Vitamins, Minerals, and Specialty Supplements and Risk of Hematological Malignancies In the VITamins and Lifestyle (VITAL) Cohort Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4143-4143
Author(s):  
Filippo Milano ◽  
Roland B. Walter ◽  
Theodore M. Brasky ◽  
Emily White
Keyword(s):  
Folic Acid ◽  
Dietary Supplements ◽  
Hematological Malignancies ◽  
Conflicts Of Interest ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Cox Proportional Hazards ◽  
Case Control Studies ◽  
History Of ◽  
Incident Cases

Abstract Abstract 4143 Introduction: The use of vitamins and dietary supplements is a common health practice in many parts of the world, in part because of the belief that they will prevent diseases, including cancer. However, results of epidemiologic studies regarding their efficacy in reducing the risk of any cancer, particularly hematologic malignancies, are inconsistent and are mostly limited to case-control studies. Materials: Participants were male and female members of the VITamins And Lifestyle (VITAL) cohort. Between 2000 and 2002, 64,839 men and women, aged 50 to 76 years, who lived in the region of Washington State covered by the Surveillance, Epidemiology, and End Results (SEER) registry, were recruited. Participants were excluded if they had any cancer prior to baseline other than non-melanoma skin cancer and were censored at the time of diagnosis of a non-hematologic malignancy during follow-up; after exclusions, there were 64,839 participants available for study. Incident cases of hematologic malignancies were identified through December 2008 by linkage to the SEER registry. Participants answered questions on the frequency (days/week), duration (years), and dose per day of their supplemental use of vitamins, including A, B3, B6, B12, C, D, E, multivitamin compounds, and folic acid; minerals, including calcium, selenium, iron, magnesium, chrome, and zinc during the 10 years before baseline. For the non-vitamin, non-mineral “specialty” supplements, garlic, ginseng, and fish oil, only frequency and duration were ascertained. Use of vitamin and mineral supplements was categorized into non-users and tertiles of use, such that the highest category was greater than could be achieved only by use of a common multivitamin (Centrum Silver). 10-year average use of specialty supplements was categorized into: non-user; low use, <4 days/week or <3 years; and high use, ≥4 days/week and ≥3 years. Multivariable-adjusted Cox proportional hazards models were used to estimate hazards ratios (HR) and 95% confidence intervals (95% CI) of the use of dietary supplements with the risk of total hematologic malignancies. Models were adjusted for age, sex, race/ethnicity (white/hispanic/other), education, smoking, self-rated health, physical activity, history of anemia in the year before baseline, and family history of leukemia or lymphoma. Results: A total of 577 case of hematological malignancies were identified including MDS [n=54], AML [n=36], myeloproliferative disorders [n=46], CLL/SLL [n=88] and other non-Hodgkin lymphomas [n=235], Hodgkin lymphomas [n=22], plasma cell disorders [n=66], mature NK/T cell neoplasms [n=17], and other entities [n=13]). None of the vitamin 10-year average intakes were associated with decreased risk of incident hematologic malignancies There was no evidence that high use of vitamins A (HR=0.79, 95% CI: 0.58–1.08; p-trend=0.28), B12 (HR=0.98, 95%CI: 0.73–1.31; p-trend=0.26), C (HR=0.97, 95% CI: 0.77–1.22; p-trend=0.99), D (HR=0.90, 95% CI: 0.62–1.31; p-trend=0.45), or folic acid (HR=1.00, 95% CI: 0.73–1.39; p-trend=0.19) was associated with the risk of blood cancer. Among specialty supplements, only high 10-year average use of garlic was significantly associated with a reduced risk of development of blood cancers (HR=0.64,95% CI: 0.42–0.98); however the association was not linear (p-trend=0.14). Conclusions: We observed no reduction in the risk of incident hematologic malignancies with dietary supplement and vitamin use with the exception of garlic when used at a high amount (≥4 days/week for ≥ 3 years). Disclosures: No relevant conflicts of interest to declare.

