Impact of Available Therapies on Survival of Very Elderly Myelodysplastic Syndrome (MDS) Patients (Age above 75 yrs)

Abstract Objective: Very elderly MDS patients (≥75 years) have limited therapeutic options and are usually ineligible for allogeneic stem cell transplantation. We aimed to study the impact of available MDS therapies on very elderly MDS patients and their correlation with patient demographics, performance status(PS) disease characteristics and patient outcomes. Methods: We performed a retrospective analysis of MDS patients ≥75 years diagnosed and treated at the University of Alabama at Birmingham from 2008 to 2014, with a minimum followup of 12 months. We analyzed demographics, ECOG PS, karyotypic risk categories as defined by the IPSS scoring system, blast percentage, IPSS and R-IPSS scores and overall survival (OS) in this population. We stratified patients based on therapy into two groups - the hypomethylating agent (HMA) group (defined as receiving therapy with ≥ 1 cycle of HMA; Azacitidine or Decitabine or both) and the non-HMA group, which included treatment with supportive transfusions, erythropoietin stimulating agents (ESAs), lenalidomide and cytotoxic chemotherapy. We analyzed group differences for all the parameters mentioned above using chi square test for categorical variables, and t test and Mann Whitney u-test for mean and medians respectively. In addition, OS was examined using Kaplan Meier curves using the log rank test. We used univariate and multivariate analysis to examine the effects of variables of interest on OS.All results were considered statistically significant at α=0.05 level. Results: The study population included 58 patients of which 35 patients were males (60%). Median age was 78 years. Forty patients (71%) of patients had good, 6% had intermediate and 23% had poor karyotypic profiles by the IPSS scoring system. ECOG ≥2 was observed in 44% of the patients with no significant differences in both groups. Average IPSS and R-IPSS scores were 1.2 and 4.5 respectively. Median OS for the entire study population was noted to be 15.5 months (7-34m). There were 25 patients in the HMA group and 33 patients in the non-HMA group. The blast percentage was higher in HMA group (20.5% vs 9.4%) compared to non-HMA group. More patients had a good karyotypic profile in the non-HMA group when compared to HMA group (80% vs 60%). There was a statistically significant difference between the mean IPSS and R-IPSS prognostic scores in non-HMA and HMA group (0.9 vs 1.7, p=0.010 and 3.5 vs 5.5, p=0.002) respectively. There was no significant difference in median overall survival between the non-HMA and HMA group (16.5 m (7-53) vs 15.5 m (5-19) p=0.278) respectively but the mean survival rates between non-HMA and HMA group were statistically different (32.81 vs 15.85, p=0.034). According to the log rank test, a statistical difference (p=0.027) in survival estimates was observed between the two groups on Kaplan Meier curve, where the HMA group had a significantly shorter survival compared to the non-HMA group. In the univariate analysis for the entire sample, higher IPSS score; R-IPSS score, and higher blast percentage were associated with increased rate of events. Moreover, rates of events were found to be lower in patients who did not receive HMA therapy (HR - 0.45, p=0.033), however in multivariable analysis, only higher blast percentage was associated with increased rate of events (HR - 1.06 p=0.025 95% CI - 1.004-1.11). Patients in the HMA group received average of 7.8 cycles. After stopping HMA therapy, 10 patients received other therapies including cytotoxic chemotherapy, hydroxyurea and lenalidomide, 4 were enrolled in a clinical trial, 9 received supportive transfusions and ESAs while 2 died immediately afterwards. Conclusion: Our study did not find a difference in median OS between patients who received HMA therapy versus non-HMA therapy in this population of very elderly MDS patients. Patients who received HMA therapy had a higher risk karyotypic profile, increased blast percentage and higher IPSS and R-IPSS scores. The average number of HMA cycles they received was 7.8, indicating adequate therapy. However, we could not evaluate transfusion needs, hospitalizations or other quality of life measures in these 2 groups. In conclusion, further studies need to be done to better evaluate various MDS therapies and their impact on quality of life and survival in this very elderly population with a higher comorbidity burden, possibly limiting the benefit of these treatments typically seen in younger MDS patients. Disclosures Borate: Genoptix: Consultancy; Seattle Genetics: Research Funding; Gilead: Speakers Bureau; Alexion: Speakers Bureau; Novartis: Speakers Bureau; Amgen: Speakers Bureau. Erba:Millennium/Takeda: Research Funding; Jannsen (J&J): Other: Data Safety and Monitoring Committees; Ariad: Consultancy; Millennium/Takeda: Research Funding; Celgene: Consultancy, Speakers Bureau; Astellas: Research Funding; Celgene: Consultancy, Speakers Bureau; Pfizer: Consultancy; Astellas: Research Funding; Incyte: Consultancy, Speakers Bureau; Pfizer: Consultancy; Seattle Genetics: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; Sunesis: Consultancy; Incyte: Consultancy, Speakers Bureau; GlycoMimetics: Other: Data Safety and Monitoring Committees; Jannsen (J&J): Other: Data Safety and Monitoring Committees; Amgen: Consultancy, Research Funding; Celator: Research Funding; Novartis: Consultancy, Speakers Bureau; Daiichi Sankyo: Consultancy; Sunesis: Consultancy; Seattle Genetics: Consultancy, Research Funding; Daiichi Sankyo: Consultancy; Ariad: Consultancy; Novartis: Consultancy, Speakers Bureau; GlycoMimetics: Other: Data Safety and Monitoring Committees; Celator: Research Funding.

