A Population-Based Study In Acute Myeloid Leukemia (AML) Suggests Improved Overall Survival (OS) up to Age 80 with Intravenous Therapy: 2000–2007 Data From the Surveillance, Epidemiology, and End Results (SEER)-Medicare Registry In the United States (US),

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3589-3589
Author(s):  
Betul Oran ◽  
Daniel J. Weisdorf ◽  
Beth Virnig
Keyword(s):  
Treatment Group ◽  
Age Groups ◽  
Human Leukocyte ◽  
The United States ◽  
Population Based ◽  
Older Age ◽  
Hla Typing ◽  
Hypomethylating Agents ◽  
Intravenous Therapy ◽  
Hematopoietic Stem

Abstract Abstract 3589 Background: AML is the most common leukemia among US adults with median age of 69. Earlier 1990s studies reported a median OS was 2.4 months among patients older than age 65. Considering the trends in older AML treatment might have changed during the last decade, we investigated clinical practice for older AML patients. Methods: Patients age ≥ 66 in the National Cancer Institute's (NCI) SEER cancer registry with a first, primary cancer of AML diagnosed between January 2000 and December 2007 were matched to their Medicare Part A and Part B claims for long-term follow-up. Diagnostic evaluation and treatment patterns with disease outcomes were assessed. There were 4633 AML patients identified, and 1791(38.6%) received intravenous leukemia therapy within 3 months of diagnosis (treatment group). Treated patients then were sub-grouped as receiving chemotherapy (chemo) (94.9%) and hypomethylating agents (hypo) (5.1%). Results: The median age of the study population was 78. Treatment group had similar demographics compared to the no treatment group except they were younger (median age, 74 vs. 80, p<0.01) and more were male (56.9 % vs. 48.8%, p<0.01). Median Charlson comorbidity score (CCS) were similar (median, 0) but less patients in treatment group had CCS ≥ 2 (13.0% vs. 20.1%, p<0.01). Patients in treatment group received more extensive diagnostic work-up including: flow cytometry (72.3% vs. 50.8%, p<0.01), cytogenetics (48% vs. 27.4%, p<0.01) and human leukocyte antigen (HLA) typing (6.8% vs. 0.6%, p<0.01). Median OS was 3 months, but superior in the treatment group (7 mo. vs. 2 mo, p<0.01). This benefit was demonstrable in all age groups with greatest improvements in age 66–69 (10 mo. vs. 4 mo, p<0.01) and 70–74 (8 mo. vs. 3 mo, p<0.01) (Figure 1). Older age and CCS ≥2 were also associated with decreased OS (HR=1.04 (for each year), p<0.01 and HR=1.3, p<0.01 respectively). Within the treatment group, 2-month mortality after treatment was 31.2 % with the lowest level in age groups 66–69 and 70–74 (19.8 % and 25.2 %). Logistic regression analyses revealed that older age and CCS ≥2 were significantly associated with higher 2-month mortality (HR=1.08 (for each year), p<0.01 and HR=1.3, p<0.01 respectively). Among treated patients, a subgroup analysis of 91 patients receiving hypo showed that they were older than chemo group (median age 78 vs. 74, p<0.01), but had similar CSS scores. Although OS with hypo was increased compared to chemo group (9 mo. vs. 6 mo.) in multivariate analysis this difference was not significant (HR=1.25, p=0.07). Hematopoietic stem cell transplantation (HCT) was performed only in 57 patients (1.2%) after AML diagnosis. Median time to HCT after AML diagnosis was 6 months. These patients were younger (median age 66 vs. 73 in other treated patients) and none had CSS scores >2 (0% vs. 6.1%). Their median OS from diagnosis was 25 months. Conclusion: Intravenous therapy improves OS in older AML patients and most patients up to 80 years of age should be considered for treatment based on their comorbidity status. New therapies including hypomethylating agents and allogeneic HCT are promising and must be compared with other chemotherapy in the appropriately selected population. Disclosures: Weisdorf: Genzyme: Consultancy, Research Funding.

