Disparity in early mortality among racial groups with multiple myeloma in the United States: A National Cancer Data Base study of 108,352 patients.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 311-311
Author(s):  
Wilson I. Gonsalves ◽  
Adam C Bartley ◽  
Ronald S. Go
Keyword(s):  
Multiple Myeloma ◽  
Native American ◽  
Race And Ethnicity ◽  
Disease Incidence ◽  
Care Facility ◽  
The United States ◽  
Early Mortality ◽  
Cell Transplant ◽  
Cancer Data ◽  
The Impact

311 Background: Previous population-based studies have shown variations in disease incidence and overall survival (OS) among multiple myeloma (MM) patients (pts) from different ethnic and racial backgrounds. However, the impact of race and ethnicity on early mortality (EM) or death in the first year after the diagnosis of MM is less well known. Methods: Pts with MM diagnosed from 2000-2011 were identified in the NCDB. We obtained data associated with socio-demographics, type and location of care facility, as well as the use of autologous stem cell transplant (ASCT) as an initial treatment option. Two cohorts were created based on the use of ASCT: 1) The group who received an upfront ASCT and 2) Pts who were 75 years or older who are unlikely to have ever received an ASCT. The rate of early mortality (EM) was estimated using the 1-year OS and assessed for all pts based on racial/ethnic background and the use of ASCT in their therapy. Results: There were a total of 108,352 pts who were included in this analysis. The median age of this cohort was 65 years (Range: 20 – 90). Of these 58,223 (54%) were male. The racial distributions of these cohorts were as follows: 78,589 (73%) White non-Hispanic (WNH), 21,292 (20%) Black non-Hispanic (BNH), 1,943 (2%) Asian Pacific-Islander (API), 293 (< 1%) Native-American (NA) and 6,235 (5%) Hispanics-any race (HIS). The estimated 1-yr OS (95% CI) was 71% (71 – 72) for WNH, 74% (73 – 74) for BNH, 77% (75 – 79) for API, 73% (68 – 78) for NA and 75% (74 – 76) for HIS. Amongst patients who received an upfront ASCT, the estimated 1-yr OS (95% CI) was 97% (97 – 98) for WNH (Reference), 98% (97 – 98) for BNH (P = 0.99), 99% (99 – 100) for API (P = 0.96) and 98% (97 – 99) for HIS (P = 0.99). Whereas amongst pts who likely never received an ASCT (75 years or older), the estimated 1-yr OS (95% CI) was 55% (54 – 56) WNH (Reference), 57% (56 – 59) for BNH (P = 0.03), 62% (58 – 67) for API (P = 0.02), 55% (43 – 72) for NA (P = 0.99) and 55% (52 – 58) for HIS (P = 0.99). Conclusions: In general, WNHs have a worse 1-yr OS compared to BNH and API. However, this disparity appears significant only among pts unlikely to get an ASCT. Further studies are required to identify explanations for such disparate outcomes based on race and use of ASCT.

scholarly journals Racial and Ethnic Enrollment Disparities and Demographic Reporting Requirements in Acute Leukemia Clinical Trials

2021 ◽  
Author(s):  
Andrew Hantel ◽  
Marlise R. Luskin ◽  
Jacqueline S Garcia ◽  
Wendy Stock ◽  
Daniel J DeAngelo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Native American ◽  
Acute Leukemia ◽  
Race And Ethnicity ◽  
Disease Incidence ◽  
The United States ◽  
Reporting Requirements ◽  
Number Of Patients ◽  
Hispanic Patients ◽  
Race Ethnicity

