We sought to evaluate the impact of cryopreservation of unrelated donor peripheral blood stem cell (PBSC) grafts on engraftment, chimerism, and immune reconstitution in the context of the Covid-19 pandemic. We reviewed stem cell product characteristics and clinical outcomes in 101 patients receiving cryopreserved PBSCs from unrelated donors (URD) between January 1, 2019, and December 31, 2020, compared with 203 patients receiving fresh URD PBSCs. We observed no differences in 6-month overall survival, progression free survival, or non-relapse mortality. Patients receiving cryopreserved PBSCs had delayed platelet engraftment and impaired reconstitution of white blood cells and T cell subsets at Day 30. Thirty-four percent of patients receiving cryopreserved grafts had CD3 chimerism <50% at Day 30 after transplantation, compared with 14% of patients receiving fresh PBSCs (p=0.0002). At day 100, this difference persisted (CD3+ chimerism <50%: 17% of cryopreserved cohort vs 6% of fresh cohort, p=0.016). Additionally, greater product age at infusion is associated with an increase in graft failure, independent of cryopreservation. Receipt of grafts >48 hours old at time of cryopreservation or infusion significantly increased the risk of graft failure (sHR =4.57 (95% CI 1.71-12.3), p=0.0025). Our data indicate that cryopreservation is associated with similar overall short-term clinical outcomes compared to fresh PBSC. However, patients must be monitored closely for increased risk of other potentially adverse outcomes including graft failure and poor immune recovery, particularly for grafts with older overall age at infusion. Longer term follow-up is needed to determine impact on relapse and survival.
IntroductionNothing has been published to describe the practices of medical societies in choosing abstracts for presentations at their annual meetings. We surveyed medical societies to determine their practices, and also present a theoretical analysis of the topic.MethodsWe contacted a convenience sample of large U.S. medical conferences, and determined their approach to choosing abstracts. We obtained information from web sites, telephone, and email. Our theoretical analysis compares values-based and empirical approaches for scoring system development.ResultsWe contacted 32 societies and obtained data on 28 (response rate 88%). We excluded one upon learning that research was not presented at its annual meeting, leaving 27 for analysis. Only 2 (7%) made their abstract scoring process available to submitters. Reviews were blinded in most societies (21;78%), and all but one asked reviewers to recuse themselves for conflict of interest (96%). All required ≥3 reviewers. Of the 24 providing information on how scores were generated, 21 (88%) reported using a single gestalt score, and three used a combined score created from pooled domain-specific sub-scores. We present a framework for societies to use in choosing abstracts, and demonstrate its application in the development of a new scoring system.ConclusionsMost medical societies use subjective, gestalt methods to select research for presentation at their annual meetings and do not disclose to submitters the details of how abstracts are chosen. We present a new scoring system that is transparent to submitters and reviewers alike with an accompanying statement of values and ground rules. We discuss the challenges faced in selecting abstracts for a large scientific meeting and share the values and practical considerations that undergird the new system.
A recent population-based analysis demonstrated lower risk of the lethal degenerative neuromuscular disease, amyotrophic lateral sclerosis (ALS) associated with history of the use of 'antineoplastic agents' and 'immunosuppressants'. To see if this finding was generalizable to other ALS cohorts, we examined associations between use of these agents and ALS risk in an independent case-control study of n = 414 ALS patients and n = 361 controls in an Eastern US population. Controls were sampled from the general population and among non-neurodegenerative disease patients. A history of chemotherapy treatment was significantly associated with a decreased ALS risk (OR 0.46, 95% CI 0.22-0.89, P = 0.026). We did not observe an association between risk of ALS and immunosuppressant therapy use (OR 0.78, 95% CI 0.50-1.02, P = 0.23). Analyses were adjusted for age, gender, and smoking. Our results support the prior report for chemotherapy treatment and lead to further discussion of the underlying mechanism.
