Effects of obesity on overall survival (OS) of patients with acute myeloid leukemia (AML).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18510-e18510
Author(s):  
Prajwal Dhakal ◽  
Elizabeth Lyden ◽  
Andrea Lee ◽  
Joel Michalski ◽  
Zaid S. Al-Kadhimi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Continuous Variable ◽  
Cell Transplant ◽  
Obese Patients ◽  
Co Morbidity ◽  
Comorbidity Burden ◽  
Baseline Characteristics ◽  
Morbidity Index

e18510 Background: The relationship between obesity and prognosis of AML has not been established. Our retrospective study aimed to determine the effect of obesity on OS of AML. Methods: AML patients diagnosed from 2000-2016 at University of Nebraska Medical Center were included. Body mass index (BMI) at the time of AML diagnosis was divided into 3 groups: normal (18.5≤25 kg/m2) or underweight (<18.5 kg/m2); over-weight (25-30 kg/m2); and obese (≥30 kg/m2). Chi-square test, Kruskal-Wallis test and ANOVA were used to look at the association of different BMI groups with other patient characteristics. Mann-Whitney test was used for pairwise comparisons of hematopoietic cell transplant (HCT) co-morbidity index and Bonferroni correction was used to adjust p-values. OS, defined as time from diagnosis to death from any cause, was determined by Kaplan-Meier method and comparisons were done using log-rank test. Cox Regression was performed to detect survival effect of BMI (as continuous variable). P<0.05 was considered statistically significant. Results: A total of 314 patients were included in the study (Table): 46% were female, 35% had adverse cytogenetics, 15% had FLT3-ITD mutation, 68% received intensive chemotherapy and 30% underwent HCT. 38% of total patients were obese. Baseline characteristics were similar in all 3 BMI groups except co-morbidity index (p=0.04). OS for normal/underweight, overweight and obese groups at 1 year was 85%, 92%, and 94% respectively (p=0.84). BMI, as a continuous variable, was not a significant risk factor for death (HR 1.00, 95% CI 0.98-1.03). Conclusions: Obese patients, compared to non-obese patients, did not differ in baseline characteristics other than increased comorbidity burden. Obesity, when adjusted for other characteristics, did not have any effect on OS of patients with AML. Patient characteristics. [Table: see text]

scholarly journals Obesity Does Not Increase Mortality after Emergency Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Paula Ferrada ◽  
Rahul J. Anand ◽  
Ajai Malhotra ◽  
Michel Aboutanos
Keyword(s):  
Wound Infection ◽  
Emergency Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Obese Patients ◽  
Exact Test ◽  
Icu Admission ◽  
Nonobese Patients ◽  
The Impact

Objective.The aim of this study is to evaluate the impact of obesity on patient outcomes after emergency surgery.Methods.A list of all patients undergoing emergent general surgical procedures during the 12 months ending in July 2012 was obtained from the operating room log. A chart review was performed to obtain the following data: patient characteristics (age, gender, BMI, and preexisting comorbidities), indication for surgery, and outcomes (pulmonary embolus (PE), deep venous thrombosis (DVT), respiratory failure, ICU admission, wound infection, pneumonia, and mortality). Obesity was defined as a BMI over 25. Comparisons of outcomes between obese and nonobese patients were evaluated using Fischer’s exact test. Predictors of mortality were evaluated using logistic regression.Results.341 patients were identified during the study period. 202 (59%) were obese. Both groups were similar in age (48 for obese versus 47 for nonobese,P=0.42). Obese patients had an increased incidence of diabetes, (27% versus 7%,P<0.05), hypertension (52% versus 34%,P<0.05), and sleep apnea (0% versus 5%,P<0.05). There was a statistically significant increased incidence of postoperative wound infection (obese 9.9% versus nonobese 4.3%,P<0.05) and ICU admission (obese 58% versus nonobese 42%,P=0.01) among the obese patients. Obesity alone was not shown to be a significant risk factor for mortality.Conclusions.A higher BMI is not an independent predictor of mortality after emergency surgery. Obese patients are at a higher risk of developing wound infections and requiring ICU admission after emergent general surgical procedure.

