Mass-spectrometry (MS) assays detect lower levels of monoclonal (M) proteins and result in earlier detection of monoclonal gammopathy of undetermined significance (MGUS). We examined heavy chain MGUS ...prevalence using matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) MS among 3 risk groups ages 50 or older: 327 African Americans (AA) and 1223 EA from a clinical Biobank and 1093 unaffected first-degree relatives (FDR) of patients with hematologic disorders. Age- and sex-adjusted prevalence rates were directly standardized to 2010 US population. Prevalence ratios were estimated for comparisons of AA and FDR to the EA group using the Poisson distribution. Results were also compared to population-based prevalence from Olmsted County, MN, using conventional gel-based methods. Risk groups had similar sex and age distributions. MALDI-TOF MGUS prevalence was higher in the AA (16.5% 95%CI: 12.2%, 20.8%) and FDR (18.3% 95%CI: 16.6%, 21.6%) than in EA (10.8% 95%CI: 8.8%, 12.7%) translating to prevalence ratios of 1.73 95% CI: 1.31, 2.29 and 1.90 95% C: 1.55, 2.34, respectively. MALDI-TOF EA prevalence was over 3-fold higher than conventional estimates but showed similar age trends. Thus, the MALDI-TOF assay found greater absolute numbers with MGUS but similar relative differences by race, family history and age as prior studies.
•Patients with MM after CP have inferior survival compared with patients with MM after BP.•Patients with MM tend to present symptoms at relapse similar to those at diagnosis.
Display omitted
Almost ...all patients with multiple myeloma (MM) eventually relapse, either asymptomatically or with end-organ damage. However, it remains unclear whether initiating therapy at the time of biochemical progression (BP) improves the outcomes compared with initiating therapy at the clinical progression (CP) stage. Here, we retrospectively assessed 1347 patients with relapsed MM. Most progressions were BP (60.4%); 39.6% had CP. The most prevalent symptoms at relapse were new or evolving bone disease (80.9%), anemia (38.0%), and renal failure (12.7%). Patients with BP had longer median time from second-line treatment to the next treatment compared with patients who had CP (17.0 vs 9.6 months; P < .001) as well as longer median overall survival from first relapse (59.4 vs 26.2 months; P < .001). Male sex (odds ratio OR, 1.49; 95% confidence interval CI, 1.02-2.18; P = .04), plasma cell labeling index ≥2% (OR, 1.58; 95% CI, 1.02-2.45; P = .04), and extramedullary disease at diagnosis (OR, 1.84; 95% CI, 1.08-3.13; P = .03) were associated with higher risk of CP, whereas very good partial remission or better had decreased risk of CP (OR, 0.62; 95% CI, 0.43-0.91; P = .02). To conclude, patients with CP have inferior postprogression outcomes compared with patients who have BP. Patients with deeper response to first-line therapy are less likely to develop CP. The presence of a specific CRAB (C, hypercalcemia; R, renal failure; A, anemia; B, bone disease) symptom at diagnosis predicts for the development of similar CRAB symptoms at relapse.
Gastrointestinal complications of multiple myeloma (MM) treatment are common and include nausea, constipation, and diarrhea. However, acute gastrointestinal events like perforations are rare. We ...aimed to describe the characteristics and outcomes of patients with MM that had colonic perforations during their treatment. This is a retrospective study that included patients from all three Mayo Clinic sites who had MM and developed a colonic perforation. All patients were diagnosed with colonic perforations based on CT scans and were surgically treated. Patients diagnosed with AL amyloidosis, a perforated colon complicating neutropenic colitis during ASCT and those with perforation due to colonic cancer were excluded. A high dose of dexamethasone was defined as ≥40 mg dexamethasone once a week. Thirty patients met inclusion criteria. All patients received steroids at doses ≥10 mg once weekly prior to the perforation, while four (11%) were on high‐dose dexamethasone without chemotherapy. Fourteen patients were given high doses of dexamethasone. Twenty‐five patients required ostomies with all surviving surgery. Twenty‐four perforations (80%) were associated with diverticulitis. Treatment with steroids was resumed in 23 patients with no further gastrointestinal complications. The median OS was 20 months following perforation (IQR 8–59). Within the same timeframe 5854 patients were treated at Mayo Clinic for MM, making the risk of bowel perforation 0.5%. Intestinal perforations in MM are rare and, in our series, always occurred with dexamethasone ≥10 mg per week. Urgent surgery is lifesaving and resumption of anti‐myeloma treatment appears to be safe.
Colon perforations are rare in MM and here we report characteristics and clinical outcomes of 30 patients that were treated at Mayo Clinic. We believe that steroids are the precipitating factor.
