Extramedullary Relapses after Allogeneic Stem Cell Transplant (allo-SCT) in Adult Patients with Acute Lymphoblastic Leukemia (ALL)

Background: Extramedullary (EM) relapses were sometimes observed in acute leukemia patients both after chemotherapy and allo-SCT. Our recent study described that the rate of EM relapses after allo-SCT was significantly higher when comparing with that after chemotherapy in acute myeloid leukemia (AML) patients. Since more potent graft-versus-leukemia (GVL) effect in EM lesion than bone marrow (BM) is proposed as potential biological basis of this phenomenon, it is expected that EM relapses after allo-SCT more frequently occurred than after chemotherapy also in ALL patients. However, this hypothesis has not been examined, and risk factors of EM relapses after allo-SCT have not been elucidated. So, we conducted this retrospective study to address this unsolved issue. Patients and methods: The study population included in this study was 215 adult patients who were diagnosed as ALL between 1990 and 2017 and received intensive chemotherapy. In the first part of this study, to compare the rates of EM relapses between after chemotherapy and allo-SCT, the initial relapses of the 88 patients were analyzed. In the second part, to investigate risk factors for EM relapses after allo-SCT, 110 patients who underwent allo-SCT against ALL were analyzed. EM relapses included both one only in EM lesions and in concurrent EM and BM lesions. Fisher's exact test was used to compare binary variables. Cumulative incidences (CIs) of EM relapse were compared using the stratified Gray test, considering relapse without EM lesions and death without the event as a competing risk. The logistic regression model and the Fine-Gray proportional hazard model were used for multivariate analysis of risk factors of EM relapses among the initial relapses and after allo-SCT, respectively. Values of p < 0.05 were considered significant. Results: Of the 88 relapsed patients included in the first part of this study, the median age at diagnosis was 47 years (range, 15-79 years), and the median duration of the first complete remission (CR1) was 7.1 months (range, 0.7-105.7 months). Philadelphia chromosome (Ph) and EM lesions at diagnosis were observed in 21 and 21 patients, respectively. Allo-SCT in CR1 was undergone in 12 patients. EM relapses occurred in 21 patients, and the sites of EM relapses were central nervous system (CNS) in 13, mediastinum in two, and bone in two. The median durations of CR1 were not significantly different between relapses with and without EM lesions (16.8 vs. 6.7 months, respectively; p = 0.295). In univariate analysis for risk factors of EM relapses, there was no significant difference in EM relapse rates between relapses after allo-SCT and chemotherapy (8.3% vs. 26.3%, respectively; p = 0.279), and in multivariate analysis, only EM lesion at diagnosis was identified as independent risk factor (odds ratio 4.21; p = 0.008). Of the 110 allo-SCT recipients included in the second part, the median age at diagnosis was 43 years (range, 16-66 years). Ph and EM lesions at diagnosis were observed in 43 and 21 patients, respectively. Disease status at the time of transplant was CR1 in 67, advanced CR in 17, and non-CR in 26. Stem cell sources were related, unrelated, and cord blood in 30, 50, and 25 patients, respectively, and almost all patients were conditioned with total body irradiation-containing myeloablative regimens. EM relapse after allo-SCT occurred in nine patients, and the 2-year CI of EM relapses was 6.5%. The sites of EM relapses after allo-SCT were CNS in three, lymph node in two, and skin in two. In univariate analysis for EM relapses after allo-SCT, the significantly higher CI of EM relapses after allo-SCT was observed in patients with EM lesion at diagnosis when comparing with those without EM lesion (28.6% vs. 1.1%, respectively; p = 0.279). Multivariate analysis extracted only EM lesion at diagnosis as an independent risk factor for EM relapses after allo-SCT (hazard ratio 24.09; p = 0.004). Conclusion: As a higher frequency of EM relapse after allo-SCT in ALL patients was not confirmed in this study, the hypothesis, more potent GVL effect in EM lesion than BM, was not able to apply to these patients. To determine whether this hypothesis is correct or not, further investigation in patients with other hematologic malignancy such as chronic myeloid leukemia is warranted. The vigilance is required regarding EM relapses in adult ALL patients with EM lesion at diagnosis both after chemotherapy and allo-SCT. Disclosures Handa: Ono: Research Funding.

