Non-Relapse Mortality (NRM) after Autologous Stem Cell Transplant (ASCT) Is Reduced with Stringent Follow-up Post-Transplant.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2155-2155
Author(s):  
Christy Stotler ◽  
Lisa Rybicki ◽  
Matt Kalaycio ◽  
Robert Dean ◽  
Edward A. Copelan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Organ Failure ◽  
Pulmonary Toxicity ◽  
Cell Transplant ◽  
Common Cause ◽  
Phone Calls ◽  
One Year

Abstract Advances in supportive care have reduced early treatment related mortality with ASCT to approximately 1%. ASCT is so well tolerated that it is commonly thought that patients (pts) either relapse or are cured from their disease. However, registry data continues to show that NRM accounts for 25% of treatment failures following ASCT. NRM in this setting is poorly studied and represents a possible area of intervention. We previously reported on NRM at the Cleveland Clinic (ASH 2007: Abstract 1671) in which we reviewed 1573 consecutive autologous transplants performed between 1/92 and 12/05. This analysis included only adult pts receiving peripheral stem cells, single transplants, busulfan based preparative regimens, diagnoses of HL, NHL and MM (n=856). Relapse was the most common cause of death in 303 (79%) pts with NRM occurring in 82 pts (21% of deaths). The most common cause of NRM was pulmonary toxicity in 26 pts, followed by secondary malignancy (19 pts), infection (12 pts), cardiac toxicity (7 pts), other organ failure (7pts) and other causes (11 pts). The majority of NRM from pulmonary toxicity, other organ failure and infection occurred within one year of transplant. Forty-seven patients died within 100 days of transplant – 30 from relapse and 17 from NRM. In an effort to reduce NRM, we targeted pulmonary toxicity as a point of intervention. To identify pts at higher risk for pulmonary toxicity we prospectively followed 137 consecutive pts from 4/05 to 4/06 with monthly phone calls from the BMT nurses using a questionnaire focused to identify pts with symptoms of pulmonary toxicity, and obtained PFTs 1 and 6 months post-ASCT. 12/137 pts had a decrease in DLCO with 7 (58%) of events occurring within one month of transplant, an additional 4 (33%) events within 6 months and one event (9%) at 11 months. HL was the underlying diagnosis in 41% of pts, and prior radiation therapy (XRT) was also identified as a risk factor. Based on this analysis high risk pts were then defined as pts with a decline in DLCO >25% at one month post-ASCT, pts with HL and those with history of prior XRT. High risk pts received 4 and 8 months post-ASCT PFTs. Increased vigilance for the low risk group included phone calls at 3, 6 and 12 months to check for symptoms of pulmonary dysfunction. Patients experiencing a drop in DLCO of >25% at any point in time received a course of steroids and repeat PFT testing. The patient’s local oncologist also received a letter which included a copy of CDC vaccination guidelines with recommendations for re-immunization at one year post-ASCT, and a list of signs and symptoms of delayed pulmonary toxicity. To evaluate if changes made to our follow-up protocol impacted on rates of NRM, we identified 149 pts undergoing ASCT from 5/06 to 12/07 (using the same inclusion criteria as the original cohort). Data regarding the original 856 patients was also updated. For the 5/06 to 12/07 study group 127 pts (85%) are alive and 22 pts (15%) have died. Twenty pts (90.9 %) died from relapse and 2 pts (9.1%) died from NRM, both due to pulmonary toxicity. Only two patients died within 100 days of transplant, both due to relapse. There was no NRM within 100 days of transplant. On multivariable analysis of risk factors for NRM for all patients, year of transplant (1/92 to 12/05) emerged as a risk factor for NRM (HR 5.24, P=0.026). Age at transplant (HR 1.26, P=.013), number of prior chemotherapy regimens (HR 1.24, P=.019), prior radiation (HR 1.81, P=.006) and time to platelet engraftment (HR 0.24, P=.001) also emerged as risk factors for NRM. We have adopted more stringent post-ASCT surveillance protocols and while follow-up is short, results suggest that it may be possible to reduce NRM after ASCT.

