Concomitant infections in patients with cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6561-6561
Author(s):  
Kyle T. Enriquez ◽  
Gowri Satyanarayana ◽  
Maheen Abidi ◽  
Shailesh M Advani ◽  
Pamela Egan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bacterial Infections ◽  
Immune Modulation ◽  
Hematologic Malignancies ◽  
Mortality Rates ◽  
Patients With Cancer ◽  
Increased Risk ◽  
All Cause Mortality ◽  
History Of ◽  
History Of Cancer

6561 Background: COVID-19 has been associated with immune modulation that may predispose infected patients to bacterial, viral, or fungal co-infections. Due to critical illness, > 70% of patients with severe COVID-19 receive empiric antibacterial or antifungal therapy, along with standard anti-COVID-19 treatments. However, the frequency of proven or probable secondary infections is < 10%. To our knowledge, there are no studies evaluating co-infections in patients with cancer and COVID-19, a vulnerable group with multiple risk factors for co-infections. We aim to describe the prevalence of bacterial, viral, and fungal co-infections, identify risk factors for coinfection, and investigate the potential impact of co-infections on mortality, in patients with a history of cancer and COVID-19. Methods: The CCC19 registry (NCT04354701) includes patients with active or prior hematologic or invasive solid malignancies reported across academic and community sites. We captured bacterial, fungal, or viral co-infections diagnosed within ±2 weeks from diagnosis of COVID-19, identified factors associated with an increased risk of having a co-infection, and evaluated the association of co-infections with 30-day all-cause mortality. Results: We examined 6732 patients with a history of cancer and a laboratory-confirmed diagnosis of SARS-CoV-2 reported to CCC19 by 82 sites between March 17, 2020 and February 3, 2021, with complete data on coinfection status. Median age was 65 (interquartile range: 55-75) years with 48% male, 52% non-Hispanic white, 19% non-Hispanic black, and 16% Hispanic. 5448 (81%) had solid tumors and 1466 (22%) had hematologic malignancies. Bacterial infections were reported in 823 patients (12%), including 296 Gram+ and 245 Gram- bacterial events. Documented viral (176 patients, 3%) and fungal (59 patients, 0.9%) co-infections were rare. The risk for co-infections increased with age, and they were more frequent among men, older patients, and those with diabetes, pulmonary or renal comorbid conditions, active progressive cancer, or hematologic malignancies (unadjusted P< 0.01). The frequency of reported co-infections decreased over the study period (divided into quartiles, Mantel-Haenszel P< 0.01). All-cause mortality rates were higher among those with bacterial (24% vs. 10%), viral (22% vs. 12%), and fungal (37% vs. 12%) coinfections compared to those without (unadjusted P< 0.01). Conclusions: The frequency of bacterial infections in patients with cancer and COVID-19 is relatively low. Viral and fungal co-infections are uncommon. Co-infections are associated with higher mortality rates. Several patient and tumor factors can be used for risk stratification and guide early empiric antimicrobial agent selection, which may improve clinical outcomes. These data could inform antimicrobial stewardship interventions in this tenuous patient population.

Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Wesley T O’Neal ◽  
J’Neka Claxton ◽  
Richard MacLehose ◽  
Lin Chen ◽  
Lindsay G Bengtson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Cox Regression ◽  
Prior History ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Increased Risk ◽  
History Of ◽  
Reduced Risk ◽  
History Of Cancer

Background: Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer. Methods: We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding. Results: A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)). Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.

A Retrospective Analysis of Risk Factors for Severe Clostridium Difficile Infection In Acute Leukemia and Aggressive Lymphoma.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3797-3797
Author(s):  
Laura Kyle Brett ◽  
Gerald R. Donowitz ◽  
Heather Cox ◽  
Gina Petroni ◽  
John Densmore
Keyword(s):  
Risk Factors ◽  
Hematologic Malignancies ◽  
Aggressive Lymphoma ◽  
Attributable Mortality ◽  
High Dose ◽  
Composite Outcome ◽  
Oral Vancomycin ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Neutropenic Patients

