Nonsurgical treatments for stage 0-IA squamous esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 113-113
Author(s):  
Hitoshi Ito ◽  
Satoshi Itasaka ◽  
Shinichi Miyamoto ◽  
Yasumasa Ezoe ◽  
Manabu Muto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Treatment Option ◽  
Alternative Treatment ◽  
Initial Treatment ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Alternative Treatment Option

113 Background: Surgery has been the standard treatment for operable squamous esophageal cancer. However, radiation therapy/chemoradiotherapy (RT/CRT) or endoscopic resection (ER) could be an alternative treatment option for stage 0-IA (TNM 7th edition) squamous esophageal cancer, because these treatments are less invasive and can preserve the organ. To evaluate the efficacy of surgery, RT/CRT and EC for stage 0-1A squamous esophageal cancer in clinical practice, we reviewed our experience. Methods: From March 2007 to December 2010, 92 patients with stage 0-IA squamous esophageal cancer were treated in our institute. Overall survival, relapse-free survival, and relapse pattern were evaluated according to the initial treatment modality. Results: Of 92 patients (pts), 76 were male and 16 were women. Median age was 65.5 years old. Tis/T1a/T1b:4/36/52. Median follow up time was 29.1(4.7-55.5) months. As an initial treatment, 9 pts received surgery, 27 pts received RT/CRT and 56 pts received ER. Among the pts underwent ER, one patient underwent esophagectomy and 13 pts were received CRT based on the pathological evaluation for the risk of the lymph node metastasis. Two-year relapse free survival and overall survival of surgery, RT/CRT and ER was 77.8%/100%, 68.6%/100% and 89.8%/95.7%, respectively. After completion of initial therapy, local failures (residual or recurrent disease), regional lymph node relapse and distant metastasis and 1 undetermined relapse were observed in 6, 3 and 5 pts, respectively. Eight out of the 15 pts with recurrence could be disease free after salvage therapy. While 4 pts died during the follow up period, all pts died from other diseases and no pts died from esophageal cancer. Overall esophageal preservation rate was 89.1% (82/92). Conclusions: Although longer follow-up was needed, this study showed that non-surgical treatments (RT/CRT or ER) for stage 0-1A squamous esophageal cancer could be an alternative treatment option and could provide a chance of organ preservation. [Table: see text]

scholarly journals Low value of whole-body dual-modality [18f]fluorodeoxyglucose positron emission tomography/computed tomography in primary staging of stage I–II nasopharyngeal carcinoma: a nest case-control study

2021 ◽  
Author(s):  
Bei-Bei Xiao ◽  
Qiu-Yan Chen ◽  
Xue-Song Sun ◽  
Ji-Bin Li ◽  
Dong-hua Luo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Stage I ◽  
Relapse Free Survival ◽  
Retropharyngeal Lymph Node ◽  
Free Survival ◽  
Pet Ct ◽  
Pre Treatment

Abstract Objectives The value of using PET/CT for staging of stage I–II NPC remains unclear. Hence, we aimed to investigate the survival benefit of PET/CT for staging of early-stage NPC before radical therapy. Methods A total of 1003 patients with pathologically confirmed NPC of stages I–II were consecutively enrolled. Among them, 218 patients underwent both PET/CT and conventional workup ([CWU], head-and-neck MRI, chest radiograph, liver ultrasound, bone scintigraphy) before treatment. The remaining 785 patients only underwent CWU. The standard of truth (SOT) for lymph node metastasis was defined by the change of size according to follow-up MRI. The diagnostic efficacies were compared in 218 patients who underwent both PET/CT and CWU. After covariate adjustment using propensity scoring, a cohort of 872 patients (218 with and 654 without pre-treatment PET/CT) was included. The primary outcome was overall survival based on intention to treat. Results Retropharyngeal lymph nodes were metastatic based on follow-up MRI in 79 cases. PET/CT was significantly less sensitive than MRI in detecting retropharyngeal lymph node lesions (72.2% [62.3–82.1] vs. 91.1% [84.8–97.4], p = 0.004). Neck lymph nodes were metastatic in 89 cases and PET/CT was more sensitive than MRI (96.6% [92.8–100.0] vs. 76.4% [67.6–85.2], p < 0.001). In the survival analyses, there was no association between pre-treatment PET/CT use and improved overall survival, progression-free survival, local relapse-free survival, regional relapse-free survival, and distant metastasis-free survival. Conclusions This study showed PET/CT is of little value for staging of stage I–II NPC patients at initial imaging. Key Points • PET/CT was more sensitive than MRI in detecting neck lymph node lesions whereas it was significantly less sensitive than MRI in detecting retropharyngeal lymph node lesions. • No association existed between pre-treatment PET/CT use and improved survival in stage I–II NPC patients.

