scholarly journals Survival Outcome and Long-Term Follow-up of Autologous and Allogeneic Stem Cell Transplantation (SCT) in Acute Myeloid Leukemia (AML): A 30 Years Single-Center Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5890-5890
Author(s):  
Carmen Montes-Gaisán ◽  
German Perez ◽  
Arancha Bermudez ◽  
Amalia Cuesta ◽  
Carlos Richard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
The Other ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Secondary Aml ◽  
Secondary Neoplasm

Abstract Background: Post-remission treatment for AML is very aggressive and many times a SCT is needed. Comparisons between Allo-SCT and Auto-SCT ve always shown more Transplant Related Mortality (TRM) but less Cumulative Incidence of Relapse (CIR) in the first group. Our study describes, not only the long-term survival outcomes, but also the quality of life in long survivors. Methods: Retrospective study of 274 patients diagnosed with non-promyelocytic AML who underwent SCT between 1982 and 2011 in our center. Characteristics in the 162 Allo-SCT and the 112 Auto-SCT groups of patients were respectively: median age of 38 and 45 years old, secondary AML in 20% and 10%, refractory to Induction AML in 16% and 3%, pre-SCT status different from Complete Remission (CR) in 13% and 3% and year of SCT before 2005 in 53% and 86%. No significant differences between both groups were found in other risk factors as hyperleucocytosis at diagnosis or adverse cytogenetics. Results: With a median follow-up of 55 months [2-316], Overall Survival (OS) until 1997 in Allo-SCT and Auto-SCT were respectively, 40% and 61% at 1 year and 28% and 45% at 5 years (figure 1), but from 1997, 66% and 70% at 1 year and 47% and 48% at 5 years (figure 2). Disease Free Survival (DFS) until 1997 in Allo-SCT and Auto-SCT were respectively, 50% and 65% at 1 year and 38% and 46% at 5 years, but from 1997, 67% and 63% at 1 year and 52% and 47% at 5 years. In the last 15 years, no differences were found between both groups in OS nor DFS. CIR in Allo-SCT and Auto-SCT were respectively, 18% and 32% at 1 year and 24% and 50% at 5 years, without dependence on year of SCT. No relapse was observed later in any group. TRM until 1997 in Allo-SCT and Auto-SCT were respectively, 30% and 7% at 1 year and 35% and 9% at 5 years, but from 1997, 16% and 2% at 1 year and 25% and 4% at 5 years. Multivariable analysis showed that the only risk factor with a negative impact on OS was not having achieved CR at the time of SCT. Other variables as older age, hyperleucocytosis at diagnosis, adverse cytogenetics, secondary AML or sooner year of SCT lost their univariable analysis significance. Allo-SCT: From the 162 patients, 72(44%) are alive by this moment, 43(60%) with ECOG 0, 21(29%) with ECOG 1 and the other 8(11%) with ECOG 2, basically because of graft versus host disease (GVHD in 39 patients, 21 steroid-dependent and 3 refractory to any treatment). All of them have been in CR during the last 2 years of follow-up. In contrast, 90(56%) patients have died: 52(58%) because of SCT complications (20 infections, 16 GVHD, 8 toxicity and 8 mixed causes), 33(37%) because of disease and 5(5%) because of other causes. With a median follow-up of 43 months [2-316], there have been 4 secondary neoplasm, all of them solid ones, which appeared with a median of 242 months [179-311] from SCT. None of them had previously received radiotherapy. Auto-SCT: From the 112 patients, 43(38%) are alive by this moment, 32(74%) with ECOG 0 and the other 11(26%) with ECOG 1. All of them have been in CR during the last 2 years of follow-up. In contrast, 69(62%) patients have died: 45(65%) because of disease, 14(20%) because of SCT complications and 10(15%) because of other causes. With a median follow-up of 93 months [5-230], there have been 6 secondary neoplasm, 5 of them hematologic ones, which appeared with a median of 90 months [76-115] from SCT. None of them had received radiotherapy, but previously treated hematopoietic stem cells. Only one is alive at the time of last follow-up. Conclusions: In one hand, despite the high incidence of relapse in Auto-SCT in any period, OS is lower in Allo-SCT during the first years [1982-1996], although it has a tendency towards OS in Auto-SCT from 1997 because of the decrease in TRM, which is more significative in Allo-SCT. In the other hand, DFS is slightly higher in Allo-SCT during the last years [1997-2011], although the quality of life in long survivors is worse, basically because of GVHD. In summary, we have not really found differences between Allo-SCT and Auto-SCT in terms of OS and DFS in our series, so both procedures are efficient to treat AML (near 50% of the patients in both groups are alive at 5 years from SCT in recent years). The decrease in TRM until 4% at 5 years in Auto-SCT makes it a good choice, particularly for older patients without risk factors. However, the development of secondary hematologic neoplasms is a relevant fact, with an incidence of 11% and a high late mortality. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Long-Term Follow-up of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Severe Alpastic Anemia After Cyclophosphamide Plus Antithymocyte Globulin Conditioning Regimen,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4090-4090
Author(s):  
Johanna Konopacki ◽  
Raphael Porcher ◽  
Marie Robin ◽  
Sabine Bieri ◽  
Jean Michel Cayuela ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Hematopoietic Stem ◽  
Gvhd Prophylaxis ◽  
Increased Risk ◽  
Long Term Follow Up

