Development of a Frailty Score for Older Patients with Myelodysplastic Syndromes and Acute Myeloid Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1775-1775
Author(s):  
Barbara Deschler ◽  
Gabriele Ihorst ◽  
Uwe Platzbecker ◽  
Ulrich Germing ◽  
Michael Lübbert
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Activities Of Daily Living ◽  
Cell Transplantation ◽  
Daily Living ◽  
Older Patients ◽  
Treatment Allocation ◽  
Frailty Score

Abstract Abstract 1775 Poster Board I-801 Introduction Treatment options in older patients (pts) with MDS/AML range from best supportive care (BSC) to intensive chemotherapy/hematopoietic stem cell transplantation (IC/HCT), with low-dose chemotherapy or novel non-intensive agents (e.g. hypomethylating agents; HA) as alternatives. Due to frequent age-related physical and/or mental impairments, intensive treatment is not always feasible. As the basis for treatment decision-making is not well defined, the generation of comprehensive assessments of age-specific functional and quality of life (QOL)-aspects in addition to disease-specific risk factor definition therefore is urgently needed. Geriatric Assessment (GA) is expected to offer rational support in this process. Patients and Methods Since January 2004, we have prospectively evaluated the prognostic impact of GA on overall survival (OS) in 195 consecutive pts ≥60 years (yrs) with AML (n=132) or MDS (n=63) in three participating centers, receiving either BSC or HA+BSC or IC/HCT. Of the pts receiving non-intensive treatment, 50% had MDS. GA included eight instruments evaluating QOL, activities of daily living, depression, mental functioning, mobility, comorbidities and performance status (PS). In addition, disease- and patient-specific laboratory parameters were obtained. Results Median age of pts was 71 yrs (range: 60-87 yrs). The primary treatment allocation was BSC in 47 pts (median age: 75 yrs); HA+BSC in 66 pts (74 yrs); IC/HCT in 75 pts (68 yrs). 62% of IC/HCT pts received a matched related/unrelated stem cell transplantation. Application of age-specific tests at the different study centers was readily feasible. The initial multidimensional GA was associated with treatment allocation, age, hematological and functional parameters and treatment outcome. Multivariate analyses revealed impairments in activities of daily living (ADL: Barthel Test, HR: 2.22) and fatigue (measured by EORTC QLQ-C30; HR: 1.68) as significant prognostic parameters for overall survival. Both risk factors were combined to construct a simple risk score for survival. Conducting a Cox regression model with established risk factors, a high risk frailty score in the entire pt population was associated with an elevated HR of 4.17 (p<0.0001), while adverse cytogenetics (AML), blasts >20% and comorbidities >1 proved to be independently associated with HRs of 2.491 (p=0.0001), 2.756 (p=0.0005) and 1.495 (p=0.1281). When this score was applied to pts receiving sole BSC or HA+BSC, highly significant differences in OS could be demonstrated, with p=0.0035 and p<0.0001, respectively. Conclusions Our data demonstrate that GA is a useful and objective tool in the in-depth evaluation process prior to treatment allocation in elderly patients with MDS/AML. A simple prognostic score based solely on ADL and fatigue to predict outcome of patients treated non-intensively has been established. Validation in independent cohorts appears warranted. Disclosures No relevant conflicts of interest to declare.

Outcome and Prognostic Factors for Patients Who Relapse After Allogeneic Stem Cell Transplantation.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3069-3069
Author(s):  
Gita Thanarajasingam ◽  
Haesook T Kim ◽  
Corey Cutler ◽  
Vincent T. Ho ◽  
John Koreth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Stem Cell ◽  
Prognostic Factors ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Risk Score ◽  
Disease Risk ◽  
Part Selection ◽  
The Impact

