Mood and clinical status in patients with multiple myeloma.

1991 ◽  
Vol 9 (12) ◽  
pp. 2219-2224 ◽  
Author(s):  
P M Silberfarb ◽  
K M Anderson ◽  
A C Rundle ◽  
J C Holland ◽  
M R Cooper ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Regression Model ◽  
Cox Regression ◽  
Clinical Status ◽  
Objective Response ◽  
Disease Process ◽  
Response To Treatment ◽  
Survival Duration ◽  
Data Set ◽  
Physical Variables

Two hundred ninety patients with a recent diagnosis of multiple myeloma were studied psychologically at the time of initial treatment. Physician- and patient-completed psychosocial scales were correlated with physical variables used to measure tumor load and physical status. A logistic regression model was used to analyze objective response to treatment. Indirect measures of response to treatment were obtained, and factors influencing survival duration were studied using a Cox regression model. If physical variables were controlled, there were no significant correlations between psychologic scores on entry and response to treatment or survival duration. Thus, the notion that mood influences disease outcome once the disease process has begun in patients with multiple myeloma is not supported by this data set.

scholarly journals Drug resistance in multiple myeloma associated with high in vitro incorporation of 3H-thymidine

Blood ◽  
1981 ◽  
Vol 58 (3) ◽  
pp. 471-476
Author(s):  
V Hofmann ◽  
SE Salmon ◽  
BG Durie
Keyword(s):  
Multiple Myeloma ◽  
Tumor Regression ◽  
Alkylating Agents ◽  
Cell Mass ◽  
Bone Marrow Aspiration ◽  
Labeling Index ◽  
Response To Treatment ◽  
Survival Duration ◽  
Thymidine Uptake

In multiple myeloma, tumor cell mass and labeling index correlate with subsequent survival duration, but do not predict for response to treatment. In the present study was have autoradiographically measured the incorporation of 3H-thymidine as determined by the number of grains over the myeloma nuclei in bone marrow aspiration samples. In 33/37 patients with less than 50% tumor regression or progressive disease, the pretreatment grain count was greater than or equal to 20/myeloma nucleus. Conversely, values of less than 20 were found in 27/29 patients who had greater than or equal to 50% cell mass reduction. Survival duration was significantly better than (p less than 0.001) in patients with grain counts less than 20. Sixty percent of the patients with both a low labeling index (less than or equal to 3%) and grain count (less than 20) were alive at 48 mo, whereas 15/17 patients with a high labeling index and grain count had a median survival of less than 6 mo. In a subset of 22 patients, there as a significant correlation between in vitro resistance to melphalan, adriamycin, and vincristine as tested in the myeloma stem cell colony assay system and a grain count of greater than 20. We can only speculate as to the reasons for the increased 3H-thymidine uptake by myeloma cells resistant to treatment, however, it could be associated with accumulation of excess DNA and /or increased unscheduled DNA synthesis following injury from alkylating agents.

scholarly journals Drug resistance in multiple myeloma associated with high in vitro incorporation of 3H-thymidine

Blood ◽  
1981 ◽  
Vol 58 (3) ◽  
pp. 471-476 ◽  
Author(s):  
V Hofmann ◽  
SE Salmon ◽  
BG Durie
Keyword(s):  
Multiple Myeloma ◽  
Tumor Regression ◽  
Alkylating Agents ◽  
Cell Mass ◽  
Bone Marrow Aspiration ◽  
Labeling Index ◽  
Response To Treatment ◽  
Survival Duration ◽  
Thymidine Uptake

Abstract In multiple myeloma, tumor cell mass and labeling index correlate with subsequent survival duration, but do not predict for response to treatment. In the present study was have autoradiographically measured the incorporation of 3H-thymidine as determined by the number of grains over the myeloma nuclei in bone marrow aspiration samples. In 33/37 patients with less than 50% tumor regression or progressive disease, the pretreatment grain count was greater than or equal to 20/myeloma nucleus. Conversely, values of less than 20 were found in 27/29 patients who had greater than or equal to 50% cell mass reduction. Survival duration was significantly better than (p less than 0.001) in patients with grain counts less than 20. Sixty percent of the patients with both a low labeling index (less than or equal to 3%) and grain count (less than 20) were alive at 48 mo, whereas 15/17 patients with a high labeling index and grain count had a median survival of less than 6 mo. In a subset of 22 patients, there as a significant correlation between in vitro resistance to melphalan, adriamycin, and vincristine as tested in the myeloma stem cell colony assay system and a grain count of greater than 20. We can only speculate as to the reasons for the increased 3H-thymidine uptake by myeloma cells resistant to treatment, however, it could be associated with accumulation of excess DNA and /or increased unscheduled DNA synthesis following injury from alkylating agents.