Abstract Abstract 4090 Background: Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) from an HLA- identical sibling is the treatment of choice for young patients with acquired severe aplastic anemia (SAA). Due to increased rates of secondary solid cancer in patients with SAA who received an irradiation-based conditioning regimen, we decided 2 decades ago to use the association of Cyclophosphamide (CY) and Antithymocyte globulin (ATG). We report here the long-term follow-up of patients who underwent HSCT from an HLA-identical related donor after this conditioning regimen. Patients and Methods: 61 consecutive patients with SAA who received a first transplantation from June 1991 to February 2010 in our center were included. Patients with Fanconi anemia or other congenital bone marrow failure were excluded. The conditioning regimen consisted in CY (200mg/Kg) and ATG (2.5 mg/kg/day × 5 days). The donors were HLA-identical siblings in 60 cases and family HLA-matched in 1 case. Graft-versus -host disease (GvHD) prophylaxis associated cyclosporine and methotrexate (days 1, 3, 6 and 11). Long-term clinical outcome, immune recovery and quality of life were assessed. Results: The median age was 21 years [range: 4–43], 41 being adults. Median duration of the disease before HSCT was 93 days. Most of the patients had idiopathic aplastic anemia (n=49, 80%). Median time from diagnosis to HSCT was 3 months (range, 1 to 140). All but 2 patients received bone marrow as source of stem cells and all but 2 engrafted (primary graft failure= 3.4%) with a neutrophils count > 0.5 G/L and a platelets count >20 G/L after a median of 23 (range, 19 to 43) and 21 days (range, 10 to 177), respectively. In patients who had achieved neutrophil recovery, no secondary graft failure was observed. Cumulative incidence (CI) of acute grade II-IV GvHD was 23% (95%CI, 13 to 34) and 18 patients developed chronic GvHD (CI: 32%, 95% CI, 20 to 46). In multivariate analysis, a higher number of infused CD3 cells was associated with an increased risk of developing chronic GvHD (p=0.017). With a median follow-up of 73 months (8 to 233), the estimated 6-year overall survival was 87% (95%CI, 78 to 97). At 72 months, the CI of secondary malignancies was 9%, 10 patients developed avascular necrosis (21% CI), 12 patients were diagnosed with endocrine dysfunctions (19% CI) and 5 presented cardiovascular complications (CI of 10%). The CI of bacterial, fungal and viral infections were 25% (95% CI, 15 to 36), 8% (95% CI, 3 to 17) and 61% (95% CI, 46 to 73) at 72 months, respectively. At 2 years post HSCT, the immune reconstitution was normal for CD3, CD8 T-cells, B-cell and NK-cell but still incomplete for CD4 T-cells. A FACT-BMT questionnaire of quality of life (QOL) was sent to all survivors (n= 53) of who 26 accepted to respond to the questionnaire. There was no evidence for a change in QOL perception with time after transplantation. Our data were compared with those obtained from HSCT recipients from a Swiss transplant center (n=125 patients), mainly transplanted for hematological malignancies. The perception of QOL in patients who were transplanted for SAA was similar to the group of patients who were transplanted for other reason than SAA. Conclusions: Our results confirm that HSCT from HLA-identical sibling donors after CY-ATG conditioning regimen is a curative treatment for patients with SAA, with an excellent long-term outcome. We found an increased risk of chronic GvHD associated with the number of infused CD3 cells. Furthermore, we also found non negligible late complications as well as a similar quality of life with patients transplanted for hematological malignancies. Improving long-term health conditions must thus be a priority field for research, exploring the use of new conditioning regimen as well as new GvHD prophylaxis to improve the quality of life post HSCT of such patients. Disclosures: Peffault de Latour: Alexion: Consultancy, Research Funding.

