scholarly journals Survival Improvement over Time of 960 s-AML Patients Included in 13 EORTC-GIMEMA-HOVON Trials

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3334
Author(s):  
Safaa M. Ramadan ◽  
Stefan Suciu ◽  
Marian J. P. L. Stevens-Kroef ◽  
Roelof Willemze ◽  
Sergio Amadori ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Hematologic Malignancies ◽  
Remission Induction ◽  
High Dose ◽  
Toxic Exposure ◽  
Secondary Acute Myeloid Leukemia ◽  
Period 2 ◽  
Systematic Improvement ◽  
History Of ◽  
Over Time

We report the outcomes of secondary acute myeloid leukemia (s-AML) patients included in one of 13 European Organisation for Research and Treatment of Cancer (EORTC) collaborative AML trials using intensive remission-induction chemotherapy. Among 8858 patients treated between May 1986 and January 2008, 960 were identified as having s-AML, either after MDS (cohort A; n = 508), occurring after primary solid tumors or hematologic malignancies other than MDS (cohort B; n = 361), or after non-malignant conditions or with a history of toxic exposure (cohort C; n = 91). Median age was 64 years, 60 years and 61 years in cohort A, B and C, respectively. Among patients ≤60 years and classified in the cohorts A or B (n = 367), the 5-year overall survival (OS) rate was 28%. There was a systematic improvement in the 5-year OS rate over three time periods (p < 0.001): 7.7% (95% CI: 1.3–21.7%) for patients treated before 1990 (period 1: n = 26), 23.3% (95% CI: 17.1–30.0%) for those treated between 1990 and 2000 (period 2: n = 188) and 36.5% (95% CI: 28.7–44.3%) for those treated in 2000 or later (period 3: n = 153). In multivariate analysis, male gender (HR = 1.39; p = 0.01), WBC ≥ 25 × 109/L (HR = 2.00; p < 0.0001), age 46-60 years (HR = 1.65; p < 0.001) and poor-risk cytogenetics (HR = 2.17; p < 0.0001) were independently associated with shorter OS, while being treated during period 2 (HR = 0.50, p = 0.003) or period 3 (HR = 0.43; p = 0.0008). Having received high-dose cytarabine (HD-AraC) (n = 48) in the induction chemotherapy (HR = 0.54, p = 0.012) was associated with a longer OS. In contrast, among patients >60 years of age (n = 502), the OS was dismal, and there was no improvement over time.

scholarly journals Survival Improvement Of Secondary Acute Myeloid Leukemia Over Time: Experience From 962 Patients Included In 13 EORTC-Gimema-HOVON Leukemia Group Trials

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 829-829 ◽  
Author(s):  
Safaa M. Ramadan ◽  
Stefan Suciu ◽  
Marian J.P.L. Stevens-Kroef ◽  
Roelof Willemze ◽  
Sergio Amadori ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Malignant Disease ◽  
Risk Group ◽  
Toxic Exposure ◽  
Secondary Acute Myeloid Leukemia ◽  
History Of ◽  
Over Time ◽  
Acute Myeloid

