Amy Karon

SCOTTSDALE, ARIZ. – Although cost-effective, a mobile phone appointment reminder service only minimally increased attendance rates at dermatology outpatient clinics, according to a large longitudinal study.

“There was a small, statistically significant increase in attendance at the adult dermatology clinic, but there was very little effect at satellite and specialty dermatology clinics,” said Dr. Noori Kim of Johns Hopkins University in Baltimore.

Baseline attendance rates were high, exceeding 80%, so perhaps mobile phone appointment reminders have little effect in that setting, she said. In addition, most reminders were by phone call, not text, which could have limited their efficacy if patients did not answer the phone or listen to their voicemail, Dr. Kim added during an oral presentation at the annual meeting of the Society for Investigative Dermatology.

©Hocus Focus Studio/iStockphoto.com

When patients miss medical appointments, it’s usually because they forget them. In this study, the first to assess mobile phone appointment reminders in dermatology, the investigators compared daily attendance at Johns Hopkins outpatient dermatology clinics before and after implementing an automated mobile phone appointment reminder system. The baseline time period without the service spanned four months in 2014, while the comparison period with the system covered the same four-month period a year later.

Patients kept 90% of 11,455 dermatology appointments scheduled during the pre-service period. A year later, the attendance rate was nearly identical, at 89%. Likewise, there were no statistically significant changes in attendance at Johns Hopkins specialty, satellite, pediatric dermatology, and pediatric laser clinics.

In contrast, attendance at the adult dermatology clinic rose by about three percentage points after the service was implemented, from 81% (2,530 visits attended of 3,141 scheduled) to 84% (2,965 visits attended of 3,533 scheduled), and the difference was statistically significant.

“About 88% of reminders were answered across sites, with little variance. The cost was about $5,500 for a 17-month period,” Dr. Kim said. She noted that 71% of patients opted into the service at the adult clinic with the increased attendance rate, compared with about 30% of patients at the other clinics that showed no statistically significant increase in attendance rates.

The “strong continuity already present between patients and providers” and high baseline attendance rates might have limited any effects of mobile phone messaging at these other clinics, she said. Attendance rates also did not change significantly at three Johns Hopkins dermatology clinics that never implemented mobile phone reminders, she noted.

Dr. Kim reported no funding sources and had no disclosures.

SCOTTSDALE, ARIZ. – Although cost-effective, a mobile phone appointment reminder service only minimally increased attendance rates at dermatology outpatient clinics, according to a large longitudinal study.

“There was a small, statistically significant increase in attendance at the adult dermatology clinic, but there was very little effect at satellite and specialty dermatology clinics,” said Dr. Noori Kim of Johns Hopkins University in Baltimore.

Baseline attendance rates were high, exceeding 80%, so perhaps mobile phone appointment reminders have little effect in that setting, she said. In addition, most reminders were by phone call, not text, which could have limited their efficacy if patients did not answer the phone or listen to their voicemail, Dr. Kim added during an oral presentation at the annual meeting of the Society for Investigative Dermatology.

©Hocus Focus Studio/iStockphoto.com

When patients miss medical appointments, it’s usually because they forget them. In this study, the first to assess mobile phone appointment reminders in dermatology, the investigators compared daily attendance at Johns Hopkins outpatient dermatology clinics before and after implementing an automated mobile phone appointment reminder system. The baseline time period without the service spanned four months in 2014, while the comparison period with the system covered the same four-month period a year later.

Patients kept 90% of 11,455 dermatology appointments scheduled during the pre-service period. A year later, the attendance rate was nearly identical, at 89%. Likewise, there were no statistically significant changes in attendance at Johns Hopkins specialty, satellite, pediatric dermatology, and pediatric laser clinics.

In contrast, attendance at the adult dermatology clinic rose by about three percentage points after the service was implemented, from 81% (2,530 visits attended of 3,141 scheduled) to 84% (2,965 visits attended of 3,533 scheduled), and the difference was statistically significant.

“About 88% of reminders were answered across sites, with little variance. The cost was about $5,500 for a 17-month period,” Dr. Kim said. She noted that 71% of patients opted into the service at the adult clinic with the increased attendance rate, compared with about 30% of patients at the other clinics that showed no statistically significant increase in attendance rates.

The “strong continuity already present between patients and providers” and high baseline attendance rates might have limited any effects of mobile phone messaging at these other clinics, she said. Attendance rates also did not change significantly at three Johns Hopkins dermatology clinics that never implemented mobile phone reminders, she noted.

Dr. Kim reported no funding sources and had no disclosures.

SCOTTSDALE, ARIZ. – Although cost-effective, a mobile phone appointment reminder service only minimally increased attendance rates at dermatology outpatient clinics, according to a large longitudinal study.

“There was a small, statistically significant increase in attendance at the adult dermatology clinic, but there was very little effect at satellite and specialty dermatology clinics,” said Dr. Noori Kim of Johns Hopkins University in Baltimore.

Baseline attendance rates were high, exceeding 80%, so perhaps mobile phone appointment reminders have little effect in that setting, she said. In addition, most reminders were by phone call, not text, which could have limited their efficacy if patients did not answer the phone or listen to their voicemail, Dr. Kim added during an oral presentation at the annual meeting of the Society for Investigative Dermatology.

