Quality of life and care in leukemia, myeloma and non-malignant disease. Opinions of patients and relatives, and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P less than 0.05). Similarly, relatives of decreased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P less than 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P less than 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P less than 0.001). The opinions of patients were similar to those of their relatives. However, the relatives of leukemia patients were even more satisfied with the contact with the medical staff than the patients themselves (P less than 0.05). As many as 10-30% of the relatives never gave up hope for their relative's survival. Only two out of 27 deaths were considered not dignified. The lung carcinoma patients reported a less good quality of life (P less than 0.001), and less satisfaction with the information given (P less than 0.01), than the hematological patients from the same year. Similarly, their attitude to the medical care improved less (P less than 0.01), and they were less content with the general care than the leukemia group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Diet and risk of multiple myeloma in Connecticut women

Multiple myeloma accounts for an estimated 19,900 incident cancer cases per year in the United States. A population-based case–control study, consisting of 179 incident cases and 691 controls, was conducted to examine the impact of diet on multiple myeloma risk. Diet was assessed using a food frequency questionnaire and odds ratios, 95% confidence intervals, and P-trends were calculated across quartiles of consumption. After controlling for potential confounders, we observed inverse associations for cooked tomatoes (P-trend = 0.002), cruciferous vegetables (P-trend = 0.01), fresh fish (P-trend < 0.001), alcohol (P-trend < 0.001), and vitamin A (P-trend < 0.001) with multiple myeloma risk. In contrast, consumption of cream soups (P-trend = 0.01), jello (P-trend = 0.01), ice cream (P-trend = 0.01), and pudding (P-trend < 0.001) were positively associated with multiple myeloma. Furthermore, there was a suggestion that carbohydrate intake may be positively associated, whereas vitamin D and calcium intake may be inversely associated, with multiple myeloma risk. Despite very limited data on dietary factors in relation to multiple myeloma, the findings from this study concur with previously published studies, suggesting an inverse association for consumption of fish, cruciferous vegetables and green vegetables, and a positive association for some dairy products.     

The relationship between the erythrocyte polyamine levels and the different types of leukemia

In a study on erythrocyte polyamine levels in 20 leukemia patients and 18 healthy individuals, following results were obtained. Putrescine(Pu) in erythrocytes was nearly undetectable but in 2 AMoL patients; Spermidine(Spd) level in ALL was higher than the control volue (P<0.05), in AML (M₁, M₂) and APL the Spd level was in the range of control group (P>0.1), while that in AMoL and AMMoL was considerably lower as compared to control (P<0.001); Spermine (Spm) level in all types of leukemia was increased (P<0.001); Spd/Spm ratio was significantly decreased, showing 1.525 in control group, 0.938 in ALL (P<0.025), 0.779 in AML (M₁, M₂)P<0.01), 0.319 in APL (P<0.001) and 0.296 in AMoL & AMMoL (P<0.001), and the differences between the Spd/Spm ratio in AMoL and AMMoL and in ALL were noted (P<0.05). These results suggested that determination of erythrocyte polyamines in leukemia patients may be helpful in diagnosis, differential diagnosis and prognosis.     

Familial occurrence of hematologic malignancies and other diseases in multiple myeloma: a case-control study

In a population-based case-control study in Sweden on multiple myeloma, the occurrence of different diseases in relatives, particularly hematologic malignancies and different types of cancer, was investigated. Through a questionnaire mailed to all living subjects, i.e. cases and controls, and to the next-of-kin for deceased subjects, information was obtained on malignant and certain other diseases among relatives. All malignant diseases reported among first-degree relatives were verified, if possible, through parochial authorities and the Swedish Cancer Register. In total, data from 239 cases with myeloma and 220 controls were analyzed. An increased risk was found for persons with first-degree relatives with hematologic malignancies (relative risk [RR]=2.36, 90 percent confidence interval [CI]=0.90–6.15), and also with multiple myeloma specifically (RR=5.64, CI=1.16–27.51). An increased risk also was seen if the close relatives had experienced another tumor disease (RR=1.21, CI=0.86–1.71). Particularly, occurrence of prostatic cancer (RR=3.11, CI=1.25–7.71) or brain tumor (RR=6.61, CI=1.42–30.67) in relatives increased the risk for multiple myeloma.Dr Eriksson in with the Department of Oncology, University Hospital, S-901-85 Umeå, Sweden. Dr Hållberg is with the Department of Statistics, Umeå University, Umeå, Sweden. Address correspondence to Dr Eriksson. This research was supported by grants from the Swedish Cancer Fund. (Project 2683-B90-02X.)     

