Use of cardioprotective dexrazoxane and myelotoxicity in anthracycline-treated soft tissue sarcoma patients.

11053 Background: Dexrazoxane (DEX) is indicated as a cardioprotective agent for patients receiving doxorubicin, who are at increased risk for cardiotoxicity. Concerns have been raised on the use of DEX, particularly in the adjuvant setting, because of the risk of interference with the antitumor effect of doxorubicin. Two meta-analyses in metastatic breast cancer have rejected this hypothesis, but have shown an apparent increase in the severity of myelosuppression when DEX is used. No data in soft-tissue sarcoma (STS) patients is available, so far. Here, we retrospectively analyzed a cohort of our Institute database to assess whether the addition of DEX causes more bone marrow suppression in STS patients receiving Anthracycline-Ifosfamide (AI) combination in perioperative and advanced setting. Methods: 133 patients who received AI between January 2006 and December 2017 were included. 46 of them received DEX concurrently with the AI treatment. Hospital records were reviewed and available for all patients (the accessibility of all the data was an inclusion criterion). Compared to the non-DEX group, patients who received DEX were more frequently treated in the context of a perioperative setting (respectively 27.3 vs 38.8%). No other differences in terms basal patient features were recorded. Significantly, all patients received similar post-medication after each cycle. Results: Compared with the non-DEX group, DEX treatment was associated with significantly higher rates of G3/4 hematological side effects: leucopenia (28.7 vs 56.5%, p value=0.0014); neutropenia (35.6 vs 69.6%, p value=0.0002); anemia (28.7 vs 41.3%, p value=0.1758); thrombocytopenia (32.1 vs 54.3%, p value=0.0159). Similarly, compared to the non-DEX group, there were more hospitalizations for febrile neutropenia (37.9 vs 63.0%, p value=0.0066) and dose reductions (19.5 vs 39.1%, p value=0.0221) in the DEX group, above all in perioperative setting (15.6 vs 58.3%, p value=0.0085); but no significant difference in the incidence of treatment delays or interruption. Conclusions: Adding DEX to Anthracycline-based chemotherapy in soft-tissue sarcoma patients leads to higher rates of bone marrow suppression in all blood components, as well as more febrile neutropenia events, and dose reductions.

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Use of Cardioprotective Dexrazoxane Is Associated with Increased Myelotoxicity in Anthracycline-Treated Soft-Tissue Sarcoma Patients

Chemotherapy ◽

10.1159/000501195 ◽

2019 ◽

Vol 64 (2) ◽

pp. 105-109 ◽

Cited By ~ 1

Author(s):

Mariella Spalato Ceruso ◽

Andrea Napolitano ◽

Marianna Silletta ◽

Alessandro Mazzocca ◽

Sergio Valeri ◽

...

Keyword(s):

Breast Cancer ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Febrile Neutropenia ◽

Metastatic Breast ◽

Hematological Toxicity ◽

Fisher Exact Test ◽

Breast Cancer Patients ◽

Exact Test ◽

Dose Reductions

Background: Dexrazoxane (DEX) is indicated as a cardioprotective agent for breast cancer patients receiving the anthracycline doxorubicin. Two meta-analyses in metastatic breast cancer reported an apparent increase in the severity of myelosuppression when DEX was used. So far, no data in soft-tissue sarcoma (STS) patients are available. Methods: We retrospectively analyzed hematological toxicity data from 133 consecutive STS patients who received a chemotherapy regimen containing an anthracycline and ifosfamide (AI) in the perioperative or metastatic settings between January 2006 and December 2017. Of these, 46 received off-label DEX concurrently with the AI treatment. The differences between incidence of any of the explored outcomes were assessed according to the Fisher exact test. Results: Compared with the non-DEX group, DEX treatment was associated with significantly higher rates of grade 3/4 hematological toxicities: leukopenia (56.5 vs. 28.7%; p = 0.0014), neutropenia (69.6 vs. 24.1%; p = 0.0001), febrile neutropenia (52.2 vs. 20.7%; p = 0.0004), anemia (41.3 vs. 28.7%; p = 0.1758), and thrombocytopenia (54.3 vs. 32.1%; p = 0.0159). Similarly, in the DEX group dose reductions were more frequent compared to the non-DEX group (39.1 vs. 19.5%; p = 0.0221). Conclusion: Adding DEX to AI in STS patients leads to higher rates of bone marrow suppression in all blood components, as well as to more frequent events of febrile neutropenia and dose reductions.

