Outcomes of Elderly Patients with AML in the Hamilton Area: How Are We Doing?

Abstract Acute myeloid leukemia (AML) is the most common form of leukemia amongst adults. Elderly patients (i.e. over the age of 60) with AML consistently have poorer outcomes than their younger counterparts and very few guidelines exist on the optimal management of AML in this population. A retrospective chart review of patients 60 years of age or older diagnosed with AML was conducted to better define this population, identify biological and patient characteristics that predict outcomes with treatment, and determine factors influencing management decisions. A total of 142 patients diagnosed with AML between April 2002 and April 2007 were included. Patients were analyzed together, as well as in pre-specified age groups (60–65, 66–75, and >75 years). Patients ranged from 60 to 92 years old, with a median of 70 years. Very few patients had a favorable cytogenetic profile (3.5%) at the time of diagnosis (Table 1). In addition, 41.5% of patients had a preceding hematologic diagnosis. Of these, 61.0% had pre-existing myelodysplastic syndrome and 16.9% had chronic myeloid leukemia. The proportion of patients with secondary transformation increased with age (age 60–65 −25%; 65–75 −39%; >75 – 51.3%). Over 60% of patients were induced, with younger patients opting for induction more often (age 60–65 − 88.6%; 65–75 − 66.1%; >75 – 20.5%). The most commonly cited reasons for not treating were the presence of comorbidities (32.1%), patient preference (26.8%), age (17.9%), and preceding hematological conditions (16.1%). Only 25% of those treated were able to complete the entire course of treatment. Despite this, more than half (58.1%) of patients were able to attain remission. As expected, overall survival was dismal across all age groups with 10.6% surviving to one year. Median survival was 2 months with survival decreasing with increasing age (Table 2). With treatment one year survival increased to 15.1% with a median survival of 3.75 months (treated vs. untreated - 15.1% vs. 3.6%, p <0.005). This result was largely driven by survival in the 60–65 year age group, in whom those treated did significantly better than those who were not (1 year survival 20.5% vs. 0%, p <0.005; median 6 vs. 0.18 months). In terms of economic resources, patients who were induced had significantly more outpatient appointments (22.2 vs. 6.4, p <0.0001), hospital days (58.8 vs. 11.6, p <0.0001), and used more blood products (65.7 vs. 12.1, p <0.001), presumably due to increased survival in those who were treated. This dramatic difference between those treated and those who were palliated was seen both in patients age 60–65 and 66–75, but was markedly attenuated in patients older than 75. Our findings are consistent with previous studies. Elderly patients with AML do poorly, with worsening outcomes with increasing age, and survival that is measured in months. This may be due to the increasing prevalence of patients with preceding hematological disorders and secondary transformation with age, as well as poor cytogenetic profiles of this population. In addition, as age and comorbidities increase, more patients opt out of induction chemotherapy. Further research is needed to establish optimal management and improve outcomes of elderly patients with AML. Table 1: Cytogenetics All patients (n; % of patients) Age 60–65 years (n; % of patients) Age 66–75 years (n; % of patients) Age 76 years and greater (n; % of patients) No of Patients 142 44 59 39 Cytogenetics Unknown 40 (28.2%) 10 (22.7%) 11 (18.6%) 19 (48.7%) Favourable 5 (3.5%) 1 (2.3%) 2 (3.5%) 2 (5.1%) 12 Intermediate 59 (41.5%) 23 (52.3%) 24 (40.7%) (30.8%) 6 Unfavourable 38 (26.8%) 10 (22.7%) 22(37.3%) (15.4%) Table 2: Survival Rates All patients (n; % of patients) Age 60–65 years (n; % of patients) Age 66–75 years (n; % of patients) Age 76 years and greater (n; % of patients 1 year survival 15 (10.6%) 8 (18.2%) 5 (8.5%) 2 (5.1%) All 2/56 (3.6%) 0/5 (0%) 1/20 (5.0%) 1/31 (3.2%) Untreated 13/86 (15.1%) 8/39 (20.5%) 4/39 (10.3%) 1/8 (12.5%) Treated (p = 0.004) (p = 0.003) (p = 0.41) (p = 0.23) Median survival (months) 2 3 2 1 All 1 5.5 days 1.5 1 Untreated 3.75 2 6 2.9 Treated Lost to Follow Up 52 (36.3%) 17 (38.6%) 24 (40.7%) 11 (28.2%)

