Older Age Is An Independent Risk Factor in AML

Abstract Among the entire patients with AML the majority is 60 years of age or older. In present German multicenter AML Cooperative Group (AMLCG) trial the proportion of these older patients amounts to 54% of all 2734 patients enrolled and receiving intensive chemotherapy. While older age AML is increasingly recognized as a main challenge the therapeutic outcome unlike that in younger patients has remained constantly poor. Thus, the patients of ≥ 60y show an overall survival (OS) of 13% and a relapse rate (RR) of 82% at 5y versus 40% and 52% in younger patients. Age related differences in treatment and in risk profiles are commonly used to explain the differences in outcome. In the AMLCG 99 trial including 2734 patients 16 to 85 (median 61) years of age we investigated factors determining the disease biology and outcome. For induction treatment patients received standard dose TAD and high-dose AraC 3 (age < 60y) and 1 (≥ 60y) g/m² × 6/mitoxantrone (HAM) or randomly HAM-HAM, for consolidation TAD, and for maintenance monthly reduced TAD randomized (in patients < 60y) against autologous SCT. When compared with patients younger than 60y older patients had more frequent secondary AML (29% vs 17%, p< 0.0001), unfavorable cytogenetics (29% vs 23%, p= 0.0004), less frequent favorable cytogenetics (4% vs 12%, p< 0.0001), and NPM1mut/FLT3-ITDneg status (26% vs 34%, p< 0.009) in those with normal karyotype, and overall even lower median WBC (7.360 vs 12.600/μl, p< 0.0001) and LDH (340 vs 413 U/l, p< 0.0001). A multivariate analysis identified independent risk factors determining therapeutic endpoints such as CR rate, OS, RR, and RFS. With similar results across all endpoints, risk factors for OS were age ≥ 60y (HR 1.96, 95% CI 1.75–2.17), AML secondary to MDS or cytotoxic treatment (1.28, 1.14–1.45), unfavorable karyotype (2.17, 1.92– 2.44), WBC > 20×10³/μl (1.15, 1.02– 1.30), LDH > 700U/L (1.32, 1.15– 1.52), favorable karyotype (0.49, 0.38– 0.63) and female gender (0.90, 0.81– 0.99). In the 891 patients with normal karyotype and complete mutation status risk factors for OS were age ≥ 60y (2.00, 1.64– 2.44), and NPM1mut/FLT3-ITDneg (0.39, 0.30– 0.49). Risk factors for RR overall were age ≥ 60y (2.04, 1.75– 2.38), unfavorable karyotype (2.08, 1.47– 2.13), LDH (1.41, 1.16– 1.72) and favorable karyotype (0.40, 0.29– 0.56). In patients with normal karyotype and complete mutation status risk factors for RR were age ≥ 60y (2.00, 1.56– 2.63), and NPM1mut/FLT3-ITDneg (0.32, 0.23– 0.43). Testing the role of older age in favorable subgroups, the 198 patients with CBF leukemia show an OS at 5 years of 27.5 (95% CI 12.0– 43.0) % in the older versus 69.4 (60.7– 78.2) % in the younger age group, and a RR of 56.6 (35.7– 77.3) % versus 25.0 (15.6– 34.4) %. Comparatively, the 264 patients with a normal karyotype and NPM1mut/FLT3-ITDneg show an OS of 37.1 (26.6– 47.5) % in the older versus 71.9 (63.4– 80.4) % in the younger age group, and a RR of 61.0 (47.8– 74.2) % versus 23.0 (14.0– 32.0) %. There was no influence by randomized treatment variables on any therapeutic endpoint. Conclusion: Considering the prognostic spectrum of all major historic or genetic subgroups older age maintains its dominant role not explained by age related differences in risk profiles. Even within CBF leukemias and sole NPM1 mutation as the best prognostic categories older age predicts for markedly shorter OS and higher RR. Thus, understanding older age AML requires further genetic and epigenetic work.

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Changes in the Hierarchy of Risk Factors with Older Age in De-Novo Acute Myeloid Leukemia (AML).