Data regarding racial and ethnic enrollment diversity for acute myeloid (AML) and lymphoid leukemia (ALL) clinical trials in the United States (US) are limited, and little is known about the effect of federal reporting requirements instituted in the late 2000s. We examined demographic data reporting and enrollment diversity for US ALL and AML trials from 2002-2017 as well as changes in reporting and diversity after reporting requirements were instituted. Of 223 AML and 97 ALL trials with results, 68 (30.5%) and 51 (52.6%) reported enrollment by both race and ethnicity. Among trials that reported race and ethnicity (AML N=6,554; ALL N=4,149), non-Hispanic (NH)-Black, NH-Native American, NH-Asian, and Hispanic patients had significantly lower enrollment compared to NH-white patients after adjusting for race-ethnic disease incidence (AML odds: 0.68, 0.31, 0.75, and 0.83; ALL: 0.74, 0.27, 0.67, and 0.64; all p≤0.01). The proportion of trials reporting race increased significantly after the reporting requirements (44.2 to 60.2%; p=0.02), but race-ethnicity reporting did not (34.8 to 38.6%; p=0.57). Reporting proportions by number of patients enrolled increased significantly after the reporting requirements (race: 51.7 to 72.7%, race-ethnicity: 39.5 to 45.4%; both p&lt;0.001), and relative enrollment of NH-Black and Hispanic patients decreased (AML odds: 0.79 and 0.77; ALL: 0.35 and 0.25; both p≤0.01). These data suggest that demographic enrollment reporting for acute leukemia trials is suboptimal, changes in diversity after the reporting requirements may be due to additional enrollment disparities that were previously unreported, and enrollment diversification strategies specific to acute leukemia care delivery are needed.

scholarly journals Outcomes of Patients with Multiple Myeloma Harboring Gain/Amplification 1q in the Era of Modern Therapy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 45-46
Author(s):  
Xiao Hu ◽  
Cherng-Horng Wu ◽  
Janet Cowan ◽  
Raymond L. Comenzo ◽  
Cindy Varga
Keyword(s):  
Multiple Myeloma ◽  
Survival Data ◽  
Research Funding ◽  
The United States ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
Rank Tests ◽  
Treatment Regimens ◽  
The Impact ◽  
Log Rank Tests

Background: Multiple myeloma (MM) is the second most common hematological malignancy in the United States. Fluorescence in-situ hybridization (FISH) is a popular tool to detect cytogenetic alterations which in turn, can contribute to the risk stratification of patients with MM. Gain or amplification of CKS1B gene at chromosome 1q21 region (gain 1q) is detected in 35-40% of newly diagnosed MM cases, and has been reported to be associated with inferior prognostic outcomes. It also frequently occurs with the deletion of CDKN2C at chromosome 1p32.3 (del 1p). There is a distinct lack of data on patients harboring this cytogenetic alteration in the era of novel agents. We sought to look at outcomes of this patient population at a single institution over the last 5 years. Methods: This retrospective study included all patients with MM as defined by the International Myeloma Working Group (IMWG) with available FISH studies identifying gain 1q between 01/01/2015 to 04/30/2020 at Tufts Medical Center. The study was approved by the Institutional Review Board. Baseline demography, disease characteristics, and treatment history were extracted from the electronic medical records. With death as primary event, overall survival (OS) was defined as the survival time from the discovery of gain 1q to death. Progression free survival (PFS) was defined as the time from discovery of gain 1q to first progression/relapse or death, whichever occurred first. Kaplan-Meier method was used to estimate survival data. Differences in survival between two groups were analyzed by log-rank tests. Multivariable cox regression adjusting for baseline characteristics and significant concurrent cytogenetic alterations were performed to explore the impact of treatment regimens on survival. Results: Of the forty-nine subjects included in this study, the age range was 39 to 85 years; 31 patients (63.3%) were over the age of 65 years, and 28 (57.1%) were male. Twenty-eight (57.1%) subjects with gain 1q were newly diagnosed while the remaining 21 (42.9%) were identified at relapse. Gain 1q was present in more than 20% of clonal cells in 73.5% of subjects and 29.6% had del 1p as well. Patients with gain 1q were more likely to have deletion 13q (65.3%) and hyperdiploidy (61.2%). Regarding treatment, 75.7% of patients received bortezomib, 70.3% received lenalidomide, 38.9% underwent autologous stem cell transplant (ASCT) and 64.9% received daratumumab. At the time of analysis, 41 patients were still alive. For the entire cohort, the estimated median OS was not reached (NR) (95% confidence interval [CI], 24.1-NR), and the estimated median PFS was 15.27 months (95% CI, 4.77-NR). In log-rank tests, presence of extra medullary disease was associated with shorter PFS (4.8 vs 24.1 months, P=0.003), while IGH abnormalities including complex IGH rearrangements or losses were associated with longer PFS (NR vs 8.2 months, P=0.046). Lenalidomide-based treatment was associated with prolonged OS (NR vs 17.2 months, P=0.048). Bortezomib-based therapy and upfront ASCT were associated with improved PFS (15.3 vs 4.7 months, P=0.036; NR vs 4.8 months, P =0.019 respectively). Further multivariate analyses adjusting for age, number of CKS1B copies, International Staging System stage, baseline creatinine, clone size, del 1p, lactate dehydrogenase, extra medullary disease, and IGH abnormalities revealed that administration of daratumumab after the discovery of gain 1q was associated with superior OS (Hazard Ratio [HR]=0.023x10^-2, 95% CI [0.002x10^-4, 0.299], P =0.022) compared with those not receiving this agent; both the use of bortezomib (HR=0.210, 95% CI [0.064, 0.687], P =0.010) and daratumumab (HR=0.126, 95% CI [0.015, 1.036], P =0.054) were associated with prolonged PFS. The use of lenalidomide or upfront ASCT lost prognostic benefit after adjusting for additional variables in multivariate models. Conclusions: The outcomes of MM patients with gain 1q were evaluated according to clinical characteristics, concurrent chromosomal alterations and treatment regimens. In our small cohort, daratumumab and daratumumab-bortezomib combination regimens were found to have a favorable impact on survival. Future prospective clinical trials with larger sample sizes are warranted to confirm the results and further improve the outcomes of MM patients with this cytogenetic alteration. Disclosures Comenzo: Amgen: Consultancy; Takeda: Consultancy, Research Funding; Sanofi: Consultancy; Unum: Consultancy; Caleum: Consultancy; Prothena: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Karyopharm: Consultancy, Research Funding.