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Employability among Statistics Graduates: Graduates’ Attributes, Competence, and Quality of Education

Education Research International ◽

10.1155/2019/7285491 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Ashenafi Abate Woya

Keyword(s):

Higher Education ◽

Quality Of Education ◽

Rank Test ◽

Government Organization ◽

Log Rank Test ◽

Kaplan Meier ◽

The Mean ◽

Quality In Higher Education ◽

Structured Questionnaire

An aspect of quality in higher education is the quality of the outcomes achieved. Higher education adds value by developing job-related skills and competencies. It is also not known to what extent, graduates’ competence goes in line with the demands of the employers. This study was to assess the employability and competency of statistics graduates. Data were collected using a structured questionnaire and analysis the using SPSS version 23. This study employed a Kaplan–Meier estimate to compare the duration of unemployed times from two or more groups. To assess whether there is a real difference between groups, we used Log-rank test. From a total of 303 statistics graduates, 17.7% were unemployed and 82.3% were employed. Of employed graduates, 65.8% had a permanent worker and the rest 16.5% of graduates had a temporary worker. The mean duration of unemployed statistics graduate at Bahir Dar University was 12.9 month (95% CI, (9.9, 15.9)). This study revealed that there is a percentage of graduates who are not yet employed and never been employed. Therefore, the department must be a linkage with the different government organization and NGO.This may improve the employability of statistics graduates.

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In Vitro Fatigue Resistance of Teeth Restored With Bulk Fill versus Conventional Composite Resin

Brazilian Dental Journal ◽

10.1590/0103-6440201600836 ◽

2016 ◽

Vol 27 (4) ◽

pp. 452-457 ◽

Cited By ~ 2

Author(s):

Gabrielle Branco Rauber ◽

Jussara Karina Bernardon ◽

Luiz Clovis Cardoso Vieira ◽

Hamilton Pires Maia ◽

Françoá Horn ◽

...

