102 research outputs found
Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome
To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS)
Recommended from our members
An Introduction to Seshat: Global History Databank
This article introduces the Seshat: Global History Databank, its potential, and its methodology. Seshat is a databank containing vast amounts of quantitative data buttressed by qualitative nuance for a large sample of historical and archaeological polities. Thee sample is global in scope and covers the period from the Neolithic Revolution to the Industrial Revolution. Seshat allows scholars to capture dynamic processes and to test theories about the co-evolution (or not) of social scale and complexity, agriculture, warfare, religion, and any number of such Big Questions. Seshat is rapidly becoming a massive resource for innovative cross-cultural and cross-disciplinary research. Seshat is part of a growing trend to use comparative historical data on a large scale and contributes as such to a growing consilience between the humanities and social sciences. Seshat is underpinned by a robust and transparent workflow to ensure the ever growing dataset is of high quality
Transplant Physicians’ Attitudes on Candidacy for Allogeneic Hematopoietic Cell Transplantation (HCT) in Older Patients: The Need for a Standardized Geriatric Assessment (GA) Tool
Background
Despite improvements in conditioning regimens and supportive care having expanded the curative potential of HCT, underutilization of HCT in older adults persists (Bhatt VR et al, BMT 2017). Therefore, we conducted a survey of transplant physicians (TP) to determine their perceptions of the impact of older age (≥60 years) on HCT candidacy and utilization of tools to gauge candidacy.
Methods
We conducted a 23-item, online cross-sectional survey of adult physicians recruited from the Center for International Blood and Marrow Transplant Research between May and July 2019.
Results
175/770 (22.7%) TP completed the survey; majority of respondents were 41-60 years old, male, and practicing in a teaching hospital. Over 75% were at centers performing ≥50 HCT per year. When considering regimen intensity, most (96%, n=168) had an upper age limit (UAL) for using a myeloablative regimen (MAC), with only 29 physicians (17%) stating they would consider MAC for patients ≥70 years. In contrast, when considering a reduced intensity/non-myeloablative conditioning (RIC/NMA), 8%, (n=13), 54% (n=93), and 20% (n=35) stated that age 70, 75, and 80 years respectively would be the UAL to use this approach, with 18% (n=31) reporting no UAL. TP agreed that Karnofsky Performance Score (KPS) could exclude older pts for HCT, with 39.1% (n=66), 42.6% (n=72), and 11.4% (n=20) requiring KPS of ≥70, 80, and 90, respectively. The majority (n=92, 52.5%) indicated an HCT-comorbidity index threshold for exclusion, mostly ranging from ≥3 to ≥ 5. Almost all (89.7%) endorsed the need for a better health assessment of pre-HCT vulnerabilities to guide candidacy for pts ≥60 with varied assessments being utilized beyond KPS (Figure 1). However, the majority of centers rarely (33.1%) or never (45.7%) utilize a dedicated geriatrician/geriatric-oncologist to assess alloHCT candidates ≥60 yrs. The largest barriers to performing GA included uncertainty about which tools to use, lack of knowledge and training, and lack of appropriate clinical support staff (Figure 2). Approximately half (n=78, 45%) endorsed GA now routinely influences candidacy.
Conclusions
The vast majority of TP will consider RIC/NMA alloHCT for patients ≥70 years. However, there is heterogeneity in assessing candidacy. Incorporation of GA into a standardized and easily applied health assessment tool for risk stratification is an unmet need. The recently opened BMT CTN 1704 may aid in addressing this gap
Does FLT3 mutation impact survival after hematopoietic stem cell transplantation for acute myeloid leukemia? A Center for International Blood and Marrow Transplant Research (CIBMTR) analysis: Impact of FLT3 on OS Post-HCT for AML
BACKGROUND: Patients with FMS like tyrosine kinase 3 (FLT3)-mutated acute myeloid leukemia (AML) have a poor prognosis and are referred for early allogeneic hematopoietic stem cell transplantation (HCT).
METHODS: Data from the Center for International Blood and Marrow Transplant Research (CIBMTR) were used to evaluate 511 adult patients with de novo AML who underwent HCT during 2008 through 2011 to determine whether FLT3 mutations had an impact on HCT outcomes.
RESULTS: In total, 158 patients (31%) had FLT3 mutations. Univariate and multivariate analyses revealed an increased risk of relapse at 3 years in the FLT3 mutated group compared with the wild-type (WT) group (38% [95% confidence interval (CI), 30%-45%] vs 28% [95% CI, 24%-33%]; P = .04; relative risk, 1.60 [95% CI, 1.15-2.22]; P = .0048). However, FLT3 mutation status was not significantly associated with nonrelapse mortality, leukemia-free survival, or overall survival. Although more patients in the FLT3 mutated group died from relapsed primary disease compared with those in the WT group (60% vs 46%), the 3-year overall survival rate was comparable for the 2 groups (mutated group: 49%; 95% CI, 40%-57%; WT group: 55%, 95% CI, 50%-60%; P = .20).
CONCLUSIONS: The current data indicate that FLT3 mutation status did not adversely impact overall survival after HCT, and about 50% of patients with this mutation who underwent HCT were long-term survivors. Cancer 2016;122:3005-3014. © 2016 American Cancer Society
Analyses of fine paste ceramics
Four chapters are included: history of Brookhaven fine paste ceramics project, chemical and mathematical procedures employed in Mayan fine paste ceramics project, and compositional and archaeological perspectives on the Mayan fine paste ceramics. (DLC
A civilização maia: contextualização historiográfica e arqueológica The Mayan Civilization: historiographic and archeological contextualization
Este artigo versa sobre a contextualização historiográfica e arqueológica da civilização maia. O intuito é traçar um perfil das primeiras explorações nos sÃtios arqueológicos, observar a construção do conhecimento criada acerca das primeiras informações obtidas pela Arqueologia, além das diversas vinculações das pesquisas empreendidas em relação aos contextos históricos de sua época e as teorias utilizadas atualmente pelos maÃstas.<br>This article deals with the historiographic and archeological contextualization of the Mayan civilization. Its purpose is to trace the profile of the first explorations into archeological sites, the construction of the knowledge created around the first information obtained by Archeology, as well as the diverse research links undertaken in relation to the historical contexts of its time, and the theories used at present by the Mayanists
- …