Long-Term Outcome of Patients with Myelodysplastic Syndromes (MDS) Treated with Hypomethylating Agents (HMA): A Report on Behalf of the MDS Clinical Research Consortium

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4641-4641
Author(s):  
Elias Jabbour ◽  
Koji Sasaki ◽  
Mikkael A. Sekeres ◽  
Rami S Komrokji ◽  
David P. Steensma ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Median Survival ◽  
Regression Models ◽  
Low Risk ◽  
Intermediate Risk ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Duration Of Response

Abstract Background: Therapy with HMA is now the standard of care for pts with MDS and chronic myelomonocytic leukemia (CMML) with complete response (CR) rates of 7% to 35%, median response durations of 9 to 10 months, and median survival of 20 to 24 months. While allogeneic stem cell transplantation (ASCT) is curative in pts with MDS, the long-term outcome of pts treated with HMA remains unknown. Aims: The aims of the study are to assess the long-term outcome of pts with MDS treated with HMA and to identify prognostic factors of long-term outcome. This may help selecting patients for this long-term treatment in whom ASCT may not be indicated. Methods: We reviewed the records of 511 pts with diagnosed MDS (n=409) and CMML (n=102) treated from 4/2000 to 4/2014 and who were treated with HMA. Pts who received ASCT (n=65) were excluded. Thus, a total of 446 pts were evaluable for the study. The probabilities of leukemia-free survival (LFS) and overall survival (OS) were estimated using the method of Kaplan and Meier. Univariate and multivariate analyses were performed to identify potential factors associated with the achievement of response with logistic regression models and survival with Cox proportional hazard regression models. Results: The median follow-up for the entire cohort was 13.6 months. Pt characteristics are outcomes described in Table 1. Best responses to HMA were CR in 124 (28%) pts, CRp in 27 (6%), PR in 9 (2%), HI in 31 (7%). Median duration of response was 7 months (1-68). 130 (29%) transformed into AML after a median of 11 months (11-60). At the last follow-up 133 (30%) remained alive. The median LFS and OS were 16.1 and 16.2 months respectively. The 2- and 5-year LFS and OS rates were 29% and 11% and 34% and 12%, respectively. By multivariate analysis, baseline characteristics associated with OS included WBC (>4 vs. ≤4), ferritin (>500 vs. ≤500), hemoglobin (>10 vs. ≤10), platelets (>500 vs. ≤500) and cytogenetics (high vs. intermediate vs. low risk) (p<0.05). Since the relative impact of each of these 5 factors on survival was similar, we assigned an arbitrary value of 1 to each of them, except for cytogenetics (0=low risk; 1=intermediate risk; and 2=high risk). Patients with 0-2 (n=265) or 3-5 (n=180) adverse factors had a median survival of 18 and 14 months, respectively (p= 0.001). To assess the benefit of achieving a response, we repeated the multivariate survival analysis using an 8-week landmark that excluded 38 patients who died within 8 weeks. The median survival was 15 months overall (8 and 20 months for patients with and without CR/CRp, PR/HI, respectively; p<0.001). The multivariate analysis included 315 patients and selected the achievement of response (CR/CRp/PR/HI vs. others), WBC (>4 vs. ≤4), ferritin (>500 vs. ≤500), platelets (>500 vs. ≤500) and cytogenetics (0=low risk; 1=intermediate risk; and 2=high risk) as independently associated with survival improvement Patients with 0-2 (n=244) or 3-5 (n=162) adverse factors had a median survival of 19 and 13 months, respectively (p<0.001). Conclusion: Our current analyses identified a small subset of pts with MDS in whom outcome of therapy with HMA is excellent and can be differentially predicted. Table 1. Patient Characteristics and Outcomes Parameter (N=446) Number (%); Median [range] Age (years) 70 (13-92) White Blood Cell Count (x 109/L) 3.5 (0.5-212) Ferritin 465.0 (0-10971) Hemoglobin (g/dL) 9.7 (6-16) Platelets (x 109/L) 68.0 (4-987) Bone marrow blasts (%) 6.0 (0-19) Prior malignancy 198 (44) Prior chemotherapy 133 (30) Prior radiotherapy 85 (19) Prior Transfusion 134 (30) Cytogenetics (by IPSS) Low 213 (48) Intermediate 78 (17.5) High 144 (8) Missing 11 (2.5) WHO RA 47 (10.5) RARS 16 (4) RCMD 75 (17) RAEB 204 (46) MDS-U 8 (2) CMML 95 (21) Missing 1 (0.2) IPSS Low 46 (10) Intermediate-1 193 (43) Intermediate-2 156 (35) High 36 (8) Missing 15 (3) MDA Score Low 59 (13) Intermediate-1 113 (25) Intermediate-2 124 (28) High 113 (25) Missing 37 (8) Type of HMA Azacitidine/ AZA+ 189 (42) Decitabine/DAC 257 (58) Response to HMA CR 124 ( 28) CRp 27 (6) PR 9 (2) HI 31 (7) NR 121 (27) Died on therapy 23 (5) NE 6 (1.4) Missing 105 (23.5) Median duration of response (mos) 7.2 (1-68) Transformed into AML 130 (29) Dead 313 (70) Disclosures No relevant conflicts of interest to declare.