The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature

2021 ◽  
Author(s):  
Jasmine Peters ◽  
Mariel S Bello ◽  
Leigh Spera ◽  
T Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Systematic Review ◽  
Native American ◽  
The United States ◽  
Current Status ◽  
Surgical Trauma ◽  
Insurance Status ◽  
Inclusion Criteria ◽  
Burn Care ◽  
Race Ethnicity ◽  
The Impact

Abstract Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000-2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the US that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. 1,169 papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally-tailored medical care and address the needs of disadvantaged burn survivors.

Impact of gender on treatment and survival of patients with esophageal cancer in the United States.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 173-173
Author(s):  
Camille Baumrucker ◽  
Dido Franceschi ◽  
Alan S Livingstone ◽  
Francis Igor Macedo
Keyword(s):  
Esophageal Cancer ◽  
The United States ◽  
Small Sample ◽  
Stage I ◽  
Disease Stage ◽  
Cancer Data ◽  
Female Patients ◽  
White Males ◽  
Chi Square Analysis ◽  
The Impact

173 Background: Esophageal cancer (EC) is historically a male-predominant disease. Current available evidence on the impact of gender on clinical presentation and survival outcomes of EC is limited by small sample size or single institutional series. Methods: Patients with EC (stage I-III) were identified in the National Cancer Data Base (NCDB, 2004-2016). Clinicopathologic and treatment characteristics of male and female patients were compared using Chi-square analysis. Overall survival (OS) was estimated using Kaplan-Meier method and Cox proportional hazards regression. Results: Of 62,893 patients included, male gender was predominant (77.7% vs 22.3%). Adenocarcinoma was the most common subtype (66.7%); however, squamous cell carcinoma was more predominant in females (57.1% vs. 26.5%, p<0.001). Females were significantly older (68.5 vs. 66.1 years; p<0.001) and more likely African American (AA) (14% vs. 8.1%; p<0.001). Females were more likely to present with local disease (stage I, 19.6% vs. 18.2%; p<0.001), while males presented more likely with locoregional disease (LRD, stage II/III, 80.4% vs 81.8%, p<0.001). Females had worse OS compared to males (18.1 vs. 19.7 mo; p=0.001; cI: 23.5 vs. 31.9mo, p<0.001; cII/III: 17.2 vs 18.3mo, p=0.473). White females had worse OS than white males (18.6 vs. 20.4mo, p<0.001), while AA females had better OS (13.5 vs. 12.6mo, p=0.001). Among patients with LRD, females less frequently received chemotherapy (CT, 75.4% vs. 82.9%, p<0.001), radiation therapy (RT, 78.9% vs. 82.6%, p<0.001), and esophagectomy (28% vs. 40.5%, p<0.001). Females who underwent esophagectomy had improved OS over males (40.3 vs. 32.7mo; p<0.001). More specifically, white females who underwent esophagectomy had improved OS over white males (47.6 vs 38mo, p<0.001); however, AA males and females who underwent esophagectomy had similar OS (33.8 vs 32.6mo, p=0.452). Female gender, advanced age, AA race, high comorbidity score and clinical stage, and lack of access to CT, RT, and esophagectomy were independent predictors of mortality (Table). Conclusions: Females with EC seem to have less access to CT, RT and esophagectomy, which is associated with worse OS compared to males. Healthcare policies should be implemented to increase access to standard of care treatment for female patients with EC. [Table: see text]