Abstract Abstract 3797 Introduction and Goals. Clostridium difficile infection (CDI) is increasing in frequency and severity. Risk factors for severity of illness and treatment recommendations for patients with concurrent aggressive hematologic malignancies have not been investigated, despite data showing that this population experiences a high rate of CDI. The goal of this study was to assess mortality associated from CDI as well as risk factors for severe CDI in a population of patients with acute hematologic malignancies. Methods. Ninety-three cases of CDI among 78 patients with active acute leukemia or aggressive lymphoma at the University of Virginia (UVa) Health System from 2004–2009 were studied retrospectively. Rates of all-cause mortality, attributable mortality secondary to CDI (defined as CDI with at least one of the following: active diarrhea, toxic megacolon, or pseudomembranes on colonoscopy at time of death), and a composite outcome (defined as at least one of the following: attributable mortality, ICU stay from CDI, pseudomembranous colitis, toxic megacolon, or colectomy) were assessed as adverse outcomes. The following potential risk factors for severe CDI were investigated, adjusting for age: onset and duration of neutropenia, exposure to high dose cytarabine, number of antimicrobials given, exposure to fluoroquinolone prophylaxis for neutropenic fever, and a designation of severe CDI as previously described (at least two of the following: white blood count >15,000 cells/mL, age >60 years, albumin <2.5 g/dL, temperature >38.3° C, or one of the following: ICU stay or pseudomembranous colitis). Results. All-cause mortality was 21.7%. CDI-attributable mortality was 14.1%. The rate of the composite outcome was 20.3%. All-cause mortality was higher in patients with leukemia and lymphoma than for all other patients hospitalized at this institution with CDI in 2008 (12.5% all-cause mortality, 76/610, p=0.015, 95% CI [13.2, 32.6]). Duration of neutropenic episode >14 days and neutropenia at diagnosis of CDI were associated with increased risk of attributable mortality (OR 3.12, 95% CI [0.82, 11.92], p=0.09; OR 3.39, 95% CI [0.57, 20.05], p=0.11). Cumulative duration of neutropenia >21 days was not associated with increased risk in adverse outcomes. Designation of severe CDI predicted an increase in all-cause mortality (OR 6.7, 95% CI [2.1, 21.5], p <0.001), attributable mortality (OR 11.5, 95% CI [2.3, 57.5], p <0.001), and the composite outcome, (OR 19.3, 95% CI [5.5, 74.7], p <0.001). Fluoroquinolone prophylaxis for neutropenic fever, high dose cytarabine, induction chemotherapy, or receipt of more than 2 concurrent antimicrobials were not associated with increased risk of all-cause mortality, attributable mortality or the composite outcome. Discussion. Patients with acute hematologic malignancies and concurrent CDI were at increased risk of all-cause and CDI-attributable mortality compared with similar data from UVa of all hospitalized patients. Prolonged neutropenia at time of CDI diagnosis was associated with an increased risk of CDI-attributable mortality, although this result was not statistically significant. Established criteria for diagnosing severe CDI were helpful at predicting poor outcomes in this population. Seven of the 10 neutropenic patients who died in this study did not receive oral vancomycin. Neutropenic patients with CDI may benefit from initial treatment with oral vancomycin instead of metronidazole, especially if other criteria for severe illness are present. Future research may assess effectiveness of oral vancomycin as initial treatment for CDI in neutropenic patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience

2020 ◽  
Vol 12 ◽  
pp. 175883592095680 ◽  
Author(s):  
Nalinie Joharatnam-Hogan ◽  
Daniel Hochhauser ◽  
Kai-Keen Shiu ◽  
Hannah Rush ◽  
Valerie Crolley ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Composite Endpoint ◽  
Time Interval ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
Novel Coronavirus ◽  
History Of Cancer ◽  
North London

