Long-term Outcomes In Elderly Patients Research Articles

Abstract 3430: Toxicity and long-term outcomes of elderly patients with refractory or relapsed diffuse large B cell lymphoma undergoing autologous stem cell transplantation

Abstract Background: High-dose immunochemotherapy followed by autologous stem cell transplantation (Auto-SCT) is the standard treatment for fit individuals with refractory or relapsed diffuse large B cell lymphoma (DLBCL). We conducted a retrospective study to investigate toxicities and long-term clinical outcomes of elderly pts with relapsed or refractory DLBCL undergoing Auto-SCT. Methods: All pts with relapsed or refractory DLBCL undergoing Auto-SCT at our institution between November 2008 and November 2013 were included in the analysis. Prior treatment, secondary age-adjusted international prognostic index (saa-IPI), response to salvage treatment, Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), and stem cell collection yields were recorded for each patient. Treatment complications and long-term clinical outcomes were compared between two age groups (65+ vs. <65 years). Results: 81 individuals underwent Auto-SCT for refractory or relapsed DLBCL. The median age was 60.1 years (24-75 years) and 26 individuals were over 65 years at the time of transplantation. The majority of pts (77%) received salvage therapy with rituximab, ifosfamide, carboplatin, and etoposide followed by AutoSCT with carmustine, cyclophosphamide, and etoposide conditioning. Pts aged greater than 65 years had similar baseline CIRS-G comorbidity scores compared to the younger cohort, but they were more likely to have HCT-CI scores of 3 or more (45% vs. 20%, p = 0.015). The advanced aged group had fewer stem cells collected (4.2 vs 6.1 x106 cells, p = 0.01), despite a trend toward higher number of apheresis sessions (3.2 vs 2.7 days, p = 0.13). However, the two groups experienced similar duration of Auto-SCT hospitalization (21.3 vs 20.9 days), time to neutrophil recovery (10.6 vs 10.4 days), and time to platelet recovery (13.1 vs. 13.1 days). The two groups also experienced similar frequency of blood stream infections, pneumonia, ICU transfers, and hospital readmissions (p = 0.61). One death occurred in each group within the first 100 days (100-day TRM 2.5%), with two additional aged individuals experiencing late deaths due to myeloid neoplasms. After adjusting for age, comorbidities and saa-IPI, response to salvage immunochemotherapy (CR vs. non-CR) remained the only significant predictor of PFS using proportional hazard modeling (HR 0.32, p = 0.002). Conclusions: While prospective clinical trials utilizing Auto-SCT for relapsed large B cell lymphomas have excluded pts over the age of 65, our results suggest selected individuals with advanced age experience an acceptable level of treatment toxicity and have clinical outcomes comparable to younger counterparts. Response to salvage immunochemotherapy, not age, appears to be the strongest predictor of long-term outcomes following Auto-SCT in the setting of relapsed DLBCL. Citation Format: Scott F. Huntington, Boyu Hu, Daniel J. Landsburg, Anthony R. Mato, Sunita D. Nasta, Stephen J. Schuster, Edward A. Stadtmauer, Jakub Svoboda. Toxicity and long-term outcomes of elderly patients with refractory or relapsed diffuse large B cell lymphoma undergoing autologous stem cell transplantation. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3430. doi:10.1158/1538-7445.AM2015-3430

Tu1576 Safety and Long-Term Survival of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Carcinoma in Elderly Patients

Endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) has been widely accepted due to its high resectability and survival. However, the safety and long-term outcome in elderly patients has not been well-described. The aim of this study is to elucidate the safety and long-term outcome of ESD for ESCC in elderly patients compared with younger patients.

Effects of laparoscopic surgery on the patterns of death in elderly colorectal cancer patients: competing risk analysis compared with open surgery.

The effects of laparoscopic colorectal surgery (LAC) on the long-term outcomes of elderly patients remain unclear. This study aimed to assess the short- and long-term outcomes of LAC in elderly colorectal cancer patients and to quantify the effects of LAC on the patient death patterns. The clinicopathological data of elderly colorectal cancer patients aged≥80years old who were treated between 2006 and 2014 were extracted. The relationships between the clinicopathological factors and overall survival (OS) were assessed using the Cox proportional hazards model and Kaplan-Meier analyses. The risk factors for the types of death were estimated using a competing risk analysis. A total of 107 patients were included. Fifty-two patients underwent LAC, whereas 55 underwent open surgery (OC). There were no significant differences in the American Society of Anesthesiologists grade or comorbidity rate between the groups. The postoperative complication rate was significantly lower with LAC than OC (p<0.001). After adjustment for covariates, laparoscopic surgery was not a significant risk factor for any of the types of death. LAC is an effective and safe technique for elderly patients with colorectal cancer. Furthermore, there was no significant association between the surgical procedure and the pattern of death.