Racial and Ethnic Differences in Response to Anticoagulation: A Review of the Literature

2019 ◽  
pp. 089719001989414 ◽  
Author(s):  
Caitlin M. Gibson ◽  
Wei C. Yuet
Keyword(s):  
Racial Differences ◽  
Race And Ethnicity ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Ethnic Disparities ◽  
The United States ◽  
End Points ◽  
Medline Search ◽  
Drug Concentrations ◽  
The Impact

Introduction: Anticoagulants are among the most frequently prescribed medications in the United States. Racial and ethnic disparities in incidence and outcomes of thrombotic disorders are well-documented, but differences in response to anticoagulation are incompletely understood. Objective: The objective of this review is to describe the impact of race and ethnicity on surrogate and clinical end points related to anticoagulation and discuss racial or ethnic considerations for prescribing anticoagulants. Methods: A PubMed and MEDLINE search of clinical trials published between 1950 and May 2018 was conducted using search terms related to anticoagulation, specific anticoagulant drugs, race, and ethnicity. References of identified studies were also reviewed. English-language human studies on safety or efficacy of anticoagulants reporting data for different races or ethnicities were eligible for inclusion. Results: Seventeen relevant studies were identified. The majority of major trials reviewed for inclusion either did not include representative populations or did not report on the racial breakdown of participants. Racial differences in pharmacokinetics, dosing requirements, drug response, and/or safety end points were identified for unfractionated heparin, enoxaparin, argatroban, warfarin, rivaroxaban, and edoxaban. Conclusions: Race appears to influence drug concentrations, dosing, or safety for some but not all direct oral anticoagulants. This information should be considered when selecting anticoagulant therapy for nonwhite individuals.

scholarly journals SUN-426 The Impact from AJCC 8Th Edition Staging System on Thyroid Cancer Outcomes by Race And Ethnicity

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Juan Antonio Santamaria-Barria ◽  
Amanda N Graff-Baker ◽  
Shu-Ching Chang ◽  
Adam Khader ◽  
Anthony J Scholer ◽  
...  
Keyword(s):  
Native American ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
Staging System ◽  
Cox Proportional Hazards ◽  
Pacific Islanders ◽  
Asian Pacific Islanders ◽  
Asian Pacific ◽  
The Impact ◽  
8Th Edition

