scholarly journals Central Serous Chorioretinopathy and Blood Serotonin Concentrations

2021 ◽  
Vol 10 (4) ◽  
pp. 558
Author(s):  
Takeshi Kimura ◽  
Takashi Araki ◽  
Yuki Komuku ◽  
Hisashi Iwami ◽  
Fumi Gomi
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Disease Status ◽  
Patient Characteristics ◽  
Smoking History ◽  
Blood Concentrations ◽  
Chronic Medication ◽  
Corrected Visual Acuity ◽  
Blood Serotonin ◽  
A Prospective Study

Background: To investigate blood serotonin (5-hydroxytryptamine (5-HT)) concentrations and their relationships with selected characteristics in patients with central serous chorioretinopathy (CSC). Methods: This was a prospective study including 93 patients with active CSC. Blood concentrations of 5-HT, adrenocorticotropic hormone, and cortisol were measured in patients with CSC. Selected patient characteristics, including disease history (acute or chronic), medication use, smoking history, mood status, best-corrected visual acuity (BCVA), subfoveal choroidal thickness (SCT), findings on fluorescein and indocyanine green angiography, and anatomical changes were evaluated during follow-up. Results: Eleven of the 93 patients had low 5-HT concentrations (<57 ng/mL) (12%, eight men and three women; mean age 55 years); we identified no significant relationship with acute/chronic disease status. The patients with low 5-HT were significantly more likely to have five or more fluorescein leakage sites (p = 0.0275), recurrence of subretinal fluids (p < 0.0001), and failure to achieve significant improvement in BCVA during follow-up (p = 0.862) than patients with 5-HT within the normal range. Conclusions: Blood serotonin concentrations may influence the pathophysiology and prognosis of CSC.

scholarly journals One-year results of half-dose versus one-third-dose photodynamic therapy in chronic or recurrent central serous chorioretinopathy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jirarattanasopa Pichai ◽  
Banchasakjaroen Vanchalerm ◽  
Ratanasukon Mansing
Keyword(s):  
Photodynamic Therapy ◽  
Recurrence Rate ◽  
Central Serous Chorioretinopathy ◽  
Subretinal Fluid ◽  
Corrected Visual Acuity ◽  
Half Dose ◽  
One Year ◽  
The One ◽  
Different Doses

Abstract Background Central serous chorioretinopathy (CSC) is characterized by an accumulation of subretinal fluid (SRF) in the macula. It is usually treated by laser photocoagulation or photodynamic therapy (PDT) with consisting of different doses and power. This study aimed to compare the efficacy of half-dose PDT and one-third-dose PDT in chronic or recurrent CSC. Methods A retrospective review of patients with chronic or recurrent CSC who were treated with either a half-dose or one-third-dose PDT, and had follow up 12 months afterwards. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and resolution of subretinal fluid (SRF) at baseline as well as 1, 3, 6 and 12 months post-PDT were assessed. Results Forty-six eyes and 20 eyes received half-dose and one-third-dose PDT, respectively. The study showed efficacy of the one-third-dose PDT compared with half-dose PDT in BCVA improvement (0.10±0.04 logMAR for one-third-dose versus 0.17±0.04, for half-dose, P=0.148) and CRT improvement (125.6±24.6 μm for one-third-dose versus 139.1±16.54, for half-dose, P=0.933) at 12 months. The SRF recurrence rate was significantly higher in the one-third-dose PDT group compared with the half-dose PDT group (40.0% versus 15.2%, P=0.027) at 12-months. Conclusion At 12 months, the one-third-dose PDT was effective in terms of BCVA and CRT improvement, when compared with half-dose PDT. However, this study showed that one-third-dose PDT had a higher recurrence rate of SRF.

