bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in cancer survival in patients with multiple myeloma: A community-based cancer center experience.
Authors: Stempel Jessica M. , Jorge Vinicius Machado , Djibo Djeneba Audrey , Dourado Claudia M. 
Published: May 2020

e20530 Background: Multiple myeloma (MM) accounts for nearly 17% of all hematological malignancies and 2% of all cancer-related deaths in 2018. Despite new treatment options, survival disparities among African Americans (AA) and other ethnic minorities still exist. Although cytogenetics and advanced age are high-risk features, equal healthcare access may also impact outcomes. We aim to investigate the social and biological factors which affect overall survival in patients with MM in a community setting with a predominantly AA population. Methods: We retrospectively identified MM cases diagnosed from January 1, 2013 and March 30, 2019, from our tumor registry. We collected demographic, clinical, histopathologic and treatment variables. Our primary endpoint was overall survival (OS). Overall and median survival with 95% confidence intervals were obtained using Kaplan Meier estimates. Results: We identified 73 patients with MM. Median age was 70 years (range, 42-88 years), 31 were female (42%) and 58 were AA (79%). Median household income in the AA group was $37,832 and $50,810 in the non-AA group ( p< 0.05). AA had a median overall survival (OS) of 15.9 months (95% CI, 8.2-23.7) compared to non-AA, 21.9 months (95% CI, 2.1-41.7). After a median follow-up of 20 months, the HR for death in AA was 1.32 (95% CI, 0.71-2.5); p= 0.37. None of the variables investigated were independently associated with an increased risk of mortality. Conclusions: Social determinants of health play a major role in community-based cancer centers, including access to care, income and social support. A difference in household income was found between both groups but was not independently associated with a survival advantage. Although, our results show AA patients with MM have a shorter OS compared to non-AA, this failed to reach statistical significance. The size of our sample limited the discovery of potential discrepancies in social determinants of health between both groups and their effect on outcomes. Larger-scale community-based studies are indispensable to investigate these differences further. [Table: see text]
Prevalence of acute kidney injury in myeloma patients visiting U.S. emergency departments: A nationwide analysis.
Authors: Zahid Umar , Ramachandran Preethi , Alasadi Lutfi , Bedi Puneet , Shurin Sergiy , Wang Jen C. , Anwer Faiz , Spitalewitz Samuel 
Published: May 2020

e20548 Background: Patients diagnosed with multiple myeloma (MM) frequently visit emergency departments (ED) with complications, commonly with kidney disease. However, data regarding the prevalence of acute kidney injury (AKI) and its effects on patient outcome, economic burden, length of hospital stay and mortality among these patients are lacking. Methods: From the Nationwide Emergency Department Sample, we obtained 7-year (2010-2016) data of myeloma patients who visited ED. Baseline characteristics of these patients with and without AKI were compared. The multivariable regression model was used to estimate hospital admission, length of stay, healthcare burden and in-hospital mortality in patients with and without AKI. Results: Between 2010-2016, 657,392 adult myeloma patients visited ED at an increased rate from 35 to 45 per 100,000 census population. The prevalence of AKI was 22.5% (n = 147,743) with a stable trend over the study period. AKI was more common in patients with relapsed MM (33.5%) than those in remission (18.6%) or never achieving remission (22.4%) (P < 0.001), male (24.1 vs 20.6% in female, P < 0.001), age ≥65 years (24.1%) vs 18-44 years (12.9%), or 45-64 years (19.3%)(P < 0.001) and urban (23.3%) vs non-urban residents (17.9%)(P < 0.001). The majority patients with AKI were hospitalized (96.5%) compared with those without AKI (69.6%) (P < 0.001). In multivariable analysis, odds of hospitalization was higher in patients with AKI (OR: 8.8, P < 0.001) after adjusting age, gender, co-morbidities and other demographics. Median hospital stay was longer in patients with AKI compared to those without (6 vs 4 days, P < 0.001). Median ED and total hospitalization charges were higher in patients with AKI (ED: $2,057; total: $45,414) vs without AKI (ED: $1,853; total: $29,299) (P < 0.001). In the multivariable adjusted-model, odds of in-hospital mortality was significantly higher in patients not in remission (OR: 1.8), patients with relapse (OR: 2.3), AKI (OR: 2.2), age ≥ 65 years (OR: 1.4), male (OR: 1.1) and urban residents (OR:1.2). Conclusions: In this largest national study of MM patients visiting ED, patients with AKI had higher in-hospital admission, ED and total charges, length of hospital stays, and mortality, both by univariate and multivariate analysis. Prevalence of AKI and mortality were highest in patients with MM relapse.
Daratumumab-based three drug regimens for high-risk multiple myeloma: A meta-analysis.
Authors: Farooqui Arafat Ali , Tariq Muhammad , Nabeel Shaha , Ashraf Aqsa , Ahmed Zahoor , Faisal Muhammad Salman , Ammad Ud Din Mohammad , Shahab Zartashia , Setarehaseman Alireza , Anwer Faiz 
Published: May 2020

