Time to Treatment Initiation Predicts Overall Survival in Hospitalized Acute Myeloid Leukemia (AML) Patients: A California Population-Based Study

Abstract Background: The impact of time from diagnosis to chemotherapy initiation (time to treatment, TTT) for AML has been a topic of ongoing debate. A prior study reported that TTT ≥5 days adversely impacted overall survival in younger (<60 years of age), but not older (≥60 years of age), patients. However, subsequent studies found either no effect of TTT on overall survival, regardless of age, or an adverse impact of TTT on overall survival for both younger (>10 days) and older patients (>5 days). Prior data also showed no impact of TTT on early mortality. Given these conflicting findings, consensus on the impact of TTT on survival is lacking and warrants further study. Using prospectively collected population-based data, we analyzed a large cohort of adult AML patients to examine the effect of TTT on overall survival. Methods: Using data from the California Cancer Registry and Patient Discharge Dataset between 1999-2012, patients≥15years diagnosed with de novo AML and who received inpatient treatment between 1-90 days from diagnosis were identified (n=5337). Multivariable logistic regression was used to determine factors associated with TTT>5 days vs 1-5 days with data presented as odds ratios (OR) and 95% confidence intervals (CI). The effect of TTT on overall and 60-day survival was estimated using multivariable Cox proportional hazards regression with TTT (1-5, 6-10,>10 days)considered as a time-dependent variable. Patients were stratified by age group (<60,≥60 years) for all analyses.Multivariable models accounted for age, race/ethnicity, sex, number of comorbidities, marital status, neighborhood socioeconomic status, health insurance type, treatment at National Cancer Institute designated (NCI) vs non-NCI designated facility, use ofleukapheresis, and year of diagnosis. Results: Of the 2659 patients <60 years of age, 61.0% were treated within 5 days and 79.7% within 10 days of diagnosis, compared to 43.8% and 65.0%, respectively, of the 2678 patients≥60 years of age. Patients≥60 years were more likely to have 3+ comorbidities compared to the younger age group (43.3% vs 25.9%, P<0.001). The likelihood of TTT>5 days increased with age in both younger and older patients. Across both age groups, patients requiringleukapheresis(age<60: OR 0.19, CI 0.10-0.34; age≥60: OR 0.23, CI 0.12-0.45), treated at a non-NCI (vs NCI) center (age<60: OR 0.62, CI 0.52-0.73; age≥60: OR 0.64, CI 0.52-0.78) and with 1-2 (vs 0) comorbidities (age<60: OR 0.81, CI 0.67-0.98; age≥60: OR 0.69, CI 0.54-0.88) or 3+ (vs 0) comorbidities (age<60: OR 0.77, CI 0.62-0.97; age≥60: OR 0.52, CI 0.41-0.66) had a lower odds of TTT>5 days. Younger (age<60) African Americans (vs non-Hispanic whites) had a higher odds of TTT >5 days (OR 1.43, CI 1.04-1.97). Delaying chemotherapy >10 days (vs 1-5 days) adversely impacted overall survival in both age groups (age<60: HR 1.26, CI 1.11-1.43; age≥60: HR 1.17, CI 1.06-1.28) (Table). However, TTT of 6-10 days (vs 1-5 days) affected overall survival in young (age<60: HR 1.15, CI 1.02-1.31), but not older patients. A TTT of 6-10 days (vs 1-5 days) adversely impacted 60-day survival in both age groups (age<60: HR 1.70, CI 1.24-2.33; age≥60: HR 1.27, CI 1.05-1.54); 60-day survival results were similar for a TTT >10 days (vs 1-5 days) (Table). Conclusions: In a large cohort of patients with de novo AML, TTT of up to 10 days did not have a negative impact on overall survival in patients over the age of 60. In younger patients (<age 60), TTT >5 days was associated with decreased overall survival. Delaying chemotherapy over 5 days adversely impacted 60-day survival in both age groups. Our observation that patients were more likely to have a shorter TTT at non-NCI designated hospitals may relate to delays associated with transfer to or clinical trial enrollment at NCI centers. Our results suggest that waiting to get results of ancillary testing, such as cytogenetic and molecular mutation analyses, in order to inform treatment decisions for AML patients, may be feasible in some patients with AML. In an era of rapidly evolving prognostic and treatment landscapes for AML, our findings may have implications for personalized therapy, including novel targeted therapies, and clinical trial design for patients withAML. Disclosures No relevant conflicts of interest to declare.