Reduced Intensity Conditioning Unrelated Transplant Plus Cyclosporine and MMF as GVHD Prophylaxis: Results of a Prospective Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5312-5312
Author(s):  
J.A. Perez-Simon ◽  
R. Martino ◽  
R. de la Camara ◽  
J. Perez de Oteiza ◽  
J.M. Moraleda ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Disease Status ◽  
Allogeneic Transplantation ◽  
Similar Efficacy ◽  
Comorbid Condition ◽  
Gvhd Prophylaxis ◽  
Risk Patients ◽  
Related Donor ◽  
A Prospective Study

Abstract Some studies have suggested that mycophenolate mofetil (MMF) offers a similar efficacy in terms of GVHD prophylaxis as compared to methotrexate (MTX) but a faster engraftment and a lower incidence of mucositis. We have analyzed the results of fludarabine (150 mg/m2) and melphalan (140 mg/m2) or busulphan (10 mg/m2) plus Cyclosporine (CsA) and MMF instead of MTX as GVHD prophylaxis in a series of 30 patients undergoing unrelated allogeneic transplantation. Median age was 44 years (18–60). Patients younger than 40 were required to have a previous comorbid condition (8 had a previous autologous transplant; 2 had proven fungal infection; 1 had severe altered lung capacity). Twelve patients were diagnosed with AML, 4 had ALL, 4 MDS, 2 CML, 3 CLL, 3 NHL, 2 MM/WM. Disease status at transplant was 1st or 2nd CR in 12 patients, &gt;2nd CR or PR in 11 patients while the remaining patients had active disease at the time of transplant (relapse, refractory, untreated diasease). Median day to reach &gt; 0,5 x 109 granulocytes / L was +17 and to reach &gt; 20 x 109 platelets / L was +13. At a median follow up of 445 days among patients alive, projected overall survival (OS) and event free survival at 3 years are 47% and 30%, respectively. Overall TRM was 32%. Cumulative incidence of grades 2–4 and 3–4 aGVHD was 67% and 33%, respectively while cumulative incidence of extensive cGVHD was 70%. Gut was the organ most severely involved in aGVHD in 10 out of 16 patients while liver was involved in only 3 cases. Interestingly, among patients who developed aGVHD, incidence of skin (80%) and liver (22%) involvement were similar to that observed in a similar series of patients receiving related donor transplant using the same RIC plus CsA and MTX instead of MMF while the incidence of gut involvement was significantly higher (64% vs 42%). In conclusion, the RIC used in the current study plus CsA and MMF offers promising results in high risk patients. In terms of GVHD prophylaxis, MMF shows a good efficacy at skin and liver but poor at the gastrointestinal tract.

Role of intravitreal ranibizumab for rapid recovery of central serous chorioretinopathy

2020 ◽  
Vol 14 (2) ◽  
pp. 78-82
Author(s):  
Kamran Shahzad ◽  
Syed Ahmer Hussain ◽  
Muhammad Zafarullah ◽  
Nausherwan Adil
Keyword(s):  
Visual Acuity ◽  
Central Serous Chorioretinopathy ◽  
Rapid Recovery ◽  
Post Injection ◽  
Intravitreal Ranibizumab ◽  
Corrected Visual Acuity ◽  
Department Of Ophthalmology ◽  
Best Corrected Visual Acuity

