Importance and Determinants of Comorbidities, Functional Limitations and Multiple Myeloma (MM)-Specific Risk Factors: Further Development of an Improved and Weighted MM-Risk Score (Freiburg Comorbidity Index [FCI])

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 733-733
Author(s):  
Anne-Saskia Domm ◽  
Stefanie Hieke ◽  
Gabriele Ihorst ◽  
Milena Pantic ◽  
Bernd Koch ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cell Transplantation ◽  
Univariate Analysis ◽  
Risk Groups ◽  
Point Score ◽  
Specific Risk ◽  
Comorbidity Index ◽  
Validation Set ◽  
Disease Specific

Abstract Introduction: In addition to disease-specific and age-related factors, type and severity of comorbidities play a relevant role, influence the tolerance of anti-MM-treatment and overall survival (OS). We have identified an impaired Karnofsky Performance Status (KPS), lung and renal impairment as significant risk factors for inferior outcome (Kleber,...Engelhardt. BCJ 2011, Kleber,...Engelhardt. CLML 2013, Engelhardt et al. Haematologica 2014). These variables were combined in a comorbidity score (initial Freiburg Comorbidity Index [iFCI]). The objectives of this analysis were to refine the iFCI ('revised FCI' [rFCI]) by adding host- and disease-specific risk factors, cytogenetics, physical function and quality of life. Moreover, we assessed the benefit of a possible weighting of the rFCI, and compared the rFCI to well-established comorbidity indices, namely Charlson Comorbidity Index (CCI), Hematopoietic cell transplantation-specific comorbidity index (HCT-CI) and Kaplan-Feinstein (KF). Methods: We assessed 803 consecutive patients (pts) treated at our institution between 1997-2012, determining comorbidities as weighted renal, lung, heart, liver, gastrointestinal diseases, KPS, disability, frailty, infection, pain, secondary malignancies, peripheral neuropathy, thrombosis and disease parameters (e.g. cytogenetics). We divided our cohort into a training (n=553) and validation set (n=250) and performed a multivariate analysis via backward selection. Regression coefficients were used to derive weights for the score. Apart from scoring both iFCI and rFCI, we also assessed the CCI, HCT-CI and KF. Results: Our pts showed a typical median age for a tertiary referral center of 63 years (range: 21-93). 26% revealed less favorable cytogenetics, defined as del(17p13), del(13q14), t(4;14), t(14;16) and chromosome 1 abnormalities. Each half of the pts had received either standard chemotherapy or stem cell transplantation. Frequent comorbidities (>30%) were KPS, heart, renal, lung impairment, disability and frailty. Univariate analysis revealed age, renal, lung and heart disease, KPS, disability, frailty, pain and infections as significant. Multivariate risks proved to be advanced age (>70 years), renal, lung, KPS impairment, frailty and cytogenetics with hazard ratios (HR) of 2.2, 1.8, 1.3, 3.2, 1.9 and 1.5, respectively. The rFCI allowed to distinguish low-, intermediate- and high-risk pts with largely different median OS of 11.2, 4.8 and 2.6 years, conclusively confirmed via validation analysis with distinct median OS differences of not reached, 6.5 or 1.4 years, respectively. Weighting of the single risk factors led to a score with maximum points of 39. In order to simplify this score, the single weights were divided by 2 and rounded, which led to a 20-point score (rFCI modified I [mod I]). A 2nd modification led to a 9-point score (rFCI mod II) which was obtained with single risk factors being scored based on their HR. These modified rFCI scores I and II allowed equally well to allocate MM pts in low-, intermediate- and high-risk groups as with the 39-point-rFCI, besides being simpler in their application. Compared to the CCI, HCT-CI and KF, the rFCI remained highly significant. For further comparison, all comorbidity indices in the training and the validation set were divided into two risk groups according to the cut-offs obtained from our initial analyses (BCJ 2011, CLML 2013). Regardless of whether we scored MM pts with the iFCI, rFCI, CCI, HCT-CI or KF, ‘low-risk’ pts had longer median survival than ‘high-risk’ pts. The comparison via median comorbidity indices showed superiority of the rFCI and CCI in the training set and of the rFCI and HCT-CI in the validation set. A further univariate analysis and comparison by dividing the different scores in risk groups based on 25% and 75% quantiles, revealed the highest HR for the rFCI both in the training and the validation set. Conclusions: As comorbidities in MM are frequent, a detailed comorbidity assessment, including host- and disease-specific risk factors, allows an improved risk evaluation in often frail pts. Age, renal, lung, KPS impairment, frailty and cytogenetics are relevant risk factors included in our rFCI. Advantages of the rFCI vs. iFCI are the inclusion of MM-specific risks including cytogenetics, the more accurate assessment of pts' physical conditions, lower prediction errors and its simple clinical applicability. Disclosures No relevant conflicts of interest to declare.

