Acute de novo Leukemia in Estonia and Western Sweden 1982-2006: Positive Trend in the Survival of Acute Leukemia over 25 Years

2016 ◽  
Vol 136 (3) ◽  
pp. 167-173 ◽  
Author(s):  
Erik Hulegårdh ◽  
Mari Punab ◽  
Erik Holmberg ◽  
Katrin Palk ◽  
Edward Laane ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Cancer Survival ◽  
De Novo ◽  
Survival Rates ◽  
Relative Survival ◽  
West Germany ◽  
Eastern Bloc ◽  
Positive Trend ◽  
The European Union ◽  
Hematopoietic Stem

This study focuses on the incidence, treatment, and survival of de novo acute leukemia in a 25-year perspective in western Sweden and Estonia. At the beginning of our study, Estonia was a part of the Eastern bloc with planned economy, but since 1991 it is a member of the European Union and transforming into a market economy. Survival rates have steadily increased in both countries. However, a gap between their survival curves remains. Based on our data, it is difficult to explain the big difference in the 5-year relative survival in favor of western Sweden (55 vs. 22%). In Germany, there was a big difference in overall cancer survival between East and West Germany after the fall of the iron curtain, but today no difference is seen. Differences in survival are probably due to a higher proportion of intense chemotherapy regimens and a higher rate of hematopoietic stem cell transplantations in Sweden. Other important factors might be better supportive care and diagnostics as well as better adjuvant therapy. Better staff training and conditions in wards are also factors that might play an essential role.

scholarly journals Lung Cancer Survival in Lithuania: Changes by Histology, Age, and Sex From 2003-2007 to 2008-2012

2019 ◽  
Vol 26 (1) ◽  
pp. 107327481983608 ◽  
Author(s):  
Vaida Gedvilaitė ◽  
Edvardas Danila ◽  
Saulius Cicėnas ◽  
Giedrė Smailytė
Keyword(s):  
Lung Cancer ◽  
Cell Carcinoma ◽  
Cancer Survival ◽  
Survival Rates ◽  
Age Groups ◽  
Relative Survival ◽  
International Classification Of Diseases ◽  
Advanced Lung Cancer ◽  
Almost All ◽  
Disease Stages

Lung cancer is the most common cancer-related death worldwide. The aim of this study is to describe the most recent survival rates by sex, age group, extent of disease, and histology of lung cancer in Lithuania. The study is based on the Lithuanian Cancer Registry database. The analysis included patients with primary invasive lung cancer diagnosed in 1998 to 2012 (International Classification of Diseases, Tenth Revision C33 and C34). Patients were followed up with respect to vital status until December 31, 2012. Five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of patients with cancer and the expected survival of the underlying general population. In our study, the overall 5-year relative survival was low but increased slightly (10.7%) from 2003–2007 to 2008–2012. Positive changes in survival were evident in both sexes, in almost all age groups and for all histological groups and disease stages. Adenocarcinoma relative survival increased from 6.7% in 2003–2007 to 12.8% in 2008–2012 and squamous cell carcinoma increased from 7.4% in 2003–2007 to 11.1% in 2008–2012. Patients with small-cell carcinoma had the worst survival (2.9% in 2003-2007 and 3.6% in 2008–2012). The majority of patients with lung cancer are diagnosed with advanced disease. The number of new cases of advanced lung cancer increased from 35.1% to 37.8%. Despite low overall survival, there were positive changes in survival in both sexes, in almost all age groups, and for all histological groups and disease stages. The survival rate of patients with lung cancer in Lithuania is similar to that in other European countries.

