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BACKGROUND: Studies have reported racial disparities in access to and use of multiple myeloma (MM) treatments between African American (AA) and White patients. Although AA patients demonstrate longer disease-specific survival, this has not uniformly translated into improved survival over time. The association between race and treatment patterns and survival outcomes was analyzed using data from the Connect MM Registry. METHODS: The Connect MM Registry is a large US, multicenter, prospective observational cohort study of patients with newly diagnosed MM. Patients who received first-line (1L) stem cell transplantation (SCT) or who did not receive SCT (non-SCT or non-stem cell transplantation [NSCT]) were grouped by raceEffects of race and transplantation status on the use of triplet treatment were estimated using logistic regression. RESULTS: Treatment patterns in 1L (types and duration of induction, posttransplantation maintenance) were similar between AA and White patients. SCT rates in 1L (32% vs 36%) and triplet treatment use (AA: 44% for NSCT patients and 72% for SCT patients; and White: 48% for NSCT patients and 72% for SCT patients) during first induction were similar. No significant effect of race or transplantation status on 1L triplet treatment use was observed. Race was not found to be associated with survival outcomes among patients who underwent NSCT; however, AA patients who received SCT had significantly longer overall survival compared with White patients who underwent SCT (not reached vs 88.2 months; hazard ratio, 0.56; 95% CI, 0.35-0.89 [P = .0141]). CONCLUSIONS: AA and White patients were found to have similar treatment patterns in the Connect MM Registry, suggesting that both groups had equal access to health care. In this real-world setting, AA patients received standard-of-care treatment, which might have contributed to better MM-specific survival compared with White patients.
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Mieloma Múltiplo/etnologia , Mieloma Múltiplo/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Grupos Raciais , Sistema de Registros , Análise de Sobrevida , Estados Unidos , Adulto JovemRESUMO
Median overall survival (OS) has improved for patients with newly diagnosed multiple myeloma (NDMM), but prognosis varies depending on baseline patient characteristics. Current models use data from selected clinical trial populations, which prevent application to patients in an unselected community setting that reflects routine clinical practice. Using data from the Connect® MM Registry, a large, US, multicentre, prospective observational cohort study (Cohort 1: 2009-2011; Cohort 2: 2012-2016) of 3011 patients with NDMM, we identified prognostic variables for OS via the multivariable analysis of baseline patient characteristics in Cohort 1 (n = 1493) and developed a tool to examine individual outcomes. Factors associated with OS (n = 1450 treated patients; P < 0·05) were age, del(17p), triplet therapy use, EQ-5D mobility, International Staging System stage, solitary plasmacytoma, history of diabetes, platelet count, Eastern Cooperative Oncology Group performance status and serum creatinine, which were used to create survival matrices for 3- and 5-year OS. The model was internally and externally validated using Connect MM Cohort 2 (Harrell's concordance index, 0·698), MM-015 (0·649), and the phase 3 FIRST (0·647) clinical trials. This novel prognostic tool may help inform outcomes for NDMM in the era of triplet therapy use with novel agents.
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Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Deleção Cromossômica , Cromossomos Humanos Par 17 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/genética , Mieloma Múltiplo/patologia , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Sistema de Registros , Reprodutibilidade dos Testes , Medição de Risco/métodos , Síndrome de Smith-Magenis/mortalidade , Análise de Sobrevida , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Sea buckthorn juice has high nutritional value and a rich flavor that consumers enjoy. Traditional sea buckthorn thermal processing (TP) technology has problems such as low juice yield, poor quality, and poor flavor. Sea buckthorn berries are processed using a technique combining pulsed electric field (PEF) and high-pressure processing (HPP) to increase juice yield and study its impact on the quality and volatile aroma of sea buckthorn juice. Results have show that, compared with TP, under the condition of PEF-HPP, the juice yield of sea buckthorn significantly increased by 11.37% (p > 0.05); TP and PEF-HPP treatments could effectively kill microorganisms in sea buckthorn juice, but the quality of sea buckthorn juice decreased significantly after TP treatment (p > 0.05), whereas PEF-HPP coupling technology could maximally retain the nutrients of sea buckthorn juice while inhibiting enzymatic browning to improve color, viscosity, and particle size. The flavor of sea buckthorn juice is analyzed using electronic nose (E-nose) and gas chromatography-ion mobility spectrometer (GC-IMS) techniques, and it has been shown that PEF-HPP retains more characteristic volatile organic compounds (VOCs) of sea buckthorn while avoiding the acrid and pungent flavors produced by TP, such as benzaldehyde, (E)-2-heptenal, and pentanoic acid, among others, which improves the sensory quality of sea buckthorn juice. PEF-HPP technology is environmentally friendly and efficient, with significant economic benefits. Research data provide information and a theoretical basis for the sea buckthorn juice processing industry.