Long-term effects of an intensive prevention program (IPP) after acute myocardial infarction – the IPP Follow-up and Prevention Boost Trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Wienbergen ◽  
A Fach ◽  
S Meyer ◽  
J Schmucker ◽  
R Osteresch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Risk Factor ◽  
Prevention Program ◽  
Study Endpoint ◽  
Funding Source ◽  
Risk Factor Control ◽  
One Year

Abstract Background The effects of an intensive prevention program (IPP) for 12 months following 3-week rehabilitation after myocardial infarction (MI) have been proven by the randomized IPP trial. The present study investigates if the effects of IPP persist one year after termination of the program and if a reintervention after >24 months (“prevention boost”) is effective. Methods In the IPP trial patients were recruited during hospitalization for acute MI and randomly assigned to IPP versus usual care (UC) one month after discharge (after 3-week rehabilitation). IPP was coordinated by non-physician prevention assistants and included intensive group education sessions, telephone calls, telemetric and clinical control of risk factors. Primary study endpoint was the IPP Prevention Score, a sum score evaluating six major risk factors. The score ranges from 0 to 15 points, with a score of 15 points indicating best risk factor control. In the present study the effects of IPP were investigated after 24 months – one year after termination of the program. Thereafter, patients of the IPP study arm with at least one insufficiently controlled risk factor were randomly assigned to a 2-months reintervention (“prevention boost”) vs. no reintervention. Results At long-term follow-up after 24 months, 129 patients of the IPP study arm were compared to 136 patients of the UC study arm. IPP was associated with a significantly better risk factor control compared to UC at 24 months (IPP Prevention Score 10.9±2.3 points in the IPP group vs. 9.4±2.3 points in the UC group, p<0.01). However, in the IPP group a decrease of risk factor control was observed at the 24-months visit compared to the 12-months visit at the end of the prevention program (IPP Prevention Score 10.9±2.3 points at 24 months vs. 11.6±2.2 points at 12 months, p<0.05, Figure 1). A 2-months reintervention (“prevention boost”) was effective to improve risk factor control during long-term course: IPP Prevention Score increased from 10.5±2.1 points to 10.7±1.9 points in the reintervention group, while it decreased from 10.5±2.1 points to 9.7±2.1 points in the group without reintervention (p<0.05 between the groups, Figure 1). Conclusions IPP was associated with a better risk factor control compared to UC during 24 months; however, a deterioration of risk factors after termination of IPP suggests that even a 12-months prevention program is not long enough. The effects of a short reintervention after >24 months (“prevention boost”) indicate the need for prevention concepts that are based on repetitive personal contacts during long-term course after coronary events. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Stiftung Bremer Herzen (Bremen Heart Foundation)

Abstract 258: Mortality Comparison of Right Bundle Branch Block and Left Bundle Branch Block in US Veterans Undergoing Left Heart Catheterization - A Long Term Follow-up Study

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Swapnil Garg ◽  
Muhammad Soofi ◽  
Ronald Markert ◽  
Ajay Agarwal
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Ejection Fraction ◽  
Heart Catheterization ◽  
Left Heart ◽  
Bundle Branch Block ◽  
Reduced Ejection Fraction ◽  
Left Heart Catheterization

