Abstract 12414: The Impact of Frailty on Cause Specific Mortality Among Elderly Patients Undergoing PCI

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Nicholas M Orme ◽  
Ryan J Lennon ◽  
Bradley R Lewis ◽  
Rajiv Gulati ◽  
Gurpreet Sandhu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Coronary Intervention ◽  
The Elderly ◽  
Cardiac Mortality ◽  
Poor Overall Survival ◽  
Telephone Interviews ◽  
Frail Patients ◽  
Specific Mortality ◽  
The Impact

Background: The presence of frailty increases the risk of long-term mortality for a myriad of reasons, but its association with cardiac-specific mortality among the elderly undergoing percutaneous coronary intervention (PCI) is unknown. We sought to determine the relationship between frailty and cause-specific (cardiac versus non-cardiac) mortality among elderly patients undergoing PCI. Methods: A prospective cohort of elderly (>65 years) patients undergoing PCI at Mayo Clinic between October 2005 and September 2008 were tested for frailty using the Fried criteria. Vital status was prospectively monitored including evaluation of death certificates, telephone interviews and review of autopsy/medical records. Results: Frailty data was obtained in 428 (84%) of 508 elderly patients (median age 74.2 years [SD 6.4, range 65-100]; 59% male). Of these, 92 (21%) patients were frail while 231 (54%) had intermediate frailty and 105(25%) were not frail. Frail patients were older than intermediate and non-frail patients (77.6 vs 74.3 vs 71.0 years; p<0.001) and had more comorbidities (mean Charlson index 4.6 vs 3.9 vs 2.8; p<0.001). There were 113 deaths (26% of cohort) during 5.1 median years of follow-up, of which 77 (68%) were classified as non-cardiac and 36 (32%) which were classified as cardiac. Frailty at baseline was associated with poor overall survival compared to non-frail patients (HR 6.1, 95% CI 3.2, 11.6; p<0.001). The estimated effect of frailty was nearly 3 times greater for cardiac mortality (HR 13.1, 95% CI 3.0, 57.0; p=0.001) than non-cardiac mortality (HR 4.6, 95% CI 2.2, 9.7; p<0.001). These findings remained significant following multivariable adjustment. Conclusions: Frailty is common among elderly patients undergoing PCI and is associated with poor overall survival and both cardiac and non-cardiac causes of death.

scholarly journals Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yongfei He ◽  
Tianyi Liang ◽  
Shutian Mo ◽  
Zijun Chen ◽  
Shuqi Zhao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Liver Cancer ◽  
Elderly Patients ◽  
Surgical Resection ◽  
Influencing Factors ◽  
The Elderly ◽  
Primary Hepatocellular Carcinoma ◽  
Surgical Timing ◽  
Duration Of Surgery

Abstract Background The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients. Methods A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed. Results A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival. Conclusions We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

scholarly journals Pacemaker therapy in the elderly and very elderly: comorbidity-burden vs age, as prognostic factors for excess of length of in-hospital stay, complications and mortality

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Marschall ◽  
H Del Castillo Carnevali ◽  
F Goncalves Sanchez ◽  
M Torres Lopez ◽  
F A Delgado Calva ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Elderly Patients ◽  
Hospital Stay ◽  
The Elderly ◽  
Very Elderly ◽  
Pacemaker Therapy ◽  
Clinical Scenarios ◽  
Comorbidity Burden ◽  
The Impact ◽  
Complications And Mortality

