scholarly journals Race-Based Differences in Routine Cytogenetic Profiles of Patients with Multiple Myeloma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2619-2619
Author(s):  
Brandon Jamaal Blue ◽  
Kristen M. Sanfilippo ◽  
Arun Ganti ◽  
Jason Gumbel ◽  
Katiuscia O'Brian ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Racial Differences ◽  
Hematologic Malignancy ◽  
Molecular Testing ◽  
Veterans Health ◽  
Health Administration ◽  
Chromosome 14 ◽  
Exact Test ◽  
Black Patients ◽  
White Patients

Abstract Background: Multiple myeloma (MM) is a common hematologic malignancy for which standard therapy does not offer a cure. Incidence of MM in African-Americans is twice that of Caucasians, suggesting differences in either environmental or genetic risk factors. Historically, black patients have also had a slightly better prognosis than white patients, suggesting racial differences in prognostic factors such as cytogenetics. Since metaphase cytogenetic profiles are routinely collected in MM patients, we sought to determine if race-based differences in cytogenetics exist, using data from the Veterans Health Administration (VHA) cancer registry. Methods: Using CPT codes, 88271-88275, 88291, 88299, 88365, 83896, 88237, 88261-88264, 88280, 88283, and 88285, we identified 988 patients with MM diagnosed between 1998 and 2009, who also had standard metaphase cytogenetic analysis performed on a bone marrow specimen at the time of diagnosis (228 Black and 585 White) . Fisher’s exact test was used to assess for race-based differences in the following cytogenetic abnormalities: 13q deletion, Hypodiploidy, Hyperdiploidy, and translocations involving chromosome 14. Results: Among the 988 patients in the cohort, normal cytogenetic profiles, isolated Y chromosome deletion, or no mitotic activity were observed in 704(71%) patients. Translocations involving the immunoglobulin heavy chain (chromosome 14) (n=4) were uncommonly observed on routine cytogenetics, such that no statistical conclusions could be drawn. Hyperdiploidy was noted in 13/228(5.7%) of the black and 45/585(7.7%) of the white patients (p=0.32). Similarly 13q deletions were detected in 8/228(3.5%) black patients, and 21/585(3.6%) of the white patients (p=0.96). Hypodiploidy was also not significantly different in black 4/228(1.8%) and white patients 12/585(2.0%). Conclusion: This is the largest study of race-based differences in MM cyogenetics presented to date. We found no significant race-based differences in standard metaphase cytogenetics. Future studies should focus on determining if race-based differences can be discovered using fluorescent in situ hybridization (FISH) or molecular testing not available for this retrospective study. Our study adds to this growing body of evidence suggesting that metaphase cytogenetic differences are not a significant factor in MM outcome disparities. Disclosures Carson: Spectrum Pharmaceuticals: Honoraria, Research Funding, Speakers Bureau.

scholarly journals Racial Disparities in Intravenous Bisphosphonate Use Among Older Patients With Multiple Myeloma Enrolled in Medicare

2021 ◽  
pp. OP.20.00479
Author(s):  
Jifang Zhou ◽  
Karen Sweiss ◽  
Edith A. Nutescu ◽  
Jin Han ◽  
Pritesh R. Patel ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Racial Differences ◽  
Minority Groups ◽  
Population Level ◽  
Subdistribution Hazard ◽  
Black Patients ◽  
Skeletal Related Events ◽  
Competing Risk Models ◽  
Hispanic And Latino ◽  
White Patients

PURPOSE: Intravenous (IV) bisphosphonates reduce the risk of skeletal-related events in patients with multiple myeloma (MM). However, data describing racial differences in IV bisphosphonate utilization outside of clinical trial settings are limited. We evaluated population-level IV bisphosphonate initiation and discontinuation among patients of age ≥ 65 years with MM. METHODS: We conducted a retrospective cohort study of patients of age ≥ 65 years diagnosed with first primary MM between 2001 and 2011. Patients were identified using the SEER-Medicare linked database and followed through December 2013. Cumulative incidences of IV bisphosphonate initiation and time to discontinuation among users were compared between racial and ethnic groups. In Fine and Gray competing risk models, we estimated subdistribution hazard ratios (SHRs) and 95% CIs for initiation and discontinuation. RESULTS: We included 14,231 eligible patients with MM (median age, 76 years; 52% male). Over a median follow-up of 23.1 months, 54% of patients received at least one IV bisphosphonate dose. Our final analytical sample included 10,456 non-Hispanic (NH) Whites, 2,267 NH Blacks, 548 Asian and Pacific islanders, and 815 Hispanic and Latino patients. A higher proportion of White patients (56.1%) newly received IV bisphosphonates after MM diagnosis compared with NH Blacks (45.4%). Compared with White patients, NH Black patients were less likely to initiate IV bisphosphonates (SHR, 0.74; 95% CI, 0.70 to 0.79) and slightly more likely to discontinue treatment (SHR, 1.10; 95% CI, 1.01 to 1.19). CONCLUSION: Approximately half of the patients with MM of age ≥ 65 years did not receive IV bisphosphonates, with significant delay among racial minority groups. These findings highlight the need for improvement of IV bisphosphonate uptake in patients with MM of age ≥ 65 years.

