Serum Ferritin Level As a Prognostic Factor for Patients with Extranodal NK/T-Cell Lymphoma, Nasal Type.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2644-2644
Author(s):  
Etsuko Yamazaki ◽  
Naoto Tomita ◽  
Satoshi Koyama ◽  
Kumiko Kishimoto ◽  
Eriko Ogusa ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cell Lymphoma ◽  
Prognostic Index ◽  
Nasal Type ◽  
Group 4 ◽  
Ann Arbor ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Abstract 2644 Background: Extranodal NK/T-cell lymphoma, nasal type (ENKL) is a rare subtype in Western countries but is more frequent in East Asia or in Central and South America. The response to conventional chemotherapy is not good, generally resulting in a poor prognosis. Several Asian investigators reported that the International Prognostic Index (IPI) score, Prognostic Index for PTCL-U (PIT) and Korean index, including regional lymph node involvement, clinical stage, presence of B symptom and serum lactate dehydrogenase (LDH) levels, are good indicators for prognosis. We retrospectively analyzed the prognostic factors of our patients with ENKL. Patients and methods: A total of forty-two patients were diagnosed as having ENKL from April 1998 to May 2011 at Yokohama City University Hematology Group, consisting of eight hospitals in Japan. Central pathological review was not performed; only the individual institutional diagnoses were used. Overall survival (OS) was measured from the date of diagnosis to the date of death or the last follow-up. This study was approved by the Yokohama City University Hospital Clinical Research Ethics Board. The procedures used in this study were in accordance with the Helsinki Declaration. Results: The study included 27 males and 15 females, with the median age at diagnosis of 63 years (range, 18–82 years). Twenty-five patients had localized while 17 patients had advanced Ann Arbor stages of lymphoma. Thirty-two patients had a good ECOG performance status of 0–1. B symptoms were present in 18 patients. Thirty patients presented with nasal and/or paranasal lesions. Twelve patients showed no nasal/paranasal involvement. Of these patients, seven (7/12) had skin involvement, and one each (1/12) with involvement of the gingiva, liver, intestines, testis and lymph node, respectively. According to IPI, 17 patients were classified as low, 9 as low-intermediate, 6 as high-intermediate (HI), and 10 as high (H) risk. According to PIT, 10 patients were categorized as group 1, 16 as group 2, 10 as group 3, and 6 as group 4. According to the Korean index, 11 patients were classified as group 1, 9 as group 2, 10 as group 3, and 12 as group 4. Combined radiotherapy-chemotherapy was administered to 23 patients, 11 patients were treated with chemotherapy alone, 6 patients received radiotherapy alone, and two could not be treated due to their poor condition. After a median follow-up duration among all patients of 12 months (range 1–93 months), and a median follow-up duration among patients still alive at their last follow-up of 47 months (range 8–93 months), 3-year OS rate was 46.7%. Factors associated with a worse overall survival in a univariate analysis were IPI score of HI or H (p<0.001), PIT group 3 or 4 (p=0.002), Korean index group 3 or 4 (p=0.003), extranasal disease (p=0.01), advanced Ann Arbor stage (stage III or IV, p<0.001), ferritin levels higher than 300 ng/ml (p=0.001), B symptoms (p=0.001), albumin levels less than 4 g/dl (p=0.003), LDH value at normal levels or above (p=0.005), soluble IL2R levels higher than 650 U/ml (p=0.006) and β2 microglobulin levels higher than 2.5 mg/l (p=0.035). Multivariate analysis revealed three factors: advanced stage (III or IV) (HR 8.994; 95%CI, 2.188–36.963, p=0.002), extranasal disease (HR 4.824; 95%CI, 1.400–16.624, p=0.013), and high ferritin levels (HR 18.767; 95%CI, 4.207–83.724, p<0.001), to be significant and independent prognostic factors. Conclusion: Advanced stage, extranasal ENKL, and high ferritin levels were associated with an adverse outcome for patients with ENKL. The former two were demonstrated as prognostic factors in previous reports. As far as we are concerned, this is first report showing ferritin levels as a prognostic factor. This result should be confirmed in a large number of cases. Disclosures: No relevant conflicts of interest to declare.

