Subtype Adjusted Therapy Improves Outcome of Elderly Patients with Acute Lymphoblastic Leukemia (ALL).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2732-2732 ◽  
Author(s):  
Dieter Hoelzer ◽  
Nicola Goekbuget ◽  
Joachim Beck ◽  
Thomas Burmeister ◽  
Aristoteles Giagounidis ◽  
...  
Keyword(s):  
Pilot Study ◽  
Chemotherapy Regimen ◽  
Lymphoblastic Leukemia ◽  
The Elderly ◽  
Term Outcome ◽  
Long Term Outcome ◽  
New Therapeutic Approaches ◽  
Cd20 Expression

Abstract Despite the major peak of ALL in childhood the incidence also increases in the elderly beyond 50 yrs. Outcome of these elderly ALL pts is very poor. In a survey including 12 studies with 370 pts (50–88 yrs) the mean CR rate was 50% and the rate of continuous CR (CCR) 13%. Also in a first prospective pilot study of the German Multicenter Study Group for Adult ALL (GMALL) for elderly ALL pts > 65 yrs with a moderate intensive chemotherapy regimen (Blood, 96(11): 3104a, 2000) the results in 94 pts were poor with a CR rate of 48% and a survival (OS) <10%. Therefore in 2003 the GMALL started new therapeutic approaches with subgroup adapted protocols for elderly pts > 55 yrs (age limit for allo SCT) according to status for 1) Ph/BCR-ABL, 2) CD20 expression and 3) a separate protocol for mature B-ALL. For 1) and 2) chemotherapy was similar to the pilot study (induction I,II consol. I–V with 2xIDMTX/MP,2xVM26/AC and reinduction). Out of a total of 824 pts recruited for the GMALL 06/99 109 were older than 55 yrs. 1) Imatinib in Ph/BCR-ABL+ ALL: In a prospective randomized trial pts received a 4 wk induction with 600 mg/d Imatinib (ImInd) compared to chemotherapy without Imatinib (ChInd). 36 pts (median age 67y) were evaluable (18 ImInd; 18 ChInd). The CR rate was higher for the Imatinib arm with 93% compared to only 44% with chemotherapy (p=.003). 3 of the 4 failure pts in the ChInd arm achieved CR after cross-over to ImInd. There were more non-hematologic severe (grade III/IV) adverse events during ChInd (pneumonia N=6 sepsis 2, enteritis 2, hepatotoxicity 1) versus ImInd (N=0). After induction both arms received the consolidation cycles parallel with Imatinib 600 mg/d for 1 yr. After a median follow-up of 4.3 mo (0.5–20+) 21 pts are in CCR and 6 relapsed. 7 pts died in CR. The OS at 18 mo is 47%. 3 pts (11%) achieved molecular remissions. 2) Rituximab in CD20+ ALL: In the 2nd study pts with CD20+ B-prec. ALL (Ph/BCR-ABL neg) received 375 mg rituximab before each cycle (induction I, II, consolidations). The small group of CD20neg ALL received the similar chemotherapy regimen without rituximab. 26 pts are evaluable (19 with rituximab and 7 with CD20 neg B-prec. or T-ALL). The median age is 66 (55–79) yrs. The CR rate in CD20+ pts is 63% and the OS after 1 yr is 54%. No pts died in CR so far. 3) Rituximab in mature B-ALL, Burkitt or other high-grade NHL: Elderly pts > 55 yrs with these diseases had a poor outcome with the former protocol B-NHL90 (Blood100(11):159a, 2002). The CR-rate in 45 pts was 71% and the OS 39% at 6 yrs. Therefore in the subsequent trial B-NHL2002 pts with mature B-ALL/B-NHL >55 yrs (86% CD20 pos) received a total of 8 cycles rituximab (375 mg), 6x before each chemotherapy cycle (day −1) and 2x rituximab only. In 26 evaluable pts the CR-rate increased to 81% and the OS at 1.5 yr is 84% (p=.03 compared to study B-NHL90). Out of 21 CR pts 19 are in CCR, 1 relapsed and 1 went off-study. Conclusion: In elderly ALL pts the application of Imatinib in Ph/BCR-ABLpos or rituximab in CD20+ pts led to a stubstantially improved antileukemic activity with high CR and low failure rates. The risk of infections remains a major problem and improved supportive measures are needed. Hopefully this risk stratified approach with targeted therapies will translate into improved long-term outcome in this age category (partly supported by Novartis Pharma and Hoffmann-La-Roche)

