Al‐Juhaishi, Taha

Abstract Aims We aimed to perform a retrospective cohort study using the Centers for Disease Control and Prevention’s (CDC’s) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to analyse the trends in cardiovascular disease (CVD)–related mortality in patients with myeloproliferative neoplasms (MPNs) from 1999 to 2020. Methods and results We analysed the death certificate data from the CDC WONDER database from 1999 to 2020 for CVD with co-morbid myeloproliferative disorders in the US population. Age-adjusted mortality rates (AAMRs) and 95% confidence intervals (CIs) were computed per 1 million population by standardizing crude mortality rates to the 2000 US census population. To assess annual national mortality trends, we employed the Joinpoint regression model, calculating the annual per cent change in AAMR and corresponding 95% CIs. A total of 15 269 deaths related to CVD occurred in patients with co-morbid MPNs from 1999 to 2020. Overall, there was a decreasing trend in CVD-related AAMRs throughout these years. Males contributed to 51% of total deaths, and their AAMR was persistently higher than women throughout the study. Non-Hispanic (NH) Whites had the highest overall AAMR, followed by NH Blacks, NH American Indians or Alaska Natives, Hispanics or Latinos, and NH Asian or Pacific Islanders. Conclusion Our findings indicate a significant decline with notable gender, racial/ethnic, and regional differences in CVD-related mortality among patients with MPN over the past two decades. We emphasize the importance of a collaborative approach between oncologists and cardiologists in managing these patients, highlighting the potential benefits of integrating cardio-oncology services to enhance patient outcomes.

Abstract Aims Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. Methods and results The National Inpatient Sample (2016–19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9–3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55–5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6–2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54–7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17–18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56–4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79–3.55; P < 0.001) and cost of care (+67 529; 36 630–98 427; P < 0.001). Conclusion Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.

BACKGROUND: Malignant lymphomatous involvement of the eye and its surrounding structures is a rare phenomenon. Due to the unique location, non-specific symptomatology, limitations for invasive procedures, physician experience, and significant effect on the quality of life related to vision, it poses many challenges in the diagnosis and management. Ocular involvement can be primary or secondary in lymphoma. Primary ocular lymphoma, based on its clinical and pathological characteristics, has been divided into 2 main groups: those involving the orbit and adnexal tissues including lacrimal gland, conjunctiva and cornea and, those affecting intra-ocular structures mainly vitreous and retina. We aim to evaluate the SEER database to assess patterns and outcomes in patients with primary ocular involvement with lymphoma. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with primary ocular lymphomas between 1975 and 2016. B-cell and T-cell lymphomas with stage I disease and primary site labeled as ocular (orbital, retina, conjunctiva, cornea, choroid, ciliary, lacrimal gland) were included. Treatment effect (surgery, radiation, systemic therapy) was analyzed when available.Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the Log-Rank test. Cox proportional hazards models were used for adjusted survival analyses. RESULTS: We identified 3610 patients with primary lymphoma of the eye and adnexa. The median age was 66 years (18-103). 70% of the patients were Caucasians, followed by Hispanic (10%). Slight female preponderance was noted (55%). Most common site of involvement was orbit (n = 2063; 57%) followed by conjunctiva (n = 986; 27.3%). 8% (n = 292) of the patients were noted to have bilateral involvement. MALT (n = 2208; 61.2%) was the most common histology followed by DLBCL (n = 576; 16%) and follicular lymphoma (n = 519; 14.4%). Other histologies were rare (see Table 1). Most common treatment modality was radiation (n = 2117; 58.6%). Systemic therapy was utilized in only about 25% of the patients. Radiation treatment was associated with improved survival HR = 0.44 (0.23-0.83 95%CI, p = 0.01). Interestingly, patients that received systemic therapy had worse survival in univariate analysis (p<0.05) but was not significant in multivariate analysis. Site-specific survival suggested conjunctiva had the best median OS (19 years [16.3 - 21.7 95% CI]), followed by orbital and lacrimal gland involvement (median OS 12 years [10.92-13.23 95% CI]) - Figure 1. Retina (median OS 1.9 years) and choroid/ ciliary body (median OS 6.3 years) involvement were associated with shorter survival (p<0.05). DISCUSSION: Ocular lymphoma is a rare occurrence. Overall MALT was the most common subtype followed by DLBCL and FL. Very few instances of Burkitt's lymphoma, T-cell, and CLL were identified. Site-specific data in our subset, albeit with low numbers, suggest worse survival in the ciliary body and choroid similar to what is seen within vitreoretinal involvement. Due to small numbers in our subset, this requires confirmation in a larger dataset to identify potential change in management similar to primary vitreoretinal lymphoma, which is now recognized and managed as primary CNS lymphoma. Patients receiving systemic therapy showed a trend towards worse survival, which may be explained by a selection bias for more aggressive disease. Our study highlights the small but relevant prevalence of primary ocular lymphomas and reports the interesting observation of different survival patterns based on the site of involvement. Disclosures Yazbeck: Celgene: Membership on an entity's Board of Directors or advisory committees; Gilead Sciences: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees.

Introduction: Primary extranodal lymphomas of the salivary glands constitute 12% of head and neck lymphomas, and less than 5% of salivary gland neoplasms. Parotid gland is the most commonly involved structure. Mucosa-associated lymphoid tissue (MALT) lymphoma is considered the most common histology in parotid lymphomas and carry a favorable prognosis. In this study, we sought to explore the impact of histologic subtype on survival. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with primary parotid lymphomas between 1975 and 2016. B-cell, T-cell, and Hodgkin's lymphomas were included. Treatment effect (surgery, radiation, chemotherapy) was analyzed when available. Only stage I lymphomas by Ann-Arbor staging system were included to ensure parotid gland as the primary site. Overall survival was estimated using the Kaplan-Meier method, and compared using Log-Rank test. Cox proportional hazards models were used for adjusted survival analyses. Results: A total of 1482 patients were included in the analysis. Median age was 66 years (18-102), and the majority were female (n=904, 61%) and Caucasian (n=1074, 72.5%). MALT was the most common histology (N=681, 46%), followed by follicular lymphoma (FL; N=407, 27.5%), and diffuse large B-cell lymphoma (DLBCL; N=310, 21%). Small lymphocytic lymphoma was the least common histology (CLL/SLL; N=3, 0.8%). A total of 1084 patients (73%) had surgery, 433 (29%) had systemic therapies and 691 (47%) had radiation. Median overall survival was 13 years [12-14.5; 95% CI]. Survival was different by histological type (Figure 1, P<0.001). Compared with MALT, DLBCL was associated with higher mortality (HR 2.05 [1.60-2.63], P <0.001), while FL was not significantly different (HR 1.11 [0.89-1.40], P=0.32); independent of other variables. In a multivariate model; surgery (HR 0.81 [0.66-0.99], P=0.042) and radiation (HR 0.67 [0.56-0.82], P <0.001), but not systemic therapies (HR 0.93 [0.76-1.15], P=0.55) were associated with lower mortality (Figures 2-4). Adjusted mortality decreased by a relative 3% annually (HR 0.97 [0.95-0.99], P=0.03). Conclusion: Primary parotid lymphomas are rare extranodal lymphomas affecting mostly elderly Caucasian women. Using a large population database, MALT was still the most common histology and carried a favorable prognosis with a median overall survival of greater than 10 years despite the high median age at diagnosis. DLBCL histology did significantly worse which highlights the need for potentially more aggressive interventions to improve outcomes. Surgery and radiation were associated with improved outcomes. Disclosures Yazbeck: Gilead Sciences: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees.