Incidence of Typical Neutrophil Count With Fy(a-b-) Status Among Hematology Referrals for Neutropenia at an Urban Safety-Net Hospital

Incidence of Typical Neutrophil Count with Fy(a-b-) Status Among Hematology Referrals for Neutropenia at an Urban Safety-Net Hospital

Peripheral blood count abnormalities among patients with hepatitis C in the United States

Abstract End-of-life care (EoL) in patients with advanced cancer is uniquely challenging in an urban safety net hospital. Low socioeconomic status, poor health literacy and non-congruent language barriers are only a few of the possible challenges that patients can encounter. The purpose of this study was to understand patterns of EoL care for patients with advanced cancer treated at a racially diverse, urban academic safety net hospital. Experimental Procedures We performed a retrospective analysis of 308 adult patients with advanced cancer who died between 2012 and 2015. A standardized chart abstraction tool included sociodemographic, clincopathologic and health services variables. We defined under-utilization of EoL care as no enrollment in hospice or enrollment for three days or less. Aggressive EoL care was defined as 1) receipt of chemotherapy in the last 14 days of life, 2) admission to the intensive care unit in the last 30 days of life, 3) more than one admission (to the hospital or emergency department) in the last 30 days of life, or 4) dying in an acute care setting. Summary of Data Among 308 abstracted records, 54% were racial minorities, 63% were not born in the United States, 72% had public health insurance. In all, 48% of cases demonstrated under-utilization of EoL care, and 45% demonstrated aggressive EoL care. A multivariate analysis demonstrated that, after adjusting for other factors, every month of increased survival was associated with a 3% decreased risk of aggressive EoL care and of under-utilization of hospice. We also demonstrate that having a documented healthcare proxy and older age was also associated with utilization of EoL care. Conclusions In conclusion, appropriate EoL care is critical for all advanced cancer patients and can be improved for patients seeking care at safety net hospitals. Our study demonstrates that advanced age, having a healthcare proxy, and longer survival from a cancer diagnosis was associated with improved EoL care. These findings can help to inform targeted interventions to improve EoL care for diverse populations. Citation Format: Vina P Nguyen, Kate Festa, Minda Gowarty, Shabatun Islam, Gregory J Patts, Naomi Y Ko. End-of-life care in patients with advanced cancer in an urban safety net hospital [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C004.

14 Background: Stage IV NSCLC is an incurable illness with significant morbidity. Chemotherapy prolongs average survival from 6 to 10 months and targeted therapies further reduce morbidity and prolong survival. These advances pose financial challenges for safety net hospitals, which may also disproportionately feel the impact of racial disparity. Outcomes in advanced lung cancer may thus differ in the underserved population and resources may not be allocated optimally. Methods: A retrospective review was conducted on all patients diagnosed with Stage IV NSCLC between 2005 and 2011 at Boston Medical Center, an urban safety net hospital. Data were collected on survival from time of diagnosis, type and duration of treatment, utilization of healthcare resources, as well as detailed personal characteristics. We calculated costs of treatment for all patients. We assessed the effect of treatment and patient characteristics on survival. Results: Of 198 patients analyzed, 57% were white, 32% were black, 6% were Hispanic. 11% were homeless. 57% did not receive antineoplastic therapy, 24% received cytotoxic chemotherapy, 18% received combined cytotoxic and targeted therapy. Median survival was 5.0 months without therapy, 7.0 months with cytotoxic chemotherapy and 9.2 months with combined therapy. Any therapy was associated with 56% longer survival. Hazard of death in white patients was 0.68 relative to non-white patients. Median total and monthly costs for patients on no therapy were $70,000 and $14,000, on cytotoxic chemotherapy were $112,000 and $19,000 and on combined therapy were $247,000 and $26,000. Cost per month of survival was $12,000 less for white patients and $15,000 more for homeless patients. Conclusions: The majority of patients did not receive antineoplastic therapy, despite robust survival gains associated with its use. Untreated patients nevertheless incurred a high cost of care. White patients showed better survival at a lower cost. Further topics for study and intervention in this population include barriers to therapy, early involvement of palliative and home-based care in patients not suitable for treatment, strategies for cancer care in the homeless, as well as closer inquiry into drivers of racial disparity.

