Prognostic Factors and Clinical Outcomes in Children and Adolescents With Metastatic Rhabdomyosarcoma—A Report From the Intergroup Rhabdomyosarcoma Study IV

Purpose: To identify risk factors associated with outcomes in children with metastatic rhabdomyosarcoma (RMS) treated on the fourth Intergroup Rhabdomyosarcoma Study (IRS-IV). Patients and Methods: Patients with metastatic RMS were treated with one of two regimens that incorporated a window of either ifosfamide and etoposide (IE) with vincristine, dactinomycin, and cyclophosphamide (VAC) or vincristine, melphalan (VM) and VAC. Study end points were failure-free survival (FFS) and overall survival (OS). Clinical factors including age, histology, sites of primary and metastatic disease, and number of sites of metastatic disease were correlated with those end points. Results: One hundred twenty-seven patients were eligible for analysis. The estimated 3-year OS and FFS for all patients were 39% and 25%, respectively. By univariate analysis, 3-year OS was significantly influenced by histology (47% for embryonal v 34% for all others, P = .026) and increasing number of metastatic sites (P = .028). By multivariate analysis, the presence of two or fewer metastatic sites was the only significant predictor (P = .007 and .006, respectively). The combination of embryonal histology with two or fewer metastatic sites identified a subgroup with 3-year FFS of 40% and OS of 47%. Conclusion: Children with group IV RMS treated on the IRS-IV study had improved OS and FFS if they had two or fewer metastatic sites and embryonal histology. This favorable subset of patients has outcomes approaching those observed in selected patients with localized, nonmetastatic disease. Thus, these patients might not be appropriate candidates for regimens that include experimental agents with substantial toxicities or unproven antitumor activity.

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Prognostic Factors for Thrombosis-Free Survival and Overall Survival in Polycytemia Vera: A Retrospective Analysis of 623 Patients Series with Long Follow-up

Blood ◽

10.1182/blood.v124.21.1855.1855 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1855-1855

Author(s):

Alessandro Andriani ◽

Roberto Latagliata ◽

Michele Cedrone ◽

Ambra Diveroli ◽

Francesca Spirito ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Platelet Count ◽

Prognostic Value ◽

Univariate Analysis ◽

Jak2 V617f ◽

Free Survival ◽

Wbc Count ◽

Spleen Enlargement

Abstract Polycythemia Vera (PV) is a myeloproliferative neoplasm characterized by trilinear marrow expansion and an increased susceptibility to thrombo-embolic complications. Data of 623 patients (pts) followed in 11 Hematological centers of our region from 1978 to December 2010 were collected in our database. The diagnosis was made according to PVSG criteria, WHO 2001 and 2008 criteria, respectively, based on the year of diagnosis. The main epidemiological and clinical features of all pts are reported in table. Of 623 pts, 161( 25,8%) died, 87 (13,9%) were lost to follow up and 375 (73,1%) were alive at the time of evaluation. The median follow up was 8.5 years. The thrombotic events during follow-up were 107 (17,2% of 622 evaluable pts): the arterious events were 67 (10.8%), the venous were 40 (6,4 %). The rate of thrombosis (patients/year) was 1,71 %. At the univariate analysis, the risk factors for thrombosis-free survival (TFS) at diagnosis that resulted statistically significant were: age (> 60 yrs, p= 0,036), WBC (> 10.2 x 109/L, p= 0,034), previous thrombosis (p< 0,0001). The presence of cardiovascular risk factors, Hb (>18.2 g/dL), PLT count (either > 457 x 109/L or >1000 x 109/L), JAK2V617F allele burden > 59.15% and spleen enlargement, did not reach the cut-off value of significance. At multivariate analysis with the Cox proportional hazards model method, age (> 60 yrs, p= 0,049) previous thrombotic events (p< 0.0001) and platelet count < 457 x 106/L (p= 0.019) maintained an independent prognostic value (p< 0,05), while WBC count (> 10.2 x 109/L, p =0,065) did not. The risk factors significant for overall survival (OS) at univariate analysis were: age > 60 yrs (p <0,0001), WBC> 10.2 x 109/L (p< 0,0001), previous thrombosis (p< 0,0001). diabetes (p= 0,0008), platelet count< 457 x 109/L (p= 0.013) and spleen enlargement (p= 0.02); Hb level < 18,2 gr% showed only a trend of significance (p= 0.056), while allele burden of JAK2 > 59.15% and the presence of at least 1 CV risk factor did not reach the cut-off value of significance. At multivariate analysis, age (p< 0,0001), WBC count > 10.2 x 109/L (p< 0,0001), previous thrombosis (p= 0,0004), diabetes (p= 0.0035) and Hb level < 18,2 gr% (p= 0.0078) maintained their independent prognostic value on OS; in contrast platelet count < 457 x 109/L and spleen enlargement lost their prognostic significance. In conclusion our retrospective analysis of a large series of PV confirm the prognostic value of age and previous thrombosis on TFS and OS, while seems to exclude any impact of spleen enlargement and high Hb level. Interesting, PLT count and Hb below median value resulted as independent risk factors for TFS and OS, respectively. Table CARACTERISTICS Evaluable N. VALUE Number of patients 623 Age years: median, (range) 63 (21 - 91) Gender, F/M : number, (%) 289 (46,4) / 334 (53,6) WBC x 109/L: median, (range) 582 10,2 (3.5-37.6) Hb g/dL: median, (range) 580 18,2 (10,5-24,8) Htc ; median, range (%) 581 56 (36-78) Plt x 109/L: median, (range) 587 457 (169-1790) JAK2 V617F : mutated / performed, (%) 386 364/386 (94,3%) JAK2 V617F quantitative (%): median, (range) 252 59,15 (0,3-99,9) Splenomegaly: number, (%) 588 247/588 (42 %) Epatomegaly: number, (%) 606 167/606 (27,5%) Disclosures Breccia: novartis: Consultancy; BMS: Consultancy; Celgene: Consultancy.