Inappropriate use of digoxin in patients presenting with digoxin toxicity.

BackgroundDigoxin remains widely used today despite its narrow therapeutic index and toxicity. The objective of this study was to investigate the percentage of inappropriate use of digoxin and long-term outcomes of elderly patients hospitalized for digoxin toxicity.MethodsThe study included 99 consecutive patients hospitalized for digoxin toxicity. The other study criteria for the inappropriate use of digoxin was regarded if participants having depressed left ventricular systolic function (ejection fraction < 45%) who were not on optimal medical therapy including beta-blocker and angiotensin-converting-enzyme inhibitor therapy or if participants having permanent AF who were not on optimal beta-blocker therapy.ResultsAppropriate digoxin usage was confirmed in 33 of patients in spite of its narrow therapeutic index. A total of 16 of 99 patients died, with a mean follow-up time of 22.1 ± 10.3 months.ConclusionsContrary to popular belief, the rate of inappropriate digoxin usage remains high. On account of its narrow therapeutic index and toxicity, digoxin should be used more carefully according to the current evidence and guidelines.

Robot-Assisted Middle Pancreatectomy for Elderly Patients: Our Initial Experience.

BackgroundThe aim of this study was to evaluate the indications, safety, feasibility, and short- and long-term outcomes for elderly patients who underwent robot-assisted middle pancreatectomies (MPs).Material/MethodsTen patients (≥60 years) underwent robot-assisted middle pancreatectomies from 2012 to 2015. The perioperative data, including tumor size, operating time, rate of postoperative pancreatic fistula (POPF), postoperative morbidity, and other parameters, were analyzed. We collected and analyzed the follow-up information.ResultsThe mean age of patients was 64.30 years (range, 60–73 years). The average tumor size was 2.61 cm. The 10 cases were all benign or low-grade malignant lesions. The mean operating time was 175.00 min. The mean blood loss was 113.00 ml with no blood transfusion needed. Postoperative fistulas developed in 5 patients; there were 2 Grade A fistulas and 3 grade B fistulas. There were 3 patients who underwent postoperative complications, including 2 Grade 1 or 2 complications and 1 Grade 3 complication. No reoperation and postoperative mortality occurred. The mean hospital stay was 19.91 days. After a median follow-up of 23 months, new onset of diabetes mellitus developed in 1 patient and none suffered from deterioration of previously diagnosed diabetes or exocrine insufficiency, and no tumor recurrence happened.ConclusionsRobot-assisted middle pancreatectomy was safe and feasible for elderly people. It had low risk of exocrine or endocrine dysfunction and benefited patients’ long-term outcomes. Incidence of POPF was relatively high but we could prevent it from resulting in bad outcomes by scientific perioperative care and systemic treatment.

Shock-index as a novel predictor of long-term outcome following primary percutaneous coronary intervention.

Early identification of higher risk patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI) will allow a more aggressive strategy and approach. The aim of this study was to evaluate the shock index (ratio of heart rate/systolic blood pressure on admission) as a predictor of mortality post PPCI in addition to other parameters. We analysed prospectively collected data on 3049 STEMI patients treated with PPCI in a large tertiary centre between March 2008-December 2011, out of which 2424 patients were aged up to 75 years (young) and 625 patients were older than 75 years (elderly). Compared to younger patients, in-hospital mortality rates were four-fold higher in the elderly (11.5% vs 2.8%, odds ratio (OR) 3.5, 95% confidence interval (CI) 2.0-5.9). Cardiogenic shock (OR 8.7 (5.1-14.6)), non-TIMI3 (Thrombosis In Myocardial Infarction) flow post percutaneous coronary intervention (PCI) (OR 5.0 (3.1-7.9)), age over 75 (OR 3.5 (2.3-5.3)) and a positive shock index pre PPCI (OR 3.5 (2.0-5.9)) were the strongest independent predictors of in-hospital mortality. For long-term outcome (median follow-up period 454 days) we excluded 141 (4.6%) patients that died during the initial hospital stay. Previous angina (hazard ratio (HR) 2.9), and previous cerebrovascular events (HR 3.7) were predictors of adverse outcome in the younger patients, while previous myocardial infarction (HR 2.0) and a positive shock index (HR 2.3) were predictors in the elderly. Cardiogenic shock prior to PPCI was not able to predict long-term outcome for in-hospital survivors. Mortality rates following PPCI were higher in elderly patients although remained acceptable. Invasively measured shock index before PPCI is the strongest independent predictor of long-term outcome in elderly patients. In addition, predictors of in-hospital mortality were similar across different age groups but differed significantly in relation to longer-term mortality.

