scholarly journals An Exploratory Study of Cytokine Markers of Cancer-Related Cognitive Impairment in Hematological Malignancy

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5914-5914
Author(s):  
Samantha J Mayo ◽  
Rob C. Laister ◽  
Sean B Rourke ◽  
John Kuruvilla
Keyword(s):  
Multiple Myeloma ◽  
Working Memory ◽  
Cognitive Impairment ◽  
Information Processing ◽  
Cognitive Performance ◽  
Exploratory Study ◽  
Research Funding ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Psychomotor Efficiency

Abstract Introduction. Cancer-related cognitive impairment is a distressing symptom that affects numerous patients after cancer therapy, including those treated for hematological malignancy. The lack of effective interventions has driven interest in determining underlying mechanisms. Accumulating evidence in the context of solid tumours suggests inflammatory processes are involved in the development of cognitive symptoms. The objective of this study was to explore whether changes in serum markers of inflammation underlie differences in cognitive functioning among patients treated for hematological malignancies. Methods. The sample comprised participants treated for lymphoma or multiple myeloma who were participating in a feasibility study of a computerized cognitive training program. Prior to the intervention, a battery of neuropsychological tests were administered to assess cognitive function in the following domains: Learning Efficiency and Memory; Information Processing and Psychomotor Efficiency; and Executive Functioning and Working Memory. Composite T-scores for each domain were computed as the mean of demographically adjusted T-scores from constituent tests. Blood was drawn concurrently from consenting participants. Soluble proteins were quantified from serum using a multiplex sandwich elisa assay of 27 arrayed cytokine and chemokine analytes. Pearson's correlations between composite T-scores and cytokine concentrations were calculated. T-tests assessed differences in cytokine concentrations between participants who met the criteria for impairment (composite T-score<40) compared to those who did not. Results. Eleven participants (Non-Hodgkin Lymphoma: n=5; Hodgkin Lymphoma: n=3; Multiple Myeloma: n=3; Mean age = 52 years; 6 males/5 females) were included in this analysis. Six of the participants were treated with autologous stem cell transplant for either lymphoma or multiple myeloma; five with primary chemotherapy treatment for lymphoma. Participants were a median 59 days (range 28-265 days) from completion of treatment. Proportion of patients impaired in each domain were: Leaning Efficiency and Memory (5/11); Information Processing and Psychomotor Efficiency (5/11); and Executive Functioning and Working Memory (3/11). Serum concentration of Chemokine Ligand 4 (CCL4, also known as Macrophage Inflammatory Protein 1β) was positively correlated with performance in Information Processing and Psychomotor Efficiency, such that increased CCL4 was associated with better cognitive performance (r=0.62, p=0.0418). Participants who met the criteria for impairment in the domain of Information Processing and Psychomotor Efficiency had a significantly lower concentration of CCL4 compared to those who did not (impaired: 8.14 pg/ml; non-impaired: 14.88 pg/ml; p= 0.0072). Participants who met the criteria for impairment in the domain of Information Processing and Psychomotor Efficiency also had a lower concentration of Granulocyte Colony Stimulating Factor (GCSF) compared to those who did not (impaired: 14.40 pg/ml; non-impaired: 22.47 pg/ml; p=0.0467). We did not detect any other significant relationships between cytokine concentration and cognitive performance. Conclusions. The findings from this exploratory study suggest that there may be a role for macrophage recruitment in modulating the pathogenesis of cancer-related cognitive impairment in hematological malignancies, particularly in the area of information processing and psychomotor speed. Larger studies are needed to validate this finding and clarify the role of CCL4 in the context of cell signalling pathways involved in cognitive functioning. Disclosures Kuruvilla: Janssen: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria; Merck: Consultancy, Honoraria; Leukemia and Lymphoma Society Canada: Research Funding; Abbvie: Consultancy; Celgene: Honoraria; Amgen: Honoraria; Gilead: Consultancy, Honoraria; Princess Margaret Cancer Foundation: Research Funding; Seattle Genetics: Consultancy, Honoraria; Karyopharm: Honoraria; Lundbeck: Honoraria; Roche: Consultancy, Honoraria, Research Funding.