Hypomethylating agents have become the standard therapy for patients with high-risk myelodysplastic syndrome (MDS). In Israel, azacitidine (AZA) is routinely used. Yet, infectious complications are common during AZA therapy. The current study was aimed to evaluate the incidence and predisposing risk factors for infections in AZA-treated patients. This retrospective study included patients treated with AZA in 18 Israeli medical institutions between 2008 and 2011. Data on 184 patients [157 high-risk MDS and 27 acute myeloid leukemia (AML)], with a median age of 71.6 (range 29-92) were recorded. Overall, 153 infectious events were reported during 928 treatment cycles (16.5%) administered to 100 patients. One hundred fourteen, 114/153 (75%) events required hospitalization and 30 (19.6%) were fatal. In a univariate analysis, unfavorable cytogenetics, low neutrophil, hemoglobin (Hb) and platelet (PLT) counts were found to be associated with infections (24.4% vs. 12.9%, P < 0.0001; 27% vs. 13.5%, P < 0.0001; 20.4% vs. 11%, P < 0.0001 and 29.2% vs. 14.2%, P < 0.0001, respectively). In multivariate analysis, only low Hb level, low PLT count, and unfavorable cytogenetics remained significant. Prior to therapy, poor cytogenetics, PLT count below 20 × 10⁹/L and neutrophil count below 0.5 × 10⁹/L were predictive of the risk of infection during the first two cycles of therapy. In conclusion, patients with unfavorable cytogenetics, presenting with low neutrophil and PLT counts, are susceptible to infections. Evaluation of infection risk should be repeated prior to each cycle. Patients with poor cytogenetics in whom AZA is prescribed despite low PLT count are particularly at high risk for infections and infection prophylaxis may be considered.

Previous studies have suggested that healthy subjects of African ancestry have lower total white cell counts, neutrophil counts and platelet counts than Caucasian subjects and that, at least among Caucasians, women have higher neutrophil and platelet counts than men. The primary aim of this study was to confirm and quantify the ethnic differences, confirm the sex difference in Caucasians and determine whether there was a similar sex difference in non-Caucasians. A secondary aim was to establish reference ranges for white cell and platelet counts for the different ethnic and sex groups. The study population comprised 417 healthy volunteers (201 women and 216 men), of whom 200 were Caucasian, 102 were Afrocaribbean and 115 were African. Full blood counts, including a differential white cell count, were measured using a H.2 automated differential counter. White cell and platelet counts were compared between the three different ethnic groups and between men and women. Reference ranges were determined for each ethnic and sex group. Africans and Afrocaribbeans had lower total white cell, neutrophil and platelet counts than Caucasians and counts were lower in Africans than in Afrocaribbeans. Women had higher neutrophil and platelet counts than men in all ethnic groups. Sex and ethnic origin should be taken into consideration when assessing white cell and platelet counts.

Management of sickle cell disease: recent advances and controversies.

Correlation between 'ACKR1/DARC null' polymorphism and benign neutropenia in Yemenite Jews.

Purpose: To analyze the efficacy, safety, and accessibility of netarsudil 0.02% in patients with glaucoma (suspect, open or closed) at a safety-net academic medical center, Boston Medical Center (BMC).Methods: Retrospective chart review of patients prescribed netarsudil 0.02% for uncontrolled glaucoma at BMC between December 2017 and September 2019. Outcome measures included change in intraocular pressure (IOP) from baseline and evaluation of adverse events (AEs).Results: One hundred thirty patients (60% severe stage) were analyzed. The IOP reduction from baseline was about 3 mmHg. Fifty-four patients (42%) experienced an AE (eg, conjunctival hyperemia). Thirty-eight patients (29%) started netarsudil 0.02% in lieu of laser or surgery. Ninety-nine patients (71%) required prior authorization for insurance coverage of netarsudil 0.02%. Ten patients (7%) were unable to obtain netarsudil 0.02% due to issues with insurance coverage.Conclusion: Netarsudil 0.02% yielded significant IOP reduction in our cohort, however, to a smaller degree compared with prior studies that bore equivocal IOP reduction regardless of baseline IOP. Conjunctival hyperemia was the most common AE. In a limited number of patients, netarsudil 0.02% was not covered by insurance.