Blood ◽

10.1182/blood.v108.11.1977.1977 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1977-1977

Author(s):

Thomas Buchner ◽

Wolfgang E. Berdel ◽

Claudia Schoch ◽

Torsten Haferlach ◽

Hubert L. Serve ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Complete Remission ◽

De Novo ◽

Older Age ◽

High Dose ◽

Age Group ◽

Risk Profiles ◽

Age Related ◽

De Novo Aml

Abstract After recent reports addressed prognostic factors and outcome in older age AML (Burnett et al. Blood106:162a,2005; Wheatley et al. Blood106:199a,2005; Appelbaum et al. Blood107:3481–5,2006; Farag et al. Blood108:63–73,2006) we evaluated 764 patients of 60–85 (median 66) years reduced to those with de-novo AML, known karyotype, and identical consolidation-maintenance chemotherapy, who were part of the 1992 and 1999 multicenter randomized trials by the German AMLCG (Buchner et al. J Clin Oncol21:4496–504,2003;24:2480–9,2006). 521 patients were 60 -< 70 (median 64) and 243 patients were 70–85 (median 73) years of age. 64% and 50% patients respectively went into complete remission, 24% and 29% remained with persistent AML, 12% and 21% succumbed to early and hypoplastic death (p<.001). The overall survival in the younger (60- < 70y) and older (70+) patients was at a median of 13 vs 6 months and 18% vs 8% survived at 5 years (p<.001). Once in complete remission, the remission duration was 14 vs 12 months (median) and equally 18% at 5 years; the relapse-free survival is 13 vs 11 months (median) and 14% vs 13% at 5 years. While all patients were randomized up-front for 2 versions of induction either by TAD-HAM (HAM, high-dose araC 1g/m2x6 and mitox 10mg/m2x3) or by HAM-HAM, response and survival did not differ between the two arms in neither age group. In contrast to response and survival between the younger (60-<70y) and older (70+y) age group corresponding differences in the risk profiles were missing. Thus, favorable/intermediate/unfavorable karyotypes accounted for 8% vs 4% / 67% vs 73% / and 25% vs 24% of patients (p=.073); WBC > 20.000/ccm was found in 40% vs 39% (p=.52); LDH > 700U/L was remarkably 26% vs 18% (p=.014), and the day 16 b.m. blasts ≥ 10% accounted for 41% and 41% of patients. Conclusion: Approximately 50% of patients 70 years of age or older benefit from standard or intensive chemotherapy by complete remission which continues after 1 year in about 50% of responders. The inferior overall survival in the patients of 70+ versus those of 60- < 70 years is mainly explained by more frequent early and hypoplastic death (21% vs 12%) (p=.0016) and death with persistent AML (26% vs 18%) (p=.0145); while death in remission (7% vs 6%), relapse rate (50% vs 53%) and death after relapse (21% vs 26%) did not show this trend. In contrast to the important differences in outcome, established risk factors such as cytogenetic groups, WBC, and early blast clearance show concordance between the two age groups. The even lower LDH may support assumptions of older age AML as a less proliferative disease (Appelbaum et al. Blood 107:3481–5,2006). Thus, the hierarchical risk profiles cannot predict the age related outcome beyond 60 years in patients with de-novo AML.

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Age-Related Differences in the Informational Experiences and Needs of Patients with Lymphoma: Results from the 2020 Lymphoma Coalition Global Patient Survey

Blood ◽

10.1182/blood-2021-148525 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1929-1929

Author(s):

Olufunmilayo A Bamigbola ◽

Lorna E Warwick

Keyword(s):

