scholarly journals Prognostic Implications of Epilepsy Onset Age According to Relapse Pattern in Patients with Four-Year Remission

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1089
Author(s):  
Soochul Park ◽  
Myeongjee Lee
Keyword(s):  
Prognostic Factors ◽  
Risk Score ◽  
Age Of Onset ◽  
Age Groups ◽  
Late Relapse ◽  
Remission Period ◽  
Relapse Pattern ◽  
Prognostic Implications ◽  
Relapse Patterns

A total of 472 epilepsy patients with a 4-year remission period were divided into 10-year age groups according to age of onset. The relapse patterns during at least 3 years of follow-up were classified as early relapse (ER), late relapse (LR), and seizure-free (SF). The remission probability and multiplicity of prognostic factors were evaluated using univariate and multivariate multinomial logistic analyses. The weighted risk score based on odd ratios (ORs) was used for comparisons of the relative risk of relapse between groups. The group with onset in their 20s had the lowest remission probability among the groups. The risks of relapse in the LR patients and the relative weighted risk score of ER patients in the group with onset in their 20s were 3.11 and 19.44, respectively, which was the highest risk among the age groups. Patients without remission within 1 year had the highest relapse risk, with an OR of 7.18 in ER patients. The OR of relapse in patients with >10 generalized tonic–clonic (GTC) seizures was the second most important prognostic factor in LR patients. The distinct risk and corresponding prognostic factors in LR and ER patients reflected inherent differences between these relapse patterns.

NCOG-25. REVISITING THE PIGNATTI RISK SCORE IN LOW-GRADE GLIOMA PATIENTS IN THE MOLECULAR ERA

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi157-vi157
Author(s):  
Christine Jungk ◽  
Mara Gluszak ◽  
Philip Dao Trong ◽  
Andreas von Deimling ◽  
Christel Herold-Mende ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Risk Score ◽  
Low Grade ◽  
Tumor Diameter ◽  
Diffuse Glioma ◽  
Who Grade ◽  
Cox Regression Analysis ◽  
Diffuse Gliomas ◽  
The Individual

Abstract Until now, the Pignatti risk score has been used to guide treatment decisions after histological diagnosis of diffuse glioma WHO grade 2. However, its prognostic value was derived from a historic cohort that has been diagnosed by morphologic rather than molecular criteria. We re-challenged the Pignatti score in a contemporary, molecularly characterized cohort. From our institutional cohort of 422 diffuse gliomas WHO grade 2, 202 patients were identified for whom IDH mutation status was known and 1p/19q co-deletion or loss of ATRX expression unambiguously classified tumors into astrocytoma or oligodendroglioma. Patients with IDH wildtype astrocytoma (n=9), multifocal lesions or brainstem involvement were excluded. Potential prognostic factors including the individual items of the Pignatti score (astrocytoma; age ≥40 years; neurologic deficit; maximum tumor diameter ≥6cm; tumor crossing midline) were correlated with progression-free survival (PFS) by univariate log-rank und multivariate Cox regression analysis. 165 patients with astrocytoma or oligodendroglioma were analysed of whom 109 (66%) did not receive adjuvant radio- or chemotherapy. 94 untreated patients with a minimum follow-up of 24 months entered survival analysis. These patients were classified as “high-risk” (Pignatti 3-5) and “low-risk” (Pignatti 0-2) in 15% and 85% and did not differ with regard to potential prognostic factors (gender; resection vs. biopsy; tumor recurrence) other than the individual Pignatti score items. Diameter ≥6 cm (p=0.006; HR=2.18) and midline crossing (p=0.003; HR=3.54) were identified as independent prognostic factors of PFS. Noteworthy, prognostic factors coincided when all patients (n=144) with a minimum follow-up of 24 months, regardless of adjuvant treatment, were analysed. In IDH mutant, molecularly characterized diffuse gliomas WHO grade 2, the Pignatti risk score as a whole no longer seems to be of prognostic relevance. Instead, outcome seems to be determined by tumor burden.

