Analysis of Risk Factors Related to Relapse and Refractory DLBCL and Study of DLBCL Maintenance Therapy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-33
Author(s):  
Jing Zhang ◽  
Baoan Chen
Keyword(s):  
Risk Factors ◽  
Chinese Medicine ◽  
High Risk ◽  
Traditional Chinese Medicine ◽  
Maintenance Therapy ◽  
B Cell Lymphoma ◽  
Kaplan Meier ◽  
Low Levels ◽  
Hs Crp

Objectives The aim of this part is to analyze the efficacy of R-CHOP regimen in the treatment of diffuse large B-cell lymphoma (DLBCL), and to explore the risk factors of relapse and refractory DLBCL by analyzing the clinical characteristics of patients, and to study the predictive efficacy of these factors on the prognosis of patients. Methods Clinical data of 71 patients with de novo DLBCL from December 2012 to December 2018 in the Department of Hematology, Zhongda Hospital Affiliated to Southeast University were collected and retrospectively analyzed. The patients with DLBCL were divided into two groups according to who were refractory or relapse after initial therapy. Then the response rate and high-risk factors of refractory and relapse lymphoma were analyzed by the chi-square test and Mann-Whitney U test. Besides, Overall survival (OS) curves and prognosis factors were estimated by the Kaplan-Meier method, Log-rank test and Cox proportional hazard regression analysis. Furthermore, the patients were divided into two groups according to the IPI score, and a comparative analysis of survival rate was performed between subgroups. Results 1.There were 71 patients who were diagnosed with DLBCL, in which 45 cases achieved complete remission (CR), 11cases achieved partial remission (PR), and the total remission rate was 78.9%. By the end of the follow-up, 25 cases (35.2%) experienced refractory and relapse, and 17 cases (23.9%) died, with an average OS of 60 months and an average EFS of 52 months. 2.Univariate analysis showed that the B symptoms (P< 0.001), low levels of Hb (P< 0.001) and LMR (P< 0.001), high levels of NLR (P= 0.042), β2-MG (P= 0.011), hs-CRP (P= 0.002) and LDH (P= 0.017) were significantly related with refractory and relapse. Multivariate Logistic analysis showed B symptoms (P= 0.033) and high levels of β2-MG (P= 0.048) were independent risk factors for refractory and relapse lymphoma. 3.Kaplan-Meier method analysis showed that the OS of patients with either B symptoms (P< 0.001), low levels of Hb (P= 0.008) and LMR (P= 0.005), or high levels of β2-MG (P= 0.007), hs-CRP (P= 0.008) and LDH (P= 0.002) were significantly shorter than that of control group. Additionally, Cox regression methods analysis showed that B symptoms (P= 0.026) and high β2-MG (P= 0.038) were independent prognosis factors for DLBCL. 4.Kaplan-Meier analysis of survival between the low-risk IPI and high-risk IPI groups showed that the OS of patients with B symptoms in both IPI low-risk group (P = 0.013) and IPI high-risk group (P = 0.027) weresignificantly shorter than those without B symptoms. Moreover, there was no significant difference in the OS of patients with either low levels of Hb and LMR,or high levels of LDH, β2-MG, and hs-CRP in both group (P > 0.05). Conclusion B symptoms and high levels of β2-MG are independent risk factors for relapse and refractory, and are expected to be incorporated into the new prognostic score system. Part two: Clinical study of maintenance therapy for DLBCL Objectives The aim of this part was to explore the efficacy of different maintenance therapies on DLBCL, and evaluate the safety of rituximab and traditional Chinese medicine maintenance therapy. Methods Clinical data of 71 patients with de novo DLBCL from December 2012 to December 2018 in the Department of Hematology, Zhongda Hospital Affiliated to Southeast University were collected and retrospectively analyzed. Follow-up and study whether patients have undergone maintenance therapy and maintenance therapy regimen. Results Of the 71 patients with DLBCL, 11 cases received maintenance therapy after CR, of which 6 cases were maintained with rituximab and 5 cases maintained with traditional Chinese medicine (TCM). The median follow-up time was 27 months. By the end of the follow-up, none of the 11 cases had relapsed and no treatment-related adverse reactions occurred. In particular, 2 patients received autologous hematopoietic stem cell transplantation after achieving CR, and then took TCM for maintenance therapy. No tumor recurrence was seen during follow-up and the clinical indicators were normal and stable. Conclusion Rituximab and TCM have good efficacy and safety in the maintenance treatment of DLBCL. TCM maintenance treatment shows unique advantages, and it is expected to be widely used in clinic after further verification in the future. Key words Diffuse large B-cell lymphoma; maintenance therapy; rituximab; traditional Chinese medicine Disclosures No relevant conflicts of interest to declare.