Background: Central serous chorioretinopathy (CSCR) is an idiopathic disorder in which there is leakage of fluid from hyper permeable choriocapillaris and the collection of fluid between neurosensory and neuropigmentry retina in the macular area that is responsible for decrease visual acuity. CSCR may be acute or chronic. Various treatment options include simple observation, argon laser photocoagulation of the leaking spot, photodynamic therapy (PDT), oral ketoconazole and oral rifampicin are available. Ranibizumab is a monoclonal antibody fragment that act as vascular endothelial growth factor inhibitor, stabilize blood retinal barrier and decrease leakage from choriocapillaris. This study aims to evaluate the role of intravitreal ranibizumab for rapid recovery in central serous chorioretinopathy. Patients and methods: This descriptive case series was carried out at Department of Ophthalmology, Nishtar Medical University Multan, Pakistan from 01-10-2019 till 30-04-2020. The study included twelve eyes of twelve patients suffering from acute CSCR. All patients were given a single injection of intravitreal ranibizumab (0.5mg/0.05ml) as a primary treatment and followed for two months after injection at one week, one month and two months interval to document efficacy of intravitreal ranibizumab. At each baseline and follow up visits, dilated fundus examination was carried out, ending up with patients’ best corrected visual acuity. Central retinal thickness (CRT) was also recorded and results were compared with prior visit results of patients. Major outcomes were the improvement in visual acuity and decrease in CRT. Baseline CRT values were also compared with post injection CRT values at one week, one month and two months intervals using paired sample t-test and best corrected visual acuity (BCVA) was compared using chi–square test. Results: Mean age of the patients was 39.6 years with a male to female ratio of 9:1. Best corrected visual acuity was 6/60 on Snellen chart at baseline. All patients exhibited mean improvement of best corrected visual acuity of three Snellen lines after one week. Eleven patients were back to best corrected visual acuity of 6/6 after one month. Remaining one patient gained best corrected visual acuity of 6/6 after two months of post injection. The mean CRT at presentation was 500 ± 80U (range; 386–580) which reduced significantly to 272 ± 52 U (range 220–338) from baseline after one month showing significant reduction (p<0.001). At the last follow-up visit, the CRT was measured 230 ± 20 U (range 220—250) which shows complete resolution of sub-retinal fluid. Conclusion: Intravitreal ranibizumab can be used for rapid absorption of sub-retinal fluid in acute CSCR and significant reduction in CRT along with improvement in BCVA indicate that it may be safely employed in CSCR to achieve better clinical outcomes.

One year outcome and predictors of treatment outcome in central serous chorioretinopathy: Multimodal imaging based analysis

2021 ◽  
pp. 112067212110550
Author(s):  
Supriya Arora ◽  
Dmitrii S. Maltsev ◽  
Sumit Singh Randhir ◽  
Niroj Kumar Sahoo ◽  
Mahima Jhingan ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Central Serous Chorioretinopathy ◽  
Multimodal Imaging ◽  
Visual Outcome ◽  
Multicentric Study ◽  
Corrected Visual Acuity ◽  
Planning Treatment ◽  
One Year ◽  
Anatomical Outcome

Purpose To evaluate the follow up and treatment outcome of central serous chorioretinopathy (CSCR) based on the new multimodal imaging-based classification and identify the predictors for anatomic and visual outcome. Methods Retrospective, multicentric study on 95 eyes diagnosed with CSCR and a follow up of at least 12 months were included. Eyes with macular neovascularization, atypical CSCR or any other disease were excluded. Results At the baseline, observation was advised to 70% eyes with simple CSCR whereas photodynamic therapy (PDT) was performed in 49% eyes with complex CSCR. Over the follow up, decrease in CMT was significantly higher in simple CSCR as compared to complex CSCR ( P = 0.008) and the recurrences were significantly more in eyes with lower CMT at baseline ( P = 0.0002). Median time of resolution of SRF was 3 months and 6 months in simple and complex CSCR respectively ( P = 0.09). For the 12 months follow up, the median fluid free period was greater ( P = 0.03) while number of interventions performed was lesser in eyes with simple CSCR as compared to complex CSCR ( P = 0.006). Multiple regression analysis showed baseline best corrected visual acuity (BCVA) and baseline persistent SRF to be significantly predictive of BCVA and persistent SRF at 12 months ( P < 0.0001, 0.04) respectively. Conclusions Complex CSCR more often required PDT, was associated with shorter fluid free interval and longer time for SRF resolution. Baseline BCVA and persistent SRF were predictive of final visual and anatomical outcome. The new multimodal imaging based classification is helpful in establishing objective criteria for planning treatment approaches for CSCR.