Information Needs ◽

Medical Information ◽

Age Groups ◽

Older Age ◽

Age Group ◽

Younger Patients ◽

Amount Of Information ◽

Age Related ◽

Younger Age ◽

Significant Difference

Abstract Background Lymphomas can occur in all age groups but most commonly occur in older adults. Despite the shift towards patient- centered care, very little has been done to explore the information needs of patients with lymphoma by age. It is important for information to accessible to patients of all ages, as informed patients are consistently associated with better outcomes and healthcare experiences. In this study, Lymphoma Coalition (LC) describes the age-related differences in the information needs of patients with lymphoma using the 2020 LC Global Patient Survey (GPS). The objectives of this study were to identify: 1) how patients felt about the amount of information they received at diagnosis 2) the content of the information received at diagnosis and the level of understanding, and 3) their informational needs. Methods Globally, 11,878 respondents including 9,179 patients and 2,699 caregivers took part in the 2020 LC GPS. There were 9,078 patients included in this analysis who self-identified their age. These patients were grouped into five age groups for analysis: 18-29 (n=638), 30-39 (n=1,196), 40-59 (n=3,261), 60-69 (n=2,216), and 70+ (n=1,767). Demographics of the five age groups were examined, and descriptive analyses for all questions relating to information needs were performed in IBM SPSS v27. Results The five age groups differed significantly (p< 0.001) in all the demographic categories examined. These categories included lymphoma subtype, sex, area of residence, education level, employment status, and household status. Patients were asked how they felt about the amount of information given to them at diagnosis. The oldest age group (70+) reported the highest prevalence (70%) of having received the right amount of information (Table 1). The younger age groups (18-29; 30-39; and 40-59) reported the highest prevalence of not receiving enough information (38%, 42%, and 41% respectively). Although not many patients reported being given too much information, of those who did, the younger age groups (18-29; 30-39; and 40-59) were the most prevalent (10%; 7%; and 5% respectively) (Table 1). Patients were asked about the type of information given to them at diagnosis, and how well they understood it. Compared to the younger age groups, the older age groups (60-69 and 70+) more frequently reported that they received and understood information given to them on different medical treatment options, the process and stages of their care, and how to manage side effects of treatment (Table 1). Patients were also asked what they needed more information about (Table 1). The top three areas that all patients needed more information about (regardless of age group) were treatment options, side effects from treatment, and their diagnosis and what it means. There was significant difference in the prevalence of how these information needs were reported between the age groups (Table 1). There was also significant difference in the prevalence of reporting a need for more information on support for self care, psychological support/counselling, and fertility across the age categories (Table 1). The lowest prevalence for needing more information in any of these areas was observed in the older age groups (60-69 and 70+), while the highest prevalence was observed in the youngest age groups (18-29 and 30-39) (Table 1). Although few patients reported not needing more information in any of these areas, its reporting was most prevalent in the older age groups (60-69 and 70+) (12% and 19%, respectively) (Table 1). Summary/Conclusions This analysis revealed that patients with lymphoma/CLL experience medical information differently across age groups. Compared to the mid and oldest patient groups, younger patients with lymphoma or CLL reported experiencing medical information differently than older patients do and reported less understanding of the medical information given to them. The younger patients also reported higher informational needs about their disease and treatment that may also be related to their age (e.g. information on fertility and family support). Clinicians should note these differences in age-group experiences and information needs, with the understanding that younger patients with lymphoma or CLL may require additional information, attention, and support. In the future, LC would like to explore how demographic differences may have confounded results. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Improvement in Outcomes of Autologous Stem Cell Transplant in Patients with Lymphoma Older Than 70 Years: The Significance of Age in 2020s?

Blood ◽

10.1182/blood-2021-144507 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2908-2908

Author(s):

Kitsada Wudhikarn ◽

Bradley K. Johnson ◽

Jose C. Villasboas ◽

Jonas Paludo ◽

David J. Inwards ◽

...

Keyword(s):