Patient satisfaction with doctor–patient interaction in a radiotherapy centre during the severe acute respiratory syndrome outbreak

An outpatient radiotherapy department assessed how precautions implemented during the severe acute respiratory syndrome (SARS) outbreak affected patient satisfaction with doctor–patient interaction and explored variables potentially influencing satisfaction. The information obtained would help prepare us for future infectious disease outbreaks. Outpatients seen during the outbreak completed a validated questionnaire assessing satisfaction with doctor–patient interaction. Additional items assessed included patients’ perception of SARS measures and patient demographics. Of 149 patients, 97% had heard of SARS, 92% believed SARS precautions necessary, and 54% believed contracting SARS was possible despite the precautions. Patients were satisfied with doctors wearing masks (97%), temperature checks (97%), and patients wearing masks (96%). Despite the high satisfaction levels with SARS precautions, 24% believed it had adversely affected doctor–patient interaction. With regards to doctor–patient interaction, 94% of patients were satisfied. Patients were most satisfied with the ‘information exchange’ domain (mean score 3.23 out of 4) compared to other domains (P < 0.0001, 100.00% confidence) and were less satisfied with the ‘empathy’ domain compared to other domains (P < 0.0001, 100.00% confidence). Patients were most satisfied with understanding their treatment plan (100%), doctor being honest (97%) and being understood (96%). Patients were least satisfied with information about caring for their illness (61%), that the visit could be better (59%), and the doctor showing more interest (58%). On multivariate analysis, patients who were less satisfied with SARS measures were significantly less satisfied with doctor–patient interaction (P = 0.0001). Dissatisfaction with SARS measures was associated with significant dissatisfaction for questions in all domains. Older age and non‐breast cancer patients were also less satisfied with doctor–patient interaction. Most (94%) of patients were satisfied with doctor–patient interaction, despite implementation of infectious disease prevention measures. However, patients who were dissatisfied with the SARS precautions had poorer satisfaction. In particular, physician empathy appeared to be most adversely affected. The results have relevance to any radiotherapy department preparing contingency plans in the event of infectious disease outbreaks.     

Changing clinical presentation of multiple myeloma

We compared the presentation features of three series of patients with multiple myeloma diagnosed between 1960 and 1971 (Kyle R, Mayo Clin Proc, 1975, 50, 29, n = 869), 1972 and 1986 (Clinica Medica, University of Pavia, n = 345) and 1987 and 1990 (Cooperative Group for Study and Treatment of Multiple Myeloma, n = 341). In the most recently diagnosed patients, the percentage of those who had symptoms related to multiple myeloma (i.e. any of bone pain, systemic symptoms, disturbances related to hypercalcemia, neurological involvement and hyperviscosity) was reduced (90 vs. 86 vs. 66%) (P < 0.001), while the percentage of asymptomatic patients diagnosed by chance was increased (not reported, and 14 vs. 34%). In the most recent series, a lower percentage of spontaneous bone pain (68 vs. 60 vs. 37%, P < 0.001) paralleled a lower incidence of advanced bone disease (osteolyses and pathological fractures, 60 vs. 64 vs. 34%), and renal failure (serum creatinine > 1.2 mg/dl) was also less common (56 vs. 44 vs. 33%, P < 0.01), at least partially due to a decreased incidence of both hypercalcemia (30 vs. 20 vs. 18%, P < 0.001) and of hyperuricemia (serum uric acid >7 mg/dl, 47 vs. 32 vs. 26%, P < 0.01). Systemic symptoms (weakness, infections, fever or weight loss) were reported more seldom by recently diagnosed patients, due to a decreased frequency of anaemia (haemoglobin < 12 g/dl), leukopenia and thrombocytopenia, as well as of the systemic effects of bone pain and of renal insufficiency. These data indicate that multiple myeloma is diagnosed earlier now than in the past, and this must be taken into account when comparing survival data in treated series.     