Predicted final spinal height in patients with adolescent idiopathic scoliosis can be achieved by surgery regardless of maturity status

2018 ◽  
Vol 100-B (10) ◽  
pp. 1372-1376 ◽  
Author(s):  
H. Bao ◽  
Z. Liu ◽  
M. Bao ◽  
Z. Zhu ◽  
P. Yan ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Growth Restriction ◽  
Fusion Surgery ◽  
Group 4 ◽  
Selective Fusion ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aims The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. Patients and Methods The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOSf) and height of pelvis at follow-up (HOPf) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOPf. One-way analysis of variance (ANOVA) was performed for statistical analysis. Results Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOSf was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOPf (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOSf was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height. Conclusion This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or ‘normal’ spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372–6.

P1031The impact of the duration of atrial fibrillation persistence for arrhythmia free survival in patients undergoing catheter ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Furukawa ◽  
T Yamada ◽  
T Morita ◽  
S Tamaki ◽  
M Kawasaki ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Outcome Data ◽  
Free Survival ◽  
Group 4 ◽  
Kaplan Meier ◽  
Group 3 ◽  
Group 2 ◽  
Af Recurrence ◽  
Group 1

Abstract Background Catheter ablation (CA) for atrial fibrillation (AF) is a curable treatment option. However, AF recurrence after CA remains an important problem. Although the success rate has been improved after catheter ablation (CA) in patients with paroxysmal AF (PAF), outcome data after CA for persistent AF (PeAF) are highly variable. Previous studies showed the PeAF is one of independent predictors for AF recurrence in comparison to PAF. However, there are little information available on the prognostic significance of AF duration after CA for AF. The aim of this study is to evaluate the impact of AF duration on long-term outcomes of AF ablation in patients with PeAF compared with PAF. Methods We enrolled 778 consecutive patients, who were referred our institution between August 2015 and December 2017 for undergoing the first time CA for AF. We divided 5 groups (Group 1; PAF (n=442), Group 2; PeAF duration ≤6 months (n=198), Group 3; PeAF duration of 6 months to 2 years (n=87), Group 4; PeAF duration of 2–5 years (n=30) and Group 5; PeAF duration ≥5 years (n=21)). All patients followed up for at least 1 year. Outcome data on recurrence of AF after ablation were collected. Results There were no significant differences in baseline clinical characteristics before CA among 5 groups, except for the prevalence of congestive heart failure, left atrial diameter and left ventricular ejection fraction. During a mean follow-up period of 511±298 days, 217 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (31% vs 20%, p=0.002) and in group 4 compared to group 3 (83% vs 30%, p<0.0001). However, AF recurrence was no significantly differences between groups 2 and 3 (31% vs 30%, p=0.76) and between groups 4 and 5 (83% vs 81%, p=0.45). Of 217 patients with AF recurrence, 154 patients had undergone multiple procedures. After last procedures, during a mean follow-up period of 546±279 days, 61 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (10% vs 3%, P=0.0005) and in group 4 compared with group 3 (35% vs 10%, p=0.0001). However, AF recurrence was no significantly difference between groups 2 and 3 (10% vs 10%, p=0.91) and between groups 4 and 5 (47% vs 35%, p=0.47). AF Free Survival Curve Conclusion Although patients with PeAF within 2 years had significantly higher AF recurrence compared to PAF, AF ablation might still be a good contributor as the first line approach to improve outcomes in patient with PeAF within 2 years.

Atypical BCR-ABL Transcripts Chronic Myelogenous Leukemias Show Particular Features, and Their Classical Worse Prognosis Seems Abrogated by Imatinib Mesylate. A Retrospective Analysis of 22 Patients, on the Behalf of the French Intergroup of CML (Fi(ϕ)-LMC Group).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3285-3285
Author(s):  
Franck E. Nicolini ◽  
Nathalie Grardel ◽  
Sandrine Hayette ◽  
Jean-Michel Cayuela ◽  
Agnès Buzyn ◽  
...  
Keyword(s):  
Chronic Phase ◽  
Myelogenous Leukemia ◽  
Chromosome 22 ◽  
Group 4 ◽  
Blastic Phase ◽  
Group 3 ◽  
Group 2 ◽  
Worse Prognosis ◽  
Group 1