©Hocus Focus Studio/iStockphoto.com

When patients miss medical appointments, it’s usually because they forget them. In this study, the first to assess mobile phone appointment reminders in dermatology, the investigators compared daily attendance at Johns Hopkins outpatient dermatology clinics before and after implementing an automated mobile phone appointment reminder system. The baseline time period without the service spanned four months in 2014, while the comparison period with the system covered the same four-month period a year later.

Patients kept 90% of 11,455 dermatology appointments scheduled during the pre-service period. A year later, the attendance rate was nearly identical, at 89%. Likewise, there were no statistically significant changes in attendance at Johns Hopkins specialty, satellite, pediatric dermatology, and pediatric laser clinics.

In contrast, attendance at the adult dermatology clinic rose by about three percentage points after the service was implemented, from 81% (2,530 visits attended of 3,141 scheduled) to 84% (2,965 visits attended of 3,533 scheduled), and the difference was statistically significant.

“About 88% of reminders were answered across sites, with little variance. The cost was about $5,500 for a 17-month period,” Dr. Kim said. She noted that 71% of patients opted into the service at the adult clinic with the increased attendance rate, compared with about 30% of patients at the other clinics that showed no statistically significant increase in attendance rates.

The “strong continuity already present between patients and providers” and high baseline attendance rates might have limited any effects of mobile phone messaging at these other clinics, she said. Attendance rates also did not change significantly at three Johns Hopkins dermatology clinics that never implemented mobile phone reminders, she noted.

Dr. Kim reported no funding sources and had no disclosures.

Contaminated duodenoscopes have caused multiple outbreaks of multidrug-resistant infections with sometimes lethal consequences; until these instruments become easier to clean, personnel must strictly follow recommendations for sterilization, surveillance, and unit-by-unit quality control, according to an extensive commentary accompanying an American Gastroenterological Association Clinical Practice Update.

“Patients and physicians want and expect no transmission of infections by any medical instrument,” wrote Bret Petersen, M.D., of the Mayo Clinic, Rochester, Minn., Johannes Koch, M.D., of Virginia Mason Medical Center, Seattle, and Gregory Ginsberg, M.D., of the University of Pennsylvania, Philadelphia. It is the collective responsibility of endoscope manufacturers, health systems, and providers to ensure endoscope reprocessing is mistake proof, establishing systems to identify and eliminate the risk of infection for patients undergoing flexible endoscopy.”

©CDC/James Archer

More than 650,000 endoscopic retrograde cholangiopancreatographies (ERCPs) occur in the United States annually, and “even the lowest reported defect rate of 0.7% will expose 4,500 patients to a preventable risk,” the experts noted. Carbapenem-resistant Enterobacteriaceae (CRE) are becoming more prevalent and have been transmitted during ERCP, even when personnel seem to have followed sterilization protocols to the letter. Clinical CRE infections have a fatality rate of at least 50%, months may elapse between exposure and symptom onset, and infections may involve distant organs. These factors, along with the phenomenon of “silent carriers,” have linked duodenoscopes to at least 250 multidrug-resistant infections and at least 20 fatalities worldwide, the experts wrote (Gastroenterology 2016 May 27. doi: 10.1053/j.gastro.2016.05.040).

Current duodenoscopes can be tough to sterilize. Between 1 billion and 1 trillion organisms typically cover a used instrument. Bedside cleaning cuts this number about 1,000-fold, and manual washing kills about another million organisms, leaving up to 1 billion bugs to be killed by high-level disinfection. That’s “a tall order” that can strain space, time, and staffing resources, especially given the fact that duodenoscopes have “tight crevices and mechanical joints that are exposed repeatedly to highly infectious bioburden,” the experts wrote. Furthermore, slips in processing enable the formation of biofilms that resist both cleaning and high-level disinfection.

The key to stopping duodenoscopes from transmitting dangerous pathogens is manual cleaning, including wiping the outside of the duodenoscope, flushing its channels, and brushing the elevator lever “immediately after use and before the surfaces have become dried,” the experts stressed. Disinfectants should be used at the right concentration and temperature, and for the intended amount of time. Biofilms form on moist surfaces only, so channels should be flushed with alcohol (a desiccant), dried with forced air, and stored in a dry environment.

But recent outbreaks spurred the Food and Drug Administration to recommend further steps – including better oversight and training of reprocessing staff and closer attention to precleaning, manual cleaning, and manufacturer recommendations for use, including determining whether the company used its own “proprietary” cleaning brushes in its validation studies, the experts noted. “Optional supplemental measures” include surveillance cultures of duodenoscopes, ethylene oxide sterilization, and double reprocessing, in which each scope undergoes two cycles of manual cleaning and high-intensity sterilization between patients. Double reprocessing might be the simplest and most easily adopted of these measures, the experts said. The AGA, for its part, recommends active surveillance of patients who undergo ERCP, surveillance cultures of scopes, and recording of the serial number of every scope used in every procedure.