Comparison of patients' needs and doctors' perceptions of information requirements related to a diagnosis of oesophageal or gastric cancer

WITTMANN E., BEATON C., LEWIS W.G., HOPPER A.N., ZAMAWI F., JACKSON C., DAVE B., BOWEN R., WILLACOMBE A., BLACKSHAW G. & CROSBY T.D.L. (2010) European Journal of Cancer Care 20 , 187–195 Comparison of patients' needs and doctors' perceptions of information requirements related to a diagnosis of oesophageal or gastric cancer The aim of this study was to assess the information needs of patients diagnosed with oesophageal and gastric cancer and to compare these with their perceived information needs in the opinion of junior doctors. One hundred patients and 100 doctors responded to a questionnaire regarding the information needs of cancer patients. Seventy‐nine per cent of patients wanted as much information as possible about their diagnosis, but only 35% of doctors were willing to give all the available information (P < 0.0001). Seventy‐seven per cent of patients wanted to receive their diagnosis from a consultant whereas only 5% of doctors believed that patients should receive their diagnoses from a consultant (P < 0.0001). Eighty‐four per cent of doctors were willing to communicate a serious illness with a good prognosis, yet only 43% would communicate a diagnosis with a poor prognosis (P < 0.0001). All 100 doctors had received formal training in breaking bad news, but 20 considered this inadequate. Socio‐economic deprivation was associated with poor access to supplementary Internet derived information (P < 0.001). The majority of patients with a diagnosis of oesophagogastric cancer want a great deal of information regarding their illness, which contrasts with doctors' perceptions. Adequate training in information disclosure may help address this issue.     

Prognostic Value of Ki67 and VEGF Expression in Laryngeal Squamous Cell Carcinoma

OBJECTIVE To investigate the prognostic value of measuring Ki67 and VEGF expression in laryngeal squamous cell carcinoma （LSCC）. METHODS The expression of Ki67 and VEGF in 32 LSCC tissues was studied by immunohistochemical staining. Of these cases, 5 recurred （recurrent group）, 3 cases metastasized （metastatic group）, 8 cases died （deceased group） and 24 cased survived （survival group） over a 3 year period of follow-up after their operation. RESULTS The expression of Ki67 and VEGF in the deceased group was higher compared to that in the survival group （P〈0.01）. Overexpression of Ki67 was found in the recurrent group and in the metastatic group （P〈0.05）. VEGF expression was higher in the recurrent group than in the non recurrent group （P〈0.05）. With Cox-regression of multivariate analysis, Ki67 （RR：3.236; P=0.001）, the clinical T stage （RR：1.382; P=0.029） and metastasis in lymph nodes （RR：0.316; P=0.033） were shown to be independent prognostic factors for survival of LSCC patients. CONCLUSION Ki67 and VEGF expression is related to the prognosis of LSCC. Overexpression of the 2 markers indicated poor prognosis of the disease, a finding which might be helpful for the treatment of laryngocarcinoma.     

Circulating markers of angiogenesis,inflammation, and coagulation in patients with glioblastoma

Inflammation, angiogenesis, and coagulation are linked to the development of cancer. In glioblastoma, microvascular proliferation is a hallmark, and lymphocytic infiltration is a common finding. Thromboses are frequent in patients with glioblastoma. The objective of this study was to assess presurgical levels of circulating markers of inflammation, angiogenesis, and coagulation in a prospective series of patients with glioblastoma, and to explore their correlations and possible associations with clinical findings. Angiogenesis markers included were vascular endothelial growth factor (VEGF), soluble vascular endothelial growth factor-receptor 1 (sVEGFR-1), and thrombospondin-1 (TSP-1). Inflammatory markers included were C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα), and sialic acid (SA). Coagulation markers included were fibrinogen (Fg), endogen thrombin generation (ETG), prothrombin fragments 1 + 2 (F1 + 2), and tissue factor (TF). Forty-seven patients and 60 healthy subjects were included in the study. Signs of tumor necrosis in presurgical MRI were associated with shorter survival (P < 0.01). All inflammation markers, F1 + 2, ETG, VEGF and sVEGFR-1, were significantly elevated in glioblastoma patients. Correlations were found between ETG and Fg (r = 0.44, P < 0.01). Sialic acid correlated with Fg (r = 0.63, P < 0,001); CPR correlated with SA (r = 0.60, P < 0.001), Fg (r = 0.76, P < 0.001), TNFα (r = 0.56, P < 0.001), and IL-6 (r = 0.65, P < 0.001); and IL-6 also correlated positively with TNFα (r = 0.40, P < 0.02) and Fg (r = 0.45, P < 0.01). Vascular endothelial growth factor inversely correlated with sVEGFR-1 (r = −0.35, P < 0.02). No associations were found between marker levels and survival or progression-free survival.     

