Modeling Future Blood Requirements in Patients with Transfusion-Dependent β-Thalassemia in Greece

Abstract Introduction : In Greece, official data confirm that blood supply is consistently declining, primarily because of decreased voluntary blood donations. At this rate, it is unclear whether there will be sufficient red blood cell (RBC) units to meet future demand for patients with β-thalassemia. We modeled future blood demand in patients with transfusion-dependent β-thalassemia (TDT) over the next 15 years to assess whether such a demand can be met. Methods: A discrete time, stochastic, individual-based model, was developed to assess future blood needs of patients with TDT in Greece. The model adopted a cohort approach and patients enter the model shortly after birth and exit at death. The model was seeded with data from the National Registry for Hemoglobinopathies in Greece (NRHG; patient population) and data from the National Blood Centre (RBC units) (Table). To quantify the decrease in TDT incidence, a linear regression model was fitted to the incident cases as described by Voskaridou (Voskaridou E, et al. Ann Hematol 2019;98:55-66). The calculated annual reduction rate was then applied to the observed thalassemia major (TM) and thalassemia intermedia (TI) incident cases for 2012 (Voskaridou E, et al. Ann Hematol 2012;91:1451-1458). The model assumes the reduction would continue through to 2020, from which time the incidence curve would be constant. Results: The model estimates a decrease in both target population, primarily due to the implementation of the national prenatal screening program and TM related mortality, (9.2%, 18.6%, and 26.0% in 2025, 2030, and 2034, respectively) and in demand for RBC units (100,665, 89,428 and 80,565, respectively) over the next 15 years. After accounting for any blood donated, based on latest (2017) data as projected to 2020, Greece is expected to be short of 56,716 RBC units to meet needs of patients with TDT in 2020. By 2025, 2030, and 2034, cumulative required RBC units for patients with TDT are estimated to be 307,150, 501,698, and 617,074, respectively. Assuming RBC units are divided among patients ≥ 18 years and those < 18 years in line with the population mix in the NRHG, cumulative RBC units required for adult patients with TDT are estimated to be 292,837, 464,337, and 554,083 by 2025, 2030, and 2034, respectively. Conclusions: Though blood demand for patients with TDT is expected to decrease in line with a decrease in the patient population, it will remain a challenge for the healthcare system in Greece to meet the demand, primarily due to a continuing shortage of available RBC units from voluntary donations. This annual deficit is estimated to accumulate to over 600,000 units over the next 15 years. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Recently Improved Results of Hematopoietic Cell Transplantation in Thalassemia Patients in Asia

Blood ◽

10.1182/blood.v124.21.1257.1257 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1257-1257

Author(s):

Chunfu Li ◽

Vincent Lee ◽

Shau Yin Ha ◽

Hai Peng Lin ◽

Anselm Lee ◽

...

Keyword(s):