Background Reactivation of hepatitis B virus (HBV) during immunosuppressive therapy (IST) can lead to severe and even fatal hepatitis but can be largely prevented with prophylactic antiviral therapy. ...Screening for HBV prior to starting IST is recommended. Both risk-based and universal screening have been recommended by different societies. For effective risk-based screening, physicians must be aware of risk factors for chronic HBV infection. Methods The HBV screening practices prior to starting IST of rheumatologists, medical and hematological oncologists were evaluated by survey and chart review. Country of origin, the primary risk factor for HBV exposure, was determined in all patients. Results Of 140 rheumatology, 79 medical oncology and 53 hematology patients reviewed, 81%, 11% and 81% were deemed to be at high risk of HBV reactivation by their physicians respectively, however only 27%, 6% and 62% (p<0.0001) were actually screened for HBV prior to starting IST. For patients from HBV-endemic regions, more hematology patients (53%) were correctly identified by their physicians as being at high risk of reactivation than rheumatology patients (2.4%, p=0.0001) or medical oncology patients (15%, p=0.009). However actual screening rates were not increased in patients from endemic regions. A total of 81 patients were screened for HBsAg; 2 were positive. Of the 33 patients screened for anti-HBc, 10 (30%) were positive. Conclusions Hematologists, rheumatologists and medical oncologists had low rates of screening for HBV prior to prescribing IST, largely due to poor identification of those at risk for infection. Risk-based screening strategies are unlikely to be effective and should be replaced by universal screening.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Factors associated with time to transplant were analyzed.•Multivariable analysis was conducted using data at our center for patients with acute leukemia.•Related donors were significantly older than ...unrelated donors.•Age of donor did not correlate with time to transplant in multivariable analysis.•Using unrelated versus related donors required 35% longer time from diagnosis to transplant.•Studying outcomes when using older related versus younger unrelated donors is needed.
Relapse after allogeneic hematopoietic cell transplantation (HCT) for acute leukemia can be reduced when pursued early after first complete remission. The impact of donor age and donor relatedness on the time from diagnosis to transplant in patients with acute leukemia was examined to clarify the design of future prospective studies that can address optimal donor choice. Files of 100 consecutive patients undergoing transplantation for leukemia were reviewed. Recipients of related donors (RDs) and unrelated donors (UDs) were not significantly different in terms of recipient gender, age, underlying diagnosis, disease risk index, graft source, or donor HLA match. UDs were significantly younger than RDs (median age, 29 versus 51, P < .001). Multivariate linear regression revealed that when controlling for age of donor and recipient, the time from diagnosis to transplant was 35% longer with UDs compared with RDs (P = .018). No significant correlation was observed between donor and recipient age on length of time to transplant (P = .134 and P = .850, respectively), when controlling for other variables. The steps in UD procurement that contribute most to the longer time to transplant relate to activating the donor workup and scheduling the donor workup before cell collection. Understanding sources of delay in the transplant process will help transplant centers and UD registries reduce the time to transplant for patients with acute leukemia and will provide necessary insight for the design of prospective controlled studies that can address optimal donor choice.
Patients(pts) who undergo autologous stem cell transplant (ASCT) for multiple myeloma (MM) are routinely assessed at Day-100 using serum monoclonal protein (M-spike), free light chains(FLC), and ...urine studies. Limited data are available to assess the prognostic value of an increasing M-spike or FLC from immediately before ASCT to Day-100 post-ASCT. We evaluated this in our cohort of patients.
We retrospectively reviewed 1070 pts with MM at Mayo Clinic, Rochester, who had their first ASCT between 2000 and 2016. We stratified pts according to a rise in M-spike by at least >0.1g/dl from immediately before ASCT to Day-100 post-ASCT (cohort 1) compared to those who did not (cohort 2). We also stratified pts according to a rise in involved FLC by at least >5mg/dl (cohort 3) compared to those who did not (cohort 4). Survival analysis for progression free survival (PFS) and overall survival (OS) was performed using the Kaplan Meier method.
46 pts were found to have a rise in M-spike by at least >0.1g/dl between pre-ASCT and Day-100 (cohort 1) and 825 pts were found to have a declining or <=0.1g/dl increase in M-spike (cohort 2). 25 pts were found to have an increase in involved FLC by at least >5mg/dl (cohort 3) and 1045 pts were found to have a decrease or a < = 5mg/dl increase in involved FLC (cohort 4). The median PFS was significantly shorter in cohort 1 compared to cohort 2 (median PFS of 10 months vs. 27 months, respectively P<0.0001). Cohort 1 patients also had an inferior OS, compared to cohort 2 (median OS of 34 months vs. 79 months, respectively, P<0.0001). Similarly the median PFS and OS were found to be inferior in cohort 3 compared to cohort 4 (median PFS of 4 months and 28 months, respectively p<0.0001 and median OS of 11 months and 82 months, respectively, p<0.0001)
An increase of M-spike by at least >0.1 g/dl and involved FLC by at least >5mg/dl from pre-ASCT to Day-100 is predictive of inferior PFS and OS in pts with MM. These patients would benefit from closer surveillance post Day-100.
PDF