Associations between allergies and risk of hematologic malignancies: Results from the Vitamins and Lifestyle (VITAL) cohort study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1527-1527
Author(s):  
Mazyar Shadman ◽  
Roland B. Walter ◽  
Anneclaire DeRoos ◽  
Emily White
Keyword(s):  
Immune System ◽  
Proportional Hazards ◽  
Nk Cell ◽  
Myeloproliferative Disorders ◽  
Hematologic Malignancies ◽  
Cox Proportional Hazards ◽  
Lymphocytic Leukemia ◽  
Case Control Studies ◽  
Increased Risk ◽  
History Of

1527 Background: Several case-control studies have suggested a reduced risk of hematologic malignancies (HMs) for individuals with allergies, but results have been inconsistent, and prospective cohort studies have not confirmed this association. Herein, we used the large prospective VITAL study to examine this association. Methods: 64,847 men and women, aged 50-76, completed a baseline questionnaire in 2000-2002 and reported on their current allergies and history of physician-diagnosed asthma. Individuals with prior cancer other than non-melanoma skin cancer were excluded from this analysis. Incident HMs were identified through December 2009 by linkage to the SEER registry; those with a diagnosis of a non-HM during follow-up were censored at the time of that diagnosis. Multivariable Cox proportional hazards models were built with adjustment for sex, race/ethnicity, education, smoking, self-rated health, physical activity, history of anemia in the year before baseline, vegetable use and family history of leukemia or lymphoma. Results: Our analysis included 64,839 participants, among whom 681 (1.03%) incident HMs were found (MDS [69], AML (41], myeloproliferative disorders [60], mature B-cell neoplasms [262], chronic lymphocytic leukemia [107], plasma cell disorders [83], Hodgkin lymphoma [23], T-cell/NK-cell neoplasms [22], and others [14]). In multivariable analyses, a history of any allergy was associated with increased risk of HM (HR=1.21; 95% CI 1.02-1.43, p=0.02). This association was seen for current allergies to plants/grass/trees (HR 1.27 [1.06-1.52], p<0.001) but not for allergies to mold/dust, animals, insects, food, or medications. We did not find an association between a history of asthma and incident HMs (HR=0.95 [0.72-1.26]). Conclusions: Our study indicates a moderately increased risk of HMs inindividuals with a history of allergy, especially to plant, grass or trees. While no causality can be inferred, this may suggest a possible carcinogenic role for chronic stimulation of the immune system. However, further mechanistic investigations focusing on the biochemical markers of immune system as well as on possible gene effect modifiers are needed.

scholarly journals Hospital visitors as controls in case-control studies

2001 ◽  
Vol 35 (5) ◽  
pp. 436-442 ◽  
Author(s):  
Gulnar Azevedo S Mendonça ◽  
José Eluf-Neto
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Family History ◽  
Case Control ◽  
Breast Size ◽  
Case Control Studies ◽  
Family History Of Cancer ◽  
History Of ◽  
Incident Cases ◽  
History Of Cancer

OBJECTIVE: Selecting controls is one of the most difficult tasks in the design of case-control studies. Hospital controls may be inadequate and random controls drawn from the base population may be unavailable. The aim was to assess the use of hospital visitors as controls in a case-control study on the association of organochlorinated compounds and other risk factors for breast cancer conducted in the main hospital of the "Instituto Nacional de Câncer" -- INCA (National Cancer Institute) in Rio de Janeiro (Brazil). METHODS: The study included 177 incident cases and 377 controls recruited among female visitors. Three different models of control group composition were compared: Model 1, with all selected visitors; Model 2, excluding women visiting relatives with breast cancer; and Model 3, excluding all women visiting relatives with any type of cancer. Odds ratios (OR) and 95% confidence intervals were calculated to test the associations. RESULTS: Age-adjusted OR for breast cancer associated with risk factors other than family history of cancer, except smoking and breast size, were similar in the three models. Regarding family history of all cancers, except for breast cancer, there was a decreased risk in Models 1 and 2, while in Model 3 there was an increased risk, but not statistically significant. Family history of breast cancer was a risk factor in Models 2 and 3, but no association was found in Model 1. In multivariate analysis a significant risk of breast cancer was found when there was a family history of breast cancer in Models 2 and 3 but not in Model 1. CONCLUSIONS: These results indicate that while investigating risk factors unrelated to family history of cancer, the use of hospital visitors as controls may be a valid and feasible alternative.

Effect of Genetic Polymorphisms Related to Folate and Homocysteine Metabolism In the Etiology of Recurrent Miscarriages

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5136-5136
Author(s):  
Elvira Maria Guerra-Shinohara ◽  
Kelma Cordeiro da Silva Giusti ◽  
Nathalia Sierra Monteiro ◽  
Robson José Lazaro ◽  
Fernanda Midori Seino ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Folic Acid ◽  
Conflicts Of Interest ◽  
Conditional Logistic Regression ◽  
The Body ◽  
Methionine Synthase ◽  
Folic Acid Deficiency ◽  
Recurrent Miscarriages ◽  
History Of ◽  
Total Homocysteine

