ABSTRACT
Higher comorbidity by the hematopoietic cell transplantation-comorbidity index increases rates of non-relapse mortality (NRM) and impairs survival following allogeneic hematopoietic transplantation. We explored the effects of cancer as a comorbid condition prior to allogeneic transplantation. Among 356 adult transplant recipients, 54 patients (15%) had 58 comorbid cancers. Among 33 solid cancers (9%), breast (n = 12; 20%) was most common; among 26 comorbid hematologic malignancies (i.e. separate hematologic malignancy not related to primary disease) (7%), lymphoma was most common (n = 14; 24%). In unadjusted analysis, increased risks for NRM were found for cancer comorbidity (HR 2.1, p < .001), solid tumor alone (HR 2.1, p < .001), and hematologic malignancy alone (HR 1.9, p = .03). Cancer comorbidity did not impair 2-year overall survival (HR 1.33, CI 0.92-1.94). Both hematologic and solid cancers likely contribute to elevated risks of nonrelapse mortality, unrelated to recurrence of the cancer comorbidity. Further study is indicated to validate these findings.
Subject(s)
Neoplasms/epidemiology , Aged , Aged, 80 and over , Cause of Death , Comorbidity , Female , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/methods , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasms/pathology , Neoplasms/therapy , Preoperative Period , Prevalence , Prognosis , Risk Factors , Transplantation Conditioning , Transplantation, Homologous , Treatment OutcomeABSTRACT
BACKGROUND: Despite newer-generation valves using smaller-sized sheaths, 10% to 20% of patients undergoing transcatheter aortic valve replacement (TAVR) require nonfemoral artery access for valve delivery. To avoid a transthoracic procedure, we have used transcarotid (TC) and transcaval (TCav) approaches in these patients. This study compared the results of a contemporary experience with transfemoral (TF), TC, and TCav approaches. METHODS: Between January 2015 and March 2017, 491 patients underwent TAVR at our institution, of which 463 were included in this analysis. Valve delivery was TF in 373 patients, TCav in 58, and TC in 32. Patient characteristics and outcomes, including 1-year survival, were compared. RESULTS: Preoperative demographics and postoperative outcomes were similar for the three groups with several exceptions. TCav patients had higher The Society of Thoracic Surgeons risk score than TF patients (8.0 ± 5.2 vs 6.1 ± 4.3, p = 0.004). Lung disease, cerebrovascular disease, and peripheral vascular disease were more common in TC and TCav patients. Median length of stay was 2 days for TF, 3 days for TC, and 4 days for TCav (TF vs TCav, p = 0.001). Procedural mortality, percentage discharged home, and the 30-day readmission rate were similar for all. Unadjusted Kaplan-Meier survival was also similar at 1 year (TF, 86%; TC, 83%; TCav, 80%). CONCLUSIONS: Patients unsuitable for TF TAVR treated with TC or TCav access had 30-day/in-hospital and 1-year survival similar to a contemporary cohort undergoing TF access. Avoiding surgical entry to the chest may offer procedural and intermediate-term outcomes equivalent to TF TAVR.