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Clinical prognostic factors associated with outcome in renal cell cancer (RCC) patients treated with modified vaccinia ankara plus tumor-associated antigen 5T4 (MVA-5T4).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15545 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15545-e15545

Author(s):

Prasamsa Pandey ◽

Youxin Xiong ◽

Yufeng Zhang ◽

Mika Stepankiw ◽

Robert J. Amato

Keyword(s):

Prognostic Model ◽

Kinase Inhibitors ◽

Univariate Analysis ◽

Cell Cancer ◽

Interleukin 2 ◽

Interferon Α ◽

Clinical Factors ◽

Factors Associated ◽

Phase Ii Studies ◽

Metastatic Sites

e15545 Background: Development of MVA-5T4 as an immunotherapeutic vaccine led to studies demonstrating it is safe and highly immunogenic as a monotherapy or combination (Amato 2008 Clin Cancer Res, Amato 2008 J Immunother, Amato 2009 J Immunother). Antitumor activity has been minimal. We examined identifiable clinical factors to develop a prognostic model to select patients for vaccine immunotherapy. Methods: Clinical data from 3 phase II studies were received for a total of 50 patients treated with MVA-5T4 alone, MVA-5T4 plus interferon-α or MVA-5T4 plus interleukin-2. Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS). Univariate and multivariate analyses were constructed using COX Proportional Hazard model and step-wise procedure. The model was validated by measuring the overall concordance index. Results: For the entire population, median PFS was 3.6 months (range 0.9-42.8 months), and median OS was 12.4 months (range 1.0-45.6 months). Univariate analysis revealed 10 clinical factors associated with PFS and 9 clinical factors associated with OS. Multivariate analysis identified 5 factors associated with PFS benefit (ECOG status ≥1, lymphocytes <25, >2 metastatic sites, neutrophils ≥69, albumin <4) and 6 factors associated with OS benefit (ECOG status ≥1, >2 metastatic sites, neutrophils ≥69, platelets >300, prior treatment with tyrosine kinase inhibitors/immunotherapy, Furham grade of 3/4). The prognostic model was divided into 3 categories. Patients with 0-1 factors (favorable) had a median PFS of 9.4 months and OS of 26.2 months, patients with 2-3 factors (intermediate) had a median PFS of 3.0 months and OS of 9.1 months, and patients with 4+ factors (poor) had a median PFS of 2.0 months and OS of 2.0 months. Conclusions: This analysis identified 7 available clinical factors that can classify patients with mRCC into 3 risk groups with various outcomes. Further validation of this model will identify which patients most likely to respond to MVA-5T4 as well as other vaccines. This will allow for the appropriate application of treatment to patients most likely to benefit.

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Next-Generation Sequencing in Myelodysplastic Syndromes: Prognostic Interaction Between Adverse Mutations and IPSS-R

Blood ◽

10.1182/blood.v128.22.1986.1986 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1986-1986

Author(s):

Naseema Gangat ◽

Terra L. Lasho ◽

Lyla Saeed ◽

Mythri Mudireddy ◽

Mrinal M Patnaik ◽

...