Changes in Serum Free Light Chain and Biochemical Markers in Patients with Multiple Myeloma Receiving Bortezomib Treatment.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5028-5028
Author(s):  
Chang-Ki Min ◽  
Ki-Seong Eom ◽  
Seok Lee ◽  
Jong-Wook Lee ◽  
Woo-Sung Min ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Biochemical Markers ◽  
Objective Response ◽  
Chemotherapeutic Agents ◽  
Free Light Chain ◽  
Response To Treatment ◽  
Serum Free ◽  
Serum Free Light Chain ◽  
Bortezomib Treatment

Abstract Bortezomib alone or in combination with chemotherapeutic agents produce a rapid disease control in patients with multiple myeloma (MM). However, laboratory factors predictive of outcome with bortezomib remain obscure. The aim of this study is to determine whether serum free light chain (SFLC) measurements could be a new sensitive test for the early detection of response to treatment with bortezomib and to perform an analysis of biochemical markers to determine their value in predicting response. Data from evaluable 49 patients receiving 2–7 cycles (median, 4) of bortezomib were analyzed. During the first and second cycles of bortezomib treatment, serial serum samples were prospectively collected for simultaneous measurement of SFLC, intact immunoglobulin (Ig) and biochemical markers such as lactic dehydrogenase (LDH), alkaline phosphatase (ALP), uric acid, calcium and phosphorus. SFLC and Ig were measured on day 0 and 12 each cycle and the biochemical markers on day 0, 2, 5, 9 and 12. Twenty-seven patients, 10, 1, 1 and 8 were IgG, IgA, IgM, IgD myelomas and light chain disease (LCD), respectively. Two patients did not secrete monoclonal protein. Patients received bortezomib alone (n=25) 1.0–1.3 mg/m2 for 3–4 week cycles along with various combinations including dexamethasone, thalidomide and/or doxorubicin (n=24). Forty of 49 patients (81.6%) showed an objective response (CR+PR) response upon completion of bortezomib treatment while 9 patients had <PR by EBMT criteria according to monoclonal Ig concentration. Thirty-two of 39 patients (82.1%) with intact Ig MM patients had an abnormal SFLC concentration kinetics after the second bortezomib treatment. All 8 patients with LCD and 2 patients with non-secretory MM showed elevated concentrations of one or both SFLC. In comparison to the intact Ig levels, SFLC concentrations fell more rapidly in response to bortezomib treatment and the pattern of initial SFLC response seems to be an early indication of tumor response or resistance (see the figure; the response after the second cycle was assessed by concentrations of intact Ig or SFLC, respectively). The increase of LDH levels from baseline between two groups during and upon completion of two cycles of therapy was statistically significant (P=0.001). The increase of UA levels from baseline exhibited a marginal significance (P=0.081). In addition, we observed significantly higher mean ALP elevation in the responder group compared with the non-responder group during the two cycles (P=0.027). The monitoring of SFLC provides a unique opportunity to follow the kinetics of tumor kill especially when the monoclonal Ig was not detected. In addition, changes in SFLC concentrations can be used as an early biomarker to assess a rapid response to bortezomib treatment. Biochemical marker assays showed that the response to bortezomib might be associated with tumor lysis and/or osteoblastic activation. Response to bortezomib treatment Response to bortezomib treatment

Exploration of risk factors for osteoporotic fracture following hematopoietic stem cell transplantation.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10080-10080
Author(s):  
Huifang Lu ◽  
William A Murphy ◽  
Chidinma Chizoba Ebede ◽  
Erfan Karim ◽  
Gabriela Rondon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Regression Model ◽  
Osteoporotic Fracture ◽  
Cox Regression ◽  
Hematopoietic Stem ◽  
Prior Fracture

