Hematopoietic cell transplantation (HCT) is the only potentially curative treatment option for many patients with hematologic malignancies. While HCT outcomes have improved drastically over the ...years, patients and clinicians continue to face numerous survivorship challenges, such as relapse, graft-versushost disease, and secondary malignancies. Recent literature suggests that clonal hematopoiesis (CH), the presence of a recurrent somatic mutation in hematopoietic cells, in HCT patients or donors may be associated with outcomes in autologous and allogeneic HCT. Herein, we perform a review of the literature and summarize reported associations between CH and clinical outcomes in HCT. For commonly reported outcomes, we used meta-analysis methods to provide estimates of effect sizes when combining results. A total of 32 articles with relevant and independent contributions were included, covering both autologous (n = 19) and allogeneic (n = 13) HCT. The articles report variable risk for developing outcomes according to CH characteristics, patient disease status, and method of HCT. Using meta-analysis of available results, HCT outcomes with statistically significant effects by CH status include therapy-related myeloid neoplasms (OR 3.65, 95%CI 2.18-6.10) and overall survival (HR 1.38, 95%CI 1.20-1.58) in autologous HCT and relapse (HR 0.80, 95%CI 0.68-0.94) in allogeneic HCT. However, heterogeneity, biases, and limitations in the literature provide challenges for informing the translation of CH to clinical decision-making. We conclude with a call to action and discussion of next steps to build upon the current literature and provide granularity to the true clinical impact of CH in the setting of HCT.
Our aim was to investigate association between OSA and radiotherapy in head and neck cancer patients.
On 9th of September 2018, we have searched 12 electronic databases to retrieve relevant studies. ...All eligible studies that assessed association between OSA and radiotherapy in head and neck cancer patients were included in our meta-analysis. Quality assessment of included studies was done using the NIH tools for cohort, cross-sectional and case series studies.
Fourteen studies met our study selection criteria, and six studies were eligible for our meta-analysis. There was no significant association between occurrence of OSA and radiotherapy in head and neck cancer patients (Odds ratio 1.54, 95% CI 0.66–3.60; P = 0.322).
These findings point to no significant association between OSA risk and radiotherapy in head and neck cancer patients. We suggest more studies to be conducted to investigate any confounders that may influence the effect of radiotherapy on development of OSA in head and neck cancer patients.
ObjectiveWe assessed the impact of political conflict (Boko Haram) on tuberculosis (TB) case notifications in Adamawa State in North-east Nigeria.DesignA retrospective analysis of TB case ...notifications from TB registers (2010–2016) to describe changes in TB notification, sex and age ratios by the degree of conflict by local government area.SettingAdamawa State.Participants21 076 TB cases notified.Results21 076 cases (62% male) were notified between 2010 and 2016, of which 19 604 (93%) were new TB cases. Areas affected by conflict in 2014 and 2015 had decreased case notification while neighbouring areas reported increased case notifications. The male to female ratio of TB cases changed in areas in conflict with more female cases being notified. The young and elderly (1–14 and >65 years old) had low notifications in all areas, with a small increase in case notifications during the years of conflict.ConclusionTB case notifications decreased in conflict areas and increased in areas without conflict. More males were notified during peace times and more female cases were reported from areas in conflict. Young and elderly populations had decreased case notifications but experienced a slight increase during the conflict years. These changes are likely to reflect population displacement and a dissimilar effect of conflict on the accessibility of services. TB services in conflict areas deserve further study to identify resilient approaches that could reach affected populations.
Background
We analyzed prognostic factors of hypopharyngeal carcinoma and developed a nomogram to predict survival rates in non-metastatic (M0) patients.
Subjects and methods
We included 4068 ...hypopharyngeal carcinoma patients identified from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2015 in a retrospective cohort study. We analyzed prognostic factors of hypopharyngeal carcinoma using cause-specific and overall survival rates. We developed a nomogram to predict patients’ survival rates by multivariate Cox regression.
