Kathrin Strasser-Weippl

Psychosocial QOL is an independent predictor of overall survival in newly diagnosed patients with multiple myeloma

Only few studies have analyzed quality of life (QOL) and its association with prognosis in patients with multiple myeloma. We studied QOL at start of conventional treatment to evaluate the impact of symptomatic myeloma on QOL and to determine the prognostic significance of various dimensions of QOL. Our study provided further evidence of the significant impairment of QOL in patients with multiple myeloma at onset of therapy. Furthermore, our data showed a closer correlation between the more physical QOL scales such as pain, fatigue, physical functioning and global QOL with the activity of the disease than between psychosocial dimensions such as role, emotional, social, and cognitive functioning and the status of the disease. Multivariate analyses including each a QOL scale and known prognostic parameters (response to therapy, creatinine level, calcium, LDH, Hb, β2‐microglobulin, and albumin) revealed a marked difference in the prognostic significance between psychosocial and other QOL scales. All psychosocial dimensions of QOL were found to be independent prognostic factors, while physical QOL and global QOL were eliminated by disease‐associated prognosticators. Taken together, QOL was found to be significantly impaired in myeloma patients at start of therapy. Psychosocial, but not physical dimensions of QOL were found to be independent prognostic factors.

Age and hemoglobin level emerge as most important clinical prognostic parameters in patients with osteomyelofibrosis: introduction of a simplified prognostic score

The course of disease in patients with myelofibrosis is highly variable, with survival ranging from few months to many years. Several prognostic models have been established, with the LILLE score now most commonly used. However, in recent series, the latter scoring system repeatedly failed to discriminate patients with intermediate and poor prognosis. In the present study, we re-evaluated previous prognostic models in a separate patient population. We have studied 107 patients with myelofibrosis and correlated clinical parameters at the time of diagnosis with survival. Previous scoring systems were applied to allocate patients to subgroups with distinct prognosis. Most previous scoring systems failed to clearly discriminate an intermediate and poor prognostic group. By contrast, age and hemoglobin level emerged as most significant parameters in multivariate analysis. By allocating one risk point each for hemoglobin < 10 g/dl and age >60 years, three subgroups of patients with distinct prognosis could be identified in our cohort. The overall model and the difference between each of the subgroups were statistically significant in a training group, a test group, the overall cohort of patients and the group of patients with chronic idiopathic myelofibrosis. In summary, we propose an alternative prognostic model for patients with myelofibrosis that reliably identifies three groups of patients with highly different outcome. This is in contrast to previous prognostic scores, in which the poor prognosis group was often very small and/or could not be consistently differentiated from patients with an intermediate prognosis.

Prognostic relevance of cytogenetics determined by fluorescent in situ hybridization in patients having myelofibrosis with myeloid metaplasia

In chronic myelofibrosis (MF), distinct recurrent cytogenetic aberrations have been identified but their true prognostic relevance remains uncertain. In this disease, cytogenetic studies as assessed by conventional metaphase karyotyping are limited due to the inherent difficulties in obtaining adequate bone marrow aspirates and the low proliferative capacity of the clonal cells. Interphase fluorescent in situ hybridization (FISH) can partly overcome these limitations and increase the sensitivity of cytogenetic assessment in MF.

Ferritin as prognostic marker in multiple myeloma patients undergoing autologous transplantation.

Abstract Serum ferritin reflects body iron stores, but this correlation is dissociated in inflammation. Ferritin has been shown to be prognostically relevant in breast cancer and in patients with hematologic malignancies undergoing autologous or allogeneic stem cell transplantation. In the present study, we evaluated the prognostic relevance of pretransplant ferritin levels in 137 patients with myeloma (median age: 56 years) subjected to autologous stem cell transplantation in our institution between 1994 and 2010. After completion of induction therapy, a minority of patients had increased β2-microglobulin (β2M) (> 3.5 mg/L: 30.6%) or low albumin (≤ 3.5 g/dL: 6.8%). Median overall survival from transplantation was 83.9 months. Pretransplant ferritin level was an independent prognostic marker in multivariate analyses (including age and ferritin levels albumin) for progression-free and overall survival and retained prognostic significance in a stepwise backward regression. Iron-independent effects of ferritin in myeloma should be prospectively investigated in preclinical and clinical studies.