For patients with blood cancers, comorbid mental health disorders at diagnosis likely affect the entire disease trajectory, as they can interfere with disease information processing, lead to poor coping, and even cause delays in care. We aimed to characterize the prevalence of depression and anxiety in patients with blood cancers. Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients 67 years and older diagnosed with lymphoma, myeloma, leukemia, or myelodysplastic syndromes between 2000 and 2015. We determined the prevalence of pre-cancer and cancer-associated (CA) depression and anxiety using claims data. We identified factors associated with CA-depression and CA-anxiety in multivariate analyses. Among 75,691 patients, 18.6% had at least one diagnosis of depression or anxiety. Of the total cohort, 13.7% had pre-cancer depression and/or pre-cancer anxiety, while 4.9% had CA-depression or CA-anxiety. Compared to patients without pre-cancer anxiety, those with pre-cancer anxiety were more likely to have subsequent claims for CA-depression (OR 2.98; 95% CI 2.61-3.41). Other factors associated with higher risk of CA-depression included female sex, non-married status, higher comorbidity, and myeloma diagnosis. Patients with pre-cancer depression were significantly more likely to have subsequent claims for CA-anxiety compared to patients without pre-cancer depression (OR 3.01; 95% CI 2.63-3.44). Female sex and myeloma diagnosis were also associated with CA-anxiety. In this large cohort of older patients with newly diagnosed blood cancers, almost one in five suffered from depression or anxiety, highlighting a critical need for systematic mental health screening and management for this population.
Background: Although accurate prognostic understanding is essential for patients to make informed decisions about their care, little is known regarding understanding of life expectancy among patients with blood cancers approaching end of life. We sought to characterize such perceptions in a cohort of patients with advanced blood cancers. Methods: In October 2020, we began a web-based survey of adult patients with hematologic malignancies recruited from two large cancer centers. Eligibility criteria included: (1) age ≥ 18 years, (2) at least 2 outpatient visits at the study centers, and (3) physician-estimated prognosis of six months or less based on the patient's hematologic oncologist answering "no" to the question: "would you be surprised if this patient died in the next six months?" The 12-month version of this question has been shown to correctly estimate death in 68.3% of patients with blood cancers (Hudson KE, JPM 2018). Among other questions, participants were asked how important it was for them to know how cancer might influence the length of their life, with response options on a 4-point scale ranging from "not important at all," to "very important." We also asked participants if anyone on their healthcare team had ever discussed how long they might expect to live with their cancer, and participants' perception of their life expectancy, with response options of "more than 2 years," "one to two years," "7 to 11 months," "1 to 6 months," and "less than 1 month." We then asked about the most important factor in determining their self-reported prognosis. We summarized responses for prognostic perceptions with relative frequencies (%). We also assessed, in univariable analysis, if patients' reports of prognostic discussion with their healthcare team was associated with self-report of prognosis of "more than 2 years." Results: As of July 2021, 102 patients had completed the survey (response rate: 64.6%). The most common diagnosis was acute leukemia (38.2%), followed by lymphoma (30.4%; Table 1). The median time between diagnosis and completion of survey was 26 months. The majority (91.1%) felt it was "moderately" or "very important" to know how cancer might influence their length of life, but only 47.1% recalled a discussion about life expectancy with their healthcare team. Most respondents (65.7%) felt their life expectancy at the time of the survey exceeded 2 years (Figure). In univariable analysis, patients who reported having had a prognostic discussion with their healthcare team were less likely to estimate their own life expectancy to be greater than 2 years compared to patients who did not (48.9% vs. 81.1%, chi-square p =0.0007). Factors cited to be most important by respondents in estimating their prognosis were their "health/how things had been going with their cancer" (35.3%), "information received from their doctor or healthcare team" (29.4%), "attitude or personal beliefs" (16.7%), "their own research" (9.8%), and "stories they heard from other people" (3.9%). Conclusions: In this cohort of blood cancer patients with a physician-estimated prognosis of ≤ 6 months based on the "surprise question," two-thirds had substantially more optimistic views of their prognosis. Our finding that over 80% of individuals who did not recall a prognostic discussion with their healthcare team thought their own life expectancy to be greater than 2 years suggests that lack of prognostic disclosure contributes to the gap between physician and patient perceptions of prognosis. The fact that almost half of patients who did report having such a discussion had overly optimistic views suggests that additional factors are also putative. Figure 1 Figure 1. Disclosures Huntington: Flatiron Health Inc.: Consultancy; TG Therapeutics: Research Funding; Thyme Inc: Consultancy; Bayer: Honoraria; DTRM Biopharm: Research Funding; SeaGen: Consultancy; AstraZeneca: Consultancy, Honoraria; Novartis: Consultancy; Servier: Consultancy; Genentech: Consultancy; AbbVie: Consultancy; Pharmacyclics: Consultancy, Honoraria; Celgene: Consultancy, Research Funding.
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