Abstract Background The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. Recent studies suggest that comorbidity burden may have an equal, if not greater, effect on length of in-hospital stay (LOS), complications and mortality, as age in a variety of clinical scenarios. Objective The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate the impact of comorbidities, as compared to age, on excess of length of in-hospital stay and mortality. Methods This is a retrospective observational study of a single centre. Patients that underwent (both elective and non-elective) PM implantation between June 2016 and December 2018 in our centre, were included for chart review. Elderly patients were defined as those with age 80–89 years, whereas very elderly patients were defined as those with ≥90 years of age. Excess in LOS was defined as an in-hospital stay &gt;3 days. Results A total of 507 patients were included in the study with a mean age of 80.6 (±8.5) years. 255 elderly and 60 very elderly patients were included. Median follow-up time was 24 months. Baseline clinical characteristics are presented in Table 1. The mortality rate for elderly patients was 18.8% for the elderly and 36.7% for the very elderly (p=0.002). The presence of ≥2 comorbidities (defined in Table 1) resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 7.1 (4.4–11.4), p&lt;0.001); HR: 1.01 (0.9–1.1), p=0.56, respectively). Neither age, nor comorbidity burden predicted the appearance of device related complications. Both comorbidites and age predicted mortality. However, the association was stronger for the presence of comorbidites, than for age (HR: 1.9 (1.1–3.1), p=0.002 vs HR: 1.1 (1.1–1.2), p&lt;0.001, respectively). Elderly patients with low comorbidity burden (&lt;2 comorbidities) showed no significant differences with regards to LOS and mortality when compared to younger patients (2 (2–4) vs 3 (2–5) days, p=0.529 and 18.3% vs 17.4%, p=0.702; respectively). Conclusions Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation. FUNDunding Acknowledgement Type of funding sources: None.

Lobar versus Sublobar Resection in the Elderly for Early Lung Cancer: A Meta-Analysis

2021 ◽  
Author(s):  
Josiah Ng ◽  
Yoshio Masuda ◽  
Jun Jie Ng ◽  
Lowell Leow ◽  
Andrew M. T. L. Choong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Cancer Recurrence ◽  
Disease Free Survival ◽  
The Elderly ◽  
Sublobar Resection ◽  
Cell Lung Carcinoma ◽  
Risk Of Death ◽  
Stage 1

Abstract Objectives We performed a systematic review and meta-analysis of outcomes of lobectomy versus sublobar resection in elderly patients (≥65) with stage 1 nonsmall cell lung carcinoma (NSCLC). Methods We searched for relevant articles using a set of inclusion and exclusion criteria. Meta-analytic techniques were applied. Results Twelve studies (n = 5834) were chosen. Our results indicate that in the elderly, lobectomy for stage 1 NSCLC confers a survival advantage over sublobar resection. Lobectomy patients had a lower risk of death within 5 years and lower odds of local cancer recurrence. Our results show that lobectomy had a better 5-year cancer-specific survival and 5-year disease-free survival that trended toward significance. The sublobar resection group showed better 30-day operative mortality that trended toward significance. Subgroup analysis of stage 1A cancer demonstrated no difference in 5-year overall survival rates. However, for stage 1B tumors 5-year overall survival favored lobectomy. Conclusion Lobectomy for stage 1 NSCLC in elderly patients is superior to sublobar resection in terms of survival and cancer recurrence and should be afforded where possible. For stage 1A tumors, sublobar resection is noninferior and may be considered. Further randomized controlled trials in this topic is required.

scholarly journals Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Mario Gruppo ◽  
Francesca Tolin ◽  
Boris Franzato ◽  
Pierluigi Pilati ◽  
Ylenia Camilla Spolverato ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Adjuvant Treatment ◽  
Long Term Outcomes ◽  
Group I ◽  
Periampullary Neoplasms ◽  
Short And Long Term ◽  
Group Ii ◽  
The Impact

Background. Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods. 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results. A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p=0.004), Karnofsky Score (p=0.025), preoperative jaundice (p=0.004), and pulmonary complications (p=0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p=0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p=0.909). Conclusion. PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.

Impact of Age on the Functional Evaluation of Intermediate Coronary Stenoses With Instantaneous Wave-Free Ratio and Fractional Flow Reserve

Angiology ◽  
2020 ◽  
Vol 72 (1) ◽  
pp. 62-69
Author(s):  
Monica Verdoia ◽  
Rocco Gioscia ◽  
Matteo Nardin ◽  
Federica Negro ◽  
Francesco Tonon ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Fractional Flow Reserve ◽  
Large Scale ◽  
The Elderly ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Minimal Lumen Diameter ◽  
Coronary Stenoses ◽  
The Impact