Hematopoietic Cell Transplant Co-Morbidity Index (HCTCI) and Multiple Myeloma (MM) Survival After Autologous Hematopoietic Cell Transplantation (AHCT)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4217-4217
Author(s):  
Anuj Mahindra ◽  
Ayman A Saad ◽  
Mei-Jie Zhang ◽  
Xiaobo Zhong ◽  
Angela Dispenzieri ◽  
...  
Keyword(s):  
Dose Reduction ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Risk Groups ◽  
Hematopoietic Cell ◽  
High Dose ◽  
Cell Transplant ◽  
Co Morbidity ◽  
Significant Difference ◽  
The Impact

Abstract Abstract 4217 Background: AHCT improves survival (OS) in newly diagnosed MM patients (pts) in large randomized trials. These trials have limited eligibility to younger, healthier pts. Selection of older pts and those with co-morbid illness for AHCT is problematic. HCT-CI, originally developed as predictor of post-allogeneic transplant outcomes, maybe valuable in stratifying risk of transplant related mortality (TRM) risk and OS in the AHCT setting. We investigated the relative impact of HCT CI along with other patient and MM related variables on outcomes after AHCT in a large cohort of transplant recipients. Methods: Outcomes of 1156 MM pts receiving AHCT after high dose Melphalan (MEL) between 2007 and 2010 reported to the CIBMTR (Center for International Blood and Marrow Transplant Research) were analyzed. HCTCI scores and individual comorbidities were prospectively reported at time of AHCT. Median follow up of survivors was 26 month. The impact of HCTCI and other potential prognostic factors including Karnofsky performance status (KPS) on OS were studied in multivariate Cox regression models. Results: HCTCI score was 0, 1, 2, 3, >3 in 42%, 18%, 13%, 13% and 14% respectively. Most common co-morbidities included pulmonary, diabetes, obesity, psychiatric, cardiac, renal and prior solid tumor. Using consolidated HCTCI scores, patients were stratified initially into 3 risk groups – HCTCI 0 (42%) vs. HCTCI 1–2 (32%) vs. HCTCI >2 (26%). Males and Caucasians were more likely to have greater HCTCI score. Higher HCTCI was associated with lower KPS <90 (33% in HCTCI 0 cohort vs. 50% in HCTCI >2). HCTCI score >2 was associated with MEL dose reduction to 140 mg/m2 (22% vs. 10% in score 0 cohort). Cytogenetic risk and MM related factors were not correlated with HCTCI. TRM at 12 month was 2%, 2%, and 3% for 3 risk groups. With extremely few TRM events, multivariate analysis did not suggest an impact of HCTCI. OS was 95%, 92%, 92% at 1 year and 87%, 81%, 80% at 2 year, respectively. OS was inferior for HCTCI >2 cohort (RR of death 1.48, p=0.02) and HCTCI cohort 1–2 (RR 1.37, p=0.04) compared with HCTCI 0 cohort. There was no significant difference in OS between HCTCI >2 vs. HCTCI 1–2 (p=0.64). Therefore the latter 2 groups were combined as the HCTCI >0 cohort [N=667] and compared with HCTCI=0 [N=489] in multivariate models. HCTCI >0 predicted inferior OS (RR of death= 1.41, p=0.01). Other significant predictors of inferior survival were KPS <90 (RR of death 1.61, p<0.01), IgA subtype (RR 1.64, p<0.01), >1 pretransplant regimen (RR 1.47, p<0.01), resistant MM at AHCT (RR 1.78, p<0.01). Major cause of death in both groups was progressive MM. Conclusion: In clinical practice, higher HCTCI score was associated with MEL dose reduction. Mortality after AHCT is predominantly related to MM progression/relapse with low incidence of TRM. Higher HCTCI scores were independently associated with inferior OS. KPS remains an important tool for risk stratification. Disclosures: No relevant conflicts of interest to declare.

