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Age and cytogenetics as predictors of event free survival in patients with acute non-lymphocytic leukemia receiving high dose cytosine arabinoside and daunorubicin as consolidation chemotherapy.
Stein RS, Wolff SN, Greer JP, Flexner JM, Goodman S, Jagasia M, Brandt SJ, Morgan DS, Arrowsmith E, McCurley TL
(2001) Leuk Lymphoma 42: 913-22
MeSH Terms: Actuarial Analysis, Adult, Age Factors, Antineoplastic Combined Chemotherapy Protocols, Cytarabine, Cytogenetic Analysis, Daunorubicin, Disease-Free Survival, Female, Humans, Leukemia, Myeloid, Acute, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors
Show Abstract · Added March 5, 2014
Between 1991 and 1999, 67 patients with acute non-lymphocytic leukemia (ANLL) in complete remission received high dose cytarabine (HiDAC) 3 gm/m2 q12h x 12 doses followed by daunorubicin 45 mg/m2/day x 3 days as consolidation therapy. Five year actuarial event free survival (EFS) was 34% +/- 6%. Age was significantly associated with EFS. EFS was 60% +/- 15% in patients age 20 to 29, 48% +/- 16% in patients age 30 to 39, 23% +/- 10% in patients age 40 to 49, 31% +/- 11% in patients age 50 to 59, and 0% in patients age > or = 60. Contrary to other reports which have used different HiDAC regimens, we found no relationship between cytogenetics and EFS. Cytogenetics were defined as favorable risk: t(8;21), inv (16), and del (16); neutral risk: normal or t(15;17); and unfavorable risk: any abnormality not included in favorable risk or neutral risk. EFS was 29% +/- 17% in patients with favorable cytogenetics, 37% +/- 14% in patients with neutral cytogenetics, and 31% +/- 12% in patients with unfavorable cytogenetics. These differences were not statistically significant. Because of the successful use of allogeneic transplantation at relapse in patients with matched related donors, five year actuarial survival (S) in this series was 40% +/- 6%. Five year actuarial survival was 57% +/- 9% for patients age < or = 44 and 25% +/- 8% for patients age > or = 45. This difference is statistically significant, p < .025. Clinicians should be cautious about making clinical decisions regarding consolidation therapy of ANLL on the basis of the presence or absence of cytogenetic abnormalities as the importance of cytogenetics may depend on the specific therapy which is employed.
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16 MeSH Terms
Intensified preparative regimens and allogeneic transplantation in refractory or relapsed intermediate and high grade non-Hodgkin's lymphoma.
Stein RS, Greer JP, Goodman S, Brandt SJ, Morgan D, Macon WR, McCurley TL, Wolff SN
(2001) Leuk Lymphoma 41: 343-52
MeSH Terms: Actuarial Analysis, Adolescent, Adult, Child, Disease-Free Survival, Female, Hematopoietic Stem Cell Transplantation, Humans, Lymphoma, Non-Hodgkin, Male, Middle Aged, Recurrence, Retrospective Studies, Survival Rate, Transplantation Conditioning, Transplantation, Homologous, Treatment Outcome
Show Abstract · Added March 5, 2014
Between September 1986 and June 1998, 32 patients with relapsed or refractory intermediate or high grade lymphoma received intensified preparative therapy and underwent allogeneic transplantation at a single institution. Patients were considered for allogeneic transplantation if they failed to respond to initial therapy, failed to respond to salvage therapy, relapsed after autologous transplantation, had bone marrow involvement, or failed attempts to harvest autologous stem cells. Patients had a median age of 39 years and had generally received at least two chemotherapy regimens. Five year actuarial survival (S) was 16% +/- 6%; median survival was 4 months. Survival was significantly worse in patients who had received high intensity brief duration chemotherapy prior to transplantation and was also significantly worse in patients who did not receive total body irradiation (TBI). This likely reflects the fact that the patients with the most resistant disease had required local radiotherapy and could not receive TBI. While treatment related mortality played a major role in limiting the effectiveness of allogeneic transplantation, in this heavily pre-treated population of patients with resistant disease, only 39% of patients achieved a complete response following allogeneic transplantation, and in only 40% of that group was long term disease free survival achieved.