Stem Cell ◽

Older Patients ◽

Research Funding ◽

Clinical Characteristics ◽

Stem Cell Transplant ◽

Autologous Stem Cell Transplant ◽

Cell Transplant ◽

Age Group ◽

Younger Patients ◽

Younger Age

Abstract Backgrounds: Autologous stem cell transplant (ASCT) has been the standard treatment approach for patients with relapsed or high-risk lymphoma for several decades. Despite the improvement in supportive care, age has remained one of the critical factors that determines transplant eligibility and outcomes. Herein, we explored the transplant-related outcomes of patients with lymphoma aged 70 years or older at our institution and compared to those with younger ages. Methods: In this retrospective single center study, we include all patients with diagnosis of lymphoma who underwent ASCT between January 2000 and February 2021 at Mayo Clinic, Rochester, Minnesota. In addition to data obtained from the transplant database, we abstracted data from electronic medical record. We described relevant clinical characteristics and transplant associated outcomes including engraftment, transplant related mortality, relapse incidence, and survival outcomes. We compared the key transplant related outcomes with patients at the younger age group between 65 and 70 years old. Results: A total of 196 patients with lymphoma aged 70 years or older underwent ASCT between January 2000 and February 2021. The median age of patients at the time of ASCT was 72.4 (70.0-78.7) years with 24 patients (12.2%) being older than 75 years old. Of 196 patients, 76 (38.8%) had Charlson comorbidity index of 3 or higher and 10 (5.1%) had performance status of 2 or higher at the time of ASCT. Table 1 summarizes the relevant baseline clinical characteristics of 196 patients in this cohort including the comparison with younger patients (age 65-70 years old, n=296). The most common transplant indication in this cohort was relapsed diffuse large B cell lymphoma. The majority of patients (91.3%) received peripheral blood graft with a median CD34+ cell dose of 5.14x10 6 cells/kg which was significantly lower than younger patients (P=0.01). The rate of neutrophil and platelet engraftment was 99.0% and 98.8% with corresponding median time to engraftment of 13 days for both cell lineages. The 30- and 100-day non-relapse mortality (NRM) of the entire cohort was 1.5% (95%CI 0-3.2%) and 4.6% (95%CI 1.6-7.5%) not statistically different between 70-75 years old and 75 years or older cohorts. With the median follow-up duration of 48 months, the 2-year event free survival (EFS) and overall survival (OS) was 55.9% (95%CI 49.2-63.5%) and 67.4% (95%CI 61.0-74.5%), respectively. Patients from the 70 years old or older cohort had similar EFS but inferior OS compared to the 65-70 years old cohort. However, there was no difference in EFS and OS between 70-75 and >75 years old cohorts. There was overall an improved trend of 30-day NRM, 2-year EFS and 2-year OS over the 3 different transplant periods (Figures). Although not statistically significant, patients who underwent ASCT between 2000 and 2006 had a trend towards higher 30-day NRM compared to patients who were transplanted at later time points (7.3% vs 0%, P=0.06). The major causes of death included progressive lymphoma, infection, and conditioning regimen related organ toxicities. Conclusion: Outcomes of ASCT in older patients with lymphoma have improved over time with an excellent 30-day NRM (0%) in the past recent years. The major cause of treatment failure after ASCT was progressive disease. With appropriate patient selection, ASCT in older patients is feasible and provides acceptable outcomes comparable to the patients from younger age group. Figure 1 Figure 1. Disclosures Paludo: Karyopharm: Research Funding. Ansell: Bristol Myers Squibb, ADC Therapeutics, Seattle Genetics, Regeneron, Affimed, AI Therapeutics, Pfizer, Trillium and Takeda: Research Funding.

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Risk Factors of Childhood Anemia Explained: Evidence From the 2016 National Survey

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_014 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 809-809

Author(s):

Tafere Belay ◽

Micaela Wakefield ◽

Kelly Pritchett ◽

Susan Hawk ◽

Nigatu Regassa

Keyword(s):

