Background: Palliative care seeks to support the physical, psycho-social and spiritual needs of patients and families who are facing life threatening diseases. Advantages of establishing a palliative care unit, or alternatively co-locating patients, include promoting optimal physical and psychological symptom management; increased family satisfaction; and facilitating resource allocation. Objective: To design a stand-alone hospital unit to provide end of life care during a pandemic. Setting: Mount Sinai Hospital (MSH), a 1,144 bed tertiary-and quaternary-care teaching facility and Brookdale
Therapy-related AML (T-AML) and myelodysplastic syndromes (t-MDS) are aggressive diseases with poor outcomes and remain a therapeutic challenge. In a retrospective study, we assessed the outcomes of patients with t-AML, with or without anteceding t-MDS, treated with allo-SCT. The study included 109 patients with t-AML with a median age of 55 years and male to female ratio of 0.6 (M¼ 41 and F¼68). The majority of the patients had a history of hematological malignancies (51%) followed by solid tumors (48%) treated with chemotherapy and/or radiation. The most common prior treatment included anthracycline-based regimens (41%) and radiation (41%). 44 of 109 patients had anteceding t-MDS (58%) while 62 had de novo t-AML. 57 of 109 patients, including 30 with prior t-MDS, received alloSCT (52%). We analyzed group differences in Relapse Free Survival (RFS) and Overall Survival (OS) using Kaplan-Meier Curves. We compared RFS and OS of all patients who received allo-SCT vs those who did not and (2) between patients who had t-MDS prior to t-AML and those with de novo t-AML using the log rank test. Patients who received allo-SCT had a significantly longer RFS (19 vs 7 months) (P¼ 0.0101). Furthermore, OS was also statistically significant between the two groups (P¼0.0128) as the alloSCT-positive group had a longer OS (28 months) when compared to patients who did not receive alloSCT (9 months). Additionally, among the patients who received alloSCT, the difference for OS was also significant between the ones with prior t-MDS vs those with de novo t-AML (P¼ 0.00281) while the RFS did not significantly differ between these two subgroups (P¼0.1322). Our results confirmed that t-MDS and t-AML have very poor prognosis. Patients that were able to get an alloSCT had significantly better outcomes; therefore, further optimization of alloSCT including alternative donors and optimal conditioning regimens may improve the clinical course.
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