Abstract Abstract 3069 Disease relapse remains a major obstacle to the success of allogeneic hematopoietic stem cell transplantation (HSCT) for patients with hematologic malignancies (HM), and the principal cause of failure after reduced intensity conditioning HSCT. Much work has focused on identifying the risk factors for relapse and devising strategies for its prevention, but comparatively little is known about the outcome of patients who relapse and the relevant prognostic factors in this setting. We conducted a retrospective study of 1080 consecutive adult patients with HM transplanted at our institution between 2004 and 2008. 351 (33%) relapsed at a median of 4.5 months after HSCT. The 4-year post-relapse overall survival (pr-OS) was 15%, with a median post-relapse follow-up of 39 months. Significant risk factors for post-relapse mortality included shorter time to relapse, higher disease risk index1 at HSCT, myeloablative conditioning, and high HCT-CI2 at HSCT. While being on immunosuppression at the time of relapse did not significantly affect outcome in multivariable models, a history of acute or chronic graft-versus host disease (GVHD) prior to relapse conferred a higher risk for death after relapse. Based on those 5 factors and their hazard ratio for mortality in the Cox models, we constructed a simple risk score that stratified patients into 4 groups, with 4-year pr-OS ranging from 64% in patients with fewer than 3 points (13% of the cohort, among whom over one third had myeloid diseases) to 0% in those with greater than 6 points (p<0.0001) (Figure). This score performed similarly in a historical validation cohort of 276 relapsed patients who were transplanted between 1998 and 2003. An analysis of the impact of post-relapse treatment on outcome showed that immune manipulation, through either donor lymphocyte infusion or repeat HSCT, was associated with significantly better pr-OS (4-year pr-OS 28% versus 9%, p<0.0001). Even though this likely reflects in part selection bias, the difference remained significant in models that accounted for other post-relapse prognostic factors, in landmark analyses of patients who survived at least 2 months from relapse, and in patients with active GVHD at the time of relapse. The results of this study may aid with prognostication and management of patients who relapse after HSCT, as well as motivate the design of clinical trials aimed at relapse prevention or treatment in the higher-risk groups. Figure. Post-Relapse Overall Survival by risk score. Figure. Post-Relapse Overall Survival by risk score. Risk factors are: Disease Risk Index (0 points for low risk, 1 point for intermediate, 2 points for high or very high)1Time to relapse (0 points for >24 months, 1 point for 6–24 months, 2 points for 3–6 months, 3 points for <3 months)HCT-CI (0 points for index of 0–2, 1 point for index of 3+)2Myeloablative conditioning (1 point)Prior GVHD (1 point) Disclosures: No relevant conflicts of interest to declare.

scholarly journals Risk Factors and Outcomes for Patients With Follicular Lymphoma Who Had Histologic Transformation After Response to First-Line Immunochemotherapy in the PRIMA Trial

2016 ◽  
Vol 34 (22) ◽  
pp. 2575-2582 ◽  
Author(s):  
Clémentine Sarkozy ◽  
Marek Trneny ◽  
Luc Xerri ◽  
Nick Wickham ◽  
Pierre Feugier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Follicular Lymphoma ◽  
Disease Progression ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
International Prognostic Index

Purpose To study the outcome of histologic transformation (HT) in a large prospective cohort of patients with follicular lymphoma (FL) who previously responded to immunochemotherapy. Patients and Methods After a median 6-year follow-up of 1,018 randomly assigned patients from the PRIMA trial, disease progression was observed in 463 patients, 194 of whom had histologic documentation. Results Forty patients had histology consistent with HT, and 154 had untransformed FL (median time to recurrence, 9.6 v 22.8 months, respectively; P = .018). Thirty-seven percent of biopsies performed during the first year of follow-up showed HT corresponding to 58% of all HTs. Altered performance status, anemia, high lactate dehydrogenase level, “B” symptoms, histologic grade 3a, and high Follicular Lymphoma International Prognostic Index scores at diagnosis were identified as HT risk factors. Response (complete v partial) to immunochemotherapy or rituximab maintenance had no impact on the risk of HT. After salvage treatment, patients with HT had less frequent complete response (50.3% v 67.4%; P = .03) and more disease progression (28.2% v 9.6%; P < .001) than patients without HT. Estimated overall survival for the patients with HT was poorer (median, 3.8 v 6.4 years; hazard ratio, 3.9; 95% CI, 2.2 to 6.9). Autologous stem cell transplantation improved the outcomes of patients with HT (median overall survival, not reached v 1.7 years) but not of patients with persistent FL histology. Conclusion HT in patients with FL who previously responded to immunochemotherapy is an early event associated with a poor outcome that may deserve intensive salvage with autologous stem cell transplantation. These data emphasize the necessity for biopsy at the first recurrence of FL.

