Multiple Myeloma Patients ≤40 Years Of Age: Clinical Characteristics and Outcome In The Era Of Novel Agents

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3226-3226
Author(s):  
Argiris S. Symeonidis ◽  
Efstathios Kastritis ◽  
Sosana Delimpasi ◽  
Charikleia Kelaidi ◽  
Anastasia Sioni ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Dysfunction ◽  
Median Survival ◽  
Advanced Disease ◽  
Age Groups ◽  
The Other ◽  
Novel Agents ◽  
Primary Therapy ◽  
Younger Patients ◽  
The Difference

Abstract Multiple myeloma (MM) is a disease of the elderly and the median age at diagnosis is 65 to 68 years; MM is rarely diagnosed in patients ≤40 years of age. Reports on the characteristics of the disease and the outcome of patients ≤40 years of age are limited. Thus, we sought to identify patients ≤40 years of age who were treated for symptomatic myeloma and describe their characteristics and outcome in the era of novel agents. Among 1239 consecutive patients who started therapy for symptomatic MM within the Greek Myeloma Study Group centers, between January 2000 and December 2012, 49 patients (3.95%) were ≤40 years of age. We compared their characteristics and outcome to that of patients 41-65 years of age, who are usually eligible for autologous transplantation and to patients >65 years, who are usually treated without high dose therapy. Most patients ≤40 years were males (67% vs. 55% of patients 41-65 and 52% of patients >65 years, p=0.069). Osteolytic bone disease at diagnosis was present in 81% (vs. 74% in each of the other two groups, p=0.553) and 65% had an ECOG performance status (PS) ≤1 (vs. 66% of patients 41-65 and 44% of patients >65 years, p<0.001). Anemia at diagnosis (Hb <10 gr/dl) was less frequent in patients ≤40 years than in older ones (29% vs. 44% in patients 41-65 and 47% in patients> 65 years, p=0.037), while low platelet counts (<130x109/l) were similar (10% vs. 13% and 12%, respectively, p=0.871). Severe renal dysfunction (eGFR <30 ml/min/1.73m2) was less common in younger patients (8% vs. 16% vs. 21%, p=0.025). Advanced disease stage (ISS-3) was present in 22% (vs. 32% and 42% for the other age groups, respectively) and most patients ≤40 years were rated as ISS-1 (55% vs. 29% vs. 20% for the other age groups; p<0.001). IgA MM was less common in patients ≤40 years (14% vs. 20% vs. 27% of patients 41-65 and> 65 years) and IgD MM was more common (6% vs. 3% vs. 2%, respectively; p=0.003). Other features of advanced disease such as LDH ≥300 IU/L were similar although bone marrow infiltration was less extensive in patients ≤40 years (52% had plasma cell infiltration <40% vs. 29% and 35% of patients of the other age groups, p=0.002). There were significant differences in the type of primary therapy among age groups: most patients ≤40 years received primary therapy with novel agents (47% bortezomib-based and 10% IMiD-based regimens), while patients in the other age groups received less often bortezomib at first line (38% of patients 41-65 years and 10% of patients >65 years received bortezomib but 17% and 47%, respectively, received primary therapy with IMiDs; p<0.001). Response to primary therapy was achieved in 75.5% vs. 76% vs. 69% of patients ≤40 years, 41-65 and <65 years respectively, but the quality of response was better in the younger patient group (sCR/CR in 33% vs. 19% vs. 11% and ≥ VGPR in 43% vs. 36% vs. 24% in the three age groups respectively, p<0.001). The calculated median survival for patients ≤40 years was 11.5 years (95% CI 7-16 years) vs. 7 years (95% CI 6-8.4 years) for patients 41-65 years (the difference was not significant p=0.162) and 3.2 years (95% CI 2.8-3.4 years) for patients >65 years (p<0.001 for comparison to the other two age groups). The survival curve indicates that only after 5 years there is a difference in the survival rate between patients ≤40 years and patients 41-65 years (74% vs. 64%). Compared to the survival of patients ≤40 years who started therapy between January 1990 and December 1999 (median survival 5 years) there has been a major improvement in the survival of younger patients (p<0.001). In order to adjust for differences in the characteristics of the disease between the three age groups (ECOG PS, ISS stage, anemia, renal dysfunction, IgA type) we performed a multivariate analysis in which the difference in the risk of death for patients ≤40 years vs. those 41-65 years was not significant (HR: 1.3, 95% CI 0.76-2.22, p=0.335); however, further follow up is needed in order to see a survival difference between these two groups of patients under the age of 65. In conclusion, about 4% of our myeloma patients were ≤40 years of age; these patients are more often males, have more often IgD MM or ISS-1 disease and less often anemia or renal dysfunction. The median survival of these young patients exceeds 10 years in the contemporary era of novel agents and has more than doubled compared to the pre 2000 era. Disclosures: No relevant conflicts of interest to declare.