Practice patterns and clinical outcomes of therapy-related acute myeloid leukemia (TAML) in the US.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18139-e18139 ◽  
Author(s):  
Manisha Pant ◽  
Smith Giri ◽  
Prajwal Dhakal ◽  
Vijaya Raj Bhatt
Keyword(s):  
Clinical Trials ◽  
Regression Model ◽  
Older Patients ◽  
Cox Regression ◽  
Single Agent ◽  
National Database ◽  
Cell Transplant ◽  
Cox Regression Model ◽  
Comorbidity Burden ◽  
Multiagent Chemotherapy

e18139 Background: tAML, compared to de novo AML, has higher adverse features and a shorter overall survival (OS). The use of chemotherapy and hematopoietic cell transplant (HCT), and OS of tAML outside of clinical trials has not been studied well. Current study was designed to identify the treatment patterns and OS of tAML based on a national database. Methods: A total of 1,611 cases of tAML were identified between 2001-2011 using the National Cancer Database (NCDB). Data on age, race, gender, income, insurance and educational status, Charlson comorbidity index (CCI), receipt of chemotherapy and HCT were abstracted. Log-rank test was used to test equality of survivor function among the variables. Factors that attained statistical significance during bivariate analysis were factored into multivariate analysis using Cox Regression model. Results: Median age at diagnosis was 63 years (range 18-90), with 54% < 65 years, 59% females and 80% Caucasians. 67% underwent chemotherapy (20% single agent, 45% multiple agents and 2% unknown). 19% received HCT. Median OS was 6.7 months (m) with 1-year OS of 33%. Median OS was lower among patients ≥65 versus < 65 years (4.1 vs. 9.5 m; p < 0.001), those with higher comorbidity burden (7.8 m for CCI of 0, 6.0 m for CCI of 1, and 3.8 m for CCI of 2; p < 0.001), and diagnosed before versus during/after 2008 (5.6 vs. 7.7 m, p = 0.05). Median OS was higher among patients who received chemotherapy (8.4 vs. 3.7 m; p < 0.001) and HCT (22.6 vs. 4.9 m, p < 0.001), as compared to those who did not. Cox regression model showed the predictors of OS to be: receipt of HCT (hazard ratio, HR 0.36); use of multiagent chemotherapy (HR 0.80); age≥65 years (HR 1.25), higher comorbidities (HR of 1.21 for CCI of 1, and 1.45 for CCI of 2) and diagnosis on or after 2008 (HR of 0.81). Conclusions: Over half of patients with tAML are younger adults ( < 65 years), however, the receipt of chemotherapy and HCT is relatively low. OS is poor in general but improves with the use of multiagent chemotherapy and HCT. OS is worse in older patients and those with comorbidities. Given a dismal prognosis, older patients may be managed by leukemia team with expertise in geriatric oncology and should be encouraged to participate in clinical trials of novel therapies.

scholarly journals Effect of Obesity on the Efficacy and Toxicities in Patients Undergoing Autologous Hematopoietic Stem Cell Transplant (AHCT) for Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4617-4617
Author(s):  
Nicole Pearl ◽  
Andrew Lin ◽  
Patrick Hilden ◽  
Larry W Buie ◽  
Kevin Robinson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Body Weight ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Obese Group ◽  
Obese Patients ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
Baseline Characteristics ◽  
Grade 3