Risk Factors ◽

Age Groups ◽

Water Source ◽

Older Age ◽

Age Group ◽

Funding Sources ◽

Piped Water ◽

Younger Age ◽

Childhood Anemia ◽

Prevalence Of Anemia

Abstract Objectives The objective of this study was to examine the key risk factors related to anemia among children aged 6–24 months (younger age group) and 25–59 months (older age group). Methods We used the 2016 Ethiopian Demographic and Health Survey data, collected from 11,023 mothers with under five children. Ordered logistic regression modeling was used for assessing risk factors of childhood anemia. Results The results suggest that the prevalence of anemia is 72% in the younger and 49% in the older age groups. The risk factors for anemia in the younger age group are morbidity (OR = 0.5; CI: 0.32–0.82), having no piped water source (OR = 1.76; CI: 1.07, 3.01) and no toilet facility (OR = 1.60; CI: 1.07, 2.38). The key risk factors for anemia in the older age group were no micronutrient intake (OR = 1.69; CI: 1.23, 2.31), having a young mother (OR = 1.35; CI: 0.84, 1.91) and a non- working mother (OR = 1.50; CI: 1.15, 1.96). Moreover, no deworming, small birth weight and residing in a large household size were key risk factors in both age groups. Conclusions Strengthening both nutrition sensitive and nutrition specific interventions may help curb the consistently higher prevalence of anemia. Intervention strategies should consider the unique characteristics of regions and rural residences where the prevalence of anemia is above the national average. Funding Sources N/A.

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Disparities in the prevalence and risk factors of anaemia among children aged 6–24 months and 25–59 months in Ethiopia

Journal of Nutritional Science ◽

10.1017/jns.2020.29 ◽

2020 ◽

Vol 9 ◽

Author(s):

Tafere Gebreegziabher ◽

Nigatu Regassa ◽

Micaela Wakefield ◽

Kelly Pritchett ◽

Susan Hawk

Keyword(s):

Risk Factors ◽

Age Groups ◽

Water Source ◽

Older Age ◽

Health Concern ◽

Age Group ◽

African Countries ◽

Piped Water ◽

Younger Age ◽

Sub Saharan

Abstract Despite global efforts made to address anaemia, the prevalence remains high in most Sub-Saharan African countries. In Ethiopia, anaemia poses a very strong public health concern. The purpose of the present study was to examine the key risk factors related to anaemia among children aged 6–24 months (younger age group) and 25–59 months (older age group). We used the 2016 Ethiopian Demographic and Health Survey data, collected from 11 023 mothers with under five children. Ordered logistic regression modelling was used for assessing risk factors of childhood anaemia. The results suggest that the prevalence of anaemia was 72 % in the younger and 49 % in the older age groups. The risk factors for anaemia in the younger age group were morbidity (odds ratio (OR) 1⋅77; CI 1⋅21, 2⋅60), having no piped water source (OR 1⋅76; CI 1⋅07, 3⋅01) and no toilet facility (OR 1⋅60; CI 1⋅07, 2⋅38). The key risk factors for anaemia in the older age group were no micronutrient intake (OR 1⋅69; CI 1⋅23, 2⋅31), having a young mother (15–24 years old) (OR 1⋅35; CI 0⋅84, 1⋅91) and a non-working mother (OR 1⋅50; CI 1⋅15, 1⋅96). Anaemia also varied by region, place of residence and economic factors. Multiple factors contributed to the high prevalence of anaemia. Given the structural problem that the country has intervention strategies should consider the unique characteristics of regions and rural residences where the prevalence of anaemia is above the national average.

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Characteristics of the treatment of perennial allergic rhinitis in patients of the older age group

Medical Council ◽

10.21518/2079-701x-2018-20-107-110 ◽

2018 ◽

pp. 107-110

Author(s):

K. I. Sapova ◽

S. V. Ryazantsev

Keyword(s):

Allergic Rhinitis ◽

Clinical Study ◽

Older Patients ◽

Older Age ◽

Age Group ◽

Perennial Allergic Rhinitis ◽

Physiological Factors ◽

Age Related ◽

Persistent Allergic Rhinitis ◽

Multicenter Clinical Study

Recent studies show that perennial allergic rhinitis is prevalent among older people, but the management of this disease is underestimated and not determined. This article describes the persistent allergic rhinitis in patients of the older age group and identifies the primary goals of treatment based on the age-related physiological factors, concomitant conditions and the use of other drugs. Special attention is paid to the various options for the drug therapy in elderly patients over the age of 60 years. The second-generation antihistamines and intranasal glucocorticosteroids also have primacy over other drugs, when supervising older patients. A randomized open multicenter clinical study showed that Momate Rhino Advance (a combination of intranasal antihistamines (azelastine) and intranasal glucocorticosteroids (mometasone) for the treatment of allergic rhinitis) made by Indian Glenmark Pharmaceuticals Ltd. is effective and safe in patients aged 60 years and older, who are diagnosed with the above disease.