Abstract Chronic Myelogenous Leukemia (CML) originates in the chromosome (Ph1), a reciprocal translocation, corresponding to the BCR-ABL fusion oncogene. A small proportion (1–2%) of CML patients show breakpoints falling outside of the M-BCR gene on chromosome 22, leading to the synthesis of a variety of atypical BCR-ABL transcripts [either shortened: e1a2 (m-BCR), e6a2, e8a2, b2a3 (e13a3), b3a3 (e14a3), or elongated transcripts: e19a2 (m-BCR)] and to the synthesis of different BCR-ABL proteins. In this study, we retrospectively analysed the clinical characteristics and outcomes of cohorts of CML patients harbouring atypical transcripts in and treated with imatinib (IM). Twenty-two patients were analysed: 9 e1a2 [Group 1 (G1)], 4 e6a2 [Group 2 (G2)], 5 e19a2 [Group 3 (G3)], and 4 e8a2 [Group 4 (G4)] BCR-ABL transcripts. Two patients were in myeloid blastic phase at onset (1 in G1 and 1 in G2) and others in chronic phase. Age at diagnosis was significantly younger for e19a2 patients (39.5 years versus 64 for G1, 58.5 for G2, 72 for G3, p=0.005). Female patients were predominant for G1 (5F/3M), but not for other groups. All patients presented a classical Ph1 at karyotyping analysis at diagnosis, but 1 had a -7 (G1), 1 an additional t(11;16) with the Ph1 (G2), 1 a +8 (G3) and 1 a -Y (G3). The majority of patients presented typical CML features at diagnosis, however number of differences could be found: WBC counts were higher for e1a2 and e8a2 patients (74.2 109/l and 62.7 respectively vs 20.9 for G2, and 37.8 for G3, p&lt;0.03). A significant relative monocytosis was present for e1a2 patients (10% vs 4 (G2), 2.5 (G3), 5.5 (G4), p&lt;0.05), and a marked basophilia was present for e6a2 patients vs others (p&lt;0.0008). There was a trend for higher platelet counts in G3 vs others. Hasford and Sokal scores were somewhat comparable in all groups. Median follow-up since diagnosis was 24 months for G1, 10 for G2, 17 for G3 and 31 for G4. Only one patient received interferon for 7 months before IM (G1), all other patients did not receive any other treatment than hydroxyurea before IM. All patients were treated with IM alone initially at 400–600 mg/day. Median duration of IM was 18 months for G1, 9 for G2, 12 for G3, and 30 for G4. At time of analysis 1 pt in G2 and 1 patient in G3 died of progression (blastic phase), and the overall survival (OS) since IM start was better for e19a2 and e8a2 patients, but patients remain very few. However, these OS do not seem different from what has been observed for M-BCR transcripts (IRIS study). In conclusion, atypical BCR-ABL transcripts CMLs show particular diagnosis features, but their poor prognosis reputation seems abrogated by IM.

Does Upfront Therapy with Fludarabine Increase the Risk of Histological Transformation In Patients with Follicular Lymphoma?

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4885-4885
Author(s):  
Sobia Yaqub ◽  
Todd W. Gress ◽  
Oscar Ballester
Keyword(s):  
Follicular Lymphoma ◽  
Relapse Rate ◽  
Group 4 ◽  
Number Of Patients ◽  
Histological Transformation ◽  
Group 3 ◽  
Group 2 ◽  
Time To Relapse ◽  
Group 1