Background: The prognostic importance of right bundle branch block (RBBB) has been debated. It has been described as a benign variant, especially when compared to left bundle branch block (LBBB). We studied the presence of bundle branch blocks in a high-risk U.S. Veteran cohort. Methods: Retrospective electrocardiogram (ECG) analysis for presence of RBBB or LBBB was conducted in 1,535 consecutive patients presenting for left heart catheterization. Evaluated risk factors were gender, age, BMI, hypertension, hyperlipidemia, diabetes, smoking history, chronic kidney disease, reduced ejection fraction and history of previous revascularization. Mean follow up time was 112 ± 66 months. Results: Analysis of 1,535 ECGs revealed 113 patients with RBBB and 65 patients with LBBB. Risk factor burden between the two groups appeared similar with exception of higher incidence of reduced ejection fraction and previous revascularization in the LBBB group. Mortality of RBBB group was 92.0% compared to 96.9% of LBBB group. Mean time to death for RBBB group was 74.1 months compared to 61.0 months for LBBB group. Hazard ratio (HR) for RBBB with Cox regression controlling for aforementioned risk factors was 1.41, 95% CI = 1.14-1.74; p =.002. HR for LBBB controlling for the same risk factors was 1.84, 95% CI = 1.42-2.40; p =<.001. Conclusion: In a high-risk cohort of US Veterans, both LBBB and RBBB are independent risk factors for mortality. While LBBB is a known adverse risk factor, presence of RBBB portends a poor prognosis and warrants further research.

Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score

2015 ◽  
Vol 114 (10) ◽  
pp. 826-834 ◽  
Author(s):  
Flemming Skjøth ◽  
Peter Nielsen ◽  
Torben Bjerregaard Larsen ◽  
Gregory Lip
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Additional Risk Factor ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors ◽  
Long Run ◽  
One Year ◽  
Net Clinical Benefit

SummaryOral anticoagulation (OAC) to prevent stroke has to be balanced against the potential harm of serious bleeding, especially intracranial haemorrhage (ICH). We determined the net clinical benefit (NCB) balancing effectiveness and safety of no antithrombotic therapy, aspirin and warfarin in AF patients with none or one stroke risk factor. Using Danish registries, we determined NCB using various definitions intrinsic to our cohort (Danish weights at 1 and 5 year follow-up), with risk weights which were derived from the hazard ratio (HR) of death following an event, relative to HR of death after ischaemic stroke. When aspirin was compared to no treatment, NCB was neutral or negative for both risk strata. For warfarin vs no treatment, NCB using Danish weights was neutral where no risk factors were present and using five years follow-up. For one stroke risk factor, NCB was positive for warfarin vs no treatment, for one year and five year follow-up. For warfarin vs aspirin use in patients with no risk factors, NCB was positive with one year follow-up, but neutral with five year follow-up. With one risk factor, NCB was generally positive for warfarin vs aspirin. In conclusion, we show a positive overall advantage (i.e. positive NCB) of effective stroke prevention with OAC, compared to no therapy or aspirin with one additional stroke risk factor, using Danish weights. ‘Low risk’ AF patients with no additional stroke risk factors (i.e. CHA2DS2-VASc 0 in males, 1 in females) do not derive any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

Non-Relapse Mortality Associated with Autologous Stem Cell Transplant (ASCT).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1671-1671
Author(s):  
Christy Stotler ◽  
Matt Kalaycio ◽  
Robert M. Dean ◽  
Ronald Sobecks ◽  
Edward A. Copelan ◽  
...  
Keyword(s):  
Stem Cells ◽  
Radiation Therapy ◽  
Organ Failure ◽  
Pulmonary Toxicity ◽  
Cardiac Toxicity ◽  
The Other ◽  
Secondary Malignancy ◽  
Common Cause ◽  
Post Transplant ◽  
One Year