Risk Factors of GANCICLOVIR–RELATED Neutropenia After Allogeneic STEM CELL Transplantation: A Retrospective Monocenter Study On 547 Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4186-4186
Author(s):  
Geoffroy Venton ◽  
Roberto Crocchiolo ◽  
Jean El-Cheikh ◽  
Sabine Furst ◽  
Angela Granata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Antiviral Therapy ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Cmv Reactivation ◽  
Related Mortality

Abstract Abstract 4186 Introduction: Cytomegalovirus (CMV) disease is a serious complication that may occur in the weeks or months following bone marrow transplantation. Therefore it must be treated as soon as positive CMV reactivation is noticed: pre-emptive therapy has demonstrated to improve survival among patients reactivating CMV after transplantation. However, GANCICLOVIR (GCV) as well as CMV infection itself involves a well-know marrow toxicity, notably neutropenia that may consequently expose these immunosuppressed patients to life-threatening bacterial and/or fungal infections. So far, only two studies specifically identified risk factors and outcome of GCV –related neutropenia, finding low marrow cellularity between day 21 and 28, hyperbilirubinemia > 6mg/dl during the first 20 days, serum creatinine > 2mg/l after day 21, and absolute neutrophil count as predictive factors. However, transplantation has evolved in recent years, especially thanks to the reduce intensity conditioning (RIC) and supportive care. The present analysis aims at identifying risk factors of neutropenia among a large cohort of patients treated by pre-emptive GCV who received allogeneic stem cell transplantation at our Institution over last years. Patients and Methods: This is a retrospective study on a cohort of 547 consecutive patients allografted from January 2005 to June 2011 at our Institution. Diagnoses were: acute myeloid and lymphoblastic leukemia, non-Hodgkin's lymphoma, Hodgkin's disease, chronic lymphocytic leukemia, myeloproliferative and myelodisplasic syndromes, aplastic anemia, metastatic solid tumor. Transplants were performed using three sources: bone marrow, peripheral blood stem cells, cord blood; patients receiving haploidentical transplant were excluded. Donors were HLA-sibling and matched or mismatched unrelated ones. Myeloablative, non-myeloablative and RIC regiments were administered according to local guidelines or established protocols. The principal objective of the study was to identify factors associated with the occurrence of grade 3–4 neutropenia among patients receiving antiviral therapy due to CMV reactivation. Secondarily, overall survival (OS), transplant-related mortality (TRM) and relapse/progression were analyzed and compared between patients who reactivated CMV vs. those who did not. Results: A total of 547 patients were included in the analysis. One hundred ninety patients presented CMV reactivation (34.7%). Thirty patients were excluded from the analysis because they already had neutropenia at the time of reactivation. Finally one hundred and sixty patients were analyzed. We found that ANC above 3000 is a protective factor, (HR= 0.26, CI 95 %, 0.125–0.545, p < 0001); creatinine <2ml/dl after 21 days is a risk factor for GCV- related neutropenia (HR= 2.4, CI 95%, 1.11 – 5.17, p = 0.002) as well as a high viral load (HR=2.68, CI 95%, 1.25–5.737, p = 0.01). Using landmark analysis at day +100, overall survival (OS) at five years is lower for patients with CMV reactivation 43% (32–54) vs. 57% (46–68), p<0.0001. As concerns treatment-related mortality (TRM), we found a higher TRM among patients who developed CMV reactivation: 29% (21–36) vs. 12% (8–17), p=0.003. There is no significant difference in the risk of relapse in patients who reactivated CMV vs. those who did not reactivate 32 % vs. 34 % (p=n.s.). In conclusion, this large analysis revealed three risk factors of GCV-related neutropenia among patients with CMV reactivation after allogeneic hematopoietic stem cell transplantation; prompt identification of patients at risk when antiviral therapy is started may allow clinicians to adopt adequate preventive measures, thus potentially reducing morbidity and mortality associated with CMV reactivation. Disclosures: No relevant conflicts of interest to declare.

Risk Factors For Readmission Following Allogeneic Hematopoietic Stem Cell Transplantation and Impact On Overall Survival

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 555-555
Author(s):  
Laura Spring ◽  
Shuli Li ◽  
Robert J. Soiffer ◽  
Joseph H. Antin ◽  
Edwin P. Alyea ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Significant Risk ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
The Impact

