BCR-ABL1 transcript at 3 months predicts long-term outcomes following second generation tyrosine kinase inhibitor therapy in the patients with chronic myeloid leukaemia in chronic phase who failed Imatinib.

The BCR-ABL1 transcript level at 3 months can predict long-term outcomes following frontline therapy with Imatinib or Dasatinib in chronic myeloid leukaemia (CML) patients. However, data is lacking for second-generation tyrosine kinase inhibitor (2GTKI) therapy after Imatinib failure. A total of 112 patients with CML in chronic phase receiving 2GTKI after Imatinib failure were reviewed. Treatment outcomes including complete cytogenetic (CCyR), major molecular (MMR) and molecular response 4.5 (4.5 log reduction of BCR-ABL1 transcript level, MR(4.5) ), treatment failure, progression-free and overall survival (OS) were compared according to BCR-ABL1 transcript levels at 3 or 6 months, divided into <1%(IS) , 1-10%(IS) and ≥ 10%(IS) . BCR-ABL1 transcript level at 3 months showed better correlation with OS (P < 0.001) than that at 6 months (P = 0.147). Better OS was also observed in the patients achieving <1%(IS) (100%) and 1-10%(IS) (100%) than those with ≥ 10%(IS) at 3 months (70.6%, P < 0.001). Those with <1%(IS) showed the best CCyR, MMR and MR(4.5) rates; 1-10%(IS) , intermediate; and ≥ 10%(IS) , the lowest CCyR, MMR and MR(4.5) rates. The group with <1%(IS) at 3 months maintained significantly lower BCR-ABL1 transcript level compared to other two groups. In conclusion, the BCR-ABL1 transcript level at 3 months is the most relevant surrogate for outcomes following 2GTKI therapy after Imatinib failure.

Ten-year comparison of all-cause mortality after endovascular or open repair of abdominal aortic aneurysms: a propensity score analysis.

BACKGROUND: This study aimed to compare the long-term survival after open (OS) or endovascular (EVAR) repair of abdominal aortic aneurysms (AAAs), exploring baseline factors that could affect long-term outcome. METHODS: We identified 774 patients (501 EVAR, 273 OS, during 1996-2004) with data on perioperative risk factors including 37 variables assessed with a standardized patient response instrument. Propensity score was used to adjust for baseline differences between the two cohorts. Matched cohorts survival analysis and Cox multivariate regression were performed. RESULTS: Median follow-up was 6.95 (interquartile range 4.46-9.27) years. EVAR patients were older [75.0 ± 7.7 (SD) vs. 71.3 ± 8.5 years, p < 0.001] and had a higher rate of previous myocardial infarction (39.3 vs. 25.3%, p < 0.001), pulmonary disease (25.9 vs. 18.3%, p = 0.020), and history of malignancy (5.0 vs. 1.8%, p = 0.039). The 30-day mortality was comparable (1.4% EVAR, 1.5% OS). Although the unadjusted survival rate was lower (median survival: 7.4 years EVAR, 8.8 OS, p = 0.011) and early (within 4 years) hazard was higher after EVAR (p = 0.003), no difference in survival was observed after propensity score-matching (p = 0.688) or propensity score-adjusted Cox regression (hazard ratio 1.01, 95 % confidence interval 0.82-1.25, p = 0.911, EVAR vs. OS). There was a trend toward higher hazard later in both groups. A multivariate Cox regression identified age, pulmonary disease, stroke, dialysis, oral anticoagulation, cardiac enlargement, and smoking history as variables associated with poor survival. Lipid-lowering medication was found to be protective. CONCLUSIONS: Over long-term follow-up, survivals after endovascular and open repair of AAA are similar. Baseline patient characteristics are correlated with survival, but whether attention to the modifiable risk factor can alter outcome remains to be defined.

Common peroneal nerve compression by a popliteal venous aneurysm.

A 58-yr-old man with a right foot drop and a sensory change in the right calf and foot, which developed after a bladder operation, was referred to our clinic for an electrodiagnostic evaluation. Neurologic examination showed grade 1 weakness of the right ankle in dorsiflexion, great toe in dorsiflexion, and ankle in eversion. In addition, the patient complained of pain and a tingling sensation in the right calf and foot. Electrodiagnostic findings were consistent with right common peroneal nerve palsy at the level of the fibula head. In addition, duplex ultrasonography, computed tomography angiography, and magnetic resonance imaging revealed a right popliteal venous aneurysm and impingement of the right common peroneal nerve between the aneurysm and the belly of the biceps femoris muscle. After resection of the aneurysm, his sensory symptoms and motor strength of the right foot and calf gradually improved. This case suggests that compression by the venous system should be considered when there is clinical evidence of focal neuropathy but no abnormal findings at common entrapment sites.

Analysis of chemotherapy-induced amenorrhea rates by three different anthracycline and taxane containing regimens for early breast cancer.

PURPOSE: Chemotherapy-induced amenorrhea (CIA) by newer taxane-containing regimens was evaluated in early breast cancer (EBC) patients. METHODS: A prospective cohort of 122 premenopausal EBC patients participated in a phase III trial of preoperative docetaxel/capecitabine (TX) versus doxorubicin/cyclophosphamide (AC); 34 patients received adjuvant AC followed by paclitaxel (T) and 129 patients received 5-fluorouracil/doxorubicin/cyclophosphamide (FAC). RESULTS: The CIA rate was 90.2% with TX/AC, 73.5% with AC followed by T, and 72.1% with FAC at 1 year (P = 0.002), and 66.7%, 73.3%, and 58.9%, respectively, at 3 years (P = 0.268). At one year, age (P < 0.001) and taxane use (P = 0.002), and after two years, age and tamoxifen use were significant factors for CIA in multivariate analysis. Serum estradiol and follicle-stimulating hormone levels were significantly correlated with menstrual status, age, and tamoxifen use. CONCLUSION: Taxanes resulted in higher CIA rates in the first year, but age and tamoxifen use were significant factors for persistent CIA.