scholarly journals Goal Setting Improves Cognitive Performance in a Randomized Trial of Chronic Stroke Survivors

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 458-470
Author(s):  
Keera N. Fishman ◽  
Andrea R. Ashbaugh ◽  
Richard H. Swartz
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Cognitive Performance ◽  
Goal Setting ◽  
Verbal Learning ◽  
Chronic Phase ◽  
Vascular Cognitive Impairment ◽  
Stroke Survivors ◽  
Verbal Recall

Background and Purpose: Cognitive impairment after stroke, especially executive and attention dysfunction, is common, negatively affects daily functioning, and has limited treatment options. A single-blind, parallel-design, randomized controlled trial was used to examine the impact of goal setting on poststroke cognitive performance. Methods: Stroke survivors (n=72; mean age, 68.38 [SD=11.84] years; 69.4% men) in the chronic phase (≥3 months) after stroke from an academic stroke prevention clinic were randomly assigned to receive goal-setting instructions (n=36) or standard instructions (n=36) after completing baseline cognitive measures of executive function (primary outcome), attention/working memory, verbal learning, and verbal recall. Results: A one-way mixed multivariate analysis of covariance (MANCOVA) found a group by instructional manipulation interaction effect for executive function (Wilks λ=0.66; F [3,66]=11.30; P ≤0.001; η 2 p =0.34), after adjusting for age and years of education. After similar adjustment, attention/working memory (Wilks λ=0.86; F [5,63]=2.10; P =0.043; η 2 p =0.16) and verbal learning ( F [1,60]=5.81; P =0.019; η 2 p =0.09) also showed improvement after instruction but not verbal recall (Wilks λ=0.95; F [1,56]=2.82; P =0.099; η 2 p =0.05). There were no adverse events. Conclusions: Goal setting improved executive function, attention/working memory, and learning in a heterogeneous sample in the chronic phase after stroke. This suggests that >3 months after stroke, vascular cognitive impairment is not a fixed deficit; there is a motivational contributor. Brief treatments targeting goal-oriented behavior and motivation may serve as a novel approach or adjunct treatment to improve cognitive outcomes after stroke. Future research should investigate the use of goal setting on functional outcomes (eg, instrumental activities of daily living and vocational function) in this population, highlighting new potential avenues for treatment for vascular cognitive impairment. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03511300.

scholarly journals Do Cognitive Performance and Physical Function Differ between Individuals with Motoric Cognitive Risk Syndrome and those with Mild Cognitive Impairment?

2020 ◽  
Author(s):  
Fang-Yu Cheng ◽  
Yuanmay Chang ◽  
Shih-Jung Cheng ◽  
Jin-Siang Shaw ◽  
Chuo-Yu Lee ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Physical Function ◽  
Cognitive Performance ◽  
Assessment Scale ◽  
Timed Up And Go ◽  
Cognitive Risk ◽  
Cognitive Complaint

Abstract Background Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. Methods A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into two groups, MCR (n=33) and MCI (n=44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, “pure” MCI had no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. Results Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. Conclusions We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.

scholarly journals T1 Relaxation Times in the Cortex and Thalamus Are Associated With Working Memory and Information Processing Speed in Patients With Multiple Sclerosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Christian Thaler ◽  
Isabelle Hartramph ◽  
Jan-Patrick Stellmann ◽  
Christoph Heesen ◽  
Maxim Bester ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Working Memory ◽  
Cognitive Impairment ◽  
Information Processing ◽  
Processing Speed ◽  
T1 Mapping ◽  
Relaxation Times ◽  
Healthy Controls ◽  
Information Processing Speed ◽  
T1 Relaxation

