Advanced stage, elevated LDH, primary sites, but not adolescent (A) age (≥ 15 years) as risk factors for disease progression in childhood (C) and adolescent (A) mature B-NHL: Report of the FAB/LMB 96 international trial

10032 Background: We recently reported the results in C & A with low risk (group A), intermediate risk (group B) and high risk (group C) mature B-NHL treated on FAB/LMB 96 (Gerrard et al, Br J Haematol, 2008; Patte et al, Blood, 2007; Cairo et al, Blood, 2007, respectively). Adolescent age (15–21 yrs) has historically been considered to be an independent risk factor for poor outcome in subsets of mature B-NHL (Hochberg/Cairo et al, Br J Haematol, 2008; Burkhardt et al, Br J Haematol 2005; Cairo et al, Br J Haematol, 2003). Methods: We analyzed the EFS of all pts treated on FAB/LMB 96 and the following risk factors were significant in a univariate and Cox multivariate analysis: age (<15 vs ≥15 yrs), stage I/II vs III/IV, primary sites, LDH <2 vs ≥2 NL and histology (DLBCL vs BL/BLL). Results: 1111 pts (15%, 15–21 years) were treated with group A (N = 132), group B (N = 744), and group C (N = 235) therapy. Five year EFS (CI95) for all, A, B, C pts was 86% (84%,88%), 98% (93%, 100%), 87%% (84%, 89%), and 79%% (73%,84%), respectively. Age (≥15 yrs), LDH ≥2NL, stage III/IV, and BM+/CNS+ and histology were significant univariate risk factors for decreased EFS (P<0.045, <0.0001, <0.0001, <0.0001, and <0.0001 respectively). Multivariate analysis demonstrated age ≥15 yrs and DLBCL histology were no longer independent significant risk factors (p = .82 and 0.08, respectively), but LDH (RR 2.0, p = .001), stage III/IV (RR 3.8, p<0.001), and primary sites including PMBL (RR 4.0, p<.001) and BM+/CNS+ (RR 2.8, p<0.001) were independent significant risk factors for poorer outcome. Conclusions: With the use of modern short but intense FAB-LMB 96 therapy, adolescent age is no longer a poor risk factor in children with mature B-NHL. The independent risk factors identified in this study (stage, LDH, primary site) for decreased EFS in C & A mature B-NHL will form the basis of the next risk adapted international pediatric mature B-NHL trial. No significant financial relationships to disclose.

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Risk factors for delayed and non-union following transfibular ankle arthrodesis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210526 ◽

2021 ◽

Vol 7 (2) ◽

pp. 199

Author(s):

Hyeon Soo Kim ◽

Sung Jin Shin ◽

Jin Woo Kim

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ankle Joint ◽

Significant Risk ◽

Significant Risk Factor ◽

Ankle Arthrodesis ◽

Delayed Union ◽

Non Union ◽

Group A ◽

Group B

Background: This study was to identify risk factors associated with delayed union and non-union in patients who underwent transfibular ankle arthrodesis.Methods: This study included 43 patients who underwent ankle arthrodesis using transfibular approach between January 2012 and September 2018 and were followed up for more than 12 months. The patients were divided into two groups according to delayed union or non-union. Group A included patients who had delayed union or non-union and Group B included patients without these complications. Variables that could contribute to non-union including etiologies, age, chronic renal failure, hypertension, diabetes, smoking, pre-operative talus bone quality, pre-operative angulation of the talus and fixation methods were evaluated.Results: The mean time to bone union was 12.7±7.25 weeks. Group A included 12 patients with 5 cases of non-union and 7 cases of delayed union and group B included 31 patients. Infection of the ankle joint (OR, 1.73; p=0.041) was risk factor for non-union and delayed union on the basis of multivariate analysis.Conclusions: We concluded that infection of the ankle joint is the most significant risk factor for delayed union and nonunion in our study. Careful attention should be paid preoperatively, intraoperatively and postoperatively to patients who have this risk factor to obtain a satisfactory surgical outcome.