Abstract Abstract 4885 Introduction: Fludarabine has been reported to increase the incidence of relapse and histological transformation in chronic lymphocytic leukemia (Thornton PD, Leukemia research, 2005) and Waldenstrom macroglobulinemia (Leleu X, J Clincal Oncology, 2009). The purpose of our study was to investigate the role of Fludarabine and the risk of transformation and relapse in follicular lymphoma (FL). Patients and Methods: This is a retrospective single institution study. We included 50 patients consecutively diagnosed with FL Grade I and II based on WHO classification of lymphoid malignancies. Grade III patients were excluded from the study. Median follow up is 2.86 years. Patients were grouped according to the initial therapy chosen by their treating physicians: Group 1(n=14) included patients on observation and radiation therapy, Group 2 (n=6) included patients on Fludarabine based regimens, Group 3(n=13) included CVP-R and other rituximab regimens and Group 4(n=17) included R-CHOP. Data collected included time to the onset of biopsy proven transformation, time to relapse, mortality and overall survival. Level of significance was set at <0.05. Results: Median age of the patients was 56.5 and it was not significantly different for the various groups. High risk FLIPI score was seen in 66% of patients treated with Fludarabine regimens as compared to 61% of R-CHOP treated patients. Overall, relapse occurred in 38% patients and transformation occurred in 16% patients during the follow up period. Fludarabine treated patients had the highest relapse rate: 50% (p=0.03). R-CHOP group has lowest relapse rate: 11%. Transformation rate was highest in the Fludarabine group: 33%, as compared to 13% to 17% in other groups (p=0.10). Mortality rate was 7% in group 1, 16% in group 2, 23% for group 3 and 5% in group 4 (p=0.44). Time to relapse/progression in group 1 was 2.9 years; in group 2 was 2.1 years; in group 3 was 2.7 years and in group 4 was 5.8 years. Conclusions: In our study, Fludarabine treated patients appear to be at higher risk for relapse and transformation compared to patients treated with R-CHOP. The differences can not be explained on the basis of known prognostic factors such as age or FLIPI score. The retrospective nature of the study and the small numbers of patients preclude more definitive conclusions. Further research is needed with large number of patients. Disclosures: No relevant conflicts of interest to declare.

CD68+ Tumor-Associated Macrophages Predict Unfavorable Treatment Outcomes in Classic Hodgkin's Lymphoma in Correlation with Early FDG-PET Assessment Results