10080 Background: The incidence of fractures following hematopoietic stem cell transplantation (HSCT) ranges from 5% to 12% and the rates are up to 10 times greater than in the general population. The risk factors involved in osteoporotic fracture development following HSCT are incompletely understood. Methods: We conducted a retrospective cohort study of patients > 18 years that received a HSCT at MD Anderson Cancer Center, from January 1, 2001 to December 31, 2010. Patients were followed until December 31, 2013 for assessment of osteoporotic fracture occurrence using ICD-9 codes and confirmed by chart review. Cox regression model was used to identify independent risk factors for osteoporotic fractures. Factors included individual risk factors included in the World Health Organization Fracture Risk Assessment Tool FRAX and type of HSCT, type of preparatory regimen and underlying indication for HSCT. Results: A total of 5,170 patients received a HSCT during the 10-year study period, of which 527 (10%) patients developed an osteoporotic fracture. The median time of follow up was 3.2 years. A multivariate Cox regression model considering all clinical and malignancy specific risk factors was fitted. With the control of all other variables, the risk of developing fracture was 1.20 (95% confidence interval (CI):1.02-1.41) times higher for every 20 years increase in age at HSCT; female patients had a 1.24 (95% CI: 1.05-1.48) times higher risk compared to male patients; patients with a fracture prior to HSCT had a 2.01 (95% CI: 1.62-2.51) times higher risk compared to patients without a prior fracture; patients receiving an allogeneic HSCT had a 1.57 (95% CI: 1.20-2.05) times higher risk compared to patients receiving an autologous HSCT; and patients with multiple myeloma had a 2.62 (95% CI: 1.97-3.49) times higher risk compared to patients without multiple myeloma. Conclusions: Age at HSCT, gender, prior fracture status, type of HSCT, and underlying indication were identified to be statistically significantly associated with fracture. This is one of the first large scale studies assessing a comprehensive set of risk factors. To develop a risk model for fracture, we should consider these factors.

Baseline apparent diffusion coefficients: Validation study of new predictor of survival in patients with unresectable hepatocellular carcinoma following chemoembolization

2021 ◽  
pp. 1-10
Author(s):  
Lichao Xu ◽  
Shiqin Wang ◽  
Shengping Wang ◽  
Ying Wang ◽  
Wentao Li ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Roc Curve ◽  
Cox Regression ◽  
Response To Treatment ◽  
Roc Curve Analysis ◽  
Adc Value ◽  
Apparent Diffusion Coefficients ◽  
Apparent Diffusion ◽  
Response Biomarker ◽  
The Difference

OBJECTIVES: To investigate whether the baseline apparent diffusion coefficient (ADC) can predict survival in the hepatocellular carcinoma (HCC) patients receiving chemoembolization. MATERIALS AND METHODS: Diffusion-weighted MR imaging of HCC patients is performed within 2 weeks before chemoembolization. The ADC of the largest index lesion is recorded. Responses are assessed by mRECIST after the start of the second course of chemoembolization. Receiver operating characteristic (ROC) curve analysis is performed to evaluate the diagnostic performance and determine optimal cut-off values. Cox regression and Kaplan–Meier survival analyses are used to explore the differences in overall survival (OS) between the responders and non-responders. RESULTS: The difference is statistically significant in the baseline ADC between the responders and non-responders (P <  0.001). ROC analyses indicate that the baseline ADC value is a good predictor of response to treatment with an area under the ROC curve (AUC) of 0.744 and the optimal cut-off value of 1.22×10–3 mm2/s. The Cox regression model shows that the baseline ADC is an independent predictor of OS, with a 57.2% reduction in risk. CONCLUSION: An optimal baseline ADC value is a functional imaging response biomarker that has higher discriminatory power to predict tumor response and prolonged survival following chemoembolization in HCC patients.

scholarly journals 813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S448-S449
Author(s):  
Jongtak Jung ◽  
Pyoeng Gyun Choe ◽  
Chang Kyung Kang ◽  
Kyung Ho Song ◽  
Wan Beom Park ◽  
...  
Keyword(s):  
Regression Model ◽  
Acinetobacter Baumannii ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Intervention Group ◽  
Feeding Tube ◽  
Control Group ◽  
Cox Regression Model ◽  
Carbapenem Resistant ◽  
Hospital Acquired

Abstract Background Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB). Methods We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis. Results A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p&lt; 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors. Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii Conclusion In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection. Disclosures All Authors: No reported disclosures

Developing a nomogram for predicting intravesical recurrence after radical nephroureterectomy: a retrospective cohort study of mainland Chinese patients

