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Đukić L, Soulis G, Janssens B, Müller F, Petrovic M, Kossioni A. Appropriate use of antibiotics for oral/dental conditions in older adults: a narrative review. Acta Clin Belg 2024; 79:193-204. [PMID: 38795066 DOI: 10.1080/17843286.2024.2359182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES Considering the high rates in the use of antibiotics for oral/dental conditions in older patients and the rise in antimicrobial resistance, appropriate antibiotic prescription is important. This narrative review aimed to discuss the challenges and special considerations when prescribing antibiotics to older patients for oral/dental conditions. METHODS PubMed/MEDLINE, Scopus, Web of Science, and articles' reference lists were searched for antibiotics use for oral conditions by older patients. Moreover, scientific and professional organisations' official websites were searched for guidelines on antibiotic use in dentistry. RESULTS Despite several guidelines about the use of antibiotics in dentistry, specific information on their administration to older patients is missing. Relevant challenges include age-related changes in pharmacokinetics and pharmacodynamics, comorbidities and polypharmacy associated with low adherence, contraindications, adverse reactions, and drug-drug interactions. In unfit and frail older patients some antibiotics should be avoided, or doses should be adjusted, according to medical conditions or medications received. Amoxicillin, with doses adapted to renal function, is one of the safest options, while other antibiotics should be chosen with caution upon indications and individual patient characteristics. CONCLUSIONS Healthcare providers should prescribe antibiotics to unfit and frail older adults with caution, given the multitude of comorbidities and potential interactions with medications received. Further research is needed on the safe and effective use of antibiotics in older patients.
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Affiliation(s)
- Ljiljana Đukić
- Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Barbara Janssens
- Department of Oral Health Sciences, Gerodontology, ELOHA (Equal Lifelong Oral Health for All) research group, Ghent University, Ghent, Belgium
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Anastassia Kossioni
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Stojkov I, Conrads-Frank A, Rochau U, Arvandi M, Koinig KA, Schomaker M, Mittelman M, Fenaux P, Bowen D, Sanz GF, Malcovati L, Langemeijer S, Germing U, Madry K, Guerci-Bresler A, Culligan DJ, Kotsianidis I, Sanhes L, Mills J, Puntscher S, Schmid D, van Marrewijk C, Smith A, Efficace F, de Witte T, Stauder R, Siebert U. Determinants of low health-related quality of life in patients with myelodysplastic syndromes: EUMDS Registry study. Blood Adv 2023; 7:2772-2783. [PMID: 36607832 PMCID: PMC10275700 DOI: 10.1182/bloodadvances.2022008360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Patients with myelodysplastic syndromes (MDS) frequently experience a significant symptom burden, which reduces health-related quality of life (HRQoL). We aimed to identify determinants of low HRQoL in patients recently diagnosed with MDS, for guiding early intervention strategies. We evaluated longitudinal data in 2205 patients with MDS during their first year after diagnosis. Median values of EQ-5D 3-level (EQ-5D-3L) index (0.78) and visual analog scale (VAS) score (0.70) were used as thresholds for low HRQoL. In addition, the 5 dimensions of EQ-5D-3L were analyzed for impairments (any level vs "no problem" category). After multiple imputation of missing values, we used generalized estimating equations (GEE) to estimate odds ratios (OR) for univariable determinant screening (P < .15), and to subsequently derive multivariable models for low HRQoL with 95% confidence intervals (CI). Multivariable GEE analysis showed the following independent determinants (OR, 95% CI) for low EQ-5D index: increased age (60-75 years: 1.33, 1.01-1.75; >75: 1.84, 1.39-2.45), female sex (1.70, 1.43-2.03), high serum ferritin level (≥1000 vs ≤300 μg/L: 1.41, 1.06-1.87), comorbidity burden (per unit: 1.11, 1.02-1.20), and reduced Karnofsky performance status (KPS, per 10 units: 0.62, 0.58-0.67). For low VAS score, additional determinants were transfusion dependence (1.53, 1.03-2.29), low hemoglobin <10 g/dL (1.34, 1.12-1.61), and high body mass index (≥30 vs 23-29.9 kg/m2: 1.26, 1.02-1.57). Sex, KPS, comorbidity burden, hemoglobin count, and transfusion burden were determinants for all EQ-5D dimensions. Low HRQoL is determined by multiple factors, which should be considered in the management and shared decision making of patients with MDS. This trial was registered at www.clinicaltrials.gov as #NCT00600860.
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Affiliation(s)
- Igor Stojkov
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Annette Conrads-Frank
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Ursula Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Marjan Arvandi
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Karin A. Koinig
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Michael Schomaker
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Moshe Mittelman
- Department of Medicine A, Tel Aviv Sourasky (Ichilov) Medical Center and Sackler Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Pierre Fenaux
- Service d’Hématologie Séniors, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris and Université Paris 7, Paris, France
| | - David Bowen
- St. James’s Institute of Oncology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Guillermo F. Sanz
- Department of Haematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Luca Malcovati
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Saskia Langemeijer
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ulrich Germing
- Department of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Krzysztof Madry
- Department of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Warsaw, Poland
| | - Agnès Guerci-Bresler
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire Brabois, Nancy, France
| | - Dominic J. Culligan
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Laurence Sanhes
- Haematology Department of Perpignan, Saint Jean Hospital, Perpignan, France
| | - Juliet Mills
- Worcestershire Acute Hospitals NHS Trust and University Hospitals Birmingham NHS Foundation Trust, Worcester, United Kingdom
| | - Sibylle Puntscher
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Corine van Marrewijk
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Fabio Efficace
- Health Outcomes Research Unit, Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA), Rome, Italy
| | - Theo de Witte
- Department of Tumor Immunology - Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard Chan School of Public Health, Boston, MA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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3
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Core Set of Patient-Reported Outcomes for Myelodysplastic Syndromes - EUMDS Delphi Study in Patients and Hematologists. Blood Adv 2021; 6:1-12. [PMID: 34492684 PMCID: PMC8753222 DOI: 10.1182/bloodadvances.2021004568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/03/2021] [Indexed: 12/04/2022] Open
Abstract
Systematically developed set of core PROs in MDS, involving patients and hematologists in a 2-round Delphi survey. Core PROs will support unified outcome measurement and facilitate inclusion of reliable patient information in MDS disease care.