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17 MeSH Terms
Renal cell carcinoma metastatic to the lung: potential benefit in the combination of biological therapy and surgery.
Tanguay S, Swanson DA, Putnam JB
(1996) J Urol 156: 1586-9
MeSH Terms: Actuarial Analysis, Adult, Aged, Carcinoma, Renal Cell, Combined Modality Therapy, Female, Humans, Kidney Neoplasms, Lung Neoplasms, Male, Middle Aged, Neoplasm Recurrence, Local, Survival Rate
Show Abstract · Added March 27, 2014
PURPOSE - We evaluated outcomes in cases of renal cell carcinoma metastatic to the lung treated with surgery or biological therapy followed by surgery.
MATERIALS AND METHODS - We retrospectively evaluated 22 patients treated with surgical resection and 29 treated with biological therapy followed by surgery.
RESULTS - At the time of this study 31 patients (61%) were alive, including 15 with no residual disease and 16 with disease. Of the 22 patients treated with surgery without initial biological therapy 12 (55%) were alive at a median followup of 57 months (range 17 to 148) and 19 of the 29 (66%) treated with combination therapy were alive at a median followup of 48 months (range 19 to 78). A total of 19 patients (37%) died of progressive disease.
CONCLUSIONS - Our results suggest a role for an aggressive surgical approach in select patients with metastatic renal cell carcinoma, and demonstrate that patients who do not achieve a complete response to biological therapy may benefit from surgical resection of residual disease.
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13 MeSH Terms
Successful transplantation of HLA-matched and HLA-mismatched umbilical cord blood from unrelated donors: analysis of engraftment and acute graft-versus-host disease.
Wagner JE, Rosenthal J, Sweetman R, Shu XO, Davies SM, Ramsay NK, McGlave PB, Sender L, Cairo MS
(1996) Blood 88: 795-802
MeSH Terms: Actuarial Analysis, Acute Disease, Adolescent, Adult, Anemia, Aplastic, Blood Donors, Blood Preservation, Child, Child, Preschool, Cryopreservation, Female, Fetal Blood, Genetic Diseases, Inborn, Graft Survival, Graft vs Host Disease, HLA Antigens, Hematopoietic Stem Cell Transplantation, Histocompatibility, Humans, Infant, Infant, Newborn, Leukemia, Male, Severity of Illness Index, Treatment Outcome
Show Abstract · Added December 10, 2013
To reduce the morbidity and mortality associated with unrelated donor bone marrow (BM) transplantation and potentially extend the pool of suitable donors, cryopreserved unrelated donor umbilical cord blood was considered as an alternate source of hematopoietic stem cells for transplantation. Patients with leukemia, BM failure syndrome, or inborn error of metabolism were eligible for a phase I clinical trial designed to estimate the risk of graft failure and severe acute graft-versus-host disease after transplantation of umbilical cord blood from unrelated donors. As of December 21, 1995, unrelated donor umbilical cord blood was used to reconstitute hematopoiesis in eighteen patients aged 0.1 to 21.3 years weighing 3.3 to 78.8 kg with acquired or congenital lympho-hematopoietic disorders or metabolic disease. Patients received either HLA-matched (n = 7) or HLA-1 to 3 antigen disparate (n = 11) grafts collected and evaluated by the New York Blood Center (New York, NY). The probability of engraftment after unrelated donor umbilical cord blood transplantation was 100% with no patient having late graft failure to date. The probability of grade III-IV acute graft-versus-host disease at 100 days was 11%. With a median follow-up of 6 months (range, 1.6 to 17 months); the probability of survival at 6 months is 65% in this high risk patient population. We conclude that cryopreserved umbilical cord blood from HLA-matched and mismatched unrelated donors is a sufficient source of transplantable hematopoietic stem cells with high probability of donor derived engraftment and low risk of refractory severe acute graft-versus-host disease. Limitations with regard to recipient size and degree of donor HLA disparity remain to be determined.