e20549 Background: Efficacy of daratumumab (D) based regimens in high risk multiple myeloma (MM) (i.e, ISS stage II/III and t(4;14) or (del17p)) has not been thoroughly investigated. The aim of this study was to assess the efficacy of D based 3-drug regimens compared to non-D based regimens in high risk MM. Methods: A systematic review of literature was performed to identify randomized controlled trials (RCTs) which reported overall response rates (ORR) and progression free survival (PFS) of MM patients (pts) with D based 3-drug regimens. Odds ratios (OR) of ORR were computed and hazard ratios (HR) of PFS (along with 95% confidence intervals; CI) were extracted to compute a pooled HR using RevMan v.5.3 to report the efficacy of D based 3-drug regimens. A random effects model was employed only when there was significant heterogeneity among studies ( > 40%, as assessed by I-squared). Results: Screening of 604 studies yielded 04 RCTs (n = 2,234 pts). D was evaluated with lenalidomide (L), carfilzomib (C), bortezomib (B) and dexamethasone (d). DLd regimen was studied in 649, DCd in 312 and DBd in 240 pts. Total 1201 pts were evaluated with D. D based 3-drug regimens proved to be of improved efficacy versus non-D 2-drug regimens in the pooled analysis i.e., PFS (HR 0.46, 95% CI 0.33-0.63; p < 0.00001; I2 = 81%) and ORR (OR 2.83, 95% CI 2.06-3.88; p < 0.00001; I2 = 44%). Relapsed/refractory MM (n = 833) also showed improved ORR (OR 2.79, 95% CI 1.78-4.36; p < 0.00001; I2 = 62%). In high risk group, addition of D decreased the risk of progression to 42% (HR 0.58, 95% CI 0.39-0.85; p = 0.005; I2 = 3%). In standard risk pts, D decreased the risk of progression/death to 66% (HR 0.34, 95% CI 0.23-0.51; p < 0.00001; I2 = 74%). D increased the risk of neutropenia (OR 1.88, 95% CI 1.54-2.31; p < 0.00001; I2 = 0%), respiratory tract infections (OR 1.87, 95% CI 1.49-2.35; p < 0.00001; I2 = 0%) and diarrhea (OR 1.83, 95% CI 1.46-2.29; p < 0.00001; I2 = 23%) in the study population. Conclusions: Daratumumab based 3-drug regimens appear to abrogate high risk features in MM compared to 2 drug regimens.
Retrospective review of chronic pain causes and management in multiple myeloma patients.
Authors: Dave Ami Atulkumar , Lewis Jaime K , Paner Agne 
Published: May 2020

e20552 Background: The survival of patients with multiple myeloma has improved dramatically since the introduction of proteasome inhibitors such as bortezomib, which can have the adverse effect of peripheral neuropathy. This study retrospectively examines causes of chronic pain in myeloma patients and the modalities and duration of treatments used for pain control. Methods: Rush University Medical Center multiple myeloma patients who were diagnosed and treated between 2000-2019 were included. Outcome measures were abstracted from the medical record and included: classes of pain medication used, duration of treatment, prevalence of peripheral neuropathy symptoms, and use of adjunct treatment modalities. Descriptive statistical models including Chi-square and Fisher’s exact test were used for categorical variable analysis. Results: In all, 134 patients were included, of which 75.4% (N = 101) patients received at least one cycle of bortezomib. 42.5% (N = 57) patients were seen in palliative clinic. 72.9% (N = 97) reported bone pain symptoms. A total of 73.7% (N = 98) patients experienced peripheral neuropathy symptoms. 86.1% (N = 87) of patients who received bortezomib reported neuropathy, as compared to 34.4% (N = 11) of patients who did not have bortezomib therapy (OR 11.8, p < 0.0001). 66.4% (N = 67) patients who received bortezomib took anticonvulsants as compared to 31.3% (N = 10) of those who did not receive bortezomib (OR 4.3, p < 0.0005). Patients were on anticonvulsant therapy for a mean of 32.6 months (SD = 26.7) with no significant difference in the bortezomib group. 79.7% (N = 106) patients took opioid medications. Norco was the most commonly used opioid (N = 55) and average duration of use was 36.6 months (SD = 34). 18.8% (N = 25) took antidepressant medications such as TCAs or SNRIs for pain, and all of these patients received bortezomib therapy (p = 0.0003). 36.6% (N = 45) of patients received radiation and 16.5% (N = 22) underwent kyphoplasty. 70.7% (N = 94) patients attended at least one physical therapy session. There was no statistically significant difference in radiation or kyphoplasty utilization between patients who had received bortezomib and those who had not, but there was a significant difference in physical therapy (OR 4.9, p < 0.0001). Conclusions: Patients who received bortezomib as part of their myeloma treatment were more likely to experience peripheral neuropathy and required anticonvulsant therapy more frequently. It is important to better understand and define the health burden of chronic pain and use of pain medications in patients with multiple myeloma.
Impact of autologous stem cell transplant utilization in a vulnerable multiple myeloma population.
Authors: Othman Tamer , Wang Yingyu , Gupta Shelly , Wu Daniel , Gupta Rohan , Celles Larissa , Lane Gregorianna , Mei Matthew Genyeh , Yeh James , Tomassetti Sarah 
Published: May 2020