Abstract Background - Increased patient obesity rates have brought into question the need for dose adjustments in chemotherapy. Strategies for dose adjustments include using adjusted body weight (adjBW) versus total body weight (TBW) (Fair, 2017). Incorrect dosing of chemotherapy can result in significant complications. Underdosing has the potential to lead to treatment failure, whereas overdosing can result in increased toxicity. Currently, there is a lack of data regarding appropriate dose adjustments for conditioning chemotherapy regimens in patients with lymphoma who undergo autologous hematopoietic stem cell transplantation (AHCT) (Fair, 2017; Bubalo, 2014). Objective - The primary objective of this study is to evaluate the effect of obesity on overall survival (OS) in lymphoma patients who have undergone AHCT. The secondary objectives are to evaluate progression-free survival (PFS), as well as safety and toxicity (particularly gastrointestinal, renal and liver toxicities, and infections). Methods - Patients with lymphoma who received an AHCT were identified from our institutional database. Baseline patient characteristics and dose adjustments to conditioning chemotherapy regimens made in the setting of obesity were collected. Obesity was defined as actual body weight that is ≥ 125% Ideal Body Weight (IBW) as per Memorial Sloan Kettering Cancer Center allogeneic/autologous hematopoietic cell transplantation chemotherapy guidelines. Transplant outcomes (OS and PFS) and toxicities were compared between non-obese and obese patients. Sub-group analysis of the obese patient population compared those who received conditioning regimens based on adjBW versus TBW. Survival outcomes were estimated using the Kaplan-Meier method with differences assessed using a log-rank test. Differences in toxicity rates were assessed using a chi-square or fisher's exact test as appropriate. Results - The 239 patients transplanted between January 2014 and August 2016 had a median age of 55.3 (range 19.1 - 77.1) and 44.8% were female. Their median Body Mass Index was 27.3 kg/m2 (range 16.8 - 53.2). Baseline characteristics of patients are summarized in Table 1, and the subset of obese patient characteristics are summarized in Table 2. Of the obese patients (N=110, 46.0%), 29.1% received chemotherapy based on adjBW. PFS and OS did not differ significantly between the non-obese group and the obese group (3-year PFS - 69.8% vs. 74.3%, P=0.25; 3-year OS - 85.7% vs. 89.7%, P=0.42). The median follow-up of surviving patients was 36.1 months. Within the obese group, PFS and OS were significantly longer in the group that received conditioning chemotherapy dosed on TBW than adjBW (3-year PFS - 84.3% vs. 49.9%, P<0.001; 3-year OS - 97.0% vs. 71.9%, P<0.001). Toxicities were graded according to the NCI Common Technology Criteria for Adverse Effects v4.0 (CTCAE). Most toxicity outcomes were similar between the non-obese and obese groups. The rate of grade 3 or 4 liver toxicity was significantly higher in the non-obese group than the obese group (5.4% vs. 0%, P=0.02). In the obese group, there were no reported grade 3 or 4 renal toxicities. No significant differences were observed between the TBW and adjBW groups for grade 3 or 4 infections (89.7% vs. 78.1%, P=0.13) or gastrointestinal toxicities (56.4% vs. 34.4%, P=0.06), potentially related to sample size. Multivariate analyses controlling for significant between-group differences in baseline characteristics are pending. Conclusion - Among obese adults with lymphoma undergoing an AHCT, conditioning chemotherapy dosed on TBW was associated with longer overall survival and progression-free survival than chemotherapy dosed on adjBW, without increased rates of toxicities. Disclosures No relevant conflicts of interest to declare.

scholarly journals 1087. Evaluation of Risk Factors for Infection among Patients Receiving Ibrutinib

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S572-S573
Author(s):  
Kenneth Tham ◽  
Stacy Prelewicz ◽  
Sara deHoll ◽  
Deborah Stephens ◽  
Carlos A Gomez
Keyword(s):  
Risk Factors ◽  
Single Agent ◽  
Interleukin 2 ◽  
Significant Risk ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cell Transplant ◽  
Serious Infection ◽  
Molecule Inhibitor ◽  
Baseline Characteristics ◽  
High Index Of Suspicion