Surveillance culture makes sense, but can be costly and hard to conduct and interpret because sampling detects vast numbers of nonpathogenic organisms in addition to any pathogens, the experts noted. The Centers for Disease Control and Prevention recommends that each institution follow its own complex outbreak sampling protocol and quarantine duodenoscopes for 2-3 days, pending negative results. That may mean buying more duodenoscopes. A less costly option is to culture a subset of scopes at the end of every workweek, the experts said. Real-time tests that reliably reflect bacterial culture results remain “elusive,” but testing for adenosine triphosphate after manual washing is easiest and best studied, they added.

Clearly, industry is responsible for making endoscopes that can be reliably disinfected. “Recent submissions by all three manufacturers (Olympus, Pentax, and Fujinon) have validated current reprocessing outcomes in test environments, and the FDA has ruled that postmarket studies of reprocessing in clinical settings are expected, but these results will not be forthcoming for several years,” the experts wrote. Redesigning duodenoscopes may be “the ultimate solution,” but in the meantime, endoscopists should carefully review indications for ERCP and ensure thorough informed consent. Doing so “will uphold the trust that we must achieve and maintain with our patients,” the authors said.

They had no funding sources. Dr. Koch has consulted for Sedasys, and Dr. Ginsberg has consulted for Olympus.

Contaminated duodenoscopes have caused multiple outbreaks of multidrug-resistant infections with sometimes lethal consequences; until these instruments become easier to clean, personnel must strictly follow recommendations for sterilization, surveillance, and unit-by-unit quality control, according to an extensive commentary accompanying an American Gastroenterological Association Clinical Practice Update.

“Patients and physicians want and expect no transmission of infections by any medical instrument,” wrote Bret Petersen, M.D., of the Mayo Clinic, Rochester, Minn., Johannes Koch, M.D., of Virginia Mason Medical Center, Seattle, and Gregory Ginsberg, M.D., of the University of Pennsylvania, Philadelphia. It is the collective responsibility of endoscope manufacturers, health systems, and providers to ensure endoscope reprocessing is mistake proof, establishing systems to identify and eliminate the risk of infection for patients undergoing flexible endoscopy.”

©CDC/James Archer

More than 650,000 endoscopic retrograde cholangiopancreatographies (ERCPs) occur in the United States annually, and “even the lowest reported defect rate of 0.7% will expose 4,500 patients to a preventable risk,” the experts noted. Carbapenem-resistant Enterobacteriaceae (CRE) are becoming more prevalent and have been transmitted during ERCP, even when personnel seem to have followed sterilization protocols to the letter. Clinical CRE infections have a fatality rate of at least 50%, months may elapse between exposure and symptom onset, and infections may involve distant organs. These factors, along with the phenomenon of “silent carriers,” have linked duodenoscopes to at least 250 multidrug-resistant infections and at least 20 fatalities worldwide, the experts wrote (Gastroenterology 2016 May 27. doi: 10.1053/j.gastro.2016.05.040).

Current duodenoscopes can be tough to sterilize. Between 1 billion and 1 trillion organisms typically cover a used instrument. Bedside cleaning cuts this number about 1,000-fold, and manual washing kills about another million organisms, leaving up to 1 billion bugs to be killed by high-level disinfection. That’s “a tall order” that can strain space, time, and staffing resources, especially given the fact that duodenoscopes have “tight crevices and mechanical joints that are exposed repeatedly to highly infectious bioburden,” the experts wrote. Furthermore, slips in processing enable the formation of biofilms that resist both cleaning and high-level disinfection.

The key to stopping duodenoscopes from transmitting dangerous pathogens is manual cleaning, including wiping the outside of the duodenoscope, flushing its channels, and brushing the elevator lever “immediately after use and before the surfaces have become dried,” the experts stressed. Disinfectants should be used at the right concentration and temperature, and for the intended amount of time. Biofilms form on moist surfaces only, so channels should be flushed with alcohol (a desiccant), dried with forced air, and stored in a dry environment.

But recent outbreaks spurred the Food and Drug Administration to recommend further steps – including better oversight and training of reprocessing staff and closer attention to precleaning, manual cleaning, and manufacturer recommendations for use, including determining whether the company used its own “proprietary” cleaning brushes in its validation studies, the experts noted. “Optional supplemental measures” include surveillance cultures of duodenoscopes, ethylene oxide sterilization, and double reprocessing, in which each scope undergoes two cycles of manual cleaning and high-intensity sterilization between patients. Double reprocessing might be the simplest and most easily adopted of these measures, the experts said. The AGA, for its part, recommends active surveillance of patients who undergo ERCP, surveillance cultures of scopes, and recording of the serial number of every scope used in every procedure.

Surveillance culture makes sense, but can be costly and hard to conduct and interpret because sampling detects vast numbers of nonpathogenic organisms in addition to any pathogens, the experts noted. The Centers for Disease Control and Prevention recommends that each institution follow its own complex outbreak sampling protocol and quarantine duodenoscopes for 2-3 days, pending negative results. That may mean buying more duodenoscopes. A less costly option is to culture a subset of scopes at the end of every workweek, the experts said. Real-time tests that reliably reflect bacterial culture results remain “elusive,” but testing for adenosine triphosphate after manual washing is easiest and best studied, they added.