scholarly journals A Prediction Model for High Risk of Positive RT-PCR Test Results in COVID-19 Patients Discharged From Wuhan Leishenshan Hospital, China

2021 ◽  
Vol 9 ◽  
Author(s):  
Yawei Qian ◽  
Guang Zeng ◽  
Yue Pan ◽  
Yang Liu ◽  
Limao Zhang ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
High Risk ◽  
Traditional Chinese Medicine ◽  
Test Results ◽  
High Risk Factors ◽  
Discharged Patients ◽  
Hospital Stays ◽  
Reduce Risk ◽  
Chinese Medicine Treatment

Several recent studies have reported that a few patients had positive SARS-CoV-2 RNA tests after hospital discharge. The high-risk factors associated with these patients remain to be identified. A total of 463 patients with COVID-19 discharged from Leishenshan Hospital in Wuhan, China, between February 8 and March 8, 2020 were initially enrolled, and 351 patients with at least 2 weeks of follow-up were finally included. Seventeen of the 351 discharged patients had positive tests for SARS-CoV-2 RNA. Based on clinical characteristics and mathematical modeling, patients with shorter hospital stays and less oxygen desaturation were at higher risk of SARS-CoV-2 RNA reoccurrence after discharge. Notably, traditional Chinese medicine treatment offered extensive benefits to reduce risk. Particular attention should be paid to those patients with high risk, and traditional Chinese medicine should be advocated.

Limited-Stage Diffuse Large B-Cell Lymphoma (DLBCL) Patients with a Negative Pet Scan Following Three Cycles of R-CHOP Can Be Effectively Treated with Abbreviated Chemoimmunotherapy Alone.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 787-787 ◽  
Author(s):  
Laurie H. Sehn ◽  
Kerry J. Savage ◽  
Paul Hoskins ◽  
Richard Klasa ◽  
Tamara Shenkier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Pet Scan ◽  
Stage I ◽  
Limited Stage ◽  
Extranodal Site ◽  
Kaplan Meier

Abstract Four cycles of CHOP chemotherapy has been shown to be sufficient treatment for low-risk elderly patients with limited-stage DLBCL, eliminating the need for radiation therapy (Bonnet et al, JCO 2007). FDG-PET scanning is an effective prognostic tool that may identify chemo-sensitive patients (regardless of age or clinical risk factors) who can appropriately be treated with abbreviated chemoimmunotherapy alone. Patients: Beginning in 2005, we have recommended that all prospective patients with limited-stage DLBCL (stage I/II, no B-symptoms, mass < 10cm) treated in British Columbia (BC) undergo a PET scan following 3 cycles of R-CHOP; PET-negative patients should then receive one additional cycle of R-CHOP (total 4 cycles R-CHOP), while PET-positive patients receive involved-field radiation therapy (IFRT). Clinical characteristics of the first 50 patients are as follows: median age 67 y (range 31–88); 56% male; 62% stage I, 38% stage II; 4% PS>1; 6% elevated LDH; 58% at least 1 extranodal site, 10% >1 extranodal site. Stage-modified IPI risk factors: 22% 0; 70% 1–2; 8% 3–4. Median follow-up is 17 mos (range 4–26). Results: 37 patients (74%) were PET-negative and 13 patients (26%) were PET-positive after 3 cycles of R-CHOP. No clinical factors were found to be predictive of PET status. Of the 37 PET-negative patients, 35 completed treatment with one additional cycle of chemoimmunotherapy, 1 received IFRT due to poor chemotherapy tolerance, and 1 died of toxicity before receiving any more treatment. Only 1/37 PET-negative patients has relapsed (alive with lymphoma after salvage therapy). All 13 PET-positive patients received IFRT, with 3 relapses and 2 deaths from lymphoma to date. Although longer follow-up is necessary, the 2-year estimated Kaplan-Meier progression-free survival is 91% overall (97% and 75% for PET-negative and PET-positive patients, respectively, p=0.09). (see figure) The 2-year estimated Kaplan-Meier overall survival is 97% for PET-negative and 69% for PET-positive patients, p=0.1. Conclusion: Patients with limited-stage DLBCL who are PET-negative after 3 cycles of R-CHOP can be effectively treated with abbreviated chemoimmunotherapy alone (4 cycles R-CHOP), avoiding the long-term toxicity of radiation while preserving excellent lymphoma control. Figure Figure