e20556 Background: Despite improvements in the survival of multiple myeloma (MM) patients, disparities in outcomes persist in underserved populations, in part due to variable access to treatments including autologous stem cell transplant (ASCT), a standard treatment for fit patients. Harbor-UCLA Medical Center (HUMC) is a safety net hospital in Los Angeles with a population of socially and medically vulnerable patients, many of whom possess limited English proficiency. Historically, access to ASCT at tertiary centers has been challenging for patients at HUMC. We present the outcomes for 160 newly diagnosed MM patients between 1998 and 2019 during which our referral process for ASCT markedly improved. Methods: We retrospectively analyzed 160 MM patients evaluated at HUMC between 1998 and 2019. The cohort was divided into 2 groups based on year of diagnosis: 1998-2013 and 2014-2019. Referral for and utilization of ASCT, and 5-year survival rates were recorded. Survival rates were calculated through a Kaplan-Meier analysis. Results: 160 MM patients were included in the analysis. 93 patients were diagnosed in 1998-2013 and 64 in 2014-2019. Three patients had an unknown diagnosis date. Patient characteristics are described in Table. ASCT referrals increased from 23% to 59% (P<0.001) after designating a nurse practitioner to coordinate referrals, and implementing a standardized referral template and an electronic medical record system to send and track requests. With an increased referral rate, ASCT utilization showed an increasing trend from 15% between 1998-2013 to 27% between 2014-2019 (P=0.11). Five-year survival rate was 49% (95% CI, 37.8%-62.5%) from 1998-2013 and 70% (95% CI, 57.5%-84.6%) from 2014-2019, and was greater in patients who received ASCT compared to those who did not, 95% (95% CI, 85.2%-100.0%) versus 55% (95% CI, 40.2%-75.1%) (P=0.01). Conclusions: Increased ASCT utilization was associated with improved survival in our underserved MM population, suggesting that adherence to the most evidence-based treatments, such as ASCT utilization, may help overcome the disadvantages of a resource-limited setting. Continued refinements in our referral process will likely increase ASCT utilization. [Table: see text]
HORIZON (OP-106): An exploratory analysis of time-to-next treatment (TTNT) in patients (pts) with relapsed/refractory multiple myeloma (RRMM) who received melflufen plus dexamethasone (dex).
Authors: Mateos Maria-Victoria , Oriol Albert , Larocca Alessandra , Blade Joan , Cavo Michele , Rodríguez Otero Paula , Leleu Xavier , Hiemenz John W. , Hassoun Hani , Touzeau Cyrille , Alegre Adrian , Paner Agne , Maisel Christopher , Mazumder Amitabha , Raptis Anastasios , Harmenberg Johan , Zavisic Stojan , Thuresson Sara , Öhman Oskar , Richardson Paul G. 
Published: May 2020