Influence of sex on outcomes after percutaneous coronary intervention in patients over 75 years of age with coronary heart disease.

BackgroundThis study aimed to investigate whether there were sex differences in in-hospital and long-term outcomes for elderly patients over 75 years of age undergoing percutaneous coronary intervention for coronary heart disease.MethodsConsecutive patients aged ≥75 years who underwent percutaneous coronary intervention at a single center in the People’s Republic of China from January 2005 to December 2010 were included in this cohort study. Clinical characteristics and in-hospital and long-term outcomes were compared between men and women.ResultsA total of 465 patients (34.8% women, mean age 78.5±3.2 years) were recruited. Men had a higher prevalence of ST elevation myocardial infarction but were less likely to have heart failure than women (P<0.05). Similar rates of successful in-hospital procedures and deaths were observed in men and women. After a mean follow-up of 3 years, no significant differences were observed between men and women in mortality (12.5% versus 8.0%, P=0.151), myocardial infarction (1.4% versus 2.7%, P=0.368), target vessel revascularization (6.1% versus 4.7%, P=0.540), or cerebral vascular disease (7.9% versus 6.0%, P=0.472). Cox proportional hazards analysis revealed that sex was not independently associated with either in-hospital mortality or long-term mortality.ConclusionIn elderly patients over 75 years of age, sex influences the prognosis after percutaneous coronary intervention for coronary heart disease.

Current controversies in nonoperative management of Type II odontoid fractures in the elderly

The study design was a review of the literature. The objective was to assess the outcomes of nonoperative management of Type II odontoid fractures in the elderly population. Type II odontoid fractures in the elderly population are associated with high morbidity and mortality rates, and the current treatment recommendation is quite controversial. This article reviews the current literature on nonoperative versus operative treatment of Type II odontoid fractures in the elderly population, in hopes of drawing conclusions for the best approach to these patients. MEDLINE and PubMed databases were searched to identify articles. Studies included were those involving elderly patients with Type II odontoid fractures, who were managed nonoperatively. Studies assessing the different methods of operative fixation were excluded. An algorithm taking into account the morbidities associated with the treatment option versus the long-term outcomes in elderly patients with Type II odontoid fractures would be extremely beneficial for spine surgeons to aid in deciding whether or not to operate. Nondisplaced fractures may be appropriately treated nonoperatively in a collar with close follow-up and early mobilization. Halo–vest immobilization should be used sparingly in the elderly population, as it is associated with significant morbidity. Cervical collars appear to have less morbidity than halo–vest immobilization with success in the less displaced fracture patterns. Lastly, operative treatment for displaced, unstable fractures can improve patient outcomes.

Long-term outcome of elderly patients with severe aortic stenosis as a function of treatment modality

ObjectiveTo assess long-term clinical outcomes of consecutive high-risk patients with severe aortic stenosis according to treatment allocation to transcatheter aortic valve implantation (TAVI), surgical aortic valve replacement (SAVR) or medical...

31 Shock-Index as a Novel Predictor of Longterm Outcome Following Primary Percutaneous Coronary Intervention

Early identification of higher risk patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI) will allow a more aggressive strategy and approach. The aim of...

Impact of renal dysfunction on long-term outcomes of elderly patients with acute coronary syndrome: a longitudinal, prospective observational study.