Patient-reported outcomes (PROs) are relevant and valuable end points in the care of patients with myelodysplastic syndromes (MDS). However, a consensus-based selection of PROs for MDS, derived by both patients and hematologists, is lacking. We aimed to develop a core set of PROs for patients with MDS as part of the prospective European LeukemiaNet MDS (EUMDS) Registry. According to international guidelines, candidate PROs were identified from a comprehensive literature search of MDS studies. Overall, 40 PROs were selected and evaluated in a two-round Delphi survey by 40 patients with MDS and 38 hematologists in the first round and 38 patients and 32 hematologists in the second round. Based on an agreement scale and predefined inclusion criteria, both patients and hematologists selected “general quality of life” as a core PRO. Hematologists also selected “transfusion-dependency burden” and “ability to work/activities of daily living” as core PROs. The second Delphi round increased PRO rating agreements. Statistically significant rating differences between patients and hematologists were observed for 28 PROs (Mann-Whitney U test; P < .05) in the first round and for 19 PROs in the second round, with “disease knowledge” and “confidence in health care services” rated notably higher by patients. The overall mean PRO ratings correlation between the 2 groups was moderate (Spearman’s rank correlation coefficient = 0.5; P < .05). This first consensus on a core set of PROs jointly developed by patients and hematologists forms the basis for patient-centered care in daily practice and clinical research.
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4
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Beer AGE, Laille E, Neuwirt H, Mayer G, Stauder R. Azacitidine is removed effectively by hemodialysis. Leuk Lymphoma 2020; 62:743-745. [PMID: 33100080 DOI: 10.1080/10428194.2020.1838505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A G E Beer
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - E Laille
- Bristol Myers Squibb (formerly Celgene Corporation), Summit, NJ, USA
| | - H Neuwirt
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - G Mayer
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - R Stauder
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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Brownstein CG, Daguenet E, Guyotat D, Millet GY. Chronic fatigue in myelodysplastic syndromes: Looking beyond anemia. Crit Rev Oncol Hematol 2020; 154:103067. [PMID: 32739782 DOI: 10.1016/j.critrevonc.2020.103067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic fatigue is the most common and severe symptom in myelodysplastic syndromes (MDS) and has a strong negative association with health-related quality of life (HRQoL). Despite anemia being the most common objective manifestation of MDS, and the associated link between anemia and fatigue, evidence on treatments which temporarily mitigate anemia is equivocal regarding the effects on fatigue. Furthermore, previous work has found weak associations between anemia and chronic fatigue in MDS. As such, given that improving HRQoL is one of the primary treatment aims in MDS, further work is required to identify other potential contributors to chronic fatigue in these patients. In addition to anemia, MDS is associated with numerous other deviations in physiological homeostasis and has negative psychological consequences with links to chronic fatigue. Accordingly, the present review provides several potential aetiologic agents relevant to chronic fatigue in MDS which can be used to guide future research in this field.
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Affiliation(s)
- Callum G Brownstein
- Univ Lyon, UJM-Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France.
| | - Elisabeth Daguenet
- Lucien Neuwirth Cancer Institute, Hematology and Cell Therapy, F-42271 Saint-Priest-en-Jarez, France; Lucien Neuwirth Cancer Institute, Research and Teaching Department, F-42271 Saint-Priest-en-Jarez, France
| | - Denis Guyotat
- Lucien Neuwirth Cancer Institute, Hematology and Cell Therapy, F-42271 Saint-Priest-en-Jarez, France; UMR 5239 Laboratoire de Biologie et Modélisation de la Cellule, Ecole Normale Supérieure, Lyon, France
| | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France; Institut Universitaire de France (IUF), France
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6
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Sakatoku K, Takeoka Y, Miura A, Araki T, Fujitani Y, Yamamura R, Nakamae H, Ohta K, Hino M. Combination of Frailty Status and Comorbidity Score Improves the Stratification of Survival in Patients With Myelodysplastic Syndrome Owing to Good Predictive Capability for Infection-related Mortality. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:799-805. [DOI: 10.1016/j.clml.2019.09.610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/08/2019] [Accepted: 09/20/2019] [Indexed: 01/28/2023]
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7
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Asano M, Ohyashiki JH, Kobayashi-Kawana C, Umezu T, Imanishi S, Azuma K, Akahane D, Fujimoto H, Ito Y, Ohyashiki K. A novel non-invasive monitoring assay of 5-azacitidine efficacy using global DNA methylation of peripheral blood in myelodysplastic syndrome. Drug Des Devel Ther 2019; 13:1821-1833. [PMID: 31239639 PMCID: PMC6553951 DOI: 10.2147/dddt.s195071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/04/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Monitoring response and resistance to 5-azacitidine (AZA) is essential when treating patients with myelodysplastic syndrome (MDS). To quantify methylated DNA not only in the promoter region but also in the gene body, we established a single-molecule methylation assay (SMMA). Patients and methods: We first investigated the methylation extent (expressed as methylation index [MI]) by SMMA among 28 MDS and 6 post-MDS acute myeloid leukemia patients. We then analyzed the MI in 13 AZA-treated patients. Results: Whole-blood DNA from all 34 patients had low MI values compared with healthy volunteers (P<0.0001). DNA hypomethylation in MDS patients was more evident in neutrophils (P=0.0008) than in peripheral mononuclear cells (P=0.0713). No consistent pattern of genome-wide DNA hypomethylation was found among MDS subtypes or revised International Prognostic Scoring System (IPSS-R) categories; however, we found that the MI was significantly increased for patients at very high risk who were separated by the new cytogenetic scoring system for IPSS-R (P=0.0398). There was no significant difference in MI before AZA, regardless of the response to AZA (P=0.8689); however, sequential measurement of MI in peripheral blood demonstrated that AZA non-responders did not have normalized MI at the time of next course of AZA (P=0.0352). Conclusion: Our results suggest that sequential SMMA of peripheral blood after AZA may represent a non-invasive monitoring marker for AZA efficacy in MDS patients.
