Right ventricular beneficial effects of intracoronary SERCA2a gene transfer in an experimental model of heart failure

SERCA2a gene transfer ameliorates heart failure pathologic processes in left ventricular myocardium. We sought to assess the simultaneous molecular changes that occur in the right ventricle. Sprague-Dawley rats underwent aortic banding and were followed by echocardiography for development of heart failure. After a decrease in fractional shortening of 25 % from baseline, intracoronary injection of adenoviral-SERCA2a or adenoviral-beta-galactosidase was performed. Successful gene transfer was confirmed by immunoblotting. Rats were randomly euthanized on post-operative day 7 or 21. Protein analysis including right ventricular levels of SERCA2a, betaARK1, inflammatory mediators (IL-1, IL-6 and TNF-alpha), apoptotic markers (Bax, Bak and Bcl-2) and MAPK (Jnk, p38 and Erk) was performed. Adenoviral-SERCA2a-treated animals showed increased right ventricular expression of SERCA2a compared with controls. Decreased levels of inflammatory markers were also demonstrated in this group. Expression of pro-apoptotic markers was similarly improved. Levels of MAPK were increased compared with the control group. These differences were most significant 7 days after gene transfer, but the majority of these changes persisted at 21 days. These results suggest that attenuation of pathologic mechanisms of calcium cycling, inflammation and apoptosis also occur in the right ventricular myocardium after SERCA2a gene transfer during heart failure. These findings support a therapeutic role for genetic manipulation of this pathway in patients with right ventricular or biventricular failure.

Treatment of wastewater from a low-temperature carbonization process industry through biological and chemical oxidation processes for recycle/reuse: a case study

Low-temperature carbonization (LTC) of coal generates highly complex wastewater warranting stringent treatment. Developing a techno-economically viable treatment facility for such wastewaters is a challenging task. The paper discusses a case study pertaining to an existing non-performing effluent treatment plant (ETP). The existing ETP comprising an ammonia stripper followed by a single stage biological oxidation was unable to treat 1,050 m(3)/d of effluent as per the stipulated discharge norms. The treated effluent from the existing ETP was characterized with high concentrations of ammonia (75-345 mg N/l), COD (313-1,422 mg/l) and cyanide (0.5-4 mg/l). Studies were undertaken to facilitate recycling/reuse of the treated effluent within the plant. A second stage biooxidation process was investigated at pilot scale for the treatment of the effluent from the ETP. This was further subjected to tertiary treatment with 0.5% dose of 4% hypochlorite which resulted in effluent with pH: 6.6-6.8, COD: 73-121 mg/l, and BOD(5):<10 mg/l. Phenol, cyanide and ammonia were below detectable limits and the colourless effluent was suitable for recycle and reuse. Thus, a modified treatment scheme comprising ammonia pre-stripping followed by two-stage biooxidation process and a chemical oxidation step with hypochlorite at tertiary stage was proposed for recycle/reuse of LTC wastewater.

Clinical and Nutritional Correlates of Survival in Breast Cancer

Background: Malnutrition can be a frequent manifestation of breast cancer and its treatment. Several nutritional assessment tools have varying levels of association with survival, and have been tested individually with different patient populations, sometimes making it difficult to assess the impact of one tool relative to the others. We therefore conducted a single-institution multivariate analysis of 3 most commonly used nutritional tools - Body Mass Index (BMI), Subjective Global Assessment (SGA) and bioimpedance-derived phase angle (PA).Material and Methods: A case series of 234 breast cancer patients treated at Cancer Treatment Centers of America. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Cox proportional hazard models were used to evaluate the independent prognostic effects of SGA, PA and BMI after controlling for each other, stage at diagnosis and prior treatment history (newly diagnosed versus previously treated).Results: Of 234 patients, 74 were newly diagnosed while 160 had received prior treatment. 159 had early stage (I/II) disease at diagnosis, while 75 had late stage (III/IV). The median age at presentation was 52.8 years (range 25-75 years). The mean PA and BMI scores were 5.5 (std. dev = 1.1) and 28.7 (std. dev = 6.2) respectively. 171 patients were well-nourished (SGA A) while 63 were malnourished (SGA B/C). Multivariate Cox modeling, after adjusting for stage at diagnosis, prior treatment history and other nutritional variables, found that malnourished status (SGA B/C) was associated with a relative risk (RR) of 2.4 (95% CI: 1.5-3.9, p &lt; 0.001). Late stage at diagnosis was associated with a RR of 2.0 (95% CI: 1.3-3.2; p = 0.003) and previously treated category was associated with a RR of 7.9 (95% CI: 3.9-15.8; p &lt; 0.001). PA and BMI were found to be statistically non-significant.Discussion: We found that SGA A (well-nourished status) versus SGA B/C (moderate to severe malnourished status) identified patients with better survival outcomes independent of BMI, PA, stage at diagnosis and prior treatment history. Among the nutritional assessment tools evaluated, SGA emerged as the strongest predictor of survival in breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6048.