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1558-1558
Author(s):  
Mohamed Touati ◽  
Manuela Delage-Corre ◽  
Jacques Monteil ◽  
Agnes Olivrie-Gamaury ◽  
Stephane Moreau ◽  
...  
Keyword(s):  
Strong Correlation ◽  
Fdg Pet ◽  
Hodgkin's Lymphoma ◽  
Tumor Associated Macrophages ◽  
Ann Arbor ◽  
Cd 68 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Abstract 1558 Background: The tumor microenvironment is an important factor in the development and progression of classic Hodgkin's Lymphoma (HL). A recent study (Steidl et al 2010) demonstrated that increased number of CD68+ tumor-associated macrophages was correlated with adverse survival in HL. Moreover the result of the early FDG-PET assessment after the first 2 courses of chemotherapy (early PET) is a major prognostic criterion in treatment of HL. The purpose of this study was to evaluate the relationship between CD68 expression and: 1) The clinical outcome in general practice for all patients treated for HL, 2) The results of initial and early PET. Patients and methods: Our retrospective study included 151 patients (pts) initially diagnosed and treated at our center from February 1995 to March 2011 and who had a formalin-fixed paraffin-embedded lymph node biopsy available. The slides were stained for CD68 by a single pathologist (MDC) using the PG-M1 antibody (Dako®) and analyzed by immunochemistry. CD68 staining was scored 1: CD68+ cells &lt; 5%, 2: CD68+ cells from 5% to 25% and 3: CD68+ cells &gt;25% relative to overall cellularity. FDG-PET is available in our center since 1999. A total of 100 pts (66%) had initial evaluation and follow up by FDG-PET. Clinical and laboratory data available on presentation and follow-up were recorded. Sex ratio was 1.16, median age was 39 years [18–85], histological subtypes in WHO classification were nodular sclerosis in 123 pts (81.46%), mixed cellularity in 21 (13.91%), lymphocyte-rich in 6 (3.97%), lymphocyte-depleted in 1 (0.66%). The Ann Arbor Stage was I-II in 78 pts (52%), and III-IV in 73 (48%). B symptoms were present in 68 pts (45%). Treatment protocols were as follows: ABVD in 100 pts (66.22%), MOPP/ABV in 26 (17.22%), BEACOPP in 8 (5.30%), ABVD-like in 8 (5.30%), other in 9 (6%). Additional radiotherapy was performed in 76 pts (50%). Mean follow-up was 75.6 months [1.87–194.5]. Results: The CD68 percentage was: group 1: &lt;5% in 49 pts (32.45%); group 2: 5 to 25% in 67 (44.37%); group 3: &gt;25% in 35 (23.17%). We found like Steidl a correlation between progression free survival (PFS) and initial tumor CD68 expression in accordance with the 3 groups. Group 1: Median PFS not reached, PFS at 5 years=79.8%, group 2: median PFS not reached, PFS at 5 years=69.4%, group 3: median PFS=52.5 month, PFS at 5 years=39.5 % (p&lt;0.0068). Overall survival (OS) was not statistically different (p= 0.77) using these 3 groups, but it was the case when we mixed groups 1 and 2 (0 to 25% CD68+cells) compared to group 3 (&gt;25%) for OS (p=0.0247) and for PFS (p=0.0026). Thus, these 2 groups with CD68 low (CD68≤25%) and CD68 high (CD68&gt;25%) were used for the other statistical analysis. There was a correlation between B symptoms and CD68 expression (63% in the CD68 high group versus 40% in the CD68 low group) (p=0.016). We also found a correlation between the Ann Arbor stage and CD68 expression. Indeed, CD68 was high in 71% of pts in the stage III-IV versus 29% in the stage I-II (p=0.0016). FDG-TEP SUV-max and SUV-mean calculation is available since September 2007 (n=58). We did not find any correlation between CD68 and initial pre-therapeutic SUV-max or SUV-mean (Anova test). Furthermore, no correlation exists between CD68 and erythrocyte sedimentation rate (ESR). Since 2004, pts have an early PET. In the 62 pts assessed to date, the rate of FDG-PET positive was significantly higher after two treatments in pts CD 68 high (9 PET+/14=64%) compared to pts CD68 low (13PET+/48=27%) (p&lt;0.012). Combining CD68 low and early negative PET (35 pts/62=56%) allowed us to define a very good prognosis group with a 100% OS and an 80% PFS with a median follow up of 31.12 months whatever the initial stage was. Conclusion: We found a strong correlation between initial Ann Arbor stages and CD68 expression. We also observe a correlation between CD68 expression and B symptoms at diagnosis. We confirm the experience of Steidl with adverse outcomes (PFS) when number of CD68 is increased. In our experience there are a worse PFS and OS when CD68 cells are &gt;25% independently from initial clinical presentation. Our results show a strong correlation between CD68 expression and the results of early PET with an excellent PFS for the CD68 low/early PET negative group. The prognostic relevance of CD 68+ tumor-associated macrophages in HL should be validated prospectively to contribute in combination with FDG-PET to a better risk stratification of pts to adapted treatment in classical HL. Disclosures: No relevant conflicts of interest to declare.

Arthrography in thumb polydactyly with bifurcation at the interphalangeal or metacarpophalangeal joints provides practical information at surgery

2012 ◽  
Vol 38 (3) ◽  
pp. 267-271 ◽  
Author(s):  
K. Iba ◽  
T. Wada ◽  
K. Kanaya ◽  
G. Oki ◽  
T. Yamashita
Keyword(s):  
Average Duration ◽  
Proximal Phalanx ◽  
Type Iv ◽  
Group 4 ◽  
Age At Surgery ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

We carried out arthrography in 19 thumbs of 18 patients in whom duplication was observed at the interphalangeal (Wassel type II) or metacarpophalangeal (Wassel type IV) joints on radiographs. The average age at surgery was 12.3 months and average duration of post-surgical follow-up was 21.3 months. Based on the arthrographic findings, the types of cartilaginous connections were subdivided into five groups. In group 1, there was a cartilaginous connection at the base of duplicated phalanges. In group 2, there was a cartilaginous connection of the radial digit between the distal and proximal phalanges, or between the proximal phalanx and metacarpal. In group 3, the phalanges separated at a common joint without any cartilaginous connection. In group 4, the radial digit demonstrated fibrous attachment to the capsule without any joint formation. In group 5, each joint was completely separated without any cartilaginous connection. These arthrographic findings could not be detected on radiographs. Different surgical procedures were carried out according to the form of cartilaginous connection.