Incidence of Post-Thrombotic Syndrome Following Asymptomatic Thrombosis in Survivors of Childhood Acute Lymphoblastic Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1631-1631
Author(s):  
Stefan Kuhle ◽  
Maria Spavour ◽  
Jacqueline Halton ◽  
Patricia Massicotte ◽  
Irene Cherrick ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group I ◽  
Arm Circumference ◽  
History Of ◽  
Group Ii

Abstract BACKGROUND: Asymptomatic deep venous thrombosis (DVT) are well-known complications of treatment of acute lymphoblastic leukemia (ALL) in children. However, the clinical significance of radiographically detected, asymptomatic DVT is unclear and controversial, as there are no studies on long-term outcome of asymptomatic DVT in children available. There are two likely reasons for the studies not being done in this area. First, there is a lack of defined cohorts of pediatric patients screened for DVT and secondly, there is a great deal of difficulty in following patients over many years. The study, Prophylaxis with Antithrombin Replacement in Kids with ALL treated with L-Asparaginase (PARKAA) was a multicentre randomized controlled trial in which children with ALL were screened for DVT. As survivors of childhood cancer, the PARKAA cohort continues to be followed in their respective centers. Therefore, establishment of the PARKAA cohort (1997–99) and the ability to locate these patients provided a unique opportunity to study the long-term outcome of asymptomatic DVT. OBJECTIVE: To assess the incidence of PTS in children with ALL who previously had an asymptomatic DVT. The objective were approached in two ways. Firstly, to assess the outcome of asymptomatic DVT by determining the prevalence of PTS in children with a history of ALL with radiographically diagnosed DVT (PARKAA cohort); secondly, to corroborate the findings by determining the prevalence of PTS in an unselected group of survivors of childhood ALL. METHODS: Cross-sectional study in two separate populations: Group I comprised of children enrolled in the PARKAA multicentre study who had been screened for, and diagnosed with, DVT in the upper venous system. Group II consisted of non-selected patients < 21 years with a history of ALL followed at Stollery Children’s Hospital, Edmonton. Patients were invited for a follow-up at their treatment centre (Group I) or were assessed for PTS childhood cancer survivor clinic (Group II). PTS was assessed by two of the investigators (Group I) or by the attending oncologist (Group II), respectively, using a standardized scoring sheet. RESULTS: Group I: 13 PARKAA patients with a history of ALL and objectively diagnosed DVT were assessed for PTS (4 males; median age 11.9 years; median age at diagnosis of ALL 4.4 years). 7/13 patients had PTS (54%, 95%CI 25;81). All patients with PTS had collaterals on examination, 3 also had increased arm circumference. Group II: 41 patients with a history of ALL were enrolled (61% males; median age at diagnosis 3.0 years; 28% high-risk, 67% standard risk). Mean length of follow-up since diagnosis was 9.5 years. PTS was diagnosed in 10/41 (24%; 95%CI 11–38) patients. All patients with PTS had collaterals on examination, 5 (50%) also had increased arm circumference. CONCLUSIONS: There is a clinically significant prevalence of PTS in children with a history of ALL and radiographically diagnosed DVT. A significant proportion of survivors of ALL develop PTS, indicating previously undiagnosed DVT in this population.

International Stroke Trial Pilot Study: Absolute Risks of Poor Long-Term Outcome in the Elderly

1993 ◽  
Vol 22 (suppl 3) ◽  
pp. P9-P9
Author(s):  
R Lindley ◽  
R. Sandercock ◽  
J. Slattery
Keyword(s):  
Pilot Study ◽  
The Elderly ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Trial

Long-Term Outcome for De Novo Lymphoblastic Lymphoma (LL) After Frontline Therapy with Hyper-CVAD Regimen and Variants.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2831-2831
Author(s):  
Deborah A. Thomas ◽  
Stefan Faderl ◽  
Susan O'Brien ◽  
William G. Wierda ◽  
Guillermo Garcia-Manero ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
De Novo ◽  
Lymphoblastic Leukemia ◽  
First Line ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cns Disease ◽  
Mediastinal Disease