Overall Survival ◽

Cell Transplantation ◽

Graft Rejection ◽

Hematopoietic Cell Transplantation ◽

Conflicts Of Interest ◽

Thalassemia Major ◽

Hematopoietic Cell ◽

Free Survival ◽

Recent Cohort ◽

Related Mortality

Abstract Objective Hematopoietic cell transplantation (HSCT) is not widely used for patients with b-thalassemia major (TM) so far because of transplant toxicities. Furthermore the tangible outcomes of contemporary HSCTs in Asia are unknown. Methods A newly founded consortium named the Viva-Asia BMT Group collected HSCT data retrospectively and investigated whether TM-HSCT outcomes had improved in recent years in Asia and whether an upper age limit can be determined for safe transplantation. Results From 1991 to 2012, 422 TM-HSCTs were performed among the 8 Asian centers; half (n=209) were before January 2009 (early cohort) and the other half (n=213) were performed thereafter (recent cohort). All major outcomes including overall survival (OS), TM-free survival (TFS), incidences of graft rejection (GR) and transplant-related mortality (TRM) improved significantly in the recent cohort (OS 93.4%, TFS 88.6%, GR 4.4% and TRM 6.6%) when compared with the earlier cohort (OS 84%, TFS 68.1%, GR 17.1% and TRM 16%). In the recent cohort, favorable OS, TFS, GR and TRM were observed with unrelated donors (n=168, 92.8%, 87.8%, 4.2% and 7.2%, respectively), with one-antigen mismatched parental donors (n=26,100%, 100%, 0% and 0%, respectively), and in patients younger than 10 years (n=173, 96%, 90.8%, 4.7% and 4.0%, respectively). TFS with unrelated cord blood (35.3%) was poor. Conclusion The excellent outcomes of contemporary TM-HSCT in general suggest that transplantation is a viable option for many Asian patients, particularly those younger than 10 years from areas with limited resources for chronic transfusion and iron chelation. Figure 1A OS, TFS, GR and TRM in (A) the total 422 patients, (B) the recent cohort, and (C) the earlier cohort. Abbreviations: GR, graft rejection; OS, overall survival; TFS, thalassemia major-free survival; TRM, transplant-related mortality. Figure 1A. OS, TFS, GR and TRM in (A) the total 422 patients, (B) the recent cohort, and (C) the earlier cohort. Abbreviations: GR, graft rejection; OS, overall survival; TFS, thalassemia major-free survival; TRM, transplant-related mortality. Figure 1B Figure 1B. Figure 1C Figure 1C. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Quality of Oral Anticoagulation with Vitamin K Antagonists in 'Real-World' Patients: Lessons from a Six Years Audit Study

Blood ◽

10.1182/blood-2019-129382 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1159-1159

Author(s):

Fernanda Leite ◽

Ângela Leite ◽

Sara Ferreira ◽

Jorge Coutinho

Keyword(s):

Vitamin K ◽

Therapeutic Range ◽

Patient Population ◽

Conflicts Of Interest ◽

Vitamin K Antagonists ◽

Recall Interval ◽

Group 3 ◽

Group 2 ◽

Group 1

Introduction: Among patients receiving vitamin K antagonists (VKA) therapy, maintenance of an international normalized ratio (INR) in the therapeutic range is essential for treatment efficacy and safety. This requires regular monitoring and appropriate dose adjustment. It has been reported that anticoagulation clinics should aim for a time in therapeutic range (TTR) between 70-80% to optimize benefit and minimize the risk of adverse events. Previously (in a study between September 2006 and June 2012), we have reported that patients with longer INR recall interval (4-8 weeks) showed no decrease of monitoring quality and that it would be safe to increase time between measurements. Aim: Since actual recommendations for improving TTR include shortening INR recall interval (Lip et al. 2018) we aimed to evaluate the quality of anticoagulation monitoring after having increased time between measurements beyond the 4-8 weeks recall interval. Methodology: We retrospectively analyzed 37931 appointments of 6 consecutive years (July 2012 to July 2018) corresponding to 1587 patients that are regularly followed up at an outpatient Anticoagulation Clinic of a central hospital under anticoagulation for at least 8 weeks, using TTR determined by Rosendaal method. Patients were divided according to target INR in three groups: Group 1 with target INR 2-3, including 1430 patients corresponding to 30743 appointments with mean age 69±15 years (mean±SD), majority (46.4%) with atrial fibrillation (AF); Group 2 with target INR 2.5-3.5, including 125 patients corresponding to 5439 appointments with mean age 67±12 years, majority (85.6%) with mechanical heart valves; Group 3 with target INR 3-4, including 32 patients corresponding to 1749 appointments with mean age 62±14 years, majority (62.5%) with antiphospholipid syndrome. Descriptive statistics (mean, standard deviation, minimum, maximum, chi-square), inferential statistics (t-test, A-Nova and effect sizes) tests and correlations were performed. Results: The 1587 patient population, 50.5% male, mean age of 68±17 years and 90.1% in Group 1, showed a mortality of 18%. A point-biserial correlation was run to determine the relationship between mortality and gender, age, INR group and diagnostic. Mortality was correlated with diagnosis (57.2% with AF) (rpb = -.071, n = 1587, p = .004), male gender (60%) (rpb = -.089, n = 1587, p <.001) and age (75±12) (rpb = .175, n= 1587, p<.001) but not with INR group (rpb = -.017, n = 1587, p = .499). Indeed, between groups mortality was not different [Χ2(2)=.492; p=.782; φ=.018] nor mean age [F(2, 1584)=2.588; p=.078; η2=.003], but gender distribution was unequal [Χ2(2)= 10.815; p=.004; φ=.083] with male predominating in Group 1 (51.9%) and female in Group 2 (60.8%) and 3 (65.6%). Patients in Group 1, corresponding to 90.1% of the total population, had TTR of 72%, patients in Group 2 had TTR of 69% and patients in Group 3 had TTR of 60%. Comparatively to the previous study (2006-2012), we noticed a significant decrease in patient population / appointments size (2087/ 61988) (p <.001) with a decrease of TTR in Group 1 (1927 patients) (83%) and Group 2 (120 patients) (74%) but a TTR increase in Group 3 (40 patients) (54%) (p <.001). Conclusions and Discussion: More than 90% of the population under VKA treatment showed effective TTR which may infer safety in increasing INR recall interval. The TTR decrease with a smaller population may be explained by the introduction of direct oral anticoagulants in patients with less comorbidities. The increase of TTR in patients with higher INR target suggests a better management of patients under VKA therapy that is actually the only choice for challenging patients. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Impact of a Targeted Free Mammography Screening Program for Underprivileged Women in Malaysia