Keyword(s):

Fatigue Resistance ◽

Composite Resin ◽

Survival Curve ◽

Maximum Force ◽

Lower Percentage ◽

Rank Test ◽

Log Rank Test ◽

Kaplan Meier ◽

Significant Difference ◽

Meier Survival Curve

Abstract The aim of this study was to compare the fatigue resistance of restored teeth with bulk fill composite resin, conventional composite resin with incremental insertion and unprepared sound teeth. Twenty-eight extracted maxillary premolars were selected and divided into 4 groups based on composite resin and insertion technique: control (C), conventional composite resin with incremental insertion (I) and bulk fill composite resin with three (BF3) or single increment (BF1). The restored specimens were submitted to fatigue resistance test with a 5 Hz frequency. An initial application of 5,000 sinusoidal load cycles with a minimum force of 50 N and a maximum force of 200 N was used. Next, were applied stages of 30,000 load cycles with the maximum force increasing gradually: 400, 600, 800, 1000, 1200 and 1400 N. The test was concluded when 185,000 load cycles were achieved or the specimen failed. The fatigue resistance data were recorded for comparison, using the Kaplan-Meier survival curve and analyzed by log-rank test at 0.05 significance. Fractures were classified based on the position of the failure - above or below the cementoenamel junction (CEJ). Statistical analysis of the Kaplan-Meier survival curve and log-rank test showed a significant difference between groups (p=0.001). The fracture analysis demonstrated that only 28.58% of failures were below the CEJ in group C, while for groups I, BF1 and BF3 they were 42.85%, 85.71% and 85.71%, respectively. Teeth restored with composite bulk fill in both techniques present similar fatigue resistance values compared with those restored with a conventional incremental insertion of composite, while the fatigue strength values of unprepared sound teeth were higher. Furthermore, unprepared sound teeth showed a lower percentage of fractures below the CEJ.

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Longitudinal analysis of quality of life following treatment with Asunercept plus reirradiation versus reirradiation in progressive glioblastoma patients

Journal of Neuro-Oncology ◽

10.1007/s11060-019-03320-x ◽

2019 ◽

Vol 145 (3) ◽

pp. 531-540

Author(s):

Wolfgang Wick ◽

Andriy Krendyukov ◽

Klaus Junge ◽

Thomas Höger ◽

Harald Fricke

Keyword(s):

Quality Of Life ◽

Neurological Status ◽

Recurrent Glioblastoma ◽

Rank Test ◽

Treatment Groups ◽

Log Rank Test ◽

Kaplan Meier ◽

The Central Nervous System ◽

Eortc Qlq

Abstract Purpose Glioblastoma is an aggressive malignant cancer of the central nervous system, with disease progression associated with deterioration of neurocognitive function and quality of life (QoL). As such, maintenance of QoL is an important treatment goal. This analysis presents time to deterioration (TtD) of QoL in patients with recurrent glioblastoma receiving Asunercept plus reirradiation (rRT) or rRT alone. Methods Data from patients with a baseline and ≥ 1 post-baseline QoL assessment were included in this analysis. TtD was defined as the time from randomisation to the first deterioration in the EORTC QLQ-C15, PAL EORTC QLQ-BN20 and Medical Research Council (MRC)-Neurological status. Deterioration was defined as a decrease of ≥ 10 points from baseline in the QLQ-C15 PAL overall QoL and functioning scales, an increase of ≥ 10 points from baseline in the QLQ-C15 PAL fatigue scale and the QLQ-BN20 total sum of score, and a rating of “Worse” in the MRC-Neurological status. Patients without a deterioration were censored at the last QoL assessment. Kaplan–Meier estimates were used to describe TtD and treatment groups (Asunercept + rRT or rRT alone) were compared using the log-rank test. Results Treatment with Asunercept + rRT was associated with significant improvement of TtD compared with rRT alone for QLQ-CL15 PAL overall QoL and physical functioning, and MRC Neurological Status (p ≤ 0.05). In the Asunercept + rRT group, QoL was maintained beyond progresison of disease (PoD). Conclusion Treatment with Asunercept plus rRT significantly prolongs TtD and maintains QoL versus rRT alone in recurrent glioblastoma patients.