Fingolimod-associated central serous chorioretinopathy in a young girl

2021 ◽  
Vol 14 (8) ◽  
pp. e243207
Author(s):  
Gajanan Chavhan Pratima ◽  
Doris Benita ◽  
Sandip Sarkar ◽  
Amit Kumar Deb
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Complete Resolution ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Corrected Visual Acuity ◽  
Sphingosine 1 Phosphate ◽  
Eye Examination ◽  
The Right

Fingolimod is a sphingosine-1-phosphate analogue used for the treatment of multiple sclerosis. We, hereby, report a rare case of fingolimod-associated central serous chorioretinopathy (CSCR) in a 21-year-old woman who presented with blurring of vision in the right eye 3 weeks after initiation of oral fingolimod. On examination, best-corrected visual acuity was 20/20 in both the eyes. Fundus examination revealed shallow, serous macular neurosensory detachment in the right eye, and it was confirmed with spectral domain optical coherence tomography. Left eye fundus was normal. Fluorescein angiography showed focal retinal pigment epithelium leak inferior to the fovea. A diagnosis of fingolimod-associated CSCR was made. Oral fingolimod was discontinued. Subsequent follow-up visits showed partial resolution of CSCR at 2 weeks and at 1 month and complete resolution of the subretinal fluid at 2 months. CSCR is, therefore, a rare adverse effect of oral fingolimod treatment. Baseline eye examination and subsequent follow-up at regular intervals are recommended for patients on fingolimod.

Hematopoietic Stem Cell Transplantation As a Successful Salvage Strategy for Relapsed Acute Promyelocytic Leukemia (APL): A Mayo Clinic Series

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3995-3995
Author(s):  
Gita Thanarajasingam ◽  
James M. Foran ◽  
Vivek Roy ◽  
Lisa Sproat ◽  
William J. Hogan ◽  
...  
Keyword(s):  
Induction Therapy ◽  
Mayo Clinic ◽  
Disease Status ◽  
Patient Characteristics ◽  
Single Institution ◽  
Hematopoietic Stem ◽  
Allogeneic Hct ◽  
Autologous Hct