Keyword(s):

Risk Factors ◽

Bone Marrow ◽

Overall Survival ◽

Platelet Count ◽

Lower Risk ◽

Univariate Analysis ◽

Bone Marrow Blast ◽

Free Survival ◽

Clinical Correlates ◽

Generation Sequencing

Abstract Background In a seminal report (NEJM 2011;30:2496), ASXL1, TP53, EZH2, ETV6 and RUNX1 mutations in myelodysplastic syndromes (MDS) were shown to carry an adverse prognostic impact that was independent of the international prognostic scoring system (IPSS) (Blood 1997;89:2079). Two recent studies (Leukemia20 May 2016; doi: 10.1038/leu.2016.138; Leukemia. 2014;28:241) have proposed mutation-enhanced prognostic models that include the revised IPSS (IPSS-R) (Blood 2012;120:2454 ). In the current study, we applied targeted next generation sequencing (NGS) in order to examine the prognostic interaction between adverse mutations and IPSS-R. Methods The study population was recruited from our institutional database of patients with primary MDS, based on availability of archived DNA from the time of diagnosis. The diagnosis of MDS and leukemic transformation (LT) was made according to WHO criteria (Blood. 2009;114:937). Targeted capture assays were carried out, on bone marrow DNA specimens, for the following genes: TET2, DNMT3A, IDH1, IDH2, ASXL1, EZH2, SUZ12, SRSF2, SF3B1, ZRSR2, U2AF1, PTPN11, Tp53, SH2B3, RUNX1, CBL, NRAS, JAK2, CSF3R, FLT3, KIT, CALR, MPL, NPM1, CEBPA, IKZF, and SETBP1.Specific variants were deemed as mutations if they are associated with a hematologic malignancy (as identified by COSMIC database), or if they have not been associated with a dbSNP. Results Patient characteristics and type and number of mutations: 179 patients were evaluated (median age 73 years; 68% males). IPSS-R risk distribution was 11% very high, 18% high, 16% intermediate, 39% low and 16% very low. At least one mutation was seen in 139 (78%) patients including 17% with one mutation, 29% with 2, 20% with 3, 10% with four, 2% with 5 and one patient with 6 mutations. The most frequent mutations were ASXL1 (30%), SF3B1 (20%), TET2 (17%), U2AF1 (16%) and SRSF2 (16%). Mutation clusters and clinical correlates: ASXL1 mutations were associated with the absence of SF3B1 (p=0.007), U2AF1 (p=0.01) and SRSF2 (p=0.003) mutations; SF3B1 with absence of U2AF1 (p=0.004) and SRSF2 (p=0.004) mutations; and U2AF1 with absence of SRSF2 mutations (p=0.01). Clinical correlates of ASXL1 mutations included older age, lower hemoglobin, and lower risk karyotype; SF3B1 with higher leukocyte count, higher platelet count, lower bone marrow blast percentage and lower risk karyotype; TET2 with older age and higher hemoglobin. Univariate overall and leukemia-free survival analysis before and after adjusting for IPSS-R: In univariate analysis, ASXL1, RUNX1 and TP53 mutations adversely and SF3B1 favorably affected survival; only ASXL1 mutations retained significance when analysis was adjusted for IPSS-R (HR 1.5, 95% CI 1.0-2.1; p=0.03). For leukemia-free survival, univariate analysis identified SRSF2, which was near-significant for overall survival (p=0.06), and RUNX1 mutations as adverse and SF3B1 mutations as favorable risk factors; SRSF2 (HR 4.1, 95% CI 1.6-10.2) and SF3B1-unmutated (HR 5.9, 95% CI 1.1-31.5) retained their significance when adjusted for IPSS-R. A borderline significance (p=0.07) indicating inferior survival for patients with three or more mutations was fully accounted for by the significant (P<0.0001) association between the presence of ASXL1 mutations and higher number of mutations. Multivariable analysis with individual IPSS-R variables: When the five IPSS-R variables (hemoglobin, platelets, absolute neutrophil count, bone marrow blast percentage and karyotype) were analyzed (both as continuous and IPSS-R-defined categorical variables) with each one of the aforementioned mutations with significant effect on overall or leukemia-free survival, only ASXL1 retained its significance for overall survival (HR 1.6, 95% CI 1.1-2.3) and SRSF2 (HR 5.2, 95% CI 2.1-13.3) for leukemia-free survival. Other IPSS-R variables that retained their significance for survival, in the presence of ASXL1 mutation status as a covariate, included hemoglobin level, platelet count and karyotype. Conclusions: In our cohort of 179 molecularly-annotated patients with newly-diagnosed primary MDS, ASXL1 and SRSF2 mutations were identified as IPSS-R-independent risk factors for overall and leukemia-free survival, respectively. The current study also suggests the need to re-evaluate currently established risk factors, in the context of prognostically-relevant molecular information. Disclosures No relevant conflicts of interest to declare.

