Clinical characteristics and course of chronic lymphocytic leukemia patients with the combination favorable and unfavorable cytogenetics

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8086-8086
Author(s):  
R. R. Harting ◽  
P. Venugopal ◽  
W. Hsu ◽  
R. Catchatourian ◽  
O. Ogundipe
Keyword(s):  
Median Survival ◽  
Chart Review ◽  
Historical Data ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Lymphocytic Leukemia ◽  
Stage Disease ◽  
Genetic Abnormalities ◽  
Genomic Aberrations

8086 Background: Patients with CLL have a highly variable clinical course. Genomic aberrations detected by FISH have been shown to correlate with survival and treatment free interval (TFI). Patients with the presence of 17p or 11q deletions (del) either alone or in combination with other cytogenetic abnormalities have the worst prognosis while patients with 13q del as a sole abnormality have the best prognosis. Our objective was to further investigate poor prognosis CLL patients with either del 17p or 11q to determine if the addition of the favorable 13q del influences the predicted clinical course and survival. Methods: We performed a retrospective chart review on 22 patients (pts) who had been identified by FISH as having either the combination of del 17p and 13q or del 11q and 13q. Results: 128 CLL FISH panels were performed from April of 2003 through October of 2006. Twenty-two pts (17%) had either del 17p and 13q (9%) or del 11q and 13q (9%). Historical data notes a frequency of 7% and 8% for deletions 17p and 11q, respectively, and 55% for 13q as a sole aberration. The median age was 66 yrs, the majority of whom were male (73%). Two of 22 pts (9%) presented with advanced stage disease. Splenomegaly was seen more often in the 17p/13q pts (36%) vs 11q/13q pts (9%). With a median follow up of 46 months since diagnosis, the median TFI for all patients (20 known) was 56 months. TFI was 13 months for patients with 17p/13q del; whereas TFI was not reached for patients with 11q/13q. Historical data noted a TFI for patients with deletions 17p, 11q, and 13q (as a sole aberration) as 9, 13, and 92 months respectively. The median survival from diagnosis was not reached for the group overall or for either combination of genetic abnormalities. Historical data noted, with 70 months follow up, a median survival of 108 months overall and 32, 79, and 133 months for 17p, 11q, and 13q (as a sole aberration) respectively. Conclusions: The addition of favorable cytogenetics, del 13q, in a CLL patient with an unfavorable cytogenetic pattern (either del 17p or del 11q) appears to improve the predicted clinical outcome and survival. Additional follow up and prospective studies are needed to further define which genetic subgroups help to prognosticate CLL patients. No significant financial relationships to disclose.

ZAP-70 Expression, VH-Mutation Status, Genomic Aberrations and Prognosis in Chronic Lymphocytic Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1920-1920 ◽  
Author(s):  
Alexander Kröber ◽  
Dirk Kienle ◽  
Dirk Winkler ◽  
Andreas Bühler ◽  
Till Seiler ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Gene Rearrangement ◽  
Progressive Disease ◽  
Clinical Course ◽  
Surrogate Marker ◽  
Lymphocytic Leukemia ◽  
Mutation Status ◽  
Free Survival ◽  
Genomic Aberrations