Journal of Global Oncology ◽

10.1200/jgo.18.10320 ◽

2018 ◽

Vol 4 (Supplement 3) ◽

pp. 28s-28s

Author(s):

Viji Nair ◽

Viji Dina Nazri ◽

Angela Lau ◽

Rozita Hashim ◽

Clare Ratnasingham ◽

...

Keyword(s):

Breast Cancer ◽

Nongovernmental Organizations ◽

Mammography Screening ◽

Conflicts Of Interest ◽

Screening Program ◽

Disease Stage ◽

Cancer Society ◽

Insurance Carrier ◽

Late Stages ◽

Malaysian Women

Purpose Breast cancer remains the most prevalent cancer among Malaysians today. Almost two thirds of patients are diagnosed in the late stages of disease, stage III to IV, with poorer outcomes. In addition, evidence has also revealed that most of patients who present in these late stages are those from poorer socioeconomic backgrounds. Women from underprivileged backgrounds have been found to have poorer health-seeking behavior, especially in terms of screening for cancer. This is for a number of reasons, such as affordability, distance to health centers, and other socioeconomic factors, which have a large impact, as Malaysia only offers opportunistic screening for breast cancer and not for free. A specific program to provide free mammography screening targeted toward underprivileged Malaysian women was planned and implemented with the aim of improving access to screening and increasing the rate of screening among this specific group of women. Methods Funding for the program was obtained from successful negotiation with a large Malaysian life insurance carrier. To ensure geographic equity, screening services were strategically purchased from 15 hospitals that were spread out across Malaysia. We also built partnerships with various nongovernmental organizations working in the social arena servicing underprivileged groups to reach these groups specifically. The nongovernmental organizations co-organized awareness programs and screening days, together with the National Cancer Society Malaysia, with additional incentivization that included subsidizing transport to mammography centers. Results A total of 5,000 underprivileged women from different geographic localities and ethnicities were screened across Malaysia. Of these, 62% received a mammogram for the first time in their lives, whereas 21% received their first repeat mammogram in more than 3 years. Conclusion A targeted screening program that incorporated a multipronged approach strategy was successful at increasing access to breast cancer screening for underprivileged Malaysian women. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Murallitharan Munisamy Employment: National Cancer Society of Malaysia Stock or Other Ownership: MMPKV Sdn Bhd–operator of Malaysian Primary Care Clinics

Download Full-text

Adaptive Estimation for Epidemic Renewal and Phylogenetic Skyline Models

Systematic Biology ◽

10.1093/sysbio/syaa035 ◽

2020 ◽

Vol 69 (6) ◽

pp. 1163-1179 ◽

Cited By ~ 5

Author(s):

Kris V Parag ◽

Christl A Donnelly

Keyword(s):