Results
Five-year survival rates of all stages between 2004 and 2010 were 25–35%. Radiotherapy pre- and post-surgery was the best modality of treatment according to 1-year and 5-year survival rates. The worst survival was in the posterior wall of the hypopharynx significantly (
HR
s 95%
CI
,
P
) (1.238 1.045–1.466,
P
= 0.013). The highest survival rate was for the combination of surgery and radiotherapy pre- and post-surgery compared to radiation pre-surgery (0.532 0.231–1.225,
P
= 0.138). Our nomogram revealed a better predictive probability over the 6th AJCC-TNM classification for predicting 5-year overall survival.
Conclusions
The worst survival was old age hypopharyngeal carcinoma patients, with the primary site in the posterior wall of the hypopharynx. The best survival was linked to receiving radiotherapy pre- and post-surgery. Our nomogram revealed a better predictive probability over TNM classification for predicting 1- and 5-year overall survival, which enables clinicians to make better treatment recommendations.
The Patient Protection and Affordable Care Act (PPACA) addresses consumer protection, employer-provided insurance coverage, as well as the government's role in providing health care access to the ...most vulnerable populations. Within the practice of neurology, the PPACA has the challenging goal of reconciling the needs of the growing elderly population with the financial barriers to costly yet available health care services. To bridge that gap, all health care professionals working in the field of neurology must reflect on the effect previous Medicare reimbursement policies have had on the current practice of neurology, and utilize lessons learned in recent years. The test of time will tell whether the PPACA will achieve the goal of decreasing in health care spending while ensuring quality universal healthcare services.
Abstract
Inflammaging, characterized by chronic low-grade systemic inflammation, is a hallmark of physiological aging. It has been postulated as a unifying risk factor for various age-related ...conditions encompassing cardiovascular, pulmonary, hepatic, renal, articular, and neurological diseases, giving rise to the concept of 'age-related diseases of inflammation.' Recent research has unveiled a significantly increased prevalence of antecedent age-related diseases of inflammation in patients with hematologic malignancies. Consequently, we posit that the risk of mortality due to cardiovascular diseases in patients with solid cancers such as prostate cancer surpasses that attributed to other causes. We conducted a population-based analysis utilizing the Surveillance, Epidemiology, and End Results (SEER 17) data spanning from 2000 to 2019. A total of 70,715 prostate cancer patients meeting our selection criteria were included in the analysis. We calculated standardized mortality ratios (SMRs) and utilized competing risk analysis. Within this cohort, 3,217 (4.5%) died of cardiovascular causes as compared to 67,498 (95.5%) due to non-cardiovascular causes. Among patients over 50 years of age, the proportion of deaths due to cardiovascular diseases (CVD) was significantly larger than that of other causes (99.41% versus 97.58%, p <0.0001). Most of the prostate cancer patients who died due to CVD were above 50 years of age (99.41%), white (76.75%), diagnosed with adenocarcinoma (99.96%), of intermediate (44.26%) and high-grade disease (30.56%), diagnosed with localized disease (91.97%), had radiotherapy (98.57%), no surgery (93.94%), no chemotherapy (98.38%), and no metastasis at diagnosis (96.05%). Prostate cancer cases above 50 years of age were 33% less likely to die from CVD after a diagnosis of prostate cancer in comparison to a reference US population of the same age and racial distribution (SMR= 0.67, 95% CI= 0.65-0.69, absolute excess ratio (AER)= -35.96 per 10,000 PYR), most probably reflecting a decline in the incidence of CVD-related deaths with time. However, the cumulative incidence of CVD deaths was higher in cases above 50 years of age as compared to cases at or below 50. Finally, taking prostate cancer-specific deaths, other cause deaths, and other cancer-specific deaths as competing risk factors to CVD deaths, and after adjustment for potential confounders, we found that cases of prostate cancer above 50 years of age were nearly 3.5 times more likely to die from CVD as compared to cases at or below the age of 50 (Subdistribution hazard ratio (SDHR)= 3.65, 95%CI= 2.32-5.73). In conclusion, despite a declining trend, CVDs are predominant contributors to mortality in prostate cancer patients. Consequently, there is a compelling need to investigate similar mortality patterns across other cancer types and to explore potential associations with genetic and treatment-related factors.
