Economic and medical consequences of myelodysplastic syndromes from a medical perspective

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Background: The myelodysplastic syndromes (MDS) are a heterogeneous group of bone marrow failure diseases affecting the elderly. The economic impact on Medicare of MDS is largely unknown. A retrospective analysis of total healthcare resource use and cost of MDS patients (pts) was conducted. Methods: The Medicare Standard Analytic File 5% (SAF5%) claims database was used to identify pts with a new primary MDS diagnosis code in first quarter (Jan-Mar) 2003 then followed through Dec 2005. Pts with myeloid leukemia or anemias of known causes in the previous year were excluded. Newly diagnosed MDS pts were descriptively characterized based on potential cause of MDS, MDS-related complications, and MDS therapies. Total healthcare costs and resource utilization for MDS pts were analyzed. Results: Of the 1,713,502 pts in SAF5%, 705 (4 per 10,000) developed MDS in first quarter 2003, including those with a previous history of unexplained anemia 159, (23%), chemotherapy or radiotherapy exposure 43, (6%), and de novo 503 (71%). Mean age was 76 (range 29- 98); 49% male, 90% Caucasian. 2003 median Medicare payment for MDS pts was $17,556, compared to $1,459 for the total SAF5% Medicare population (mean: $28,023.67 vs. $6,739.48; p< 0.001). Median Medicare payments for therapy induced were $34,271, prior anemia $17,191, and de novo MDS $16,493. 278 (39%) died; including 63% of the therapy-induced, 40% of the prior anemia and 37% of the de novo. 79% were hospitalized and 59% had at least one emergency room visit. Of 46% receiving blood transfusions 6% were coded with transfusional hemachromatosis. 314 (45%) received growth factor treatments and 108 (15%) chemotherapy. Of those at risk for MDS-related complications, 55%, 23%, and 2% experienced new onset cardiac complications, diabetes, and hepatic diseases, post MDS diagnosis. Additionally, 51% had pulmonary problems and 45% infections in the 3 year study. Conclusions: The majority of newly diagnosed MDS pts develop disease-related complications, resulting in significantly higher healthcare resource utilization and costs compared to non-MDS patients.

No significant financial relationships to disclose.

Knowledge of and Attitudes about Alzheimer Disease Genetics: Report of a Pilot Survey and Two Focus Groups

OBJECTIVES

In preparation for the development of an educational intervention on Alzheimer disease (AD) genetics, we undertook a pilot survey of knowledge in this area and attitudes toward genetic testing for AD among individuals with a family history of AD.

METHODS

For the pilot study, we administered a 30-min questionnaire to 57 unaffected individuals from a genetic linkage study. For the focus groups, we interviewed two groups of subjects, ages 44-70 years, with a family history of AD, one of 10 Caucasians and the other of 6 African-Americans.

RESULTS

The pilot study showed that there was limited knowledge of genetics overall and AD genetics in particular, considerable concern about personal risk, and little knowledge of or interest in genetic testing for the disease. The focus groups reinforced and fleshed out these impressions and highlighted the importance of caregiving experience in the attitudes toward personal risk for AD.

CONCLUSIONS

These results underscore the value of genetics education for this and other complex diseases and suggest specific foci for educational interventions.

Ultrasonic imaging of myocardial vibrations associated with coronary artery disease

Coronary artery disease (CAD) is a major cause of mortality in the western world. Although progress has been made in recent years for the noninvasive diagnosis of CAD, a widely available, inexpensive and effective diagnostic solution remains elusive. We have developed a novel ultrasound-based technology to detect and analyze the myocardial vibrations associated with diastolic murmurs produced by CAD. Conventional ultrasound imaging systems suppress these vibrations. We have developed algorithms to process the raw ultrasound data and isolate these vibrations and integrated them into a programmable ultrasound system for real-time vibration imaging. In preliminary results from clinical studies of patients with CAD, we have observed localized areas of vibrations in the neighborhood of the stenosed coronary artery. The vibrations are narrowband with frequency >200 Hz, and appear to have harmonic components, thus indicating reasonance phenomena potentially with nonlinear mechanisms involved. No such vibrations were observed in normal subjects. Analysis of myocardial vibrations could provide a noninvasive diagnostic test for CAD that overcomes many of the limitations of conventional noninvasive tests. Potentially, this technology could provide a new way of evaluating CAD and cardiac function.

Ultrasonic imaging of myocardial vibrations associated with coronary artery disease

Coronary artery disease (CAD) is a major cause of majority in the western world. Although progress has been made in recent years for the noninvasive diagnosis of CAD, a widely available, inexpensive and effective diagnostic solution remains elusive. We have developed a novel ultrasound-based technology to detect and analyze the myocardial vibrations associated with diastolic murmurs produced by CAD. Conventional ultrasound imaging systems suppress these vibrations. We have developed algorithms to process the raw ultrasound data and isolate these vibrations and integrated them into a programmable ultrasound system for real-time vibration imaging. In preliminary results from clinical studies of patients with CAD, we have observed localized areas of vibrations in the neighborhood of the stenosed coronary artery. The vibrations are narrowband with frequency >200 Hz, and appear to have harmonic components, thus indicating resonance phenomena potentially with nonlinear mechanisms involved. No such vibrations were observed in normal subjects. Analysis of myocardial vibrations could provide a noninvasive diagnostic test for CAD that overcomes many of the limitations of conventional noninvasive tests. Potentially, this technology could provide a new way of evaluating CAD and cardiac function.