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This study used a real-world population as a synthetic comparator for the single-arm TRANSCEND NHL 001 study (TRANSCEND; NCT02631044) to evaluate the efficacy of lisocabtagene maraleucel (liso-cel) compared with conventional (noncellular) therapies in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Inclusion and exclusion criteria for the real-world study closely matched the enrollment criteria in TRANSCEND. The analytic comparator cohort was created by matching and balancing observed baseline characteristics of real-world patients with those in TRANSCEND using propensity score methodology. Efficacy outcomes comparing liso-cel- (n = 257) and conventional therapy-treated (n = 257) patients, respectively, significantly favored liso-cel: overall response rate (74% vs 39%; p < 0.0001), complete response rate (50% vs 24%; p < 0.0001), median overall survival (23.5 vs 6.8 months; p < 0.0001), and median progression-free survival (3.5 vs 2.2 months; p < 0.0001). These results demonstrated a statistically significant and clinically meaningful benefit of liso-cel in patients with third- or later-line R/R LBCL relative to conventional therapies.Clinical trial registration: ClinicalTrials.gov identifier: NCT02631044.
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Linfoma Difuso de Grandes Células B , Humanos , Antígenos CD19 , Imunoterapia Adotiva/efeitos adversos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Intervalo Livre de Progressão , Pontuação de PropensãoRESUMO
BACKGROUND: Multiple myeloma (MM) in Hispanics has never been studied. We therefore sought to determine the clinical characteristics and overall survival in MM of Hispanics compared to non-Hispanic whites (NHW) and non-Hispanic blacks (NHB). PATIENTS AND METHODS: A single-center analysis of 939 patients diagnosed with MM from 2000 to 2017 with a large representation of NHB (n = 489), Hispanics (n = 281), and NHW (n = 169) was conducted to evaluate outcomes and disease characteristics. We used the Connect MM Registry, a large US multicenter prospective observational study with newly diagnosed MM patients, as a validation cohort. RESULTS: Hispanics had a higher incidence of MM compared to NHW. The median age at presentation was 5 years younger (median, 65 years) in Hispanics compared to NHW (median, 70 years), and patients were more likely to present with renal dysfunction (estimated glomerular filtration rate < 30 mL/min). Hispanics had a higher proportion of Revised International Staging System (R-ISS) stage I disease compared to NHW and NHB (P = .03), while there was no difference in cytogenetics between Hispanics and NHB/NHW. In the multivariate analysis, only high-risk disease and response to first-line therapy significantly affected survival. CONCLUSION: In this first and largest analysis of MM in Hispanics, we found that Hispanics present at a younger age, have a higher incidence of renal dysfunction, and have low R-ISS stage disease at presentation. With equal access to therapy, Hispanics have survival similar to NHW/NHB.