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Risk factors for unsuccessful removal of central venous access ports implanted in the forearm of adult oncologic patients

Japanese Journal of Radiology ◽

10.1007/s11604-021-01214-5 ◽

2021 ◽

Author(s):

Mitsuhiro Kinoshita ◽

Shoichiro Takao ◽

Junichiro Hiraoka ◽

Katsuya Takechi ◽

Yoko Akagawa ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Independent Risk Factor ◽

Central Venous Access ◽

Univariate Analysis ◽

Venous Access ◽

Central Venous ◽

Significant Difference ◽

Oncologic Patients

Abstract Purpose To evaluate the risk factors for unsuccessful removal of a central venous access port (CV port) implanted in the forearm of adult oncologic patients. Materials and methods This study included 97 adult oncologic patients (51 males, 46 females; age range, 30–88 years; mean age, 63.7 years) in whom removal of a CV port implanted in the forearm was attempted at our hospital between January 2015 and May 2021. Gender, age at removal, body mass index, and diagnosis were examined as patient characteristics; and indwelling period, indwelling side, and indication for removal were examined as factors associated with removal of a CV port. These variables were compared between successful and unsuccessful cases using univariate analysis. Then, multivariate analysis was performed to identify independent risk factors for unsuccessful removal of a CV port using variables with a significant difference in the univariate analysis. A receiver-operating characteristics (ROC) curve was drawn for significant risk factors in the multivariate analysis and the Youden index was used to determine the optimum cut-off value for predicting unsuccessful removal of a CV port. Results Removal of CV ports was successful in 79 cases (81.4%), but unsuccessful in 18 cases (18.6%) due to fixation of the catheter to the vessel wall. Multivariate logistic regression analysis showed that the indwelling period (odds ratio 1.048; 95% confidence interval 1.026–1.070; P < 0.0001) was a significant independent risk factor for unsuccessful removal of a CV port. ROC analysis showed that the cut-off value for successful removal was 41 months, and 54% of cases with an indwelling period > 60 months had unsuccessful removal. Conclusion The indwelling period is an independent risk factor for unsuccessful removal of a CV port implanted in the forearm of adult oncologic patients, with a cut-off of 41 months.

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Risk factors for post-bronchoscopy pneumonia: a case–control study

Scientific Reports ◽

10.1038/s41598-020-76998-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yu Sato ◽

Kengo Murata ◽

Miake Yamamoto ◽

Tsukasa Ishiwata ◽

Miyako Kitazono-Saitoh ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Independent Risk Factor ◽

Case Control Study ◽

Case Control ◽

Control Group ◽

Tracheobronchial Stenosis ◽

Control Study ◽

Age And Sex

AbstractThe bronchoscopy, though usually safe, is occasionally associated with complications, such as pneumonia. However, the use of prophylactic antibiotics is not recommended by the guidelines of the British Thoracic Society. Thus far there are few reports of the risk factors for post-bronchoscopy pneumonia; the purpose of this study was to evaluate these risk factors. We retrospectively collected data on patients in whom post-bronchoscopy pneumonia developed from the medical records of 2,265 patients who received 2666 diagnostic bronchoscopies at our institution between April 2006 and November 2011. Twice as many patients were enrolled in the control group as in the pneumonia group. The patients were matched for age and sex. In total, 37 patients (1.4%) had post-bronchoscopy pneumonia. Univariate analysis showed that a significantly larger proportion of patients in the pneumonia group had tracheobronchial stenosis (75.7% vs 18.9%, p < 0.01) and a final diagnosis of primary lung cancer (75.7% vs 43.2%, p < 0.01) than in the control group. The pneumonia group tended to have more patients with a history of smoking (83.8% vs 67.1%, p = 0.06) or bronchoalveolar lavage (BAL) (4.3% vs 14.9%, p = 0.14) than the control group. In multivariate analysis, we found that tracheobronchial stenosis remained an independent risk factor for post-bronchoscopy pneumonia (odds ratio: 7.8, 95%CI: 2.5–24.2). In conclusion, tracheobronchial stenosis was identified as an independent risk factor for post-bronchoscopy pneumonia by multivariate analysis in this age- and sex- matched case control study.

