Does Histologic Grade Have a Role in the Management of Head and Neck Cancers?

2001 ◽  
Vol 19 (21) ◽  
pp. 4107-4116 ◽  
Author(s):  
André Fortin ◽  
Christian Couture ◽  
René Doucet ◽  
Michele Albert ◽  
Josée Allard ◽  
...  
Keyword(s):  
Head And Neck ◽  
Independent Predictor ◽  
Cox Model ◽  
Postoperative Radiotherapy ◽  
Distant Metastases ◽  
Histologic Grade ◽  
Kaplan Meier ◽  
N Stage ◽  
Grade 3 ◽  
Cox Analysis

PURPOSE: High histologic grade is usually associated with a greater propensity to distant metastases (DM). Its role to predict DM in head and neck cancer is not yet defined. The aim of this study is to evaluate the role of histologic grade as an independent predictor of DM and to determine a subgroup of patients who may benefit from systemic chemotherapy. PATIENTS AND METHODS: This is a retrospective study of 1,266 consecutive patients treated by definitive or postoperative radiotherapy between 1989 and 1997. All patients received at least 50 Gy. All stages and subsites of head/neck were included. DM rates were evaluated by the Kaplan-Meier method with a subsequent Cox analysis. RESULTS: There is a strong correlation of grade with N stage (P < .000001). The metastases-free survival (MFS) was 98%, 90%, and 72% for grades 1, 2, and 3, respectively (P < .000001). In patients with N0 stage, MFS is always greater than 90%, whatever the grade. In the 222 N1 patients, MFS was more than 90% in grade 1 and 2 but dropped to 75% for grade 3 (P = .001). In patients with N2 and N3, MFS was 91%, 79%, and 59% for grades 1, 2, and 3, respectively (P = .008). The same conclusion is applicable when only patients with neck control are analyzed. In a Cox model, grade was an independent predictor of DM (P = .000001) as well as T stage (P = .003), N stage (P = .000001), and neck failure (P = .0003). Higher grade was also an independent predictor of survival (P = .02). CONCLUSION: Patients with histologic grade 1 and grade 2 (except N3) are at low risk of DM. Patients with grade 2 and N3 or patients with grade 3 and N1 to N3 have a higher risk of distant metastases and should be considered for systemic treatment.

Adjuvant radiotherapy plus systemic chemotherapy in resected head and neck mucosal melanoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18042-e18042
Author(s):  
Rong Duan ◽  
Bixia Tang ◽  
Zhihong Chi ◽  
Chuanliang Cui ◽  
Bin Lian ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Head And Neck ◽  
Distant Metastasis ◽  
Adjuvant Radiotherapy ◽  
Postoperative Radiotherapy ◽  
Local Relapse ◽  
Mucosal Melanoma ◽  
Uicc Stage ◽  
Free Survival ◽  
Cox Analysis