BackgroundThis study investigated the impact of renal dysfunction (RD) on long-term outcomes in elderly patients with acute coronary syndrome (ACS), and evaluated prognostic factors in elderly patients with ACS and RD.MethodsThis longitudinal prospective study included 184 consecutive patients who were admitted with ACS between January 2009 and January 2010 and also had RD. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR): 1) eGFR ≥ 90 mL/min/1.73 m2 with evidence of kidney damage, 2) 60 ≤ eGFR < 90 mL/min/1.73 m2, 3) 30 ≤ eGFR < 60 mL/min/1.73 m2, 4) 15 ≤ eGFR < 30 mL/min/1.73 m2, and 5) eGFR < 15 mL/min/1.73 m2. The primary endpoints were death and complications during hospitalization. The secondary endpoint was any major adverse cardiac event (MACE) during follow-up.ResultsThe mean follow-up period was 502.2 ± 203.6 days. The mean patient age was 73.7 ± 9.4 years, and 61.4% of the patients were men. Severe RD (eGFR < 30 mL/min/1.73 m2) was an independent predictor of MACE. Severe RD was associated with a low hemoglobin level, low left ventricular ejection fraction, and high levels of high-sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide, and cystatin C. Survival was significantly poorer in patients with severe RD than in patients with mild RD.ConclusionsAmong patients with ACS, severe RD was associated with advanced age, diabetes, hypertension, and cardiac dysfunction. Severe RD was an independent risk factor for MACE, and was associated with poor prognosis.

Impact of postoperative renal replacement therapy on long-term outcome after cardiac surgery increases with age.

In the present study, we investigated the survival of patients who received postoperative renal replacement therapy (RRT) after cardiac surgery. We specifically focused on factors predicting long-term outcome in elderly patients. Data of all patients that received unintentional renal replacement therapy following cardiac surgery between 2004 and 2010 were analyzed. Logistic- and Cox regression analyses were performed to detect the predictors of early and late mortality, respectively. During the study period, 11,899 patients underwent cardiac surgery in our center. Post-operative RRT was performed in 138 patients (1.2%). In this group of patients, 30-day mortality included 72 patients (52%) and the total overall mortality included 107 patients (77.5%). Regression analyses revealed that age predicted 30-day mortality (odds ratio = 1.08 [1.03 to 1.12]) as well as late mortality (odds ratio = 1.05 [1.02 to 1.07]. Patients requiring RRT after cardiac surgery have a poor prognosis with a high mortality. Older age predicted both 30-day and late mortality in these patients.

Long-Term Outcomes of Percutaneous Coronary Interventions or Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease in Octogenarians (from a Drug-Eluting stent for LefT main Artery Registry Substudy)

Percutaneous coronary intervention (PCI) with drug-eluting stents is an accepted alternative to surgery for the treatment of unprotected left main coronary artery (ULMCA) disease, but the long-term outcome in elderly patients is unclear. Aim of our study was to compare the clinical outcomes of octogenarians with ULMCA disease treated either with PCI with drug-eluting stents or coronary artery bypass grafting (CABG). The primary study end point was the composite of death, cerebrovascular accident, and myocardial infarction at follow-up. A total of 304 consecutive patients with ULMCA stenosis treated with PCI or CABG and aged ≥80 years were selected and analyzed in a large multinational registry. Two hundred eighteen were treated with PCI and 86 with CABG. During the hospitalization, a trend toward a higher mortality rate was reported in PCI-treated patients (3.5% vs 7.3%, p = 0.32). At a median follow-up of 1,088 days, the incidence of the primary end point was similar in the 2 groups (32.6% vs 30.2%, p = 0.69). Incidence of target vessel revascularization at follow-up was higher in PCI-treated patients (10% vs 4.2%, p = 0.05). At multivariate analysis, left ventricular ejection fraction was the only independent predictor of the primary end point (hazard ratio 0.95, 95% confidence interval 0.91 to 0.98, p = 0.001). After adjustment with propensity score, the revascularization strategy was not significantly correlated to the incidence of the primary end point (hazard ratio 0.98, 95% confidence interval 0.57 to 1.71, p = 0.95). In octogenarians, no difference was observed in the occurrence of the primary end point after PCI or CABG for the treatment of ULMCA disease. However, the rate of target vessel revascularization was higher in the PCI group.