Use of a novel convolutional neural network-based mammographic evaluation to assess response to adjuvant endocrine therapy in women with early-stage breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 530-530
Author(s):  
Julia Elizabeth McGuinness ◽  
Vicky Ro ◽  
Simukayi Mutasa ◽  
Richard Ha ◽  
Katherine D. Crew
Keyword(s):  
Breast Cancer ◽  
Neural Network ◽  
Prognostic Factors ◽  
Convolutional Neural Network ◽  
Endocrine Therapy ◽  
Risk Score ◽  
Early Stage ◽  
Stage I ◽  
Risk Scores

530 Background: The standard of care for early-stage hormone receptor (HR)-positive breast cancer (BC) is 5-10 years of adjuvant endocrine therapy (ET), which leads to a 50-60% relative risk reduction in BC recurrence. However, 10-40% of patients may relapse up to 20 years (y) after diagnosis, and there is a need for biomarkers of response to ET. We developed a novel, fully-automated convolutional neural network (CNN)-based mammographic evaluation that accurately predicts BC risk, which is being evaluated as a pharmacodynamic response biomarker to adjuvant ET. Methods: We conducted a retrospective cohort study among women with HR-positive stage I-III unilateral BC diagnosed at Columbia University Irving Medical Center from 2007-2017, who received adjuvant ET and had at least 2 mammograms of the contralateral breast (baseline and annual follow-up). Demographics, clinical characteristics, BC treatments, and relapse status were extracted from the electronic health record and New York-Presbyterian Hospital Tumor Registry. We performed CNN analysis of mammograms at baseline (start of ET) and annual follow-up. Our primary endpoint was change in CNN risk score, expressed as a continuous variable (range, 0-1). We used two-sample t-tests to assess for differences in mean CNN scores between patients who relapsed or remained in remission. We evaluated if CNN score at baseline and change from baseline were associated with relapse using logistic regression, with adjustment for known prognostic factors. Results: Among 870 evaluable women, mean age at diagnosis was 59.5y (standard deviation [SD], 12.4); 60.3% had stage I tumors, 72.6% underwent lumpectomy, and 45.8% received chemotherapy. With a median follow-up of 4.9y, there were 68 (7.9%) breast cancer relapses (36 distant, 26 local, 6 new primary). Median number of evaluable mammograms per patient was 5 (range, 2-13). Mean baseline CNN risk scores were significantly higher among women who relapsed compared to those in remission (0.258 vs 0.237, p = 0.022), which remained significant after adjustment for known prognostic factors. There was a significant difference in mean absolute change in CNN risk score from baseline to 1y follow-up between those who relapsed vs. remained in remission (0.001 vs. -0.022, p = 0.027), but this was no longer significant in multivariable analysis. Conclusions: We demonstrated that higher baseline CNN risk score was an independent predictor of BC relapse. A greater decrease in mean CNN risk scores at 1-year follow-up after initiating adjuvant ET was seen among BC patients who remained in remission compared to those who relapsed. Therefore, baseline CNN risk scores may identify patients at high-risk for breast cancer recurrence to target for more intensive adjuvant treatment. Early changes in CNN risk scores may be used to predict response to long-term ET in the adjuvant setting.

Anorexia Nervosa: Outcome and Prognostic Factors after 20 Years

1991 ◽  
Vol 158 (4) ◽  
pp. 495-502 ◽  
Author(s):  
R. H. Ratnasuriya ◽  
I. Eisler ◽  
G. I. Szmukler ◽  
G. F. M. Russell
Keyword(s):  
Anorexia Nervosa ◽  
Prognostic Factors ◽  
Bulimia Nervosa ◽  
Age Of Onset ◽  
Duration Of Illness ◽  
General Outcome ◽  
The Family ◽  
History Of ◽  
Disturbed Relationships

