Acute Myeloid Leukemia: The Outcome Is Determined By Age, Genetic Group, White Blood Cell Count, Lactate Dehydrogenase, Rather Than By Chemotherapy Intensity

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1447-1447
Author(s):  
Thomas Buchner ◽  
Wolfgang E. Berdel ◽  
Utz Krug ◽  
Claudia Haferlach ◽  
Susanne Schnittger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lactate Dehydrogenase ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
Standard Dose ◽  
High Dose ◽  
Blood Cell Count ◽  
Younger Patients ◽  
Baseline Characteristics

Abstract Background Data on benefit and toxicity by treatment intensification for AML are now available and allow rediscussing current dosing. Methods In a multicenter trial involving patients between 16 and 86 years of age, patients below 60 years received uniform double induction by the 1st course with standard dose araC/ daunorubicin (60mg/m²x3)/ thioguanine followed by the 2nd course with high-dose araC (3g/m²x6)/ mitoxantrone (10mg/m²x3), or randomly two high-dose courses. As age adaption patients of 60y or older received the 2nd course only in case of persistent blasts, and high-dose araC at 1 instead of 3g/m². Post remission treatment was consolidation and maintenance or randomly autologous stem cell transplantation in younger patients. Results 3369 patients entered the trial with 1843 patients 60y or older. A multivariate analysis identified age as continuous variable, favorable cytogenetics/ molecular genetics, unfavorable cytogenetics, white blood cell count and lactate dehydrogenase as categorical variables to be risk factors predicting complete remission, overall survival as well as relapse free survival. To separate the age effect from the treatment effect, two subgroups of similar age and baseline characteristics but different treatment were compared. Thus, the 239 patients aged 57-59 and the 336 patients aged 60-62 years shared not only similar age but also similar baseline characteristics, while their treatment by protocol and age adaption differed substantially. The difference as expressed by the cumulative araC dosis amounted to a factor of 3.6, which however did not translate into a different overall survival (equally 28%) or relapse rate (equally 70%) at 5 years. In contrast to different treatment, different age had a strong effect on outcome. Thus, the survival in patients aged 16-46y was 65% at 5 years versus 40% in those of 47-59y receiving the same treatment (p< 0.001). A corresponding age related difference was also found between the patients of 60-66y and those of 67-86y (p< 0.001) receiving the same age adapted treatment. As shown by others in patients of 18-60y doubling an intermediate cumulative dose of araC produced excessive toxicity without therapeutic benefit (Löwenberg B et al. NEJM 2011; 364: 1027-36), while high dose daunorubicin (90mg/m²) instead of standard dose (45mg/m²) improved the remission rate and survival in younger patients (Fernandez H et al. NEJM 2009; 361: 1249-59) and older patients of 60-65y (Löwenberg B et al. NEJM 2009; 361: 1235-48). No comparable data are available about daunorubicin 60mg/m² the standard in present study. Conclusion Age and disease biology rather than chemotherapy intensity are the main determinants of outcome in AML. Once a certain intensity and antileukemic effect has been achieved, a further escalation does not seem to overcome the age factor in AML. Present data require rediscussing current chemotherapy dosing and treatment alternatives. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical Characteristics and Prognosis of Patients with COVID-19 Combineded with or without Diabetes, Hypertension or Coronary

2020 ◽  
Author(s):  
Haoxiang Li ◽  
Jianguo Zhang ◽  
Jinhui Zhang ◽  
Ling Yang ◽  
Dong Wang ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Blood Cell ◽  
Cell Count ◽  
Chronic Diseases ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Neutrophil Count ◽  
Blood Cell Count ◽  
Neutrophil Percentage ◽  
D Dimer

