bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends of Palliative Care Utilization in Acute Myeloid Leukemia in the United States
Authors: Tella Sri Harsha , Kommalapati Anuhya , Bennett Charles L. , Goyal Gaurav 
Published: October 2019

Abstract

Background: Early integration of Palliative Care (PC) have shown to improve survival in some solid malignancies such as lung and colon cancers. In this study we sought to analyze the PC utilization in acute myeloid leukemia (AML) patients.
Methods: Using the National Cancer Data Base (NCDB) Participant User File, we extracted patient-level data of patients with AML reported between 2004 to 2015.Patients who received pain management and/or other palliative procedures were considered as PC utilizers. After excluding the cases with acute promyelocytic leukemia t (15, 17) (given its excellent prognosis), we classified the AML into three groups- AML with genetic abnormalities, therapy related AML and AML with dysplasia. Other co-variates included in the analysis were age, sex, race, origin, Charlson-Deyo comorbidity score, insurance status, household income, educational status, facility type (academic vs non-academic) and year of diagnosis. Multivariate logistic regression was performed to identify the predictors of palliative care utilization. Statistical analysis was done using PC SPSS v24.0.
Results: Of 102,778 patients, 3.4% (n=3504) received PC as initial treatment. PC utilization increased significantly from 2004-2006 to 2013-2015 (2.5% vs 3.9%, p < 0.001). Individuals of non-Hispanic origin (as compared to that of Hispanics) are more likely to receive PC as compared to that of non-Hispanics. (3.5 vs 1.8%, p<0.001). The patterns of PC utilization at non-academic centers were much higher than that of academic centers (4.4% vs 2.9%, p<0.001). As compared to that of AML, not otherwise specified subtype (3.3%), therapy-related AML (4%) and AML with dysplasia (4.3%) had higher rates of PC utilization, whereas individuals with AML with genetic abnormalities have lesser rates of PC utilization (1.9%) (p<0.001, all comparisons). Significant predictors of PC on multivariable regression are listed in the Table and forest plot.
Conclusions: We noticed a differential utilization of palliative care based on the histological subtype of AML. The lesser utilization of PC in AML with certain genetic abnormalities may be attributed to their better overall survival outcomes. Though we noticed an increased trend in PC utilization over the past decade, the overall PC utilization in AML is markedly low and plagued by origin and socio-economic status.

Disclosures
No relevant conflicts of interest to declare.
Development of Novel Nanobiosensor for Direct Measurement of the Oral Anticoagulant Agent: Dabigatran Etexilate
Authors: Al Johani Maher M , Chinnappana Raja , Eissaa Shimaa , Owaidah Tarek , Cialla-Mayc Dana , Poppc Jürgen , Zourob Mohammed 
Published: October 2019

Abstract
Dabigatran Etexilate is a new oral anticoagulant increasingly used for number of blood thrombosis conditions, prevention of strokes and systemic emboli among patients with atrial fibrillation. It provides safe and adequate anticoagulation for prevention and treatment of thrombus in several clinical settings. However, anticoagulation therapy can be associated with an increased risk of bleeding. There is a lack of specific laboratory tests to determine the level of this drug in blood. This is considered the most important obstacles of using this medication, particularly for patients with trauma, drug toxicity, in urgent need for surgical interventions or uncontrolled bleeding.The goal of this research project is to obtain and characterize DNA aptamers for Dabigatran Etexilate and to evaluate potential applications of these aptamers to develop low cost, sensitive, selective and user-friendly biosensors. In this work, we performed Systematic evolution of ligands by exponential enrichment (SELEX) to select specific DNA aptamers against dabigatran etexilate. Following multiple rounds of selection and enrichment with a randomized 60-mer DNA library, specific DNA aptamers for dabigatran were selected. We investigated the affinity and specificity of generated aptamers to the drug showing dissociation constants (Kd) ranging from 46.8- 208 nM. A preliminary application of one of the selected aptamers in an electrochemical nano-biosensor was successfully performed and showed high sensitivity and selectivity. This work represents novel work and clinically available. With further improvement of the assay and optimization, these aptamers are useful in developing Dabigatran Etexilate detection and analytical applications and with unique potentials of clinical uses in the near future.