Abstract Abstract 5136 Introduction: Folic acid deficiency has been associated with obstetric complications such as preeclampsia, placental abruption and recurrent miscarriages (RM). Folic acid is a methyl group donating in various reactions. Low concentrations of 5,10-methylenetetrahydrofolate, the cofactor of enzyme thymidylate synthase, decrease the synthesis of thymidylate, which results in increased ratio deoxyuridylate monophosphate/deoxytimidylate monophosphate (dUMP/dTMP) and increased incorporation of deoxyuridylate triphosphate (dUTP) to DNA. The removal of dUTP by DNA-glycosylase can cause permanent damage to DNA, which may lead to apoptosis or increase the risk of developing cancer. Polymorphisms in genes of enzymes (MTHFR - methylene tetrahydrofolate reductase, MTR - methionine synthase and MTRR - methionine synthase reductase) and also in the gene of the reduced folate carrier (RFC1) were related to reduced folate and increased total homocysteine concentrations and have been associated as risk factors for RM. Material and Methods: 171 women with a history of three or more recurrent miscarriages and 95 healthy women with no history of abortion and having two or more normal babies were included. Weight and height of women were obtained and the body mass index (BMI) was calculated. The presence of antibodies (ANA and anti-DNA) was evaluated using immunofluorescence kits. The genotypes of the polymorphisms MTHFR c. 677C>T, MTR c. 2756A>G and RFC1 c.80G>A were obtained by PCR-RFLP, while genotyping for polymorphisms MTRR c. 66A>G and MTHFR c. 1298A>C was made by real time PCR. Multivariate logistic regression model (forward conditional) was used to obtain the odds ratio and its 95% confidence intervals of having MR (dependent variable). The independent variables were: quartiles of BMI, age range, positive ANA (titer of 1/40), positive anti-DNA (titre 1/10), genotypes for the MTHFR c. 677C>T, MTHFR c.1298A>C, MTR c. 2756A>G, MTRR c. 66A>G and RFC1 c. 80G>A. Results: No differences between the groups were observed for serum total homocysteine or allele frequencies for MTHFR c. 677C>T, MTHFR c. 1298A>C, MTR c. 2756A>G and RFC1 c.80G>A polymorphisms. In a conditional logistic regression analysis the risk of RM was significantly associated with BMI OR [95% CI] = 1.40 [1.02, 1.93] per quartile increase in BMI), positive anti-DNA OR [95% CI] = 7.24 [0.92, 57.25], positive ANA OR [95% CI] = 2.48 [1.21, 5.08], and AA genotype for MTRR c. 66A>G polymorphism (OR [95% CI] = 2.19 [1.16, 4.12]. Conclusion: The etiology of RM is multifactorial and it is associated with increasing of BMI, presence of autoantibodies and AA genotype for MTRR c. 66A>G polymorphism. Disclosures: No relevant conflicts of interest to declare.

Family History Of Hematologic Malignancies and Disorders In a Population Based Study Of Myelodysplastic Syndromes (MDS)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1541-1541
Author(s):  
Angela R. Smith ◽  
Erica D. Warlick ◽  
Rachel K. Fonstad ◽  
Michelle A. Roesler ◽  
Jenny N. Poynter ◽  
...  
Keyword(s):  
Family History ◽  
Conflicts Of Interest ◽  
Positive Family History ◽  
Hematologic Malignancies ◽  
Population Based ◽  
Newly Diagnosed ◽  
Population Based Study ◽  
Hematopoietic Stem ◽  
Increased Risk ◽  
History Of

