Neutrophil to lymphocyte ratio (NLR) impact on the progression-free survival and overall survival of multiple myeloma patients treated with high-dose chemotherapy and autologous stem cell transplantation.

High-dose chemotherapy with autologous stem-cell transplantation (ASCT) remains the standard of care in multiple myeloma (MM) patients. This retrospective study aimed to assess the impact of neutrophil-to-lymphocyte ratio (NLR) and other complete blood count (CBC)-based predictors on PFS and OS of transplant-eligible MM patients. The CBC-based biomarkers were evaluated in a single-center cohort of 176 MM patients at three time points: at the diagnosis, the time of ASCT, and +100 d after ASCT. Univariable and multivariable Cox's regression analyses and Kaplan-Meier estimate were used in statistical analysis. NLR at ASCT (HR 1.15, 95% CI: 1.05-1.26) and hemoglobin at ASCT (HR 0.80, 95% CI: 0.68-0.94) were independent factors influencing PFS. In the model for OS, the only statistically significant factors were NLR at ASCT (HR 1.15, 95% CI: 1.04-1.27), bortezomib administration prior to ASCT (HR 0.52, 95% CI: 0.33-0.83) and age at diagnosis (HR 1.03, 95% CI: 1.00-1.06). NLR at ASCT is an independent predictive factor in MM patients undergoing ASCT.

Safe and uncomplicated inguinal hernia surgery in the elderly - message from anesthesiologists to general surgeons.

Introduction Elderly patients are often discouraged from surgery due to the risk of complications that increases with age. Aim We wanted to assess mortality, morbidity, and complications in patients older than 75 years who underwent elective or emergency inguinal hernia repair in a single center. Methods All patients older than 75 years who were operated on because of inguinal hernia in the Department of General and Colorectal Surgery, Medical University of Lodz between 2003 and 2015 were analyzed. Detailed information was collected with regard to patient demographics, mode of admission, comorbidities, type of intervention, applied anesthesia, and 30-day outcomes. Postoperative outcomes included medical and surgical complications, readmissions, and survival status. Results One hundred thirty-two patients older than 75 years were operated on for inguinal hernia, 16 (12.1%) in an emergency setting and 116 (87.9%) in an elective setting. Eighteen patients (13.6%) developed complications, 8 (50%) in the emergency group, and 10 (8.6%) in the elective group. In the emergency group, severe medical complications (Clavien-Dindo 4) were frequent, whereas in the elective group, severity of surgical and medical complications was not significantly different (Clavien-Dindo median score 2, p=0.6084), and these complications were classified as mild (Clavien-Dindo 1-2). One death occurred in the emergency group. Conclusion Inguinal hernia surgery in the elderly may be safe and effective in an elective setting and if regional anesthesia is used. Careful examination of patients before surgery and identification of potential risk factors associated with co-existing diseases are vital for reducing the risk of complications. Key point: Hernia surgery in patients older than 65 years is a low-risk intervention, if carried out in an elective setting.