Concerns about disease management and psychological stress in SAPHO patients during the COVID-19 epidemic

Objectives The coronavirus disease 2019 (COVID-19) epidemic brings potentially impact on the care of patients with rheumatic diseases, including SAPHO syndrome. We aimed to investigate the disease status, concerns about management, and psychological stress in SAPHO patients during the COVID-19 epidemic. Method A structured questionnaire was distributed online to patients with SAPHO syndrome enrolled in a Chinese cohort study on March 3rd, 2020. Patients were ask about the current treatments, disease status, and concerns about disease management during the epidemic. Psychologic stress (scored from 0 to 10 points) and psychological problems were reported by the patients. Results A total of 157 patients (mean age 38.4 ± 12.3 years, 66.9% females) were included in the study. None of the patients were diagnosed with COVID-19. Sixty-five (41.4%) patients worried about their disease conditions during the epidemic with concerns including medication shortage (73.8%), delay of consultation (46.2%), and disease aggravation (61.5%). Sixty-seven (42.7%) patients had medication withdrawal or dose reduction due to lack of drugs, irregular daily schedule or subjective reasons. The most common psychological problems reported was little interest or pleasure in doing things (66.2%). Patients with progressive disease condition were more distressed and disturbed by the epidemic. Patients with nail involvement felt more worried about their disease conditions than patients without (59.6% vs 31.0%, p =0. 001). Conclusions The COVID-19 epidemic imposes a negative impact on the disease management and psychological stress in SAPHO patients. Patients' access to specialty care and medication well as mental stress is of great concern.

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NOMOPHOBIA PADA MAHASISWA UNAIR ( STUDI PADA MAHASISWA TINGKAT AKHIR FKM PSDKU UNIVERSITAS AIRLANGGA DI BANYUWANGI)

Journal of Community Mental Health and Public Policy ◽

10.51602/cmhp.v3i2.53 ◽

2021 ◽

Vol 3 (2) ◽

pp. 59-68

Author(s):

Iftitah Amalia Rahmadani ◽

Ayik Mirayanti Mandagi

Keyword(s):

Physical Activity ◽

College Students ◽

Social Interaction ◽

Negative Impact ◽

Cross Sectional ◽

Final Level ◽

Quantitative Studies ◽

Telecommunication Equipment ◽

Daily Schedule ◽

Smartphone Use

ABSTRACTSmartphone is one of the telecommunication equipment, nowadays has become a must-have for everyone. Unfortunately, people do not realize that smartphone use have a negative impact in the form of nomophobia. Nomophobia is a person's anxiety if they cannot access their smartphone. College students are a group that can also be affected by nomophobia. This study aimed to find out the picture of nomophobia in final level students of FKM PSDKU Universitas Airlangga in Banyuwangi. The population used weres 41 people. The research design used descriptive quantitative studies with a cross sectional approach. The research was conducted by providing google form related to Nomophobia Questionnaire (NMP-Q). The results showed that students with the number of 4 people (9.76%) have mild nomophobia and 37 people (90.24%) have moderate nomophobia. The conclusion of the results obtained that all college students of the final level of FKM PSDKU Universitas Airlangga in Banyuwangi experienced nomophobia. It is recommended for students to increase physical activity and social interaction and set a daily schedule of activities in order to do more activities without using a smartphone.Keywords: Nomophobia, Smartphone, Final Students ABSTRAKPonsel pintar sebagai salah satu alat telekomunikasi, saat ini telah menjadi barang wajib untuk dimiliki setiap orang. Sayangnya manusia tidak menyadari bahwa penggunaan ponsel pintar memiliki dampak negatif berupa nomophobia. Nomophobia merupakan suatu kecemasan seseorang apabila tidak dapat mengakses ponsel pintarnya. Mahasiswa merupakan suatu kalangan yang juga bisa terdampak nomophobia. Penelitian ini bertujuan untuk mengetahui gambaran nomophobia pada mahasiswa tingkat akhir FKM PSDKU Universitas Airlangga di Banyuwangi. Jumlah populasi yang digunakan adalah sejumlah 41 orang. Desain penelitian menggunakan studi deskriptif kuantitatif dengan pendekatan cross sectional. Penelitian dilakukan dengan memberikan google form terkait Nomophobia Questionnaire (NMP-Q). Hasil dari penelitian menunjukkan bahwa mahasiswa dengan jumlah 4 orang (9,76%) mengalami nomophobia ringan dan 37 orang (90,24%) mengalami nomophobia sedang. Kesimpulan dari hasil yang didapatkan bahwa seluruh mahasiswa tingkat akhir FKM PSDKU Universitas Airlangga di Banyuwangi mengalami nomophobia. Disarankan terhadap mahasiswa untuk memperbanyak aktivitas fisik dan interaksi sosial serta mengatur jadwal kegiatan harian agar dapat lebih melakukan aktivitas tanpa menggunakan ponsel pintar.Kata Kunci: Nomophobia, Ponsel pintar, Mahasiswa tingkat akhir.