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Low expression of MN1 associates with better treatment response in older patients with de novo cytogenetically normal acute myeloid leukemia

Blood ◽

10.1182/blood-2011-06-357764 ◽

2011 ◽

Vol 118 (15) ◽

pp. 4188-4198 ◽

Cited By ~ 40

Author(s):

Sebastian Schwind ◽

Guido Marcucci ◽

Jessica Kohlschmidt ◽

Michael D. Radmacher ◽

Krzysztof Mrózek ◽

...

Keyword(s):

Overall Survival ◽

Acute Myeloid Leukemia ◽

Older Patients ◽

Myeloid Leukemia ◽

Hox Genes ◽

De Novo ◽

Prognostic Significance ◽

The Impact ◽

Favorable Group ◽

Acute Myeloid

AbstractLow MN1 expression bestows favorable prognosis in younger adults with cytogenetically normal acute myeloid leukemia (CN-AML), but its prognostic significance in older patients is unknown. We analyzed pretherapy MN1 expression in 140 older (≥ 60 years) de novo CN-AML patients treated on cytarabine/daunorubicin-based protocols. Low MN1 expressers had higher complete remission (CR) rates (P = .001), and longer overall survival (P = .03) and event-free survival (EFS; P = .004). In multivariable models, low MN1 expression was associated with better CR rates and EFS. The impact of MN1 expression on overall survival and EFS was predominantly in patients 70 years of age or older, with low MN1 expressers with mutated NPM1 having the best outcome. The impact of MN1 expression was also observed in the Intermediate-I, but not the Favorable group of the European LeukemiaNet classification, where low MN1 expressers had CR rates and EFS similar to those of Favorable group patients. MN1 expresser-status-associated gene- and microRNA-expression signatures revealed underexpression of drug resistance and adverse outcome predictors, and overexpression of HOX genes and HOX-gene–embedded microRNAs in low MN1 expressers. We conclude that low MN1 expression confers better prognosis in older CN-AML patients and may refine the European LeukemiaNet classification. Biologic features associated with MN1 expression may help identify new treatment targets.

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The impact of a time target on older patients attending the emergency department

Emergency Medicine Journal ◽

10.1136/emj.2010.103150.05 ◽

2010 ◽

Vol 27 (Suppl 1) ◽

pp. A2.1-A2

Author(s):

Sue Mason

Keyword(s):

Emergency Department ◽

Older Patients ◽

Age Groups ◽

Unintended Consequences ◽

Older Patient ◽

Younger Patients ◽

Patient Level ◽

Level Data ◽

Younger Age ◽

The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

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Changes in the Hierarchy of Risk Factors with Older Age in De-Novo Acute Myeloid Leukemia (AML).

Blood ◽

10.1182/blood.v108.11.1977.1977 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1977-1977

Author(s):

Thomas Buchner ◽

Wolfgang E. Berdel ◽

Claudia Schoch ◽

Torsten Haferlach ◽

Hubert L. Serve ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Complete Remission ◽

