The Retrospective Analysis of Pediatric Acute Leukemia Cases between 1980–2003: Hacettepe Experience.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4542-4542
Author(s):  
Sule Unal ◽  
Gonul Hicsonmez ◽  
Sevgi Yetgin ◽  
Aytemiz Gurgey ◽  
Fatma Gumruk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Leukemia ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Hematologic Malignancies ◽  
Cns Involvement ◽  
Laboratory Findings ◽  
Cancer Data ◽  
Significant Difference

Abstract Leukemia constitutes 25–30% of all pediatric malignancy cases. The epidemiologic and demographic characteristics of this group of patients are important not only for determination of the prognostic factors, but also the risk factors. In this study, 683 patients under 16 years of age who were diagnosed with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) between January 1980-July 2003 in Hacettepe University, Pediatric Hematolgy Division are analyzed retrospectively. Besides the epidemiologic characteristics including age, sex, geographic distiribution; the type of disease, clinical presentation, physical examination and laboratory findings on admission and the survival and prognosis relationships are also evaluated in order to determine the disease properties of our country. ALL patients have recieved St. Jude Total XI until 1997, and after 1997 they are treated by St. Jude Total XIII protocol. AML patients have been treated by AML 1995 and AML 1998 protocols. The study group includes 548 (80.2%) ALL and 135 (19.8%) AML cases. Two thirds of the all acute leukemia cases are males in both ALL and AML cases. The median age at diagnosis is 62 months for ALL and 108 months for AML patients. ALL is more common among 1–5 year old group; AML is more common among adolescent age group. The incidence of hematologic malignancies increases suddenly in 1997 and 1998 and then showes a decline later. The hematologic malignancy cases who have been admitted to our clinic is most commonly living in the northern and southeastern parts of Turkey. 50% of ALL and AML patients presents with the complaints of fever and pallor. Bone pain is significantly more common in ALL patients. Median time between onset of syptoms and diagnosis is 30 days for both ALL and AML patients. Lymphadenopathy is present in almost half of ALL and AML patients at diagnosis. Hepatomegaly (72.4% vs 50.4%) and splenomegaly (53.8% vs 36.3%) are more commonly observed in ALL then AML patients (p<0.001). The central nervous system (CNS) involvement is present in 5.8% of ALL and 5.9% of AML patients. There is no statisticaly significant difference between ALL and AML patients in terms of bone, mediastinial and CNS involvements. The most common cytogenetical abnormality in ALL patients is hypodiploidy. 25.4% of ALL and 43.7% of AML patients have relapsed subsequently. The most common type of relaps is seen in bone marrow in both ALL and AML cases, however CNS relaps is seen more commonly among ALL patients (31% vs 4%). Fatality rates of ALL and AML are 20.1% and 56.3%, respectively. The fatality rate of AML is significantly higher than ALL. The CNS involvement at diagnosis and sex have no influnce on the fatality rates; on the other hand the presence of relaps for ALL and AML groups and L3 subtype, being less then 1 year old at diagnosis for ALL cases have a negative effect on fatality rates. Also the fatality rates of ALL patients who have been diagnosed before 1997 and recieved St. Jude Total XI protocol has higher fatality rates then who have been diagnosed after 1997 and recieved St. Jude Total XIII (23.3% vs 14.1%). The collection of the cancer data throughout the country is crucial for the determination of the distribution and risk factors of our country. The best way of cancer data collection is development of cancer recording systems and analyzing these data for the determination of distribution and risk factors of patients with hematologic malignancies.

Risk of Relapse (REL) after Umbilical Cord Blood Transplantation (UCBT) in Patients with Acute Leukemia: Marked Reduction in Recipients of Two Units.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 305-305 ◽  
Author(s):  
Michael R. Verneris ◽  
Claudio Brunstein ◽  
Todd E. DeFor ◽  
Juliet Barker ◽  
Daniel J. Weisdorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Leukemia ◽  
Disease Risk ◽  
Lymphoblastic Leukemia ◽  
Cord Blood Transplantation ◽  
Hematopoietic Stem ◽  
Cox Regression Analysis ◽  
Relapse Risk ◽  
Significant Difference ◽  
Risk Of Relapse