Abstract Background MDS is a clonal hematopoietic stem cell disorder characterized by dysplastic changes in the bone marrow, ineffective hematopoiesis and an increased risk for developing acute myeloid leukemia (AML). The majority of MDS cases are sporadic, but rare familial cases have been described and are often ascertained through clinic-based referrals. To our knowledge, no population based study of MDS has examined the frequency of family history of hematologic malignancies and disorders in patients, nor associations with disease characteristics and outcomes. Methods Newly diagnosed MDS cases are being identified by rapid case ascertainment by the Minnesota Cancer Surveillance System (MCSS), a population-based cancer registry in Minnesota. Eligibility criteria include all newly diagnosed cases of MDS during the period April 1, 2010-October 31, 2014, between 20-85 years, Minnesota resident, and ability to understand English or Spanish. Proxy interviews are not being conducted. Medical records and biologic samples are obtained and questionnaires are filled out by participants. Centralized pathology and cytogenetics review confirm diagnosis and classify by subtype and risk score including the Revised International Prognostic Scoring System (IPSS-R). Since 2010, information on family history has been obtained through questionnaire responses and/or medical record review on 353 MDS patients. Cases were considered to have a positive family history if they reported a first degree relative with MDS, leukemia, lymphoma or other hematologic condition (multiple myeloma [n=4], Waldenstrom’s macroglobulinemia [n=1] and idiopathic thrombocytopenic purpura [n=1]). Treatment related MDS cases were excluded leaving 330 MDS patients for analysis. Unconditional logistic regression was used to calculate crude odds ratios (ORs) and 95% confidence intervals (CI) overall and by sex. Results A total of 61/330 (18.5%) cases reported a family history of a hematologic condition. The mean age at diagnosis was 71.3 years in those with a family history compared to 72.2 years in those without a family history (p=0.53). There was no difference in the sex distribution between the two groups. Though not statistically significant, the odds of having abnormal cytogenetics or an IPSS-R of High/Very High was lower for those having a positive family history (OR 0.57 [CI 0.25-1.33, p=0.19 and 0.67 [CI 0.24-1.84, p=0.29], respectively). The odds of survival at one year after diagnosis was significantly higher in those with a family history (OR 2.79 [CI 1.04-7.51, p=0.04]) compared to those without (Table). Further stratification by sex revealed that this association was strongest for males (OR=4.23, [CI 0.94-19.0, p=0.06] compared to females (OR=1.84 [CI=0.47-7.19, p=0.38]). Discussion In this population based study of adults with MDS, the prevalence of MDS cases having a positive family history was higher than previous reports. Additionally, cases reporting a family history of hematologic malignancies and disorders appear to experience lower risk disease and have significantly improved overall survival, especially males. It is possible that patients with a family history of hematologic conditions are diagnosed earlier in the course of their disease secondary to increased awareness about blood disorders and/or more active screening within the family. Our analysis is limited by relatively small numbers, but enrollment is ongoing so subsequent analyses with larger numbers of subjects may be more revealing. Additionally, a prospective study to examine these families further, including detailed medical histories and collection of biospecimens (saliva, blood, skin) for genetic analyses is underway in order to identify potential mechanisms and mutations involved in the development of MDS and progression to AML. Disclosures: No relevant conflicts of interest to declare.

scholarly journals IVIG-Induced Abrupt Hemolysis in Neurological Conditions

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4991-4991 ◽  
Author(s):  
Juskaran Chadha ◽  
Randy L. Levine ◽  
Omer Ilyas
Keyword(s):  
Folic Acid ◽  
Vitamin B12 ◽  
Hemolytic Anemia ◽  
Conflicts Of Interest ◽  
Type A ◽  
Blood Type ◽  
Lower Extremity Weakness ◽  
Autoimmune Conditions ◽  
History Of ◽  
Work Up

Background Immunoglobulin (IVIG) is used to treat autoimmune conditions, but there are reports of brisk hemolysis within 48 hours (hrs) of treatment due to anti-A isohemogglutinins(1). Despite these reports, hemolysis remains an unrecognized side effect of IVIG. Methods We presented a series of 3 cases of IVIG-induced hemolysis in patients with autoimmune neurological disorders. In the investigative phase, we traced the cases to a common IVIG lot number. The sample was tested to determine the anti-A titer levels. Case Studies (See Table 1) Case 1 75-year-old man presented with SOB and dysarthria from myasthenia gravis (MG). He received IVIG for 4 days. He developed a hemolytic anemia with 3 g drop in hemoglobin (Hb) 48 hours later. He needed a pRBC transfusion and folic acid. Case 2 59-year-old female with history of MG treated with IVIG at another hospital until 3 months earlier in crisis, with SOB and dysphagia. She received IVIG for 5 days and rituximab. She improved and was discharged, but returned to the ER 7 days later with SOB. Her Hb fell to 8.0 g/dL from 13 g/dL on last admission. She required a pRBC transfusion, folic acid, and vitamin B12 with improvement of SOB. Case 3 20-year-old female admitted for lower extremity weakness, diagnosed with presumed syndrome (GBS). She received IVIG for 4 days. On the 5th day, her Hb fell from 15 g/dL to 9 g/dL. She began prednisone, folic acid, and vitamin B12 with improvement in her Hb. Conclusions Although acute hemolysis is well described in the literature, it is under recognized, as exemplified by the first two cases. Their initial SOB was due to MG, so when SOB recurred, they were misdiagnosed with recurrent MG. A hemolytic anemia was later suspected, and a work up revealed a positive DAT. The initial eluate was negative against type O panel cells, suggesting a drug related hemolysis. It was only when the eluate was tested against type A cells that the etiology became clear. The third patient's hemolytic reaction was then rapidly identified. These cases remind us to consider IVIG induced anti-A hemolysis in patients who are blood type A and AB, and to evaluate the eluate against the appropriate reagent cells. These patients should receive specific IVIG that is low in anti-A isohemagglutinins. Since the second patient did not hemolyze from earlier exposure to IVIG, she likely received a low titer product. Disclosures No relevant conflicts of interest to declare.