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Patient Characteristics and Outcomes in Adolescents and Young Adults (AYA) with Acute Myeloid Leukemia (AML): Princess Margaret Cancer Centre Experience

Blood ◽

10.1182/blood-2019-125449 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2609-2609

Author(s):

Muhned Alhumaid ◽

Georgina S Daher-Reyes ◽

Wilson Lam ◽

Arjun Law ◽

Tracy Murphy ◽

...

Keyword(s):

Board Of Directors ◽

Older Patients ◽

Myeloid Leukemia ◽

Research Funding ◽

Age Groups ◽

Treatment Strategies ◽

Patient Characteristics ◽

Cancer Center ◽

Advisory Committees ◽

Disease Behavior

Introduction: Clinical outcomes of acute myeloid leukemia (AML) in adolescents and young adults (AYA) are rarely reported as an isolated subgroup. Treatments vary little across age groups, and treatment intensity depends upon comorbid conditions and performance status. Optimal treatment strategies focused on disease behavior, biological factors, and the distinct needs of this subset of AML patients remain elusive. The purpose of this retrospective analysis is to determine the characteristics and outcomes of AYA AML patients treated at a specialized adult leukemia cancer center in comparison to older adults with AML (40-60 years). Methods: A retrospective analysis was performed on all patients treated at Princess Margaret Cancer Center from 2008-2018. Patients with acute promyelocytic leukemia were excluded. Clinical characteristics, treatment strategies, and survival outcomes were recorded for all patients. Overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier product-limit method and the impact of covariates were assessed using the Log-rank test. Finally, we compared the outcomes of AYA patients treated at our centre between 2015-2018 with older patients. Results: A total of 175 patients aged 18-39 were identified. Patient characteristics are shown in (Table 1). Cytogenetic were available in 163 patients. Based on MRC criteria, 27 (16%) were favorable risk, intermediate in 95 (54%), adverse in 39 (22%), and missing/failed in 14(8%). NPM1 status was available in 110 patients of whom 38 (35%) were positive. FLT3-ITD was available in 67 patients with 24 (36%) positive. Both mutations were present in 13 (54%) patients. There were no significant differences in terms of risk stratification based on cytogenetic and molecular markers based on age (18-29 vs.30-39) (P= 0.98). Most patients 172 (98%) received induction, 157 (91%) with 3+7, and 15 (9%) with FLAG-IDA. Complete remission (CR) was achieved in 133 (77%) after first induction [120 (76%) after 3+7 and 11 (73%) after FLAG-IDA]. Induction related mortality was low (2%). Of the 39 who did not achieve CR, thirty-four patients received re-induction (13 FLAG-IDA, 16 NOVE-HiDAC, 5 others) with CR in 21 (62%). Overall, 154 (89.5%) achieved CR1. Sixty-four (42%) proceeded to hematopoietic stem cell transplantation (HSCT) in CR1. 59 (38%) patients relapsed in CR1 with 8 (12%) relapsing post HSCT. Fifty-five (5 post HSCT) patients received reinduction with 30 (51%) (2 after HSCT) achieving CR2. Fifteen patients received HSCT in CR2. OS and DFS at 2 years were 62% (95% CI 0.53-0.69) and 50% (95% CI 0.41-0.57), respectively. Stratified by cytogenetic risk, OS was 81% for favorable risk, 61% for intermediate, and 50% for adverse risk (P=0.0001), respectively. DFS in these groups was 85%, 57%, and 46 % (P=0.0025), respectively. We further compared outcomes in the 18-29y and 30-39y age groups. The OS was 61.9% compared to 62.5% (P=0.91) and DFS of 52.1% compared to 47% (P=0.65) respectively. On univariate analysis for OS and DFS, cytogenetic risk stratification was the only significant variable (P=0.0004 and P=0.0042). We then compared the outcomes 67 sequential patients aged I8-39 treated from 2014-2018, with those of 176 sequential patients aged 40-60 treated during the same period (table 2). OS at 2 years was not statistically higher in the younger group compared to the older group (66.7% vs. 61.2%, P=0.372). While relapse rate was lower in older patients (15.5% vs. 22.6%, P=0.093), NRM was higher in older patients (29.7% vs. 18.8%,P=0.094). Conclusion: AYA pts. occupy a unique niche amongst AML as a whole. While treatment responses have improved in general, there may be potential for further gains in these patients. Increased tolerance for more intense treatment strategies as well as the incorporation of novel agents into standard treatment protocols may provide a means to optimize care in AYA patients. Finally, research is needed to elucidate biological mechanisms and predictors of disease behavior instead of arbitrary, age-stratified treatment schema. Disclosures McNamara: Novartis Pharmaceutical Canada Inc.: Consultancy. Schimmer:Jazz Pharmaceuticals: Consultancy; Medivir Pharmaceuticals: Research Funding; Novartis Pharmaceuticals: Consultancy; Otsuka Pharmaceuticals: Consultancy. Schuh:Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Teva Canada Innovation: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria; Jazz: Honoraria, Membership on an entity's Board of Directors or advisory committees. Maze:Pfizer Inc: Consultancy; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Yee:Astellas: Membership on an entity's Board of Directors or advisory committees; Millennium: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees; Astex: Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; MedImmune: Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffman La Roche: Research Funding. Minden:Trillium Therapetuics: Other: licensing agreement. Gupta:Incyte: Honoraria, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sierra Oncology: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽

10.1017/cem.2020.253 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S81-S81

Author(s):

R. Pinnell ◽

P. Joo

Keyword(s):

Emergency Department ◽

Elderly Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Urinary Symptoms ◽

Categorical Variables ◽

Continuous Variables ◽

Indwelling Catheter ◽

Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

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Ten-year survival of Finnish lower limb amputees

Prosthetics and Orthotics International ◽

10.3109/03093649809164452 ◽

1998 ◽

Vol 22 (1) ◽

pp. 10-16 ◽

Cited By ~ 39

Author(s):

T. Pohjolainen ◽

H. Alaranta

Keyword(s):

Median Survival ◽

Lower Limb ◽

Social Insurance ◽

Age Groups ◽

Vascular Diseases ◽

The Elderly ◽

Limb Amputation ◽

Diabetic Patients ◽

Trauma Patients ◽

One Year

Data on mortality for the ten years following lower limb amputation were obtained from all the 16 surgical units in Southern Finland and the National Social Insurance Institution. In Southern Finland during the period 1984-1985, amputations of the lower limb were performed on 705 patients, of whom 382 (54%) were women and 323 (46%) men. The majority of the amputations, 47%, were performed for vascular diseases and 41% were performed for diabetes mellitus. The overall survival was 62% at one year after amputation, 49% at two years, 27% at five years and 15% at ten years. The median survival after amputation was 1 yr 5 mth for the women and 2 yr 8 mth for the men. Of the arteriosclerotics, 43% died within one postoperative year while 43% lived longer than two years and 23% longer than five years. The median survival of arteriosclerotics was 1 yr 6 mth. The corresponding figure for patients with diabetes was 1 yr 11 mth. Of the diabetics, 38% died within one postoperative year while 47% lived longer than two years and 20% longer than five years. Of the trauma patients, 86% lived longer than five years and 71% longer than ten years. Of the trans-femoral amputees, 54% lived longer than one year, 36% over two years, 18% over five years and 8% over ten years. The corresponding figures for trans-tibial amputees were 70%. 53%, 21% and 4%. Many elderly vascular and diabetic patients undergoing amputation have a reduced physiological reserve and high mortality. The more proximal the amputation, the greater the risk that the patient will never be able to walk or that the duration of use of the prosthesis will be short. If a prosthesis seems to be a reasonable option for the elderly amputee, any delays in prosthetic fitting should be avoided in older age groups.

