Outcomes Of Relapse Of AML Post Allogeneic Transplantation In The Era Of Hypomethylating Agents: An Analysis Of 162 Allogeneic Transplants From a Single Center

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2086-2086
Author(s):  
Justin LaPorte ◽  
Xu Zhang ◽  
Zaamin Hussain ◽  
Stacey Brown ◽  
Connie A. Sizemore ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Patient Characteristics ◽  
Hypomethylating Agents ◽  
Term Survival ◽  
Long Term Outcome ◽  
Post Transplant ◽  
Hypomethylating Agent ◽  
One Year ◽  
Relapse Therapy

Abstract Allogeneic hematopoietic cell transplantation (allo-HCT) can be curative in many patients with intermediate and high risk AML. However, post-transplant relapse remains an important cause of treatment failure. Patients with AML who relapse post allo-HCT typically have a dismal prognosis with limited therapeutic options. Hypomethylating agents alone are increasingly being used to treat AML in patients who are elderly or otherwise unfit for chemotherapy. They may also be used for maintenance/consolidation following induction chemotherapy. The activity and minimal toxicity associated with hypomethylating agents makes them potentially useful in the management of AML patients who relapse following allo-HCT. However, their use in this setting has not been well studied. We assessed one hundred and sixty two consecutive patients who underwent a first allo-HCT for AML at our center during a period when hypomethylating agent therapy was widely available (February 2005 through May 2013). Patient characteristics were: median age, 53 (range18-74); M=75, F=87; donor-matched-sibling (MRD) =59, matched-unrelated (MUD) =67, HLA-haploidentical (Haplo) =36; ablative conditioning=98, RICT/NST=64; PBSC=142, BM=20; CIBMTR risk category- high=53, intermediate=28, low=74, unknown=7. Post-relapse therapy was determined by the attending physician and patient preference. Patient characteristics, post-relapse therapy, GVHD and survival were prospectively collected as part of our comprehensive HCT database. With a median follow-up for surviving patients of 22.4 months, relapse of AML post-allo-HCT was experienced by fifty-five patients (22 MRD, 24 MUD, 9 Haplo; cytogenetic risk 23 poor, 31 intermediate, 1 unknown) at a median of 113 days (range 25-1106) post-transplant. Thirty-four patients (62%) were treated with a hypomethylating agent post-relapse (17 azacitidine, 10 decitabine, 7 both) (12 hypomethylating agent alone, 11 combined with chemotherapy, 11 sequentially with chemotherapy). Median number of cycles of hypomethylating agent therapy was 2 (range 1-9). Of the 23 patients that received at least 2 cycles of hypomethylating agents, 14 achieved CR or CRi. Donor lymphocyte infusions (DLI) were administered in 15 of the 55 relapsed patients and 16 patients received a second allo-HCT. Estimated Kaplan-Meier probability of post-relapse survival (PRS) at 6, 12 and 24 months post-relapse for all patients was 53%, 36% and 19% and was not significantly different for patients who developed any versus no GVHD following post-relapse therapy. However, PRS at 6 and 12 months was 62% (95% CI 43-76%) and 38% (95% CI 22-54%) in patients who received hypomethylating agent therapy post-relapse versus 38% (95% CI 18-58%) and 33% (95% CI 15-53%) in patients who did not (p=0.063 Gehan’s test). PRS was not different between the two groups at 24 months. Survival > 1 year post relapse was achieved in 19 of 55 relapsing patients (35%). Of these patients, 9 received a second allo-HCT, 9 received DLI and 12 were treated with a hypomethylating agent. At the time of writing 6 patients are alive and in complete remission at a median of 49 months (10-72) following relapse. Of the 6 patients (5 MRD, 1 MUD; cytogenetic risk 2 poor, 4 intermediate), 4 received hypomethylating agents, 3 received a second transplant, 1 received DLI, and 4 have active GVHD. These data demonstrate that relapse post allo-HCT remains a major obstacle to long-term survival in patients transplanted for AML. Hypomethylating agents can be used in the majority of relapsed patients in this setting and appear effective in inducing responses. The use of hypomethylating agents may be associated with a prolongation of early post-relapse survival although it does not appear to increase survival beyond one year post-relapse. Survival beyond one year post-relapse can be achieved even without a second allogeneic transplant, but is only achieved in a minority of relapsing patients. Combination of therapy with hypomethylating agents and novel agents may be necessary to impact long-term outcome. Disclosures: No relevant conflicts of interest to declare.

