Albumin Is a Prognostic Factor for Overall Survival in Newly Diagnosed Patients with Acute Myeloid Leukemia (AML)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4253-4253
Author(s):  
Awais M. Khan ◽  
Jeffrey E. Lancet ◽  
Mohamed A. Kharfan-Dabaja ◽  
Najla H Al Ali ◽  
Alan F. List ◽  
...  
Keyword(s):  
Overall Survival ◽  
Serum Albumin ◽  
Induction Chemotherapy ◽  
Serum Albumin Level ◽  
Cox Regression ◽  
Albumin Level ◽  
Normal Serum ◽  
Newly Diagnosed ◽  
Kaplan Meier ◽  
History Of

Abstract Abstract 4253 Background: Hypoalbuminemia (HA) is a strong predictor of poor clinical outcomes in many medical conditions. Low serum albumin is recognized as an adverse prognostic factor in patients with neoplastic diseases such as multiple myeloma, melanoma, and colon cancer. Severe hypoalbuminemia (<3.0 g/dl) at day +90 post allogeneic hematopoietic cell transplant (AHCT) was reported as an independent predictive variable for non-relapse mortality and overall survival (Kharfan-Dabaja, et al Biol Blood Marrow Transplant 2009; 15). A separate study conducted by our group showed that in patients with relapsed and refractory AML, serum albumin < 3.5 g/dl prior to salvage chemotherapy, correlated with lower complete remission (CR) rate and inferior overall survival (OS) (Komrokji, et al ASH 2009). We examined the prognostic value of serum albumin level prior to induction chemotherapy in patients with newly diagnosed AML. Methods: Data were collected retrospectively in a cohort of newly diagnosed AML patients who received induction chemotherapy (3+ 7 regimen). The primary objective of this study is to examine the relationship between serum albumin at baseline and probability for achieving complete remission (CR) or incomplete remission (CRi) and overall survival (OS). All analyses were conducted using SPSS version 19.0. The Kaplan–Meier method was used to estimate median overall survival; chi-square test was used for comparison of categorical variables and t-test for continuous variables. Log rank test was used to compare Kaplan–Meier survival estimates between two groups and Cox regression for multivariable analysis. Results: Between November 2004 and July 2007, 135 patients who received 3+7 induction chemotherapy at Moffitt Cancer Center were included in this analysis. Patient baseline characteristics were similar between patients with baseline serum albumin < 3.5 g/dl (HA) and those with serum albumin ≥ 3.5 g/dl (no HA) with respect to age, sex, FAB subtype, history of antecedent MDS, karyotype, and chemotherapy. Patients with HA, mean age was 60 years compared to 56.5 years in non HA group. The median OS for patients with HA was 221 days (95%CI 149.5–292.5) compared to 421 days (95%CI 236.7–605) with normal serum albumin (p<0.005). (Figure-1) The CR/CRi rate was 64%% for HA and 77.6% for those with normal albumin (p=0.09). In a multivariable Cox regression analysis including age ≥ 60 years, history of MDS, karyotype, and serum albumin level at baseline; only age, karyotype and serum albumin were independent predictors of OS [Hazard ratio 0.47 (95%CI 0.31–0.71) (p<0.005) for normal serum albumin group]. Conclusion: In this cohort of patients with newly diagnosed AML, we demonstrate that hypoalbuminemia < 3.5 g/dl is an independent covariate for overall survival with conventional chemotherapy management. Serum albumin is a surrogate marker of general health, comorbidities, and performance status. The prognostic value of low serum albumin should be validated in a prospective study. Disclosures: No relevant conflicts of interest to declare.

Albumin as a prognostic factor for overall survival in newly diagnosed patients with acute myeloid leukemia (AML).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6586-6586
Author(s):  
Awais M. Khan ◽  
Jeffrey E. Lancet ◽  
Mohamed A. Kharfan-Dabaja ◽  
Najla Al Ali ◽  
Alan F. List ◽  
...  
Keyword(s):  
Overall Survival ◽  
Serum Albumin ◽  
Induction Chemotherapy ◽  
Prognostic Value ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
Normal Serum ◽  
Newly Diagnosed ◽  
Kaplan Meier ◽  
History Of

