Romy Jose Thekkekara

Tumor Lysis Syndrome in Multiple Myeloma: An Increasingly Recognized Risk—A Report of Seven Cases

Abstract Tumor lysis syndrome is a constellation of metabolic disturbances commonly seen during therapy of bulky, rapidly proliferative tumors. Multiple myeloma is a low proliferation tumor with rare incidence of tumor lysis syndrome in the pre-Bortezomib era. Post Bortezomib use, a rise in the incidence of tumor lysis has been noted. We present seven cases of tumor lysis syndrome with three patients in spontaneous tumor lysis and four developing the same after chemotherapy. In the previous studies, elevated LDH and deletion of chromosome 13 has been associated with risk of TLS. In our study, we noted several abnormal karyotpes including del 9p13, del 17 and monosomy 13 were more frequently found but larger studies are needed to explore the causative nature of these associations. Prognosis in these patients is relatively poor reflecting the higher tumor burden. However, further studies are needed to learn about other poor prognostic markers.

Depression and smoking patterns among head and neck cancer patients in an inner city minority population.

184 Background: Continued smoking among head and neck cancer patients(HNCP) is associated with poor prognosis. These patients (pts) experience highest rates of depressive symptoms of all oncology patients. Smoking and depression are among factors that influence long term quality of life in these pts. METHODS HNCP were evaluated for patterns of smoking and depression at our Hospital. Survey using a standardized questionnaire about smoking patterns and depression using PHQ9 was employed. Pts were stratified as nonsmokers, ex-smokers (quit > 6 mo), recent smokers ( < 6 mo), and current smokers ( < 7 days). EMR was reviewed for sociodemographic variables, stage (stg), diagnosis (Dx) date, treatment(Rx) modality. The cohort was followed till 7/31/2015 to assess disease recurrence and survival. RESULTS 39 pts were interviewed. Mean age at Dx was 56 +/-7 yrs. 82% were men. 46% were African American, 36% Caucasians(cau) and 8% Hispanics. 74% had stg IV disease at Dx. 76.9% were recent/current smokers at Dx. At 280 days from Dx, 41% continued smoking; decrease in smoking was statistically significant (p value: .000). 52% of smokers with stg III/IV cancer quit smoking while pts with stg I/II continued to smoke. Continued smoking was higher in Cau (p = 0.038). Mild to severe depression was seen in 56% of pts. Higher rates of depression were noted among smokers (62%) with stage III/IV disease; though it was not statistically significant. Complete response to Rx was seen in 82% and recurrence in 20.5%. No difference in outcomes based on smoking patterns was noted. CONCLUSIONS Although smoking rates at Dx were comparable to literature, our pts had higher rates of continued smoking and depression. Dx and stg appear to be important factors in smoking cessation. SSRIs have been prophylactically used to reduce rates of depression in these pts. Studies are needed to determine if they can be used with the same success in minority population. Larger studies are also needed to assess the role of smoking cessation as a strategy to prevent depression among minority population.