Abstract WMP12: Benefits of Thrombectomy Among Patients Who Did Not Achieve Functional Independence in DEFUSE 3

Background: While endovascular thrombectomy (EVT) patients may not achieve functional independence, they may avoid devastating outcomes as in profound disability/death. Methods: DEFUSE 3 patients who did not achieve mRS 0-2 were assessed for a shift towards reductions in severe (mRS 4-6) and profound (mRS 5-6) disability, mortality, length of stay (LOS) and increased rates of home/rehabilitation discharges. Results: 126 of the 182 randomized in DEFUSE 3 did not achieve mRS 0-2 (EVT 51, MM 75). Baseline characteristics were similar. EVT was associated with a higher mRS 3 rate (28% vs 18%) and lower rates of severe (72% vs 82%) and profound disability (39% vs. 50%), EVT vs MM respectively, with a trend for a shift towards less disability aOR=1.6 (95%CI=0.9-3.2, P=0.138), figure 1. Mortality rates were numerically lower with EVT (25% vs 31, p=0.528). EVT patients had a trend for shorter LOS (8.6 (6.5-13.7) vs 9.3 (7.1-16.3) days, p=0.156) and increased rates of home/rehabilitation discharges 51% vs. 40%, p=0.224. Older age correlated independently with severe disability aOR=1.04 per year/age, (95%CI=1.01-1.07, p=0.023) as did more severe strokes, aOR per NIHSS point=1.07, 95%CI=0.99-1.15, P=0.096). Larger final infarct volumes had a trend towards severe disability in EVT aOR=1.005, 95%CI=0.996-1.013, p=0.257, but not in MM aOR=1.0 (95% CI 0.993-1.007, p=0.966). Lack of reperfusion (>90% Tmax>6 reduction) had a strong trend for severe disability in MM (83% in non-reperfusers vs. 50% for reperfusers), p=0.056, but not in EVT: 77% vs. 63%, p=0.484. Conclusion: In patients who did not achieve functional independence, EVT resulted in reduced rates of severe and profound disability, decreased length of stay and increased home and rehabilitation discharges. Older patients, more severe strokes and those who did not achieve reperfusion were more likely to have severe disability especially if not treated with EVT. EVT may result in avoiding severe disability in elderly patients.

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Abstract P525: Endovascular Thrombectomy Outcomes in Transferred Octogenarians: A Multicenter Pooled Analysis

Stroke ◽

10.1161/str.52.suppl_1.p525 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jonathan Greco ◽

Michael Chen ◽

Ameer E Hassan ◽

Nitin Goyal ◽

Haris Kamal ◽

...

Keyword(s):

Elderly Patients ◽

Functional Independence ◽

Pooled Analysis ◽

Stroke Severity ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Younger Patients ◽