Prognostic Relevance of Celiac Lymph Node Involvement in Ovarian Cancer

2014 ◽  
Vol 24 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Alejandra Martínez ◽  
Cristophe Pomel ◽  
Thomas Filleron ◽  
Marjolein De Cuypere ◽  
Eliane Mery ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Oncologic Outcome ◽  
Progression Free Survival ◽  
Disease Spread ◽  
Short Term ◽  
Free Survival ◽  
Increased Risk

ObjectiveThe aim of the study was to report on the oncologic outcome of the disease spread to celiac lymph nodes (CLNs) in advanced-stage ovarian cancer patients.MethodsAll patients who had CLN resection as part of their cytoreductive surgery for epithelial ovarian, fallopian, or primary peritoneal cancer were identified. Patient demographic data with particular emphasis on operative records to detail the extent and distribution of the disease spread, lymphadenectomy procedures, pathologic data, and follow-up data were included.ResultsThe median follow-up was 26.3 months. The median overall survival values in the group with positive CLNs and in the group with negative CLNs were 26.9 months and 40.04 months, respectively. The median progression-free survival values in the group with metastatic CLNs and in the group with negative CLNs were 8.8 months and 20.24 months, respectively (P = 0.053). Positive CLNs were associated with progression during or within 6 months after the completion of chemotherapy (P = 0.0044). Tumor burden and extensive disease distribution were significantly associated with poor progression-free survival, short-term progression, and overall survival. In multivariate analysis, only the CLN status was independently associated with short-term progression.ConclusionsDisease in the CLN is a marker of disease severity, which is associated to a high-risk group of patients with presumed adverse tumor biology, increased risk of lymph node progression, and worst oncologic outcome.