e18042 Background: The median over survival (OS) of resected head and neck mucosal melanoma (HNMM) is 49.0 months. About 65% of patients experience local recurrence or distant metastasis after surgery. Therefore, adjuvant therapy is critical to improve the poor prognosis. Methods: Data regarding HNMMs with radical surgery (stage III-IVa, AJCC HNMM 8th version) between September 1, 2006 and February 28, 2020 at Peking University Cancer Hospital was collected retrospectively. Postoperative radiotherapy was usually prescribed as GTV 60-70Gy/CTV 60Gy/30f. Patients were divided into four groups by the adjuvant regimens: radiotherapy+chemotherapy (RC), chemotherapy (C), radiotherapy (R) and observation (O). Results: In total, 368 patients were enrolled, including 104 RC,114 C, 53 R, 97 O, respectively. After median follow-up of 63.9 mo (range: 0.9-146.7), the median local relapse-free survival (LRFS) was 10.1 mo (95%CI: 6.7-13.6) in the O group, as compared with 65.9 mo (95%CI: 31.7-100.1, P＜0.001) in the R group, 75.6 mo (95%CI: 50.1-101.0, P＜0.001) in the C group, and 84.6 mo (95%CI: 48.5-120.8, P＜0.001) in the RC group. The median distant metastasis-free survival (DMFS) was 13.7 mo (95%CI: 8.0-19.5) in the O group, 15.3 mo (95%CI: 8.7-21.9, P = 0.898) in the R group, as compared with 25.7 mo (95%CI: 14.6-36.8, P = 0.001) in the C group, 49.3 mo (95%CI: 32.6-66.0, P＜0.001) in the RC group. Estimated OS was 36.4 mo (95%CI: 24.0-48.8) in the O group, as compared with 30.8 mo (95%CI: 23.0-38.6, P = 0.733) in the R group, 40.8 mo (95%CI: 34.8-46.8, P = 0.289) in the C group, 58.2 mp (95%CI: 36.4-79.9, P = 0.002) in the RC group. Primary location, age, gender, UICC staging and adjuvant regimens were included for multivariate Cox analysis. With regard to OS, UICC stage and RC were the prognostic factors. With regard to DMFS, UICC stage, RC and C were the prognostic factors. With regard to LRFS, UICC stage, RC, R, C were the prognostic factors. Conclusions: It is the largest study on the role of adjuvant radiotherapy and chemotherapy on HNMM till now. The results demonstrate that postoperative radiotherapy improves LRFS but has no impact on DMFS, while adjuvant radiotherapy plus chemotherapy prolongs OS. It further validates the clinical practice of UICC stage of HNMM, which might shed lights on the study of the whole mucosal melanoma.

scholarly journals P198 Long-term outcomes after mitraclip implantation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J P Dias Ferreira Reis ◽  
L Moura Branco ◽  
L Almeida Morais ◽  
R Ilhao Moreira ◽  
P Rio ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Univariate Analysis ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
First Year ◽  
Exclusion Criteria ◽  
Kaplan Meier ◽  
Cox Analysis ◽  
Overall Mortality

Abstract Background Mitraclip implantation (MI) is a well-established option for patients (P) with severe mitral regurgitation (MR) noneligible to surgery. Its impact on long term prognosis is being addressed by several recent studies. Purpose To identify predictors of morbidity and mortality in P undergoing MI and evaluate if the COAPT, Everest and MITRAFR exclusion criteria (EC) had any impact on the outcome of our population. Methods prospective study of P who underwent MI between 2013 and 2018 in one medical center. EC: COAPT: LVEF &lt; 20%, LV end-diastolic diameter &gt; 70mm or pulmonary artery systolic pressure &gt; 70mmHg; Everest: LVEF &lt; 25% or LV end-systolic diameter (LVESD)&gt;55mm; MITRA-FR: LVEF &lt; 15% or &gt;40% or primary MR. An univariate analysis was performed followed by a multivariate Cox analysis to evaluate overall mortality (M), overall mortality/ heart failure hospitalization (MH) and mortality in the first year post-MI(M1). Survival analysis using Kaplan-Meier plots. p &lt; 0.05 were considered significant. Results 40P, 60% male, mean age 66 ± 12 years (Y) and mean follow-up time of 18 ± 15 months. 67.5% presented with MR grade IV and 75% had functional MR. Successful implantation in 97.5%, with 55% presenting mild MR post-procedure. Overall mortality was 30% (12P), mostly due to cardiovascular causes, with 9P dying in the first year (30%). There was no difference between pts with functional and primary MR: M- 33%vs20% (p = 0.6); MH– 53.3%vs30% (p = 0.5). P who met the COAPT exclusion criteria (N-22) presented an inferior 1Ysurvival (64.5%vs86.7%, p = 0.046). The overall outcome was comparable between P who matched and didn"t match Everest and MITRA-FR exclusion criteria. Basal BNP value (p = 0.037), mean preprocedural MAGGIC score (p = 0.040) and EROA (p = 0.039) were associated to M1. Multivariate Cox analysis revealed that basal BNP was an independent predictor of M (p = 0.017), whereas a higher distance in the pre-procedural 6 minute walk test (p = 0.008) and the "reduction in the MR severity and PASP" (p = 0.008) presented a protective effect. LVESD &gt; 55mm was an independent predictor of MH (p = 0.017), but MR of grade 2 or less after procedure was protective (p = 0.006). Conclusion There was no M difference between P with functional and primary MR. P with COAPT exclusion criteria had worse 1Ysurvival. A higher distance in 6MWT and a reduction in MR severity and PASP were protective. An LVESD &gt; 55 mm had a worse prognosis. Careful P selection may be crucial to improve MI"s results Abstract P198 Figure. Kaplan-Meier Plots

