This study describes baseline and clinical characteristics, treatment patterns, survival, and safety outcomes of patients with acute myeloid leukemia (AML) who received oral azacitidine (oral-AZA) maintenance therapy in Canada following its approval in 2021.
A retrospective, observational medical record review was conducted of patients with AML in remission after induction therapy and who initiated treatment with oral-AZA between March 2021 and July 2023 in Canada. Real-world relapse-free survival and overall survival outcomes were estimated using Kaplan–Meier methodology.
Data from 119 patients were analyzed. The median age at oral-AZA initiation was 62.5 years. Most patients had favorable (39.5%) or intermediate (39.5%) genetic risk per the 2017/2022 European LeukemiaNet classification. Nearly all patients (99.2%) received cytarabine-based induction regimens. A total of 55.5% of patients received consolidation therapy, with a median of two cycles. After a median follow-up of 9.4 months, 68.1% of all patients were still receiving oral-AZA at last follow-up. After oral-AZA treatment, 21.0% of patients relapsed. Rates of real-world relapse-free survival and overall survival at 12 months from oral-AZA initiation were 66.9% and 74.5%, respectively. During oral-AZA treatment, 67.2% of patients experienced ≥1 adverse event. Concomitant antiemetic treatment was received by 78.2% of patients.
These findings provide real-world evidence further supporting the use of oral-AZA as a standard-of-care maintenance therapy in current routine clinical practice for patients with AML in remission who do not receive hematopoietic stem cell transplantation. These results may inform a broader clinical audience because of the inclusion of patients with diverse demographic and clinical characteristics.
Mortgage lending bias is a critical driver of residential segregation, and may contribute to disparities in cancer survival. This study investigated the association between contemporary redlining and racial lending bias and prostate cancer survival.
This cohort study used a Surveillance, Epidemiology, and End Results–Medicare database that included 34,163 Black and White men diagnosed with prostate cancer between 2010 and 2013. Home Mortgage Disclosure Act data were used to calculate the census-tract redlining index (the systematic denial of mortgages based on property location) and racial lending bias index (the systematic denial of a mortgage application for a Black applicant compared with a White applicant in the local area). Both indices were assessed continuously and categorically (low, moderate, or high). Multivariable-adjusted Cox models were used to estimate hazard ratios (HRs) for prostate cancer–specific and all-cause mortality.
Overall, as the redlining index increased, men experienced poorer prostate cancer survival. Compared to men residing in low-redlined neighborhoods, those in high-redlined neighborhoods had an increased risk of prostate cancer–specific mortality (HR, 1.21; 95% confidence interval [CI], 1.03–1.42) and all-cause mortality (HR, 1.25; 95% CI, 1.17–1.34). Similar results were observed for redlining in a race-stratified analysis among Black and White men. Among White men, compared with those residing in low racial lending bias neighborhoods, those in high racial lending bias neighborhoods had an increased all-cause mortality risk (HR, 1.11; 95% CI, 1.03–1.21).
Contemporary redlining was associated with poorer prostate cancer survival in the overall population. However, an association between racial lending bias and elevated mortality was only observed among White men. Findings suggest that mortgage lending discrimination may contribute to disparities in prostate cancer survival.
Major events, such as Hurricanes Irma and Maria and the coronavirus disease 2019 (COVID-19) pandemic disrupted Puerto Rico's health system. Lack of access to colorectal cancer (CRC) screening services may have impeded timely diagnosis. The authors examined the impact of these events on CRC incidence in Puerto Rico.
The Puerto Rico Central Cancer Registry database allowed the authors to obtain CRC cases from 2012 to 2021. An interrupted time-series analysis was performed to examine changes in CRC incidence immediately after and during the periods after the hurricanes and the pandemic. Analysis periods included: pre-hurricanes, post-hurricanes, and post-COVID-19 lockdown restrictions.
We observed a level change of −8.3 CRC cases was observed in the month the hurricanes struck Puerto Rico, corresponding to an immediate decrease of 17.5%. After a slight upward trend, a second decline of 39.4 CRC cases was estimated after the COVID-19 lockdown restrictions, representing an immediate change of −24.2%. By the end of the study, the estimated numbers of patients with early stage CRC patients and those aged 50–75 years did not reach the expected numbers. In addition, CRC cases in patients with late-stage disease and in those aged younger than 50 years and aged 76 years and older exceeded the expected numbers.
Hurricanes Irma and Maria and the COVID-19 pandemic caused a decrease in CRC incidence in Puerto Rico. This analysis suggests that limited access to CRC screening services during these events likely hindered CRC diagnoses. To fully understand the long-term effects, monitoring of CRC trends will be necessary in the coming years.
The prognostic impact of cohesin mutations in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) is controversial.
In patients with AML and MDS who underwent next-generation sequencing at the authors' center during 2017–2023, the authors assessed the landscape of cohesin mutations and the impact of co-occurring mutations on overall survival (OS) and compared outcomes between patients with cohesin mutations and those with wild-type (WT) cohesin genes.
The study included 83 patients, 36 with cohesin mutations (STAG2, n = 28; SMC1A, n = 7; SMC3, n = 3; co-expression of cohesin mutations, n = 2) and 47 with WT cohesin genes. Of the 36 patients with cohesin mutations, 17 (47%) had AML (six de novo and 11 secondary), and 19 (53%) had MDS. Patients who had STAG2 mutations had better median OS than patients who had only SMC1A and SMC3 mutations (26 vs. 10 months; p = .043). SRSF2 mutation was the most frequent co-occurring mutation (n = 12; 33%) and was associated with worse median OS than WT SRSF2 (13 vs. 43 months; p = .016). Seven patients (19%) with cohesin mutations underwent hematopoietic transplantation; their median OS was 70 months. Compared with the WT cohesin group, patients who had cohesin mutations were more likely to have adverse-risk AML (82% vs. 53%). The median OS was similar among patients with adverse-risk AML in the cohesin-mutation and WT cohesin groups (10 vs. 14 months, respectively; p = .9).
The current study provides insight into the prognostic impact of cohesin mutations and co-occurring mutations in patients with myeloid malignancies.
Cancer-related cognitive impairment (CRCI) has traditionally been assessed in a dichotomous manner. Identifying subclasses of CRCI and novel biomarkers can improve the accuracy of identifying patients most at risk for CRCI.
A total of 139 breast cancer patients undergoing chemotherapy completed neurocognitive batteries over 12 months. Growth mixture modeling (GMM) was used to determine latent subgroups based on different trajectories of cognitive test performance across the four time points. Additionally, the authors collected peripheral blood to measure neuron-derived exosomes (NDE).
Mean cognitive performance improved significantly over time (p < .001). However, GMM identified three distinct latent subgroups: patients with stable, high performance (class 1, N = 45), patients with variable low performance (class 2, N = 15), and patients with average performance who improved over time (class 3, N = 79). Cognitive subclass 2 was characterized by significantly lower education levels than the other two classes (p = .001). Cognitive subclass 1 had fewer racial/ethnic minority patients than the other two classes (p = .015). Cognitive subclasses did not differ significantly in any other demographic or clinical characteristic. There were no significant differences observed by NDE.
There are multiple distinct longitudinal trajectories of CRCI and these may be influenced by social determinants of health such as education and race/ethnicity. Future research can focus on ways to administer interventions earlier to those at most risk for CRCI and continue to explore novel biomarkers of CRCI.
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