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Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Mieloma Múltiplo/epidemiologia , Insuficiência Renal/epidemiologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Insuficiência Renal/etiologia , Análise de Sobrevida , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: The Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB) show improved overall survival (OS) in patients with multiple myeloma (MM) over the last 15 years. This analysis evaluated the validity of the largely community-based Connect MM Registry as a national reference for MM. METHODS: Baseline disease characteristics and survival in US newly diagnosed MM patients were examined using the Connect MM Registry as well as SEER and NCDB databases. Baseline characteristics predictive of longer survival in Connect MM were also identified. RESULTS: As of February 2017, 3011 patients were enrolled in the Connect MM Registry; 2912 were treated. Median age at time of MM diagnosis and age range were numerically similar from 2010 to 2015 across all 3 registries; SEER had a higher representation of nonwhite racial groups than that in the other 2 registries. OS rates suggest proportionate improvement with year of diagnosis among the 3 registries. A Cox proportional hazards model suggests that younger age (<65 years) is associated with longer survival (vs ≥75; HR, 0.39; 95% confidence interval, 0.34-0.46) in the Connect MM Registry. However, sex (HR, 0.91; P = .15) and race (black vs white; HR, 0.88; P = .21) were not associated with longer OS. CONCLUSIONS: Data from the Connect MM Registry appear to be largely representative of national trends, comprehensive, and reliable representations of the national MM population. Baseline characteristics were comparable, and survival similarly improved over time among the 3 registries. CLINICALTRIALS. GOV, IDENTIFIER: NCT01081028.
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Bases de Dados Factuais/estatística & dados numéricos , Mieloma Múltiplo/mortalidade , Sistema de Registros/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Porto Rico/epidemiologia , Reprodutibilidade dos Testes , Taxa de Sobrevida , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: The treatment landscape for multiple myeloma (MM) has undergone recent changes with the regulatory approval of several new therapies indicated for second- and later-line disease. Using data from Connect MM, the largest multisite, primarily community-based, prospective, observational registry of MM patients in the United States, selection of second-line treatments was evaluated during a 5-year period from 2010 to 2016. PATIENTS AND METHODS: Eligible patients were aged ≥ 18 years, had newly diagnosed MM ≤ 2 months before study entry, and were followed for up to 8 years. Patients who received ≥ 2 lines of therapy were analyzed. "Tepee" plots of stacked area graphs differentiated treatments by color to allow visualization of second-line treatment trends in MM patients. RESULTS: As of February 2017, 855 of 2897 treated patients had progressed to second-line treatment. Treatment selection was heterogeneous; shifting patterns of treatment choices coincided with the approval status of newer agents. The most common treatment regimens in the early part of the decade were lenalidomide and/or bortezomib, with or without dexamethasone, with increasing use of newer agents (carfilzomib, pomalidomide, daratumumab, and elotuzumab) and triplet combinations over time. The influence of the baseline patient characteristics of age, history of diabetes, peripheral neuropathy, and renal function on treatment choice was also examined. CONCLUSION: These findings indicate that community physicians are current in their MM management practices, with uptake of new drugs and acquaintance with results of randomized clinical trials using combinations almost concurrent with their regulatory approval and publication.
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Mieloma Múltiplo/epidemiologia , Mieloma Múltiplo/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gerenciamento Clínico , História do Século XXI , Humanos , Mieloma Múltiplo/história , Prognóstico , Vigilância em Saúde Pública , Retratamento , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
We evaluated the prognostic significance of p34cdc2 expression in 50 tongue squamous cell carcinomas (SCC) using immunohistochemical methods. The p34cdc2 protein was expressed in 33 cases of 50 tumor tissues (66.0%), compared with 15 cases of 42 controlled epithelia (35.7%). The expression of p34cdc2 was significantly correlated with the histological grade of tongue carcinoma (P<0.01). In addition, on evaluation of prognosis of tumor, the p34cdc2 protein was overexpressed in recurrent tumors or in those with lymph node metastasis. Statistics showed a significant reduction in the 5-year accumulative survival rate of p34cdc2 positive cases compared with p34cdc2 negative cases (P<0.01). Namely, the p34cdc2 positive patients had worse prognosis. The results suggested that the expression of p34cdc2 suited to the histological grade might reflect the malignant degree of tongue carcinoma biologically. Therefore, the evaluation of p34cdc2 expression was of benefit in elucidating the nature of tumor malignancy and the prognostic prediction of tongue SCC.