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Proportion and risk factors for death by euthanasia in dogs in the UK

Scientific Reports ◽

10.1038/s41598-021-88342-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Camilla Pegram ◽

Carol Gray ◽

Rowena M. A. Packer ◽

Ysabelle Richards ◽

David B. Church ◽

...

Keyword(s):

Risk Factors ◽

Poor Quality ◽

Clinical Factors ◽

Sampling Frame ◽

Additional Risk ◽

Factors Associated ◽

Regression Modelling ◽

The Uk ◽

Logistic Regression Modelling

AbstractThe loss of a pet can be particularly distressing for owners, whether the method of death is euthanasia or is unassisted. Using primary-care clinical data, this study aimed to report the demographic and clinical factors associated with euthanasia, relative to unassisted death, in dogs. Method of death (euthanasia or unassisted) and clinical cause of death were extracted from a random sample of 29,865 dogs within the VetCompass Programme from a sampling frame of 905,544 dogs under UK veterinary care in 2016. Multivariable logistic regression modelling was used to evaluate associations between risk factors and method of death. Of the confirmed deaths, 26,676 (89.3%) were euthanased and 2,487 (8.3%) died unassisted. After accounting for confounding factors, 6 grouped-level disorders had higher odds in euthanased dogs (than dogs that died unassisted), using neoplasia as the baseline. The disorders with greatest odds included: poor quality of life (OR 16.28), undesirable behaviour (OR 11.36) and spinal cord disorder (OR 6.00). Breed, larger bodyweight and increasing age were additional risk factors for euthanasia. The results highlight that a large majority of owners will face euthanasia decisions and these findings can support veterinarians and owners to better prepare for such an eventuality.

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AN INDIAN PROSPECTIVE STUDY OF DOCETAXEL THERAPY IN CRPC: CAN PRETREATMENT FACTORS PREDICT THE RESPONSE

10.36106/ijsr/6014322 ◽

2021 ◽

pp. 78-81

Author(s):

Devashish Kaushal ◽

Rajeev Sood

Keyword(s):

Overall Survival ◽

Alkaline Phosphatase ◽

Multivariate Analysis ◽

Gleason Score ◽

Univariate Analysis ◽

Progression Free Survival ◽

Castration Resistant Prostate Cancer ◽

Poor Overall Survival ◽

Free Survival ◽

Carcinoma Prostate

Introduction: Studies on the effects of chemotherapy in Indian Castration-Resistant Prostate Cancer (CRPC) patients are very limited and world data is inconsistent. The purpose of the present study is to assess the effects of Docetaxel therapy in CRPC in Indian patients in terms of survival benet, both progression-free survival, and overall survival. This study also analyzes the effects of various factors on the survival of CRPC patients. Methodology: This is a single institutional prospective observational study. CRPC patients were treated with Docetaxel and followed till death as the primary endpoint or till the end of the study. Survivals were calculated with the Kaplan Meier method. Factors affecting survival were analyzed with univariate and multivariate analysis by log-rank t-test and Cox proportion hazard regression analysis. Result: Out of enrolled 101 patients, 78 were treated with Docetaxel. A decline in PSA (>50% reduction) was observed in 61.54%. Radiological response of regression noted in 40 % Nuclear Bone Scan and 19.23% CT/MRI by RECIST criteria. Progression-free survival and overall survival with Docetaxel (n=78) were 11.8 and 21 months respectively. Hemoglobin less than 11 gm%, Alkaline phosphatase more than 115 IU/dl, PSAmore than 14 ng/ml, Gleason score more than 7 and duration from diagnosis of carcinoma prostate to CRPC less than 24 months, the number of chemotherapy cycles less than 6 were all found to be signicantly associated with poor overall survival in univariate analysis while only Hemoglobin (P=0.0159) showed an independent association with overall survival in multivariate analysis. Conclusion: Overall and progression-free survival of CRPC patients with Docetaxel is 21 & 11.8 months respectively. Hemoglobin, Alkaline phosphatase, PSA, Gleason score, Docetaxel cycle, and duration from diagnosis of carcinoma prostate to CRPC were found to be signicantly associated with poor overall survival.