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A Prognostic Score For Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽

10.1182/blood.v122.21.3389.3389 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3389-3389

Author(s):

Bernd Gruhn ◽

Ilona Wolff ◽

James F. Beck ◽

Clemens Arndt

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Multivariate Analysis ◽

Myeloid Leukemia ◽

Disease Risk ◽

Univariate Analysis ◽

Peripheral Blood Stem Cells ◽

Hematopoietic Stem ◽

Allogeneic Hsct ◽

Blood Stem Cells

Abstract Background The effects of certain risk factors on the survival of adults undergoing allogeneic hematopoietic stem cell transplantation (HSCT) have been the subject of research for many years. The impact of graft source and donor type, for instance, has already been examined closely. Lately iron parameters like ferritin became point of interest. Several prognostic scores utilizing those risk factors have been proposed. However, observations of pediatric populations considering those factors remain rare and no score in this regard for children with HSCT is available yet. Methods We retrospectively analyzed the effects of patient sex, recipient-donor sex match status, patient age, donor age, disease risk, graft source, donor HLA match as well as ferritin, albumin, total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), cholinesterase (CHE), gamma glutamyl transpeptidase (GGT), C-reactive protein (CRP) and lactate dehydrogenase (LDH) taken at the time of transplantation on the 5-year-overall survival of 132 children with malignant or non-malignant diseases undergoing allogeneic HSCT between 2001 and 2011 in a single center. The graft source was either bone marrow (n=82) or peripheral blood stem cells (n=50). The patients had the following underlying diseases: acute lymphoblastic leukemia (n=44), acute myeloid leukemia (n=29), chronic myeloid leukemia (n=5), myelodysplastic syndrome (n=16), non-Hodgkin lymphoma (n=7), solid tumor (n=4), severe aplastic anemia (n=7), myelofibrosis (n=2) and genetic disease (n=18). Conditioning regimen was myeloablative in all cases. The disease risk was formed by dividing the patients into two groups according to their clinical risk. Patients with genetic diseases, severe aplastic anemia, refractory cytopenia, myelofibrosis, leukemia and lymphoma in first or second remission as well as chronic myeloid leukemia in chronic phase were low risk, while patients with solid tumors, leukemia and lymphoma in relapse or in more than second remission and refractory anemia with excess blast in or not in transformation were high risk. For statistics we used Kaplan-Meier-method for univariate analysis and Cox regression for multivariate analysis. Results On univariate analysis 5-year-overall survival decreased significantly in patients with ferritin >1500 µg/L (40.8% versus 78.8%, p<0.001), GGT >1 µmol/L∙s (43.2% versus 67.9%, p=0.032), CRP >10 mg/L (54.6% versus 69.4%, p=0.017), LDH >6 µmol/L∙s (22.2% versus 66.8%, p=0.001), CHE <60 µmol/L∙s (35.7% versus 70%, p=0.002) as well as in patients with high disease risk (38.3% versus 74.7%, p<0.001), peripheral blood stem cells as graft source (47.1% versus 72.2% for bone marrow, p=0.001). For HLA donor match there was a 5-year-overall survival of 82.0% for matched related, 58.4% for matched unrelated, 56.3% for mismatched unrelated and 50.0% for haploidentical related donors (p=0.020). Other factors did not show a significant correlation. We subsequently developed a score of those parameters that were significant in multivariate analysis, i.e. disease risk (HR=3.744, p=0.035), ferritin (HR=6.860, p=0.002) and cholinesterase (HR=4.556, p=0.043), dividing the patient population into three groups: low with no risk factor, intermediate with one risk factor and high with two or three risk factors. For this score we found a 5-year-overall survival of 92.3% for low risk group, 66.2% for intermediate risk and 17.4% for high risk (p<0.001). Conclusion Our data show that ferritin, cholinesterase and disease risk are factors that decisively influence the prognosis after allogeneic HSCT in children. They should be evaluated in further trials as well as our proposed score. The characteristics that showed up significant in univariate but not in multivariate analysis appear to have an influence as well and might show a stronger correlation in larger trials. Disclosures: No relevant conflicts of interest to declare.