Multivariate analyses of prognostic factors associated with hematopoietic recovery in autograft patients with different sources of progenitor cells: A GATMO experience

OBJECTIVE:: To evaluate in a multivariate analysis the prognostic factorsassociated with hematopoietic recovery and the supportive carerequirements after autotransplant of progenitor cells (PC) fromvarious sources: bone marrow (BMPC), BMPC & peripheral blood(PBPC), and PBPC alone. PATIENTS AND METHODS:: A total of 570 patients with hematological malignancies andsolid tumors underwent high-dose therapy followed by autotransplant.PBPC were obtained after mobilization with chemotherapy and/orcytokines. One-hundred five patients received BMPC, 217 receivedBMPC & PBPC and 248 PBPC alone; all of the patients receivedG-CSF or GM-CSF after infusion. RESULTS:: In a multivariate analysis the recovery of neutrophils was adverselyassociated with low numbers of nucleated cells infused (P<0.13),bone marrow progenitor cell source, and diagnosis of multiplemyeloma and acute leukemia (P<0.001). The factors that adverselyaffected platelet recovery were low number of nucleated cellsand diagnosis of multiple myeloma and acute leukemia (P<.001). CONCLUSION:: We conclude that BMPC adversely affect neutrophil recovery whilelow numbers of nucleated cells and diagnosis of multiple myelomaand acute leukemia adversely affect both neutrophil and plateletrecovery. autograft, bone marrow, hematological recovery, peripheral blood, progenitor cells, prognostic factors     

High expression of TRIM44 is associated with enhanced cell proliferation,migration, invasion,and resistance to doxorubicin in hepatocellular carcinoma

Dysregulation of TRIM44 has been reported to be involved in tumorigenesis, but its role in hepatocellular carcinoma (HCC) remains unclear. In the present study, we investigated the clinicopathological and biological significance of TRIM44 in HCC. We found that TRIM44 mRNA and protein expression was upregulated in HCC compared with matched normal tissues. Intriguingly, we also found that TRIM44 expression was significantly correlated with tumor size (P < 0.001), vascular invasion (P < 0.001), intrahepatic metastasis (P < 0.001), distant metastasis (P < 0.001), and Ki-67 expression (P < 0.001). Kaplan-Meier analysis showed that high TRIM44 staining was significantly correlated with shorter overall survival (P < 0.001). TRIM44 was an independent predictor of overall survival in patients with HCC. Furthermore, we found that ectopic expression of TRIM44 could promote cell proliferation via accelerating the G1/S-phase transition in HCC. Moreover, overexpression of TRIM44 could enhance the invasive and migratory capacity of HCC cells. Meanwhile, we found that high expression of TRIM44 could enhance resistance of HCC cells to doxorubicin via accelerating NF-κB activation. In conclusion, our results suggest that TRIM44 may be a novel prognostic indicator and potential therapeutic target of HCC.

     

Univariate and multivariate analyses of the prognostic significance of discontinuous intramural metastasis in patients with esophageal cancer

A review of 167 cases of esophageal carcinoma without preoperative treatment revealed 24 (14.4%) to have intramural metastasis (IM) within the esophagus. Among the clinicopathologic factors, the length of the lesions (P < 0.01), lymph node metastasis (P < 0.001), and the depth of the invasion of the tumor (P < 0.0001) were found to be statistically significant different factors between the two groups of patients both with and without intramural metastasis. The survival curve for patients with IM was significantly lower than that for patients without IM (P < 0.0001). A univariate analysis revealed that the depth of invasion, lymph node metastasis, IM (P < 0.0001), and the length of the lesion (P < 0.001) all had a significant correlation with the prognosis. Moreover, in a multivariate analysis, the depth of the invasion (<0.001), length of the lesion (0.001), and IM (0.049) were all determined to be significant prognostic factors. Therefore, IM is considered to be one of the independent significant prognostic factors for predicting a poor prognosis in esophageal cancer. © 1994 Wiley-Liss, Inc.     