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Calcium channel blockers use and overall survival in pancreatic cancer patients receiving gemcitabine.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15756 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15756-e15756 ◽

Cited By ~ 1

Author(s):

Leszek Kraj ◽

Andrzej Śliwczyński ◽

Joanna Krawczyk-Lipiec ◽

Krzysztof Woźniak ◽

Anna Waszczuk-Gajda ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Calcium Channel ◽

Calcium Channel Blockers ◽

Rank Test ◽

Channel Blockers ◽

Test Results ◽

Log Rank Test ◽

Kaplan Meier ◽

Significant Difference

e15756 Background: Preclinical studies have shown that calcium channel blockers (CCB) may potentiate anticancer effect of chemotherapy via intra-cellular drug accumulation. Gemcitabine-based chemotherapy is commonly used in pancreatic cancer (PC) patients. The aim of this study was to determine whether CCB may affect overall survival (OS) in PC patients receiving gemcitabine-based chemotherapy. Methods: The retrospective cohort of PC patients treated with gemcitabine between 2007 and 2016 was identified in the Polish National Health Fund databases. Electronic records of prescriptions were searched to identify in this cohort patients receiving CCB (amlodipine, nitrendipine, felodipine, lacidipine). The primary endpoint was OS and it was determined by Kaplan-Meier methods and compared by the log-rank test. Results: In total 4628 PC patients treated with gemcitabine (median OS 7.7 months; 95% CI: 7.4-7.9) were identified. Among these 380 patients were prescribed any CCB. There was a significant difference (p < 0.001) in median OS between patients prescribed CCB (n = 380; OS 9.3 months; 95% CI: 7.8-11.0) and those who did not (n = 4214; OS 7.6 months; 95% CI: 7.3-7.8) with hazard ratio for death 0.70 (95% CI: 0.62-0.79). Notably, the survival curves tended to flatten in CCB group, with 24% of patients alive at 2 years (95% CI: 20-29%) and 15% alive at 5 years (95% CI: 11-19%), compared with 11% (95% CI: 10-12%) and 4% (95% CI: 4-5%) in controls respectively. Conclusions: The use of CCB in PC patients receiving gemcitabine-based chemotherapy was associated with improved OS. Further validation is needed to evaluate effectiveness of CCB-gemcitabine combinations in the management of PC.

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Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients

Journal of Neurosurgery Spine ◽

10.3171/2015.7.spine15353 ◽

2016 ◽

Vol 24 (4) ◽

pp. 556-564 ◽

Cited By ~ 8

Author(s):

Kern H. Guppy ◽

Jessica Harris ◽

Jason Chen ◽

Elizabeth W. Paxton ◽

Julie Alvarez ◽

...

Keyword(s):

Bone Morphogenetic Protein ◽

Patient Characteristics ◽

Rank Test ◽

Log Rank Test ◽

Kaplan Meier ◽

Morphogenetic Protein ◽

Significant Difference ◽

Spinal Fusions ◽

Reoperation Rates

OBJECTIVE Bone morphogenetic protein (BMP) was first approved in 2002 for use in single-level anterior lumbar fusions as an alternative to iliac crest grafts. Subsequent studies have concluded that BMP provides superior fusions rates and therefore reduces reoperations for nonunions. The purpose of this study was to determine the reoperation rates for symptomatic nonunions in posterior cervical (subaxial) spinal fusions with and without the use of BMP and to determine if the nonunion rates are statistically significantly different between the two groups. METHODS Between January 2009 and September 2013, the authors identified 1158 posterior cervical spinal fusion cases in the subaxial spine (C2–7) from a large spine registry (Kaiser Permanente). Patient characteristics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was conducted to produce estimates of odds ratios (OR) and 95% confidence intervals (CIs). Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test. RESULTS In this cohort there were 1158 patients (19.3% with BMP) with a median follow up of 1.7 years (interquartile range [IQR] 0.7–2.9 years) and median duration to operative nonunion of 0.63 years (IQR 0.44–1.57 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.179). In a subset of patients with more than 1 year of follow-up, 788 patients were identified (22.5% with BMP) with a median follow-up duration of 2.5 years (IQR 1.7–3.4 years) and a median time to operative nonunion of 0.73 years (IQR 0.44–1.57 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervical (subaxial) fusions with BMP compared with non-BMP (1.1% vs 0.7%; crude OR 1.73, 95% CI 0.32–9.55, p = 0.527) for more than 1 year of follow-up. CONCLUSIONS This study presents the largest series of patients using BMP in posterior cervical (subaxial) spinal fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were found to be 1.1% with BMP and 0.7% without BMP. There was no significant difference in the reoperation rates for symptomatic nonunions with or without BMP.