Clearly, industry is responsible for making endoscopes that can be reliably disinfected. “Recent submissions by all three manufacturers (Olympus, Pentax, and Fujinon) have validated current reprocessing outcomes in test environments, and the FDA has ruled that postmarket studies of reprocessing in clinical settings are expected, but these results will not be forthcoming for several years,” the experts wrote. Redesigning duodenoscopes may be “the ultimate solution,” but in the meantime, endoscopists should carefully review indications for ERCP and ensure thorough informed consent. Doing so “will uphold the trust that we must achieve and maintain with our patients,” the authors said.

They had no funding sources. Dr. Koch has consulted for Sedasys, and Dr. Ginsberg has consulted for Olympus.

Contaminated duodenoscopes have caused multiple outbreaks of multidrug-resistant infections with sometimes lethal consequences; until these instruments become easier to clean, personnel must strictly follow recommendations for sterilization, surveillance, and unit-by-unit quality control, according to an extensive commentary accompanying an American Gastroenterological Association Clinical Practice Update.

“Patients and physicians want and expect no transmission of infections by any medical instrument,” wrote Bret Petersen, M.D., of the Mayo Clinic, Rochester, Minn., Johannes Koch, M.D., of Virginia Mason Medical Center, Seattle, and Gregory Ginsberg, M.D., of the University of Pennsylvania, Philadelphia. It is the collective responsibility of endoscope manufacturers, health systems, and providers to ensure endoscope reprocessing is mistake proof, establishing systems to identify and eliminate the risk of infection for patients undergoing flexible endoscopy.”

©CDC/James Archer

More than 650,000 endoscopic retrograde cholangiopancreatographies (ERCPs) occur in the United States annually, and “even the lowest reported defect rate of 0.7% will expose 4,500 patients to a preventable risk,” the experts noted. Carbapenem-resistant Enterobacteriaceae (CRE) are becoming more prevalent and have been transmitted during ERCP, even when personnel seem to have followed sterilization protocols to the letter. Clinical CRE infections have a fatality rate of at least 50%, months may elapse between exposure and symptom onset, and infections may involve distant organs. These factors, along with the phenomenon of “silent carriers,” have linked duodenoscopes to at least 250 multidrug-resistant infections and at least 20 fatalities worldwide, the experts wrote (Gastroenterology 2016 May 27. doi: 10.1053/j.gastro.2016.05.040).

Current duodenoscopes can be tough to sterilize. Between 1 billion and 1 trillion organisms typically cover a used instrument. Bedside cleaning cuts this number about 1,000-fold, and manual washing kills about another million organisms, leaving up to 1 billion bugs to be killed by high-level disinfection. That’s “a tall order” that can strain space, time, and staffing resources, especially given the fact that duodenoscopes have “tight crevices and mechanical joints that are exposed repeatedly to highly infectious bioburden,” the experts wrote. Furthermore, slips in processing enable the formation of biofilms that resist both cleaning and high-level disinfection.

The key to stopping duodenoscopes from transmitting dangerous pathogens is manual cleaning, including wiping the outside of the duodenoscope, flushing its channels, and brushing the elevator lever “immediately after use and before the surfaces have become dried,” the experts stressed. Disinfectants should be used at the right concentration and temperature, and for the intended amount of time. Biofilms form on moist surfaces only, so channels should be flushed with alcohol (a desiccant), dried with forced air, and stored in a dry environment.

But recent outbreaks spurred the Food and Drug Administration to recommend further steps – including better oversight and training of reprocessing staff and closer attention to precleaning, manual cleaning, and manufacturer recommendations for use, including determining whether the company used its own “proprietary” cleaning brushes in its validation studies, the experts noted. “Optional supplemental measures” include surveillance cultures of duodenoscopes, ethylene oxide sterilization, and double reprocessing, in which each scope undergoes two cycles of manual cleaning and high-intensity sterilization between patients. Double reprocessing might be the simplest and most easily adopted of these measures, the experts said. The AGA, for its part, recommends active surveillance of patients who undergo ERCP, surveillance cultures of scopes, and recording of the serial number of every scope used in every procedure.

Surveillance culture makes sense, but can be costly and hard to conduct and interpret because sampling detects vast numbers of nonpathogenic organisms in addition to any pathogens, the experts noted. The Centers for Disease Control and Prevention recommends that each institution follow its own complex outbreak sampling protocol and quarantine duodenoscopes for 2-3 days, pending negative results. That may mean buying more duodenoscopes. A less costly option is to culture a subset of scopes at the end of every workweek, the experts said. Real-time tests that reliably reflect bacterial culture results remain “elusive,” but testing for adenosine triphosphate after manual washing is easiest and best studied, they added.