De Novo ◽

Older Age ◽

High Dose ◽

Age Group ◽

Risk Profiles ◽

Age Related ◽

De Novo Aml

Abstract After recent reports addressed prognostic factors and outcome in older age AML (Burnett et al. Blood106:162a,2005; Wheatley et al. Blood106:199a,2005; Appelbaum et al. Blood107:3481–5,2006; Farag et al. Blood108:63–73,2006) we evaluated 764 patients of 60–85 (median 66) years reduced to those with de-novo AML, known karyotype, and identical consolidation-maintenance chemotherapy, who were part of the 1992 and 1999 multicenter randomized trials by the German AMLCG (Buchner et al. J Clin Oncol21:4496–504,2003;24:2480–9,2006). 521 patients were 60 -< 70 (median 64) and 243 patients were 70–85 (median 73) years of age. 64% and 50% patients respectively went into complete remission, 24% and 29% remained with persistent AML, 12% and 21% succumbed to early and hypoplastic death (p<.001). The overall survival in the younger (60- < 70y) and older (70+) patients was at a median of 13 vs 6 months and 18% vs 8% survived at 5 years (p<.001). Once in complete remission, the remission duration was 14 vs 12 months (median) and equally 18% at 5 years; the relapse-free survival is 13 vs 11 months (median) and 14% vs 13% at 5 years. While all patients were randomized up-front for 2 versions of induction either by TAD-HAM (HAM, high-dose araC 1g/m2x6 and mitox 10mg/m2x3) or by HAM-HAM, response and survival did not differ between the two arms in neither age group. In contrast to response and survival between the younger (60-<70y) and older (70+y) age group corresponding differences in the risk profiles were missing. Thus, favorable/intermediate/unfavorable karyotypes accounted for 8% vs 4% / 67% vs 73% / and 25% vs 24% of patients (p=.073); WBC > 20.000/ccm was found in 40% vs 39% (p=.52); LDH > 700U/L was remarkably 26% vs 18% (p=.014), and the day 16 b.m. blasts ≥ 10% accounted for 41% and 41% of patients. Conclusion: Approximately 50% of patients 70 years of age or older benefit from standard or intensive chemotherapy by complete remission which continues after 1 year in about 50% of responders. The inferior overall survival in the patients of 70+ versus those of 60- < 70 years is mainly explained by more frequent early and hypoplastic death (21% vs 12%) (p=.0016) and death with persistent AML (26% vs 18%) (p=.0145); while death in remission (7% vs 6%), relapse rate (50% vs 53%) and death after relapse (21% vs 26%) did not show this trend. In contrast to the important differences in outcome, established risk factors such as cytogenetic groups, WBC, and early blast clearance show concordance between the two age groups. The even lower LDH may support assumptions of older age AML as a less proliferative disease (Appelbaum et al. Blood 107:3481–5,2006). Thus, the hierarchical risk profiles cannot predict the age related outcome beyond 60 years in patients with de-novo AML.

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Epidemiology of Childhood Hyperthyroidism in France: A Nationwide Population-Based Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-00273 ◽

2018 ◽

Vol 103 (8) ◽

pp. 2980-2987 ◽

Cited By ~ 3

Author(s):

Marie Simon ◽

Annabel Rigou ◽

Joëlle Le Moal ◽

Abdelkrim Zeghnoun ◽

Alain Le Tertre ◽

...

Keyword(s):

Age Groups ◽

Poisson Model ◽

Epidemiological Data ◽

Epidemiological Survey ◽

Population Based ◽

Antithyroid Drugs ◽

Childhood And Adolescence ◽

Age Group ◽

Cross Sectional ◽

The Impact

Abstract Context Hyperthyroidism affects all age groups, but epidemiological data for children are scarce. Objective To perform a nationwide epidemiological survey of hyperthyroidism in children and adolescents. Design A cross-sectional descriptive study. Setting Identification of entries corresponding to reimbursements for antithyroid drugs in the French national insurance database. Participants All cases of childhood hyperthyroidism (6 months to 17 years of age) in 2015. Main Outcome Measures National incidence rate estimated with a nonlinear Poisson model and spatial distribution of cases. Results A total of 670 cases of childhood hyperthyroidism were identified. Twenty patients (3%) had associated autoimmune or genetic disease, with type 1 diabetes and Down syndrome the most frequent. The annual incidence for 2015 was 4.58/100,000 person-years (95% CI 3.00 to 6.99/100,000). Incidence increased with age, in both sexes. This increase accelerated after the age of 8 in girls and 10 in boys and was stronger in girls. About 10% of patients were affected before the age of 5 years (sex ratio 1.43). There was an interaction between age and sex, the effect of being female increasing with age: girls were 3.2 times more likely to be affected than boys in the 10 to 14 years age group and 5.7 times more likely to be affected in the 15 to 17 years age group. No conclusions about spatial pattern emerged. Conclusion These findings shed light on the incidence of hyperthyroidism and the impact of sex on this incidence during childhood and adolescence. The observed incidence was higher than expected from the results published for earlier studies in Northern European countries.

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Changes in Hysterectomy Route and Adnexal Removal for Benign Disease in Australia 2001–2015: A National Population-Based Study

Minimally Invasive Surgery ◽

10.1155/2018/5828071 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Natalie De Cure ◽

Stephen J. Robson

Keyword(s):