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Pharmacogenetic Study of Trabectedin-Induced Severe Hepatotoxicity in Patients with Advanced Soft Tissue Sarcoma

Cancers ◽

10.3390/cancers12123647 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3647

Author(s):

Maud Maillard ◽

Christine Chevreau ◽

Félicien Le Louedec ◽

Manon Cassou ◽

Caroline Delmas ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

R Package ◽

P Value ◽

Advanced Soft Tissue Sarcoma ◽

Pharmacogenetic Study ◽

Association Analyses ◽

Important Concern ◽

Increased Risk ◽

Functional Consequences

Hepatotoxicity is an important concern for nearly 40% of the patients treated with trabectedin for advanced soft tissue sarcoma (ASTS). The mechanisms underlying these liver damages have not yet been elucidated but they have been suggested to be related to the production of reactive metabolites. The aim of this pharmacogenetic study was to identify genetic variants of pharmacokinetic genes such as CYP450 and ABC drug transporters that could impair the trabectedin metabolism in hepatocytes. Sixty-three patients with ASTS from the TSAR clinical trial (NCT02672527) were genotyped by next-generation sequencing for 11 genes, and genotype–toxicity association analyses were performed with R package SNPassoc. Among the results, ABCC2 c.1249A allele (rs2273697) and ABCG2 intron variant c.-15994T (rs7699188) were associated with an increased risk of severe cytolysis, whereas ABCC2 c.3563A allele had a protective effect, as well as ABCB1 variants rs2032582 and rs1128503 (p-value < 0.05). Furthermore, CYP3A5*1 rs776746 (c.6986A > G) increased the risk of severe overall hepatotoxicity (p = 0.012, odds ratio (OR) = 5.75), suggesting the implication of metabolites in the hepatotoxicity. However, these results did not remain significant after multiple analysis correction. These findings need to be validated on larger cohorts of patients, with mechanistic studies potentially being able to validate the functional consequences of these variants.

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Management and outcome of acral soft-tissue sarcomas

The Bone & Joint Journal ◽

10.1302/0301-620x.100b11.bjj-2018-0301.r1 ◽

2018 ◽

Vol 100-B (11) ◽

pp. 1518-1523 ◽

Cited By ~ 2

Author(s):

B. J. F. Dean ◽

H. Branford-White ◽

H. Giele ◽

P. Critchley ◽

L. Cogswell ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcoma ◽

Tumour Size ◽

Epithelioid Sarcoma ◽

Soft Tissue Sarcomas ◽

Amputation Rate ◽

Increased Risk ◽

Significant Difference ◽

Partial Amputation

Aims The aim of this study was to evaluate the surgical management and outcome of patients with an acral soft-tissue sarcoma of the hand or foot. Patients and Methods We identified 63 patients with an acral soft-tissue sarcoma who presented to our tertiary referral sarcoma service between 2000 and 2016. There were 35 men and 28 women with a mean age of 49 years (sd 21). Of the 63 sarcomas, 27 were in the hands and 36 in the feet. The commonest subtypes were epithelioid sarcoma in the hand (n = 8) and synovial sarcoma in the foot (n = 11). Results In 41 patients (65%), the tumour measured less than 5 cm in its largest dimension (median size 3 cm (2 to 6)); 27 patients (43%) were diagnosed after inadvertent excision prior to their referral to the specialist sarcoma unit. After biopsy and staging, primary surgical intervention at the sarcoma unit was excision and limb salvage in 43 (68%), partial (digit or ray) amputation in 14 (22%), and more proximal amputation in six (10%). At final follow up, local recurrence had been treated by one partial amputation and six amputations, resulting in a partial amputation rate of 24% and a proximal amputation rate of 19%. The five-year survival rate was 82%. Patients who underwent inadvertent excision showed no statistically significant difference in survival or local recurrence, but were more likely to undergo amputation (p = 0.008). Large tumour size (> 5 cm) was associated with lower survival (p = 0.04) and a higher risk of local recurrence (p = 0.009;). Conclusion Most acral soft-tissue sarcomas measure less than 5 cm at presentation, indicating that while size can be a useful prognostic factor, it should not be used as a diagnostic threshold for referral. Increased tumour size is associated with a higher rate of local recurrence and reduced survival. Sarcoma excision with limb preservation does not result in an increased risk of local recurrence. Cite this article: Bone Joint J 2018;100-B:1518–23.