e20570 Background: Melflufen is a novel peptide-drug conjugate that rapidly delivers a cytotoxic payload into tumor cells. Melflufen + dex showed efficacy and a manageable safety profile in pts with poor-risk, heavily pretreated RRMM in the phase 2 HORIZON study (Mateos et al. ASH 2019. Abs. 1883). For pts with RRMM, longer TTNT is indicative of disease stabilization and clinical benefit and is associated with lower costs (Chen et al. J Manag Care Spec Pharm. 2017). This report of TTNT after melflufen + dex from HORIZON is, to our knowledge, the first report from a trial population with such advanced RRMM. Methods: Pts with RRMM who had received ≥2 prior lines of therapy, including an IMiD and a proteasome inhibitor (PI), and were refractory to pomalidomide and/or an anti-CD38 monoclonal antibody (mAb), received melflufen 40 mg (IV on d1 of each 28-d cycle) + dex 40 mg/wk until disease progression or unacceptable toxicity. The primary endpoint was overall response rate. Secondary endpoints included progression-free survival (PFS) and safety. TTNT was defined as the time from start of melflufen + dex to first subsequent therapy. Results: Overall, 154 pts were treated (data cutoff, Oct 1, 2019); median age was 64.5 y (range, 35-86), 32% had International Staging System stage 3 disease, 38% had high-risk cytogenetics, 32% had extramedullary disease (EMD), the median number of prior therapies was 5 (range, 2-12), and 71% had triple-class refractory MM (IMiD + PI + anti-CD38 mAb). Treatment discontinuation occurred in 108 pts (70%), most commonly due to disease progression (47%) and adverse events (14%). Among 125 pts evaluable for response, with a median follow up of 15.3 mo, the median TTNT was 8.0 mo (95% CI, 7.2-8.9) and the median PFS was 4.2 mo (95% CI, 3.7-4.9). TTNT and PFS were similar in subgroups of pts with triple-class refractory MM and EMD (Table). Subsequent therapies after melflufen + dex will be presented. Conclusions: TTNT in HORIZON (median 5 prior lines) was consistent with previous reports of TTNT in pts with RRMM who received melflufen + dex or other therapies (median 2-4 prior lines) (Bringhen et al. J Clin Oncol. 2019. Abs. 8043). Melflufen + dex is being further evaluated in the phase 3 OCEAN study (NCT03151811) in pts with RRMM who are refractory to lenalidomide. Clinical trial information: NCT02963493. [Table: see text]
The impact of programmed death-ligand 1 expression on the prognosis of early-stage resected non-small cell lung cancer: A meta-analysis of literatures.
Authors: Zhu Shuai , Li Xiongfei , Zhao Shikang , Wang Yanye , Lei Xi , Huang Dingzhi , Chen Jun , Li Ziming , Xu Song 
Published: May 2020

e21004 Background: Previous studies have demonstrated that programmed cell death-ligand 1 (PD-L1) serves as a poor prognostic biomarker for the survival in advanced-stage non-small-cell lung cancer (NSCLC) patients. However, the value of PD-L1 expression for the prognosis of early-stage NSCLC patients after complete resection remains controversial. Here, we conduct a meta-analysis to investigate the relationship between PD-L1 expression and prognosis in resected NSCLC. Methods: Electronic databases, including PubMed, EMBASE, and the Cochrane Library, were searched up until June 30 2019, for studies evaluating the expression of PD-L1 and prognosis of the resected NSCLC. Hazard ratios (HRs) with 95% confidence interval (CI) of overall survival (OS) and disease-free survival (DFS) were pooled and analyzed. Heterogeneity and publication bias analyses were also performed. Results: A total of 15 studies involving 3501 patients were enrolled. The pooled hazard ratio (HR) showed that PD-L1 expression was related to a much shorter DFS (HR = 1.63, 95% CI: 1.26-2.12, P = 0.022), as well a significantly worse OS (HR = 1.68, 95% CI: 1.32-2.14, P = 0.000). Furthermore, our analysis indicated that PD-L1 expression was significantly associated with gender (male vs. female: HR = 1.25, 95% CI:1.02-1.52, p = 0.028), tumor stage (III/IV vs. I/ II: HR = 2.39, 95% CI:1.85-3.08, p = 0.000), lymph node metastasis (N+ vs N-: HR = 3.54, 95%CI:2.56-4.88, p = 0.000) and smoking status (Yes vs No: HR = 1.37,95% CI:1.20-1.560, p = 0.000). Conclusions: The results of this meta-analysis suggest that PD-L1 expression predict an unfavorable prognosis in early-stage resected NSCLC. The role of individualized anti-PD-L1/PD-1immunotherapy in the adjuvant settings of resected NSCLC is worthy of being further investigated.
The role of adjuvant chemotherapy in the management of surgically resected primary pulmonary salivary gland-type carcinomas.
Authors: Younis Moustafa , Rakhra Sunpreet , Kennedy Kevin F , Heimes Jessica K , Davis John Russell , Kujtan Lara , Subramanian Janakiraman 
Published: May 2020