Management of Acute Myeloid Leukemia (AML) in First Relapse: Retrospective Analysis about 101 Adults Cases Receiving Homogeneous First-Line Therapy. Impact of Prognostic Factors and Treatment.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 882-882
Author(s):  
Cecile Fohrer ◽  
Brigitte Witz ◽  
Jean Luc Harousseau ◽  
Francis Witz ◽  
Shanti Ame ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Median Survival ◽  
Complete Response ◽  
Intensive Chemotherapy ◽  
Group 4 ◽  
Line Therapy ◽  
First Relapse ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract We retrospectively analyzed impact of prognostic factors and salvage therapy in 101 patients (pts) with AML in 1st relapse. All pts were treated as 1st line according protocols GOELAMs 1 (87–94) or 2 (95–99). They all achieved complete remission after one (85%) or two (16%) induction with a combination of anthracycline and cytarabine. Consolidation therapy included one course of high-dose cytarabine (HiDAC) and a second consolidation (amsacrine-VP16) or, for a subset of pts, intensification with allogeneic or autologous stem cell transplantation (SCT). Data were collected in 3 of the centers participating to these trials. Main characteristics of pts at initial diagnosis were: median age : 39 y (range 17–64); sex : 55 male, 46 female; WBC count > 30 000/μl in 42 (42%) pts; 16/85 (18%) pts had unfavorable karyotype. Median duration of 1st complete remission (CR1) was 10 months (range: 1–101). Duration of CR1 was shorter than 6 months in 22 (22%) pts, between 6 and 12 months in 41 (40%) pts and longer than 12 months in 38 (38%) pts. At time of 1st relapse, median age was 40 y (range 18–66) and 10/38 (26%) unfavorable karyotype. There were no specific recommendations in the GOELAMs protocols for the second line therapy: modalities of treatment were therefore left to investigator’s decision. First step of relapse treatment was based on intensive chemotherapy in 79 (79%) pts including 55 pts who received a regimen containing HiDAC (Group 1) and 24 pts who received a chemotherapy without HiDAC (Group 2). Eight pts received an autologous SCT (4 pts) or an allogeneic SCT (4 pts) without any previous salvage chemotherapy (Group 3). One pt received gemtuzumab ozogamicin and thirteen pts received only oral chemotherapy and/or supportive care (Group 4). Fifty-seven pts (56%) achieved a second CR. Response rate and median survival according to initial therapy of relapse are shown in the following table. Differences are not significant. Complete response (%) Median survival (months) Group 1 (n = 55) 39 (71%) 11.5 Group 2 (n = 24 10 (42%) 8 Group 3 (n = 8) 6 (75%) 7.5 Group 4 (n = 14) 2 (14%) 3.5 Twenty seven pts out of the 49 pts who achieved a CR2 after intensive chemotherapy (Group 1 and 2) received subsequent intensification with either an allogeneic SCT (7 pts) or an autologous SCT (20 pts). Median survival of these pts subsequently transplanted was 18 months compared to only 10 months in the 22 pts of group 1 and 2 who did not receive a subsequent transplantation. Difference is not significant (log rank test, p = 0.65). Nine (33%) of the 27 transplanted pts are alive more than 36 months after relapse (range 41–120). Univariate analysis demonstrated that adverse prognosis factors on survival at 1st relapse were duration of RC1 shorter than 12 months (p= 0.005)and complex cytogenetic abnormalities (p= 0.0086). Conclusion: Intensive chemotherapy including HiDAC at 1st relapse in AML in adults provided a high rate of complete response. Intensification with SCT after CR2 was obtained can provide a very long survival in a limited number of pts. At 1st relapse, adverse prognostic factors on survival were short CR1 and unfavorable karyotype. Risk-adapted of AML in first relapse may therefore be warranted. Figure Figure