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A retrospective study of primitive neuroectodermal tumor (PNET) of the kidney in a tertiary cancer center in India.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.361 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 361-361

Author(s):

Nandini Sharrel Menon ◽

Devanshi Kalra ◽

Kumar Prabhash ◽

Vanita Noronha ◽

Santosh Menon ◽

...

Keyword(s):

Overall Survival ◽

Retrospective Study ◽

Metastatic Disease ◽

Tumor Size ◽

Progression Free Survival ◽

Adjuvant Radiation ◽

Pathological Feature ◽

Free Survival ◽

Rare Tumours ◽

Multimodality Approach

361 Background: Primitive neuroectodermal tumours (PNET) of the kidney are rare tumours with aggressive behaviour. This study was conducted to review the diagnosis and management of patients with renal PNET at our centre. Methods: This was a retrospective study conducted at a tertiary cancer care centre in Mumbai, India. The demographic and clinical data of 17 patients treated by the uro-oncology services were retrieved from electronic medical records. Descriptive analysis was performed for baseline characteristics.Overall & progression-free survival was determined using the Kaplan Meier method. Cox regression was used for multivariate analysis. Results: There were 12 male and 5 female patients in this cohort with a median age of 27 years. At diagnosis 2 patients had metastatic disease and 15 patients had non-metastatic disease. Median follow up in this cohort was 22 months (range 2-30 months). Presenting complaints were hematuria, abdominal pain, flank pain, fever, bone pain, and incidentally detected renal mass. All patients were Mic -2 positive and 13 were FLI-1 positive on immunohistochemistry. Fourteen patients underwent radical nephrectomy. One (5.9%) patient received both neoadjuvant and adjuvant chemotherapy, 8 (47.1%) received adjuvant and 2 (11.8%) received palliative chemotherapy upfront. Eight patients received adjuvant radiation to the renal bed.There was disease progression in12 patients,10 of 15 patients with non metastatic disease at diagnosis eventually developed metastasis.The median progression free survival (PFS) was 10.55 months.The pathological feature that was associated with a shorter PFS was tumor size ⩾10 cm(p = 0.044).The median overall survival was 20.04 months (95% CI 9.49 -not reached). The presence of metastasis and treatment received significantly impacted overall survival (OS). Median OS in patients with non-metastatic disease was not reached versus 14.1 months in those with metastatic disease (p = .019).The median OS in patients treated with multimodality approach was 20.11 months. Patients did not undergo surgery had a median OS of 5.45 months (p < .001) and those who did not receive any chemotherapy had a median OS of 4.57 months (p = .024).Thus, patients who received multimodality treatment had better outcomes. Conclusions: PNET kidney is an aggressive tumor which should be treated with a multimodality approach. Tumor size ⩾10 cm was an adverse prognostic factor.

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Risk Factors for Community Acquired Extended-Spectrum Β-lactamase (ESBL) Producing Enterobacteriaceae Urinary Tract Infections (UTIs)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.827 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S345-S345

Author(s):