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Outcomes of carcinosarcoma of the uterus

10.1055/s-0039-1685334 ◽

2016 ◽

Author(s):

Anne George ◽

Ajit Sebastian ◽

Vinotha Thomas ◽

Anitha Thomas ◽

Rachel Chandy ◽

...

Keyword(s):

Adjuvant Therapy ◽

Rank Test ◽

Uterine Carcinosarcoma ◽

Log Rank Test ◽

Kaplan Meier ◽

Time Period ◽

The Mean ◽

Post Menopausal ◽

Stage 1

Objectives: To evaluate the outcome of women with uterine carcinosarcoma. Methods: The medical records of all patients admitted with uterine carcinosarcoma between January 2012 and October 2015 were reviewed. Baseline characteristics were compared and survival was calculated using Kaplan Meier method and compared using log rank test. Results: The total number of uterine malignancies operated in our centre over this time period was 247 of which 33 were sarcomas (13%). Median age of presentation was 56 years (21-77 years). Most women were postmenopausal (76%) and 46% of them presented with post menopausal bleeding.There were 16 carcinosarcomas of the uterus. Eight presented at Stage 1 (50%) and the remaining 8 in stage III or IV. All patients had TAH/BSO but only 15 had omentectomy and 12 had pelvic and para-aortic lymphadenectomy. Adjuvant treatment was given only to 10 (63%). Seven patients had expired at the time of follow up. The mean survival was 502 days (304-699) with a median of 284 days. Patients who received adjuvant therapy did better compared to those who did not (p=0.05). Conclusions: Carcinosarcomas are aggressive tumours and the optimal therapy is yet to be determined. Adequate surgical staging followed by adjuvant therapy improves survival.

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The Impact of Pathologic Upgrading of Gleason Score 7 Prostate Cancer on the Risk of the Biochemical Recurrence after Radical Prostatectomy

BioMed Research International ◽

10.1155/2018/4510149 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Juhyun Park ◽

Sangjun Yoo ◽

Min Chul Cho ◽

Min Hyun Cho ◽

Chang Wook Jeong ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Surgical Margin ◽

Rank Test ◽

Kaplan Meier ◽

Significant Difference ◽

The Mean ◽

The Impact

Objective. To investigate the impact of pathologic upgrading of Gleason score (GS) 7 prostate cancer on the risk of the biochemical recurrence. Materials and Methods. A total of 1678 patients with postoperative GS 7 prostate cancer without lymph node metastasis were reviewed retrospectively. The patients were categorized into four groups depending on pathologic upgrading: upgraded GS 3+4, nonupgraded GS 3+4, upgraded GS 4+3, and nonupgraded GS 4+3. Kaplan-Meier multivariate model was created. Results. The mean age was significantly higher in the nonupgraded GS 4+3 group than in other groups, whereas the mean prostate-specific antigen (PSA) level was lower in the upgraded GS 3+4 group. Pathologic findings, such as extracapsular extension, seminal vesical invasion, and the surgical margin rate, were different from each other. Five-year biochemical recurrence-free survival rate was 85%, 73%, 69%, and 60% in upgraded GS 3+4, nonupgraded GS 3+4, upgraded GS 4+3, and nonupgraded GS 4+3 group, respectively. There was significant difference between the nonupgraded 4+3 and upgraded 4+3 group, as well as between upgraded 3+4 and nonupgraded 3+4 group. However, the two middle patient groups, that is, the nonupgraded GS 3+4 group and the upgraded GS 4+3 group, did not show the statistical difference (Log-rank test, p value = 0.259). Conclusion. The information on pathologic upgrading in the biopsy reports of patients could help to provide more detailed analysis for the biochemical recurrence of GS 7 prostate cancer.