Short Chemotherapy-Phased Imatinib (IM) Pulses Improve Long-Term Outcome of Adult Patients with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2029-2029
Author(s):  
Renato Bassan ◽  
Giuseppe Rossi ◽  
Enrico Maria Pogliani ◽  
Eros Di Bona ◽  
Emanuele Angelucci ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Observation Interval ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Pcr Analysis ◽  
Remission Induction ◽  
Term Survival ◽  
Multicentric Study ◽  
Long Term Outcome

Abstract Abstract 2029 Poster Board II-6 In a prospective NILG (Northern Italy Leukemia Group) study, short IM pulses were added to chemotherapy in order to 1) reduce incidence of early failures, 2) obtain higher transfer rates to stem cell transplantation (SCT), and 3) improve survival in comparison with a prior patient cohort treated with the same chemotherapy program without IM. IM 600 mg/d was given orally for 7 consecutive dd. with each chemotherapy block, starting from day 15 of induction (IDR/VCR/PDN±ASP) and day –3 of the following consolidation courses (5x IDR/VCR/CY/DEXA; 2x HD-MTX/ARA-C). All pts. received CNS chemoradioprophylaxis and were eligible to allogeneic SCT, or alternatively to HD therapy with autologous SCT and long-term maintenance with 6MP/MTX and intermittent IM. Between April '00 and November '08, 100 out of 404 pts. registered in NILG study 09/00 had Ph+ ALL (Ph chromosome and/or BCR-ABL rearrangement). M/F ratio was 1.17 and median age 46 years (range 19-66). 35 pts. constituted the control cohort (IM-) while, starting December '02, 59 pts. were included in the modified protocol (IM+), and 6 were excluded from analysis because treated on a continuous IM schedule. Of 59 IM+ pts., 53 received IM during induction/consolidation as planned and 6 during consolidation only (included in IM- group for remission induction analysis). Outcome to induction therapy of IM+ vs. IM- group was: CR 49/53 (92%) vs. 33/41 (80%), NR 2 (3.7%) vs. 5 (12%), ED 2 (3.7%) vs. 3 (7%) (P=NS). With a median observation interval from diagnosis of 5 years (range 0.6-9.2 years), 21 IM+ vs. 6 IM- pts. are alive in remission (CR1 pts.: 43% vs. 18%, P=0.02), and both OS (Figure) and DFS (0.39 vs. 0.21, P=0.044) rates at 5 years are significantly improved in IM+ group, especially when IM was administered from the induction cycle. The ability to perform a SCT increased from 53%(n=15: 11 allogeneic, 4 autologous) to 68%(n=37: 22 allogeneic, 5 autologous), partly owing to lower incidence of early relapse (26% vs. 56% at 1 year, P=0.005). SCT-related mortality was not different (P=0.58) and postgraft survival probability at 5 years was 0.45 overall, again with no difference related to SCT source or IM. Use of IM was not associated with greater reduction of BCR-ABL transcripts: by PCR analysis of BM samples taken at weeks 10, 16 and 22 in pretransplantation pts., a major response (absent/<10-4 PCR signals) was documented in 13/27 (48%) determinations from 13 evaluable IM- pts. vs. 16/49 (33%) from 25 IM+ pts.(P=NS). The short IM schedule used in this multicentric study demonstrated synergy with chemotherapy, resulting for the first time in NILG studies in improved long-term survival for this adverse subset. Problems of SCT-related toxicity and postgraft relapse need to be addressed further, to confirm curability of Ph+ ALL in a greater proportion of cases. Disclosures: No relevant conflicts of interest to declare.

