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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20090101_19_2606"
                     title="Graft vs Host Risk Cut With Anti-T-Cell Globulins"
                     score="-0.005"
                     href="http://www.medpagetoday.com/HematologyOncology/Hematology/tb/15591?impressionId=1265797520341"
                     
      The frequency of graft versus host disease (GVHD) declined significantly with the addition of anti-T-cell globulins (ATG) to cyclosporine and methotrexate in patients undergoing allogeneic hematopoietic cell transplantation.&lt;br&gt;
&lt;br&gt;The incidence of grade III-IV acute GVHD declined by 50% and chronic GVHD was reduced by almost 80% in patients who received ATG, comopared to those who received standard prophylaxis, investigators reported in the Aug. 19 issue of &lt;em&gt;Lancet Oncology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Neither relapse nor nonrelapse mortality increased with the investigational GVHD prophylaxis.&lt;br&gt;
&lt;br&gt;&quot;With regard to less severe forms of acute GVHD (grade II-IV and grade I-IV) even larger differences in favour of ATG were seen,&quot; Jurgen Finke, MD, of Universitatsklinikum Freiburg in Germany, and colleagues reported.&lt;/p&gt;
&lt;p&gt;Despite advances in transplantation science, GVHD remains a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation.&lt;/p&gt;
&lt;p&gt;Researchers have tried various, experimental ATG conditioning regimens in hopes of preventing GVHD, the authors noted. However, the potency and dose of the regimens have differed substantially, leading to inconsistent clinical results that have included increased mortality.&lt;/p&gt;
&lt;p&gt;Promising results came from phase II clinical trials of rabbit anti-Jurkat cell-line T-lymphoblasts (ATG-Fresenius) added to cyclosporine and methotrexate for patients receiving matched and mismatched cells from unrelated donors, the authors continued.&lt;/p&gt;
&lt;p&gt;Investigation of the regimen continued in a phase III trial, comparing cyclosporine and short-course methotrexate with or without ATG-Fresenius.&lt;/p&gt;
&lt;p&gt;The trial involved 201 patients with hematologic malignancies treated by transplantation of peripheral blood cells (82%) or bone marrow (18%) from unrelated donors.&lt;/p&gt;
&lt;p&gt;All patients underwent myeloablative conditioning therapy with whole-body irradiation, systemic agents, or a combination. Supportive care was provided in accordance with the treating center&apos;s standards. Use of growth factors was not permitted.&lt;/p&gt;
&lt;p&gt;All patients received cyclosporine and methotrexate at standard doses and were randomized to ATG-Frenisius or no additional prophylaxis. The primary endpoint was the composite of grade III-IV GVHD or death within 100 days of transplantation.&lt;/p&gt;
&lt;p&gt;In the ATG-Fresenius group, 12 patients developed grade III-IV and 10 died during the first 100 days, resulting in a total event rate of 21.4%.&lt;/p&gt;
&lt;p&gt;Among patients who did not receive ATG-Fresenius, 24 developed severe GVHD and nine died, resulting in a total event rate of 33.7%. The difference between groups translated into an adjusted hazard ratio of 0.59 in favor of ATG-Fresenius (95% CI 0.30 to 1.17).&lt;/p&gt;
&lt;p&gt;The cumulative incidence of grade III-IV acute GVHD was 11.7% in the ATG-F group and 24.5% in the control group (HR 0.50, 95% CI 0.25 to 1.01, &lt;em&gt;P&lt;/em&gt;=0.054). However, only one patient in the ATG group died as a result of GVHD, compared with nine in the control group.&lt;/p&gt;
&lt;p&gt;The addition of ATG-Fresenius reduced the incidence of grade II-IV acute GVHD from 51% in the control group to 33% (HR 0.56, 95% 0.36-0.87, &lt;em&gt;P&lt;/em&gt;=0.011).&lt;/p&gt;
&lt;p&gt;The two-year cumulative incidence of chronic GVHD was 12.2% in the ATG group and 42.6% in the control arm, resulting in an adjusted hazard ratio of 0.22 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;&quot;There were no differences between treatment groups with regard to relapse, nonrelapse mortality, overall survival, and mortality from infectious causes,&quot; the authors reported.&lt;/p&gt;