scholarly journals Overexpression of KIAA1199 is an independent prognostic marker in laryngeal squamous cell carcinoma

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9637
Author(s):  
Meixiang Huang ◽  
Feifei Liao ◽  
Yexun Song ◽  
Gang Zuo ◽  
Guolin Tan ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Protein Expression ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Clinical Stage ◽  
Rt Pcr ◽  
Independent Prognostic Marker ◽  
Kaplan Meier ◽  
Tumor Tissues ◽  
N Stage ◽  
Cox Analysis

Background KIAA1199 is a recently identified novel gene that is upregulated in various human cancers with poor survival, but its role and the underlying mechanisms in laryngeal squamous cell carcinoma (LSCC) remain unknown. Here, we collected tissues from 105 cases of LSCC to investigate the relationships between KIAA1199 protein expression and clinical factors. Methods Western blotting and real-time quantitative PCR (RT-PCR) were used for detect the protein and mRNA expression of KIAA1199 in LSCC tissue. Immunohistochemistry (IHC) staining was used to detect the expression of KIAA1199. Patient clinical information, for instance sex, age, pathological differentiation, clinical region, T stage, N stage, clinical stage, operation type, neck lymph dissection, smoking status, and drinking status were recorded. Kaplan–Meier survival analysis and Cox analysis were applied to identify the relationship between KIAA1199 and LSCC. Results Western blotting results showed KIAA1199 protein was significantly higher in tumor tissues vs. adjacent non-cancerous tissues (0.9385 ± 0.1363 vs. 1.838 ± 0.3209, P = 0.04). The KIAA1199 mRNA expression was considerably higher in tumor tissues (P < 0.001) than in adjacent non-cancerous tissues by RT-PCR. IHC results showed up-regulated KIAA1199 expression was related with some severe clinicopathological parameters: pathologic differentiation (P = 0.002), T stage (P < 0.001), N stage (P < 0.001), clinical stage (P < 0.001), survival time (P = 0.008) and survival status (P < 0.001). Kaplan–Meier survival analysis showed that patients with high KIAA1199 protein expression had poor overall survival (OS) (P < 0.05). Cox analysis suggested that the KIAA1199 protein expression constituted an independent prognostic marker for LSCC patients (P < 0.001). Conclusion Our findings revealed that KIAA1199 protein expression may be used to predict LSCC patient outcome.

scholarly journals Sinonasal mucosal melanomas in Quito, Ecuador

2017 ◽  
Vol 4 (3) ◽  
pp. 1009
Author(s):  
Luis Pacheco-Ojeda
Keyword(s):  
Local Recurrence ◽  
Head And Neck ◽  
Postoperative Radiotherapy ◽  
Distant Metastases ◽  
Tertiary Referral ◽  
Tumor Patients ◽  
Presenting Symptoms ◽  
Local Disease ◽  
The Social ◽  
Clinical Records

