scholarly journals Age at menarche and depression: results from the NHANES 2005–2016

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7150 ◽  
Author(s):  
Yun Shen ◽  
Deepthi S. Varma ◽  
Yi Zheng ◽  
Jenny Boc ◽  
Hui Hu
Keyword(s):  
Depressive Symptoms ◽  
Smoking Status ◽  
Small Sample ◽  
Age At Menarche ◽  
Early Age ◽  
Adult Women ◽  
Early Menarche ◽  
Increased Risk ◽  
Significant Difference ◽  
Adjusted Model

Objective The association between early age at menarche and depression among adolescent girls and adult women has been examined in many studies. However, inconsistent results and limitations such as small sample size, low generalizability, and measurement error exist. We aimed to address these issues to assess the association between age at menarche and depressive symptoms in a nationally representative sample of US women aged 18 years and older. Methods We used the 2005–2016 National Health and Nutrition Examination Survey (NHANES) data with a total of 15,674 women aged 18 years and older included in our study. Logistic regression models were used after adjusting for sociodemographic and health-related factors. Results The crude-adjusted model suggests that women with early age of menarche had 1.36 (95% CI [1.16–1.61]) times the odds of current depressive symptoms compared with the normal menarche group, after controlling for age, race/ethnicity, education, poverty income ratio (PIR) and marital status. In the fully-adjusted model, women with early menarche had 1.25 (95% CI [1.05–1.48]) times the odds of current depressive symptoms, after additionally adjusting for smoking status and body mass index (BMI). However, no significant difference was observed between the normal and late menarche groups. Conclusion Further studies are warranted to determine the causal relationship and mechanisms between early menarche and increased risk of depression.

Discrepancy of blast percentage between the bone marrow aspirate and biopsy and its impact on survival outcomes in patients with myelodysplastic syndromes excess blast (MDS-EB).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 7053-7053
Author(s):  
Meera Yogarajah ◽  
Phuong L. Nguyen ◽  
Rong He ◽  
Hassan Alkhateeb ◽  
Mithun Vinod Shah ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Scoring System ◽  
Small Sample Size ◽  
Scoring Systems ◽  
Standard Of Care ◽  
Small Sample ◽  
International Prognostic Scoring System ◽  
Increased Risk ◽  
Significant Difference ◽  
Impact On Survival

7053 Background: The revised International Prognostic Scoring System (IPSS-R) aids in prognosticating MDS. The percentage (%) of blasts in the bone marrow is one of the major determinants of the scoring system. The aspirate blast % is utilized as the standard of care, but there could be discrepancies in the blast % reported by the aspirate and the biopsy. We aim to study the possible use of bone marrow biopsy blasts in MDS-EB in calculating IPSS-R. Methods: The MDS database was reviewed for cases of MDS-EB after due IRB approval. We calculated IPSS-R scores based on the aspirate blast % (IPSS-RAsp) and biopsy blast % (IPSS-RBx). The biopsy blast % was reported morphologically or by the CD34 stain. Whenever a range was reported the highest value was utilized as the blast %. Suboptimal aspirates were excluded from the study. The overall survival (OS) was determined by IPSS-RAsp, IPSS-RBx and IPSS-R highest blast (IPSS-RHi). OS estimates were calculated by Kaplan-Meier curves and log-rank testing using JMP v.13. Uno’s concordance statistic was used to compare all 3 risk scoring systems. Results: Of 1322 patients, 431 (33%) cases were identified with MDS-EB; out of which 173 cases had both blasts reported in the biopsy and the aspirate. Out of 173 cases, 35 (20%) had MDS-EB1, and 61 (35%) had MDS EB-2 based on both biopsy and aspirate (concordant cases). Seventy seven (45%) patients changed from EB-1 to EB2 or vice versa based on the biopsy blast (44/77 (57%) cases were upstaged). The OS outcomes based on the IPSS-RBx biopsy showed a clear and meaningful separation with median OS decreasing with increased risk but IPSS-RAsp and IPSS-RHi did not (Table). We compared the 3 models for observed OS differences using the Uno model and there was no statistically significant difference. Conclusions: IPSS-RBx (but not IPSS-RAsp and IPSS-RHi) identified prognostic groups for OS with median OS decreasing with increased risk. The small sample size may have led to an insignificant effect on model power by Uno model. This finding needs to be validated by other centers. [Table: see text]

scholarly journals Associations of Tryptophan, Docosahexaenoic Acid (DHA), and Vitamin D With Sleep Quality and Depression During Pregnancy

