatment. GBM patients did not receive temozolomide since the drug cannot be sold to Cuba. The objectives of this study were to assess the overall survival, progression free survival (PFS), response rate, immunogenicity and safety in both treatment groups. Results: Seventy patients were included in the study: 41 AA and 29 GBM. The median cumulative dose was 3600 mg of nimotuzumab and the median antibody number of doses was 16. The combination of nimotuzumab and radiotherapy was very safe. The most prevalent related adverse events included grade 1-2 nausea, fever, tremors and anorexia. There was no increasing toxicity with repeated drug exposure. No anti-idyotipic response was detected. The mean and median survival time for subjects treated with nimotuzumab and RT was 31.06 and 17.76 months while the mean and median survival time for controls was 21.07 and 12.63 months, respectively. For the evaluable patients of the AA stratum, the median survival time was 44.56 months (active drug) vs. 14.6 months (control). For the evaluable patients in the GBM cohort, the median survival time was 16.06 months (nimotuzumab arm) vs. 8.36 months (placebo arm). Median PFS was 18.23 vs. 6.25 months. Conclusions: In this randomized trial, nimotuzumab continues showing an excellent safety profile and positive efficacy results in patients with high grade glioma in combination with irradiation.

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The Effects of High Temperatures on Roach (Rutilus Rutilus)

Journal of Experimental Biology ◽

10.1242/jeb.36.1.203 ◽

1959 ◽

Vol 36 (1) ◽

pp. 203-216 ◽

Cited By ~ 2

Author(s):

ANTHONY W. COCKING

Keyword(s):

Gall Bladder ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Yellow Perch ◽

Perca Flavescens ◽

Rutilus Rutilus ◽

Lethal Temperature ◽

Roach Rutilus Rutilus ◽

The Mean

1. The temperature at which 50% of a sample of roach (Rutilus rutilus) die within a week cannot be raised above 33.5° C. by raising the acclimatization temperature. 2. The roach is about as eurythermal as the yellow perch (Perca flavescens). 3. The mean asphyxial concentration of oxygen at 30 and 32°C is approximately 0.8 mg./l. 4. Median survival time at any lethal temperature increases with increase in acclimatization temperature; survival time for any acclimatization temperature decreases as test temperature increases; the temperature at which 50% of a sample die within a week rises by about 1° C. for each 3° C. rise in acclimatization temperature. 5. The behaviour, on transfer to higher temperatures, depends on the acclimatization temperature and the size of the jump in temperature and can be divided into five characteristic stages. 6. Dying fish develop a black pattern; myotomic swimming muscles die first and opercular muscles last. The heart was still beating when the fish were opened but the gall bladder was abnormal.

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Prevalence, Median Time and Associated Factors with the Likelihood of Initial Antidepressant Change in Treatment of Major Depressive Disorder: A Cross-Sectional Study in Qatar.

10.21203/rs.3.rs-120061/v1 ◽

2020 ◽

Author(s):

Nervana Elbakary ◽

Sami Ouanes ◽

Sadaf Riaz ◽

Oraib Abdallah ◽

Islam Mahran ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Survival Time ◽

Median Time ◽

Median Survival ◽

Median Survival Time ◽

Associated Factors ◽

Cox Regression ◽

Secondary Outcome ◽

Major Depressive

Abstract Background: Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4-12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Hence, we aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the factors that were associated with IAD change.Methods: This was a retrospective study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated factors were examined using three cox regression models.Results: A total of 487 patients met the inclusion criteria of the study, 431 (88%) of them had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44% - 53%]) had their IAD changed within less than or equal to 30 days. The median time to IAD change was 43 days with 95% CI [33.2 – 52.7]. Cox regression analysis showed three statistically significant factors were associated with our secondary outcome: age, un-optimization of the dose, and absence of comorbid anxiety.Conclusions: Our findings suggest that clinicians resorted to IAD change within a median time of six weeks. However, this change often occurred without optimization of the IAD dose and might be too late. Future prospective studies with adequate randomization can better investigate the median survival time on IAD and other associated factors.