Background: Head and neck mucosal melanoma account for 2 to 8% of head and neck melanomas, the majority of which arises in the nasal cavity or paranasal sinuses. The aim of this report was to review our experience on sinonasal malignant melanomas (SNMM) treated over a long period of time at a tertiary referral hospital.Methods: Clinical records of all of the patients operated on for SNMM at the Social Security Hospital and private clinics in Quito, Ecuador, were reviewed. Nineteen patients had histologically proven diagnosis. Eleven patients were men and mean age was 64. The most common presenting symptoms were nasal obstruction and epistaxis. Most tumors were located at the nasal fossa. Extranasal extension was present in 11 patients. Twelve had stage III- IV tumors. All patients were treated by surgery.  Postoperative radiotherapy was given to 7.Results: Local recurrence (11 events) occurred in 9 cases. These 11 events were treated with surgery in 8, eventually associated to radiation therapy (RT) and chemotherapy (CT). Eight out of these 9 patients died. Five overall survival was 46%. Death was related to local disease and distant metastases. All stage I tumor patients are alive.Conclusions: Most sinunasal melanomas have a poor prognosis, mainly attributed to initial advanced local disease, local recurrence and distant metastasis. Surgery is the mainstay treatment, followed by radiotherapy, according to the T category.

scholarly journals Analysis of Perioperative Platelet Indices and Their Prognostic Value in Head and Neck Cancer Patients Treated with Surgery and Postoperative Radiotherapy: A Retrospective Cohort Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1858 ◽  
Author(s):  
Jank ◽  
Haas ◽  
Dunkler ◽  
Campion ◽  
Brkic ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Postoperative Radiotherapy ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Surrogate Marker ◽  
Platelet Indices ◽  
Kaplan Meier

Objectives: Activated platelets might play an important role in tumor progression. Mean platelet volume (MPV) has been used as a surrogate marker for platelet activation, and therefore its value as a marker of tumor prognosis has attracted recent attention. In this study, we aimed to critically evaluate the prognostic significance of the perioperative platelet count (COP), MPV and the MPV/COP ratio in head and neck cancer patients. Additionally, we explored the individual postoperative trajectory of these indices and their association with overall survival (OS) and disease-free survival (DFS). Methods: We retrospectively evaluated 122 head and neck squamous cell carcinoma patients receiving surgery with curative intent followed by postoperative radiotherapy. Platelet indices were measured preoperatively and on days 1 and 7 postoperatively. OS and DFS were analyzed using Kaplan–Meier estimators, the log-rank test and uni and multivariable Cox models. Cutoffs to dichotomize patients for Kaplan–Meier curves and log-rank tests were empirically chosen at the respective median. The median follow-up was 8.8 years. Results: The adjusted preoperative COP, MPV and MPV/COP ratio were not associated with disease outcome. A low postoperative COP and a high MPV/COP ratio on the first postoperative day were independently associated with worse OS and DFS. In comparison to the preoperative measurements, patients whose COP increased by day 1 post-op showed a better OS (hazard ratio (HR) per 50 G/L increase: 0.73, 95% confidence interval (CI): 0.58–0.93, p = 0.013) and DFS (HR per 50 G/L increase: 0.74, 95% CI: 0.58–0.94, p = 0.018) in multivariable analysis. Conclusions: Our results suggest that a low postoperative COP and a high MPV/COP ratio represent a negative prognostic factor for OS and DFS. Notably, patients with an increase in COP by day 1 post-op when compared to their preoperative value showed a significantly better OS and DFS.

scholarly journals Role of Baseline Albumin-Bilirubin Grade on Predict Overall Survival Among Sorafenib-Treated Patients With Hepatocellular Carcinoma in Vietnam

2019 ◽  
Vol 26 (1) ◽  
pp. 107327481986526 ◽  
Author(s):  
Thi Thu Huong Nguyen ◽  
Van Hieu Nguyen ◽  
Van Hung Nguyen ◽  
Thanh Long Nguyen ◽  
Van Quang Le
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Value ◽  
Independent Predictor ◽  
Survival Outcome ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Liver Functions ◽  
Tertiary Hospitals ◽  
Grade 3