Forty-one patients with anorexia nervosa, admitted to the Maudsley Hospital between 1959 and 1966, were followed up after a mean of 20 years. An assessment of general outcome (based on the Morgan-Russell scales) yielded three outcome categories: ‘good’ (n = 12), ‘intermediate’ (n = 13) and ‘poor’ (n = 15). Six patients (15%) had died from causes related to anorexia nervosa; at least 15% had developed bulimia nervosa. There was a general consistency between the follow-up at 20 years and that previously conducted five years after admission, although with a few individual patients there were serious prognostic errors at the earlier follow-up. A poorer outcome was associated with a later age of onset, a history of neurotic and personality disturbances, disturbed relationships in the family and a longer duration of illness.

scholarly journals Prevalence and susceptibility to diabetes mellitus using Indian diabetic risk score

2018 ◽  
Vol 5 (9) ◽  
pp. 4119
Author(s):  
Divya S. ◽  
Radhamani M. V. ◽  
Kiran Ravi ◽  
Deepa S.
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Risk Score ◽  
Age Of Onset ◽  
Age Groups ◽  
Educational Status ◽  
Diabetes Risk ◽  
Undiagnosed Diabetes ◽  
Cross Sectional ◽  
Diabetes Risk Score

Background: India is the diabetes capital of the world. The burden of diabetes mellitus is increasing daily. If people with higher risk for diabetes are identified before the disease has developed, then some interventions could be undertaken to reduce the modifiable risk factors. Objective of the study was to identify the high risk subjects by using Indian diabetes risk score (IDRS) for detecting undiagnosed diabetes among people aged above twenty five years in rural area of Thrissur.Methods: A cross-sectional study was conducted among 262 inhabitants above 25 in Thrissur. Fasting blood sugar within 3 months prior was noted. The risk of diabetes was assessed using Indian Diabetes Risk Score and grouped into low, moderate and high risk.Results: Majority were females (58.4%) and (80.5%) reported either of their parents as diabetic. Waist circumference was higher for majority. Most (62.2%) people had regular exercise. 199 (76%) had moderate risk. 92% were at moderate to high risk of developing diabetes. Higher the risk score higher was the FBS, and was statistically significant (p=0.035). IDRS was statistically significant with the educational status (p=0.023) and sex (0.000). Forty four (16.8%) were diabetic, 60 (22.9%) hypertensive and 12 (4.6%) had coronary artery disease.Conclusions: There is a shift in age of onset to younger age groups. Hence, the early identification of at risk individuals and appropriate intervention help to prevent, or delay, the onset of complications. This definitely suggests the importance of IDRS for identifying undiagnosed high risk diabetes.

Patients with Follicular Lymphoma, Grade 3, Have a Prolonged Relapse-Free Survival Following Aggressive Combination Chemotherapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 613-613 ◽  
Author(s):  
Apar Kishor Ganti ◽  
Dennis D. Weisenburger ◽  
Lynette M. Smith ◽  
Christine P. Hans ◽  
R. Gregory Bociek ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Follicular Lymphoma ◽  
Combination Chemotherapy ◽  
Age Groups ◽  
Specific Treatment ◽  
Free Survival ◽  
Younger Patients ◽  
Lymphoma Treatment ◽  
Grade 3