Age Groups ◽

Laparoscopic Hysterectomy ◽

Abdominal Hysterectomy ◽

Population Based ◽

Incidence Rates ◽

Older Age ◽

Age Group ◽

Female Population ◽

Younger Women ◽

Younger Age

Objective. Hysterectomy rates have fallen over recent years and there remains debate whether salpingectomy should be performed to reduce the lifetime risk of ovarian cancer. We examined trends in adnexal removal and route of hysterectomy in Australia between 2001 and 2015. Methods. Data were obtained from the national procedural dataset for hysterectomy approach (vaginal, VH; abdominal, AH; and, laparoscopic, LH) and rates of adnexal removal, as well as endometrial ablation. The total female population in two age groups (“younger age group,” 35 to 54 years, and “older age group,” 55 to 74 years) was obtained from the Australian Bureau of Statistics. Results. The rate of hysterectomy fell in both younger (61.7 versus 45.2/10000/year, p<0.005) and older (38.8 versus 33.2/10000/year, p<0.005) age groups. In both age groups there were significant decreases in the incidence rates for VH (by 53% in the younger age group and 29% in the older age group) and AH (by 53% and 55%, respectively). The rates of LH increased by 153% in the younger age group and 307% in the older age group. Overall, the proportion of hysterectomies involving adnexal removal increased (31% versus 65% in the younger age group, p<0.005; 44% versus 58% in the older age group, p<0.005). The increase occurred almost entirely after 2011. Conclusion. Hysterectomy is becoming less common, and both vaginal and abdominal hysterectomy are being replaced by laparoscopic hysterectomy. Removal of the adnexae is now more common in younger women.

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Higher Incidence of Secondary AML and Adverse Molecular Markers, Together with Lower CR and Higher AML Related Death Rates in Elderly Compared to Younger Patients: Results from 2435 Patients Included in the Two German AML Intergroup Studies

Blood ◽

10.1182/blood.v126.23.2517.2517 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2517-2517

Author(s):

Dietger Niederwieser ◽

Verena Sophia Hoffmann ◽

Utz Krug ◽

Rainer Krahl ◽

Christina Sauerland ◽

...

Keyword(s):

Older Patients ◽

Research Funding ◽

De Novo ◽

Age Groups ◽

Disease Status ◽

Study Group ◽

Advisory Committees ◽

Younger Patients ◽

Secondary Aml ◽

De Novo Aml

Abstract Background The German AML Intergroup conducted two randomized studies in younger (<60 years) and elderly (≥60 years) patients in which the study arms were compared to a common standard arm. Here, we compared the two studies in younger and elderly patients focusing on disease characteristics and outcome. Patients and Methods The East German Study Group (OSHO) and the Acute Myeloid Leukemia Cooperative Group (AMLCG) each entered patients from 18 to 59 years into one study and patients aged 60 years and older into another. Each study group randomized upfront 10% of all AML patients into a common standard arm and 90% in the study group specific arm. All patients with de novo AML or AML after myelodysplastic syndrome or cytotoxic treatment were eligible. Chi-squared and Mann-Whitney-U tests were used to detect significant differences between the age groups regarding demographic, clinical and cytogenetic characteristics at baseline. Complete Remission (CR) at 90 days and cumulative probabilities of death were determined for outcome. To avoid bias due to the higher probability of death in older patients, cumulative probabilities of death were calculated for relapsed patients or those who did not achieve CR after 90 days. Other deaths were considered as a competing risk. Results A total of 2435 AML patients were analyzed, 1132 in the study <60 years and 1303 in the study ≥60 years. Significant differences in patient characteristics were noted between the studies. The elderly patient group contained a higher proportion of males than the younger group (55% vs 49% respectively, p=0.0031) and a higher percentage of secondary AML (40% vs 21% respectively, p<0.0001). In contrast, younger patients had higher median WBC count [13x109/L (range 0.03-798) for <60 years and 6.9x109/L (range 0.23-450) for ≥60 years, p<0.0001] and higher median lactate dehydrogenase [442U/L (range 35-19,624) for <60 years and 350U/L (range 51-9,486) for ≥60 years, p<0.0001]. Cytogenetic risk was similarly distributed in both groups (favorable: 12% in both age groups, intermediate: 66% in <60 years and 63% in ≥60 years, adverse: 22% in <60 years and 25% in ≥60 years, p=0.1672). However, the favorable combination of FLT3-ITDwt and NPM1mut in normal karyotype was more common in the younger (35%) than in the older group (27%; p=0.0212). A higher rate of CR at 90 days was observed in the younger (66%) than in the older (51%) patients (p=<0.0001). Of the younger patients 14.8% died (3.8% with persisting AML, 3.3% without AML and 7.7% without evaluable disease status) while of the older patients 21.8% died (6.2% with persisting AML, 2.5% without AML and 13.1% without evaluable disease status) during this period (p=0.0001). Relapse at 90 days was seen in 1% of the younger and in 2% of the older patients. The cumulative probability of AML-related death was lower in younger patients than in older patients (p<0.0001). Of the younger patients 29% (95% CI: 26% to 31%) and 44% (95% CI: 40% to 46%) died after one and three years due to AML; in the older group the corresponding frequencies were 45% (95% CI: 42% to 48%) and 62% (95% CI: 59% to 65%; Figure 1a). The probability of dying from AML was lowest for the younger patients with de novo AML [27% (95% CI 24% to 29%) at 1 year and 41% (95% CI 38% to 44%) at 3 years] and highest for those with secondary AML [38% (95% CI 32% to 44%) at 1 year and 56% (95% CI 49% to 62%) at 3 years (p=0.0001)], with similar differences being observed in the older patients (p=0.0001, Figure 1b). In the younger patients, CR at 90 days was lower in the standard (58%) than in the study arm (66%, p=0.0558), while AML related death was 29% and 27% at 1 year and 44% and 39% at 3 years respectively. In the older patients CR at 90 days was 52% vs. 51%, AML related death at 1 year 45% and 45% and at 3 years 63% and 69% for study arm and standard arm, respectively (Figure 1c). Conclusion This analysis reveals significant differences in gender, laboratory characteristics and proportion of secondary AML in elderly compared to younger AML patients. While there was no clear difference in cytogenetic risk groups, favorable molecular markers were more frequent in younger patients. Clear differences in CR rates after 90 days of therapy and AML related death rate were seen in regard to age (<60 years and ≥60 years) and disease type (de novo and secondary AML). As the common standard arm in both of the studies was age adapted, the differences between the two age groups are likely to be related to disease biology. Disclosures Niederwieser: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Hoffmann:Novartis Oncology Europe: Research Funding. Krug:Sunesis; Clavis Pharma; usa Pharma, Catapult Cell Therapy, Gilead, Roche: Membership on an entity's Board of Directors or advisory committees; Sunesis: Speakers Bureau; Boehringer Ingelheim: Research Funding; Novartis; BMS; Roche; Boehringer Ingelheim; Bayer: Honoraria. Hegenbart:Janssen: Honoraria, Other: travel support. Pfirrmann:Novartis Pharma: Consultancy, Honoraria; BMS: Consultancy, Honoraria. Kraemer:TEVA: Other: travel support. Al-Ali:Celgene: Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding.