Prospective Cohort Study Comparing the Effects of Different Artificial Nutrition Methods on Long‐Term Survival in the Elderly

The effects of various artificial nutrition methods on the long-term outcomes of elderly patients are still not well known. We aimed to compare the long-term survival of the elderly newly administered with parenteral nutrition (PN) or enteral nutrition. This multicenter, prospective, observational cohort study was conducted on 546 elderly patients who were administered artificial nutrition. The main outcome was the survival ratio at 180 and 360 days after initiation of 3 different nutrition methods and estimated mean survival time: PN, nasal tube feeding (EN_N), and percutaneous endoscopic gastrostomy (PEG) feeding (EN_G). The incidence of systemic infection was also compared among different cohorts. At 180 and 360 days after initiation of artificial nutrition, the mortality rates in the PN, EN_N, and EN_G cohorts were 52% and 63%, 32% and 41%, and 22% and 33%, respectively. Multivariate logistic regression analysis showed that, whereas PN nutrition had significant associations with a higher death rate at 180 and 360 days in all samples, there is no significant difference on the main outcome among the 3 cohorts with neurological diseases. A subgroup analysis with neurological diseases showed that the proportional hazard ratios of the PN and EN_N cohorts in comparison with the EN_G cohort were 1.13 (95% confidence interval [CI], 0.66-1.92) and 1.22 (95% CI, 0.82-1.81). There is no significant superiority of PEG feeding compared with nasal tube feeding or PN. Clinicians should consider the choice of nutrition support method, taking into consideration the limitation of the patient's interest.

Long-term outcome of elderly patients (75 years or older) with hepatocellular carcinoma

The aim of this study was to evaluate the long-term outcome of elderly patients with hepatocellular carcinoma (HCC) aged 75 years or older. The study included 422 patients with HCC, who were divided into two age groups: 75 years or older (n = 140) and younger than 75 (n = 282). Outcomes were compared between the two groups. The number of elderly patients treated with supportive care alone (33 patients; 24%) was significantly higher than younger patients (30 patients; 11%, P < 0.01). The 1-, 3-, 5- and 7-year overall survival rates of the elderly patients (81%, 55%, 39% and 23%, respectively) were worse than those of younger patients (85%, 64%, 49% and 36%, respectively, P = 0.042). However, the overall survival rate of the elderly group after excluding 63 patients treated with supportive care alone, was similar to that of the younger group (P = 0.615). Multivariate analysis identified age, total bilirubin levels, albumin levels, serum des-γ-carboxy prothrombin levels, tumor size, number of HCC nodules, vascular invasion, extrahepatic metastasis and treatment modality as independent and significant factors of overall survival. Advanced age is a negative prognostic factor in patients with HCC due to the tendency for frequent use of conservative treatment rather than locoregional or surgical treatment.

Abstract T MP103: Long-Term Outcomes of Elderly Patients with Intracerebral Hemorrhage and Atrial Fibrillation

Background: There has been limited investigation into the long-term outcomes of elderly patients with intracerebral hemorrhage (ICH) and atrial fibrillation (AF). Although ICH is associated with high short-term mortality, the long-term mortality of those patients with AF who survive a first ICH is unknown, as is the true incidence of recurrent ICH, ischemic stroke and major bleeding. The aims of this study were to examine the long-term outcomes of a cohort of patients with ICH and AF and to identify factors associated with long-term survival. Methods: We used the Ontario Stroke Registry (OSR) to identify a population-based cohort of patients ≥ 65 years of age with ICH and AF who were admitted to one of Ontario’s 150 acute care hospitals between 2002 and 2011. Linkage to health administrative databases was performed to assess mortality at 30 days, 1 year and 2 years as well as rates of recurrent ICH, ischemic stroke and major hemorrhage at 1 year. Prescription drug utilization in the year following hospital discharge was assessed through linkage to the Ontario Drug Benefits (ODB) database. Multivariable logistic regression was used to identify factors associated with long-term survival in these patients. Results: Of the 1,236 elderly patients diagnosed with ICH, 329 (26.6%) had AF. Of those patients discharged alive, 21.1% were prescribed warfarin in the year following discharge. Mortality was 42.6% at 30 days, 58.7% at 1 year and 66.9% at 2 years. The all-cause readmission rate at 1 year was 12.1%, 5.0% for ischemic stroke, 3.5% for recurrent ICH and 7.5% for major bleeding. Multivariable analysis showed that being prescribed an antihypertensive agent (HR 0.151, p&lt;0.0001), a statin (HR 0.463, p=0.0102) or warfarin (HR 0.136, p=0.0056) after ICH was associated with a decreased risk of death at 1 year. Conclusions: In patients with ICH and AF, the incidence of recurrent ICH is lower than the incidence of ischemic stroke or major bleeding at 1 year. Although ICH is associated with high short-term mortality, the 2 year mortality rate for those patients who survive the first 30 days remains stable. Although ICH is often considered a relative contraindication for anticoagulation, this study demonstrates a reduction in long-term mortality in ICH patients treated with warfarin.