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Affiliation(s)
- Michiyo Asano
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Junko H Ohyashiki
- Department of Advanced Cellular Therapy, Tokyo Medical University, Tokyo, Japan
| | | | - Tomohiro Umezu
- Department of Hematology, Tokyo Medical University, Tokyo, Japan.,Department of Molecular Oncology, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Imanishi
- Department of Molecular Oncology, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Kenko Azuma
- Department of Molecular Oncology, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Daigo Akahane
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Hiroaki Fujimoto
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Yoshikazu Ito
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Ohyashiki
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
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McDonald LS, McCarthy P, Khan M, Hogan P, Kelleher E, Murphy PT, Quinn J, Desmond R, McHugh J, Strickland M, O'Connell E, Cahill M, Maung SW, Keohane C, O'Neill D, Ryan D, Mykytiv V, Enright H. A multicenter report on the natural history of myelodysplastic syndromes in very old patients (aged over 85 years). Leuk Lymphoma 2019; 60:1324-1327. [DOI: 10.1080/10428194.2018.1538513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Peter McCarthy
- Haematology, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Patrick Hogan
- Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | | | | | - John Quinn
- Haematology, Beaumont Hospital, Dublin, Ireland
| | - Ronan Desmond
- Haematology, Tallaght University Hospital, Dublin, Ireland
| | - John McHugh
- Haematology, Tallaght University Hospital, Dublin, Ireland
| | | | | | - Mary Cahill
- Haematology, Cork University Hospital and University College Cork, Cork, Ireland
| | - Su W. Maung
- Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Desmond O'Neill
- Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Dan Ryan
- Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Vitaliy Mykytiv
- Haematology, Cork University Hospital and University College Cork, Cork, Ireland
| | - Helen Enright
- Haematology, Tallaght University Hospital, Dublin, Ireland
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Affiliation(s)
- Athanase Benetos
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, France (A.B.)
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, and Ghent University, Belgium (M.P.)
| | - Timo Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland (T.S.)
- Center for Life Course Health Research, University of Oulu, Finland (T.S.)
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Hawi N, Ratuszny D, Liodakis E, Omar M, Krettek C, Meller R. [Shoulder dislocations in elderly patients]. Unfallchirurg 2017; 121:126-133. [PMID: 29064032 DOI: 10.1007/s00113-017-0421-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In contrast to shoulder dislocations in younger patients, anterior shoulder dislocation in the elderly is often associated with concomitant injuries to the rotator cuff and fractures. There is also frequent involvement of the brachial plexus or peripheral nerves. After closed reduction and a short period of immobilization, physiotherapy should be performed to restore mobility and strength. The evaluation of the rotator cuff is essential for further treatment decisions. The majority of patients are classically treated conservatively. Elderly patients with accompanying rotator cuff lesions and failed conservative therapy can benefit from a surgical intervention. Reconstructive interventions of the rotator cuff should be principally considered; however, some individuals may benefit from a reverse prosthesis in this elderly subgroup of patients. The challenge for the treating surgeon is to exactly define the structural injury of the shoulder (which may include pre-existing lesions) and to select the optimal treatment option.
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Affiliation(s)
- N Hawi
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - D Ratuszny
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - E Liodakis
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Omar
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Krettek
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - R Meller
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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11
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Effects of whole-body vibration on postural control in elderly: An update of a systematic review and meta-analysis. Arch Gerontol Geriatr 2017; 73:95-112. [PMID: 28800481 DOI: 10.1016/j.archger.2017.07.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 06/26/2017] [Accepted: 07/22/2017] [Indexed: 01/04/2023]
Abstract
The aim of this systematic review and meta-analysis was to offer an updated overview of the current studies on all types of whole-body vibration (WBV), to determine the effects of WBV on balance in Go-Go (active, independent), Slow-Go (some physical activity limitations) and No-Go (in need of care) elderly and to provide recommendations on available evidence on WBV for clinicians and researchers. An electronic literature search was conducted in PubMed, Cochrane Register of Controlled Trials, Physiotherapy Evidence Database (PEDro) and CINAHL (Ebsco Host) to identify studies on WBV therapy in Go-Goes, Slow-Goes and No-Goes. Outcomes were static, dynamic and functional balance. Thirty-tree studies were included in this systematic review. Pooling was possible for static balance and dynamic balance. Effect size (SMD) of WBV on static balance was 0.34 (95% CI 0.18, 0.49) in Go-Goes. Effect size (SMD) of WBV on dynamic balance was -0.15 (95% CI -0.44, 0.15) in Slow-Go and -0.90 (95% CI -1.63, -0.17) in No-Go elderly people respectively. The results of this current meta-analysis suggest that WBV can be used for improving static balance in Go-Go elderly and that it has the potential to positively influence dynamic balance in Slow-Go and No-Go elderly.
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12
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Schulkes KJG, Souwer ETD, van Elden LJR, Codrington H, van der Sar-van der Brugge S, Lammers JWJ, Portielje JEA, van den Bos F, Hamaker ME. Prognostic Value of Geriatric 8 and Identification of Seniors at Risk for Hospitalized Patients Screening Tools for Patients With Lung Cancer. Clin Lung Cancer 2017; 18:660-666.e1. [PMID: 28320638 DOI: 10.1016/j.cllc.2017.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/08/2017] [Accepted: 02/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Because of the time-consuming aspect of geriatric assessments, cancer specialists are seeking shorter screening tools to distinguish fit and frail patients. We analyzed the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) in elderly patients with lung cancer. PATIENTS AND METHODS From January 2014 to April 2016, the data from patients with lung cancer aged > 70 years at 2 teaching hospitals in the Netherlands were included in a database. The patients were classified as potentially frail if they had a G8 of ≤ 14 or ISAR-HP of ≥ 2. RESULTS Of the 142 included patients (median age, 77 years; interquartile range, 73-82 years), 108 (76%) were potentially frail. After correction for possible confounders, the potentially frail patients had a significantly greater risk of 1-year mortality (hazard ratio [HR], 4.08; 95% confidence interval [CI] 1.67-9.99; P = .02). Higher disease stage (HR, 1.72; 95% CI, 1.40-2.12; P < .001) was also a significant predictor of mortality; however, initial treatment (standard or otherwise) and age were not. When using both screening instruments separately, an impaired score on the G8 and higher disease stage were the variables remaining in the regression analyses (HR for impaired G8, 3.01; 95% CI, 1.35-6.72; P < .001). Patients with impaired scores on the ISAR-HP and G8 had more geriatric impairments than did patients with only an impaired G8 score. CONCLUSION G8 screening is useful for the prognostication of elderly patients with lung cancer and could be used in combination with ISAR-HP to increase specificity at the cost of sensitivity. Using the ISAR-HP as the only screening tool would be insufficient.