Absence of High-Dose Consolidation Courses and Low Numbers of Allogeneic HSCTs Did Not Affect Overall Optimistic Results in B-Cell Precursor Ph-Negative Adult ALL Patients Treated By Non-Intensive but Non-Interruptive ALL-2009 Protocol: Data of the Russian ALL Study Group

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2497-2497
Author(s):  
Elena N. Parovichnikova ◽  
Vera V. Troitskaya ◽  
Andrey Sokolov ◽  
Galina Kliasova ◽  
Larisa A. Kuzmina ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Normal Karyotype ◽  
Risk Groups ◽  
High Dose ◽  
Late Response ◽  
Allogeneic Hsct ◽  
Blast Cells

Abstract Introduction It is postulated that the improvement in the overall treatment outcome in adult Ph-negative ALL came from the implementation of more aggressive pediatric-like protocols and higher portion of allogeneic HSCT. Here we report the results of the adult (15-55 yy) Ph-negative ALL protocol based on the opposite approaches: less intensive but non-interruptive treatment with low numbers of allo-HSCT. The study is registered on the ClinicalTrials.gov public site; NCT01193933. Patients and Methods The ALL-2009 is based on: (1) the replacement of prednisolone (Pdn) 60 mg/m2 with dexamethazone (Dexa) 10 mg/m2 if blast cells are >25% in b/m after prephase (7d); (2) de-intensified but non-interruptive 5 months induction/consolidation treatment (5 wks prd/dexa with 3 instead of 4 dauno/vncr pulses, 4 weeks of 6MP with 5 L-asp, 2 instead of 4 ARA-C blocks, 1 instead of 2 Cph injections during induction; induction-like 3 consolidations for 3wks, 2wks, 4wks-continuously without intervals), followed by (3) 2 late (at 6 mo) intensifications- with 1 day HD MTX and with 1 d HD ARA-C, both with L-asp and 3 ds dexa and (4) 2-yrs continuous 6MP/MTX maintenance with doses modification according to myelosuppression with monthly 3-days dexa/vncr/L-asp pulses (∑ L-asp = 590.000 IU/m2). The protocol was identical for all risk groups. Allo-HSCT was indicated only for extremely high-risk BCP-ALL (t(4;11),L>100). No central MRD monitoring was performed. Since Apr 2009 till June 2015 20 centers had recruited 168 BCP-Ph-negative ALL pts with a median age 28 years (15-54), 84f/84 m. Full cytogenetics was available in 67,3% (n=113), 43,4% of them (n=49) had normal karyotype (NK), 10% (n=9%) had no mitosis, 47,6% (n=54) - different abnormalities (hypoploid-1, hyperploid-12, t(11q23)/MLL-8, del11q23-2, t(1;19)-2, t(12;21)-1;others-28). 26,7% of pts (n=45) were in the standard risk (SR) group (WBC <30, EGIL BII-III, LDH < 2N; no late CR; t(4;11)-negative), 56,5% (n=95) - in the high risk (HR) group (WBC >30; EGIL BI, LDH > 2N; late CR; t(4;11)-positive), 28 patients (n=16,8%) were not qualified by the risk. The analysis was performed in June 2015. 158 pts were available for analysis. Results CR rate in 158 available for analysis pts was 87,7% (n=139), induction death occurred in 9,1% (n=14), resistance was registered in 3,2% (n=5). The majority of CR pts (87,8%) achieved it after prephase (12,2%, n=17) and the 1st phase of induction (75,6%, n=105). Late responders constituted 12,2% (n=17). Allogeneic BMT was performed only in 9 of 144 patients who survived induction (6,2%). Totally 31 pts (22,3%) had relapsed. At 60 mo OS for the whole group constituted - 50%, DFS - 51.3%. In a univariate analysis among various risk factors (age <> 30y, initial risk group, WBC, LDH, immunophenotype, late response >35d, PRD resistance) age (>30 y) became statistically significant for OS, DFS and relapse probability (RP) (pic.1), abnormal karyotype - for DFS (30% vs 68%, p=0,04) and RP (42% vs 19%, p= 0,04). In a multivariate analysis no common risk factors were significant. Conclusions Our data demonstrate that the proposed treatment approach is rather effective. We believe that constant non-interruptive treatment without intensive highly myelosuppressive consolidation courses and high portion of allogeneic HSCT may become an alternative and reproducible approach in adult Ph-negative ALL, though we have to stress that it should be very strict compliance of the pts to the protocol. All pts, mostly from the region hospitals who refused prolonged and constant treatment (~5%), relapsed. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals ВИВЧЕННЯ ВПЛИВУ ВІКУ ТА ІНДЕКСУ КОМОРБІДНОСТІ НА РИЗИК ТРОМБОТИЧНИХ УСКЛАДНЕНЬ У ХВОРИХ НА РАК ЕНДОМЕТРІЯ НА ДООПЕРАЦІЙНОМУ ЕТАПІ