Abstract Background Ibrutinib is a small-molecule inhibitor of Bruton tyrosine kinase (BTK) approved for various B-cell malignancies and cGVHD. Rates of serious infection—defined as requiring hospitalization or parenteral antimicrobials— and invasive fungal infection (IFI) in patients on ibrutinib are as high as 11.4% and 4.2% respectively (Varughese T, et al. Clin Infect Dis 2018;67(5):687-92), which may be related to off-target inhibition of interleukin-2-inducible T-cell kinase or macrophage function. Methods We retrospectively reviewed infection complications in patients receiving ibrutinib at our institution between 06/01/2014 and 08/31/2019, including patients who received single-agent or combination ibrutinib. In this study, serious infection was defined as above, or a diagnosis of pneumonia regardless of hospitalization or parenteral antimicrobial therapy. Logistic regression was used to identify risk factors. Results Baseline characteristics of 134 included patients are in Table 1. Infection and serious infection occurred in 96 (72%) and 48 (36%) patients, respectively. When pneumonia was not included as a criterion for serious infection, the serious infection rate was 22%. Prior allogeneic stem cell transplant (allo-HSCT) (OR 4.50; 95% CI 1.19 – 17.00) and corticosteroid use (OR 5.42; 95% CI 1.49 – 19.82) were significant risk factors for serious infection without pneumonia (Table 2). Of 37 patients (28%) who received primary HSV/VZV prophylaxis with acyclovir, there was one case of suspected herpes zoster infection (3%). IFI developed in 7 patients (5%): 5 with Pneumocystis jirovecii pneumonia (PJP), 1 with invasive aspergillosis, and 1 with a filamentous fungus, species unknown. Other identified organisms are detailed in Figure 1. Classical risk factors for IFI, including diabetes, allo-HSCT, and concurrent corticosteroid use, were not significant predictors in this group. Table 1. Baseline Characteristics Table 2. Risk Factor Analysis Figure 1. Identified Organisms in Serious Infection Conclusion Serious infections developed at a higher rate than previously reported in the literature, with IFI rates similar to those previously described. Prior allo-HSCT and steroid use were found to be risk factors for serious infection without pneumonia. Treating physicians should have a high index of suspicion for pneumonia, IFI, and PJP in this population. Disclosures All Authors: No reported disclosures

Abstract P105: Women with Atrial Fibrillation have Increased Risk of Incident Stroke: Insights from a Propensity-Matched Study of the AFFIRM Trial

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Brita Roy ◽  
Ravi V Desai ◽  
Mustafa I Ahmed ◽  
Gregg C Fonarow ◽  
Wilbert S Anorow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Scores ◽  
Cox Regression ◽  
Men And Women ◽  
Female Sex ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
All Cause Mortality ◽  
Baseline Characteristics

Background: Women with atrial fibrillation (AF) have been reported to have poor outcomes. It remains unclear if this association is intrinsic or mediated by the higher comorbidity burden of female AF patients. Therefore, we examined the association between sex and outcomes in a balanced cohort of propensity-matched AF patients who participated in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. Methods: Of the 4060 AFFIRM patients, 1594 (39%) were women. Propensity scores for female sex were calculated for each of the 4060 patients, and were used to assemble a cohort of 1097 pairs of men and women who were balanced on 51 baseline characteristics, including major cardiovascular (CV) risk factors and medication use, including warfarin. Matched Cox regression models were used to estimate the association between female sex and outcomes during 6 years of follow-up. Results: Patients (n=4060) had a mean (±SD) age of 70 (±8) years and 13% were African American. All-cause mortality occurred in 19% and 15% of matched men and women, respectively (matched HR when women were compared to men, 0.88; 95% CI, 0.69-1.11; p=0.279). All-cause hospitalization occurred in 61% of both men and women (matched HR for women, 1.06; 95% CI, 0.93-1.21; p=0.372). Sex was not associated with CV hospitalization (matched HR for women, 1.13; 95% CI, 0.97-1.32; p=0.111). Ischemic stroke occurred in 3% and 5% of matched men and women, respectively (OR when women were compared to men, 2.02; 95% CI, 1.28-3.18; p=0.002). There was no sex-related difference in major bleeding (7% each). Conclusion: In a cohort of AF patient in which men and women were well-balanced on 51 baseline characteristics including warfarin use, women had increased risk of stroke, but there was no sex-related variation in all-cause mortality or CV hospitalization.