Profound Disability ◽

Iv Tpa

Background: Acute ischemic strokes outcomes may be less favorable in elderly patients. Whether transferring octogenarians with large vessel occlusion (LVO) for endovascular thrombectomy (EVT) results in similar outcomes to younger patients is uncertain. Methods: A pooled cohort from 6 centers (Europe, US) from 1/2014 to 5/2020 of pts with (ICA, M1, M2) LVO transferred for EVT ≤ 24 hrs from LKW. Patients were stratified into < 80 vs ≥ 80 years old. We compared 90 day functional independence and safety outcomes and assessed for predictors of good outcome (mRS 0-2) and profound disability (mRS 5-6). Results: Of 1176 pts received EVT as transfers, 216 (18%) were octogenarians. Baseline NIHSS was higher in octogenarians [19 (14, 22) vs 17 (12, 21), p<0.001], while IV tPA (52% vs 54%, p=0.52) and time LKW to EVT center [285 (193, 537) vs 272 (190, 470) min, p=0.15] were similar. Functional independence rates were lower in patients ≥ 80 as compared to < 80 (26% vs 46%, aOR 0.50, 95%CI 0.34-0.75, p=0.001). sICH was similar (8.6 vs 9.9%, p=0.56), but octogenarians had significantly higher 90-day mortality (42% vs 17%, p<0.001). Milder strokes (aOR 0.88, 95%CI 0.86-0.91, p<0.001), earlier presentation (aOR 0.95, 95%CI 0.91-0.98, p=0.004) and IV tPA (aOR 1.34, 95%CI 0.98-1.84, p=0.069) were associated with higher functional independence odds after EVT in octogenarians. Higher stroke severity (12% for each point, aOR=1.12, 95%CI 1.11-1.17-, p<0.001) and delayed reperfusion (3% for each additional hr, aOR 1.03, 95%CI 1.00-1.06, p=0.071) were associated with profound disability following EVT in octogenarians. Conclusion: EVT may be associated with lower independence rates in transferred octogenarians with LVO. Milder stroke severity, earlier presentation and IV thrombolysis increased the odds of good outcomes in octogenarians. Severe strokes and later treatment were associated with profound disability. Optimized selection and workflow is warranted in transferring elderly patients for EVT.

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Using machine learning to optimize selection of elderly patients for endovascular thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014381 ◽

2019 ◽

Vol 11 (8) ◽

pp. 847-851 ◽

Cited By ~ 6

Author(s):

Ali Alawieh ◽

Fadi Zaraket ◽

Mohamed Baker Alawieh ◽

Arindam Rano Chatterjee ◽

Alejandro Spiotta

Keyword(s):

Machine Learning ◽

Elderly Patients ◽

Characteristic Curve ◽

Clinical Decision ◽

Functional Independence ◽

Machine Learning Algorithms ◽

Tree Model ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Symptomatic Intracerebral Hemorrhage

BackgroundEndovascular thrombectomy (ET) is the standard of care for treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion. The elderly population has been under-represented in clinical trials on ET, and recent studies have reported higher morbidity and mortality in elderly patients than in their younger counterparts.ObjectiveTo use machine learning algorithms to develop a clinical decision support tool that can be used to select elderly patients for ET.MethodsWe used a retrospectively identified cohort of 110 patients undergoing ET for AIS at our institution to train a regression tree model that can predict 90-day modified Rankin Scale (mRS) scores. The identified algorithm, termed SPOT, was compared with other decision trees and regression models, and then validated using a prospective cohort of 36 patients.ResultsWhen predicting rates of functional independence at 90 days, SPOT showed a sensitivity of 89.36% and a specificity of 89.66% with an area under the receiver operating characteristic curve of 0.952. Performance of SPOT was significantly better than results obtained using National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT score, or patients’ baseline deficits. The negative predictive value for SPOT was >95%, and in patients who were SPOT-negative, we observed higher rates of symptomatic intracerebral hemorrhage after thrombectomy. With mRS scores prediction, the mean absolute error for SPOT was 0.82.ConclusionsSPOT is designed to aid clinical decision of whether to undergo ET in elderly patients. Our data show that SPOT is a useful tool to determine which patients to exclude from ET, and has been implemented in an online calculator for public use.

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Abstract P548: Multiple Attempts Complete Reperfusion versus Single Pass Successful Reperfusion: A Sub-Analysis From the Select Study

Stroke ◽

10.1161/str.52.suppl_1.p548 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ameer E Hassan ◽

Spiros Blackburn ◽

Michael G Abraham ◽

Wondwossen G Tekle ◽

Nirav Vora ◽

...