scholarly journals Health-related quality of life of COVID-19 survivors at 6 months after hospital discharge: a cohort study

2021 ◽  
Author(s):  
MeiXuan Lin ◽  
Liqun Huang ◽  
Danwen Zheng ◽  
Linjie Zhang ◽  
Bing Feng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Cognitive Function ◽  
Health Related Quality ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

Abstract Background: COVID-19 is a multi-systemic disease that is highly contagious and pathogenic. The long-term consequences of it are not yet clear, as is whether society and life can return to a healthy state. Long-term assessment of their health-related quality of life (HRQoL) is essential. This study aimed to investigate HRQoL and its risk factors in COVID-19 survivors at a follow-up of 6-month. Methods: A multicenter cross-sectional survey was conducted among 192 COVID-19 patients with confirmed age ≥ 18 years who were discharged from various hospitals in Wuhan from January to April 2020. The demographic characteristics, clinical characteristics, and laboratory results of the study subjects were obtained from the hospital's medical records. Survivors' HRQoL was assessed using the Short Form 36 (SF-36), cognition was assessed using the ascertain dementia eight-item informant questionnaire (AD8), and survivors' pulmonary function were examined. All participants in this study completed the survey and testing at Hubei Provincial Hospital of Chinese and Western Medicine. SF-36 scores were compared with the Chinese norm, and logistic regression and multivariate analysis were used to investigate the factors affecting HRQoL in COVID-19 survivors. Results: SF-36 showed significant differences in HRQoL between COVID-19 survivors and the general Chinese population ( P< 0.05).Multiple linear regression demonstrated that age was negatively correlated with physical functioning (PF), role-physical limitation (RP) and social functioning (SF) ( P <0.05). Bodily pain (BP), vitality (VT), SF and role-emotional limitation (RE) were negatively correlated with females ( P <0.05). Length from discharge to follow‐up was positively correlated with PF and RP ( P <0.05). Abnormal cognitive function was negatively correlated with PF, RP, general health (GH), VT, SF, RE and mental health (MH) ( P <0.05). Abnormal Carbon Monoxide Diffusing Capacity (DLCO%<80%) was significantly negatively correlated with PF and SF ( P <0.05).In addition, there was a significant negative correlation between Coronary heart disease and RP, GH, VT and RE ( P <0.05).Logistic regression analysis demonstrated that age(OR 1.032) and AD8 scores (OR 1.203)were risk factors associated with a low physical component summary (PCS) score. Length from discharge to follow‐up (OR 0.971) was the protective factor for PCS score. Abnormal cognitive function (OR 1.543) was a significant determinant associated with a mental component summary (MCS)<50 in COVID-19 patients. Conclusions: The HRQoL of COVID-19 survivors remains to be improved at six-month follow-up. Future studies should track HRQoL in older adults, women, patients with abnormal DLCO, and abnormal cognitive function for a long time and provide them with rehabilitation advice and guidance.

Genetic and Clinical Spectrum of Osteopetrosis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1087-1087
Author(s):  
Ansgar S Schulz ◽  
Despina Moshous ◽  
Klaus-Michael Debatin ◽  
Anna Villa
Keyword(s):  
Quality Of Life ◽  
Genetic Background ◽  
Clinical Presentation ◽  
Hematopoietic Stem ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Unrelated Donors