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Affiliation(s)
- Karlijn J G Schulkes
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands.
| | | | | | - Henk Codrington
- Department of Pulmonology, Haga Hospital, The Hague, Netherlands
| | | | - Jan-Willem J Lammers
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands
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Identification and validation of the dopamine agonist bromocriptine as a novel therapy for high-risk myelodysplastic syndromes and secondary acute myeloid leukemia. Oncotarget 2016; 7:6609-19. [PMID: 26735888 PMCID: PMC4872736 DOI: 10.18632/oncotarget.6773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/28/2015] [Indexed: 01/23/2023] Open
Abstract
Myelodysplastic syndromes (MDS) represent a broad spectrum of diseases characterized by their clinical manifestation as one or more cytopenias, or a reduction in circulating blood cells. MDS is predominantly a disease of the elderly, with a median age in the UK of around 75. Approximately one third of MDS patients will develop secondary acute myeloid leukemia (sAML) that has a very poor prognosis. Unfortunately, most standard cytotoxic agents are often too toxic for older patients. This means there is a pressing unmet need for novel therapies that have fewer side effects to assist this vulnerable group. This challenge was tackled using bioinformatic analysis of available transcriptomic data to establish a gene-based signature of the development and progression of MDS. This signature was then used to identify novel therapeutic compounds via statistically-significant connectivity mapping. This approach suggested re-purposing an existing and widely-prescribed drug, bromocriptine as a novel potential therapy in these disease settings. This drug has shown selectivity for leukemic cells as well as synergy with current therapies.
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14
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Schulkes KJ, Hamaker ME, van den Bos F, van Elden LJ. Relevance of a Geriatric Assessment for Elderly Patients With Lung Cancer—A Systematic Review. Clin Lung Cancer 2016; 17:341-349.e3. [DOI: 10.1016/j.cllc.2016.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 12/27/2022]
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15
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Myelodysplastic Syndromes in the Elderly: Treatment Options and Personalized Management. Drugs Aging 2016; 32:891-905. [PMID: 26476843 DOI: 10.1007/s40266-015-0312-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Myelodysplastic syndromes (MDS) are typical diseases of the elderly, with a median age of 68-75 years at initial diagnosis. Demographic changes producing an increased proportion of elderly in our societies mean the incidence of MDS will rise dramatically. Considering the increasing number of treatment options, ranging from best supportive care to hematopoietic stem cell transplantation (HSCT), decision making is rather complex in this cohort of patients. Moreover, aspects of the aging process also have to be considered in therapy planning. Treatment of elderly MDS patients is dependent on the patient's individual risk and prognosis. Comorbidities play an essential role as predictors of survival and therapy tolerance. Age-adjusted models and the use of geriatric assessment scores are described as a basis for individualized treatment algorithms. Specific treatment recommendations for the different groups of patients are given. Currently available therapeutic agents, including supportive care, erythropoiesis-stimulating agents (ESAs), immune-modulating agents, hypomethylating agents, and HSCT are described in detail and discussed with a special focus on elderly MDS patients. The inclusion of elderly patients in clinical trials is of utmost importance to obtain data on efficacy and safety in this particular group of patients. Endpoints relevant for the elderly should be integrated, including maintenance of quality of life and functional activities as well as evaluation of use of healthcare resources.
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Hamaker ME, Augschoell J, Stauder R. Clinical judgement and geriatric assessment for predicting prognosis and chemotherapy completion in older patients with a hematological malignancy. Leuk Lymphoma 2016; 57:2560-7. [PMID: 27050121 DOI: 10.3109/10428194.2016.1163345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prior research has focused on comparing clinical judgment with geriatric assessments in identifying potentially unfit patients or the prognostic value of geriatric impairments. In this study, we set out to compare and combine geriatric impairments with clinical judgment in predicting mortality and non-completion of chemotherapy in older patients with a hematological malignancy. Between March 2004 and August 2014, a multi-dimensional geriatric assessment was performed in consecutive patients aged ≥65 years diagnosed with a hematological malignancy at the Innsbruck university hospital. Associations between geriatric assessment, clinical judgment (derived from initial treatment decision) and outcome (mortality, non-completion) were analyzed. Patient sample consisted of 157 patients, of which 37% was 80 + years of age. Aggressive non-Hodgkin lymphoma (29%), acute myeloid leukemia (27%) and myelodysplastic syndromes (20%) were most common diagnoses. Prevalence of an impaired geriatric assessment (i.e. impairments in ≥2 of eight assessed domains) was 71% and similar for patients receiving standard (71%) or attenuated treatment (72%). Clinical judgment was the strongest predictor of mortality (p = 0.003); addition of geriatric assessment allowed for further stratification of patients with a good (>75% one year survival), intermediate (50-60%) and poor prognosis (<30%). Cumulative burden of geriatric impairments further increased risk of mortality. Clinical judgment was greatly superior to geriatric assessment in identifying patients at risk for non-completion. The combination of clinical judgment and geriatric assessment allows for better prognostic stratification of patients compared to clinical judgment alone.
