The rare myelomas, immunoglobulin (Ig)D, IgM, and non-secretory, have been associated with poorer outcomes following treatment than the common myelomas (IgG, IgA, and light-chain only). We show... Show moreThe rare myelomas, immunoglobulin (Ig)D, IgM, and non-secretory, have been associated with poorer outcomes following treatment than the common myelomas (IgG, IgA, and light-chain only). We show that even with "novel" therapies, augmented with autologous transplantation, this remains true for IgD myeloma. In contrast, IgM and non-secretory myelomas have a prognosis similar to the usual myelomas.Background: The Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study has provided an opportunity to evaluate the real-world outcomes of patients with myeloma. The aim of this study was to compare the outcome according to the different subtypes of myeloma using CALM data. Patients: This study compared overall survival (OS), progression-free survival (PFS), and complete remission (CR) and the impact of novel versus non-novel drug containing induction regimens prior to autologous hematopoietic cell transplantation (HCT) of 2802 patients with "usual" and "rare" myelomas. Results: Our data suggest that IgM and non-secretory myeloma have superior PFS and OS compared with IgD myeloma and outcomes comparable to those for usual myeloma. Patients who received novel agent induction had higher rates of CR prior to transplant. Non-novel induction regimens were associated with inferior PFS but no difference in OS. Although not the primary focus of this study, we show that poor mobilization status is associated with reduced PFS and OS, but these differences disappear in multivariate analysis suggesting that poor mobilization status is a surrogate for other indicators of poor prognosis. Conclusion: We confirm that IgD myeloma is associated with the worst prognosis and inferior outcomes compared with the other isotypes. (C) 2021 Elsevier Inc. All rights reserved. Show less
Background Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF... Show moreBackground Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry. Methods We described the real-life clinical epidemiology, therapeutic strategies, and the short- and mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (<2 years or >= 2 years). Results The mean AF history duration was 46.2 +/- 57.4 months, 592 patients had an AF history duration <2 years (mean 10.2 +/- 5.9 months), and 1356 patients >= 2 years (mean 75.5 +/- 63.5 months) (P < 0.001). Patients with AF history duration <2 years were younger; had a lower incidence of hypertension, coronary artery disease, and hypertrophic cardiomyopathy; and had a lower CHA(2)DS(2)-VaSc Score. At 1 year, the logrank test showed a lower incidence of AF recurrence in patients with AF history duration <2 years (28.9%) than in patients with AF history duration >= 2 years (34.0%) (P = 0.037). AF history duration >= 2 years, overall ablation procedure duration, hypertension, and chronic kidney disease were all predictors of recurrences after the blanking period. Conclusions In this multicenter registry, performing catheter ablation in patients with an AF history >= 2 years was associated with higher rates of AF recurrences at 1 year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified. Show less