Clearly, industry is responsible for making endoscopes that can be reliably disinfected. “Recent submissions by all three manufacturers (Olympus, Pentax, and Fujinon) have validated current reprocessing outcomes in test environments, and the FDA has ruled that postmarket studies of reprocessing in clinical settings are expected, but these results will not be forthcoming for several years,” the experts wrote. Redesigning duodenoscopes may be “the ultimate solution,” but in the meantime, endoscopists should carefully review indications for ERCP and ensure thorough informed consent. Doing so “will uphold the trust that we must achieve and maintain with our patients,” the authors said.

They had no funding sources. Dr. Koch has consulted for Sedasys, and Dr. Ginsberg has consulted for Olympus.

Among children with de novo acute myeloid leukemia, shorter telomere length at the end of induction chemotherapy predicted delayed bone marrow recovery in later courses, according to a study of 115 patients published online in the Journal of Clinical Oncology.

“This association was not related to differences in host factors, telomere maintenance gene variants, AML disease characteristics, or therapeutic exposures,” wrote Robert Gerbing of Children’s Oncology Group (Monrovia, Calif.), and his associates. “If validated in a larger cohort, prospective ascertainment of telomere length at end of AML induction may permit individualized risk assessment for severe myelosuppression and toxicities with subsequent therapy, as well as clarify the influence of age and cytogenetic or molecular disease characteristics.”

Acute myeloid leukemia comprises about one in five childhood leukemias and requires intensive treatment that has led to mortality in up to 19% of patients, the researchers noted (Blood 2008 Feb 1;111[3]:1044-53).

“Prolonged, profound neutropenia is a well recognized risk factor for sepsis and invasive fungal infections, both major contributors to treatment-related mortality,” they added. In nonleukemic hematopoietic cells, telomere length is a “quantifiable host factor that may indicate potential risk for impaired bone marrow recovery after chemotherapy,” they wrote (J Clin Oncol. 2016 Jun 27. doi: 10.1200/JCO.2016.67.3467).

To test this hypothesis, the researchers analyzed paired diagnostic and remission bone marrow samples for 115 children with de novo AML enrolled in a Children’s Oncology Group protocol (AAML0531) that involved five chemotherapy courses. After each course, 62 patients reached absolute neutrophil count (ANC) recovery (500 cells/mcL) within the expected time frame, meaning that the recovery time was always less than one standard deviation of the group average. The remaining 53 patients had significantly delayed ANC recovery, meaning that they exceeded the group average by at least one standard deviation after at least two courses of chemotherapy.

The study size was adequate to detect a 0.2-unit difference in average telomere length between the two groups, the investigators noted. To measure telomere length, they estimated telomere content based on quantitative polymerase chain reaction (PCR) of bone marrow samples taken after induction chemotherapy. Then they compared patients who fell within the lowest quartile of telomere content to those in quartiles 2 through 4.

Telomere content was not associated with days to ANC recovery after the first three chemotherapy courses. After the fourth and fifth courses (intensifications two and three), patients had longer ANC recovery times than during the first three courses (mean, 45.2 days for intensification two and 43.7 days for intensification three). But patients with the shortest telomeres (that is, the patients in telomere content quartile 1) had significantly longer average ANC recovery times compared with patients in telomere content quartiles 2 through 4, both for intensifications two (P less than .001) and three (P = .002).

“Analysis of individual quartiles confirmed the association between less telomere content in quartile 1 and delays in ANC recovery,” the investigators noted. After they accounted for age at diagnosis, short telomere length remained a significant predictor of delayed ANC recovery after the fourth (P = .002) and fifth (P = .009) courses. Finally, DNA sequencing revealed evidence of telomere biology disorders, the investigators said.

The work was supported by an Alex’s Lemonade Stand Young Investigators Award, by a St. Baldrick’s Foundation Scholar Award, and by the National Institutes of Health. Mr. Gerbing and senior author Maria Gramatges, MD, had no disclosures. Two coinvestigators disclosed ties to Pfizer, Novartis, Dexcom, and several other pharmaceutical companies.

Among children with de novo acute myeloid leukemia, shorter telomere length at the end of induction chemotherapy predicted delayed bone marrow recovery in later courses, according to a study of 115 patients published online in the Journal of Clinical Oncology.

“This association was not related to differences in host factors, telomere maintenance gene variants, AML disease characteristics, or therapeutic exposures,” wrote Robert Gerbing of Children’s Oncology Group (Monrovia, Calif.), and his associates. “If validated in a larger cohort, prospective ascertainment of telomere length at end of AML induction may permit individualized risk assessment for severe myelosuppression and toxicities with subsequent therapy, as well as clarify the influence of age and cytogenetic or molecular disease characteristics.”

Acute myeloid leukemia comprises about one in five childhood leukemias and requires intensive treatment that has led to mortality in up to 19% of patients, the researchers noted (Blood 2008 Feb 1;111[3]:1044-53).

“Prolonged, profound neutropenia is a well recognized risk factor for sepsis and invasive fungal infections, both major contributors to treatment-related mortality,” they added. In nonleukemic hematopoietic cells, telomere length is a “quantifiable host factor that may indicate potential risk for impaired bone marrow recovery after chemotherapy,” they wrote (J Clin Oncol. 2016 Jun 27. doi: 10.1200/JCO.2016.67.3467).