Introduction: Albumin-bilirubin (ALBI) grade has been recently used in evaluation of liver function and prognosis of patients with hepatocellular carcinoma (HCC). However, in Vietnam, the utility of ALBI grade in clinical setting has not been adequately investigated. Methods: This is a retrospective study of 110 patients with HCC treated with sorafenib from January 2010 to November 2018 at 2 tertiary hospitals in Vietnam. Prognostic value of ALBI grade was evaluated by Kaplan-Meier survival analysis and Cox proportional regression model. Results: Results showed that the majority of ALBI grade 1 were Child-Pugh level A (97.5%); ALBI grade 2 was seen in all Child-Pugh score groups of 5, 6, 7, ≥8, whereas ALBI grade 3 was mostly reported in Child-Pugh score ≥8 group (83.3%). Compared with ALBI grade 3, ALBI grade 1 reduced 66.4% risk of death (hazards ratio [HR] = 0.336, 95% confidence interval [CI]: 0.115-0.981; P = .046). Compared with ALBI grade 3, ALBI grade 2 reduced 67.3% risk of death (HR = 0.327, 95% CI: 0.122-0.875; P = .026). Albumin-bilirubin grade was an independent predictor of survival outcome. Conclusion: Baseline ALBI grade is a simple and objective approach in assessing liver functions of patients with HCC. Baseline ALBI grade is an independent predictor of survival in patients treated with sorafenib.

Postoperative concurrent radiochemotherapy versus radiotherapy in high-risk SCCA of the head and neck: Results of the German phase III trial ARO 96–3

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5507-5507 ◽  
Author(s):  
R. Fietkau ◽  
C. Lautenschläger ◽  
R. Sauer ◽  
J. Dunst ◽  
A. Becker ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Toxicity ◽  
Head And Neck ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Phase Iii ◽  
Phase Iii Trial ◽  
Free Survival ◽  
Tumor Bed ◽  
Grade 3

5507 Background: Despite resection and postoperative irradiation high-risk (3 or more involved lymph nodes, extra-capsular disease and/or microscopically involved mucosal margins of resection) squamous cell carcinomas (SCCAs) of the head and neck frequently recur in the tumor bed. Postoperatively radiochemotherapy (RCT) with cis-Platin (CDDP)/5-FU versus radiotherapy (RT) alone was compared in a randomized trial. Methods: Between 5/97 and 12/04, 440 patients who had high-risk SCCAs of the head and neck were enrolled in this prospectively randomized phase III trial. Following resection and neck dissection, 214 patients were randomly assigned to RT (66 Gy/33 Fx/6.6 weeks) and 226 patients to identical RT plus CDDP (20 mg/m2 on day 1–5, 29–33) and 5-FU (600 mg/m2 on day 1–5, 29–33). Results: The 5 year local-regional control rate is 72.2 ± 3.7% following RT and 88.6 ± 2.4% for the RCT group (p = 0.00259; 5-year progression free survival 50.1 ± 4.0% and 62.4 ± 4.4% (p = 0.024) and 5-year overall survival 48.6 ± 4.4% vs. 58.1 ± 4.6% (p = 0.11). There was no difference in the 5 year incidence of distant metastases (19.3 ± 3.6% vs 25.5 ± 4.6%; p = 0.45). The incidence of grade 3+ acute toxicity was higher during RCT: mucositis 12.6% vs. 20.8% (p = 0.04), leucopenia 0% vs. 4.4% (p = 0.007). Conclusions: Acute toxicity is increased to an acceptable level by RCT. Postoperative RCT compared to RT improves locoregional control and progression free survival; thus survival as a trend is improved by 10% after 5 years. Supported by Deutsche Krebshilfe 70–2140. No significant financial relationships to disclose.