Information Theory ◽

Model Selection ◽

Adaptive Estimation ◽

Minimum Description Length ◽

Target Population ◽

Theory Model ◽

Information Criteria ◽

Classification Problems ◽

Effective Population ◽

Incident Cases

Abstract Estimating temporal changes in a target population from phylogenetic or count data is an important problem in ecology and epidemiology. Reliable estimates can provide key insights into the climatic and biological drivers influencing the diversity or structure of that population and evidence hypotheses concerning its future growth or decline. In infectious disease applications, the individuals infected across an epidemic form the target population. The renewal model estimates the effective reproduction number, R, of the epidemic from counts of observed incident cases. The skyline model infers the effective population size, N, underlying a phylogeny of sequences sampled from that epidemic. Practically, R measures ongoing epidemic growth while N informs on historical caseload. While both models solve distinct problems, the reliability of their estimates depends on p-dimensional piecewise-constant functions. If p is misspecified, the model might underfit significant changes or overfit noise and promote a spurious understanding of the epidemic, which might misguide intervention policies or misinform forecasts. Surprisingly, no transparent yet principled approach for optimizing p exists. Usually, p is heuristically set, or obscurely controlled via complex algorithms. We present a computable and interpretable p-selection method based on the minimum description length (MDL) formalism of information theory. Unlike many standard model selection techniques, MDL accounts for the additional statistical complexity induced by how parameters interact. As a result, our method optimizes p so that R and N estimates properly and meaningfully adapt to available data. It also outperforms comparable Akaike and Bayesian information criteria on several classification problems, given minimal knowledge of the parameter space, and exposes statistical similarities among renewal, skyline, and other models in biology. Rigorous and interpretable model selection is necessary if trustworthy and justifiable conclusions are to be drawn from piecewise models. [Coalescent processes; epidemiology; information theory; model selection; phylodynamics; renewal models; skyline plots]

Download Full-text

The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain)

BMC Public Health ◽

10.1186/s12889-020-09603-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Cristina Agustí ◽

Núria Font-Casaseca ◽

Francesc Belvis ◽

Mireia Julià ◽

Núria Vives ◽

...

Keyword(s):

Spatial Distribution ◽

Hiv Infection ◽

Urban Areas ◽

Western Europe ◽

Hiv Infections ◽

National Registry ◽

Surveillance Data ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Incident Cases

Abstract Background Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. Methods Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012–2016) and associated risk factors at the small area level (ABS, acronym for “basic health area” in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. Results New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15–44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. Conclusions Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.

Download Full-text

Study on the Annual Reduction Rate of Vehicle Emission Factors for Carbon Monoxide: A Case Study of Urban Road Tunnels in Shenzhen, China

Advances in Civil Engineering ◽

10.1155/2020/1686753 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17

Author(s):

Weiwei Liu ◽

Jianxun Chen ◽

Yanbin Luo ◽

Zhou Shi ◽

Xiang Ji ◽

...

Keyword(s):

Carbon Monoxide ◽

Reduction Rate ◽

Emission Factors ◽

Pollutant Emission ◽

Passenger Cars ◽

Urban Road ◽

Road Tunnels ◽

Measurement Results ◽

Annual Reduction ◽

Co Emission

Environmental pollution and energy conservation in urban tunnels have become important issues that affect the scientific design and sustainable development of urban tunnels. The carbon monoxide (CO) concentration in urban road tunnels is regarded as a direct reflection and a useful tracer of the intensity of anthropogenic transportation activities. Previous studies in recent years have paid more attention to pollutant emission factors, but less to the calculation parameters of ventilation design for tunnels. This paper aims to study a reasonable annual reduction rate of CO base emission factors. Therefore, a detailed field measurement was carried out in the four typical urban road tunnels, Henglongshan Tunnel, Cejiexian Tunnel, Jiuweiling Tunnel, and Dameisha Tunnel in Shenzhen, China, from March 29 to September 16, 2014. Measurement results showed that the traffic flow of the four urban tunnels had been approaching the design value, or even beyond the limit. The average daily air velocities in the four tunnels were all within 5 m/s, whereas the maximum air velocity had exceeded the limit of 10 m/s. The CO concentrations in Henglongshan Tunnel, Cejiexian Tunnel, Jiuweiling Tunnel, and Dameisha Tunnel were 17 ppm, 7 ppm, 39 ppm, and 8 ppm, respectively. Moreover, it was found that the average CO emission factors of Henglongshan Tunnel, Cejiexian Tunnel, Jiuweiling Tunnel, and Dameisha Tunnel were 1.075 g/(km·veh), 1.245 g/(km·veh), 4.154 g/(km·veh), and 1.739 g/(km·veh), respectively. Based on the statistical data, the CO emission factors of mixed traffic and passenger cars decrease by an average of 16.4% and 33.3%, respectively, per year through the regression method and by an average of 17.4% and 29.0%, respectively, per year through the extremum method. Finally, when considering the safety factor of 20%, it is more reasonable for the CO base emission to adopt 4% as an annual reduction rate for ventilation design in urban tunnels.