e21009 Background: Primary pulmonary salivary gland-type carcinomas (PSGC) are rare tumors. There are limited data on the role of adjuvant chemotherapy after surgical resection of these tumors. Here, we examine the role of adjuvant chemotherapy in the management of resected PSGC. Methods: The National Cancer Database was queried to identify patients with PSGC who underwent surgical resection. Histology codes 8200- adenoid cystic carcinoma (ACC), 8430- mucoepidermoid carcinoma (MEC), 8550- acinic cell carcinoma (AIC) and 8551- adenocarcinoma, acinar predominant were used. Patients were divided based on chemotherapy status. Summary and univariate analysis was performed. Multivariable proportional hazard regression analyses were used to obtain hazard ratios (HR). Results: A total of 6685 patients, with a mean (±SD) age of 66.1 ± 11.0 years, were included; 4148 (62%) were females. Most patients were Caucasian (84%). Chemotherapy was administered in 1141 patients (17%); multiagent chemotherapy: n = 1034 (91%). AIC was the most common subtype (n = 6302, 94%) followed by MEC (n = 304, 4.6%) and ACC (n = 73, 1.1%). Patients who received chemotherapy were younger (64.0 ± 9.0 vs 66.5 ± 11.3; p < 0.001), otherwise, there was no significant difference in baseline demographics. Unadjusted 5-year survival for stage I PSGC was significantly lower in the chemotherapy arm (60.5% vs 72%, p < 0.001). Chemotherapy did not improve survival in resected stage II or III PSGC. Overall survival was inferior with chemotherapy on multivariable analysis (adjusted HR: 1.32, 95%CI (1.13-1.55), p = 0.0006). Older age, male gender, positive margins, higher clinical stage, comorbidities, rural population and pneumonectomy were associated with lower overall survival (Table). Conclusions: Contrary to previous studies AIC is the most common tumor type among PSGC. Adjuvant chemotherapy is associated with worse survival in resected PSGC and current guidelines for administering adjuvant chemotherapy in resected lung cancer is inadequate for this population. [Table: see text]
Dynamic changes of lymphocyte subsets during multimodal treatment of patients with inoperable stage III NSCLC.
Authors: Hofer Thomas Philipp , Käsmann Lukas , Pelikan Carolyn , Mathur Saloni , Eze Chukwuka , Karin Monika , Taugner Julian , Roengvoraphoj Olarn , Belka Claus , Noessner Elfriede , Manapov Farkhad 
Published: May 2020

e21011 Background: Lymphocytopenia is associated with deterioration of patient survival in solid cancers treated with concurrent chemo/radiotherapy (cCRT). A prospective analysis of peripheral blood mononuclear cells during cCRT in inoperable stage III NSCLC patients was performed to determine dynamic changes of individual lymphocyte subsets. Methods: Twenty-one patients were prospectively enrolled in this study. Eighteen patients received platinum-based cCRT, seven of them received, additionally, concurrent and/or sequential immune checkpoint-inhibition (ICI). Thoracic irradiation (TRT) was delivered with median total dose of 62Gy (31 daily fractions of 2Gy) in all patients. Peripheral blood was collected 5-10 days before treatment (A1), three weeks after start of cCRT (A3), on the last day of TRT (RTend) and during follow-up. Samples were analyzed using polychromatic flow cytometry. Results are reported for time-points A1, A3 and RTend. Results: Sixteen patients met final analysis criteria, 50% of them received concurrent and/or sequential ICI. All patients developed severe lymphocytopenia; in 81% of them lymphocyte nadir was documented at A3. Lymphocyte subsets, B cells, T cells (CD4, CD8), regulatory T cells, and NK cells, decreased with medians between 99.9% and 59%. Lymphocyte nadir was independent of the absolute numbers of immune cells that a patient had before start of cCRT or whether additional ICI was applied. From A3 to RTend, all lymphocyte subsets started to recover in patients treated with cCRT alone, while they remained low in patients who received additional ICI. The ratios of CD4/CD8 and CD8/Treg cells did not change during treatment (A1 to RTend) and was not different between the patients treated with or without ICI. However, the fraction of PD-1 cells among CD8 T-cells decreased in patients treated with ICI and remained low until RTend (range 0.55%-13.8%). In contrast, in 50% of patients treated with cCRT alone, PD-1 T-cell among CD8 T-cells increased and remained high (range 6.8%-46.3%) until RTend. Conclusions: Delayed recovery of lymphocyte subsets in peripheral blood was observed in patients treated with cCRT combined with concurrent or sequential ICI. A decrease of PD-1 T-cells among CD8 T-cells was described exclusively in patients treated with additional ICI.