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Risk factors for mortality in children with Wilms tumor

Paediatrica Indonesiana ◽

10.14238/pi56.4.2016.226-9 ◽

2016 ◽

Vol 56 (4) ◽

pp. 226

Author(s):

Yuni Purwanti ◽

Sutaryo Sutaryo ◽

Sri Mulatsih ◽

Pungky Ardani Kusuma

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Wilms Tumor ◽

Significant Risk ◽

Significant Risk Factor ◽

Stage Iii ◽

Control Group ◽

Case Group ◽

Chi Square ◽

Potential Risk Factors

Background Wilms tumor is the most common renal malignancy in children (95%) and one of the leading causes of death in children, with high mortality rates in developing countries. Identifying risk factors for mortality is important in order to provide early intervention to improve cure rates.Objective To identify risk factors for mortality in children with Wilms tumor.Methods We performed a case-control study of children (0-18 years of age) with Wilms tumor admitted to Dr. Sardjito Hospital between 2005 and 2012. The case group consisted of children who died of Wilms tumor, whereas the control group were children who survived. Data were collected from medical records. Statistical analyses using Chi-square and logistic regression tests were done to determine odds ratios and 95% CI of the potential risk factors for mortality from Wilms tumor.Results Thirty-five children with Wilms tumor were admitted to Dr. Sardjito Hospital during the study period. Nine (26%) children died and 26 survived. Stage ≥III was a significant risk factor for mortality in chidren with Wilms tumor (OR 62.8; 95%CI 5.6 to 70.5). Age ≥2 years (OR 1.4; 95%CI 0.1 to 14.3) and male sex (OR 1.2; 95%CI 0.1 to 10.8) were not significant risk factors for mortality.Conclusion Stage ≥III is a risk factor for mortality in children with Wilms tumor.

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A risk-factor analysis of medical litigation judgments related to fall injuries in Korea

Medicine Science and the Law ◽

10.1177/0025802417735265 ◽

2017 ◽

Vol 58 (1) ◽

pp. 16-24

Author(s):

Insook Kim ◽

Seonae Won ◽

Mijin Lee ◽

Won Lee

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Environmental Factors ◽

Fall Prevention ◽

Systems Approach ◽

Risk Group ◽

Past History ◽

High Risk Group ◽

Fall Injuries

The aim of this study was to find out the risk factors through analysis of seven medical malpractice judgments related to fall injuries. The risk factors were analysed by using the framework that approaches falls from a systems perspective and comprised people, organisational or environmental factors, with each factor being comprised of subfactors. The risk factors found in each of the seven judgments were aggregated into one framework. The risk factors related to patients (i.e. the people factor) were age, pain, related disease, activities and functional status, urination state, cognitive function impairment, past history of fall, blood transfusion, sleep endoscopy state and uncooperative attitude. The risk factors related to the medical staff and caregivers (i.e. people factor) were observation negligence, no fall prevention activities and negligence in managing high-risk group for fall. Organisational risk factors were a lack of workforce, a lack of training, neglecting the management of the high-risk group, neglecting the management of caregivers and the absence of a fall prevention procedure. Regarding the environment, the risk factors were found to be the emergency room, chairs without a backrest and the examination table. Identifying risk factors is essential for preventing fall accidents, since falls are preventable patient-safety incidents. Falls do not happen as a result of a single risk factor. Therefore, a systems approach is effective to identify risk factors, especially organisational and environmental factors.

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Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach?

Perfusion ◽

10.1177/0267659119827231 ◽

2019 ◽

Vol 34 (6) ◽

pp. 453-459 ◽

Cited By ~ 6

Author(s):

Tim Kaufeld ◽

Eric Beckmann ◽

Fabio Ius ◽

Nurbol Koigeldiev ◽

Wiebke Sommer ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Extracorporeal Membrane Oxygenation ◽

Limb Ischemia ◽

Distal Limb ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Limb Perfusion ◽