Identifying Symptom Clusters in Breast Cancer: Implications on Patient Quality of Life

Background: Patients undergoing treatment for advanced cancer often experience multiple symptoms. These symptoms occur with varying frequency, intensity, and impact. Pain, fatigue, insomnia, anorexia and dyspnea are consistently among the 10 most prevalent symptoms associated with cancer and its treatment. We conducted a multivariate analysis to investigate the impact of cancer symptoms on patient quality of life (QoL) in breast cancer.Material and Methods: A consecutive series of 226 breast cancer patients treated at the Cancer Treatment Centers of America at Southwestern Regional Medical Center between Jan 2001 and Nov 2006. Cancer symptoms were assessed using the symptom subscales of European Organization for Research Treatment of Cancer - Quality of Life Questionnaire (QLQ-C30). Symptom scores range from 0-100 with lower scores indicating better while higher scores indicating worse symptoms. QoL was assessed using Ferrans and Powers Quality of Life Index (QLI). QLI measures overall QoL and QoL in 4 major subscales: health/physical, social/economic, psychological/spiritual, and family. QLI scores range from 0-30 with higher scores indicating better QoL. The relationship between QLQ-C30 symptoms and QLI was evaluated using multivariate linear regression.Results: Of 226 patients, 98 were newly diagnosed while 128 had failed prior treatment before coming to our hospital. The mean age was 52.5 years (range = 27-82 years). We found that every 10 unit increase in fatigue (p=.004) and pain (p=.001) was significantly associated with 0.65 and 0.66 unit decline in QLI health/physical subscale after controlling for age, treatment history, stage at diagnosis and other cancer symptoms. Similarly, every 10 unit increase in insomnia (p=.02) was significantly associated with 0.35 unit decline in QLI family subscale. Finally, every 10 unit increase in pain (p=.01) and insomnia (p=.03) was significantly associated with 0.34 and 0.21 unit decline in overall QoL.Discussion: We found fatigue, pain and insomnia to be independent predictors of QoL after controlling for each other, age, treatment history and stage at diagnosis. Recognition and timely treatment of symptom clusters could result in improved QoL in patients with breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5043.

Case report: A rare cause of miliary nodules -- allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a complex immune hypersensitivity reaction to the fungus Aspergillus fumigatus, which occurs in patients with asthma and cystic fibrosis. The common radiological findings include fleeting pulmonary opacities, bronchiectasis and mucoid impaction. Uncommon radiological findings encountered in ABPA include lung masses, perihilar opacities simulating hilar adenopathy and pleural effusions. Herein, we describe a 36-year-old man who presented to the chest clinic with miliary nodules on a chest radiograph and was diagnosed as having ABPA confirmed on both serology and lung biopsy. This is the first report of ABPA presenting as randomly scattered nodules on CT.

Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis

BACKGROUND

The prevalence of Aspergillus hypersensitivity (AH) and allergic bronchopulmonary aspergillosis (ABPA) in bronchial asthma is reported differently in various studies.

OBJECTIVE

To determine the prevalence of AH and ABPA in asthma using a systematic review.