IgD Myeloma: Clinical Features and Outcome In The Era Of Novel Agents

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1935-1935 ◽  
Author(s):  
Flora Zagouri ◽  
Efstathios Kastritis ◽  
Argiris S. Symeonidis ◽  
Nikolaos Giannakoulas ◽  
Eirini Katodritou ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Risk ◽  
Renal Dysfunction ◽  
Light Chain ◽  
The Other ◽  
Novel Agents ◽  
Primary Therapy ◽  
Lambda Light Chain ◽  
Prognostic Features ◽  
High Risk Disease

Abstract IgD multiple myeloma is a rare variant of the disease and in various series accounts for about 2% of patients with symptomatic myeloma. It has been suggested that patients with IgD myeloma may have an inferior outcome when compared to other patients. However, data on IgD myeloma patients treated in the novel agent era are lacking. In order to assess the frequency and evaluate the outcome and the specific characteristics of patients with IgD myeloma we analyzed the database of the Greek Myeloma Study Group to identify such patients. Between January 2000 and December 2012, among the 1239 patients with previously untreated, symptomatic, myeloma, 31 patients (2.5%) were diagnosed with IgD myeloma. Of interest, 84% of patients with IgD myeloma had lambda light chain (versus 38% of the patients with other subtypes of MM, p<0.001). The median age of patients with IgD myeloma was 65 years (range 26-80 years) versus 68 years (range 23-96 years) for patients with other subtypes of MM (p=0.073), while 10% of patients with IgD versus 28% of the other patients were >65 years (p=0.023) and 10% of patients with IgD versus 3.8% of the other patients were ≤40 years of age. Patients with IgD myeloma presented more often with significant renal dysfunction (serum creatinine ≥2 mg/dl in 52% versus in 19%, p<0.001 or eGFR <30 ml/min/1.73m2 in 42% versus 18% in patients of other subtypes, p=0.001) and excreted larger amounts of Bence Jones protein (59% excreted ≥2 gr per day versus 17% of the other patients, p<0.001). Patients with IgD myeloma had also more often features of high risk disease including ISS-3 disease (60% versus 37% for the other patients, p=0.011) and elevated serum LDH (≥300 IU/L) in 29% versus10% of the other patients (p=0.001). Response to primary therapy for patients with IgD myeloma was similar to other patients (at least PR in 77% versus 72% respectively), although there was a trend for better quality of responses in patients with IgD myeloma (sCR and CR in 26% versus 15% of patients, and at least VGPR in 53% versus 29% in patients of other subtypes, respectively, p=0.059). However, more patients with IgD myeloma had received primary therapy with bortezomib-based regimens (40% versus 22%) and less often IMiD-based therapy (20% versus 35%), while similar proportions of patients received conventional chemotherapy-based regimens (40% versus 44%; p=0.043). Despite the increased frequency of features of high risk disease in patients with IgD myeloma, the median survival of these patients was 51.5 months versus 50.7 months for patients of other subtypes (p=0.850). In a multivariate model to adjust for differences in prognostic features, IgD myeloma was not associated with a different prognosis. We also compared the outcome of patients with IgD myeloma treated before and after January 1st, 2000. The survival of the patients with IgD myeloma who started therapy before versus after 2000 was 44 months (p=0.018). In conclusion, in a large series of patients with symptomatic multiple myeloma, the incidence of IgD myeloma is 2.5%. The vast majority of patients with IgD myeloma is associated with lambda light chain and present more often with significant Bence Jones proteinuria, significant renal dysfunction and features of advanced disease. However, their outcome in the era of novel agents is similar to that of patients with other myeloma subtypes. Disclosures: No relevant conflicts of interest to declare.

