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: Little is known about mental health disorders among patients with hematologic malignancies. As depression and anxiety substantially impair the quality of life of patients with cancer, the Institute of Medicine recommends diagnosis and management of these disorders as an integral part of cancer care (Cancer Care for the Whole Patient, IOM, 2008). Moreover, it has been suggested that non-White patients are less likely to disclose depression and anxiety to physicians due to concerns about stigma, and that physicians also inadequately screen this population (Bell, Annals FM, 2011). We aimed to characterize the prevalence and sociodemographic predictors of pre-diagnostic and cancer-associated (CA) depression and anxiety among patients with hematologic malignancies in the United States. Methods: We conducted a retrospective analysis using the Surveillance Epidemiology and End Results (SEER)-Medicare database. Patients ≥ 67 years old diagnosed with a hematologic malignancy (lymphoma, myeloma, leukemia, or myelodysplastic syndromes) between 2000 and 2015 who died prior to December 31, 2016 were eligible for inclusion. We examined prevalence of pre-diagnostic depression or anxiety, defined as having at least one inpatient or two outpatient Medicare claims for depression or anxiety starting from 24 months to 1 month prior to their blood cancer diagnosis. We also examined prevalence of CA-depression or anxiety, defined as at least one inpatient or two outpatient claims for these conditions between 1 month prior to and 3 months after their blood cancer diagnosis. CA-depression or anxiety were mutually exclusive with pre-diagnostic depression or anxiety respectively. We performed univariable analysis to determine sociodemographic and clinical covariates of CA-depression or CA-anxiety. Next, we fit multivariable logistic regression models to characterize factors independently associated with these two outcomes, adjusting for potential confounders: blood cancer type, age, sex, race, marital status, income, education, comorbidity regardless of univariable significance, and additional variables with p<0.05 in univariable analysis. Results: A total of 64,018 patients were eligible, of which 53.4% had lymphoma, 18.6% myeloma, 18.0% leukemia, and 10.0% myelodysplastic syndromes. Most patients were White (89.6%) and 51.0% were female. Of the entire cohort, 10.6% had pre-diagnostic depression, 4.4% had CA-depression, 7.4% had pre-diagnostic anxiety, and 2.8% had CA-anxiety. Overall, 20.7% of the cohort met our claims-based definition of at least one of these four mental health disorders. In univariable analysis, patients with CA-depression were more likely to have pre-diagnostic anxiety (10.7% vs. 7.3%, p<0.001), have a high comorbidity score (37.5% vs. 31.8%, p<0.001), be female (56.7% vs. 50.6%, p<0.001), and be unmarried (55.3% vs. 52.0%, p=0.001) versus patients without CA-depression. They were also less likely to be non-White (8.8% vs. 10.5%, p=0.005). All associations except marital status remained significant in multivariable analysis (Table 1). In univariable analysis, patients with CA-anxiety were more likely to have pre-diagnostic depression (18.9% vs. 10.4%, p<0.001) and be female (63.2% vs. 50.5%, p<0.001); they were also less likely to be non-White (7.7% vs. 10.5%, p<0.001) compared to patients without CA-anxiety. All associations remained significant in multivariable analysis (Table 2). Conclusions: In this large cohort of patients with blood cancers, more than one in five individuals struggled with depression or anxiety either before their blood cancer diagnosis or as a new mental health syndrome during the three months afterward. These data suggest a critical need for systematic mental health screening and management for this patient population. Moreover, the fact that patients with pre-diagnostic anxiety or depression were at increased risk of developing CA-depression or anxiety respectively emphasizes the importance of additional psychosocial support for patients with pre-existing mental disorders. Finally, our finding that non-White patients were significantly less likely to develop CA-depression or anxiety is provocative, and suggests that either non-White patients with hematologic malignancies have a lower incidence of these disorders or that the mental health concerns of this population are less likely to be routinely captured. Disclosures No relevant conflicts of interest to declare.
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