Abstract Advances in supportive care have reduced early treatment related mortality with ASCT to approximately 1%. Registry data has shown that relapse is the cause of treatment failure in approximately 80% of patients. However, non-relapse mortality (NRM), over time, affects 20% of transplant recipients. Delayed NRM is poorly studied. To characterize the factors associated with NRM, we reviewed 1573 consecutive autologous transplants performed at the Cleveland Clinic from 1/1992 through 12/2005. This analysis included only adult patients (pts) receiving peripheral stem cells, busulfan based preparative regimens, single transplants, and diagnoses of NHL, HD and MM (n = 856). The median age was 49, 62% were male, and 30% received prior radiation therapy. The most common number of prior chemotherapy regimens was 2 (48%); the primary diagnosis was NHL (67%), HD (18%), MM (15%); and 90% had sensitive disease at the time of transplant. 471 (55%) are alive and 385 (45%) have died. Relapse was the most common cause of death, occurring in 303 (79%) patients. Non-relapse mortality occurred in 82 patients (21% of deaths). The most common cause of NRM was pulmonary toxicity, occurring in 26 patients, followed by secondary malignancy in 19 pts, infection (12 pts), cardiac toxicity (7 pts), other organ failure (7 pts), and other causes (11 pts). Patients who died from secondary malignancy were significantly more likely to have received prior radiation therapy (p = 0.004), to require more days of pheresis to collect stem cells (p&lt;0.001) and had a longer time to platelet engraftment than did other patients (p&lt;0.001). 16/19 deaths due to secondary malignancy were from hematologic malignancies. Causes of death in the “other” category included accidents (n=3), homicide (n=1) and suicide (n=1). Liver toxicity was the most common organ affected in the “other organ failure” category. 46% of patients with NRM due to pulmonary toxicity had a prior exposure to radiation therapy, as did 43% of those with cardiac toxicity. The time to development of NRM is shown below: Figure Figure The substantial majority of NRM due to pulmonary toxicity, other organ failure or infection occurs within one year post-transplant. This suggests a need for more intensive surveillance of recipients of autologous transplantation for 12 months, possibly with regular visits to the transplanting institution. We have adopted more stringent follow up with promising early results at reducing 1 year NRM. The median time of NRM from secondary malignancy is 3.5 years, which suggests that surveillance of blood counts should continue well beyond one year post-transplant. Whether more aggressive surveillance will reduce NRM associated with ASCT requires further study.

Transfusion Requirement, Spleen Size and Donor Type Are Strong Predictors of Outcome in Patients with Primary Myelofibrosis Undergoing an Allogeneic Stem Cell Transplant

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1725-1725
Author(s):  
Andrea P Bacigalupo ◽  
Alida Dominietto ◽  
Sarah Pozzi ◽  
Simona Geroldi ◽  
Maria Teresa van Lint ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Spleen Size ◽  
Allogeneic Stem Cell Transplant ◽  
Donor Type ◽  
Risk Patients ◽  
Transfusion History

Abstract Abstract 1725 Patients with myelofibrosis undergoing an allogeneic stem cell transplant (SCT), can be classified as low or high risk based on spleen size, transfusion history, and donor type (BMT 2010;45:458). In the present study we wished to validate this scoring system, based on a larger number of patients and longer follow up. We have now analyzed 70 patients with myelofibrosis and a median age of 51, who underwent an allogeneic SCT in our Unit. The median follow up for surviving patients is 4.4 years (range 0.4–17 years). 33 patients had 0–1 unfavourable predictors (low risk) and 37 patients had 2 or more negative predictors (high risk). Results. The overall actuarial 10 year survival is 41%. In multivariate COX analysis independent unfavourable factors for survival were red blood cell (RBC) transfusions > 20 (RR 3,9; p=0,007), a spleen size >22 cm (RR 2,8; p=0.01) and an alternative donor (RR 3,4;p=0.001). Donor and patient age and gender, splenectomy and interval diagnosis transplant were not predictive. The actuarial 10 year survival of patients with no risk factors (n=14), is 100%, with 1 risk factor (n=19) 47%, with 2 factors (n=27), 30%, and with 3 negative predictors (n=10) 0%.The actuarial 10 year survival of low risk (0–1 risk factors) and high risk patients (2–3 risk factors) is respectively 66% and 20%(p=0.0001): the difference is due both to a higher transplant related mortality for high risk patients (38% vs 9%, p=0.005) and a higher relapse related death (35% vs 21%; p=0.1). Peripheral blood CD34+ cell counts, pre-transplant, was a strong predictor of survival in univariate, but not in multivariate analysis. Conclusions. Patients with myelofibrosis undergoing an allogeneic SCT, can be classified as low or high risk based on spleen size, transfusion history, and donor type. This scoring system may be useful to identify patients who would most benefit of the transplant procedure. Disclosures: No relevant conflicts of interest to declare.

