scholarly journals Preoperative Thrombocytopenia May Predict Poor Surgical Outcome after Extended Hepatectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Mohammad Golriz ◽  
Omid Ghamarnejad ◽  
Elias Khajeh ◽  
Mohammadsadegh Sabagh ◽  
Markus Mieth ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Platelet Count ◽  
Independent Predictor ◽  
Postoperative Outcome ◽  
High Morbidity ◽  
Extended Hepatectomy ◽  
Platelet Counts ◽  
Extended Liver Resection ◽  
Predictive Role ◽  
The Impact

Background. It is a novel idea that platelet counts may be associated with postoperative outcome following liver surgery. This may help in planning an extended hepatectomy (EH), which is a surgical procedure with high morbidity and mortality. Aim. The aim of this study was to evaluate the predictive potential of platelet counts on the outcome of EH in patients without portal hypertension, splenomegaly, or cirrhosis. Methods. A series of 213 consecutive patients underwent EH (resection of ≥ five liver segments) between 2001 and 2016. The association of preoperative platelet counts with posthepatectomy liver failure (PHLF), morbidity (based on Clavien-Dindo classification), and 30-day mortality was evaluated using multivariate analysis. Results. PHLF was detected in 26.3% of patients, major complications in 26.8%, and 30-day mortality in 11.3% of patients. Multivariate analysis revealed that the preoperative platelet count is an independent predictor of PHLF (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.3–15.0, p=0.020) and 30-day mortality (OR 4.4, 95% CI 1.1–18.8, p=0.043). Conclusions. Preoperative platelet count is associated with PHLF and mortality following extended liver resection. This association was independent of other related parameters. Prospective studies are needed to evaluate the predictive role and to determine the impact of preoperative correction of platelet count on postoperative outcomes after EH.

Abstract 4455: The Impact of Platelet Count Decline on Clinical Outcome of Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Axel de Labriolle ◽  
Laurent Bonello ◽  
Gilles Lemesle ◽  
Probal Roy ◽  
Daniel H Steinberg ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Platelet Count ◽  
Clinical Outcome ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Coronary Intervention ◽  
Careful Attention ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
The Impact

BACKGROUND: Severe decline in platelet count (DPC) ≥ 50% has been shown to be predictor of outcome after PCI. The prognosis of mild or moderate DPC is unknown. This study aimed to examine the impact of various degrees of DPC on clinical outcome. METHODS: The study included 10,146 consecutive patients who were subjected to PCI. The population was divided in four groups according to the magnitude of the decline in platelet post PCI: no DPC (DPC ≤ 10 %), minor DPC (10 –25 %), mild DPC (26 –50 %) and severe DPC (≥50%). The primary endpoint for this analysis was the composite criteria of death-MI at 30 days. RESULTS: Among the 10,146 patients, 36 % had a DPC ≤10 %, 47.7% had a DPC 10 –25%, 14% had a DPC 26 –50% and 2.3% had a DPC ≥50%. At 30 days, there was a worsening of clinical outcome with the severity of DPC (table 1 ). In univariate analysis, numerous variables were detected associated with the risk of death-MI at 30 days including both mild and severe DPC. After adjustment in multivariate analysis, DPC (25–50 %) and DPC (≥50%) were independently associated with the composite criteria death-MI at 30 days. All independent predictors in multivariate analysis are listed in table 2 . CONCLUSIONS: DPC after PCI is an independent predictor of death-MI at 30 days. The clinical significance of DPC is not limited to major DPC (≥50%) but also seen with moderate DPC (26 –50 %). Careful attention to platelet count is required in patients subjected to PCI who experienced more than 25% decline in their platelet count following the intervention. Relation between Decline in platelet count and Death - MI Independent predictors of death-MI at 30 days

scholarly journals Relative Frequency and Risk Factors of COVID-19 Related Headache in a Sample of Egyptian Population: A Hospital-Based Study

Pain Medicine ◽  
2021 ◽  
Author(s):  
Mona Hussein ◽  
Wael Fathy ◽  
Ragaey A Eid ◽  
Hoda M Abdel-Hamid ◽  
Ahmed Yehia ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Platelet Count ◽  
Relative Frequency ◽  
Clinical Laboratory ◽  
Primary Headache ◽  
Female Gender ◽  
Imaging Data ◽  
Laboratory Findings ◽  
Neutrophil Lymphocyte Ratio ◽  
The Impact