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Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

10.2196/preprints.23937 ◽

2020 ◽

Author(s):

Dr. Animesh Ray ◽

Dr. Komal Singh ◽

Souvick Chattopadhyay ◽

Farha Mehdi ◽

Dr. Gaurav Batra ◽

...

Keyword(s):

Tertiary Care ◽

Age Groups ◽

Hospitalized Patients ◽

North India ◽

P Value ◽

Care Hospital ◽

Igg Antibodies ◽

Igg Antibody ◽

Increased Risk ◽

Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

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Impaired atrial electromechanical coupling in lichen planus patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.109 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

I Jafaripour ◽

Z Aryanian ◽

S Hosseinzadeh ◽

R Pourkia ◽

MM Ansari Ramandi ◽

...

Keyword(s):

Lichen Planus ◽

Electromechanical Coupling ◽

Wave Dispersion ◽

Tissue Doppler ◽

P Wave ◽

Control Group ◽

P Value ◽

P Wave Dispersion ◽

Increased Risk ◽

Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Lichen planus (LP) which is a chronic inflammatory disease can cause impaired atrial electromechanical coupling, leading to increased risk of atrial fibrillation. Purpose The present study aimed to evaluate atrial electromechanical coupling in LP patients by using electrocardiography (ECG) and echocardiography. Methods Forty-six LP patients were investigated in this cross-sectional case-control study. The control group comprised healthy individuals selected in age and gender-matched manner. Echocardiography and ECG were done for all patients to show inter and intra-atrial electromechanical delays and P wave dispersion respectively. The electromechanical delays were calculated by using the difference between the delays from the onset of the P wave on ECG to the onset of A wave on tissue Doppler recordings of the different areas. Results The baseline characteristics of the case and control group were similar and did not differ significantly. The P wave dispersion was 45.63 ± 3.48 milliseconds in the LP group in comparison to 36.56 ± 2.87 milliseconds in the control group (p < 0.001). As shown in the table, the intra and inter-atrial electromechanical delays were also significantly prolonged in LP patients when compared to the control group (p < 0.001). There was no significant difference between the left and right ventricular systolic function and diastolic function of the two groups. Conclusion The results of the study indicate the presence of significant impaired atrial electromechanical coupling in patients with LP confirmed by both electrocardiographic and echocardiographic tools. Electromechanical delays Case N = 46 (mean ± SD) Control N = 46 (mean ± SD) P value Septal - PA (msec) 59.71 ± 13.24 44.39 ± 11.07 0.002 Lateral - PA (msec) 55.71 ± 13.26 48.89 ± 11.21 0.009 Tricuspid - PA (msec) 52.37 ± 13.12 43.28 ± 10.58 0.002 Inter-atrial delay (msec) (lateral PA−RV PA) 8.47 ± 1.62 6.37 ± 1.36 <0.001 Intra-atrial delay (msec) (LA) [lateral PA−septal PA] 4.80 ± 1.48 3.83 ± 0.82 <0.001 Intra-atrial delay (msec) (RA) [septal PA−RV PA] 3.91 ± 0.96 2.02 ± 0.71 <0.001 PA Delay from the onset of the P wave on ECG to the onset of A wave on tissue Doppler, N: number, SD: Standard Deviation, LA: Left Atrium, RA: Right Atrium, RV: Right Ventricle

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A double-blind randomized placebo-controlled study of low dose mirtazapine once daily in patients of major depressive disorders on escitalopram

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191602 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1067

Author(s):

Mallikarjuna Rao I. ◽

Usha Kiran Prayaga ◽

Dharma Rao Uppada ◽

Ramachandra Rao E. ◽

B. L. Kudagi

Keyword(s):

Depressive Disorders ◽

Low Dose ◽

Rating Scale ◽

Controlled Study ◽

P Value ◽

Chi Square ◽

Double Blind ◽

Increased Risk ◽

Significant Difference ◽

Chi Square Test

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.