Long-Term Outcome of Anemic Non Del 5q Lower-Risk MDS Refractory to or Relapsing After Erythropoiesis Stimulating Agents (ESAs)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 442-442
Author(s):  
Charikleia Kelaidi ◽  
Sophie Park ◽  
Rosa Sapena ◽  
Odile Beyne-Rauzy ◽  
Valérie Coiteux ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lower Risk ◽  
Who Classification ◽  
Initial Response ◽  
Primary Resistance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Median Serum

Abstract Abstract 442 Background. ESAs are usually the first line tx of anemia in non del 5q lower risk MDS. However, not all pts respond to ESAs and median response duration is only about 2 years (Park, Blood 2008;111:574). Long-term outcome of pts who do not respond to or relapse after response to ESAs is incompletely known. We analyzed this outcome by updating a previously reported lower-risk MDS cohort of 403 pts treated with ESA in centers of the GFM (Blood 2008;111:574). Methods. We analyzed in that cohort low and int-1 (lower risk) IPSS pts with Hb<10g/dL, requiring or not RBC transfusions, who did not respond to or relapsed after ESAs, according to IWG 2000 criteria. Pts with MPN/MDS, unclassified MDS, therapy related-MDS, del 5q or 3q, IPSS int-2/high and pts who, at the time of relapse of ESAs, had progressed to AML or higher risk MDS were excluded. Pts had started ESA tx between 1998 and 2006, and data were reanalyzed 4 years after the last pt inclusion (at the reference date of 1 July 2010). 93 pts of the cohort who responded to ESAs but had not relapsed at the end of this follow up period were used for comparisons. Results. 177 pts, including 94 with primary resistance to ESAs and 83 with relapse after an initial response were analyzed. In the 94 pts with primary resistance to ESAs, M/F was 2, median age 75, WHO classification at tx onset RA, RCMD, RARS, RAEB-1 in 17%, 27%, 28%, 27% of cases, respectively (resp), karyotype fav, intermediate (int) in 86% and 14% pts, resp, IPSS low, int-1 or assignable to low/int-1 in 35%, 60% and 5% pts, resp. Median serum ferritin was 658 ng/mL and median serum EPO level (sEPO) 125 IU/L. 63% of the pts were RBC transfusion dependent (TD) (median 2 RBC units/month). Median overall survival (OS) and 3-y cumulative incidence (CI) of AML from tx onset were 43 months (mo) and 18%, resp. Among pre-tx characteristics, age >75 was associated with shorter survival (median OS 31 mo vs. not reached for age <75, P=0.01) along with int karyotype (median 26 vs 56 mo in pts with fav karyotype, P=0.005). Using multivariate analysis, only cytogenetics maintained prognostic significance for OS. No prognostic factor of AML progression was found. 21% of the 94 pts were aged <65. Their 3-y CI of AML was 19.4% vs 7.4% in pts aged >65 (P=0.93), and their median OS was not reached vs 41 mo in pts aged >65 (P=0.03). 