Abstract Objectives Headache is considered one of the most frequent neurological manifestations of coronavirus disease 2019 (COVID-19). This work aimed to identify the relative frequency of COVID-19-related headache and to clarify the impact of clinical, laboratory findings of COVID-19 infection on headache occurrence and its response to analgesics. Design Cross-sectional study. Setting Recovered COVID-19 patients. Subjects In total, 782 patients with a confirmed diagnosis of COVID-19 infection. Methods Clinical, laboratory, and imaging data were obtained from the hospital medical records. Regarding patients who developed COVID-19 related headache, a trained neurologist performed an analysis of headache and its response to analgesics. Results The relative frequency of COVID-19 related headache among our sample was 55.1% with 95% confidence interval (CI) (.516–.586) for the estimated population prevalence. Female gender, malignancy, primary headache, fever, dehydration, lower levels of hemoglobin and platelets and higher levels of neutrophil/lymphocyte ratio (NLR) and CRP were significantly associated with COVID-19 related headache. Multivariate analysis revealed that female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count were independent predictors of headache occurrence. By evaluating headache response to analgesics, old age, diabetes, hypertension, primary headache, severe COVID-19, steroid intake, higher CRP and ferritin and lower hemoglobin levels were associated with poor response to analgesics. Multivariate analysis revealed that primary headache, steroids intake, moderate and severe COVID-19 were independent predictors of non-response to analgesics. Discussion Headache occurs in 55.1% of patients with COVID-19. Female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count are considered independent predictors of COVID-19 related headache.

scholarly journals Platelet Decrease and Efficacy of Platelet-Rich Plasma Return for Peripheral Blood Stem Cell Apheresis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Takahiro Shima ◽  
Teppei Sakoda ◽  
Tomoko Henzan ◽  
Yuya Kunisaki ◽  
Takahiro Maeda ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Stem Cell ◽  
Platelet Count ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Platelet Rich Plasma ◽  
Blood Stem Cell ◽  
Platelet Recovery ◽  
Platelet Counts ◽  
Cd34 Cells

Peripheral blood stem cell (PBSC) transplantation is a key treatment option for hematological diseases and widely performed in clinical practice. Platelet loss is the major complication of PBSC apheresis, and platelet-rich plasma (PRP) return is recommended in case of severe platelet decrease following apheresis; however, little is known about the frequency and severity of platelet loss nor the efficacy of PRP return post-apheresis. To address these questions, we assessed changes in platelet counts following PBSC-related apheresis in 270 allogeneic (allo)- and 105 autologous (auto)-PBSC settings. We also evaluated efficacy of PRP transfusion on platelet recovery post-apheresis. Platelet counts reduced up to 70% post-apheresis in both allo- and auto-PBSC settings, while severe platelet count decrease (< 50 x 109/L) was only observed in auto-PBSC patients (Figure 1). We next analyzed the relationship between severe platelet (< 50 x 109/L) after apheresis and several clinical factors by using univariate and multivariate analysis for auto-PBSC patients. As shown in Table 1, in univariate analysis, severe platelet counts following auto-PBSC apheresis was found more frequently in patients with lower platelet count, lower percentage of CD34+ cells in PB at pre-apheresis, repeated round of apheresis, and smaller number of collected CD34+ cells. On the other hand, in multivariate analysis, the white blood cell (WBC) counts pre-apheresis was the only significant risk factor of severe platelet count following apheresis (p = 0.038). We finally analyzed the transitions of platelet counts in the setting of apheresis. The median platelet counts at pre-apheresis, post-apheresis, and post-PRP return were 187.0 x 109/L, 132.0 x 109/L, and 154.0 x 109/L for allo-PBSC apheresis, and 147.0 x 109/L, 111.0 x 109/L, and 127.0 x 109/L for auto-PBSC apheresis (p < 0.0001 for all, allo-PBSC donors and auto-PBSC patients, respectively) (Figure 2), indicating that PRP return post-apheresis facilitated a rapid platelet recovery in both allo- and auto-settings. Collectively, our data suggest that WBC counts pre-apheresis is a useful predictor for severe platelet decrease following auto-PBSC apheresis and that PRP return is an effective mean to facilitate platelet recovery post-apheresis. Disclosures No relevant conflicts of interest to declare.