Frontline Allogeneic and Autologous Hematopoietic Cell Transplant for Peripheral T-Cell Lymphomas (PTCLs): A Comparison Study Between Conventional Chemotherapy and Hematopoietic Cell Transplant from a Chinese Center

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4381-4381
Author(s):  
Haiwen Huang ◽  
Qiangli Wang ◽  
Ting Xu ◽  
Xiaochen Chen ◽  
Zhengming Jin ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Status ◽  
Patient Characteristics ◽  
Cell Transplant ◽  
Conventional Chemotherapy ◽  
Hematopoietic Cell Transplant ◽  
T Cell Lymphomas ◽  
One Year ◽  
The One

Abstract Purpose We present the result of a comparison study between conventional chemotherapy and HCT for Peripheral T-cell lymphomas (PTCLs) in our center, especially the comparison between allo-HCT and auto-HCT. Patients and Methods From July 2007 to July 2014, 112 cases were analyzed retrospectively. All 112 patients were high risk group (IPI®3-4), 52 patients received conventional chemotherapy alone and 60 patients underwent HCT. In HCT group, Twenty-one (36.5%) patients received allo-HCT and thirty-nine patients (63.5%) received auto-HCT. Before receiving transplantation, 40 patients were in complete remission (CR), 2 patients were in partial remission (PR) and 18 patients were in refractory or relapse (NR). In the 18 NR patients, 11 patients accepted allo-HCT and 7 patients accepted auto-HCT. Patients¡¯ baseline characteristics were listed in Table 1 and Table 2. Results In this study, the longest follow-up time was 76 months and the shortest follow-up time was only two months. After chemotherapy, 31/52 patients achieved complete remission (CR)£¬5/52 patients achieved PR and 16/52 patients were not remission£¡§NR). The overall response rate was 69.2%. However, 14 patients suffered relapse in 36 responding patients, the recurrence rate was close to 50%. In allo-HCT group, 19/21 patients achieved CR and 2/21 patients died of severe infection within 100 days after HCT. In auto-HCT patients, 35/39 patients achieved CR and 4/39 patients were in NR. 7 patients experienced relapse after auto-HCT. After a median follow-up of 33.5 months, the K-M analysis showed that the 5-year PFS for HCT and chemotherapy were 60% and 30% (p =0.006), the 5-year OS were 65% and 33% (p =0.007). The difference between the two groups was significant The 5-year PFS for auto-HCT and allo-HCT were 61% and 60% (p=0.724). The 5-year OS were 62% and 61% (p=0.724). In transplant group, the 5-year OS for patients who were CR or NR before transplantation were 81% and 53% (p=0.303). The one-year cumulative TRM of allo-HCT and auto-HCT were 22.5% and 7.8% (p=0.250). For patients whose ages are below 50, the 2-year PFS for HCT and chemotherapy were 62.7% and 34.8% (p=0.017), the 3-year OS were 71.2% and 36.7% (p=0.033). The one-year TRM of HCT and chemotherapy were 15.5% and 12.4% (p=0.203). For patients more than 50 years old, the 1-year OS for HCT and chemotherapy were 85.7% and 66.5% (p=0.384). And the one-year TRM of HCT and chemotherapy were 28.6% and 33.3% (p=0.352). Conclusion The majorities of PTCL patients are at high risk and have a high recurrence rate after conventional chemotherapy alone. Our results suggest that HCT is superior to conventional chemotherapy in long-term survival for PTCLs and HCT is feasible for high-risk patients with low TRM, especially in the young patients. Therefore, HCT should be considered to be the first-line therapy in high risk PTCL patients. As to PFS and OS, there seems to be no difference between auto-HCT and allo-HCT. While before transplantation, there are more NR and relapsed patients in allo-HCT group, we recommend allo-HCT for refractory and relapsed patients. Table 1. Patient characteristics Parameters Chemotherapy HCT p value Number 52 60 Gender(female/male) 16/36 16/44 0.521 Median Age 45 29 0.003 Histological subtypes N PTCL-NOS 9 17 ALK-negative ALCL 15 15 AITL 15 17 NK/T 13 11 High risk factors B-symptoms 27 25 0.436 IPI score ®3 52 60 1.000 Ann Arbor III-IV stage 40 40 0.376 Evaluated LDH 40 42 0.546 Response to chemotherapy N CR 31 40 PR 5 2 NR 16 18 Responses to transplantation N N CR 54 PR 0 NR 4 Uncertain 2 Table 2. Patient characteristics of transplantation group Parameters Auto-HCT Allo-HCT Number 39 21 Histological subtypes PTCL-NOS 12 4 ALK-negative ALCL 13 4 AITL 7 9 NK/T 7 4 Conditioning regimen BEAM 39 0 BUCY 0 11 TBI+BUCY 0 10 Donor source N Matched unrelated donor 8 Matched sibling donor 4 Haploid donor 8 Cord blood 1 Disease status before HCT CR 30 10 PR 2 0 NR 7 11 Disease status after HCT CR 35 19 PR 0 0 NR 4 0 uncertain 0 2 Disclosures No relevant conflicts of interest to declare.