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 766-766
Author(s):  
Amber Kautz ◽  
Ying Meng ◽  
Emily S Barrett ◽  
Jessica Brunner ◽  
Richard Miller ◽  
...  
Keyword(s):  
Vitamin D ◽  
Depressive Symptoms ◽  
Docosahexaenoic Acid ◽  
Sleep Quality ◽  
Pregnant Women ◽  
Maternal Mental Health ◽  
Smoking Status ◽  
Depression Scale ◽  
Poor Sleep ◽  
Increased Risk

Abstract Objectives During pregnancy women are at increased risk of poor sleep quality and depression. Serotonin and melatonin are compounds that are involved in regulation of sleep and mood. Several nutrients are involved in the synthesis of these compounds, including tryptophan, docosahexaenoic acid (DHA), and vitamin D. Studies exploring associations between these nutrients and sleep, as well as mood, have been largely limited to the general population, showing mixed results. The aim of this study was to assess the associations of dietary intake of these nutrients with sleep quality and depression in pregnant women. Methods Participants enrolled in the Understanding Pregnancy Signals and Infant Development (UPSIDE) Study (n = 253) were included in this analysis if they completed dietary, sleep and depression assessments during the 2nd trimester. Dietary and supplement intake were measured using 24-hour dietary recalls. The NCI method was used to estimate usual intake. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear regression was conducted to estimate the associations between nutrients and sleep/depression, adjusting for age, race/ethnicity, parity, education, early pregnancy body mass index, smoking status, energy and macronutrient intake. Results The NCI adjusted mean intakes of tryptophan, DHA, and vitamin D were 1.02 ± 0.11 g/day, 0.13 ± 0.11g/day, and 19.74 ± 21.80 mcg/day, respectively. Mean PSQI score was 6.15 ± 3.39, where higher scores indicated worse sleep quality, and mean EPDS score was 5.84 ± 4.77, where higher scores indicated increased severity of depressive symptoms. Tryptophan intake was inversely associated with EPDS scores (b = −15.23, 95%CI: −26.75, −3.72). The associations between DHA, vitamin D, and depression were not significant. The selected nutrients were not associated with PSQI scores. Conclusions In this study, higher tryptophan intake was associated with lower depressive symptoms among pregnant women during the second trimester. Additional research on the relationship between tryptophan intake and maternal mental health during pregnancy is warranted. Funding Sources NIH, Mae Stone Goode Foundation, Wynne Family Foundation.

scholarly journals Age at Menarche and Asthma Onset Among US Girls and Women: Findings from NHANES, 2001-2018

2021 ◽  
Author(s):  
Li Cai ◽  
Lan Qiu ◽  
Yaqi Wang ◽  
Li Wu ◽  
Xiaojie Wu ◽  
...  
Keyword(s):  
Family Income ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Age At Menarche ◽  
Adult Onset ◽  
Childhood Onset ◽  
Early Menarche ◽  
Representative Study ◽  
Increased Risk ◽  
Menarche Age