METHODS

We searched the MEDLINE and EMBASE databases for studies published from 1965 to 2008 and included studies that report the prevalence of AH/ABPA in asthma. We calculated the proportions with 95% confidence interval (CI) to assess the prevalence of AH/ABPA in the individual studies and pooled the results using a random effects model.

RESULTS

Our search yielded 21 eligible studies. The prevalence of AH in bronchial asthma was 28% (95%CI 24-34), and was higher with an intradermal test vs. a prick test (28.7% vs. 24.8%, P = 0.002), but did not vary with the type of antigen used (indigenous or commercial). The prevalence of ABPA in bronchial asthma and Aspergillus-hypersensitive bronchial asthma was respectively 12.9% (95%CI 7.9-18.9) and 40% (95%CI 27-53). There was a wide variation in the criteria used for the diagnosis of ABPA. There was significant statistical heterogeneity assessed by the I(2) test and Cochran Q statistic in all the outcomes.

CONCLUSIONS

There is a high prevalence of AH and ABPA in patients with bronchial asthma. Careful screening should therefore be performed in all patients with bronchial asthma. Intradermal tests are more sensitive than prick tests for the diagnosis of AH. Finally, there is a need to adopt a uniform methodology and criteria for the diagnosis of AH/ABPA.

Is noninvasive pressure support ventilation as effective and safe as continuous positive airway pressure in cardiogenic pulmonary oedema?

INTRODUCTION

Noninvasive ventilation (NIV) with continuous positive airway pressure (CPAP) has been shown to decrease endotracheal intubation and mortality in patients with acute cardiogenic pulmonary oedema (ACPE). The Three Interventions in Cardiogenic Pulmonary Oedema showed no advantage of NIV over standard medical therapy. This meta-analysis is an update on the efficacy and safety of two different forms of NIV (noninvasive pressure support ventilation [NIPSV] vs. CPAP) in patients with ACPE.

METHODS

We searched the MEDLINE and EMBASE databases for randomised clinical trials published from 1980 to 2008 that have compared NIPSV and CPAP in patients with ACPE. We calculated the odds ratio (OR) with 95 percent confidence intervals (CI) and pooled the results using three different statistical models (fixed effects, random effects and exact method).

RESULTS

Ten studies (577 and 576 in the CPAP and NIPSV groups, respectively) met our inclusion criteria. NIPSV performed similar to CPAP in decreasing the intubation rates (OR 0.8; 95 percent CI 0.43-1.49), hospital mortality (OR 1.08; 95 percent CI 0.76-1.54) and the occurrence of myocardial infarction (OR 0.8; 95 percent CI 0.36-1.76). The results were similar when pooling the data with any of the three statistical methods and stratifying for the type of pressure therapy (fixed vs. variable) except for myocardial infarction, which was more frequent in the fixed pressure NIPSV arm (OR 5.06; 95 percent CI 1.66-15.44).

CONCLUSION

NIPSV appears to be as safe and efficacious as CPAP, if titrated rather than fixed pressures are employed.

Islet beta cell failure in the 60% pancreatectomised obese hyperlipidaemic Zucker fatty rat: severe dysfunction with altered glycerolipid metabolism without steatosis or a falling beta cell mass

AIMS/HYPOTHESIS

The Zucker fatty (ZF) rat subjected to 60% pancreatectomy (Px) develops moderate diabetes by 3 weeks. We determined whether a progressive fall in beta cell mass and/or beta cell dysfunction contribute to beta cell failure in this type 2 diabetes model.

METHODS

Partial (60%) or sham Px was performed in ZF and Zucker lean (ZL) rats. At 3 weeks post-surgery, beta cell mass and proliferation, proinsulin biosynthesis, pancreatic insulin content, insulin secretion, and islet glucose and lipid metabolism were measured.

