Background.The European Population Register EUTOS for CML includes data on adult patients (n = 2904) diagnosed with Ph-positive (Ph+) and/or BCR-ABL1-positive (BCR-ABL1+) chronic myeloid leukemia (CML) in 20 European countries during the period from 2008 to December 2012. Russia took part in this study, having contributed 6.8 % of CML patients to the total number of patients in the Register.Aim.To estimate long-term treatment outcomes in patients with newly diagnosed CML in the Russian Federation in comparison with the data obtained for a pan-European population cohort of patients.Patients and methods.The cohort under study consisted of 197 patients from 6 Russia regions, all of whom were diagnosed with a Ph+ / BCR-ABL1 + CML during the period from October, 1, 2009 to December, 31, 2012. The patients’ median age was 50 (18–82) years, with men and women being represented in approximately equal proportions.Results.In the first line, 97 % and 3 % of the patients received Imatinib and 2nd generation tyrosine kinase (TKI) inhibitors, respectively. The response dynamics was as follows: 12 months after the treatment, a complete cytogenetic response and a major molecular response were achieved in 40 % and 20 % of the patients. The overall survival (OS) and progression-free survival rates in patients in Russia following 12, 24 and 30 months were 93 %, 87 % and 84 %, and 92 %, 87 % and 87 %, respectively. In Russia, the study was prolonged. By 80 months of observation, the OS of patients in the chronic CML phase with a low and high risk of the disease progression had been 88 % and 56 %, respectively. In the acceleration phase, the 5-year overall survival rate was 39 %.Conclusion.An analysis of treatment outcomes in CML patients in a population-based non-selected sample indicates an increase in the survival of CML patients. However, problematic aspects of the therapy have been identified, along with a need for intensification of the treatment in patients with an unfavourable CML prognosis.
Background. Since 2018 a widespread national project “Healthcare” has been implemented in the Russian Federation (RF) to improve the quality, efficiency, availability, and affordability of medical care in the profiles of specialties in constituent entities of the RF. Modern hematology as a medical field of high technology and crucial solutions is notable for its multi- and interdisciplinarity of most nosological forms, complexity of diagnostic process, multi-structuredness and diversity of related physician teams in different structural units and subdivisions. One of the key issues in federal proj ects is to determine the indicators for assessing the efficiency of regional hematological services in constituent entities of the RF. Aim. To elaborate and substantiate a new integrated operational efficiency index for hematological services in constituent entities of the RF. Materials & Methods. The analysis of data and assessment of feasibility of a new integrated operational index “early mortality in acute leukemia” (AL) were based on the results of 5 multi-center trials, including an epidemiological one. Results. Multi-center clinical studies on AL are the only objective tools for assessing the treatment efficacy, its improvement, and further training of hematologists taking part in the trials. AL treatment requires well-developed infrastructure of hematological services involving not only staff matters and organization of hematologists’ activities, but also management of many highly important related subdivisions and laboratories, logistics of their interaction, time specifications, meeting clinical guidelines, and lastly, and most importantly, financial support. Conclusion. The Unified State Information System “Hematology” is the only platform providing the objective information on patients’ vital status and enabling the use of the suggested integrated index for assessing the quality and efficiency of hematological services in the regions of the RF. This indicator of early mortality in AL patients less than 60 years of age is 15 % for acute myeloid leukemias and 10 % for acute lymphoblastic leukemias. Its low values would demonstrate that this or that constituent entity of the RF is provided with sufficient infrastructure, technologies, and a professional team to keep those patients alive who have severe but curable hematological diseases. The indicator of long-term survival or “life years gained” should become the main strategic criterion for the therapy efficacy in hematological diseases.