Abstract Background: Findings on the association between early menarche and asthma onset remain inconsistent and the evidence in the US is lacking. Furthermore, there was no clear separation of childhood- and adult-onset asthma in previous studies. Therefore, we aim at quantitatively estimating the association of age at menarche with risk of childhood- and adult-onset asthma separately in US girls and women.Methods: We conducted a retrospective cohort study of 24,282 US girls and women aged less than 80 years by using continuous NHANES data in 2001-2018. Weighted Cox proportional-hazards regression models with censoring ages of 19 and 79 were used to separately estimate hazard ratios of childhood- and adult-onset asthma associated with age at menarche. Results: Each one-year increase of age at menarche was significantly associated with a 17% (HR [95%CI]: 0.83 [0.77, 0.90]) decrease in the risk of childhood-onset asthma. Compared with age at menarche of 12-14, we observed a 60% (HR [95%CI]: 1.60 [1.22, 2.09]) increased risk of childhood-onset asthma for early menarche (age at menarche <12 years) and 41% (HR [95%CI]: 0.59 [0.32, 1.08]) decreased risk for late menarche (age at menarche ≥15 years). Race, family income, education and family history of asthma did not modify these associations. No significant association between age at menarche and adult-onset asthma.Conclusions: In this US nationally representative study, we found that early menarche was associated with increased risk of childhood-onset asthma, but not adult-onset asthma. These findings help demonstrate early menarche may be a risk factor for childhood-onset asthma in US, indicating timely and effective management of special individuals with early menarche for preventing asthma.

scholarly journals TPA Use for Central Line De-Occlusion and Its Relationship to Symptomatic Venous Thromboembolism in Pediatric Leukemia Patients

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2111-2111
Author(s):  
Katherine Armstrong ◽  
Kavitha Ramaswamy ◽  
Victoria Cooley ◽  
Linda M Gerber ◽  
Nicole Kucine
Keyword(s):  
Venous Thromboembolism ◽  
Sample Size ◽  
Central Line ◽  
Small Sample ◽  
Myelogenous Leukemia ◽  
Pediatric Leukemia ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Significant Difference ◽  
Picc Line

Introduction: Venous thromboembolism (VTE) is a known complication of pediatric leukemia with reported incidence ranging widely from 1.5-40%. It is associated with significant morbidity including loss of venous access, post thrombotic syndrome, and thrombosis recurrence or embolization. Increased risk of VTE in these patients is often multifactorial. There are currently no standard guidelines for VTE prophylaxis in pediatric leukemia patients, and it is unclear which patients are at highest risk. Identifying potential markers for patients at risk for VTE could be helpful for guiding prophylaxis practices and ultimately decreasing rates of VTE in these children. Thrombolytic agents are commonly used to treat catheter obstruction by breaking down fibrin that forms within the catheter. Therefore, we hypothesize that patients requiring more tissue plasminogen activator (TPA) for treatment of catheter obstruction may be at higher risk of developing fulminant thromboses. Therefore, the primary objectiveof this study is to determine the association between central line clearance with TPA and development of symptomatic VTE (sVTE) in pediatric leukemia patients. Methods: This is a multi-center,retrospective cohort study of patients under 21 years old with a central line (CVC), including peripherally inserted central catheters (PICC), who began treatment at Weill Cornell Medicine (WCM) or Memorial Sloan Kettering Cancer Center (MSKCC) from January 2012-December 2015 for newly diagnosed or relapsed leukemia. Patients were excluded if they had a prior VTE, or an incidental VTE was identified. Transplant and CAR-T -cell patients were excluded, as were those who transferred into the institution over 30 days from start of treatment. Data collected included demographics, disease-specific information (including type of leukemia, treatment regimen, and CVC details), dates of TPA administration, and details of sVTE. Data analysis was performed with Fisher's exact test andWilcoxon rank-sum test. Results: A total of 96 patients with leukemia were included. The median age was 6.5 years (Q1, Q3: 3.15-15.05 years), and 55% (n=53) were male. 78% (n=75) were new diagnoses. Acute lymphoblastic leukemia (ALL; 72%, n=69) was most common, followed by acute myelogenous leukemia (AML; 25%, n=24), and mixed lineage leukemias (3%, n=3). There were no significant differences between gender, age, type of leukemia, or TPA use between the two centers. The overall incidence of sVTE over the 4-year period in this cohort was 6% (6/96). At the time of thrombosis, five of the six patients had a PICC line in place and one patient had a mediport (Table 1). Four sVTE patients were diagnosed with ALL. Four of the thromboses were line-associated, one was a sinus venous thrombosis, and one was an inferior vena cava thrombus. Five of the six sVTEs were diagnosed at WCM. There was no association found between use of TPA for line de-occlusion and development of sVTE (OR 0.55, CI 0.07-6.57, p=0.61) or between number of TPA doses needed and development of sVTE (p=0.830). The patients who developed sVTE were significantly older than those who did not develop sVTE (Figure 1, p=0.048). There was no significant difference between gender and development of sVTE. A significant difference (p <0.05) was seen when analyzing the association between PICC line and development of sVTE, however the sample size was too small to draw formal conclusions. Conclusions: In our cohort, neither TPA use for line occlusion nor the number of TPA doses was predictive of sVTE development. This may be due to the small sample size and low number of sVTE events. Single center analysis of data from WCM, however, previously indicated a significant association between TPA use and development of thrombosis in their patients. Given the increased use of PICC lines at WCM, this raises the question of whether TPA use may be predictive in patients who have PICC lines. Our data are consistent with previous pediatric studies, which found older age to be a risk factor for thrombosis. Analysis of a larger cohort of patients is necessary to further investigate our hypothesis. Given the importance of preventing sVTE in pediatric leukemia patients, further prospective studies are needed to investigate potential predictors of thrombosis in this population. Disclosures Cooley: off-label: Other: drug use.