&lt;p&gt;The significant reduction in chronic GVHD emerged as a key message from the study, Francesco Frassoni, MD, of Ospedale San Martino in Genova, Italy, wrote in an invited commentary.&lt;/p&gt;
&lt;p&gt;&quot;Outpatient wards treat many patients for chronic GVHD, and this number has increased with the use of mobilized peripheral-blood sources, as was used for many patients in the study by Finke and colleagues,&quot; said Frassoni&lt;/p&gt;
&lt;p&gt;&quot;Although not analyzed in the study, patients in the ATG-Fresenius group surviving hematopoietic cell transplantation are also likely to have a better quality of life than those in the control group,&quot; he added.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Finke and coauthors Wolfgang Bethge, Karin Kolbe, Hartmut Bertz, and Matthias Egger disclosed relationships with Fresenius.&lt;/p&gt;&lt;p&gt;Frassoni reported no competing interests.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3945"
                     title="Young Cancer Survivors May Risk Late Recurrence (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/HematologyOncology/Hematology/tb/17336?impressionId=1265797520341"
                     
      &lt;p&gt;Survivors of some pediatric cancers may be at risk for late recurrence, particularly if they&apos;ve had Ewing sarcoma or astrocytoma, researchers said.&lt;/p&gt;
&lt;p&gt;After 20 years, patients in a cohort of childhood cancer survivors had a 6.2% cumulative recurrence rate, Karen Wasilewski-Masker, MD, of the Aflac Cancer Center in Atlanta, and colleagues reported online in the &lt;em&gt;Journal of the National Cancer Institute&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Five-year disease-free survival is often interpreted to mean &apos;cure,&apos;&quot; the researchers wrote. &quot;However, this study of five-year disease-free survivors of the most common forms of childhood cancer [had a higher-than-expected] cumulative incidence for a recurrence five to 20 years after the primary diagnosis.&quot;&lt;/p&gt;
&lt;p&gt;&quot;These data can help identify which cancer survivors are at greatest risk for recurrence and hence should be followed more closely,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;To that end, investigators estimated late recurrence rates for the most common pediatric cancers and determined risk factors for late recurrence, which was defined as occurring more than five years after diagnosis.&lt;/p&gt;
&lt;p&gt;They looked at data from the Childhood Cancer Survivor Study, a retrospective cohort of five-year survivors of childhood and adolescent cancers who were diagnosed between 1970 and 1986.&lt;/p&gt;
&lt;p&gt;The analysis included 12,795 survivors with no history of recurrence within five years of their original diagnosis. The mean age at diagnosis was 8.3 years and the mean age at follow-up was 26 years.&lt;/p&gt;
&lt;p&gt;A total of 806 patients had a late recurrence, and the majority of those  --  69.1%  --  occurred from five to 10 years after the diagnosis.&lt;/p&gt;
&lt;p&gt;Five-year survivors of pediatric cancers had a cumulative incidence of recurrent disease of 4.4%, 5.6%, and 6.2% at 10, 15, and 20 years, respectively.&lt;/p&gt;
&lt;p&gt;There was a slightly higher cumulative incidence of late recurrence among male survivors compared with females, and in all other racial groups compared with blacks.&lt;/p&gt;
&lt;p&gt;Also, the vast majority of childhood cancer survivors with no recurrence  --  92.9%  --  were alive at follow-up, compared with 49.1% of those who&apos;d had a late recurrence.&lt;/p&gt;
&lt;p&gt;Cumulative incidence also varied by diagnosis. Survivors of Ewing sarcoma and astrocytoma had the highest 20-year cumulative incidence at 13% (95% CI 9.4% to 16.5%) and 14.4% (95% CI 12.3% to 16.6%), respectively.&lt;/p&gt;
&lt;p&gt;Survivors of childhood kidney tumors were at the lowest risk for recurrence, the researchers found.&lt;/p&gt;
&lt;p&gt;In multivariate analyses, the greatest risks for late recurrence included diagnosis, combination treatment with chemotherapy and radiation, an earlier treatment era, and fewer years since diagnosis (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;The researchers said the study was limited by the lack of subgroup data needed to make more specific recommendations with regard to risk and surveillance. It also lacked information on the site of recurrence.&lt;/p&gt;
