Altered Host Immunity, Human T Lymphotropic Virus Type I Replication, and Risk of Adult T-Cell Leukemia/Lymphoma: A Prospective Analysis from the ATL Cohort Consortium

Background: Adult T-cell leukemia/lymphoma (ATL) is a rare and often fatal outcome of infection with human T-lymphotropic virus type I (HTLV-I). Altered host immunity in HTLV-I carriers has been postulated as a risk factor for ATL, but is not well understood. Methods: We prospectively examined well-validated serologic markers of HTLV-I pathogenesis and host immunity in 53 incident ATL cases and 150 carefully matched asymptomatic HTLV-I carriers from eight population-based studies in Japan, Jamaica, the United States and Brazil. We used multivariable conditional logistic regression, conditioned on the matching factors (cohort/race, age, sex, and sample collection year), to evaluate the biomarkers’ associations with ATL in all subjects and by years (≤5, >5) from blood draw to ATL diagnosis. Results: In the pooled population, above-median soluble interleukin-2-receptor-alpha levels (sIL2R, v. ≤ median; odds ratio (OR), 95% confidence interval (CI)=4.08, 1.47-11.29) and anti-Tax seropositivity (anti-Tax; OR, 95% CI=2.97, 1.15-7.67), which indicate T cell activation and HTLV-I replication, respectively, were independently associated with an increased ATL risk. Above-median total immunoglobulin E levels (v. ≤ median; OR, 95% CI=0.45, 0.19-1.06), which indicate type 2 (B cell) activation, predicted a lower ATL risk. The sIL2R and anti-Tax associations with ATL were stronger in samples collected ≤5 years pre-diagnosis. Conclusions: The biomarker profile predictive of ATL risk suggests a role for heightened T cell activation and HTLV-I replication and diminished type 2 immunity in the etiology of ATL in HTLV-I carriers. Translation of these findings to clinical risk prediction or early ATL detection requires further investigation. Acknowledgements: This abstract is presented on behalf of the ATL Cohort Consortium

Incidence of Severe Pain in Newly Diagnosed Ambulatory Patients with Stage IV Cancer

BACKGROUND: Pain is common among cancer patients

Slow Gait Speed and Risk of Long‐Term Nursing Home Residence in Older Women, Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures

ObjectivesTo determine whether slow gait speed increases the risk of costly long-term nursing home residence when accounting for death as a competing risk remains unknown.DesignLongitudinal cohort study using proportional hazards models to predict long-term nursing home residence and subdistribution models with death as a competing risk.SettingCommunity-based prospective cohort study.ParticipantsOlder women (mean age 76.3) participating in the Study of Osteoporotic Fractures who were also enrolled in Medicare fee-for-service plans (N = 3,755).MeasurementsGait speed was measured on a straight 6-m course and averaged over two trials. Long-term nursing home residence was defined using a validated algorithm based on Medicare Part B claims for nursing home-related care.ResultsParticipants were followed until long-term nursing home residence, disenrollment from Medicare plan, death, or December 31, 2010. Over the follow-up period (median 11 years), 881 participants (23%) experienced long-term nursing home residence, and 1,013 (27%) died before experiencing this outcome. Slow walkers (55% of participants with gait speed <1 m/s) were significantly more likely than fast walkers to reside in a nursing home long-term (adjusted hazards ratio (aHR) = 1.79, 95% confidence interval (CI) = 1.54-2.09). Associations were attenuated in subdistribution models (aHR = 1.52, 95% CI = 1.30-1.77) but remained statistically significant.ConclusionOlder community-dwelling women with slow gait speed are more likely to experience long-term nursing home residence, as well as mortality without long-term residence. Ignoring the competing mortality risk may overestimate long-term care needs and costs

Slow Gait Speed and Risk of Long‐Term Nursing Home Residence in Older Women, Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures

ObjectivesTo determine whether slow gait speed increases the risk of costly long-term nursing home residence when accounting for death as a competing risk remains unknown.DesignLongitudinal cohort study using proportional hazards models to predict long-term nursing home residence and subdistribution models with death as a competing risk.SettingCommunity-based prospective cohort study.ParticipantsOlder women (mean age 76.3) participating in the Study of Osteoporotic Fractures who were also enrolled in Medicare fee-for-service plans (N = 3,755).MeasurementsGait speed was measured on a straight 6-m course and averaged over two trials. Long-term nursing home residence was defined using a validated algorithm based on Medicare Part B claims for nursing home-related care.ResultsParticipants were followed until long-term nursing home residence, disenrollment from Medicare plan, death, or December 31, 2010. Over the follow-up period (median 11 years), 881 participants (23%) experienced long-term nursing home residence, and 1,013 (27%) died before experiencing this outcome. Slow walkers (55% of participants with gait speed <1 m/s) were significantly more likely than fast walkers to reside in a nursing home long-term (adjusted hazards ratio (aHR) = 1.79, 95% confidence interval (CI) = 1.54-2.09). Associations were attenuated in subdistribution models (aHR = 1.52, 95% CI = 1.30-1.77) but remained statistically significant.ConclusionOlder community-dwelling women with slow gait speed are more likely to experience long-term nursing home residence, as well as mortality without long-term residence. Ignoring the competing mortality risk may overestimate long-term care needs and costs