scholarly journals Low alanine aminotransferase as a risk factor for chronic obstructive pulmonary disease in males

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yong Jun Choi ◽  
Do Sun Kwon ◽  
Taehee Kim ◽  
Jae Hwa Cho ◽  
Hyung Jung Kim ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Risk Factor ◽  
Pulmonary Disease ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Significant Risk ◽  
Continuous Variable ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cox Regression Analysis

AbstractAlanine aminotransferase (ALT) levels reflect skeletal muscle volume and general performance, which are associated with chronic obstructive pulmonary disease (COPD) development and prognosis. This study aimed to investigate ALT levels as a risk factor for COPD development. This 13-year population-based retrospective observational cohort study included 422,452 participants for analysis. We classified groups according to the baseline ALT levels (groups 1–5: ALT (IU/L) < 10; 10–19; 20–29; 30–39; and ≥ 40, respectively). The incidence of COPD was the highest in group 1, decreasing as the group number increased in males, but not in females. The Cox regression analysis in males revealed that a lower ALT level, as a continuous variable, was a significant risk factor for COPD development [univariable, hazard ratio (HR): 0.992, 95% confidence interval (CI): 0.991–0.994; multivariable, HR: 0.998, 95% CI: 0.996–0.999]. In addition, COPD was more likely to develop in the lower ALT level groups (groups 1–4; < 40 IU/L), than in the highest ALT level group (group 5; ≥ 40 IU/L) (univariable, HR: 1.341, 95% CI: 1.263–1.424; multivariable, HR: 1.097, 95% CI: 1.030–1.168). Our findings suggest that males with low ALT levels should be carefully monitored for COPD development.

Abstract 10847: Circadian Variation of In-Hospital and Out-of-Hospital Sudden Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Yicheng Tang ◽  
Tarryn Tertulien ◽  
Samir Saba
Keyword(s):  
Cardiac Arrest ◽  
Seasonal Pattern ◽  
Circadian Variation ◽  
Sudden Cardiac Arrest ◽  
Patient Characteristics ◽  
Activity Level ◽  
Common Mechanism ◽  
Circadian Pattern ◽  
Co Morbidity ◽  
Comorbidity Burden

Introduction: Several studies have reported circadian periodicity of sudden cardiac arrest (SCA), most commonly a nadir in event frequency during overnight hours. It remains unclear to what extent this circadian pattern is influenced by variation in patients’ physical activities. One way to elucidate this is to compare patients with out-of-hospital (OHCA) versus in-hospital (IHCA) cardiac arrests, which has not been previously done. We hypothesize that the circadian pattern of SCA will be preserved in a mixed contemporary cohort of OHCA and IHCA survivors. Methods: A total of 1,433 consecutive survivors of SCA in the Pittsburgh area from 2002 to 2012 were included. Patient demographics including clinical histories and details of SCA were collected using records from emergency medical services and rapid response teams. Unwitnessed SCA and those with potential non-cardiac confounders were excluded. The distribution of SCA throughout the day and associated patient characteristics were tested for differences using chi-square test and student’s t-test. Results: Of the 1,224 patients analyzed, 706 had IHCA and 518 OHCA. We observed a nadir of SCA in the nighttime hours between 0000 - 0600 in both IHCA and OHCA groups (p<0.001). Patients who arrested in this nighttime window had more co-morbidities (p=0.01) and lower percent of angiographically confirmed acute myocardial infarction (p=0.025). A similar circadian pattern was noted for patients with higher or lower comorbidity burden (p<0.001), although more blunted in sicker patients, as well as for patients whose arrest was due to a shockable rhythm (p<0.001). Correspondingly, the IHCA group had higher co-morbidity burden (p<0.001) and a blunted nighttime nadir compared to the OHCA group (p<0.001). We did not observe a temporal variation by day of week but did see a seasonal pattern with a peak in SCA in the Pittsburgh cold months (p<0.001). Conclusion: The typical pattern of nighttime nadir in SCA is seen in both OHCA and IHCA but is more blunted in sicker patients and in the hospital. This suggests a common mechanism that transcends differences between the two settings but may be influenced by non-cardiac comorbidities or environmental factors such as activity level.