Abstract P033: Alcohol and Incident Heart Failure among the Cohort of Swedish Men

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Kirsten S Dorans ◽  
Elizabeth Mostofsky ◽  
Emily B Levitan ◽  
Niclas Håkansson ◽  
Alicja Wolk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Alcohol Intake ◽  
Missing Values ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Alcoholic Beverages ◽  
History Of ◽  
Incident Heart Failure ◽  
Incident Cases

Background: The relationship between alcohol intake and incident heart failure (HF) is complex. Compared with no alcohol consumption, heavy alcohol intake is associated with higher HF risk whereas light or moderate consumption may be associated with lower risk. Methods: We analyzed 34,581 men 45-79 years old with no history of HF, diabetes mellitus or myocardial infarction (MI) who were participants in the population-based Cohort of Swedish Men study. We excluded former drinkers. At baseline, participants reported how frequently they consumed specific alcoholic beverages in the past year and other characteristics. HF was defined as hospitalization for or death from HF (primary diagnosis), ascertained by Swedish inpatient and cause-of-death records from January 1, 1998 to December 31, 2011. Due to missing values for two covariates, we used Markov chain Monte Carlo multiple imputation to simulate 5 complete datasets. We used Cox proportional hazards models to estimate rate ratios and 95% confidence intervals, adjusting for age, total energy intake, education, body mass index, physical activity, a dietary component score, cigarette smoking, marital status, family history of MI before age 60, history of hypertension and history of high cholesterol. Results: At baseline, mean age was 58.6 years. There were 1592 incident cases of HF over the follow-up period. Compared with never drinkers, the multivariable-adjusted rate of HF was 19% lower among men who drank <1 drink per week (rate ratio: 0.81, 95% confidence interval: 0.64, 1.04%). The multivariable-adjusted HF rate was similar among men who drank <1 drink per week and men who drank ≥1 drink per week. Conclusions: Light-to-moderate drinking is associated with lower rate of HF compared with never drinking, but the association was not statistically significant.

Screening for Psychosocial Distress in Patients with Hematological Malignancies and Identifying Specific Factors That Cause Distress throughout Stage of Disease

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2086-2086 ◽  
Author(s):  
Craig E. Cole ◽  
Alyson R Haugen ◽  
Michelle A Mathiason ◽  
Vicki L McHugh
Keyword(s):  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Hematologic Malignancies ◽  
Psychosocial Distress ◽  
Disease State ◽  
Anxiety And Depression ◽  
History Of ◽  
Specific Factors ◽  
The Mean ◽  
Anxiety Depression