The Novel FLT3-N676K Mutant Induces Acute Leukemia Independently of the Inv(16) Chimeric Gene CBFB-MYH11

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1383-1383
Author(s):  
Kezhi Huang ◽  
Min Yang ◽  
Zengkai Pan ◽  
Florian H. Heidel ◽  
Michaela Scherr ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
High Throughput ◽  
High Throughput Sequencing ◽  
De Novo ◽  
Chimeric Gene ◽  
Leukemic Cells ◽  
Single Amino Acid ◽  
Hematopoietic Stem ◽  
Transforming Activity

Abstract Using high-throughput sequencing, an increased number of gene mutations has been identified in cancer. Among the up to hundreds of acquired mutations in cancer clones, only a few cooperating mutations are believed to be needed for initiation of the malignant disease. Recently, we reported a single amino acid substitution at position 676 (N676K) within the FLT3 kinase domain as the sole cause of resistance to PKC412 in one patient with FLT3-ITD associated acute myeloid leukemia (AML). The FLT3-N676K mutation was more recently identified independently in up to 6% of de novo AML patients with inv(16) by other groups. As FLT3-TKD mutations are strongly associated with inv(16) in AML and particularly FLT3-N676K was found almost exclusively in AML patients with inv(16), this prompted us to investigate the transforming activity of FLT3-N676K and to test whether FLT3-N676K would cooperate with inv(16) to promote AML. First, we analyzed in vivo leukemogenesis mediated by FLT3-N676K. Retroviral expression of FLT3-N676K in myeloid 32D cells induced AML in syngeneic C3H/HeJ mice (n=11/13, latency ~8 weeks), with a transforming activity similar to FLT3-ITD (n=8/8), FLT3-TKD D835Y (n=8/9), and FLT3-ITD-N676K (n=9/9) mutations. Three out of 14 C57BL/6J mice transplanted with FLT3-N676K-transduced primary lineage negative (Lin-) bone marrow cells died of acute leukemia (latency of 68, 77, and 273 days), while none of 16 animals in the control groups including FLT3-ITD and CBFß-SMMHC developed any hematological malignancy. Secondly, co-expression of FLT3-N676K and CBFß-SMMHC did not promote acute leukemia in 3 independent experiments using C3H/HeJ and C57BL/6J mice (n=16). So far only 1 out of 11 C57BL/6J mice co-expressing FLT3-N676K and CBFß-SMMHC developed acute leukemia (AML with latency of 166 days). In comparison with FLT3-ITD, FLT3-N676K tended to result in stronger phosphorylation of FLT3, MAPK and AKT, and diseased animals carrying FLT3-N676K demonstrated much lower frequency of leukemic stem cells in the majority of analyzed cases. Importantly, leukemic cells co-expressing FLT3-N676K and CBFß-SMMHC were still highly sensitive to the FLT3 inhibitor AC220. Taken together, we show that FLT3-N676K mutant is potent to transform murine hematopoietic stem/progenitor cells in vivo independently of the inv(16) chimeric gene CBFB-MYH11. This is the first report of acute leukemia induced by an activating FLT3 mutation in C57BL/6J mice. Moreover, our data suggest that targeting FLT3-N676K mutation may be an attractive treatment option for FLT3-N676K-positive patients without concurrent ITD. Our data emphasize more careful analysis of the cooperating network of mutations identified in AML by high-throughput sequencing. This work was supported by DJCLS (grant: 13/22) and the Deutsche Forschungsgemeinschaft (grant: Li 1608/2-1). KH and ZP were supported by the China Scholarship Council (2011638024 and 201406100008). Disclosures Heidel: Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Timing of initiation of defibrotide (DF) post-diagnosis of hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) after hematopoietic stem cell transplantation (HSCT): Final data from an expanded-access protocol.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 7047-7047 ◽  
Author(s):  
Stephan A. Grupp ◽  
Paul G. Richardson ◽  
Angela R. Smith ◽  
Brandon Triplett ◽  
Nancy A. Kernan ◽  
...  
Keyword(s):  
Survival Rates ◽  
Study Data ◽  
Trend Test ◽  
Sinusoidal Obstruction Syndrome ◽  
The European Union ◽  
Hematopoietic Stem ◽  
Exact Test ◽  
Expanded Access ◽  
Final Study ◽  
Timing Of Initiation