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The Impact of Patient Age on the Acceptability of Telemedicine in the Context of COVID-19

UF Journal of Undergraduate Research ◽

10.32473/ufjur.v23i.128354 ◽

2021 ◽

Vol 23 ◽

Author(s):

Briana Williams ◽

Katelin McDilda ◽

Melissa Bright

Keyword(s):

Older Patients ◽

New Technology ◽

Healthcare Delivery ◽

Age Groups ◽

Outpatient Clinics ◽

Age Group ◽

Chi Square ◽

Younger Patients ◽

Patient Dissatisfaction ◽

The Impact

The objective of the study was to determine the extent to which patients from various age groups perceive telemedicine as a viable mode of healthcare delivery in the context of COVID-19. A RedCap survey was sent to patients in our OB/GYN outpatient clinics with in-person, telemedicine, re-scheduled or cancelled appointments between 3/11/20 to 5/11/20. Patients’ online responses were analyzed using a 5-point Likert scale. Statistical analysis was performed using Chi-Square and Fischer’s Exact Analysis with p < 0.05 considered significant. A total of 1083 patients completed the survey of whom 280 (25.9%) had a telemedicine appointment. Patients answered questions relating to their telemedicine visit. While older patients did encounter a higher proportion of technological difficulties (p<0.0001), younger patients, specifically those in the 25-34 age group, expressed greater dissatisfaction with their appointment being changed to telemedicine than older patients (p=0.02), and felt that telemedicine did not accomplish the same goals as an in-person visit (p=0.01). Nonetheless, all patients, regardless of age, were satisfied with the introduction to telemedicine (p=0.02) and the instructions provided to them prior to the visit (p=0.02). Connectivity issues seem to be the biggest obstacle to older patients particularly when there is absence of a reliable internet connection and a telemedicine-compatible device. Younger patients, though less satisfied, are more comfortable with new technology and with using telemedicine; they tend to experience less connectivity issues. Our focus going forward should be on finding ways to simplify the process, overcome the connectivity issues while addressing the main reasons leading to patient dissatisfaction.