The optimal strategy for assessing the ischemic significance of intermediate coronary stenoses with adenosine-induced fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) is still debated. Few studies have previously assessed the impact of age on FFR and iFR, which was the aim of our study. Patients undergoing FFR and iFR evaluation for intermediate (40%-70%) coronary lesions were included and divided according to age. Fractional flow reserve was performed by intracoronary boluses of adenosine (60-1440 μg). Instantaneous wave-free ratio was automatically calculated. Among 148 patients undergoing FFR measurement of 166 lesions, 45.3% were ≥70 years. Elderly patients had higher minimal lumen diameter ( P = .03). We also observed a linear relationship between iFR and FFR independently of age. Fractional flow reserve values were higher in the elderly patients, whereas iFR was not related to age. A total of 33 lesions had a positive iFR with no difference for age (17.3% vs 22%, P = .56), while FFR <0.80 was more infrequent in the elderly patients (17.1% vs 34.8%, P = .02). In intermediate coronary stenoses, iFR and FFR correlation is unaffected by age. Fractional flow reserve is higher in the elderly patients, whereas iFR is less affected by age. Future large-scale studies are needed to define whether iFR should be the preferred choice in elderly patients.

scholarly journals Impact of clinical pharmacist’s interventions on pharmacotherapy management in elderly patients on polypharmacy with mental health problems including quality of life: A prospective non-randomized study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Matej Stuhec ◽  
Nika Bratović ◽  
Aleš Mrhar
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Elderly Patients ◽  
Mental Health Problems ◽  
Randomized Study ◽  
The Elderly ◽  
Health Problems ◽  
Potentially Inappropriate Medications ◽  
The Impact

AbstractMental health problems (MHPs) are very common in the elderly and can have an important influence on their quality of life (QoL). There is almost no data on the impact of clinical pharmacists’ (CPs) interventions on the QoL including elderly patients and MHPs. The main aim of this study was to determinate the impact of (CP’s) interventions on the QoL and quality of pharmacotherapy. A prospective non-randomized pre-post study was designed which included residents of a nursing home aged 65 age or more with at least one MHP. Each patient also filled out the EQ-5D questionnaire. The medical review MR included drug-related problems (DRPs) and potentially drug-drug interactions (pDDIs), as well as potentially inappropriate medications (PIMs). After 2 months, the participants were interviewed again. The mean number of medications before the intervention was 12,2 ± 3,1 per patient and decreased to 10,3 ± 3,0 medications per patient (p < 0,05) (n = 24). The total number of PIMs and pDDIs was also reduced and QoL was also significantly higher (p < 0,05). A collaborative care approach with a CP led to a decrease of DRPs, pDDIs, PIMs, the total number of medications and to an improvement in the patients’ QoL.

Elderly Patients with Early-Unfavorable Stage Hodgkin’s Disease (HD) Have a Poorer Outcome When Treated with Combined Modality Treatment and Extended Field Radiotherapy (EF): A Retrospective Analysis of the German Hodgkin Study Group.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1305-1305
Author(s):  
Andreas Engert ◽  
Heinz Haverkamp ◽  
Hans T. Eich ◽  
Andreas Josting ◽  
Beate Pfistner ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
The Elderly ◽  
Combined Modality Treatment ◽  
Study Group ◽  
Younger Patients ◽  
German Hodgkin Study Group ◽  
Mediastinal Tumours ◽  
Extended Field ◽  
Involved Field

Abstract Purpose: The HD8 study of the German Hodgkin Study Group (GHSG) demonstrated that involved field (IF) radiotherapy is equally effective when compared with EF radiotherapy after four cycles of chemotherapy (2 x COPP/ABVD). Since there are indications that elderly patients with HD might fare worse depending on the type of treatment applied, we revisited the HD8 data for possible differences between younger and older patients. Methods and results: A total of 1204 patients were randomised to receive two double cycles of COPP/ABVD and either 30 Gy EF + 10 Gy bulk or 30 Gy IF + 10 Gy bulk. Of these, 98 evaluable patients were older than 60 years and 1038 patients were younger than 60 years. In general, there were more risk factors such as B-symptoms, elevated ESR, and poorer Karnofski index in the elderly group. On the other hand, there were fewer bulky tumours, large mediastinal tumours and a lower number of lymph node areas involved in elderly patients. The toxicity of treatment was more pronounced in elderly patients with 76 of 96 patients experiencing chemotoxicity Grade III or IV (79%) compared with 699 of 1018 (69%) in those younger than 60 years. After a median follow up of 52 months, the 5-year-FFTF was 85% in younger patients and 63% in patients older than 60 years (p &lt;0.001). The 5-year-overall survival was 94% for patients younger than 60 years and 66% for patients older than 60 years (p &lt; 0.001). In addition, patients older than 60 years treated with EF had a trend for worse FFTF and overall survival compared to those receiving IF radiotherapy. Conclusion: Event-free and overall survival of patients older than 60 years old are worse compared with younger patients. In particular, patients older than 60 years receiving EF radiotherapy had a poorer prognosis.