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Clinical Characteristics and Prognosis of Renal Cell Carcinoma With Spinal Bone Metastases

Frontiers in Oncology ◽

10.3389/fonc.2021.659779 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jianpo Zhai ◽

Ning Liu ◽

Hai Wang ◽

Guanglin Huang ◽

Libo Man

Keyword(s):

Renal Cell Carcinoma ◽

Regression Analysis ◽

Prognostic Factors ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Clinical Characteristics ◽

Cox Regression ◽

Visceral Metastasis ◽

Cox Regression Analysis

BackgroundThe prognosis of renal cell carcinoma (RCC) with spinal bone metastasis (sBM) varies greatly. In this study, we aimed to define the clinical characteristics and prognostic factors of RCC with spinal bone metastasis (sBM) in our center.MethodsThe clinical and medical records of RCC patients with sBMs were collected. The gender, age, time of BM, the extent of BM, the number of BMs, the presence or absence of visceral metastasis, and the pathological type of BM were investigated. All patients were followed up regularly. Overall survival (OS) was calculated from the date of BMs diagnosis to death or last follow-up using Kaplan-Meier method and modelled with Cox regression analysis.ResultsForty-three RCC patients with sBM were collected. sBM was found synchronously in 30 patients (70%) and metachronously in 13 patients (30%). The median survival time was 30 months in 13 patients (30%) with solitary sBM and 19 months in 30 patients (70%) with multiple sBMs (P = 0.002). Visceral metastasis occurred in 12 patients (28%) with the median survival time of 17 months, while the other 31 patients (72%) had no visceral metastasis with the median survival time of 29 months (P<0.001). En-block resection was done in 10 patients with median survival time of 40.1 months. Non-en-block resection were done in 33 patients with median survival time of 19.7 months (P<0.001). Multivariate COX regression analysis showed that MSKCC score, number of BM, visceral metastasis, and en-block resection are the independent prognosis factors of RCC patients with sBM.ConclusionsMSKCC risk stratification, number of sBM, visceral metastasis and en-block resection are significant prognostic factors for OS in RCC patients with spinal BM. Therefore, for selected patients who has solitary spinal BM with no visceral metastasis, en-block resection of spinal BM can potentially prolong survival and is the treatment of choice.

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Six-minute walk distance and survival time in patients with idiopathic pulmonary fibrosis in Brazil

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562018000000049 ◽

2018 ◽

Vol 44 (4) ◽

pp. 267-272 ◽

Cited By ~ 3

Author(s):

Eliane Viana Mancuzo ◽

Maria Raquel Soares ◽

Carlos Alberto de Castro Pereira

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Walk Distance ◽

Lower Survival ◽

The Mean ◽

Minute Walk Distance ◽

Minute Walk

ABSTRACT Objective: To determine the cut-off point for the six-minute walk distance (6MWD) that indicates lower survival time in patients with idiopathic pulmonary fibrosis (IPF) in Brazil. Methods: This was retrospective study carried out in two referral centers for IPF. The 6MWT was performed twice, considering the highest value of the 6MWD. Various cut-off points were estimated, in absolute values and in percentage of predicted values, using ROC curves, the Kaplan-Meier method, and data from other studies. Results: The sample comprised 70 patients with IPF. The mean age was 71.9 ± 6.4 years, and 50 patients (71.4%) were male. The mean FVC was 76.6 ± 18.2% of predicted value. The mean SpO2 at rest before and after 6MWT were 93.8 ± 2.5% and 85.3 ± 6.5%, respectively. The median survival time was 44 months (95% CI: 37-51 months). The mean 6MWD was 381 ± 115 m (79.2 ± 24.0% of predicted). After the analyses, the best cut-off points for estimating survival were 6MWD < 330 m and < 70% of predicted. The median survival time of patients with a 6MWD < 330 m was 24 months (95% CI: 3-45 months), whereas that of those with a 6MWD ≥ 330 m was 59 months (95% CI: 41-77 months; p = 0.009). Similarly, the median survival times of those with a 6MWD < 70% and ≥ 70% of predicted, respectively, were 24 months (95% CI: 13-35 months) and 59 months (95% CI: 38-80 months; p = 0.013). Cox multivariate regression models including age, sex, smoking status, SpO2 at the end of the 6MWT, and FVC% showed that 6MWD remained significantly associated with survival (p = 0.003). Conclusions: Values of 6MWD < 330 m and < 70% of predicted value were associated with lower survival time in IPF patients in Brazil.

