Little is known about the patterns and predictors of the use of end-of-life health care among patients with acute myeloid leukemia (AML) | Journal of Clinical Oncology
End-of-life care is particularly relevant for older adults with AML because of their poor prognosis.
We performed a population-based, retrospective cohort study of patients with AML who were ≥ 66 years of age at diagnosis and diagnosed during the period from 1999 to 2011 and died before December 31, 2012. Medicare claims were used to assess patterns of hospice care and use of aggressive treatment. Predictors of these end points were evaluated using multivariable logistic regression analyses.
In the overall cohort (N = 13,156), hospice care after AML diagnosis increased from 31.3% in 1999 to 56.4% in 2012, but the increase was primarily driven by late hospice enrollment that occurred in the last 7 days of life. Among the 5,847 patients who enrolled in hospice, 47.4% and 28.8% started their first hospice enrollment in the last 7 and 3 days of life, respectively. Among patients who transferred in and out of hospice care, 62% received transfusions outside hospice. Additionally, the use of chemotherapy within the last 14 days of life increased from 7.7% in 1999 to 18.8% in 2012. Patients who were male and nonwhite were less likely to enroll in hospice and more likely to receive chemotherapy or be admitted to intensive care units at the end of life. Conversely, older patients were less likely to receive chemotherapy or have intensive care unit admission at the end of life, and were more likely to enroll in hospice.
End-of-life care for older patients with AML is suboptimal. Additional research is warranted to identify reasons for their low use of hospice services and strategies to enhance end-of-life care for these patients.
In a project funded by Bloodwise and the Scottish Cancer Foundation, we have created LEUKomics. This online data portal brings together a wealth of CML gene expression data from specialised laboratories across the globe | Lorna Jackson & Lisa Hopcroft for The Conversation
Our intention is to eliminate the bottleneck surrounding big data analysis in CML. Each dataset is subjected to manual quality checks, and all the necessary computational processing to extract information on gene expression. This enables immediate access to and interpretation of data that previously would not have been easily accessible to academics or clinicians without training in specialised computational approaches.
Consolidating these data into a single resource also allows large-scale, computationally-intensive research efforts by bioinformaticians (specialists in the analysis of big data in biology). From a computational perspective, the fact that CML is caused by a single mutation makes it an attractive disease model for cancer stem cells. However, existing datasets tend to have small sample numbers, which can limit their potential.
Medical University of Vienna. ScienceDaily, 15 March 2016.
Image shows photomicrograph of bone marrow acid phosphatase in acute T-cell lymphocytic leukaemia
Studies conducted at the Comprehensive Cancer Center at MedUni Vienna and Vienna General Hospital show that the drugs ibrutinib and idelalisib used in the targeted treatment of chronic lymphatic leukemia can significantly prolong the survival time of high-risk patients. The average survival time of these patients is between one and two years when they receive standard treatment, whereas 80% of patients receiving the new treatment were still alive after two years. These results give us reason to hope that, in future, these two drugs could not only replace chemotherapy but even stem cell transplantation.
Both drugs are so-called “small molecules” and belong to the class of substances known as kinase inhibitors. They are used in targeted cancer treatment, where they interrupt the signalling pathways of the cancer cells. Both substances inhibit cell growth and idelalisib additionally affects the cells’ ability to metastasize. Over the course of the last two years, they have been separately tested in studies at MedUni Vienna and are now routinely available to patients.
Greaves, M. Nature Reviews Cancer. 16, 163–172 (2016)
Our understanding of cancer biology has been radically transformed over recent years with a more realistic grasp of its multilayered cellular and genetic complexity. These advances are being translated into more selective and effective treatment of cancers and, although there are still considerable challenges, particularly with drug resistance and metastatic disease, many patients with otherwise lethal malignancies now enjoy protracted remissions or cure.
One largely unheralded theme of this story is the extent to which new biological insights and novel clinical applications have their origins with leukaemia and related blood cell cancers, including lymphoma. In this Timeline article, I review the remarkable and ground-breaking role that studies in leukaemia have had at the forefront of this progress.
Researchers detail in a new article how they have been able to fingerprint myelodysplastic syndromes, a state for blood cells that turns into acute myeloid leukemia cancer in approximately 30 percent of patients.
In the paper published by the scientific journal Cancer Cell, the researchers detail how they have been able to fingerprint myelodysplastic syndromes (MDS), a state for blood cells that turns into acute myeloid leukemia (AML) cancer in approximately 30% of patients. The study demonstrates that early and accurate prediction of this aggressive cancer is possible.
AML is the most common type of leukemia in adults, and about 1,300 Canadians are expected to develop the disease each year.
Bhatia’s research team found when they deleted one version of the important GSK-3 gene, the other version of the gene became active but remained non-cancerous. However, when the second version of the gene was also deleted, AML cancer began.
To test this, Bhatia’s team collaborated with Italian researchers at the University of Bologna to apply these initial findings to human blood samples that had been previously collected from patients with MDS, some of whom eventually developed AML. McMaster researchers did a retroactive study, and demonstrated that gene expression analysis of patient blood samples was accurate in predicting which patients would develop AML and which would not.
Burger, J. et al. New England Journal of Medicine, 2015.
A multi-center, international, randomized, Phase III study of older untreated patients with chronic lymphocytic leukemia (CLL) demonstrated that ibrutinib, a kinase inhibitor, is significantly more effective than traditional chemotherapy with chlorambucil.
The study, which followed 269 patients, revealed a 24-month overall survival rate of 97.8 percent for patients taking ibrutinib versus 85.3 percent for those on chlorambucil. Minor adverse effects were reported.
Original article: S. N. Furlan et al. Transcriptome analysis of GVHD reveals aurora kinase A as a targetable pathway for disease prevention. Science TranslationalMedicine, 2015; 7 (315): 315ra191 DOI: 10.1126/scitranslmed.aad3231#
A Seattle Children’s Research Institute lab has discovered a genetic pathway that can be targeted with existing drugs to prevent graft-versus-host disease (GVHD), a common and deadly complication of bone marrow transplants. The results of their work were published in the journal Science Translational Medicine.
In patients with GVHD, newly transplanted T cells from the bone marrow graft attack the transplant recipient’s body. Over 10,000 people in the United States receive bone marrow transplants each year for leukemia, other non-malignant blood conditions and autoimmune diseases. About 50-70 percent of bone marrow transplant patients will acquire GVHD. Of those who develop the most severe form, up to half will die.