The bone resorption marker Ntx provides valuable prognostic information in patients with bone metastases receiving bisphosphonates.

Baseline and recent bone marker levels were predictive of negative clinical outcomes in patients with bone metastases secondary to prostate cancer and to NSCLC and other solid tumors. N-telopeptide levels were more consistent prognostic indicators than bone-specific alkaline phosphatase for all tumor types, reflecting the key role of osteolysis in the development of skeletal complications.

Objective. To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis, and to identify risk factors for its development.Methods. The study was designed as a prospective cohort study involving psoriasis patients who did not have a diagnosis of arthritis at the time of study enrollment. Information was collected about lifestyle habits, comorbidities, psoriasis activity, and medications. Patients who developed inflammatory arthritis or spondylitis were classified as having PsA if they fulfilled the criteria of the Classification of Psoriatic Arthritis Study group. The annual incidence of PsA was estimated using an event per person-years analysis. Cox proportional hazards models, involving fixed and timedependent explanatory variables, were fitted to obtain estimates of the relative risk (RR) of the onset of PsA, determined in multivariate models stratified by sex and controlled for age at onset of psoriasis.Results. The data obtained from the 464 patients who were followed up for 8 years were analyzed. A total of 51 patients developed PsA during the 8 years since enrollment. The annual incidence rate of PsA was 2.7 cases (95% confidence interval 2.1-3.6) per 100 psoriasis patients. The following baseline variables were associated with the development of PsA in multivariate analysis: severe psoriasis (RR 5.4, P 5 0.006), low level of education (university/college versus high school incomplete RR 0.22, P 5 0.005; high school graduate versus high school incomplete RR 0.30, P 5 0.049), and use of retinoid medications (RR 3.4, P 5 0.02). In multivariate models with time-dependent variables, psoriatic nail pitting (RR 2.5, P 5 0.002) and uveitis (RR 31.5, P 5 0.0002) were associated with the development of PsA.Conclusion. The incidence of PsA in patients with psoriasis is higher than previously reported. A severe psoriasis phenotype, presence of nail pitting, low level of education, and uveitis are predictive of the development of PsA in patients with psoriasis.

A noninferiority study was performed comparing low-dose and standard-dose prophylactic platelet transfusions. A double-blind randomized controlled trial (RCT) was performed in 6 sites in 3 countries. Thrombocytopenic adults requiring prophylactic platelet transfusion were randomly allocated to standard-dose (300-600 ؋ 10 9 platelets/product) or low-dose (150-< 300 ؋ 10 9 platelets/product) platelets

BACKGROUND:Anemia may be an important factor contributing to an increased risk of bleeding, particularly in patients with thrombocytopenia. STUDY DESIGN AND METHODS:A multicenter, single-blinded pilot randomized controlled trial (RCT) was performed to evaluate the feasibility of conducting a larger RCT to determine the effect of the hemoglobin (Hb) concentration on bleeding risk. Patients with acute leukemia receiving induction chemotherapy or those undergoing stem cell transplantation were assigned to one of two treatment groups: standard transfusion strategy (transfusion of 2 units of red blood cells [RBCs] when their Hb level was less than 80 g/L) or an augmented transfusion strategy (transfusion of 2 units of RBCs when their Hb level was less than 120 g/L). RESULTS: Sixty patients were enrolled: 29 in the control group and 31 in the experimental group. The proportions of patients experiencing clinically significant bleeding and the time to first bleed were not significantly different between the control and experimental groups. The experimental group received more RBC transfusions (transfusions/patient-day) than the control group (0.233 vs. 0.151; relative risk, 1.56; 95% confidence interval, 1.16-2.10; p = 0.003). The proportion of patient-days with platelet (PLT) transfusions was not different between the experimental and control groups. The mean number of donor exposures (PLT and RBC transfusions) was not different between experimental and control groups. Bleeding symptoms were systematically documented. CONCLUSION: This pilot study thus indicated that it would be feasible to enroll the required number of patients to enable the performance of a large RCT to investigate the effect of Hb on bleeding risk in thrombocytopenic patients. P atients with acute leukemia undergoing induction chemotherapy or patients undergoing stem cell transplantation (SCT) often have prolonged thrombocytopenia both because of the cytotoxic therapies they receive and because of their underlying disorders. The relationship between bleeding and thrombocytopenia has been well described, and bleeding is a frequent complication occurring in this patient population.1-8 Despite the administration of prophylactic or therapeutic platelet (PLT) transfusions, these patients are still at risk of bleeding.Experimental evidence in animal models suggests that the hemoglobin (Hb) concentration may play a role in determining the bleeding risk in patients with thrombocytopenia. In contrast, other groups have suggested that ABBREVIATIONS: AML = acute myeloid leukemia; RCT(s) = randomized controlled trial(s); RR(s) = relative risk(s). acute hemodilution may increase coagulation. 9,10 With a thrombocytopenic rabbit model, Blajchman and coworkers 11 demonstrated the bleeding time to be inversely correlated with the hematocrit (Hct). This study showed that increasing the red blood cell (RBC) mass by RBC transfusion partially corrected the bleeding time in thrombocytopenic anemic rabbits. The reasons for this are not clearly understood, but several mec...