Abstract Relapse remains a major obstacle that limits the success of hematopoietic stem cell transplantation. Therefore, we analyzed the outcome of patients with acute leukemia transplanted with myeloablative conditioning at a single institution who had a minimum follow-up of 1 year to determine if there were any unique risk factors associated with relapse after UCBT. 96 consecutive patients were evaluated, 39 were &gt;18 years of age, 50 were male; 46 were CMV seropositive; 50 had acute lymphoblastic leukemia (11 CR1, 27 CR2, 9 CR3+, 4 relapse), and 46 had acute myeloid leukemia (11 CR1, 20 CR2, 3 CR3+, 11 relapse). Patients received two different conditioning regimens. Regimen A consisted of cyclophosphamide 120 mg/kg, TBI 1320–1375 cGy, and ATG, followed by cyclosporine A (CSA)/methylprednisolone immunosuppression (n=53). Regimen B consisted of cyclophosphamide 120 mg/kg, fludarabine 75 mg/m2, TBI 1320–1375 cGy pre-transplant and CSA/mycophenolate mofetil immunosuppression (n=43). Patients received either one (n=67) or two (n=29) 4–6/6 HLA-matched UCB units, so that the total MNC count was &gt;2.5 x 107/kg. Accordingly, the demographics for recipients of one or two UCB units were similar except for older age (median age 24 yrs. [range 13–42] vs. 8 yrs. [range 1–52 yrs], p&lt;0.01) and greater weight (median wt. 70 kg [range 48–120 kg] vs. 32 kg [range 10–108 kg], p&lt;0.01) for recipients of two UCB units. Potential risk factors for relapse that were evaluated included: age, gender, recipient CMV sero-status, diagnosis, disease risk, HLA disparity, regimen (A vs. B), and TNC (or CD34+) dose of the unit responsible for sustained engraftment. Notably, in Cox regression analysis two factors were associated with lower relapse risk: disease risk (CR1/CR2 vs CR3+/REL [RR 0.32, p=0.02]) and transplantation of two UCB units (RR 0.3, p=0.03). Importantly, the diagnosis, UCB graft cell dose, and presence of acute GVHD had no demonstrable impact. All recipients of regimen A received a single UCB unit (relapse was 28% (95% CI, 15–41%)), thus interactions between regimen A and number of UCB units could not be assessed. For patients who received regimen B and were in CR1/2, there was a significantly lower risk of relapse for recipients of two UCB units compared to one unit (11% (95% CI, 0–25%) vs. 54% (95% CI, 23–85%), p&lt;0.01). No significant difference in relapse risk could be discerned for patients with advanced disease (CR3-REL) when comparing single vs double UCBT (p=0.48). This report is the first to suggest that the use of double unit UCB grafts may be associated with a reduced risk of relapse in patients with acute leukemia. Larger studies are needed to confirm this clinical experience and to investigate the potential mechanisms by which double unit grafts could mediate protection against relapse.

scholarly journals Comparison of clinical features of pulmonary cryptococcosis with and without central nervous system involvement in China

2021 ◽  
Vol 49 (2) ◽  
pp. ???
Author(s):  
Xinying Xue ◽  
Xuelei Zang ◽  
Lifeng Wang ◽  
Dongliang Lin ◽  
Tianjiao Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Clinical Features ◽  
Central Nervous System Involvement ◽  
Pulmonary Cryptococcosis ◽  
Cns Involvement ◽  
Laboratory Findings ◽  
Logistic Regression Models ◽  
Presenting Symptoms