6586 Background: Hypoalbuminemia (HA) is an adverse prognostic factor in multiple neoplastic diseases. Severe hypoalbuminemia (<3.0 g/dl) at day +90 post allogeneic hematopoietic cell transplant (AHCT) was reported as an independent predictive variable for non-relapse mortality and overall survival (Kharfan-Dabaja, et al Biol Blood Marrow Transplant 2009; 15). We examined the prognostic value of serum albumin level prior to induction chemotherapy in patients with newly diagnosed AML. Methods: Data were collected retrospectively in newly diagnosed AML patients receiving induction chemotherapy (3+ 7 regimen). Primary objective was to examine the relationship between serum albumin at baseline and probability of achieving complete remission (CR) or incomplete remission (CRi) and overall survival (OS). The Kaplan–Meier method used to estimate median overall survival; chi-square test used for comparison of categorical variables and t-test for continuous variables. Log rank test used to compare Kaplan–Meier survival estimates between two groups. Results: Between November 2004 to July 2007, 135 patients who received 3+7 induction chemotherapy were included. Patient baseline characteristics were similar between patients with serum albumin < 3.5 g/dl (HA) and those with serum albumin ≥ 3.5 g/dl (no HA) with respect to age, sex, FAB subtype, history of antecedent MDS, karyotype, and chemotherapy . In patients with HA, mean age was 60 years compared to 56.5 years in non HA group. The median OS for patients with HA was 221 days (95%CI 149.5-292.5) compared to 421 days (95%CI 236.7-605) with normal serum albumin (p<0.005). (Figure-1) The CR/CRi rate was 64%% for HA and 77.6% for those with normal albumin (p=0.09). In a multivariable Cox regression analysis including age ≥ 60 years, history of MDS, karyotype, and serum albumin level at baseline; only age, karyotype and serum albumin were independent predictors of OS [Hazard ratio 0.47 (95%CI 0.31-0.71) (p<0.005) for normal serum albumin group]. Conclusions: In newly diagnosed AML, we demonstrate that hypoalbuminemia < 3.5 g/dl is an independent covariate for overall survival with conventional chemotherapy management. The prognostic value of low serum albumin should be validated in a prospective study.

Albumin Is a Prognostic Factor for Response and Overall Survival in Relapsed or Refractory Acute Myeloid Leukemia (AML).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4685-4685
Author(s):  
Rami S. Komrokji ◽  
Mohamed A Kharfan-Dabaja ◽  
Samantha L Price ◽  
Gene A Wetzstein ◽  
Alan F List ◽  
...  
Keyword(s):  
Overall Survival ◽  
Serum Albumin ◽  
Prognostic Value ◽  
Serum Albumin Level ◽  
Cox Regression ◽  
Salvage Chemotherapy ◽  
Albumin Level ◽  
Baseline Serum ◽  
Kaplan Meier ◽  
History Of