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Can Allo-HSCT Improve the Poor Clinical Outcome of the “Internal Tandem Duplication” of the FLT3 Gene?

Blood ◽

10.1182/blood.v124.21.5938.5938 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5938-5938

Author(s):

Paolo Bernasconi ◽

Catherine Klersy ◽

Anna Amelia Colombo ◽

Daniela Caldera ◽

Francesco Ripamonti ◽

...

Keyword(s):

Survival Time ◽

Median Time ◽

Median Survival ◽

Median Survival Time ◽

Tandem Duplication ◽

Cox Model ◽

High Dose ◽

Internal Tandem Duplication ◽

Relapse Risk

Abstract AML patients (pts) with a normal chromosome pattern and the “Internal Tandem Duplication” (ITD) of the FLT3 gene have an overall and event-free survival (OS, EFS) inferior than those of pts with a FLT3 “wild-type” gene because of a higher relapse risk, are placed in the intermediate-1 prognostic category, and when in complete remission (CR) are candidates to allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the role of allo-HSCT in ITD+ pts is still debated and a recent retrospective analysis has stated that FLT3/ITD adversely affected allo-HSCT outcome in the same direction as it does after chemotherapy. Thus, the present study was aimed to compare the OS, EFS and relapse risk of pts submitted to allo-HSCT in first CR or in initial relapse, defined by a 5-10% bone marrow blast cell percentage, with those of pts submitted to chemotherapy alone. The study cohort consisted of 54 chromosomally normal, ITD+ consecutive non-M3 AML pts who were included in 168 AML pts aged 18-66 years who came to our observation in the period January 2007-December 2013. At diagnosis median age was 48.6 years (range 18-66), 25 pts were males and 29 females. Median follow-up was 16.2 months (0.4-68.8): median follow-up for responsive pts was 7.15 months (range 0.26-27.6), for relapsed pts was 18.1 (range 1.9-68.8) and for transplanted pts was 9.1 months (range 2.9-26.8). All pts received the same induction treatment that consisted of standard Idarubicine+Ara-c “3+7” followed by two consolidation courses with high-dose Ara-c. Those who failed induction received other treatment schedules among which Fludarabine+Ara-c+Idarubicine was the most common. At the end of consolidation 38 pts were in first CR, achieved after 3+7 in 27 pts and after a second different course in 11. Sixteen pts had a resistant disease. After a median time of five months (range 1-21) 21/38 pts (55.2%) relapsed. All received a re-induction and 8/21 (38.1%) attained a second CR. Allo-HSCT was performed in a total of 23 pts: 12 first CRs, 6 second CRs and 5 initial relapses. The donor was a sibling in 7 pts, an unrelated donor in 13 and an haplo-identical donor in 3; the HSC source was the marrow in 6 pts, the peripheral blood in 16 and the cord blood (CB) in one. The Conditioning regimen was myeloblative (mainly Busulfan+Fludarabine) in 21 and non-myeloblative in 2; GvHD prophylaxis consisted of Cyclosporine A, steroids and methotrexate “short course”. The median number of CD34+ cells infused was 5.14x106/kg (1.3-12.7). All pts except that who received CB engrafted after a median time of 15 days (12-28); 21 were complete chimeras, two partial chimeras. Thirteen pts developed acute GvHD (grade I in 3 pts, grade II in 5, grade III in 2 and grade IV in 3) which totally/partially recovered after high dose steroids along with different immunosuppressive drugs in 4 and 9 pts respectively. Eleven pts developed a chronic GvHD which was the evolution of an aGvHD in 9, targeted different organs, was stable in 3 pts and completely/partially recovered in 4 and 2 pts respectively. Post-transplant relapse occurred in 3/12 first CRs, in none second CRs and in 3/5 initial relapse. The estimated response rate for CR pts submitted to allo-HSCT was 422.1 (95% CI: 262.4-679.1) versus 64.6 (95% CI: 40.7-102.6) for those submitted to chemotherapy alone with a median survival time of 7.2 months (range 5.3-8.8) versus not reached (1.9-not available); on univariable Cox model the HR of allo-HSCT pts was 37.9 (95% CI: 9.4-152.0) with p=0.0000. The estimated relapse rate for CR pts submitted to allo-HSCT was 8.6 (95% CI: 2.1-34.4) versus 44.3 (95% CI: 25.7-76.3) for those submitted to chemotherapy alone with a median survival time not reached (range not available) versus 13.2 (7.2-not available); on univariable Cox model the HR of allo-HSCT pts was 0.5 (95% CI: 0.2-1.1) with p=0.06. The estimated death rate for CR pts submitted to allo-HSCT was 28.7 (95% CI: 13.7-60.4) versus 49.7 (95% CI: 32.1-77.1) for those submitted to chemotherapy alone with a median survival time of 18.3 months (range 14.2-not available) versus 12.2 (8.8-18.9); on univariable Cox model the HR for allo-HSCT pts was 0.48 (95% CI: 0.2-1.1) with p=0.09. In conclusion, our series suggests that in ITD+ pts allo-HSCT significantly strengthens CR in pts who had already responded to conventional chemotherapy, but it presents only a trend towards significance when its superiority to prevent relapse was considered. Disclosures Castagnola: Gilead Sciences: Research Funding.