A concise prognostic score system for diffuse large B-cell lymphoma: a retrospective study with long-term follow-up

2021 ◽  
Author(s):  
Ying Yang ◽  
Zhuogang Liu ◽  
Guojun Zhang ◽  
Hongtao Wang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Prognostic Score ◽  
B Cell Lymphoma ◽  
Score System ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Independent Risk Factors

Aim: To identify risk factors and establish a concise prognostic scoring system in patients with diffuse large B-cell lymphoma (DLBCL). Methods: A total of 131 DLBCL patients were enrolled with long-term follow-up who were treated in Shengjing Hospital of the China Medical University. The relationship between clinical parameters and outcomes was analyzed. Results: Multivariate analysis showed that patient age, BMI, CA125 and rituximab application were independent risk factors. Thereafter, a concise scoring system was established, and the new system could identify high-risk patients (p < 0.0001). The patients were divided into three groups: low-risk, medium-risk and high-risk groups. There were significant differences among different groups on overall survival and progression-free survival by log-rank test (p < 0.05). Conclusion: Old age, low BMI, high CA125 and no rituximab application were independent risk factors for DLBCL. The new established prognostic score system, which includes all the risk factors, could identify high-risk patients.

scholarly journals Early Intensive Therapy in Multiple Myeloma Using Tandem Transplantation with Novel Conditioning and Two Years Maintenance: A Single Institution Experience

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2152-2152
Author(s):  
Kalyan Nadiminti ◽  
Christopher Strouse ◽  
Praveen Vikas ◽  
Lindsay Dozeman ◽  
Allyson Schultz ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Maintenance Therapy ◽  
Maintenance Phase ◽  
Progression Free Survival ◽  
Free Survival ◽  
Kaplan Meier ◽  
Regimen Change ◽  
Preparative Regimen

Abstract Introduction The role of early intensive treatment of multiple myeloma, including tandem autologous stem cell transplantation( ASCT) with bortezomib, thalidomide, dexamethasone( VDT) and melphalan 200mg/m2 as a preparative regimen, followed by 2 years of combination agent maintenance therapy, is being studied. We sought to analyze a cohort of patients who received early intensive treatment at the University of Iowa between 2012 and 2016. Patients and Methods All consecutive patients who received early( < 12 months since diagnosis) tandem ASCT and have completed at least 2 years of maintenance therapy between 2012 and 2016 were included for analysis. Planned maintenance therapy consisted of a combination of VDT in 28 day cycles for year 1 and bortezomib, cyclophosphamide and dexamethasone(VCD) in 28 day cycles for year 2. Alternate regimen were used in case of toxicities. The patients were considered to have high risk cytogenetics if they had 17p deletion, t(14;16), amp 1q, or t(4;14) by FISH. Event-free (EFS) and overall survival (OS) probabilities were estimated and plotted using the Kaplan-Meier method. For EFS, time was calculated from date of first transplant to relapse or death due to any cause. Treatment-related mortality was defined as death during transplant phase or maintenance phase due to causes other than disease relapse.The effect of clinical characteristics on outcomes was evaluated using Cox regression models. Estimated effects of predictors are reported as hazard ratios (HR) along with 95% confidence intervals. All statistical testing was two-sided and assessed for significance at the 5% level using SAS v9.4 (SAS Institute, Cary, NC). Responses were measured using IMWG consensus criteria. Results A total of 135 patients met the criteria for inclusion. Key patient characteristics are shown in table 1. The median age at first transplant was 58 years. HCT-CI was high in 68% of patients. 36% of the patients were ISS stage III, and high risk cytogenetics were present in 56%. Preparative regimen was VTD-Mel 200 in 88.9% of patients. Following the first transplant, 59% of patients had achieved CR, and following the second transplant 94.4% of patients achieved CR. At the time of median follow up, 27.4% of patients had died. The cause of death was infection (25%), organ failure (11%), relapsing myeloma (28%) or other (36%). Univariable analysis identified a statistically significant association only for age with risk of progression or death. Kaplan-Meier curves for progression free survival and overall survival in patients with high risk or low risk cytogenetics are shown in Figures 1 and 2 respectively. The hazard ratio for progression free survival and overall survival in patients with high risk vs low risk cytogenetics was 0.86 (95% confidence interval 0.45 - 1.64, p=0.65), and 0.88 (95% confidence interval 0.45 - 1.73, p=0.71), respectively. The 3 year EFS and OS of patients who received early tandem ASCT followed by 2 years of maintenance were 73% and 72%, respectively. Following the 2nd autologous transplant, 128 of 135( 94%) patients were started on maintenance therapy. VTD ( 74%) and VRD (6%) were the most common regimens used. Fifty six patients completed maintenance therapy for 1 year without regimen change, and 60 required regimen change due to toxicities. VRD (20), VPomD (9) and VRMp (8) were the most commonly used alternative regimens in the case of toxicities. Following year 1 of maintenance, 96 patients (75%) started a second year of maintenance. VCD (30%) or RD (23%) were the most common regimens. 63(43%) patients completed 2 years of combination maintenance therapy. Grade III-V non-hematologic toxicities during the combined maintenance phase were infection (56%) and peripheral neuropathy (23%) and hematologic toxicities were thrombocytopenia (13%), neutropenia (12%) and anemia (8%). Conclusion According to our results, patients with high risk cytogenetics did not have an inferior PFS and OS. These results suggest that in newly diagnosed MM patients, upfront treatment using novel conditioning regimen and tandem ASCT followed by intensive maintenance therapy can result in a very high CR rates, particularly in patients with high risk cytogenetics. Infections and peripheral neuropathies were the most common non-hematologic toxicities during maintenance. Longer follow up will determine further impact of maintenance therapy. Disclosures No relevant conflicts of interest to declare.