Abstract Abstract 2086 Background: Studies incorporating measurement tools for emotional distress into clinical care for hematology patients are rare. We previously reported that distress levels of >5 on the National Comprehensive Cancer Network (NCCN) distress thermometer (DT) were significantly more likely to occur in patients who were seen within the first 30 day of presentation, women, younger patients, those with previous depression/anxiety, and those who are unmarried. However, the diagnosis of malignant or non-malignant hematologic disorder was not associated with DT levels >5. Since this report, the DT indicator of distress was adjusted to ≥4. AIM: To assess and measure psychosocial distress in adult patients with hematological malignancies pertaining to Hodgkin's Lymphoma (HL), Non-Hodgkin's Lymphoma (NHL), Multiple Myeloma (MM), and Chronic Lymphocytic Leukemia (CLL) at a multidisciplinary community-based hematology/oncology clinic, and identify the specific factors of these subjects associated with the most distress. Methods: Consecutive adult subjects with HL, NHL, MM, and CLL (n=302) seen at the Gundersen Lutheran Center for Cancer and Blood Disorders were approached over a period from September 2010 to March 2011. Study subjects consented to a one-time assessment of two prospective surveys that included the DT (scale of 0–10) and the Hospital Anxiety and Depression Scale (HADS), which indicates the specific factors that cause distress in daily life. Subjects were excluded for incomplete surveys. The Charlson Comorbidity Index (CCI) was utilized to assess comorbid conditions at the time of consent and is predictive of mortality within one year. Additional medical information including history of anxiety/depression, as well as disease related information and disease state (diagnosed, observation, remission, treatment) were collected by chart review. A score ≥4 was used an indicator of distress for the DT, and a score of ≥8 was used as a positive indicator of anxiety/depression for the HADS. All prospective surveys were completed prior to the subject's clinic appointment. Results: A total of 190 subjects (63%) consented and completed both the DT and HADS (mean age 65.8±13.4 yrs; 62% men). Subjects were grouped into hematological malignancy cohorts, with 31% having NHL, 25% CLL, 11% HL and MM 20%. The mean DT score was 2.8±2.5 and the mean CCI was 4.5±1.4, with 34% of subjects rating distress ≥4 and 31% of subjects having a positive HADS result. No differences between hematological malignancy cohorts were found for subjects with a history of anxiety/depression (p=0.079), DT ≥4 (p=0.468) or positive HADS results (p=0.079); however, the percentage of subjects with a positive HADS result trended higher in HL subjects (52%). When stratified by DT score (≥4 vs. 0–3), no differences were found for hematological malignancy cohorts, disease state, sex, age, marital status or CCI. However, a positive HADS result was associated with a DT score ≥4 (p=0.001), thereby validating DT as a screening tool for anxiety/depression. Women were more likely to have a history of depression (p=0.008), but a history of anxiety/depression or medication usage was strongly associated with a DT score ≥4 (p=0.001) for the entire population. Conclusion: In subjects with common hematologic malignancies, a history of anxiety/depression was a very strong indicator of distress. Degree of comorbid illness, disease status and type of hematologic malignancy were not associated with distress. Based on these results, patients with hematologic malignancies who have a DT score ≥4 and/or a positive HADS result should be considered for aggressive management of prior anxiety and depression to ensure treatment that encompasses patient-centered care. Disclosures: No relevant conflicts of interest to declare.

Safety and Efficacy of Fecal Microbiota Transplantation for Recurrent Clostridium Infection in Patients with Hematologic Malignancies

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3599-3599
Author(s):  
Mehrdad Hefazi ◽  
Mrinal M Patnaik ◽  
William J Hogan ◽  
Mark R Litzow ◽  
Darrell S Pardi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Broad Spectrum ◽  
Hematological Malignancies ◽  
Conflicts Of Interest ◽  
Fecal Microbiota Transplantation ◽  
Hematologic Malignancies ◽  
Fecal Microbiota ◽  
High Risk Population ◽  
Safety And Efficacy ◽  
Increased Risk

Abstract Background: Patients with hematological malignancies are at an increased risk for developing both primary and recurrent Clostridium difficile Infection (RCDI) along with complications such as toxic mega colon and treatment failure likely due to underlying immunosuppression and frequent use of broad spectrum antibiotics that lead to altered gut microbiome. Fecal Microbiota Transplantation (FMT) is an effective treatment for RCDI (Brandt et. al; 2012). However, experience in patients with hematologic malignancies is sparse and most clinical trials exclude these patients due to potential complications. We report the largest case series to date from a single institution evaluating the safety and efficacy of FMT for RCDI in patients with hematologic malignancies. Methods: After IRB approval, a database of 452 RCDI patients treated with FMT between August 2012 and June 2016 was reviewed to identify those with an underlying hematologic malignancy. Data regarding demographics, hematologic disease, C. difficile history, treatments, and outcomes were retrospectively abstracted from the electronic medical record. Results: Sixteen patients (median age 74 years; male 50%) with known hematologic malignancies underwent FMT during the study period. The underlying diagnoses are outlined in Table 1. Five patients had received hematopoietic cell transplantation (3 allogeneic and 2 autologous) prior to FMT. Patients had a median of 4.5 (range 2-9) CDI episodes before FMT, and 4 of them had severe/severe-complicated CDI at some stage. Prior treatments included a median of 3 (range 1-5) standard vancomycin/metronidazole courses, median of 2 (range 0-4) vancomycin taper courses, fidaxomicin in 3 patients, and chronic vancomycin suppression in one patient. Diarrheal symptoms were in remission in all but 3 patients in the week before FMT. FMT was performed via colonoscopy in all patients. At the time of FMT, hematologic malignancies were in complete remission in 9 patients, stable on active treatment in 4, stable off treatment in 2, and relapsed awaiting treatment in 1 patient. Median time from last anti-neoplastic treatment (n = 14) and from last neutropenia (n = 8) to FMT were 10 (range 0-301) and 9.5 (0-68) months, respectively. One patient with hairy cell leukemia was still neutropenic and on prophylactic oral trimethoprim/sulfamethoxazole at the time of FMT. Five patients were on active immunosuppressive medications, including prednisone (n = 2), methotrexate (n = 2), sirolimus (n =1), and cyclosporine (n =1) for related comorbidities at the time of FMT (Table 2). At last follow up (median 12, range 0-32 months), 6 patients had active/relapsed hematological disease, 6 had received additional antineoplastic treatments, and 7 had received additional antibiotics. RCDI developed in two (12%) patients at 8 and 22 months post FMT secondary to exposure to broad spectrum antimicrobials. These patients were successfully treated with a second FMT and with metronidazole, respectively. Severe adverse events included death in one patient that occurred 3 days post FMT due to unexpected cardiac arrest and was deemed unrelated to the procedure. Another patient developed community-acquired pneumonia 15 days post FMT and was treated successfully with oral azithromycin. Minor adverse events within the first two weeks post FMT were noted in 6 (38%) patients (self-limited diarrhea in 3, fecal urgency in 2, abdominal cramps in 2, and constipation in one patient) (Table 3). Only one patient had persistent diarrhea shortly after FMT, with the cause attributed to underlying Crohn's disease. No complications related to the colonoscopy procedure were noted. Conclusion: FMT appears to be a safe and effective therapeutic option for RCDI in patients with hematological malignancies. Considering very few adverse events and particularly no infectious complications in our series, we conclude that immunosuppression should not preclude the use of FMT for treatment of RCDI in this high risk population. These results need prospective validation. Disclosures No relevant conflicts of interest to declare.