Race Has No Effect on Survival in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5242-5242
Author(s):  
Francis Buadi ◽  
Brian McClune ◽  
Yoriann Moore ◽  
Robin Womeodu ◽  
Furhan Yunus ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Median Survival ◽  
Age Groups ◽  
Transplant Patients ◽  
Time Period ◽  
Seer Data ◽  
The Difference ◽  
Improvement In Survival ◽  
Age Range

Abstract Multiple myeloma (MM) is more common in African Americans (AA) compared to White Americans (WA) with an incidence ratio of 2:1. The incidence of MM as well as mortality from MM has been on the rise in AA. SEER data shows a higher death rate in AA than WA diagnosed with multiple myeloma. The benefit of autologous stem cell trasnplantation (ASCT) for multiple myeloma has been clearly demonstrated in randomized trials. However the influence of race on survival in patients receiving ASCT for multiple myeloma has not been well studied. Between January 1996 and December 2003, 60 patients with multiple myeloma underwent ASCT in our program. We evaluated the influence of race on survival and also compared the survival of all transplanted patients to 74 myeloma patients from the hospital tumor registry who were diagnosed with multiple myeloma in the same time period, who received standard chemotherapy without ASCT, and who are in the same age range at diagnosis as the transplant patients. The transplant group included 32 AA and 28 WA, while the registry group had 42 AA and 32 WA. There was no difference between groups in the distribution by gender, but the transplant patients were significantly younger (median age 56.5 years, range 37–72 years) than the registry patients (median age 65 years, range 39–72 years). At analysis, median time from diagnosis was 4.6 years (range 1.2–10.3 years) for the transplant group and 7.7 years (range 3.7–10.6 years) for the registry group. For AA patients, median survival was 2.1 years in the registry group and 5.9 years in the transplant group (p=0.003). For WA patients, median survival was 2.0 years in the registry group and 5.8 years in the transplant group (p<0.0001). Median survivals did not differ in the transplant group when compared by race (5.9 years vs 5.8 years). The benefit of ASCT was seen in all age groups, so the difference in survival was not due to the younger age of the transplant patients. In a multivariate analysis of all 134 patients, ASCT was predictive of improved survival, but gender, race and quartile of age at diagnosis had no significant association with survival. We conclude that the improvement in survival with ASCT is independent of race.

Prevalence and Causal Factors of Playing-Related Musculoskeletal Disorders of the Upper Extremity and Trunk among Japanese Pianists and Piano Students

2006 ◽  
Vol 21 (3) ◽  
pp. 112-117
Author(s):  
Shinichi Furuya ◽  
Hidehiro Nakahara ◽  
Tomoko Aoki ◽  
Hiroshi Kinoshita
Keyword(s):  
Musculoskeletal Disorders ◽  
Age Groups ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Daily Practice ◽  
The Other ◽  
Causal Factors ◽  
Western Countries ◽  
Other Hand ◽  
The Difference

The purpose of this study was to investigate the prevalence of playing-related musculoskeletal disorders (PRMDs) among Japanese female classical pianists of different age groups. The causal factors for PRMDs also were examined. A group of 203 senior pianists, including piano teachers and students with piano majors at high schools and colleges, were surveyed using questionnaires. Results showed that 77% of these pianists suffered from PRMDs in at least one of their body portions. This value was larger than those reported in Western countries. Forty-four percent of these were serious enough to warrant medical treatment, which was a lower rate than reported in Western countries. The difference in these numbers may reflect the current state of understanding of PRMDs among Japanese pianists and their educators. The prevalence of PRMDs was found to be age-dependent. In the student groups, the finger/hand had the highest rate of PRMDs, followed by the forearm and shoulder. The senior group, on the other hand, had the highest PRMD incidence at the neck/trunk, followed by the forearm and hand/finger. Care may need to be exercised for these differences. The results also indicated that prolonged daily practice (>4 hours), playing chords forcefully, eagerness about practice, and nervous traits were found to contribute to the development of PRMDs in these pianists. Hand size was, on the other hand, not a significant risk factor of PRMDs.