To test this hypothesis, the researchers analyzed paired diagnostic and remission bone marrow samples for 115 children with de novo AML enrolled in a Children’s Oncology Group protocol (AAML0531) that involved five chemotherapy courses. After each course, 62 patients reached absolute neutrophil count (ANC) recovery (500 cells/mcL) within the expected time frame, meaning that the recovery time was always less than one standard deviation of the group average. The remaining 53 patients had significantly delayed ANC recovery, meaning that they exceeded the group average by at least one standard deviation after at least two courses of chemotherapy.

The study size was adequate to detect a 0.2-unit difference in average telomere length between the two groups, the investigators noted. To measure telomere length, they estimated telomere content based on quantitative polymerase chain reaction (PCR) of bone marrow samples taken after induction chemotherapy. Then they compared patients who fell within the lowest quartile of telomere content to those in quartiles 2 through 4.

Telomere content was not associated with days to ANC recovery after the first three chemotherapy courses. After the fourth and fifth courses (intensifications two and three), patients had longer ANC recovery times than during the first three courses (mean, 45.2 days for intensification two and 43.7 days for intensification three). But patients with the shortest telomeres (that is, the patients in telomere content quartile 1) had significantly longer average ANC recovery times compared with patients in telomere content quartiles 2 through 4, both for intensifications two (P less than .001) and three (P = .002).

“Analysis of individual quartiles confirmed the association between less telomere content in quartile 1 and delays in ANC recovery,” the investigators noted. After they accounted for age at diagnosis, short telomere length remained a significant predictor of delayed ANC recovery after the fourth (P = .002) and fifth (P = .009) courses. Finally, DNA sequencing revealed evidence of telomere biology disorders, the investigators said.

The work was supported by an Alex’s Lemonade Stand Young Investigators Award, by a St. Baldrick’s Foundation Scholar Award, and by the National Institutes of Health. Mr. Gerbing and senior author Maria Gramatges, MD, had no disclosures. Two coinvestigators disclosed ties to Pfizer, Novartis, Dexcom, and several other pharmaceutical companies.

Among children with de novo acute myeloid leukemia, shorter telomere length at the end of induction chemotherapy predicted delayed bone marrow recovery in later courses, according to a study of 115 patients published online in the Journal of Clinical Oncology.

“This association was not related to differences in host factors, telomere maintenance gene variants, AML disease characteristics, or therapeutic exposures,” wrote Robert Gerbing of Children’s Oncology Group (Monrovia, Calif.), and his associates. “If validated in a larger cohort, prospective ascertainment of telomere length at end of AML induction may permit individualized risk assessment for severe myelosuppression and toxicities with subsequent therapy, as well as clarify the influence of age and cytogenetic or molecular disease characteristics.”

Acute myeloid leukemia comprises about one in five childhood leukemias and requires intensive treatment that has led to mortality in up to 19% of patients, the researchers noted (Blood 2008 Feb 1;111[3]:1044-53).

“Prolonged, profound neutropenia is a well recognized risk factor for sepsis and invasive fungal infections, both major contributors to treatment-related mortality,” they added. In nonleukemic hematopoietic cells, telomere length is a “quantifiable host factor that may indicate potential risk for impaired bone marrow recovery after chemotherapy,” they wrote (J Clin Oncol. 2016 Jun 27. doi: 10.1200/JCO.2016.67.3467).

To test this hypothesis, the researchers analyzed paired diagnostic and remission bone marrow samples for 115 children with de novo AML enrolled in a Children’s Oncology Group protocol (AAML0531) that involved five chemotherapy courses. After each course, 62 patients reached absolute neutrophil count (ANC) recovery (500 cells/mcL) within the expected time frame, meaning that the recovery time was always less than one standard deviation of the group average. The remaining 53 patients had significantly delayed ANC recovery, meaning that they exceeded the group average by at least one standard deviation after at least two courses of chemotherapy.

The study size was adequate to detect a 0.2-unit difference in average telomere length between the two groups, the investigators noted. To measure telomere length, they estimated telomere content based on quantitative polymerase chain reaction (PCR) of bone marrow samples taken after induction chemotherapy. Then they compared patients who fell within the lowest quartile of telomere content to those in quartiles 2 through 4.

Telomere content was not associated with days to ANC recovery after the first three chemotherapy courses. After the fourth and fifth courses (intensifications two and three), patients had longer ANC recovery times than during the first three courses (mean, 45.2 days for intensification two and 43.7 days for intensification three). But patients with the shortest telomeres (that is, the patients in telomere content quartile 1) had significantly longer average ANC recovery times compared with patients in telomere content quartiles 2 through 4, both for intensifications two (P less than .001) and three (P = .002).

“Analysis of individual quartiles confirmed the association between less telomere content in quartile 1 and delays in ANC recovery,” the investigators noted. After they accounted for age at diagnosis, short telomere length remained a significant predictor of delayed ANC recovery after the fourth (P = .002) and fifth (P = .009) courses. Finally, DNA sequencing revealed evidence of telomere biology disorders, the investigators said.