Prognostic Factors for Developing Thrombosis in Polycytemia Vera: A Retrospective Analysis of 331 Patients with Long-Term Follow-up Highlights the Importance of White Blood Cells Levels

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 48-49
Author(s):  
Samantha Ferrari ◽  
Chiara Pagani ◽  
Mariella D'Adda ◽  
Nicola Bianchetti ◽  
Annamaria Pelizzari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
High Risk ◽  
Board Of Directors ◽  
Advisory Board ◽  
Advisory Committees ◽  
Risk Status ◽  
History Of ◽  
Wbc Count

Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm characterized by erythrocytosis, constitutively active mutations in JAK2 and an increased susceptibility to thrombotic events (TEs). There is still controversy about the role of increased hematocrit and of other variables including elevated white blood cell count as risk factors for the occurrence of TEs. A better definition of the relative prognostic importance of hematologic parameters would help us to better tailor the therapeutic approach to PV patients (pts), which is currently mainly based on the use of acetilsalycilic acid (ASA), venesection and hydroxyurea . The aim of our study was to analyze if any clinical or laboratory variables were significantly associated to the occurrence of TEs both at PV diagnosis and during the course of the disease in a large series of PV pts uniformly followed at a single Center over a period of 29.5 years from January 1986 to June 2019. Clinical and laboratory data were obtained from the time of diagnosis until death, progression to acute leukemia or last follow-up. Hematocrit (Hct), hemoglobin (Hb), white blood cell (WBC) and platelet (PLT) levels were recorded for each patient at least every 6 months. Among a total of 331 pts, the median age was 65 years (range 30-92 years), and 56% were male. "High risk" features (age ≥ 60 years and/or history of prior thrombosis) were present in 221 pts (66.7%). The incidence of cardiovascular risk factors was: hypertension 64%, diabetes 15%, hyperlipidemia 28%, history of active or remote smoking 41%. Patients on ASA were 279 (84%), 19 (6%) were on oral anticoagulation, while 27 (8%) were on ASA+oral anticoagulant. At PV diagnosis 54 pts (16%) presented with thrombosis, arterial in 32 (59%) and venous in 22 (41%). A previous TE was recorded in 57 pts (17%): in 43 (75%) arterial, in 12 (22%) venous and in 2 (3%) mixed (arterial+venous). Previous thrombosis was the only variable significantly associated with the presence of a TE at PV diagnosis (P=0.02). After PV diagnosis, with a median follow-up of 81 months (range 1-374 months), 63 pts (19%) experienced a TE and 11 of them a further episode, for a total of 74 TEs. The incidence rate (pts/year) of TEs was 2.7%. Forty-two events were arterial (57%), 31 were venous (42%) and 1 (1%) was mixed. It was the first TE for 37 pts. Cerebrovascular accidents and deep-venous thrombosis were the most frequent arterial and venous TEs both at PV diagnosis and throughout the disease course, with a relative incidence of 50% and 32% respectively. The table compares the characteristics of patients who did or did not develop a TE after PV diagnosis. At univariate analysis, PV high risk status, a previous TE and hyperlipidemia at PV diagnosis were significantly associated with a subsequent TE. Among hematologic variables an elevated WBC count at the time of thrombosis, but not Hct or PLT levels, was highly significantly associated with the development of a TE. At multivariate analysis, WBC count ≥10.4 x 10^9/L and hyperlipidemia maintained their independent prognostic value, while high risk status and a previous TE lost their prognostic significance. Both at univariate and multivariate analysis, hyperlipidemia at diagnosis (P=0.009 and P=0.002) and high WBC count at thrombosis (P=0.001 and P=&lt;0.0001) predicted for arterial thromboses, while only a history of prior thrombosis (P=0.03) predicted for venous ones. In conclusion, our analysis confirms that elevated WBC count at the moment of the event more than increased hematocrit is associated to the development of thrombosis in PV pts. We also found that hyperlipidemia was an independent risk factor for arterial thrombosis, calling for an accurate management of increased lipid levels. Whether a reduction of the WBC count during the course of PV may reduce the frequency of TE remains to be demonstrated by prospective studies. Table Disclosures D'Adda: Novartis: Other: Advisory board; Incyte: Other: Advisory board; Pfizer: Other: Advisory board. Rossi:Daiichi Sankyo: Consultancy, Honoraria; Sanofi: Honoraria; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: Advisory board; Alexion: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria; Celgene: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Jazz: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