scholarly journals Comprehensive evaluation of the revised international staging system in multiple myeloma patients treated with novel agents as a primary therapy

2017 ◽  
Vol 92 (12) ◽  
pp. 1280-1286 ◽  
Author(s):  
Hyungwoo Cho ◽  
Dok Hyun Yoon ◽  
Jung Bok Lee ◽  
Sung-Yong Kim ◽  
Joon Ho Moon ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Comprehensive Evaluation ◽  
Staging System ◽  
Novel Agents ◽  
Primary Therapy ◽  
International Staging System

Moving Beyond Autologous Transplantation in Multiple Myeloma: Consolidation, Maintenance, Allogeneic Transplant, and Immune Therapy

2016 ◽  
pp. 210-221 ◽  
Author(s):  
Amrita Krishnan ◽  
Ravi Vij ◽  
Jesse Keller ◽  
Binod Dhakal ◽  
Parameswaran Hari
Keyword(s):  
Multiple Myeloma ◽  
Disease Control ◽  
Minimal Residual Disease ◽  
Residual Disease ◽  
The Other ◽  
Novel Agents ◽  
Patient Specific ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Minimal Residual

For multiple myeloma, introduction of novel agents as part of the front-line treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT) induces deep responses in a majority of patients with this disease. However, disease relapse is inevitable, and, with each relapse, the remission duration becomes shorter, ultimately leading to a refractory disease. Consolidation and maintenance strategy after ASCT is one route to provide sustained disease control and prevent repeated relapses. Though the consolidation strategy remains largely confined to clinical trials, significant data support the efficacy of consolidation in improving the depth of response and outcomes. There are also increasing rates of minimal residual disease–negativity with additional consolidation therapy. On the other hand, maintenance with novel agents post-transplant is well established and has been shown to improve both progression-free and overall survival. Evolving paradigms in maintenance include the use of newer proteasome inhibitors, immunotherapy maintenance, and patient-specific maintenance—a concept that utilizes minimal residual disease as the primary driver of decisions regarding starting or continuing maintenance therapy. The other approach to overcome residual disease is immune therapeutic strategies. The demonstration of myeloma-specific alloimmunity from allogeneic transplantation is well established. More sophisticated and promising immune approaches include adoptive cellular therapies, tumor vaccines, and immune checkpoint manipulations. In the future, personalized minimal residual disease–driven treatment strategies following ASCT will help overcome the residual disease, restore multiple myeloma–specific immunity, and achieve sustained disease control while minimizing the risk of overtreatment.

Disease Characteristics and Patterns of Care In Elderly Patients (80+ years) with Follicular Lymphoma (FL) In the United States (US); Are Older Patients Treated Differently? Report From the National LymphoCare Study (NLCS)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4152-4152
Author(s):  
Chadi Nabhan ◽  
Michelle Byrtek ◽  
Michael Taylor ◽  
Jill Tydell ◽  
Jamie H. Hirata ◽  
...  
Keyword(s):  
Older Patients ◽  
Research Funding ◽  
Age Groups ◽  
Treatment Patterns ◽  
Disease Stage ◽  
Younger Patients ◽  
Disease Characteristics ◽  
Significant Difference ◽  
The Difference ◽  
Grade 3