Does adolescent depression predict obesity in black and white young adult women?

2005 ◽  
Vol 35 (10) ◽  
pp. 1505-1513 ◽  
Author(s):  
DEBRA L. FRANKO ◽  
RUTH H. STRIEGEL-MOORE ◽  
DOUGLAS THOMPSON ◽  
GEORGE B. SCHREIBER ◽  
STEPHEN R. DANIELS
Keyword(s):  
Depressive Symptoms ◽  
Young Adult ◽  
White Women ◽  
Depression Scale ◽  
Black Girls ◽  
Health Study ◽  
Adult Women ◽  
Black And White ◽  
White Girls ◽  
Increased Risk

Background. To examine whether adolescent depressive symptoms predict young adult body mass index (BMI) and obesity in black and white women.Method. Participants included 1554 black and white adolescent girls from the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) who completed the Center for Epidemiological Studies – Depression Scale (CES-D) at ages 16 and 18 years.Results. Regression analyses showed that depressive symptoms at both ages 16 and 18 were associated with increased risk of obesity (BMI[ges ]30) and elevated BMI in young adulthood (age 21) in both black and white girls. Black girls exhibited a significantly greater likelihood of obesity and higher BMI (i.e. a main effect of race), but the race×CES-D interaction was not significant in any analysis.Conclusions. Depressive symptoms in adolescence appear to be predictive of obesity and elevated BMI in early adulthood for both black and white girls, even when taking prior BMI into account, indicating that depressive symptoms confer risk for obesity above and beyond the known tracking of body weight. Obesity prevention studies might consider assessing depressive symptoms in adolescence in order to more fully capture important risk variables.

scholarly journals Timing of menarche and self-harm in adolescence and adulthood: a population-based cohort study

2019 ◽  
Vol 50 (12) ◽  
pp. 2010-2018 ◽  
Author(s):  
Elystan Roberts ◽  
Abigail Fraser ◽  
David Gunnell ◽  
Carol Joinson ◽  
Becky Mars
Keyword(s):  
Cohort Study ◽  
Suicide Attempts ◽  
Pubertal Timing ◽  
Birth Cohort Study ◽  
Future Research ◽  
Age At Menarche ◽  
Suicidal Intent ◽  
Early Menarche ◽  
Increased Risk ◽  
Self Harm