Impact of Peripheral Blood Stem Cell Recruitment on Outcome of Single or Double Autologous Hematopoietic stem Cell Transplantation for Multiple Myeloma.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5221-5221
Author(s):  
Mauricette Michallet ◽  
Quoc-Hung Le ◽  
Anne-Sophie Michallet ◽  
Anne Thiebaut ◽  
Emmanuelle Tavernier ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Light Chains ◽  
Hematopoietic Stem ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Multiple myeloma remains one of the best indication for intensive chemotherapy followed by autologous hematopoietic stem cell transplantation (autoT). Intensive therapy followed by autologous transplantation is superior to conventional chemotherapy and it was demonstrated that two autoT were superior to one except for patients in very good partial response or in complete response after the first autotransplant. Peripheral blood stem cells (PBSC) can be used as well as bone marrow as HSC source with the same efficacy but very few data have been reported regarding PBSC recruitment. The main goal of our work was to study the impact on overall and event-free survival (OS and EFS) of PBSC recruitment using either growth factors (GF) alone (steady state) or chemotherapy followed by GF. Secondly, we performed a multivariate analysis studying influence on OS and EFS of sex, age, lines of therapy, pretransplant status, TBI, PBSC recruitment and number of autoT. We have analyzed 193 PBSC autoT (1 autoT=160, 2 autoT=33) performed for 160 MM patients [81 males and 71 females, mean age: 55 years (39–71)]. At diagnosis, 88 patients presented a MM Ig G (70k and 18l), 28 Ig A (16k and 12l), 3 Ig D (1k and 2l), 21 light chains k and 13 light chains l, 3 non secreting and 4 with plasmocyte leukemias. According to Durie and Salmon classification 75% of patients were in stage III, 15% in stage II and 10% in progressive I. Before transplantation, patients have received 1 line of poly-chemotherapy (n=141), 2 lines (n=15) or 3 lines (n=4) and 154 were evaluated for the response with 11 complete remission, 113 partial remission and 30 stable or evolutive disease just before transplant. As HSC (n=189), patients received PBSC which were recruited by GF alone (n=105) or cyclophosphamide+GF (n= 84). Conditioning (n=189),consisted in melphalan and TBI (n=51), melphalan alone (n=132), melphalan associated to cyclophosphamide or busulfan (n=6). We divided the population into 4 groups : group 1 who received one autoT of PBSC recruited by GF (n=76), group 2 one autoT of PBSC recruited by chemotherapy+GF (n=50), group 3 two autoT of PBSC recruited by GF (n=16) and group 4 two autoT of PBSC recruited by chemotherapy+GF (n=17). The median follow-up (FU) of the 4 groups were different with shorter FU (group 3: 9.9 months, group 4: 13 months) for patients who received tandem autoT because of the recent character of this strategy as compared to a long term follow-up for patients who received only one transplant (group 1: 35months, group 2: 55.3 months). Probabilities of OS and EFS at 2 years were 76% (95%CI 67–87) and 60% (95%CI 49.5–73) for group 1, 77% (95%CI 65–90.5) and 70% (95%CI 57.5–85) for group 2, 87.5% (95%CI 73–100) and 72.9% (95%CI 49–100) for group 3, 100% and 66.7% (95%CI 36–100) for group 4. The difference was not significant because of follow-up differences between the 4 groups and small number of patients in groups 3 and 4. In addition, multivariate analysis did not show any significant influence of the different studied parameters on OS and EFS. Nevertheless, because of these interesting preliminary results, a longer follow-up is warranted for definitive conclusions.