Citation Format: Amr Ebied, Abdelrahman Ali, Chighaf Bakour. Cardiovascular diseases predominate inflammaging causes of death among patients with prostate cancer: A population-based analysis using the SEER database abstract. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr A002.
Abstract
Blood transfusion has long been regarded as a determinant of cancer, plausibly because it influences inflammatory and immunological changes in the recipient's body. Recently, there has been ...evidence of a role of donor-derived malignancy in donors of autologous stem cell transplants, supporting the possible cancer-driving role of age-related clonal hematopoiesis. Given that routine blood transfusion is more ubiquitous than stem cell transplantation, we hypothesize an association between blood transfusion and the occurrence of hematologic malignancies. We conducted a secondary analysis using data from the 2017-2018 survey of the National Health and Nutrition Examination Survey (NHANES). A total of 4,917 participants were included in our final analytic sample, of whom 587 (11.9%) had ever received a blood transfusion. Out of the participants receiving a blood transfusion, six (1.1%) were diagnosed with hematologic cancer versus 9 (0.21%) from the non-transfusion group. Specifically, three (0.51%) participants from the transfusion group were diagnosed with leukemia versus 2 (0.046%) from the non-transfusion group. Using multivariable logistic regression, we have found that, after adjustment of other predictors, people with a history of blood transfusion were 4.08 (95%CI= 1.18-14.05), 2.09 (95%CI= 0.47-9.27), and 6.76 (95%CI= 1.13-40.44) times more likely to report a history of hematologic cancers, Hodgkin lymphoma, and leukemia, respectively than those who were never transfused. In conclusion, we found a possible significant association between blood transfusion and the risk of developing hematological cancers (particularly leukemia) in the United States. Prospective studies are needed to confirm the temporal sequence of blood transfusion and hematologic cancers in that regard.
Citation Format: Amr Ebied, Jason Salemi, Chighaf Bakour, Nancy Gillis. History of blood transfusion and the risk of developing hematologic cancers in the United States: A cross-sectional study using the NHANES database. R abstract. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A026.
Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant plasma cell dyscrasia that occurs in 3-5% of patients above the age of 50. In addition to its ...known progression to multiple myeloma (MM), MGUS is associated with higher risks of second malignancies. The progression from MGUS to more advanced diseases has a significant impact on overall survival. This systematic review and meta-analysis therefore aimed to comprehensively evaluate the incidence of malignant progression and the development of second malignancies in patients with MGUS.
Methods: The protocol of our study was registered in PROSPERO with ID(CRD42018092067). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive electronic search in nine electronic databases, including PubMed, Google Scholar, POPLINE, WHO health library, System for Information on Grey Literature in Europe, Scopus, Web of Science, Virtual Health Library, and The New York Academy of Medicine. The following predetermined search terms were used: (monoclonal gammopathy of undetermined significance or MGUS); (incidence or progression or transformation); (myeloma or lymphoma or amyloidosis or macroglobulinemia or leukemia or plasmacytoma or malignancy or malignant). Risk of bias was assessed using the National Institute of Health (NIH) study quality assessment tool. Random-effects model was used to synthesize the pooled event rates of MGUS progression and development of second malignancies. Statistical heterogeneity was evaluated using Cochran’s Q statistics and I² tests, with p-value≤0.10 or I² value>50% considered as statistically significant. Sub-group analysis based on the duration of follow-up was conducted to obtain rates of progression in patients who were followed-up for 0-5 years, 5-10 years, and more than 10 years. Meta-regression based on age, gender, immunoglobulin subtype of MGUS, and publication year was performed to explore any statistically significant heterogeneity if there were more than 10 studies. Publication bias was assessed using Begg’s funnel plot and Egger’s regression test if the number of studies was more than 10.