Background: Cortical and thalamic pathologies have been associated with cognitive impairment in patients with multiple sclerosis (MS).Objective: We aimed to quantify cortical and thalamic damage in patients with MS using a high-resolution T1 mapping technique and to evaluate the association of these changes with clinical and cognitive impairment.Methods: The study group consisted of 49 patients with mainly relapsing-remitting MS and 17 age-matched healthy controls who received 3T MRIs including a T1 mapping sequence (MP2RAGE). Mean T1 relaxation times (T1-RT) in the cortex and thalami were compared between patients with MS and healthy controls. Additionally, correlation analysis was performed to assess the relationship between MRI parameters and clinical and cognitive disability.Results: Patients with MS had significantly decreased normalized brain, gray matter, and white matter volumes, as well as increased T1-RT in the normal-appearing white matter, compared to healthy controls (p &lt; 0.001). Partial correlation analysis with age, sex, and disease duration as covariates revealed correlations for T1-RT in the cortex (r = −0.33, p &lt; 0.05), and thalami (right thalamus: r = −0.37, left thalamus: r = −0.50, both p &lt; 0.05) with working memory and information processing speed, as measured by the Symbol-Digit Modalities Test.Conclusion: T1-RT in the cortex and thalamus correlate with information processing speed in patients with MS.

scholarly journals Globulin fraction and albumin: globulin ratio as a predictor of mortality in a South African multiple myeloma cohort

2020 ◽  
Vol 9 (3) ◽  
pp. IJH27
Author(s):  
Garrick Edouard Laudin ◽  
Peter F Levay ◽  
Buks Coetzer
Keyword(s):  
Multiple Myeloma ◽  
South African ◽  
Hematological Malignancies ◽  
Plasma Cells ◽  
Hematological Malignancy ◽  
Clonal Expansion ◽  
Globulin Fraction ◽  
Bone Marrow Plasma ◽  
Risk Categories ◽  
Laboratory Measures

Multiple myeloma, a hematological malignancy typified by the clonal expansion of bone marrow plasma cells, contributes to one percent of all malignancies worldwide. Despite myeloma only contributing to 10% of all hematological malignancies, it carries significant morbidity owing to its heterogenous presentation from orthopedic manifestations to renal sequelae. Patients with the disease can be risk stratified into high risk categories by the presence of various cytogenetic and other laboratory measures, albeit expensive. The albumin:globulin ratio and its inverse the globulin:albumin ratio is proposed as a means of predicting survival in this group of patients as a cheaper and more accessible marker of disease.

scholarly journals French National Retrospective Cohort of Hairy-Cell Leukemias: Risk of Second Malignancies after 10 Years of Follow-up

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1537-1537
Author(s):  
Jérôme Paillassa ◽  
Edouard Cornet ◽  
Stephanie Noel ◽  
Cecile Tomowiak ◽  
Aline Schmidt ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Retrospective Cohort ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Solid Cancer ◽  
Advisory Committees ◽  
History Of ◽  
History Of Cancer