New chemotherapies in breast cancer

SummaryIn the era of targeted therapies and immunotherapy for cancer, the focus in breast cancer (BC) research has shifted away from classical chemotherapy. Many BC patients, however, still need chemotherapy and thus benefit from the development of new chemotherapeutic agents or regimens. In the past decade, the approval of eribulin and trastuzumab emtansine (T-DM1) have been important advances in this regard. Improved ways of delivery of paclitaxel, anthracyclines, and vinorelbine have also had axa0considerable clinical impact. Finally, optimizing the use of well-known drugs, such as carboplatin, capecitabine, or adjuvant chemoimmunotherapy in low-risk early BC, has brought about progress in the field of chemo(immuno)therapy.

A Survey among Oncologists on Measures Needed to Improve Cancer Care

There is a continuous need for optimizing cancer care in Europe and globally. We aimed to apprehend the perception of (mainly medical) oncologists with regards to the importance of measures intended to improve the standard of cancer care. Methods: Oncologists attending the 29th ESMO (European Society of Medical Oncology) congress were invited to respond to a rated (1-5) questionnaire addressing the following issues: research; medical training and education; funding; supportive therapy; interdisciplinary cooperation; structure of care; patient information and empowerment. Results: 327 oncologists (median age: 43 years (23-80), 63.6% males) from 55 countries (77.7% European) responded. Academic research was considered the most important issue, followed by medical training and education, and interdisciplinary cooperation. Low ratings were given to the type of medical background of the caregiver and to the preferred treatment setting. The most highly rated single measures (on a scale of 0-100) were: more funding for clinical research by governments (100); more research by academic institutions (98.97); and better international cooperation in clinical studies (98.58). On the lowest end of priorities were: inclusion of alternative medicine into treatment plans (0); and cancer treatment provided by disease specialists only (15.14). Conclusion: Oncologists consider increased academic research and enhanced international cooperation as the most important prerequisites to cancer care improvement.

Local therapy of stage IV renal cell cancer: a case report

SummaryThis mini-review and case report demonstrates how systemic and local treatments work synergistically for patients with metastatic renal cell carcinoma (mRCC). Although new targeted and immunotherapies have revolutionized the treatment armamentarium of mRCC and dramatically improved patients’ prognosis, local treatment remains an important part of therapy. Here, we report on a patient who benefitted enormously from the combination and interaction of both therapeutic approaches, and we summarize the literature and guidelines that supported our treatment decisions in this case.

Breast cancer milestones 2007–2016

SummaryOver the past 10xa0years, enormous progress has been made in breast cancer (BC) treatment, leading to axa0substantial decline in BC mortality in Western countries. Although the following short review is necessarily incomplete, the discussion will highlight major achievements in the field.

Treatment of elderly patients with advanced urological cancer

The treatment of advanced urological cancers has evolved tremendously over the last decade. As the incidence of these cancers is increasing with age, uro-oncologists are increasingly faced with the challenge of choosing optimal therapeutic strategies for elderly patients. Comorbidities interfering with cancer treatment can be identified by geriatric assessment tools that should be applied in elderly cancer patients before starting therapy. Using these tools competing risks of morbidity and mortality can be evaluated. We provide a review on evidence based treatments in elderly prostate, bladder and renal cell carcinoma patients.

Treatment outcome in AML: a single-centre experience in an unselected patient cohort

PurposeData on prognostic factors and treatment outcomes in patients with acute myeloid leukemia (AML) are usually based on highly selected patient groups. We analysed a cohort of unselected consecutive patients with AML diagnosed more than 10 years at a single institution.Patients and methodsTreatment outcome and prognostic factors were retrospectively analysed in 147 AML patients. Treatment was selected according to study protocols of the OSHO (East German Study Group for Hematology and Oncology) if patients were eligible.ResultsMedian age at diagnosis was 68 years. Eighty-eight (59.9xa0%) patients were treated with curative intent, palliative treatment was given to 27.2xa0%, and supportive therapy only to 12.9xa0% of patients. Of patients aged £u200960 years, 97.7xa0% were treated with curative intent, versus only 43.7xa0% of those aged >u200960 years. Curative treatment resulted in complete remission in 70xa0%, a median survival of 15.3 months, a significantly decreased early death rate (35 versus 68.4xa0%,Pu2009<u20091u2009´u200910−8), and significantly prolonged survival compared to all other patients. This was also true for the sub-group of patients aged >u200960 years. In multivariate analysis, age >u200960 years, high cytogenetic risk, thrombocytopenia, leukocytosis and non-curative treatment intent emerged as risk factors for poor survival.ConclusionOutcome and prognostic parameters in unselected consecutive patients with AML treated in a single institution were found to be similar to those obtained in larger more selected patient cohorts. Our results confirmed that elderly patients should be treated with intensive treatment whenever possible to improve early death rate and overall survival.