7047 Background: VOD/SOS is an unpredictable, potentially life-threatening complication of HSCT. VOD/SOS with multi-organ dysfunction (MOD) may be associated with > 80% mortality. DF is approved to treat hepatic VOD/SOS with renal/pulmonary dysfunction post-HSCT in the US and to treat severe hepatic VOD/SOS post-HSCT in the European Union. Methods: In an expanded-access study, VOD/SOS patients (pts) with or without renal/pulmonary MOD after HSCT or chemotherapy received DF 25 mg/kg/d (6.25 mg/kg q6h) for a recommended ≥21 days. For these exploratory analyses, D ay +100 survival rates in HSCT pts were examined post hoc by time from diagnosis to start of DF for (1) all pts before/after days 1, 2, 3, 4, 7, and 14, using Fisher’s exact test and (2) pts starting DF on a particular day: 0, 1, 2, 3, 4, 5, 6, 7, 8–14, and ≥15, by Cochran-Armitage test for trend across days. Causes of treatment delay were not assessed. Results: In the final dataset, timing of initiation was available for 1000 HSCT pts (512 with MOD) who received ≥1 dose of DF. In 31.0% of pts, DF was started the day of diagnosis; in 92.9%, by Day 7. In the analysis of initiation before/after days 1, 2, 3, 4, 7, and 14 post-diagnosis, earlier initiation was associated with significantly higher Day +100 survival rates for all days ( P≤.001), except Day 14 (2.6% of pts started DF after Day 14). The trend test for particular initiation days also showed a significant trend over time for higher Day +100 survival with earlier DF initiation post-diagnosis ( P< .001). Adverse events (AEs) and serious AEs occurred in 70.8% and 53.4% of pts. Other than VOD/SOS and MOD, the most common AE was hypotension (11.7%) and most common serious AE was respiratory failure (7.3%). Conclusions: In this exploratory analysis of final study data, earlier DF initiation post-VOD/SOS diagnosis improved Day +100 survival, confirmed by the Cochran-Armitage test ( P< .001). No specific day provides a clinically meaningful cutoff for better Day +100 survival, suggesting that later intervention retains value if treatment must be delayed. Support: Jazz Pharmaceuticals. Clinical trial information: NCT00628498.

Racial disparities in cancer survival: A trend analysis based on SEER data (1973-2010).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1571-1571
Author(s):  
Seyed Navid Alavi ◽  
Chibuzo Eze ◽  
Poornima Pandellapalli
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Racial Differences ◽  
Cancer Survival ◽  
Care Delivery ◽  
Survival Rates ◽  
Relative Survival ◽  
Population Data ◽  
The United States ◽  
Survival Ratio

1571 Background: African Americans have higher incidence of cancer and lower survival rates compared to other ethnicities. We studied the 5-year relative survival between black and white races for the most common cancers in the United States. Methods: Data was obtained from the SEER database, the largest population-based cancer database including 28% of US population. Data containing 5-year relative survival from the patients who were diagnosed from 1973 to 2010. We included data for cancers of colorectal, lung, prostate, breast and melanoma, the most common cancers in the United States. Results: For colorectal cancer average 5-year relative survival from 1973 to 2010 is 59.9% for whites and 51.5% for blacks. Same results for lung cancer are 14.6% for whites and 12.2% for blacks, for breast cancer is 84.5% for whites and 71.6% for blacks, for prostate cancer is 86.9% for whites and 80.5% for blacks, and for melanoma is 87.9% for whites and 66.4% for blacks. The average black to white 5-year relative survival ratio is 0.86, 0.84, 0.85, 0.92, and 0.76 for cancers of colorectal, lung, breast, prostate, and melanoma, respectively. This ratio has decreased from 0.89 to 0.86 and from 0.87 to 0.81 for colorectal and lung cancer, respectively and for cancers of breast, prostate and melanoma it has increased from 0.85 to 0.87, from 0.88 to 0.89, and from 0.73 to 0.80 respectively. Conclusions: Our analysis shows that for colorectal and lung cancer the survival rate difference between blacks and whites has increased over 4 decades but for cancers of breast, prostate and melanoma this ratio has decreased. Better understating of the factors contributing to racial differences in cancer survival has potential applicability in policymaking for a better and equal health care delivery.