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The psychological effects of unmarried women “a field study on a sample of unmarried women in Algeria”

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1845 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s902-s902

Author(s):

L. Fekih ◽

B. Mounis

Keyword(s):

Psychological Stress ◽

Negative Impact ◽

Self Esteem ◽

Professional Status ◽

Self Confidence ◽

Common Problems ◽

Competing Interest ◽

The Impact ◽

Late Stages ◽

Confidence Scale

BackgroundThe present research was designed to determine the psychological stress as experienced by unmarried women in the education sector, and how to help them to discover the meaning of their presence in the framework, innovation and achievement, art, science, comprehension, love and adaptation in life.AimThis research aims to identify the various problems and mental disorders that unmarried women suffering from, and to determine the differences between unmarried women in terms of the psychological problems resulting from “unmarried” in: ages, kind and professional status.MethodThe method used in this research is purely descriptive following the collected data from the sample of 200 unmarried women. The tools that were used in this research as follow: Self-Confidence Scale, Psychological Stress Scale, “List of Information Collection for unmarried women”; we proceeded with some statistical techniques.ResultsThe findings of this research were:– emotional problems are the most common problems experienced by unmarried women;– the present study indicates the presence of depressive symptoms in 17%, which can evolve toward psychotic depression as dysthymia (loss of interest in daily activities, hopelessness, low self-esteem, self-criticism, trouble concentrating and trouble making decisions, effectiveness and productivity, avoidance of social activities, feelings of guilt and worries over the past, insomnia…);– the impact of unmarried on late stages have more negative impact, and psychological effect on them was more severe and the greatest harm.ConclusionThe advancement of women in the age without marriage or “unmarried women” is origin of psychological stress and low self-confidence.Dissclosure of interestThe authors have not supplied their declaration of competing interest.

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Evaluation of Probabilistic Disease Forecasts

Phytopathology ◽

10.1094/phyto-01-17-0023-fi ◽

2017 ◽

Vol 107 (10) ◽

pp. 1136-1143 ◽

Cited By ~ 5

Author(s):

Gareth Hughes ◽

Fiona J. Burnett

Keyword(s):

Disease Management ◽

Statistical Evaluation ◽

Disease Status ◽

Scoring Rules ◽

Management Decision ◽

Predictive Values ◽

Clinical Literature ◽

Probabilistic Forecasts ◽

Management Decision Making ◽

Plant Disease Management

The statistical evaluation of probabilistic disease forecasts often involves calculation of metrics defined conditionally on disease status, such as sensitivity and specificity. However, for the purpose of disease management decision making, metrics defined conditionally on the result of the forecast—predictive values—are also important, although less frequently reported. In this context, the application of scoring rules in the evaluation of probabilistic disease forecasts is discussed. An index of separation with application in the evaluation of probabilistic disease forecasts, described in the clinical literature, is also considered and its relation to scoring rules illustrated. Scoring rules provide a principled basis for the evaluation of probabilistic forecasts used in plant disease management. In particular, the decomposition of scoring rules into interpretable components is an advantageous feature of their application in the evaluation of disease forecasts.

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Assessment of Psychological Stress Associated with COVID-19 Lockdown in the Urban Adult Population of India

Biomedical & Pharmacology Journal ◽

10.13005/bpj/2303 ◽

2021 ◽

Vol 14 (4) ◽

pp. 2063-2072

Author(s):

Kayalvizhi Kumaravel ◽

Praveen Kumar Ratavaru Sathyam ◽

Rejili Grace Joy Manickaraj ◽

Poonguzhali Sivagananam ◽

Divya Ravikumar ◽

...