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Donor Selection For Haploidentical Hematopoietic Stem Cell Transplantation: Who Is The Better – Donor-Recipient Risk Factor Analysis

Blood ◽

10.1182/blood.v122.21.705.705 ◽

2013 ◽

Vol 122 (21) ◽

pp. 705-705

Author(s):

Yu Wang ◽

Xiao Jun Huang

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Stem Cell ◽

Lower Incidence ◽

Family Relationship ◽

Donor Age ◽

Sibling Donor ◽

The Difference ◽

Grade 3

Abstract Background many aspects should be considered when selecting an ideal donor. The progress made in haploidentical HSCT in recent years offers almost unlimited donor and availabilities of more than one donor at many occasions. To date, there have been no studies to answer the question of apart from HLA disparity, whether one donor should be preferred over another among various haploidentical donors available. The goal of the current study was to attempt to answer the question by analyzing the data on haploidentical HSCT without in-vitro T cell depletion modality. Methods Consecutive patients with leukemia or MDS who received HSCT from 3-5 of 6 HLA loci-matched family donors excluding collateral relatives between May 2002 and December 2010 were enrolled in this study (n=749). The stem cell source was G-CSF mobilized BM combined with PB. The conditioning regimen was modified BUCY plus ATG with 10mg/kg in total dosage. Patients receiving prophylactic DLI for prevention of leukemia relapse were excluded. Donor-recipient risk factors relevant to selection of optimal donor for haploidentical HCT were analyzed. Results (1)donor sex: male donor had lower incidence of both grade 2-4 (39% vs. 46%, p=.07) and grade 3-4 acute GVHD (aGVHD) (11% vs. 17%, p=.04), lower rate of NRM (16% vs. 24%, p=.006) and higher probabilities of OS (70% vs. 62%, p=.02) and LFS (67% vs. 60%, p=.03), compared with female donor. In multivariate analysis, donor sex was still a risk factor for GVHD, NRM and survival. However, if mother donor was excluded, all the difference became no longer significant. (2) Donor age: donor younger than 30 years old had lower incidence of both grade 2-4 (25% vs. 48%, p<.0001) and grade 3-4 aGVHD (5% vs. 16%, p=.0005), lower rate of NRM (12% vs. 22%, p=.007) and higher probabilities of OS (78% vs. 64%, p=.001) and LFS (76% vs. 64%, p=.002), compared with donor older than 30 years old. In multivariate analysis, donor age was a more prominent risk factor for GVHD, NRM and survival compared with donor sex. And if mother donor was excluded, all the difference remained significant both in univariate and multivariate analysis. (3)The rate of GVHD was not associated with the extent of HLA disparity or any individual allele disparity. (4) comparison between mother and father: father donor had lower incidence of both grade 2-4 (45% vs. 56%, p=.03) and grade 3-4 aGVHD (13% vs. 22%, p=.007), lower rate of NRM (14% vs. 26%, p=.003) and higher probabilities of OS (70% vs. 57%, p=.007) and LFS (67% vs. 57%, p=.03), compared with mother donor. In multivariate analysis, mother donor was still a risk factor for GVHD, NRM and survival. (5) comparison between offspring and sibling: offspring donor had significant lower incidence of grade 2-4 aGVHD (16% vs. 37%, p=.002), lower NRM and higher survival, although not reaching statistical significance, compared with sibling donor. In multivariate analysis, sibling donor was still a risk factor for GVHD. (6) comparison among sibling and father donors: donor older than 30 years old was the most important risk factor affecting GVHD, NRM and survival while the rates between father and sibling donor were comparable. Conclusions Not abiding by the rule of HLA disparity, this study was the first one to confirm that significant different outcomes were achieved among various haploidentical donors and proved once again that haploidentical HSCT overcame HLA barriers. Instead of HLA disparity, donor age and the family relationship were important risk factors under our treatment modality. The underlying mechanisms of crossing human leukocyte antigen barriers need further investigation and to be validated by other treatment modalities. Figure impact of donor age and family relationship on GVHD This work was partly supported by The Key Program of National Natural Science Foundation of China (Grant No. 81230013), Beijing Municipal Science & Technology Commission (No.Z121107002812033) and Beijing Municipal Science & Technology Commission(No. Z121107002612035). Disclosures: No relevant conflicts of interest to declare.