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25 MeSH Terms
Outcomes analysis for 50 liver transplant recipients: the Vanderbilt experience.
Payne JL, McCarty KR, Drougas JG, Chapman WC, Wright JK, Pinson NY, Beliles KE, Newsom VL, Hunter EB, Raiford DS, Awad JA, Burk RF, Donovan KL, Van Buren DH, Pinson CW
(1996) Am Surg 62: 320-5
MeSH Terms: Activities of Daily Living, Actuarial Analysis, Adolescent, Adult, Fees and Charges, Female, Follow-Up Studies, Humans, Length of Stay, Liver Transplantation, Male, Middle Aged, Quality of Life, Reoperation, Survival Analysis, Treatment Outcome
Show Abstract · Added March 5, 2014
Healthcare reform has mandated scrutiny of the fiscal aspects of patient care as well as medical outcomes. Therefore, we reviewed our experience with 50 liver transplant recipients from a multidisciplinary collaborative transplant team. From February 1991 to July 1994, of 175 patients referred, 75 were formally evaluated for transplantation; 56 (76%) of these patients were accepted for transplantation; 50 patients underwent 53 transplants. Operative mortality of 6 per cent, retransplantation rate of 6 per cent, 6-month actuarial survival of 88 per cent, 1-year survival of 86 per cent, and the 2 and 3-year survival of 83 per cent were unchanged over time. Quality of life evaluated by the Karnofsky Performance Status was a mean of 55 pretransplant, 72 at 3 months, 79 at 6 months, 84 at 1 year, 88 at 2 years, and 95 at 3 years, demonstrating improved general health and functional rehabilitation after transplantation. Psychosocial Adjustment to Illness Scale scores demonstrated significant improvement following transplantation, improving most dramatically in the vocation environment, domestic environment, and sexual relationship domains. Postoperative length of stay has declined with an average of 28 days in 1991, 22 days in 1992, 19 days in 1993, and 14 days in 1994. Average total hospital, organ procurement, and physician charges for the transplantation hospitalization was $165,000. Average 91-92 hospital charges were $154,000 and were reduced in 93-95 to $103,000 (P < .05). We found that charges and length of stay decreased over time, while the outcome and quality of patient care was maintained. We believe the collaborative practice, case management, and revised patient care protocols are responsible.
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16 MeSH Terms
Resection of sternal tumors: extent, reconstruction, and survival.
Soysal O, Walsh GL, Nesbitt JC, McMurtrey MJ, Roth JA, Putnam JB
(1995) Ann Thorac Surg 60: 1353-8; discussion 1358-9
MeSH Terms: Actuarial Analysis, Adult, Aged, Bone Neoplasms, Female, Humans, Length of Stay, Male, Middle Aged, Neoplasm Recurrence, Local, Postoperative Complications, Prostheses and Implants, Retrospective Studies, Sternum, Surgical Flaps, Survival Analysis, Treatment Outcome
Show Abstract · Added March 5, 2014
BACKGROUND - Resection of sternal tumors may be tailored to the patient and the location of the malignancy.
METHODS - We reviewed our results of sternectomy (typically 5-cm margins) performed in 30 patients over a 10-year period.
RESULTS - Thirteen patients had primary sternal sarcoma (six chondrosarcoma, five osteosarcoma, two other); 10 patients had local recurrence from breast cancer; 4 patients had metastases; 3 patients had other (two osteoradionecrosis, one malignant fibrous histiocytoma). Morbidity occurred in 8 patients (26.7%): wound dehiscence, 2; wound infection, 1; hemorrhage, 1; pneumonia, 1; prolonged air leak, 1; empyema, 1; and bronchopleural fistula, 1. One patient, with multiple metastases, died from adult respiratory distress syndrome on day 25 (overall mortality, 3.3%; 1 of 30). The area of reconstruction ranged from 35 to 264 cm2. The technique of reconstruction included muscle flap alone in 13 patients; muscle flap and mesh, 9; muscle flap and rigid prosthesis (Marlex methylmethacrylate), 7; or other, 1 patient. Nineteen patients (63%) were extubated within 24 hours after operation. Median intensive care unit stay was 2 days; median hospitalization, 6 days. Late local recurrence after resection occurred in 6 patients; 4 from breast cancer (3 patients had concurrent distant metastases). Five-year actuarial survival after primary tumor resection was 73% and 33% after resection of recurrent breast cancer (median, 21 months).