2018 ◽  
Author(s):  
B. D. Kryvokulsky ◽  
I. V. Zhulkevich ◽  
D. B. Kryvokulsky ◽  
L. V. Shkrobot
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Groups ◽  
Pelvic Plexus ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Comorbidity Index ◽  
D Dimer

Endometrial cancer (EC) is the most common gynecological malignancy in women over 50 years of age. Age is a specific, significant predictor of the survival outcome in EC. Thrombotic complications (TC) are the other frequencies due to death in cancer patients. The problem of thrombosis is relevant and occupies a large proportion of the immediate causes of death in patients with oncological practice. Identification of risk groups, the implementation of a personalized approach to the prevention of TB is very practical in patients with EC.The aim of the study – to conduct an assessment of the Charleson Comorbidity Index and identify the link between an increased risk of thrombotic formation in patients with EС and associated pathology at the preoperative stage.Materials and Methods. The study used general clinical methods of examination: laboratory, specific for determining the state of hemostasis (D-dimer, antithrombin III, protein C, fibrinogen B, ACTH , IF, PM ), ultrasound examination (abdominal organs, small pelvis, lower vessels limbs and pelvic plexus; elastography of the vessels of the lower extremities and pelvic plexus). Histologic methods of tumor investigation – to determine the relationship between histological type, depth of invasion, degree of malignancy of the tumor. Mathematical, statistical – for analysis and generalization of data in the package "Statgraph" (v.3.0).Results and Discussion. On the basis of the obtained data and analysis of the risk factors of the occurrence of TC on the scale of Caprini, we came to the conclusion that the whole surveyed group of patients in the EC referred to the high risk of TC since they had 6 or more points. This is due to age, overweight, increased body surface area and body mass index, cancer pathology, concomitant pathology, which coincides with the data of world literature. Based on the integrated assessment of the Charleson Comorbidity Index and the assessment of the risk of developing TC on the Caprini scale, we noted that the most common risk factors for thrombosis are: abnormal fat metabolism, hypertonic disease, atherosclerosis, vascular disease. The combination of two or more risk factors for thrombosis was noted at 46.25 %. Relevant statistical discrepancies (p <0.05) in the hemostasis system in patients, depending on anthropometric indices, were confirmed by correlation bonds. We established a statistically significant (0.001 <p <0.05) positive relationship (r2> 0.17) between pelvic vein thrombosis and weight, age, BM I, Caprini scale, PPT , proper weight and PPT , PM , ACTCH Fibrinogen, D-dimer and a reliable negative (r2 <-0.17) relationship between thrombosis of the veins of the small pelvis and: the relation between the level of the MS and the level of D-dimer; PM / D-dimer; AT III / D-dimer.Conclusions. Based on the correlation data, it can be argued that the calculation of the Charleson Comorbidity Index is an important element in predicting survival rates in patients, but it does not provide an opportunity to predict the risk of thrombotic complications in patients with PE . The parallel compilation of the Charleson Comorbidity Index and the determination of the risk of developing thrombotic complications in endometrial cancer patients at the preoperative stage allows the isolation of high and high-risk groups of TU , especially in women over the age of 50 with existing comorbidity.