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Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e19556 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e19556-e19556

Author(s):

Kitsada Wudhikarn ◽

Radhika Bansal ◽

Arushi Khurana ◽

Matthew Hathcock ◽

Michael Ruff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Older Patients ◽

Clinical Course ◽

International Prognostic Index ◽

Age Groups ◽

Central Nervous System Involvement ◽

Microvascular Disease ◽

B Cell Lymphoma ◽

Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

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Clinical Characteristics, Risk Factors and Predictive Value of COVID-19 Pneumonia: A Retrospective Study of 173 Patients in Wuhan, China

10.21203/rs.3.rs-76134/v1 ◽

2020 ◽

Author(s):

Yang Zhang ◽

Jun Xue ◽

Mi Yan ◽

Jing Chen ◽

Hai Liu ◽

...

Keyword(s):

Risk Factors ◽

Predictive Model ◽

Disease Severity ◽

Roc Curve ◽

Predictive Value ◽

Older Patients ◽

Clinical Characteristics ◽

Lactic Dehydrogenase ◽

Older Age ◽

Hospital Outcome

Abstract Background: COVID-19 is a globally emerging infectious disease. As the global epidemic continues to spread, the risk of COVID-19 transmission and diffusion in the world will also remain. Currently, several studies describing its clinical characteristics have focused on the initial outbreak, but rarely to the later stage. Here we described clinical characteristics, risk factors for disease severity and in-hospital outcome in patients with COVID-19 pneumonia from Wuhan. Methods: Patients with COVID-19 pneumonia admitted to Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 13 to March 8, 2020, were retrospectively enrolled. Multivariable logistic regression analysis was used to identify risk factors for disease severity and in-hospital outcome and establish predictive models. Receiver operating characteristic (ROC) curve was used to assess the predictive value of above models.Results: 106 (61.3%) of the patients were female. The mean age of study populations was 62.0 years, of whom 73 (42.2%) had underlying comorbidities mainly including hypertension (24.9%). The most common symptoms on admission were fever (67.6%) and cough (60.1%), digestive symptoms (22.0%) was also very common. Older age (OR: 3.420; 95%Cl: 1.415-8.266; P=0.006), diarrhea (OR: 0.143; 95%Cl: 0.033-0.611; P=0.009) and lymphopenia (OR: 4.769; 95%Cl: 2.019-11.266; P=0.000) were associated with severe illness on admission; the area under the ROC curve (AUC) of predictive model were 0.860 (95%CI: 0.802-0.918; P=0.000). Older age (OR: 0.309; 95%Cl: 0.142-0.674; P=0.003), leucopenia (OR: 0.165; 95%Cl: 0.034-0.793; P=0.025), increased lactic dehydrogenase (OR: 0.257; 95%Cl: 0.100-0.659; P=0.005) and interleukins-6 levels (OR: 0.294; 95%Cl: 0.099-0.872; P=0.027) were associated with poor in-hospital outcome; AUC of predictive model were 0.752 (95%CI: 0.681-0.824; P=0.000).Conclusion: Older patients with diarrhea and lymphopenia need early identification and timely intervention to prevent the progression to severe COVID-19 pneumonia. However, older patients with leucopenia, increased lactic dehydrogenase and interleukins-6 levels are at a high risk for poor in-hospital outcome.Trial registration: ChiCTR2000029549

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Advanced and metastatic renal cell carcinoma – Ain Shams Clinical Oncology Department Experience

Journal of Solid Tumors ◽

10.5430/jst.v10n1p18 ◽

2020 ◽

Vol 10 (1) ◽

pp. 18

Author(s):