scholarly journals Recommendation on Advanced Molecular Testing in Hematolymphoid Malignancies in the Veterans Population

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4983-4983
Author(s):  
Jadee L Neff ◽  
Claudio A. Mosse ◽  
Jessica Wang-Rodriguez ◽  
Sara Ahmed ◽  
Michael Kelley
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
Hematologic Malignancy ◽  
Tumor Board ◽  
Molecular Testing ◽  
Precision Oncology ◽  
Veterans Health ◽  
Health Administration ◽  
Prognostic Information ◽  
Acute Leukemias

Abstract The Veterans Health Administration is the largest integrated provider of cancer services in the nation, with approximately 50,000 new cancer cases diagnosed each year. The goal of the VA's National Oncology Program is to establish a System of Excellence in cancer care with the help of tools, resources, programs, and best practices across the enterprise to ensure every veteran, regardless of location, receives the same high level of cancer care and access to precision diagnostics. This is mediated through a variety of programs, including the National TeleOncology Service and the National Precision Oncology Program which includes standardized clinical pathways for molecular testing, a second opinion service on diagnostic consultations, test result interpretation and treatment recommendations, as well as a molecular oncology tumor board. The VA National Oncology Program and the Pathology and Laboratory Medicine Program offices have collaborated on a recommended guideline for advanced laboratory and molecular testing algorithm in hematologic diagnosis. We aim to offer best practice for all VA providers who must decide the type of ancillary tests at the time of initial clinical presentation in order to gain prognostic information and guide therapy. The recommendations include traditional laboratory tests, such as morphology, flow cytometry, and immunohistochemistry, as well as the use of fluorescent in situ hybridization (FISH), karyotype, polymerase chain reaction (PCR), and next generation sequencing (NGS). An overview of the draft algorithm for acute leukemias and chronic myeloid neoplasms is presented in Table 1; details will be discussed at the annual meeting. Conclusion: The joint effort from VA Oncology and Pathology presents advanced testing algorithms in a variety of hematolymphoid malignancies as a systematic approach to hematopathology diagnosis, classification, as well as offering prognostic and therapeutic information. The recommendations across VA Healthcare would ensure standardized care for all VA patients with hematologic malignancy to benefit from the latest advances in precision medicine. Figure 1 Figure 1. Disclosures Neff: Spring Discovery: Consultancy, Ended employment in the past 24 months; EUSA Pharma: Speakers Bureau; Enzyvant: Consultancy.

scholarly journals Outcomes of Black Patients with Multiple Myeloma in the Veterans Health Administration

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 840-840
Author(s):  
Martin W. Schoen ◽  
Suhong Luo ◽  
Kenneth R. Carson ◽  
Kristen M. Sanfilippo
Keyword(s):  
United States ◽  
Multiple Myeloma ◽  
Renal Function ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Black Race ◽  
Disease Biology ◽  
Black Patients ◽  
Statin Use