Objective This study aimed to compare the clinical features of pulmonary cryptococcosis (PC) in patients with and without central nervous system (CNS) involvement. Methods We retrospectively reviewed demographics, presenting symptoms, radiographic features, and laboratory findings of patients diagnosed with PC in 28 hospitals from 2010 to 2019. Risk factors for CNS involvement were analyzed using logistic regression models. Result A total of 440 patients were included, and 36 (8.2%) had CNS involvement. Significant differences in fever, headache, and chills occurred between the two groups (overall and with/without CNS involvement) for fever (17.8% [78/440]; 52.8% vs. 14.6% of patients, respectively), headache (4.5% [20/440]; 55.6% vs. 0% of patients, respectively), and chills (4.3% [19/440]; 13.9% vs. 3.5% of patients, respectively). The common imaging manifestation was nodules (66.4%). Multivariate analysis showed that cavitation (adjusted odds ratio [AOR] = 3.552), fever (AOR = 4.182), and headache were risk factors for CNS involvement. Routine blood tests showed no differences between the groups, whereas in cerebrospinal fluid the white blood cell count increased significantly and glucose decreased significantly. Conclusion In patients with PC, the risk of CNS involvement increases in patients with headache, fever, and cavitation; these unique clinical features may be helpful in the diagnosis.

scholarly journals Non-Intensive Continuous Treatment with a Tyrosine Kinase Inhibitor (TKI) Followed By Allo-HSCT Is an Effective Therapeutic Strategy for Adult Ph-Positive Acute Lymphoblastic Leukemia: Outcomes of the Russian Prospective Multicenter RALL Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4395-4395
Author(s):  
Olga A. Gavrilina ◽  
Elena N. Parovichnikova ◽  
Vera V. Troitskaya ◽  
Zalina Kh. Akhmerzaeva ◽  
Sergey N. Bondarenko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymphoblastic Leukemia ◽  
Significant Risk ◽  
Continuous Treatment ◽  
Molecular Response ◽  
Monosomy 7 ◽  
Long Term Outcome ◽  
Landmark Analysis ◽  
Significant Difference ◽  
New Generation

Abstract Introduction. As Ph-positive (Ph+) ALL in adults remains less favorable in prognosis than other ALL, and by expert opinion needs non-intensive chemotherapy protocols and new generation TKI with the majority of pts undergoing allo-HSCT, the results of treatment based on the different approach: de-escalated but continuous treatment with the change of TKI according to the molecular response and allo-HSCT may be of interest and provide new insights to the treatment of Ph+ ALL. Aim. To evaluate survival and outcomes in different risk groups in pts with Ph+ ALL in the RALL-study (Ph+ALL-2009, Ph+ALL-2012 and Ph+ALL-2012m protocols). Patients and methods. Between January 2010 and June 2021, 74 new Ph+ ALL cases were diagnosed in 6 centers of the RALL-group and 63 of them were evaluable for analysis (median age 37 years (17-73), m/f 32(43%)/42(57%), CNS disease in 13(21%) pts, WBC&gt;30*10 9/l in 27(43%) pts, bcr/abl transcript p190/p210/p190+210 in 31(60%)/12(23%)/9(17%) cases). Standard cytogenetic was performed in all 63 pts, 1 had no mitosis, 6(10%) monosomy 7 and 2 (3%) complex karyotypes were detected. All pts were treated according to RALL protocols with continuous Imatinib. Ph+ALL-2009 protocol included 600 mg Imatinib with prednisone, VNCR, L-asp, Dauno, Cph, followed by 6-MP and MTX. Imatinib had to be changed to Dasatinib (140 mg) after non-achievement of molecular complete response (MolCR) on day 70. MolCR was defined as bcr/abl chimeric transcript &lt;0,01% by PCR with 10 -4 sensitivity. In protocols Ph+ALL-2012 and Ph+ALLm, we de-intensified chemotherapy: reduced Dauno, Cph and L-asp doses, accordingly. All pts were considered as candidates for allogeneic HSCT in CR1 if HLA-identical donor was available. 36 (57%) pts underwent HSCT in the first-line therapy: 2(6%) autologous, 9 (25%) matched related, 20 (56%) matched unrelated and 5 (13%) haplo-HSCT. Results. Hematological complete remission (CR) was achieved in 60 (95%) of 63 pts (1 early death and 2 refractory cases occurred). On day 70, MolCR was achieved in 21(38%) of 56 pts. Death on therapy in CR (within 5 months of induction/consolidation) was registered in 4 (6%) cases. The major causes of the non-relapsed mortality in unrelated allo-HSCT (n=9) were aGVHD and severe infections, at a median +4 months after HSCT. The 5-year overall survival (OS) and disease-free survival (DFS) for all 63 pts were 58% and 45%, respectively. The long-term outcome on different protocols (Ph+ALL-2009, Ph+ALL-2012 and Ph+ALL-2012m) were similar: 3-year OS - 55% vs 51% vs 75% (p=0,27), 3-year DFS - 56% vs 44% vs 50% (p=0,54), respectively. The 5-year OS was 65% vs 61% (p=0,84), and DFS was 57% vs 31% (p=0,24) in transplanted vs non-transplanted patients by landmark analysis with a median 5,3 month of CR. Landmark analysis of 5-year OS for transplanted and non-transplanted pts depending on age showed no significant difference for both groups: &gt;45y 40% vs 80%; and ≤45y 70% vs 49%, respectively (p=0,1625), although data for 5-year OS was still not mature at the time of analysis. DFS was significantly different in transplanted vs. non-transplanted pts: &gt;45y 40% vs 71%; ≤45y 61% vs 0%; respectively (p=0,0439). In a multivariate analysis for Ph+ ALL among common risk factors (age &gt; 45y, WBC&gt;30, LDH&gt;2N, immunophenotype, late MolCR &gt;70d, CNS leukemia) WBC&gt;30, HSCT were significant risk factors for OS and DFS. Conclusions. Our data demonstrate that de-intensification of chemotherapy does not affect the efficacy of Ph+ ALL therapy in the era of TKIs. We confirmed that patients older than 45y old could be treated by chemotherapy with TKI (new generation TKI if needed) only, but all pts younger than 45y should be considered for HSCT. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Acute Myeloid and Lymphoblastic Leukemia Cell Interactions with Endothelial Selectins: Critical Role of PSGL-1, CD44 and CD43