Results: A total of 4690 articles were identified. Of those, 315 articles were found eligible for full-text screening. We finally included 48 studies for analysis including a total of 20945 patients with a mean age of 64.1 years. The mean duration of follow-up was 7.43 (1.8-34.1) years. The overall cumulative rate of MGUS progression and development of second malignancies was 8.6% (95% CI, 7.2-10.2%). The rates stratified based on years of follow-up were 6.9% (95% CI, 5.3-8.9%) at 0-5 years, 8.8% (95% CI, 6.4-11.8%) at 5-10 years, and 14.9% (95% CI, 10.8-20.2%) beyond 10 years. Rates of progression to MM, Waldenstrom macroglobulinemia, and amyloidosis were 5.8% (95% CI, 4.7-7.2%), 2.1% (95% CI, 1.1-4.0%), and 0.7% (95% CI, 0.3-1.5%) respectively. The rates of development of non-Hodgkin lymphoma and leukemia were 2.5% (95% CI, 1.5-4.3%) and 1.4% (95% CI, 0.4-4.4%) respectively. The rate of development of solid tumors was 6.4% (95% CI, 2.5-15.4%). Meta-regression for evaluation of statistical heterogeneity was performed for most outcomes, except for those with less than 10 studies (leukemia, amyloidosis, solid tumors, and follow-up beyond 10 years). Age and publication year were the source of heterogeneity in most. Overall risk of progression does not vary with MGUS subtypes. There was no publication bias based on Begg's funnel plot and Egger's regression test.
Conclusions: The risks of MGUS malignant progression and development of other hematological/solid malignancies remain significant, approximating 15% after 10 years of diagnosis. Future efforts could be directed toward better cancer surveillance and deferral of malignant progression among patients with MGUS.
No relevant conflicts of interest to declare.
Abstract
Introduction: Multiple myelomas (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Despite the remarkable improvement in survival ...rates with different treatment approaches; multiple myeloma patients are at higher risk of cardiovascular and thromboembolic events. Therefore, we aim to identify high-risk patients for cardiovascular mortality and provoke awareness among physicians for choosing appropriate therapy for better survival rates in those patients.
Methods Surveillance, Epidemiology, and End Results Program database used for this work. Kaplan Meier survival curves were constructed to compare the survival probabilities. Furthermore, Cox regression analysis was conducted to detect the most important factors determining the survival time. The significant variables were used to construct nomogram and its fit was assessed using c-index.
Results The cohort included 55991 multiple myeloma patients with 4510 deaths by cardiovascular and thromboembolic events. There was a significant difference in age between both groups (P-value < 0.001). There was a significant difference between both groups regarding the treatment choices, type of radiation, race and marital status. SEER database identified four diseases as a cause of death in multiple myeloma: Aortic aneurysm and dissection (n = 39), atherosclerosis (n = 88), cerebrovascular diseases (n = 1861) and diseases of the heart (n = 3799). Kaplan Meier survival curves revealed a significant difference in the survival probability between the multiple myeloma grades (P < 0.001). We found that hypertension with multiple myeloma has the best median survival (median =1, 95% CI (0.133,1) and the worst survival was in patients diagnosed with an aortic aneurysm and dissection (median =0.09, 95% CI (0.03,0.25). Cardiac causes of death had less survival than other reported causes of death. The log-rank test found significantly different median survival between different cardiac causes (p<0.0001). Cox proportional hazard ratio regression revealed that gender Male (HR = 1.39, SE = 0.03, P-value = 0.005, age (HR = 1.07, SE = 0.0015, P-value = 0.005), marital status (HR = 0.81, SE = 0.064, P-value = 0.0014), grade and surgery were significant risk factors for death with thromboembolic and cardiovascular diseases. These variables were used in nomogram. The c-index of the nomogram was 0.72, 95%CI (0.71 - 0.73). The prediction error (OOB) of the tree was 0.10. We found that random forest model had less survival over time than cox regression.
Conclusion: The mortality from by cardiovascular and thromboembolic events in MM was associated with several factors. Our considerations and further investigations of them is needful. It may aid in identifying the patients who can get the uppermost benefits of cardiovascular and thromboembolic prophylaxis and treatment measures.
Citation Format: Muhammed Khaled Elfaituri, Sara Morsy, Amr Ehab El-Qushayri, Hazem Abdelkarem Faraj, Minh-Duc Nguyen Tran, Amr Ebied, Amr Ebied, Nguyen Tien Huy. Cardiovascular and thromboembolic diseases as a cause of death in multiple myeloma patients: A population based study abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3302.
PDF