Abstract Abstract 1087 Poster Board I-109 Background Osteopetrosis (OP) is a multi-systemic inborn disorder characterized by heterogeneous clinical presentations on the basis of a variety of mutated genes. We performed a retrospective analysis in patients with OP from 28 European centers on behalf of the ESID and the EBMT. Main objectives of this analysis were survival and quality of life with respect to genetic background, initial clinical presentation, and treatment modality. Methods A set of clinical parameters, genetic findings, transplant information and follow up data were collected using specific questionnaires. Questionnaires were sent at several time points to European centers treating patients with OP and the collected data were stored in a central OP database. DNA sequencing of candidate genes involved in human OP was done predominantly at laboratories in Milan, Paris and Ulm. Results Data of 173 patients and of 134 hematopoietic stem cell transplantations (HSCT) were obtained during a time frame between 1983 and 2008. In the whole cohort, mutations in the following genes were detected: 47% biallelic TCIRG1, 9% biallelic CLCN7, 6% monoallelic CLCN7, 5% OSTM1, 2% RANK, 1% RANKL; 30% of patients have no mutations in these genes or could not be tested completely. In 23% of patients HSCT was not considered because of severe neurological problems or other complications mostly in the context of OSTM1 or CLCN7 mutations, or because of less severe phenotypes mainly due to monoallelic CLCN7 mutations (autosomal dominant OP, ADO). Follow up data of 103 transplanted patients were available. With respect to donor type, the probability of survival at 2 years was 88% for matched family donors, 80% for matched unrelated donors, 68% for HLA-haploidentical donors and 54% for mismatched unrelated donors. There was no significant difference in survival of patients with different gene mutations but a trend to a worse long term outcome in CLCN7 patients. Most notably, several major sequelae were present in the majority of surviving patients. Visual impairment or dwarfism were found in about 2/3 of children showing no significant influence of the affected genes. About 10% of patients are suffering from significant persistent neurological problems after HSCT, which were found in patients with TCIRG and CLCN7 mutations. The quality of life were judged as normal by the parents in about 2/3 of surviving patients. Conclusion HSCT in infantile OP results in acceptable survival rates even after HLA-nonidentical transplants. However, outcome is influenced by a set of specific disease related problems and long term sequelae. The heterogeneity of OP necessitates an individualised therapeutic strategy respecting the genetic background, the clinical presentation and the type of the available donor. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prediction of quality of life at long-term follow-up after Fontan operation by scoring risk factors.

1994 ◽  
Vol 58 (8) ◽  
pp. 646-652 ◽  
Author(s):  
PARK INSAM ◽  
MAKOTO NAKAZAWA ◽  
YASUHARU IMAI ◽  
KAZUO SAWATARI ◽  
KAZUO MOMMA
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Fontan Operation ◽  
Long Term Follow Up

scholarly journals Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Helen Elden ◽  
Monika Fagevik Olsen ◽  
Nasrin Farah Hussein ◽  
Lisa Wibeck Axelsson ◽  
Verena Sengpiel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Health Related Quality ◽  
Related Quality ◽  
Long Term Follow Up ◽  
Health Related ◽  
Long Term Consequences

Abstract Background Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment, and long-term follow-up of PPSS. Methods This follow-up study included 19 out of 21 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbopelvic pain (LPP) were offered a clinical examination. Results 1) PPSS was diagnosed after a normal postpartum period of 24 to 50 h by blood tests (n = 19/19), ultrasonography (n = 9 /19), computer tomography (n = 8/19) or magnetic resonance imaging (n = 16/19) Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and different physiotherapeutic interventions. Women with PPSS more frequently were primiparous (n = 14/19, p = 0.001), had an instrumental delivery (n = 14/19, p = 0.003), longer time of active labour (p = 0.01) and second stage of labour (p = 0.001) than women in the regional registry. 2) Ten out of 19 (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p < 0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p = 0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p = 0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS) HADS-Anxiety, 7 versus 2, p = 0.010; and HADS-Depression, 1 versus 0, p = 0.028) than women with no pain. 3). Of the eight women who were clinically assessed, one had lumbar pain and seven had pelvic girdle pain (PGP). Conclusions In the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP at follow-up, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors, long-term consequences, and adequate treatment for this rare pregnancy complication.

scholarly journals A teljes nagyér-transzpozíción átesett betegek Senning- és Mustard-féle műtéti megoldásának hosszú távú utánkövetése. Eredmények a CSONGRAD Regiszterből

2016 ◽  
Vol 157 (3) ◽  
pp. 104-110 ◽  
Author(s):  
Kálmán Havasi ◽  
Anita Kalapos ◽  
Krisztina Berek ◽  
Péter Domsik ◽  
Mária Kohári ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Capacity ◽  
Heart Diseases ◽  
Term Survival ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Long Term Follow Up

Introduction: Transposition of the great arteries is one of the most common cyanotic congenital heart diseases. Aim: The present study aimed to examine and compare long-term survival, functional grading, arrhytmologic and quality of life control in patients with transposition of the great arteries following Senning- and Mustard-operations. Methods: The present study comprised 85 patients with transposition of the great arteries, of whom Senning-operation was performed in 37 cases and Mustard-operation in 48 subjects. Follow-up study was performed in all cases. Results: The success rate of long-term follow-up proved to be 74%. Twelve out of the 31 Senning-operated and 16 out of 32 Mustard-operated patients died during the follow-up (39% vs. 50%, p = 0.45). Neither features of heart failure, nor those of arrhythmias showed differences between the groups, but parameters of quality of life and functional capacity proved to be favourable in Senning-operated patients. Conclusions: There is no significant difference in mortality and morbidity of patients with transposition of the great arteries following Mustard- and Senning-operations. Regarding to long-term follow-up quality of life and functional capacity of Senning-operated patients were more favourable. Orv. Hetil., 2016, 157(3), 104–110.