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The Latent Tuberculin Test after 1-year Therapy with Anti-TNF in Babylon, Iraq

Journal of University of Babylon for Pure and Applied Sciences ◽

10.29196/jubpas.v26i8.1680 ◽

2018 ◽

Vol 26 (8) ◽

pp. 144-150

Author(s):

Ali Alkazzaz ◽

Murtadha Najah Jawad ◽

Zeyad Tareq Kareem

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Medical History ◽

Demographic Data ◽

Latent Tuberculosis ◽

Tuberculin Test ◽

P Value ◽

Cross Sectional ◽

Increased Risk ◽

Significant Difference

Background: Rheumatoid arthritis (RA) patients receiving receive anti-TNF agents are at increased risk of reactivation of latent tuberculosis infection (LTBI). The tuberculin skin test (TST) is widely used to screen LTBI and providing preventive treatment, in an effort to meet the WHO target of a 90% reduction in TB by 2035. Objectives: To determine the proportion of TST conversion among RA patients after 1 year of anti-TNF treatment and association of positive TST result with patients’ socio-demographic characteristics and medical history. Methods: This community-based cross-sectional study was conducted at the Department of Rheumatology of Marjan Teaching Hospital in Iraq, for a period of 1 year. Patients with RA/and spondyloarthropathy, and who received anti-TNF therapy for >1 year, underwent TST. Their demographic data and medical history were also obtained. All statistical analysis was performed using SPSS (Version 20) and, p < 0.05 was considered as a sign. Data from the baseline and 1 year follow-up was subjected to the Kolmogorov-Smirnov test to determine whether they were normally distributed. Chi-Square test used to test significance of TST among etanrecept and infliximab at the end of the study. Results: A total of 96 patients were enrolled, including 55 (57.3%) males and 41 (42.3%) females with an average age of 41.1, and mostly 68 (70.8%) from Babylon Governorate of Iraq. A total of 40 (41.7%) patients had rheumatoid arthritis alone, and the remaining 56 (58.3%) had a comorbidity of spondyloarthropathy. Majority of the patients 65 (67.7%) received the biological agent infliximab, while 31 (32.3%) patients received Etanercept for RA for a period of 1 year. There was a statistically significant decreasing in the median ESR and disease activity from the baseline to the end of the study (p-value <0.01). There was no significant difference in TST results based on gender or age. Both infliximab and etanercept were significantly associated with a decreasing in ESR and disease activity Conclusion: This study has shown that there was very low TST conversion among RA patients after 1 year of anti-TNF treatment and, age and gender were not associated with TST.

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Assessment of Bone Marrow Function in Sickle Cell Anaemia Patients Using Corrected Reticulocyte Counts

Blood ◽

10.1182/blood.v126.23.4581.4581 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4581-4581

Author(s):

Titilola S. Akingbola ◽

Chinedu Anthony Ezekekwu ◽

Joseph Yaria ◽

Santosh L. Saraf ◽

Lewis L. Hsu ◽

...

Keyword(s):

Bone Marrow ◽

Steady State ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Reticulocyte Count ◽