Abstract Abstract 4152 Background: While FL is the most common low-grade lymphoma in the US, median age was less than 60 in patients enrolled on pivotal studies that led to our understanding of disease biology and optimal therapy. It remains unclear whether similar disease characteristics, presentation, prognostic factors, treatment patterns, and outcomes pertain to older patients with FL. No clear guidelines exist on how older patients should be treated and data is lacking as to whether current practice patterns affect their survival and progression. Previous reports on FL in the elderly have been retrospective and single center-based. Methods: The NLCS is a prospective, longitudinal multicenter, observational study that enrolled consecutive newly diagnosed FL patients from 3/2004 through 3/2007 collecting data on disease and patients' characteristics, treatment patterns, and outcome. Using the NLCS data we analyzed information on disease stage, grade, FL International Prognostic Index (FLIPI), B symptoms, and treatment choice for patients <60 years, 60–69 years, 70–79 years, and 80+ years. Either Chi-square or Fisher's exact comparison was used to assess the correlations depending on the sample size of the test. Results: A total of 2,736 pts were enrolled, of which 1,215 (44%) were < 60, 708 (25%) were between 60–69, 549 (20%) were between 70–79, and 264 (9%) were >80. There was a significant difference in grade distribution across the different age groups (p < 0.0001), with 22% of pts 80+ having grade 3 FL vs 17% pts <60. No significant differences across age groups in B symptoms, extra nodal sites, or LDH values were observed. A significant difference in FLIPI score was seen across the age groups (p < 0.0001) where high-score FLIPI was present in 48% of pts 80+ as opposed to 16% of pts <60, although calculating FLIPI might be confounded by the fact that older patients were more likely to not have received a bone marrow (BM) exam with 66% of pts 80+ not having BM exam vs. only 40% of those <60 (p < 0.0001). The difference in FLIPI was mainly due to lower Hgb values as older patients were more likely to have had Hgb < 12 g/dL than younger patients (31% of pts 80+ vs. 15% of pts <60) and to age being a component of the FLIPI index. The difference in FLIPI score across age groups was also observed in patients with grade 3 FL where 53% of pts 80+ had poor FLIPI vs. 15% of pts <60 (p < 0.0001). A statistically significant difference in treatment patterns was found across age groups (p <0.0001). When treatment was implemented, older patients were more likely to have received rituximab (R) monotherapy (37% of 80+ vs. 12% of <60) and less likely to have received R+Chemotherapy (40% of pts 80+ vs. 64% of pts<60). In addition, more pts 80+ were observed compared to those <60 (23% vs. 16%). These differences persisted even in those with advanced stage (III/IV), grade 3 disease, region of diagnosis, and in poor-risk FLIPI. When chemotherapy was used, older patients were less likely than younger patients to receive anthracyclines (p < 0.0001) (31% of pts 80+ vs. 69% of pts<60). Anthracycline use remained significantly different regardless of disease stage, grade, or FLIPI score. Conclusions: To our knowledge, this is the largest prospective data collection available for FL pts 80+ years of age. We demonstrate that these pts have higher FLIPI score and grade 3 disease. When treatment is initiated, these patients receive R monotherapy more often than their younger counterpart. Anthracycline use in this population is also less common regardless of disease stage, grade, or risk profile. Whether these baseline differences translate into different outcomes remains to be seen. Disclosures: Nabhan: genentech: Research Funding, Speakers Bureau. Byrtek:Genentech: Employment. Taylor:Genentech: Employment. Hirata:Genentech: Employment. Flowers:Genentech/Biogen-Idec (unpaid): Consultancy; Celgene, Intellikine: Consultancy; Millennium: Research Funding.

Efficacy of Novel Agents in Multiple Myeloma in Comparison to Autologous Stem Cell Transplant: A Retrospective Study in a Single Inner City Institution

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5118-5118
Author(s):  
Tareq Braik ◽  
Dayra Avila ◽  
Shivi Jain ◽  
Manila Gaddh ◽  
Barabara Yim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Median Survival ◽  
Standard Of Care ◽  
High Dose Chemotherapy ◽  
Novel Agents ◽  
High Dose ◽  
Cell Transplant ◽  
Conventional Chemotherapy ◽  
Novel Therapy

