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Liu S, Hu B, Zhang J. Epidemiological characteristics and influencing factors of acute leukemia in children and adolescents and adults: a large population-based study. Hematology 2024; 29:2327916. [PMID: 38578123 DOI: 10.1080/16078454.2024.2327916] [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: 07/30/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE To assess the epidemiological characteristics and prognostic factors of acute leukemia (AL) in children and adolescents, and make comparisons between pediatric and adult patients. METHODS This retrospective cohort study enrolled AL patients from the Surveillance, Epidemiology, and End Results (SEER) 1975-2016. OS in children and adolescents and adults with AL was compared and analyzed separately by age and AL subtype. RESULTS Totally 61,694 AL patients were identified, with 45,411 (73.6%) adults and 16,283 (26.4%) children and adolescents. From 2000 to 2016, the incidence rates of AL [annual percent changes (APC) = 1.2, 95%CI = 0.9-1.6, P < 0.05] and acute lymphoblastic leukemia (ALL) (APC = 1.5, 95%CI = 1.1-1.8, P < 0.05) in children and adolescents were significantly increasing. For adults, AL (APC = 0.9, 95%CI = 0.3-1.5, P < 0.05), ALL (APC = 2.5, 95%CI = 2.0-3.1, P < 0.05) and acute myeloid leukemia (AML) (APC = 0.9, 95%CI = 0.4-1.5, P < 0.05) had significantly elevated incidence rates. Overall survival (OS) in children and adolescents with AL was significantly higher than that in adults with AL (log-rank P < 0.0001). OS in children and adolescents and adults with ALL, AML and AUL decreased with age (all log-rank P < 0.0001). Older age, male sex and black race were risk factors for the survival of children and adolescents and adults with ALL, AML and AUL. CONCLUSION From 2000 to 2016, the incidence rates of AL in children and adolescents and adults were increasing. Children and adolescents with AL had significantly better OS than adults with AL, and OS declined with age in both children and adolescents and adults with ALL, AML and AUL.
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Affiliation(s)
- Shuojie Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Gene Detection, Xiamen, People's Republic of China
| | - Bin Hu
- Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jiaqin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Gene Detection, Xiamen, People's Republic of China
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Zhang L, Che C. Clinical manifestations and outcome analysis of invasive pulmonary aspergillosis infection: a retrospective study in 43 nonneutropenic patients. J Int Med Res 2019; 47:5680-5688. [PMID: 31566035 PMCID: PMC6862873 DOI: 10.1177/0300060519874901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate clinical characteristics of early-onset invasive pulmonary aspergillosis (IPA) in nonneutropenic patients. Methods Retrospective analysis was used to investigate clinical manifestations and auxiliary examination characteristics in 43 patients with IPA and 51 patients with community-acquired pneumonia in the early stage. Results Risk factors of IPA were dust and mold exposure, bronchiectasis, old pulmonary tuberculosis, and nasosinusitis. The incidence rate of complex clinical manifestations was 60.47% during the first week of IPA. The incidence rate of white blood cell (WBC) count >20.0 × 109/L was 51.16%. Lung CT findings indicated incidence rates of single or multiple nodules with a halo sign and central airway expansion with ground glass opacity were 27.9% and 37.21%, respectively. Mortality rates of patients with IPA given empirical and targeted antifungal treatments were 12.0% and 42.9%, respectively. Conclusions Bronchiectasis, old pulmonary tuberculosis, nasosinusitis, and dust and mold exposure may increase the risk of IPA. Single or multiple nodules with a halo sign and central airway expansion with ground glass opacity may be early-stage lung CT findings in patients with IPA. A WBC count >20.0 × 109/L may aid in early diagnosis, and empirical antifungal therapy may reduce mortality in patients with IPA.
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Affiliation(s)
- Lihong Zhang
- Department of Radiology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chunli Che
- Department of Respiratory Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Mediwake H, Curley C, Butler J, Mclean A, Tey S, Hill GR, Morton A, Misra A, Subramoniapillai E, Durrant S, Kennedy GA. Mismatched unrelated donor allogeneic stem cell transplant for high risk haematological malignancy: A single centre experience. Blood Cancer J 2017; 7:655. [PMID: 29242598 PMCID: PMC5802457 DOI: 10.1038/s41408-017-0012-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Heshani Mediwake
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia.,School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Cameron Curley
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Jason Butler
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Angela Mclean
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Siok Tey
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia
| | - Geoffrey R Hill
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia
| | - Anthony Morton
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Ashish Misra
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Elango Subramoniapillai
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Simon Durrant
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Glen A Kennedy
- Department of Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia. .,School of Medicine, University of Queensland, St Lucia, Queensland, Australia.