Recurrence Patterns of Non-Mycosis Fungoides Cutaneous Lymphoma Following Various Treatment Modalities.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4676-4676
Author(s):  
Michael E. Confer ◽  
Jonathan D. Tward ◽  
Sherrie L. Perkins ◽  
Glen M. Bowen ◽  
Robert J. Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
B Cell ◽  
Initial Treatment ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract INTRODUCTION: Non-mycosis fungoides (MF) primary cutaneous lymphoma (PCL) is rare, and the more indolent forms seldom progress to fatal, systemic lymphoma. Nevertheless, frequent relapses are common. Although several therapies exist, no standard of care has been established for initial treatment. OBJECTIVES: To compare the role of radiotherapy to other initial treatment options and to evaluate clinicopathologic factors affecting overall, cause-specific, and relapse-free survival METHODS: Thirty-eight patients from 1985 to 2006 were retrospectively identified and reviewed with non-MF PCLs including: primary cutaneous anaplastic large cell lymphoma, subcutaneous panniculitis-like T-cell lymphoma, primary cutaneous marginal zone B-cell lymphoma, primary cutaneous follicle-center lymphoma, primary cutaneous diffuse large B-cell lymphoma, leg type, or primary cutaneous intravascular large B-cell lymphoma. Regression-free, cause-specific, and overall survival was estimated using the methods of Kaplan and Meier. Outcomes were compared with the log-rank test and Cox regression analysis. RESULTS: 38 patients were included in the analysis with a median follow-up time of 34.6 months (range 2 – 138 months). The distribution of initial treatment was: surgery - 29%, topical therapy - 16%, systemic therapy - 18%, and radiation - 63%. Three patients never received radiation. For the entire cohort, the 5-year overall (OS), cause-specific (CSS), and relapse free survival (RFS) was 86.2%, 88.9%, and 29.5% respectively. Subjects who received radiation therapy (n=24) as part of their initial treatment course had a significantly longer median time to first relapse of 57 months compared to 3.2 months for the 14 subjects who did not receive radiotherapy (log-rank p &lt; 0.0001). Overall survival was significantly improved for subjects whose International Prognostic Index (IPI) score was 0–1 (n=25) versus those whose score was 2 or greater (n=13, p=0.05). Multivariate analysis for RFS revealed that the absence of radiation as part of initial treatment (Hazard Ratio (HR) = 22.2, 95% CI 2.1 – 238.5, p=0.01) and aggregate size less than 10cm (HR 0.04, 95% CI 0.0 – 0.3, p&lt;0.01) significantly altered the risk of relapse. No relapses were observed within the radiation therapy treatment field in 31/35 (89%) subjects following their first course of radiation therapy. Of the 15/35 (43%) of patients that relapsed anywhere following radiation, only 2/15 (13%) relapsed in-field exclusively, 2/15 (13%) relapsed both in and out-of-field, and the remaining 11/15 (73%) relapsed exclusively outside the area treated. No patient relapsed within the treatment field of after 24 months. CONCLUSION: An initial course of radiation therapy significantly delays relapse compared to other therapies for non-MF PCL and provides excellent local control of plaques. Our findings also extend the IPI as prognostic for overall survival for this rare disease. Bulky lesions greater than 10cm in any one dimension are more strongly correlated with relapse.

Five-Year Outcomes of a Randomized Phase III Trial Comparing Adjuvant Chemotherapy With S-1 Versus Surgery Alone in Stage II or III Gastric Cancer

2011 ◽  
Vol 29 (33) ◽  
pp. 4387-4393 ◽  
Author(s):  
Mitsuru Sasako ◽  
Shinichi Sakuramoto ◽  
Hitoshi Katai ◽  
Taira Kinoshita ◽  
Hiroshi Furukawa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Survival Rate ◽  
Adjuvant Chemotherapy ◽  
Stage Ii ◽  
Disease Stage ◽  
Relapse Free Survival ◽  
Free Survival ◽  
End Point

Purpose The first planned interim analysis (median follow-up, 3 years) of the Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer confirmed that the oral fluoropyrimidine derivative S-1 significantly improved overall survival, the primary end point. The results were therefore opened at the recommendation of an independent data and safety monitoring committee. We report 5-year follow-up data on patients enrolled onto the ACTS-GC study. Patients and Methods Patients with histologically confirmed stage II or III gastric cancer who underwent gastrectomy with D2 lymphadenectomy were randomly assigned to receive S-1 after surgery or surgery only. S-1 (80 to 120 mg per day) was given for 4 weeks, followed by 2 weeks of rest. This 6-week cycle was repeated for 1 year. The primary end point was overall survival, and the secondary end points were relapse-free survival and safety. Results The overall survival rate at 5 years was 71.7% in the S-1 group and 61.1% in the surgery-only group (hazard ratio [HR], 0.669; 95% CI, 0.540 to 0.828). The relapse-free survival rate at 5 years was 65.4% in the S-1 group and 53.1% in the surgery-only group (HR, 0.653; 95% CI, 0.537 to 0.793). Subgroup analyses according to principal demographic factors such as sex, age, disease stage, and histologic type showed no interaction between treatment and any characteristic. Conclusion On the basis of 5-year follow-up data, postoperative adjuvant therapy with S-1 was confirmed to improve overall survival and relapse-free survival in patients with stage II or III gastric cancer who had undergone D2 gastrectomy.