Cancers ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1253 ◽  
Author(s):  
Caroline Spertini ◽  
Bénédicte Baïsse ◽  
Marta Bellone ◽  
Milica Gikic ◽  
Tatiana Smirnova ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Vascular Endothelium ◽  
Lymphoblastic Leukemia ◽  
Critical Role ◽  
Leukemia Cell ◽  
Hematologic Malignancies ◽  
Selectin Ligands ◽  
Blast Cells ◽  
Acute Myeloid

Acute myeloid and lymphoblastic leukemia are poor prognosis hematologic malignancies, which disseminate from the bone marrow into the blood. Blast interactions with selectins expressed by vascular endothelium promote the development of drug resistance and leukostasis. While the role of selectins in initiating leukemia blast adhesion is established, our knowledge of the involved selectin ligands is incomplete. Using various primary acute leukemia cells and U937 monoblasts, we identified here functional selectin ligands expressed by myeloblasts and lymphoblasts by performing biochemical studies, expression inhibition by RNA interference and flow adhesion assays on recombinant selectins or selectin ligands immunoadsorbed from primary blast cells. Results demonstrate that P-selectin glycoprotein ligand-1 (PSGL-1) is the major P-selectin ligand on myeloblasts, while it is much less frequently expressed and used by lymphoblasts to interact with endothelial selectins. To roll on E-selectin, myeloblasts use PSGL-1, CD44, and CD43 to various extents and the contribution of these ligands varies strongly among patients. In contrast, the interactions of PSGL-1-deficient lymphoblasts with E-selectin are mainly supported by CD43 and/or CD44. By identifying key selectin ligands expressed by acute leukemia blasts, this study offers novel insight into their involvement in mediating acute leukemia cell adhesion with vascular endothelium and may identify novel therapeutic targets.

scholarly journals Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival

Blood ◽  
2009 ◽  
Vol 113 (17) ◽  
pp. 3911-3917 ◽  
Author(s):  
Grace H. Ku ◽  
Richard H. White ◽  
Helen K. Chew ◽  
Danielle J. Harvey ◽  
Hong Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Acute Leukemia ◽  
Lymphoblastic Leukemia ◽  
Venous Catheter ◽  
Population Based ◽  
Older Age ◽  
Myelogenous Leukemia ◽  
Vein Thrombosis ◽  
Chronic Comorbidities