Abstract Abstract 4685 Background Hypoalbuminemia (HA) is a strong predictor of poor clinical outcomes in many medical conditions. Low serum albumin levels has been shown to be an adverse prognostic factor in patients with neoplastic diseases such as multiple myeloma, melanoma, and colon cancer. Severe hypoalbuminemia (<3.0 g/dl) at day +90 post allogeneic hematopoietic cell transplant (AHCT) was recently reported as an independent predictive variable for non-relapse mortality and overall survival (Kharfan-Dabaja, et al Biol Blood Marrow Transplant 2009;15). In this retrospective analysis we examined the prognostic value of serum albumin level at baseline, day 14 and day 30 of treatment with salvage chemotherapy regimens for relapsed or refractory AML (RR-AML). Methods Data were collected retrospectively in a cohort of patients with RR-AML patients who received CLAG (cladribine, cytarabine, and filgrastim) or MEC (mitoxantrone, etoposide, and cytarabine) regimens as salvage chemotherapy. The primary objective was to examine the relationship between serum albumin at baseline, day 14 and day 30 of salvage chemotherapy and probability for achieving complete remission (CR) and overall survival (OS). Patients were divided into two groups; the first group with serum albumin < 3.5 g/dl and the second group patients with serum albumin ≥3.5 g/dl. International Working Group criteria were used to define CR. Primary refractory AML (PR-AML) in this study was defined as failure to achieve CR1 and less than 50% reduction in myeloblasts after first line of induction. All analyses were conducted using SPSS version 15.0. (SPSS Inc, Chicago, IL). The Kaplan–Meier method was used to estimate median overall survival; chi-square test was used for comparison of categorical variables and t-test for continuous variables. Log rank test was used to compare Kaplan–Meier survival estimates between two groups and Cox regression for multivariable analysis. Results Between January 2005 and June 2008, 162 patients were treated with CLAG or MEC for RR-AML. Patient baseline characteristics were similar between patients with baseline serum albumin < 3.5 g/dl (HA) and those with serum albumin ≥ 3.5 g/dl (no HA) with respect to sex, FAB subtype, salvage chemotherapy, prior therapy and cytogenetics. Patients with HA were older, mean age 57 years compared to 52 years in non HA group (p=0.039). More patients with HA had prior history of MDS (35.6% versus 19.2%) (p=0.021). Based on baseline serum albumin obtained prior to start of salvage chemotherapy for RR-AML; overall CR rates were HA, 23.8% (19/80) vs. no HA, 41.2% (28/68) (p= 0.033). Median OS was 4.3 months for HA group vs. 8.07 months for no HA, p=0.028. Serum albumin at day 14 of salvage chemotherapy also correlated with OS. The CR was 38.5% for no HA and 27.1% for HA (p=0.12), median OS was 10.0 mo for no HA group versus 4.8 month (p=0.046). Serum albumin at day 30 of salvage chemotherapy was significantly correlated with survival as well with a median OS for HA group was 6.7 month compared to 13.44 month for no HA group (p=0.008).(figure-1) CR was 58% in no HA and 38% in HA group (p=0.072). In a multivariable Cox regression analysis including age, history of MDS, CR rates and serum albumin level at day 30; only CR rates and serum albumin were independent predictors of OS. (Table-1) Conclusion In this retrospective analysis of a cohort of patients with RR-AML; we demonstrated that serum albumin < 3.5 g/dl prior to start of salvage chemotherapy, at day 14 and at day 30 correlated with lower CR rates and worse OS. Serum albumin is a surrogate marker of general health, co- morbidities, and performance status. The prognostic value of low serum albumin need to be examined in newly diagnosed AML patients in context of known other prognostic factors; and validated in a prospective fashion. Disclosures: No relevant conflicts of interest to declare.

Nutritional Status of the Children with Acute Lymphoblastic Leukemia at Diagnosis and after Completion of Induction

2021 ◽  
Vol 5 (02) ◽  
pp. 50-56
Author(s):  
Noor-A-Sabah Liza ◽  
S. M. Rezanur Rahman ◽  
Afiqul Islam ◽  
Chowdhury Yakub Jamal ◽  
Mohosina Sultana Setu ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Serum Albumin ◽  
Induction Chemotherapy ◽  
Induction Therapy ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
Anthropometric Measurements ◽  
Newly Diagnosed ◽  
Significant Difference ◽  
Nutritional Status Of Children

Background: Adequate nutrition is an important concern in children with leukemia. Malnutrition and weight lost are common and are due to verity of mechanism involving the tumor, the host response to the tumor such as infection and pharmacokinetics of chemotherapeutic drugs. Objective: To evaluate and compare the nutritional status of children with ALL at diagnosis and after completion of induction therapy. Methodology: This prospective observational study included 60 children newly diagnosed as ALL, aged 2-15 years, over a period from April 2012 to September 2012 in the Department of Pediatric Hematology and Oncology, BSMMU. The anthropometric measurements and serum albumin level were taken. Anthropometric indices are calculated by NCHS (WHO-2000) and classified as Z score. Children <-2 SD are considered as underweight (WFA), stunted (HFA) and wasted (WFH). Serum albumin level below 21g/dl is considered as severely malnourished. The Hb values of the children are compared with normal values by age. The children got induction chemotherapy according to MRC-11 protocol. They were in regular follow up and again anthropometric measurements and serum albumin level were taken after completion of induction. Results: Out of 60 children with ALL, 48 (70%) were underweight, 45 (75%) were stunted 36 (60%) were wasted at diagnosis. Incidence of malnutrition among leukemia children after completion of induction were 24 (40%) underweight, 45 (75%) were stunted and 6 (10%) were wasted. The results showed that children in the newly diagnosed stage had a higher prevalence of malnutrition. However no statistically significant difference in the nutritional status was found among newly diagnosed and after completion of induction in term of underweight and stunting but newly diagnosed patients had statistically significant wasting than patients who had completed induction chemotherapy. No patient showed severe malnutrition based on the cut-off point for serum albumin on both stages. All the children (100%) had less than normal range hemoglobin levels. Conclusion: Malnutrition was higher in children with newly diagnosed leukemia. Children had significant differences in the nutritional status in term of wasting at diagnosis than after completion of induction therapy. So, the nutritional status of children with leukemia should be monitor periodically.