Background: This study aims to compare the outcomes of COVID-19-positive disease in patients with a history of cancer to those without. Methods: We retrospectively collected clinical data and outcomes of COVID-19 positive cancer patients treated consecutively in five North London hospitals (cohort A). Outcomes recorded included time interval between most recent anti-cancer treatment and admission, severe outcome [a composite endpoint of intensive care unit (ITU) admission, ventilation and/or death] and mortality. Outcomes were compared with consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (1 March–30 April 2020). Patients were matched for age, gender and comorbidity. Results: The median age in both cohorts was 74 years, with 67% male, and comprised of 30 patients with cancer, and 90 without (1:3 ratio). For cohort B, 579 patients without a history of cancer and consecutively admitted were screened from the primary London hospital, 105 were COVID-19 positive and 90 were matched and included. Excluding cancer, both cohorts had a median of two comorbidities. The odds ratio (OR) for mortality, comparing patients with cancer to those without, was 1.05 [95% confidence interval (CI) 0.4–2.5], and severe outcome (OR 0.89, 95% CI 0.4–2.0) suggesting no increased risk of death or a severe outcome in patients with cancer. Cancer patients who received systemic treatment within 28 days had an OR for mortality of 4.05 (95% CI 0.68–23.95), p = 0.12. On presentation anaemia, hypokalaemia, hypoalbuminaemia and hypoproteinaemia were identified predominantly in cohort A. Median duration of admission was 8 days for cancer patients and 7 days for non-cancer. Conclusion: A diagnosis of cancer does not appear to increase the risk of death or a severe outcome in COVID-19 patients with cancer compared with those without cancer. If a second spike of virus strikes, rational decision making is required to ensure optimal cancer care.

scholarly journals Estimation of Acutely Ill Medical Patients at Venous Thromboembolism Risk Eligible for Extended Thromboprophylaxis Using APEX Criteria in US Hospitals

2019 ◽  
Vol 25 ◽  
pp. 107602961988000 ◽  
Author(s):  
Anne-Céline Martin ◽  
Wei Huang ◽  
Samuel Z. Goldhaber ◽  
Russell D. Hull ◽  
Adrian F. Hernandez ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Venous Thromboembolism ◽  
The United States ◽  
Care Hospital ◽  
Medical Patients ◽  
Hospital Discharges ◽  
Increased Risk ◽  
History Of ◽  
History Of Cancer

Major medical illnesses place patients at risk of venous thromboembolism (VTE). Some risk factors including age ≥75 years or history of cancer place them at increased risk of VTE that extends for at least 5 to 6 weeks following hospital admission. Betrixaban thromboprophylaxis is now approved in the United States for this indication. We estimated the annual number of acutely ill medical patients at extended risk of VTE discharged from US hospital. Major medical illnesses (stroke, respiratory failure/chronic obstructive pulmonary disease, heart failure, pneumonia, other infections, and rheumatologic disorders) and 2 common risk factors for extended VTE risk, namely, age ≥75 years and history of cancer (active or past) were examined in 2014 US hospital discharges using the first 3 discharge diagnosis codes in the National Inpatient Sample (database of acute-care hospital discharges from the US Agency for Health Care Quality and Research). In 2014, there were 20.8 million discharges with potentially at risk of nonsurgical-related VTE. Overall, 7.2 million (35%) discharges corresponded to major medical illness that warranted thromboprophylaxis according to 2012 American College of Chest Physicians (ACCP) guideline. Among them, 2.79 million were aged ≥75 years and 1.36 million had a history of cancer (aged 40-74 years). Overall, 3.48 million discharges were at extended risk of VTE. Many medical inpatients at risk of VTE according to 2012 ACCP guideline might benefit from the awareness of continuing risk and some of these patients might benefit from extended thromboprophylaxis, depending on the risk of bleeding and comorbidities.

scholarly journals Postpartum Period Is a Risk Factor for Cerebral Venous Thrombosis

Stroke ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 501-503 ◽  
Author(s):  
Suzanne M. Silvis ◽  
Erik Lindgren ◽  
Sini Hiltunen ◽  
Sharon Devasagayam ◽  
Luuk J. Scheres ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Postpartum Period ◽  
Cerebral Venous Thrombosis ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Increased Risk ◽  
History Of ◽  
Using Data ◽  
History Of Cancer