Abstract The VH status is a strong prognostic marker in chronic lymphocytic leukemia (CLL). ZAP-70, a zeta associated tyrosine kinase physiologically expressed by T-cells, is overexpressed in VH unmutated CLL and could therefore serve as a surrogate marker for the VH status. We analyzed ZAP-70 expression (n=96), the VH status (n=75) and genomic aberrations (n=84) in a single center CLL cohort to study associations among these parameters and to assess their relative prognostic value. ZAP-70 expression was measured by 4-colour flow cytometry (CD5, CD19, CD3/56, ZAP-70) applying an unconjugated anti-ZAP-70-antibody (Upstate, clone 2F3.2) according to Crespo et al., NEJM 2003. ZAP-70 expression was positive (cut-off 20%) in 67% and negative in 33% of cases. VH was mutated in 33% and unmutated in 67% of cases. Unfavorable genomic aberrations (17p−, 11q−) were more frequently observed in cases with unmutated VH (46 vs. 9%) and in ZAP-70 positive cases (39 vs. 20%), while favorable genomic aberrations (13q− as single aberration) occurred more frequently in VH mutated (48 vs. 17%) and ZAP-70 negative subgroups (50 vs. 18%). ZAP-70 expression predicted the VH status in 84% of cases. At a median follow up time of 47 months (m), the median treatment free survival (TFS) of ZAP-70 positive and negative cases was 31 and 86 m (p=.057). The median TFS of the VH unmutated and VH mutated subgroups were 24 and 172 m (p<.001). Within the follow up time 10 deaths occurred. Of these, 8 cases exhibited high ZAP-70 expression and an unmutated VH, whereas 2 cases showed discordant results. Overall, discordant results for ZAP-70 expression and VH status were identified in 12 cases (ZAP-70 positive/VH mutated, 8 cases; ZAP-70 negative/VH unmutated, 4 cases). Of the 8 VH mutated cases with high ZAP-70 expression, only 1 case exhibited unfavorable genomic aberrations, 4 remained in stable disease, 4 developed progressive disease, 3 patients required therapy, and 1 of these 3 died within follow up time. Two of the 3 patients who required therapy, including the patient who died, showed a mutated V3-21 gene rearrangement, associated with an unfavorable outcome. Among the 4 cases with an unmutated VH and low ZAP-70 expression, 2 cases exhibited unfavorable genomic aberrations, 3 cases required therapy, 1 of these 3 died, and for one patient no clinical data were available. In summary, the imbalanced distribution of high risk genomic aberrations was similar when comparing the subgroups according to ZAP-70 expression and VH status. In our series an unmutated VH status predicted for shorter TFS, whereas high ZAP-70 expression did not reach significance. ZAP-70 expression was associated with unmutated VH, but a substantial number of cases showed discordant results for ZAP-70 expression and VH status. The pattern of genomic aberrations and the clinical course of the discordant cases were typical for their respective VH status. Compared to ZAP-70 expression the VH status appeared to be more informative in the prediction of the clinical course in our series of CLL patients.

Complex Karyotype in Patients with Chronic Lymphocytic Leukemia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4989-4989
Author(s):  
Lucrecia Yañez ◽  
Maria Angeles Cuadrado ◽  
Andres Insunza ◽  
Belen Gonzalez Mesones ◽  
Arancha Bermudez ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Median Survival ◽  
Chromosome Abnormalities ◽  
Lymphocytic Leukemia ◽  
Complex Karyotype ◽  
Cellular Expression ◽  
Clinical Stages ◽  
Trisomy 12 ◽  
Genomic Aberrations

Abstract Chronic Lymphocytic Leukemia (CLL) is heterogeneous and there are two clinical forms with different outcome, in which initial stage and parameters of tumor burden, expression of CD38 and /or ZAP 70, chromosome abnormalities such as 11q23 and 17p13 are associated with a more aggressive course of disease. The aim of this study is to analyse clinical and biological characteristics and outcome of patients with complex karyotype, and to asses if there are differences with other genomic aberrations. Fifty patients diagnosed of CLL between 1980 and 1994 were studied (median age: 71 yrs; female/male: 18/32; median follow up 6.6 yrs.). Biological studies with flow cytometry and fluorescence in situ hybridization were done on cryopreserved blood cells. Clinical stages at diagnosis were: Rai stage 0: 56%; I: 20%; II: 16%; III: 6%; IV: 2%. Binet A: 72%; B: 20%; C: 8%. At the time of diagnosis 37% of patients needed treatment and 61% presented disease progression. At the time of this study, 10% of patients are alive with a median follow up of 15.3 yrs. Seven patients (28%) presented complex karyotype. At the time of diagnosis 43% patients needed treatment and clinical stages were: Rai stage O: 29%, I: 14%, II: 43%, III: 14%, IV: 0%. Binet A: 43%; B: 43%; C: 14%. Median overall median survival was 72 months. The most frequent genomic aberrations associated with complex karyotype were: del (17p13) and trisomy 12 (60 %). Cellular expression of CD38 and ZAP 70 was not able to separate this group. Compared with other chromosome abnormalities, there were not important differences in clinical stage at diagnosis or expression of CD38 or ZAP 70, but overall median survival could distinguish three groups: del 11q22-23 or del 17p13 (34 months, p &lt; 0,05) complex karyotype (72 months), and trisomy 12 or del 13q14 (79 months, p &gt; 0,05). In conclusion, complex karyotype is frequently formed by del 17p13 and trisomy 12 and identifies a subgroup of patients with better prognosis compared with isolated p53 deletion. More studies have to be realized to determine if trisomy 12 is a cell defence mechanism.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