RESULTS

ZL-Px rats maintained normal glycaemia and glucose-stimulated insulin secretion (GSIS) despite incomplete recovery of beta cell mass possibly due to compensatory enhanced islet glucose metabolism and lipolysis. ZF-Px rats developed moderate hyperglycaemia (14 mmol/l), hypertriacylglycerolaemia and relative hypoinsulinaemia. Despite beta cell mass recovery and normal arginine-induced insulin secretion, GSIS and pancreatic insulin content were profoundly lowered in ZF-Px rats. Proinsulin biosynthesis was not reduced. Compensatory increases in islet glucose metabolism above those observed in ZF-Sham rats were not seen in ZF-Px rats. Triacylglycerol content was not increased in ZF-Px islets, possibly due to lipodetoxification by enhanced lipolysis and fatty acid oxidation. Fatty acid accumulation into monoacylglycerol and diacylglycerol was increased in ZF-Px islets together with a 4.5-fold elevation in stearoyl-CoA desaturase mRNA expression.

CONCLUSIONS/INTERPRETATION

Falling beta cell mass, reduced proinsulin biosynthesis and islet steatosis are not implicated in early beta cell failure and glucolipotoxicity in ZF-Px rats. Rather, severe beta cell dysfunction with a specific reduction in GSIS and marked depletion of beta cell insulin stores with altered lipid partitioning underlie beta cell failure in this animal model of type 2 diabetes.

Primary testicular non-Hodgkin lymphoma: a single institution experience from India

BACKGROUND

Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal presentation, constituting 1% of all NHL. Median age at time of presentation is 60 years. Anthracycline based chemotherapies are most frequently used. There is not enough data on use of monoclonal antibody (Rituximab) in testicular NHL.

METHODS

We screened approximately eight hundred and fifty NHL cases registered from January 2002 to May 2008 and found six primary testicular NHL patients. These six cases were analyzed for baseline clinical features, investigations, staging, treatment and outcome variables.

RESULTS

Median age was 55 years (range 7-72 years) and median duration of symptoms was 3.5 months (range 1-8 months). All patients had testicular swelling and abdominal lymphadenopathy. Five patients (83%) had stage IV and one had stage IE disease. Majority had diffuse large B-cell histology (83%). All patients were treated with anthracycline based combination chemotherapy and CNS prophylaxis after local therapy except one pediatric patient who did not receive any local therapy. Four patients completed therapy and are on follow up while two patients having extensive disease with poor performance status died of neutropenic sepsis after 1-2 cycles of chemotherapy. The surviving four patients achieved complete remission and are without any recurrence with a median follow up of 26 months (1-78 months).

CONCLUSION

Primary testicular NHL is an uncommon entity and with current combined modality treatment and CNS prophylaxis, the outcome may be as good as nodal NHL.

Retrospective comparison of response rates and survival with neoadjuvant docetaxel versus anthracycline-based chemotherapy for locally advanced breast cancer patients

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Background: LABC is a major problem in our country comprising of ≥ 20% of all breast cancer patients. Neoadjuvant chemotherapy is now standard treatment for LABC but randomized trials have failed to show survival advantage. Methods: We retrospectively analyzed locally advanced breast cancer (stage III) patients who received neoadjuvant chemotherapy (NACT) from January 2000 to December 2008. Out of 3000 case records screened, 570 (19%) were LABC and 110/570 (19%) treatment-naïve patients started on NACT were analyzed. Ninety one (37 docetaxel [D], 54 anthracycline [A]) patients were eligible for response and survival analysis. Pathological CR (pCR) was defined as no evidence of malignancy in both breast and axilla. Survival curves generated using Kaplan-Meier method and survivals compared using log-rank test. Results: Median age of whole cohort was 45 years (range 25–68 years). Premenopausal were 42% and ER+ 49.5%. Most (90%) were T4 tumors and 70% were stage IIIB. Median number of preoperative cycles was 3 and 6 in D and A group. Overall clinical response rates for breast primary were 74.3% (CR 28.6%) and 53.7% (CR 16.7%, p=0.58) while for axilla ORR were 75.7% (51.4% CR) vs 54.8% (40.4% CR, p=0.77) respectively for D and A. Corresponding pCR rates were 19% vs 13% respectively. There was no significant difference in disease free (3 year 56.84% vs 61.16%, p=0.80) and overall survival (3 year 70% vs 78.5%, p=0.86) between two groups. Those who achieved pCR in both groups also had no survival advantage (p=0.34) over non achievers. There was no difference in pCR rates for ER+ vs ER- patients but ER+ patients had significantly higher DFS than ER- patients (p=0.05). Conclusions: Although pCR rates were higher with docetaxel based NACT, it did not translate into superior DFS/OS compared to anthracycline based chemotherapies. Achievement of pCR too, was not associated with any survival advantage.