The prognostic role of serum albumin in patients receiving induction chemotherapy for acute myeloid leukemia (AML).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6618-6618
Author(s):  
Hossein Sadrzadeh ◽  
Andrew Mark Brunner ◽  
Benjamin Jacob Drapkin ◽  
Loren Babirak ◽  
Lillian Werner ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Induction Chemotherapy ◽  
Serum Albumin Level ◽  
Cox Regression ◽  
Massachusetts General Hospital ◽  
Disease Free Survival ◽  
Albumin Level ◽  
Categorical Variables ◽  
Oncologic Patients ◽  
Prognostic Utility

6618 Background: Serum albumin has been investigated as a prognostic tool in the care of patients with hematologic malignancies, including multiple myeloma and myelodysplastic syndromes. However, its prognostic utility in patients with AML is unknown. We hypothesized that a lower serum albumin is associated with worse outcomes following induction chemotherapy for AML. Methods: We conducted a retrospective medical record review of 166 adult, non-promyelocytic AML patients who had received induction chemotherapy at Massachusetts General Hospital from 1992 to 2007. Patient characteristics were summarized as numbers and percentages for categorical variables. The Kaplan Meier method was used to estimate median disease-free survival (DFS) and overall survival (OS). We dichotomized our patients by serum albumin ≥3 and <3, and determined the association of albumin with 60-day survival and complete remission (CR) rate using Fisher’s exact test. Association of albumin with DFS and OS was summarized using Cox regression in both univariate and multivariable analyses. Results: Of 166 patients, 125 (75%) achieved CR and 143 (86%) were alive at 60 days following diagnosis. After risk-adjusting for age and LDH, we found that a serum albumin level <3 mg/dL was associated with decreased 60-day survival (OR 0.30, p=0.015) and CR rate (OR 0.41, p=0.02) compared to patients with serum albumin ≥3. There was no association between serum albumin and DFS (p=0.88) or OS (p=0.31). As expected, younger age was associated with better induction outcomes. Conclusions: Serum albumin was negatively associated with short-term outcomes in patients receiving induction chemotherapy. A serum albumin level less than 3, clinically relevant to oncologic patients, was associated with a significantly decreased CR rate and lower 60-day survival after induction chemotherapy. This data suggests that serum albumin, a surrogate commonly used for nutritional status and suppressed in inflammatory comorbid states, has prognostic utility for AML patients undergoing induction chemotherapy.

Survival Outcomes for Induction vs Adjuvant Chemotherapy in Squamous Cell Carcinoma of the Maxillary Sinus

2018 ◽  
Vol 160 (4) ◽  
pp. 658-663 ◽  
Author(s):  
Phoebe Kuo ◽  
Sina J. Torabi ◽  
Dennis Kraus ◽  
Benjamin L. Judson
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Maxillary Sinus ◽  
Induction Chemotherapy ◽  
Squamous Cell ◽  
Cox Regression ◽  
Rank Test ◽  
Controlled Clinical Trial ◽  
Log Rank Test ◽  
Kaplan Meier

Objective In advanced maxillary sinus cancers treated with surgery and radiotherapy, poor local control rates and the potential for organ preservation have prompted interest in the use of systemic therapy. Our objective was to present outcomes for induction compared to adjuvant chemotherapy in the maxillary sinus. Study Design Secondary database analysis. Setting National Cancer Database (NCDB). Subjects and Methods In total, 218 cases of squamous cell maxillary sinus cancer treated with surgery, radiation, and chemotherapy between 2004 and 2012 were identified from the NCDB and stratified into induction chemotherapy and adjuvant chemotherapy cohorts. Univariate Kaplan-Meier analyses were compared by log-rank test, and multivariate Cox regression was performed to evaluate overall survival when adjusting for other prognostic factors. Propensity score matching was also used for further comparison. Results Twenty-three patients received induction chemotherapy (10.6%) and 195 adjuvant chemotherapy (89.4%). The log-rank test comparing induction to adjuvant chemotherapy was not significant ( P = .076). In multivariate Cox regression when adjusting for age, sex, race, comorbidity, grade, insurance, and T/N stage, there was a significant mortality hazard ratio of 2.305 for adjuvant relative to induction chemotherapy (confidence interval, 1.076-4.937; P = .032). Conclusion Induction chemotherapy was associated with improved overall survival in comparison to adjuvant chemotherapy in a relatively small cohort of patients (in whom treatment choice cannot be characterized), suggesting that this question warrants further investigation in a controlled clinical trial before any recommendations are made.

scholarly journals In maintenance hemodialysis patients, there were “U-shaped” relationships between serum albumin level and mortality or hospitalization, negative linear relationship between serum albumin level and hospitalization for infection.