Keyword(s):

Statistical Significance ◽

Functional Independence ◽

Multicenter Cohort Study ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Single Pass ◽

First Pass ◽

Baseline Characteristics ◽

Similar Good ◽

The Ideal

Introduction: Successful and fast reperfusion with endovascular thrombectomy (EVT) improves outcomes in acute ischemic strokes due to large vessel occlusion (LVO). While complete reperfusion (mTICI 3) is the ideal target, multiple passes could prolong EVT and increase complications likelihood without improving clinical outcomes. We hypothesized that pts with a single pass mTICI2b would have similar good outcomes to those with multiple passes mTICI3 with a better safety profile. Methods: From the prospective multicenter cohort study of imaging selection (SELECT), EVT pts who achieved mTICI2b and mTICI3 were stratified into those with single pass vs multiple passes. Functional independence rates at 90 day mRS and safety (sICH, neuro-worsening and mortality) were compared between pts with single pass mTICI 2b and multiple passes mTICI 3. Results: Of 361 pts enrolled, 285 received EVT, of those 70 (25%) achieved mTICI 2b and 159 (56%) mTICI 3. 89 (31%) achieved mTICI 3 with single pass, 70 (25%) with multiple passes, 33 (12%) had mTICI 2b with a single pass and 37 (13%) with multiple passes. Baseline characteristics were similar between the two groups except for larger perfusion deficit (Tmax >6s) volume in pts with multiple passes mTICI3 55 (25, 99) cc vs first pass mTICI 2b 43 (4, 79), p=0.047). Functional independence rates were higher with single pass mTICI 2b as compared to multiple passes mTICI 3 (70% vs 56%, aOR=1.51, 95% CI=0.48-4.76, p=0.78), fig 1 but did not reach statistical significance. Multiple passes mTICI 3 was associated with numerically higher mortality (13% vs 3%, p=0.16) and Neuro-worsening (13% vs 3%, p=0.16) with similar sICH: 4% vs 3%, p=1.00 rates. Conclusion: Complete reperfusion with multiple passes did not confer better outcome rates than single pass mTICI 2b and was associated with worse safety profiles. These results suggest that in the absence of complete reperfusion on first attempt, a single pass mTICI 2b may be sufficient for a successful thrombectomy.

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Thrombectomy 24 hours after stroke: beyond DAWN

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013923 ◽

2018 ◽

Vol 10 (11) ◽

pp. 1039-1042 ◽

Cited By ~ 33

Author(s):

Shashvat M Desai ◽

Diogo C Haussen ◽

Amin Aghaebrahim ◽

Alhamza R Al-Bayati ◽

Roberta Santos ◽

...

Keyword(s):

Functional Independence ◽

Efficacy And Safety ◽

Large Vessel Occlusion ◽

Inclusion Criteria ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Symptomatic Intracranial Hemorrhage ◽

Baseline Characteristics ◽

Trial Intervention

Background and purposeThe results of the DAWN trial support the benefit of thrombectomy in patients with anterior circulation large vessel occlusion (LVO) acute stroke presenting within 6–24 hours from time last known well (TLKW). We sought to evaluate the characteristics and outcomes of patients who met DAWN criteria but underwent thrombectomy beyond 24 hours of TLKW.MethodsA retrospective review of endovascular thrombectomy databases at three comprehensive stroke centers was performed to identify all patients who received thrombectomy beyond 24 hours of TLKW and otherwise met the DAWN criteria. Baseline characteristics, efficacy, and safety outcomes were compared with patients in the DAWN trial intervention arm.ResultsTwenty-one patients met the inclusion criteria. Rates of successful reperfusion (mTICI2b–3: 81% vs 84%, P=0.72), 90-day functional independence (modified Rankin Scale score 0–2, 43% vs 48%, P=0.68), and symptomatic intracranial hemorrhage (5% vs 6%, P=0.87) were comparable across the two groups.ConclusionThrombectomy appears to be safe and feasible in patients with acute ischemic stroke due to LVO meeting all DAWN trial criteria but treated beyond 24 hours of TLKW with outcomes comparable to patients in the DAWN trial intervention arm. Further studies are warranted to validate these findings.