Abstract Background: Multiple myeloma (MM) is the most common hematologic malignancy in blacks with more than twice the incidence of non-black populations in national registry data. Prior studies have shown that blacks present with MM at an earlier age and have improved survival compared to non-blacks, contrary to the pattern in most malignancies. These findings have been theorized due to the effects of obesity, treatment variation, and disparities in care, in addition to alternate disease biology in black patients. In order to understand possible effects of race on outcomes while adjusting for confounders not available in other national datasets such as treatment, comorbidities, and baseline laboratory characteristics, we studied outcomes in a nationwide population of United States veterans with MM in the Veterans Health Administration (VHA). Methods: Patients with MM were identified by the VHA Central Cancer Registry between September 1, 1999 and December 31, 2013 and followed through December 31, 2014. Age, sex, race, body mass index (BMI), Charlson (Romano) comorbidity index, treatment (including transplant), hemoglobin (hgb), albumin, renal function (eGFR), and statin use were included. Cox proportional hazards regression modeling was used to assess the association between black race and overall survival at five years while controlling for known prognostic factors. The study was approved the Saint Louis VA Medical Center institutional review board. Results: 4805 patients were identified with MM, of which 1418 (29.5%) were black. Black patients were younger (66.2 years vs. 69.2, p<0.001) with increased mean comorbidity scores (3.7 vs. 3.0 p<0.001) compared to non-black patients. Black patients had lower mean BMI (27.0 years vs. 27.8, p<0.001) and higher rates of hgb <10 g/dL, 49.1% vs. 35.3%, p<0.001) and albumin below 3 g/dL (35.3% vs. 28.3% p<0.001) with similar rates of decreased renal function of eGFR <30 (22.1% vs. 21.2%, p=0.69) compared to non-black patients. Black patients underwent stem cell transplantation at similar rates (12.3% vs. 14.2%, p=0.09) and there no differences based on race in treatment with lenalidomide (35.1% vs. 36.0%, p=0.52), thalidomide (36.7% vs. 38.7%, p=0.20), or melphalan (32.7% vs. 34.8%, p=0.16). More black patients were treated with bortezomib compared to non-blacks (50.1% vs 44.4%, p<0.001). In unadjusted analyses, black race was associated with reduced risk of death at five years (Hazard Ratio [HR] 0.89, 95% CI 0.83-0.97). After controlling for age, comorbidity score, hgb, albumin, transplant, and treatment; black patients also had improved survival (HR 0.82, 95% CI 0.76-0.89). After adding BMI, year of diagnosis, and statin use to the final Cox model, black patients continued to have improved survival (HR 0.80, 95% CI 0.73-0.86). Conclusions: Survival of black patients with MM was improved compared to non-blacks in the VHA, a national comprehensive care delivery system. Black patients also received similar therapies compared to non-blacks, while presenting at a younger age with more comorbidities. These results are strengthened after adjusting for treatments and patient characteristics not available in other large data studies. Despite increased incidence of MM in the black population, outcomes are improved, similar to other large studies of patients in the United States. Alternate disease biology may be responsible for improved survival and further studies of MM based on race are appropriate. Disclosures Carson: Flatiron Health: Employment; Washington University in St. Louis: Employment; Roche: Consultancy. Sanfilippo:BMS/Pfizer: Speakers Bureau.

scholarly journals Divergent poststroke outcomes for black patients

Neurology ◽  
2019 ◽  
Vol 93 (18) ◽  
pp. e1664-e1674 ◽  
Author(s):  
James F. Burke ◽  
Chunyang Feng ◽  
Lesli E. Skolarus
Keyword(s):  
Racial Differences ◽  
Care Setting ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Fee For Service ◽  
Primary Analysis ◽  
Skilled Nursing ◽  
Black Patients ◽  
Postacute Care ◽  
White Patients

ObjectiveTo explore racial differences in disability at the time of first postdischarge disability assessment.MethodsThis was a retrospective cohort study of all Medicare fee-for-service beneficiaries hospitalized with primary ischemic stroke (ICD-9,433.x1, 434.x1, 436) or intracerebral hemorrhage (431) diagnosed from 2011 to 2014. Racial differences in poststroke disability were measured in the initial postacute care setting (inpatient rehabilitation facility, skilled nursing facility, or home health) with the Pseudo-Functional Independence Measure. Given that assignment into postacute care setting may be nonrandom, patient location during the first year after stroke admission was explored.ResultsA total of 390,251 functional outcome assessments (white = 339,253, 87% vs black = 50,998, 13%) were included in the primary analysis. At the initial functional assessment, black patients with stroke had greater disability than white patients with stroke across all 3 postacute care settings. The difference between white and black patients with stroke was largest in skilled nursing facilities (black patients 1.8 points lower than white patients, 11% lower) compared to the other 2 settings. Conversely, 30-day mortality was greater in white patients with stroke compared to black patients with stroke (18.4% vs 12.6% [p < 0.001]) and a 3 percentage point difference in mortality persisted at 1 year. Black patients with stroke were more likely to be in each postacute care setting at 30 days, but only very small differences existed at 1 year.ConclusionsBlack patients with stroke have 30% lower 30-day mortality than white patients with stroke, but greater short-term disability. The reasons for this disconnect are uncertain, but the pattern of reduced mortality coupled with increased disability suggests that racial differences in care preferences may play a role.

