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  • 1
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 62, No. 8 ( 2021-07-03), p. 1949-1957
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2030637-4
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  • 2
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2023
    In:  Journal of Clinical Oncology Vol. 41, No. 16_suppl ( 2023-06-01), p. e20035-e20035
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. e20035-e20035
    Abstract: e20035 Background: The survival of older adults with multiple myeloma (MM) continues to improve due to advancements in therapy but there is limited real-world data around the outcome of elderly (≥ 75 years old) MM patients. These patients are at risk due to comorbidities, frailty and potential for reduced tolerance to treatment. In this IRB approved retrospective analysis, the NCDB was used to evaluate the 30-day mortality and the determinants of overall survival (OS) of elderly MM patients who were treated at commission on cancer (CoC) accredited facilities across the USA. Methods: Using the NCDB, we identified N = 54,766 patients ≥ 75 years old diagnosed and treated for MM from 2004 to 2017. Multivariable cox regression analysis with backward elimination was utilized to identify the independent survival factors, using significance level of p 〈 0.05. Kaplan-Meier survival curves were produced, and SAS version 9.4 was used to analyze the data. Results: Overall median survival time was 23 months; while survival rates of 1, 3, and 5-year were 61.9%, 38.0%, and 23.6%, respectively. Multivariable cox regression analysis with backward elimination method revealed that there were 10 significant independent survival factors including age, sex, race, ethnicity, education level, Charlson-Deyo score, facility type, median income, year of diagnosis, and treatment-regimen. Male patients were more likely to die compared to female patients (HR = 1.08, p 〈 0.0001). Black patients were predicted to have less death events compared to White patients (HR = 0.90, p 〈 0.0001). In addition to that, patients of Hispanic ethnicity were more likely to die compared to non-Hispanic patients (HR = 1.16, p 〈 0.0001). Subjects who were treated in non-academic facilities were more likely to suffer death compared to the ones who received care in academic centers (HR = 1.15, p 〈 0.0001). Patients with median income 〈 $38,000 (HR = 1.10, p 〈 0.0001), $38,000-$47,999 (HR = 1.06, p = 0.0011) and $48,000-$62,999 (HR = 1.04, p = 0.0031) were more likely to die compared to patients with higher median income ≥ $63,000. The hematopoietic stem cell transplantation utilization rate was 0.1%. The 30-day mortality rate was 8%. Detailed analysis will be presented. Conclusions: This large real-world analysis of elderly MM patients shows that White and Hispanic patients have inferior OS compared to Blacks and non-Hispanics. Patients with lower economic status and those treated at a non-academic facility also had inferior survival compared to those with higher income and with access to care at an academic facility. The 30-day mortality is strikingly high (8%) in the elderly. The unacceptably high mortality could be improved by facilitating access to high quality care and prompt use of novel agents. Prospective studies are needed to identify and address determinants of disparity in MM care in elderly patients.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 3
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. e20013-e20013
    Abstract: e20013 Background: Despite the advent of novel chemo-immunotherapies in multiple myeloma (MM), hematopoietic stem cell transplantation (HSCT) remains a crucial aspect of therapy in eligible patients. However, disparities in access to HSCT have been well documented. In this IRB approved retrospective analysis, the NCDB was used to evaluate the determinants of access to HSCT among MM patients who were treated in Commission on Cancer (CoC) accredited facilities across the USA. Methods: Using the NCDB, we identified N = 171,261 patients diagnosed and treated for MM from 2004 to 2017. Multivariable logistic regression analysis was conducted to identify the predictors for receiving HSCT, using significance level of p 〈 0.05. SAS version 9.4 was used to analyze the data. Results: Multivariable logistic regression analysis showed that there were 12 significant factors associated with HSCT: age, sex, race, ethnicity, facility, insurance, median income, education level, year of diagnosis, distance to facility, Charlson score, and type of treatment regimen. Patients of age 65-75 (OR = 0.65, p 〈 0.0001) and age ≥ 75 (OR = 0.04, p 〈 0.0001) were less likely to receive HSCT compared to patients of age 〈 55. Male patients were more likely to be treated with HSCT compared to female patients (OR = 1.08, p = 0.005). Black patients were predicted to have less access to HSCT compared to White patients (OR = 0.69, p 〈 0.0001). Patients of non-Hispanic ethnicity were predicted to have better access to HSCT compared to Hispanic patients (OR = 1.25, p = 0.0007). Furthermore, subjects who were treated in non-academic facilities were less likely to receive HSCT compared to the ones who received care in academic or research centers (OR = 0.51, p 〈 0.0001). Patients with Medicare (OR = 0.79, p 〈 0.0001), Medicaid (OR = 0.77, p 〈 0.0001), and no insurance (OR = 0.38, p 〈 0.0001) were less likely to receive HSCT compared to patients with private insurance. Interestingly, the lower median income 〈 $38,000 was associated with increased frequency of HSCT in comparison with higher median income ≥ $63,000 (OR = 1.17, p 〈 0.0001). This may be due to reduced access to novel agents by lower income patients who typically cannot afford high co-payment associated with novel agents. In contrast, subjects with a lower level of education (no high school diploma in 21% or more) were predicted to have less access to HSCT in comparison with subjects who had a higher level of education (no high school diploma in less than 7%) (OR = 0.57, p 〈 0.0001). Detailed analysis will be presented. Conclusions: Our study shows that Black and Hispanic patients as well as those with non-private insurance were less likely to receive HSCT in this large cohort of real world data set from across the USA. These results further corroborate the need to improve equitable access to care to all myeloma patients to ameliorate outcomes.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 4
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2023
    In:  Journal of Clinical Oncology Vol. 41, No. 16_suppl ( 2023-06-01), p. e20060-e20060