Complete Donor Chimerism Predicts Molecular Remission in High Risk CLL Following Nonmyeloablative Transplantation.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3283-3283
Author(s):  
Carol Jones ◽  
Renee Letzinger ◽  
James L. Zehnder ◽  
David Miklos
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Molecular Remission ◽  
Allogeneic Hct ◽  
Donor Chimerism ◽  
Cdr3 Region ◽  
One Year ◽  
Univariate Analyses

Abstract Introduction: The ability to define high-risk cohorts of chronic lymphocytic leukemia (CLL) patients has led to clinical trials exploring the utility of early aggressive interventions. Recent work, such as that by the Spanish GELCAB group, demonstrates that molecular remission is an appropriate therapeutic goal for high risk CLL. However, molecular remission may not be evident in some patients until 9 to 12 months post-hematopoietic cell transplant (HCT), even with highly sensitive minimal residual disease (MRD) testing methods. To facilitate clinical management of these patients during the first year after HCT, we evaluated HCT and CLL risk factors for predictive associations to molecular remission as determined by MRD monitoring in 19 patients undergoing nonmyeloablative allogeneic HCT. Methods: Nineteen high-risk CLL patients received a nonmyeloablative transplant preparative regimen consisting of total lymphoid irradiation and anti-thymocyte globulin, followed by rituximab 375mg/m2 on days 56, 63, 70, and 77 after transplant. Median follow-up was 611 days, with a range of 1–3 years. Peripheral blood was collected pre-HCT, and post-HCT monthly for six months, then every 3 months thereafter. Serial assessment of MRD by allele-specific oligonucleotide quantitative PCR (ASOQ-PCR) was performed (177 analyses), using a TaqMan probe specific for the unique CDR3 region of the clonal IgH gene rearrangement. Molecular remission was defined as two consecutive measurements of 2 30 copies/ug WBC-DNA (1.8E-4 cells) at a minimum interval of 30 days. Molecular remission, as determined by the MRD analyses, was compared by univariate analyses with CLL and HCT risk factors. The CLL risk factors evaluated were VH-mutation status, high risk cytogenetics (deletions or mutations of p53 and/or ATM), and fludarabine refractoriness. Allogeneic HCT risk factors evaluated were lymph node >5cm, elapsed time from diagnosis to HCT, disease status before HCT, MRD level before HCT, number of prior treatment regimens, related vs. unrelated donor, female donor to male recipient and time to establish full donor chimerism. Data for the latter was obtained by serial PB analyses of T-cell (CD3+) and NK-cell (CD56+) donor chimerism (119 analyses) by DNA fragment analysis of serial tandem repeat (STR) polymorphisms. Samples were collected in parallel with the MRD specimens. Complete donor chimerism (CDC) was defined as ≥95% donor for both T- and NK-cells. Because of the therapeutic use of rituximab in this trial, B-cell (CD19+) chimerism was not included in our analysis. Results: Twelve of 19 patients (63%) achieved molecular remission by one year. Univariate analyses of found no statistically significant association between this “MR” group –those that attain molecular remission at one year -- and any of the factors studied except complete T/NK donor chimerism. Table 1 shows that CDC precedes and predicts molecular remission. Table 1. Time to complete donor chimerism in patients that achieve molecular remission by one year post HCT (“MR group”) days post-HCT Percent of MR group in CDC p-value d+90 58% (7/12) 0.0113 d+120 75% (9/12) 0.0037 d+150 83% (10/12) 0.0013 d+180 92% (11/12) 0.0002 d+180 92% (11/12) 0.0002 d+365 100% (12/12) Figure 1 is an example of the univariate analyses comparing chimerism data with time to molecular remission, here showing the percent of patients achieving durable molecular remission for two groups of patients – those showing CDC by d+150 post HCT and those whose chimerism is <95% at that time. Conclusion: Extensive ASO-Q-PCR MRD and donor-chimeric status monitoring was performed in this study, demonstrating that complete donor chimerism (CD3 and CD56) in nonmyeloablative allogeneic HCT for CLL is strong predictor for achieving molecular remission by one year post transplantation. Figure 1: Complete donor T-NK chimenism at d+ 150 correlates with molecular remission. Figure 1:. Complete donor T-NK chimenism at d+ 150 correlates with molecular remission.