Descriptive epidemiology of meningiomas in the United States.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2099-2099
Author(s):  
John L. Villano ◽  
Stephen Todd Anderson ◽  
Therese A. Dolecek
Keyword(s):  
Age Groups ◽  
Relative Survival ◽  
Cancer Registries ◽  
The United States ◽  
Population Based ◽  
Public Law ◽  
Incidence Rates ◽  
Primary Site ◽  
Older Age ◽  
Site Location

2099 Background: Although meningioma is the most common tumor in the central nervous system (CNS), the incidence, epidemiology, and clinical outcomes have historically been poorly defined. Our analysis follows the implementation of Public Law 107–260, the Benign Brain Tumor Cancer Registries Act mandating collection of non-malignant meningiomas. Methods: Surveillance Epidemiology End Results Program (SEER) 18 registries research data on cases diagnosed during 2004-2009 with meningioma (ICD-O-3 histology codes 9530-9534 & 9537-9539) in brain or CNS primary site (C70.0-72.9, 75.1-75.3 ) were analyzed. Population-based statistics were generated using SEER*Stat 8.0.1 software. Results: A total of 35,302 cases (34,718 non-malignant; 584 malignant) were available providing a rate of 7.18/100,000, with meningioma, NOS (9530/0) the most common histology. Rates increased with age (0.13/100,000, 0-19 years; 37.78/100,000, 75+ years). The annual percentage change in incidence rates showed a statistically significant increase of 2.57% over 2004-2009. Significant increases were also observed for males, females, whites, blacks, non-Hispanics, and older age groups. The gender ratio M:F was 0.35 in the 0-49 age group and 0.48 in the 50+ age. Primary site location included cerebral meninges (83%) with almost 5% in the spinal meninges. 51% of cases were diagnosed pathologically versus imaging. However, diagnosis among 85% of spinal cases was surgically based. Older age and females were less likely to have a surgical diagnosis. 3.4% received radiation therapy (RT) with 97% receiving RT following surgery. For grade III or malignant cases, 22% received RT, and in grade 1 and 2 nearly 97% of cases did not receive RT, with older age groups less likely to receive RT. Overall survival was high, except for grade 3 or malignant cases where 5 year relative survival was 61.7%. Conclusions: Our analysis following Public Law 107–260 demonstrates an increasing incidence of meningiomas and provides new information, including a decrease in the gender difference with age. Clinical diagnosis is common and higher in women and older adults. Use of RT is low, even in malignant meningiomas, and employed following surgery. These observations were similar for white and black cases.

Abstract WP365: STARS PLUS Patient Transition Pilot Program

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Alexandra Graves ◽  
Angie West ◽  
Miranda N Bretz ◽  
Marie Welch ◽  
Lynn Toth ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Age Groups ◽  
The United States ◽  
Lifestyle Changes ◽  
Older Age ◽  
Stroke Survivors ◽  
Pilot Program

Background: As the leading cause of adult disability and the fourth leading cause of death in the United States, stroke prevention strategies are imperative. Arguably equal attention should be given towards both primary and secondary prevention of stroke. While much is known about medications and lifestyle changes to prevent recurrent stroke, additional research is needed to effectively ensure stroke survivors are following the recommended guidelines. Research shows that support after discharge from the hospital post-stroke is frequently inadequate. Purpose: The purpose of the Steps Against Recurrent Stroke (STARS) Plus Patient Transition Pilot Program was to design and deliver a program to facilitate optimal recovery for stroke survivors and prevent recurrent stroke. The program began at discharge from the hospital and continued through the first year of rehabilitation and recovery. Patients could opt in based on perceived benefits of support with medication management, timed educational mailings and calls about stroke recovery and recurrent stroke prevention. Results: Twelve hospitals participated; 261 patients enrolled and contact was established with 193. Outcomes were gathered based on patient self-report of health status using the Standard Form 12 (SF-12) Health Survey at 30, 90, 180 and 360 days. A total of 72 patients completed each follow-up in the full 12 months of the program. A dependent sample t-test was completed comparing participants’ 30 and 360 day follow-up scores. Results demonstrated an overall increase in subjective pain. A repeated MANOVA was conducted to compare 30 and 360 day SF-12 scores across age and subscales. Results revealed that those in the younger and older age groups reported poorer health outcomes. Conclusion: STARS Plus Program found no statistically significant change in perceived health benefits, although the majority found the program to be beneficial. Future programs should consider targeting pain management in all ages and education targeted at younger and older age groups, as they reported poorer health outcomes. The findings from this program should contribute to the guidance and insight for others developing transitional interventions for stroke survivors.

scholarly journals Stroke risk, phenotypes, and death in COVID-19

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3373-e3385 ◽  
Author(s):  
Sebastian Fridman ◽  
Maria Bres Bullrich ◽  
Amado Jimenez-Ruiz ◽  
Pablo Costantini ◽  
Palak Shah ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Respiratory Symptoms ◽  
Stroke Risk ◽  
Age Groups ◽  
The United States ◽  
Older Age ◽  
Systematic Search ◽  
Comorbid Conditions ◽  
Clinical Phenotypes ◽  
Risk Of Death