Improved Outcome in High Risk and Very High Risk ALL by Risk Adapted SCT and in Standard Risk ALL by Intensive Chemotherapy in 713 Adult ALL Patients Treated According to the Prospective GMALL Study 07/2003.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 12-12 ◽  
Author(s):  
Nicola Gökbuget ◽  
Renate Arnold ◽  
Angelika Böhme ◽  
Rainer Fietkau ◽  
Mathias Freund ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Residual Disease ◽  
Univariate Analysis ◽  
Early Death ◽  
Risk Groups ◽  
Prognostic Impact ◽  
Standard Risk ◽  
Very High ◽  
Improved Outcome

Abstract In 2003 the German Multicenter ALL Study Group (GMALL) initiated the trial GMALL 07/2003. Major aims were improvement of outcome by shortened, intensified induction, intensified consolidation, risk adapted and extended SCT indication and minimal residual disease (MRD) based treatment stratification. 8drug-induction was followed by uniform 1st consolidation based on HDARAC and HDMTX. Further treatment was stratified according to the following risk factors (RF): WBC > 30.000 in B-prec. ALL, late CR (>3wks), proB-, earlyT and mature T-ALL, Ph/BCR-ABL and t(4;11)/ALL1-AF4. The risk groups were defined as follows: standard risk (SR, no RF), high risk (HR,>= 1RF) and very high risk (VHR,Ph/BCR-ABL). HR and VHR pts were scheduled for SCT in CR1 with the following priorities: allo sibling, allo matched unrelated and autologous. VHR pts mostly received Imatinib according to different schedules. SR pts received 5 consolidation cycles (HDMTX/ASPx3, VP16/ARAC, CYCLO/ARAC) and reinduction. SR pts with high MRD after consolidation I were allocated to SCT. In the remaining SR pts decision on maintenance therapy was based on MRD. Between 04/03-12/06 713 evaluable (15–55 yrs) pts were included. The median age was 34 yrs. The CR rate after induction was 89% with 5% early death and 6% failure. 50%, 33% and 17% were allocated to SR (N=353), HR (N=235) and VHR (N=117) with similar CR rates of 92%, 88% and 85%. CR rate was not different in pts < vs > 35 yrs (90% vs 89%). 5 year overall survival (OS) was 54% and survival of CR (S-CR) pts was 59%. HR and VHR pts obtained 55% and 49% S-CR at 3 yrs resp. HR subgroups showed different S-CR for early T (58%), mature T (70%), pro B (66%) and other B-lineage ALL (37%). 68% and 71% of HR and VHR pts received SCT in CR1 as scheduled which thus contributed substantially to improved outcome. In SR- ALL S-CR was 69% (68% c/preB, 66% thymicT). The CCR probability was 52% at 3 yrs. CNS prophylaxis was very effective since only 2% of the CR pts had CNS involvement at relapse. Univariate analysis confirmed a significant prognostic impact of immunphenotype, WBC in B-lin ALL, time to CR and Ph/BCR-ABL. WBC was no prognostic factor in T-lin-ALL. Age was highly significant for survival with 64% survival < 35 yrs vs 48% above 35 yrs. In adolescents below 25 years the most favourable survival of 67% was achieved. In standard risk pts below 35 yrs the survival was 73% without SCT in CR1. Overall the study yielded improved CR rates (89%) and survival (54%). Risk adapted SCT indication was feasible (realised in 70% of HR/VHR pts) and lead to improved survival particularly in early/mature T-ALL and pro B-ALL. In standard risk (SR) the survival is favourable, even above 70% in young pts; however, the relapse rate is still high. Further intensification of therapy during the first year seems required. By definition of new risk factors additional SR patients could be allocated to SCT in CR1. There is however no intention to transfer all SR patients to SCT. Future improvement will be attempted by further inclusion of subtype specific and targeted therapies.