Keyword(s):

Psychological Stress ◽

Online Survey ◽

Adult Population ◽

Psychological Problems ◽

Snowball Sampling ◽

Cognitive Changes ◽

Cross Sectional ◽

The People ◽

Wide Range ◽

Structured Questionnaire

Background: COVID-19, the unprecedented deadly pandemic has turned the world topsy-turvy. It has affected all the people like poor and rich, young and old, educated and uneducated, male and female with detrimental consequences. People who are in quarantine and/or lockdown are likely to develop a wide range of symptoms like psychological stress, irritability, anxiety, depression etc. Hence, this study was undertaken to assess the psychological effects of COVID-19 lockdown among adult population residing in Chennai, India. This study is a cross sectional descriptive study carried out in Chennai, India. A structured questionnaire was developed containing 25 questions related to the emotional disturbance, depression, self-concept, physical problems, cognitive changes and role performance and 7 questions related to the demographics. An online survey was conducted using a structured questionnaire using a non-probability snowball sampling technique. A total of 579 responses were received. The findings of the present study revealed that, among 579 respondents, more than half of the respondents 320(56.3%)were under severe psychological stress, 192(33.2%) respondents that is one third of the people had moderate psychological stress and remaining were having mild psychological stress. The study also revealed that there was a statistically significant association of psychological problems associated with demographic variables. Our Study revealed that people living in Chennai had severe psychological problem due to theCOVID-19 lockdown. This highlights the importance and immediate need for the development special intervention programmes for the people with psychological problems due to the COVID-19 lockdown.

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Cooperation and Coordination in Plant Disease Management

Phytopathology ◽

10.1094/phyto-01-19-0010-r ◽

2019 ◽

Vol 109 (10) ◽

pp. 1720-1731 ◽

Cited By ~ 7

Author(s):

Jennifer Sherman ◽

Jordan M. Burke ◽

David H. Gent

Keyword(s):

Disease Management ◽

Collective Action ◽

Information Sharing ◽

Best Management Practices ◽

Management Practices ◽

Disease Risk ◽

Disease Status ◽

Best Management ◽

Trust And Reciprocity ◽

Plant Disease Management

Scaling of management efforts beyond the boundaries of individual farms may require that individuals act collectively. Such approaches have been suggested several times in plant pathology contexts but rarely have been implemented, in part because the institutional structures that enable successful collective action are poorly understood. In this research, we conducted in-depth interviews with hop producers in Oregon and Washington State to identify their motivations for and barriers to collective action regarding communication of disease levels, coordination of management practices, and sharing of best management practices and other data for powdery mildew (caused by Podosphaera macularis). Growers were generally open to and engaged in communication with neighbors and others on disease status in their hop yards and some evidence of higher levels of information sharing on management practices was found. However, growers who had developed extensive knowledge and databases were reluctant to share information viewed as proprietary. Relationships, trust, and reciprocity were facilitating factors for communication and information sharing, whereas lack of these factors and social norms of independence and pride in portions of the grower community were identified as impediments. Given the heterogeneity of trust, lack of confidence in reciprocity, and weak shared norms, communication of disease risk and coordinated management may be most successful if directed at a smaller scale as a series of neighborhood-based partnerships of growers and their immediate neighbors. Developing a disease reporting system and coordinated disease management efforts with more producers and at larger spatial extents would require formalized structures and rules that would provide assurance that there is consistency in disease data collection and reporting, reciprocation, and sanctions for those who use the information for marketing purposes against other growers. Given the analyses presented here, we believe there is potential for collective action in disease management but with limitations on the scope and nature of the actions.

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The Negative Impact of Group Psychological Abuse on Life Satisfaction and Well-being

Journal of Interpersonal Violence ◽

10.1177/08862605211042598 ◽

2021 ◽

pp. 088626052110425

Author(s):

Omar Saldaña ◽

Oscar Wu-Salmeron ◽

Emma Antelo ◽

Álvaro Rodríguez-Carballeira

Keyword(s):