Abstract Background. Previous studies have demonstrated racial and ethnic outcome disparities among differentiated thyroid cancer (DTC) patients. However, the impact of the 8th edition of the American Joint Committee on Cancer staging system (AJCC8) on these disparities is unknown. Methods. DTC patients with sufficient tumor and survival data were identified in the National Cancer Database from 2004-2013. The 7th edition of the staging system (AJCC7) and AJCC8 criteria were compared. Multivariable logistic regression was used to evaluate the association between AJCC7 to AJCC8 staging change and race and ethnicity. Cox-proportional hazards regression was then used to evaluate the association between AJCC7 to AJCC8 staging change and overall survival. Results. Of 33,323 DTC patients, 76.7% were White/Non-Hispanics, 7.6% Blacks, 6.7% Hispanics, 5.4% Asian/Pacific-Islanders, and 3.6% Native-American/Other. Most were female (77%) with papillary DTC (90%). After adjusting for demographic, tumor, and treatment characteristics, Hispanics and Asian/Pacific-Islanders were 27% and 12% less likely to be AJCC7 to AJCC8 downstaged than White/Non-Hispanics (OR=0.73, 95%CI: 0.66-0.81; and OR=0.88, 95%CI: 0.79-0.99, respectively); Blacks had no significant downstaging difference compared to White/Non-Hispanics (OR=0.99, 95% CI: 0.90-1.09, p=0.79). Although AJCC8 was a better survival prognosticator than AJCC7, Cox-proportional hazards regression showed that all AJCC7 to AJCC8 downstaged patients had an increased risk of death compared to patients with unchanged staging, regardless of race and ethnicity: White/Non-Hispanics (HR=2.64, 95%CI: 2.34-2.98), Blacks (HR=1.77, 95%CI: 1.23-2.54), Hispanic (HR=3.27, 95%CI: 2.05-5.22), Asian/Pacific-Islanders (HR=2.31, 95%CI: 1.35-3.98), and Native-American/Other (HR=5.26, 95%CI: 2.10-13.19). However, based on two way interaction, the magnitude of negative change in survival from downstaging was only different between White/Non-Hispanics and Blacks (HR=2.64 vs. HR=1.77, respectively; p=0.04). Conclusions. Racial and ethnic outcome disparities persist with AJCC8. The proportion of downstaged DTC patients with AJCC8 varies by race and ethnicity, with the least impact found in Hispanics and Asian/Pacific-Islanders. Downstaged patients across all racial and ethnic groups had a decreased survival than those with unchanged stage, with the least impact in Blacks. These disparities should be taken into account when counseling patients about their prognosis with the new AJCC8.

scholarly journals 566. Reduction of Hospital-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia in an Acute Care Hospital: Impact of Bundles and Universal Decolonization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S268-S268
Author(s):  
Adriana Jimenez ◽  
Kathleen Sposato ◽  
Alicia de Leon-Sanchez ◽  
Regina Williams ◽  
Reynande Francois ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Care Facility ◽  
The United States ◽  
Adult Patients ◽  
Care Hospital ◽  
Icu Patients ◽  
Improvement Project ◽  
Contact Precautions ◽  
The Impact

Abstract Background MRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility. Methods This quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report. During baseline period (Figure1 Phase 1 January 2015–August 2016) all adult patients in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In Phase 2 (September 2016–June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at the bedside. SIR were compared by exact binomial test. Results We observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P = 0.003). The largest decrease in cases and SIR was attained using combined hospital-wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table 1). Conclusion Our bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia. Disclosures All authors: No reported disclosures.

164 Hispanic Ethnicity and Socioeconomic Status are Independently Associated with Improved Prognosis in Glioblastoma Patients

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 241-241
Author(s):  
Kevin J Moore ◽  
Angela Richardson ◽  
Tulay Koru-Sengul ◽  
Michael E Ivan
Keyword(s):  
Socioeconomic Status ◽  
Race And Ethnicity ◽  
Cox Regression ◽  
The United States ◽  
Population Based ◽  
Epidemiologic Studies ◽  
Hispanic Ethnicity ◽  
Cancer Data ◽  
Hispanic Patients

Abstract INTRODUCTION Significant racial and social disparities have previously been identified in outcomes from glioblastoma. Although some epidemiologic studies have shown Hispanic ethnicity to be protective, other studies have not replicated this finding. As many studies do not consider race separately from ethnicity, the role of Hispanic ethnicity in glioblastoma survival is not well understood. Florida has one of the largest Hispanic populations in the United States. Using a population-based cancer database, this study examines sociodemographic and survival disparities in glioblastoma patients. METHODS Data from the Florida Cancer Data System (FCDS) and the US Census were linked for adult (>18 yrs) glioblastoma patients to determine disease burden and survival. A multivariable Cox regression model was used to model patient survival adjusting for sociodemographic, tumor, and clinical characteristics. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated for overall sample. All statistical analyses were completed with SAS v.9.4. RESULTS >In total, 16,180 Florida adults were diagnosed with glioblastoma between 1981 and 2013. The majority were male (56.0%) and white (93.0%), and 11.2% of glioblastoma patients identified as Hispanic with 2.4% self-identifying as Cuban. Hispanics had significantly better survival compared to non-Hispanics (aHR 0.84; 95% CI 0.78 0.90). Current smokers fared significantly worse (aHR 1.11; 95% CI 1.04 1.18). Higher socioeconomic status was also associated with increased survival (aHR 0.91, 95% CI 0.84 0.99). Younger age at diagnosis, surgical resection, chemotherapy, radiation therapy, and female sex were also associated with significantly improved outcomes. CONCLUSION This study demonstrates clear sociodemographic and survival disparities for glioblastoma patients. This analysis considers race and ethnicity as two distinct variables and shows improved survival outcomes for Hispanic patients. Additionally patients from neighborhoods with higher socioeconomic status have increased survival. Further analysis is needed to assess the role of histologic and molecular subtypes in these ethnic groups.