Download Full-text

Andalusian program for early detection of diabetic retinopathy: implementation and 15-year follow-up of a population-based screening program in Andalusia, Southern Spain

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001622 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001622 ◽

Cited By ~ 1

Author(s):

Rafael Rodriguez-Acuña ◽

Eduardo Mayoral ◽

Manuel Aguilar-Diosdado ◽

Reyes Rave ◽

Beatriz Oyarzabal ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Early Detection ◽

Vision Loss ◽

Screening Program ◽

Target Population ◽

Population Based ◽

Annual Incidence ◽

Population Coverage ◽

Visual Disability ◽

The Impact

IntroductionDiabetic retinopathy (DR) is a preventable cause of vision loss and blindness worldwide. We aim at analyzing the impact of a population-based screening program of DR using retinal photography with remote reading in terms of population coverage, diagnosis of asymptomatic DR and impact on visual disability, in the region of Andalusia, Spain, in the period 2005–2019.Research design and methodsDescriptive study. Sociodemographic and clinical features included in the Andalusian program for early detection of diabetic retinopathy (APDR) were analyzed. Population coverage, annual incidence of DR, and DR severity gradation were analyzed. Estimated data on prevalence and incidence of legal blindness due to DR were included.Results407 762 patients with at least one successful DR examination during the study period were included. Most of the performed retinographies (784 584, 84.3%) were ‘non-pathological.’ Asymptomatic DR was detected in 52 748 (5.9%) retinographies, most of them (94.2%) being classified as ‘mild to moderate non-proliferative DR.’ DR was detected in 44 815 patients, while sight-threatening DR (STDR) in 6256 patients; cumulative incidence of DR was 11.0% and STDR was 1.5%, as DR and STDR was detected in 44 815 and 6256 patients, respectively. Annual incidence risk per patient recruitment year progressively decreased from 22.0% by January 2005 to 3.2% by June 2019.ConclusionsImplementation of a long-term population-based screening program for early detection of DR is technically feasible and clinically viable. Thus, after 15 years of existence, the program has enabled the screening of the vast majority of the target population allowing the optimization of healthcare resources and the identification of asymptomatic DR.

Download Full-text

Unrelated Cord Blood Transplantation (UCBT) for Transfusion- Dependent Thalassemia a CIBMTR Audited Retrospective Analysis of 30 Consecutive Patients from a Single Center

Blood ◽

10.1182/blood.v112.11.131.131 ◽

2008 ◽

Vol 112 (11) ◽

pp. 131-131 ◽

Cited By ~ 1

Author(s):

Tang-Her Jaing ◽

Brian Wang ◽

David Gjertson ◽

Ping Law ◽

Lawrence Petz ◽

...

