Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Self-esteem and the intersection of age, class, and gender

In this paper, we explore the relationships among self-esteem, age, class, and gender. We ask whether relationships between self-esteem and gender are similar across age and class groups. Contrary to past research, which suggests that age has little influence on self-esteem or that self-esteem increases with age, we find that levels of self-esteem are lower in older age groups for both men and women. Furthermore, in all age groups, women have lower levels of self-esteem than do men. Social class does not influence levels of self-esteem for young men or women but does so for those in middle age and older age groups. From middle age on, social classes diverge in their levels of self-esteem such that men and women from lower social classes experience the lowest levels of self-esteem. Unlike past research that links age differences in self-esteem to either role or development theories, we consider these findings within a theoretical framework that recognizes the structural power relations embedded in class, age, and gender, which in turn influence gendered identities

Ageing, Disability and Workplace Accommodations

In most western nations, laws discourage discrimination in paid employment on the basis of disability, but for these policies to be of benefit, individuals must define their functional limitations as disabilities. There is a strong relationship between age and disability among those of working age, yet it is unclear whether older workers attribute their limitations to disability or to ‘natural ageing’. If the latter is true, they may not believe that they need or qualify for workplace accommodations (i.e. adaptations or interventions at the workplace). Similarly, if an employer ascribes a worker\u27s limitation to ‘natural ageing’, rather than to a disability, they may not offer compensatory accommodation. Using data from the Canadian 2001 Participation and Activity Limitation Survey, this paper asks whether workers who ascribe their functional limitation to ageing are as likely as those who do not to report a need for a workplace accommodation. It also addresses whether those who identify a need for compensatory accommodations and who ascribe their limitation to ageing have unmet workplace-accommodation needs. The findings suggest that, even when other factors are controlled, e.g. the type and severity of disability, the number of limiting conditions, gender, age, education, income and occupation, those who made the ageing attribution were less likely to recognise the need for an accommodation; and among those who acknowledged a need, those who ascribed their disability to ageing were less likely to have their needs met

Falling Through the Cracks: Addressing the Needs of Individuals Between Employment and Retirement

In this paper, we examine some of the public policy that provides financial support to individuals who are no longer in the labour force. We argue that these programs neglect the specific needs of individuals who are considered older by labour force standards and who are yet too young to collect full pension benefits. We show that the potential exists for these workers to fall through the cracks of public policy, leaving them with a financially insecure future. Finally, we explore some of the programs that have been used in other countries to address the needs of this group.