Abstract Background Secondary acute myeloid leukemia (sAML) describes patients (pts) with a history of malignant or non-malignant disease or AML secondary to environmental, occupational or therapeutic exposures. They are generally associated with poor outcome despite the use of intensive treatments. The impact of clinical features and type of treatment on pts' outcome is still not well established. In the current analysis we evaluated sAML pts who were treated in 13 EORTC collaborative trials conducted between May 1986 and January 2008. sAML pts in the database were pooled to characterize clinical features of the disease and evaluate changes in survival over these years (yrs). Method Main selection criteria were AML with bone marrows blasts ≥20% and documented history of prior malignancy, non-malignant disease and/or toxic exposure. AML-M3 and MDS without confirmed diagnosis ≥2 months before AML were excluded. All pts were eligible for standard treatment. Induction regimens were anthracycline and AraC based: 7+3, including etoposide, intensified with high dose (HD)-AraC randomized to standard doses (SD) in younger (AML12) or gemtuzumab ozogamicin in elderly pts. Consolidation regimens were age adapted. In mid-1980s, autologous transplant was tested vs a 2nd consolidation cycle (AML8A) in pts ≤45 yrs and thereafter used systematically in pts ≤60 yrs without available donor. Allogeneic transplant (Allo-SCT) was offered to pts ≤46 yrs with HLA-compatible sibling since mid-1980s and expanded in the last decade to pts up to 59 yrs. Selected pts were divided into 3 sAML cohorts, cohort A after MDS, cohort B after other malignant diseases and cohort C after non-malignant conditions and/or toxic exposure. Results Of 8858 pts enrolled in the 13 evaluated studies, 962 were sAML. Median age was 63 yrs (range 16-85), 413 were young (≤60 yrs) and 549 were elderly (≥61 yrs); 54% were males. Cohort A consisted of 509 pts (median age 64 yrs), cohort B of 362 pts (median age 59 yrs) and cohort C of 91 pts (median age 61 yrs). In cohort B, breast cancer (24%) and lymphoma (14%) were the most frequent primary tumors. Autoimmune diseases represented 22% of non-malignant conditions. In young pts, complete remissions (CR/CRi) rate was 59%; 55% in SD-AraC vs 89% in HD-AraC treated pts. Allo-SCT in CR1 was performed in 21% of all pts. The Allo-SCT rate increased from 5% before 1990, 20% in 1990-1999 to 25% from 2000 (20% in SD-AraC vs 31% of HD-AraC treated pts). CR/CRi was achieved in 45% of elderly pts. Median follow-up was 6 yrs. Median overall-survival (OS) was 14.5 months in young and 9 months in elderly pts. The 5-yr OS was 28% and 7% respectively. Five-yr OS was 11% in cohort A and 22% in both cohort B and C. Treatment outcome of younger pts according to disease features and treatment type over time in cohort A and B are detailed in table 1 & 2. Using Cox model stratified by cohort age, gender, WBC, risk group, year of treatment and HD-AraC were independent prognostic factors for OS. In the AML12 study, compared to denovo pts, sAML pts ≤45 yrs had worse outcome if treated with SD-AraC whereas a better OS was seen if treated with HD-AraC. In elderly pts only the good/intermediate risk group of cohort B had a relatively better 5-yr OS (15%). Conclusions The outcome of sAML in younger pts has improved over the yrs in parallel with HD-AraC introduction in induction of remission. HD-AraC should be considered for younger pts with sAML. Disclosures: Ramadan: Alwaleed Bin Talal Foundation : A research funding is under advanced negotiation with the foundation Other. Suciu:Alwaleed Bin Talal Foundation : A research funding is under advanced negotiation with the foundation Other. Meert:Alwaleed Bin Talal Foundation : A research funding is under advanced negotiation with the foundation Other. de Schaetzen:Alwaleed Bin Talal Foundation : A research funding is under advanced negotiation with the foundation Other Other.

scholarly journals High-dose cytarabine and daunorubicin induction and postremission chemotherapy for the treatment of acute myelogenous leukemia in adults

Blood ◽  
1991 ◽  
Vol 77 (7) ◽  
pp. 1429-1435 ◽  
Author(s):  
GL Phillips ◽  
DE Reece ◽  
JD Shepherd ◽  
MJ Barnett ◽  
RA Brown ◽  
...  
Keyword(s):  
Acute Myelogenous Leukemia ◽  
Previous History ◽  
Myelogenous Leukemia ◽  
Remission Induction ◽  
High Dose ◽  
Free Survival ◽  
High Dose Cytarabine ◽  
Acute Myelogenous ◽  
History Of ◽  
Leukocyte Counts

