The epidemiology of malignant giant cell tumors of bone: an analysis of data from the Surveillance, Epidemiology and End Results Program (1975–2004)

Malignant giant cell tumor (GCT) of bone is a rare tumor with debilitating consequences. Patients with GCT of bone typically present with mechanical difficulty and pain as a result of bone destruction and are at an increased risk for fracture. Because of its unusual occurrence, little is known about the epidemiology of malignant GCT of bone. This report offers the first reliable population-based estimates of incidence, patient demographics, treatment course and survival for malignancy in GCT of bone in the United States. Using data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, we estimated the overall incidence and determinants of survival among patients diagnosed with malignant GCT of bone from 1975–2004. Cox proportional hazards regression was used to evaluate demographic and clinical determinants of survival among malignant GCT cases. Based on analyses of 117 malignant GCT cases, the estimated annual incidence in the United States was 1.6 per 10,000,000 persons per year. Incidence was highest among adults aged 20 to 44 years (2.4 per 10,000,000 per year) and most patients were diagnosed with localized (31.6%) or regional (29.9%) disease compared to distant disease (16.2%). Approximately 85% of patients survived at least 5 years, with survival poorest among older patients and those with evidence of distant metastases at time of diagnosis. The current study represents the largest systematic investigation examining the occurrence and distribution of malignancy in GCT of bone in the general U.S. population. We confirm its rare occurrence and suggest that age and stage at diagnosis are strongly associated with long-term survival

Predictors and patterns of red blood cell transfusion use among newly diagnosed cancer patients with chemotherapy-associated anemia in Western Denmark (1998–2003)

Mellissa Yong1, Anders H. Riis3, Jon P. Fryzek2, Bjarne K. Møller4, Søren P. Johnsen3 1Department of Global Biostatistics and Epidemiology, Amgen Inc, Thousand Oaks, CA, USA; 2Department of Epidemiology and Computational Biology, Exponent, Alexandria, VA, USA; 3Department of Clinical Epidemiology; 4Department of Clinical Immunology, Aarhus University Hospital, Aarhus, DenmarkObjective: Cancer patients receiving chemotherapy are at increased risk of anemia. We conducted a population-based historical cohort study in newly diagnosed cancer patients with chemotherapy-associated anemia in order to characterize red blood cell transfusion (RBCT) use.Design: This study evaluated cancer patients diagnosed between January 1, 1998 and December 31, 2003 using Danish National Patient Registry data. Patients were receiving chemotherapy and had a hemoglobin level ≤10.9 g/dL during the 4 months following cancer diagnosis. We characterized patterns of RBCT use and inpatient and outpatient hospitalization for transfusion. Adjusted Poisson regression models were used to evaluate the likelihood of RBCT, estimated by relative risk (RR), based on demographic and clinical factors.Results: Women constituted 58% of 1782 patients studied; the median age was 58 years. Two-thirds (67%) had solid tumors; 67% had stage III or IV disease at diagnosis. Overall, 713 (40%) patients received an RBCT within 120 days of cancer diagnosis, of which 94% were administered in the inpatient setting; 84% of these patients required subsequent transfusions. The median (Q1, Q3) pretransfusion hemoglobin level was 9.0 (8.4, 9.8) g/dL. Patients aged <20 years were more likely to receive an RBCT than older patients (RR 1.89; 95% confidence interval [CI] 1.44–2.49). Compared with stage IV disease, those with stage II or III disease had a lower likelihood of RBCT (stage II: RR 0.52, 95% CI: 0.37–0.72; stage III: RR 0.68, 95% CI: 0.55–0.83). Patients diagnosed with breast cancer were less likely to receive an RBCT than patients with hematologic cancers (RR 0.34, 95% CI: 0.21–0.55).Conclusion: In this study, 40% of cancer patients with chemotherapy-associated anemia in Western Denmark received an RBCT, usually in the inpatient setting; of these, most required subsequent transfusions. Younger age increased the likelihood of receiving an RBCT, and earlier stage or breast cancer decreased RBCT likelihood.Keywords: red blood cell transfusions, epidemiology, anemi

Characteristics of Patients with Myelodysplastic Syndromes (MDS) in the United States from 4528 Physician Surveys

Abstract The estimated incidence of MDS in the United States is 3.6 per 100,000 people, or approximately 10,000 new cases per year. Few published studies about the characteristics of incident and prevalent cases exist. This study analyzes MDS patient (pt) demographics, classification, cytopenias, and treatment options as reported in surveys of AMA-listed hematology and/or medical oncology specialists. Physicians completed 6 distinct surveys on their 4 to 10 most recently seen MDS pts. Surveys were collected in June and Oct 2005; Jan, Apr, and Sept 2006; and Jan 2007. Data included information about demographics, disease information, hematologic status, transfusion dependency, and type and rationale for treatment given. Results are presented as minimum and maximum percentages observed across surveys. Per survey, 100 specialists were contacted; 77 to 97 physicians per survey returned information for at least one MDS pt, resulting in a total of 4528 pt surveys (621 to 827 per survey). Most (67–76%) had office-based practices; others were university, community, or VA hospital-based. Across surveys, 51-57% of pts were male. The median age was 72-74 years, with no marked difference between males and females. Median duration of MDS at the time of survey was 26-36 months. Secondary MDS was seen in 8-13% of pts, most following chemo (64-81%) or radiation therapy (10-22%). Lower-risk MDS was more common in follow-up (prevalent) MDS pts than in newly-diagnosed (incident) pts (Table). Cytogenetics were available on approximately 90% of all pts, with 68-71% classified (per IPSS) as low risk, 14-21% intermediate, and 11-16% poor. The most commonly reported abnormality was 5q- (7-9% of primary MDS cases). Platelet data were collected in the final 2 surveys: 37-42% of pts had counts <100,000mm3, and 15-18% <50,000mm3; the median transfusion trigger value was 15,000mm3. Low/Int-1 MDS pts were less dependent than Int-2/High-risk pts on both red blood cell transfusions (17–29% vs 52–67%) and platelet transfusions (3–10% vs 21–34%). Erythropoiesis stimulating agents (ESAs, such as erythropoietin or darbepoetin) were used by the majority of pts (68–74%), independent of IPSS risk. Most incident pts (57–65%) received supportive care with ESAs, and there was a trend towards increased use of non-ESA therapy over time (28% in 2005 to 40% in 2007). Among all pts, lenalidomide use was similar for Low/Int-1 vs Int-2/High-risk pts (0–12% vs 0–12%), as was use of azacitidine (41–53% vs 41–57%) and decitabine (12–60% vs 0-80%). Only a minority of MDS pts (1.5–4.2%) either had or were being considered for bone marrow transplantation. The proportion of MDS pts in clinical trials was also low (0.7–3.7%), and 14–18% of pts were categorized as watch and wait. In conclusion, the majority of MDS pts have lower-risk disease, and few have secondary MDS. Transfusion needs were greater, but ESA use similar, in higher-risk MDS compared to lower-risk pts. Transplantation, and clinical trial involvement, continues to be an option for only a minority of MDS pts. Figure Figur