Influenza Vaccination in Patients with Hematologic Malignancies: Analysis of Practices in 200 Patients in a Single Center

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4693-4693
Author(s):  
Florence Lachenal ◽  
Catherine Sebban ◽  
Mickael Duruisseaux ◽  
Irène Philip ◽  
Pierre Biron ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Cell Lymphoma ◽  
Hematologic Malignancy ◽  
B Cell Lymphoma ◽  
Hematologic Malignancies ◽  
Epidemic Season ◽  
Lymphoid Malignancies ◽  
Mantle Cell ◽  
History Of ◽  
Tract Infections

Abstract Vaccination against influenza in patients with hematologic malignancies has long been a matter of clinical uncertainty. Recent studies demonstrated the immunogenicity and the tolerance of the vaccine in this population and the absence of exacerbation of the hematologic disease after vaccination. However practices are still heterogeneous and there are no established routines in France regarding the influenza vaccination of these patients. The aim of this study was to analyse vaccinal practices in a single centre and to determine clinical efficiency of the vaccination. A standardized questionnaire about influenza vaccination was filled out by 200 patients with hematologic malignancies in January, 2008 and the patients were then observed prospectively during the epidemic season to May, 2008. The median age was 58.3 (range 18–87) ; 40% of patients were older than 65 y and could benefit from a free influenza vaccine after information by social security. Most patients suffered from lymphoid malignancies (diffuse large B-cell lymphoma: 30%; follicular, marginal, lymphoplasmacytic or mantle cell lymphoma: 31.5%; multiple myeloma: 13.5%; Hodgkin’s disease:13%). The treatment was ongoing in 53.5% of cases, using aplasia-inducing chemotherapy regimens in 27.5%, rituximab in 27.5% and/or steroids in 33.5%. One quarter of patients disclosed one or several comorbidities and 14.5% had a a past medical history of autologous stem cell transplantation. Lymphopenia was present in 34.9% of cases and hypogammaglobulinemia in 21.7%. Global vaccinal rate was 25.5%; it was 16.6% among patients younger than 65 y and 38.75% among those older than 65 y. The most frequent reasons for not being vaccinated were: the vaccination was not suggested to the patients (53.7%), vaccination was contraindicated by doctors (24.2%), the patient refused the vaccine (21.5%). The main reasons for physicians for contraindicating the vaccine were: hematologic malignancy could be worsened by vaccination (33.3%), the vaccination could generate illness or asthenia (27.8%), the vaccination could not be efficient under chemotherapy (16.7%), unknown (22.2%). Half of patients who refused the vaccine were afraid of having fever; 15.5% refused because they thought that the vaccine was uselessness. Thirteen patients (6.7%) developed influenza during follow-up and 38 (19.5%) presented a significant pulmonary infection. We did not establish a significant link between the vaccination and a protection against influenza, even in specific subgroups of patients, nor between vaccination and prevention of lower respiratory tract infections. Additionnal prospective studies are thus requested. In conclusion our study revealed that the vaccination coverage could be improved in patients with hematologic malignancies. Even if we failed to demonstrate the clinical usefullness of influenza vaccination, we believe that a better knowledge by physicians of studies demonstrating its tolerance and efficiency in this population could enhance the rate of vaccination.