scholarly journals Partial splenectomy followed by total splenectomy in thalassemia

2017 ◽  
Vol 10 (3) ◽  
pp. 173
Author(s):  
Abu Saleh Md. Oli Ullah ◽  
Bhupal Chandra Barman ◽  
Md. Ruhul Amin
Keyword(s):  
Treatment Option ◽  
Alternative Treatment ◽  
Initial Treatment ◽  
Prophylactic Antibiotic ◽  
Partial Splenectomy ◽  
Thalassemic Patient ◽  
Alternative Treatment Option ◽  
Total Splenectomy

<p class="Abstract">Total splenectomy is the usual operative practice for children with thalassemia requiring splenectomy. But wherever possible, the surgical community should carefully consider partial splenectomy as an alternative treatment option that may offer few important benefits to the patient with the same indication. Here, we are reporting a case where a thalassemic boy enjoyed six years free from overwhelming post-splenectomy infection after partial splenectomy without any vaccination or prophylactic antibiotic before eventual total splenectomy. So, partial splenectopmy may be considered as a preferable initial treatment option for the thalassemic patient with splenomegally requiring splenectomy.</p>

scholarly journals Outcome comparison between radiochemotherapy and surgery in the management of locally advanced non-metastatic laryngeal cancer a single institution experience

2021 ◽  
Vol 13 (2) ◽  
pp. 34-41
Author(s):  
Nimubona Désiré ◽  
Benyouness Leilla ◽  
El Lanigri Merriam ◽  
Diouf Kady ◽  
Bounid Oumaima ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Node Dissection ◽  
Free Survival ◽  
Surgery Group ◽  
Radio Chemotherapy

he treatment of locally advanced non-metastatic laryngeal squamous cell carcinoma is very controversial. Total laryngectomy associated with lymph node dissection and adjuvant radiotherapy with or without chemotherapy is considered the gold standard treatment. The functional impairment on voice and breathing that result from this approach called for discussion of preservation of this organ. Since the publication of the Veterans' Study in 1991 on laryngeal cancer and the confirmation by subsequent randomized trials of an equivalent survival, treatment strategies for advanced laryngeal carcinoma have shown significant changes in favour of an organ-sparing approach by chemoradiotherapy. Purpose: We aim to assess the outcome of locally advanced non-metastatic laryngeal cancer classified as (T3NxM0 -T4NxM0) by comparing the carcinological results and the survival at one and three years between two cohorts of patients, one treated by surgery and the other by organ preservation protocols. Between the two series, we will analyze the carcinological outcomes, local control, local and lymph node recurrence, distant metastases, overall survival, and recurrence-free survival, lymph Node-free survival, and metastatic evolution. Results: 106 patients were treated for locally advanced squamous cell laryngeal carcinoma of the ENT department and radiation Oncology department of Mohamed VI University hospital between January 2014 and December 2018; Sixty-three patients in surgery group I and forty-three patients in group II went on organ sparing approach by radiochemotherapy. The two groups were compared according to local tumor control, local recurrence, lymph node recurrence, and distant metastasis. Early deaths and patients who were lost to follow-up were excluded from this analysis. The average age was 61 years in the surgery group versus 60 years in the RCC. The male predominance was marked in both treatment groups, 102 were male (96.23%) and only 4 female (3.77 %.).88.7% were smokers with an average consumption of 26.4 package-years. Only 15% of our smoking patients reported a withdrawal period estimated at two months on average. Alcohol-smoking synergy was observed in 19% of cases. In the surgery group, 47 patients or 83.9% had local tumor control compared to 12 patients or 41.4% in the radio-chemotherapy group with a statistically significant difference p<0.0001. Local recurrence was observed in 8 patients (14.5%) in the surgery group against 6 patients (46.2%) in the radio-chemotherapy cohort with a p= 0.02. We noted that there was a large number of missing data (30 patients) in the radio-chemotherapy group due to the large number of patients who were lost to follow-up, early deaths, and patients who did not progress well after treatment. There was no statistically significant difference between the two groups in terms of lymph node recurrence and metastatic progression. At 1 year, Overall survival was 87.9% of patients were alive (n=51 out of 58) in the surgery arm versus 60.6% (n=20 out of 33) in the radio-chemotherapy arm. At 3 years overall survival was 77.5% for surgery versus 48.4% for radiotherapy (p= 0.005).Lymph node free recurrence and metastatic free progression at 1 year was 94.5% in the surgery group compared with 84.6% for radio-chemotherapy. Survival at 3 years was 85.4% versus 53.8% respectively (p=0.05).In the chemoradiation therapy group, there were 30 missing data due to a large number of deaths and loss of the follow-up during the first year without any indication of the presence or absence of recurrence, compared to 8 missing data for the radio-chemotherapy group. Conclusion: The optimal treatment for advanced squamous cell carcinoma of the larynx is highly controversial. Total laryngectomy associated with cervical lymph node dissection remains the gold standard of treatment but organ-sparing protocols are as effective as surgical therapy. However, in our study, total laryngectomy plus lymph node dissection showed better survival outcomes in terms of locoregional control and significantly increased overall survival and recurrence-free survival. This makes surgery the treatment of choice in the management of locally advanced non-metastatic laryngeal cancer in our single institutional Moroccan setting. Possible reasons for these results may be poor patient selection, inadequate follow-up, incomplete treatment, and interrupted treatment sessions but also the long delay in consultation. Patients and professionals should be made aware of the small but significant disadvantage of the non-surgical therapy approach as part of the shared decision-making process when selecting treatment. Both surgery and radio-chemotherapy can be effective if the treatment indications are well directed. These indications depend on several many several parameters and should be considered at the multidisciplinary consultation meetings and adapted on a case-by-case basis.