Thrombocytopenia Is a Strong Adverse Feature in Transplant-Eligible Patients with Myelofibrosis: Utility for an Improved CBC-Based Scoring System.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2584-2584
Author(s):  
David Dingli ◽  
Susan M. Schwager ◽  
Ruben A. Mesa ◽  
Chin-Yang Li ◽  
Ayalew Tefferi
Keyword(s):  
Multivariate Analysis ◽  
Platelet Count ◽  
High Risk ◽  
Scoring System ◽  
High Risk Patient ◽  
Risk Patient ◽  
Poor Survival ◽  
Hematopoietic Stem ◽  
Myeloid Metaplasia ◽  
The Impact

Abstract Background: Allogeneic hematopoietic stem cell transplantation is potentially curative in agnogenic myeloid metaplasia (AMM) but is associated with substantial mortality and morbidity that necessitates accurate identification of patients in whom benefit outweighs risk. The current single institutional study investigates prognostic variables in transplant-eligible patients with AMM with the main objective of improved discrimination between intermediate- and high-risk patient categories. Methods: Patients diagnosed with AMM before the age of 60 years and seen at Mayo Clinic were identified and the diagnosis confirmed. Relevant demographic, clinical and laboratory characteristics were abstracted and the impact of various parameters on overall survival was evaluated with univariate and multivariate analysis. Results: A cohort of 159 patients (median age 52 years, range 18–60; 89 males) with AMM is described. Median follow-up from initial diagnosis was 63 months (range 0–300). During this period, 102 patients have died; overall median survival 79 months. Multivariate analysis of parameters measured in all study patients at diagnosis identified thrombocytopenia (platelet count < 100 x 109/L) as the strongest predictor of inferior survival (p=0.002). In addition, a hemoglobin level of <10 g/dL (p=0.003), white blood cell count of either <4 or >30 x 109/L (p=0.03), and older age (p=0.02) were also found to be independent indicators of poor prognosis. However, when the analysis included parameters that were measured in variable proportion of the study population, the independent prognostic factors for poor survival were thrombocytopenia (p=0.0001), anemia (p=0.01), and the presence of unfavorable cytogenetic abnormalities (0.001). Based on the above findings, we constructed a new complete blood count (CBC)-based prognostic scoring system (Figure 1) that performed better than the Dupriez scoring system in discriminating intermediate- from high-risk patient categories(Figure 2). Figure Figure Conclusions: Thrombocytopenia is a strong predictor of poor survival in transplant-eligible patients with AMM. The incorporation of platelet count into the Dupriez prognostic scoring system might allow the construction of an improved, CBC-based scoring system that can accurately identify high-risk as well as intermediate-risk patients with AMM.

scholarly journals Dynamics of the mean transmitral pressure gradient and its impact on clinical outcomes after MitraClip

2021 ◽  
Author(s):  
Can Öztürk ◽  
Kim Sprenger ◽  
Noriaki Tabata ◽  
Atsushi Sugiura ◽  
Marcel Weber ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Independent Predictor ◽  
Time Varying ◽  
Severe Mitral Regurgitation ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.

scholarly journals Risk Factors of Hospital-acquired Thrombocytopenia in Toxicological Intensive Care Unit

2020 ◽  
Vol 10 (3) ◽  
pp. 32256-32256
Author(s):  
Haleh Talaie ◽  
◽  
Sayed Masoud Hosseini ◽  
Maryam Nazari ◽  
Mehdi Salavati Esfahani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Platelet Count ◽  
Antihypertensive Drugs ◽  
International Normalized Ratio ◽  
Severe Thrombocytopenia ◽  
Old Patients ◽  
Platelet Counts ◽  
Hospital Acquired ◽  
The Impact