Disclosures
No relevant conflicts of interest to declare.
Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) Determinations in Newborns with Beta Thalassemia
Authors: Bierman Kaitlin , Maurer Harold M. , Harper James 
Published: October 2019

Abstract
Newborns with alpha thalassemia trait have microcytic red blood cells (RBCs) used as a diagnostic screening tool at birth. Infants with beta thalassemia present with microcytosis sometime during the first year of life; however, whether microcytosis is present in newborns is unknown. In this study, we determined the MCV and MCH values in newborn infants, who have beta0 thalassemia major, intermedia, and minor by performing a retrospective study, with IRB approval.
189 eligible patients seen by the hematology/oncology group of 10 physicians at Children's Hospital Medical Center (CHMC) and UNMC were reviewed. Patients were identified by International Classification Codes-10 (56.1, 56.3, 57.3, 57.4). Of the 189 eligible patients with beta thalassemia major, intermedia, minor, and sickle cell trait (used as controls), there were 28 evaluable and 161 non-evaluable patients. The non-evaluable patients had either the wrong diagnosis (coexisting alpha thalassemia trait) (68) or no laboratory data within the newborn period or up to 6 months of age (93). A second control group used were normal complete blood count (CBC) values by age from the Pathology Laboratory at CHMC. Of the 28 evaluable infants, 5 had beta0 thalassemia major, 2 had sickle-beta+ thalassemia (regarded as intermedia for this study), 7 had beta thalassemia minor, and 14 had sickle cell trait. The diagnosis in each of the 28 infants was confirmed by newborn screening for a hemoglobinopathy and hemoglobin electrophoresis sometime after birth. The MCV, MCH, mean corpuscular hemoglobin concentration (MCHC), hemoglobin (hgb), hematocrit (hct), and red blood cell count (RBC) were taken on evaluable patients within the newborn period through 6 months of age and de-identified using the Safe Harbor Method.
MCV and MCH were found to be reduced in newborns with beta0 thalassemia and sickle-beta+ thalassemia. However, infants with beta thalassemia minor had normal MCV and MCH values. The MCHC, RBC, hgb, and hct were comparable to controls and within normal limits. By 3-4 months of age, in the infants with beta thalassemia major or intermedia, the MCV and MCH fell to clinically characteristic levels when compared to controls, and plateaued through 6 months of age. MCV and MCH values for infants with beta thalassemia minor, 0-6 months of age, were incomplete to be able to draw a similar conclusion.
The proposed mechanism for microcytosis in major and intermedia is an imbalance between alpha and beta globin chain synthesis, which is not apparent in newborns with minor.
In conclusion, the MCV and MCH can be used to screen for beta0 thalassemia major and intermedia in newborns. Although the data are discriminating despite the small numbers, a prospective study should confirm these findings.
Figure. Figure.

Disclosures
No relevant conflicts of interest to declare.
Computational Modeling and Microfluidics Reveal Characteristic Patterns of Regulation of Clot Structure and Mechanics By Tissue Factor Localization
Authors: Mitrophanov Alexander Y. , Govindarajan Vijay , Zhu Shu , Diamond Scott L. , Reifman Jaques 
Published: October 2019

Abstract
The growth of a blood clot is initiated by tissue factor (TF) exposure and is expected to depend on TF localization (i.e., its level and spatial distribution). We sought to understand how the structural and mechanical properties of clots under flow are shaped by simultaneously varying the surface density of TF and its area of exposure. We used a microfluidic device harboring thrombogenic surfaces that differed in length and TF surface density. We perfused human whole blood through this device and continually measured platelet deposition, thrombin formation, and fibrin accumulation by means of fluorescence microscopy. Using our recently developed, detailed mathematical model of spatial clot growth under flow, we performed computational simulations to gain insights into the connection between the structure of a clot and its mechanical properties, such as resistance to blood flow and flow axial velocity.
We detected a non-additive, synergistic influence of the thrombogenic surface length and TF surface density on bulk thrombin and fibrin generation. We found that thrombogenic surface length and TF density controlled not only bulk accumulation, but also the occlusivity of the deposited platelet mass, as well as clot resistance to flow. The extent of this control depended on the blood flow velocity. An increase in the TF surface density resulted in condition-dependent differential acceleration of platelet deposition, thrombin formation, and fibrin accumulation. The viscous resistance of the clot was characterized by spatial variations and was higher in the inner clot region. Notably, despite variations in the intraclot structure, variations in the intraclot flow velocity were minor compared to the abrupt decrease in flow velocity at the boundary of the platelet deposition domain.
Our analysis revealed characteristic patterns that describe how the shape, size, internal structure, and viscous resistance of a clot depend on the surface density of TF and its area of exposure. Taken together, our results suggest that the structure and mechanics of a growing clot are correlated, but can differ in their regulation by the distinct aspects of TF localization. These findings provide new insights into how initiating signals can temporally and spatially affect thrombus growth under flow.
DISCLAIMER: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army or of the U.S. Department of Defense. This abstract has been approved for public release with unlimited distribution.