Abstract Bcakground: This study was to investigate the clinical characteristics and prognosis of COVID-19 patients combined with or without major chronic diseases like diabetes, hypertension or coronary. Methods: We retrospectively analyzed 183 patients with COVID-19 diagnosed at First People's Hospital of Jiangxia District (FPHJD) in Wuhan, China attended by Affiliated Hospital of Jiangsu University supporting medical team from February 1, 2020 to March 15, 2020. Patients were divided into simple COVID-19 group(n=134), COVID-19 combined with diabetes, hypertension or coronary group(n=49). Besides, COVID-19 patients with diabetes, hypertension or coronary were further classified into severe pneumonia group(n=23) and common pneumonia group(n=26), death group(n=17) and survival group(n=32). The prognosis of COVID-19 patients was evaluated by analyzing the clinical data and the results of laboratory tests. Results: 183 patients were included in this study, of whom 166 were discharged and 16 died in hospital. 49 (26.92%) patients had a comorbidity, with hypertension being the most common [37 (20.33%) patients], followed by diabetes [25 (13.74%) patients] and coronary heart disease [4 (2.2%) patients]. Compared with simple COVID-19 group, the proportion of history of chronic respiratory system disease, age, D-dimer, procalcitonin, C-reactive protein, myoglobin, cardiac troponin I, creatine kinase MB, lactate dehydrogenase, white blood cell count, neutrophil count, neutrophil percentage, blood urea nitrogen, creatinine and mortality rate were significantly higher in COVID-19 combined with chronic diseases group, whereas lymphocyte count, lymphocyte percentage and alanine transferase were significantly lower in COVID-19 combined with chronic diseases group. Among COVID-19 patients with chronic diseases, D-dimer, procalcitonin, C-reactive protein, myoglobin, cardiac troponin I, lactate dehydrogenase, white blood cell count, neutrophil count, neutrophil percentage, blood urea nitrogen, death rate was significantly higher in severe pneumonia group than common pneumonia group. While lymphocyte count and lymphocyte percentage were significantly lower in severe pneumonia group than common pneumonia group. Besides, we found that the proportion of history of chronic respiratory system disease, D-dimer, procalcitonin, myoglobin, cardiac troponin I, creatine kinase MB, lactate dehydrogenase, neutrophil count, neutrophil percentage, blood urea nitrogen were significantly higher in death group compared with survival group, whereas lymphocyte count and lymphocyte percentage were significantly lower in survival group. In COVID-19 combined with chronic diseases group, univariate logistic regression showed that the risk for severe pneumonia were D-dimer, C-reactive protein, lactate dehydrogenase, white blood cell count, neutrophil count and neutrophil percentage. Univariate logistic regression also showed that the risk for death were D-dimer, lactate dehydrogenase, white blood cell count, neutrophil count, neutrophil percentage and blood urea nitrogen. Multivariate regression logistic showed that lactate dehydrogenase were independent risk factors for death among COVID-19 patients combined with chronic diseases. Cox regression analysis showed that compared with simple COVID-19 group, the RR(95% CI) in COVID-19 patients combined with diabetes, hypertension, and coronary were 2.187 (1.141~4.191) for death (P<0.05). Conclusion: Among COVID-19 patients combined with diabetes, hypertension or coronary, the risk factors for severe pneumonia were D-dimer, C-reactive protein, lactate dehydrogenase, white blood cell count, neutrophil count and neutrophil percentage, whereas the risk factors for death were D-dimer, lactate dehydrogenase, white blood cell count, neutrophil count, neutrophil percentage and blood urea nitrogen. Moreover, lactate dehydrogenase were independent risk factors for death. The mortality rate of COVID-19 patients combined with diabetes, hypertension or coronary was higher than that of simple COVID-19 patients.