Abstract Abstract 2831 The long-term outcome for newly diagnosed LL has improved with use of intensive chemotherapy regimens designed for acute lymphoblastic leukemia (ALL) when compared to the historical experience with modified NHL regimens. An early report established the hyper-CVAD regimen (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high dose methotrexate (MTX) and cytarabine) as an effective first line therapy for LL [Thomas D, Blood 104:1624, 2004]. From April 1992 to March 2009, 49 patients (pts) with de novo LL were treated with hyper-CVAD (n=20) or modified hyper-CVAD regimens (n=11 anthracycline intensification with liposomal daunorubicin-ara-C for course 2 [regimen detailed in Thomas D, Cancer, e-pub], n=18 without anthracycline intensification). CNS prophylaxis alternated intrathecal MTX and ara-C on days 2 and 7 of the first 4 courses in the absence of CNS disease. Bulky (> 7 cm) mediastinal disease at presentation was an indication for consolidative XRT (after consolidation prior to maintenance therapy). POMP (6-mercaptopurine, vincristine, MTX, prednisone) maintenance therapy was administered for 24 months with standard hyper-CVAD (MTX-L-asparaginase intensifications mos 7 & 11); and extended to 30 mos with the modified hyper-CVAD regimens (hyper-CVAD followed by MTX-L-asparaginase mos 6 & 7 and 18 & 19). Allogeneic stem cell transplant (SCT) was performed in first complete remission (CR) only if inadequate response to therapy. Median age was 31 yrs (range, 17–59); 77% were males. Mediastinal disease was noted in 74%; 30% were associated with pericardial and/or pleural effusions. Two pts had superior vena cava syndrome and five had CNS disease. T-lineage disease was present in majority (79%). Eight (17%) pts had bone marrow involvement. Overall CR rate was 96% in 46 evaluable patients (3 in CR at start), with remainder achieving partial response (PET scan negative residual mediastinal disease not qualifying for CR). Of the 23 pts with bulky mediastinal disease at presentation, 74% underwent XRT as planned. With a median follow-up of 80 months (range 30–187+ months), 31 (66%) pts remained alive without disease. Overall 5-yr rates for CR duration and survival were 72% and 68%, respectively. Fourteen pts relapsed or progressed within a median of 13 months (6 with standard, 8 with modified hyper-CVAD); five pts were successfully salvaged with chemotherapy and allogeneic SCT. The hyper-CVAD is a highly active regimen for de novo LL with long-term follow-up confirming the earlier report. Early anthracycline intensification was clearly not beneficial. The treatment paradigm for LL has recently changed owing to availability of new agents and data supporting superior efficacy of pediatric regimens compared with conventional adult regimens. For older adults with de novo LL, the deoxyguanosine analog nelarabine has now been incorporated into the hyper-CVAD regimen as a single agent during consolidation (cycles 9 & 10) and maintenance (in lieu of the early intensifications) [Vigil CE, ASCO 2010, abstract 6524], whereas adolescents and younger adults are treated according to the pediatric-inspired augmented Berlin-Frankfurt-Muenster regimen. An augmented hyper-CVAD regimen (dose intensifying VCR/dexamethasone components and incorporating pegylated asparaginase) has been successfully piloted in the salvage setting. The optimal first line chemotherapy of LL continues to be refined; the role of autologous or allogeneic SCT for LL in first CR remains unclear since majority of patients can be cured without use of these modalities. Disclosures: Off Label Use: Nelarabine for de novo T-lymphoblastic leukemia/lymphoma Nelarabine for de novo T-lymphoblastic leukemia/lymphoma.

Predictors of long-term outcome in an elderly group after laminectomy for lumbar stenosis

2010 ◽  
Vol 13 (3) ◽  
pp. 329-334 ◽  
Author(s):  
Triantafyllos Bouras ◽  
George Stranjalis ◽  
Maria Loufardaki ◽  
Ilias Sourtzis ◽  
Lampis C. Stavrinou ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Patient Satisfaction ◽  
Prognostic Value ◽  
The Elderly ◽  
Low Back ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vas Score