P Value ◽

Production Index ◽

Risk Of Death ◽

Increased Risk ◽

Reticulocyte Production

Abstract Introduction: Chronic hemolysis occurs in sickle cell anemia as a result of recurrent sickling and other abnormalities of the red blood cells including eryptosis. Exuberant reticulocytosis is anticipated to partially compensate for the resultant anemia. Sickle cell anemia patients may also have aplastic crisis, bone marrow (BM) infarction and erythropoietin deficiency which could lead to reticulocytopenia despite the anemia. High degree of reticulocytosis among asymptomatic infants with sickle cell anemia has been associated with an increased risk of death or stroke during childhood. Assessment of BM function in sickle cell anemia is important due to potential complications associated with both under-activity and hyperactivity. This study aimed at evaluating the erythropoietic function of the BM in steady state sickle cell anemia using corrected reticulocyte counts. Methods: This study was carried out at the hematology clinic in the University College Hospital, Ibadan. HbSS patients in steady state were recruited from the hematology clinic. Local ethical committee approval was obtained and all participants gave written informed consent. Patients with M. tuberculosis, Hepatitis B, HIV and P. falciparum infection were excluded. Peripheral blood samples were analyzed using Sysmex Ki-X21 for complete blood count (CBC) and standard point of care for serum electrolytes and liver function tests. The glomerular filtration rates were calculated using the Cockcroft-Gault formula. Reticulocyte counts were determined manually using fresh samples from K2 EDTA bottles and methylene blue stain. Two drops of stain were mixed with two to four volumes of anticoagulated blood and incubated at 37ºC for 15 minutes. Afterwards, the cells were re-suspended and blood films were made. Corrected reticulocyte count and reticulocyte production index were calculated. Participants were categorized according to corrected reticulocyte counts of greater than or less than 2.5%. Univariate and multivariate analyses were performed to determine variables associated with corrected reticulocyte count <2.5%. Results: 92 HbSS patients were recruited with a mean (SD) age of 19.6 (5.8) years. There was no correlation between age and eGFR (p-value: 0.227). Median (range) reticulocyte count, corrected reticulocyte count and reticulocyte production index were 5.5 (0.5 - 29.9), 3.3 (0.1 - 17.1) and 1.7 (0.2 - 8.6) respectively. 40 (43.5%) patients had corrected reticulocyte count <2.5% and 52 (56.5%) had a corrected count >2.5%. Those corrected reticulocyte count <2.5% were older (p: 0.013), taller (p: 0.041) and had higher aspartate transaminase (AST) levels (p: 0.006) than those with corrected counts >2.5% (Table 1). CBC parameters were not different when compared between both groups. Results of multivariate logistic regression analysis carried out showed that only AST was independently linked with corrected reticulocyte count <2.5% (R2: 0.172, p-value: 0.001) (Table 2). Table 1. Factors Associated with Low Reticulocyte Count Corrected count<2.5% Corrected count>2.5% p-Value Age (Mean, SD) 21.4 (6.3) 18.4 (5.0) 0.013 Gender (N, %) Male 22 (55.0) 28 (53.8) 0.912 Female 18 (45.0) 24 (46.2) Height (Mean, SD) 1.6 (0.1) 1.5 (0.1) 0.041 BMI (Mean, SD) 18.7 (3.1) 18.7 (3.0) 0.753 GFR (Mean, SD) 64.3 (37.7) 66.4 (29.3) 0.453 Bilirubin (Mean, SD) 1.7 (1.1) 1.9 (2.6) 0.674 AST (Mean, SD) 22.5 (13.5) 14.5 (6.6) 0.006 ALT (Mean, SD) 13.4 (7.7) 14.4 (11.1) 0.876 Table 2. Independent Predictors of Corrected Reticulocyte Count <2.5% or 95% CI p-Value Age 1.08 0.97 - 1.21 0.169 Height 19.8 0.11 - 366.10 0.259 AST 1.10 1.04 - 1.17 0.002 Hemoglobin 1.00 0.97 - 1.02 0.872 R2: 0.172, p: 0.001 Conclusion: Despite corrected reticulocyte count <2.5% in about half of the patients, there were similar hematological parameters and eGFR in both groups of patients. AST is a marker of hemolysis and low ALT rules out hepatic involvement. Since only 17.2% of the variability in BM response as assessed by corrected reticulocyte count could be accounted for by variables included in this study, there is a need to further evaluate the BM function of sickle cell patients to establish the causes of corrected reticulocyte count <2.5% in the setting of anemia, having ruled out erythropoietin as well as iron, folate or cobalamin deficiencies. This will aid the development of a functional algorithm for the individualized management of sickle cell disease patients with anemia. Disclosures No relevant conflicts of interest to declare.

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Impact of interdisciplinary sarcoma board evaluation on treatment outcome of primary soft-tissue sarcoma patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e23540 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e23540-e23540

Author(s):

Jana Kaethe Striefler ◽

Annika Strönisch ◽

Daniel Rau ◽

David Kaul ◽

Georgios Koulaxouzidis ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Tumor Stage ◽