scholarly journals Oropharyngeal Cancer Survival: A Population-Based Study of Patients Diagnosed between 1978 and 2002

ISRN Oncology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Dyego Leandro Bezerra de Souza ◽  
María Milagros Bernal ◽  
Javier Jerez Roig ◽  
Maria Paula Curado
Keyword(s):  
Oropharyngeal Cancer ◽  
Cancer Survival ◽  
Survival Rates ◽  
Age Groups ◽  
Relative Survival ◽  
Population Based ◽  
First Year ◽  
Population Based Study ◽  
Kaplan Meier ◽  
One Year

Objective. This paper aims at studying oropharyngeal cancer survival from the Population-Based Cancer Registry of Zaragoza, Spain, for the 1978–2002 period. Methods. The survival rates were calculated by the Kaplan-Meier method, and the automated calculation method of the Catalan Institute of Oncology was utilized to obtain the relative survival. Results. The oropharyngeal cancer survival rate was 61.3% in the first year and 33.9% in the fifth year. One-year relative survival was 62.2% (CI 95%: 57.4–67.4), and five-year relative survival was 36.6% (CI 95%: 31.8–42.1). Comparison of survival rates by sex revealed statistically significant differences (P value = 0.017) with better survival in women. There were no differences when comparing the three age groups and the three studied time periods 1978–1986, 1987–1994, and 1995–2002. Conclusions. The data suggests that there were no significant changes in oropharyngeal cancer survival in the province of Zaragoza throughout the years.

scholarly journals Prognostic Factors Associated with Lung Cancer Survival: A Population-Based Study in Southern Spain

2019 ◽  
pp. 1-10
Author(s):  
Isabel Linares ◽  
José Expósito ◽  
Elena Molina-Portillo ◽  
Yoe-Ling Chang ◽  
Juan Pedro Arrebola ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Survival ◽  
Performance Status ◽  
Treatment Options ◽  
Survival Rates ◽  
Primary Lung Cancer ◽  
Stage Iv ◽  
Relative Survival ◽  
Population Based ◽  
Stage I

Purpose: Lung cancer is the leading cause of cancer death worldwide. The objective was to analyze survival for lung cancer in Granada, and to identify the factors influencing survival. Methods: Data were obtained from the population-based cancer registry in Granada (Spain). All cases of newly diagnosed primary lung cancer in 2011-2012 (n=685) were included. One and two-year relative survival was estimated. Results: Of our population, 65% of the patients were over 65 years of age, and 83% were men. 74% of patients had good performance status (PS); 81% of the tumors were microscopically verified; and 81% were non-small cell lung cancer. Overall, 16% were stage I-II, whereas 57% were stage IV. Radiotherapy was administered in 28% of cases, chemotherapy in 45%, whereas 23% of patients were operated. The two-year survival rate was 18% (67% and 5% for stage I and IV). Survival was higher among women (29%), <75 years of age (21.6%), and those with good PS (23%). Microscopic verification and surgery led to higher survival rates of 23.4% and 69%, respectively. Conclusions: Since the factors affecting survival were PS, stage, and surgery, efforts should target the early diagnosis of lung cancer since this would improve treatment options and outcomes.

Allogeneic Hematopoietic Stem Cell Transplantation (Allo-SCT) Versus Conventional Postremission Therapy (PRT) for AML in First Complete Remission (CR1): A Matched Pairs Analysis Based on Data of the AML Cooperative Group (AMLCG) 1999 Trial.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 328-328 ◽  
Author(s):  
Joachim Kienast ◽  
D.W. Beelen ◽  
H.J. Kolb ◽  
R. Schwerdtfeger ◽  
R. Arnold ◽  
...  
Keyword(s):  
De Novo ◽  
Risk Group ◽  
Survival Rates ◽  
Rank Test ◽  
Unrelated Donor ◽  
Matched Pairs ◽  
Maintenance Chemotherapy ◽  
Control Cohort ◽  
Hematopoietic Stem ◽  
Using Data