Keyword(s):

Cord Blood Transplantation ◽

Chronic Gvhd ◽

Young Patients ◽

Disease Free Survival ◽

Thalassemia Major ◽

Clinical Results ◽

Traumatic Head Injury ◽

Cell Dose ◽

Abo Incompatibility ◽

Related Mortality

Abstract UCBT offers a cure for thalassemia and has advantages as a stem cell source because the requirement for an HLA match between donor and recipient is less stringent. Previous reports of UCBT for thalassemia have yielded transplant related mortality (TRM) that was quite high and it is known that pre-freeze total nucleated cell (TNC) dose is critical for UCBT. With strategies that maximize TNC dose – using non-red cell reduced but plasma depleted (PD) CB, no post-thaw wash (NW), and double cord transplantation (DCT) when necessary – we have achieved promising results with UCBT in young patients with transfusion-dependent β-thalassemia. Between 10/2003 and 5/2008, 39 CB products were infused after Bu/Cy/ATG myeloablation into 30 pediatric thalassemia major patients (9 DCT) using NW PD CB exclusively. Patient status: 21 Pesaro class−1, 8 Pesaro class−2, and 2 unknown. Median age was 5 years (range 1–14 years) with a median weight of 18 kg (range 11–37 kg). The data was audited by the transplant center (TC) and on-site by CIBMTR (98.5% accuracy for Chang Gung). Median pre-freeze TNC cell dose was 10.9×107/kg, and median pre-freeze CD34+ cell dose was 4.0×105/kg. The number of CB products HLA ABDR matched were 4, 11, and 24 for 6/6, 5/6, and 4/6 or fewer matches. No significant adverse events were observed despite major ABO incompatibility in some cases and forgoing post-thaw wash. Cumulative incidences of donor-derived (determined by chimerism studies) neutrophil (ANC500), platelet 20K and 50K (plt 20K & 50K) engraftment were 96±11%, 92±11% and 92±12%, and median times to ANC500, plt 20K and 50K engraftment were 17.5 days (range 11–26), 49.5 days (range 28–135) and 63.5 days (range 35–203), respectively. Grade III/IV acute GvHD occurred in 40±9%, and extensive chronic GvHD occurred in 4±4% of the patients. Transplant related mortality were 10±5% at 100 days and 13±6% at 1 year. Overall survival at 1 and 3 years were 87±6% and 82±8%, while disease-free survival at 1 and 3 years were 85±7% and 78±9%. Five patients expired including 1 death prior to day +10 due to traumatic head injury. Mean and median follow up times were 24 and 16 months respectively (range 0.3–58 months) as of August 2008. To our knowledge, this is the largest single-institutional UCBT series for thalassemia, and shows the favorable clinical results that are attainable when TNC dose is optimized with PD CBU, no post-thaw wash and DCT when necessary.

Download Full-text

Comorbidities Index Is Not Predictive of Treatment Related Mortality in Patients (pts) Older Than 60 Years Treated with Reduced Intensity Conditioning and Allogeneic Stem Cell Transplantation (RIC-ALLO).

Blood ◽

10.1182/blood.v114.22.1180.1180 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1180-1180

Author(s):

Luca Castagna ◽

Sabine Furst ◽

Jean El Cheikh ◽

Catherine Faucher ◽

Mohamad Mohty ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Viral Infections ◽