Disclosures
No relevant conflicts of interest to declare.
Favorable Overall Survival in Refractory Diffuse Large B-Cell Lymphoma When Responded to High-Dose Etoposide Mobilization Chemotherapy Followed By Autologous Peripheral Blood Stem Cell Transplantation
Authors: CAI Yu , Wang Chun , Song Xianmin , Wan Liping , Li Su , Yang Jun , Jiang Jieling 
Published: October 2019

Abstract
Objective: To evaluate the strategy of using high-dose etoposide mobilization followed by autologous peripheral blood stem cell transplantation (APBSCT) in patients with diffuse large B-cell lymphoma (DLBCL) refractory to Rituximab-based chemotherapy.
Methods: Forty patients with refractory DLBCL were treated with high-dose etoposide for stem cell mobilization. All patients were in progressive disease (PD) prior to mobilization, and underwent high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (APBSCT).
Results: Successful PBSC mobilization was achieved in all patients. Twenty-three patients (57.5%) showed clinical response to high-dose etoposide. After APBSCT, 17 patients (42.5%) achieved CR. The 2-year progression-free (PFS) and overall survival (OS) rate were higher in patients responded to high dose etoposide (64.1% and 77.7%) compared to those without response (11.8% and 11.8%; P<0.001 for both). The response to high dose etoposide mobilization therapy was an independent prognostic factor for CR achievement, PFS and OS after APBSCT.
Conclusion: High-dose etoposide mobilization chemotherapy followed by APBSCT could rescue a proportion of patients with refractory diffuse large B-cell lymphoma who responded to etoposide mobilization regimen.

Disclosures
No relevant conflicts of interest to declare.
Stratification for Age in Non-Transfusion-Dependent Thalassemia: Data from a National Italian Networking
Authors: Pepe Alessia , Pistoia Laura , Romano Nicola , Colaci Giuseppe , Maggio Aurelio , Carollo Antonella , Campisi Saveria , Putti Maria Caterina , Fotzi Ilaria , D'Ascola Domenico , Grassedonio Emanuele , Positano Vincenzo , Meloni Antonella 
Published: October 2019

Abstract
Background: Non-transfusion-dependent thalassemia (NTDT) is a term used to indicate patients who do not require lifelong regular transfusions for survival. Morbidity in NTDT patients is more common and serious than previously recognized. This study aimed to examine the association of age with the presence of iron overload assessed by Magnetic Resonance Imaging (MRI) and cardiovascular and endocrine complications in NTDT patients.
Methods: We considered 170 patients with thalassemia intermedia never transfused o who received occasional transfusions consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) project. Iron overload was quantified by the T2* Magnetic Resonance Imaging (MRI) technique. All complications were classified according to international guidelines.
Results: Six groups of patients were identified: age<18 years (N=7), age 18-30 years (N=36), age 30-40 years (N=48), age 40-50 (N=45), age 50-60 years (N=26), and age≥60 years (N=8). The Table shows the comparison among the groups.
The youngest patient showing hepatic iron (MRI liver iron concentration-LIC>3 mg/g dw) had 9 years of age and the frequency of hepatic iron did not significantly increase with age.
Only one patient showed cardiac iron (global heart T2*<20 ms).
Diabetes appeared only in patients with more than 50 years and showed a trend toward increasing with increasing age. Hypothyroidism and osteoporosis were not present in pediatric patients and were not associated to age. Hypogonadism was not present in patients with less than 30 years and its frequency was comparable among the age groups. No patient showed hypoparathyroidism.
Only patients older than 30 years showed a cardiac complication (heart failure or arrhythmias), but the rate did not significantly increase with increasing age.
Conclusions: Our data in NTDT are indicative of high rate of liver iron overload at early age and extremely rare cardiac iron overload. Endocrine or cardiac complications were not present in pediatric patients but in adult patients the frequency did not increase with advancing age.
Table. Table.