The work was supported by an Alex’s Lemonade Stand Young Investigators Award, by a St. Baldrick’s Foundation Scholar Award, and by the National Institutes of Health. Mr. Gerbing and senior author Maria Gramatges, MD, had no disclosures. Two coinvestigators disclosed ties to Pfizer, Novartis, Dexcom, and several other pharmaceutical companies.

SCOTTSDALE, ARIZ. – Distant metastatic sites of Merkel cell carcinoma most often involved the supraclavicular, retroperitoneal, and iliac lymph nodes, in a single center retrospective study of 305 patients.

Merkel cell carcinoma metastases “clearly favored distant nodes, but the distribution of other metastatic sites was distinct from other cancers, such as melanoma,” Jamiluddin Qazi, an undergraduate student at the University of Washington, Seattle, said at the annual meeting of the Society for Investigative Dermatology. The findings could help guide imaging and other surveillance of patients after they develop a primary Merkel cell tumor, he added.

Wikimedia Commons/Ed Uthman/CC BY-SA 2.0

About 2,000 individuals in the United States are diagnosed with Merkel cell carcinoma every year. About 40% of these patients develop metastatic disease, which has a 5-year survival rate of less than 25%, Mr. Qazi noted. Indeed, median survival after diagnosis of metastatic Merkel cell carcinoma was only 9.5 months in one recent study (J Cutan Pathol. 2010;37:20-7). Programmed death 1 (PD-1) blockade with pembrolizumab (Keytruda) can potentially improve survival (N Engl J Med. 2016; 374:2542-52), “but there is no consensus regarding follow-up for Merkel cell carcinoma. The 2016 National Comprehensive Cancer Network (NCCN) guidelines recommend ‘follow up as clinically indicated,’ and a lack of data has led to ambiguity,” Mr. Qazi said.

Working with oncologists and radiologists at the Seattle Cancer Care Alliance, he analyzed a tissue and clinical database of 442 initial distant Merkel cell carcinoma metastases among 305 patients. Initial distant metastases were defined as the first lesions detected beyond the regional lymph nodes of the primary tumor. A total of 69% of patients had one initial distant metastasis, 19% had two concurrently identified lesions, 9% had three lesions, and 4% had at least four lesions, Mr. Qazi reported.

“Merkel cell carcinoma seemed to metastasize to unusual places, but clearly preferred the distant lymph nodes. In all, 26% of metastases localized there, most commonly to the supraclavicular, retroperitoneal, and iliac nodes,” he said. The next most common site of distant metastasis was the liver (15% of lesions), followed by the skin and bone (13% of lesions each), lung (6%), and pancreas (5%). Less common sites included the heart, spleen, abdominal muscle, brain, kidneys, adrenal glands, gonad, chest wall, and stomach.

Comparing these findings with a similar study in melanoma (J Oncol 2012. doi: 10.1155/2012/647684) showed that both cancers have about the same chances of metastasizing to the liver, bone, kidneys, adrenal glands, and stomach, Mr. Qazi said. However, Merkel cell carcinoma was less likely to metastasize to the brain (3% of lesions, vs. 12% for melanoma) and lung (6% vs. 14%), and was more likely to metastasize to the pancreas (5% vs. 1%).

Now the investigators are working to link metastatic sites with factors such as the location of the primary tumor, the presence or absence of lymphovascular invasion, and the status of the immune system and Merkel polyomavirus infection, said Mr. Qazi. They also are analyzing time from diagnosis or treatment to metastasis to help guide decisions about when to order follow-up imaging. Ultimately, they hope to create an online tool that enables clinicians to describe a primary Merkel cell carcinoma and rapidly receive automated information about the most likely timing and location of metastasis.

The National Institutes of Health supported the study. Mr. Qazi had no conflicts of interest.

SCOTTSDALE, ARIZ. – Distant metastatic sites of Merkel cell carcinoma most often involved the supraclavicular, retroperitoneal, and iliac lymph nodes, in a single center retrospective study of 305 patients.

Merkel cell carcinoma metastases “clearly favored distant nodes, but the distribution of other metastatic sites was distinct from other cancers, such as melanoma,” Jamiluddin Qazi, an undergraduate student at the University of Washington, Seattle, said at the annual meeting of the Society for Investigative Dermatology. The findings could help guide imaging and other surveillance of patients after they develop a primary Merkel cell tumor, he added.

Wikimedia Commons/Ed Uthman/CC BY-SA 2.0

About 2,000 individuals in the United States are diagnosed with Merkel cell carcinoma every year. About 40% of these patients develop metastatic disease, which has a 5-year survival rate of less than 25%, Mr. Qazi noted. Indeed, median survival after diagnosis of metastatic Merkel cell carcinoma was only 9.5 months in one recent study (J Cutan Pathol. 2010;37:20-7). Programmed death 1 (PD-1) blockade with pembrolizumab (Keytruda) can potentially improve survival (N Engl J Med. 2016; 374:2542-52), “but there is no consensus regarding follow-up for Merkel cell carcinoma. The 2016 National Comprehensive Cancer Network (NCCN) guidelines recommend ‘follow up as clinically indicated,’ and a lack of data has led to ambiguity,” Mr. Qazi said.