Pelvic lymph node recurrence in high-risk prostate cancer following prostate-only radiotherapy

2021 ◽  
pp. 1-5
Author(s):  
Sameed Hussain ◽  
Muhammad Imran Wajid ◽  
Muhammad Omer ◽  
Muhammad Yousuf Khan ◽  
Talha Maqsood ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Abstract Introduction: High-risk prostate cancer is the most common presentation at our institute among patients with non-metastatic prostate cancer. Traditionally, pelvic lymph nodes were given a prophylactic dose of radiotherapy while the prostate was given a curative dose of radiation. This study aims to evaluate patterns of failure in patients who had prostate-only radiation at our centre. Materials and Methods: All high-risk prostate cancer patients who underwent radical radiotherapy to prostate only since 2014 were retrospectively analysed. Local T stage, baseline prostate-specific antigen (PSA) and Gleason score were recorded. Bone scan and staging CT scan data were collected. Various dose levels prescribed to prostate were analysed. The follow-up records of these patients were assessed. Patients who failed in pelvic lymph nodes were recorded separately. Overall survival and failure-free survival were calculated using Kaplan–Meier curve. Results: One-hundred five patients fulfilling the inclusion criteria were analysed. Only three patients developed recurrence in pelvic lymph node following prostate-only radiotherapy (PORT). Five year overall survival was 77% while failure-free survival was 64%. Forty patients had a PSA failure after a median follow-up of 62 months. Conclusions: Most high-risk prostate cancer patients who progress following hormone therapy and PORT have metastases outside pelvis. Till further conclusive evidence is available PORT can be considered as a safe option.