scholarly journals Mortality Over Long-term Follow-up for People With HIV Receiving Longitudinal Care and Antiretroviral Therapy in Rural Haiti

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Aaron Richterman ◽  
Fernet Leandre ◽  
J Gregory Jerome ◽  
Alexander C Tsai ◽  
Louise C Ivers
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Antiretroviral Therapy ◽  
Marital Status ◽  
Low Income ◽  
Program Effectiveness ◽  
Cox Regression

Abstract Background Deaths from HIV have fallen dramatically with the increasing availability of fully suppressive antiretroviral therapy (ART), and yet HIV remains the ninth leading cause of death in low-income countries. As more people with HIV enter care and receive ART, the focus will need to shift from expanding ART to including long-term program effectiveness and outcomes for people with HIV already engaged in care. Methods We evaluated risk factors for mortality among people with HIV on ART receiving longitudinal care in rural Haiti. We assessed baseline characteristics using a household survey and abstracted clinical characteristics from the electronic record. We used multivariable Cox regression models to identify risk factors for mortality. Results There were 464 people included in this study with a median follow-up (interquartile range [IQR]) of 69 (44–77) months, during which time 37 (8%) were lost to follow-up and 118 (25%) died (median time to death [IQR], 29 [12–53] months). After adjustment, poverty (adjusted hazard ratio [AHR], 1.12 per 10–percentage point increased probability; 95% CI, 1.01–1.24) and single marital status (AHR, 1.59; 95% CI, 1.08–2.36) were associated with increased mortality. Age (AHR, 0.78 per 10-year increase; 95% CI, 0.64–0.94), role function quality of life (AHR, 0.75 per quintile increase; 95% CI, 0.62–0.90), and CD4 count (AHR, 0.66 per 100 cells/μL; 95% CI, 0.58–0.75) were associated with decreased mortality. Conclusions Poverty, marital status, and quality of life were associated with mortality. Social protection should be evaluated as a strategy to reduce mortality for people with HIV in concert with increasing access to ART.

scholarly journals Diabetics have Inferior Long-Term Survival and Quality of Life after CABG

2019 ◽  
Vol 28 (01) ◽  
pp. 050-056
Author(s):  
Matti Hokkanen ◽  
Heini Huhtala ◽  
Otso Järvinen
Keyword(s):  
Quality Of Life ◽  
Health Survey ◽  
Artery Bypass ◽  
Survival Rates ◽  
Term Survival ◽  
Long Term Survival ◽  
Related Quality

A prevalence of diabetes is increasing among the patients undergoing coronary artery bypass grafting (CABG). Data on whether health-related quality of life improves similarly after CABG in diabetics and nondiabetics are limited. We assessed long-term mortality and changes in quality of life (RAND-36 Health Survey) after CABG.Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared with nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 1 and 12 years later.Thirty-day mortality was 2.7 versus 1.6 (p = 0.511) in the diabetics and nondiabetics. One- and 10-year survival rates in the diabetics and nondiabetics were 94.6% versus 97.0% (p = 0.287) and 63.5% versus 81.6% (p < 0.001), respectively. After 1 year, diabetics improved significantly (p < 0.005) in seven, and nondiabetics (p < 0.001) in all eight RAND-36 dimensions. Despite an ongoing decline in quality of life over the 12-year follow-up, an improvement was maintained in four out of eight dimensions among diabetics and in seven dimensions among nondiabetics. Physical and mental component summary scores on the RAND-36 improved significantly (p < 0.001) in both groups after 1 year, and at least slight improvement was maintained during the 12-year follow-up time.Diabetics have inferior long-term survival after CABG as compared with nondiabetics. They gain similar improvement of quality of life in 1 year after surgery, but they have a stronger decline tendency over the years.