To examine the rates of and risk factors for neutropenia together with the dynamics of neutrophil and other white cell subset counts in a cohort of patients treated with a tumor necrosis factor (TNF) inhibitor for inflammatory arthritis. We performed a retrospective cohort study examining the association between baseline demographics, clinical features, medications used, and development of neutropenia, and behavior of neutrophil and other white cell subset counts during TNF inhibitor therapy. In 367 patients (298 [81.2%] with rheumatoid arthritis, 38 [10.4%] with ankylosing spondylitis, and 31 [8.4%] with psoriatic arthritis), 69 (18.8%) had at least one episode of neutropenia (<2.0 x 10(9)/liter) during TNF inhibitor therapy, and of these, 6% developed serious infections secondary to neutropenia. There was no significant difference in disease, demographic, or drug variables between patients with and without neutropenia. However, patients with neutropenia had significantly lower baseline neutrophil counts (4.2 x 10(9)/liter; 95% confidence interval [95% CI] 3.8, 4.6 versus 6.2 x 10(9)/liter; 95% CI 6.0, 6.5), and a previous history of neutropenia while receiving disease-modifying antirheumatic drugs increased the risk while receiving TNF inhibitors (hazard ratio 2.97; 95% CI 1.69, 5.25). A significant drop in mean neutrophil count (1.12 x 10(9)/liter; 95% CI 0.92, 1.32) was observed after 2 weeks of TNF inhibitor therapy. Other white cell subsets tended to significantly increase. TNF inhibitor therapy is associated with a significant reduction in peripheral blood neutrophil count, leading to 19% of patients becoming neutropenic. Risk of neutropenia is significantly higher in patients with a low baseline neutrophil count or previous history of neutropenia. We suggest that patients receiving TNF inhibitor therapy would benefit from regular complete blood cell count monitoring.

To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment. This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors. Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant. A majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC. IV Laryngoscope, 134:4003-4010, 2024.

Benign reductions in neutrophil counts may be more common at certain ages and in certain ethnic groups and may be affected by sex and smoking status. To determine differences in neutrophil counts in the U.S. population according to ethnicity, age, sex, and smoking status. Population-based, cross-sectional study. Various locations in the United States. 25,222 participants in the 1999 to 2004 National Health and Nutrition Examination Survey who were 1 year of age or older. Complete blood counts and comparison of means and the proportion of participants with neutropenia. Relative to white participants, black participants had lower leukocyte counts (mean difference, 0.89 x 10(9) cells/L; P < 0.001), lower neutrophil counts (0.83 x 10(9) cells/L; P < 0.001), and similar lymphocyte counts (0.022 x 10(9) cells/L; P = 0.36), whereas Mexican-American participants had slightly higher mean leukocyte counts (0.16 x 10(9) cells/L; P = 0.014), higher neutrophil counts (0.11 x 10(9) cells/L; P = 0.026), and higher lymphocyte counts (0.095 x 10(9) cells/L; P < 0.001). The prevalence of neutropenia (neutrophil count <1.5 x 10(9) cells/L) was 4.5% among black participants, 0.79% among white participants, and 0.38% among Mexican-American participants. The prevalence of neutropenia was higher among males and children younger than 5 years of age. Neutrophil counts less than 1.0 x 10(9) cells/L were observed in fewer than 1% of the overall sample (0.57% in black participants, 0.11% in white participants, and 0.08% in Mexican-American participants). Smoking was associated with higher leukocyte and neutrophil counts but had a smaller effect among black and Mexican-American participants than among white participants. Because estimates are based on single measures, fluctuations over time could not be determined. In the United States, neutrophil counts are lower in black persons than in white persons and neutropenia is more prevalent in black persons. Neutrophil counts are slightly higher in Mexican-American persons than in white persons, and neutropenia is uncommon in both groups. The clinical implications of these findings are unclear, but they suggest that when determining the need for a diagnostic evaluation for neutropenia, clinicians should consider the patient's age, sex, ethnicity, and smoking status.