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Risk factors for peritoneal recurrence in serosa-negative gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.19 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 19-19 ◽

Cited By ~ 1

Author(s):

Hayato Omori ◽

Yuichiro Miki ◽

Wataru Takagi ◽

Fumiko Hirata ◽

Taichi Tatsubayashi ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Multivariate Analysis ◽

Risk Factor ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Independent Risk Factor ◽

Peritoneal Recurrence ◽

Node Metastasis ◽

Gastric Cancer Patients

19 Background: Peritoneal recurrence is often observed in gastric cancer patients without serosal invasion. It is difficult for pathologists to evaluate whether tumor cells penetrate serosa or not, because the subserosa layer is very thin. We evaluated the incidence and risk factors of peritoneal recurrence in serosa -negative gastric cancer patients to clarify the mechanism of peritoneal recurrence in these patients. Methods: A total of 1,745 gastric cancer patients underwent R0 resection from 2002 to 2009 were enrolled. The incidence of peritoneal recurrence according to tumor depth was analyzed. In serosa-nagative patients, the univariate and multivariate analysis were performed to identify the risk factors for peritoneal recurrence. Results: Peritoneal recurrence was observed in 64 (3.7 %) out of 1,745 patients. The incidence of peritoneal recurrence according to depth of tumor invasion was in 0 / 466 in T1a, 5 / 567 (0.88 %) in T1b, 4 / 187 (2.1 %) in T2, 31 / 360 (7.9 %) in T3, 20 / 108 (15.9 %) in T4a, and 4 / 12 (25 %) in T4b, respectively (p<0.001). As for the risk factor for peritoneal recurrence in T3 patients, histologically undifferentiated type, negative lymphatic invasion, scirrhous type, invasive infiltrating growth pattern were the significant factors identified by univariate analysis. Only the invasive infiltrating growth pattern (OR3.44 p0.038) was selected as significant independent risk factor for peritoneal recurrence by multivariate analysis. In T1b / T2 patients, massive lymph node metastasis (N3a, 3b), scirrhous type were the significant factor for peritoneal recurrence by univariate analysis. Only massive lymph node metastasis (OR25.1 p<0.001) was selected as the significant independent risk factor by multivariate analysis. Conclusions: The incidence of peritoneal recurrence increases in proportion to the tumor depth. Invasive infiltrating growth pattern was selected as an independent risk factor for peritoneal recurrence in T3 patients, while it was massive lymph node metastasis in T1b / T2 patients. The results suggest the possibility that microscopic serosal invasion in T3 tumor and lymphatic progression in T1b / T2 tumor may contribute to peritoneal recurrence in gastric cancer.

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Allogeneic Stem Cell Transplantation (alloSCT) and Donor Lymphocyte Infusion (DLI) In Patients with Non-Hodgkin Lymphoma (NHL) Who Experienced Relapse or Progression After Autologous Stem Cell Transplantation (autoSCT): Retrospective Analysis From the Korean Society of Blood and Marrow Transplantation

Blood ◽

10.1182/blood.v116.21.3536.3536 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3536-3536 ◽

Cited By ~ 1

Author(s):