ObjectivesTo investigate the hypothesis that strokes occurring in patients with coronavirus disease 2019 (COVID-19) have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population.MethodsWe performed a systematic search resulting in 10 studies reporting stroke frequency among patients with COVID-19, which were pooled with 1 unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in patients with COVID-19 (n = 125), and we pooled these data with 35 unpublished cases from Canada, the United States, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50–70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death.ResultsThe proportions of patients with COVID-19 with stroke (1.8%, 95% confidence interval [CI] 0.9%–3.7%) and in-hospital mortality (34.4%, 95% CI 27.2%–42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years of age relative to those >70 years of age (odds ratio [OR] 0.33, 95% CI 0.12–0.94, p = 0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbid conditions. A clinical phenotype characterized by older age, a higher burden of comorbid conditions, and severe COVID-19 respiratory symptoms was associated with the highest in-hospital mortality (58.6%) and a 3 times higher risk of death than the rest of the cohort (OR 3.52, 95% CI 1.53–8.09, p = 0.003).ConclusionsStroke is relatively frequent among patients with COVID-19 and has devastating consequences across all ages. The interplay of older age, comorbid conditions, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.

Superior Outcomes with Matched Unrelated Donors Compared with One Human Leukocyte Antigen Mismatched Related Donors In Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 907-907
Author(s):  
Stefan O. Ciurea ◽  
Rima M. Saliba ◽  
Gabriela Rondon ◽  
Poliana A. Patah ◽  
Fleur Aung ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Resolution ◽  
Graft Failure ◽  
Human Leukocyte ◽  
Hla Typing ◽  
Class I ◽  
Hematopoietic Stem ◽  
Leukocyte Antigen ◽  
Unrelated Donors ◽  
Related Donor

Abstract Abstract 907 Most candidates for hematopoietic stem cell transplantation lack a human leukocyte antigen (HLA)-identical sibling donor; however, many patients may have a related donor with whom they are mismatched at one antigen/allele. It is not known whether such a match is preferable to a matched unrelated donor (MUD). We hypothesized that, in transplantation using related donors, adding a single HLA antigen/allele mismatch, identified through high resolution HLA typing at HLA-A, -B, -C, -DRB1 and -DQB1, would be associated with worse outcomes than transplantation using matched unrelated donors. Patients and Methods: To test this hypothesis, we analyzed outcomes (survival, relapse, non-relapse mortality) of 367 patients who received transplants from either a 10/10 MUD (n=318) or a one-antigen/allele mismatched related donor (MRD) by 7/8 HLA typing (n=49) treated during the same period of time (1995-2009) at our institution. All patients had intermediate/high-resolution HLA typing at all 5 loci either prospectively or retrospectively, if treated after or before year 2002. Of the 49 patients treated with mismatched related donors, 28 patients (57%) had one antigen/allele mismatched at HLA class I or II loci (or 9/10), 18 patients (37%) had 2 alleles mismatched (or 8/10), and 3 patients (6%) had 3 alleles mismatched (or 7/10). From the 28 patients with a one-allele mismatch, 24 had class I mismatches at either HLA-A or -B loci, and 4 had class II mismatches at either HLA-DR or -DQ loci. Characteristics between the MUD group and 9/10 MRD group were similar [median age 53 vs. 47 years (p=0.08); AML/MDS diagnosis 84% vs. 82% (p=0.5); active disease at transplant 59% vs. 57% (p=0.9); myeloablatie conditioning 63% vs. 75% (p=0.2); bone marrow stem cells 58% vs. 70% (p=0.2); pentostatin use 14% vs. 11% (p=0.4); median year of transplant 2006 vs. 2004, respectively] except more patients in the MUD group received ATG (96% vs. 68%, p=0.02). Results: Outcomes at 3-years were analyzed for the 28 consecutive patients who had received a transplant from a 9/10 MRD based on 5-loci (including -DQB1) HLA typing. Graft failure was more common in patients treated from 9/10 related donors than from MUD. The incidences of primary and secondary graft failure for the 9/10 MRD were 7% and 14%, respectively, whereas none of the MUD transplant recipients had either primary or secondary graft failure (p= 0.02). Cumulative incidence of progression was 40% vs. 25% (p=0.02, HR 1.9, CI 1.1–3.9), non-relapse mortality 40% vs. 26% (p=0.05, HR 1.9, CI 1.0–3.6) and grade II-IV a GVHD was 27% vs. 38% (p=0.4, HR 0.7, CI 0.3–2.5) for the two groups, respectively. Median survival was 6 months for the 9/10 MRD vs. 18 months for the MUD group. The overall survival and progression-free survival rates were 19% and 45% (p=0.007, HR 1.8, CI 1.2–2.9) and 19% vs. 42% (p=0.006, HR1.8, CI 1.2–2.9), respectively. Outcomes for 9/10 MRD transplant patients with class I mismatches (n=24) were significantly worse than outcomes in those with MUD transplants (n=318). The 2-year actuarial OS rate was 27% for the 9/10 MRD and 48% for the MUD transplant group (HR 1.9; 95% CI 1.1 – 3.1; p=0.01). Conclusion: These results indicate that transplant outcomes for patients treated from a one-antigen/allele mismatch related donor are significantly worse than from a MUD, primarily due to increased non-relapse mortality. Patients receiving transplants form a 9/10 related donors, at least with a class I mismatch, should be treated on investigational protocols. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Influence of Covid-19 Vaccine on Daily Cases, Hospitalization, and Death Rate in Tennessee: A Case Study in the United States