Abstract A population-based cohort was used to determine the incidence and risk factors associated with development of venous thromboembolism (VTE) among Californians diagnosed with acute leukemia between 1993 to 1999. Principal outcomes were deep vein thrombosis in both the lower and upper extremities, pulmonary embolism, and mortality. Among 5394 cases with acute myelogenous leukemia (AML), the 2-year cumulative incidence of VTE was 281 (5.2%). Sixty-four percent of the VTE events occurred within 3 months of AML diagnosis. In AML patients, female sex, older age, number of chronic comorbidities, and presence of a catheter were significant predictors of development of VTE within 1 year. A diagnosis of VTE was not associated with reduced survival in AML patients. Among 2482 cases with acute lymphoblastic leukemia (ALL), the 2-year incidence of VTE in ALL was 4.5%. Risk factors for VTE were presence of a central venous catheter, older age, and number of chronic comorbidities. In the patients with ALL, development of VTE was associated with a 40% increase in the risk of dying within 1 year. The incidence of VTE in acute leukemia is appreciable, and is comparable with the incidence in many solid tumors.

scholarly journals Death Within 1 Month of Diagnosis in Childhood Cancer: An Analysis of Risk Factors and Scope of the Problem

2017 ◽  
Vol 35 (12) ◽  
pp. 1320-1327 ◽  
Author(s):  
Adam L. Green ◽  
Elissa Furutani ◽  
Karina Braga Ribeiro ◽  
Carlos Rodriguez Galindo
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Childhood Cancer ◽  
Race And Ethnicity ◽  
Lymphoblastic Leukemia ◽  
Strong Predictor ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Early Death ◽  
Hematologic Malignancies

Purpose Despite advances in childhood cancer care, some patients die soon after diagnosis. This population is not well described and may be under-reported. Better understanding of risk factors for early death and scope of the problem could lead to prevention of these occurrences and thus better survival rates in childhood cancer. Methods We retrieved data from SEER 13 registries on 36,337 patients age 0 to 19 years diagnosed with cancer between 1992 and 2011. Early death was defined as death within 1 month of diagnosis. Socioeconomic status data for each individual’s county of residence were derived from Census 2000. Crude and adjusted odds ratios and corresponding 95% CIs were estimated for the association between early death and demographic, clinical, and socioeconomic factors. Results Percentage of early death in the period was 1.5% (n = 555). Children with acute myeloid leukemia, infant acute lymphoblastic leukemia, hepatoblastoma, and malignant brain tumors had the highest risk of early death. On multivariable analysis, an age younger than 1 year was a strong predictor of early death in all disease groups examined. Black race and Hispanic ethnicity were both risk factors for early death in multiple disease groups. Residence in counties with lower than median average income was associated with a higher risk of early death in hematologic malignancies. Percentages of early death decreased significantly over time, especially in hematologic malignancies. Conclusion Risk factors for early death in childhood cancer include an age younger than 1 year, specific diagnoses, minority race and ethnicity, and disadvantaged socioeconomic status. The population-based disease-specific percentages of early death were uniformly higher than those reported in cooperative clinical trials, suggesting that early death is under-reported in the medical literature. Initiatives to identify those at risk and develop preventive interventions should be prioritized.

Study on the Phenotype Polymorphism of CYP3A4 Gene in Chinese Children with Acute Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4376-4376
Author(s):  
Xiao-jun Yuan ◽  
Long-Jun Gu ◽  
Hui-jun Zhao ◽  
Jin-cai Zhao ◽  
Jing-Yan Tang ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Healthy Children ◽  
Cyp3a4 Activity ◽  
Significant Difference ◽  
Average Activity ◽  
Cyp3a4 Gene ◽  
Wbc Count