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Affiliation(s)
- M E Hamaker
- a Department of Geriatric Medicine , Diakonessenhuis , Utrecht , the Netherlands
| | - J Augschoell
- b Department of Internal Medicine V (Hematology and Oncology) , Innsbruck Medical University , Innsbruck , Austria
| | - R Stauder
- b Department of Internal Medicine V (Hematology and Oncology) , Innsbruck Medical University , Innsbruck , Austria
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17
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Buckstein R, Wells RA, Zhu N, Leitch HA, Nevill TJ, Yee KWL, Leber B, Sabloff M, St Hilaire E, Kumar R, Geddes M, Shamy A, Storring J, Kew A, Elemary M, Levitt M, Lenis M, Mamedov A, Zhang L, Rockwood K, Alibhai SMH. Patient-related factors independently impact overall survival in patients with myelodysplastic syndromes: an MDS-CAN prospective study. Br J Haematol 2016; 174:88-101. [PMID: 26991631 DOI: 10.1111/bjh.14033] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/12/2016] [Indexed: 01/21/2023]
Abstract
UNLABELLED Little is known about the effects of frailty, disability and physical functioning on the clinical outcomes for myelodysplastic syndromes (MDS). We investigated the predictive value of these factors on overall survival (OS) in 445 consecutive patients with MDS and chronic monomyelocytic leukaemia (CMML) enrolled in a multi-centre prospective national registry. Frailty, comorbidity, instrumental activities of daily living, disability, quality of life, fatigue and physical performance measures were evaluated at baseline and were added as covariates to conventional MDS-related factors as predictors of OS in Cox proportional hazards models. The median age was 73 years, and 79% had revised International Prognostic Scoring System (IPSS-R) risk scores of intermediate or lower. Frailty correlated only modestly with comorbidity. OS was significantly shorter for patients with higher frailty and comorbidity scores, any disability, impaired grip strength and timed chair stand tests. By multivariate analysis, the age-adjusted IPSS-R, frailty (Hazard ratio 2·7 (95% confidence interval [CI] 1·7-4·2), P < 0·0001) and Charlson comorbidity score (Hazard ratio 1·8 (95% CI 1·1-2·8), P = 0·01) were independently prognostic of OS. Incorporation of frailty and comorbidity scores improved risk stratification of the IPSS-R by 30% and 5%, respectively. These data demonstrate for the first time, the importance of considering frailty in prognostic models and a potential target for therapeutic intervention in optimizing clinical outcomes in older MDS patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02537990.
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Affiliation(s)
- Rena Buckstein
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Richard A Wells
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nancy Zhu
- University of Alberta Hospital, Edmonton, AB, Canada
| | - Heather A Leitch
- St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | | | - Karen W L Yee
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Brian Leber
- Juravinski Cancer Center, Hamilton Health Sciences Center, Hamilton, ON, Canada
| | - Mitchell Sabloff
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Eve St Hilaire
- Centre Hospitalier Universitaire Dr-Georges-L.-Dumont, Moncton, QC, Canada
| | | | | | - April Shamy
- Jewish General Hospital, Montreal, QC, Canada
| | - John Storring
- McGill University, Health Centre-Royal Victoria Hospital, Montreal, QC, Canada
| | - Andrea Kew
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Max Levitt
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Martha Lenis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alex Mamedov
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Ken Rockwood
- Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
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Fletcher SA, Cronin AM, Zeidan AM, Odejide OO, Gore SD, Davidoff AJ, Steensma DP, Abel GA. Intensity of end-of-life care for patients with myelodysplastic syndromes: Findings from a large national database. Cancer 2016; 122:1209-15. [DOI: 10.1002/cncr.29913] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/07/2016] [Indexed: 11/08/2022]
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19
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Lee EJ, Podoltsev N, Gore SD, Zeidan AM. The evolving field of prognostication and risk stratification in MDS: Recent developments and future directions. Blood Rev 2016; 30:1-10. [DOI: 10.1016/j.blre.2015.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/08/2015] [Accepted: 06/15/2015] [Indexed: 01/01/2023]
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20
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Prognostic value of self-reported fatigue on overall survival in patients with myelodysplastic syndromes: a multicentre, prospective, observational, cohort study. Lancet Oncol 2015; 16:1506-1514. [PMID: 26404501 DOI: 10.1016/s1470-2045(15)00206-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical presentation of myelodysplastic syndromes is highly variable and so accurate prediction of outcomes in these patients is crucial. We aimed to assess whether self-reported fatigue severity predicts overall survival beyond gold-standard prognostic indices in patients with higher-risk myelodysplastic syndromes. METHODS We did a multicentre, prospective, observational, cohort study of patients from 37 centres in Europe, USA, and east Asia. Adults (≥18 years) with myelodysplastic syndromes were consecutively enrolled within 6 months of diagnosis with an intermediate-2-risk or high-risk score according to the International Prognostic Scoring System (IPSS). Patients were enrolled irrespective of older age, comorbidities, performance status, and progression from a lower IPSS risk score category. All patients had to complete a quality of life assessment at baseline. With use of univariate and then multivariate Cox proportional hazards regression analysis, we constructed a multivariate model of how prognostic variables, including IPSS and fatigue score from the European Organisation for Research and Treatment of Cancer quality-of-life questionnaire-core 30, predicted overall survival. The primary endpoint was overall survival by baseline self-reported fatigue scale ratings. This study was registered with ClinicalTrials.gov, number NCT00809575. FINDINGS Between Nov 10, 2008, and Aug 13, 2012, we enrolled 280 patients with a median age of 71 years (IQR 64-77). The median follow-up was 15 months (IQR 8-27), and the last patient was assessed Feb 16, 2015. The median overall survival from diagnosis was 17 months (95% CI 15-19). In univariate analysis, the baseline factors that were significantly associated with reduced overall survival were increasing age, transfusion dependency (defined as having received at least one red blood cell transfusion every 8 weeks over a period of 4 months), Eastern Cooperative Oncology Group (ECOG) performance status of two or more, increased white blood cell count, high-risk IPSS score, and higher self-reported fatigue severity. In multivariate analysis, baseline factors independently associated with reduced overall survival were high-risk IPSS score (hazard ratio [HR] 2·525, 95% CI 1·357-4·697; p=0·0035) and a higher score for fatigue (1·110, 1·040-1·170, for every ten points of fatigue deterioration; p=0·0007). In further multivariate models for survival, including either the WHO-based prognostic scoring system or the revised version of the IPSS classification, fatigue remained a statistically significant independent prognostic factor with a HR of 1·120 (1·050-1·180, p=0.0003) and a HR of 1·130 (1·060-1·190, p=0·0002), respectively. INTERPRETATION In patients with newly diagnosed higher-risk myelodysplastic syndromes, self-reported fatigue severity provides prognostic information for survival independent from gold-standard risk classifications. Our findings suggest that fatigue assessment should be included in routine diagnostic investigation for these patients and considered as a standard baseline stratification factor in future randomised controlled trials. FUNDING Associazione Italiana contro le Leucemie, Linfomi e Mieloma (AIL).