83 pts relapsed after an initial response (IWG 2000 major and minor in 60.2% and 39.8% pts, resp) of 16.5 mo median duration (range 3–74 mo). At tx onset, M/F was 1.35, median age 74.3, WHO classification RA, RCMD, RARS, RAEB-1 in 14%, 38%, 32%, 16% of cases, resp, karyotype fav, int in 92% and 8% pts, resp, IPSS low, int-1 in 51% and 49% of pts. Median serum ferritin was 695 ng/mL and median sEPO 64 IU/L. 45% of the pts were TD (median 2 RBC units/mo). Median OS and 3-y CI of AML after relapse were 53 mo and 9.7%, resp. Median OS after relapse was 26 mo in RAEB-1 and not reached in other WHO subtypes (P=0.06) and was not influenced by the presence of multilineage dysplasia. Pts who relapsed after 24 mo had a 4.1% 3-y CI of AML vs 12.8% in pts who relapsed before 24 mo (P=0.40). Median OS was not reached in pts who relapsed after 24 mo vs 53 mo in those relapsing before 24 mo (P=0.90). No pre-tx characteristic was predictive of relapse before or after 24 mo. 16% of the 83 pts were aged <65. Their median OS after relapse was not reached at 4 years vs also not reached in pts aged >65 (P=0.17), and their 3- CI of AML after relapse was 0% vs 12% in pts aged >65 (P=0.31). In the overall pt population (ie pts with primary resistance, pts with relapse and pts with sustained response), univariate competing risk modeling found CI of death from cardiovascular causes to be correlated with TD and older age at tx onset but not with response status, while only age remained significant in multivariate analysis (HR=1.12 [1.014-1.24], P=0.02). Both older age and early failure (ie primary failure or relapse <24 mo) were associated with increased CI of death from MDS-related causes (AML, hemorrhage, infection) (HR=1.05 [1.00-1.10], P=0.04; and HR=5.64 [1.85-17.22], P=0.002, resp). Conclusions. Failure to respond or loss of response to ESAs in the absence of frank disease progression to AML or higher risk MDS was not associated with poor outcome in lower-risk MDS, except in some pt subgroups (pts with intermediate karyotype and with a diagnosis of RAEB-1). Those figures have to be taken into account for therapeutic decisions, especially in pts aged <65 years, where median survival was not reached with relatively long term follow up. Disclosures: Off Label Use: ESAs for anemia in MDS. Fenaux:CELGENE, JANSSEN CILAG, ROCHE, AMGEN, MERCK, GSK, NOVARTIS, CEPHALON: Honoraria, Research Funding.

scholarly journals Long-Term Outcome of Chronic Myelomonocytic Leukemia (CMML) Patients Treated with Hypomethylating Agents (HMA): A Single-Institution Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1924-1924
Author(s):  
Adolfo Diaz Duque ◽  
Monica Cabrero ◽  
Farhad Ravandi ◽  
Naveen Pemmaraju ◽  
Gautam Borthakur ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Response Rate ◽  
Cox Regression ◽  
Continuous Variables ◽  
Hypomethylating Agents ◽  
Independent Factor ◽  
Term Outcome ◽  
Long Term Outcome