The Veterans Health Administration Provides Equal Access to Autologous Hematopoietic Stem Cell Transplantation for Patients with Multiple Myeloma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2629-2629
Author(s):  
Cesar O. Freytes ◽  
Natalie S Callander ◽  
Stacey A Goodman ◽  
Suhong Luo ◽  
Juan J. Toro ◽  
...  
Keyword(s):  
Household Income ◽  
Research Funding ◽  
Equal Access ◽  
Racial Groups ◽  
Veterans Health ◽  
Health Administration ◽  
Hematopoietic Stem ◽  
Black And White ◽  
Black Patients ◽  
Income Quartile

Abstract Autologous hematopoietic stem cell transplantation (AHSCT) remains an integral part of multiple myeloma (MM) therapy. Previous studies have documented disparities in the utilization of AHSCT, with black MM patients receiving AHSCT less frequently than white patients. Among the factors that may influence AHSCT utilization is the availability and quality of health insurance. A previous analysis of black and white MM patients who underwent AHSCT in an equal access health care system, demonstrated comparable survival between black and white patients following AHSCT in MM. Unfortunately, this study did not provide information regarding potential race-based differences in AHSCT utilization. In an effort to understand the relationship between race and AHSCT utilization in an equal access healthcare system, we evaluated AHSCT utilization in a cohort of MM patients from the Veterans Health Administration (VHA) central cancer registry. Patients diagnosed with MM at any VHA medical center between September 1, 1999 and September 30, 2009 using International Classification of Diseases for Oncology, third revision, code 9732/3. Patients who did not receive treatment within 6 months of diagnosis were excluded in order to remove patients with monoclonal gammopathy or smoldering myeloma miscoded as MM (n=1,002). This resulted in a cohort of 2,968 patients. AHSCT was identified by ICD-9 procedure codes (410.4, 410.7, 410.0, 410.1, 410.9) or use of high-dose melphalan. Household income was estimated based upon zip code of residence, linked to census data on median household income by zip code. Of the 2,968 patients, 2,040 (68.7%) were white, 850 (28.6%) were black, 40 (0.1%) from other racial groups, and 38 (0.1%) were from unknown racial groups. The proportion of patients who underwent AHSCT was similar: 270 of 2118 white/other MM patients underwent AHSCT compared to 94 black patients (12.8% vs. 11%, respectively, p = 0.2). Demographics of the patients who received AHSCT are presented in table 1. Comparison of socioeconomic status demonstrated that across the entire cohort of 2,698 patients, black patients were significantly more likely to be from the lowest income quartile compared to white/other patients (38.2% vs. 18.4%, p < 0.001). Among the patients who received transplant, black patients again were more likely to come from the lowest income quartile (29.8% vs. 18.2%, p = 0.07). We conclude that the proportion of white and black patients who undergo AHSCT for MM is similar in the VHA, a finding that was present despite significant differences in estimated household income. Our finding is in contrast to previous registry studies that have shown limited access to transplantation for black MM patients. This suggests that in the VHA, utilization of high-cost interventions such as AHSCT is equal, despite differences in race and socioeconomic status. Table- Demographic and clinical characteristics by race among transplanted MM patients diagnosed 1999 to 2009 Demographic clinical characteristics Overall (N=364) White or other (n=270) Black (n=94) p-value Age (mean / range) 57.5 (27-73) 58 (27-73) 56.1 (30 - 71) 0.02 Sex (Male %) 96.7 97.4 94.7 0.2 Comorbidities (mean Charlson score) 1.4 1.3 1.6 0.09 BMI (%) <18.5 1.1 0.7 2.1 18.5-<25 22 22.2 21.3 25-<30 44.8 41.5 54.3 >=30 32.1 35.6 22.3 0.1 Estimated Household Income (%) Quartile 1 21.2 18.2 29.8 Quartile 2 23.4 23.7 22.3 Quartile 3 25.6 27 21.3 Quartile 4 27.5 28.2 25.5 Unknown 2.5 3 1.1 0.07 Hemoglobin (mean) 11 11.2 10.3 < 0.001 Creatinine (mean) 1.8 1.9 1.5 0.03 Albumin (mean) 3.3 3.4 3.3 0.3 Time(months) between Dx and transplant (mean/range) 12.8 (3.4-87.7) 12.3 (3.4-55.5) 14.1 (3.6-87.7) 0.15 Disclosures Freytes: Merck: Research Funding; Otsuka: Consultancy, Research Funding; Sanofi: Speakers Bureau. Carson:Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Millennium: Consultancy, Research Funding.