2021 ◽  
Author(s):  
Ali Roghani
Keyword(s):  
Death Rate ◽  
Age Groups ◽  
Vaccination Strategy ◽  
The Elderly ◽  
The United States ◽  
Hospitalization Rate ◽  
Older Age ◽  
Study Cohort ◽  
Lower Death Rate

The COVID-19 outbreak highlights the vulnerability to novel infections, and vaccination remains a foreseeable method to return to normal life. However, infrastructure is inadequate for the whole population to be vaccinated immediately. Therefore, policies have adopted a strategy to vaccinate the elderly and vulnerable population while delaying others. This study uses the Tennessee official statistic from the onset of COVID vaccination (17th of December 2021) to understand how age-specific vaccination strategies reduce daily cases, hospitalization, and death rate. The result shows that vaccination strategy can significantly influence the numbers of patients with COVID-19 in all age groups and lower hospitalization and death rates just in older age groups. The Elderly had a 95% lower death rate from December to March; however, and no change in the death rate in other age groups. The Hospitalization rate was reduced by 80% in this study cohort for people aged 80 or older, while people who were between 50 to 70 had almost the same hospitalization rate. The study indicates that vaccination targeting older age groups is the optimal way to avoid higher transmissions and reduce hospitalization and death rate for older groups.

scholarly journals The role of HLA-typing in transplantation of hematopoietic stem cells

2017 ◽  
Vol 5 (2) ◽  
pp. 159-153
Author(s):  
V. Khomenko
Keyword(s):  
High Resolution ◽  
Molecular Genetic ◽  
Human Leukocyte ◽  
Cost Effective ◽  
Hla Typing ◽  
Potential Donor ◽  
Hematopoietic Stem ◽  
Literary Sources ◽  
Resolution Level ◽  
Typing Methods

The system of human leukocyte antigen (HLA) and HLA-typing were used to match a potential donor with a recipient for allogeneic hematopoietic stem cell transplantation (HSCT). The HLA matching between donor and recipient is key role in allogeneic HSCT. The mismatch of HLA can cause graft rejection, graft-versus-host disease and decrease survival in patients receiving grafts from both related and unrelated donors. The adverse HLA effect on the outcome depends on the total number of mismatched alleles/loci and the resolution level of the mismatch (antigen or allele level).Thus, the final choice of compatible donor-recipient pairs should be based on high resolution molecular-genetic methods of HLA-typing. Serologic and molecular genetic methods of low resolution HLA-typing, which are cheaper than HLA-typing high-resolution, should be used for donor screening studies. HSCT from a fully compatible donor, matched high-resolution HLA-typing methods gives better results than from partially compatible. In some clinical circumstances, a partially compatible donor may be as effective as fully compatible. The selection of such a donor, taking into account the controversy of data from various literary sources, should be based on own research and experience. Creation and development of a Ukrainian database of donors with the HLA-haplotype specific to the indigenous population will make search of matching pairs of donor recipients more effective and cost-effective.