Life Satisfaction ◽

Psychological Stress ◽

Social Acceptance ◽

Satisfaction With Life ◽

Psychological Abuse ◽

Negative Impact ◽

Well Being ◽

Online Questionnaire ◽

Psychological Well Being ◽

The Impact

In the context of the adverse effects of psychological abuse, this study examined satisfaction with life, psychological well-being, and social well-being in survivors of social groups that are high-demand, manipulative, totalitarian, or abusive toward their members. We specifically tested the mediating role between group psychological abuse and current well-being of psychological stress suffered after leaving the group. An online questionnaire was administered to 636 Spanish-speaking former members of different groups, 377 victims of group psychological abuse and 259 nonvictims. Participants reporting group psychological abuse showed significantly lower levels of life satisfaction, psychological well-being, and social well-being compared to nonvictims. Greater differences in well-being between victims and nonvictims were related to positive relationships with others ( d = .85), self-acceptance ( d = .51), social integration ( d = .44), and social acceptance ( d = .41). Victims’ life satisfaction and well-being were positively correlated with the time that has passed since leaving the group, but nonsignificant effects were found regarding the type of the group (i.e., religious vs. nonreligious), the age at which they joined the group (i.e., born into or raised in the group vs. during adulthood), the length of group membership, and the method of leaving (i.e., personal reflection, counseled, or expelled). Moderate associations were found between group psychological abuse, psychological stress, and well-being measures, and results demonstrated that psychological stress mediated the impact of group psychological abuse on life satisfaction and well-being. Understanding the negative impact of group psychological abuse on well-being is important to promote survivors’ optimal functioning during their integration process into the out-group society.

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Allogeneic Stem Cell Transplantation with Reduced Intensity Conditionning Regimen (RIC) for Adult Patients with AML: Same Results in Secondary and De Novo AML.

Blood ◽

10.1182/blood.v108.11.3015.3015 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3015-3015

Author(s):

Noel-Jean Milpied ◽

Reza Tabrizi ◽

Thierry Guillaume ◽

Patrice Chevallier ◽

Arnaud Pigneux ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

De Novo ◽

Negative Impact ◽

Chronic Gvhd ◽

Disease Status ◽

Secondary Aml ◽

Autologous Transplant

Abstract We have evaluated the outcome of RIC in 114 adult pts with AML either de novo (74) or secondary to cancer or MDS (40). There were 43 men, median age was 55 yo (22–65). Cytogenetic was available in 104 and was abnormal in 55 (favorable: 13; intermediate: 21; poor: 21). Pts had received a median of 1 line of Tx before RIC (0–3). Twenty had a previous autologous transplant. At time of RIC, 28 patients were refractory or in relapse while 71 were in CR (1st: 48; 2d: 20). The donor was an id sib for 80 and a MUD in 34 (with1allelic mismatch in 6). The cond regimen was of Slavin type in 56, only 11 pts received the Seattle program. Overall 74 had ATG as part of cond reg. GVHD prophylaxis consisted of CSA or CSA-MTX in 95 pts, 14 had CSA-MMF. With a median FU of surviving pts of 21 m (3–73) the 3y survival (OS) and EFS are 40% and 38% respectively. Sixty pts died with the main cause of death being relapse. The probability of TRM at 100 d and 1 y are 7% and 14% respectively. The 2y probability of relapse is 50%. These figures are strictly superimposable for pts with de-novo or secondary AML. The factors affecting significantly (p<0.05) the 3y OS and EFS were: disease status at time of RIC (50% vs 0 to 24% in pts in CR vs not), the N° of previous lines of Tx (55% vs 0 to 24% after one line vs more), an id sib as donor ( 45% vs 32% for OS and 44% vs 19% for EFS), having an aGVHD grade 1 or 2 ( OS: 75% vs 25% if aGVHD grade 3–4 vs 38% if no aGVHD), and a CGVHD limited or extensive (OS: 50% or 78% respectively vs 29% if no CGVHD; EFS: 50% or 56% respectively vs 29% if no CGVHD). The single factors that affected the risk of relapse was the occurence of an acute and or chronic GVHD. The TRM was significantly increased in pts with previous autologous transplant, a MUD, an aGVHD and a female donor. Conclusion: RIC allo is well tolerated ( max TRM :14% at 1 y) and allows the same result in de-novo and secondary AML. The best results are achieved in patients in CR1 ( 3y OS and EFS: 63% and 62% respectively) whatever was the type of donor. As most of the pts beyond CR1 were transplanted with a MUD, it is not possible to separate the negative impact of advanced disease or MUD. An active search of a donor at the time of diagnosis, particularly in patients with secondary AML, could allow early RIC with MUD in pts with an indication of allogeneic stem cell transplantation.