Abstract CMML is a myelodysplastic/myeloproliferative disease considered a separate entity by WHO, but from a therapeutic perspective, most clinicians consider CMML a subtype of myelodysplastic syndromes (MDS), for which hypomethylating agents (HMA) are the standard of therapy. Herein, we report on the long-term outcome of patients with CMML treated with HMA as well as prognostic associated factors. Methods: We reviewed the records of 102 consecutive patients with CMML treated between March 2004 and June 2014. Patients who underwent ASCT were excluded (n=5), and thus a total of 97 patients were analyzed. Responses were assessed according to IWG 2006. Differences among variables were evaluated by the Chi-square test and Mann–Whitney U test for categorical and continuous variables, respectively. Progression-free survival (PFS) was defined as the time from start of therapy to leukemia transformation or death. Overall survival (OS) was defined as the time from start of therapy to death. Patients who were alive were censored at the last follow-up date. PFS and OS were estimated using Kaplan-Meier analysis, and multivariate analysis was performed by Cox regression. Results: Median age at diagnosis was 71 years (50-87). Treatment was azacitidine (AZA) in 30 patients (31%) and decitabine (DEC) in 67 (69%), and they received a median of 6 courses of therapy (1-70). IPSS risk score was low in 18 patients (18.6%), int-1 in 47 (48.5%), int-2 in 23 (23.7%), and high in 4 (4.1%). Fourteen patients (14.4%) had poor-risk cytogenetics. Among patients with available mutation data, we found RAS mutations in 18 out of 79 analyzed cases (22.7%), FLT3-ITD mutations in 3 out of 86 (3.5%), NPM1 mutations in 2 out of 40 (5%), and Jak2 mutations in 1 out of 36 (2.8%). Overall response rate (ORR) was 51%, and best responses to HMA were complete remission (CR) in 51 (52%) patients, partial response (PR) in 3 (3.1%), and hematological improvement (HI) in 7 (7.2%). Median duration of response was 11.5 months (range, 1.1 to 67.5). There was no difference in response rate between DAC and AZA therapies. With a median follow-up of 11 months (1-73), 27 cases (28%) transformed into AML after a median of 19 months (5-59). At the last follow-up, 32 patients (33%) remained alive. The median PFS and OS were 18 and 23 months, respectively. The 1- and 2-year OS rates were 94.7% and 85.6%, respectively, and the 1- and 2-year PFS rates were 92.7% and 81.3%, respectively. By multivariate analysis, patients with higher hemoglobin levels (HR=0.83, 95%CI [0.72-0.97]; p=0.024) and those who achieved CR (HR=0.46 [0.26-0.81]; p=0.007) had better OS, whereas high-risk cytogenetics was associated with poorer OS (HR: 2.89 [1.34-6.21]; p=0.007). Only achievement of CR was an independent factor with impact on PFS (HR: 0.32 [0.18 – 0.55]; p<0.001). We did not identify any independent factor with significant impact on response rate. Conclusions HMA is a suitable therapy for patients with CMML, and the achievement of CR is the most important goal to improve patient outcomes. Disclosures Cortes: Celgene: Research Support Other.

Long-Term Outcome in Polycythemia Vera (PV): Final Analysis of a Randomized Trial Comparing Hydroxyurea (HU) to Pipobroman (Pi).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1746-1746 ◽  
Author(s):  
Jean-Jacques Kiladjian ◽  
Sylvie Chevret ◽  
Christine Dosquet ◽  
Pierre Fenaux ◽  
Christine Chomienne ◽  
...  
Keyword(s):  
Median Survival ◽  
Cumulative Incidence ◽  
Randomized Clinical Trials ◽  
Final Analysis ◽  
Vascular Events ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mortality And Morbidity