Ji-Won Kim ◽

Byung-Su Kim ◽

Soo-Mee Bang ◽

Inho Kim ◽

Dong Hwan Kim ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Stem Cell ◽

Serum Albumin ◽

Cell Lymphoma ◽

Univariate Analysis ◽

Stage Iv ◽

Grade 3 ◽

Ecog Ps ◽

Significant Factors

Abstract Abstract 3536 Prognosis of patients with NHL who underwent relapse or progression after autoSCT is generally dismal and treatment option is limited. AlloSCT has been performed to overcome this problem and long term survivors have been reported. However, substantial transplant-related mortality (TRM) is a significant problem. We report clinical outcomes of alloSCT in these patients and DLI after failure of alloSCT along with analysis of risk factors for treatment results and adverse events. This retrospective study was performed in 7 hospitals in Korea. Candidate risk factors were age, sex, histology, Ann Arbor stage at diagnosis, number of prior treatments, time to progression (TTP) after autoSCT, bone marrow involvement, Eastern Cooperative Oncology Group (ECOG) performance status (PS), donor type, stem cell source, conditioning regimens of alloSCT, serum lactate dehydrogenase (above 250 IU/L), serum albumin (above 3.0 g/dL), and acute graft-versus-host disease (aGvHD). Between August 1998 and March 2009, 38 patients received alloSCT. Median age was 37 (range, 17–54) years. Male to female ratio was 26:12. Eighteen patients (47.4%) had B-cell lymphoma and 20 patients (52.6%), T/NK-cell lymphoma. Before alloSCT, patients had received median 4 (range, 2–7) prior treatments including autoSCT. Median TTP after autoSCT was 5.9 (range, 0.8–35.8) months. Twenty four patients (63.2%) received stem cells from related donors and 14 patients (36.8%) from unrelated donors. Median number of CD34+ cells infused was 5.41 × 106 (range, 0.86 × 106-16.60 × 106) /kg. Eighteen patients (47.4%) underwent a myeloablative conditioning and 20 patients (52.6%), a reduced intensity conditioning. During a median follow-up of 45.2 (range, 1.3–137.1) months, 24 patients (63.2%) experienced treatment failure and 22 patients (57.9%) died. Median event-free survival (EFS) was 6.3 (95% confidence interval (CI), 4.3–8.4) months. Median overall survival (OS) was 19.0 (95% CI, 3.8–34.2) months. Estimated 5-year survival rate was 35.0% (Figure). Treatment response was evaluable in 30 patients. Response rate was 73.3%; complete remission (CR) was achieved in 20 patients (66.7%) and partial response in 2 patients (6.7%). Grade 3 or 4 renal toxicity developed in 6 patients (15.8%), grade 3 or 4 hepatic toxicity in 15 patients (39.5%) including veno-occlusive disease (VOD) in 6 patients (15.8%), aGvHD in 13 patients (34.2%), and neutropenic fever in 34 patients (89.5%) including documented sepsis in 11 patients (28.9%). TRM was reported in 8 patients (21.1%). Causes of TRM were infection in 7 patients and VOD in 1 patient. In univariate analysis, no significant association was found with treatment response. By contrast, EFS was related to stage (p=0.039), TTP after autoSCT (p=0.033), and PS (p<0.001). OS was associated with stage (p=0.037), number of prior treatments (p=0.049), TTP after autoSCT (p=0.032), PS (p<0.001), and serum albumin (p=0.016). On the other hand, aGvHD was not associated with EFS (p=0.545) and OS (p=0.476). Multivariate analysis demonstrated that stage IV (hazard ratio (HR) 2.85 (95% CI, 1.13–7.22); p=0.027) and ECOG PS 2 (HR 3.94 (95% CI, 2.08–7.47); p<0.001) were significant factors for EFS and that stage IV (HR 3.28 (95% CI, 1.19–9.04); p=0.022), ECOG PS 2 (HR 5.26 (95% CI, 2.22–12.48); p<0.001), and serum albumin above 3.0 g/dL (HR 0.15 (95% CI, 0.03–0.63); p=0.010) were significant factors for OS. TRM was associated with PS (p=0.010) and serum albumin (p=0.040) by univariate analysis. Multivariate analysis showed that ECOG PS 2 was the only significant factor for TRM (relative risk (RR) 11.77 (95% CI, 1.43–97.01); p=0.022). ECOG PS 2 was also a significant factor for documented sepsis (RR 7.14 (95% CI, 1.08–47.42); p=0.042). DLI was performed in 8 patients who failed alloSCT. After median 1.5 (range, 1–6) cycles of DLI, 2 patients achieved CR. Grade III or IV aGvHD developed in these patients. By contrast, among 6 patients who failed to achieve CR, aGvHD developed in 2 patients. In conclusion, alloSCT is a viable option for patients with NHL who failed autoSCT despite high TRM. Stage and PS were significant factors for EFS and OS. Serum albumin was a significant factor for OS. In patients with ECOG PS 2, alloSCT should be avoided and novel treatment approaches should be offered due to high risk of TRM. DLI after failure of alloSCT showed promising results, which supports the presence of graft-versus-lymphoma effect. Disclosures: No relevant conflicts of interest to declare.