Abstract Background: Relapse after ATRA-based induction therapy is relatively uncommon in patients with acute promyelocytic leukemia (APL). Long term follow up studies have estimated a 15-25% relapse rate. Autologous and allogeneic hematopoietic stem cell transplantation (HCT) has been used as an effective salvage strategy. We present a single institution study of the outcomes of patients with relapsed APL that underwent HCT. Methods: After due IRB approval, the Mayo Clinic Transplant Database was retrospectively reviewed to identify all patients across three Mayo Clinic sites with relapsed APL that underwent HCT from 1995-2013. Data was abstracted at diagnosis and at relapse. The aims of this study were to report the descriptive characteristics of patients, with a focus on HCT outcomes. Results: Baseline Patient Characteristics A total of 15 patients (9 (60%) males) with relapsed APL that underwent HCT were identified. Median age was 36 years (range: 19-63) and median follow up from diagnosis was 8.8 years (range: 1.7-17). 2 (13%) deaths (1 from relapse) were recorded. 14 (93%) received ATRA and anthracycline-based induction therapy and 1 received anthracycline-based induction without ATRA. All relapsed patients achieved a complete remission (CR) after induction. Median time to relapse was 1.6 years (range: 0.6-3.9). 10 (67%) patients had a medullary relapse (hematologic-7(70%), cytogenetic -2 (20%) and molecular-1(10%)), 3 (20%) had additional extramedullary (EM) disease (CNS-2, myeloid sarcoma-1), while 2 (13%) presented with EM disease only (CNS-2). Salvage regimens included ATRA in 5 (33%) patients and arsenic trioxide (ATO) in 8 (53%) patients. 12 (80%) patients were transplanted in CR2 and 1 in CR3 (7%), while 2 (13%) had persistent disease (PD) at time of HCT. Allogeneic HCT 4 (27%) patients with a median age of 37 years (range: 33-49) underwent allogeneic HCT. 2 (50%) patients received myeloablative (MA) conditioning and 2 received reduced-intensity conditioning (RIC). 2 patients who underwent MA HCT had PD at time of transplant, while 1 patient in CR3 received a RIC. 2 (50%) patients developed acute GVHD while 2 (50%) had extensive stage chronic GVHD. At a median follow up of 2.6 years (range: 0.3-10.9), 3 (75%) patients remain alive and disease-free. 1 patient died of infectious complications within 100 days of transplant. Autologous Transplantation 11 (73%) patients with a median age of 40 years (range: 23-68) underwent autologous HCT with MA conditioning. 7 (64%) patients were in molecular remission at time of HCT, 3 (27%) patients transplanted before 2004 were in cytogenetic remission and information about type of remission was unavailable in 1 patient. At a median follow up of 6.8 years (range: 0.5-16) since HCT, 1 (9%) patient had a documented relapse at 175 days after HCT and died of disease-related complications. 10 (91%) are alive and in remission. Conclusions: Our single-institution study reaffirms the efficacy of HCT for APL patients with medullary and EM relapse. Autologous HCT has excellent long-term results in selected patients in CR2. Allogeneic HCT was mainly reserved for patients with high risk disease (CR3) and persistent disease at time of HCT. Table 1: Baseline Patient Characteristics N (%) Number of patients 15 Follow up (years) (median, range) 8.8 (1.7-17) Age at diagnosis (years) (median, range) 36 (19-53) Gender Male 9 (60%) Female 6 (40%) Sanz risk score High 4 (29%) Intermediate 8 (57%) Low 2 (14%) Induction Regimen ATRA + anthracycline 14 (93%) Anthracycline-based 1 (7%) Response to induction therapy CR 15 (100%) Time from diagnosis to relapse (years) (median, range) 1.6 (0.6 - 3.9) Type of relapse Hematologic 7 (47%) Cytogenetic 2 (13%) Molecular 1 (7%) Hematologic and EM 3 (20%) CNS only 2 (13%) Salvage regimen ATRA-based 5 (33%) ATO-based 8 (53%) Chemotherapy only 2 (13%) Table 2: Outcomes at HCT N (%) Age at HCT (years) (median, range) 38 (23-68) Disease status at HCT CR2 12 (80%) CR3 1 (7%) PD 2 (13%) Type of HCT Allogeneic 4 (27%) Autologous 11 (73%) Conditioning regimen Myeloablative 13 (87%) Non-myeloablative 2 (13%) Follow up since HCT (years) (median, range) 4.5 (0.3 - 16.3) Disease status at last follow up CR 13 (86%) Relapsed disease 1 (7%) Unable to assess 1 (7%) Alive at last follow up 13 (87%) Disclosures No relevant conflicts of interest to declare.

scholarly journals LO004: Short-term risk of arrhythmias among syncope patients presenting with atrial fibrillation/flutter to Canadian emergency departments

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S31-S31
Author(s):  
C. Toarta ◽  
K. Kwong ◽  
I.G. Stiell ◽  
M.A. Mukarram ◽  
M. Taljaard ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Baseline Risk ◽  
Future Research ◽  
Short Term ◽  
Secondary Outcomes ◽  
A Prospective Study

Introduction: Short-term risk of arrhythmia or death among emergency department (ED) syncope patients with atrial fibrillation/flutter (AFF) has not been reported in the literature. Our objectives were to assess the incidence and the independent risk of 30-day arrhythmia or death for syncope patients with AFF after ED disposition. Methods: We conducted a prospective study at 6 Canadian academic EDs to include adults with syncope. We collected demographic, clinical and ECG characteristics while our outcome assessments were completed by medical records review and by telephone follow-up of patients after 30 days. Primary outcome was arrhythmia or death within 30-days after ED disposition and secondary outcomes included non-arrhythmic cardiac and non-cardiac outcomes. We performed descriptive and logistic regression analyses. Results: We enrolled 4,266 patients: mean age 53.4 years, 55.4% females, and 8.5% with AFF. After excluding those with outcomes in the ED, lost to follow-up and those with other non-sinus rhythms, 3,417 patients in the sinus and 280 patients in the AFF groups were analyzed. The incidence of arrhythmia or death was significantly higher in the AFF group (Relative Risk 5.1; 95% CI 3.1-8.4; p<0.0001) but there were no significant differences in secondary outcomes between the groups. The unadjusted odds ratio for 30-days arrhythmia or deaths among ED syncope patients with AFF was 5.4 (95% CI 3.2- 9.2). After adjusting for important baseline risk factors by multivariable analysis, the odds ratio for arrhythmia or death in patients with AFF was 1.5 (95% CI 0.8-2.7). Conclusion: The risk of AFF for 30-day arrhythmia or death among syncope patients after ED disposition is higher but is attenuated when adjusted for important patient characteristics. Future research should assess long-term outcomes among syncope patients with AFF to guide follow-up after ED discharge.

