Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been... more Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been dramatic over the last few decades. Traditionally, clinical risk factors such as age and performance status have been the main prognostic factors in AML. However, recent advances in cytogenetic studies and molecular markers in AML have revolutionized our approach to this disease. These have changed our understanding of AML as a heterogeneous group of diseases rather than a single disease, provided greater insight not only in understanding disease biology but also into predicting response to therapy and helped in the development of risk stratification-based treatment approach. In 2010, there are about 12,330 new cases in the United States which represent about 0.8% and 29% of all new cancer and leukemia cases respectively. With about 8,950 estimated deaths related to AML, this represents about 1.6% of cancer related deaths in 2010. (American Cancer Society, 2010) Although there has been some improvement in survival for AML patients over the last few decades, mainly in younger age groups as shown in figure 1, AML long term survival is still a big challenge. In the United States, data from Surveillance Epidemiology and End Results (SEER) dataset for 2001 to 2007 showed 5-year overall survival (OS) of 22.6% for all AML patients. There is still a lot to be done especially in the oldest age group (>65 years), that is showing a dismal 5-year OS of less than 5%, See Figure 2. This is of particular concern as more than half of the patients diagnosed in 2000-2004 were over 65 years old. (Howlader et al., 2011). 2. Clinical prognostic factors 2.1 Age AML is seen more commonly in the elderly with median age at diagnosis of 66 with incidence increases dramatically after age of 55, See figure 3. Data from SEER (see figure 2) as well as from major studies of the largest cooperative groups including the Medical Research Council (MRC), the Southwest Oncology Group/Eastern Cooperative Oncology Group (SWOG/ECOG), AML cooperative group (AMLCG) and the Cancer and Leukemia Group B (CALGB) that included elderly patients have shown consistently worse outcome in this patient population, See figure 4.
4642 Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease in which early diagn... more 4642 Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease in which early diagnosis and management has a major impact on outcome. TTP has been historically linked to a pentad of clinical features (mental status changes, fever, acute renal failure, anemia and thrombocytopenia). The frequency of the classical pentand in the pre plasma exchange era has been reported to be as high as 40 percent. With the introduction of plasma exchange and increased awareness of this disease a different pattern of clinical presentation of TTP might be forming based on early diagnosis. We reviewed the clinical presentation of 91 patients with a diagnosis of TTP in terms of pattern and duration of symptoms. Only 9% of patients (n=8) presented with the pentad. Duration of symptoms in all patients ranged between 1 and 60 days, with a mean of 9.3 days. Statistical analysis showed no correlation between the duration of symptoms prior to diagnosis and the presence of the pentand (mean of symp...
4653 Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease that has... more 4653 Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease that has been reported more frequently in African-Americans (AA). While recent reports have showed an increased incidence of TTP amongs AA patients, there is no data with regards to the patterns of clinical presentation in this racial subgroup and if there is any difference as compared to other racial subgroups. Patients and methods: In this retrospective study we reviewed characterstics and clinical presentation of 91 patients with the diagnosis of TTP. Sixty four patients were AAs (70%). The second largest racial subgroup was Caucasians (24 patients, 26%). Demographics, lab values and symptoms were compared between AAs and Caucasians. Continuous variables were compared using two-sided two-sample t-tests. Alternatively, the Wilcoxon rank-sum test was used if the data were not normally distributed. Categorical variables were compared using Chi-square tests. Results: AA patients were older [media...
5081 Background: Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease that has been d... more 5081 Background: Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease that has been divided into three different prognostic subgroups: Germinal Center B cell-like (GC), Activated B cell-like (ABC) and type 3 according to gene expression profile using cDNA. Immunohistochemistry (IHC) has been used as surrogate to identify these cell-of-origin subgroups. Data about the prognostic value of IHC has been conflicting. Patients and methods: In this retrospective study, we reviewed the charts of 252 patients diagnosed with DLBCL at Henry Ford Hospital from 1999 to 2012. We excluded patients with HIV, transformed lymphomas and unavailable samples. Data was collected on a total of 157 patients. The following data was gathered: age, sex, race, IPI score, disease stage, hemoglobin, white blood and platelet counts, best response achieved and dates of treatment start, relapse, death or last follow up. Tissue microarray slides with the following IHC stains (CD10, MUM1, Bcl6) were prepa...