Introduction: Hairy-cell leukemia (HCL) is a chronic B-cell lymphoproliferative disorder with a favorable outcome thanks to treatment with purine analogues (PNA) like cladribine and pentostatin. Here, we updated the French national retrospective cohort of HCL after 10 years of follow-up, in order to evaluate the risk of second cancers in these patients. Methods: Data were collected up to June 2018 through a questionnaire sent to the members of the Société Française d'Hématologie, and centralized in the cohort database. We described the second malignancies observed during the follow-up, distinguishing second 'solid' cancers from second hematological malignancies. Then, using a Fine and Gray model, we performed a multivariate analysis in order to identify second cancer risk factors. Finally, to evaluate the excess of cancers in our cohort in comparison with the French general population, we calculated the standardized incidence ratio (SIR). Results: 279 patients (pts) from 19 centers were included in our retrospective cohort. The median age was 59 years old (range 29-88). 21% had an infectious disease at diagnosis, 23% had a familial history of cancer and 11% a personal history of cancer before HCL diagnosis. The median number of lines of treatments was 1 (0-7). PNA (cladribine or pentostatin) were the first therapeutic choice in frontline (75% of pts) and at relapse (69%). With a median follow-up of 127 months (2-413), the median overall survival for the overall study population was 328 months (95% CI 299-357) and the median relapse-free survival (RFS) was 136 months (95% CI 109-163). Pts treated with cladribine or pentostatin in first line had a statistically significant better RFS than pts treated with 'other' treatments (log rank test, p &lt; 0.001). The 10-year cumulative incidence of relapse was 39% (95% CI 33-46). Pts who received treatments other than PNA in first line had a higher risk of relapse (Gray's test, p &lt; 0.001). For pts receiving PNA in first and second lines, there was no difference in outcomes between those who switched PNA and those who did not. In this cohort, we observed 68 second malignancies during the follow-up: 49 solid cancers (most prevalent: prostate and non-melanoma skin cancers) and 19 hematological malignancies (most prevalent: monoclonal gammopathy of undetermined significance (MGUS) and myelodysplastic syndromes (MDS)). The median onset of second cancer, second solid cancer and second hematological malignancy from HCL diagnosis was 81 months, 99 months and 78 months, respectively. The median age at diagnosis of cancer, solid cancer and hematological malignancy was 70, 69 and 77 years old, respectively. Considering death as a competing risk, the 10-year cumulative incidence of cancer, solid cancer and hematological malignancy was 15% (95% CI 11-19), 11% (95% CI 7.2-15), and 5.0% (95% CI 2.8-8.2), respectively. In multivariate analyses, IFN treatment was associated with a decreased risk for all cancers (Fine and Gray regression model, subdistribution Hazard Ratio (sdHR) 0.53 (95% CI 0.29-0.97); p = 0.038), a familial history of cancer was a risk factor for solid cancers (sdHR 2.12 (95% CI 1.15-3.91); p = 0.017), a personal history of cancer was a risk factor for hematological malignancies (sdHR 3.47 (95% CI 1.14-10.55); p = 0.028). Even after excluding non-melanoma skin cancers and MGUS, there was an excess of cancers (SIR = 2.22), solid cancers (SIR = 1.81) and hematological malignancies (SIR = 6.67). Conclusions: In this updated real-world retrospective cohort with a long follow-up and most pts treated with PNA, we highlighted the importance and the excess of second cancers in HCL patients, in particular hematological malignancies. Figure Disclosures Paillassa: Janssen: Other: Bibliography board with young hematologists. Thieblemont:Roche: Honoraria, Research Funding; Gilead: Honoraria; Novartis: Honoraria; Kyte: Honoraria; Janssen: Honoraria; Celgene: Honoraria; Cellectis: Membership on an entity's Board of Directors or advisory committees. Hermine:AB Science: Membership on an entity's Board of Directors or advisory committees. Feugier:janssen: Honoraria, Research Funding, Speakers Bureau; gilead: Honoraria, Research Funding, Speakers Bureau; roche: Honoraria, Research Funding, Speakers Bureau; abbvie: Honoraria, Research Funding, Speakers Bureau. Troussard:Innate Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche: Other: Research Support; Sysmex: Other: Research Support.

scholarly journals Do Cognitive Performance and Physical Function Differ between Individuals with Motoric Cognitive Risk Syndrome and those with Mild Cognitive Impairment?

2020 ◽  
Author(s):  
Fang-Yu Cheng ◽  
Yuanmay Chang ◽  
Shih-Jung Cheng ◽  
Jin-Siang Shaw ◽  
Chuo-Yu Lee ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Physical Function ◽  
Cognitive Performance ◽  
Assessment Scale ◽  
Timed Up And Go ◽  
Cognitive Risk ◽  
Cognitive Complaint

Abstract Background Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. Methods A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into two groups, MCR (n = 33) and MCI (n = 44) groups, based on definition criteria from previous studies. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. Results Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. Conclusions We noted that cognitive performance and physical function were lower in MCR individuals than MCI individuals. The significant differences between those two groups may provide insight that MCR might lead to more severe overall functional deterioration in older adults than MCI patients.

scholarly journals Do Cognitive Performance and Physical Function Differ between Individuals with Motoric Cognitive Risk Syndrome and those with Mild Cognitive Impairment?