Dheeraj Goyal ◽

Kristin Dascomb ◽

Peter S Jones ◽

Bert K Lopansri

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Catheter ◽

Univariate Analysis ◽

Prior History ◽

Factors Associated ◽

Extended Spectrum ◽

History Of ◽

Enterobacteriaceae Infections ◽

Tract Infections

Abstract Background Community-acquired extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infections pose unique treatment challenges. Identifying risk factors associated with ESBL Enterobacteriaceae infections outside of prior colonization is important for empiric management in an era of antimicrobial stewardship. Methods We randomly selected 251 adult inpatients admitted to an Intermountain healthcare facility in Utah with an ESBL Enterobacteriaceae urinary tract infection (UTI) between January 1, 2001 and January 1, 2016. 1:1 matched controls had UTI at admission with Enterobacteriaceae but did not produce ESBL. UTI at admission was defined as urine culture positive for > 100,000 colony forming units per milliliter (cfu/mL) of Enterobacteriaceae and positive symptoms within 7 days prior or 2 days after admission. Repeated UTI was defined as more than 3 episodes of UTI within 12 months preceding index hospitalization. Cases with prior history of ESBL Enterobacteriaceae UTIs or another hospitalization three months preceding the index admission were excluded. Univariate and multiple logistic regression techniques were used to identify the risk factors associated with first episode of ESBL Enterobacteriaceae UTI at the time of hospitalization. Results In univariate analysis, history of repeated UTIs, neurogenic bladder, presence of a urinary catheter at time of admission, and prior exposure to outpatient antibiotics within past one month were found to be significantly associated with ESBL Enterobacteriaceae UTIs. When controlling for age differences, severity of illness and co-morbid conditions, history of repeated UTIs (adjusted odds ratio (AOR) 6.76, 95% confidence interval (CI) 3.60–13.41), presence of a urinary catheter at admission (AOR 2.75, 95% CI 1.25 – 6.24) and prior antibiotic exposure (AOR: 8.50, 95% CI: 3.09 – 30.13) remained significantly associated with development of new ESBL Enterobacteriaceae UTIs. Conclusion Patients in the community with urinary catheters, history of recurrent UTIs, or recent antimicrobial use can develop de novo ESBL Enterobacteriaceae UTIs. Disclosures All authors: No reported disclosures.

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Clinical Impact of Additional Cytogenetic Aberrations, cKIT and RAS Mutations, and Treatment Elements in Pediatric t(8;21)-AML: Results From an International Retrospective Study by the International Berlin-Frankfurt-Münster Study Group

Journal of Clinical Oncology ◽

10.1200/jco.2015.61.1947 ◽

2015 ◽

Vol 33 (36) ◽

pp. 4247-4258 ◽

Cited By ~ 35

Author(s):

Kim Klein ◽

Gertjan Kaspers ◽

Christine J. Harrison ◽

H. Berna Beverloo ◽

Ardine Reedijk ◽

...

Keyword(s):

Overall Survival ◽

Complete Remission ◽

Pediatric Patients ◽

Lower Probability ◽

Event Free Survival ◽

End Points ◽

Free Survival ◽

Ras Mutations ◽

Cytogenetic Aberrations ◽

High Doses

Purpose This retrospective cohort study aimed to determine the predictive relevance of clinical characteristics, additional cytogenetic aberrations, and cKIT and RAS mutations, as well as to evaluate whether specific treatment elements were associated with outcomes in pediatric t(8;21)-positive patients with acute myeloid leukemia (AML). Patients and Methods Karyotypes of 916 pediatric patients with t(8;21)-AML were reviewed for the presence of additional cytogenetic aberrations, and 228 samples were screened for presence of cKIT and RAS mutations. Multivariable regression models were used to assess the relevance of anthracyclines, cytarabine, and etoposide during induction and overall treatment. End points were the probability of achieving complete remission, cumulative incidence of relapse (CIR), probability of event-free survival, and probability of overall survival. Results Of 838 patients included in final analyses, 92% achieved complete remission. The 5-year overall survival, event-free survival, and CIR were 74%, 58%, and 26%, respectively. cKIT mutations and RAS mutations were not significantly associated with outcome. Patients with deletions of chromosome arm 9q [del(9q); n = 104] had a lower probability of complete remission (P = .01). Gain of chromosome 4 (+4; n = 21) was associated with inferior CIR and survival (P < .01). Anthracycline doses greater than 150 mg/m2 and etoposide doses greater than 500 mg/m2 in the first induction course and high-dose cytarabine 3 g/m2 during induction were associated with better outcomes on various end points. Cumulative doses of cytarabine greater than 30 g/m2 and etoposide greater than 1,500 mg/m2 were associated with lower CIR rates and better probability of event-free survival. Conclusion Pediatric patients with t(8;21)-AML and additional del(9q) or additional +4 might not be considered at good risk. Patients with t(8;21)-AML likely benefit from protocols that have high doses of anthracyclines, etoposide, and cytarabine during induction, as well as from protocols comprising cumulative high doses of cytarabine and etoposide.

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Language Delay Is Not Predictable from Available Risk Factors

The Scientific World JOURNAL ◽

10.1155/2013/947018 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Philip Wilson ◽

Fiona McQuaige ◽

Lucy Thompson ◽

Alex McConnachie

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Positive Predictive Value ◽

Predictive Value ◽

Univariate Analysis ◽

Male Gender ◽

Language Delay ◽

Predictive Capacity ◽

Factors Associated ◽

Health Visitors

Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families.Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed.Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant.Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families.

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