scholarly journals The efficacy of intravitreal conbercept for chronic central serous chorioretinopathy: a retrospective clinical study

2019 ◽  
Author(s):  
Jianbo Mao ◽  
Caiyun Zhang ◽  
Chenyi Liu ◽  
Lijun Shen ◽  
Jimeng Lao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Clinical Study ◽  
Central Serous Chorioretinopathy ◽  
Central Macular Thickness ◽  
Chronic Central Serous Chorioretinopathy ◽  
Corrected Visual Acuity ◽  
Retrospective Clinical Study ◽  
The Difference ◽  
Best Corrected Visual Acuity

Abstract Background: To evaluate the efficacy and safety of conbercept for patients with chronic central serous chorioretinopathy (CSC). Methods: A retrospective clinical study. This study included twenty-seven patients (32 eyes) who were diagnosed with chronic CSC in our hospital from November 2015 to March 2018. All the patients received intravitreal conbercept with one intravitreal injection and pro re nata (PRN). Follow-up observations occurred at 1 week and 1, 2, 3, and 6 months after initial injection. Observed indicators included best-corrected visual acuity (BCVA), central macular thickness (CMT) and presence of subretinal fluid (SRF). Results: During the 6-month follow-up, the mean number of injections required and performed was 1.50±0.67. The BCVA at the first visit, 1-week, 1-, 2-, 3- and 6-month follow-ups after the first injection was 0.44±0.26, 0.39±0.29, 0.38±0.29, 0.33±0.29, 0.31±0.30, and 0.31±0.29, respectively. The difference between the BCVA at each follow-up and the first visit was statistically significant (F=9.717, P<0.05). CMT at the first visit, 1-week, 1-, 2-, 3- and 6- month after first injection was 323.25±158.49μm, 263.78±122.52μm, 222.34±92.46μm, 195.63±69.18μm, 189.25±68.71μm, and 200.47±86.30μm, respectively. The difference between the CMT at each follow-up and the first visit was also statistically significant (F=17.072, P<0.05). Full resolution of fluid was achieved in 7 (21.9%) eyes at 1 month, 14 (43.8%) eyes at 2 months, 19 (59.4%) eyes at 3 months and 23 (71.9%) eyes at 6 months after the initial treatment of anti-VEGF injection. No severe adverse event was noted relevant to the therapy. Conclusion: Intravitreal injection of conbercept can effectively reduce the CMT and improve the BCVA in chronic CSC in a short term of 6 months. Keywords: Chronic central serous chorioretinopathy, Conbercept, Best-corrected visual acuity, Central macular thickness.

Prognostic Impact of JAK2V617F Mutation In MDS: a Matched Case Control Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 440-440
Author(s):  
Benoit de Renzis ◽  
Eric Wattel ◽  
Odile Beyne-Rauzy ◽  
Laurent Knoops ◽  
Françoise Boyer ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Cox Model ◽  
Univariate Analysis ◽  
Patient Characteristics ◽  
Jak2v617f Mutation ◽  
Prognostic Impact ◽  
Jak2 Mutation ◽  
Platelet Counts ◽  
A Prospective Study