Homoharringtonine and Low-Dose Cytosine Arabinoside Combined with G-CSF or GM-CSF Administered in Patients with Advanced Myelodysplastic Syndromes and Relapsed or Refractory Acute Myeloid Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1465-1465
Author(s):  
Caigang Xu ◽  
Juan Xu ◽  
Ting Liu ◽  
Bing Xiang ◽  
Hong Chang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Low Dose ◽  
Refractory Anemia ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Gm Csf ◽  
Acute Myeloid

Abstract According to the FAB classification of myelodysplastic syndromes (MDS), subgroups of refractory anemia with excess blasts(RAEB) and refractory anemia with excess blasts in transformation(RAEB-t) are considered as high-risk MDS or advanced MDS which tend to involve into acute myeloid leukemia(AML). Even though various strategies have been in use, chemotherapy remains the main treatment option. With low remission rates, short duration of remission and high relapse rates, conventional chemotherapy for high-risk MDS and AML transforming from MDS is generally unsatisfactory. Relapsed or refractory AML, geriatric AML and secondary AML have a poor response to the classical induction chemotherapy. Studies indicate that CRs have occurred(8∼56%) at the cost of a high incidence of deaths from toxicity(24%∼64%). Although allogeneic stem cell transplantation could potentially be curative, it is appropriate for only a small subset of patients. This challenges us to work towards new reasonable therapeutic strategies. In vitro, studies have confirmed that granulocyte colony stimulating factor(G-CSF) can enhance the cytotoxic effects of S-phase-specific drugs such as Ara-C by the mechanism of driving myeloid leukemic cells of resting G0-phase into the cell cycle as well as intensifying the metabolism of Ara-C and anthracyclines in the leukemic cell. Recently the regimen of low-dose Ara-C and aclarubicin in combination with G-CSF(CAG regimen) has presented both well-tolerated and highly effective in treating the above categories of AML and MDS. The reported overall CR rate is 35∼75%. We designed a combination chemotherapy of homoharringtonine, low-dose cytarabine and G-CSF or GM-CSF(HAG priming regimen) for remission induction in this study which enrolled 42 patients with advanced MDS or AML between January 2002 and July 2005. 42 patients who received HAG chemotherapy were followed up till April 2006. Clinical and laboratory data of all these patients, which concerned with a)medical interventions including induction chemotherapy, post-remission treatment, and management of complications, etc; b)follow up for conditions of remission, relapse-free survival and overall survival after HAG induction therapy; c)adverse events following HAG induction therapy, were recorded in detail. Among Forty appraisable patients, 20 of them (50%) achieved complete remission (CR), including 66.7% patients with MDS-RAEB and 46.2% patients with refractory or relapsed AML. The fact of 80% patients with AML-M1 achieved CR, demonstrates a better response than those with other subtypes of AML. The overall response rate was 52.5%. After a follow-up of 6—47 months(median 23) from the date of remission, the median times of relapse-free survival and overall survival were 7.0±1.1 and 28±12.3 months, respectively. Meanwhile, these patients aged under 60-year-old who have achieved complete remission and received regular post-remission treatment showed a better survival rate. Myelosuppression was the most significant toxicity. More than 80% of patients experienced neutropenia or thrombocytopenia of grade III to IV after the first induction therapy. The incidences of infection and hemorrhage in the total of 64 induction courses were 43.8%(28/64) and 37.5%(24/64), respectively. Nonhematologic adverse-effects were minimal.

Long-Term Outcomes in Patients with Acute Myelogenous Leukemia (AML) Following Allogeneic Stem Cell Transplantation (AlloSCT) for Relapse After Initial Autologous Bone Marrow Transplant (ASCT).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2299-2299
Author(s):  
Mary-Elizabeth Percival ◽  
Lloyd E. Damon ◽  
Thomas Martin ◽  
Lawrence Kaplan ◽  
Weiyun Ai ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Stem Cell ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Response Status