Background: Racial and ethnic disparity in breast cancer outcomes is a long-standing problem that continues to worsen. Recent evidence has underscored the importance of timely care, as delays in treatment can lead to decreased survival. We sought to understand predictors of delay to first treatment among a racially diverse cancer population. Methods: This is a retrospective study of breast cancer cases diagnosed between the years 2000 to 2014. Data was extracted from the cancer registry at Boston Medical Center (BMC), an urban safety net hospital. Inclusion criteria were any breast cancer diagnosis from 2000-2014, receiving first treatment at BMC, and disease stage 0-III. Cox Proportional Hazards regression analysis was performed to identify predictors of time to first treatment, defined as days from date of diagnosis to date of first treatment with surgery or neo-adjuvant chemotherapy. Covariates included age, sex, race, type of insurance, marital status, US birth, disease stage and year of diagnosis. Results: Patients were 99% female and with a mean age of 58 years (range 23-96). Among a sample of 1545 breast cancer cases, 1372 (89%) had surgery as first treatment and 173 (11%) had neoadjuvant chemotherapy. Median days to treatment was 45 days (IQR 27, 71). In the multi-variable adjusted models for both treatment groups, race, and insurance were significantly associated with delay. In the surgical group, Black race, public or no insurance, non-US born, later stage and unmarried status were associated with increased risk of delay. For example, Blacks were at higher risk for delay (HR= 1.2; 95% CI 1.37-1.04) compared to the Hispanic or White (reference) groups. Public insurance (HR = 1.19; 95%CI 1.37-1.04) and no insurance (HR = 1.43; 95%CI 1.85-1.09) was significantly associated with increased delay when compared to private insurance (reference). In patients with neoadjuvant chemotherapy as first treatment, additional significant predictors of delay were age and year of diagnosis. Conclusion: Race and insurance status were significant predictors of delay to first treatment in a population of diverse breast cancer patients seeking care at a safety net hospital. Intervention efforts need to target patients at greatest risk for treatment delays. Citation Format: Ko NY, Patts G, Battaglia TA, Wang C, Denis GV, Hirsch A, Weinberg J. Socio-demographic predictors for delay of treatment among a racially diverse, urban breast cancer population [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-08.

Background Bronchoalveolar lavage (BAL) is frequently performed to diagnose invasive pulmonary aspergillosis (IPA) in patients (pts) with hematologic malignancies (HM). Given the critical role of the pulmonary immune environment for fungal control, BAL might be leveraged for diagnostic and prognostic immune biomarkers in IPA pts. However, data on the concordance of cell counts in peripheral blood (PB) and BAL fluid (BALF) of IPA pts is lacking.Figure 1.Heatmap summarizing Spearman’s rank correlation coefficients between peripheral blood white blood cell counts and differentials and those from bronchoalveolar lavage fluid at diagnosis of invasive pulmonary aspergillosis. * p&amp;lt;0.05, ** p&amp;lt;0.01, *** p&amp;lt;0.001. Methods We retrospectively reviewed 63 culture-positive proven/probable IPA cases in adult pts who underwent bronchoscopy at MD Anderson Cancer Center in 2011–2022. BALF cell counts, microbiology data, PB white blood cell (WBC) differentials on the day of bronchoscopy, and IPA outcomes were analyzed.Figure 2.Comparison of bronchoalveolar lavage fluid cell composition according to neutropenia status (A) and 42-day outcomes (B) in invasive aspergillosis patients with hematologic malignancies. Mann-Whitney U test. ** p&amp;lt;0.01, *** p&amp;lt;0.001. Results The median BALF WBC count at IPA diagnosis was 129/µL (interquartile range [IQR] 54–272/µL) and median neutrophil percentage was 11% (IQR 2–46%). PB total WBC counts significantly correlated with BALF WBC (r=0.55, p&amp;lt; 0.001), neutrophil (r=0.59, p&amp;lt; 0.001), and lymphocyte (r=0.48, p&amp;lt; 0.001) counts. Likewise, PB WBC differentials, i.e., absolute neutrophil and lymphocyte counts, significantly correlated with those in BALF (Fig. 1). Neutropenic pts (&amp;lt; 500/µL) had lower median BALF WBC (66 vs. 140/µL, p=0.005) and neutrophil counts (1 vs. 41/µL, p&amp;lt; 0.001) than non-neutropenic pts (Fig. 2A). BALF neutrophil counts were significantly higher in pts with bacterial coinfections than in those without coinfection (143 vs. 8/µL, p=0.005), while both neutrophil (37 vs. 5/µL, p=0.005) and lymphocyte (20 vs. 8/µL, p=0.021) counts were higher in pts with respiratory viral coinfection. Notably, cellular composition of BALF was not significantly associated with BALF galactomannan positivity or 42-day mortality after IPA diagnosis (Fig. 2B). Conclusion Unlike the well-known association between PB cytopenias and IPA outcome, severity of IPA was not significantly influenced by quantitative BAL cell composition, underscoring the unmet need for reliable qualitative/functional BAL biomarkers to prognosticate fungal control in HM pts. Both PB cytopenias and coinfections significantly affected immune cell mobilization into BALF. Thus, clinical context will be critical for normalization and validation of BAL-based host biomarkers. Disclosures Sebastian Wurster, MD, MSc, Astellas Pharma: Grant/Research Support|Gilead Sciences: Grant/Research Support Dimitrios P. Kontoyiannis, MD, AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Knight: Advisor/Consultant|Merck: Advisor/Consultant|Scynexis: Advisor/Consultant

Background: Racial disparities persist in the incidence and mortality of colorectal cancer despite the availability of screening tools. Adenoma detection rates have been associated with diabetes in some studies. This study seeks to evaluate the effect of diabetes mellitus on adenoma detection rates (ADR) in initial screening colonoscopies performed at three distinct institutions. Methods: A retrospective chart review was performed on all initial average risk screening colonoscopies performed on patients between 45-75 years at an Urban Safety Net Hospital (USNH), an Urban University Hospital (UUH) and a Suburban University Hospital (SUH) from January 1st to December 30th 2012 to coordinate existing databases at the three institutions. Patients were excluded if they had a history of colon cancer, polyps, alarm symptoms, or if the current colonoscopy was incomplete or had poor bowel prep. Data points collected included sex, age, race, insurance, BMI, smoking status, diabetic status and attending provider. Univariate analysis was performed comparing ADRs between the three institutions using Graph Pad Prism. Further comparisons were made between current smoking and diabetes status with ADR. Results: There were a total of 2225 initial screening colonoscopies (SUH, n =647; UUH, n = 444; USNH, n = 1134) excluding 135 incomplete and/or poor prep colonoscopies (SUH, n = 34; UUH, n = 50; USNH, n = 51). USNH and UUH patients were more likely to be African-American (93% and 88% vs 7%, p&amp;lt;0.0001) and diabetic (29.7 and 29.8% vs 12%, p &amp;lt;0.0001) than the SUH patients. UUH and SUH patients were more likely to be male (39% and 40% vs. 32%, p&amp;lt;0.0001), more likely to be current smokers than the USNH patients (11.9% and 12.8% vs 5.8%, p&amp;lt;0.0001), and were less likely to be uninsured (7% and 3% vs 43%, p&amp;lt;0.0001). In 2012 the ADR was significantly lower in patients at the USNH compared to both the UUH and SUH( 17% vs 30% and 26%, p&amp;lt;0.0001), but with the institution of ADR monitoring at the USNH, the ADR has since increased to 29% in 2017. Across all three institutions diabetics were noted to have higher ADRs (26% vs 18%, OR 1.6 95% CI 1.3-2.0, p&amp;lt;0.0001) and current smokers were noted to have higher ADRs (30% vs. 20%, OR 1.8 95% CI 1.3-2.4, p = 0.001) Discussion: Diabetes and current smoking are associated with increased ADR across all three institutions despite differences in race and baseline ADR. Patients should be counseled on the increased risk associated with diabetes and smoking. Initiatives should be implemented to insure improved screening rates for adenomas among diabetics and also to screen for diabetes so that interventions can be made early to reduce the impact of diabetes on colon cancer risk. Further prospective studies are needed to validate these findings. Citation Format: Yakira David, Lorenzo Ottaviano, Sadat Iqbal, Brandon Lung, Michelle Likhtshtegyn, Samir Kumar, Ellen Li, Laura Martello-Rooney, Shivakumar Vignesh, Joshua Miller, Evan Grossman. Impact of diabetes mellitus on adenoma detection rates in three disparate institutions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4238.