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Severe Mucositis Adversely Affects Survival after Autologous Stem Cell Transplantation (ABMT) for Lymphoid Malignancies.

Blood ◽

10.1182/blood.v106.11.837.837 ◽

2005 ◽

Vol 106 (11) ◽

pp. 837-837

Author(s):

Brian Bolwell ◽

Matt Kalaycio ◽

Ronald Sobecks ◽

Steven Andresen ◽

Lisa Rybicki ◽

...

Keyword(s):

Negative Impact ◽

Surrogate Marker ◽

Disease Status ◽

Entire Group ◽

High Dose ◽

Prior Chemotherapy ◽

Lymphoid Malignancies ◽

Transplant Patients ◽

Cox Analysis ◽

Severe Mucositis

Abstract Mucositis is a well known short term complication of ABMT. Many studies of mucositis in ABMT, however, are flawed due to heterogeneity of both mobilizing regimens and high-dose preparative regimens. There is also sparse data on the long term consequences of mucositis after ABMT. This study retrospectively reviews all patients with lymphoid malignancies undergoing ABMT from 5/2000 to 2/2005 at our institution that received a uniform mobilizing regimen of VP-16 plus G-CSF and a uniform high dose preparative regimen of busulfan, cyclophosphamide and VP-16. 191 patients fit the entry criteria into this study. Mucositis was graded using the OMAS mucositis grading scale, which has a scoring range of 0–2.0. Severe mucositis for the purposes of this study was designated as having a maximal OMAS scale of ≥ 1.0. 87 patients experienced severe mucositis and 104 did not. Median age for patients was 52 years; underlying diagnoses were non-Hodgkin’s Lymphoma (n=155) and Hodgkin’s Disease (n=36). The two groups (developing severe mucositis vs not) were balanced with respect to disease status at transplant, number of courses of prior chemotherapy, prior exposure to radiation therapy of any kind, and elevated LDH at the time of transplant. Median CD34+ cell dose collected for the entire group was 8.5 x 106 /kg; there was no difference between the 2 groups. Severe mucositis correlated with mortality within 100 days of transplant. Patients with a maximal OMAS scale of < 1.0 had 99% 100-day survival (103/104) as compared to 92% (80/87) for those with an OMAS scale ≥ 1.0 (p=0.015). To date, 30% of patients have relapsed with no difference in the two groups. However, Kaplan-Meier estimates of survival reveal that severe mucositis has a profound negative impact on survival (p=0.002) as shown graphically below: Figure Figure One of the key drivers of this difference in survival was the fact the patients with severe mucositis were more likely to experience pulmonary or multi-organ failure as a cause of death: 8 patients with severe mucositis died of these toxicities, as compared to zero in the less severe mucositis group. Multivariable Cox analysis was performed to analyze risk factors for mortality. Three variables were found to be significant: elevated LDH at transplant (p=0.03), number of prior chemotherapy regimens (for one regimen increase, p=0.024) and severe mucositis (p=0.003). In conclusion, patients that develop severe mucositis have a higher risk of mortality after ABMT. The etiology is likely multi-factorial; mucositis may directly contribute to mortality risk, and may also be a surrogate marker of other organ toxicities.

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Impact of Pre-Transplantation, Mobilization and Graft Variables on Transplant Outcome after Autologus Hematopoietic Stem Cell Transplantation in Multiple Myeloma in Patients

Blood ◽

10.1182/blood.v112.11.5137.5137 ◽

2008 ◽

Vol 112 (11) ◽

pp. 5137-5137

Author(s):

Mauricette Michallet ◽

Quoc Hung Le ◽

Mohamad Sobh ◽

Nicole Raus ◽

Melissa Clarck ◽

...