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Clinical characteristics and prognosis of renal cell carcinoma with spinal bone metastases

10.21203/rs.2.18443/v1 ◽

2019 ◽

Author(s):

Jianpo Zhai ◽

Ning Liu ◽

Hai Wang ◽

Haidong Wang ◽

Guanglin Huang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Regression Analysis ◽

Prognostic Factors ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Clinical Characteristics ◽

Cox Regression ◽

Visceral Metastasis ◽

Cox Regression Analysis

Abstract Background: The prognosis of renal cell carcinoma (RCC) with spinal bone metastasis (sBM) varies greatly. To define the clinical characteristics and prognostic factors of RCC with spinal bone metastasis (sBM) in our center. Methods: The clinical and medical records of RCC patients with sBMs were collected. The gender, age, time of BM, the extent of BM, the number of BMs, the presence or absence of visceral metastasis and the pathological type of BM were investigated. All patients were followed up regularly. OS was calculated from the date of BMs diagnosis to death or last follow-up using Kaplan-Meier method and modelled with Cox regression analysis. Results: 22 RCC patients with sBM were collected. sBM was found synchronously in 15 patients (68.2%) and metachronously in 7 patients (31.8%) . The median survival time was 30 months in 7 patients (31.8%) with solitary sBM and 19 months in 15 patients (68.2%) with multiple sBMs. Visceral metastasis occurred in 6 patients (27.3%)with the median survival time of 17 months, while the other 16 patients (72.7%) had no visceral metastasis with the median survival time of 29 months ( P =0.006). Enblock resection was done in 7 patients with median survival time of 34 months. Non-Enblock resection were done in 15 patients with median survival time of 18 months( P =0.006). Multivariate COX regression analysis showed that visceral metastasis and Enblock resection are the independent prognostic factors of RCC with sBM. Conclusions: No visceral metastasis, En-block resection are good prognostic factors for RCC with sBM. Therefore En-block resection of sBM is recommended for RCC without visceral metastasis.

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