Seventy consecutive adult patients with acute myelogenous leukemia (AML), median age 44 years, received high-dose cytarabine (3 g/m2 every 12 hours for 12 doses) followed by daunorubicin (45 mg/m2 daily for three doses) for remission induction. A single, identical course was planned for postremission therapy. Complete remission (CR) was achieved in 63 patients (90%, 95% confidence interval [CI] 83% to 97%), 60 after a single course. Eight patients were selected to undergo elective bone marrow transplantation (BMT) during first CR. Of the remaining 55 patients, 40 (73%) underwent planned post-CR therapy; 15 patients did not, owing to early relapse, excessive toxicity from the induction chemotherapy, or refusal. Nineteen patients, including 13 who received planned post-CR therapy, remain in continuous CR at a median follow-up of 5.2 years (range 3.0 to 7.1 years). The 5-year actuarial leukemia- free survival was 30% (95% Cl, 19% to 42%) for all patients achieving CR and 32% (95% Cl, 19% to 47%) for the 40 patients who received the planned post-CR chemotherapy. Analysis of various putative prognostic factors for CR and overall and leukemia-free survival showed significance for a previous history of myelodysplasia, higher initial leukocyte counts, certain French-American-British (FAB) types, and certain abnormal karyotypes. None of these factors was consistently significant regarding the above parameters, although small patient numbers in certain analyses may have obscured significant associations. Myelosuppression was occasionally prolonged after remission induction and especially post-CR therapy. Severe cerebellar toxicity was observed in 13 patients; in 11 cases, this toxicity was fully reversible. Other serious complications were infrequent. Intensive chemotherapy with high- dose cytarabine and daunorubicin has substantial antileukemic activity in adult AML, and may represent an improvement over conventional therapy. Relapses were common, however, even in patients who received planned therapy, and substantial toxicity was observed. The optimum use of this regimen in AML remains to be determined.

Comparison of Prognostic Factors and Outcomes of Patients with Secondary Acute Myeloid Leukemia (AML) Following Myelodysplastic Syndromes (MDS), Myeloproliferative Disorders (MPD), or Therapy-Related AML (t-AML).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4292-4292 ◽  
Author(s):  
Sanjay Mohan ◽  
Paul Elson ◽  
Cristina Rodriguez ◽  
Rachid Baz ◽  
Matt Kalaycio ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Induction Chemotherapy ◽  
De Novo ◽  
Risk Group ◽  
Myeloproliferative Disorders ◽  
Remission Induction ◽  
Secondary Aml ◽  
Secondary Acute Myeloid Leukemia ◽  
Significant Difference ◽  
Multivariable Analyses

Abstract Background: Response rates to induction chemotherapy and survival are poorer for patients (pts) with secondary AML compared to those with de novo AML. Within the category of secondary AML, no studies have compared the outcomes of induction chemotherapy in pts with AML arising from antecedent MDS vs. from MPD vs. t-AML. Methods: We conducted a retrospective review of all pts with newly diagnosed, pathologically-confirmed AML at a single institution between 1997 and 2005 and identified pts who also were diagnosed with an antecedent MDS, MPD, or t-AML. Data were collected on baseline characteristics and outcome, and controlled for in stepwise multivariable analyses. All pts were treated with anthracycline-based induction regimens. The primary endpoints were: complete remission (CR) rate (as defined by the IWG criteria) and survival from time of AML diagnosis, to determine whether those with AML arising from MDS, from MPD, or t-AML had different outcomes; and to define predictors of outcome among pts with secondary AML. Results: Of 457 AML patients, 281 were treated with remission induction therapy, of whom 66 had AML arising from MDS, MPD, or t-AML. Thirty-one (47%) had antecedent MDS, 20 (30%) an MPD, and 15 (23%) had t-AML. Twenty-six pts (39%) were female. The median age at the time of AML diagnosis for those with MDS, MPD, and t-AML was 67, 61, and 57 years, respectively (range 36–82, p=0.03 for all). Time from antecedent diagnosis/event was 7, 42, and 38 months, respectively (p=0.001). Cytogenetic risk categories (per CALGB 8461) were favorable in 3 pts (5%), intermediate in 30 (45%), unfavorable in 22 (33%), and unknown in 11 (17%). Neither cytogenetics (p=0.19) nor FAB/WHO AML classification (p=0.43) differed among groups. Median WBC at AML diagnosis was lower for pts with AML from MDS (3.7k/uL, vs. 9.9 k/uL for AML from MPD and 7.2 k/uL for t-AML, p=0.04), as were the percentage of peripheral blasts (6%, vs. 30% for AML from MPD and 23% for t-AML, p=0.005) and incidence of splenomegaly (6%, vs. 50% for AML from MPD and 0% for t-AML, p<0.001). CR rate was not significantly lower for patients with AML from MDS (35%) than for those with AML from MPD (55%) or t-AML (53%, p=0.33). Overall median survival was 8.0 months, with no significant difference among the 3 groups (7.7 months for AML from MDS, 11.1 months for AML from MPD, and 5.2 months for t-AML, p=0.23). Gender, interval from diagnosis of the antecedent disorder to diagnosis of AML, and marrow blast count did not correlate with CR rate or survival. In multivariable analyses, the antecedent diagnosis remained non-predictive of response rate or survival. Favorable- or intermediate-risk cytogenetics, however, compared to poor-risk, were significant predictors of higher CR rates (p= .005) and longer survival (p<.001). Lower peripheral blast percentage and age <60 years were favorable prognostic factors for CR. Conclusions: Contrary to expectations, pts with AML from MDS, from MPD, or t-AML had similar outcomes. The most important predictors of response to induction chemotherapy were cytogenetic risk group, age, and peripheral blast percentage. Only cytogenetic risk group was predictive of survival.