A Combination of Testosterone and White Blood Cell Count as a Predictive Factor of Overall Survival in Localized Prostate Cancer

2017 ◽  
Vol 12 (5) ◽  
pp. 695-701 ◽  
Author(s):  
Daniel Taussky ◽  
Denis Souliéres ◽  
Laurent Azoulay ◽  
Hui Yin ◽  
Houda Bahig ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Predictive Factor ◽  
Localized Prostate Cancer ◽  
Blood Cell Count

scholarly journals Gasless Trans-Umbilical Laparoscopically-Assisted Appendectomy in the Pediatric Population: An Early Experience

2020 ◽  
Vol 5 (1) ◽  
pp. p40
Author(s):  
Raed Nael Al-Taher, Md. ◽  
Ibrahim Abdel Qader Ibrahim Khrais, M.D. ◽  
Tayseer Ahmad Sabbah Al-Tawarah M.D. ◽  
Mohammad Talat M. Al-Sebou’ M.D. ◽  
Walid Adel Zakaria Alnatsheh M.D. ◽  
...  
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Age Group ◽  
Pediatric Age ◽  
Blood Cell Count ◽  
Pediatric Age Group ◽  
Significant Difference ◽  
Baseline Characteristics

Background: The aim of this study is to determine the feasibility and safety of the single-port gasless trans-umbilical laparoscopically-assisted appendectomy in the pediatric age group at a single center in a tertiary university hospital in Jordan. Methods: Between April 2018 and July 2019, the surgical records of all patients aged between 0 and 13 years treated with trans-umbilical laparoscopic-assisted appendectomy TULAA for a suspected appendicitis following a clinical, laboratory and ultrasound findings were reviewed retrospectively. Baseline characteristics, white blood cell count, operative time, intraoperative findings, need for additional trocars or for conversion, length of hospital stay and surgical complications were reported.Results: 36 cases were included in the study, 23 (64%) were completed successfully using the gasless TULAA technique. Gas insufflation was needed in 10 (28%) cases and only 3 (8%) had to be converted to the three-port laparoscopic appendectomy technique. There was no significant difference between the gaseous and gasless groups in terms of baseline characteristics, BMI, surgery duration, postoperative recovery period or length of stay. However, the group of patients who needed gas insufflation to complete the procedure had a higher white blood cell count compared to the gasless group. The surgery was completed successfully by senior general surgery residents in 27 (75%) cases while the consultant’s intervention was needed in the remaining cases. The gasless TULAA group were less likely to require complex analgesia (i.e., IV analgesia) compared to the gasless group (OR=0.683).Conclusions: Gasless TULAA is a feasible procedure that can be performed safely by surgical residents as an initial approach for all grades of acute appendicitis in the pediatric age group.

scholarly journals White Blood Cells and Severe COVID-19: A Mendelian Randomization Study

2021 ◽  
Vol 11 (3) ◽  
pp. 195
Author(s):  
Yitang Sun ◽  
Jingqi Zhou ◽  
Kaixiong Ye
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cells ◽  
Mendelian Randomization ◽  
Association Studies ◽  
White Blood Cells ◽  
Genome Wide Association Studies ◽  
Blood Cell Count

Increasing evidence shows that white blood cells are associated with the risk of coronavirus disease 2019 (COVID-19), but the direction and causality of this association are not clear. To evaluate the causal associations between various white blood cell traits and the COVID-19 susceptibility and severity, we conducted two-sample bidirectional Mendelian Randomization (MR) analyses with summary statistics from the largest and most recent genome-wide association studies. Our MR results indicated causal protective effects of higher basophil count, basophil percentage of white blood cells, and myeloid white blood cell count on severe COVID-19, with odds ratios (OR) per standard deviation increment of 0.75 (95% CI: 0.60–0.95), 0.70 (95% CI: 0.54–0.92), and 0.85 (95% CI: 0.73–0.98), respectively. Neither COVID-19 severity nor susceptibility was associated with white blood cell traits in our reverse MR results. Genetically predicted high basophil count, basophil percentage of white blood cells, and myeloid white blood cell count are associated with a lower risk of developing severe COVID-19. Individuals with a lower genetic capacity for basophils are likely at risk, while enhancing the production of basophils may be an effective therapeutic strategy.