Abstract Using data of the prospective AMLCG 1999 trial, we performed a matched pairs analysis to evaluate outcome in patients (pts) with AML according to postremission allo-SCT or randomly allocated autologous SCT or maintenance chemotherapy. As of 07/2007, 2547 pts accrued to the trial were evaluable. 135 pt pairs in CR1 were identified who matched for the following criteria: AML type (de novo AML, s-AML, t-AML, MDS); cytogenetic risk group [unfavorable (UNF-CG), intermediate (INT-CG), and favorable with the exclusion of t(15;17)]; age (± 5 years); and time in CR1 to account for the time to transplant in allo-SCT pts. 30 pt pairs had an UNF-CG, 97 pairs INT-CG, and 8 pairs had favorable cytogenetics. Median pt age was 45 years (range: 16–63). In the control cohort, 86 pts were assigned to cyclic maintenance chemotherapy and 49 to autologous SCT (see J Clin Oncol2006; 24: 2480–9). In the allo-SCT cohort, 87 pts had an HLA identical sibling donor (SIB) and 48 a matched volunteer unrelated donor (VUD). Median follow-up was 1349 days (range:70–2820). Projected 5-year relapse-free survival (RFS) was 57% in the allo-SCT group and 37% in controls (p<.001, log-rank test). Overall survival (OS) was 58% and 41% (p=.115), respectively. Median RFS was significantly improved by allo-SCT in pts with UNF-CG (25 vs. 7 months; p=.019) or INT-CG (not reached after 7 years vs. 25 months; p=.005). Median OS was 32 months in allo-SCT pts with UNF-CG versus 14 months in matched controls (p=.183) and not reached after 7 years in INT-CG pts with allo-SCT versus 71 months in matched controls (p=.257). Of note, 40 pts in the control cohort received an allo-SCT (16 from SIBs, 24 from VUDs) beyond CR1 (9/30 with UNF-CG; 30/97 with INT-CG). Median OS of 40 matched pts receiving an allo-SCT in CR1 was not reached after 7 years, while it was only 31 months in paired pts with allo-SCT beyond CR1 (p<.05). In a subset of pts with INT-CG (35 allo-SCT pts and 35 paired controls), information on NPM1 and FLT3 (ITD) mutation status was available. In these pts, we performed a preliminary analysis comparing AML pts with mutated NPM1 (NPM1-Mt) and wild-type FLT3 (FLT3-Wt) to the remainder of the respective cohorts. With conventional PRT, NPM1-Mt/FLT3-Wt pts (18) had a projected OS at 6 years of 69% versus 41% in the remaining 17 pts (p=.112). Interestingly, NPM1-Mt/FLT3-Wt pts receiving an allo-SCT in CR1 (11) had a projected 6-year OS of 91% versus 45% in 24 pts with other NPM1/FLT3 phenotype combinations (p=.024). We conclude that allo-SCT to date is the most potent PRT for AML with UNF-CG and INT-CG. Its impact on OS is difficult to assess as about a third of pts initially treated with conventional PRT undergo allo-SCT beyond CR1 with significantly worse survival rates. AML pts with NPM1-Mt/FLT3-Wt phenotype appear to constitute a good risk group with conventional PRT, but at the same time seem to particularly benefit from allo-SCT in CR1.

Estimating Relative Survival of Italian Cancer Patients from Sparse Cancer Registries Data

1997 ◽  
Vol 83 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Roberta De Angelis ◽  
Riccardo Capocaccia ◽  
Arduino Verdecchia
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Survival Data ◽  
Cancer Survival ◽  
National Level ◽  
Survival Rates ◽  
Relative Survival ◽  
Cancer Registries ◽  
Breast Cancer Patients ◽  
National Estimates