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Nucci M, Nouér SA, Cappone D, Anaissie E. Early diagnosis of invasive pulmonary aspergillosis in hematologic patients: an opportunity to improve the outcome. Haematologica 2014; 98:1657-60. [PMID: 24186309 DOI: 10.3324/haematol.2013.094359] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wang HI, Aas E, Howell D, Roman E, Patmore R, Jack A, Smith A. Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:205-14. [PMID: 24636378 DOI: 10.1016/j.jval.2013.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 10/12/2013] [Accepted: 12/15/2013] [Indexed: 05/22/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) can be diagnosed at any age and treatment, which can be given with supportive and/or curative intent, is considered expensive compared with that for other cancers. Despite this, no long-term predictive models have been developed for AML, mainly because of the complexities associated with this disease. OBJECTIVE The objective of the current study was to develop a model (based on a UK cohort) to predict cost and life expectancy at a population level. METHODS The model developed in this study combined a decision tree with several Markov models to reflect the complexity of the prognostic factors and treatments of AML. The model was simulated with a cycle length of 1 month for a time period of 5 years and further simulated until age 100 years or death. Results were compared for two age groups and five different initial treatment intents and responses. Transition probabilities, life expectancies, and costs were derived from a UK population-based specialist registry-the Haematological Malignancy Research Network (www.hmrn.org). RESULTS Overall, expected 5-year medical costs and life expectancy ranged from £8,170 to £81,636 and 3.03 to 34.74 months, respectively. The economic and health outcomes varied with initial treatment intent, age at diagnosis, trial participation, and study time horizon. The model was validated by using face, internal, and external validation methods. The results show that the model captured more than 90% of the empirical costs, and it demonstrated good fit with the empirical overall survival. CONCLUSIONS Costs and life expectancy of AML varied with patient characteristics and initial treatment intent. The robust AML model developed in this study could be used to evaluate new diagnostic tools/treatments, as well as enable policy makers to make informed decisions.
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Affiliation(s)
- Han-I Wang
- Epidemiology & Cancer Statistics Group, University of York, York, UK.
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Debra Howell
- Epidemiology & Cancer Statistics Group, University of York, York, UK
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, University of York, York, UK
| | - Russell Patmore
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK
| | - Andrew Jack
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Alexandra Smith
- Epidemiology & Cancer Statistics Group, University of York, York, UK
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Clinicopathologic analysis of acute myeloid leukemia arising from chronic myelomonocytic leukemia. Mod Pathol 2013; 26:751-61. [PMID: 23307061 DOI: 10.1038/modpathol.2012.218] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Acute myeloid leukemia arising from chronic myelomonocytic leukemia is currently classified as acute myeloid leukemia with myelodysplasia-related changes, a high-risk subtype. However, the specific features of these cases have not been well described. We studied 38 patients with chronic myelomonocytic leukemia who progressed to acute myeloid leukemia. We compared the clinicopathologic and genetic features of these cases with 180 patients with de novo acute myeloid leukemia and 34 patients with acute myeloid leukemia following myelodysplastic syndromes. We also examined features associated with progression from chronic myelomonocytic leukemia to acute myeloid leukemia by comparing the progressed chronic myelomonocytic leukemia cases with a cohort of chronic myelomonocytic leukemia cases that did not transform to acute myeloid leukemia. Higher white blood cell count, marrow cellularity, karyotype risk score, and Revised International Prognostic Scoring System score were associated with more rapid progression from chronic myelomonocytic leukemia to acute myeloid leukemia. Patients with acute myeloid leukemia ex chronic myelomonocytic leukemia were older (P<0.01) and less likely to receive aggressive treatment (P=0.02) than de novo acute myeloid leukemia patients. Most cases showed monocytic differentiation and fell into the intermediate acute myeloid leukemia karyotype risk group; 55% had normal karyotype and 17% had NPM1 mutation. Median overall survival was 6 months, which was inferior to de novo acute myeloid leukemia (17 months, P=0.002) but similar to post myelodysplastic syndrome acute myeloid leukemia. On multivariate analysis of all acute myeloid leukemia patients, only age and karyotype were independent prognostic variables for overall survival. Our findings indicate that acute myeloid leukemia following chronic myelomonocytic leukemia displays aggressive behavior and support placement of these cases within the category of acute myeloid leukemia with myelodysplasia-related changes. The poor prognosis of these patients may be related to an older population and lack of favorable-prognosis karyotypes that characterize many de novo acute myeloid leukemia cases.
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De Santis GC, Benicio MTL, Oliveira LC, Falcão RP, Rego EM. Genetic mutations in patients with acute myeloid leukemia and leukostasis. Acta Haematol 2013; 130:95-7. [PMID: 23548579 DOI: 10.1159/000346442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 12/06/2012] [Indexed: 01/05/2023]
Affiliation(s)
- Gil C De Santis
- Center for Cell-Based Therapy, University of São Paulo, Ribeirão Preto, Brazil
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Abstract
Although the majority of adult patients with both acute lymphoblastic leukemia and acute myelogenous leukemia achieve remission with upfront chemotherapy, many patients still suffer relapse. Often, the strategy is proposed of treating patients with relapsed leukemia into a second remission (CR2) and then proceeding to allogeneic transplantation as the definitive curative approach. However, the long-term outcomes of such a strategy are poor: the 5-year overall survival from first relapse for patients with acute leukemia is only approximately 10%. This Perspective highlights the fact that most patients do not achieve CR2 and therefore never really have an opportunity for a potential curative therapy. Although patients who undergo transplantation after relapse may be cured, those who do not achieve CR2 are rarely candidates for transplantation; therefore, the overall outcome for patients who relapse is dismal. There is therefore an urgent need not only for more effective upfront therapy to prevent relapse, but also for the development of therapies that can serve as effective bridging treatments between relapse and transplantation. We suggest that more optimal use of minimal residual disease detection during first remission may also improve the chances for successful transplantation therapy via earlier reinduction therapy, allowing transplantation before overt relapse.
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