Identifying Top Predictors of Change in Noncalcified Coronary Burden in Psoriasis by Machine Learning Over 1-Year

2021 ◽  
pp. 247553032110007
Author(s):  
Eric Munger ◽  
Amit K. Dey ◽  
Justin Rodante ◽  
Martin P. Playford ◽  
Alexander V. Sorokin ◽  
...  
Keyword(s):  
Machine Learning ◽  
Blood Pressure ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Severity Index ◽  
Blood Cell Count ◽  
Psoriasis Area Severity Index ◽  
Severity Index Score

Background: Psoriasis is associated with accelerated non-calcified coronary plaque burden (NCB) by coronary computed tomography angiography (CCTA). Machine learning (ML) algorithms have been shown to effectively identify cardiometabolic variables with NCB in cross-sectional analysis. Objective: To use ML methods to characterize important predictors of change in NCB by CCTA in psoriasis over 1-year of observation. Methods: The analysis included 182 consecutive patients with 80 available variables from the Psoriasis Atherosclerosis Cardiometabolic Initiative, a prospective, observational cohort study at baseline and 1-year using the random forest regression algorithm. NCB was assessed at baseline and 1-year from CCTA. Results: Using ML, we identified variables of high importance in the context of predicting changes in NCB. For the cohort that worsened NCB (n = 102), top baseline variables were cholesterol (total and HDL), white blood cell count, psoriasis area severity index score, and diastolic blood pressure. Top predictors of 1-year change were change in visceral adiposity, white blood cell count, total cholesterol, c-reactive protein, and absolute lymphocyte count. For the cohort that improved NCB (n = 80), the top baseline variables were HDL cholesterol related including apolipoprotein A1, basophil count, and psoriasis area severity index score, and top predictors of 1-year change were change in apoA, apoB, and systolic blood pressure. Conclusion: ML methods ranked predictors of progression and regression of NCB in psoriasis over 1 year providing strong evidence to focus on treating LDL, blood pressure, and obesity; as well as the importance of controlling cutaneous disease in psoriasis.

scholarly journals Enoxaparin-induced reactive thrombocytosis: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tao Xiang ◽  
Ming Cheng
Keyword(s):  
Molecular Weight ◽  
Platelet Count ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Hip Replacement ◽  
Low Molecular Weight ◽  
Blood Cell Count ◽  
Reactive Thrombocytosis

Abstract Background Enoxaparin is an anticoagulant that falls in the class of medications called low molecular weight heparins (LMWHs), and is used to prevent or treat patients with deep vein thrombosis (DVT) and pulmonary embolism. Enoxaparin is the most widely used LMWH for DVT prophylaxis following knee or hip replacement surgery. Common side effects of enoxaparin include bleeding, petechiae at the injection site, and thrombocytopenia. However, reactive thrombocytosis is a rarely reported adverse reaction. We managed a patient who developed enoxaparin-associated thrombocytosis, which was completely resolved after treatment cessation. Case presentation A 78-year-old female was hospitalized for post-hip replacement rehabilitation. Low molecular weight heparin 40 mg/day was administered subcutaneously to prevent deep venous thrombosis (DVT). At admission, her platelet count was normal (228 × 109/L) and her white blood cell count was slightly elevated (12.91 × 109/L). Seven days after admission, the patient developed thrombocytosis, which peaked on the 14th day (836 × 109/L), while her white blood cell count had returned to normal (8.86 × 109/L). Her therapeutic regimen was reviewed, and enoxaparin was identified as a potentially reversible cause of reactive thrombocytosis. Switching from enoxaparin to rivaroxaban lead to a gradual decrease in the patient’s platelet count, which eventually returned to normal levels 16 days after enoxaparin was discontinued. No complications secondary to thrombocytosis was observed, and no conclusion was reached on the use of small doses of aspirin for antithrombotic therapy under these circumstances. Conclusion Enoxaparin-induced reactive thrombocytosis should be suspected in patients with thrombocytosis following enoxaparin administration as an anticoagulant to prevent certain complications.

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