Outcomes Among High-Risk and Standard-Risk Multiple Myeloma Patients Treated With High-Dose Chemotherapy and Autologous Hematopoietic Stem-Cell Transplantation.

BACKGROUND: Conventional cytogenetics and interphase fluorescence in-situ hybridization (FISH) identify a high-risk multiple myeloma population characterized by poor response and short survival. PATIENTS AND METHODS: We compared outcomes between high-risk and standard-risk myeloma patients who underwent autologous hematopoietic stem-cell transplantation (auto-HCT) at our institution between January 2005 and December 2009. High-risk myeloma was defined as -13/del(13q) or hypodiploidy in at least 2 metaphases of conventional cytogenetics, or -17/del(17p), t(4;14), t(14;16), t(14;20), hypodiploidy (< 45 chromosomes excluding -Y), or chromosome 1 abnormalities (+1q, -1p, t(1;x)) on FISH or conventional cytogenetics. RESULTS: Of 670 myeloma patients, 74 (11%) had high-risk myeloma. These high-risk patients had significantly lower overall response rates (74% vs. 85%; P < .01), shorter median progression-free survival (10.3 vs. 32.4 months; P < .001), and shorter overall survival (28 months vs. not reached; P < .001) than the standard-risk patients. Having only 1 high-risk cytogenetic abnormality or experiencing at least very good partial remission after auto-HCT independently predicted improved progression-free survival and overall survival (P < .05) in high-risk patients. CONCLUSION: Even in an era of novel therapies, cytogenetically identified high-risk myeloma patients have worse prognoses than standard-risk myeloma patients after auto-HCT, and having more than 1 high-risk cytogenetic abnormality further reduces survival.

Attitudes among medical and nonmedical university students toward the survivors of childhood abuse.

OBJECTIVE: Childhood sexual abuse (CSA) is increasing, and current studies should address issues such as stigmas and casual attitudes that may be amenable to intervention. Thus, we aimed to investigate the effects of education on the attitudes of medical students toward CSA survivors. METHOD: We divided medical students into 2 groups: preclinical and clinical medical students. We compare the attitudes of nonmedical students with the attitudes of medical students with respect to survivors of CSA. All participants were asked to complete a questionnaire about stigmatization. RESULTS: There were 572 students in our study, 347 of whom were enrolled in medical school. Of the 347 medical students, 151 were from the preclinical group, and 196 were from the clinical practice group. The remainder of the participants (n = 225) were in other fields of university. Of the medical students, 68.3% responded negatively about "asking a survivor of abuse to supervise their child for a few hours," whereas 62.7% of the nonmedical students responded negatively. When asked, "What would you think if your child wanted to marry a survivor of sexual abuse?", 72.9% of the medical students and 59.1% of the nonmedical students displayed negative attitudes toward that idea. Our research also found that significantly more preclinical students than clinical students would not want to be in a companionship/friendship with a CSA survivor at work (P = .015) or in their neighborhoods (P = .034). CONCLUSION: Both medical and nonmedical students seem to have negative thoughts about sexual abuse survivors, particularly when the issue involves their own children and/or social situations. Thus, the medical professionals must be careful and should avoid over interpretations of findings on childhood abuse studies that may lead to stigmatization.