No significant financial relationships to disclose.

Association of serum 25-hydroxy vitamin D and body mass index in cancer

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Background: The association between vitamin D and obesity remains unsettled with studies reporting conflicting findings on the relationship between the two. This association assumes even greater importance in cancer because of the alleged role of vitamin D in cancer risk and survival. Currently, the dietary recommendations for Vitamin D do not take into account a person's body mass index (BMI). We investigated the relationship between serum 25-hydroxy-vitamin D [25(OH)D] and BMI in a large sample of cancer patients. Methods: A consecutive case series of 740 cancer patients seen at Cancer Treatment Centers of America from Jan 08 to June 08. Serum 25(OH)D was measured at presentation to the hospital. The cohort was divided in 4 BMI groups (<18.5, 18.5–24.9, 25–29.9, and >30.0 kg/m2). Correlation between 25(OH)D and BMI was evaluated using Spearman correlation coefficient. Mean 25(OH)D was compared across the 4 BMI groups using ANOVA. Linear regression was used to quantify the relationship between BMI and 25(OH)D. Results: Of 740 patients, 303 were males and 437 females. The mean age at presentation was 55.7 years (SD = 10.2). The mean BMI was 27.9 kg/m2 (SD = 6.7). Most common cancers were lung (134, 18.1%), breast (131, 17.7%), colorectal (97, 13.1%), pancreas (86, 11.6%), prostate (45, 6.1%) and ovarian (39, 5.3%). The mean serum 25(OH)D was 21.9 ng/ml (SD = 13.5). Analysis revealed that as BMI groups increased from normal to overweight or obese classifications, there was a significant decrease in 25(OH)D (Table). The Spearman correlation between 25(OH)D and BMI was -0.20 (p = 0.001). Every 1 kg/m2 increase in BMI was significantly associated with a 0.43 ng/ml decline in serum 25(OH)D (p = 0.001). Conclusions: We found that obese cancer patients (BMI >=30 kg/m2) had significantly lower levels of serum 25(OH)D as compared to nonobese patients (BMI <30 kg/m2). BMI should be taken into account when assessing a patient's vitamin D status and more aggressive vitamin D supplementation should be considered in obese cancer patients.

[Table: see text]

No significant financial relationships to disclose.

Serum 25-hydroxy vitamin D and nutritional status: Implications for vitamin D assessment and dietary supplementation in oncology

9638

Background: There is emerging evidence in the literature to suggest a protective role of vitamin D in cancer survival. Vitamin D status is not routinely assessed, despite the high prevalence of malnutrition in this population. We hypothesized that malnutrition could contribute to vitamin D deficiency, and therefore expected mean serum 25-hydroxy-vitamin D [25(OH)D] levels to be significantly lower in malnourished oncology patients. Methods: A consecutive case series of 737 cancer patients seen at Cancer Treatment Centers of America between Jan-June 08. Nutritional status was assessed using Subjective Global Assessment (SGA) and serum albumin. SGA categorizes patients into 3 distinct classes of nutritional status; well nourished (SGA-A), moderately malnourished (SGA-B) and severely malnourished (SGA-C). Serum albumin was divided into 2 groups: >=3.6 g/dl and <=3.5 g/dl. Mean serum 25(OH)D was compared across 3 categories of SGA using ANOVA and across 2 categories of serum albumin using 2 sample t test. Results: Of 737 patients, 302 were males and 435 females. The mean age at presentation was 55.7 years (SD = 10.2). The most common cancer types were lung (133, 18%), breast (131, 17.8%), colorectal (97, 13.2%), pancreas (86, 11.7%), prostate (44, 6%) and ovarian (38, 5.2%). The mean serum albumin and serum 25(OH)D was 3.5g/dl (SD = 0.6) and 21.9 ng/ml (SD = 13.5) respectively. There was no significant difference in the mean vitamin D levels across serum albumin (p = 0.76). The mean vitamin D levels across the 3 classes of SGA also showed no statistically significant difference ( Table ). Conclusions: Contrary to what we expected, vitamin D deficiency was found to be prevalent in cancer regardless of nutritional status. No significant differences were found across the 3 classes of SGA. Based on these results, screening for vitamin D deficiency and aggressive vitamin D repletion should be considered for all people with cancer. [Table: see text]

No significant financial relationships to disclose.

sFLC in healthy Indian subjects and myeloma patients

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Background: Serum free light chain (sFLC) analysis for detection and monitoring of monoclonal gammopathies has been validated by several studies but none from India. We report sFLC in Indian healthy subjects and myeloma patients. Methods: Serum samples from 73 healthy subjects and 39 myeloma patients were analyzed using serum protein electrophoresis, immunofixation where appropriate and estimation of sFLC, the latter using FREELITE reagent kit and Hitachi-912 autoanalyzer. Parameters evaluated were κ and λ levels, κ/λ ratio and dFLC (involved-uninvolved chain). Results: Median age of controls (50 males, 23 females) was 40 years (range 20–65 years) and of patients (34 males, 5 females) was 53.5 years (range 35–80 years). In control group, λ levels were significantly higher than κ. There were 26 of kappa- and 13 of lambda- type myeloma as judged by immunofixation. Results were significantly different between myeloma and control group for κ, λ and κ/λ ratio (p=0.00). Only thirteen patients had iFLC >100 mg/L but ratios were abnormal in all (100%) patients (26 κ, 13 λ) when judged by the full range of normal κ/λ (0.51–1.66). dFLC >50 mg/L with abnormal ratio was seen in 28 (70%) patients. All patients had concordance with immunofixation. Conclusions: Healthy Indian subjects have higher κ and λ values than reported, possibly because of greater incidence of subclinical infections. However κ/λ range is comparable and iFLC >100mg/l appears uncommon. The κ/λ ratio is highly sensitive method for myeloma detection. Results need validation in larger cohort of healthy subjects and patients.

No significant financial relationships to disclose.

Significance of changes in serum CA125 level on overall survival in ovarian cancer

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Background: The role of baseline serum CA125 as a prognostic indicator in ovarian cancer is well documented. However, little is known about the impact of change in CA125 on survival after 3 months of therapy. We conducted survival analysis to answer the question “what is the prognostic impact of change in serum CA125 after 3 months of therapy in ovarian cancer?” Methods: A case series of 170 ovarian cancer patients treated at Cancer Treatment Centers of America between Jan 01 and May 06. Based on CA125 levels at baseline and 3 months, patients were classified into 4 groups: 1) Normal (0–35U/ml) at baseline and three months; 2) High (>35U/ml) at baseline, normal at three months; 3) Normal at baseline, high at 3 months; 4) High at baseline and three months. Kaplan Meier method was used to calculate survival across the 4 categories, which was defined as the time interval between date of patient visit at 3 months from first visit and date of death from any cause or date of last contact. Results: Of 170 patients, 36 were newly diagnosed while 134 had received prior treatment. 25 had stage I disease at diagnosis, 15 stage II, 106 stage III and 14 stage IV. The median age at presentation was 54.2 years (range 23.1 - 82.5 years). At baseline, 31 patients had normal (0–35U/ml) serum CA125 levels while 138 had high (>35U/ml) levels. At 3 months, 59 had normal while 111 had high levels. In this cohort, patients with a reduced CA125 at 3 months (stratum 2) had a significantly better survival than those with increased CA125 at 3 months (stratum 3). Patients with normal values of CA125 at both baseline and 3 months (stratum 1) had the best overall survival. Conclusions: These data show that reduction in CA125 after 3 months of therapy is associated with better overall survival in ovarian cancer. Patients without a significant decline in CA125 after 3 months of therapy have a particularly poor prognosis. [Table: see text]

No significant financial relationships to disclose.