Abstract In order to offer objective refering paramete for individualized chemotherapy, to clarify the distribution feature of CYP3A4 activity in Chinese children with acute leukemia and in healthy children, to explore the possible correlation between the activity of CYP3A4 gene and the predisposition or chemotherapy effect in acute leukemia children. High performance liquid chromatography (HPLC) was used to detecte the activity of CYP3A4 in 85 healthy children and 120 acute leukemia children, then analyzed the difference of phenotypebetween two groups. The activity coverage of CYP3A4 was 2.34~48.88 in healthy children and the average activity was 9.76±6.99. Among them, CYP3A4 activity was 11.88±8.88 in male group and 7.12±3.37 in female group, the former was obviously higher than the latter (P=0.0077). In less than 12-years group, CYP3A4 activity was 8.97±6.27, while it was 10.43±7.74 in more than 12-years group, there was no significant difference (P&gt;0.05). The change scope of CYP3A4 activity was very large in children with acute lymphoblastic leukemia, from 2.00 to 585.72, the average activity was 53.52, with no dfference in sex and age. According to the clinical risk degree, the activity of CYP3A4 was 4.87±2.93 in standard-risk group, it was 31.63±19.20 in middle-risk group, the latter was significantly higher thanthe former (P=0.0004). Comparison based on WBC count at the beginning of preliminary diagnosis, the CYP3A4 activity was the lowest in WBC count less than 50 x 109/L group, it was second in the group of WBC count between 50 x 109/L to 100 x 109/L, and the activity was the highest in WBC count more than 100 x 109/L group. The mean activity of CYP3A4 in childern with acute lymphoblastic leukemia with P170 less than 5% was 17.56±13.44, while it was 87.62±49.28 in those children with P170 more than 5%Ä, there was statistic difference between the two group(P=0.022). The activity in those preliminary diagnosed children with BCR-ABL(+) or Ph (+) or t (4,11) abnormal karyotype (105.86±44.41) was higher than those with normal karyotype patients (47.61±22.63), P=0.0219. Comparison the activity of CYP3A4 between those chlidren with clinical presentation as prednisone good response (PGR) and those with prednisone poor response, the activity in former group (27.23±13.58) was obviously lower than that of latter group (114.12±48.39), P=0.0358. The average CYP3A4 activity in children with acute myelocytic leukemia (AML) was 13.97±10.84. Of them, it was 15.09±7.52 in AML children with diploid chromosome and only 2.95±1.39 in hypodiploidy group, obviously, the activity of former group higher than that of latter group (P=0.0132). The CYP3A4 activity was respectively 19.78±11.59 and 2.86±1.16 in normal LDH group and in increased LDH group, there was significant difference (P=0.0036). The AML children with exo-marrow infiltration when diagnosis, their CYP3A4 activity (6.50±3.05) was lower than those children with pure marrow infiltration (19.06±11.15), P=0.044. There may be no race difference between the CYP3A4 activity of Chinese healthy children and White people. Increased CYP3A4 activity has closed correlation with ALL risk factors. The general CYP3A4 activity in AML children group was lower than that of ALL chlidren group. Much higher or much lower CYP3A4 activity may produce adverse influence to individuals.

Trends in Survival after Diagnosis with Hematologic Malignancy in Adolescence or Young Adulthood in the United States, 1981- 2005

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 877-877
Author(s):  
Dianne Pulte ◽  
Adam Gondos ◽  
Hermann Brenner
Keyword(s):  
21St Century ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Relative Survival ◽  
Hematologic Malignancies ◽  
The United States ◽  
Acute Leukemias ◽  
Period Analysis ◽  
Early 21St Century ◽  
Survival Expectations