Comprehensive geriatric assessment in intensive care unit: a pilot study (pre-Seniorea)

long-term outcomes of elderly patients after an intensive care unit (ICU) stay are not fully elucidated. The objective of the pre-Seniorea study was to examine the feasibility of comprehensive geriatric assessment (CGA) during and after the ICU stay. inpatients aged 75 years and over admitted to medical and surgical ICUs of Angers University Hospital, France, from june to september 2012, received a SGA (assessment of morbidities, frailty, cognition, anxiety, mood, nutrition, functional abilities, motor function, pain, caregiver burden and quality of life) at ICU admission (through a proxy interview), at the end of the ICU stay, and 3 month later in the place of life. fifty-two patients were included (81 [78; 83] years (median [25(th); 75(th) percentile]); 35 males; SAPSII 47 [38; 56]; 80% ventilation). ICU survival was 73% (n=38), 58% (n=30) after three months, and 54% (n=28) after 12 months. The CGA at ICU admission was performed in all patients and lasted 10 [5; 10] minutes. The CGA at discharge was performed in all survivors and lasted 10 [5; 15] minutes. In all, 26 survivors received CGA in their place of life after 3 months. Travel time by evaluators was 42 minutes, and time on site 45 [45; 60] minutes. At 3 months, 85% of surviving patients were at home and felt happy, 80% had preserved autonomy. The only variable predictive of survival at three months was the SAPSII score. the follow-up of elderly inpatient admitted to ICU with repeated CGAs, including long-term evaluations in the place of life, was feasible and well-accepted. These results set the place for larger multicentric trials.

Comparative effectiveness of drug‐eluting stents on long‐term outcomes in elderly patients treated for in‐stent restenosis: A report from the National Cardiovascular Data Registry

We assessed the long-term outcomes of elderly patients who had in-stent restenosis (ISR) treated with drug-eluting stents (DES) compared with other treatment strategies. Elderly patients with ISR represent a vulnerable group of which little is known regarding the safety and efficacy of repeat percutaneous coronary intervention (PCI). We analyzed patients ≥ 65 years of age who underwent PCI for ISR in the National Cardiovascular Data Registry(®) from 2004 to 2008. Death, myocardial infarction (MI), revascularization, stroke, and bleeding were assessed for up to 30 months by a linkage with Medicare rehospitalization claims. Of 43,679 linked patients, 30,012 were treated with DES, 8,277 with balloon angioplasty (BA), and 4,917 with bare metal stents (BMS). Compared with BMS, DES use was associated with a lower propensity score-matched (PM) risk of death (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.66-0.80, P < 0.001), MI (HR 0.81; 95% CI 0.70-0.93, P = 0.003), and revascularization (HR 0.90; 95% CI 0.82-1.00, P = 0.055). Compared with BA, DES use was associated with a lower PM risk of death (HR 0.82; 95% CI 0.76-0.89, P < 0.001) and revascularization (HR 0.86; 95% CI 0.80-0.93, P < 0.001), but no statistically significant difference across other endpoints. There were no significant differences in long-term outcomes for BA compared with BMS. There was lower mortality and reduced risk for MI, revascularization, and stroke, but a similar rate of bleeding with DES compared with other modalities. Our results indicate that DES use is a comparatively effective strategy to treat elderly patients with ISR.