2019 ◽  
Vol 30 (3) ◽  
pp. 402-407
Author(s):  
Daphne M Stol ◽  
Monika Hollander ◽  
Ilse F Badenbroek ◽  
Mark M J Nielen ◽  
François G Schellevis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Newly Diagnosed ◽  
Additional Risk ◽  
High Risk Patients ◽  
Detection Program ◽  
Risk Patients

Abstract Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

scholarly journals Open-Labeled, Multicenter Phase II Study of Bortezomib for Maintenance Therapy in Patients with High Risk Diffuse Large B Cell Lymphoma (DLBCL): Borma Trial from Consortium for Improving Survival of Lymphoma (CISL)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2884-2884
Author(s):  
Jae-Cheol Jo ◽  
Ho Sup Lee ◽  
Cheolwon Suh ◽  
Hye Jin Kang ◽  
Won Seog Kim ◽  
...  
Keyword(s):  
High Risk ◽  
Maintenance Therapy ◽  
B Cell ◽  
Research Funding ◽  
Maintenance Treatment ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Risk Patients ◽  
Large B Cell Lymphoma ◽  
Risk Patients

Background: High-intermediate or high risk in international prognostic index (IPI) has a long-term chance of cure in the range about 50% in patients with diffuse large B cell lymphoma (DLBCL) treated by R-CHOP. These high risk patients should be considered for additional new treatment to standard R-CHOP or investigational approaches in the context of clinical trials that are designed to ensure that potentially curative therapy. Bortezomib inhibits NF-κB activation through proteasome inhibition, providing rationale for its use in cells that constitutively express NF-κB. Non-germinal center B cell (GCB) DLBCL has a worse survival after upfront chemotherapy and is characterized by constitutive activation of the antiapoptotic NF-κB pathway, which can inhibit chemotherapy. There is no study of bortezomib as maintenance therapy after treated with R-CHOP in high risk patients with DLBCL. So we applied additional bortezomib as maintenance therapy in order to assess improving efficacy and survival rates in high risk patients with non-GCB DLBCL who had been confirmed complete response (CR) after treated with R-CHOP. Methods: Patients with newly diagnosed stage II(bulky)-IV DLBCL with high or high intermediate IPI score of 3 to 5, and patients achieving a CR at the end of 6 or 8 cycles of R-CHOP21 were eligible for enrollment. Non-GCB DLBCL according to Hans criteria confirmed by central review was need before enrollment. Bortezomib maintenance treatment was consisted of bortezomib 1.3mg/m2 subcutaneously administration day 1 and day 15 per 28-day cycle with a total of 12 cycles. The primary endpoint was 3-year progression-free survival (PFS). Secondary endpoints were 3-year overall survival (OS), and toxicites. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. Results: Fifty-nine patients were enrolled between May 2014 and Oct 2018. The type of Non-GCB DLBCL in all patients was confirmed by the central pathology review. The median age was 65 years (range: 27-86 years), and 60% were > 61 years. The baseline clinical features were as follows: female sex, 45.8%; ECOG >1, 10.2%; stage II bulky (>10cm), 6.8%; stage III/IV, 93.2%. At the time of analysis, 29 patients completed 12-cycles of bortezomib maintenance, and 3 patients is ongoing. Seven patients did not finished maintenance therapy due to toxicities (fatigue, atrial flutter, neuropathy, pleural effusion, thrombocytopenia), and withdrawal of informed consent (n=4). Sixteen patients experienced disease progression during bortezomib maintenance treatment. With a median follow-up of 25.1 months, 3-year PFS rate was 56.9% and 3-year OS rate was 86.4% (Figure 1). Toxicity was assessed in 489 cycles of bortezomib maintenance in all 59 patients. There was no treatment-related death and febrile neutropenia. Conclusion: Bortezomib maintenance showed 3-year PFS rate of 56.9% with acceptable toxicities in patients with high risk DLBCL achieving a CR at the end of 6 or 8 cycles of R-CHOP21. Figure 1 Disclosures Kim: Celltrion: Research Funding; Novartis: Research Funding; J + J: Research Funding; Donga: Research Funding; Kyowa-Kirin: Research Funding; Novartis: Research Funding; F. Hoffmann-La Roche Ltd: Research Funding.