2020 ◽  
Author(s):  
Fang-Yu Cheng ◽  
Yuanmay Chang ◽  
Shih-Jung Cheng ◽  
Jin-Siang Shaw ◽  
Chuo-Yu Lee ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Physical Function ◽  
Cognitive Performance ◽  
Assessment Scale ◽  
Timed Up And Go ◽  
Cognitive Risk ◽  
Cognitive Complaint

Abstract Background Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. Methods A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into two groups, MCR (n=33) and MCI (n=44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, “pure” MCI has no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. Results Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. Conclusions We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.

scholarly journals Impact of Neurocognitive Dysfunction in a Veteran Population Undergoing First Outpatient Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5883-5883
Author(s):  
Shakira J. Grant ◽  
Lindsay M. Hannan ◽  
Jessica L. Brand ◽  
Robert E. Richard ◽  
Daniel Y. Wu ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Cognitive Impairment ◽  
Daily Living ◽  
Research Funding ◽  
Stem Cell Transplant ◽  
P Value ◽  
Cell Transplant ◽  
Neurocognitive Dysfunction ◽  
Hematopoietic Stem

INTRODUCTION Older adults (age > 70 years) with multiple myeloma (MM) are at higher risk of early mortality partly due to age-related factors, including impairments of cognition and function. To date, few studies have investigated the prevalence of neurocognitive impairment prior to autologous hematopoietic stem cell transplantation (ASCT) and its impact on post-transplant outcomes. We hypothesize, for patients with MM undergoing first outpatient ASCT, age >70 years or the presence of comorbid neurocognitive dysfunction decreases the time to first unplanned hospitalization occurring within 30 days post ASCT, and increases the overall length of stay (LOS) on the transplant service. METHODS We conducted a retrospective cohort study of 76 consecutive patients who underwent first ASCT at the Puget Sound Veterans Health Administration, for MM between January 2017 and December 2018. Patients with the following were excluded: amyloidosis, anaplastic plasmacytoma, and POEMS. Comprehensive psychological evaluations performed within 30 days prior to ASCT included: cognitive screening [Montreal Cognitive Assessment (MOCA)], depression [Patient Health Questionnaire-9 (PHQ-9)], and anxiety [General Anxiety Disorder- 7 (GAD-7)]. Functional status was assessed by activities of daily living (ADLS) and instrumental activities of daily living (IADLS). Data sources for table 1, included the institutional stem cell transplant database, and comprehensive electronic medical record review for each patient. This included vital status as of 7/15/19. Total LOS on the transplant service was measured as the time from arrival until discharge post-engraftment. For eligible patients, all portions of ASCT, including, stem cell collection, conditioning and stem cell infusion were completed as an outpatient. Statistical analyses were performed using SAS version 9.4. Kaplan Meier curves were generated to explore the association of cognitive scores and 1) time until first unplanned hospitalization within 30 days post-ASCT and 2) outpatient LOS on the stem cell transplant service. RESULTS Of the 76 patients undergoing ASCT, median age was 67 (range 40-79), 29% (22/76) were ≥ 70 years old . 67% (51/76) underwent ASCT within 1 year from diagnosis. The majority (73/76) scored ≥ 70 on a provider-assessed Karnofsky performance scale. Of those with MOCA scores available (n=64), impairments in cognition ranged from suspected mild cognitive impairment (MOCA 20-25) to probable cognitive impairment (MOCA 15-19), in 50% (32/64) and 6%( 8/64) of patients respectively. Those with MOCA scores< 26 were more likely to have ≥ 1 IADL impairment compared to those with scores ≥ 26 (Fisher Exact p=0.014). A total of 19 patients underwent planned hospitalization for conditioning followed by stem cell rescue, and therefore were not included in our analysis of unplanned hospitalization. Of the 57% (33/59) of patients with an unplanned inpatient admission within 30 days post-ASCT, the median time to first admission was 11 days. A total of 61% (17/28) and 53%(10/19) patients with MOCA <26 and ≥26, respectively, required hospitalization post-ASCT (log-rank p-value=0.70). There was no difference in the time to first unplanned hospitalization by age (<70, ≥70 years; log-rank p-value 0.58). Median time spent on the transplant service was 78 days (range 30 - 118). Suspected cognitive impairment did not influence time on the outpatient transplant service (median: 79 days MOCA <26 and 77 days MOCA ≥ 26, log-rank p-value=0.38). Median number of days on the transplant service differed by age group (log-rank p-value=0.02),) 76 vs 79 days in those age <70 and ≥70 respectively. CONCLUSION We found a high prevalence of cognitive impairment in MM patients undergoing first ASCT. However, we found no significant association between cognitive impairment or age and 30-day unplanned hospitalization. Older age (>70 years) was associated with a longer transplant service LOS. Thus, select older patients may have higher utilization of hospital resources post-ASCT compared to their younger counterparts. However confounding variables and selection bias may have influenced these preliminary results and additional analyses are ongoing. Future studies will evaluate the impact of age and pre-transplant neurocognitive function on additional outcomes, including longitudinal neurocognitive deterioration and impact on long-term morbidity and mortality. Disclosures Graf: TG Therapeutics: Research Funding; AstraZeneca: Research Funding; BeiGene: Research Funding.