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ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

Wiadomości Lekarskie ◽

10.36740/wlek201908109 ◽

2019 ◽

Vol 72 (8) ◽

pp. 1466-1472

Author(s):

Grażyna Kobus ◽

Jolanta Małyszko ◽

Hanna Bachórzewska-Gajewska

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Elderly Patients ◽

Older Patients ◽

Age Groups ◽

Kidney Injury ◽

The Elderly ◽

Younger Patients ◽

Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

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Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01842-x ◽

2021 ◽

Author(s):

Andrea Kirfel ◽

Jan Menzenbach ◽

Vera Guttenthaler ◽

Johanna Feggeler ◽

Andreas Mayr ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Elderly Patients ◽

Postoperative Delirium ◽

Confusion Assessment Method ◽

Assessment Method ◽

Hospital Length Of Stay ◽

Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

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Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study

BMC Geriatrics ◽

10.1186/s12877-021-02044-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jenny Liu ◽

Therese Palmgren ◽

Sari Ponzer ◽

Italo Masiello ◽

Nasim Farrokhnia

Keyword(s):

Length Of Stay ◽

Hospital Admission ◽

Older Patients ◽

Outcome Measure ◽

Admission Rate ◽

Intervention Period ◽

Total Hospital ◽

Hospital Admission Rate ◽

Emergency Team ◽

Interprofessional Team

Abstract Background Emergency department (ED) care of older patients is often complex. Geriatric ED guidelines can help to meet this challenge. However, training requirements, the use of time-consuming tools for comprehensive geriatric assessment (CGA), a lack of golden standard to identify the frail patients, and the weak evidence of positive outcomes of using CGA in EDs pose barriers to introduce the guidelines. Dedicating an interprofessional team of regular ED medical and nursing staff and an older-friendly ED area can be another approach. Previous studies of geriatrician-led CGA in EDs have reported a reduced hospital admission rate. The aim of this study was to investigate whether a dedicated interprofessional emergency team also can reduce the hospital admission rate without the resources required by the formal use of CGA. Methods An observational pre-post study at a large adult ED, where all patients 80 years or older arriving on weekdays in the intervention period from 2016.09.26 to 2016.11.28 and the corresponding weekdays in the previous year from 2015.09.28 to 2015.11.30 were included. In the intervention period, older patients either received care in the geriatric module by the dedicated team or in the regular team modules for patients of mixed ages. In 2015, all patients received care in regular team modules. The primary outcome measure was the total hospital admission rate and the ED length of stay was the secondary outcome measure. Results We included 2377 arrivals in the intervention period, when 26.7% (N = 634) received care in the geriatric module, and 2207 arrivals in the 2015 period. The total hospital admission rate was 61.7% (N = 1466/2377) in the intervention period compared to 64.8% (N = 1431/2207) in 2015 (p = 0.03). The difference was larger for patients treated in the geriatric module, 51.1% compared to 62.1% (95% CI: 56.3 to 68.0%) for patients who would have been eligible in 2015. The ED length of stay was longer in the intervention period. Conclusions An interprofessional team and area dedicated to older patients was associated to a lower hospital admission rate. Further studies are needed to confirm the results.

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Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients – A Retrospective Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0135066 ◽

2015 ◽

Vol 10 (8) ◽

pp. e0135066 ◽

Cited By ~ 17

Author(s):

Steffie H. A. Brouns ◽

Patricia M. Stassen ◽

Suze L. E. Lambooij ◽

Jeanne Dieleman ◽

Irene T. P. Vanderfeesten ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Elderly Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Organisational Factors

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Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit

Infection Control and Hospital Epidemiology ◽

10.1086/501868 ◽

2001 ◽

Vol 22 (02) ◽

pp. 83-87 ◽

Cited By ~ 37

Author(s):

Joseph M. Mylotte ◽

Robin Graham ◽

Lucinda Kahler ◽

B. Lauren Young ◽

Susan Goodnough

Keyword(s):

Length Of Stay ◽

Nosocomial Infection ◽

Functional Status ◽

Functional Independence ◽

Functional Improvement ◽

Multivariate Linear Regression Analysis ◽

Rehabilitation Unit ◽

Cord Injury ◽

Acute Rehabilitation ◽

First Time

AbstractObjective:To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.Setting:A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.Study Population:All patients admitted to the unit between January 1997 and July 1998.Design:Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).Results:There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), andClostridium difficilediarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P<.001), pressure ulcer (.002), and nosocomial infection (<.001). Significant negative predictors of ΔFIM were age (P<.001), FIM score on admission (<.001), prior hospital LOS (.002), and nosocomial infection (.007).Conclusions:Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.