Background: Platelet count is a readily available biomarker predicting disease severity and risk of mortality in the intensive care units (ICU). This study aims to describe the frequency, to assess the risk factors, and to evaluate the impact of thrombocytopenia on patient outcomes in a Toxicological ICU (TICU).Methods: In this prospective observational Cohort study, we enrolled 184 patients admitted to our TICU from October 1st, 2019, to August 23rd, 2020. Mild/moderate and severe thrombocytopenia were defined as at least one platelet counts less than 150×103/μL and 50×103/μL during the ICU stay, respectively.Results: Of 184 enrolled patients, 45.7% had mild to moderate thrombocytopenia and 5.4% had severe thrombocytopenia. Old age (OR: 1.042, 95%CI: 1.01-1.075, P=0.01), male gender (OR: 4.348, 95%CI: 1.33-14.22, P=0.015), increased international normalized ratio (INR) levels (OR: 3.72, 95%CI: 1.15-112, P=0.028), and administration of some medications including heparin (OR: 3.553, 95%CI: 1.11-11.36, P=0.033), antihypertensive drugs (OR: 2.841, 95%CI: 1.081-7.471, P=0.034), linezolid (OR: 13.46, 95%CI: 4.75-38.13, P<0.001), erythromycin (OR: 19.58, 95%CI: 3.23-118.86, P=0.001), and colistin (OR: 10.29, 95% CI 1.44-73.69, P=0.02) were the risk factors of hospital-acquired thrombocytopenia. The outcomes of patients with normal platelet count were significantly better than those who developed thrombocytopenia (P<0.001).Conclusion: We found that thrombocytopenia could develop in almost 50% of patients admitted to TICU, which is associated with poor prognosis. Additionally, the platelet counts should be closely monitored to administer some medications (heparin, antihypertensive drug, and linezolid), especially in old patients.

scholarly journals The Impact of Ethnicity on the Response to Eltrombopag in Patients with Immune Thrombocytopenia (ITP) in Qatar: A Single Institution Experience

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 7-8
Author(s):  
Mohamed A Yassin ◽  
Aya Alasmar ◽  
Rola Ghasoub ◽  
Omer Ismail ◽  
Abdulqadir Jeprel Nashwan ◽  
...  
Keyword(s):  
Platelet Count ◽  
Treatment Guidelines ◽  
Conflicts Of Interest ◽  
Standard Dose ◽  
East Asian ◽  
Area Under The Curve ◽  
Cost Effective ◽  
Complete Response ◽  
Platelet Counts ◽  
The Impact

Background: Thrombopoietin receptor agonists stimulate platelet production . Eltrombopag olamine (ELT) is alow molecular weight, synthetic nonpeptide agent thathas been studied in multiple phase 3 trials and proved efficacy at a standard dose of 50 mg. ELT exposure has been reported to be different in different ethnic descents. In East Asian ITP patients, the area under the curve (AUC) was reported to be more than 85% those of non-East Asian descent Objectives: The objective of this study is to evaluate the efficacy of ELT in Arab and Asian ITP patients of the subcontinent of India by using a lower starting dose (12.5 mg) and maximum (50 mg) doses of ELT than the standard starting dosing of (50 mg) and maximum of (75 mg) approved in the USA and Europe. Methods A retrospective study was conducted to evaluate the role of ethnicity (Arab and East Asians) in response to ELT among ITP patients by reviewing patients' electronic medical records between Jan 2015 - Jan 2019. A total of 58 patients were identified. We examined retrospectively Arab (n = 41) and non-Arab Asian (n = 17) patients who are 18 years and older in Qatar, with previously treated chronic ITP who had a platelet count of &lt; 30 000 /L and who presented with bleeding manifestations. Patients' responses were evaluated after receiving ELT for 3 months or more, as well as their response to different doses of ELT (100, 75, 50, 25, 12.5 or any alternating doses e.g., 50/25). Results: The response rate (platelet count of ‡ 50 000 /L) after 3 months of ELT treatment was comparable in the Arab (87.5%) and non-Arab (88.2%) patients. 26% of the Arab patients required 12.5 or 25 mg and 41.5 % required 50 mg of ELT to achieve an acceptable response. In the Non-Arab Asian group 17.6% required 25 mg and 52.9% required 50 mg of ELT to achieve acceptable response. 22% of the Arab patients and 35.3% of the Non-Arab Asians patients required 75 mg or more of ELT to achieve acceptable control. Further sub-analysis of this data showed that 70% of the Arab patients who achieved complete response were females (14/20) whereas 33.3% (3/9) were Asian females. Two-third the Arab patients who achieved clinical remission were females whereas more than Two-third were non-Arab Asian males. Conclusion: ELT is generally well tolerated and effectively achieves target platelet counts in adult ITP patients. Low doses (12.5 - 50 mg) of ELT were effective in achieving and maintaining safe platelet counts in most Arab patients. This helps in achieving the maximum benefit for the patient at the lower possible dose to prevent toxicity. Tailoring treatment guidelines to match ethnic variations will help in providing a more cost-effective approach for both the patients and the health care system. Disclosures No relevant conflicts of interest to declare.