Quality Parameters ◽

Low Grade ◽

Early Presentation ◽

Risk Of Death ◽

Increased Risk ◽

Interdisciplinary Approaches

e23540 Background: Early presentation of soft-tissue sarcoma (STS) patients to a specialized sarcoma center including discussion in the interdisciplinary sarcoma board (ISB) prior to surgery is essential to the treatment of sarcomas. This approach significantly improves patient survival and guideline coherence. However, there exists only limited information on the adherence to the recommendations of the ISB. Accordingly, we decided to analyze a STS cohort at a large German sarcoma center focusing on outcome parameters and adherence to quality parameters defined by the German Cancer Society (Deutsche Krebsgesellschaft). Methods: In a retrospective data analysis, we identified n = 230 adult patients presented at the ISB of the Charité–Universitätsmedizin Berlin in Germany from January 2015 until December 2019. Inclusion criteria were as follows: newly diagnosed STS, presentation during first-line therapy and recommendation of at least one treatment modality such as surgery, chemotherapy, radiotherapy, regional hyperthermia or follow-up by the ISB. Clinical and follow up data was collected by using the hospital information system and the outpatient network. Results: Our patient cohort included 53% male and 47% female patients with a median age of 58 years (range 19-96). The majority (86%) showed a localized tumor stage, while 14% already had metastases. In 24% of the cases the sarcomas were classified as low-grade, in 76% as high-grade. Surgery was recommended for 66% of the cases, for 80% of them combined with chemotherapy, radiotherapy or hyperthermia. 14% of the patients received a recommendation for all 4 modalities. For 9% of the patients, chemotherapy alone was recommended. Both overall survival and progression-free survival was significantly higher in the group with complete adherence to the recommendations of the ISB (p < 0.001). The worst prognosis was found in patients unable to adhere to the recommendations due to rapid progression or complications of the therapy (HR for death 15.06, 95%CI 7.94-32.22). If one recommended modality was not carried out, there also was a higher risk of death (HR 4.38, 95%CI 1.75-10.96). Most common reasons were patient refusal or individual decision by the treating physician. A metastasized tumor stage was associated with an increased risk of death (HR 2.62, 95%CI 1.45-4.75). In contrast, neither the histological grading (low vs. high) nor age did influence the mortality significantly. Conclusions: In our cohort of STS patients, survival depends significantly on adherence to the recommendations of the ISB. Our analysis at a German sarcoma center is in line with previous international reports demonstrating the importance of interdisciplinary decisions and therapeutic adherence. We hereby underline the essential role of interdisciplinary approaches in care of STS patients and the effort to implement defined quality parameters.

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Association of Clinical and Para-clinical Factors With the Occurrence of Febrile Neutropenia Following Autologous Bone Marrow Transplantation in Patients With Lymphoma

10.21203/rs.3.rs-39811/v1 ◽

2020 ◽

Author(s):

Babak Nejati ◽

Zohreh Kourehpaz ◽

Roya Dolatkhah ◽

mojtaba Varshochi ◽

Maryam Farmani

Keyword(s):

Bone Marrow ◽

Uric Acid ◽

Bone Marrow Transplantation ◽

Febrile Neutropenia ◽

Marrow Transplantation ◽

Autologous Bone Marrow Transplantation ◽

Autologous Bone Marrow ◽

Multivariable Logistic Regression Analysis ◽

Significant Difference ◽

Autologous Bone

Abstract Purpose: Promising results have been achieved by the administration of autologous bone marrow transplantation (BMT) in patients with lymphoma. However, infectious complications limit its positive outcomes. Therefore, better identification of related factors to the occurrence of febrile neutropenia may lead to improved management of these patients. This study aimed to evaluate the incidence and associated factors with the occurrence of febrile neutropenia in following BMT in patients with lymphoma Method: In this prospective study, 45 patients with a definite diagnosis of lymphoma who were candidates for BMT were consecutively included. Demographic characteristics, lymphoma type, and medical history, as well as the results of selected laboratory tests, were recorded. After BMT, neutrophil count and body temperature were evaluated. Results: Febrile neutropenia occurred in 28 patients (62.5 %). No statistically significant difference was seen between those with febrile neutropenia and those without, in terms of age, gender, BMI, type of lymphoma, blood group, and the number of radiotherapy or chemotherapy courses (p>0.05 for all). Multivariable logistic regression analysis demonstrated a significant positive relationship between the number of administered units of platelet and serum uric acid and development of febrile neutropenia. Conclusion: The results of our study showed that the incidence of febrile neutropenia is significantly high in lymphoma patients who receive BMT. Moreover, the number of administered units of platelet and uric acid before BMT are significantly associated with febrile neutropenia.

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