One-Year Post-Transplant Serum Ferritin Level Is a Predictor of Long-Term Survival Following Allogeneic Transplantation.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3453-3453 ◽  
Author(s):  
Stuart L Goldberg ◽  
Marc Elmann ◽  
Mark Kaminetzky ◽  
Eriene-Heidi Sidhom ◽  
Anthony R Mato ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Iron Overload ◽  
Serum Ferritin ◽  
Cox Regression ◽  
Allogeneic Transplantation ◽  
Term Survival ◽  
Post Transplant ◽  
Kaplan Meier ◽  
One Year

Abstract Abstract 3453 Individuals undergoing allogeneic transplantation receive multiple red blood cell transfusions both as part of the transplant procedure and as part of the pre-transplant care of the underlying disease. Therefore these patients may be at risk for complications of transfusional iron overload. Several studies have noted that individuals entering the transplant with baseline elevated serum ferritin values have decreased overall survival and higher rates of disease relapse. Whether the iron is a direct contributor to inferior outcomes or is a marker of more advanced disease (thereby requiring greater transfusions) is unclear. Little is known about the incidence and consequences of iron overload among long-term survivors of allogeneic transplantation. Methods: Using Kaplan-Meier and Cox regression analyses, we performed a single center, retrospective cohort study of consecutive allogeneic transplants performed at Hackensack University Medical Center from January 2002 through June 30, 2009 to determine the association between serum ferritin (measured approximately 1 yr post allogeneic transplant) and overall survival. Results: During the study time frame, 637 allogeneic transplants (Donor Lymphocyte Infusion procedures excluded) were performed at our center and 342 (54%) survived ≥ one year. Among 1-year survivors 240 (70%) had post-transplant serum ferritin values available for review, including 132 (55%) allogeneic sibling, 68 (28%) matched unrelated, and 40 (17%) mismatched unrelated donor transplants. The median post-transplant ferritin value among 1-year survivors of allogeneic transplant was 628 ng/ml (95% CI 17, 5010), with 93 (39%) above 1000 ng/ml and 40 (17%) above 2500 ng/ml. The median post-transplant ferritin levels varied by underlying hematologic disease (aplastic anemia = 1147, acute leukemia = 1067, MDS = 944, CLL = 297, CML = 219, lymphoma = 123, multiple myeloma = 90). The Kaplan-Meier projected 5-year survival rate was 76% for the cohort that had survived one year and had available ferritin values. Fifty late deaths have occurred; causes of late death were disease relapse (n=37, 74%), GVHD (n=7, 14%), infection (n=4, 8%), cardiac (n=1, 2%) and second malignancy (n=1, 2%). The 1-year post-transplant serum ferritin value was a significant predictor of long term survival. Using a cut-off ferritin value of 1000 ng/ml, the 5-year projected survivals were 85% (95 CI 75%-91%) and 64% (95% CI 52–73%) for the low and high ferritin cohorts respectively (Figure, log-rank p<0.001), with a hazard ratio of 3.5 (95% CI 2–6.4, p<0.001). Similarly a serum ferritin value >2500 ng/ml was associated with inferior survival (HR 2.97, p<0.001). Underlying hematologic disease also correlated with 5-year projected survival including 70%, 83%, and 89% for acute leukemia/MDS, lymphoma/myeloma/CLL, and aplastic anemia/CML groupings, respectively (log-rank p<0.01 for leukemia/MDS vs other groupings). Patients receiving bone marrow grafts did better than those receiving peripheral blood stem cells (HR = 2.2; p = 0.03). Age, gender, donor type (sibling, matched unrelated, mismatch unrelated) and intensity of regimen (ablative vs. non-myeloablative) were not predictive of inferior survival in univariate analysis. In the multivariate Cox-regression analysis, elevated post-transplant ferritin >1000 ng/ml (HR 3.3, 95%CI 1.6–6.1; p<0.001) and diagnosis of acute leukemia/MDS (HR 4.5, 95%CI 1.1–18.7; p=0.04) remained independent predictors of inferior survival, even when adjusted for age, gender, type of graft, donor type, and intensity of conditioning regimen. Relapse deaths (25% vs. 9%; p<0.001) and GVHD deaths (6% vs 0.6%; p=0.03) were more common in the high ferritin cohort. Conclusions: Among patients who have survived one-year following allogeneic transplantation, a post-transplant serum ferritin value greater than 1000 ng/ml is a predictor of inferior long-term outcomes. To our knowledge this is the first report on the importance of late monitoring of serum ferritin, but it is in agreement with prior studies suggesting a pre-transplant ferritin value is a predictor of outcomes. Prospective studies attempting to modify outcomes by reducing post-transplant iron overload states are needed. Disclosures: No relevant conflicts of interest to declare.