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PALOMAGE, a French real-world cohort of elderly women beyond age 70 with advanced breast cancer receiving palbociclib: Baseline characteristics and safety evaluation.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1012 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1012-1012

Author(s):

Philippe Caillet ◽

Marina Pulido ◽

Etienne Brain ◽

Claire Falandry ◽

Isabelle Desmoulins ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Real World ◽

Older Patients ◽

Systemic Treatment ◽

Safety Data ◽

Real Life ◽

Advanced Breast ◽

Baseline Characteristics ◽

Grade 3

1012 Background: Advanced breast cancer (ABC) is common in older patients, resulting from the high incidence of breast cancer beyond age 70. This population is often limited in clinical trials. Endocrine therapy (ET) combined with a CDK4/6 inhibitor is the standard of care in ABC overexpressing hormonal receptors (HR+). Data specific to older patients are scarce in the literature, deserving further research. Methods: PALOMAGE is an ongoing French prospective study evaluating palbociclib (PAL) + ET in real life setting in women aged ≥70 with HR+ HER2- ABC, split in 2 cohorts: ET sensitive patients with no prior systemic treatment for ABC (cohort A), and ET resistant patients and/or with prior systemic treatment for ABC (cohort B). Data collected include clinical characteristics, quality of life (EORTC QLQ-C30 and ELD14) and geriatric description [G8 and Geriatric-COre DatasEt (G-CODE)]. This analysis reports on baseline characteristics and safety data for the whole population. Results: From 10/2018 to 10/2020, 400 and 407 patients were included in cohort A and B, respectively. The median age was 79 years (69-98), 15.1% with an age > 85. ECOG performance status (PS) was ≥2 in 17.9% patients, 68.3% had a G8 score ≤14 suggesting frailty, 32.1% had bone only metastasis, and 44% had visceral disease. 35.8% of patients in cohort B had no prior treatment for ABC. Safety data were available for 787 patients. The median follow-up was 6.7 months (IC95% = 6.1-7.6). At start of treatment, full dose of PAL (125 mg) was used in 76% of the patients: 62.6%, 68.7% and 71.6% of patients aged ≥ 80, those with ECOG PS ≥2 and those with a G8 score ≤14, respectively. In the safety population, 70% had ≥1 adverse event (AE), including 43.1% grade 3/4 AE, and 22.9% ≥ 1 serious AE. Most frequent AE reported were neutropenia (43.2%), anemia (17.5%), asthenia (16.3%) and thrombocytopenia (13.6%). Grade 3/4 neutropenia was observed in 32.3% of patients, with febrile neutropenia in 1.1%. Grade 3/4 AE PAL-related were reported in 40.1%, 31.4% of patients aged < 80, ≥80, respectively. Regarding PAL, 23.4% of patients had a dose reduction and 41.8% had a temporary or permanent discontinuation due to AE. Safety data were similar in both cohorts. Geriatric data and impact on safety will be presented. Conclusions: PALOMAGE is a unique large real-world cohort focusing on older patients treated with PAL in France. These preliminary data do not suggest any new safety signal, matching data derived from PALOMA trials. The occurrence of less grade3/4 AE related to PAL in patients aged 80 and beyond might reflect the 30% decrease of PAL dose upfront. Effectiveness analyses are eagerly awaited. Clinical trial information: EUPAS23012 .

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