Abstract Clinical prognostic factors for grade 3 follicular lymphoma (FL3), using the new WHO classification, have not yet been clearly defined. Hence, we conducted a retrospective study to identify the outcome and clinical features predictive of survival in patients with FL3. Two hundred and two patients diagnosed with FL3 using the Berard criteria, who were staged and treated with various aggressive combination chemotherapy regimens containing either an anthracycline or mitoxantrone, are included in this study. After a median follow-up of 8.4 years (range, 0.5 – 19.5 years), 105 patients (52%) have died and 97 patients (48%) are alive at last contact. The estimated 10-yr event-free survival (EFS) and overall survival (OS) are 34% (95% CI: 26–41%) and 45% (95% CI: 37–53%), respectively. By multivariate analysis, older age (≥60 years; Figure 1) and a low hemoglobin (<12 gm/dL) were independent adverse predictors of OS (RR: 2.3, 95% CI: 1.5–3.7, p=0.0002; and RR: 1.9, 95% CI 1.2–3.0, p=0.0095, respectively). A low hemoglobin and advanced stage (III/IV) at presentation were independent adverse predictors of EFS (RR: 1.8, 95% CI: 1.2–2.8, p=0.0072; and RR: 1.7, 95% CI: 1.1–2.5, p=0.0096 respectively). When patients were compared based on age, there were no significant differences in the distribution of adverse prognostic factors among patients ≥60 years of age as compared to younger patients. There were also no differences in the frequency of relapse/progression (10-year rate of 50% in patients <60 years vs. 44% in patients ≥60 years, p=0.71) or lymphoma-specific/treatment-related deaths between the two age groups (10-year rate of 30% in patients <60 years vs. 35% in patients ≥60 years, p=0.17; Figure 2). Although younger patients (<60 years) had a significantly better OS and EFS as compared to older patients, there were no differences in the relapse/progression rates or lymphoma/treatment-related survival. Thus, aggressive combination chemotherapy led to durable remissions in 50–60% of patients with FL3. Figure Figure Figure Figure

Time to First Acute Exacerbation Can Stratify the Patients According to Their Prognosis during Clinical Course of Chronic GVHD: Evaluation of New End-Point for Chronic GVHD.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5335-5335
Author(s):  
Dong Hwan Kim ◽  
Sang Kyun Sohn ◽  
Kun Soo Lee ◽  
Jong Gwang Kim ◽  
Kyu Bo Lee ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Acute Exacerbation ◽  
Chronic Gvhd ◽  
Immunosuppressive Treatment ◽  
Observation Time ◽  
Time Dependent ◽  
Background Variable ◽  
Progressive Type ◽  
Prognostic Implications

Abstract Background: Variable endpoints have been investigated in the filed of chronic GVHD (cGVHD) such as GVHD-specific survival (GSS) or the duration of systemic immunosuppressive treatment. It enables to evaluate the prognosis of cGVHD patients more precisely than that using overall survival (OS). However, to reach its endpoint, long observation time and follow-up duration is demanding. Accordingly, the new endpoint for the prognosis of cGVHD, the time-to-first attack of acute exacerbation of cGVHD (TTF), was evaluated in the current study. Patients and Methods: Out of 99 patients who experienced acute GVHD and evaluated for cGVHD, 78 patients (79%) was diagnosed as a cGVHD. The correlation of TTF with GSS was performed using time-dependent Cox’s proportional regression. Also, GSS and TTF were evaluated as a endpoint of cGVHD according to previously well-known prognostic factors such as extent of cGVHD, the Hopkin’s system, and the severity system of cGVHD by Lee et al. Results: The median time to first attack of was 129 days after diagnosis of cGVHD (95% confidence interval 92 to 166 days). The 2 years rates of free from acute exacerbation was estimated as 23.4±5.3%, 53.6±6.6%, and 75.1±6.4% for first, second, and third episode of acute exacerbation of cGVHD. With respect to GSS according to the episode number of acute exacerbation of cGVHD, the group without any episodes showed 95.0±4.9% of GSS rates, while those with 1-, 2-, and 3-episode(s), 54.6±9.7%, 23.5±10.3%, and 63.5±15.0% (Comparing the groups without or with episode of acute exacerbation of cGVHD, 95.0±4.9% versus 47.0±6.9%, p=0.001). In a multivariate survival analysis, time-dependent covariate of TTF was the only independent prognostic factor for GSS. The correlation of TTF with GSS also revealed as regards the extent of cGVHD (p&lt;0.001 versus 0.014), the Hopkin’s model (p=0.002 versus 0.05), and the severity of cGVHD by Lee et al (p=0.025 versus &lt;0.001), respectively. The TTF was significantly associated with the progressive type onset (p&lt;0.001) and extensive cGVHD (p=0.032) by Cox’s proportional hazard model. Conclusion: The TTF seemed to be well correlated with GSS, and the prognostic factors that were associated with GSS also showed good prognostic implications with respect to TTF. The new endpoint, TTF, might reduce time and labor in further trials or studies of cGVHD. Figure. The time-to-first attack of acute exacerbation during systematic immunosuppression for chronic GVHD (n=78): The probability of free from first, second, and third episode of acute exacerbation of chronic GVHD at 2 years was estimated as 23.4±5.3%, 53.6±6.6%, and 75.1±6.4%, respectively (A), GVHD-specific survival between the group with or without acute exacerbation during systematic immunosuppression for chronic GVHD (B) Figure. The time-to-first attack of acute exacerbation during systematic immunosuppression for chronic GVHD (n=78): The probability of free from first, second, and third episode of acute exacerbation of chronic GVHD at 2 years was estimated as 23.4±5.3%, 53.6±6.6%, and 75.1±6.4%, respectively (A), GVHD-specific survival between the group with or without acute exacerbation during systematic immunosuppression for chronic GVHD (B)