scholarly journals 59. Persistence of Respiratory and Non-respiratory Symptoms Among COVID-19 Patients Seeking Care at an Ambulatory COVID-19 Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Aditi Ramakrishnan ◽  
Jennifer Zreloff ◽  
Miranda Moore ◽  
Sharon H Bergquist ◽  
Michele Cellai ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Chart Review ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Illness Onset ◽  
Persistent Symptoms ◽  
Emory University ◽  
Ambulatory Patients ◽  
Three Stages ◽  
Taste Alteration

Abstract Background While hospitalized COVID-19 patients are well described in the literature, studies of the natural history and ambulatory cases are limited. We aim to describe the symptoms and clinical course of COVID-19 among ambulatory patients seen at the Emory University multidisciplinary Acute Respiratory Clinic (ARC) developed to care for patients with confirmed or suspected COVID-19. Methods PCR-confirmed COVID-19 cases seen at ARC from 4/3–5/16/2020 were included in a retrospective chart review. Encounters were classified as acute, subacute, or convalescent depending on the duration since illness onset (&lt; 1, 1–4, or &gt;4 weeks, respectively). Demographic, clinical, physical exam, diagnostic test, and disposition data were abstracted and analyzed with standard descriptive statistics. Results Among 404 visits at ARC, 127 (31.4%) were for confirmed COVID-19 illness (107 unique patients with 1–4 visits). The majority (75.7%) of patients were female, and the median age was 55 years (range 24–89). Patients presented during acute, subacute, and convalescent phases of illness (15.7%, 58.3%, and 26.0%, respectively; Table). Prevalent co-morbidities included hypertension (39.3%), obesity (27.1%), diabetes (20.6%), and asthma (21.5%). While measured or subjective fever was reported in the majority of acute visits (60.0%), it was less common in subacute and convalescent encounters (27.0% and 30.3%). Cough was commonly reported in acute, subacute, and convalescent visits (70.0%, 79.7%, 66.7%), as were dyspnea on exertion (45.0%, 70.3%, 66.7%) and chest tightness (40.0%, 40.5%, 60.6%). Although smell or taste alteration was present in almost half of acute and subacute patients, it was only reported in a quarter of convalescent patients. Among the three stages of illness, transfers from ARC to the ED or direct hospitalizations occurred in 15.0%, 23.0%, and 12.1% of acute, subacute and convalescent visits, respectively. Table Timecourse of Symptoms among COVID-19 Patients in the Ambulatory Context Conclusion Following acute illness, COVID-19 patients can experience persistent symptoms, primarily respiratory symptoms, which can be severe enough to warrant hospitalization. Clinics evaluating recovering patients should prepare to manage these symptoms. Further study of the pathophysiology and treatment of persistent pulmonary symptoms in COVID-19 is needed. Disclosures All Authors: No reported disclosures

Kasai Procedure in Patients Older Than 90 Days: Worth a Cut

2021 ◽  
Author(s):  
Marie Uecker ◽  
Joachim F. Kuebler ◽  
Nagoud Schukfeh ◽  
Eva-Doreen Pfister ◽  
Ulrich Baumann ◽  
...  
Keyword(s):  
Treatment Option ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Treatment ◽  
Inclusion Criteria ◽  
Bridge To Transplant ◽  
Kasai Procedure ◽  
Native Liver ◽  
Native Liver Survival