scholarly journals Racial Differences in Pain Treatment and Empathy in a Canadian Sample

2012 ◽  
Vol 17 (6) ◽  
pp. 381-384 ◽  
Author(s):  
Kimberley A Kaseweter ◽  
Brian B Drwecki ◽  
Kenneth M Prkachin
Keyword(s):  
Racial Differences ◽  
Facial Expressions ◽  
Undergraduate Students ◽  
Pain Treatment ◽  
Black And White ◽  
Racial Biases ◽  
Patient Race ◽  
Black Patients ◽  
Treatment Bias ◽  
White Patients

BACKGROUND: Evidence of inadequate pain treatment as a result of patient race has been extensively documented, yet remains poorly understood. Previous research has indicated that nonwhite patients are significantly more likely to be undertreated for pain.OBJECTIVE: To determine whether previous findings of racial biases in pain treatment recommendations and empathy are generalizable to a sample of Canadian observers and, if so, to determine whether empathy biases mediate the pain treatment disparity.METHODS: Fifty Canadian undergraduate students (24 men and 26 women) watched videos of black and white patients exhibiting facial expressions of pain. Participants provided pain treatment decisions and reported their feelings of empathy for each patient.RESULTS: Participants demonstrated both a prowhite treatment bias and a prowhite empathy bias, reporting more empathy for white patients than black patients and prescribing more pain treatment for white patients than black patients. Empathy was found to mediate the effect of race on pain treatment.CONCLUSIONS: The results of the present study closely replicate those from a previous study of American observers, providing evidence that a prowhite bias is not a peculiar feature of the American population. These results also add support to the claim that empathy plays a crucial role in racial pain treatment disparity.

scholarly journals Risk of Progression in Patients with Smoldering Myeloma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1892-1892
Author(s):  
Fahrettin Covut ◽  
Kamal Chamoun ◽  
Leland Metheny ◽  
Kirsten M Boughan ◽  
James Driscoll ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cumulative Incidence ◽  
Systemic Treatment ◽  
Multivariable Analysis ◽  
Rank Test ◽  
Cell Transplant ◽  
Annual Household Income ◽  
Screening Programs ◽  
Black Patients ◽  
White Patients

