Survival Outcomes and Health-Related Quality of Life in Older Adults Diagnosed with Acute Myeloid Leukemia Receiving Frontline Therapy in Daily Practice.

Acute myeloid leukemia has a poor prognosis in older adults, and its management is often unclear due to its underrepresentation in clinical trials. Both overall survival (OS) and health-related quality-of-life (HRQoL) are key outcomes in this population, and patient-reported outcomes may contribute to patient stratification and treatment assignment. This prospective study included 138 consecutive patients treated in daily practice with the currently available non-targeted therapies (intensive chemotherapy [IC], attenuated chemotherapy [AC], hypomethylating agents [HMA], or palliative care [PC]). We evaluated patients' condition at diagnosis (Life expectancy [Lee Index for Older Adults], Geriatric Assessment in Hematology [GAH scale], HRQoL [EQ-5D-5L questionnaire], and fatigue [fatigue items of the QLQ-C30 scale]), OS, early death (ED), treatment tolerability (TT) and change in HRQoL over 12 months follow-up. The median OS was 7.1 months (IC not reached, AC 5.9, HMA 8.8, and PC 1.0). Poor risk AML category and receiving just palliative care, as well as a higher Lee index score in the patients receiving active therapy, independently predicted a shorter OS. The Lee Index and GAH scale were not useful for predicting TT. The white blood cell count was a valid predictor for ED. Patients' HRQoL remained stable during follow-up.

Cistitis incrustada por Pseudomonas aeruginosa: una causa infrecuente de síndrome miccional / Incrusted cistitis due to Pseudomas aeriginosa: an unusual cause of mictional syndrome

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What does apoptosis have to do with clinical features in myelodysplastic syndrome?

BACKGROUND AND OBJECTIVES: Apoptosis is thought to play a key pathogenic role in myelodysplastic syndrome. The aim of our study was to determine whether apoptotic index, p53 and bcl-2 levels correlate with the clinical consequences of ineffective hematopoiesis; namely, the development of cytopenia and the shortened survival of patients with myelodysplastic syndrome. DESIGN AND METHODS: The apoptotic index, determined by TdT-mediated dUTP nick-end labeling, as well as bcl-2 and p53 protein levels, evaluated by immunohistochemistry, were studied in bone marrow trephine biopsy archival samples from 25 healthy subjects aged over fifty (control group), 61 consecutive patients with myelodysplastic syndrome and 17 patients with de novo acute myeloid leukemia according to FAB criteria. The correlation between relevant clinical parameters was analyzed with Spearman's correlation test. Factors influencing survival were studied by Cox proportional hazards regression analysis. RESULTS: The apoptotic index did not correlate with blood counts at diagnosis and had no prognostic influence on the overall survival of patients with myelodysplastic syndrome. The p53 score correlated with both the leukocyte count (r=-0.274, p=0.034, Spearman's) and hemoglobin concentration (r=-0.316; p=0.014) in the myelodysplastic syndrome patients and showed an independent and significant prognostic influence on their overall survival (p=0.045, Cox's) while the bcl-2 score was not correlated with their blood counts or prognosis. INTERPRETATION AND CONCLUSIONS: Apoptotic index and bcl-2 do not correlate with key clinical data in patients with myelodysplastic syndrome, while p53 levels show a good correlation with these data and may be a useful parameter to add to current prognostic schemes in this entity.