Myeloid Leukemia - Clinical Diagnosis and Treatment, 2012
Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been... more Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been dramatic over the last few decades. Traditionally, clinical risk factors such as age and performance status have been the main prognostic factors in AML. However, recent advances in cytogenetic studies and molecular markers in AML have revolutionized our approach to this disease. These have changed our understanding of AML as a heterogeneous group of diseases rather than a single disease, provided greater insight not only in understanding disease biology but also into predicting response to therapy and helped in the development of risk stratification-based treatment approach. In 2010, there are about 12,330 new cases in the United States which represent about 0.8% and 29% of all new cancer and leukemia cases respectively. With about 8,950 estimated deaths related to AML, this represents about 1.6% of cancer related deaths in 2010. (American Cancer Society, 2010) Although there has been some improvement in survival for AML patients over the last few decades, mainly in younger age groups as shown in figure 1, AML long term survival is still a big challenge. In the United States, data from Surveillance Epidemiology and End Results (SEER) dataset for 2001 to 2007 showed 5-year overall survival (OS) of 22.6% for all AML patients. There is still a lot to be done especially in the oldest age group (>65 years), that is showing a dismal 5-year OS of less than 5%, See Figure 2. This is of particular concern as more than half of the patients diagnosed in 2000-2004 were over 65 years old. (Howlader et al., 2011). 2. Clinical prognostic factors 2.1 Age AML is seen more commonly in the elderly with median age at diagnosis of 66 with incidence increases dramatically after age of 55, See figure 3. Data from SEER (see figure 2) as well as from major studies of the largest cooperative groups including the Medical Research Council (MRC), the Southwest Oncology Group/Eastern Cooperative Oncology Group (SWOG/ECOG), AML cooperative group (AMLCG) and the Cancer and Leukemia Group B (CALGB) that included elderly patients have shown consistently worse outcome in this patient population, See figure 4.
Background. Abnormal stress myocardial perfusion imaging studies (SMPI) with angiographically ins... more Background. Abnormal stress myocardial perfusion imaging studies (SMPI) with angiographically insignificant coronary artery disease (ICAD) have often been labeled "false positive" scans. We evaluated the prognostic predictors and outcomes in an unselected patient population having abnormal SMPI and ICAD (study group) over a 24 month period of follow-up. Methods. Retrospective study of consecutive patients who had SMPI and subsequent coronary angiography showing ICAD within 6 months of index scan with matched control group with normal scans. Major Adverse Cardiac Events (MACE) were defined as the first occurrence of death or myocardial infarction (MI). Patients were followed up to 24 months from the time of their SMPI to identify the development of MACE. Results. One hundred and twenty five patients formed the study group and one hundred and thirty six patients formed the control group. Over a two-year follow up, approximately 13% of the study group had MACE as compared to 4.2% in the control group (P ؍ .022). Abnormal SMPI, EF < 40% and chronic kidney disease (GFR < 60 ml/min) were independent predictors of MACE in the study group. In multivariate analysis for MACE prediction, chronic kidney disease remained the sole independent predictor regardless of size or severity of perfusion abnormalities (P ؍ <.001). Conclusion. Patients with abnormal SMPI and ICAD have a 13% event rate of MACE over a two-year follow up. CKD seems a very important marker of a higher risk subgroup amongst such patients.
Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is defined as the presenc... more Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is defined as the presence of a serum monoclonal protein <3g/dl, with fewer than 10% plasma cells in bone marrow and absence of lytic bone lesions, anemia, hypercalcemia and renal insufficiency. Incidence increases with age, especially over 70 and its progression to malignant disease occurs at 1% per year. However, so far there are no studies which can reliably distinguish patients who would progress from those who would remain stable. Based on available literature, it is concluded that MGUS has low risk of progression when M-protein is less than 1.5 g/dl, with no reduction in polyclonal immunoglobulins and bone marrow plasma cells less than 5%. The recommended testing with suspected MGUS is hemoglobin concentration, protein studies, serum calcium, and creatinine. Metastatic bone survey (MBS) and bone marrow aspiration are felt unnecessary if M-protein is less than 1.5 g/dl. However literature to support the ...
Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been... more Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been dramatic over the last few decades. Traditionally, clinical risk factors such as age and performance status have been the main prognostic factors in AML. However, recent advances in cytogenetic studies and molecular markers in AML have revolutionized our approach to this disease. These have changed our understanding of AML as a heterogeneous group of diseases rather than a single disease, provided greater insight not only in understanding disease biology but also into predicting response to therapy and helped in the development of risk stratification-based treatment approach. In 2010, there are about 12,330 new cases in the United States which represent about 0.8% and 29% of all new cancer and leukemia cases respectively. With about 8,950 estimated deaths related to AML, this represents about 1.6% of cancer related deaths in 2010. (American Cancer Society, 2010) Although there has been some improvement in survival for AML patients over the last few decades, mainly in younger age groups as shown in figure 1, AML long term survival is still a big challenge. In the United States, data from Surveillance Epidemiology and End Results (SEER) dataset for 2001 to 2007 showed 5-year overall survival (OS) of 22.6% for all AML patients. There is still a lot to be done especially in the oldest age group (>65 years), that is showing a dismal 5-year OS of less than 5%, See Figure 2. This is of particular concern as more than half of the patients diagnosed in 2000-2004 were over 65 years old. (Howlader et al., 2011). 2. Clinical prognostic factors 2.1 Age AML is seen more commonly in the elderly with median age at diagnosis of 66 with incidence increases dramatically after age of 55, See figure 3. Data from SEER (see figure 2) as well as from major studies of the largest cooperative groups including the Medical Research Council (MRC), the Southwest Oncology Group/Eastern Cooperative Oncology Group (SWOG/ECOG), AML cooperative group (AMLCG) and the Cancer and Leukemia Group B (CALGB) that included elderly patients have shown consistently worse outcome in this patient population, See figure 4.
4642 Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease in which early diagn... more 4642 Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease in which early diagnosis and management has a major impact on outcome. TTP has been historically linked to a pentad of clinical features (mental status changes, fever, acute renal failure, anemia and thrombocytopenia). The frequency of the classical pentand in the pre plasma exchange era has been reported to be as high as 40 percent. With the introduction of plasma exchange and increased awareness of this disease a different pattern of clinical presentation of TTP might be forming based on early diagnosis. We reviewed the clinical presentation of 91 patients with a diagnosis of TTP in terms of pattern and duration of symptoms. Only 9% of patients (n=8) presented with the pentad. Duration of symptoms in all patients ranged between 1 and 60 days, with a mean of 9.3 days. Statistical analysis showed no correlation between the duration of symptoms prior to diagnosis and the presence of the pentand (mean of symp...
4653 Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease that has... more 4653 Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease that has been reported more frequently in African-Americans (AA). While recent reports have showed an increased incidence of TTP amongs AA patients, there is no data with regards to the patterns of clinical presentation in this racial subgroup and if there is any difference as compared to other racial subgroups. Patients and methods: In this retrospective study we reviewed characterstics and clinical presentation of 91 patients with the diagnosis of TTP. Sixty four patients were AAs (70%). The second largest racial subgroup was Caucasians (24 patients, 26%). Demographics, lab values and symptoms were compared between AAs and Caucasians. Continuous variables were compared using two-sided two-sample t-tests. Alternatively, the Wilcoxon rank-sum test was used if the data were not normally distributed. Categorical variables were compared using Chi-square tests. Results: AA patients were older [media...
5081 Background: Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease that has been d... more 5081 Background: Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease that has been divided into three different prognostic subgroups: Germinal Center B cell-like (GC), Activated B cell-like (ABC) and type 3 according to gene expression profile using cDNA. Immunohistochemistry (IHC) has been used as surrogate to identify these cell-of-origin subgroups. Data about the prognostic value of IHC has been conflicting. Patients and methods: In this retrospective study, we reviewed the charts of 252 patients diagnosed with DLBCL at Henry Ford Hospital from 1999 to 2012. We excluded patients with HIV, transformed lymphomas and unavailable samples. Data was collected on a total of 157 patients. The following data was gathered: age, sex, race, IPI score, disease stage, hemoglobin, white blood and platelet counts, best response achieved and dates of treatment start, relapse, death or last follow up. Tissue microarray slides with the following IHC stains (CD10, MUM1, Bcl6) were prepa...