CONCLUSIONS - Partial sternectomy may be performed for primary sternal tumors with short hospitalization and good local control. Wider local excision or total sternectomy may minimize local re-recurrence of breast carcinoma to the sternum.
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17 MeSH Terms
Extended resection of pulmonary metastases: is the risk justified?
Putnam JB, Suell DM, Natarajan G, Roth JA
(1993) Ann Thorac Surg 55: 1440-6
MeSH Terms: Actuarial Analysis, Female, Follow-Up Studies, Humans, Lung Neoplasms, Male, Middle Aged, Pneumonectomy, Risk Factors, Survival Analysis, Survival Rate, Thoracotomy, Time Factors
Show Abstract · Added March 27, 2014
Extended resection of pulmonary metastases by pneumonectomy or by pulmonary resection en bloc with chest wall or other thoracic structures (diaphragm, pericardium, superior vena cava) is infrequently performed as survival benefit is presumed low. Between 1981 and 1992, 38 patients underwent extended resection for pulmonary metastases (24 men, 14 women; average age, 48 years) from various primary neoplasms. Thirty-three patients (33/38, 87%) had complete resection. Five-year actuarial survival was 25.4%. Mortality was 5.3% (2/38) and occurred in patients undergoing pneumonectomy (2/19, 10.5%). Nineteen patients underwent pneumonectomy, and 19 patients had other assorted resections: pulmonary resection en bloc with chest wall in 11 and pulmonary resection en bloc with other thoracic structures in 8. Actuarial median survival (median, 27 months) did not differ between patients having pneumonectomy and those having pulmonary resection en bloc with chest wall or other thoracic structures. Initial disease-free interval (median) was no different between those patients undergoing pneumonectomy (32 months) or other type resection (35 months; p = 0.16). Median survival for extended resection as the initial operation for pulmonary metastases was 28 months compared with 14 months for all others (p = 0.095). Pneumonectomy for pulmonary metastases may be performed with operative risk equivalent to pneumonectomy for primary bronchogenic carcinoma. Patients may safely undergo extended resection of pulmonary metastases by pneumonectomy or in continuity with chest wall or other thoracic structures. Despite advanced localized metastatic disease, some patients achieve long-term survival after pneumonectomy and extended resection for pulmonary metastases.
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C-erbB-2 expression and codon 12 K-ras mutations both predict shortened survival for patients with pulmonary adenocarcinomas.
Kern JA, Slebos RJ, Top B, Rodenhuis S, Lager D, Robinson RA, Weiner D, Schwartz DA
(1994) J Clin Invest 93: 516-20
MeSH Terms: Actuarial Analysis, Adenocarcinoma, Age Factors, Base Sequence, Biomarkers, Tumor, DNA Primers, DNA, Neoplasm, ErbB Receptors, Female, Genes, ras, Humans, Lung Neoplasms, Male, Molecular Sequence Data, Multivariate Analysis, Neoplasm Staging, Point Mutation, Polymerase Chain Reaction, Prognosis, Proportional Hazards Models, Proto-Oncogene Proteins, Proto-Oncogenes, Receptor, ErbB-2, Risk Factors, Survival Analysis, Time Factors
Show Abstract · Added March 5, 2014
We evaluated the prognostic significance of p185c-erbB-2 expression and ras gene mutations in all patients diagnosed with a pulmonary adenocarcinoma between 1982 and 1985 at the University of Iowa. p185c-erbB-2 expression was detected in 15 cases (34%). A ras gene mutation was found in 16 cases (36%) and all were in codon-12 of K-ras. No N-ras mutations were identified. Both p185c-erbB-2 expression and a K-ras mutation were found only in codon-12 and present in six cases (14%). By univariate analysis p185c-erbB-2 expression was associated with shortened survival (P = 0.02) while the presence of a K-ras mutation was not (P = 0.16). Multivariate analysis by the Cox proportional hazards model, controlling for patient age and tumor stage, also continued to identify p185c-erbB-2 expression as an independent unfavorable prognostic factor (P = 0.01). In this model a K-ras mutation also approached significance as a poor prognostic indicator (P = 0.06). The impact of both p185c-erbB-2 expression and a K-ras mutation on survival was additive and highly significant (P = 0.004). This additive nature suggests that together these two markers identify a high-risk population of lung adenocarcinoma patients that may benefit from aggressive therapy.