Distribution and determinants of patient satisfaction in oncology with a focus on health-related quality of life

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Background: Cancer patients usually undergo extensive and debilitating treatments, which makes patient satisfaction with care in oncology an important health care assessment measure. We conducted a study to examine patients’ experiences with the care they receive and to investigate the clinical, demographic and quality of life (QoL) factors that can predict satisfaction in a large heterogeneous sample of cancer patients. Methods: A case series of 538 cancer patients treated at Cancer Treatment Centers of America (CTCA) at Midwestern and Southwestern Regional Medical Centers between August 2006-December 2007. A patient satisfaction questionnaire developed in-house by CTCA was used. The questionnaire covered the following dimensions of patient satisfaction: hospital operations and services, physicians and staff, and patient endorsements for themselves and others. QoL was assessed using EORTC QLQ-C30. The available clinical, demographic and QoL factors were evaluated for predictive significance using univariate (t-test or chi-square test) and multivariate logistic regression. Results: The response rate for this study was 24.4%. The mean age of our patient population was 54.1 years (SD = 10.5, range 17–86), with a slight preponderance of females (57.2 %). Breast cancer (n = 124, 23.0 %) and lung cancer (n = 101, 18.8%) were the most frequent cancer types. 481 (89.4%) patients were “very satisfied” with their overall experience with CTCA. Age and several QoL function and symptom scales were predictive of satisfaction upon univariate analysis. However, in the multivariate modeling, only those with a score above the median on the fatigue measure (i.e., worse fatigue) had reduced odds of 0.28 of being “very satisfied” with CTCA (p = 0.03). Conclusions: We found that fatigue was an independent significant predictor of patient satisfaction. This finding argues for special attention and programs for cancer patients who report higher levels of fatigue. Such efforts will help lessen the effect of fatigue on their daily functioning, and may increase their satisfaction with treatment.

No significant financial relationships to disclose.

Multiple myeloma: Autologous stem cell transplantation versus conventional chemotherapy—A retrospective age and stage matched analysis

7041

Background: We retrospectively analyzed results of MM patients who underwent high-dose chemotherapy and stem cell transplantation (ASCT). In age and stage matched analysis, we compared with those patients who received conventional chemotherapy. Methods: Between January 1995 and June 2007, 95 patients underwent ASCT (Tx Group). 149 age and stage matched patients received conventional chemotherapy (CC Group). High-dose melphalan (200 mg/m2) was used for conditioning in Tx group. Baseline characteristics were comparable in both groups: median age was 50 years (range, 26 to 68 years) in Tx group versus 52 years (range 24 to 68 years) in CC group, p < 0.05; M:F = Tx Group -68:27 versus CC Group 98:51, p = 0.34; stage 3A/3B = 76.8%/23.2% in Tx Group versus 62.4%/37.6%, p = 0.02; mean Hb (Gm/dl) 9.1(range, 3.3–14.3) versus 8.6 (3.3–14.8), p = 0.21; median serum albumin (Gm/dl) 3.5 (range, 1.8–5.2) versus 3.4 (1.6–6.2), p = 0.7, respectively in two groups. Results: Following treatment, the response rates (CR + VGPR + PR = 81%) were significantly higher in Tx group compared to CC group (55%), p = 0.001. CR rate was higher in Tx group, 34.7% versus 12.8%, p < 0.001. The median overall survival was significantly higher in Tx group (75 months, 95%CI [72–106 months]) versus (24 months, 95%CI [19–36months]), p = 0.001. The median progression free survival was 30 months in Tx group (95%CI [21–48 months]) compared to 6 months in CC group (95% CI 3–9 months), p < 0.0001. Estimated overall survival at 5 years in Tx group is 66.6% (95% CI [54.8%-75.9%]) compared to 20.7% (95% CI [13.5%-29%]) in CC group. Conclusions: High-dose chemotherapy followed by autologous stem cell transplantation results in higher overall and complete response rates in multiple myeloma patients. This is associated with improved progression free and overall survival. Low-dose maintenance therapy to sustain the survival benefit of transplant would be possible areas of research in future studies.

No significant financial relationships to disclose.