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21
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Accuracy of physician assessment of treatment preferences and health status in elderly patients with higher-risk myelodysplastic syndromes. Leuk Res 2015; 39:859-65. [DOI: 10.1016/j.leukres.2015.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/27/2015] [Accepted: 05/05/2015] [Indexed: 01/22/2023]
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22
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Fega KR, Abel GA, Motyckova G, Sherman AE, DeAngelo DJ, Steensma DP, Galinsky I, Wadleigh M, Stone RM, Driver JA. Non-hematologic predictors of mortality improve the prognostic value of the international prognostic scoring system for MDS in older adults. J Geriatr Oncol 2015; 6:288-98. [PMID: 26073533 DOI: 10.1016/j.jgo.2015.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/04/2015] [Accepted: 05/27/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The International Prognostic Scoring System (IPSS) is commonly used to predict survival and assign treatment for the myelodysplastic syndromes (MDS). We explored whether self-reported and readily available non-hematologic predictors of survival add independent prognostic information to the IPSS. MATERIALS AND METHODS Retrospective cohort study of consecutive MDS patients ≥age 65 who presented to Dana-Farber Cancer Institute between 2006 and 2011 and completed a baseline quality of life questionnaire. Questions corresponding to functional status and symptoms and extracted clinical-pathologic data from medical records. Kaplan-Meier and Cox proportional hazards models were used to estimate survival. RESULTS One hundred fourteen patients consented and were available for analysis. Median age was 73 years, and the majority of patients were White, were male, and had a Charlson comorbidity score of <2. Few patients (24%) had an IPSS score consistent with lower-risk disease and the majority received chemotherapy. In addition to IPSS score and history of prior chemotherapy or radiation, significant univariate predictors of survival included low serum albumin, Charlson score, performance status, ability to take a long walk, and interference of physical symptoms in family life. The multivariate model that best predicted mortality included low serum albumin (HR=2.3; 95% CI: 1.06-5.14), therapy-related MDS (HR=2.1; 95% CI: 1.16-4.24), IPSS score (HR=1.7; 95% CI: 1.14-2.49), and ease taking a long walk (HR=0.44; 95% CI: 0.23-0.90). CONCLUSIONS In this study of older adults with MDS, we found that low serum albumin and physical function added important prognostic information to the IPSS score. Self-reported physical function was more predictive than physician-assigned performance status.
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Affiliation(s)
- K Rebecca Fega
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, United States
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Gabriela Motyckova
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Alexander E Sherman
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - David P Steensma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Ilene Galinsky
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jane A Driver
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Geriatric Research Education and Clinical Center, VA Boston Medical Center, Boston, MA, United States; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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23
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de Swart L, Smith A, Johnston TW, Haase D, Droste J, Fenaux P, Symeonidis A, Sanz G, Hellström-Lindberg E, Cermák J, Germing U, Stauder R, Georgescu O, MacKenzie M, Malcovati L, Holm MS, Almeida AM, Mądry K, Slama B, Guerci-Bresler A, Sanhes L, Beyne-Rauzy O, Luño E, Bowen D, de Witte T. Validation of the revised international prognostic scoring system (IPSS-R) in patients with lower-risk myelodysplastic syndromes: a report from the prospective European LeukaemiaNet MDS (EUMDS) registry. Br J Haematol 2015; 170:372-83. [PMID: 25907546 DOI: 10.1111/bjh.13450] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/01/2015] [Indexed: 01/22/2023]
Abstract
Baseline characteristics, disease-management and outcome of 1000 lower-risk myelodysplastic syndrome (MDS) patients within the European LeukaemiaNet MDS (EUMDS) Registry are described in conjunction with the validation of the revised International Prognostic Scoring System (IPSS-R). The EUMDS registry confirmed established prognostic factors, such as age, gender and World Health Organization 2001 classification. Low quality of life (EQ-5D visual analogue scale score) was significantly associated with reduced survival. A high co-morbidity index predicted poor outcome in univariate analyses. The IPSS-R identified a large group of 247 patients with Low (43%) and Very low (23%) risk score within the IPSS intermediate-1 patients. The IPSS-R also identified 32 High or Very high risk patients within the IPSS intermediate-1 patients. IPSS-R was superior to the IPSS for predicting both disease progression and survival. Seventy percent of patients received MDS-specific treatment or supportive care, including red blood cell transfusions (51%), haematopoietic growth factors (58%) and iron chelation therapy (8%), within 2 years of diagnosis; while 30% of the patients only required active monitoring. The IPSS-R proved its utility as a more refined risk stratification tool for the identification of patients with a very good or poor prognosis and in this lower-risk MDS population.