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12-Month Self-Ligating Bracket Failure Rate with a Self-Etching Primer

The Angle Orthodontist ◽

10.2319/112507-552.1 ◽

2008 ◽

Vol 78 (6) ◽

pp. 1095-1100 ◽

Cited By ~ 21

Author(s):

Selma Elekdag-Turk ◽

Fethiye Cakmak ◽

Devrim Isci ◽

Tamer Turk

Keyword(s):

Survival Rate ◽

Clinical Performance ◽

Survival Rates ◽

Rank Test ◽

Dental Arch ◽

Bond Failure ◽

Lower Survival Rate ◽

Log Rank Test ◽

Kaplan Meier ◽

Significant Difference

Abstract Objective: To compare the clinical performance of a self-etching primer (SEP) with a conventional two-step etch and primer method (CM). Materials and Methods: Study subjects were 39 patients with a mean age of 15 years 7 months. Six hundred and eighty-eight brackets were bonded by one operator with a split-mouth design, using Transbond Plus Self-Etching Primer or a conventional two-step etch and primer (Transbond XT). The survival rate of the brackets was estimated by the Kaplan-Meier analysis. Bracket survival distributions with respect to bonding procedure, dental arch, type of tooth (incisor, canine, and premolar) and patients' gender were compared using the log-rank test. Bond failure interface was determined using the Adhesive Remnant Index (ARI). Results: The bond failure rates of SEP and CM were 4.7% and 1.7%, respectively. A significant difference was found between the bonding procedures using the log-rank test (P < .05). Furthermore, canine and premolar teeth displayed a lower survival rate than incisor teeth (P < .05). Survival rates did not show significant differences between the upper and lower dental arches and patients' gender (P > .05). No significant difference was observed for ARI scores (P > .05). Conclusion: These findings indicate that the SEP (Transbond Plus) can be effectively used to bond orthodontic brackets.

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Treatment of Recurrent or Metastatic Uterine Adenosarcoma

Sarcoma ◽

10.1155/2017/4680273 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Michael J. Nathenson ◽

Anthony P. Conley ◽

Heather Lin ◽

Nicole Fleming ◽

Vinod Ravi

Keyword(s):

Hormonal Therapy ◽

Response Rate ◽

Progression Free Survival ◽

Rank Test ◽

Free Survival ◽

Log Rank Test ◽

Recist 1.1 ◽

Kaplan Meier ◽

Study Population ◽

The Difference

Purpose. This study retrospectively evaluated overall survival (OS) by treatment of recurrent or metastatic uterine adenosarcoma including surgery, radiation, chemotherapy, and hormonal therapy and evaluated OS and progression-free survival (PFS) after 1st line systemic chemotherapy. Methods. 78 patients with recurrent or metastatic adenosarcoma comprised the study population. The Kaplan-Meier method was used to estimate OS and PFS. The log-rank test was performed to test the difference in survival between groups. Results. Median OS from diagnosis of recurrent or metastatic disease was 1.8 yrs. OS was influenced by pathology on recurrence, p=0.035. Median OS differed by surgery for 1st recurrence 26.3 months versus 15.1 months. OS was not influenced by chemotherapy, p=0.58, palliative radiation, p=0.58, or hormonal therapy, p=0.15. The response rate (CR + PR) per RECIST 1.1 for chemotherapy was 31.2% for doxorubicin-based regimens and 14.3% for gemcitabine/docetaxel. OS since 1st line chemotherapy was not significantly different among chemotherapy regimens. However, the median PFS was superior for doxorubicin/ifosfamide (15.4 months) compared to gemcitabine/docetaxel (5.0 months), platinum-based regimens (5.7 mo), or other doxorubicin-based regimens (6.5 months). Conclusion. These results suggest that surgery is an important treatment modality for recurrent or metastatic uterine adenosarcoma, and the most effective chemotherapeutics are doxorubicin/ifosfamide and gemcitabine/docetaxel.