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Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia

Blood ◽

10.1182/blood-2010-03-276485 ◽

2010 ◽

Vol 116 (22) ◽

pp. 4422-4429 ◽

Cited By ~ 211

Author(s):

Hagop Kantarjian ◽

Farhad Ravandi ◽

Susan O'Brien ◽

Jorge Cortes ◽

Stefan Faderl ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Median Survival ◽

Myeloid Leukemia ◽

Survival Rates ◽

Eastern Cooperative Oncology Group ◽

Poor Performance ◽

Risk Groups ◽

Complete Response ◽

Intensive Chemotherapy ◽

Acute Myeloid

Patients ≥ 70 years of age with acute myeloid leukemia (AML) have a poor prognosis. Recent studies suggested that intensive AML-type therapy is tolerated and may benefit most. We analyzed 446 patients ≥ 70 years of age with AML (≥ 20% blasts) treated with cytarabine-based intensive chemotherapy between 1990 and 2008 to identify risk groups for high induction (8-week) mortality. Excluding patients with favorable karyotypes, the overall complete response rate was 45%, 4-week mortality was 26%, and 8-week mortality was 36%. The median survival was 4.6 months, and the 1-year survival rate was 28%. Survival was similar among patients treated before 2000 and since 2000. A multivariate analysis of prognostic factors for 8-week mortality identified the following to be independently adverse: age ≥ 80 years, complex karyotypes, (≥ 3 abnormalities), poor performance (2-4 Eastern Cooperative Oncology Group), and elevated creatinine > 1.3 mg/dL. Patients with none (28%), 1 (40%), 2 (23%), or ≥ 3 factors (9%) had estimated 8-week mortality rates of 16%, 31%, 55%, and 71% respectively. The 8-week mortality model also predicted for differences in complete response and survival rates. In summary, the prognosis of most patients (72%) ≥ 70 years of age with AML is poor with intensive chemotherapy (8-week mortality ≥ 30%; median survival < 6 months).

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Clinical outcome of chemoradiotherapy in elderly patients with non-small cell lung cancer at G.V Montgomery Veterans Affairs Medical Center

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19683 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19683-19683

Author(s):