2019 ◽  
Author(s):  
Xiaoyan Jia ◽  
Ping Chen ◽  
Xue Wang ◽  
Xianglei Kong ◽  
Juan Chen ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Cerebrovascular Disease ◽  
Linear Relationship ◽  
Serum Albumin Level ◽  
Cox Regression ◽  
Albumin Level ◽  
Maintenance Hemodialysis ◽  
Linear Association ◽  
Non Linear ◽  
Negative Linear Relationship

Abstract Background: Few studies are available on the non-linear association between serum albumin (S-Alb) level and prognosis in maintenance hemodialysis (MHD) patients. Methods: All stable MHD patients treated in our center from 2007 to 2011 were enrolled into this study. Demographics, laboratory data, hospitalization and mortality were collected; Cox regressive models were fitted to investigate predicting outcomes, restricted cubic splines (RCS) were allowing for non-linear association between S-Alb and prognosis. Results: S-Alb was independent protective factor for mortality, all-cause hospitalization, hospitalization for cardiovascular or cerebrovascular disease and hospitalization for infection. The relationships between S-Alb and mortality, all-cause hospitalization, hospitalization for cardiovascular or cerebrovascular disease were U-shaped; relationships between S-Alb and hospitalization for infection were negative linear relationships both in univariable Cox regression models and in multivariable Cox regression. Conclusions: In MHD population, there were “U-shaped” relationships between serum albumin level and mortality or hospitalization; the potential risks associated with excessive S-Alb should been taken into consideration. There was negative linear relationship between S-Alb and hospitalization for infection, S-Alb may be even more important in preventing infection in MHD population.

Prognostic factors in aggressive malignant lymphomas: description and validation of a prognostic index that could identify patients requiring a more intensive therapy. The Groupe d'Etudes des Lymphomes Agressifs.

1991 ◽  
Vol 9 (2) ◽  
pp. 211-219 ◽  
Author(s):  
B Coiffier ◽  
C Gisselbrecht ◽  
J M Vose ◽  
H Tilly ◽  
R Herbrecht ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Bone Marrow Involvement ◽  
Prognostic Index ◽  
Albumin Level ◽  
Advanced Stage ◽  
Low Serum

The objectives of this study were to determine prognostic factors for response to treatment, freedom-from-relapse (FFR) survival, and overall survival of 737 aggressive malignant lymphoma patients treated with the doxorubicin, cyclophosphamide, vindesine, bleomycin, methylprednisolone, methotrexate with leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH-84) regimen; to construct a prognostic index with factors isolated by multivariate analyses; and to validate this prognostic index with another set of patients. Complete response (CR) was reached in 75% of LNH-84 patients, and 30% of them relapsed. With a median follow-up of 36 months, median FFR survival and median overall survival were not reached. Low serum albumin level, high tumoral mass, weight loss, bone marrow involvement, greater than or equal to 2 extranodal sites, and increased lactic dehydrogenase (LDH) level were associated with a low response rate. Advanced stage, increased LDH level, and nonlarge-cell histologic subtypes (diffuse mixed, lymphoblastic, and small non-cleaved) were statistically associated with a high relapse rate and short FFR survival. Increased LDH level, low serum albumin level, tumoral mass larger than 10 cm, greater than or equal to 2 extranodal sites, advanced stage, and age older than 65 years were statistically associated with short overall survival. Four of these parameters, namely, LDH level, stage, number of extranodal sites, and tumoral mass, were put together to construct a prognostic index. This index partitioned LNH-84 patients into three subgroups of good, intermediate, and poor prognosis (P less than .00001): CR rates of 93%, 83%, and 61%; relapse rates of 12%, 25%, and 45%; 3-year FFR survival of 87%, 73%, and 53%, and 3-year survival of 88%, 71%, and 41%, respectively. This prognostic index was applied to a test set of patients: 155 patients treated on protocols of the Nebraska Lymphoma Study Group. Using this index, these patients had 3-year FFR survival of 70%, 40%, and 22% (P = .0002) and 3-year survival of 79%, 52%, and 31% (P = .005). In patients with aggressive lymphomas, this simple prognostic index could distinguish between patients requiring intensive treatment such as autologous bone marrow transplantation in first complete remission and those who could be treated with standard regimens.