Abstract Introduction Age at Kasai portoenterostomy (KPE) has been identified as a predictive factor for native-liver survival in patients with biliary atresia (BA). Outcomes of pediatric liver transplantation (LT) have improved over recent years. It has been proposed to consider primary LT as a treatment option for late-presenting BA infants instead of attempting KPE. We present our experience with patients older than 90 days undergoing KPE. Materials and Methods A retrospective chart review of patients with BA undergoing KPE at our institution between January 2010 and December 2020 was performed. Patients 90 days and older at the time of surgery were included. Patients' characteristics, perioperative data, and follow-up results were collected. Eleven patients matched the inclusion criteria. Mean age at KPE was 108 days (range: 90–133 days). Results Postoperative jaundice clearance (bilirubin < 2 mg/dL) at 2-year follow-up was achieved in three patients (27%). Eight patients (73%) received a liver transplant at a mean of 626 days (range: 57–2,109 days) after KPE. Four patients (36%) were transplanted within 12 months post-KPE. Two patients died 237 and 139 days after KPE due to disease-related complications. One patient is still alive with his native liver, currently 10 years old. Conclusion Even when performed at an advanced age, KPE can help prolong native-liver survival in BA patients and offers an important bridge to transplant. In our opinion, it continues to represent a viable primary treatment option for late-presenting infants with BA.

Cofactors of Pediatric Tinnitus: A Look at the Whole Picture

2018 ◽  
Vol 58 (3) ◽  
pp. 320-327
Author(s):  
Jessica Levi ◽  
Krystyne Basa ◽  
Kevin Wong ◽  
Thierry Morlet ◽  
Robert O’Reilly
Keyword(s):  
General Population ◽  
Otitis Media ◽  
Chart Review ◽  
Noise Exposure ◽  
Historical Data ◽  
Age Distribution ◽  
Retrospective Chart Review ◽  
Psychiatric Diagnoses ◽  
Laboratory Results ◽  
Tube Dysfunction

Retrospective chart review of 248 children (1-19 years old) with tinnitus who presented to a tertiary pediatric hospital between 2006 and 2011, looking at which cofactors are predictors of pediatric tinnitus. In our review, we extracted demographics, symptoms, historical data, imaging, and laboratory results; we compared with the general population. Eighty-seven percent had normal hearing. Age distribution, noise exposure, and frequency of psychiatric diagnoses in our cohort were consistent with previous reports. We found a lower incidence of otitis media and the same prevalence of dizziness, asthma, and hearing loss as the general population, a lower prevalence of Eustachian tube dysfunction, otitis media, headaches, and higher incidence of rhinosinusitis. Lack of patient reporting and objective testing complicate the ability to detect pediatric tinnitus. We revealed a gap in the literature regarding rhinosinusitis as a cofactor, imaging during diagnosis, and if psychiatric diagnoses are associated with tinnitus in younger children.

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

scholarly journals Unpacking Loss to Follow-Up Among HIV-Infected Women Initiated on Option B+ In Northern Tanzania: A Retrospective Chart Review

2019 ◽  
Vol 3 (1) ◽  
pp. 6-15
Author(s):  
Festo Mazuguni ◽  
Boaz Mwaikugile ◽  
Cody Cichowitz ◽  
Melissa Watt ◽  
Amasha Mwanamsangu ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Loss To Follow Up ◽  
Northern Tanzania

Cochlear Implantation in the Elderly: Results and Quality-of-Life Assessment

2002 ◽  
Vol 111 (10) ◽  
pp. 890-895 ◽  
Author(s):  
Hamid R. Djalilian ◽  
Sharon L. Smith ◽  
Timothy A. King ◽  
Samuel C. Levine
Keyword(s):  
Quality Of Life ◽  
Complication Rate ◽  
Cochlear Implantation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Life Assessment ◽  
Test Results

To assess the efficacy, quality of life, and complication rate of cochlear implantation in patients over 60 years of age, we performed a retrospective chart review of 31 cochlear implant patients more than 60 years old at the time of surgery (mean, 70 years; range, 62 to 86 years). All patients had improvement in their audiological test results after operation. Twenty-eight patients (93%) are regular implant users at a median follow-up of 12 months. Major complications occurred in 2 patients (6%). We conclude that cochlear implantation in the elderly population has excellent results, with a complication rate similar to that in patients less than 60 years old, and yields an improved quality of life.

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