Abstract Abstract 2299 Poster Board II-276 Introduction: Patients with low- and intermediate-risk AML have several options for consolidation therapy, including chemotherapy alone and ACST or AlloSCT. Since randomized studies comparing these approaches show no option to be clearly superior to the others, several centers focus on sequencing of therapies in terms of patient tolerance and toxicity. Since 1986 our preferred consolidation regimen at UCSF for these patients consists of high-dose chemotherapy with ASCT. Consequently, at the time of relapse, we are often presented with the need for a second transplant (usually AlloSCT), in the setting of prior ASCT. As there is a paucity of data describing the toxicity and efficacy of AlloSCT in this setting, we designed this study to evaluate these parameters. Patients and Methods: This is a retrospective-cohort, single-institution study of patients with AML treated at UCSF between 1986 and 2008 and who received a second transplant at the time of relapse. Patients were identified through our prospective database, and data were collected from electronic medical records and primary clinical charts when available. Dates of death were corroborated with the social security database. Statistical analysis was performed using STATA (v9). Censoring date for all analyses was July 31st, 2009. This study was approved by the UCSF institutional review board. Results: Thirty-one patients with AML were identified who underwent an AlloSCT in the setting of relapse following a prior ASCT, with a median follow up of 54 months. The median time from the first to the second transplant was 17 months (range: 6 – 48). The median age at the time of the AlloSCT was 43 years (range: 20 – 64). Response status at the time of transplant was: 17 patients (55%) in complete remission (CR), 12 patients (39%) with less than CR, and 2 patients (6%) with response status unknown. The transplant was myeloablative in 14 patients (45%), non-myeloablative in 13 patients (42%), and cord-blood-based in 4 patients (13%). The donor was unrelated in 17 patients (55%). There were 7 (18%) treatment-related deaths in the first 6 months and 10 (32%) treatment-related deaths overall (pulmonary toxicity: 4, graft-versus-host-disease: 3, and infection: 3). Twelve patients (39%) died due to progressive disease. The median overall survival was 7 months, with 48% and 31% of patients being alive at 12 and 24 months respectively. Remission status prior to transplant was the most significant predictor of survival; the median survival among complete responders vs. all others was 19 months vs. 3.5 months respectively (p=0.006). Following transplantation, the median relapse-free survival among responders was 38 months, with 31% of patients being relapse-free at last follow-up. The time between transplants, as well as age, sex, and intensity of conditioning regimen had no effect on overall and relapse-free survival in our cohort. However, peripheral stem cell transplant was associated with improved overall survival (compared to bone marrow, p=0.02), though this likely reflects different eras of supportive therapy. Conclusions: Our results suggest that AlloSCT is an effective approach for patients with AML with relapsed or refractory disease after a prior ASCT. In this cohort spanning 22 years, treatment-related mortality from AlloSCT was 32%, and 31% of responders remain free of relapse with long-term follow-up. Disclosures: No relevant conflicts of interest to declare.

Age up to 75 Years Does Not Influence the Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia and Myelodysplastic Syndrome

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3501-3501
Author(s):  
Dipenkumar Modi ◽  
Abhinav Deol ◽  
Seongho Kim ◽  
Kendra Mellert ◽  
Marie Ventimiglia ◽  
...  
Keyword(s):  
Overall Survival ◽  
Relapse Rate ◽  
Cumulative Incidence ◽  
Relapse Free Survival ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
Allogeneic Hsct ◽  
Gvhd Prophylaxis ◽  
Reduced Intensity