Impact of metformin on survival and mTOR pathway in head and neck cancer patients: An updated analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17500-e17500
Author(s):  
Shuchi Gulati ◽  
Vinita Takiar ◽  
Jonathan Mark ◽  
Randall Butler ◽  
Joshua NeCamp ◽  
...  
Keyword(s):  
Head And Neck ◽  
Cox Model ◽  
Progression Free Survival ◽  
Tissue Microarrays ◽  
Mtor Pathway ◽  
Free Survival ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Phosphoinositide 3 Kinase ◽  
Pathway Inhibition

e17500 Background: Metformin is hypothesized to suppress tumor cell growth by mTOR pathway inhibition, which mediates the phosphoinositide 3-kinase/Akt signaling pathway (frequently deregulated in human cancers). This effect is mediated by activation of the AMP protein kinase (AMPK). Despite knowledge of the mechanism, various retrospective studies show conflicting results about effect of metformin on survival in head and neck squamous cell carcinoma (HNSCC) patients (pts). Methods: We analyzed a retrospective cohort of 1500 consecutive pts (between 2009-2015) with HNSCC. We added about 1000 pts to previously presented data (e17514-ASCO 2016). These pts included those with diabetes (DM) on metformin (MET) or other anti-diabetic agents. Descriptive statistics were used for demographic and pt data. Kaplan-Meier method was used to calculate median overall survival (OS) and progression free survival (PFS), 95% CI. Cox model was used to test association between MET (or DM) and OS (or PFS) (using SPSS-24 (IBM)). Results: Of the 1500 pts with HNSCC, 329 had advanced cancer (stage III/ IV), and received definitive chemo-radiation (CRT). Of these, majority were Caucasian (90%), males (90%) and smokers (70%). Mean age at diagnosis was 57 years (SD 10). 53 pts had DM, of which 37 were on MET. Statistical results are shown in Table 1. Conclusions: This retrospective study showed no statistically significant difference between various subgroups described in the table. Given the low number of diabetics, and pts on MET, data is limiting. However, further subset analyses are ongoing to determine whether a difference in treatment (RT vs. cetuximab vs. cisplatin) had an impact on outcomes. Future experiments will utilize tissue microarrays to evaluate for association with mTOR pathway aberrations. [Table: see text][Table: see text]

scholarly journals The effect of cytoreductive partial nephrectomy in elderly patients with metastatic renal cell carcinoma：a systematic review

2019 ◽  
Author(s):  
Wei Zhuang ◽  
Jiabi Chen ◽  
Yining Li ◽  
Xiaoping Su
Keyword(s):  
Partial Nephrectomy ◽  
Tumor Size ◽  
Renal Cell ◽  
Term Survival ◽  
Factors Affecting ◽  
Kaplan Meier ◽  
N Stage ◽  
Independent Risk Factors ◽  
Male Patients ◽  
Cox Analysis

Abstract Background To explore the survival value of cytoreductive partial nephrectomy (cPN) in elderly metastatic renal cell carcinoma (EmRCC).Methods RCC patients aged ≥65 years from 2010 to 2015 in The Surveillance, Epidemiology and End Result database (SEER) were analyzed using Kaplan-Meier (K-M) method and multivariate COX analysis. Propensity score matching (PSM) was performed to balance effects of confounding factors such as general features and pathological features. We were committed to study the long-term survival advantages of cPN patients, explore the appropriate population of cPN, and try to establish a Nomogram model to predict individual survival.Results In EmRCC patients, especially in male patients with tumors size ≦7cm, N0 stage, or isolated metastases, cPN brought a better survival than cytoreductive radical nephrectomy (cRN). Tumor size and N stage were independent risk factors affecting the survival of cPN patients, cPN in patients with tumor size >7cm or N1 stage may present a higher risk of death.Conclusions The implementation of cPN in EmRCC patients who meet specific clinical characteristics like tumors size ≦7cm, N0 stage, or isolated metastases seems to help improve the tumor outcomes.