Abstract Abstract 440 Background: The JAK2V617F mutation is found in a small proportion of MDS, especially in RARS-T and occasionally in other MDS subtypes, but the overall impact of JAK2V617F on MDS characteristics and outcome remains unclear. Method: Diagnostic and follow up data on MDS patients (pts) with known JAK2V617F mutation status were collected from 19 centers of the Groupe Francophone des Myélodysplasies (GFM) and the French Intergroup of MPN (FIM). MDS post MPN and CMML were excluded. Patient characteristics and outcome according to JAK2V617F status were analyzed by univariate analysis. Survival analysis with Cox model matched on age, IPSS score and sex according to JAK2 status was also made. Analysis was performed using STATA 10.0 software. Result: 161 cases were collected, including 65 JAK2V617F mutated (JAK2 pos) and 96 unmutated (JAK2 neg) cases. Median age was 75 years and M/F ratio 1.2 in JAK2 pos vs 71 years (p=NS) and 1 (p=NS) in JAK2 neg pts, respectively (resp). WHO 2008 distribution was RA (8%), RARS (12%), RARS-T (41%), CRDM (15%), RAEB-1 (11%), RAEB-2 (5%), 5q- (3%), unclassified (5%) in JAK2 pos pts and RA (25%), RARS (9%), RARS-T (1%), CRDM (14%), RAEB-1 (28%), RAEB-2 (19%), 5q- (1%), unclassified (3%) in JAK2 neg pts, resp (p&lt;0.001). Hb (median 103 vs 98 g/L, p=NS) and MCV (98 vs 98 fL, p=NS) were similar in JAK2 pos and JAK2 neg pts resp but WBC (median 7.3 vs 4.4 G/L, p&lt;0.001), ANC (4.85 vs 2.1 G/L, p&lt;0.001) and platelets counts (541 vs 160 G/L p&lt;0.001) were higher in JAK2 pos than in JAK2 neg pts. Conversely, marrow blasts % was significantly lower in JAK2 pos than in JAK2 neg pts (median 2% vs 4%, p&lt;0.001). Karyotype was abnormal in 40% JAK2 pos pts (10% +8, 17% del5q, 7% −7/del7q, 3% del20q) and in 35% JAK2 neg pts (3% +8, 5% del5q, 2% −7/del 7q, 3% del20q) (p=NS). Unfavorable karyotypes (complex and −7/del7q) were seen in 9% JAK2 pos and 13% JAK2 neg pts (p=NS). IPSS was low or int-1 in 93% JAK2 pos and in 82% JAK2 neg pts (p=0.056). Median follow up was 44 months [8-350] in JAK2 pos and 62 months [25-182] in JAK2 neg pts. Progression to AML occurred in 6% JAK2 pos and in 20% JAK2 neg pts (p&lt;0.001). 5-year OS was 88% in JAK2 pos and 57.8% in JAK2 neg pts (p&lt;0.001). When the analysis was performed after exclusion of RARS-T (n=133) median age was 74 years and M/F 1.1 in JAK2 pos vs 70 years (p=NS) and 0.7 (p=NS) in JAK2 neg pts resp. Hb (median 103 vs 98 g/L, p=NS) and MCV (102.5 vs 98 fL, p=NS) remained similar in JAK2 pos and JAK2 neg pts, resp. WBC (median 6.4 vs 4.4 G/L, p&lt;0.001), ANC (3.88 versus 2.1 G/L, p=0.001) and platelet counts (268 versus 156 G/L p&lt;0.001) were still higher in JAK2 pos than in JAK2 neg pts. Marrow blasts % was still significantly lower in JAK2 pos than in JAK2 neg pts (median 2% vs 4%, p=0.016). IPSS was low and int-1 in 88% JAK2 pos and in 82% JAK2 neg pts (p=NS). Progression to AML occurred in 9.7% JAK2 pos and in 20% JAK2 neg pts (p=NS). 5 year OS was 92.2% in JAK2 pos and 57.6% in JAK2 neg pts (p=0.0052). When survival analysis was matched on age, IPSS and sex, JAK2 mutation was associated with better OS both in the whole population (p=0.011) and after excluding RARS-T (p=0.028). Finally, in JAK2 pos RARS-T pts (n=27) no AML progression was seen, and 5-year OS was 84.9%. Conclusion: We found JAK2V617F mutation in MDS to be associated with higher WBC, ANC and platelet counts, lower % marrow blasts, less progression to AML and better survival than JAK2V617F neg MDS. This positive prognostic impact persisted after exclusion of RARS-T. However, our results will require confirmation in a prospective study. Disclosures: Fenaux: CELGENE, JANSSEN CILAG, AMGEN, ROCHE, GSK, NOVARTIS, MERCK, CEPHALON: Honoraria, Research Funding.