AbstractBackgroundPrevious studies of pubertal timing and self-harm are limited by subjective measures of pubertal timing or by the conflation of self-harm with suicide attempts and ideation. The current study investigates the association between an objective measure of pubertal timing – age at menarche – and self-harm with and without suicidal intent in adolescence and adulthood in females.MethodBirth cohort study based on 4042 females from the Avon Longitudinal Study of Parents and Children (ALSPAC). Age at menarche was assessed prospectively between ages 8 and 17 years. Lifetime history of self-harm was self-reported at ages 16 and 21 years. Associations between age at menarche and self-harm, both with and without suicidal intent, were examined using multivariable logistic regression.ResultsLater age at menarche was associated with a lower risk of lifetime self-harm at age 16 years (OR per-year increase in age at menarche 0.87; 95% CI 0.80–0.95). Compared with normative timing, early menarche (<11.5 years) was associated with an increased risk of self-harm (OR 1.31, 95% CI 1.04–1.64) and later menarche (>13.8 years) with a reduced risk (OR 0.74, 95% CI 0.58–0.93). The pattern of association was similar at age 21 years (OR per-year increase in age at menarche 0.92, 95% CI 0.85–1.00). There was no strong evidence for a difference in associations with suicidal v. non-suicidal self-harm.ConclusionsRisk of self-harm is higher in females with early menarche onset. Future research is needed to establish whether this association is causal and to identify potential mechanisms.

P029 VTE RISK WITH IBD PLUS ORAL CONTRACEPTIVES: ARE PATIENTS AWARE?

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S58-S59
Author(s):  
Jenny Dave ◽  
Karan Chawla ◽  
Francis Carro-Cruz ◽  
Vinay Rao ◽  
Jessica Gibilisco ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Oral Contraceptives ◽  
Institutional Design ◽  
Small Sample Size ◽  
Fold Increase ◽  
Small Sample ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Increased Risk ◽  
Significant Difference

Abstract Background The risk of venous thromboembolism (VTE) is 1.5–3 fold higher in individuals with IBD compared to the general population. In addition, combination hormonal oral contraceptives (OCPs) are associated with a 3–5 fold increase in VTE. However, there is limited data regarding VTE risk in women with IBD who are on OCPs. It is speculated that women with IBD who may be at increased risk for VTE occurrence are not consistently counselled about VTE risks. This study evaluated the rate of VTE counselling in reproductive aged women and those on oral contraceptives. Methods A retrospective medical record review of all IBD women seen at a university gastroenterology practice during a 5 year period was performed. Patients’ age, disease type, OCP use and VTE risk counseling were obtained. A database was created maintaining patient confidentiality. Analysis was conducted using Fisher’s Exact Test with significance set at p&lt; 0.05. The study was approved by the university IRB. Results There were 209 female IBD patients with a mean age of 44 years (range 23–82). 153 had ulcerative colitis, 53 had Crohn’s disease and 3 had indeterminate IBD. Self-reported ethnicity included 93 White, 67 Black/African-American, 7 Asian, 1 Hawaiian, 19 other and 22 declined reporting their ethnicity. There were 146 women of reproductive age (&lt;50 years) and 63 women &gt;50 years. 7 women, all age &lt;50, were counselled about potential VTE risk. There was no significant difference (p=0.105) in the rate of VTE counselling in women based upon age. In the 24 women of reproductive age who were on OCPs, one patient was counselled about increased VTE risk. There was no significant difference (p=1.00) in the rate at which women of reproductive age on OCPs (1 in 24, 4.2%) were counselled compared to women of reproductive age who were not on OCPs (6 in 122; 4.9%). Discussion Venous thromboembolism can result in significant morbidity and mortality. Individuals with IBD are at increased risk for VTEs. Women with IBD on oral contraceptives may be at greater risk for VTEs than other IBD patients. This study revealed that IBD women infrequently receive education about VTE risk. There was no significant difference in the rate of counselling in women based upon age. There was also no significant difference in the VTE counselling in women of reproductive age who were on OCPs compared to those who were not on OCPs. Whle this study is limited based upon single institutional design, retrospective evaluation and small sample size, it offers important information for further study and educational initiatives. Enhanced efforts to educate individuals about the risk for VTEs can improve IBD management and outcomes.