Long term survival after early unloading with Impella CP® in acute myocardial infarction complicated by cardiogenic shock

2018 ◽  
Vol 9 (2) ◽  
pp. 149-157 ◽  
Author(s):  
Tobias Loehn ◽  
William W O’Neill ◽  
Bjoern Lange ◽  
Christian Pfluecke ◽  
Tina Schweigler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Term Survival ◽  
Long Term Outcome ◽  
Device Implantation ◽  
One Year

Background: The use of percutaneous left ventricular assist devices in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) is evolving. The aim of the study was to assess the long-term outcome of patients with AMICS depending on early initiation of Impella CP® support prior to a percutaneous coronary intervention (PCI). Methods: We retrospectively reviewed all patients who underwent PCI and Impella CP® support between 2014 and 2016 for AMICS at our institution. We compared survival to discharge between those with support initiation before (pre-PCI) and after (post-PCI) PCI. Results: A total of 73 consecutive patients (69±12 years old, 27.4% female) were supported with Impella CP® and underwent PCI for AMICS (34 pre-PCI vs. 39 post-PCI). All patients were admitted with cardiogenic shock, and 58.9% sustained cardiac arrest. Survival at discharge was 35.6%. Compared with the post-PCI group, patients in the pre-PCI group had more lesions treated ( p=0.03), a higher device weaning rate ( p=0.005) and higher survival to discharge as well as to 30 and 90 days after device implantation, respectively (50.0% vs. 23.1%, 48.5% vs. 23.1%, 46.9 vs. 20.5%, p < 0.05). Kaplan–Meier analysis showed a higher survival at one year (31.3% vs. 17.6%, log-rank p-value=0.03) in the pre-PCI group. Impella support initiation before PCI was an independent predictor of survival up to 180 days after device implantation. Conclusions: In this small, single-centre, non-randomized study Impella CP® initiation prior to PCI was associated with higher survival rates at discharge and up to one year in AMICS patients presenting with high risk for in-hospital mortality.

Late Effects Following Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) From Alternative Donors In Patients With Fanconi Anemia (FA)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1233-1233
Author(s):  
Praveen Anur ◽  
Danielle Friedman ◽  
Charles A. Sklar ◽  
Kevin C. Oeffinger ◽  
Susan E. Prockop ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Late Effects ◽  
Term Outcome ◽  
Hematopoietic Stem ◽  
Long Term Outcome ◽  
Post Transplant ◽  
One Year ◽  
Disease Free

Abstract Hematopoietic Stem Cell Transplantation is the only curative approach for the hematological complications of Fanconi Anemia. However, patients with FA remain at increased risk for HSCT-specific late effects and FA-associated complications including solid tumors, which may affect their long-term outcome. We performed a single-institutional, retrospective review of late effects and long-term outcome in patients with FA who underwent HCST from alternative donors at MSKCC from March 1999 to December 2012. This review was approved by MSKCC IRB/Privacy Board. Twenty-two patients including 14 males and 8 females who underwent T-cell depleted HSCT and survived more than one-year post-transplant were eligible for inclusion in this study. The hematologic diagnoses of these patients were: severe aplastic anemia (SAA, n=11), myelodysplastic syndrome (MDS n=6) and acute myelogenous leukemia (AML n=5). Cytoreduction regimens included Total Body Irradiation (TBI), Cyclophosphamide (CY) and Fludarabine (FLU) (n=18) or Busulfan, CY and FLU (n=4). Donors were unrelated matched (n=9), unrelated mismatched (n=5) or related mismatched (n=8). The median post transplant follow-up for the 22 patients was 6.7 years (range 1.1- 15.1 years). Of the 22 patients who survived more than 1 year post HSCT, 20 are alive and 19 are alive disease-free, with overall survival and disease-free survival rates of 90.9% and 86.3% respectively for this patient group. Two female patients died of complications related to squamous cell carcinoma of the tongue and the vulvo-vaginal area respectively; one patient developed a relapse of MDS and is alive following a second transplant. Full donor chimerism was present in 18 of 20 evaluable patients. No chronic GVHD was observed in any of the 22 patients who received grafts from alternative donors. Of the 18 patients who received a TBI based regimen, 4 patients (22%) developed hypothyroidism post transplant, 7 patients (39%) developed insulin resistance (HOMA-IR >2.6) and one patient developed Insulin dependent diabetes mellitus, a year after transplant. Germ cell dysfunction was noted in 8 of 11 evaluable males and 4 of 5 evaluable females following a TBI based regimen. Among 4 patients receiving a Busulfan-based regimen, only one patient developed hypothyroidism. Prior to transplant, 13 patients (59%) had elevated ferritin levels (>500ng/ml) and seven of these 13 patients had received >20 transfusions. Post transplant, 12 patients had persisting high ferritin levels and six underwent phlebotomy. None of the patients had documented adverse cardiac or pulmonary late outcomes post-transplant. In summary, patients with FA are at risk for treatment-related late effects, and multidisciplinary follow up of patients with FA (including cancer screening) is essential for the early detection and management of late complications. Patients with FA who survive greater than one year post transplant have a very good outcome. However, these patients remain at risk for solid tumors of the head and neck and anogenital area post transplant. It is hoped that newer regimens that minimize radiation exposure and the use of T-cell depletion associated with minimal GvHD will further decrease the risks of solid tumors and other adverse late effects in patients with FA post transplant. Disclosures: No relevant conflicts of interest to declare.