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Affiliation(s)
- Louise de Swart
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Thomas W Johnston
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Detlef Haase
- Department of Haematology and Oncology, Georg-August-University of Göttingen, Göttingen, Germany
| | - Jackie Droste
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pierre Fenaux
- Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7, Paris, France
| | - Argiris Symeonidis
- Department of Medicine, Divison of Haematology, University of Patras Medical School, Patras, Greece
| | - Guillermo Sanz
- Department of Haematology, Hospital Universitario La Fe, Valencia, Spain
| | - Eva Hellström-Lindberg
- Department of Medicine, Division of Haematology, Karolinska Institutet, Stockholm, Sweden
| | - Jaroslav Cermák
- Department of Clinical Haematology, Institute of Haematology & Blood Transfusion, Praha, Czech Republic
| | - Ulrich Germing
- Department Of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Otilia Georgescu
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Marius MacKenzie
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luca Malcovati
- Department of Haematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mette S Holm
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio M Almeida
- Serviço d'Hematologia - Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Warszawa, Poland
| | - Borhane Slama
- Service d'Hématologie, Centre Hospitalier d'Avignon, Avignon, France
| | - Agnes Guerci-Bresler
- Service d'Hématologie, Centre Hospitalier Universtaire Brabois Vandoeuvre, Nancy, France
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier de Perpignan, Perpignan, France
| | - Odile Beyne-Rauzy
- Service d'Hématologie, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Elisa Luño
- Servicio d'Hematología, Servicio de Salud del Principado de Asturias, Oviedo, Spain
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
| | - Theo de Witte
- Department of Tumor Immunology - Nijmegen, Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
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Beguin Y, Selleslag D, Meers S, Graux C, Bries G, Deeren D, Vrelust I, Ravoet C, Theunissen K, Voelter V, Potier H, Trullemans F, Noens L, Mineur P. Safety and efficacy of azacitidine in Belgian patients with high-risk myelodysplastic syndromes, acute myeloid leukaemia, or chronic myelomonocytic leukaemia: results of a real-life, non-interventional post-marketing survey. Acta Clin Belg 2015; 70:34-43. [PMID: 25444072 DOI: 10.1179/2295333714y.0000000102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We evaluated azacitidine (Vidaza(®)) safety and efficacy in patients with myelodysplastic syndrome (MDS), acute myeloid leukaemia (AML), and chronic myelomonocytic leukaemia (CMML), in a real-life setting. Treatment response, dose, and schedule were assessed. METHODS This non-interventional, post-marketing survey included 49/50 patients receiving azacitidine at 14 Belgian haematology centres from 2010-2012. Treatment-emergent adverse events (TEAEs), including treatment-related TEAEs, and serious TEAEs (TESAEs) were recorded throughout the study. Treatment response [complete response (CR), partial response (PR), haematological improvement (HI), stable disease (SD), treatment failure (TF)) and transfusion-independence (TI) were evaluated at completion of a 1-year observation period (1YOP) or at treatment discontinuation, and overall survival (OS), at study conclusion. RESULTS The median age of patients was 74·7 (range: 43·9-87·8) years; 69·4% had MDS, 26·5% had primary or secondary AML, and 4·1% had CMML. Treatment-related TEAEs, grade 3-4 TEAEs, and TESAEs were reported in 67·3%, 28·6%, and 18·4% of patients, respectively. During 1YOP, patients received a median of 7 (1-12) treatment cycles. Treatment response was assessed for 38/49 patients. Among MDS and CMML patients (n = 29), 41·4% had CR, PR, or HI, 41·4% had SD, and 17·2% had TF. Among AML patients (n = 9), 44·4% had CR or PR, 33·3% had SD, and 22·2% had TF. TI was observed in 14/32 (43·8%) patients who were transfusion-dependent at baseline. Median (95% confidence interval) OS was 490 (326-555) days; 1-year OS estimate was 0·571 (0·422-0·696). CONCLUSIONS Our data support previous findings that azacitidine has a clinically acceptable safety profile and shows efficacy.
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Affiliation(s)
- Y. Beguin
- Avenue de l’Hopital 1, Liège, Belgium
| | | | | | - C. Graux
- CHU Dinant-Godinne UCL Namur Godinne (Yvoir), Belgium
| | | | - D. Deeren
- Hematology-Medical Oncology H.-Hartziekenhuis Roeselare-Menen vzw, Belgium
| | | | - C. Ravoet
- Centres hospitaliers JolimontHaine-Saint-Paul, Belgium
| | | | - V. Voelter
- Celgene International, Boudry, Switzerland
| | - H. Potier
- Avenue de l’Hopital 1, Liège, Belgium
| | - F. Trullemans
- Departement Oncologie/Hematologie, UZ Brussel, Belgium
| | - L. Noens
- Ghent University Hospital, Belgium
| | - P. Mineur
- Grand Hopital de Charleroi (GHdC), Belgium
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25
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10th anniversary of the Austrian MDS Platform: aims and ongoing projects. Wien Klin Wochenschr 2014; 127:12-5. [PMID: 25421367 DOI: 10.1007/s00508-014-0627-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/28/2014] [Indexed: 01/19/2023]
Abstract
The Austrian myelodysplastic syndromes (MDS) Platform was founded as a national working group in 2003 to initiate and coordinate common projects in the field. The incidence of MDS in Austria is approximately 400-500 new MDS cases per year. The overall low number of MDS patients underlines the importance of a national initiative to concentrate knowledge at certain specialized centres, where treatment of these patients mainly takes place. Clinical trials as well as basic research are facilitated by the cooperation of university and non-university hospitals. Other objectives are the generation of therapeutic standards, organization of meetings to spread this information to physicians and patients as well as promoting patient-support groups. Cooperation with international working groups is another important aim of the Platform. The 10th anniversary of the Austrian MDS Platform was organized as a meeting for all interested physicians throughout Austria providing an update on the disease and ongoing projects.