Variations in the Use of Chemotherapy for Elderly Patients With Advanced Ovarian Cancer: A Population-Based Study

2002 ◽  
Vol 20 (1) ◽  
pp. 173-178 ◽  
Author(s):  
Vijaya Sundararajan ◽  
Dawn Hershman ◽  
Victor R. Grann ◽  
Judith S. Jacobson ◽  
Alfred I. Neugut
Keyword(s):  
Ovarian Cancer ◽  
Elderly Patients ◽  
Clinical Judgment ◽  
Age Groups ◽  
Advanced Ovarian Cancer ◽  
The United States ◽  
Population Based ◽  
Patient Choice ◽  
Care Utilization ◽  
Platinum Compound

PURPOSE: Since 1986, the recommended therapy for patients with ovarian cancer has included surgery and chemotherapy with a platinum compound (cisplatin or carboplatin). The purpose of this study is to assess the use of chemotherapy in elderly patients with advanced ovarian cancer. METHODS: The Surveillance, Epidemiology, and End Results–Medicare database represents approximately 14% of the United States population and provides clinical and demographic information on cancer patients covered by Medicare, along with health care–utilization data from Medicare claims files. We analyzed the association of demographic and clinical factors with treatment among patients diagnosed from 1992 to 1996 with stage III or IV ovarian cancer, who survived ≥ 120 days beyond diagnosis, and were ≥ 65 years of age (N = 1,775). RESULTS: Approximately 83% of elderly patients received some form of chemotherapy within 4 months of diagnosis. In a multiple logistic regression model with patients aged 65 to 69 years as the reference, the odds ratios of receiving chemotherapy were 0.96 (95% confidence interval [CI], 0.63 to 1.46) for ages 70 to 74, 0.65 (95% CI, 0.43 to 1.00) for 75 to 79, 0.24 (95% CI, 0.15 to 0.37) for 80 to 84, and 0.12 (95% CI, 0.07 to 0.19) for 85+. Hispanic patients were less likely to receive chemotherapy than non-Hispanic white patients. Since 1992, paclitaxel has gradually replaced cyclophosphamide as the drug most commonly used with platinum. CONCLUSION: Despite its proven efficacy in treating ovarian cancer, chemotherapy seems to be used less among patients over age 65, especially those who are nonwhite and/or in the oldest age groups. Further research is needed to elucidate to what degree this represents appropriate clinical judgment and to what degree other factors, such as patient choice, play a role.

scholarly journals Prevalence in the eligibility for weight loss treatment in a Mediterranean population

2008 ◽  
Vol 99 (2) ◽  
pp. 442-446
Author(s):  
Helmut Schröder ◽  
Roberto Elosua ◽  
Juan Vila ◽  
Helena Martí ◽  
Maria-Isabel Covas ◽  
...  
Keyword(s):  
Weight Loss ◽  
Treatment Algorithm ◽  
Age Groups ◽  
Population Based ◽  
National Institutes Of Health ◽  
Older Age ◽  
Mediterranean Population ◽  
Weight Loss Treatment ◽  
Cross Sectional ◽  
Independent Population

The aim of the present study was to analyse the prevalence and time trends of the subjects in a Mediterranean population meeting the criteria for weight loss treatment according to the National Institutes of Health (US) treatment algorithm proposed by the National Heart, Lung and Blood Institute's Obesity Education Initiative Expert Panel. A random sample of the 25–74 year old population (n 4908) of Gerona, Spain, was examined in 1994–1995 and 1999–2000 in two independent population-based cross-sectional surveys. Cardiovascular risk factors, lifestyle measures and anthropometric variables were analysed. The prevalence of subjects meeting the criteria for weight loss treatment according to the National Institutes of Health algorithm significantly increased from 46·4 to 52·9 % in men and from 35·1 to 40·4 % in women from 1995 to 2000. Stratifying this analysis for age groups revealed a significant increase among women aged 25 to 39 years and the older age group (60 to 74 years) of both genders. This increase was mainly observed in men and women with primary school education. The high prevalence of subjects meeting the criteria for weight loss treatment and the increasing secular trend is an important issue for health policy. This trend is more pronounced in older age groups and among the population with a basic educational level.

Future Needs for Dental Restorative Materials

1992 ◽  
Vol 6 (1) ◽  
pp. 4-6 ◽  
Author(s):  
C.W. Douglass
Keyword(s):  
United States ◽  
Age Groups ◽  
The United States ◽  
Older Age ◽  
Upward Trend ◽  
Age Cohorts ◽  
United States Population ◽  
Younger Age ◽  
Dental Restorative ◽  
Tooth Retention

While the population of the United States increases from 250 to 310 million people, the number in older age groups will increase dramatically from 28 million to about 64 million. Tooth retention has improved remarkably in the 65-74 age groups, from 7.4 in 1962 to 17.9 in 1986. While younger age groups will require less treatment due to decline in dental caries, older age groups appear to require more treatment than did similar age cohorts in previous generations. Hence, the need for restorative procedures by the United States population will be on an upward trend for the next decade or two.

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