Long-term survival of EMR-PDT for gastric cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 85-85
Author(s):  
Hiroyuki Narahara ◽  
Kaori Morita ◽  
Kayo Yasuda ◽  
Kenji Aoi ◽  
Miki Saita ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Muscularis Propria ◽  
Surgical Operation ◽  
Term Outcome ◽  
Cancer Disease ◽  
Term Survival ◽  
Long Term Outcome ◽  
One Year

85 Background: Some patients and their family refuse to undergo the surgical operation because of age or complicated diseases. Endoscopic mucosal resection (EMR) technique is popular in Japan. This method has the advantage of a histologic examination, but its uses are limited to mucosal lesions and a part of submucosal lesions (sm1). For early gastric cancer, we treated patients by photodynamic therapy (PDT) in combination with EMR (that is EMR-PDT). Methods: We treated twenty-five patients with gastric cancer by EMR-PDT from April, 1997 till March, 2004. The median age was 79 (56-88) years old. All the patients were diagnosed that it is impossible to undergo a surgical operation due to their age or complicated diseases. The endoscopic ultrasonography (EUS) showed massive invasion of the submucosal layer in sixteen cancer lesions and the muscularis propria in nine cancer lesions.In order to reduce the tumor size, piecemeal snarectomy (EMR) is performed. One week later, PDT is performed. After the intravenous injection of 2 mg/kg of Photofrin, the excimer dye laser (EDL) at 630 nm is irradiated transmitted endoscopically. The energy intensity is over 60 J/cm2. Results: 1. Early gastric cancer (sm massive): as for complications, two patients showed pyloric stenosis after treatment but both of them were cured successfully by endoscopic treatment. As for local response, 15 out of 16 patients showed cure completely. From a viewpoint of long-term outcome, during the observation period of five years (from one year to 11 years), nine patients died and six patients are alive. Only one patint died of gastric cancer four years later, and other eight patients died from other causes. The longest cancer survivor is still alive after 11 years after EMR-PDT with no recurrence of cancer. Disease-specific survival is 93%. Three- year survival rate is 85%. 2. Advanced cancer: Any of the patient were not alive more than three years. 3. Regardless of their advanced age and complications, such as liver dysfunction and renal dysfunctions, both PDT and EMR-PDT showed extremely high safety. No treatment related death was observed. Conclusions: EMR-PDT is a promising method for early gastric cancer because of its safety and long-term good outcome.

scholarly journals Long-term outcome of prolonged critical illness: A multicentered study in North Brisbane, Australia

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249840
Author(s):  
Kevin B. Laupland ◽  
Mahesh Ramanan ◽  
Kiran Shekar ◽  
Felicity Edwards ◽  
Pierre Clement ◽  
...  
Keyword(s):  
Critical Illness ◽  
Cox Regression ◽  
Case Fatality ◽  
Severity Of Illness ◽  
Term Survival ◽  
Long Term Outcome ◽  
Icu Stay ◽  
Lengths Of Stay ◽  
One Year