scholarly journals Vasospasm following aneurysmal subarachnoid hemorrhage: Thrombocytopenia a marker

2013 ◽  
Vol 04 (03) ◽  
pp. 257-261 ◽  
Author(s):  
Ashish Aggarwal ◽  
Pravin Salunke ◽  
Harnarayan Singh ◽  
Harnarayan Singh ◽  
Sunil Kumar Gupta ◽  
...  
Keyword(s):  
Platelet Count ◽  
Subarachnoid Hemorrhage ◽  
Odds Ratio ◽  
Clinical Symptoms ◽  
Independent Predictor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Platelet Counts ◽  
Symptomatic Vasospasm ◽  
Relationship Of ◽  
The Relationship

ABSTRACT Background: Symptomatic vasospasm (SV) is often seen after aneurysmal subarachnoid hemorrhage (aSAH). The pathophysiology suggests that platelets initiate the process and are consumed. This is likely to result in thrombocytopenia. The objective of this study was to find out if thrombocytopenia preceded or followed SV and to analyze the relationship between the two. Materials and Methods: The platelet counts of 74 patients were studied on day 1, 3, 5, 7, 9, 11, and 14 following aSAH. Clinical symptoms and raised velocities on transcranial Doppler were studied on the same days to determine SV. The relationship of platelet counts and SV were analyzed. Results: Thirty-nine (52.7%) patients developed SV. Platelet counts dropped on postictal day (PID) 3-7 and SV was commonly seen on PID 5-9. The median platelet counts were significantly lower in patients with SV when compared to those without SV. Platelet count <150,000/mm 3 on PID 1 and 7 had statistically significant association (P < 0.001) with SV. The odds ratio was 5.1, 6.9, and 5.1 on PID 5, 7, and 9, respectively, for patients with relative thrombocytopenia (P < 0.001). Conclusions: There is a strong correlation between thrombocytopenia and SV. A platelet count < 150,000/mm 3 on PID 1 and 7 predicts presence of SV. The relative risk of developing SV is >5 times for a patient with relative thrombocytopenia especially on PID 5-9. Additionally, it appears that thrombocytopenia precedes vasospasm and may be an independent predictor. However, this requires further studies for validation.

Preoperative Bacterobilia Is an Independent Risk Factor of SSIs after Partial PD

2020 ◽  
Vol 37 (5) ◽  
pp. 428-435
Author(s):  
Ioannis Mintziras ◽  
Elisabeth Maurer ◽  
Veit Kanngiesser ◽  
Michael Lohoff ◽  
Detlef K. Bartsch
Keyword(s):  
Independent Predictor ◽  
Multivariable Analysis ◽  
Postoperative Outcome ◽  
Surgical Site Infections ◽  
Complete Information ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage ◽  
Pancreatic Fistulas ◽  
Partial Pancreaticoduodenectomy ◽  
The Impact

Introduction: The impact of bacterobilia on postoperative surgical and infectious complications after partial pancreaticoduodenectomy (PD) is still a matter of debate. Methods: All patients undergoing PD with and without a preoperative biliary drainage (PBD) with complete information regarding microbial bile colonization were included. Logistic regression was applied to assess the influence of bacterobilia on postoperative outcome. Results: One hundred seventy patients were retrospectively analysed. Clinically relevant postoperative complications (Clavien-Dindo ≥ III) occurred in 40 (23.5%) patients, clinically relevant postoperative pancreatic fistulas in 29 (17.1%) patients, and surgical site infections (SSIs) in 16 (9.4%) patients. Thirty-seven of 39 (94.9%) patients with PBD and 33 of 131 (25.2%) patients without PBD had positive bile cultures (p < 0.001). A polymicrobial bile colonization was reported in 9 of 33 (27.3%) patients without PBD and 27 of 37 (73%) patients with PBD (p < 0.001). Resistance to ampicillin-sulbactam was shown in 26 of 37 (70.3%) patients with PBD and 12 of 33 (36.4%) patients without PBD (p = 0.001). PBD (OR 0.015, 95% CI 0.003–0.07, p < 0.001) and male sex (OR 3.286, 95% CI 1.441–7.492, p = 0.005) were independent predictors of bacterobilia in the multivariable analysis. Bacterobilia was the only independent predictor of SSIs in the multivariable analysis (OR 0.143, 95% CI 0.038–0.535, p = 0.004). Conclusions: Patients with a PBD show significantly higher rates of bacterobilia, polymicrobial bile colonization, and resistance to ampicillin-sulbactam. Bacterobilia is an independent predictor of SSI after PD.