scholarly journals Early Phenotypes in Girls at Risk for PCOS Replicate Metabolic and Reproductive Subtypes: An Unsupervised Clustering Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A739-A739
Author(s):  
Laura Christine Torchen ◽  
Ryan Sisk ◽  
Sarayu Ratnam ◽  
Andrea Elizabeth Dunaif
Keyword(s):  
At Risk ◽  
Longitudinal Studies ◽  
Quantitative Traits ◽  
Hierarchical Cluster ◽  
Unsupervised Hierarchical Cluster ◽  
Adult Women ◽  
Gonadotropin Secretion ◽  
Insulin Levels ◽  
Increased Risk ◽  
Significant Difference

Abstract Both daughters of women with PCOS (PCOS-d) and overweight girls (OW-g) are proposed to be at increased risk of PCOS because they have peripubertal increases in testosterone (T) levels, a cardinal feature of PCOS. We are testing this hypothesis by performing longitudinal studies in these girls after menarche. In adult women with PCOS, we have recently identified reproductive and metabolic subtypes using unsupervised cluster analyses. These subtypes were associated with novel PCOS susceptibility genetic loci suggesting that the subtypes reflect biologically discrete entities. We performed similar analyses in our cohort of early postmenarchal PCOS-d and OW-g to test the hypothesis that these subtypes are present in girls at risk for PCOS. Fifteen PCOS-d and 10 OW-g aged 11-16 years and with postmenarchal age less than 2 years were studied. Mothers of PCOS-d fulfilled NIH criteria for PCOS, mothers of OW-g were reproductively normal with no history of irregular menses or clinical hyperandrogenism. OW-g had a BMI above the 85th percentile for age. There was no BMI inclusion criterion for PCOS-d; four PCOS-d had a BMI above the 85th percentile. The girls were of comparable age, post-menarchal age and BMI z score. A fasting morning blood sample was drawn for T, SHBG, DHEAS, glucose and insulin. Leuprolide 10 mcg/kg SC was administered. LH and FSH levels were measured at baseline, 30 min, and 60 min following leuprolide. Unsupervised hierarchical cluster analysis adjusted for age was performed on quantitative traits including BMI, T, fasting insulin, fasting glucose, DHEAS, SHBG, and LH and FSH. These are the same quantitative traits used for clustering in adult PCOS. The clustering revealed 2 distinct PCOS subtypes: a reproductive group (41%), characterized by higher SHBG levels, LH and FSH with relatively low BMI and insulin levels, and a metabolic group (41%), characterized by higher BMI and insulin levels and lower SHBG, LH, and FSH. Jaccard coefficients indicated cluster stability (0.70 reproductive, 0.69 metabolic). There was a significant difference in the distribution of the two subgroups in PCOS-d and OW-g: PCOS-d 60% reproductive, 13% metabolic, 27% indeterminate; OW-g 25% reproductive, 50% metabolic, 25% indeterminate (Chi Sq P=0.05). We found that early postmenarchal PCOS-d and OW-g demonstrate reproductive and metabolic subtypes similar to those identified in adult women with PCOS. The majority of PCOS-d had the reproductive subtype. These findings suggest that this subtype, which is characterized by disordered gonadotropin secretion, is an early harbinger of PCOS. Longitudinal studies are ongoing to test this hypothesis.

scholarly journals Infection at the Time of Initial Therapy for Hairy Cell Leukemia Is Associated with Inferior Time to Next Treatment