Background: Smoldering multiple myeloma (SM) is a heterogenous clinical entity with a variable rate of progression to symptomatic multiple myeloma (MM). Identification of demographic characteristics and outcomes of SM patients have been hampered by the lack of specific ICD code for SM. Here, we analyzed the National Cancer Database (NCDB) for this purpose, which covers >70% of cancer patients in the U.S. Methods: We reviewed patients in the NCDB who were diagnosed with MM between 2010 and 2014. Patients who did not receive any treatment within 3 months after the diagnosis and still alive were considered to have had SM (Ravindran et al. Blood Cancer J. 2016). Initiation of systemic treatment was considered as a surrogate of progression to symptomatic MM. Overall survival (OS) of SM patients was calculated from initiation of systemic treatment after they progressed to MM, estimated by the Kaplan-Meier method, and compared with the log-rank test. Cumulative incidence of progression from SM to MM was calculated with death as a competing risk and compared with the Gray's test. Multivariable Cox and logistic regression analysis were performed to identify independent predictors of OS and progression to MM, respectively. Results: We reviewed 68,234 patients and identified 12,984 patients with SM. Among SM patients, 3002 (23%) were black, 6796 (52%) were male, and median age at diagnosis was 69 years (range: 22 - 90). SM patients' insurance types were private for 4164 (32%), Medicare for 7420 (57%), Medicaid for 669 (5%), and 260 (2%) were uninsured. Majority of the cases were reported from non-academic hospitals (59%). Patient and treatment characteristics are summarized in Table 1. SM was diagnosed in black patients a median of 4 years younger than in white patients (median age 66 vs 70 years, p<0.0001). Charlson comorbidity index was 2 or more for 325 (11%) black and 629 (7%) white patients (p<0.0001). Median annual household income of white patients was higher than black patients (p<0.0001). Median time to progression from SM to MM was 4.5 months (range: 3 - 64). Progression to MM was seen in 3144 (24%) patients during median follow-up of 39 months. All SM patients received chemo- or immunotherapy after progression and 867 (7%) underwent hematopoietic cell transplant. Four-year cumulative incidence of progression to MM for SM patients at ages of <60 vs 60-70 and >70 years was 34% (95% CI: 32 - 35) vs 28% (95% CI: 26 - 29, p<0.0001) and 18% (95% CI: 17 - 19, p<0.0001), respectively (Figure 1A). Four-year cumulative incidence of progression to MM for patients of black and white race was 24.5% (95% CI: 23 - 26) and 24.4% (95% CI: 24 - 25), respectively (p=0.99) (Figure 1B). Four-year cumulative incidence of progression to MM for patients who were diagnosed between 2010-2012 and 2013-2014 was 25% (95% CI: 24 - 26) and 24% (95% CI: 23 - 25), respectively (p=0.17) (Figure 1D). On multivariable analysis, each 10-year decrease in age (OR 1.06, 95% CI: 1.05 - 1.06, p<0.0001), white vs black race (OR 1.02, 95% CI: 1.00 - 1.04, p=0.027), and each 1-year decrease in diagnosis year (OR 1.01, 95% CI: 1.00 - 1.01, p=0.015) were associated with progression to MM, however male vs female gender (OR 1.01, 95% CI: 0.99 - 1.02, p=0.26) was not statistically significant. Four-year OS of SM patients after progression and MM patients without known preceding SM who received treatment were 63% (95% CI: 61 - 65) and 54% (95% CI: 54 - 55), respectively (p<0.0001). Figure 2 shows OS of the patients with SM in several subgroups. Four-year OS of SM patients after progression to MM at ages of >70 vs 60-70 and <60 years were 44% (95% CI: 40 - 48) vs 67% (95% CI: 63 - 71, p<0.0001) and 76% (95% CI: 73 - 80, p<0.0001), respectively (Figure 2A). On multivariable analysis, each 1-year increase in age (HR 1.04, 95% CI: 1.03 - 1.05, p<0.0001), each 1 increase in Charlson comorbidity score (HR 1.30, 95% CI: 1.19 - 1.42, p<0.0001), academic vs non-academic hospital (HR 0.79, 95% CI: 0.69 - 0.90, p=0.0005), and immunotherapy vs no immunotherapy (HR 0.71, 95% CI: 0.59 - 0.86, p=0.0004) were statistically significant predictors of OS (Table 2). Conclusion: Taken together, our result shows higher rate of MM progression in younger SMM patients than old ones as well as earlier age of SMM diagnosis in Blacks. Also, this study highlights the importance of known SMM stage before MM in prolonging survival which can be indicative of benefit from screening programs. Disclosures Metheny: Incyte: Speakers Bureau; Takeda: Speakers Bureau. Malek:Celgene: Consultancy; Takeda: Consultancy; Sanofi: Consultancy; Medpacto: Research Funding; Janssen: Speakers Bureau; Amgen: Speakers Bureau; Adaptive: Consultancy.

Temporal trends of inpatient C. difficile infections within the Veterans Health Administration hospitals: An analysis of the effect of molecular testing, time to testing, and mandatory reporting

2019 ◽  
Vol 41 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Zarchi E. Sumon ◽  
Alan J. Lesse ◽  
John A. Sellick ◽  
Sheldon Tetewsky ◽  
Kari A. Mergenhagen
Keyword(s):  
Temporal Trends ◽  
Healthcare Facility ◽  
Veterans Health Administration ◽  
Mandatory Reporting ◽  
Molecular Testing ◽  
Testing Time ◽  
Third Generation ◽  
Veterans Health ◽  
Health Administration ◽  
Third Generation Cephalosporins