Hypoalbuminemia Is An Independent Prognostic Factor In Myelodysplastic Syndromes

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4001-4001
Author(s):  
Maria Corrales-Yepez ◽  
Mohamed A. Kharfan-Dabaja ◽  
Jeffrey Lancet ◽  
Alan F. List ◽  
Eric Padron ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Risk Group ◽  
Risk Groups ◽  
Albumin Level ◽  
Refractory Anemia ◽  
Lower Serum ◽  
Kaplan Meier ◽  
Low Serum

Abstract Abstract 4001 Background: Low serum albumin level is known to be an adverse prognostic factor in patients with malignancies such as multiple myeloma. We previously reported that severe hypoalbuminemia (&lt;3.0 g/dl) at day +90 post allogeneic hematopoietic stem cell transplant (AHCT) was an independent predictor of non-relapse and overall mortality in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) (Kharfan-Dabaja et al Biol Blood Marrow Transplant. 2010 Jul). In this study we examined prognostic value of serum albumin level in patients with MDS. Methods: Data were analyzed from the Moffitt Cancer Center (MCC) MDS database with chart review verification. The primary objective was to examine the role of serum albumin at time of presentation to MCC as a prognostic marker for overall survival (OS). Patients were divided into 3 groups of serum albumin levels (≤ 3.5, 3.6–4.0 and &gt; 4.0 g/dl). The Kaplan–Meier method was used to estimate median OS. The log rank test was used to compare Kaplan–Meier survival estimates between two groups. Cox proportional hazards regression was used for multivariable analysis. Results: Between January 2001 and December 2009, 844 patients were captured by the MCC MDS database. The median age was 69 years. MDS subtypes were coded as refractory anemia (RA) (n=98;12%), refractory anemia with ring sideroblasts (RARS) (n=76;9%), del(5q) (n=20;2.4%), refractory cytopenia with multi-lineage dysplasia (RCMD) (n=96;11%), refractory anemia with excess blasts (RAEB) (n=255;30%), therapy related MDS (n=22;2.6%), and MDS-NOS (n=275; 33%). The distribution of IPSS risk groups was: 18.7% Low risk, 42.9% Intermediate-1 (Int-1), 19.9% Int-2, 5.3% High risk, and 13.2% unknown. Baseline characteristics for the three patient groups defined by serum albumin level are summarized in (Table-1). There was no difference in red blood cell transfusion dependency (RBC-TD) rate between the 3 groups (p=0.21). The median OS for all patients was 36 months (95% confidence interval (CI) 31.5–40.5 mo). Age, IPSS risk group, RBC-TD, Serum ferritin were statistically significant prognostic factors in univariable analysis. The median OS was 19 mo (95%CI= 14.9–23.1 mo), 35 mo (95%CI= 28.7–41.3 mo), and 53 mo (95%CI= 44.7–61.3 mo) for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl, &gt; 4.0 g/dl, respectively. (Figure-1) (p= &lt;0.005). After adjustment for age, RBC-TD, OS was statistically significantly inferior among MDS patients with lower serum albumin (Hazard Ratio (HR) = 0.79.; 95%CI= 0.69–0.90; p= 0.001), and higher-risk IPSS group (HR=1.67; 95%CI=1.48-1.87; p= &lt;0.005). The overall rate of AML transformation was 29.2%. Rate of AML transformation was higher in patients with lower serum albumin, 38% in patients with serum albumin ≤ 3.5 g/dl, 30% for patients 3.6–4.0 g/dl, and 23% in patients with serum albumin &gt; 4.0 g/dl (p-value 0.005). Among patients in the Low/Int-1 IPSS risk group, the median OS was 28 mo (95%CI=15.7-40.3 mo), 48 mo (95%CI=38.8-58.0 mo), and 60 mo (95%CI=47.6-72.4 mo) for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl and &gt; 4.0 g/dl, respectively (p=0.003). Among patients in the Int-2/High IPSS risk group, the median OS was 16 mo (95%CI 13.3–15.7 mo), 22 mo (95%CI 18.0–26.0 mo), and 21 mo (95%CI 8.8–33.2 mo) respectively for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl and &gt; 4.0 g/dl, respectively p=0.03). Conclusion: In this retrospective analysis of a large single institution MDS database, serum albumin is found to be an independent prognostic factor for OS and AML transformation in MDS patients. The prognostic power of low serum albumin was greatest among patients with Low/Int-1 IPSS risk group, but remained an independent variable across all risk groups. Serum albumin may also be a surrogate marker of general health, co- morbidities, and performance status. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Incidence of spinal disease and role of spinal radiotherapy in multiple myeloma