M. Choi ◽

W. Chan ◽

J. Jaiwatana ◽

T. Khansur

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Elderly Patients ◽

Cancer Patients ◽

Median Survival ◽

Concurrent Chemoradiotherapy ◽

Medical Center ◽

Survival Rates ◽

The United States ◽

Lung Cancer Patients

19683 Background: More than 2/3 of lung cancer patients are age = 65 and the proportion of elderly patients are expected to rise in the United States. However data on the use of optimal chemoradiotherapy in this group of patients are limited. Methods: All lung cancer patients = 65 years, who received both chemotherapy and radiation therapy at the G. V. Montgomery VAMC between Jan 2000 to Dec 2005, were analyzed from tumor registry and computerized medical records. Patients who only received palliative radiation therapy for bone and brain metastasis were excluded. Results: Among 652 lung cancer patients diagnose, 46 patients = 65 years received both chemotherapy and radiation therapy over the 6 year study period. The median age was 72 (range:65–84) and 70% of the patients were = 70 years. All patients were male with 65% white and 35% black population. The majority of patients were stage III (85%) while there was one stage I and six stage II patients. 41 patients (89%) were able to complete the planned radiation therapy and median dose delivered was 6140 cGy. The chemotherapy regimen was carboplatin and paclitaxel either weekly during radiation therapy and every three weeks in sequential treatment. There was only 1 treatment related mortality and only 15% of patients survived less than 6 months. The 1, 2, 3 year survival rates were 67%, 24%, and 15% respectively and median survival was 15.3 months. 15 patients were treated sequentially(S) with chemotherapy (median cycle-3) followed by radiation therapy and 31 patients concurrently (C) with chemoradiotherapy. (median- 5 weekly treatment) The survival among the two groups did not differ statistically. (median survival-19.1 month (S) vs. 14 month (C) p=0.78) Conclusions: Both sequential and concurrent chemoradiotherapy is feasible and beneficial in elderly patients with lung cancer. Sequential treatments might be as effective as concurrent chemoradiotherapy in elderly VA patient population. No significant financial relationships to disclose.

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Characteristics of colorectal cancer in patients younger than 40 years compared to older patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.371 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 371-371

Author(s):

Mohamed E. Salem ◽

Monica Arun ◽

Greg Dyson ◽

Chadi Saad ◽

Cassra Arbabi ◽

...

Keyword(s):

Colorectal Cancer ◽

Survival Rates ◽

Age Groups ◽

Cancer Center ◽

Tumor Characteristics ◽

Surgical Interventions ◽

Significant Difference ◽

Poorly Differentiated ◽

One Year ◽

The Right

371 Background: The incidence of colorectal cancer (CRC) in younger patients (pts) is increasing. There is limited data on tumor characteristics and treatment outcome in this population. Methods: Patients with CRC treated at the Karmanos Cancer Center from 2005 to 2011 were studied. Younger (≤40 years) and older (>40 years) groups from a predominantly inner city population were compared for patient and tumor characteristics, treatment patterns, and survivals. T-tests and Fisher’s exact tests were used to determine statistical differences between age groups while the Kaplan-Meier method was used to estimate survival. Results: 42 pts were ≤ 40 (range, 17-40 years) and 96 pts were > 40 (range, 42-88 years). Mean ages for the groups were 33 and 60 years, respectively. There was no statistically significant difference in the distribution of race, gender, stage or KRAS mutation status between the two groups; however, older pts had a higher mean body mass index compared to younger pts (28 versus 23, p<0.001). Older pts were more likely to have a right colon primary (OR = 7.5, p = 0.04), while younger pts had higher likelihood of having sigmoid primary (OR = 3.4, p = 0.002) and worse grade (poorly differentiated) tumors (OR = 8.3, p <0.001). There were no significant differences between metastatic status or sites of metastases between the two groups. Significantly more young pts underwent surgery than older pts (92% versus 62%, p = 0.005). FOLFOX plus bevacizumab was the most commonly used first line treatment for both groups. The median survival estimates were 16.9 (8.1-23.9) and 17.1 months (13.3-31.0) for the younger and older pts, respectively. Importantly, the one-year survival rates were similar for both groups: 41% for both (p = 1). On the multivariate analysis, whether pts had a primary in the right or sigmoid colon was the only independent predictor of survival. Conclusions: Younger pts with colon cancer were diagnosed at a similar stage of the disease as older pts, but more likely to have poorly differentiated tumors. Younger pts were more likely to receive surgical interventions; however, both groups had equivalent one-year survivals. These results support the need for further prospective investigation in a larger population.

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Increase in the Incidence of Secondary Acute Myeloid Leukemia (2-AML): A Single Institution Experience Over 20 Years.