Keyword(s):

Multiple Myeloma ◽

Negative Impact ◽

Disease Status ◽

Median Number ◽

Gm Csf ◽

Group I ◽

Cd34 Cells ◽

Significant Negative Impact ◽

Group Ii ◽

Length Of Hospitalization

Abstract This analysis studied 197 autologous HSCT performed in 132 patients treated for multiple myeloma (MM) in our center between 2000 and 2007. There were 53 females and 79 males with a median age of 56.8 years (34–72). At diagnosis there were 71 IgG (49κ, 22λ), 26 IgA (15κ,11λ), 2 IgD (1κ, 1λ), 27 light chain (18κ,9λ), 2 plasma cell leukemia, 3 non secretory, 1 non secretory/non excretory. There were 11 stage I (10A and 1B), 12 IIA, 96 III(75A and 21B) and 13 not classified. At diagnosis, 24/98pts had a del(13), and 65/179 had high levels of β2microglobulin. Before 2004, 50% of transplants were done and the median interval between diagnosis and HSCT was 7.8 months (3.5–131). We divided the population into 2 groups (I = 65: double-auto, II = 67 simple auto). The disease status pre-transplant according to the number of apheresis were: 1 apheresis (group I: 3CR, 29PR, 3SD, 1PD; group II: 2CR, 24PR, 3PD), 2 apheresis (group I: 16PR, 1SD, 1PD; group II: 3CR, 9PR, 1PD), 3 apheresis (group I: 1CR, 4PR; group II: 10PR, 1unknown), 4 apheresis (group I: 4PR, 1PD; group II: 1CR, 10PR, 2SD), 6 apheresis (group II: 1PR) and 8 apheresis (group: 1PR). PBSC were mobilized in steady state in 135 cases, 53 after cyclophosphamide alone, 9 cyclophosphamide with other drugs. During mobilization, we used GCSF in 179cases, GM-CSF in 5cases, SCF in 4 cases and associations of GM-CSF+ GCSF in 2(1%) cases and SCF+GCSF in 7(3.5%) cases. The median number of infused cells were: TNC 5×107/kg (1–59), CFU-GM 70.5×104/kg (0–2616) and CD34+cells 3×106/kg (0–27). Of these, 115 (58%) had a number of CD34+cells<4×106/kg and 82 (42%) ≥4×106/kg. As conditioning regimens, all pts received melphalan alone with a median total dose of 304mg [130–440]. After transplantation, 156(79%) have received growth factors [1(0.5%) GM-CSF, 148 (95%) G-CSF and 7 (4.5%) SCF] and 195 pts well engrafted (99%). Concerning red blood cell (RBC) transfusions, 60% of pts did not received any RBC transfusions, 30% received between 1 and 4 transfusions, 7% between 5 and 8 and 3% 10 or more and concerning platelet (Pt) transfusions, 35,5% did not received any Pt transfusions, 53% received between 1 and 3, 9% between 4 and 7 and 2.5% 10 or more. The median number of RBC and Pt transfusions were 0 [0–23] and 1 [0–20] respectively. The median number of days with neutrophils <0.5G/L was 6 (0–33) and with Pt<50G/L 17 (2–104) and the median length of hospitalization for auto transplantation was 18 days (14–54). The probability of 5-year overall and event-free survival (OS and EFS) were 64.3% (56.3–73.4%) and 32.4% (24.9–42.2%) and the median OS was not reached. Among all pts, 25 received an allogeneic HSCT as further treatment. Statistical analysis studied age disease status at transplant infused TNC, CD34+cell and CFU-GM, growth factors during mobilization and after transplantation, mobilization chemotherapy, interval Diag-T and transplantation period in a conditional logistic-regression model to analyze associations between these variables and length of hospitalization, number of RBC and Pt transfusions; a multivariate analysis using Cox model to analyze the impact of these variables on length of aplasia (<0.5G/L neutrophils and <50G/L Pt). We observed no significant impact of all studied variables on length of hospitalization and RBC transfusions and a significant negative impact of long interval diagnosis-T (p=0.05) and of the period > 2004 on Pt transfusion number (p=0.03). We showed a significant positive impact of CFU-GM number [HR=1 (1000–1.002) (p=0.03)] and growth factor use after transplantation [HR=0.55 (0.36–0.85) (p=0.005)] on days <0.5 G/L neutrophils and a significant negative impact of CD34+cell<4 ×106/kg on the number of days <50G/L Pt ([HR=1.65 (1.09–2.50) (p=0.01)]. A more refined analysis of the groups, as well as a medico-economic analysis are ongoing and will be presented. In conclusion, this retrospective analysis showed an interesting long-term overall survival probability for this high risk MM population. We demonstrated no apparent impact of the pre-transplant, mobilization, and graft variables on number of transfusions and the length of hospitalization in this global analysis. However, we did show a significant influence of the diagnosis-T interval on platelet transfusions and of the CD34+ cell number, GCSF post-transplant and CFU-GM number on the length of aplasia.