Favorable Outcome and Quality of Life in Patients Surviving 5 or More Years After Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3312-3312
Author(s):  
Robert Quan Le ◽  
Margaret Bevans ◽  
Bipin N. Savani ◽  
Sandra Mitchell ◽  
Kate Stringaris ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Hematological Malignancies ◽  
Performance Status ◽  
Excellent Performance ◽  
Hematopoietic Stem

Abstract Abstract 3312 Poster Board III-200 Allogeneic hematopoietic stem cell transplantation (SCT) is a curative treatment for some hematological malignancies. The ultimate measure of success of allogeneic SCT for hematological malignancies is its ability to eradicate malignant disease and restore a good quality of life (QOL) in long-term survivors. As numbers of survivors continue to increase, studies systematically examining outcomes in this group of survivors are needed. We studied the clinical and QOL outcomes in a large cohort of patients with hematological malignancies surviving 5 or more years after allogeneic SCT from a single institution. In 2005 we initiated a long term follow up protocol to further study complications in survivors after allogeneic SCT. Patients were enrolled at the third annual visit after transplantation. Annual follow-up visit includes comprehensive clinical evaluation and detailed assessment of QOL, symptom distress, physical and mental health. Measures for QOL included the Functional Assessment of Cancer Therapy-General (FACT-G), the Physical and Mental Component Summary scales (PCS, MCS) of the Medical Outcomes Short-Form 36 (SF-36), and the Rotterdam Symptom Checklist (RSCL). Two hundred sixty two patients with hematological disorder received a SCT from an HLA identical sibling since 1993. One hundred and twenty one patients (46 %) survived 3 or more years and were eligible for participation in the long-term evaluation protocol. Ninety two (35%) survived beyond 5 years from SCT (median follow-up 9.4 years, range 5.1-15.3) and were included in this analysis. Median age at transplantation was 35 years (range 10 - 56). Twenty-two (24%) received a bone marrow transplant, and 70 (76%) received a peripheral blood SCT. We examined chronic graft-versus-host-disease (cGVHD), disease relapse, survival and QOL. Seventeen (18%) of 92 survivors had active cGVHD (limited 9, extensive 8) and were receiving prolonged immunosuppressive treatment 5 years following allogeneic SCT. Four relapsed with leukemia, at a median of 8.5 years (range 6.2 -14.0) post SCT. Four (4.3%) died between 7.4 -13.4 years post SCT (1 relapse, 1 lung cancer, 1 pneumonia, 1 brain hemorrhage). Sixty (65%) completed QOL measures. Most survivors beyond 5 years had an excellent performance status with no difference in the PCS (p =0.89) and MCS (p =0.15) scores and higher FACT-G scores compared with population norms (p =0.02). Although the overall distress for physical and psychological symptoms was low, higher levels of symptom distress were associated with impairments in QOL. In eleven survivors with cGVHD, there was no statistical difference across QOL outcomes although the difference was meaningfully lower (≥5 points). In conclusion, five or more years after SCT for hematological malignancy most individuals survive disease free with an excellent performance status, preserved physical and psychological health, and excellent QOL. However patients with leukemia appear to have a persistent but low chance of disease recurrence. Although cGVHD persists in about 20% of patients it did not appear to affect the excellent QOL that most of our patients experience. The association between cGVHD severity and specific cGVHD manifestations and QOL outcomes requires further study. Disclosures No relevant conflicts of interest to declare.

scholarly journals Postpartum Septic Symphysitis, a Rare Condition With Possible Long-Term Consequences: A Cohort Study With Long-Term Follow-Up

2021 ◽  
Author(s):  
Helen Elden ◽  
Monika Fagevik Olsen ◽  
Nasrin Farah Hussein ◽  
Lisa Wibeck Axelsson ◽  
Verena Sengpiel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Health Related Quality ◽  
Related Quality ◽  
Long Term Follow Up ◽  
Health Related ◽  
Long Term Consequences

Abstract BackgroundPostpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment and long-term follow-up of PPSS.MethodsThis was a follow-up study including 19 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbo-pelvic pain (LPP) were offered a clinical examination.Results1) PPSS was diagnosed after a normal postpartum period of 24 to 50 hours by blood tests (n=19); MRI, (n=13/19); ultrasonography (n=8 /19) or CT (n=3/19). Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and physiotherapy. Women with PPSS more frequently were primiparous (n=14/19, p=0.001), had an instrumental delivery (n=14/19, p=0.003), had a longer time of active labour (p=0.01) and second stage of labour (p=0.001) than women in the regional registry. 2) Ten out of nineteen (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p<0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p=0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p=0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS)-A, 7 versus 2, p=0.010; and HADS-D, 1 versus 0, p=0.028) than women with no pain. 3). Of the eight women who received a clinical assessment, one had lumbar pain and seven had PGP.ConclusionsIn the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors for, long-term consequences of and adequate treatment for this rare pregnancy complication.

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