Group A ◽

Group B

Background: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique. Both techniques may obstruct the blood flow to the lower limb and may cause a significant ischemia with possible limb loss. Malperfusion of the distal limb can be avoided using an ipsilateral distal limb perfusion, which may be established by adding a single-lumen catheter during venoarterial extracorporeal membrane oxygenation treatment to overcome the obstruction. The aim of this study is to distinguish the presence or absence of a distal limb perfusion regarding the incidence of distal limb ischemia. Furthermore, expected risk factors of open and percutaneous femoral venoarterial extracorporeal membrane oxygenation installation were evaluated for the development of distal limb ischemia. Methods: Between January 2012 and September 2015, 489 patients received venoarterial extracorporeal membrane oxygenation support at our institution. In total, 307 patients (204 male, 103 female) with femoral cannulation were included in the analysis. The cohort was distinguished by the presence (group A; n = 237) or absence (group B; n = 70) of a distal limb perfusion during peripheral venoarterial extracorporeal membrane oxygenation treatment. Furthermore, a risk factor analysis for the development of distal limb ischemia was performed. Results: The main indications for venoarterial extracorporeal membrane oxygenation therapy were a low cardiac output syndrome (LCOS) (53%) and failed weaning of extracorporeal circulation (23%). A total of 23 patients (7.49%) under venoarterial extracorporeal membrane oxygenation support developed severe distal limb malperfusion (3.38% in group A vs 21.42% in group B). Preemptive installation of distal limb perfusion extended the intervention-free intervals to 7.8 ± 19.3 days in group A and 6.3 ± 12.5 in group B. A missing distal limb perfusion (p = 0.001) was identified as a main risk factor for critical limb ischemia. Other comorbidities such as arterial occlusion disease (p = 0.738) were not statistically significantly associated. Surgical intervention due to vascular complications after extracorporeal membrane oxygenation explantation was needed in 14 cases (4.22% in group A and 5.71% in group B). Conclusion: We were able to identify the absence of distal limb perfusion as an independent risk factor for the development of critical distal limb ischemia during femoral venoarterial extracorporeal membrane oxygenation treatment. The application of a distal limb perfusion should be considered as a mandatory approach in the context of femoral venoarterial extracorporeal membrane oxygenation treatment regardless of the implantation technique.

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Multiple Factor Analysis of Symptomatic Intracranial Arterial Stenosis

Translational Neuroscience and Clinics ◽

10.18679/cn11-6030_r.2017.011 ◽

2017 ◽

Vol 3 (2) ◽

pp. 84-89

Author(s):

Chuanqiang Qu ◽

Yuanyuan Zhao ◽

Qinjian Sun ◽

Yifeng Du

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Protective Factor ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis ◽

Group A ◽

Group B

Objective To discuss the correlation among intracranial arterial stenosis and its risk factors. Methods A total of 486 patients with transient ischemic attack (TIA) or ischemic cerebral infarction were examined using color doppler flow imaging (CDFI) and transcranial doppler ultrosonography (TCD). According to the degrees of extracranial arterial stenosis, patients with mild-to-moderate extracranial stenosis were classified into group A (435 cases) while those with constant severe stenosis or occlusion were classified into group B (51 cases). The differences between the two groups of risk factors were compared, and the multi-factor logistic regression analysis of risk factors associated with moderately severe intracranial arterial stenosis was performed. Results ① The risk factors that were significantly associated with intracranial arterial stenosis included age (P = 0.034) and gender (P = 0.044). ② Intracranial artery stenosis was observed in both anterior and posterior cerebral arteries in patients with hypertension, diabetes, and coronary heart disease respectively (P < 0.05). ③ Compared with group A, patients in group B were older (P = 0.000), with a higher proportion of men (P = 0.037), and the intracranial arterial stenosis degrees were significantly higher (P = 0.013). ④ Multi-factor logistic regression analysis showed that diabetes is a risk factor for moderately severe intracranial arterial stenosis (P < 0.05), and hyperlipidemia is a protective factor (P = 0.012). Conclusions Age, gender, hypertension, diabetes, coronary heart disease, and smoking are risk factors for the distribution of intracranial arterial stenosis. The degrees of intracranial arterial stenosis are related with extracranial arterial stenosis. Diabetes is a risk factor for moderately severe intracranial arterial stenosis while hyperlipidemia is a protective factor.