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Biomarcadores Tumorais/metabolismo , Proteína Quinase CDC2/metabolismo , Carcinoma de Células Escamosas/enzimologia , Neoplasias da Língua/enzimologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Feminino , Humanos , Técnicas Imunoenzimáticas , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/metabolismo , Recidiva Local de Neoplasia/enzimologia , Estadiamento de Neoplasias , Prognóstico , Análise de Sobrevida , Neoplasias da Língua/patologiaRESUMO
OBJECTIVE: To evaluate the relation of EB virus latent membrane protein-1 (LMP-1) and the phenotype of epithelial-mesenchymal transition (EMT) and cervical lymph node metastasis in nasopharyngeal carcinoma. METHOD: Based on histopathology and MRI imaging, nasopharyngeal biopsy tissues from 88 patients with nasopharyngeal carcinoma were divided into 3 groups: pathologic metastasis (18), MRI metastasis(40) and without metastasis (30). The expressions of LMP-1, STAT3, Twist, E-Cadherin and Vimentin were examined immunohistochemically in biopsy tissues. RESULT: LMP-1 expression was found in 35 of 88 biopsy tissues with a positive rate of 38.7%. The positive rates of LMP-1 in groups of pathologic metastasis, MRI metastasis and without metastasis were 38.9% (7/18), 47.5% (19/40) and 30.0% (9/30), respectively, and significant difference were not found among three groups. The expression of LMP-1 was positively correlated to both expressions of Twist and Vimentin (r = 0.276 and 0.282, are P < 0.01), but not to both expressions of STAT3 and E-Cadherin. The positive expressions or abnormal expression of STAT3, Twist, Vimentin and E-Cadherin were found in 57 of 88 (64.8%), 48 of 88 (54.5%), 22 of 88 (20.0%)and 53 of 88 (60.2%), respectively. Significant differences in the expression of STAT3, Twist, Vimentin and E-Cadherin were all found among groups of pathologic metastasis, MRI metastasis and without metastasis, respectively (are P < 0.05). The expression of STAT3 was positively correlated to both expressions of Twist and Vimentin (r = 0.712 and 0.316, P < 0.01). CONCLUSION: EMT plays important role in cervical lymph node metastasis in nasopharyngeal carcinoma. LMP-1 may be only as one of upstream factors associated with the EMT, but not the decisive factor for cervical lymph node metastasis.
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Transição Epitelial-Mesenquimal , Herpesvirus Humano 4/metabolismo , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/virologia , Proteínas da Matriz Viral/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Caderinas/metabolismo , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Proteínas Nucleares/metabolismo , Fator de Transcrição STAT3/metabolismo , Proteína 1 Relacionada a Twist/metabolismo , Vimentina/metabolismo , Adulto JovemRESUMO
OBJECTIVE: To study the expression and its significance of STAT3, STAT5, Survivin and Ki67 in the Epstein-Barr virus associated nasal NK/T cell lymphoma. METHOD: The expression of STAT3, STAT5, Survivin and Ki67 were detected with immunohistochemistry in 25 cases of nasal NK/T cell lymphoma, and their relationship was analyzed. Nasal cavity tissues from 20 cases of chronic sinusitis were as the control group. RESULT: The positive rates of STAT3 in the lymphoma and in control group were 56% and 10%, respectively (P <0.01). The positive rates of STAT5 in the lymphoma and in control group were 68% and 15%, respectively (P <0.01). The positive rates of Survivin and Ki67 of nasal NK/T cell-lymphoma were 68% and 72%, respectively; but it in the control group was 0% and 20%, respectively, P <0.01. The expression of STAT3 was positively related to that of Survivin and Ki67(r =0. 428, P <0. 05 and r =0. 704, P <0. 01); The expression of STAT5 was not related to that of Survivin and Ki67. CONCLUSION: The pathway of STAT may play a role in the development of nasal NK/T cell lymphoma. STAT maybe take part in the formation of nasal NK/T cell lymphoma through induction of Survivin and Ki67.