scholarly journals Trends in Inpatient Chemotherapy Hospitalizations, Cost and Mortality for Patients with Hematological Malignancies: Insights from the National Inpatient Sample

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 53-54
Author(s):  
Ghulam Rehman Mohyuddin ◽  
Kellen Gil ◽  
Brian McClune ◽  
Nausheen Ahmed ◽  
Al-Ola Abdallah ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Length Of Stay ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Hematological Malignancies ◽  
Mortality Rates ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Lymphoid Leukemia ◽  
Acute Myeloid

INTRODUCTION: With the advent of newer treatment options for patients with acute leukemia and myeloma, therapies are increasingly safely administered on an outpatient basis. We hypothesized increasing utilization of outpatient options would result in decreased hospitalizations for chemotherapy, albeit with increased hospitalization charges. We interrogated chemotherapy utilization amongst adult inpatients with these malignancies using the National Inpatient Sample (NIS). METHODS: The NIS is a database providing information on all inpatient hospitalizations in the United States (US), including primary and secondary diagnoses, procedures, length of stay, and disposition. Approximately 20% of admissions are tracked, and weighted estimates are provided regarding the total number of hospitalizations in the US. Using the NIS, we tracked chemotherapy admissions for patients with the following hematological malignancies: acute myeloid leukemia (AML), acute lymphoid leukemia (ALL) and multiple myeloma (MM). Admissions for hematopoietic stem cell transplants were excluded from our analysis, and only patients aged 18 or greater were included in our analysis. Procedural International Classification of Disease (ICD) 9 and 10 codes were used to gain insight into trends of hospitalizations, elective versus urgent status, costs and length of stay for each indication. Time frame 2002-2017 was chosen as this was the most recent year for which NIS data is available. Inflation adjustments for charges were calculated based on US Department of Labor statistics. RESULTS: For MM, there were a total of 54,357 admissions for chemotherapy from 2002-2017. Amongst these admissions, 37,517 were elective, and 16,670 were non-elective, with the remainder lacking data on elective status. Figure 1 highlights trends in admissions for MM, with a significant decrease noted in the overall volume (7,547 in 2002 to 2,710 in 2014 (p=0.003)). Mortality rates for MM chemotherapy admissions, also highlighted in Figure 1, did not change significantly from 2002 to 2017 (p=0.15). Mean length of stay for chemotherapy hospitalizations increased from 4.67 days in 2002 to 6.47 days in 2017 (p&lt;0.0001). Mean inflation-adjusted hospitalization charges increased from $20,865 in 2002 to $79,161 in 2017 (p&lt;0.0001). For AML, we noted 198,288 admissions for chemotherapy from 2002-2017 of which 127,277 were considered elective, and 70,566 non-elective, with the remainder