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Risk Factors for Silent Cerebral Infarcts in a Pediatric Sickle Cell Anemia (SCA) Cohort

Blood ◽

10.1182/blood.v112.11.2487.2487 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2487-2487 ◽

Cited By ~ 1

Author(s):

Francoise Bernaudin ◽

Suzanne Verlhac ◽

Annie Kamdem ◽

Cécile Arnaud ◽

Lena Coïc ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Logistic Regression Analysis ◽

G6pd Deficiency ◽

Significant Risk ◽

Significant Risk Factor ◽

History Of ◽

Independent Risk Factors

Abstract Background Silent infarcts are associated with impaired cognitive functioning and have been shown to be predictors of stroke (Miller ST J Pediatr 2001). Until now, reported risk factors for silent infarcts were low pain event rate, history of seizures, high leukocyte count and Sen bS haplotype (Kinney TR Pediatrics 1999). Here, we seek to define the prevalence and risk factors of silent infarcts in the Créteil SCA pediatric cohort comprising patients assessed at least yearly by transcranial doppler (TCD) since 1992, and by MRI/MRA. Methods This study retrospectively analyzed data from the Créteil cohort stroke-free SS/Sb0 children (280; 134 F, 146 M), according to institutional review board. Time-averaged mean of maximum velocities higher than 200 cm/sec were considered as abnormal, resulting in initiation of a transfusion program (TP). A switch to hydroxyurea was proposed to patients with normalized velocities (< 170 cm/sec) and normal MRA on TP, although TP was re-initiated in case of abnormal velocities recurrence. Patients with “conditional” velocities (170–199 cm/sec) were assessed by TCD 4 times yearly. Alpha genes and beta-globin haplotypes were determined. Baseline biological parameters (G6PD activity; WBC, PMN, Reticulocytes, Platelets counts; Hemoglobin, Hematocrit, HbF, LDH levels; MCV; SpO2) were obtained a minimum of 3 months away from a transfusion, one month from a painful episode, after 12 months of age, before the first TCD, and always before therapy intensification. Results. Patients were followed for a total of 2139 patient-years. Alpha-Thal was present in 114/254 patients (45%) and 27/241 (11.2%) had G6PD deficiency. Beta genotype, available in 240 patients, was BaBa in 102 (42.5%), BeBe in 54 (22.5%), SeSe in 19 (7.9%) and “other” in 65 (27.1%); TCD was abnormal in 52 of 280 patients (18.6%). MRA showed stenoses in 30 of 226 evaluated patients (13.3%) while MRI demonstrated presence of silent infarcts in 81/280 patients (28.9%). Abnormal TCD (p<0.001), G6PD deficiency (p=0.008), high LDH (p=0.03), and low Hb (p=0.026) were significant risk factors for stenoses by univariate analysis while multivariate analysis retained only abnormal TCD as a significant risk factor for stenoses ([OR= 10.6, 95% CI (4.6–24.4)]; p<0.001). Univariate logistic regression analysis showed that the risk of silent infarcts was not related to alpha-Thal, beta genotype, abnormal TCD, WBC, PMN, platelets, reticulocyte counts, MCV, LDH level, HbF %, pain or ACS rates but was significantly associated with stenoses detected by MRA (p<0.001), gender (male; p=0.04), G6PD deficiency (p=0.05), low Hb (p=0.016) and Hct (p=0.012). Multivariate logistic regression analysis showed that gender ([OR= 2.1, 95% CI (1.03–4.27)]; p=0.042), low Hb ([OR= 1.4, 95% CI (1.0–1.1)]; p=0.05) and stenoses ([OR= 4.8, 95% CI (1.88–12.28)]; p=0.001) were all significant independent risk factors for silent infarcts. The presence of stenoses was the only significant risk factor for silent infarcts in patients with a history of abnormal TCD ([OR= 5.9, 95% CI (1.6–21.7)]; p=0.008). Conclusion We recently showed that G6PD deficiency, absence of alpha-Thal, and hemolysis are independent significant risk factors for abnormal TCD in stroke-free SCA patients (Bernaudin et al, Blood, 2008, in press). Here, we report that an abnormal TCD is the most significant risk factor for stenoses and, expanding previous studies, we demonstrate that stenoses, low Hb and gender are significant independent risk factors for silent infarcts.