Abstract Background: Only 4 randomized clinical trials in PV have directly compared cytoreductive therapies (32P, busulfan, chlorambucil, HU, and Pi), all published after a median follow-up of 10 years or less. Thrombosis was the main cause of mortality and morbidity in all trials. Cumulative incidence of evolution to myelofibrosis (MF), and acute myeloid leukemia or myelodysplastic syndromes (AML/MDS) was about 8%, and 6%, respectively. In 1 of those trials, conducted between 1980 and 1996 by the French Polycythemia Study Group (FPSG) in 292 PV patients (pts) younger than 65 yrs, no difference between HU and Pi was found in terms of survival, risk of thrombosis, and AML/MDS/MF evolution at the time of first analysis with a median follow up of 7 years (Najean, Blood, 1997, 90:3370). Methods: We updated the results of the FPSG trial at the reference date of April 15, 2008, with a median follow-up of 16.3 years. After randomization in the trial (136 pts in the HU arm, 149 in the Pi arm), 94 (33%) pts had received only HU, 130 (46%) only Pi, and 61 (21%) both drugs (including 42 who had switched from HU to Pi, and 19 from Pi to HU) during the whole follow-up period (7 patients were excluded from the final analysis because of incomplete follow up data). To take into account treatment crossovers, statistical analysis was performed both in “intention to treat” (ITT) and according to the main treatment received (i.e. treatment effectively received). Results: Median survival was 20.3 years (95%CI: 16.4 – 25) in HU arm, and 15.4 years (95%CI: 13.4 – 17) in Pi arm (p=0.008). 95 pts have died, the 3 main causes of death being evolution to AML/MDS in 51 pts (54%), vascular events in 19 pts (20%), and solid tumor in 11 (12%) pts. The 51 cases of evolution to AML/MDS included 10 MDS, and 41 AML (including 5 preceded by an MDS phase). Cumulative incidence (CI) of AML/MDS at 10, 15, and 20 years in ITT analysis was 6.6%, 16.5%, and 24% in the HU arm, and 13%, 34%, and 52% in the Pi arm, respectively (p= 0.004). As the median duration of HU treatment (12 years) was significantly longer than that of Pi treatment (9.5 years, p=0.0002), we also performed the analyses according to the main treatment actually received by pts, which showed cumulative incidence of AML/MDS of 7%, 14%, and 22% with HU, and 12%, 37%, and 56% with Pi at 10, 15, and 20 years, respectively (p=0.008), confirming the results obtained in ITT analyses. Regarding MF, the CI at 10, 15 and 20 years was comparable in both arms in ITT analysis: 12.6%, 19%, and 27% in the HU arm, and 7.8%, 16%, and 27% in the Pi arm, respectively (p=0.7). However, a significantly higher incidence of MF was found in pts who had received HU as main treatment: 15%, 24%, and 32% at 10, 15, and 20 years, compared to 5%, 10%, and 21%, respectively, in patients who received mainly Pi (p=0.02). Conclusion: Although medium-term analysis of FPSG trial did not show differences between HU and Pi, current update after a median follow-up of 16.3 years finally showed that median survival was shorter, and incidence of AML/MDS higher in Pi treated pts. By contrast, risk of MF was higher in pts treated predominantly with HU. Of note, was the clearly higher than previously reported cumulative incidence of AML/MDS with HU. Evolution to AML/MDS represented by far the first cause of death in the long-term (54% versus 20% for vascular events). Those results suggest that Pi should not be used as first line therapy in PV patients, and that very long term may be required to draw conclusions regarding leukemic evolution in PV trials.

LONG-TERM Outcome of a Fondazione Italiana Linfomi Study Comparing Short Rituximab Maintenance Vs Observation after Brief First-LINE R-FND Chemoimmunotherapy Followed By Rituximab Consolidation in Elderly Patients with Advanced Follicular Lymphoma (FL)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3985-3985
Author(s):  
Carola Boccomini ◽  
Marco Ladetto ◽  
Francesca Dutto ◽  
Simone Ferrero ◽  
Luca Baldini ◽  
...  
Keyword(s):  
High Risk ◽  
Low Risk ◽  
First Line ◽  
Term Outcome ◽  
Long Term Outcome ◽  
High Risk Patients ◽  
Rituximab Maintenance ◽  
Risk Patients