Abstract Abstract 5118 Introduction: Since the mid 1990s, high dose chemotherapy with hematopoietic stem cell rescue has been considered the standard of care for front-line treatment in younger patients with multiple myeloma. This standard of care has been based on randomized controlled trials that compared autologus stem cell transplant (ASCT) with conventional chemotherapy. During the past decade, novel agents (NA), thalidomide, bortezomib and lenalinomide, have replaced conventional chemotherapy in the treatment of myeloma. These agents, used frontline, have shown promise in improving the outcome of myeloma patients without increasing toxicity. There are no studies to date comparing NA therapy to ASCT to determine whether there is a survival difference or whether NA therapy may reduce the need for transplantation. Many of our patients have no health insurance coverage and transplant is not a therapeutic option for them. We have attempted to compare the outcome of such patients receiving NA therapy with those in the literature who received conventional chemotherapy followed by ASCT. Methods: Ninety nine patients with multiple myeloma were treated at John H Stroger Hospital of Cook County between 2001 and 2011. All patients received novel agents (thalidomide, bortezomib and lenalinomide) as part of their therapy. Only 18/99 (18.2%) went for high-dose chemotherapy with ASCT and the remaining 81/99 (81.8%) received novel therapy without ASCT. We compared the outcome of patients who received novel therapy alone to a historical control group from the literature who received ASCT with conventional therapy (N Engl J Med 2003;348:1875–83). Overall survival was determined by Kaplan-Meier estimates. Results: We evaluated 99 consecutive myeloma patients (38% males and 61% female) of which 65% were African Americans, 19% Hispanics and 7% whites. All 3 stages (international staging system) of myeloma were equally represented. The median age at diagnosis was 60 years (40–85yr). Median follow up was 48 months (12–120). During the ten year follow up period, 60 patients (60.4%) have died. Twenty four out of 99 patients (24.2%) received only one line of therapy. 75 patients received more than one line of therapy. 75% received thalidomide-based therapy, 13% received bortezomib-based therapy and 12% received lenalinomide-based therapy. The median survival of patients who received novel therapy without ASCT (n=81) was 60 months, which is higher than the median survival of the historical controls who received ASCT reported by Child et al, N Engl J Med 2003;348:1875–83, (median survival = 54.1 months), the difference was statistically significant (P=0.0329). There was no statistically significant difference between the two groups by sex (p=0.927) and race (p=0.421). The 5-year survival of patients who received novel therapy without ASCT (n=81) was 48.2%. For those who were younger than 65 years (n=54), the median survival was 72 months and the 5-year survival was 58.1% in comparison to those who were 65 years and older (n=27), the median survival was 46 months and the 5-year survival was 29.2% (P=0.029). Conclusion: Novel agents are effective frontline therapy for multiple myeloma, especially in patients younger than 65. Our cohort had remarkable results in comparison to a historical population of patients who had ASCT with conventional chemotherapy. Since there is no curative therapy to date, a prospective randomized trial comparing NA with ASCT will be essential to clarify the role of ASCT in the era of novel therapy. Disclosures: No relevant conflicts of interest to declare.

Comparision of histologic distribution of RCC in young and older patients: Results from the SEER database.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 419-419 ◽  
Author(s):  
Michael R. Daugherty ◽  
Stephen Blakely ◽  
Oleg Shapiro ◽  
Gennady Bratslavsky
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Collecting Duct ◽  
Cell Cancer ◽  
Age Groups ◽  
Genetic Mutations ◽  
Chi Square ◽  
Younger Patients ◽  
The Difference ◽  
Chi Square Analysis