AbstractBackground:Clostridium difficile infection (CDI) is a reportable hospital metric associated with significant healthcare expenditures. The epidemiology of CDI is pivotal to the implementation of preventative measures.Objective:To portray temporal CDI trends in Veterans Health Administration (VA) hospitals.Design:A retrospective analysis of veterans who had stool testing for C. difficile.Setting:VA acute-care hospitals within the continental United States.Methods:Data were mined from the VA’s Corporate Data Warehouse. CDI is reported per 10,000 patient days.Results:From 2006 to 2016, 472,346 patients had C. difficile testing. Overall, decreases in incidence of total CDI (16.81 to 13.66) and hospital-onset healthcare facility-associated (HO-HCFA) CDI (10.87 to 6.41) were observed. Temporal increases in the incidence of total and HO-HCFA CDI were associated with the increased use of molecular testing (P < .0001). Decreased use of fluoroquinolones (P < .0001), clindamycin (P = .0006), and third-generation cephalosporins (P = .0002) correlated with decreased rates of CDI, but VA mandatory reporting did not influence CDI rates (P = .24). The overall crude 30-day mortality of patients with CDI decreased from 2.17 deaths per 10,000 patient days in 2006 to 1.41 in 2016. The frequency of International Classification of Disease, Ninth/Tenth Revision (ICD-9/10) discharge diagnosis for CDI was 73.3%.Conclusion:Molecular testing was associated with increased incidence of CDI. Controlling CDI is likely multifactorial. Although the VA initiative to report cases of hospital-acquired CDI was not significant in our model, the advent of stewardship programs throughout the VA and reductions in the use of third-generation cephalosporins, fluoroquinolones, and clindamycin were significantly associated with reduced rates of CDI.

Real-World Validity of the Revised International Staging System in Multiple Myeloma By Race

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 40-41
Author(s):  
Lucia D Notardonato ◽  
Spencer S Langerman ◽  
Brian C.-H. Chiu ◽  
Benjamin A Derman
Keyword(s):  
Multiple Myeloma ◽  
Staging System ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
First Line ◽  
Kaplan Meier ◽  
Black Patients ◽  
International Staging System ◽  
Cox Analysis ◽  
White Patients

Introduction: The incidence of multiple myeloma (MM) is 2-to-3-fold higher among Black compared to White individuals, which may reflect an underlying biological difference between races. Though there does not appear to be a difference in the distribution of cytogenetic abnormalities between races, high-risk cytogenetic abnormalities (HRCA) have not proven to carry the same negative prognostic significance in Black individuals as is seen in White patients (Derman et al. Blood Cancer Journal 2020). The most commonly used MM risk stratification schema are the International Staging System (ISS) and Revised-ISS (R-ISS), an extension of the ISS that includes serum lactate dehydrogenase (LDH) levels and HRCA identified by fluorescence in-situ hybridization (FISH) (Palumbo et al. JCO 2015). These schema were derived from clinical trial data made up of predominately White patients, and thus it is unknown whether these are applicable for Black patients. We sought to evaluate the relative prognostic impact of ISS and R-ISS on progression-free survival (PFS) and overall survival (OS) in White and Black patients. Methods: Data was collected from the Multiple Myeloma Research Foundation (MMRF) CoMMpass global registry version IA15, which includes 1143 newly diagnosed MM patients with clinical lab data at the time of diagnosis. Race was self-reported. Data were analyzed through R version 4.0.2 using the Survival package version 3.2-3. PFS was defined as the time from diagnosis until progression or death. OS was defined as the time from diagnosis until death from any cause. Survival curves were constructed using the Kaplan-Meier method and compared with the log-rank test. Linear trend Hazard ratios (HR) and 95% confidence intervals were derived from Cox proportional hazards regression models incorporating the risk stratification score as an ordinal predictor. Results: A total of 617 MM patients (505 Non-Hispanic White and 112 Non-Hispanic Black) were identified in the MMRF CoMMpass registry version IA15 with complete baseline data available to generate ISS and R-ISS scoring. 268/505 (53%) White patients received an autologous stem cell transplant in the first line compared to 50/112 (45%) Black patients (p=0.11). Multivariate Cox analysis for PFS was performed for each race and included age, sex, and either ISS or R-ISS. Among Black patients, R-ISS demonstrated increased discrimination for the PFS endpoint compared to ISS (Black ISS, PFS HR 1.74 (1.22-2.48), p &lt; 0.001; Black R-ISS, PFS HR 2.19 (1.37-3.49), p &lt; 0.001). Among White patients, there was no demonstrable difference in discrimination between ISS and R-ISS for the PFS endpoint (White ISS, PFS HR 1.35 (1.16-1.58), p&lt;0.001; White R-ISS, PFS HR 1.36 (1.11-1.67), p &lt; 0.001). Multivariate Cox analysis for OS was performed in an identical fashion. Regardless of race, R-ISS demonstrated increased discrimination for risk of death compared to ISS (White ISS, OS HR 1.88 (1.48-2.38), p&lt;0.001; White R-ISS, OS HR 2.19 (1.61-2.98), p&lt;0.001; Black ISS, OS HR 1.70 (1.06-2.71), p = 0.030; Black R-ISS, OS HR 2.21 (1.18-4.14, p= 0.013). Kaplan-Meier Curves for PFS and OS can be found in Figure 1. Further analyses stratifying by receipt of first-line autologous stem cell transplant (ASCT) showed that R-ISS did not add discriminatory capacity for PFS or OS over ISS for Black patients who received first-line ASCT (Black ISS, OS HR 1.89 (1.39-2.56), p&lt;0.001; Black R-ISS, OS HR 1.97 (1.32-2.94), p&lt;0.001), whereas it did for White patients (data not shown). Conclusions: In a modern prospective cohort of real-world patients who received novel MM therapy and a high rate of transplantation, we found that the R-ISS offered additional discrimination of OS compared to ISS regardless of race. R-ISS did not offer additional discriminatory capacity over ISS for PFS among White patients (possibly reflecting more intensive non-transplant therapies among higher R-ISS risk patients) nor for PFS and OS among Black patients receiving first-line ASCT. Further work is needed to improve risk prognostication among Black patients with MM. Figure 1 Disclosures No relevant conflicts of interest to declare.