Clinicopathologic features and prognosis analysis of mucinous gastric carcinoma

Mucious gastric carcinoma (MGC) is a subtype of gastric carcinoma and its clinicopathologic features and prognosis still remain unclear. To investigate the clinical significance and surgical outcomes of mucinous gastric carcinoma, 2,769 patients with gastric carcinoma were analyzed in a case control study. We reviewed the records of 196 patients with mucinous gastric carcinoma and 2,573 with nonmucinous gastric carcinoma (NGC). Clinicopathologic features and survival rate of patients were analyzed. In all registered patients, patients with MGC had a larger size, more T3 and T4 invasion to the gastric wall, more positive lymph node metastasis, more III and IV stage and more positive peritoneal dissemination, but less curative gastrectomy. In curative gastrectomy patients, MGC had larger size, deeper invasion to gastric wall, more positive lymph node metastasis and more advanced TNM stage. The overall survival rate in curative gastrectomy patients with MGC was significantly lower than that for patients with NGC (P < 0.021). Age (P = 0.001), location of tumor (P < 0.001), Borrmann type (P = 0.037), depth of invasion (P < 0.001), lymph node metastasis (P < 0.001) and lymphovascular invasion (P = 0.001) were independent prognostic factors of gastric carcinoma, but MGC itself was not. The prognosis of MGC did not have significant difference compared with NGC. Frequently, MGC was of advanced stage at the time of diagnosis. Age, location of tumor, Borrmann type, depth of invasion, lymph node metastasis and lymphovascular invasion are independent prognostic factors of gastric carcinoma, but mucinous histological type itself is not. Further study on the origin and progression of MGC is needed in future.     

Compliance and Satisfaction with Long-Term Surveillance in Finnish HNPCC Families

Objective: Nation-wide preventative colonoscopic surveillance for mutation carriers in HNPCC families has been organized since the early 1980 by the Finnish HNPCC registry. After characterization of MMR genes, a predisposing mutation has been verified in 111 HNPCC families and over 1500 family members at risk have been tested. The aim of this study was to evaluate the compliance and satisfaction of mutation carriers during life-long colonoscopic surveillance. Materials and Methods: Hospital records of long-term surveillance were obtained for all mutation carriers (n=664). A questionnaire assessing overall experience, willingness to continue the surveillance, painfulness (a three-rank scale), possible interruption of endoscopy and the need for pain relief medication during colonoscopy, was sent to all living mutation carriers (n=587). The questionnaire was returned by 441 persons (75%) of whom 415 persons under colonoscopic surveillance were included in the study and 26 young mutation carriers excluded as they were still pending their first endoscopy. Results: Out of 664 mutation carriers, surveillance had been interrupted in 8 cases (1.2%). Colonoscopies were described as painful by 151 (36%), uncomfortable by 161 (39%) and easy by 103 (25%) patients. Endoscopy was more often rated as painful by females (1.36, SD 0.71) than by males (0.86, SD 0.75), P<0.001. Medication for pain during colonoscopies was administered more often to females (32%) than males (15%), P<0.001. Colonoscopy had to be discontinued because of pain at least once in 10% of the patients. Conclusion: Patient compliance under life-long surveillance was excellent, but painfulness, especially in females, must be seen as a risk for compliance and the quality of endoscopies.     

Investigation of QOL after Laryngectomy Using the UW-QOL Questionnaire with Chinese Patients

OBJECTIVE To assess the postoperative QOL(Quality of Life) of Chinese laryngeal cancer patients who have undergone a partial or total laryngec-tomy, and to analyze their prognostic factors, as well as to assess the feasibility of using the University of Washington Quality of Life (UW-QOL) questionnaire in QOL studies of laryngeal cancer patients, METHODS Using the UW-QOL questionnaire, a survey was conducted in patients treated by a partial or total laryngectomy for laryngeal cancer. RESULTS Questionnaires were sent to 142 patients who were disease-free for more than half a year after surgery. Replies were received from 130 patients (91% response rate) with 118 patients completing the questionnaire. These patients were divided into 2 groups: a partial-laryngectomy group (n=81; excluding cordectomy) and a total -laryngectomy group (n=37). The composite QOL scores of the partial-laryngectomy group (692.3±127.9) were higher than those of total-laryngectomy group (636.4±140.0), showing a statistically significant difference (P<0.05). The partial-laryngectomy group (74.3±23.8; 80.9±20.3) was better than the total-laryngectomy group (40.3±25.8; 69.6±27.1) in speech and appearance (P<0.001; P<0.05); but the total-laryngectomy group (92.6±13.0) was superior to the partial-laryngectomy group (83.0±20.5) in pain (P< 0.01). Six factors including cancer stage, operative modality, complications, postoperative radiotherapy or chemotherapy, living partners and chronic disease before or after operation were related to postlaryngecto-my QOL. CONCLUSION Partial laryngectomy is superior to total laryngectomy in speech, appearance and overall QOL. Besides operative modality, cancer stage, complications, postoperative radiotherapy or chemotherapy, living partners and chronic diseases before or after operation are factors influencing postlaryngectomy QOL. As a whole, the UW-QOL questionnaire is a good instrument for studying QOL of laryngeal cancer patients in China, and it can be used to explore the QOL outcomes obtained from different reconstructive techniques.     