Object This is a retrospective long-term outcome study of results after laminectomy for lumbar spinal stenosis in an elderly group of patients. The study was designed to evaluate possible demographic, comorbidity, and clinical prognosticators for pain reduction and functional improvement in this population. Because the assessment of functional outcome in the elderly is complicated by several specific factors, the use of outcome measurement parameters should be revised and refined. Moreover, despite numerous relevant studies, the results of various techniques remain equivocal, particularly among the elderly, which renders the implementation of focused studies necessary. New data could be used to refine patient selection and choice of technique to improve prognosis. Methods During a 5-year period, lumbar laminectomies were performed in 182 elderly patients. Of these 182, 125 patients (68.8%) were followed up for a mean period of 60.8 months. The outcome was assessed by means of pain visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), and patient satisfaction questionnaire, and results were correlated to demographic (age, sex), comorbidity (Charlson Comorbidity Index, diabetes, depression, and history of lumbar spine surgery), and clinical (main preoperative complaint, preoperative VAS score, and ODI) factors. Results In terms of the VAS score, 106 patients (84.8%) exhibited improvement at follow-up. The corresponding ODI improvement rate was 69.6% (87 patients). The mean VAS and ODI differences were 5.1 and 29.1, respectively. One hundred two patients (81.6%) were satisfied with the results of the operation. Univariate analysis for possible prognostic factors revealed the significant influence of low-back pain on VAS score (p = 0.024) and ODI (p < 0.001) not improving, while the ODI was also affected by sex (females had a poorer outcome [p = 0.019]). In contrast, patient satisfaction was not related to any of the preoperative parameters recorded; nevertheless, it was strongly related to all functional measurements on follow-up. Conclusions Considering the methodological issues of such studies, particularly in elderly patients, the authors conclude that the ODI is more sensitive than the VAS score in assessing prognostic value and that patient satisfaction is difficult to prognosticate, underscoring the particularities that this population presents regarding functionality assessment. Considering the prognostic value of preoperative factors, a negative influence of low-back pain and female sex is reported.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

Psychopathology 8½ Years Post Parasuicide

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 115-120 ◽  
Author(s):  
Stephen Curran ◽  
Michael Fitzgerald ◽  
Vincent T Greene
Keyword(s):  
Rating Scales ◽  
Psychiatric Morbidity ◽  
Parental Bonding ◽  
Social Maladjustment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Face To Face ◽  
Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Muenke syndrome: long-term outcome of a syndrome-specific treatment protocol

2019 ◽  
Vol 24 (4) ◽  
pp. 415-422 ◽  
Author(s):  
Bianca K. den Ottelander ◽  
Robbin de Goederen ◽  
Marie-Lise C. van Veelen ◽  
Stephanie D. C. van de Beeten ◽  
Maarten H. Lequin ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
First Year ◽  
Ventricular Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Skull Growth ◽  
Muenke Syndrome ◽  
First Year Of Life

OBJECTIVEThe authors evaluated the long-term outcome of their treatment protocol for Muenke syndrome, which includes a single craniofacial procedure.METHODSThis was a prospective observational cohort study of Muenke syndrome patients who underwent surgery for craniosynostosis within the first year of life. Symptoms and determinants of intracranial hypertension were evaluated by longitudinal monitoring of the presence of papilledema (fundoscopy), obstructive sleep apnea (OSA; with polysomnography), cerebellar tonsillar herniation (MRI studies), ventricular size (MRI and CT studies), and skull growth (occipital frontal head circumference [OFC]). Other evaluated factors included hearing, speech, and ophthalmological outcomes.RESULTSThe study included 38 patients; 36 patients underwent fronto-supraorbital advancement. The median age at last follow-up was 13.2 years (range 1.3–24.4 years). Three patients had papilledema, which was related to ophthalmological disorders in 2 patients. Three patients had mild OSA. Three patients had a Chiari I malformation, and tonsillar descent < 5 mm was present in 6 patients. Tonsillar position was unrelated to papilledema, ventricular size, or restricted skull growth. Ten patients had ventriculomegaly, and the OFC growth curve deflected in 3 patients. Twenty-two patients had hearing loss. Refraction anomalies were diagnosed in 14/15 patients measured at ≥ 8 years of age.CONCLUSIONSPatients with Muenke syndrome treated with a single fronto-supraorbital advancement in their first year of life rarely develop signs of intracranial hypertension, in accordance with the very low prevalence of its causative factors (OSA, hydrocephalus, and restricted skull growth). This illustrates that there is no need for a routine second craniofacial procedure. Patient follow-up should focus on visual assessment and speech and hearing outcomes.

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