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Prediction of risk factors of bronchial mucus plugs in children with Mycoplasma pneumoniae pneumonia

10.21203/rs.3.rs-54708/v2 ◽

2020 ◽

Author(s):

Jiahui zhang ◽

Ting Wang ◽

Wei Ji ◽

Yongdong Yan ◽

Zhichao Sun ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Mycoplasma Pneumoniae ◽

Roc Curve ◽

Scoring System ◽

Clinical Laboratory ◽

Risk Group ◽

Independent Risk Factors ◽

Mucus Plug ◽

Plug Formation

Abstract Background: Recently, many cases of pneumonia in children with Mycoplasma pneumoniae infection have been shown to have varying degrees of intrabronchial mucus plug formation. The clinical, laboratory, radiological characteristics, and treatment of patients with Mycoplasma infection are analyzed in this study. The risk factors for M. pneumoniae pneumonia (MPP) mucus plug formation in children are explored, and a risk factor scoring system is established.Methods: MPP patients treated with bronchoscopy were retrospectively enrolled in the study from February 2015 to December 2019. The children were divided into a mucus plug group and a control group according to the presence or absence of mucus plug formation. The clinical, laboratory, radiological characteristics, and treatment of the two groups of children were compared. Univariate and multivariate logistic regression models were used to identify the risk factors for MPP mucus plug formation. The receiver operating characteristic (ROC) curve was drawn to evaluate the regression model and establish the MPP mucous plug risk factor scoring system.Results: A univariate analysis showed that the children in the mucous group were older and had a longer fever duration, longer hospital stay, higher fever peak, more cases of wheezing symptoms and allergies, and azithromycin or corticosteroids were administered later. In addition, neutrophil, C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (DD), sputum MP-DNA copy number, and total immunoglobulin A (IgA) levels were higher, while prealbumin (PA) levels were lower. The ROC curve analysis showed that children with MPP had PA ≤144.5 mg/L, had used corticosteroids during the course of the illness of ≥4.5 days, CRP ≥12.27 mg/L, an LDH≥462.65 U/L, and there was a possibility of intra-airway mucus formation. The independent risk factors were scored according to their odds ratio (OR) value. Among the 255 children with MPP, the high-risk group had 44 (83.02%) mucus plugs out of 53; the middle-risk group had 35 (34.3%) mucus plugs out of 102; and the low-risk group had 11 (11%) mucus plugs out of 100.Conclusions: PA levels, timing of corticosteroid use (use in the first few days), CRP levels, and LDH levels were independent risk factors for MPP mucus plug formation. This provides a basis for the early identification of MPP in children combined with mucus plug formation.

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Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

10.21203/rs.3.rs-34282/v4 ◽

2020 ◽

Author(s):

Po-Han Chen ◽

Chun-Fang Tung ◽

Yen-Chung Peng ◽

Hong-Zen Yeh ◽

Chi-Sen Chang ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Significant Risk ◽

Significant Risk Factor ◽

Biliary Cannulation ◽

Small Papilla ◽

Type 3

Abstract BackgroundWe investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.MethodsA prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.ResultsA total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.ConclusionSmall papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

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Risk scoring model to predict recurrence in locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy (NACT).

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.98 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 98-98

Author(s):