Ahmed Nagy ◽

Mona Kamal ◽

Hesham El Halawani

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Clinical Oncology ◽

Renal Cell ◽

Older Patients ◽

Treatment Options ◽

Tumor Grade ◽

Kaplan Meier ◽

Younger Age

Background: Renal cell carcinoma is a rare tumor and till recently few treatment options were available. It is poorly understood why people develop RCC since only a few etiologic factors have been clinically identified as risk factors for RCC.Purpose: To analyze our experience at Ain Shams University Clinical Oncology department in Egypt with patients presenting with advanced renal cell carcinoma to provide a correlations between clinic-pathological factors, treatment and survival outcomes.Methodology: Retrospective review of the data of 54 patients who were diagnosed as RCC and presented to Ain Shams University Clinical Oncology department in Egypt from 1 May 2013 till 1 May 2015. Descriptive and clinic-pathological data were described using simple and relative frequencies. Survival outcome for the patients will be described using Kaplan Meier curves stratified according to morphology, age group and treatment received.Results: The sample included 54 patients (53.7% were males) of whom 14.3% were less than 40 years and 3.7% were elderly (≥ 70 years old). The median age was 55.5 years (SD ± 13.6 , range 19-71). Median PFS was 6.5 months (SD ± 12.3846 Range 43) while the median OS was 13 months (SD ± 12.161 Range 46). PFS in patients aged below 55.5 years was 9 months (95% CI=6.509-11.491) compared to 4 months (95% CI=2.704-5.296) in older patients (p = .004). PFS in patients who achieved PR after sunitinb was 17 months (95% CI=6.916-27.084) compared to 5 months (95% CI=3.699-6.301) in patients who didn’t achieved PR (p < .001). OS in patients aged below 55.5 years was 15 months (95% CI=9.131-20.869) compared to 11 months (95% CI=8.947-13.053) in older patients (p = .012). Favorable pathology status was associated with prolonged OS of 14 months (95% CI= 9.403-18.597) versus 11 months (95% CI=8.363-13.637) for unfavourable pathology status (p = .11). Low grades histopathogy was associated with prolonged OS of 44 months (95% CI= 38.456-49.544) versus 12 months (95% CI=10.077-13.923) for higher grades (p = < .001).Conclusion: Multivariate analyses supported a conclusion that younger age was an independent prognostic factor for survival along with other known risk factors such as tumor grade and pathology status.

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TSH enhancement of FT4 to FT3 conversion is age dependent

Acta Endocrinologica ◽

10.1530/eje-16-0007 ◽

2016 ◽

Vol 175 (1) ◽

pp. 49-54 ◽

Cited By ~ 27

Author(s):

David Strich ◽

Gilad Karavani ◽

Shalom Edri ◽

David Gillis

Keyword(s):

Age Groups ◽

Thyroid Stimulating Hormone ◽

Older Age ◽

Age Group ◽

Free T4 ◽

Free T3 ◽

Age Related ◽

Differential Increase ◽

Retrospective Examination ◽

Tsh Levels

ObjectiveWe previously reported increasing free T3 (FT3) to free T4 (FT4) ratios as thyroid-stimulating hormone (TSH) increases within the normal range in children. It is not known if this phenomenon is age-related among humans, as previously reported in rats. This study examines the relationships between TSH and FT3/FT4 ratios in different ages.DesignRetrospective examination of thyroid tests from patients without thyroid disease from community clinics.MethodsFree T3, free T4, and TSH levels from 527 564 sera collected from patients aged 1 year or greater were studied. Exclusion criteria were the following: missing data, TSH greater than 7.5mIU/L, and medications that may interfere with thyroid hormone activity. A total of 27 940 samples remaining after exclusion were stratified by age. Samples with available anthropometric data were additionally stratified for body mass index (BMI). Correlations of TSH to FT4, FT3, and FT3/FT4 ratios by age group were examined.ResultsUp to age 40, for each increasing TSH quartile, FT3 and the FT3/FT4 ratio increased and FT4 decreased significantly (for both FT3, FT4 and FT3/FT4 ratio,P<0.05 for every TSH quartile when compared with the 1st quartile, except FT3 in the 30–40 age group). In older age groups, increasing TSH was not associated with increased FT3/FT4 ratio.ConclusionAs TSH levels increase, FT3/FT4 ratios increase until age 40, but this differential increase does not occur in older age groups. This may reflect a decrease in thyroxine (T4) to triiodothyronine (T3) conversion with age, which may be part of the aging process.

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