Management Of PICC-Associated Thrombosis In Patients Receiving Chemotherapy For Hematologic Malignancies

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5000-5000
Author(s):  
Meera Sridharan ◽  
Aref Al-Kali ◽  
Aneel A. Ashrani ◽  
Kebede Begna ◽  
Michelle Elliott ◽  
...  
Keyword(s):  
Platelet Count ◽  
Conflicts Of Interest ◽  
Hematologic Malignancy ◽  
Superior Vena ◽  
Vena Cava ◽  
Hematologic Malignancies ◽  
Limited Information ◽  
Jugular Veins ◽  
Increased Risk

Abstract Background Tunneled central venous catheters have traditionally been used for administration of chemotherapy (chemo) for acute leukemia treatment. Peripherally inserted central catheters (PICC) are increasingly being used, but there is an increased risk of PICC-associated thrombosis (PAT). There is limited information on management of PAT in this subgroup of patients (pt). Methods In this retrospective cohort study we investigated the primary management of PICC related upper extremity venous thrombosis (TB) in pt with hematologic malignancy undergoing chemo at Mayo Clinic Rochester.  Eligible pt were 18 years and older, had documentation of PICC placement at our institution, initiation of chemo within a week of PICC placement, and the TB was objectively documented by compression venous ultrasound (CVU).   Superficial venous TB (SVT) was defined as TB of subcutaneous veins (basilic and cephalic) and deep venous TB (DVT) defined as TB of brachial, axillary, subclavian, or innominate superior vena cava and internal jugular veins. We retrospectively stratified initial management (IM) into 1) PICC removal alone (PR), 2) PR and therapeutic anticoagulation (AC), 3) AC alone, and 4) conservative management (CM) consisting of symptomatic care and observation.  We also investigated factors influencing IM of PAT.  Long term outcomes including incidence of pulmonary embolism (PE), post phlebitic syndrome and recurrence of TB were noted. Results Between 2006 and 2012, 190 pt with AML (n=160), MDS or MDS/MF (n=10), or ALL (n=20) met our study criteria.  Overall, 40/190 (21.6%) developed PAT: AML n=38, ALL n=1, MDS/MF n=1. SVT occurred in 16/40 (40%) pt and DVT occurred in 24/40 (60%) pt. IM is shown in Table 1. One pt with SVT received AC for 6 weeks as well as PR.  In this pt, IM included AC because of proximity of TB to deep veins. 7 pt had a follow up (f/u) CVU within 3 months demonstrating: TB progression (prog, n=1, IM with PR alone but with prog AC was started); TB stability (stab, n=2, both IM with PR alone) and TB resolution/improvement (R/I, n= 4, 2 IM with PR and 2 IM with CM)  In the 5 pt with CM, 2 pt had f/u CVU demonstrating improvement, one pt had charted clinical improvement , and 2 pt had no charted clinical f/u. Of DVT pt on AC (n=14), 5 pt completed at least 2 months of AC.  Reasons for early cessation (n=9) of AC included thrombocytopenia (tcp, n=4), hematoma (n=1), hematuria (n=1), subarachnoid hemorrhage (n=1), and unknown (n=1).   One pt died 2 days after presence of DVT was noted. Two pt initially treated with PR alone developed a second TB with placement of a new PICC on contralateral arm and AC was subsequently initiated (duration: 3 months (n=1), and 8 days (n=1)). 14 pt with DVT had f/u CVU within 3 months which demonstrated prog (n=2), stab (n= 8), or R/I ( n=4) of TB (Table 2). The 2 pt with TB prog subsequently received longer term AC guided by platelet count.   In 5 pt with PICC not initially removed, 3 pt had PR after completion of chemo. (1-4 days), one pt had PR at discharge (27 days from TB), and one pt had PICC in place on discharge. One pt with DVT experienced a PE within one year f/u.  This pt had initially completed 3 days of AC which was stopped because of tcp. Conclusion In this cohort of patients with PAT, the most common IM consisted of PR, which appeared to result in a low recurrence rate among pt with SVT.  In pt with DVT, the role of AC remains to be defined given the abbreviated course of AC in most pt.  Though, the lack of CVU followup in all pt limits conclusions, there appeared to be a low rate of symptomatic prog.  Initiation of AC was largely guided by platelet count and degree of occlusive symptoms. Thrombocytopenia was also the most commonly cited reason for discontinuing AC.  Close clinical follow up aided by the use of CVU was integral to ensure that PAT did not lead to further adverse events. Disclosures: No relevant conflicts of interest to declare.

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