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High Dose Mitoxantrone Based "5+1" Induction Chemotherapy Regimen in Newly Diagnosed Acute Myeloid Leukemia

Blood ◽

10.1182/blood-2018-99-116857 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 1430-1430

Author(s):

Neeraj Y Saini ◽

Jan Cerny ◽

Vanessa Furtado ◽

Angela Desmond ◽

Zheng Zhou ◽

...

Keyword(s):

Myeloid Leukemia ◽

Median Overall Survival ◽

De Novo ◽

Chemotherapy Regimen ◽

Age Groups ◽

High Dose ◽

Age Group ◽

Newly Diagnosed ◽

Secondary Aml ◽

De Novo Aml

Abstract Introduction In acute myeloid leukemia (AML), dose intensification of "7+3" has not produced improved outcomes. At our center, we evaluated an intensive "5+1" regimen of high dose mitoxantrone (HDM) with high dose cytarabine (HiDAC) in all newly diagnosed AML patients. We present here our experience of this regimen at our institution. Patients and Methods The treatment regimen included bolus HiDAC at 3000 mg/m2 over three hours on days 1 to 5 and HDM 80 mg/m2 once on the second day immediately after the completion of cytarabine infusion. A total of 101 consecutive patients were treated from January 2009 to March 2013 with this regimen. There were twelve exceptions to the regimen dosages, where patients received a lower dose of 60 mg/m2 of mitoxantrone due to their significant comorbidities. The mean doses of mitoxantrone and Cytarabine administered for the whole cohort was 76 mg/m2 and 2844 mg/m2/day respectively. Patients who achieved CR were further consolidated by HiDAC chemotherapy cycles (1-4) and/or hypomethylating agent q28 day cycles. Patients with intermediate/adverse risk group were evaluated and considered for allogeneic transplant. Survival rates were calculated by the Kaplan-Meier method. Results The median age was 65 years (range 18-90). The total number of patients in the age group <60, 60-69 and ≥70 were 30(29.7%), 35(34.6%) and 36(35.6%) respectively. Patients in favorable, intermediate and adverse cytogenetics group as per European Leukemia Net(ELN)-AML 2017 criteria were 16(15.8%), 40(39.6%) and 41(40.5%) respectively. 33 patients had secondary AML (therapy-related AML, AML with antecedent MDS or CMML, or de novo AML with MDS related cytogenetics abnormalities). The overall complete response (CR) was 76.2% (77/101). 22% (23/101) were either primary refractory or had partial responses. The CR rates in patients <60, 60-69 and ≥70 age groups were similar at 80% (24/30), 74.2% (26/35) and 77.1% (27/35) respectively. The de-novo AML patients had higher CR 83.5%(56/67) compared to secondary AML 63.6%(21/33), p=0.04. The 4 and 8-week mortality in our cohort was 3/101 (2.9%) and 7/99 (7%) respectively. Median follow-up among survivors was 62 months (range 1-109 months). The median overall survival (OS) stratified by age group < 60, 60-69 and >=70 years were 56, 31 and 9 months respectively (log-rank, p=0.02). The median overall survival in patients with secondary AML was 9 months versus 43 months in de-novo AML patients. Sixty patients underwent transplant during consolidation, 47 (46.5%) were allogeneic and 13 (12.8%) autologous. 51.7% (45/84) of patients with intermediate/adverse cytogenetic risk groups as per ENL/AML criteria proceeded to allogeneic transplants. Among these 84 patients, the percentage of patients able to proceed to transplant in age groups <60, 60-69 and ≥70 years were 75% (18/24), 60.7 % (17/28) and 31.2% (10/32) respectively. Conclusion In conclusion, HDM based chemotherapy regimen produces high CR rates, is well tolerated and more patients can undergo curative post-remission therapy including stem cell transplant. Together with the low number of toxic deaths this induction regimen warrants further investigation. Disclosures Raffel: Magenta Therapeutics: Employment, Equity Ownership.

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The impact of race, age, and sex in follicular lymphoma (FL): A comprehensive SEER analysis in the pre- and post-rituximab (R) eras.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8072 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8072-8072

Author(s):

Chadi Nabhan ◽

Briseis Aschebrook-Kilfoy ◽

Brian C-H Chiu ◽

Kimberly R. Kruczek ◽

Angelo Clemenzi-allen ◽

...