Military Service in Vietnam/Korea and Serum Dioxin Levels Do Not Affect the Outcomes of Patients Diagnosed with Plasma Cell Dyscrasias

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5098-5098
Author(s):  
Prasanth Ganesan ◽  
Emil Kuriakose ◽  
Carla Smith ◽  
Robert T Harris ◽  
Jonathan E Dowell ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cell ◽  
Military Service ◽  
Conflicts Of Interest ◽  
Military Veterans ◽  
Cell Transplant ◽  
Increased Risk ◽  
Plasma Cell Dyscrasias ◽  
Chlorinated Dioxins ◽  
The Impact

Abstract Abstract 5098 Military Service in Vietnam/Korea and Serum Dioxin Levels Do Not Affect the Outcomes of Patients Diagnosed with Plasma Cell Dyscrasias. Background: Exposure to dioxin, a contaminant found in herbicides has been associated with increased risk of cancers including multiple myeloma and postulated to cause poorer survival in the exposed population. Military personnel, especially those who had served in Vietnam and Korea have an increased risk of dioxin (which contaminated the herbicide Agent Orange which was sprayed during these wars) exposure. We looked at the impact of dioxin exposure and blood levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) which is the most toxic of the poly-chlorinated dioxins on the survival outcomes of military veterans diagnosed with plasma cell dyscrasias (PCD). Methods: A prospective analysis of newly diagnosed and existing myeloma patients was done. Information regarding the patient and disease characteristics, the military record, and outcomes were collected. Approximately 60 ml of heparinised peripheral blood was collected and immediately frozen at −20 degrees. These samples were shipped to Eurofins Laboratory, Hamburg, Germany for dioxin level measurement. Patients' blood lipid levels were also measured and the dioxin toxic equivalent (Teq) was calculated. Overall survival (OS) was calculated from the date of diagnosis till death (Kaplan Meier method). Cox regression and log rank analysis were used to look for prognostic variables. Results: Fifty two (52) patients of PCD were available for analysis. Majority had a diagnosis of multiple myeloma. Forty one underwent treatment including stem cell transplant in 16 (Table 1 shows the patient characteristics, laboratory results and treatment outcomes). During a median follow up of 54 months (2–348), 21 patients died (progressive myeloma: 12(23%), cardiac failure: 3 (5.7%), infections: 1 (1.9%), acute myeloid leukemia: 1 (1.9%), pulmonary embolism: 1 (1.9%) and unknown: 3 (5.7%). The median OS was 111 mos (95% CI 56–155) and the estimated survival at 5 yrs was 69.5% (+/− SE 0.067). The 5 yr OS was negatively impacted by abnormal cytogenetics (40.3 % vs. 75.5%; p=0.012), and service in the army (non-army vs. army: 83% vs. 40%; p=0.032). Patients who had served in Vietnam had outcomes similar to others; Korean War veterans had a poorer OS, but this was not statistically significant (5 yr OS 68% vs. 48%; p=0.1). There was no association between TCDD levels or the Teq with OS. Abnormal cytogenetics was the only significant factor on multivariate analysis. Conclusions: We did not find an association between military service in Korea/Vietnam or serum dioxin levels and poor survival in military veterans diagnosed with Plasma cell dyscrasias. However, a study of a larger sample of myeloma patients with similar service and exposure histories maybe warranted. Disclosures: No relevant conflicts of interest to declare.