419 Background: Renal cell cancer (RCC) incidence is relatively low in younger patients, encompassing 3-5% of all RCC tumors. These tumors tend to be due to hereditary syndromes and genetic mutations that predispose to cancer development. Patients with hereditary renal cancer (HRC) are at a higher risk of multiple tumors and bilateral disease. We hypothesize that there is a difference in histologic distribution in the younger patients and that the younger distribution contains more aggressive histologic subtypes. Methods: SEER 18-registries database was queried for all patients ≥20 years old that were surgically treated for renal cell carcinoma between the years 2001 and 2008. Patients with unknown race, grade, stage, or histology were excluded from the study. Histologies selected were clear cell, papillary, chromophobe, sarcomatoid, and collecting duct. Three cohorts were created with the ages 20-44, 45-64, and ≥65 year olds that contained 3,926, 19,661, and 16,323 patients respectively. Chi-square analysis was used to compare the histologic distributions between the cohorts. Results: There was no difference in the incidence of clear cell RCC between the three cohorts (p = 0.63). The histology distribution was not different in the 45-64 year olds compared to those ≥65 (p = 0.47). The non-clear cell histologies were different between the 3 age groups (p < 0.001). There were a larger percentage of patients in the younger patients that had chromophobe tumors compared to all non-clear cell histologies (p< 0.001). Conclusions: The difference in the non-clear cell histologic distribution between the groups is most likely due to genetic mutations predisposing these patients to chromophobe RCC. There has been limited data on HRCs, due in large part to its low incidence. Although the HRCs are known to have a most common histology, it is likely that this information is incomplete, as younger patients have undiagnosed genetic mutations that led to development of chromophobe tumors. [Table: see text]

Protein-bound iodine, erythrocytes and haemoglobin in the blood of beef steers and their relation to rate of gain

1962 ◽  
Vol 58 (3) ◽  
pp. 287-290 ◽  
Author(s):  
H. C. Luitingh
Keyword(s):  
Serum Protein ◽  
Age Groups ◽  
Live Weight ◽  
Iodine Concentration ◽  
The Other ◽  
Beef Steers ◽  
Red Cell ◽  
The Difference ◽  
Haemoglobin Content ◽  
Daily Gain

The serum protein-bound iodine concentration in the blood of beef steers varied between animals and was not correlated with the daily gain during the fattening period. The data, however, are insufficient to arrive at a definite conclusion.The average erythrocyte counts of the blood were 7·86 (range: 5·89–8·75), 8·59 (range: 6·55–10·15), and 8·54 (range: 5·23–9·62) million per mm.3 for steers of 14, 26 and 38 months of age. The difference between the counts of the yearlings and that of the other age groups was statistically significant. The red cell fraction increased with live weight over the range 700–1230 lb. Although a significant (P < 0·01) correlation was found between the number of erythrocytes in the blood and the daily gain of the steers, the erythrocyte count cannot be employed to predict the possible gaining ability of single beef animals.The haemoglobin content of the blood was found to be 14·02 (range: 9·8–17·4) in the case of the yearlings, 14·68 (range: 11·8–18·5)and 14·61 (range: 7·95–16·85) g./100 ml. blood in the case of the 2-year-olds and 3-year-olds respectively. These differences between age groups were not significant.A correlation of 0·31 was found between the haemoglobin content and live weight of steers within the weight range of 600–1230 lb. The data suggest that for every 100% increase in weight, the haemoglobin in the blood increased by 17%. No correlation was found between the haemoglobin content and the rate of gain of the steers.

Pomalidomide and dexamethasone in myelomatous pleural effusion

2020 ◽  
Vol 13 (12) ◽  
pp. e235899
Author(s):  
Isin Yagmur Comba ◽  
Anthony Chahin ◽  
Hiffsa Taj ◽  
Allison Carilli
Keyword(s):  
Multiple Myeloma ◽  
Pleural Effusion ◽  
Partial Response ◽  
Median Survival ◽  
Poor Prognosis ◽  
Clinical Entity ◽  
Novel Agents ◽  
Progression Of Disease ◽  
Good Partial Response

Myelomatous pleural effusion (MPE) is an uncommon clinical entity and occurs in less than 1% of all patients with multiple myeloma. MPE indicates a progression of disease, therefore is associated with a poor prognosis and estimated median survival of <3 months. Treatment of MPE is challenging, and the data regarding the role of novel agents lack in the literature. Herein, we report a relapsed IgA myeloma case of a patient presenting with MPE, who was treated with pomalidomide with a very good partial response.

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