Keyword(s):

Overall Survival ◽

Racial Disparities ◽

Racial Disparity ◽

Age Groups ◽

Population Based ◽

Asian Pacific Islander ◽

Asian Pacific ◽

The Impact ◽

Modern Era ◽

Age And Sex

8072 Background: While racial disparity has been well documented in a number of cancers, the impact of race in FL outcomes is not well defined. Further, the importance of gender in FL has not been fully explored. Methods: We examined population-based FL overall survival (OS) data from SEER 13 (1993-2008) regarding race, sex, age, and socioeconomic status (SES) over two consecutive 8-year (yr) periods: Era 1 (1993-2000, n=7,409) and Era 2 (2001–2008, n=9,083). Results: We identified16,492 FL patients (pts) (white (W): n=13,441; Hispanic (H): n=1,417; Asian/Pacific Islander (A/PI): n=887; and Black (B): n=747). Median ages at diagnosis differed significantly according to: (in yrs, W: 62.1, H: 57.3, A/PI: 60.5, B: 56.6; P<0.01 for each race vs. W). For all pts, OS was superior in Era 2 vs. Era 1 (5-yr OS: 77% vs. 68%, respectively, P<0.0001). Further, OS was significantly improved for all age groups (<50, 50-59, 60-69, and 70-79 yrs) as well as for males (P=0.0019) and females (P<0.0001) across eras. Interestingly, females had superior OS compared with males in Era 1 (P=0.004), but not in Era 2 (P=0.83). We subsequently compared OS within and across races (Table). All races, except A/PI, had improved 5-yr OS rates (age adjusted) from Era 1 to Era 2 (W: <0.001, H: 0.049, A/PI: 0.15, B: 0.003). Notably, A/PIs had the highest OS in Era 1, while H had the poorest OS in Era 2. These differences were more evident in males compared with females within each race. Finally, pts with higher SES had better OS in both eras, although OS was improved across eras for lower and higher SES populations. Conclusions: Collectively, we identified improved OS across eras, which was apparent for all ages, both sexes, and all races. We did not find superior outcome for females in the modern era as has been recently noted. However, several racial disparities persist, including inferior OS for H and superior OS A/PIs in the contemporary era. The disproportionate improvement in outcomes for some, but not all races, warrants continued study of racial disparities in FL. [Table: see text]

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Conventional Cytogenetic and Molecular Analysis in Acute Myeloid Leukemia (AML) and Their Association with Overall Survival

Acta Medica Bulgarica ◽

10.2478/amb-2021-0043 ◽

2021 ◽

Vol 48 (4) ◽

pp. 15-22

Author(s):

S. Shakeri ◽

M. R. Javan ◽

H. Ayatollahi ◽

M. Salehi ◽

A. Bari ◽

...

Keyword(s):

Overall Survival ◽

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

De Novo ◽

Molecular Classification ◽

Population Based ◽

Diagnostic Tools ◽

Differential Distribution ◽

The Impact ◽

Acute Myeloid

Abstract Background: Conventional cytogenetic is one of the most important diagnostic tools for predicting the overall survival of the patients. Molecular genetics in acute myeloid leukemia (AML) has provided insights into the molecular mechanism of leukemogenesis. In this study we aimed to investigate the impact of cytogenetic and molecular methods on the survival of patients with de novo established AML in order to achieve a useful marker or test in the process of predicting the disease course. Material and methods: Eighty newly diagnosed AML patients who were treatment naive entered the study. Cytogenetic and molecular studies such as, the conventional karyotyping, sequencing and reverse transcriptase real time quantitative PCR (RT-qPCR) were included. Overall survival was calculated by Kaplan-Maier technique and the data were analyzed by SPSS.V.19. Results: Among 80 patients, 36 (45%) were female and 44 (55%) were male patients. Patients’ median age was 29 years, ranging from 1 to 76 years. The mean overall survival was 19 months (95% CI: 1523 months). The 1-year AML survival rate was 61%. There were significant differences in overall survival between the NPM1-mutated groups compared to the patients without any mutations (19% versus 61%) (p < 0.032). Conclusion: This study makes a significant contribution in assessing the prognostic value of cytogenetic and molecular markers. This study showed the heterogeneity of de novo AML that involved various factors and prevalence of distinct cytogenetic subgroups. Our data in comparison with other population-based studies, confirmed a differential distribution of cytogenetic and molecular classification indicating geographic heterogeneity.

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