Introduction and data: Social and demographic personal data are important to be included in analysis and interpretation of results of any population studies in oncology. But it looks like social status is underestimated as cofounder for survival of patients with chronic myeloid leukemia (CML). The aim of this study was to check the prognostic value of social parameters like marital status and education level in comparison with standard risk factors. Russian CML Registry include more than 10 thousand patients (pts) data. In the analysis 8326 CML pts in chronic phase (CP) with first line TKI therapy were included: 91% of pts were treated by Imatinib and 9% by other TKIs. Mean age was 49years, 4607 f/ 3705 m. Me of follow-up-4.24years. Overall survival(OS) was estimated starting the diagnosis date, event was death from any reason, date of last contact was censored for alive pts. Survival analysis was performed by SAS procedures. Results:Firstly, we perform one-way survival analysis and estimate OS depending upon the 3 parameters Sokal Score, Marital Status and Education. There are high significant dependences OS on all three factors as shown on picture 1 (OS estimates depending on values of: 1A) Sokal score (low, intermediate, high), 1B) Marital Status (married, single, widowed/divorced), 1C) Education (low/secondary, higher). Marital Status and Education are correlated with Sokal Score (corresponding Pearson's coefficients are 0.19 and 0.12, p<0.0001). This association is caused by age but is not so strong. Than we have estimate OS in each Sokal's risk groups (picture 2. OS estimates depending on Marital Status (single, married - blue line, widowed/divorced - green line) in different Sokal's risk groups: 2A) - low, 2B) - intermediate, 2C) - high). OS estimates depending on Education (picture 3; (low/secondary red line, higher- blue line) in different Sokal's risk groups: 3A) low, 3B) intermediate, 3C) high. And we see that Marital Status and Education are predictive in each risk group but the most influent in high risk group. Marital Status and Education are correlated with other impotent cofounder- age. It should be checked in additional multi factor analysis we plan to do. We also run the proportional risk regression Cox's model on this data. Hazard ratio (HR) and significance (Px2) for included parameters are following: Sokal score - HR=1.59, Px2<0.0001; Education- HR=1.76, Px2<0.0001; Marital Status- HR=1.40, Px2<0.0006. Conclusions: The social and demographic personal data should be included in any analysis of CML population data. Marital Status and Educationare obviously associated with adherence behavior of CML patients and must influent on longitude therapy output. The highly education level is favorable factor, widowed/divorced marital status is unfavorable factor for OS prognosis. Figure. Figure. Disclosures Kulikov: Russian Foundation for Basic Research grant 18-015-00399 A: Research Funding. Turkina:Novartis: Other: provided consultations; Bristol Myers Squibb: Other: provided consultations; Phizer: Other: provided consultations; Fusion Pharma: Other: provided consultations.
Subject. The depth of the overbite increases with age. With the loss of teeth secondary deformations of the dentition, dysfunctions, teeth wearing, periodontal disease and temporomandibular joint (TMJ) dysfunctions occurs, facial aesthetics is affected. The urgency of the topic depends on the high prevalence of anomaly and self-destruction of the orofacial system (OFS) with deep overbite in adults. The aim was to identify the factors of decompensation of the dentition in adults with deep overbite. Methodology. Clinical (questioning, examination, functional tests), anthropometric (photo analysis, casts’ analysis, Shimbachi index) methods and X-ray analysis(cephalometry, analysis of zonograms of TMJ, orthopantomography) were performed for 84 adult patients with deep overbite more than 3 mm (GRP) and Angle Class I or II. All patients were divided into 2 main groups according to the size of overjet: OG-1 ― 42 people with a normal overjet (2 ± 2 mm) between the incisors; OG-2 ― 42 people with an enlarged overjet (more than 4 mm). We used the MSUMD classification of malocclusion (1991). The results of the examination of the patients in 2 main groups were compared with each other and with the average structure of the OFS in patients with physiological occlusion. We have identified specific clinical, anthropometric, and radiological groups of symptoms of decompensation in OFS, which are common for adults with GRP. Conclusions. In adult patients with GRP the main factor of decompensation in OFS is lower jaw displacement. In the development of displacement of the lower jaw a few factors are important: transversal disproportion of the dentition; sagittal jaw disproportion; loss of posterior teeth. The loss of the teeth, the reduction of the interalveolar height and the associated functional and aesthetic problems are adaptive mechanisms for the displacement of the mandible.
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