2018 ◽  
Vol 25 (6) ◽  
Author(s):  
A. M. Sharma ◽  
M. Sackett ◽  
D. Bueddefeld ◽  
P. Lambert ◽  
A. Dubey ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Systemic Therapy ◽  
Cox Regression ◽  
Cord Compression ◽  
Newly Diagnosed ◽  
Spinal Disease ◽  
Kaplan Meier ◽  
Long Term Survivors

Background Spinal disease (spd) in multiple myeloma (mm) can be a major source of morbidity in newly diagnosed patients and long-term survivors. We retrospectively assessed the incidence of spinal disease in patients newly diagnosed with myeloma, its effect on survival, and the possible effect of spinal radiation therapy (rt).Methods Patients diagnosed with mm between 2010 and 2014 were identified through the provincial cancer registry. Plain radiography, computed tomography, and magnetic resonance imaging were reviewed to detect and document the type of spd. Data related to rt and systemic therapy were collected. Kaplan–Meier and time-varying Cox regression models were used to describe overall survival.Results Of 306 identified patients with newly diagnosed mm, 51% had spd, including 17% with lytic disease, 68% with compression fractures, and 15% with spinal cord compression. Of the patients with spd, 61% received spinal rt. Of those patients, 84% received spinal rt within 3 months after their diagnosis. Median dose was 20 Gy. Most patients (89.2%) received chemotherapy, and 22.5% underwent autologous stem-cell transplantation. Only 6 of the patients treated with spinal rt received re-irradiation to the same site. Overall survival was similar for patients with and without spd. On multivariate analysis, spinal rt had no effect on survival.Conclusions In patients newly diagnosed with mm, spd is a common presentation. With current systemic therapy, the presence of spd had no adverse effect on overall survival. The effect of spinal rt on overall survival was nonsignificant.

A low albumin to globulin ratio with a high serum globulin level is a prognostic marker for poor survival in cervical cancer patients treated with radiation based therapy

2019 ◽  
Vol 29 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Yasunori Yoshino ◽  
Ayumi Taguchi ◽  
Takuya Shimizuguchi ◽  
Yujiro Nakajima ◽  
Maki Takao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Serum Albumin ◽  
Cancer Patients ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
High Serum ◽  
Serum Globulin ◽  
Globulin Level ◽  
Albumin To Globulin Ratio

ObjectiveWe investigated whether the pretreatment albumin to globulin ratio, serum albumin level, and serum globulin level can be used to predict survival among cervical cancer patients treated with radiation based therapy and assessed globulin fractions.MethodsWe retrospectively enrolled 128 patients with cervical cancer treated with radiation based therapy at our institution between 2010 and 2015. The associations of the pretreatment albumin to globulin ratio, and serum albumin and globulin levels with overall survival were assessed. Additionally, the associations of the globulin fractions with the serum globulin levels and overall survival were evaluated.ResultsMedian follow-up duration was 30 months (IQR 16–44 months). A low albumin to globulin ratio (< 1.53) was found to be an independent prognostic factor for overall survival (HR= 3.07; 95% CI, 1.03 to 13.3; P=0.044). On evaluating serum globulin and albumin separately, a high serum globulin level was significantly associated with overall survival (cut-off value 2.9 g/dL; HR=3.74; 95% CI 1.08 to 23.6; P=0.036) whereas a low serum albumin level was not associated with overall survival (cut-off value 3.6 g/dL; HR=1.77; 95% CI 0.57 to 4.54; P=0.29). Electrophoresis data of the serum proteins revealed that the γ-globulin fraction was most strongly correlated with the globulin levels (P<0.001). Furthermore, a high γ-globulin level (≥1.28 g/dL) was significantly associated with poor overall survival (log rank test, P=0.034).ConclusionsA pretreatment low albumin to globulin ratio, which might be attributable to a high serum globulin level, can be used to predict poor prognosis in cervical cancer patients treated with radiation based therapy.

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