Multi-Center Phase II Study of CAMPATH-1H Dose De-Escalation Prior to Nonmyeloablative HLA-Identical Sibling Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1055-1055
Author(s):  
Ronjon Chakraverty ◽  
Nilusha Manji ◽  
Richard Clark ◽  
Charles Crawley ◽  
Peter Johnson ◽  
...  
Keyword(s):  
Total Dose ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Significant Risk ◽  
Post Transplantation ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Inclusion of CAMPATH-1H as part of a Fludarabine/Melphalan conditioning regimen is effective at preventing GVHD and reducing non-relapse mortality (NRM)following allogeneic stem cell transplantation. However, these benefits are offset by high rates of infection and potentially a loss of graft-versus-tumor effects. When used at a total dose of 100mg, CAMPATH-1H antibody can still be detected at levels in excess of those required to induce ADCC for several weeks. We reasoned that a reduction in the dose of CAMPATH-1H would permit improved immune reconstitution post-transplantation. We report here the analysis of a national, multi-center trial in which the total dose of CAMPATH-1H was reduced step-wise in separate cohorts from 60mg to 20mg prior to HLA-identical sibling transplantation (n=106). Eligibility criteria included patients with haematological malignancies who were aged 18–65, who had a life expectancy >3 months and who were not suitable for standard myeloablative conditioning. Primary endpoints included PK data, chimerism, NRM and incidence of GVHD or infection. The study received IRB approval and all patients gave informed consent. Four total doses of CAMPATH-1H were tested in consecutive cohorts: group 1, 60mg split between d-2 and d-1 (n=26); group 2, 40mg split between d-2 and d-1 (n=27); group 3, 30mg d-1 (n=28); and group 4, 20mg on day -1 (n=25). 97/106 patients recruited to the study are evaluable with a median follow up of 12 months. Median age was 50 (range 19–64). No major differences were identified in patient characteristics between each cohort. 1-year OS and PFS for the whole population was 80.8% and 67.2% respectively. Peak CAMPATH-IH levels (ug/ml) measured by ELISA on day 0 (n=5 each group) were 7.7 ±1.1 in group 1, 4.3 ±0.7 in group 2, 4.9 ±0.8 in group 3 and 2.7± 0.7 in group 4 (p<0.05 groups 1 vs. each group 2–4). By day 28, CAMPATH-1H levels had fallen substantially in all groups, but especially groups 3/4: 1.1 ±0.4 in group1, 0.6 ±0.1 in group 2, 0.1 ±0.06 in group 3 and 0.1 ±0.06 in group 4 (p<0.05 group 1 vs. each group 3 and 4). In groups 3 and 4, 40% of patients had undetectable CAMPATH-1H levels by day 28. Chimerism data was available in 78 patients and of these, 1 patient showed autologous reconstitution, 52 were mixed chimeras and 25 were full chimeras, with no differences between the groups. Day 100 NRM was 4% in group 1, 8% in group 2, 0% in group 3 and 12% in group 4. Grade III-IV GVHD was 0% in group 1, 4% in group 2, 0% in group 3 and 11% in group 4 (p=0.09 group 1 vs. 4). It is noteworthy that 2 patients in group 4 died of complications secondary to grade IV GVHD, although no patients died of this complication in any of the other cohorts. There were no significant differences in the rates of initial CMV reactivation between the groups, or in the rates of CD4 reconstitution. Cumulative incidences of chronic GVHD at 1-year were 55% and 30% in groups 1 and 2, although further follow up is required in later cohorts. We conclude that significant de-escalation of the CAMPATH-1H dose prior to HLA-identical sibling transplantation is feasible without increasing NRM, although reductions below 30mg are associated with a clinically significant risk of severe acute GVHD. Further studies are warranted to determine whether reductions in CAMPATH-1H dosage will translate into improvements in progression-free survival.

scholarly journals Development of Polyps and Cancer in Patients with a Negative Colonoscopy: A Follow-Up Study of More Than 20 Years

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
R. J. L. F. Loffeld
Keyword(s):  
Colorectal Cancer ◽  
Outpatient Clinics ◽  
Exclusion Criterion ◽  
Follow Up Study ◽  
Group 4 ◽  
Hospital Systems ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background. Adenomas are missed during colonoscopy. Aim. Assess the occurrence of colorectal cancer (CRC) and polyps in patients with a negative index colonoscopy (IC). Patients and Methods. All patients with a IC in 1992–1994, aged 40 and 60 years, were included. Exclusion criterion was presence of abnormalities, a family history, or surveillance. At the end of 2013 all records were studied in order to gather follow-up information. Results. 394 patients were included in four groups: group 1 patients who died, group 2 patients who were not in the hospital systems anymore, group 3 patients still visiting the hospital but not the department of gastroenterology, and group 4 patients undergoing new colonoscopies. In group 1, 2 patients died of CRC and 4 developed a polyp. No data were available from the patients in group 2. Patients in group 3 visited the outpatient clinics but did not undergo new colonoscopy. Patients in group 4 underwent additional colonoscopies. The yield was 35 patients polyps and three CRCs. Five patients (1.3%) developed CRC, and 39 (9%) developed a polyp. Conclusion. Given these results the number of potentially missed adenomas in IC is very low and the consequences of missed adenomas are highly exaggerated.

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