scholarly journals Early life wheeze and risk factors for subsequent asthma -- a revisit at age 7 years in the GEWAC-cohort

2020 ◽  
Author(s):  
Idun Holmdahl ◽  
Anastasia Filiou ◽  
Katarina Stenberg Hammar ◽  
Anna Asarnoj ◽  
Magnus Borres ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Risk Factor ◽  
Early Life ◽  
School Age ◽  
Emergency Ward ◽  
Recurrent Wheeze ◽  
One Year ◽  
Airborne Allergens

Background: One third of all toddlers are in need of medical care because of acute wheeze and many of these children continue to have asthma at school age. Our aim was to assess the prevalence of asthma among the children in GEWAC at age 7 years. And investigate why some children continue to have recurrent wheeze and asthma at school age. Methods: The study included 156 cases with acute wheeze, recruited from the paediatric emergency ward, Astrid Lindgren’s Children’s Hospital, Stockholm, Sweden and 102 age-matched controls. Cases attended a follow-up visit after 3 months, after one year and at age 7 years. The protocol included questionnaires, ACT, FENO, nasopharyngeal virus samples, blood sampling for cell count, Vitamin D and IgE to food and airborne allergens. Results: A total of 70.8 % of the cases and 1.9 % of the controls had asthma at age 7 (p<0.001). Acute wheeze caused by Rhinovirus (RV) infection at inclusion was more common among cases with asthma at age 7 compared to cases without asthma (p=0.011). When adjusting for other viruses, RV remained significantly associated with asthma at age 7 (OR 3.8 95% CI 1.4-10.5). Cases with asthma at age 7 had been admitted to hospital more often (p=0.024) and spent more days admitted (p=0.01) during the year following inclusion. Conclusion: Rhinovirus induced acute wheeze is a risk factor for asthma by age 7. Cases with asthma at age 7 were hospitalized more frequently and needed more inpatient time during the year after inclusion.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

scholarly journals THU0254 Risk factors for back pain in a cross sectional and in a one-year follow up study in nurses

2001 ◽  
Author(s):  
M Brzosko ◽  
I Fiedorowicz-Fabrycy ◽  
J Fliciñski ◽  
H Przepiera-Bêdzak ◽  
K Prajs
Keyword(s):  
Risk Factors ◽  
Back Pain ◽  
Cross Sectional ◽  
Follow Up Study ◽  
One Year
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