scholarly journals Survival Outcomes in Oral Tongue Cancer: A Mono-Institutional Experience Focusing on Age

2021 ◽  
Vol 11 ◽  
Author(s):  
Mohssen Ansarin ◽  
Rita De Berardinis ◽  
Federica Corso ◽  
Gioacchino Giugliano ◽  
Roberto Bruschini ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Tongue Cancer ◽  
Age Groups ◽  
Age At Diagnosis ◽  
Oral Tongue ◽  
Free Survival

ObjectiveThe prognostic role of age among patients affected by Oral Tongue Squamous Cell Carcinoma (OTSCC) is a topic of debate. Recent cohort studies have found that patients diagnosed at 40 years of age or younger have a better prognosis. The aim of this cohort study was to clarify whether age is an independent prognostic factor and discuss heterogeneity of outcomes by stage and treatments in different age groups.MethodsWe performed a study on 577 consecutive patients affected by primary tongue cancer and treated with surgery and adjuvant therapy according to stage, at European Institute of Oncology, IRCCS. Patients with age at diagnosis below 40 years totaled 109 (19%). Overall survival (OS), disease-free survival (DFS), tongue specific free survival (TSFS) and cause-specific survival (CSS) were compared by age groups. Multivariate Cox proportional hazards models were used to assess the independent role of age.ResultsThe median follow-up time was 5.01 years (range 0–18.68) years with follow-up recorded up to February 2020. After adjustment for all the significant confounding and prognostic factors, age remained independently associated with OS and DSF (respectively, p = 0.002 and p = 0.02). In CSS and TSFS curves, the role of age seems less evident (respectively, p = 0.14 and p = 0.0.37). In the advanced stage sub-group (stages III–IV), age was significantly associated with OS and CSS with almost double increased risk of dying (OS) and dying from tongue cancer (CSS) in elderly compared to younger groups (OS: HR = 2.16 95%, CI: 1.33–3.51, p= 0.001; CSS: HR = 1.76 95%, CI: 1.03–3.01, p = 0.02, respectively). In our study, young patients were more likely to be treated with intensified therapies (glossectomies types III–V and adjuvant radio-chemotherapy). Age was found as a prognostic factor, independently of other significant factors and treatment. Also the T–N tract involved by disease and neutrophil-to-lymphocyte ratio ≥3 were independent prognostic factors.ConclusionsYoung age at diagnosis is associated with a better overall survival. Fewer younger people than older people died from tongue cancer in advanced stages.

scholarly journals Differences in disease phenotype and severity in SLE across age groups