Long-Term Remissions Of Patients With Follicular Lymphoma Grade 3 Treated With Rituximab, Cyclophospamide, Doxorubicine, Vincristine and Prednisone (R-CHOP)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3028-3028
Author(s):  
Paolo Strati ◽  
Jorge Enrique Romaguera ◽  
Larry W. Kwak ◽  
Fredrick B Hagemeister ◽  
Maria Alma Rodriguez ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Follicular Lymphoma ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Single Agent ◽  
World Health ◽  
Cell Transplant ◽  
Baseline Characteristics ◽  
Grade 3

Abstract Background Follicular lymphoma grade 3 (FLG3) are recognized as a distinct entity in the World Health Organization classification of lymphoma. FLG3 are defined as > 15 centroblasts per high power field and are further subdivided into A or B on the basis of the presence of centrocytes. Their natural history is similar to that of diffuse large B cell lymphomas (DLBCL) and there is still debate about their optimal management. Methods We conducted a retroprospective analysis of 156 patients with FLG3 receiving frontline treatment at MD Anderson Cancer Center between 06/1973 and 11/2004. Multivariate analysis (MVA) was performed using Hazard Ratio (HR) Cox regression with backward stepwise selection. Logistic regression with odds ratio (OR) was used for MVA of categorical variable. Results Patient baseline characteristics are shown in the Table. Forty-five (29%) patients received R-CHOP, of which 12 (27%) received more than 6 cycles and 9 (20%) and radiation therapy as consolidation. In particular, patients with stage I/II disease (9) all received 5-6 cycles, with additional radiation therapy consolidation in 4 patients. The overall response rate was 100% and 43 (96%) patients achieved complete remission (CR). After a median follow-up of 9 (2-12) years, median PFS has not been reached with 14 (31%) patients relapsing. Nearly all relapses occurred within 3 years, except for 1 patient who relapsed after 8 years and achieved a second durable CR with single agent Rituximab (Figure). On MVA, the only characteristic associated with a shorter PFS was the presence of > 4 nodal sites (HR 4.2, p=0.03). Among relapsed patients, 3 (21%) transformed to DLBCL (1 at first relapse) and died. Six (43%) relapsed patients received stem cell transplant (1 allogeneic) and 5 (36%) received more than 2 salvage regimens. Median OS has not been reached for all R-CHOP treated and relapsed patients. On univariate analysis, the only factor associated with a shorter OS after relapse was transformation (p=0.01). Baseline characteristics associated with transformation on MVA were IPI score 3-4 (OR 1.1, p=0.004) and elevated LDH (OR 2.4, p=0.01). Nine patients died, 2 (22%) of lymphoma progression, 4 (44%) of therapy-related acute myeloid leukemia (AML) and 3 (32%) of cancer-unrelated causes On MVA, factors associated with shorter OS after R-CHOP were age > 60 years (HR 11, p=0.02) and LDH > 618 IU/L (HR 5.9, p=0.01). On univariate analysis, age > 60 years was the only factor associated with AML onset (p=0.04). Conclusions R-CHOP is an effective treatment for patients with FLG3 and small number of nodal sites, with rare late progressions. The incidence of transformation is low but is fatal. Onset of second myeloid malignancies is the main cause of death and warrants caution in elderly patients. Disclosures: No relevant conflicts of interest to declare.

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