A 48-year-old woman presented with a 3-day history of fatigue and abdominal pain 2 weeks after receiving the Ad26.COV2.S vaccine. She had a low platelet count and was found to have cerebral venous ...sinus thrombosis and clots in the right hepatic and splenic veins. Testing for antibody to PF4–polyanion was positive.
Polypharmacy, usually defined as taking ≥5 prescribed medications, increases chances of drug-drug interactions and toxicities, and may harm cancer patients who need multiple chemotherapeutic agents ...and supportive medications. We analyzed the effects of polypharmacy in overall survival (OS) in acute myeloid leukemia (AML). A total of 399 patients were divided into two groups: patients with polypharmacy (≥5 medications) versus without polypharmacy (<5 medications). Polypharmacy was associated with age ≥60 years, Karnofsky Performance Status of ≤80, hematopoietic cell transplant (HCT) comorbidity index of ≥5, and adverse cytogenetics. Patients with polypharmacy were less likely to receive intensity chemotherapy or HCT. One-year OS of patients with polypharmacy versus those without polypharmacy was 29 vs. 49% (p<.001). Polypharmacy conferred worse OS in patients <60 years (37 vs. 65% at 1 year, HR 1.95, 95% CI 1.21-3.15) but not in patients ≥60 years (26 vs. 27% at 1 year, HR 1.12, 95% CI 0.81-1.57). Thus, polypharmacy has negative impact on OS in AML, particularly among patients aged <60 years.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Patients living farther away from academic centers may not have easy access to resources for management of acute myeloid leukemia (AML). We aimed to analyze the effect of distance traveled on overall ...survival (OS) of AML patients treated at an academic center.
AML patients diagnosed at the University of Nebraska Medical Center were divided into 4 groups according to the shortest distance between the cancer center and patients’ residence (<25, 25-50, 50-100, and > 100 miles). Chi-square test and ANOVA were used to examine the association of distance with patient characteristics. OS, defined as the time from diagnosis of AML to death from any cause, was determined by the Kaplan-Meier method. Comparison of survival curves was done by the log-rank test. Multivariable analysis using Cox regression was performed to detect the survival effect of distance from the cancer center.
The total number of patients was 449. Median distance was 85 miles (interquartile range, 20-180). OS at 1 year for < 25, 25-50, 50-100, and > 100 miles was 45%, 55%, 38%, and 40% respectively (P = .6). In a Cox regression analysis, distance from treatment center, as a continuous variable, was not a significant factor for death (hazard ratio, 1.001; 95% confidence interval, 1.000-1.001). Multivariable analysis showed nonsignificant trend of increased mortality for patients traveling > 100 miles to a cancer center.
This study did not demonstrate an association between distance from an academic cancer center and OS in AML. This finding should provide some assurance to patients who live farther away from academic centers.
We analyzed the effects of distance traveled on overall survival (OS) of acute myeloid leukemia (AML). One-year OS for 4 patient groups, based on shortest distance between the cancer center and patients’ residence (<25, 25-50, 50-100, and > 100 miles), was 45%, 55%, 38%, and 40%, respectively. This study did not demonstrate an association between distance from an academic cancer center and OS in AML.
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Introduction
Polypharmacy, commonly defined as taking ≥5 prescribed medications, is a major issue in adults, especially those ≥60 years of age. Drug-drug interactions can significantly increase ...toxicities while undergoing chemotherapy, and may affect OS in AML. Polypharmacy can also increase treatment costs. We aimed to evaluate the effects of polypharmacy on OS in AML.
Methods
We included adult AML patients diagnosed from 2000-2016 at University of Nebraska Medical Center. Based on the number of prescribed medications at the time of AML diagnosis, patients were divided into 2 groups: patients with (≥5 medications) versus without polypharmacy (<5 medications). Fisher's exact test was used to identify the association of polypharmacy with baseline characteristics. OS, defined as the time from diagnosis of AML to death from any cause, was determined by the Kaplan-Meier method, and comparisons of survival curves was done using the log-rank test. Cox proportional hazard model was used to determine the effect of polypharmacy on OS adjusting for other covariates for the entire cohort, and separately for <60 years and ≥60 years old.
Results
We included a total of 399 patients in the study- 59% were ≥60 years, 52% were male, 96% were white, and 34% had adverse cytogenetics (Table 1). Median number of medications was 4 (range 0-39). Forty-nine percent of patients received ≥5 medications. In patients with polypharmacy, median number of medications was 8 (range 5-39) vs. 2 (range 0-4) among patients without polypharmacy. Patients with polypharmacy, compared to those without polypharmacy, were more likely to be ≥60 years (77% vs 42%, p<0.0001), had Karnofsky performance status (KPS) of ≤80 (53% vs.26%, p<0.0001) and adverse cytogenetics (41% vs 27%, p=0.01). Median hematopoietic cell transplant (HCT) comorbidity index (HCT-CI) was 2 (range 1-4) in the polypharmacy group vs 1 (range 1-4) in the group without polypharmacy (p<0.0001). Patients with polypharmacy were less likely to receive intensive chemotherapy (56% vs 81%, p<0.0001) and undergo HCT (17% vs 37%, p<0.0001).
Patients with polypharmacy had worse OS compared to those without polypharmacy (hazard ratio HR 2.1, (95% confidence interval CI 1.6-2.6, p=0.03) (Figure 1). One-year OS of patients with polypharmacy vs. those without polypharmacy was 29% vs 49% (p<0.001) (Table 1). OS was significantly lower with polypharmacy in patients <60 years of age (37% vs 65% at 1-year, p<0.001) but similar in patients ≥60 years (26% vs 27% at 1-year, p=0.09) (Figure 2 and 3). In polypharmacy group, 1-year OS for patients ≥60 years was 26% compared to 37% for patients <60 years (p=0.02). In two separate multivariate analyses, polypharmacy conferred worse OS in patients <60 years of age (HR 1.9, 95% CI 1.2-3.1) but not in patients ≥60 years (HR 1.1, 95% CI 0.8-1.6).
Conclusion
Patients with polypharmacy were older and had greater incidence of adverse cytogenetics, and were less likely to receive intensive chemotherapy and HCT. While HCT CI was slightly greater in the polypharmacy group, the difference in HCT CI does not seem to be clinically remarkable for the degree of difference in the median number of medicines between groups. AML patients with polypharmacy, when adjusted for age, had worse OS than those without polypharmacy. In multivariate analysis based on the age cutoff of 60 years, polypharmacy had negative impact on OS of patients aged <60 years but not on patients aged ≥60 years. While traditionally older adults are considered to be at a greater risk of polypharmacy, our study highlights that the effect of polypharmacy may be even more important in younger adults with AML. Given the impact of polypharmacy on OS, patients with newly diagnosed AML should be assessed for appropriateness of prescribed and over the counter medication.
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Al-Kadhimi:Celldex Biotech: Other: Stocks; Seattle Genetics: Other: Stocks. Gundabolu:Pfizer: Consultancy; Novartis: Consultancy; Jazz pharmaceuticals: Consultancy; Samus Therapeutics: Research Funding. Bhatt:National Marrow Donor Program: Consultancy; Tolero Pharmaceuticals: Research Funding; Incyte: Consultancy, Research Funding; Partner therapeutics: Consultancy; Abbvie: Consultancy; Agios: Consultancy; CSL Behring: Consultancy; Pfizer: Consultancy.
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