Infection, graft-versus-host disease (GVHD), and to a lesser extent sinusoidal obstructive syndrome (SOS) represent the major causes of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT). During the last decade, progress in prevention and treatment of these complications led to improvement in the outcome of these patients. Despite the fact that nonmyeloablative regimens have been increasingly used in elderly patients and in patients with co-morbidities, the nonrelapse related mortality remains a challenge and long-term follow-up is required. The objective of this manuscript is to provide an updated concise review of the complications of AHSCT and of the available treatment interventions.
Introduction:The human epidermal growth factor receptor (HER-2) is a cell membrane surface-bound receptor tyrosine kinase which has been associated with increased breast cancer recurrence and a worse prognosis. Its presence also determines which patients are candidates for targeted therapy with trastuzumab. The purpose of this retrospective study was to determine the percentage of HER-2 status change in recurrent breast cancer.Methods:In this study, we retrospectively reviewed the charts of 2,652 patients diagnosed with breast cancer in our institutution between 2003 and 2009. Forty-four patients with recurrent breast cancer and available HER-2 status at the time of diagnosis and at recurrence were identified. HER-2 status was assessed by immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH). When both methods were available, we used FISH as our reference.Results:A change in HER-2 status at recurrence was observed in six patients (13.6%). One patient (2.3%) changed from negative to positive. Five patients (11.3%) had a change from positive to negative. These five patients represented 50% of the patients with positive HER-2 at the time of initial diagnosis. HER-2 status remained unchanged in thirty-eight patients (86.4%).Conclusion:A change in HER-2 status can be noted at the time of recurrence. The exact mechanism is not yet well understood, and further studies are needed to identify it. Our data support the fact that patients with recurrent breast cancer should have their HER-2 status re-evaluated, since this affects therapeutic options. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5109.
4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.
4969 BACKGROUND Hydroxyurea (HU) is one of the mainstay agents used to treat myeloproliferative disorders as well as sickle cell anemia. There has been lately increasing reports of secondary skin malignancies in patients receiving Hydroxyurea therapy but the literature consists essentially of case reports. Current incidence of melanoma skin cancer in the general population in the United States is 15 per 100 000 person, and of non melanoma skin cancer is 230 per 100 000 lightly pigmented individuals and 3.4 per 100 000 darkly pigmented individuals. METHODS We reviewed 292 charts of patients treated with HU in our institution. 237 patients carried a diagnosis of myeloproliferative disorder, 14 patients were treated for sickle cell anemia and 41 patients were being treated with HU for HIV as part of a regimen to decrease viral load. Charts were reviewed looking for development of skin malignancies. RESULTS Among the patients with sickle cell anemia, the incidence of skin cancer was nil. Among the patients with HIV there were 2 cases of non melanoma skin cancer. Among patients with myeloproliferative disorders, there were 16 cases of skin cancer. The pathology was non-melanoma skin cancer. Subgroup analysis based on skin phenotype revealed that the incidence was higher than the general population in both dark and light-skinned individuals: the rate was 0.9434 per 100 among the dark skinned individuals, statistically significant when compared to the established rate of 0.0034 per 100 dark-skinned individual in the general population. Similarly among light-skinned individuals, the calculated rate was 12.0968 per 100-person, which is statistically significant compared to the rates in light-skinned individuals in the general population of 0.2300 per 100 person with a p-value of 0.001. CONCLUSION Our study showed a significantly higher incidence of non-melanoma skin cancer among patients treated with HU. While HU is well known to have cutaneous side effects in terms of hyperpigmentation, skin ulcers, scaling or skin atrophy, its implication in skin cancers had only been in the form of case reports. Our study thus highlights a true risk of skin malignancies with HU. It is worth noting though that there were only non-melanoma skin cancers, which are non-aggressive, localized and treatable. Thus this heightened incidence of skin cancer does not appear to bear a mortality or morbidity burden on patients treated with HU. Disclosures No relevant conflicts of interest to declare.
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