Incidence and Prognostic Factors for Infectious and Hemorrhagic Death in Patients with Acute Myeloid Leukemia: A Single-Centre Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4300-4300 ◽  
Author(s):  
Pau Montesinos ◽  
Guillermo Martin ◽  
Ninotchka Mendoza ◽  
Jesus Martinez ◽  
Federico Moscardo ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Induction Chemotherapy ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Remission Induction ◽  
High Dose ◽  
Induction Failure ◽  
Acute Myeloid

Abstract INTRODUCTION: Death is as a common cause of remission induction failure in patients with acute myeloid leukemia (AML), mainly due to hemorrhage and infection. The relative incidence and chronology of each of these categories of induction failure, as well as their prognostic factors, have been investigated critically and in detail in rare studies only. OBJECTIVES: We report the incidence, chronology, and prognostic factors for induction death, analyzing separately hemorrhagic and infectious death, in a large series of 946 patients with AML who received induction therapy in a single institution over the last 30 years. PATIENTS AND METHODS: Adult patients were consecutively diagnosed of AML and started first induction chemotherapy in our institution. AML was classified according to the FAB criteria. Induction therapy consisted of the classic combination of cytarabine and anthracyclines (with or without a third agent) in 50% of patients, cytarabine plus adriamicine and thioguanine or vincristine in 17%, ATRA with chemotherapy in 9%, monochemotherapy with anthracycline in 7%, high dose cytarabine in 7%, and other regimens in 10%. Causes of induction death include the following categories: Infection, when death was due to a clinical, radiological or microbiologically documented infection, Hemorrhage, when a major bleeding occured in a vital organ (central nervous system, lungs). Gastrointestinal hemorrhage required massive melena or hematemesis accompanied by fall in blood pressure, and Other, i.e., any other cause not classified as infection or hemorrhage. RESULTS: From 1977 to 2007, 946 consecutive patients with diagnosis of AML received induction chemotherapy, 24% in the period 1 (1977–1986), 28% in the period 2 (1987–1993), 28% in the period 3 (1994–2000), and 20% in the period 4 (2001–2007). Median age was 55 years (range 13–83 years). One hundred and sixty-seven patients (18%) had antecedents of myelodysplastic/myeloprolipherative disease (10%) or other neoplasia (8%). Two hundred and thirty-seven patients (25%) died during induction therapy, 13% due to infection, 7% due to hemorrhage, 2% due to hemorrhage and infection, and 3% due to other causes. The induction mortality rates decreased gradually over the 4 periods (31% vs 24% vs 18% vs 18%), due to reduction of both hemorrhagic and non-hemorrhagic deaths. Overall, 42% of hemorrhagic deaths occurred within the first 10 days of induction therapy, whereas 86% of infectious deaths occurred after 10 days. In multivariate analysis, the following characteristics had an unfavorable impact on overall induction mortality: age >60 years, WBC >50x109/L, Quick index <65%, ECOG >1, and albumin serum levels <3.5mg/dL. Multivariate analysis identified the following factors predicting for infectious mortality: albumin <3.5mg/dL, age >50 years, AML secondary to neoplasia, ECOG >1, and fever at presentation. The following factors were associated with hemorrhagic mortality: WBC >50x109/L, FAB-M3, age >60 years, de novo AML, and ECOG >1. CONCLUSIONS: The main causes of induction death in AML patients, infection and hemorrhage, shows a different chronologic pattern and can be separately predicted by their own specific prognostic factors.