Background Although critical illness is usually of high acuity and short duration, some patients require prolonged management in intensive care units (ICU) and suffer long-term morbidity and mortality. Objective To describe the long-term survival and examine determinants of death among patients with prolonged ICU admission. Methods A retrospective cohort of adult Queensland residents admitted to ICUs for 14 days or longer in North Brisbane, Australia was assembled. Comorbid illnesses were classified using the Charlson definitions and all cause case fatality established using statewide vital statistics. Results During the study a total of 28,742 adult Queensland residents had first admissions to participating ICUs of which 1,157 (4.0%) had prolonged admissions for two weeks or longer. Patients with prolonged admissions included 645 (55.8%), 243 (21.0%), and 269 (23.3%) with ICU lengths of stay lasting 14–20, 21–27, and ≥28 days, respectively. Although the severity of illness at admission did not vary, pre-existing comorbid illnesses including myocardial infarction, congestive heart failure, kidney disease, and peptic ulcer disease were more frequent whereas cancer, cerebrovascular accidents, and plegia were less frequently observed among patients with increasing ICU lengths of stay lasting 14–20, 21–27, and ≥28 days. The ICU, hospital, 90-day, and one-year all cause case-fatality rates were 12.7%, 18.5%, 20.2%, and 24.9%, respectively, and were not different according to duration of ICU stay. The median duration of observation was 1,037 (interquartile range, 214–1888) days. Although comorbidity, age, and admitting diagnosis were significant, neither ICU duration of stay nor severity of illness at admission were associated with overall survival outcome in a multivariable Cox regression model. Conclusions Most patients with prolonged stays in our ICUs are alive at one year post-admission. Older age and previous comorbidities, but not severity of illness or duration of ICU stay, are associated with adverse long-term mortality outcome.

Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

2005 ◽  
Vol 8 (1) ◽  
pp. 55 ◽  
Author(s):  
Azman Ates ◽  
Yahya �nl� ◽  
Ibrahim Yekeler ◽  
Bilgehan Erkut ◽  
Yavuz Balci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Operating Time ◽  
Term Survival ◽  
Long Term Outcome ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

scholarly journals Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3390
Author(s):  
Mats Enlund
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Retrospective Studies ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
One Year

Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

scholarly journals Long-term outcome after allogeneic stem cell transplantation in multiple myeloma

2021 ◽  
Author(s):  
Sini Luoma ◽  
Raija Silvennoinen ◽  
Auvo Rauhala ◽  
Riitta Niittyvuopio ◽  
Eeva Martelin ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Relapse Group

AbstractThe role of allogeneic hematopoietic stem cell transplantation (allo-SCT) in multiple myeloma is controversial. We analyzed the results of 205 patients transplanted in one center during 2000–2017. Transplantation was performed on 75 patients without a previous autologous SCT (upfront-allo), on 74 as tandem transplant (auto-allo), and on 56 patients after relapse. Median overall survival (OS) was 9.9 years for upfront-allo, 11.2 years for auto-allo, and 3.9 years for the relapse group (p = 0.015). Progression-free survival (PFS) was 2.4, 2.4, and 0.9 years, respectively (p < 0.001). Non-relapse mortality at 5 years was 8% overall, with no significant difference between the groups. Post-relapse survival was 4.1 years for upfront-allo and auto-allo, and 2.6 years for the relapse group (p = 0.066). Survival of high-risk patients was reduced. In multivariate analysis, the auto-allo group had improved OS and chronic graft-versus-host disease was advantageous in terms of PFS, OS, and relapse incidence. Late relapses occurred in all groups. Allo-SCT resulted in long-term survival in a small subgroup of patients. Our results indicate that auto-allo-SCT is feasible and could be considered for younger patients in the upfront setting.

Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures

Gerontology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Amit Frenkel ◽  
Vladimir Zeldetz ◽  
Roni Gat ◽  
Yair Binyamin ◽  
Asaf Acker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Hip Fractures ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Oldest Old ◽  
Postoperative Mortality ◽  
Patient Characteristics ◽  
One Year

Introduction: One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. Objective: The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. Method: This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000–2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. Results: The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63–1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82–0.89) versus 0.68 (95% CI 0.61–0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63–0.72) versus 0.48 (95% CI 0.42–0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42–0.52) versus 0.28 (95% CI 0.27–0.34), p < 0.001. Conclusions: Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.

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