2021 ◽  
Author(s):  
Shicong Lai ◽  
Xingbo Long ◽  
Pengjie Wu ◽  
Jianyong Liu ◽  
Samuel Seery ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Tract Urothelial Carcinoma ◽  
Chinese Patients ◽  
Clinicopathological Parameters ◽  
Radical Nephroureterectomy ◽  
Ki 67 ◽  
Data Set ◽  
Mainland Chinese ◽  
Upper Tract

Abstract Objective To evaluate the role of Ki-67 in predicting subsequent intravesical recurrence following radical nephroureterectomy and to develop a predictive nomogram for upper tract urothelial carcinoma patients. Methods This retrospective analysis involved 489 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision. The data set was randomly split into a training cohort of 293 patients and a validation cohort of 196 patients. Immunohistochemical analysis was used to assess the immunoreactivity of the biomarker Ki-67 in the tumor tissues. A multivariable Cox regression model was utilized to identify independent intravesical recurrence predictors after radical nephroureterectomy before constructing a nomographic model. Predictive accuracy was quantified using time-dependent receiver operating characteristic curve. Decision curve analysis was performed to evaluate the clinical benefit of models. Results With a median follow-up of 54 months, intravesical recurrence developed in 28.2% of this sample (n = 137). Tumor location, multifocality, pathological T stage, surgical approach, bladder cancer history and Ki-67 expression levels were independently associated with intravesical recurrence (all P &lt; 0.05). The full model, which intercalated Ki-67 with traditional clinicopathological parameters, outperformed both the basic model and Xylinas’ model in terms of discriminative capacity (all P &lt; 0.05). Decision-making analysis suggests that the more comprehensive model can also improve patients’ net benefit. Conclusions This new model, which intercalates the Ki-67 biomarker with traditional clinicopathological factors, appears to be more sensitive than nomograms previously tested across mainland Chinese populations. The findings suggest that Ki-67 could be useful for determining risk-stratified surveillance protocols following radical nephroureterectomy and in generating an individualized strategy based around intravesical recurrence predictions.

scholarly journals Testing the proportional hazards assumption in cox regression and dealing with possible non-proportionality in total joint arthroplasty research: methodological perspectives and review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ilari Kuitunen ◽  
Ville T. Ponkilainen ◽  
Mikko M. Uimonen ◽  
Antti Eskelinen ◽  
Aleksi Reito
Keyword(s):  
Survival Analysis ◽  
Regression Model ◽  
Total Joint Arthroplasty ◽  
Full Text ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Joint Arthroplasty ◽  
Central Research ◽  
Cox Regression Model ◽  
Pubmed Database

Abstract Background Survival analysis and effect of covariates on survival time is a central research interest. Cox proportional hazards regression remains as a gold standard in the survival analysis. The Cox model relies on the assumption of proportional hazards (PH) across different covariates. PH assumptions should be assessed and handled if violated. Our aim was to investigate the reporting of the Cox regression model details and testing of the PH assumption in survival analysis in total joint arthroplasty (TJA) studies. Methods We conducted a review in the PubMed database on 28th August 2019. A total of 1154 studies were identified. The abstracts of these studies were screened for words “cox and “hazard*” and if either was found the abstract was read. The abstract had to fulfill the following criteria to be included in the full-text phase: topic was knee or hip TJA surgery; survival analysis was used, and hazard ratio reported. If all the presented criteria were met, the full-text version of the article was then read. The full-text was included if Cox method was used to analyze TJA survival. After accessing the full-texts 318 articles were included in final analysis. Results The PH assumption was mentioned in 114 of the included studies (36%). KM analysis was used in 281 (88%) studies and the KM curves were presented graphically in 243 of these (87%). In 110 (45%) studies, the KM survival curves crossed in at least one of the presented figures. The most common way to test the PH assumption was to inspect the log-minus-log plots (n = 59). The time-axis division method was the most used corrected model (n = 30) in cox analysis. Of the 318 included studies only 63 (20%) met the following criteria: PH assumption mentioned, PH assumption tested, testing method of the PH assumption named, the result of the testing mentioned, and the Cox regression model corrected, if required. Conclusions Reporting and testing of the PH assumption and dealing with non-proportionality in hip and knee TJA studies was limited. More awareness and education regarding the assumptions behind the used statistical models among researchers, reviewers and editors are needed to improve the quality of TJA research. This could be achieved by better collaboration with methodologists and statisticians and introducing more specific reporting guidelines for TJA studies. Neglecting obvious non-proportionality undermines the overall research efforts since causes of non-proportionality, such as possible underlying pathomechanisms, are not considered and discussed.

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