Background and Purpose— Pregnancy and the postpartum period are generally considered to be risk factors for cerebral venous thrombosis (CVT), but no controlled studies have quantified the risk. Methods— Case-control study using data of consecutive adult patients with CVT from 5 academic hospitals and controls from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). Men, women over the age of 50, women using oral contraceptives or with a recent abortion or miscarriage were excluded. We adjusted for age and history of cancer, and stratified for pregnancy versus postpartum, and 0 to 6 versus 7 to 12 weeks postpartum. Results— In total 163/813 cases and 1230/6296 controls were included. Cases were younger (median 38 versus 41 years) and more often had a history of cancer (14% versus 4%) than controls. In total 41/163 (25%) cases and 82/1230 (7%) controls were pregnant or postpartum (adjusted odds ratio, 3.8; 95% CI, 2.4–6.0). The association was fully attributable to an increased risk of CVT during the postpartum period (adjusted odds ratio, 10.6; 95% CI, 5.6–20.0). We found no association between pregnancy and CVT (adjusted odds ratio, 1.2; 95% CI, 0.6–2.3). The risk was highest during the first 6 weeks postpartum (adjusted odds ratio, 18.7; 95% CI, 8.3–41.9). Conclusions— Women who have recently delivered are at increased risk of developing CVT, while there does not seem to be an increased risk of CVT during pregnancy.

Previous Cancer/Lymphoma and Refractory Inflammatory Bowel Disease

2015 ◽  
Vol 33 (Suppl. 1) ◽  
pp. 44-49 ◽  
Author(s):  
Oren Bernheim ◽  
Jordan Axelrad ◽  
Steven H. Itzkowitz ◽  
Jean-Frederic Colombel
Keyword(s):  
Cancer Recurrence ◽  
Hematologic Malignancies ◽  
Multicentric Study ◽  
Recurrent Cancer ◽  
Incident Cancer ◽  
Increased Risk ◽  
History Of ◽  
Inflammatory Bowel ◽  
History Of Cancer

Immunomodulators and biologic agents are effective in treating inflammatory bowel diseases (IBDs), and recent evidence supports their introduction earlier in the disease course. An important concern to both patients and physicians considering immunosuppression (IS) for the treatment of IBD is the potential associated cancer risk. Several important clinical questions deserve attention with respect to IBD therapy and cancer. First, does medical therapy for IBD predispose to developing cancer? Second, in an IBD patient with a history of cancer, does IBD therapy impact cancer recurrence? Third, once cancer develops in an IBD patient, is the cancer outcome different? Finally, in an IBD patient with current cancer, does the cancer therapy affect IBD outcomes? In a recent multicentric study, patients were identified based on a diagnosis of IBD and cancer with subsequent exposure to anti-tumor necrosis factor α (anti-TNFα arm), thiopurines or methotrexate (antimetabolite arm) or without subsequent IS exposure (control arm). Two hundred and fifty-five patients met the inclusion criteria. Prior cancers included 121 solid, 62 gastrointestinal, 55 dermatologic and 17 hematologic malignancies. During the follow-up period, 75 (29.4%) patients developed incident cancer: 36 (14.1%) a new cancer, 33 (12.9%) a recurrent cancer and 6 (2.4%) a new and recurrent cancer. Incident cancer rate per 100 person-years for patients exposed to anti-TNFα, anti-metabolites and controls was 2.6 with 795 person-years of follow-up, 14.8 with 122 person-years of follow-up and 8.52 with 422 person-years of follow-up, respectively. In this series of IBD patients with a history of cancer, exposure to IS following a cancer diagnosis was not associated with an increased risk of incident cancer compared to patients who did not receive these agents. Prospective data are needed to confirm these findings.

scholarly journals Factors Associated with Cause-Specific Death in Russia. Data from Longitudinal Prospective Study 1977-2001

2019 ◽  
Vol 15 (1) ◽  
pp. 4-16 ◽  
Author(s):  
S. A. Shalnova ◽  
A. V. Kapustina ◽  
A. D. Deev ◽  
Yu. A. Balanova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
High Blood Pressure ◽  
Total Cholesterol Level ◽  
Common Factor ◽  
Mortality Rates ◽  
Factors Associated ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Related Mortality