The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology

Venous thromboembolism (VTE) is common and has a high impact on morbidity, mortality, and costs of care. Although most of the patients with VTE are aged ≥65 years, there is little data about the medical outcomes in the elderly with VTE. The Swiss Cohort of Elderly Patients with VTE (SWITCO65+) is a prospective multicenter cohort study of in- and outpatients aged ≥65 years with acute VTE from all five Swiss university and four high-volume non-university hospitals. The goal is to examine which clinical and biological factors and processes of care drive short- and long-term medical outcomes, health-related quality of life, and medical resource utilization in elderly patients with acute VTE. The cohort also includes a large biobank with biological material from each participant. From September 2009 to March 2012, 1,863 elderly patients with VTE were screened and 1003 (53.8%) were enrolled in the cohort. Overall, 51.7% of patients were aged ≥75 years and 52.7% were men. By October 16, 2012, after an average follow-up time of 512 days, 799 (79.7%) patients were still actively participating. SWITCO65+ is a unique opportunity to study short- and long-term outcomes in elderly patients with VTE. The Steering Committee encourages national and international collaborative research projects related to SWITCO65+, including sharing anonymized data and biological samples.

Long Term Follow-up of 121 Elderly Patients with Philadelphia-Positive Acute Lymphoblastic Leukaemia (Ph+ALL) Treated in Prospective GMALL Trials Supports a Greater Emphasis On Allogeneic SCT as Definitive Postremission Therapy.

AbstractAbstract 2608▪▪This icon denotes a clinically relevant abstract Background:Combined treatment with a tyrosine kinase inhibitor (TKI) and ALL-type induction and consolidation chemotherapy followed by allogeneic SCT is standard front-line therapy for younger patients with Ph+ALL, but the value of adding intensive chemotherapy to a TKI in elderly patients is controversial. More than 90% of elderly patients achieve a complete remission, irrespective of the type of TKI-based induction, but relapse is the major cause of treatment failure. In a previously reported randomized trial examining imatinib combined with intensive induction and consolidation chemotherapy for Ph+ALL in elderly patients (n=55), the probability of overall survival (OS) after 24 months was 42% ± 8% (Ottmann OG et al., Cancer. 2007; 109:2068-76). To date, very little published data on long-term outcome of elderly patients with Ph+ALL are available. Aims:We conducted the present analysis to determine whether subsets of patients derive long-term benefit from combined imatinib plus intensive chemoptherapy, examine the characteristics of long-term survivors, determine whether such patients can be identified by assessment of MRD, and obtain preliminary results on the feasibility and efficacy of SCT in this population of elderly patient. Study design and patients demographics:Our current analysis includes a total of 121 patients (119 ALL, 2 CML in lymphoid blast crisis), with a median age of 66 years (range 54–80). Fifty-five patients were enrolled in a previously reported randomized clinical trial comparing single-agent imatinib and chemotherapy as induction therapy, followed by up to 6 cycles of consolidation chemotherapy; a further 67 patients were subsequently treated according to this protocol as per recommendation by the GMALL Study Group. Results:The overall CR rate was 88%, median time to progression was 14.5 months (range 0.5–102) and OS was 18.6 months (range 0.5–102), respectively. Probabilities of remission duration, survival and TTP at 5 years were 19%, 22% and 19%, respectively. The type of initial induction therapy had no significant impact on OS and DFS. Of 113 pts, who were evaluable for comorbities, pulmonary disease was the only comorbidity associated with inferior outcome (median OS 13 months vs. 20 months, univariate analysis p=0.02). Allogeneic SCT was performed in CR1 in 12 patients and as salvage therapy in another 7 patients. Median age of these 19 patients was 62y (range 54–69). The time from diagnosis to SCT in CR1 was 4.6 months (2.9 mo – 16.8 mo) and from relapse to SCT in >CR1 3 months (2.1 mo – 6.1 mo).The 5yr OS in patients transplanted in CR1 vs. non-transplanted patients was superior (48% vs 22%). Remarkably, OS of the 7 patients transplanted beyond CR1 as part of salvage therapy was 43% after 4.5 years. With a median follow-up of 21.6 months (range 3.3– 54) after SCT, 8 patients are in ongoing CR with a median OS of 51.8 months from initial diagnosis (range 35 – 66), 5 pts. died in CR, 6 pts. relapsed. Conclusions:The combination of imatinib with intensive chemotherapy is feasible in elderly patients, but long-term survival is poor primarily due to high relapse rate. Allogeneic SCT in CR1 is superior to conventional therapy and should be considered as front-line therapy in this elderly patient population. The encouraging results of allogeneic SCT performed beyond CR1 suggest that SCT should be considered as definite postremission therapy in a larger proportion of elderly patients than is current practice. Disclosures:Ottmann:Novartis: Honoraria, Research Funding; BMS: Honoraria, Research Funding.