Blood ◽

10.1182/blood.v112.11.1498.1498 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1498-1498

Author(s):

Elias Jabbour ◽

Hagop M Kantarjian ◽

Sherry Pierce ◽

Guillermo Garcia-Manero ◽

Jorge Cortes ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Median Survival ◽

Myeloid Leukemia ◽

De Novo ◽

Survival Rates ◽

Primary Cancer ◽

Chromosome 11 ◽

Secondary Acute Myeloid Leukemia ◽

Acute Myeloid ◽

Clonal Abnormalities

Abstract Secondary acute myeloid leukemia (2-AML) is a distinctive clinical syndrome occurring after primary malignancy treated or not with chemotherapy (CT), radiotherapy (RT), surgery, or a multimodality strategy. We analyzed the data on 2898 consecutive patients (pts) with AML (WHO criteria) referred to our institution between 1985 and 2005, including 1642 males and 1256 females. The median age was 58 years (range, 13–89 years) for pts with de novo AML (1-AML) (n=2198) and 66 years (range, 18–89 years) for those with 2-AML (n=700). 171 pts (18%) were treated for 2-AML between 1985 and 1994 versus 529 patients (27%) treated between 1995 and 2005 (p<0.001). The predominant primary malignancies included lymphoma (18%), breast (16%), and prostate (13%). Pts had been administered various cytotoxic chemotherapy agents (185 pts, 26%) and RT (102 pts, 15%); 182 (26%) had undergone both modalities, and 231 pts (33%) had undergone surgery alone. At diagnosis, 181 (26%) pts with 2-AML had diploid cytogenetics versus 845 (38%) pts with 1-AML (p<0.001). 252 (32%) pts with 2-AML had clonal abnormalities involving chromosomes 5 and 7 versus 383 (17%) pts with 1-AML (p<0.001), and 49 (7%) pts with 2-AML had 11q abnormalities versus 73 (3%) with 1-AML (p<0.001). Pts undergoing CT/RT had a worse cytogenetic risk profile compared to those undergoing surgery alone with more clonal abnormalities involving chromosomes 5 and 7 (36% versus 24%; p=0.002) and chromosome 11 (10% versus 2%; p<0.001), and less diploid karyotype (19% versus 39%; p<0.001). Median survival time after diagnosis of 2-AML was 6 months with 2- and 5-year survival rates of 18% and 11%, respectively. The median survival for pts treated with surgery alone for the primary cancer was 8 months versus 5 months for those receiving CT/RT (p=0.007); their 2- and 5-year survival rates were 22% and 14% and 16% and 9%, respectively. The median survival for pts treated for their primary cancer between 1985 and 1994 was 4 months versus 6 months for those treated after 1994 (p=0.089); their 2-year and 5-year survival rates were 16% and 9% and 19% and 12%, respectively. In conclusion, the incidence of 2-AML is increasing; patients receiving CT/RT had worse cytogenetic profiles and clinical outcomes than those receiving surgical treatment alone. There remains to be seen whether increased use of targeted therapies as prime modality of therapy in primary cancers will be associated with a decreased risk of 2-AML.

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Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2016/8435257 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 16

Author(s):

Marie Yan ◽

Marion Elligsen ◽

Andrew E. Simor ◽

Nick Daneman

Keyword(s):

Infectious Diseases ◽

Antimicrobial Therapy ◽

Retrospective Chart Review ◽

Surgical Site Infections ◽

Patient Characteristics ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Health Care Encounters ◽

One Year ◽

Alternative To Hospitalization

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials. The most commonly treated syndromes included surgical site infections (33%), osteoarticular infections (28%), and bacteremia (21%). The most frequently prescribed antimicrobials were ceftriaxone (21%) and cefazolin (20%). Only 56% of the patients received follow-up care from an infectious diseases specialist. In the 60 days following discharge, 43% of the patients returned to the emergency department, while 26% required readmission. Forty-eight percent of the return visits were due to infection relapse or treatment failure, and 23% could be attributed to OPAT-related complications. These results suggest that many OPAT patients have unplanned health care encounters because of issues related to their infection or treatment, and the creation of a formal OPAT clinic may help improve outcomes.