Purpose A method is presented for estimating relative survival of cancer patients at the national level from survival data provided by cancer registries covering only a subset of the general population and referring to different, and not necessarily overlapping, incidence periods. Methods Relative survival rates are estimated as a function of the covariates sex, age, epoch of diagnosis, and registry area by means of a multiple regression model. National estimates are then computed by appropriate weighting of the sex-, age-, time- and registry-specific expected relative survival values. Results The method is illustrated by a sample application to survival data of female breast cancer patients in Italy. The national estimates of breast cancer survival pattern show a mild decrease of survival with age and a marked increase with period of diagnosis.

scholarly journals Recent Trends in Multiple Myeloma Incidence and Survival By Age, Race and Ethnicity in the US

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4774-4774
Author(s):  
Luciano J. Costa ◽  
Jim Omel ◽  
Elizabeth E. Brown
Keyword(s):  
Multiple Myeloma ◽  
Ethnic Groups ◽  
Race And Ethnicity ◽  
Survival Rates ◽  
Age Groups ◽  
Relative Survival ◽  
Advisory Committees ◽  
Hematopoietic Stem ◽  
Hispanic Patients ◽  
Racial Ethnic

Abstract Background: Improvements in multiple myeloma (MM) survival for patients diagnosed through mid-2000s have been well characterized; however, such improvements have not been shown among older patients and among racial/ethnic minorities. We hypothesized that the broader use of autologous hematopoietic stem cell transplantation introduced in the mid-1990s, and novel agents introduced since mid-2000s have further improved MM survival among all age and racial/ethnic groups. Methods: We used data available from the Surveillance, Epidemiology and End Results (SEER-13) to calculate MM incidence and relative survival rates (RSR) for four time periods including 1993-1997, 1998-2002, 2003-2007 and 2008-2012. Follow up data were available through 2013. Data were obtained using SEER*Stat 8.3.2. Incidence and RSRs were calculated for non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) and Hispanics and for three age groups, <65, 65-74 and 75 years of age or older at time of diagnosis. Results: We included a total 34,505 patients, of which n=7,494 patients were diagnosed between 1993-1997, n=7,952 patients between 1998-2002, n=8,803 patients between 2003-2007 and n=10,256 patients between 2008-2012. Overall, 13,229 (38.3%) patients were < 65 years of age, 9,834 (28.5%) 65-74 years of age, and 11,442 (33.2%) 75 years of age or older. There were 21,660 (62.8%) NHW, 6,349 (18.4%) NHB, and 3,599 (10.4%) Hispanic patients. MM incidence (per 100,000 persons) increased from 5.5 in 1993-1997 to 6.1 in 2008-2012 (P<0.001). An increase in incidence was observed among females (4.6 to 4.9, P<0.001), males (6.8 to 7.6, P<0.001), NHW (5.1 to 5.6, P<0.001), NHB (12.0 to 13.4, P<0.001), but not among Hispanics (5.2 to 5.3, P=0.7; Figure 1). Median age at diagnosis declined between 1993-199 and 2008-2012 from 72 to 69 years among females (P<0.001) and from 72 to 70 years among NHW (P=0.007), but not significantly among males (70 to 69; P=0.4), NHB (68 to 66 years, P= 0.4) or Hispanics (66 to 66 years, p= 0.9). RSR at 5 year (RSR-5), compared between 1993-1997 and 2008-2012 cohorts, improved among patients <65years (38.2% to 61.8%, P<0.001), 65-74 years (29.0% to 48.4%, P<0.001) and 75+ years (21.1% to 34.0%, P<0.001). RSR-5 improved among NHW (29.1% to 50.0%, P<0.001) at similar magnitude of the improvement among NHB (32.0% to 50.1%, P<0.001) and Hispanics (29.9% to 47.3%, P<0.001). RSR at 10 years (RSR-10), compared between 1993-1997 and 2003-2007 cohorts showed improvement among patients diagnosed <65 years (19.6% to 35.0%, P<0.001), and 65-74 (11.7% to 20.6%, P<0.001), but not among patients 75+ (7.8% to 9.3%, P=0.5). RSR-10 improved among NHW (13.2% to 24.3%, P<0.001), NHB (14.6% to 23.4%, P=0.002) and Hispanics (13.0% to 23.8%, P=0.001), Figure 2. Conclusion: MM incidence has increased in recent years among NHWs and NHBs, but not in Hispanics. Improvements in RSR- 5 were evident for all age and racial/ethnic groups; however, improvements in RSR-10 were not detected for patients 75 years of age or older at diagnosis. The observed increase in MM incidence together with younger age of diagnosis and increased relative survival suggests a link between early intervention and prolonged survival. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures Costa: Sanofi: Honoraria, Research Funding. Omel:Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Member of Takeda's "Patient Leadership Council". Token payment.