Dasatinib in patients with chronic phase chronic myeloid leukemia (CP-CML) who are resistant or intolerant to imatinib: Results of the CA180013 ’START-C’ Study

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Background: Dasatinib (BMS-354825) is a novel, oral, multi-targeted kinase inhibitor of BCR-ABL and SRC kinases with proven preclinical and clinical activity against imatinib resistant BCR-ABL mutations. Methods: CA180013 is an open-label Phase II study of dasatinib in imatinib-resistant (IM-R) or -intolerant (IM-I) patients (pts) with CP-CML. Between February-August 2005, 424 pts were recruited from 75 centers worldwide. Dasatinib was given at 70 mg twice daily (BID) with dose escalation to 90 mg BID in pts lacking response, and dose reductions to 50 and 40 mg BID for toxicity. Evaluations were weekly blood counts for the first 12 weeks; bone marrow cytology and cytogenetics every 3 months. The primary endpoint was rate of major cytogenetic response (MCyR; ≤35% Philadelphia pos. metaphases) in IM-R pts. Results: Data are currently available from the first 186 pts (127 IM-R, 59 IM-I) accrued prior to May 12, 2005. Median age was 59 yrs (range 24–79); 46% were male. Median time from diagnosis of CML was 64 months. Of the IM-R pts, 72% received IM >3 yrs, and 72% had >600 mg/day of IM. Overall, 70% had received prior interferon alpha. 62 (33%) pts achieved a prior MCyR to IM. With ≥6 months of follow up, 168 (90%) pts had a complete hematologic response (CHR). MCyR were achieved in 83 (45%) pts including 40 (31%) of IM-R pts, and 43 (73%) of IM-I pts. Mutations in the BCR-ABL domain were found in 65/176 (37%) pts; 57 (88%) achieved CHR, and 24 (37%) MCyR. Molecular response analysis is ongoing. 160 (86%) pts remain on study without progression. Grade 3/4 neutropenia or thrombocytopenia was reported in 83 (45%) pts and 85 (46%) pts with onset after 4–8 weeks of therapy in most pts. Temporary dose interruptions occurred in 146 (78%), and dose reductions in 96 (52%) pts with a median daily of 108 (range 19–169) mg. Non-hematologic toxicity consisted mainly of Grade 1/2 diarrhea, headache, superficial edema, and pleural effusion, with ≤2% Grade 3/4. There was no cross-intolerance between dasatinib and IM. Conclusions: Dasatinib demonstrated substantial hematologic and cytogenetic activity in IM-R and IM-I pts with CP-CML. An updated analysis of 424 pts with ≥6 months of follow up will be presented.

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Intra-European Differences in the Radiotherapeutic Management of Breast Cancer: A Survey Study

AIMS

To document and explain self-reported practices of the radiotherapeutic management of breast cancer within different European regions.

METHODS

An original survey questionnaire was developed to assess radiation oncologists' self-reported management of breast cancer. The questionnaire was distributed to physician members of the American Society for Therapeutic Radiology and Oncology and the European Society of Therapeutic Radiation Oncology. This paper presents the results of the comparative analysis of 702 responses from North America and 435 responses from Europe.

RESULTS

Several areas of variation are identified. These include the selection criteria for post-mastectomy radiation and radiation for ductal carcinoma in situ (DCIS). Variations are also seen in the management of regional lymph nodes after lumpectomy, and radiation dose and fractionation.

CONCLUSIONS

Radiation oncologists within Europe vary in their self-reported practices for managing women with breast cancer. These differences may be rooted in deeper cultural differences and differences in the healthcare systems of different European countries. They may also reflect differences in the relative weight radiation oncologists place upon data generated within their own countries. These results support the need for co-operative group trials to provide evidence for more uniform treatment recommendations and policies.

Vortex nanoliquid in high-temperature superconductors

Using a differential magneto-optical technique to visualize the flow of transport currents, we reveal a new delocalization line within the reversible vortex liquid region in the presence of a low density of columnar defects. This line separates a homogeneous vortex liquid, in which all the vortices are delocalized, from a heterogeneous "nanoliquid" phase, in which interconnected nanodroplets of vortex liquid are caged in the pores of a solid skeleton formed by vortices pinned on columnar defects. The nanoliquid phase displays high correlation along the columnar defects but no transverse critical current.

Negative mass instability for interacting particles in a 1D box: theory and application

We demonstrate that the synchronization effect observed [Pedersen et al., Phys. Rev. Lett. 87, 055001 (2001)]], when a bunch of ions oscillates between two mirrors in an electrostatic ion beam trap, can be explained as a negative mass instability. We derive simple necessary conditions for the existence of a regime in which this dispersionless behavior occurs and demonstrate that in this regime, the ion trap can be used as a high resolution mass spectrometer.