High Complete Remission (CR) Rates and Reduced Early Mortality with High Dose Ara-c (HiDAC) and Mitoxantrone (MITO) Induction Chemotherapy for Older (age>60) High Risk Patients with Acute Myeloid Leukemia (AML)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3290-3290
Author(s):  
Muthalagu Ramanathan ◽  
Zheng Zhou ◽  
Jan Cerny ◽  
Glen D Raffel ◽  
Laura Petrillo-Deluca ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Induction Chemotherapy ◽  
Cardiac Toxicity ◽  
Remission Induction ◽  
High Dose ◽  
Induction Regimen ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Abstract 3290 Background: Patients with high risk AML, defined as those with age > 60 years or multiple medical co-morbidities determined by Charleston comorbidity index (CCI) carry a poor prognosis and inferior outcomes after 7+3 induction chemotherapy. CR rates tend to range from 6–51% and induction death rates between 9–48%. We present here a single institution experience of high risk AML patients treated with an induction regimen consisting of high dose mitoxantrone and cytarabine (HiDAC/MITO). Methods: We performed a retrospective analysis of all patients with AML who received HiDAC/MITO induction from January 2009- January 2010 at our institution. Patients with age ≥60 or age <60 with high CCI received HiDAC at 3gm/m2 over three hours on days 1 to 5 plus MITO 80mg/m2 once on day 2. Effect of other high risk features including poor risk cytogenetics, therapy related AML (t-AML), AML with prior antecedent hematological disorder (AHD) and relapsed AML on treatment outcome were also evaluated. The primary endpoints of the study were CR (defined as bone marrow blasts <5%) at day 30 and treatment related mortality within 30 days of initiation of treatment. End of follow-up was June 30, 2010. Results: 20 AML had received HiDAC/MITO for remission induction. The median age was 66.5 years (range 47 to 78), those with age ≥ 70 was 8 (40%). CCI was ≥ 5 in 18 (90%) patients. Other high risk features included high risk cytogenetics in 8 (40%) and non-denovo AML (AML with AHD, t-AML or relapsed AML) in 11 (55%). Overall CR rate was 17 (85%, CI: 61%-96%) and 3 (15%) patients had refractory disease. There was no treatment related mortality. Median time to neutrophil recovery (>1000/ul) was 27 (range 19 to 37) days and median time to platelet recovery (>100,000/ul) was 28 days (range 23 to 44) days. Patients with non–denovo AML were more likely to be refractory to treatment or relapse after day 30. Median follow up of the entire cohort is 288 (range 29 to 530) days. 3 month and 6 month overall survival (OS) was 94.7% and 73.3% and progression free survival (PFS) 93.8% and 87.5%, respectively. The median OS was 410 days (CI: 243-*); (denovo 410 vs. others 381 days). Median PFS is 524 days (CI: 381-*); (denovo *not reached vs. others 381 days). 11(55%) patients were able to proceed to autologous (4) or allogeneic (7) stem cell transplantation (SCT) after receiving HiDAC/MITO. The time to transplant ranged from 44 to 195 days. Median OS of the patients who underwent SCT is 524 days versus 269 days for the non transplant group (p =0.0038). The HiDAC/MITO induction regimen was well tolerated. Cardiac toxicity defined by symptomatic CHF was noted in 6/20 patients. Of the six patients 2 had prior cardiac history and 1 had prior anthracycline exposure and 1 had both anthracycline exposure and cardiac history. Cardiac toxicity was delayed and identified by echo at a median of 90 range (42 to139) days after induction chemotherapy. None of these patients died from cardiac toxicity. Conclusions: In this high risk AML population, HiDAC/MITO induction was well tolerated and demonstrated an overall response rate of 85% and no induction deaths, allowing a substantial number (55%) of patients to proceed to SCT. Contrary to our expectations advanced age or multiple medical co-morbidities did not affect CR rate or survival, thus high lighting the utility of this regimen for high risk newly diagnosed elderly patients with AML. Disclosures: No relevant conflicts of interest to declare.