lacking data on elective status. Figure 2 highlights trends in AML admissions with a decreased volume of admissions noted from 2011 onwards after an initial increase from 2005-2008. There was a total of 14,214 admissions in 2011 compared to 10,515 in 2017 (p=0.004) There was a decrease in inpatient mortality rates from 5.5% in 2002 to 2.4% in 2017 (p&lt;0.0001). Mean length of stay was consistent during this time period from 13.35 days in 2002 to 13.34 days in 2017 (p=0.15). Mean inflation-adjusted hospitalization charges increased from $83,904 in 2002 to $133,295 in 2017 (p&lt;0.001). There was a total of 82,730 admissions for chemotherapy from 2002-2017 for ALL. Amongst these admissions, 54,565 were elective and 27,963 were non-elective, with the remainder lacking data on elective status. Figure 3 highlights trends in admissions, with an increase in number of admissions from 4,092 in 2002 to 5,960 in 2017 (p=0.86). There was a decrease in the inpatient mortality rate from 0.8% in 2002 to 0.4% in 2017 (p=0.0007). Mean length of stay stayed consistent at 7.70 days in 2002 to 7.62 days in 2017 (p=0.06). Mean inflation-adjusted hospitalization charges increased from $49,283 in 2002 to $94,787 in 2017 (p&lt;0.0001). CONCLUSIONS: There has been a steady decline in the number of admissions for inpatient chemotherapy for patients with multiple myeloma and acute myeloid leukemia over time, owing to advances in therapies delivered safely and efficaciously as an outpatient. There has also been a steady decline in inpatient mortality for chemotherapy for acute myeloid and acute lymphoid leukemia, in part due to advances in supportive care. However, the inpatient mortality rate for myeloma has not decreased, likely due to sicker patients preferentially needing admission for inpatient chemotherapy. Inflation-adjusted hospitalization charges have gone up dramatically and further work is needed to elucidate factors driving these costs, and how to mitigate them. Disclosures Ganguly: Kadmon: Other: Ad Board; Settle Genetics: Speakers Bureau; KITE Pharma: Speakers Bureau. McGuirk:Astellas: Research Funding; Novartis: Research Funding; Allo Vir: Consultancy, Honoraria, Research Funding; Juno Therapeutics: Consultancy, Honoraria, Research Funding; Kite Pharmaceuticals: Consultancy, Honoraria, Research Funding, Speakers Bureau; Pluristem Ltd: Research Funding; Gamida Cell: Research Funding; Bellicum Pharmaceutical: Research Funding; Fresenius Biotech: Research Funding.

scholarly journals A Comparative Study of Biosimilar Filgrastim Versus Originator G-CSF for CD34+ Cells Mobilization and Autografting in Hematological Malignancies

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2183-2183 ◽  
Author(s):  
Lucia Brunello ◽  
Luisa Giaccone ◽  
Maria Josè Fornaro ◽  
Matilde Scaldaferri ◽  
Valter Redoglia ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Blood Cells ◽  
Research Funding ◽  
Hematological Malignancies ◽  
Advisory Board ◽  
High Dose ◽  
Historical Cohort ◽  
Cd34 Cells ◽  
The Impact ◽  
Biosimilar Filgrastim