Lupus ◽  
2016 ◽  
Vol 25 (14) ◽  
pp. 1542-1550 ◽  
Author(s):  
N Ambrose ◽  
T A Morgan ◽  
J Galloway ◽  
Y Ionnoau ◽  
M W Beresford ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Age Of Onset ◽  
Age Groups ◽  
Standardized Mortality Ratio ◽  
Adult Onset ◽  
Disease Phenotype ◽  
Mortality Ratio ◽  
The Uk ◽  
Effect Of Age

Objectives Significant differences have been reported in disease phenotype and severity of systemic lupus erythematosus (SLE) presenting in different age groups. Most indicate a more severe phenotype in juvenile-onset SLE (JSLE). There have been limited studies in older patients and no large studies looking at SLE across all age groups. Methods We assessed the effect of age of onset of SLE on the clinical phenotype by analysing data from two large UK cohorts (the UK JSLE Cohort and the UCLH SLE cohort). Results A total of 924 individuals were compared (413 JSLE, 511 adult-onset SLE). A female preponderance was present, but less pronounced at either end of the age spectrum. Arthritis was more common with advancing age (93% vs 72%, p < 0.001), whereas renal disease (44% vs 33%, p = 0.001), alopecia (47% vs 23%, p < 0.001) and aphthous ulcerations (39% vs 26%, p = 0.001) were more common in the young. Neuropsychiatric lupus was less common in mature-onset SLE ( p < 0.01). JSLE was associated more commonly with thrombocytopenia (21% vs 15%, p = 0.01), haemolytic anaemia (20% vs 3%, p < 0.001), high anti-dsDNA (71% vs 63%, p = 0.009), Sm (22% vs 16%, p = 0.02) and RNP (36% vs 29%, p < 0.04) auto-antibodies. Leucopenia increased with advancing age ( p < 0.001). Mortality has been declining over recent decades. However, death rates were substantially higher than the general population. The standardized mortality ratio was 18.3 in JSLE and 3.1 in adult-onset SLE. Conclusion These data from the largest-ever direct comparison of JSLE with adult-onset SLE suggest an aggressive phenotype of disease with a worse outcome in patients with JSLE and emphasizes the importance of careful follow-up in this population.

Patterns of Relapse and Progression in Multiple Myeloma Patients Treated with Conventional and Novel Agent-Based Therapy: A Single Centre Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5361-5361
Author(s):  
Bethany E Monteith ◽  
Esther Masih-Khan ◽  
Eshetu G Atenafu ◽  
Christine Chen ◽  
Anca Prica ◽  
...  
Keyword(s):  
Plasma Cell ◽  
Research Funding ◽  
Plasma Cell Leukemia ◽  
Biochemical Relapse ◽  
Cell Leukemia ◽  
Relapse Pattern ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
Relapse Patterns