Abstract Introduction: Patients with AML and MDS who are age 60 or above represent a discrete group of patients with a different disease biology compared to younger patients. These patients are often not offered allogeneic hematopoietic stem cell transplant (HSCT) as a curative intent because of concern of increased nonrelapse mortality (NRM) and poor overall survival (OS). Hence, the information on transplant outcomes among this population is very limited. Recently with the use of better supportive care measures and reduced intensity preparative regimens, patients greater than 60 are often recommended to proceed to transplant. This study evaluates our single center experience of allogeneic transplantation in patients with MDS and AML aged 60 and older. Patients and Methods: We retrospectively evaluated 60 years or older consecutive patients with AML and MDS who underwent allogeneic HSCT between January 2005 and December 2014. The primary objectives of our study were to determine NRM, relapse, relapse free survival (RFS) and OS at 1 year following transplant. The secondary objectives were to estimate cumulative incidence of acute (aGVHD) and chronic GVHD (cGVHD) at 1 year, length of stay and readmission rate in the first 100 days following transplant. Results: Between January 2005 and December 2014, 159 patients underwent allogeneic HSCT with the median age of 64 (range, 60-75) years and median follow-up duration for OS of 3.34 (95% CI, 2.51-3.87) years. Increasing number of patients were transplanted in recent years, i.e., 67% patients between 2010-2014 compared to 33% between 2005-2009. One hundred three patients (65%) had AML and 56 patients (35%) had MDS. Forty-nine patients (31%) received full intensity regimen and 110 patients (69%) received reduced intensity regimen. Fifty-two patients (33%) underwent allogeneic related transplant and 107 patients (67%) had allogeneic unrelated transplant. Thymoglobulin based GVHD prophylaxis was given in 77 patients (48%) whereas non-thymoglobulin based GVHD prophylaxis was given in 82 patients (52%). The median day to neutrophil and platelet engraftment was 11 (range, 7-22) days and 16 (range, 0-675) days, respectively. Graft failure occurred in 3 patients. At 1-year follow-up, the cumulative incidence of grade II-IV aGVHD was 39.7% (95% CI, 32.0-47.2%), grade III-IV aGVHD was 20.8% (95% CI, 14.9-27.5%) and cGVHD was 54.1% (95% CI, 46.0-61.5%). The cumulative incidence of chronic extensive GVHD was 39.8% (95% CI, 32.1-47.4%). Blood stream infection, cytomegalovirus reactivation, Epstein-Barr virus reactivation, C. difficile diarrhea occurred in 44%, 35%, 22% and 26% of patients, respectively. At 1-year follow-up, NRM was 25.3% (95% CI, 18.8-32.3%), RFS was 53.3% (95% CI, 46.1-61.7%), relapse rate was 21.4% (95% CI, 15.4-28.1%) and OS was 56.4% (95% CI, 49.2-54.7%). The median day of hospitalization following transplant was 26 (range, 19-112) days and almost half (52%) of patients were readmitted in the first 100 days following transplant. Leukemia recurrence was the most common cause of death. Multivariable analysis demonstrated high disease risk index to be the independent predictor of poor RFS, OS and higher relapse rate (p<0.03), whereas non-thymoglobulin based GVHD prophylaxis, higher comorbidity index (≥3) and MDS were found to be associated with higher NRM (p<0.03). Most importantly, age did not shown to have any effect on relapse rate, OS, RFS, or NRM. Conclusion: Our results indicate that allogeneic HSCT is well tolerated and had acceptable NRM, and OS among this group. Hence, older age alone should not be considered a contraindication to HSCT. Figure 1 Overall survival (OS) and relapse-free survival (RFS) estimates. The median OS is 1.60 years (95% CI, 0.94 to 5.00 years) and the median RFS is 1.15 years (95% CI, 0.63 to 3.07 years). The median follow-up time of OS and RFS are 3.34 years (95% CI, 2.51 to 3.87 years) and 3.25 years (95% CI, 2.51 to 3.87 years), respectively. Figure 1. Overall survival (OS) and relapse-free survival (RFS) estimates. The median OS is 1.60 years (95% CI, 0.94 to 5.00 years) and the median RFS is 1.15 years (95% CI, 0.63 to 3.07 years). The median follow-up time of OS and RFS are 3.34 years (95% CI, 2.51 to 3.87 years) and 3.25 years (95% CI, 2.51 to 3.87 years), respectively. Figure 2 Cumulative incidences of aGVHD, cGVHD, relapse and non-relapse mortality after transplantation. Figure 2. Cumulative incidences of aGVHD, cGVHD, relapse and non-relapse mortality after transplantation. Disclosures Deol: Jazz Pharmaceuticals: Consultancy.

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