Myeloid Leukemia - Clinical Diagnosis and Treatment, 2012
Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been... more Progress in understanding the prognosis and survival in acute myelogenous leukemia (AML) has been dramatic over the last few decades. Traditionally, clinical risk factors such as age and performance status have been the main prognostic factors in AML. However, recent advances in cytogenetic studies and molecular markers in AML have revolutionized our approach to this disease. These have changed our understanding of AML as a heterogeneous group of diseases rather than a single disease, provided greater insight not only in understanding disease biology but also into predicting response to therapy and helped in the development of risk stratification-based treatment approach. In 2010, there are about 12,330 new cases in the United States which represent about 0.8% and 29% of all new cancer and leukemia cases respectively. With about 8,950 estimated deaths related to AML, this represents about 1.6% of cancer related deaths in 2010. (American Cancer Society, 2010) Although there has been some improvement in survival for AML patients over the last few decades, mainly in younger age groups as shown in figure 1, AML long term survival is still a big challenge. In the United States, data from Surveillance Epidemiology and End Results (SEER) dataset for 2001 to 2007 showed 5-year overall survival (OS) of 22.6% for all AML patients. There is still a lot to be done especially in the oldest age group (>65 years), that is showing a dismal 5-year OS of less than 5%, See Figure 2. This is of particular concern as more than half of the patients diagnosed in 2000-2004 were over 65 years old. (Howlader et al., 2011). 2. Clinical prognostic factors 2.1 Age AML is seen more commonly in the elderly with median age at diagnosis of 66 with incidence increases dramatically after age of 55, See figure 3. Data from SEER (see figure 2) as well as from major studies of the largest cooperative groups including the Medical Research Council (MRC), the Southwest Oncology Group/Eastern Cooperative Oncology Group (SWOG/ECOG), AML cooperative group (AMLCG) and the Cancer and Leukemia Group B (CALGB) that included elderly patients have shown consistently worse outcome in this patient population, See figure 4.
Background. Abnormal stress myocardial perfusion imaging studies (SMPI) with angiographically ins... more Background. Abnormal stress myocardial perfusion imaging studies (SMPI) with angiographically insignificant coronary artery disease (ICAD) have often been labeled "false positive" scans. We evaluated the prognostic predictors and outcomes in an unselected patient population having abnormal SMPI and ICAD (study group) over a 24 month period of follow-up. Methods. Retrospective study of consecutive patients who had SMPI and subsequent coronary angiography showing ICAD within 6 months of index scan with matched control group with normal scans. Major Adverse Cardiac Events (MACE) were defined as the first occurrence of death or myocardial infarction (MI). Patients were followed up to 24 months from the time of their SMPI to identify the development of MACE. Results. One hundred and twenty five patients formed the study group and one hundred and thirty six patients formed the control group. Over a two-year follow up, approximately 13% of the study group had MACE as compared to 4.2% in the control group (P ؍ .022). Abnormal SMPI, EF < 40% and chronic kidney disease (GFR < 60 ml/min) were independent predictors of MACE in the study group. In multivariate analysis for MACE prediction, chronic kidney disease remained the sole independent predictor regardless of size or severity of perfusion abnormalities (P ؍ <.001). Conclusion. Patients with abnormal SMPI and ICAD have a 13% event rate of MACE over a two-year follow up. CKD seems a very important marker of a higher risk subgroup amongst such patients.
Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is defined as the presenc... more Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is defined as the presence of a serum monoclonal protein <3g/dl, with fewer than 10% plasma cells in bone marrow and absence of lytic bone lesions, anemia, hypercalcemia and renal insufficiency. Incidence increases with age, especially over 70 and its progression to malignant disease occurs at 1% per year. However, so far there are no studies which can reliably distinguish patients who would progress from those who would remain stable. Based on available literature, it is concluded that MGUS has low risk of progression when M-protein is less than 1.5 g/dl, with no reduction in polyclonal immunoglobulins and bone marrow plasma cells less than 5%. The recommended testing with suspected MGUS is hemoglobin concentration, protein studies, serum calcium, and creatinine. Metastatic bone survey (MBS) and bone marrow aspiration are felt unnecessary if M-protein is less than 1.5 g/dl. However literature to support the ...
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