Abstract Background The incorporation of novel agents (NA) for multiple myeloma (MM) has improved the response rates (RR), overall survival (OS), and progression free survival (PFS) when compared to conventional agents (CA). Unfortunately, relapse is inevitable and few studies focus on patterns of relapse, especially in non-transplant patients (pts). We aim to describe the different patterns of relapse in non-transplant MM pts and determine if any pre-treatment clinical or disease characteristics can predict the patterns relapse. We will evaluate whether NA treated pts have higher rates of aggressive relapse with plasmacytomas or plasma cell leukemia (Leuk Res. 2009 Aug;33(8):1137-40). Secondly, RR and PFS for pts treated with CA vs NA will be described. Methods A retrospective evaluation of 156 consecutive newly diagnosed non-transplant eligible MM pts at Princess Margaret Cancer Centre receiving at least two consecutive cycles of CA or NA from 1999 to 2015. CA included steroids and alkylators while NA had immunomodulatory (IMiD) drugs (thalidomide, lenalidomide) and proteasome inhibitors (PI) (bortezomib). Response type was defined by the revised International Myeloma Working Group criteria (Leukemia. 2006 Sep;20(9):1467-73. Epub 2006 Jul 20); relapse patterns as defined in the Spanish Registry (Haematologica. 2002 Jun;87(6):609-14) Results For 156 non-transplant MM pts: 81 (52%) male, average age 76 yrs, 87 (56%) treated with NA (thalidomide=15; PI=52). Baseline characteristics were not significantly different between groups (Table 1). Sixty three (52%) pts had a clinical relapse, 37 (30%) pts had a biochemical relapse, and 22 (18%) were switched immediately to second line therapy given suboptimal response (lack of clinical benefit or PD). Six pts relapsed with isolated plasmacytomas (4 CA vs 2 NA). There was one case of plasma cell leukemia relapse in an IMiD-treated pt.Twenty seven (17.3%) pts had not relapsed at the time of analysis and had ongoing follow-up. There was no significant difference in the types of relapse patterns for pts treated with CA versus NA (p=0.26) or for CA versus IMiD versus PI therapy (p=0.22). Pts with insufficient response to first line chemotherapy were more likely to have a 17p deletion (p=0.07). All pts with a biochemical relapse did not have a 17p deletion. The median follow-up time was 16.4 (range 0.6 to 99) months (mo) for CA vs. 19.6 (range 0.4 to 107) mo for NA. Table 1. Patient Characteristics Relapse Pattern - Mean (sd) Clinicaln =63 Biochemicaln =37 Insufficient n=22 p -value Hgb 108 (17) 99 (21) 110 (18) 0.08 WBC 6.1 (2.4) 6.4 (3.3) 5.6 (1.9) 0.72 Plt 231 (107) 224 (117) 237 (103) 0.64 Ca 2.5 (0.3) 2.5 (0.4) 2.4 (0.3) 0.58 Cr 125 (92) 130 (87) 136 (133) 0.92 B2M 492 (537) 596 (448) 618 (618) 0.19 Alb 37 (7) 36 (6) 36 (5) 0.29 CRP 6.7 (7.4) 9.3 (19.1) 13.0 (17.5) 0.56 Relapse Pattern - Count (%) ConventionalNovel 35 (56)28 (44) 15 (41)22 (59) 13 (59)9 (41) 0.26 IgGIgAFLCOther 34 (54)17 (27)10 (16) 2 (3) 23 (62) 6 (16) 8 (22) 0 (0) 14 (63) 4 (18) 4 (18) 0 (0) 0.78 KappaLambda 32 (58)23 (42) 19 (59)13 (41) 12 (57)9 (43) 0.99 Chr 13 Del 8/29 (28) 7/10 (41) 3/9 (33) 0.64 t(4,14) 2/29 (7) 3/15 (20) 0/8 (0) 0.34 17p Del 4/28 (14) 0/15 (0) 3/9 (33) 0.07 Extramed. Inv. 4 (6) 1 (3) 1 (5) 0.85 Sixty (38%) pts achieved VGPR/CR/sCR, 53 (34%) PR, 35 (22%) SD, and 8 (5%) PD with upfront therapy. VGPR/CR/sCR was seen in 13 (21%) pts with CA vs 47 (78%) with NA (p<0.01). For NA, 28 (47%) pts in the PI-based group achieved VGPR/CR/sCR compared to 19 (32%) in IMiD-based (p<0.01). The median PFS for all pts was 21 (95% CI 17-23) mo, with 17 (95% CI 13-23) mo for CA vs 23 (95% CI 17-29) mo in NA. There is a statistically significant difference between CA and NA in PFS (p=0.0045; Figure 1). Discussion In non-transplant MM pts, we did not find a significant difference in the patterns of disease relapse between those treated with CA versus NA. Baseline characteristics such as renal failure or type of treatment do not seem to predict for the pattern of relapse; except the presence of 17p deletion trended toward more treatment failure. We note that the number of pts with aggressive relapses (plasmacytomas or plasma cell leukemia) was low and this limits our ability to detect differences in outcomes and baseline factors. Pts treated with NA continue to have better RR and PFS than those treated with CA. Future work with longer follow-up intervals is needed in order to capture late relapses, better describe relapse patterns with NA as well as understanding disease biology. Disclosures Chen: Celgene: Consultancy, Honoraria, Research Funding. Prica:Janssen: Honoraria; Celgene: Honoraria. Reece:Lundbeck: Honoraria; Janssen-Cilag: Consultancy, Honoraria, Research Funding; Merck: Research Funding; Millennium Takeda: Research Funding; Bristol-Myers Squibb: Research Funding; Otsuka: Research Funding; Novartis: Honoraria, Research Funding; Onyx: Consultancy; Amgen: Honoraria; Celgene: Consultancy, Honoraria, Research Funding. Tiedemann:Janssen Ortho: Honoraria; Celgene: Honoraria; Amgen: Honoraria. Kukreti:Celgene: Honoraria; Amgen: Honoraria; Lundbeck: Honoraria; Roche: Honoraria; Janssen Ortho: Honoraria.