Abstract Introduction: we previously reported (Vitolo U, JCO 2013) the results of a randomized study with brief first-line chemoimmunotherapy followed by rituximab maintenance vs observation. With a median follow-up of 42 months, 3-year Progression Free Survival (PFS) and Overall Survival (OS) were 66% and 89%, respectively. The addition of Rituximab maintenance gave a benefit to the patients: 2-year PFS was 81% for rituximab maintenance versus 69% for observation with a HR of 0.63 (95% CI: 0.38-1.05, p=0.079), although not statistically significant. Moreover we also found that achievement of Minimal Residual Disease (MRD) negativity predicted a better PFS: 3-year PFS 72% vs 39%, HR 3.1 (Ladetto M, Blood 2013). Overall these data showed the good efficacy of this brief chemoimmunotherapy regimen in elderly FL patients. Aim of this analysis was to report long-term outcome and long-term toxicities of this regimen. Methods: From January 2004 to December 2007, 242 treatment-naive patients aged 60-75 years with FL Grade I, II and IIIa were enrolled by 33 FIL centres. Patients had to have advanced (high tumor burden stage II or stage III-IV) disease requiring treatment: 4 monthly courses of R-FND (standard doses of Rituximab, Fludarabine, Mitoxantrone, Dexamethasone) every 28 days followed by 4 weekly Rituximab infusions as consolidation. Responders patients [complete remission (CR) + unconfirmed CR + partial remission (PR)] were randomized to brief rituximab maintenance (Arm A), once every 2 months for a total of 4 doses, or observation (Arm B). MRD for the bcl-2/IgH translocation was determined on bone marrow cells in a centralized laboratory belonging to Euro-MRD consortium, using qualitative and quantitative PCR. Results: a total of 234 patients began chemoimmunotherapy: after induction and consolidation treatment overall response rate was 86%, with 69% CR. Of these, 210 completed the planned treatment and 202 responders were randomized. Up to date, median follow-up were 96 months from enrollment and 87 months from randomization; additional follow-up data were available for 127/146 (87%) not relapsed/progressed patients. Five- and 7-year PFS for the whole population were 57% and 51%, respectively; 5- and 7-year OS for the whole population were 85% and 80%, respectively. From enrollment, an advantage in term of PFS and also OS was observed in FLIPI low risk patients: 7-year PFS was 67% for low risk versus 38% for intermediate-high risk patients (p<0.001) and 7-year OS was 86% versus 75%, respectively (p=0.03). After randomization, no differences between the two arms were detected for both PFS and for OS at 5 (data not showed) and 7 years: 7-year PFS was 55% for rituximab maintenance arm versus 52% for observation arm (p=0.331; HR 0.8); 7-year OS was 83% for both arms (p=0.208; HR 0.67). Moreover, after randomization no differences between the two arms were detected for both FLIPI low risk and intermediate-high risk patients: 7-year PFS was 67% for Rituximab maintenance arm versus 68% for observation arm (p=0.808) in low risk patients; in intermediate-high risk patients 7-year PFS was 46% vs 35% (p=0.301), respectively in Arm A vs B. Conversion to PCR negativity at the end of treatment maintains predictive value for better PFS: 7-year PFS were 58% and 36% (p=0.084), respectively for MRD negative vs positive patients. The same risk of late toxicity (infections or cardiac events) or secondary cancers was observed in both arms: in particular, 13 secondary neoplasms in maintenance arm vs 16 in observation arm were recorded. Conclusions: the present long-term results of this trial with a prolonged follow-up of 7 years confirm that a good outcome is achievable in elderly FL patients with a short-term chemoimmunotherapy (R-FND + Rituximab consolidation) with a 7-year PFS of 51% and low toxicity. In addition these results did not show clear evidence in favor of a shortened Rituximab maintenance after R-fludarabine containing chemotherapy. Conversely, the achievement of PCR negativity maintains predictive value for a better outcome. Figure 1. Figure 1. Disclosures Off Label Use: Rituximab maintenance was not licensed in first-line treatment for follicular lymphoma at that time in Italy; Rituximab was provided free by Roche.

Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission: Results of a multivariate analysis.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 154-154
Author(s):  
Christiane Matuschek ◽  
Edwin Boelke ◽  
Hans Bojar ◽  
Stephan L. Roth ◽  
Matthias Peiper ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Locally Advanced ◽  
Breast Conservation ◽  
Time Interval ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome

154 Background: An earlier published series of neoadjuvant radio-chemotherapy (NRT-CHX) in locally advanced noninflammatory breast cancer (LABC) has now been updated with a follow-up of more than 15 years. Long-term outcome data and predictive factors for pathologic complete response (PCR) were analyzed. Methods: 315 LABC patients (cT1-cT4 /cN0-N1) were treated during 1991-1998 with NRT-CHX. Preoperative radiotherapy (RT) consisted of external beam radiation therapy (EBRT) of 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with an electron boost in 214 cases afterwards or—in case of breast conservation—a 10-Gy interstitial boost with 192Ir afterloading before EBRT. Chemotherapy was administered prior to RT in 192 patients, and concomitantly in 113; 10 patients received no chemotherapy. The update of all follow up ended in November 2011. Age, tumor grade, nodal status, hormone receptor status, simultaneous vs. sequential CHX and the time interval between end of RT and surgery were examined in multivariate terms with as endpoint pCR and overall survival. Results: The total PCR rate after neoadjuvant RT-CHX reached 29.2 % with LABC breast conservation becoming possible in 50.8%. In initially node-positive cases (cN+), a complete nodal response (pN0) after NRT-CHX was observed in 56% (89/159). The multivariate analysis revealed that a longer time interval to surgery increased the probability for a pCR (HR 1,17 [95% CI 1,05-1,31], p<0,01). However, in large tumors (T3-T4) a significantly reduced pCR rate (HR 0.89 [95% CI 0.80 to 0.99], p = 0.03) could be obtained. Importantly, a pCR was the strongest prognostic factor for long-term survival (HR 0.28 [95% CI 0.19-0.56], p<0.001). Conclusions: A PCR identifies patients with a significant better prognosis for long-term survival. However, a long time interval to surgery (> 2 months) increases the probability of a pCR after NRT-CHX.

Spectrum and Outcome of Noninfectious Aortitis

2021 ◽  
pp. jrheum.201274
Author(s):  
Yasmina Ferfar ◽  
Sarah Morinet ◽  
Olivier Espitia ◽  
Christian Agard ◽  
Mathieu Vautier ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Inflammatory Diseases ◽  
Vascular Complications ◽  
Relapsing Polychondritis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Igg4 Related Disease ◽  
Cogan Syndrome

Objective To assess the spectrum and long-term outcome of patients with noninfectious aortitis. Methods We performed a retrospective multicenter study of 353 patients (median age at diagnosis was 62 [IQR 46–71] yrs and 242 [68.6%] patients were women) with noninfectious aortitis. Factors associated with vascular complications were assessed in multivariate analysis. Results We included 136 patients with giant cell arteritis (GCA), 96 with Takayasu arteritis (TA), 73 with clinically isolated aortitis (CIA), and 48 with aortitis secondary to inflammatory diseases (including Behçet disease, relapsing polychondritis, IgG4-related disease, Cogan syndrome, ankylosing spondylitis). After a median follow-up of 52 months, vascular complications were observed in 32.3%, revascularizations in 30% of patients, and death in 7.6%. The 5-year cumulative incidence of vascular complications was 58% (95% CI 41–71), 20% (95% CI 13–29), and 19% (95% CI 11–28) in CIA, GCA, and TA, respectively. In multivariate analysis, male sex (HR 2.10, 95% CI 1.45–3.05, P < 0.0001) and CIA (HR 1.76, 95% CI 1.11–2.81, P = 0.02) were independently associated with vascular complications. Conclusion Noninfectious aortitis accounts for significant morbidity and mortality. CIA seems to carry the highest rate of vascular complications.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

Psychopathology 8½ Years Post Parasuicide

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 115-120 ◽  
Author(s):  
Stephen Curran ◽  
Michael Fitzgerald ◽  
Vincent T Greene
Keyword(s):  
Rating Scales ◽  
Psychiatric Morbidity ◽  
Parental Bonding ◽  
Social Maladjustment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Face To Face ◽  
Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Sign in / Sign up

Export Citation Format

Share Document