Disclosures
Pepe: Chiesi Farmaceutici S.p.A., ApoPharma Inc., and Bayer: Other: No profit support.
Variables Correlating to Transition of Care for the Bleeding Disorder Population at the University of California San Francisco
Authors: Burdekin Emma D , Suzuki Sachiko , Riddel James , Lesh Mary B. , Tobase Patricia , Lin Tiffany 
Published: October 2019

Abstract
Background An effective and coordinated process of transitioning adolescents with bleeding disorders from pediatric to adult medical care is essential for maintaining continuity of care and establishing a lifelong medical support system. Barriers to transition among people with a bleeding disorder (PWBD) at the University of California San Francisco (UCSF) are currently unknown.
Objective The purpose of this study is to collect and evaluate data on potential demographic, clinical and socioeconomic determinants of the length of time to transition among PWBD at UCSF.
Methods A retrospective chart review of 60 patients with bleeding disorders born between 1982 and 1996 was conducted to collect baseline demographic, clinical and socioeconomic data. The data was analyzed using a two-tailed t-test to determine factors associated with length of time to transition.
Results Of the 60 total patients included in this analysis, 15 were lost to follow-up. The average length of time to transition for the 45 patients who completed transition into adult care was 1.31 years, and the average age at transition was 22 years old. We analyzed various determinants of length of time to transition that fell into five categories: demographics, socioeconomic status, disease severity, level of independence and adherence to recommended care. Females trended toward a longer average time to transition of 1.93 years compared to 1.13 years for males (p=0.08). One variable had a statistically significant correlation to length of time to transition. Patients prescribed a factor product had a significantly shorter time to transition of 0.85 years compared to 2.13 years for patients not prescribed a factor product (p=0.0009). Of the 45 patients who completed transition into adult care, 62% were prescribed a factor product.
Conclusions Our study demonstrated that prescription of a factor product, which is likely an indicator of a greater disease severity, is correlated with time to transition. Our univariate analysis did not indicate that demographics, socioeconomic status, level of independence or adherence to recommended care related to length of time to transition. The results of this study are preliminary and further analysis is required to better understand the barriers to transition that exist among PWBD at UCSF.

Disclosures
Lesh: Bayer: Membership on an entity's Board of Directors or advisory committees, Other: International Nursing Advisory Board 2017. Tobase:Partners: Consultancy, Honoraria.
Does Mixed Chimerism after Allogeneic Hematopoietic Cell Transplantation in Patients with Fanconi Anemia Impact on Outcome?
Authors: Ayas Mouhab , Siddiqui Khawar , Amao Antonette , Aljefri Abdullah , Ahmari Ali Abdallah , Ghemlas Ibrahim A. , Alsaedi Hawazen S. , Alanazi Awatif , Al-Seraihy Amal 
Published: October 2019