Predictors of Recurrence, Progression, and Retreatment in Basilar Tip Aneurysms: A Location-Controlled Analysis

2018 ◽  
Vol 16 (4) ◽  
pp. 435-444 ◽  
Author(s):  
Isaac Josh Abecassis ◽  
Rajeev D Sen ◽  
Jason Barber ◽  
Rakshith Shetty ◽  
Cory M Kelly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Hazard Ratio ◽  
Anterior Communicating Artery ◽  
Multivariate Modeling ◽  
Ruptured Aneurysms ◽  
Endovascular Interventions ◽  
Kaplan Meier ◽  
Event Rates

Abstract BACKGROUND Endovascular treatment of intracranial aneurysms is associated with higher rates of recurrence and retreatment, though contemporary rates and risk factors for basilar tip aneurysms (BTAs) are less well-described. OBJECTIVE To characterize progression, retreatement, and retreated progression of BTAs treated with microsurgical or endovascular interventions. METHODS We retrospectively reviewed records for 141 consecutive BTA patients. We included 158 anterior communicating artery (ACoA) and 118 middle cerebral artery (MCA) aneurysms as controls. Univariate and multivariate analyses were used to calculate rates of progression (recurrence of previously obliterated aneurysms and progression of known residual aneurysm dome or neck), retreatment, and retreated progression. Kaplan–Meier analysis was used to characterize 24-mo event rates for primary outcome prediction. RESULTS Of 141 BTA patients, 62.4% were ruptured and 37.6% were unruptured. Average radiographical follow-up was 33 mo. Among ruptured aneurysms treated with clipping, there were 2 rehemorrhages due to recurrence (6.1%), and none in any other cohorts. Overall rates of progression (28.9%), retreatment (28.9%), and retreated progression (24.7%) were not significantly different between surgical and endovascular subgroups, though ruptured aneurysms had higher event rates. Multivariate modeling confirmed rupture status (P = .003, hazard ratio = 0.14) and aneurysm dome width (P = .005, hazard ratio = 1.23) as independent predictors of progression requiring retreatment. In a separate multivariate analysis with ACoA and MCA aneurysms, basilar tip location was an independent predictor of progression, retreatment, and retreated progression. CONCLUSION BTAs have higher rates of progression and retreated progression than other aneurysm locations, independent of treatment modality. Rupture status and dome width are risk factors for progression requiring retreatment.

scholarly journals Long term outcomes of acute and transient psychotic disorders: The missed opportunity of preventive interventions

2018 ◽  
Vol 52 ◽  
pp. 126-133 ◽  
Author(s):  
Grazia Rutigliano ◽  
Sergio Merlino ◽  
Amedeo Minichino ◽  
Rashmi Patel ◽  
Cathy Davies ◽  
...  
Keyword(s):  
High Risk ◽  
Psychotic Disorders ◽  
Cumulative Risk ◽  
Acute Onset ◽  
Kaplan Meier ◽  
Schizophrenia Spectrum ◽  
National Health Service Trust ◽  
Icd 10

AbstractBackground:Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.Methods:Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.Results:A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).Conclusions:Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.

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