HCT.CI in Autologous Stem Cell Transplantation. Predicting Early and Late Transplant Related Mortality

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3449-3449 ◽  
Author(s):  
Mariano Berro ◽  
Maria M Rivas ◽  
Jorge Alberto Arbelbide ◽  
Ana Lisa Basquiera ◽  
Adriana Vitriu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Stem Cell ◽  
High Risk ◽  
Hodgkin Lymphoma ◽  
Early Mortality ◽  
Cell Transplant ◽  
End Point ◽  
The Impact ◽  
Autologous Hsct ◽  
Related Mortality

Abstract Background. Hematopoietic Stem Cell Transplant Comorbidity Index (HCT.CI) score, described by Sorror, is a useful tool to assess the risk for Non Relapse Mortality (NRM) after Allogeneic HSCT. The impact of this score in Autologous HSCT is still to be confirmed. Aims. To determine the impact of HCT.Ci score in the morbidity and mortality after autologous HSCT, assessing the 100 day morbidity defined as orothraqueal intubation (OTI), dialysis or shock (defined as vasopressors need), 100 day mortality, early morbi-mortality (combined end-point by any of the previous end-point) and long term NRM. Materials and Methods. We retrospectively reviewed 1478 medical records of adult patients who received an autologous HSCT in our centre between October 2002 and April 2016. Median age was 49 years (range 16-74 years), 58% were male, prevalent diseases were Multiple Myeloma (48%), Non Hodgkin Lymphoma (27%) and Hodgkin Lymphoma (18%), 49% were in complete remission, 46% received one chemotherapy scheme before transplant, 41% two schemes and 12% three or more (heavily pre-treated). In respect to conditionings, melphalan was used in 48% of the cases, CBV in 25%, BEAM in 8% as well as BendaEAM. Seventy five percent received an infusion of stem cells CD34+≥3x10.6/kg. Regarding comorbidities, 58% had low risk (LR) HCT.CI (score 0), 32% intermediate risk (IR) (1-2) and 11% high risk (HR) (≥3). For univariate analysis we use Chi2 for dichotomic variables, Kaplan-Meier for Overall Survival (OS) and cumulative incidence for NRM; for multivariate analysis we used logistic regression for dichotomic and Cox regression for time dependant variables. Results. Median follow up was 1.9 years. Early mortality (day 100) was 2.8%, 5.6% required OTI, 4.8% required vassopresors and 2.2% dialysis, 1-3 years NRM and OS were 4.3-5.2% and 89-77% respectively. High risk HCT.Ci patients had a significant increase in 100 day mortality compared to IR and LR (7% vs.3% vs. 2% respectively, p=0.002), OTI (12% vs. 7% vs. 4%, p<0.001), dialysis (4.5% vs.2.6% vs. 1.5%, p=0.04), shock (10% vs.6.4% vs. 3%, p<0.001), early morbi-mortality (15% vs.9 % vs. 4.6%, p<0.001) and NRM (1-3 years 9.2-13% vs. 3.8-3.8% vs. 3.5-4.5%, p<0.001) (figure 1). After multivariate analysis these outcomes remain significant (showed as OR with 95% CI, IR and HR compared to LR): early mortality (1.8, 0.8-4.2 and 3.9, 1.6-9.7, p=0.003), OTI (2.1, 1.2-3.7, p<0.01 and 3.9, 2.0-7.5, p<0.001), dialysis (2.2, 0.8-5.5 and 4.1, 1.4-11.7, p<0.01), shock (2.7, 1.4-4.9, p=0.001 and 4.4, 2.1-8.9, p<0.001), early morbi-mortality (2.4, 1.4-4.0, p=0.001 and 4.2, 2.3-7.6, p<0.001) and NRM (1.3, 0.7-2.4 and 3.0, 1.5-5.7, p=0.001) (table 1). No significant impact was observed in OS. Other than comorbidities, significant impact was observed in early mortality (pre-transplant status, heavily pre-treated patients and BendaEAM conditioning), OTI (NHL, heavily pre-treated patients, BendaEAM conditioning), dialysis (pre-transplant status and BendaEAM conditioning), shock (NHL, heavily pre-treated patients and BendaEAM conditioning), morbi-mortality (NHL and BendaEAM conditioning) and NRM (male patients, NHL, pre-transplant status, heavily pre-treated patients and BendaEAM conditioning). Conclusions. We observed that HCT.CI had a significant impact on Autologous HSCT treatment related mortality basically due to early toxicity express as 100 day mortality and the three main morbidity outcomes as well as the combined end point. This observation should be confirmed in larger series. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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