Do Elderly Myeloma Patients Benefit From High Dose Therapy (HDT) and Autologous Stem Cell Transplant (ASCT)?: A Comparative Survival Analysis using SEER Registry

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2072-2072 ◽  
Author(s):  
Eden Hailemichael ◽  
Jonathan L. Kaufman ◽  
Christopher R. Flowers ◽  
Edmund K. Waller ◽  
Mary Jo Lechowicz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Research Funding ◽  
Selection Process ◽  
Progression Free Survival ◽  
The Elderly ◽  
Autologous Stem Cell Transplant ◽  
High Dose ◽  
Cell Transplant ◽  
Significant Survival

Abstract Abstract 2072 Introduction: Many randomized control trials demonstrated that HDT-ASCT is superior to conventional therapies in myeloma patients and prolongs progression free survival (PFS) and overall survival (OS) (Attal M, 1996, Childs JA, 2003). However, in treating a malignancy with a median age of diagnosis of 69 years, the majority of the patients will not be eligible for this beneficial approach if a nominal numerical age cut-off (<65 years) is followed based on the assumption that elderly patients cannot tolerate HDT-ASCT; nor will they be eligible for clinical trials involving HDT-ASCT if stringent age-restricted inclusion criteria are incorporated. Therefore, we have evaluated if the elderly patients benefit from HDT-ASCT. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) 18 registry data (www.seer.cancer.gov) as our comparator (reflects 28% of the US population);to provide information on incidence, prevalence and survival from 1973–2009. The data from an institutional cohort (IC) is obtained from the records of patients that underwent HDT-ASCT from January 2000 to January 2012. We used IBM SPSS version 20 to generate the Kaplan-Meier survival curves. Results: Of the 6,571,117 malignant cases listed in SEER registry, a total of 74,826 cases (1.1%) of multiple myeloma (ICD-03 code 9732) were identified (39735 males and 35091 females). Median age of the patients is 70 years. Among these patients 48,988 patients (65%) are over the age of 65. A total of 901 myeloma patients underwent HDT-ASCT from IC during the evaluable period and 167 patients (19%) were over the age of 65. The median survival for each subset is listed in Table 1. Both male and female WCI-ASCT myeloma patientshad prolonged OS compared to the SEER myeloma patients, despite the difference in magnitude of advantage in IC-ASCT male patients vs. female patients. Both white and black patients, as well as patients undergoing HDT-ASCT across all age subgroups had a significant survival advantage. Conclusions: In each subgroup, by the decade of diagnosis, gender, race, age subsets we have consistently demonstrated a significant survival benefit for IC transplant patients ≥age 65 compared to SEER myeloma patients ≥age 65 if offered HDT-ASCT. Selection-bias prevails in the groups showing improved overall survival. Hence, a careful selection process considering physiologic age as a determinant for transplant eligibility would result in better outcomes, and not preclude the elderly from the survival benefits of HDT-ASCT. Disclosures: Kaufman: Millenium: Consultancy; Celgene: Consultancy; Novartis: Consultancy; Onyx: Consultancy. Flowers:Celgene: Consultancy; Prescription Solutions: Consultancy; Seattle Genetics: Consultancy; Millennium: Research Funding, Unpaid consultancy, Unpaid consultancy Other; Genentech: Unpaid consultancy, Unpaid consultancy Other; Gilead: Research Funding; Spectrum: Research Funding; Janssen lymphoma research foundation: Membership on an entity's Board of Directors or advisory committees. Waller:Outsuka: Research Funding.