Background The natural history of castration-resistant nonmetastatic prostate cancer is poorly defined. Methods We used data from 331 subjects in the placebo group of a randomized controlled trial to evaluate the relationships between disease and host characteristics with time to first bone metastases in men with prostate cancer, rising PSA despite androgen deprivation therapy, and no radiographic evidence of metastases. Relationships between baseline covariates and clinical outcomes were assessed by Cox proportional hazard analyses. Covariates in the model were age, body mass index, prior prostatectomy, prior orchiectomy, Gleason score, performance status, PSA, urinary N-telopeptide, bone alkaline phosphatase, albumin, lactate dehydrogenase, and hemoglobin. Results At 2 years, 46% of subjects had developed bone metastases and 20% had died. Median bone metastasis-free survival was 25 months. In multivariate analyses, baseline PSA ≥ 13.1 ng/mL was associated with shorter overall survival (relative risk 2.34; 95% CI 1.71, 3.21; p<0.0001), time to first bone metastasis (relative risk 1.98; 95% CI 1.43, 2.74; p<0.0001), and bone metastasis-free survival (relative risk 1.98; 95% CI 1.45, 2.70; p<0.0001). PSA velocity was significantly associated with overall and bone metastasis-free survival. Other covariates were not consistently associated with clinical outcomes. Conclusions In men with progressive castration-resistant prostate cancer and no detectable metastases, baseline PSA was significantly associated with time to first bone metastasis, bone metastasis-free survival, and overall survival. Other disease and host characteristics, including body mass index and bone turnover markers, were not consistently associated with clinical outcomes.

Objective. To establish the frequency and predictors of minimal disease activity in psoriatic arthritis (PsA) and to investigate the prognostic ability of minimal disease activity criteria to predict future joint damage. Methods. The study was conducted using an observational PsA cohort. Patients were classified as being in minimal disease activity if they fulfilled the criteria on consecutive visits for >12 months. Predictive factors for minimal disease activity and joint damage were investigated using regression models. Joint damage progression was based on clinically damaged joint counts. Results. Of the 344 patients, 208 (60%) achieved minimal disease activity at >1 visit and 116 (34%) achieved minimal disease activity for >12 months (sustained minimal disease activity). The average duration of minimal disease activity was 28 months (range 12-48 months). Twelve patients (10%) experienced a flare of disease after 34 months in minimal disease activity. Low erythrocyte sedimentation rate (ESR) and oligoarthritis were predictors of achieving sustained minimal disease activity (P < 0.03). The mean change in damaged joint counts was 0.931 (range 0 -12) in the sustained minimal disease activity group and 2.245 (range 0 -17) in the controls (P < 0.001). Of the sustained minimal disease activity group, 69% showed no progression of joint damage, compared with 51% in the control group. Elevated ESR, baseline joint damage, and use of biologic therapies increased the likelihood of damage progression (P < 0.05). Conclusion. Minimal disease activity was achieved by a significant proportion of patients and was sustained in one-third of the population studied. Patients achieving sustained minimal disease activity had a significant reduction in joint damage progression. Other factors, representing disease activity and disease severity, impact on the likelihood of achieving sustained minimal disease activity and on damage progression.

The prevalence and incidence of psoriasis and PsA in Ontario are similar to those observed in Europe and the United States. The steady increase in the prevalence of psoriasis and PsA over the past decade may be due to a combination of population aging, population growth, and increasing life expectancy. This article is protected by copyright. All rights reserved.