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Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia

Healthcare ◽

10.3390/healthcare9070783 ◽

2021 ◽

Vol 9 (7) ◽

pp. 783

Author(s):

Mei-Chi Hsu ◽

Shang-Chi Lee ◽

Wen-Chen Ouyang

Keyword(s):

Elderly Patients ◽

Charlson Comorbidity Index ◽

Survival Rates ◽

Age Groups ◽

Population Based ◽

Increased Risk ◽

Comorbidity Burden ◽

Comorbidity Index ◽

The Mean ◽

First Admission

Objectives: Comorbid illness burden signifies a poor prognosis in schizophrenia. The aims of this study were to estimate the severity of comorbidities in elderly patients with schizophrenia, determine risk factors associated with mortality, and establish a reliable nomogram for predicting 1-, 3- and 5-year mortality and survival. Methods: This population-based study rigorously selected schizophrenia patients (≥65 years) having their first admission due to schizophrenia during the study period (2000–2013). Comorbidity was scored using the updated Charlson Comorbidity Index (CCI). Results: This study comprised 3827 subjects. The mean stay of first admission due to schizophrenia was 26 days. Mean numbers of schizophrenia and non-schizophrenia-related hospitalization (not including the first admission) were 1.80 and 3.58, respectively. Mean ages at death were 73.50, 82.14 and 89.32 years old, and the mean times from first admission to death were 4.24, 3.33, and 1.87 years in three different age groups, respectively. Nearly 30% were diagnosed with ≥3 comorbidities. The most frequent comorbidities were dementia, chronic pulmonary disease and diabetes. The estimated 1-, 3- and 5-year survival rates were 90%, 70%, and 64%, respectively. Schizophrenia patients with comorbid diseases are at increased risk of hospitalization and mortality (p < 0.05). Conclusion: The nomogram, composed of age, sex, the severity of comorbidity burden, and working type could be applied to predict mortality risk in the extremely fragile patients.

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Potential to Improve Therapy of Chronic Myeloid Leukemia (CML), Especially for Patients with Older Age: Incidence, Mortality, and Survival Rates of Patients with CML in Switzerland from 1995 to 2017

Cancers ◽

10.3390/cancers13246269 ◽

2021 ◽

Vol 13 (24) ◽

pp. 6269

Author(s):

Michael Daskalakis ◽

Anita Feller ◽

Jasmine Noetzli ◽

Nicolas Bonadies ◽

Volker Arndt ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Older Patients ◽

Myeloid Leukemia ◽

Survival Rates ◽

Age Groups ◽

Cancer Registries ◽

Population Based ◽

Older Age ◽

Similar Data ◽

Real World Data

Background: Tyrosine kinase inhibitors (TKI) substantially improved chronic myeloid leukemia (CML) prognosis. We aimed to describe time period- and age-dependent outcomes by reporting real-world data of CML patients from Switzerland. Methods: Population-based incidence, mortality, and survival were assessed for four different study periods and age groups on the basis of aggregated data from Swiss Cantonal Cancer Registries. Results: A total of 1552 new CML cases were reported from 1995 to 2017. The age-standardized rate (ASR) for the incidence remained stable, while the ASR for mortality decreased by 50–80%, resulting in a five-year RS from 36% to 74% over all four age groups. Importantly, for patients <60 years (yrs), the five-year RS increased only in earlier time periods up to 92%, whereas for older patients (+80 yrs), the five-year RS continued to increase later, however, reaching only 53% until 2017. Conclusions: This is the first population-based study of CML patients in Switzerland confirming similar data compared to other population-based registries in Europe. The RS increased significantly in all age groups over the last decades after the establishment of TKI therapy. Interestingly, we found a more prominent increase in RS of patients with older age at later observation periods (45%) compared to patients at younger age (10%), implicating a greater benefit from TKI treatment for elderly occurring with delay since the establishment of TKI therapy. Our findings suggest more potential to improve CML therapy, especially for older patients.

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