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2305-2305 ◽  
Author(s):  
Narendranath Epperla ◽  
Mirela Anghelina ◽  
Qiuhong Zhao ◽  
Akwasi Agyeman ◽  
James S. Blachly ◽  
...  
Keyword(s):  
Hairy Cell Leukemia ◽  
Research Funding ◽  
Nucleoside Analogs ◽  
Small Sample ◽  
Hairy Cell ◽  
Cell Leukemia ◽  
Infection Group ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Abstract Introduction: Hairy Cell Leukemia (HCL) is a rare, chronic hematological malignancy that makes up approximately 2% of all leukemias. HCL patients are at a markedly increased risk for infection related to a combination of disease-related and treatment-related immunosuppression which has been well described in the literature. However, the significance of infection prior to initiation of HCL therapy and its impact on the subsequent selection of HCL treatment, or outcomes, is not well described. Using the HCL patient data registry, we report here the impact of antecedent infection on the treatment patterns and outcomes of HCL patients. Methods: We evaluated adult (≥18 years) patients with HCL who had information regarding antecedent infections and subsequent HCL treatment during 1984-2018. The primary endpoint was progression-free survival (PFS-1). Secondary endpoint included time to next treatment (TTNT). PFS-1 was measured from the date of first HCL treatment to date of progression/death or last follow-up. TTNT was defined as the time from first HCL treatment to initiation of second HCL treatment. The study population was stratified into 3 groups based on the presence or absence of antecedent infections: no infection prior to first HCL treatment (no infection group), infection within 30 days prior to first HCL treatment (infection1 group) and infection >30 days prior to first HCL treatment (infection2 group). Fisher's exact test or Kruskal-Wallis test was used to compare the characteristics among the no infection and infection groups and the Cox proportional hazard model was used to evaluate the association with PFS-1 and TTNT. Results: A total of 205 HCL patients who had information regarding antecedent infections and subsequent HCL treatment were eligible for the study. Among these, 144 (70%) belonged to the no infection group, while 26 patients (13%) belonged to infection1 group and 35 (17%) to infection2 group. Patient characteristics are shown in Table 1 with a breakdown between the three groups. The majority of the patients were Caucasian with a male preponderance and had classic HCL. The patients in the infection1 group had a lower median WBC (K/uL) (1.9 vs 3.1 vs 2.9), particularly the absolute neutrophil count (K/uL) (0.4 vs 0.7 vs 0.8) and significantly lower median hemoglobin (gm%) (10.1 vs 12.2 vs 12.4) relative to the no infection and infection2 groups, respectively (p=0.01). Similarly, a greater proportion of patients in the infection1 group had significant comorbidities (including pulmonary, gastrointestinal and hepatic disease) relative to no infection and infection2 groups as shown in Table 1. The majority of patients received purine nucleoside analogs as their first HCL treatment (no infection group=92%, infection1 group=85%, infection2 group=94%). The median PFS-1 (in years) was better in the no infection group compared to the infection1 group but was not statistically significant (17.0 [95% CI=7.9-not reached (NR)] vs 8.8 [95% CI=4.2-NR], respectively, p=0.98, Figure 1). However, the median TTNT (in years) was significantly longer for HCL patients with no infection versus the infection1 group (6.3 [95% CI=5.4-7.8] vs 3.6 [95% CI=0.7-NR], respectively, p=0.001, Figure 1). On subgroup analysis, relative to the no infection group, median PFS-1 (in years) was not significantly different in infection1 group treated with Pentostatin (10.7 [95% CI=3.53-NR] vs NR [95% CI=1.38-NR], respectively, p=0.43), however, the median PFS-1 (in years) was shorter in the infection1 group treated with Cladribine (17.0 [95% CI=7.67-NR] vs 4.0 [95% CI=2.00-NR], respectively), although not reaching statistical significance (p=0.09) probably due to small sample size. Conclusion: In this large series of HCL patients who received treatment, we show that the patients who had infections at the time of HCL treatment have a significantly shorter TTNT. The reasons for this are unclear but may indicate that patients were unable to receive treatment in a timely manner because of the infection, or were unable to complete treatment because of complications. The significant difference in hemoglobin between the infection1 and other groups indicates the possibility that these patients had more advanced HCL at the time of diagnosis. These findings indicate the potential long term negative impact of infections in patients who need treatment for HCL and reinforce the need for careful management in this setting. Disclosures Lozanski: Beckman: Research Funding; Coulter: Research Funding; Stem Line: Research Funding; Genentech: Research Funding; Novartis: Research Funding; BI: Research Funding. Andritsos:HCLF: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Consultancy.

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