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Thrombotic Microangiopathy: Multi-Institutional Review of Pediatric Patients Who Underwent HSCT

10.22541/au.161284826.68153982/v1 ◽

2021 ◽

Author(s):

Archana Ramgopal ◽

Shiva Sridhar ◽

Jignesh Dalal ◽

Ram Kalpatthi

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Thrombotic Microangiopathy ◽

Independent Risk Factor ◽

Pediatric Patients ◽

Review Of The Literature ◽

Hematopoietic Stem ◽

Institutional Review

Thrombotic microangiopathy (TMA) is a rare but serious complication of hematopoietic stem cell transplantation (HSCT). The purpose of our study is to estimate the incidence and risk factors of TMA in 93 out of a total of 12369 children (0.8%) receiving HSCT. HHV6 infection was an independent risk factor associated with increased mortality in patients with TMA (Hazard Ratio: 2.86 [1.01, 8.39], p=0.05), and our study conducts a review of the literature with the association of HHV-6 and complement activation. Studies exploring the pathophysiology of TMA and its relationship to HSCT are needed to optimize the outcome of pediatric patients.

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Risk factors of hypothyroxinemia in premature infants

10.21203/rs.3.rs-449944/v1 ◽

2021 ◽

Author(s):

Aslan Yilmaz ◽

Yavuz Özer ◽

Nesrin Kaya ◽

Hande Turan ◽

Hazal Cansu Acar ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Gestational Age ◽

Univariate Analysis ◽

Thyroid Stimulating Hormone ◽

Control Group ◽

Postnatal Life ◽

Thyroid Function Tests ◽

Retrospective Case

Abstract Background: Hypothyroxinemia is defined by low levels of thyroxine (T4) despite low or normal levels of thyroid-stimulating hormone (TSH). This study aimed to evaluate the risk factors associated with transient hypothyroxinemia (THOP) in premature newborn.Method: This is a single center, retrospective, case-control study. Premature newborns, between 24-34 weeks of gestation, hospitalised between January 2014-December 2019 in our Newborn Intensive Care Unit (NICU) were analyzed through their medical records. Thyroid function tests were routinely performed between the 10th and 20th days of postnatal life and were evaluated according to the gestational age references. Thirty six risk factors (prenatal and postnatal parameters, medical treatments, clinical diagnoses and applications in NICU) were searched in the patient group with THOP (n=71) and the control group with euthyroid prematures (n=73). The risk factors for THOP were identified by univariate analysis, followed by multivariate analysis. Results: Mean gestational ages of the study and the control groups were 29.7 ± 2.48 and 30.5 ± 2.30 weeks, respectively (p = 0.606). The birth weight, small for gestational age (SGA), intraventricular hemorrhage (IVH), congenital heart disease (CHD) were found to be the risk factors for THOP in the univariate analysis and CHD (p=0.033, odds ratio [OR]:3.7, 95% confidence interval [CI]: 1.1-12.3), BW (p=0.012, OR:0.998, 95% CI: 0.9-1.01) and SGA (p=0.006, OR:5.3, 95% CI: 1.6-17.71) were found to be an independent risk factor for THOP as a result of the multivariate analysis.Conclusıons: Although some treatment practices might have had direct effects on pituitary–thyroid axis, associated with the severity of the newborn clinical conditions, non of them was found to be a risk factor for THOP. However, preterm babies with CHD and SGA could have more risk for THOP.