Abstract Background Recent initiatives to improve patient safety and reduce healthcare costs have focused on preventing hospital readmissions. Historically, patients treated with allogeneic hematopoietic stem cell transplantation (HSCT) have high rates of hospital readmission. The purpose of this study was to identify the incidence and associated risk factors for readmissions in allogeneic HSCT patients and to evaluate the impact of readmissions on overall survival. Methods A retrospective review of patients receiving a myeloablative (MAC) or reduced intensity conditioning (RIC) HSCT at Dana Farber/Brigham and Women’s Hospital between January 1, 2005 and December 31, 2010 was performed. At our institution, RIC transplant patients are typically discharged on day +1. The 30-day readmission rate, a standard benchmark used by the Centers for Medicare & Medicaid Services, and the day 100, a traditional assessment point in transplantation, readmission rates were examined. Reasons for readmission as well as sociodemographic, disease, and HSCT-related variables were evaluated. Risk factors for readmission and the impact of readmission on overall survival were assessed by multivariate regression analysis. Results A total of 1097 HSCT patients were reviewed. In the MAC group, 130 of 495 (26.3%) patients were readmitted within 30 days of discharge and 194 (39.2%) patients were readmitted by day 100 following transplantation. 74.2% of the MAC patients had one readmission by day 100. In the RIC group, 105 of 602 (17.4%) patients were readmitted within 30 days of discharge and 185 (30.7%) patients were readmitted by day 100 following transplantation. 69% of the RIC patients had one readmission by day 100. In both groups, the most frequent reasons for readmission were infection (27.6% in MAC group, 26% in RIC group), fever without a source (19.1% in MAC group, 19% in RIC group), and graft versus host disease (17.9% in MAC group, 15.1% in RIC group). In the MAC group, a multivariate logistic regression model of the probability of being readmitted suggested that the principal risk factors for readmission by day 100 were infection during the index transplant admission (OR 1.9, p=0.0006) and Latino ethnicity (OR 4.6, p=0.013). In the RIC group, active disease at the time of HSCT (OR 2.1, p=0.0001), infection during the index admission (OR 4.8, p<0.0001), a mismatched donor (OR 2.1, p=0.030) and non-private (32.1% Medicaid, 66.4% Medicare, 1.5% other) insurance (OR 1.6, p=0.029) were significant risk factors for readmission by day 100. In a landmark analysis of patients who survived beyond the studied time points, the 5-year overall survival (OS) for those readmitted within 30 days of discharge from the index HSCT in the MAC group was 42% compared with 56% among patients not readmitted (p=0.0026). Similarly, OS in the RIC group was 26% compared with 50% (p<0.0001). The 5-year OS for those readmitted by day 100 following HSCT in the MAC group was 52% compared with 61% among patients not readmitted (p=0.058) and in the RIC group was 26% compared with 57% (p=<0.0001). After adjusting for age, donor type, and the disease risk index (DRI), a multivariate analysis confirmed that readmission within 30 days of discharge or by day 100 was associated with decreased OS (table 1). Conclusions Infection and fever without a source were the most common causes of readmission after HSCT. In the RIC group, disease, transplant, and sociodemographic factors were associated with readmission. Being readmitted within 30 days of discharge from transplant was a significant risk factor for a lower 5-year overall survival rate in both the RIC and MAC groups. A better understanding of the risk factors for readmission in the HSCT population will allow for more transitional care and clinical resources to be focused on the highest risk patients. Strategies to decrease readmissions may improve the overall survival of patients undergoing allogeneic HSCT. More research is needed to better learn how to balance early discharge with preventable readmissions. Disclosures: No relevant conflicts of interest to declare.

Analysis of Risk Factors and Outcome for Extramedullary Relapses Post Allogeneic Stem Cell Transplantation for Myeloma.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4562-4562
Author(s):  
Myo Htut ◽  
Firoozeh Sahebi ◽  
George Somlo ◽  
Pablo Parker ◽  
Chatchada Karanes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Risk Ratio ◽  
Allogeneic Stem Cell Transplantation ◽  
Novel Agents ◽  
Cell Transplant ◽  
Allogeneic Hsct