Long-term results of high-dose chemotherapy (HDCT) supported by hematopoietic circulating (ASCT) or bone marrow (BMT) stem cell autografting as first salvage treatment for refractory or relapsed Hodgkin’s lymphoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7567-7567
Author(s):  
S. Viviani ◽  
V. Bonfante ◽  
M. Di Nicola ◽  
S. Cortelazzo ◽  
C. Carlostella ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Dose Chemotherapy ◽  
Stage Iii ◽  
Long Term Results ◽  
Late Relapse ◽  
High Dose ◽  
First Line ◽  
Early Relapse

7567 Background: The aim of this retrospective study was to evaluate with a long follow-up the efficacy of HDCT + ASCT or ABMT for refractory or relapsed HL. Methods: Data were collected from 99 pts who failed or relapsed after first-line CT± radiotherapy and were treated with HDCT+ASCT or ABMT between Oct 1984 and Dec 2003. Thirty-two pts had late relapse (CR≥12 months), 31 had early relapse (CR<12 months), while 36 had primary refractory (IF) HL.The main pts characteristics at relapse/progression were as follows: M/F: 50/49; median age 28 years; stage III-IV:54%; B symptoms: 33%; bulky disease 22%; extranodal ± nodal disease 54%; IPI≥3 39%. HDCT program consisted in a debulking phase with sequential high-dose chemotherapy (Cyclophosphamide 7gr/mq followed by ASC or BM harvest, Methotrexate 8 gr/mq+ Vincristine 1.4 mg/mq, VP16 2 gr/mq) in 71 cases; 3–4 courses of Ifosfamide (3gr/mq × 4 days)+ Vinorelbine (25mg/mq day 1+5) in 28 cases. Final myeloablative course was BEAM (63%), or high-dose Melphalan combined with high-dose Mitoxantrone (11%) or with high-dose Carmustine (9%) or TBI (17%) followed by ABMT or ASCT. Results: Ninety-two pts (93%) completed the HDCT program, while seven pts (7%) progressed during debulking CT. Early and late toxicity were mild. After a median follow-up of 66 months both 10-year freedom from second progression (FF2P) and overall survival (OS) were 61% for all pts. FF2P and OS were respectively 70% and 66% for pts with late relapse; 64% and 60% for pts with early relapse; 52% and 56% for primary refractory pts. Multivariate analysis showed that prognostic factors for FF2P were stage III-IV vs I-II (HR 2.09; p=0.04), response to first-line CT: CR≥12 vs CR<12 vs IF (HR 2.19; p=0.058) and bulky vs non bulky (HR 1.96; p=0.07). Prognostic factors for OS were response to first-line CT (HR 2.59; p=0.05), stage III-IV vs I-II (HR 1.37; p=0.39) and bulky vs non bulky (HR 2.06; p=0.06).Conclusion: These long-term results confirm that HDCT + ASCT or ABMT was feasible, safe and very effective for the treatment of relapsed/refractory HL.Our data support the use of this strategy for the salvage therapy even in the unfavourable group of primary refractory pts. No significant financial relationships to disclose.

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