Sushma Agrawal ◽

Prabhakar Mishra ◽

Punita Lal ◽

Gaurav Agarwal ◽

Amit Agarwal ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Risk Group ◽

Locally Advanced ◽

High Risk Group ◽

Low Risk ◽

Scoring Model ◽

Group Score ◽

Risk Scoring ◽

Independent Risk Factors

98 Background: Complete response (CR) to NACT portends favorable long term outcomes in LABC. There is a need for a tool to risk categorise patients for recurrence risk (RR), so that intensification of treatment can be offered to women with high risk of recurrence. Methods: A prospectively maintained database of LABC (between January 2007 to December 2012), who received NACT followed by definitive surgery, radiotherapy and endocrine therapy in endocrine sensitive disease was retrospectively analyzed for clinico-pathological and treatment factors affecting disease free survival (DFS). A risk scoring model was developed on the basis of beta coefficients of identified independent risk factors for DFS. Results: The incidence of loco-regional relapse was 8% and that of distant metastases was 32% in a dataset of 206 patients at a median follow-up of 47 months (IQR 24-62 mo). The independent risk factors for recurrence were index T stage [HR 1.8 (0.9-3.6)], N stage [HR 1.7 (0.4 – 4.7)], grade [HR 1.8 (0.8-4.2)], age less than and more than 40 years [HR 1.6 (0.4-0.9)], pathologic CR [HR 4.3 (1.7- 10.7)], intrinsic subtype [HR 2.2 (1.3-3.7)], and type of surgery (BCS vs MRM) [HR 2.2 (1.3-3.6)]. The ROC of the model for the prediction of recurrence was 0.67 (95 % CI: 0.61-0.75). The results of this model were validated by dividing the population into 3 risk groups: low risk (score less than 12), intermediate risk group (score between 13-15), high risk group (score 16 or more). The chances of recurrence are 16% versus 34% versus 57% in low, intermediate and high risk group respectively. Presence of three risk factors implies low risk, five intermediate and more than five high risk. Conclusions: The risk scoring model developed by us predicts RR and can be used for selecting patients for treatment intensification in high risk category.

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Hodgkin Lymphoma (HL), A Retrospective Analysis in Young Adults.

Blood ◽

10.1182/blood.v106.11.4721.4721 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4721-4721

Author(s):

Anna A. Koumarianou ◽

Nikolaos Xiros ◽

Efstathios Papageorgiou ◽

Dimitris Pectasidis ◽

Theofanis Economopoulos

Keyword(s):

Risk Factors ◽

Young Adults ◽

Stage Iii ◽

Extranodal Involvement ◽

Mixed Cellularity ◽

Bulky Disease ◽

Mediastinal Disease ◽

Prognostic Groups ◽

Group A ◽

Group B

Abstract INTRODUCTION: Over the last four decades survival of patients with HL has improved. Various risk factors (stage III/IV, abnormal ESR, bulky mediastinal disease, >3 involved nodes, extranodal involvement) classify patients into prognostic groups for treatment accordingly. PURPOSE: This study was conducted to review the risk factors, treatments and outcomes in young adults with HL over the past 25 years in our Unit. METHODS: Retrospective chart review of 55 young adults 16–23 years old (25 women, 35 men), treated from 1978–2003, was performed. Patients were divided according to risk factors into three prognostic groups: low (stage I/II without risk factors; 5 patients [9.1%]), intermediate (stageI/II with risk factors; 19 patients [34.5%]) and advanced HL (stage IIB with bulky mediastinal disease and extranodal involvement or stage III/IV; 31 patients [56.4%]). Patients were treated with established chemotherapy regimens available at each time period including MOPP (Group A, 1978–1987; 17 patients), MOPP/ABVD (Group B, 1988–1993; 21 patients), and ABVD or BEACOPP (Group C, 1994–2003; 17 patients). Patients with bulky disease at diagnosis (>5cm) or residual disease following chemotherapy received additional radiotherapy. RESULTS: Histological diagnosis included 42 nodular sclerosis, 10 mixed cellularity and 3 lymphocyte predominant. Thirty five patients had mediastinal involvement (16 patients with bulky disease). Following chemotherapy completion 27 patients were referred for radiotherapy. A total of 21 patients experienced relapse (5 intermediate and 16 advanced stage), of whom 14 (66 %) within the first 2 years of diagnosis. Although the follow up periods were not equal between the three treatment groups, surveillance of evaluable patients showed significant improvement of the 5-year survival and 5-year relapse rate (Group A:64.7% and 47%, Group B:80.9% and 33.3%, Group C:94.1 % and 11.7% respectively) over the years. Eight out of 10 mixed cellularity patients died. One second primary malignacy (acute non lymphocytic leukaemia) was observed. In our study albumin less than 4 g/dl, and lymphocyte count less than 8% were identified as the most important risk factors in relation to relapse and survival regardless treatment. CONCLUSION: Survival of young patients with HL is significantly improving over the last 25 years most probably due to improved treatment resources and understanding of risk factors. Tailoring treatment according to prognostic groups and inclusion of molecular markers is expected to refine further treatment strategies and improve survival.

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