Ongoing Strong Improvement in Treatment Outcomes for Patients Diagnosed with Non-Hodgkin Lymphoma from the 1990s to the Early 21st Century.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3314-3314
Author(s):  
Dianne Pulte ◽  
Adam Gondos ◽  
Hermann Brenner
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
Older Patients ◽  
Hematologic Malignancy ◽  
Relative Survival ◽  
The United States ◽  
Treatment Protocols ◽  
Non Hodgkin Lymphoma ◽  
Black Patients ◽  
White Patients

Abstract Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy in adults in the United States. Studies of new treatments of NHL suggest that the prognosis is improving for patients with this disease. Here we used the novel method of period analysis1 to disclose recent trends in survival among adults diagnosed with NHL on the population level. Methods: We estimated trends in 5- and 10-year relative survival in patients 15+ years of age diagnosed with NHL in the US between 1990 and 2004 using data from the Surveillance, Epidemiology, and End Results (SEER) program. We also estimated survival by age, location of tumor, gender, and race to further elucidate trends in survival in this disease. Results: Overall, 5- and 10-year relative survival increased from 50.4% to 66.8% and from 39.4% to 56.3%, respectively, between 1990–92 and 2002–04 (see table). Improvements were most pronounced in patients below 45 years of age (+26.8 and +27.1 percentage points for 5- and 10-year survival respectively). However, unlike in many hematologic malignancies, strong improvement was seen in older patients as well, with 10-year survival increasing 10.1% points in patients 75+ years of age at diagnosis. Strong improvement was seen in both nodal and extra-nodal disease, with 10-year relative survival going from 36.7% and 47.4%, respectively, in 1990–92 to 52.0% and 65.1% in 2002–04. Highly significant improvements in survival were seen in both men and women, but the extent of improvement was greater in men, except in patients aged 75+. Overall, 10-year relative survival improved by 19.2% points for men, 13.9% points for women. Although improvements in survival were seen in both black and white patients, the improvements were greater in white patients, with an overall improvement of 16.8% points for white patients, 13.9% points for black patients. Since white patients already had a higher survival rate in 1990–92, this resulted in a widening of the gap in survival. Conclusions: The outlook for patients diagnosed with NHL improved strongly between 1990–92 and 2002–04. Changes in treatment of the disease, particularly the addition of antibody therapy to chemotherapy, and a decrease in the number of HIV related NHL cases due to highly active anti-retroviral therapy are probably primarily responsible for these improvements. Of particular note, improvements in survival in elderly patients may be due to documentation of the safety and efficacy of rituximab with chemotherapy in elderly patients in clinical trials, leading clinicians to feel comfortable prescribing this treatment in older patients. In contrast, the relative lack of progress in black patients is probably multifactorial, but differences in frequency of less treatable histologies and less frequent use of optimal treatment in this population may play roles in this finding. Better dissemination of improved treatment protocols and further improvements in the treatment of NHL and HIV may further improve prognosis. 10-year relative survival for NHL Age 1990–92 (SE) 2002–04 (SE) Difference 15–44 41.5 (1.2) 68.6 (1.2) +27.1 45–54 48.2 (1.6) 67.2 (1.3) +19.0 55–64 44.8 (1.4) 61.5 (1.3) +16.7 65–74 38.2 (1.5) 54.7 (1.4) +16.5 75+ 26.4 (2.0) 36.5 (1.8) +10.1 Total 39.4 (0.7) 56.3 (0.6) +16.9

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