scholarly journals Diagnosis, Treatment Pattern and Prognosis of Acute Leukemia in People with Disabilities: A Cohort Study in the Republic of Korea

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1399-1399
Author(s):  
Jihyun Kwon ◽  
So Young Kim ◽  
Kyoung Eun Yeob ◽  
Jong Hyock Park
Keyword(s):  
Acute Leukemia ◽  
Physical Disability ◽  
Survival Rates ◽  
People With Disabilities ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Appropriate Treatment ◽  
Group Frequency ◽  
The Disabled ◽  
Psychological Disability

Abstract Introduction Acute leukemia is a fatal hematologic malignancy. Because the clinical features of patients with acute leukemia can deteriorate very quickly, an early diagnosis and appropriate treatment are important for these patients. People with disabilities tend to be physically and mentally vulnerable and often have serious economic issues as well. Such situations can be linked to suboptimal diagnoses and treatments in case of acute leukemia. The purpose of this study is to analyze diagnosis rates, treatment patterns and prognoses of acute leukemia patients with disabilities and compare these findings with those of patients without disabilities. Method The major data sources were the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claim database. We built a cohort of 2,776,450 people with disabilities from the Korean National Disability Database. To establish a non-disabled cohort of 8,329,350 as a comparative group, frequency-matched sampling with the disabled group was performed using a merged database, with individuals grouped by age and sex at a ratio of 1:3. From this population, adult patients who were diagnosed with acute myeloid or lymphoblastic leukemia were selected for analysis. Disabilities were categorized into the following types: physical, communication, and intellectual/psychological. Results Among the 8,329,350 people without disabilities and 2,776,450 with disabilities, 3,171 and 873 were diagnosed with acute leukemia, respectively. The prevalence rates of acute leukemia were 38.07 per 100,000 without disabilities and 31.44 per 100,000 with disabilities. Among the acute leukemia patients with disabilities, those in the lowest income group amounted to 13.4% of the total, which was significantly higher than the rate of 4.3% of the patients without disabilities (P < 0.0001). When analyzed by disability type, the numbers of patients with intellectual/psychological disability (50.37 per 100,000) and a communication disability (31.93 per 100,000) was exceeded the number of those with a physical disability (28.34 per 100,000). Chemotherapy for acute leukemia was performed in 61.7% of patients with disabilities, which was significantly lower than the rate of 68.0% for acute leukemia patients without a disability (p = 0.0006). Patients with communication (53.7%) or intellectual/psychological disabilities (54.2%) received chemotherapy less often than those with a physical disability (68.6%). Allogeneic hematopoietic stem cell transplantation was performed in 11.2% of patients without a disability and 8.0% of disabled patients (p = 0.0026). The number of hospitalization days per patient during the first year after diagnosis was 109.3 days for the disabled and 126.1 days for the non - disabled (P <0.0001). The median survival was 14.0 months for patients with disabilities, which was significantly shorter than those without a disability (21.4 months) (P <0.0001). Patients with a communication disorder (8.1 months) and an intellectual/psychological disability (13.1 months) had significantly worse survival rates than patients with a physical disability (15.2 months) (P < 0.0001). Conclusion People with disabilities overall have a relatively low diagnosis rate of acute leukemia and undergo less active treatment of acute leukemia. This tendency is particularly evident in patients with intellectual/psychological and communication disabilities. Patients with acute leukemia with disabilities have significantly lower survival rates than those without a disability. Various measures including financial support are needed to ensure that acute leukemia patients with disabilities receive appropriate treatment and achieve long-term survival. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

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