Validation of Comorbidity Indexes in Reduced-Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation. the Hematopoietic Cell Transplantation Comorbidity Index Is the Best Predictor of NRM and Survival.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3277-3277 ◽  
Author(s):  
Pere Barba ◽  
Jose Luis Piñana ◽  
Alex Amoros ◽  
David Valcárcel ◽  
Rodrigo Martino ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Risk Groups ◽  
Low Risk ◽  
Intermediate Risk ◽  
Predictive Capacity ◽  
Hematopoietic Stem ◽  
Comorbidity Index

Abstract Introduction: Morbidity and mortality after allogeneic hematopoietic stem cell transplantation (AlloHSCT) are considerable, but historically it has been difficult to generate a reproducible and easy model for predicting mortality after the procedure. The use of RIC or nonmyeloablative conditioning regimens may allow an extension of the procedure to patients not eligible for conventional AlloHSCT. However, such patients are usually older and have more comorbidities than patients who meet the strict criteria for a conventional AlloHSCT. In an attempt to predict before transplantation the higher mortality risks attributable to patient comorbidities, researchers from Seattle have recently developed several comorbidity indexes (HCT-CI Blood, 2005 and PAM Ann Int Med, 2006) with the aim of improving non-transplant classical models, such as the Charlson Comorbidity Index (CCI). The validation of these comorbidity indexes in other institutions and in different disease and conditioning-related settings is of utmost importance for the extension of their use to clinical practice and clinical research. We thus performed a retrospective study in our institution to validate these indexes in the setting of RIC AlloHSCT recipients only. Methods: Overall survival (OS) curves were estimated using the Kaplan-Meier method, while the cumulative incidence of non-relapse mortality (NRM) was calculated considering relapse as a competitive event. Likelihood ratio statistics from proportional hazard regression models were computed for each index for the study events over the first two years post-AlloHSCT. The c-statistic was calculated to estimate the predictive capacity of each index for the analyzed transplant outcomes as previously described (Stat Med, 1984). Results: We retrospectively calculated for each patient the HCT-CI, PAM and CCI scores. Study subjects included 194 consecutive patients who underwent RIC-AlloHSCT in our institution up to November 2006, to allow at least 18 months follow-up in all cases. The median age was 57 years (range 17–71). According to the score, three risk groups were created for each index (low, intermediate and high risk). No significant differences were found between the three risk groups of each index regarding age, sex, underlying disease, relapse risk at transplantation and donor type (79% HLA identical sibling donors). The median patient pre-transplant comorbidity scores for CCI, HCT-CI and PAM were 0, 3.5 and 22, respectively. For predicting 2-year NRM, the HCT-CI score groups were associated with the highest predictive hazard ratios (HR) (Low risk, HR 1.0; Intermediate risk, HR, 5.01 [95% C.I., 1.53–16.4]; High risk, 6.97 [95% C.I., 2.20–22.1], p<0.01). However, we found no predictive value for NRM with the risk group categorization using the PAM nor the CCI. The better predictive capacity for NRM of the HCT-CI than PAM and CCI was confirmed with the c-statistics (c-statistics of 0.672, 0.634, 0,595, respectively). Regarding the 2-year OS, the HCT-CI scores categories were also associated with the highest predictive HR (Low risk, HR 1.0; Intermediate risk, HR 1.6 [95% C.I., 0.99–2.72], High risk, 2.7 [95% C.I., 1.66–4.28], p<0.01). In conclusion, our single-center study suggests that the HCT-CI is a good predictor of 2-year NRM and survival after a RIC AlloHSCT, and thus we encourage international efforts to validate and improve this and other predictive indexes.

Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) Combined with Leukemic Risk Factors Predict Outcome of AML Patients after Allogeneic Stem Cell Transplantation Following Reduced Intensity Conditioning (RIC).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3276-3276
Author(s):  
Philipp Hemmati ◽  
Theis Terwey ◽  
Gero Massenkeil ◽  
Philipp D. le Coutre ◽  
Stefan Neuburger ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Disease Status ◽  
High Risk Group ◽  
Group Iv ◽  
Group Iii ◽  
Group I ◽  
Comorbidity Index

Abstract Purpose: The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) is used to assess the impact of comorbidities on the outcome of patients following alloSCT. Nonetheless, in AML patients leukemia-associated risk factors, i.e. cytogenetics, the presence of secondary (sAML) or therapy-related AML (tAML), or disease status prior to alloSCT, are highly relevant with regards to the long-term outcome. We therefore investigated whether the HCT-CI combined with the analysis of a defined set of AML-specific high risk factors may be used to predict the overall outcome of AML patients after alloSCT following RIC. Patients and Methods: 90 patients with high-risk AML (median age 51 (17 – 68) years) who underwent alloHSCT at our institution between 1999 and 2007 were retrospectively analyzed (median follow-up of the surviving patients: 16 (range 2 – 113) months). 50/90 patients (56%) were in CR1, 12/90 (13%) were in CR2, 2/90 (2%) were >CR2, and 26/90 (29%) had refractory or relapsed disease at the time of transplantation. 57/90 patients (63%) had de novo AML and 33/90 patients (37%) had either secondary AML (sAML) or therapy-related AML (tAML). Whereas 4/90 patients (4%) had a favorable risk karyotype, 51/90 patients (57%) or 29/90 patients (32%) had an intermediate risk or a poor risk karyotype as defined by the SWOG/ECOG criteria (Slovak et al., Blood 2000). Notably, 18/90 (20%) patients had an intermediate risk HCT-CI (1–2 points) and 72/90 patients (80%) had an unfavorable score (>2 points). As a preparative regimen all patients received RIC, which consisted of fludarabine 180 mg/m2 + oral busulfane 8 mg/kg + anti-thymocyte globulin 30 mg/kg. As stem cell source peripheral blood stem cells (PBSC) were used in 85/90 patients (94%), whereas 5/90 patients (6%) received bone marrow (BM). 38/90 patients (42%) were transplanted from a matched related donor. A matched unrelated or a mismatched unrelated donor was available in 36/90 patients (40%) or in 16/90 patients (18%). Graft-versus-host disease (GvHD) prophylaxis consisted of cyclosporin (CSA) + mycophenolate mofetil (MMF). Results: Projected overall survival (OS) or disease-free survival (DFS) of the whole cohort at 1, 3, and 5 years was 60%, 44%, and 44% or 56%, 46%, and 46%. 49/90 patients (54%) are in CCR. Causes of death were relapse (23/90 patients (26%)) or TRM (18/90 patients (20%)). Notably, the HCT-CI alone was not sufficient to predict the overall outcome our cohort of patients after RIC-alloSCT. Therefore, depending on the presence or absence of at least one additional leukemia-specific high-risk factor, i.e. disease status prior to alloSCT >CR1, tAML, or poor risk karyotype, patients were grouped into four subgroups: group I (HCT-CI <4, no high risk), group II (HCT-CI >4, no high risk), group III (HCT-CI <4, high risk), and group IV (HCT-CI >4, high risk). Projected OS in at 1, 2, and 3 years after alloSCT was 73%, 59%, and 59% (group I), 86%, 57%, and 57% (group II), 56%, 46%, and 37% (group III), or 33%, 16%, and 16% (group IV), which differed statistically significant between the 4 subgroups (p = 0.04). In turn, there was no statistically significant difference in TRM between groups I – IV (p = 0.61). Conclusions: These results indicate that the combined analysis of TRM-related factors, as assessed by the HCT-CI, and a limited set of leukemia-specific risk factors, i.e. cytogenetic risk, disease status before alloSCT, and the presence of tAML, may be useful in predicting the overall outcome of patients with AML after alloSCT following RIC.