Cervical cancer screening in Kolkata,India: Beliefs and predictors of cervical cancer screening among women attending a women’s health clinic in Kolkata,India

Background. Proportionally, India has the highest mortality from cervical cancer in the world. Methods. A 2nd-year medical student recruited 299 women from a gynecology clinic in Kolkata, India who completed a questionnaire assessing demographic information; health care history; Pap test utilization; and knowledge, beliefs, and attitudes about cervical cancer and screening. Results. A total of 10% had received a Pap test at least once. Most women reported “limited” to “no” knowledge of cervical cancer (84%) and the Pap test (95%). Age (P<.013) and perceived knowledge of a Pap test (P<0.001) were significant predictors of first-time screening. Conclusions. Findings suggest a need to increase cervical cancer awareness in the community and to develop community-based screening programs.     

Therapy related acute myeloid leukemia in breast cancer survivors,a population-based study

The aim of this study was to determine the association between age and stage at diagnosis of breast cancer with the subsequent development of acute myeloid leukemia (AML). The National Cancer Institute’s Surveillance, Epidemiology, and End Results program were analyzed for incidence of second malignancies by age and stage at diagnosis of breast cancer. 420,076 female patients were identified. There was an age dependent risk of a subsequent diagnosis of AML in women younger than 50 years old (RR 4.14; P < 0.001) and women 50–64 years old (RR 2.19; P < 0.001), but not those 65 and older (RR 1.19; P = 0.123) when compared with the expected incidence of AML. A similar age dependent pattern was observed for second breast and ovarian cancers. There was also a stage dependent increase in risk of subsequent AML in younger women with stage III disease when compared with stage I disease (RR 2.92; P = 0.004), and to a lesser extent in middle age women (RR 2.24; P = 0.029), but not in older women (RR 0.79; P = 0.80).Younger age and stage III disease at the time of breast cancer diagnosis are associated with increased risk of a subsequent diagnosis of AML. This association maybe explained by either greater chemotherapy exposure or an interaction between therapy and genetic predisposition.     

Differences among young adults,adults and elderly chronic myeloid leukemia patients

BackgroundThe incidence of chronic myeloid leukemia (CML) increases with age, but it is unclear how the characteristics of the disease vary with age. In children, where CML is very rare, it presents with more aggressive features, including huge splenomegaly, higher cell count and higher blast cell percentage.Patients and methodsTo investigate if after childhood the disease maintains or loses these characteristics of aggressiveness, we analyzed 2784 adult patients, at least 18 years old, registered by GIMEMA CML WP over a 40-year period.ResultsYoung adults (YAs: 18–29 years old) significantly differed from adults (30–59 years old) and elderly patients (at least 60 years old) particularly for the frequency of splenomegaly (71%, 63% and 55%, P < 0.001), and the greater spleen size (median value: 4.5, 3.0 and 1.0 cm, P < 0.001). According to the EUTOS score, that is age-independent, high-risk patients were more frequent among YAs, than among adult and elderly patients (18%, 9% and 6%, P < 0.001). In tyrosine kinase inhibitors-treated patients, the rates of complete cytogenetic and major molecular response were lower in YAs, and the probability of transformation was higher (16%, 5% and 7%, P = 0.011).ConclusionsThe characteristics of CML or the host response to leukemia differ with age. The knowledge of these differences and of their causes may help to refine the treatment and to improve the outcome.Clinical trial numbersNCT00510926, NCT00514488, NCT00769327, NCT00481052.