Outcome of Submyeloablative Allogeneic HSCT for Hematologic Malignancies: Development of a Prognostic Model Based on Pre-Transplant Characteristics.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1145-1145
Author(s):  
Jayesh Mehta ◽  
A. Evens ◽  
O. Frankfurt ◽  
L. Gordon ◽  
D. Grinblatt ◽  
...  
Keyword(s):  
Cox Model ◽  
Performance Status ◽  
Hematologic Malignancies ◽  
Refractory Disease ◽  
Donor Age ◽  
Gm Csf ◽  
Kaplan Meier ◽  
Gvhd Prophylaxis ◽  
Locus Allele ◽  
Cox Analysis

Abstract Our aim was to identify pre-transplant variables affecting the outcome of submyeloablative HSCT in 63 patients (27–66 y, median 52) with NHL/Hodgkin/CLL (n=29), acute leukemia (n=19), and myeloma (n=15). Donors were HLA-matched sibs (n=37), 10/10 allele-matched unrelated (n=19), or 1-locus/allele mismatched (n=7). The conditioning was 100 mg/m2 melphalan with (n=42; no prior auto) or without (n=21; prior auto) 50 mg/kg cyclophosphamide. GVHD prophylaxis comprised cyclosporine-mycophenolate (HLA-matched sibs) or tacrolimus-mycophenolate (others). G/GM-CSF were not used. Supportive care was uniform. 16 patients died of transplant-related causes (TRM), and 35 relapsed (8 alive after salvage therapy). Of the variables analyzed in univariate fashion for effect on OS, the following were found to be significant and were entered into a Cox model for TRM, relapse, EFS and OS: age (83% <60 y vs 17% ≥60 y), performance status (33% 0 vs 41% 1 vs 25% ≥2), chemosensitivity (60% refractory vs 40% non-refractory), donor (63% sib vs 37% unrelated), HLA (89% match vs 11% mismatch), donor age (48% ≤45 y vs 52% >45 y), 108/kg CD3+ cells infused (49% <3 vs 51% ≥3), LDH (56% normal vs 44% increased), platelet count (40% <100 vs 60% ≥100), albumin (32% ≤3 vs 68% >3), and hemoglobin (24% <9 vs 76% ≥9). Relapse was higher with refractory disease (RR 3.2; P=0.003) and donor age >45 (RR 2.7; P=0.007), and TRM higher with PS ≥2 (RR 22.7 vs PS 0; P=0.001), donor age >45 (RR 5.3; P=0.013) and increased LDH (RR 8.6; P=0.003). The table shows factors influencing OS and EFS. Variable OS DFS Adverse Favorable RR (95% CI) P RR (95% CI) P PS ≥2 PS 0 0.17 (0.06–0.47) 0.001 0.28 (0.11–0.78) 0.007 PS ≥2 PS 1 0.48 (0.24–0.98) 0.045 0.50 (0.24–1.03) 0.061 Increased LDH Normal LDH 0.29 (0.14–0.62) 0.001 0.43 (0.22–0.83) 0.012 Refractory disease Non-refractory disease 0.38 (0.15–0.92) 0.033 0.36 (0.17–0.77) 0.008 Donor age >45 Donor age ≤45 0.39 (0.19–0.77) 0.007 0.27 (0.14–0.53) <0.001 Scoring 1 point for each adverse factor (2 for PS ≥2), patients were divided into 4 groups: none (n=9), 1–2 (n=20), 3–4 (n=29), and 5 (n=5). The figures below show adjusted OS and EFS curves derived from the Cox analysis by the number of adverse variables. The figures below show actual OS and EFS Kaplan-Meier curves by the number of adverse variables. Figure Figure The figures below show actual OS and EFS Kaplan–Meier curves by the number of adverse variables. Figure Figure Interestingly, diagnosis, patient age and type of donor did not affect outcome. These data will allow better prediction of outcome in patients proposed to be treated with this regimen, and suggest that modification of therapy is needed for patients with ≥3 adverse variables to improve survival.

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