scholarly journals High-dose cytarabine and daunorubicin induction and postremission chemotherapy for the treatment of acute myelogenous leukemia in adults

Blood ◽  
1991 ◽  
Vol 77 (7) ◽  
pp. 1429-1435 ◽  
Author(s):  
GL Phillips ◽  
DE Reece ◽  
JD Shepherd ◽  
MJ Barnett ◽  
RA Brown ◽  
...  
Keyword(s):  
Acute Myelogenous Leukemia ◽  
Previous History ◽  
Myelogenous Leukemia ◽  
Remission Induction ◽  
High Dose ◽  
Free Survival ◽  
High Dose Cytarabine ◽  
Acute Myelogenous ◽  
History Of ◽  
Leukocyte Counts

Abstract Seventy consecutive adult patients with acute myelogenous leukemia (AML), median age 44 years, received high-dose cytarabine (3 g/m2 every 12 hours for 12 doses) followed by daunorubicin (45 mg/m2 daily for three doses) for remission induction. A single, identical course was planned for postremission therapy. Complete remission (CR) was achieved in 63 patients (90%, 95% confidence interval [CI] 83% to 97%), 60 after a single course. Eight patients were selected to undergo elective bone marrow transplantation (BMT) during first CR. Of the remaining 55 patients, 40 (73%) underwent planned post-CR therapy; 15 patients did not, owing to early relapse, excessive toxicity from the induction chemotherapy, or refusal. Nineteen patients, including 13 who received planned post-CR therapy, remain in continuous CR at a median follow-up of 5.2 years (range 3.0 to 7.1 years). The 5-year actuarial leukemia- free survival was 30% (95% Cl, 19% to 42%) for all patients achieving CR and 32% (95% Cl, 19% to 47%) for the 40 patients who received the planned post-CR chemotherapy. Analysis of various putative prognostic factors for CR and overall and leukemia-free survival showed significance for a previous history of myelodysplasia, higher initial leukocyte counts, certain French-American-British (FAB) types, and certain abnormal karyotypes. None of these factors was consistently significant regarding the above parameters, although small patient numbers in certain analyses may have obscured significant associations. Myelosuppression was occasionally prolonged after remission induction and especially post-CR therapy. Severe cerebellar toxicity was observed in 13 patients; in 11 cases, this toxicity was fully reversible. Other serious complications were infrequent. Intensive chemotherapy with high- dose cytarabine and daunorubicin has substantial antileukemic activity in adult AML, and may represent an improvement over conventional therapy. Relapses were common, however, even in patients who received planned therapy, and substantial toxicity was observed. The optimum use of this regimen in AML remains to be determined.

Impact of preexisting CNS involvement on the outcome of bone marrow transplantation in adult hematologic malignancies.

1996 ◽  
Vol 14 (11) ◽  
pp. 3036-3042 ◽  
Author(s):  
K van Besien ◽  
D Przepiorka ◽  
R Mehra ◽  
S Giralt ◽  
I Khouri ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Hematologic Malignancies ◽  
Control Group ◽  
High Dose ◽  
Cns Involvement ◽  
Cns Disease ◽  
History Of ◽  
The Impact