&lt;p&gt;They added the study could also be limited by reliance on self-reported data and incomplete medical records.&lt;/p&gt;
&lt;p&gt;&quot;What can be confirmed by this analysis,&quot; they concluded, &quot;are those at higher and lower risk for a late recurrence, which can help direct surveillance practices.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Department of Health and Human Services, the American Lebanese Syrian Associated Charities to St. Jude Children&apos;s Research Hospital, and the Children&apos;s Oncology Group.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3986"
                     title="Cancer Report Card Reveals Decline in Disease and Death"
                     score="-0.005"
                     href="http://www.medpagetoday.com/HematologyOncology/Hematology/tb/17385?impressionId=1265797520341"
                     
      &lt;p&gt;Cancer incidence and mortality continue to decline, with the most dramatic decreases in lung, prostate, and colorectal cancers among men, and breast and colorectal cancers in women, according to the latest national report card.&lt;/p&gt;
&lt;p&gt;&quot;Overall cancer incidence rates for all racial/ethnic groups combined decreased by 0.7% per year during 1999-2006 for both sexes combined, by 1.3% per year during 2000-2006 for men, and by 0.5% per year during 1998-2006 for women,&quot; authors from the American Cancer Society, the CDC, the National Cancer Institute, and the North American Association of Central Cancer Registries concluded.&lt;/p&gt;
&lt;p&gt;The report, which has become an annual ritual, was published online in the ACS journal, &lt;em&gt;Cancer.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;There has been a decline in cancer death rates since the early 1990s and that trend appears to be durable.&lt;/p&gt;
&lt;p&gt;&quot;The decreases were slightly larger for men, who had declines of 1.5% per year during 1993-2001 and 2.0% per year during 2001-2006 compared with women, whose cancer death rates declined 0.8% per year during 1994-2002 and 1.5% per year during 2002-2006,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;But the news was not all good. As men saw decreased rates of prostate, lung, oral, stomach, brain, and colorectal cancers, there was a concurrent increase in the cancers of the kidney, renal, liver, and esophagus  --  as well as increases in leukemia, myeloma, and melanoma of the skin.&lt;/p&gt;
&lt;p&gt;For women the story was similar -- decreased rates of breast, colorectal, ovarian, cervical, uterine corpus, and oral cancers, but an uptick in lung, thyroid, pancreas, bladder, and kidney cancers, as well as increases in non-Hodgkin lymphoma, melanoma, and leukemia.&lt;/p&gt;
&lt;p&gt;Colorectal cancer is a focus of this year&apos;s report, not a surprising choice because the news here is good: &quot;CRC death rates have declined since 1984 in both men and women, with an accelerated rate of decline since 2002 (for men) and 2001 (for women).&quot;&lt;/p&gt;
&lt;p&gt;And a &quot;microsimulation model&quot; suggests that death rates from colorectal cancer could be reduced by 36% over the next decade if &quot;1995-2000 trends for risk factor prevalence, screening, and treatment continue.&quot;&lt;/p&gt;
&lt;p&gt;But the authors point out that increased obesity among younger Americans could derail this trend.&lt;/p&gt;
&lt;p&gt;The annual report often paints a rosy picture based on a patchwork of data collected from a number of sources and analyzed using a complex array of statistical methods.&lt;/p&gt;
&lt;p&gt;The report&apos;s lead author, Brenda K. Edwards, PhD, of the National Cancer Institute, and her colleagues, provide detailed descriptions of potential problems  --  so much so that the report includes two pages of possible limitations.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_1_30"
                     title="U.S. Cancer Deaths Edge Down -- for the First Time in 70 Years"
                     score="-0.006"
                     href="