Conflicts Of Interest ◽

Chronic Gvhd ◽

Univariate Analysis ◽

Treatment Related Mortality ◽

Related Mortality

Abstract Abstract 1180 Poster Board I-202 Benjamin Esterni, Didier Blaise Background: Allogeneic stem cell transplantation (ALLO) is the only curative therapy for many hematological malignancies. For many of these diseases, the median age at diagnosis is around the sixth decade of life, precluding myeloablative ALLO (MAC-ALLO). RIC-ALLO is less toxic and it has been performed in elderly pts, mainly affected by acute leukemia. Finally, comorbidities index seem to predict treatment related mortality (TRM) and overall survival (OS). Patients and methods: From 2001 and 2008, 67 pts older than 60 years (median age 63 y, range 60-70) received RIC-ALLO. Diseases were: acute myeloid leukemia 45%, multiple myeloma 18%, chronic lymphocytic leukemia 12%, non-Hodgkin lymphoma 10%, myelodysplasia 6%, plasmacellular leukemia 3%, others 6%. Disease status at RIC-ALLO was: complete remission 54%, partial remission 16%, and active disease 30%. RIC consisted of fludarabine-based with thymoglobulin 64%, or low-dose TBI-based 36%. Donors were: HLAid sibling 73%, matched unrelated 21%, and cord blood 6%. Previous autologous transplant was performed in 59% of pts. The median number of CD34+ and CD3+ cells infused was 5 (range 1-9.4) and 296 (range 84-704), respectively. Karnofski score was 60-80% in 25% and 90-100% in 75%; HCT-CI was 0 in 33%, 1-2 in 33%, and more than 3 in 34%; PAM score was 8-16 in 9%, 17-33 in 65%, 24-30 in 22%, and more than 31 in 3%; EBMT score was 2 in 22%, 3 in 36%, 4 in 28%, more than 5 in 12%. Results: The median follow-up was 22 months. The 2-y OS and PFS were 66.8% (IC95 [55.5-80.4]) and 52.4% (IC95 [39.5-69.5]), respectively. Grade II-IV acute graft versus host disease (aGVHD) and chronic GVHD (cGVHD) incidence were 49% and 43%, respectively. Early infections were fever of unknown origin in 42% of pts, bacterial infection in 6 cases, pneumonia in 8, and viral infections in 14. The early infection-related mortality was null. Late infections were bacterial in 3 cases, pneumonia in 1, viral infections in 6, and candidemia in 1. Seven pts died from late infective complications. Overall, the cause of death was toxicities in 18 pts and disease progression in 6 pts. The 100-d and 1-y TRM were 6.35% (IC95 [0.278-12.4]) and 24.2% (IC95 [12.9-35.4]), respectively. In univariate analysis, HCT-CI, EBMT score, and PAM score did not influence TRM or OS. Furthermore, age (60-65 vs 66-70) was not related to TRM. Conclusions: The aim of this retrospective study was to verify if TRM was excessively high in elderly pts, affected from several haematological diseases and receiving ALLO from different donors and after different RIC. A secondary objective was to evaluate if several comorbidities index could predict TRM and OS. This heterogeneity should be regarded as a more realistic view of general population. TRM was acceptable and not different when compared to younger pts as reported in literature. Furthermore, neither comorbidities index nor age help segregate a group of pts with different TRM. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Two-Dimensional Speckle Strain for Evaluation of Left Ventricular Systolic Deformation in Children with Thalassemia Major.

Blood ◽

10.1182/blood.v114.22.4520.4520 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4520-4520

Author(s):

Osama Abd Rab-Rassol Tolba ◽

Mohamed Ramadan El-Shanshory ◽

Adel Abd El-Halum Hagag

Keyword(s):

Early Detection ◽

Conflicts Of Interest ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Mitral Annulus ◽

Thalassemia Major ◽

Left Ventricular ◽

Systolic Strain ◽

2D Strain ◽

Significant Difference

Abstract Abstract 4520 Objective In β-thalassemia major, Identifying early myocardial insult is important since significant cardiac involvement may predate a decrease in left ventricular systolic functions. The aim of this study is to clarify the value of 2 D-strain (2DS) in early detection of segmental and global left ventricular systolic dysfunction in thalassemic children. Subjects and Methods This study included two age-matched groups:Group 1 (n=30) thalassemic children and Group 2 (n=10) healthy control children. They undergo conventional echo-Doppler measures of left ventricular (LV) systolic and diastolic functions. The pulsed tissue Doppler of lateral mitral annulus was recorded. Longitudinal 2D strain in 18 left ventricular segments using 2 dimensional (2DS) speckle-tracking imaging from apical 4, 2, and 3-chamber views, using a Vivid 7 ultrasound system. The images were analyzed using Echopac soft ware. Results There was no significant difference among thalassemic patients and controls in LV fraction shortening, peak systolic and diastolic tissue velocities of lateral mitral annulus. But by the 2 D strain study there were a significant multi-segmental affection of the LV mainly the posterior, anterior walls with predilection mainly to the apical segments, also there was a significant affection of the peak global LV systolic strain with a median value (-17.7 versus -20.75; P = 0.008.). There was no significant correlation between all segmental or global LV systolic strain and the serum ferretin. Conclusion 2DS is a sensitive and accurate tool for early detection of segmental and global cardiac insult in thalassemic children. Disclosures: No relevant conflicts of interest to declare.

Download Full-text