Immediate Allogeneic Hematopoietic Cell Transplantation (HCT) in Acute Myeloid Leukemia (AML) Arising From Myelodysplastic Syndrome (MDS)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2031-2031
Author(s):  
Sung-Doo Kim ◽  
Yunsuk Choi ◽  
Young-Hun Park ◽  
Jae Seok Lee ◽  
Dae-Young Kim ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Hematopoietic Cell Transplantation ◽  
Conflicts Of Interest ◽  
Disease Status ◽  
Patient Characteristics ◽  
Allogeneic Hct ◽  
Leukocyte Counts ◽  
Matched Sibling ◽  
The Difference

Abstract Abstract 2031 Introduction: Treatment of secondary AML arising from MDS is unsatisfactory. Induction rate of complete remission (CR) is low with standard inuction chemotherapy regimen and relapse is common without allogeneic HCT. Immediate allogeneic HCT without induction chemotherapy can be an option if an appropriate donor is available in patients whose disease progress into AML from MDS. We intended to analyze the benefit of immediate allogeneic HCT versus induction chemotherapy in patients with AML arising from MDS. Methods: Between 1991 and 2010, 95 patients were diagnosed with AML that had evolved from antecedent MDS. After the diagnosis of AML, 10 patients received supportive care only. This retrospective study involved analysis of data from remaining 85 patients; 11 proceeded to immediate allogeneic HCT without induction chemotherapy (HCT group) and 74 were treated with induction chemotherapy (IC group). The clinical outcomes between the HCT group and the IC group were compared. Results: Median age was 48 years (range, 18–78). Patient characteristics at the time of AML diagnosis were similar between the HCT and IC groups except total leukocyte counts, which were higher in the IC group than the HCT group (P=0.009). Patients in the IC group were initially treated with induction chemotherapy consisted mostly of cytarabine plus daunorubicin or idarubicin, while those in the HCT group received allogeneic HCT from HLA matched sibling donors (n=7) or unrelated volunteers (n=4). Thirty-one patients (41.9%) in the IC group achieved CR with induction chemotherapy, whereas 9 (81.8%) in the HCT group achieved CR after HCT (P=0.013). Of 74 patients in IC group, 28 underwent allogeneic HCT in their disease status of the first CR (n=13), primary refractory disease (n=10), or the first or second relapse (n=5). The median follow-up duration for surviving patients was 8.2 months (range, 0.2–171.3). During this time, 62 patients died, 16 relapsed after CR, and 68 died or relapse. The median overall survival (OS) and event-free survival (EFS) were 8.3 and 6.4 months, respectively. Relapse probability at 5 years was 49.2%. The HCT group showed a significantly longer EFS than did the IC group (median 29.2 vs. 5.2 months, P=0.042). OS of the HCT group was higher than that of the IC group, but the difference was not statistically significant (median 34.6 vs. 7.6 months, P=0.149). Relapse probability was not significantly different between the two groups (35.7% vs. 53.1% at 5 years, P=0.278). After adjustment for other variables, the HCT group showed significantly better outcomes than did the IC group in terms of CR rate (HR, 11.195; 95% CI, 1.940–64.619; P=0.007) and EFS (HR, 0.384; 95% CI, 0.163–0.905; P=0.029). Conclusions: Immediate allogeneic HCT is a viable option in AML arising from MDS if an appropriate donor is available. Disclosures: No relevant conflicts of interest to declare.

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