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Relapse After Allogeneic Hematopoietic Stem Cell Transplantation in Hematological Malignancies: Factors Impacting Its Occurrence and Treatment Options for a Better Management,

Blood ◽

10.1182/blood.v118.21.4093.4093 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4093-4093

Author(s):

Mauricette Michallet ◽

Mohamad Sobh ◽

Stephane Morisset ◽

Helene Labussiere ◽

Marie Y. Detrait ◽

...

Keyword(s):

Multivariate Analysis ◽

Stem Cell ◽

Cumulative Incidence ◽

Hematological Malignancies ◽

Negative Impact ◽

Treatment Options ◽

Disease Status ◽

Hematopoietic Stem ◽

Abo Incompatibility ◽

One Year

Abstract Abstract 4093 Introduction: Relapse remains a major cause of mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with hematological diseases. During the last decade, many improvements have been achieved in the understanding of the disease- and patient-related conditions in order to obtain the optimal allogeneic effect but the relapse is still representative which leaded to the development of different chemo- and immuno-therapy strategies. Aims: To evaluate at a first time the different pre- and post-transplantation factors impacting the relapse occurrence after allo-HSCT, and at a second time, to evaluate factors impact the survival post-relapse including the different treatment options. Material and methods: We have retrospectively studied the occurrence of relapse in 345 patients, 198 (57%) males and 147 (43%) females with a median age of 43 years (range17–66) who received allo-HSCT at our institution for hematological malignancies between years 2000 and 2011; 205 (59%) from siblings donors and 140 (41%) form unrelated donors. At transplantation, there were 148 (43%) patients in first complete response or first chronic phase (CR1/CP1), 66 (19%) in CR2/CP2 and 131 (38%) < CR2/CP2. Two hundred and six (60%) patients received a full intensity conditioning and 139 (40%) a reduced intensity one. The different patients and transplantations characteristics are detailed in Table 1. Results: After HSCT, 336 (97%) patients engrafted. The cumulative incidence of acute GVHD≥2 at 3 months was 35% (95%CI 32–37); the cumulative incidence of extensive and limited chronic GVHD at one year was the same 15% (95%CI 13–17). After a median follow-up of 11.4 months (range 4–129), the median overall survival (OS) for the whole population was 19 months (range 12–33) with a 2-years probability of 47% (95%CI 42–53). Eighty eight (25.5%) patients relapsed with a cumulative incidence at one and two years of 19% (95%CI 17–21) and 22% (95%CI 20–24) respectively. Characteristics of relapsed patients are described in Table 1. After relapse, 65 (74%) patients were treated [21 (32%) received donor lymphocyte infusion (DLI) alone, 21 (32%) chemotherapy alone, 14 (22%) DLI + chemotherapy and 9 (14%) received other treatment] and 23 (26%) were not treated due to deadly relapse. The median OS from relapse was 4 months (range 3–5) and the one year probability of OS in patients who relapsed was 21% (95%CI 14–31). The multivariate analysis studying the impact of different variables on the occurrence of relapse showed a negative impact of disease status [<CR/CP: HR=3.9 (2.4–6.7), p=0.0001], a negative impact of CMV status [D+R-: HR=2.4 [1.2–4.7], p=0.009] and a protective impact of cGVHD [HR=0.37 (0.2–0.6), p=0.0002]. The multivariate analysis studying the pre- and post-relapse variables on the survival after relapse showed a positive impact of ABO incompatibility [Major ABO incompatibility: HR=0.39 (0.16–0.9), p=0.03], a negative impact of disease status [<CR/CP: HR=2.4 (1.3–4.4), p=0.003] and a positive survival outcome in patients receiving DLI with or without chemotherapy [HR=0.5 (0.3–0.8), p=0.005]. Conclusion: We showed that relapse after allo-HSCT in hematological malignancies is still a significant issue, disease status at HSCT and CMV matching worsen its occurrence while cGVHD can be protective. Survival rate after relapse is still very low reflecting the difficulty to find an optimal treatment, disease status at transplantation seem to have a long term effect while the use of DLI with or without chemotherapy can offer better results. In addition to the new chemotherapy molecules, immunotherapy should be used in order to enhance the graft-versus-leukemia effect not only after relapse, but also early in presence of a minimal residual disease. Disclosures: No relevant conflicts of interest to declare.

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