scholarly journals The Integrated Glasgow Prognostic- and Cytogenetic Risk Score (CytoGPS) at Diagnosis Is a Strong and Independent Predictor of Survival in Transplant-Eligible Patients with Multiple Myelom

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4509-4509
Author(s):  
Hanno Maximilian Witte ◽  
Harald Biersack ◽  
Armin Riecke ◽  
Bastian Bonorden ◽  
Svenja Kopelke ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
High Risk ◽  
Clinical Outcome ◽  
Risk Stratification ◽  
Independent Predictor ◽  
Prognostic Score ◽  
High Dose ◽  
Prognostic Impact ◽  
Group I ◽  
The Impact

Abstract Abstract Introduction: Immunity and inflammatory response impact tumor microenvironment and progression of malignancies. Metabolic and inflammatory parameters of the peripheral blood, and ratios of the latter, correlate with outcome in cancer patients. There exist several established inflammation-based scores of prognostic significance including the Glasgow-prognostic-score (GPS; integrating serum-CRP (>10 mg/L: 1pt) and albumin (< 35g/L: 1 pt). Methods: In this retrospective multi-center study we investigated the prognostic capabilities of an integrated scoring system including GPS and information on cytogenetic high-risk aberrations as determined by FisH (CytoGPS) in transplant-eligible MM patients as a complementary resource for risk-stratification. Patients with MM admitted to our institutions between January 2000 and July 2017 were screened and established prognostic factors were assessed. CytoGPS was calculated as conventional GPS score plus one additional point for high-risk cytogenetics. Statistical evaluation resulted in three significantly divergent groups in terms of clinical outcome (Group I: 0-1 pts.; group II. 2 pts.; III: 3 pts.). Characteristics significantly associated with OS or PFS were included in a proportional-hazard-model. The study was approved by the local ethics committee. Results: Following initial assessment we identified 212 eligible and fully evaluable as well as transplant eligible patients. Centralized review of pathology and cytogenetic reports was conducted and central hematopathology assessment was performed in 163/212 (76.9%) cases. All patients included in the study proceeded to high-dose melphalan and subsequent autologous stem cell transplantation. Median age at diagnosis was 59 years (range 35 - 76 years) with a median follow-up of 76 months. Mean GPS was 0.849, with a mean CytoGPS of 0.472. Multivariate analysis revealed ISS (HR = 1.677, 95% CI = 1.035 - 2.716, p = 0.036) and CytoGPS but not R-ISS to be the only independent predictors of OS and CytoGPS constituted the only independent predictor of PFS (OS: HR = 2.172; 95% CI = 1.607 - 2.936 p = 0.001; PFS: HR = 1.517; 95% CI = 1.174 - 1.960, p = 0.001). The impact of CytoGPS on OS and PFS is presented in Figure 1. Discussion: There is growing evidence stating a drastic impact of systemic inflammatory scores and cytogenetic data on clinical outcome in various malignancies including lymphoma and solid tumors. Our data show that baseline CytoGPS, integrating both these aspects, correlates with rates of relapse and refractory disease across all primary stages of MM in transplant-eligible patients. Upon multivariate analysis these effects were preserved with prognostic impact beyond established prognosticators. CytoGPS constitutes a promising means of risk-stratification in MM requiring further validation. Acknowledgments The authors would like to thank Mr. Jan Kroenke (ASH-Member) for the sponsorship of this abstract. Figure 1: Overall and Progression-free Survival in transplant-eligible Multiple Myeloma patients according to CytoGPS (Log-rank: A: p < 0.0001, B: p = 0.0001). Disclosures No relevant conflicts of interest to declare.

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