Aim.To evaluate the associations between main risk factors (RF) with cause-specific death in cohorts of Russian men and women.Material and methods. Data of a number of crossectional studies conducted in different years by unified base protocol had become the subjects for the study. A total of 12,497 men and 5,039 women aged 35-74 years, residents of Moscow and S-Petersburg (former Leningrad) cities at the moment of examination, were enrolled into the study. We analyzed 17 previously selected risk factors and their associations with cause-specific mortalities: coronary heart disease (CHD), stroke, cardiovascular diseases (CVD), non-CVD, all causes. A total of 10,650 deaths were registered: 8,726 in men (for 10 years) and 1,924 – in women (for 20 years).Results.Men died more often from all the examined causes except for stroke, what was more typical to women. Mortality in men was associated with significantly larger number of RF than in women and correlations were stronger. In particular, smoking (hazard ratio [HR] 2.25; 95% confidence interval [95%CI] 1.75-2.89; р=0.0001), high blood pressure (HR 1.78; 95%CI 1.43-2.22; р=0.0001) and history of CHD (HR 3.23; 95%CI 2.71- 3.84; р=0.0001) significantly increased CHD-related mortality in the men’s cohort but were much less significant for women. The total cholesterol level demonstrated significance in men but was not even selected in the model for women. The main RF for stroke-related mortality were smoking, high blood pressure and atrial fibrillation, while for non-cardiovascular mortality there was only one common factor – smoking. Factors associated with CVD and all-cause mortality were almost the same because CVD cover more than half in the all-cause mortality, however a larger number of predictors were reported in men.Conclusion. The data obtained indicate: 1) considerably larger number of unfavorable risk factors in the men’s cohort, which significantly increased risk for death from any cause; 2) statistically more pronounced relation between risk factors and mortality rates in men as compared to women, especially note that mortality rates were followed up for 10 years in men and 20 years in women. It is obvious that successful prevention focused on risk factors must be gender-based. 

scholarly journals Clinical characteristics, outcomes, and risk factors for mortality in hospitalized patients with COVID-19 and cancer history: a propensity score-matched study

2020 ◽  
Author(s):  
Majid Sorouri ◽  
Amir Kasaeian ◽  
Helia Mojtabavi ◽  
Amir Reza Radmard ◽  
Shadi Kolahdoozan ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Hematologic Malignancies ◽  
Cancer History ◽  
Clinical Indicators ◽  
Female Ratio ◽  
Risk Of Death ◽  
Hematologic Cancer ◽  
Increased Risk ◽  
History Of ◽  
History Of Cancer

Abstract Background: COVID-19 has caused great concern for patients with underlying medical conditions. We aimed to determine the prognosis of patients with current or previous cancer with either a PCR-confirmed COVID-19 infection or a probable diagnosis according to chest CT scan.Methods: We conducted a case control study in a referral hospital on confirmed COVID-19 adult patients with and without a history of cancer from February25th to April21st, 2020. Patients were matched according to age, gender, and underlying diseases. Demographic features, clinical and Para clinical data have been extracted from medical records. Multivariable logistic regression was used to estimate odd ratios and 95% confidence intervals of each factor of interest with outcomes. Results: Fifty-three confirmed COVID-19 patients with history of cancer were recruited and compared with 106 non-cancerous COVID-19 patients. Male to female ratio was 1.33 and 45% were older than 65. Dyspnea was significantly associated with an increased rate of mortality in the cancer subgroup (p=0.013). Twenty-six patients (49%) survived among the cancer group while 89 patients (84%) survived in control (p=0.000). Patients with hematologic cancer had 63% mortality while those with solid tumors had 37%. Multivariate analysis showed that cancer, impaired consciousness, tachypnea, tachycardia, leukocytosis and thrombocytopenia were associated with an increased risk of death.Conclusion: Cancer increased mortality rate and hospital stay of COVID-19 patients and remained significant after adjustment of confounders. Compared to solid tumors, hematologic malignancies have been associated with worse consequences and higher mortality. Clinical and Para clinical indicators were not appropriate to predict death.

scholarly journals Cancer incidence and risk factors in dialysis patients with human immunodeficiency virus: a cohort study

2020 ◽  
Author(s):  
Mihir Patel ◽  
Jennifer L Waller ◽  
Stephanie L Baer ◽  
Vanessa Spearman ◽  
Mufaddal Kheda ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Risk Factor ◽  
Adjusted Relative Risk ◽  
Dialysis Patients ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
History Of ◽  
History Of Cancer