PURPOSE To determine the impact of prior or current CNS disease on the outcome of high-dose chemotherapy for patients with hematologic malignancies. PATIENTS AND METHODS In a 54-month period, 373 patients with hematologic malignancies underwent allogeneic or autologous bone marrow transplantation (BMT) or blood stem-cell transplantation using high-dose thiotepa, busulfan, and cyclophosphamide (TBC) as the preparative regimen. Four patients with active CNS disease at BMT and 20 patients with a history of prior CNS disease were identified. The outcomes of those with a history of CNS disease were compared with those of a matched control group. RESULTS Of four patients with active CNS disease at the time of BMT, two had CNS recurrences and one recurred in the bone marrow. One patient died of treatment-related toxicity. Four of 20 patients with prior CNS involvement currently remain free of disease. At 2 years, the disease-free survival (DFS) rate was 23% +/- 19%, and the DFS rate for the control group 39% +/- 24% (P = .053). An increased rate of treatment-related toxicity and especially grades II to IV CNS toxicity accounted for the poorer outcome of patients who had a history of CNS disease. Recurrence rates were not significantly different between the two groups. Prior radiation to the CNS correlated with CNS complications posttransplant (p = .01). CONCLUSION Consolidation with TBC and BMT can induce prolonged DFS in a proportion of patients with a history of CNS disease. Such patients are at increased risk for CNS complications that lead to an inferior overall outcome when compared with a control group.

scholarly journals 75. Utility of Fungal Blood Cultures in Portland, Oregon

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S154-S155
Author(s):  
Sujeet Govindan ◽  
Luke Strnad
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Blood Cultures ◽  
Biologic Agent ◽  
Systemic Steroid ◽  
High Dose ◽  
Inappropriate Use ◽  
History Of

Abstract Background Fungal blood cultures (fungal isolators) should be used, if at all, primarily for identification of mold infections. At our institution we noted patients having fungal blood cultures drawn in many other situations, including when the primary team was concerned for candida bloodstream infection. We sought to describe the utility of this practice and of fungal blood cultures in general. Methods We retrospectively reviewed the results of fungal blood cultures for 2 years, from 3/1/2019-3/1/2021. We evaluated the number of episodes, culture results, whether there was a had prior bloodstream infection, and risk factors for fungal infection including renal replacement (RRT), ECMO, and immunosuppression (IS). Immunosuppression was defined as chronic systemic steroid use, recent receipt of high dose steroids within 2 weeks, history of organ transplantation, history of stem cell transplantation, hematologic malignancies, or receipt of a biologic agent. Results 187 fungal blood cultures were drawn in 143 patients - 80 cultures in 70 patients from 3/2019-3/2020 and 107 cultures in 73 patients from 3/2020-3/2021. Only 3 patients had positive fungal blood cultures:1 (Candida krusei) from 3/2019-3/2020 and 2 (Candida albicans and Cyrptococcus neoformans) from 3/2020-3/2021; in all 3 cases the organism also grew from standard blood culture isolators. From 3/2019-3/2020, 1/80 cultures were drawn from an individual on ECMO while 15/80 were drawn from individuals on RRT, and 32/80 were in a IS individuals. From 3/2020-3/2021, 45/107 cultures were drawn from an individual on ECMO, 24/107 were drawn in an individual on RRT, and 73/107 were drawn in a IS individuals. The majority of individuals in whom a fungal blood culture was drawn during 3/2020-3/2021 were individuals with COVID-19. Upon chart review most of the cultures were drawn due to concern for candidemia. Results of fungal blood cultures drawn from 3/2019-3/2021 at OHSU Conclusion Fungal blood cultures have an extremely low yield at our institution, with a 1.6% positivity rate over a 2 year period, and all of those cultures were detected by standard blood culture isolators. Most of these cultures were drawn in situations where this test has no utility. Furthermore, the test has limited utility to detect dimorphic and mold bloodstream infections. Restriction of this test may limit inappropriate use. Disclosures All Authors: No reported disclosures

Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment

2007 ◽  
Vol 12 (2) ◽  
pp. 4-8
Author(s):  
Frederick Fung
Keyword(s):  
Concentration Level ◽  
Treatment Plan ◽  
Toxic Exposure ◽  
Dose Response Relationship ◽  
Specialty Board ◽  
History Of ◽  
Subjective Complaints ◽  
Based Medicine ◽  
Illness Causation ◽  
Rule Out

Abstract A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.

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