Abstract Background: There are few population based studies of long-term survival of adolescents and young adults (AYA) with hematologic malignancies, mostly pertaining to patients diagnosed in the 1990s or earlier. Traditionally, survival in AYA with hematologic malignancies has been worse than survival for children with similar malignancies. Here, we use period analysis to obtain up-to-date information on survival expectations of AYA diagnosed with hematologic malignancies through the early 21st century. Methods: Period analysis was used to calculate 5- and 10-year relative survival for AYA aged 15–24 diagnosed with hematologic malignancies for five calendar periods from 1981–85 to 2001–2005, using data from the Surveillance, Epidemiology, and End Results (SEER) database. Results: Data from 9836 patients aged 15–24 included in the SEER database who were diagnosed with Hodgkin’s lymphoma (HL), non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), acute myeloblastic leukemia (AML), and chronic myelocytic leukemia (CML) were analyzed. HL was the most common malignancy, accounting for about 50% of all hematologic maligancies in each calendar period examined. Survival strongly improved for each of the five hematologic malignancies. Increases in 10-year relative survival were as follows: HL, from 80.4 to 93.4%; NHL, from 55.6 to 76.2%; ALL, from 30.5 to 52.1%; AML, from 15.2 to 45.1%; CML, from 0 to 74.5% (p<0.0001 in all cases, see table). However, while survival improved steadily throughout the period examined for the lymphomas and CML, survival was stable during the late 1990s and early 21st century for the acute leukemias. Survival has not improved for AML since 1990–95 or for ALL since 1996–2000 (see table). Discussion: Survival expectations for AYA with hematologic malignancies have strongly improved since the 1980s. However, with the exception of HL, survival rates have not reached the levels observed for children diagnosed with the same malignancies. In particular, 10-year survival in children aged 10–14 with ALL was over 75% for the 2000–04 period1 compared to about 50% for AYA in 2001–05. Similarly, 10-year survival for children aged 0–14 diagnosed with acute non-lymphoblastic leukemia was about 60% in the 2000–04 period compared with less than 50% for AYA with AML in the 2001–05 period. Some caution must be used when comparing survival in AYA versus in children since survival estimates for children are for absolute survival, while those for AYA are for relative survival. However, relative survival in children and AYA is close to 100%, making the comparison relatively straightforward. Furthermore, survival estimates for the acute leukemias have not improved since the 1990s while survival for children continued to improve during the early 21st century. Reasons for the poorer survival observed may include differences in the biology of the malignancies, poorer compliance in AYA, differences in treatment protocols in children versus AYA, lower availability of clinical trials in AYA than in children, and low rates of health insurance in AYA patients, particularly after age 18. Further examination of the reasons for the poorer outcomes observed for AYA with acute leukemias may clarify this issue. 1 Pulte D, Gondos A, Brenner H. Trends in 5- and 10-year survival after diagnosis with childhood hematologic malignancies in the United States, 1990–2004. Accepted JNCI 7/08. Table: 10-year relative survival 1981–85 to 2001–05 by hematologic malignancy Diagnosis 1981– 85 1986–90 1991–95 1996–2000 2001–05 Diff1 p-val2 PE3 SE4 PE SE PE SE PE SE PE SE 1 Difference in survival, 1981–85 versus 2001–05. 2 P-value for trend. 3 Point estimate 4 Standard error HL 80.4 1.5 82.6 1.4 86.9 1.2 88.9 1.2 93.4 1.0 +13.0 <0.0001 NHL 55.6 3.1 59.9 2.9 62.7 2.7 67.9 2.6 76.2 2.3 +20.6 <0.0001 ALL 30.5 4.1 35.8 4.0 42.1 3.9 51.6 3.9 52.1 3.7 +21.6 <0.0001 AML 15.2 3.4 22.3 4.1 43.6 4.7 39.5 4.0 45.1 4.0 +29.9 <0.0001 CML 0 0 22.5 6.5 20.8 6.5 41.4 7.9 74.5 7.6 +74.5 <0.0001

Bleeding and thrombosis outcomes in patients with acute leukemia.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19501-e19501 ◽  
Author(s):  
Amar Harry Kelkar ◽  
Asha R. Dhanarajan ◽  
Mona Arti Kelkar ◽  
John R. Wingard
Keyword(s):  
Risk Factors ◽  
Acute Leukemia ◽  
Major Bleeding ◽  
Significant Risk ◽  
Bleeding Events ◽  
Logrank Test ◽  
Hospital System ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Significant Difference