Abstract Background Patients with human immunodeficiency virus (HIV) or end-stage renal disease receiving dialysis have an increased risk of developing malignancies, but few data are available on cancer in patients with both conditions. Thus, the objective of this study was to determine the incidence of selected malignancies and identify their potential risk factors in HIV-infected dialysis patients. Methods This study was a nationwide cohort analysis using the US Renal Data System. Participants included all HIV-infected patients starting dialysis from 2005 to 2011. HIV status, comorbidities and malignancies were identified using International Classification of Diseases, Ninth Revision codes. Descriptive statistics and generalized linear models quantifying risk factors were performed for the overall cohort and the three most common malignancies. Results Overall, 6641 HIV-infected dialysis patients were identified, with 543 (8.2%) carrying a malignancy diagnosis. The most common malignancies were non-Hodgkin’s lymphoma (NHL, 25%), Kaposi sarcoma (KS, 16%) and colorectal cancer (13%). Factors increasing the risk of any malignancy diagnosis included: history of cancer [adjusted relative risk (aRR) = 5.37], two or more acquired immunodeficiency syndrome-defining opportunistic infections (ADOIs) (aRR = 3.11), one ADOI (aRR = 2.23), cirrhosis (aRR = 2.20), male sex (aRR = 1.54) and hepatitis B (aRR = 1.52). For NHL and colorectal cancer, history of cancer (aRR = 7.05 and 9.80, respectively) was the most significant risk factor. For KS, two or more ADOIs (aRR = 6.78) was the largest risk factor. Conclusions Over 8% of HIV-infected dialysis patients developed a malignancy. History of cancer and ADOIs were major risk factors, underscoring the significance of immune dysregulation in malignancy development.

Incidence and Risk Factors of Venous Thromboembolism in Patients with Multiple Myeloma Receiving Immunomodulatory Agents

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2624-2624 ◽  
Author(s):  
Miriam Kimpton ◽  
Ryan Buyting ◽  
Daniel J Corsi ◽  
Natasha Rupani ◽  
Marc Carrier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Venous Thromboembolism ◽  
Previous History ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
Personal History ◽  
Immunomodulatory Agents ◽  
Increased Risk ◽  
History Of

Abstract Multiple myeloma (MM) is an incurable plasma cell disorder representing 10% of all hematologic malignancies. Cancer is a known risk factor for venous thromboembolism (VTE). Patients with MM are at a particularly high risk of developing VTE owing to patient characteristics (e.g. previous history of VTE), disease characteristics, and treatment characteristics including use of the immunomodulatory agents (IMIDs). Unfortunately, standard criteria to identify the patients most at risk for developing VTE in MM while receiving IMIDs are unknown. We sought to assess the incidence of VTE and its associated risk factors in MM patients receiving IMID therapy. A retrospective cohort study including 1680 consecutive patients with multiple myeloma treated at our centre between January 01, 1995 and January 26, 2016 was conducted. The annual incidence of VTE on immunomodulatory agents including thalidomide, lenalidomide, and pomalidomide was derived. Univariate incidence ratio analyses of VTE for different risk factors was performed including: previous history of VTE, concomitant use of dexamethasone, and ≥/< 6 months after IMID initiation. A total of 309 MM patients treated with an immunomodulatory agent were identified. Nineteen patients were excluded (incomplete data, lost to follow). Of the remaining 290 patients, the mean age was 67.9 and 42.4% were female. Twenty-seven VTE events were recorded. The overall risk ratio was 6.1 for the development of VTE. Patients with a personal history of VTE had an increased risk of suffering a VTE while on IMID therapy (IRR 5.4; CI, 1.9-13.6). The time from the initiation of the IMID therapy (less than 6 months) also increased the risk of developing a VTE (IRR 51.7; CI,19.4-160.1). The concomitant use of dexamethasone was not associated with a statistically significant increased risk (IRR 1.7; CI, 0.3-69.5). Incidence risk ratios for these risk factors are depicted in Table 1. Our results suggest that a personal history of VTE and the time from the initiation of the IMID (less than 6 months) are associated with an increased risk of VTE in MM patients receiving IMID therapy. This may be helpful in determining which multiple myeloma patients treated with an IMID agent warrant more aggressive thromboprophylaxis. Further prospective studies are needed to determine the optimal agent, intensity, and duration of thromboprophylaxis in patients with MM on IMID therapy. Disclosures McCurdy: Celgene: Honoraria.

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