scholarly journals The Prognostic Value of the New Combined Hemo-Eosinophil Inflammation Index (HEI Index): A Multicenter Analysis of Anal Cancer Patients Treated with Concurrent Chemo-Radiation

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 671
Author(s):  
Margherita Rimini ◽  
Pierfrancesco Franco ◽  
Berardino De Bari ◽  
Maria Giulia Zampino ◽  
Stefano Vagge ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Anal Cancer ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
External Validation ◽  
Risk Groups ◽  
Anal Squamous Cell Carcinoma ◽  
Predictors Of Response ◽  
Risk Patients

Anal squamous cell carcinoma (SCC) is a rare tumor, and bio-humoral predictors of response to chemo-radiation (CT-RT) are lacking. We developed a prognostic score system based on laboratory inflammation parameters. We investigated the correlation between baseline clinical and laboratory variables and disease-free (DFS) and overall (OS) survival in anal SCC patients treated with CT-RT in five institutions. The bio-humoral parameters of significance were included in a new scoring system, which was tested with other significant variables in a Cox’s proportional hazard model. A total of 308 patients was included. We devised a prognostic model by combining baseline hemoglobin level, SII, and eosinophil count: the Hemo-Eosinophils Inflammation (HEI) Index. We stratified patients according to the HEI index into low- and high-risk groups. Median DFS for low-risk patients was not reached, and it was found to be 79.5 months for high-risk cases (Hazard Ratio 3.22; 95% CI: 2.04–5.10; p < 0.0001). Following adjustment for clinical covariates found significant at univariate analysis, multivariate analysis confirmed the HEI index as an independent prognostic factor for DFS and OS. The HEI index was shown to be a prognostic parameter for DFS and OS in anal cancer patients treated with CT-RT. An external validation of the HEI index is mandatory for its use in clinical practice.

Comparison of the Prognoses of FIGO Stage I to Stage II Adenosquamous Carcinoma and Adenocarcinoma of the Uterine Cervix Treated With Radical Hysterectomy

2012 ◽  
Vol 22 (8) ◽  
pp. 1389-1397 ◽  
Author(s):  
Seiji Mabuchi ◽  
Mika Okazawa ◽  
Yasuto Kinose ◽  
Koji Matsuo ◽  
Masateru Fujiwara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
High Risk ◽  
Uterine Cervix ◽  
Radical Hysterectomy ◽  
Adenosquamous Carcinoma ◽  
Early Stage ◽  
Univariate Analysis ◽  
Low Risk ◽  
Histological Subtype

ObjectivesTo evaluate the significance of adenosquamous carcinoma (ASC) compared with adenocarcinoma (AC) in the survival of surgically treated early-stage cervical cancer.MethodsWe retrospectively reviewed the medical records of 163 patients with International Federation of Gynecology and Obstetrics stage IA2 to stage IIB cervical cancer who had been treated with radical hysterectomy with or without adjuvant radiotherapy between January 1998 and December 2008. The patients were classified according to the following: (1) histological subtype (ASC group or AC group) and (2) pathological risk factors (low-risk or intermediate/high-risk group). Survival was evaluated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis of progression-free survival (PFS) was performed using the Cox proportional hazards regression model to investigate the prognostic significance of histological subtype.ResultsClinicopathological characteristics were similar between the ASC and AC histology groups. Patients with the ASC histology displayed a PFS rate similar to that of the patients with the AC histology in both the low-risk and intermediate/high-risk groups. Neither the recurrence rate nor the pattern of recurrence differed between the ASC group and the AC group. Univariate analysis revealed that patients with pelvic lymph node metastasis and parametrial invasion achieved significantly shorter PFS than those without these risk factors.ConclusionsCharacteristics of the patients and the tumors as well as survival outcomes of ASC were comparable to adenocarcinoma of early-stage uterine cervix treated with radical hysterectomy. Our results in part support that the management of ASC could be the same as the one of AC of the uterine cervix.

EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients

2008 ◽  
Vol 18 (2) ◽  
pp. 357-362 ◽  
Author(s):  
W.-G. Lu ◽  
F. Ye ◽  
Y.-M. Shen ◽  
Y.-F. Fu ◽  
H.-Z. Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
High Risk ◽  
Complete Remission ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Clinical Analysis ◽  
Secondary Malignancy ◽  
Primary Therapy ◽  
Gestational Trophoblastic Neoplasia

This study was designed to analyze the outcomes of chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) with EMA-CO regimen as primary and secondary protocol in China. Fifty-four patients with high-risk GTN received 292 EMA/CO treatment cycles between 1996 and 2005. Forty-five patients were primarily treated with EMA-CO, and nine were secondarily treated after failure to other combination chemotherapy. Adjuvant surgery and radiotherapy were used in the selected patients. Response, survival and related risk factors, as well as chemotherapy complications, were retrospectively analyzed. Thirty-five of forty-five patients (77.8%) receiving EMA-CO as first-line treatment achieved complete remission, and 77.8% (7/9) as secondary treatment. The overall survival rate was 87.0% in all high-risk GTN patients, with 93.3% (42/45) as primary therapy and 55.6% (5/9) as secondary therapy. The survival rates were significantly different between two groups (χ2= 6.434, P = 0.011). Univariate analysis showed that the metastatic site and the number of metastatic organs were significant risk factors, but binomial distribution logistic regression analysis revealed that only the number of metastatic organs was an independent risk factor for the survival rate. No life-threatening toxicity and secondary malignancy were found. EMA-EP regimen was used for ten patients who were resistant to EMA-CO and three who relapsed after EMA-CO. Of those, 11 patients (84.6%) achieved complete remission. We conclude that EMA-CO regimen is an effective and safe primary therapy for high-risk GTN, but not an appropriate second-line protocol. The number of metastatic organs is an independent prognostic factor for the patient with high-risk GTN. EMA-EP regimen is a highly effective salvage therapy for those failing to EMA-CO.

scholarly journals Risk stratification for intestinal dysbiosis in hospitalized adult patients according to the National Dysbiosis Survey (INDIS)

2020 ◽  
Vol 2 (35) ◽  
pp. 149-159
Author(s):  
Aline Okipney ◽  
Jéssica Romanelli Amorim de Souza ◽  
Antonio Carlos Ligocki Campos ◽  
Leticia Fuganti Campos ◽  
Paula Rodrigues Anjo ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Stratification ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Intestinal Flora ◽  
Adult Patients ◽  
Therapeutic Interventions ◽  
Intestinal Dysbiosis ◽  
Very High

Introduction: The intestinal microbiota has a symbiotic relationship with the human being. Its alteration, known as dysbiosis, can result in several diseases. Some risk factors may predict the occurrence of this condition. The purpose of this study was to evaluate the effectiveness of the National Dysbiosis Survey (INDIS) in the risk stratification of hospitalized adult patients that presented with intestinal dysbiosis. Methods: 100 patients hospitalized at the Hospital das Clínicas da UFPR were interviewed through INDIS. In this questionnaire, risk factors for dysbiosis of each patient were established and the dysbiosis degree was stratified in low, medium, high, and very high risk. Results: Most patients were classified as medium (43%) and high risk (39%) of dysbiosis. The univariate analysis revealed an association between the degree of dysbiosis and elderly patients (p=0.034), number of comorbidities (p<0.001), presence of diarrhea or constipation (p<0.001) and medication in use [antibiotic and/or proton pump inhibitor (PII); p<0.001]. In the multivariate analysis, the most important influence in classification was the presence of diarrhea or constipation (OR=3.00, 95% CI [1.73, 5.21] p<0.001) and medication in use (Score 3: OR = 53.4, 95% CI [2.73, 1045.5], p=0.009 and Score 4-8: OR = 1709.1, 95% CI [50.27, 58103.5] p<0.001), both independent predictors of high and very high risk of dysbiosis. Conclusion: The risk degree of intestinal dysbiosis is greater in the presence of diarrhea or constipation, the use of antibiotics and/or PII, and in elderly patients. Once the risks of dysbiosis have been defined, INDIS proved to be an effective and rapid tool for risk stratification of dysbiosis in the study population, future studies should determine the relevance of therapeutic interventions with the purpose of normalizing the intestinal flora.

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