e19501 Background: Management of acute leukemia is often complicated by acute venous thromboembolism (VTE) and bleeding. However, it is unknown which risk factors contribute to these VTE and bleeding events, how they impact survival, or whether they warrant VTE prophylaxis. Methods: A retrospective study was conducted at the University of Florida Health Shands Hospital System. The study included patients aged 18 or older with acute leukemia who received induction chemotherapy between January 2000 and December 2011. Bleeding was defined as clinically significant non-major bleeding and major bleeding per the International Society on Thrombosis and Haemostasis guidelines. VTE was defined as pulmonary embolism, deep vein thrombosis of the upper or lower extremities, or visceral vein thrombosis. Results: Of the 250 patients with acute leukemia, 65 had VTE, 60 had bleeding, and 152 had no significant VTE or bleeding. There were 27 patients with both VTE and bleeding. There were no significant differences in demographics or disease types between these three groups. There was a total of 77 VTE events and 72 bleeding events. We performed a logistic regression analysis in a mixed model to identify risk factors for VTE and bleeding, considering leukemia type, presence of infection, chemotherapy, number of comorbidities, VTE prophylaxis, and transplant as covariates. Presence of infection and number of comorbidities were significantly associated with VTE (p = 0.0094 and 0.0009, respectively). We did not find any significant risk factor associated with bleeding. Kaplan-Meier survival analysis showed a non-significant difference in survival between the non-VTE, non-bleed group and the VTE group (Logrank test, p = 0.52). In contrast, survival in the non-VTE, non-bleed group was significantly higher than the bleed group (Logrank test, p = 0.0006). The table demonstrates higher two-year survival in the non-VTE, non-bleed group (68.7%) compared to the VTE and bleed groups (54.4% and 30.3%, respectively). Conclusions: Acute leukemia patients without VTE or bleeding had significantly higher duration of survival than patients with bleeding. Patients with acute leukemia and presence of infection or multiple comorbidities may warrant greater consideration of VTE prophylaxis. [Table: see text]

scholarly journals Bacillus Infection Among Children with Hematologic Malignancy, a Single Institution Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1292-1292
Author(s):  
David S Shulman ◽  
Preeti Mehrotra ◽  
Neeraj K. Surana ◽  
Traci M. Blonquist ◽  
Lewis B. Silverman ◽  
...  
Keyword(s):  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Optic Pathway Glioma ◽  
Remission Induction ◽  
High Morbidity ◽  
Cell Transplant ◽  
Cns Involvement ◽  
Children With Cancer ◽  
Pediatric Cancer Patients ◽  
Bacillus Spp

Abstract BACKGROUND: Bacillus species, including B. cereus and other non-anthracis species, are spore-forming, gram-positive rods, found ubiquitously in the environment and cause bacteremia and CNS infection in children with cancer. Case reports have demonstrated that Bacillus spp. infections carry a high morbidity, with rates of CNS involvement of 30%, and mortality as high as 40%. These studies indicate the preponderance of cases occur in children receiving induction chemotherapy for acute lymphoblastic leukemia (ALL). There have been no large, recent studies describing Bacillus spp. infection in children with an underlying oncologic condition. METHODS: We performed a retrospective medical record review of pediatric cancer patients who received care at the Dana-Farber/Boston Children's Cancer and Blood Disorders Center and developed Bacillus spp. infection between January 1st, 2005 and December 31st 2014. Given that the majority of these infections were found to occur in children with underlying hematologic malignancy, we provide a more detailed description of cases with these underlying conditions. RESULTS: Twenty-six children developed Bacillus bacteremia during the study period. Of the 26 patients, 21 (81%) had acute leukemia (18 ALL; 3 AML), 3 had neuroblastoma, one had Ewing's sarcoma and one had an optic pathway glioma. The mean age of patients with hematologic malignancies at time of Bacillus spp. infection was 7.3 years [range: 1-17]. Sixteen (76%) children were neutropenic at the time of infection. Of the children with ALL, 11 (61%) developed infection during the remission induction phase of treatment, 3 during post-induction/pre-maintenance treatment phases and 3 after relapse (1 during stem cell transplant, 1 at a year post-transplant and 1 during re-induction). Of the 26 patients, 5 (19%) developed CNS complications, all during remission induction for ALL, and the overall mortality two-weeks following Bacillus infection was 19%. DISCUSSION: Bacillus spp. continues to cause serious infections in children with cancer, especially in those with underlying hematologic malignancies. While the mortality at our center is lower than that reported in the literature, the rate of death is still higher than what is typically seen with other organisms and CNS involvement remains common. Further study in this area will include identification of risk factors for development of this infection and recommendations regarding use of prophylactic antibiotics. Disclosures No relevant conflicts of interest to declare.

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