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26 MeSH Terms
Assessment of the use of the age- and sex-specific United States population as a control group for analysis of survival in coronary artery disease.
Califf RM, Lee KL, Harrell FE, Kimm SY, Grufferman S, Rosati RA
(1982) Am J Cardiol 50: 1279-82
MeSH Terms: Actuarial Analysis, Age Factors, Coronary Disease, Female, Humans, Male, Mortality, Myocardial Contraction, Outcome and Process Assessment, Health Care, Sex Factors, United States
Show Abstract · Added February 28, 2014
The use of the age- and sex-specific U.S. population as a control group for analysis of survival in coronary artery disease was assessed. Population-based survival rates were calculated for nonsurgically treated patients evaluated for coronary artery disease at Duke University Medical Center. Survival of the overall group of medically treated patients with significant coronary artery disease was lower than the corresponding age- and sex-specific U.S. population rates. However, survival of patients with significant disease who had normal left ventricular contraction and stable chest pain was similar to the age- and sex-specific population survival rates. Both the observed survival and the population-based survival estimates for patients with normal left ventricular contraction and stable pain were lower than the survival of patients with normal coronary arteriograms. Even after deaths from ischemic heart disease are eliminated from the population rates, survival of patients with normal coronary arteries exceeded the age-and sex-specific population survival. Because of biases inherent in the selection of patients for cardiac catheterization and the presence of other serious diseases in persons in the general population is not an adequate control group for rigorous analysis of the effect of therapy in coronary artery disease.
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11 MeSH Terms
Survival following aggressive resection of pulmonary metastases from osteogenic sarcoma: analysis of prognostic factors.
Putnam JB, Roth JA, Wesley MN, Johnston MR, Rosenberg SA
(1983) Ann Thorac Surg 36: 516-23
MeSH Terms: Actuarial Analysis, Adolescent, Adult, Age Factors, Child, Female, Humans, Lung Neoplasms, Male, Middle Aged, Osteosarcoma, Postoperative Period, Prognosis, Prospective Studies, Sex Factors, Time Factors
Show Abstract · Added March 27, 2014
Between 1975 and 1982, 80 patients with osteogenic sarcoma were entered into prospective trials in the Surgery Branch of the National Cancer Institute. In 43 of these patients, pulmonary metastases developed as the initial site of recurrence, and 39 underwent one or more thoracotomies for resection of the disease. The actuarial five-year survival for the group of 43 patients with pulmonary metastases was 40%. Various prognostic factors were analyzed for their influence on survival after thoracotomy. Age, sex, location of primary tumor, tumor doubling time, and involvement of one or both lungs (bilaterality) were not significant in predicting survival. Prognostic factors that influenced survival, calculated by regression analysis, included the number of nodules on preoperative lung tomograms (negative correlation, p = 0.0004), disease-free interval (positive correlation, p = 0.0136), resectability (positive correlation, p = 0.002), and the number of metastases resected at thoracotomy (negative correlation, p = 0.0032). The presence of 3 nodules or less on preoperative full-lung linear tomography was found to be the single most useful preoperative prognostic factor. The application of these prognostic factors preoperatively may identify patients who will benefit optimally from thoracotomy.
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16 MeSH Terms