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. e20060-e20060
    Abstract: e20060 Background: Due to its rarity, comprehensive studies on plasmacytoma are limited. There are two main subtypes: solitary bone plasmacytoma (P-Bone) and extramedullary plasmacytoma (P-EM). In this IRB approved retrospective analysis, the NCDB was used to evaluate the clinical features and factors affecting the overall survival of patients with plasmacytoma who were treated at commission on cancer (CoC) accredited facilities across the USA. Methods: Using the NCDB, we identified N = 6,579 patients with plasmacytoma from 2004 to 2017, after excluding multiple myeloma patients. N = 4,816 patients had P-Bone & N = 1,763 patients had P-EM. Descriptive statistics were used and multivariable cox regression analysis was utilized to identify the independent survival factors, using significance level of p 〈 0.05. Kaplan-Meier curves were produced. SPSS was used to analyze the data. Results: P-Bone represented 73.2% of cases. Overall median survival time was 105 and 147 months for P-Bone and P-EM respectively; 56 and 149 months for 〈 37 Gy and ≥ 37 Gy radiation dose respectively; 66, 112, 107 and 132 months for no treatment, surgery alone, radiation therapy alone and combination therapy (surgery + radiation) respectively. Multivariable cox regression revealed that there were 10 significant independent survival factors including age, ethnicity, facility type, insurance status, median income, education level, Charlson-Deyo score, year of diagnosis, plasmacytoma site and treatment pattern. Patients with P-EM were less likely to die compared to P-Bone (HR = 0.734, p 〈 0.001). Hispanic patients were less likely to die compared to non-Hispanics (HR = 0.66, p 〈 0.001). In addition to that, patients with private insurance were less likely to suffer death compared to patients with no insurance (HR = 0.71, p = 0.01). Subjects who were treated in academic facilities were less likely to die compared to the ones who received care in non-academic centers (HR = 0.86, p 〈 0.001). Moreover, patients with median income ≥ $63,000 were less likely to die compared to patients with median income 〈 $38,000 (HR = 0.85, p = 0.04). Subjects with higher level of education (no high school diploma in 〈 7%) were less likely to suffer death compared to subjects with lower level of education (no high school diploma in ≥ 21%) (HR = 0.82, p = 0.018). Patients who were treated with radiation alone (HR = 0.54, p 〈 0.001), surgery alone (HR = 0.57, p 〈 0.001), and combination therapy (HR = 0.43, p 〈 0.001) were less likely to die compared to patients who did not receive any treatment. Detailed analysis will be presented. Conclusions: In this largest real-world plasmacytoma cohort ever reported, we found that patients with P-Bone and those with lower socio-economic status had worse outcomes. In addition use of combination therapy and the use of a higher radiation dose ≥ 37 Gy were associated with better outcomes.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 5
    Online Resource
    Online Resource
    American Society of Hematology ; 2022
    In:  Blood Vol. 140, No. Supplement 1 ( 2022-11-15), p. 12530-12531
    In: Blood, American Society of Hematology, Vol. 140, No. Supplement 1 ( 2022-11-15), p. 12530-12531
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 6
    In: Blood, American Society of Hematology, Vol. 140, No. Supplement 1 ( 2022-11-15), p. 9333-9334
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 7
    Online Resource
    Online Resource
    Wiley ; 2020
    In:  British Journal of Haematology Vol. 189, No. 6 ( 2020-06), p. 1002-1002
    In: British Journal of Haematology, Wiley, Vol. 189, No. 6 ( 2020-06), p. 1002-1002
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1475751-5
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  • 8
    Online Resource
    Online Resource
    Wiley ; 2019
    In:  British Journal of Haematology Vol. 186, No. 1 ( 2019-07), p. 10-10
    In: British Journal of Haematology, Wiley, Vol. 186, No. 1 ( 2019-07), p. 10-10
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 1475751-5
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  • 9
    Online Resource
    Online Resource
    Elsevier BV ; 2020
    In:  Hematology/Oncology Clinics of North America Vol. 34, No. 6 ( 2020-12), p. 1115-1131
    In: Hematology/Oncology Clinics of North America, Elsevier BV, Vol. 34, No. 6 ( 2020-12), p. 1115-1131
    Type of Medium: Online Resource
    ISSN: 0889-8588
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 93115-9
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  • 10
    In: Frontiers in Oncology, Frontiers Media SA, Vol. 13 ( 2023-5-5)
    Abstract: Minimal residual disease (MRD) assessment through blood component sampling by liquid biopsies (LBs) is increasingly being investigated in myeloid malignancies. Blood components then undergo molecular analysis by flow cytometry or sequencing techniques and can be used as a powerful tool for prognostic and predictive purposes in myeloid malignancies. There is evidence and more is evolving about the quantification and identification of cell-based and gene-based biomarkers in myeloid malignancies to monitor treatment response. MRD based acute myeloid leukemia protocol and clinical trials are currently incorporating LB testing and preliminary results are encouraging for potential widespread use in clinic in the near future. MRD monitoring using LBs are not standard in myelodysplastic syndrome (MDS) but this is an area of active investigation. In the future, LBs can replace more invasive techniques such as bone marrow biopsies. However, the routine clinical application of these markers continues to be an issue due to lack of standardization and limited number of studies investigating their specificities. Integrating artificial intelligence (AI) could help simplify the complex interpretation of molecular testing and reduce errors related to operator dependency. Though the field is rapidly evolving, the applicability of MRD testing using LB is mostly limited to research setting at this time due to the need for validation, regulatory approval, payer coverage, and cost issues. This review focuses on the types of biomarkers, most recent research exploring MRD and LB in myeloid malignancies, ongoing clinical trials, and the future of LB in the setting of AI.
    Type of Medium: Online Resource
    ISSN: 2234-943X
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2649216-7
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