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Outcome of Adolescents and Young Adults with Acute Myeloid Leukemia (AML) As Compared to Pediatric AML Patients: Real World Data from SEER Registry

Blood ◽

10.1182/blood.v126.23.4484.4484 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4484-4484

Author(s):

Smith Giri ◽

Nunnery Sara ◽

Syed S. Nasir ◽

Michael G Martin

Keyword(s):

Overall Survival ◽

Pediatric Patients ◽

Survival Curve ◽

Population Based ◽

Early Mortality ◽

Rank Test ◽

P Value ◽

Log Rank Test ◽

Kaplan Meier ◽

Significant Difference

Abstract Background: Limited data exists regarding the characteristics and outcomes of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) which are largely under-represented in both pediatric and adult trials. We sought to compare the characteristics and outcomes of AYAs with AML using a large population based registry in the United States. Methods: We utilized Surveillance Epidemiology and End Results (SEER)-18 registry to identify all pediatric (0-18 years) and AYA (age 19-30 years) patients diagnosed with AML using appropriate histology codes based on the International Classification of Diseases for Oncology, 3rd version. Patients with acute promyelocytic leukemia (APL) were excluded from all analysis. Survival statistics were computed for each group using actuarial (Kaplan-Meier method) and compared using Z test for comparison of population proportions. Early mortality, defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment related mortality. Kaplan Meier survival curves were plotted and compared using log-rank test. Multivariate analysis was done using logistic regression and Cox proportional hazard regression model. All p values were two sided and the level of significance was chosen at 0.05. Results: A total of 6343 eligible patients were identified, which comprised 2836 (44.7%) AYAs. A total of 52% (n=3346) were males, whereas 76%(n=4825) were whites. Histologically, majority of patients (56%; n=3545) were categorized as AML, not otherwise specified, followed by acute monocytic leukemia (9.9%, n=630). Majority (55%; n-3509) of the patients were diagnosed between 2001-2012. The early mortality rate was lower in the pediatric AML patients (pAML) as compared to AYAs (6.2% vs 9.2%; p<0.01). Similarly the 1 year (70.3% versus 62.1%; p <0.01) and 5 year (48.2% vs 36.4%; p<0.01) was higher in pediatric patients as compared to AYAs. Kaplan Meier plot showed worse overall survival of AYAs compared to pAMLs (Figure 1; p value of log rank <0.01). Multivariate logistic regression showed higher early mortality among AYAs as compared to pAML patients (OR 1.48; 95% CI 1.23-1.79; p<0.01). Similarly Cox regression showed worse overall survival among AYAs as compared to pAML (HR 1.34; 95% CI 1.26-1.44; p <0.01) Conclusions: Our population based analysis shows worse overall survival among AYAs as compared to pAML patients. Future clinical trials specifically focused on this age group are warranted to establish appropriate treatment regimens in this population. Figure 1. Kaplan Meier Survival curve showing cumulative survival among pediatric patients with AML as compared to AYAs. Log rank test showed statistically significant difference between the two curves (p value <0.01) Figure 1. Kaplan Meier Survival curve showing cumulative survival among pediatric patients with AML as compared to AYAs. Log rank test showed statistically significant difference between the two curves (p value <0.01) Disclosures No relevant conflicts of interest to declare.

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