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26
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Bammer C, Sperr WR, Kemmler G, Wimazal F, Nösslinger T, Schönmetzler A, Krieger O, Pfeilstöcker M, Valent P, Stauder R. Clustering of comorbidities is related to age and sex and impacts clinical outcome in myelodysplastic syndromes. J Geriatr Oncol 2014; 5:299-306. [DOI: 10.1016/j.jgo.2014.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/30/2013] [Accepted: 02/14/2014] [Indexed: 11/16/2022]
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27
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The G8 screening tool detects relevant geriatric impairments and predicts survival in elderly patients with a haematological malignancy. Ann Hematol 2014; 93:1031-40. [PMID: 24488257 DOI: 10.1007/s00277-013-2001-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/23/2013] [Indexed: 12/27/2022]
Abstract
The G8 screening tool was developed to separate fit older cancer patients who were able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. We set out to determine the discriminative power and prognostic value of the G8 in older patients with a haematological malignancy. Between September 2009 and May 2013, a multi-dimensional geriatric assessment was performed in consecutive patients aged ≥67 years diagnosed with blood cancer at the Innsbruck University Hospital. The assessment included (instrumental) activities of daily living, cognition, mood, nutritional status, mobility, polypharmacy and social support. In parallel, the G8 was also administered (cut-off ≤ 14). Using a cut-off of ≥2 impaired domains, 70 % of the 108 included patients were considered as having an impaired geriatric assessment while 61 % had an impaired G8. The G8 lacked discriminative power for impairments on full geriatric assessment: sensitivity 69, specificity 79, positive predictive value 89 and negative predictive value 50 %. However, G8 was an independent predictor of mortality within the first year after inclusion (hazard ratio 3.93; 95 % confidence interval 1.67-9.22, p < 0.001). Remarkably, patients with impaired G8 fared poorly, irrespective of treatment choices (p < 0.001). This is the first report on the clinical and prognostic relevance of G8 in elderly patients with haematological malignancies. Although the G8 lacked discriminative power for outcome of multi-dimensional geriatric assessment, this score appears to be a powerful prognosticator and could potentially represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration.
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Efficace F, Gaidano G, Sprangers M, Cottone F, Breccia M, Voso M, Caocci G, Stauder R, Di Tucci A, Sanpaolo G, Selleslag D, Angelucci E, Platzbecker U, Mandelli F. Preference for involvement in treatment decisions and request for prognostic information in newly diagnosed patients with higher-risk myelodysplastic syndromes. Ann Oncol 2014; 25:447-54. [DOI: 10.1093/annonc/mdt557] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Hamaker ME, Prins MC, Stauder R. The relevance of a geriatric assessment for elderly patients with a haematological malignancy--a systematic review. Leuk Res 2013; 38:275-83. [PMID: 24439052 DOI: 10.1016/j.leukres.2013.12.018] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Geriatric assessment is increasingly used to assess the health status of older cancer patients. We set out to assemble all available evidence on the relevance of a geriatric assessment in the treatment of older patients with haematological malignancies. METHODS A systematic Medline and Embase search for studies in which a geriatric assessment was used to detect health issues or to address the association between baseline geriatric assessment and outcome. RESULTS 18 publications from 15 studies were included. The median age of patients was 73 years (range 58-86). Despite generally good performance status, the prevalence of geriatric impairments was high. Geriatric impairments were associated with a shorter overall survival in a relevant proportion of studies (instrumental activities 55%, nutritional status 67%, cognitive capacities 83%, objectively measured physical capacity 100%). Comorbidity, physical capacity and nutritional status retained their significance even in multivariate analyses in 50%, 75%, and 67% of analyses respectively, whereas age and performance status lost their predictive value in most studies. One study found an association between comorbidity and chemotherapy-related non-haematological toxicity. In another study a pronounced association between summarised outcome of geriatric assessment and chemotherapy-related toxicity as well as response to treatment was described. CONCLUSION This review demonstrates that a geriatric assessment can detect multiple health issues, even in patients with good performance status. Impairments in geriatric domains have predictive value for mortality and also appear to be associated with toxicity and other outcome measures and should thus be integrated in individualised treatment algorithms.
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Affiliation(s)
- M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, The Netherlands.
| | - M C Prins
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, The Netherlands
| | - R Stauder
- Department of Oncology and Haematology, Innsbruck Medical University, Innsbruck, Austria
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Zeidan AM, Komrokji RS. There's risk, and then there's risk: The latest clinical prognostic risk stratification models in myelodysplastic syndromes. Curr Hematol Malig Rep 2013; 8:351-60. [PMID: 23979829 PMCID: PMC4133773 DOI: 10.1007/s11899-013-0172-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Myelodysplastic syndromes (MDS) include a diverse group of clonal hematopoietic disorders characterized by progressive cytopenias and propensity for leukemic progression. The biologic heterogeneity that underlies MDS translates clinically in wide variations of clinical outcomes. Several prognostic schemes were developed to predict the natural course of MDS, counsel patients, and allow evidence-based, risk-adaptive implementation of therapeutic strategies. The prognostic schemes divide patients into subgroups with similar prognosis, but the extent to which the prognostic prediction applies to any individual patient is more variable. None of these instruments was designed to predict the clinical benefit in relation to any specific MDS therapy. The prognostic impact of molecular mutations is being more recognized and attempts at incorporating it into the current prognostic schemes are ongoing.
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Affiliation(s)
- Amer M Zeidan
- Department of Oncology, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, CRB1 building, room 186, Baltimore, MD, 21287, USA,
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Merkel DG, Nagler A. The role of hypomethylating agents in myelodysplastic syndrome: changing the management paradigm. Expert Rev Hematol 2013; 6:665-76. [PMID: 24191866 DOI: 10.1586/17474086.2013.854699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Modern treatment of myelodysplastic syndromes (MDS) with hypomethylating agents (HMAs) such as azacitidine (Vidaza) and decitabine (Dacogen) has changed the clinical landscape of these disorders. Novel drug combinations of HMAs with histone deacetylase inhibitor therapy may synergistically target different dysregulated molecular mechanisms within MDS clones. This article reviews current trial data concerning the use of the main HMAs in MDS patients where intensive chemotherapy and allogeneic stem cell transplantation is generally not an option. Collated data are presented of the clinical response outcomes, toxicity profiles and prognostic response criteria. Vidaza use in low-risk MDS cases, the selected place of allogeneic stem cell transplantation in older patients with significant comorbidity and the novel drug combination strategies for the future are discussed.
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Affiliation(s)
- Drorit G Merkel
- Division of Hematology, the Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel
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Valentiny C, Mitrovic M, Pleyer L, Steurer M, Willenbacher W, Stauder R. Complete remission after a single cycle of azacitidine in a case of relapsed acute myeloid leukemia. Wien Klin Wochenschr 2013; 125:50-3. [DOI: 10.1007/s00508-012-0319-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 12/10/2012] [Indexed: 12/01/2022]
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