Abstract Abstract 4562 Analysis of Risk Factors and Outcome for Extramedullary Relapses post Allogeneic Stem Cell Transplantation for Myeloma Relapse after both autologous and allogeneic hematopietic stem cell transplant (HSCT) is common in multiple myeloma (MM). Unusual sites of relapse have been reported after allogeneic HSCT in the form of isolated extramedullary (EM) lesion or light chain escape. It is hypothesized that these EM relapses are due to changes in the marrow microenvironment or selection of resistant subclones from therapy with novel agents and or allogeneic stem cell transplantation. Several case reports have shown that EM relapse is associated with dismal prognosis compared to medullary or bone marrow (BM) relapse. To study the relapse patterns and outcome, we performed a retrospective analysis of 56 pts who underwent tandem autologous-nonmyeloablative allogeneic HSCT (auto-allo) or reduced intensity conditioning (RIC) allogeneic transplant. Between January, 2000 to March 2008, 38 pts received planned auto-allo HSCT using melphalan (200 mg/m2) prior to auto-HSCT and TBI (200 cGy) prior to allo-HSCT and 18 pts received RIC allo-HSCT following fludarabine (125mg/m2) and melphalan 140mg/m2. Donors included 52 HLA matched siblings and 4 matched unrelated donors.Table 1.Patients characteristicsParametersPts without relapse (n)BM relapse (n)EM relapse (n)P-valueTotal number of patients33167.Age at transplant (median, yr.)50.85154.10.84Interval between diagnosis-transplant (median, mo.)11.79.414.60.12B2-micr (median)2.06 (1.18-10)1.67 (1.28-2.15)2.08 (0.79- 9.05)0.15Median f/u for alive pts (yr.)6.88.79.6.Type of transplant....Auto- allo graft70% (23)69 % (11)57 % (4)0.84RIC30% (10)31% (5)43% (3)Response before allograft....CR/PR64% (21)56% (9)71% (5)0.79MR/SD/RE/refractory36% (12)44% (7)29% (2)Stage III disease at the time of transplant78% (25)81% (13)100% (7)0.94Ch 13 del at dx18% (6)12% (2)29% (2)0.69Novel agent prior to transplant45% (15)38% (6)57% (4)0.74 RESULTS After a median follow up of 7.8 years; there were 16 BM and 7 EM relapses. There was no correlation between either relapse or the pattern of relapse (BM and EM) and development of acute and chronic graft vs. chronic disease (GVHD). The risk ratio for BM relapse in 5 year is 0.27 for patients with chronic GVHD (cGVHD) and 0.15 for patients without cGVHD (P=0.69). The risk ratio for EM relapse in 5 year is 0.12 for patients with cGVHD and 0.25 for patients without cGVHD (P=0.10) (Figure 1). Overall survival (OS) and progression-free survival (PFS) for the whole group (N=56) is shown in figure 1. Four year OS was 43% in EM group and 88% in BM group (P=0.005) (Figure 3). There were no significant differences between age, B2 microglobulin, numbers of treatment before HSCT, use of novel agents before HSCT, cytogenetics, stage, transplant regimen and development of GVHD and pattern of relapse (BM vs. EM). In conclusion our data suggest that EM relapse can occur post allogeneic HSCT and is associated with shorter overall survival. The development of GVHD does not prevent against EM relapse. Disclosures: No relevant conflicts of interest to declare.

P1825ANALYSIS OF LATE RENAL COMPLICATIONS AND RISK FACTORS IN CHILDREN WITH HEMATOPOIETIC STEM CELL TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anar Gurbanov ◽  
Bora Gülhan ◽  
Barış Kuşkonmaz ◽  
Fatma Visal Okur ◽  
Duygu Uçkan Çetinkaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem ◽  
Renal Complications

Abstract Background and Aims The aim of the study is to investigate the incidence and risk factors of hypertension (HT) and chronic kidney disease (CKD) in patients who had hematopoietic stem cell transplantation (HSCT) during their childhood. Method Patients who had HSCT between January 2010-2019 with a minimum follow-up period of 6 months were included in the study. Data regarding renal complications were collected from the medical records of the patients. Guidelines of European Society of Hypertension (ESH) and American Academy of Pediatrics (APA) were used for the evaluation of hypertension. 24-hr ambulatory blood pressure monitoring (ABPM) was performed in children older than 5 years of age (68 patients). Ambulatory hypertension is diagnosed when systolic and/or diastolic blood pressure (BP) load is higher than 25%. Ambulatory prehypertension is diagnosed when mean systolic and/or diastolic BP is less than 95th percentile with systolic and/or diastolic BP load higher than 25%. Results A total of 72 patients (41 males and 31 females) were included in the study. The mean age of the patients at last visit was 10.8±4 years. ABPM revealed ambulatory HT in 6 patients (8.8%) and ambulatory prehypertension in 12 patients (17.6%). Office BP revealed HT in 3 patients (4.2%) and increased BP in four patients (5.6%) according to APA guideline (2017). In cohort, 12 patients with normal office BP (according to APA guideline) had ambulatory prehypertension or hypertension with ABPM. Office BP revealed HT in 1 patient (1.4%) and high-normal BP in 3 patients (4.2%) according to ESH guideline. In cohort, 15 patients with normal office BP (according to ESH guideline) had ambulatory prehypertension or hypertension with ABPM (Table 1). After a mean follow-up period of 4.4±2.5 years, CKD developed in 8 patients (11.1%). Patients with chronic graft-versus-host disease, with HLA-mismatched HSCT and/or transplantation of peripheric or cord blood hematopoietic stem cells had increased risk of CKD (p=0.041, p=0.033 and p=0.002, respectively). Conclusion Patients with HSCT should be regularly followed for the development of HT and ABPM should be used on regular basis. Patients with risk factors should be closely monitored for the development of CKD.

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