Abstract
Fanconi anemia (FA) cells are characterized by genomic instability which places FA patients (pts) at risk for malignancies; leukemia and oropharyngeal/urogenital cancers. The risk of development of leukemia is theoretically eliminated after hematopoietic cell transplantation (HCT).
Simultaneous presence of both host- and donor-derived cells in the recipient often referred to as mixed chimerism (MC) is observed in a large proportion of patients after HCT with non-malignant disorders. In FA patients however, MC might have a unique implication and the persistent existence of FA cells represents a management dilemma as the lingering FA cells may theoretically evolve into a malignant clone. We have studied a large population of FA patients who underwent allogeneic HCT at our institution and report here the outcome of those with MC.
From January 1995 until December 2017, 163 FA pts underwent allogeneic HCT at our center; chimerism data at last contact were available on 100 pts who are the subject of this analysis. Females (51) had a mean age at HCT of 8.7 (SD:3.0, Min-Max: 2.0-14.1) years whereas in males (49) it was 8.1 (SD:3.4; Min-Max: 1.4-17.4) years (P-Value: 0.415). Donor was HLA matched family member in 78 pts, Haplo-identical family member in 17 (92 of them were bone marrow and 3 peripheral stem cells); 3 had unrelated cord blood. Total body irradiation was used in 24 pts.
Median time to ANC and platelets recovery was 14 and 22 days respectively. Cumulative incidence of overall aGVHD Grade III or above was 4%. Median follow up time was 67.2±14.6 months (95% CI: 38.7-95.7) from HCT date (Min: 7.3, Max:188.1). Chimerism analysis at last follow up showed full chimerism (100%; Myeloid/lymphoid) in 46 pts; 54 had MC defined as the presence of any residual recipient cells. No statistically significant association was noted between full and MC pts in the incidence of aGvHD (P-Value: 0.331). The 10-year cumulative probability of Overall Survival (OS) was 0.904±0.042. No significant difference was observed in OS between full and MC pts (0.954±0.032 vs. 0.883±0.059, P-value: 0.943) with 4 deaths in each group. New malignancy occurred in 4 pts; 2 in each group. In full Chimerism pts: Acute Mixed Lineage Leukemia and carcinoma and in MC pts: acute myeloid leukemia and acute lymphocytic leukemia, (P-Value=1.00). Graft failure occurred in 2 pts in the mixed chimerism group vs none in the full chimerism group (P-Value=1.0).
We conclude that mixed chimerism in FA pts does not appear to have an adverse effect on outcome in our follow-up period; longer follow-up time however is needed to confirm the validity of this statement.

Disclosures
No relevant conflicts of interest to declare.
18f-FDG PET/CT and the Revised International Staging System Are More Discriminating of Survival Outcomes in Newly Diagnosed Multiple Myeloma
Authors: Jung Sung-Hoon , Kwon Seong Young , Min Jung-Joon , Bom Hee Seung , Ahn Seo-Yeon , Jung Seung-Yeon , Lee Seung-Shin , Park Moo-Rim , Yang Deok-Hwan , Ahn Jae-Sook , Kim Hyeoung-Joon , Lee Je-Jung 
Published: October 2019

Abstract
Purpose : This study evaluated the prognostic role of 18F-FDG PET/CT at baseline in patients with newly diagnosed multiple myeloa (MM) and evaluated the prognostic relevance of 18F-FDG PET/CT for each stage according to the Revised International Staging System (R-ISS).
Method: We retrospectively analyzed the records of 167 patients with newly diagnosed MM. 18F-FDG PET/CT was performed prior to induction therapy in patients with newly diagnosed MM. A Focal lesions (FL) at diagnosis was defined as focally increased FDG uptake greater than the physiologic bone marrow or liver uptake, with or without any underlying lesion. Extramedullary disease (EMD) was defined as FDG-avid soft tissue that was not contiguous to bone.
Results: A total of 102 patients (61.1%) had at least one FL at diagnosis, and 44.9% had more than three FLs. EMD was present in 13.2% of all patients. In the total cohort, the presence of more than three hypermetabolic FLs or EMD on baseline PET/CT was associated with significantly inferior progression free survival (PFS) and overall survival (OS) than other patients. Because most patients (91%) with EMD had more than three FLs, PET/CT positivity was defined as the presence of more than three FLs or the presence of EMD. The C-reactive protein level was higher (0.550 vs. 0.245 mg/L, P = 0.004) and the serum albumin level was lower in the PET/CT-positive group (3.5 vs. 3.6 g/dL, P = 0.040). Patients who were PET/CT-positive had a significantly lower complete response rate after first-line therapy compared with those who were PET/CT-negative (15.6% vs. 34.4%, P = 0.007). In multivariate analyses, PET/CT positivity was an independent predictor of PFS and OS in all patients. Fifty-five patients (46.1%) with R-ISS II were PET/CT-positive at baseline and had significantly shorter PFS and OS. PET/CT positivity was also correlated with poor PFS and OS in patients with R-ISS III.
Conclusion : 18F-FDG PET/CT was an independent predictor of survival outcomes in patients with newly diagnosed MM. In addition, performing 18F- FDG PET/CT at diagnosis may be useful for determining the survival outcomes of MM patients with R-ISS II and III.
Figure. Figure.

Disclosures
No relevant conflicts of interest to declare.