Abstract INTRODUCTION: Autografting (auto-HSCT) is widely used for the treatment of hematological malignancies. Since 2010, Biosimilar Filgrastim (Nivestim™, Pfizer Inc.) (BioG-CSF) has been approved and introduced into clinical practice to mobilize hematopoietic stem cells (CD34+cells) and to reduce the duration of chemo-induced neutropenia. This single institution study was designed to evaluate its safety and efficacy in the setting of "real life" medical practice. METHODS: We designed a "mixed retrospetive-prospective study" to evaluate the impact of BioG-CSF on CD34+ cells collections and engraftment kinetics after autografting. Patients who received BioG-CSF were compared with a historical cohort treated with Originator G-CSF (Filgrastim or Lenograstim). Primary endopoints were CD34+ mobilizations and post auto-HSCT engraftment kinetics. Secondary objectives included transfusions requirements, duration of hospitalization and 1-year overall survival (OS). Leukapheresis (LA) was initiated when circulating CD34+ count was at least 20/uL. Day of neutrophil engraftment was defined as the first of 3 consecutive days of absolute neutrophil count (ANC) ≥ 500/ul whereas day of platelet engraftment was defined as the first of 7 consecutive days without transfusion support. RESULTS: Initially,187 patients (137/187 affected by multiple myeloma) have been enrolled in the cohort under evaluation for CD34+ mobilization kinetics. Overall, 138 and 49 patients received originator and BioG-CSF (5-10 ug/kg/day) to collect CD34+cells. All but two patients underwent chemotherapy for mobilization (high-dose cyclophosphamide in 157/187 patients). Less than 3% of patients were poor mobilizers in both cohorts. No differences between Originator and BioG-CSF cohort were observed in time from chemotherapy to first day of LA (median day 11 vs day 11 p=0.473), CD34+/ul (mean 157.3/ul vs 166.2/ul, p=0.59) and CD34+*10^6/kg recipient harvested on the first day of LA (mean 10.5*10^6/kg vs 11.1*10^6/kg, p=0.323). A higher count of white blood cells on the first day of LA was observed in patients treated with BioG-CSF (mean originator 18.6*10^9/L vs BioG-CSF 27.1*10^9/L, p=0.001). A further analysis was conducted on 175 patients (126/175 affected my multiple myeloma) for a total of 220 auto-HSCTs, evaluable for hematological recovery and clinical outcomes. Overall, 137 and 83 patients received Originator and BioG-CSF, respectively. All patients were hospitalized and prepared for the autograft with a high-dose conditioning (Melphalan 200mg/sqm in 171/220 auto-HSCTs). Infused CD34+ cells were 5*10^6/kg recipient (IQR 3.8-5.1) and 4.1*10^6/kg recipient (IQR 3.5-5.3) in the Originator and BioG-CSF cohorts. After the autograft, patients were prescribed 30-34 milliion units (MU) of Originator G-CSF and 30 MU dose of BioG-CSF starting on day +1/+3. Day +25 cumulative incidences of ANC and platelets recovery were 99.3% and 98.5% and 97.6% and 90.2% in the Originator and BioG-CSF groups, respectively (p=0.786, p=0.006). Of note, by Mann-Whitney test, no differences between cohorts were found in a)median duration of neutropenia (median 7 and 6 days, p=0.355), platelets (median 1 pool/patient in both, p=0.894) and red blood cells (median 0/patient in both, p=0.704) transfusion requirements, hospital stay (median 20 days and 21 days, p=0.33). Serial measurements of complete blood counts were performed from discharge to day +90 post auto-HSCT; no significant differences were found at any time point between the two groups. No severe adverse reactions attributable to G-CSFs were documented. Thrombocytopenia lasted longer for patients treated with BioG-CSF, however this finding did not translate into a higher transfusion requirement or bleeding episodes. Finally, 1-year OS was comparable between cohorts (p=0.699). CONCLUSIONS: In this sizable study, BioG-CSF was as effective as Originator G-CSF in mobilizing CD34+ cells as well as in treating post-transplant neutropenia in patients with hematological malignancies. Moreover, the extensive use of BioG-CSF led to a significant cost containment. Disclosures Massaia: Janssen: Other: advisory board; Gilead: Other: advisory board; Roche: Other: advisory board, research support. Cavallo:JANSSEN: Honoraria; CELGENE: Honoraria; ONYX: Honoraria. Palumbo:Janssen Cilag: Honoraria; Takeda: Employment, Honoraria. Boccadoro:Janssen: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Mundipharma: Research Funding; Abbivie: Honoraria; SANOFI: Honoraria, Research Funding; BMS: Honoraria, Research Funding; CELGENE: Honoraria, Research Funding.

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