Association of Deferasirox and Vitamin D Promotes Cell Differentiation and Improves Overall Survival in Acute Myeloid Leukemia (AML) Elderly Patients After Demethylating Agents Failure: A Retrospective Case Control Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3622-3622
Author(s):  
Etienne Paubelle ◽  
Felipe Suarez ◽  
Florence Zylbersztejn ◽  
Celine Callens ◽  
Michael Dussiot ◽  
...  
Keyword(s):  
Vitamin D ◽  
Overall Survival ◽  
Cell Differentiation ◽  
Elderly Patients ◽  
The Elderly ◽  
Iron Chelators ◽  
Increase Life Expectancy ◽  
Monocyte Differentiation ◽  
Demethylating Agents

Abstract Abstract 3622 Background: AML is a group of heterogeneous malignant diseases characterized by uncontrolled cell growth and differentiation arrest. Following the success of differentiating therapies in APL, great hopes were placed in Vitamin D (VD) and its ability to promote differentiation of non-APL AML cells. However, results of clinical studies were disappointing and trials were interrupted due to the occurrence of life-threatening hypercalcemia. Our group has shown that iron chelators such as deferasirox (DFX) are able to promote monocytes differentiation in both normal hematopoietic progenitors and AML cells (Callens et al Jexp Med 2010). Moreover, iron deprivation synergized with VD to promote cell differentiation on leukemic cells. Most elderly patients diagnosed with AML suffer from secondary iron overload because of in some cases ineffective erythropoiesis and iterative red blood cell transfusions. Furthermore, in myelodysplastic syndromes, retrospective studies have suggested that iron chelators may increase life expectancy and decrease the risk of transformation into AML. In AML of the elderly, the use of demethylating agents such as 5-azacytidine or decitabine may induce hematological response and increase life expectancy. However, response is often of short duration. Since VD deficiency and iron overload prevalence is high in the elderly, the association of VD and DFX was given to a subgroup of patients following demethylating agents failure. Methods: A retrospective chart review of 17 elderly AML patients after demethylating agents failure was performed in three French centers. Patients treated by the combination of DFX/VD were matched to patients treated with best supportive care (BSC). Based on ferritin, and creatinin levels the dose of DFX was adapted in each case. DFX dose was up to 2000 mg a day and VD was used at 100,000 units orally weekly. The tolerance and the overall survival (OS) were analyzed. Pre-clinical studies were conducted in vitro on cell lines (HL60, U937, OCI-AML3, THP-1, MOLM 13) to evaluate cell differentiation induced by DFX and a new VDR agonist (Inecalcitol) by cell morphology and flow cytometry (expression of CD11b and CD14 markers). VDR activity and expression were evaluated by flow cytometry, immunoblotting, luciferase reporter assays and qPCR to detect VDR-targeted genes. Results: Median age of DFX/VD patients and BSC control group were 76 (range 63–84) and 71 (58–85) respectively. Most patients were diagnosed with AML with multilineage dysplasia (cases 70%, controls 76%). Prognosis groups were distributed homogeneously between the treated patients and controls. There were no significant differences in blast infiltration, leukocytosis, neutropenia, systemic iron and phosphocalcium parameters. All patients received 5-azacytidine (median of 8 courses for the cases and 7 for the controls).No renal insufficiency, hepatotoxicity or hypercalcemia were observed in DFX/VD patients. At 3 months, 4 treated patients (23.5%) had significant monocyte level increase an evidence of the enhanced monocyte differentiation efficacy. The treatment did not decrease the need of transfusion. Most interestingly median survival of treated patients was significantly increased (10.4 m vs 4 m, p=0.002). In vitro studies were conducted in parallel aiming to characterize new potential alternative therapeutic associations, which could improve patients' response. We show that the use of a new highly potent VDR agonist (Inecalcitol) potentiated the effect of DFX in promoting terminal monocyte differentiation of leukemic cell lines. It also increased VDR activity evaluated by VDR expression and phosphorylation and expression of VDR-targeted genes. In vivo studies in mice model of AML using combined DFX/inecalcitol therapy will be presented. Conclusions: The prognosis of elderly patients diagnosed with AML after demethylating agents remains poor. Here we show that the differentiating therapy by the association of Deferasirox and Vitamin D was able to improve overall survival with low toxicity. New generation of highly-potent VDR agonists (which are devoided of hypercalcemic properties) significantly enhanced VDR activation and terminal monocyte differentiation of AML cells and represent potential therapeutic alternatives in the near future. These encouraging results should be verified in a large randomized prospective multicenter study. Disclosures: No relevant conflicts of interest to declare.

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