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The Impact of Graft Nephrectomy on Subsequent Transplants: Multivariate Analysis of Risk Factors for Second Graft Loss and for Multiple Transplantations–A Single-Center Retrospective Study

ISRN Transplantation ◽

10.5402/2013/362571 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Emmanouil Giorgakis ◽

Asim Syed ◽

Hector Gonzalez

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Retrospective Study ◽

Independent Risk Factor ◽

Graft Loss ◽

Kaplan Meier ◽

Independent Risk Factors ◽

Allograft Loss ◽

The Impact

Introduction. The management of a failed primary allograft remains unclear and the evidence of the effect of transplantectomy to future transplants conflicting. Aim of this study is to review the impact of failed primary graft nephrectomy on future transplants. Materials/Methods. Retrospective study of 101 patients retransplanted in a single institution. Median follow-up was 68 months. Patients were divided into two groups; G1 (n=49) was the nephrectomy group; G2 (n=52) was the graft in situ group. The patients’ and second graft survival were analysed with the Kaplan-Meier method. The patients’ and transplant characteristics were analyzed with student’s t-test. The retransplant risk factors and the risk factors for multiple transplants were obtained via a logistic regression model. Results. The odds of second graft loss post-transplantectomy were high (OR = 5.24). Demographics, HLA mismatch and first graft rejection rates were similar among the two groups and did not affect the outcome. Transplantectomy accelerated the loss of a future failing graft. Multivariate analysis showed transplantectomy as independent risk factor for second allograft loss. Transplantectomy and younger age are significant independent risk factors for future multiple transplants. Conclusion. Transplantectomy of the failed primary graft is an independent risk factor for retransplant loss and for multiple renal transplants.

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Risk Factor of Hepatic Veno-Occlusive Disease: Analysis of Clinical Data of 5024 Patients Extracted from the Database of the Japan Marrow Donor Program.

Blood ◽

10.1182/blood.v108.11.2970.2970 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2970-2970

Author(s):

Miwa Sakai ◽

Kazuteru Ohashi ◽

Takuya Yamashita ◽

Hideki Akiyama ◽

Hisashi Sakamaki

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Stem Cell ◽

Clinical Data ◽

Univariate Analysis ◽

Disease Status ◽

Occlusive Disease ◽

Blood Type ◽

Hematopoietic Stem ◽

Increased Risk

Abstract Hepatic veno-occlusive disease (VOD) is one of the most serious complication of hematopoietic stem cell transplantation (HSCT). Various factors have been identified as increasing the risk of hepatic VOD, but few of them have been associated with a significantly increased risk. We retrospectively analyzed the clinical data of 5024 transplant recipients (median age28, range 0–68) which extracted from the Japan Marrow Donar Program. The diagnosis of VOD was made according to the McDonald’s criteria, and 324 out of 4833 patients (6.7%) were eventually diagnosed with VOD. The possible risk factors based on the previous studies were counted on an initial univariate analysis, and cumulated significant factors were further analyzed for their potential value for VOD development in multivariate analysis. Variables correlated with an increased risk of VOD were: time of transplant >2 times (relative risk (RR) 2.7; p=0.006), pretransplant disease status (RR 2.3; p=0.000), prior liver disease (RR 2.1; p=0.017), ABO blood type mismatch (RR1.7; p=0.000). In patients receiving either busulfan or melphalan for conditioning increased VOD risk (RR 1.5 and 1.8; p=0.007 and 0.002, respectively). In our multivariate analysis, stem cell source, and prophylactic use of heparin and Ursodiol had no significant effect on VOD development. This analysis might contribute to revise the previously reported risk factors for VOD and the data could be used to know which patients might be suitable subjects for new trials for VOD prevention.

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