Working with oncologists and radiologists at the Seattle Cancer Care Alliance, he analyzed a tissue and clinical database of 442 initial distant Merkel cell carcinoma metastases among 305 patients. Initial distant metastases were defined as the first lesions detected beyond the regional lymph nodes of the primary tumor. A total of 69% of patients had one initial distant metastasis, 19% had two concurrently identified lesions, 9% had three lesions, and 4% had at least four lesions, Mr. Qazi reported.

“Merkel cell carcinoma seemed to metastasize to unusual places, but clearly preferred the distant lymph nodes. In all, 26% of metastases localized there, most commonly to the supraclavicular, retroperitoneal, and iliac nodes,” he said. The next most common site of distant metastasis was the liver (15% of lesions), followed by the skin and bone (13% of lesions each), lung (6%), and pancreas (5%). Less common sites included the heart, spleen, abdominal muscle, brain, kidneys, adrenal glands, gonad, chest wall, and stomach.

Comparing these findings with a similar study in melanoma (J Oncol 2012. doi: 10.1155/2012/647684) showed that both cancers have about the same chances of metastasizing to the liver, bone, kidneys, adrenal glands, and stomach, Mr. Qazi said. However, Merkel cell carcinoma was less likely to metastasize to the brain (3% of lesions, vs. 12% for melanoma) and lung (6% vs. 14%), and was more likely to metastasize to the pancreas (5% vs. 1%).

Now the investigators are working to link metastatic sites with factors such as the location of the primary tumor, the presence or absence of lymphovascular invasion, and the status of the immune system and Merkel polyomavirus infection, said Mr. Qazi. They also are analyzing time from diagnosis or treatment to metastasis to help guide decisions about when to order follow-up imaging. Ultimately, they hope to create an online tool that enables clinicians to describe a primary Merkel cell carcinoma and rapidly receive automated information about the most likely timing and location of metastasis.

The National Institutes of Health supported the study. Mr. Qazi had no conflicts of interest.

SCOTTSDALE, ARIZ. – Distant metastatic sites of Merkel cell carcinoma most often involved the supraclavicular, retroperitoneal, and iliac lymph nodes, in a single center retrospective study of 305 patients.

Merkel cell carcinoma metastases “clearly favored distant nodes, but the distribution of other metastatic sites was distinct from other cancers, such as melanoma,” Jamiluddin Qazi, an undergraduate student at the University of Washington, Seattle, said at the annual meeting of the Society for Investigative Dermatology. The findings could help guide imaging and other surveillance of patients after they develop a primary Merkel cell tumor, he added.

Wikimedia Commons/Ed Uthman/CC BY-SA 2.0

About 2,000 individuals in the United States are diagnosed with Merkel cell carcinoma every year. About 40% of these patients develop metastatic disease, which has a 5-year survival rate of less than 25%, Mr. Qazi noted. Indeed, median survival after diagnosis of metastatic Merkel cell carcinoma was only 9.5 months in one recent study (J Cutan Pathol. 2010;37:20-7). Programmed death 1 (PD-1) blockade with pembrolizumab (Keytruda) can potentially improve survival (N Engl J Med. 2016; 374:2542-52), “but there is no consensus regarding follow-up for Merkel cell carcinoma. The 2016 National Comprehensive Cancer Network (NCCN) guidelines recommend ‘follow up as clinically indicated,’ and a lack of data has led to ambiguity,” Mr. Qazi said.

Working with oncologists and radiologists at the Seattle Cancer Care Alliance, he analyzed a tissue and clinical database of 442 initial distant Merkel cell carcinoma metastases among 305 patients. Initial distant metastases were defined as the first lesions detected beyond the regional lymph nodes of the primary tumor. A total of 69% of patients had one initial distant metastasis, 19% had two concurrently identified lesions, 9% had three lesions, and 4% had at least four lesions, Mr. Qazi reported.

“Merkel cell carcinoma seemed to metastasize to unusual places, but clearly preferred the distant lymph nodes. In all, 26% of metastases localized there, most commonly to the supraclavicular, retroperitoneal, and iliac nodes,” he said. The next most common site of distant metastasis was the liver (15% of lesions), followed by the skin and bone (13% of lesions each), lung (6%), and pancreas (5%). Less common sites included the heart, spleen, abdominal muscle, brain, kidneys, adrenal glands, gonad, chest wall, and stomach.

Comparing these findings with a similar study in melanoma (J Oncol 2012. doi: 10.1155/2012/647684) showed that both cancers have about the same chances of metastasizing to the liver, bone, kidneys, adrenal glands, and stomach, Mr. Qazi said. However, Merkel cell carcinoma was less likely to metastasize to the brain (3% of lesions, vs. 12% for melanoma) and lung (6% vs. 14%), and was more likely to metastasize to the pancreas (5% vs. 1%).

Now the investigators are working to link metastatic sites with factors such as the location of the primary tumor, the presence or absence of lymphovascular invasion, and the status of the immune system and Merkel polyomavirus infection, said Mr. Qazi. They also are analyzing time from diagnosis or treatment to metastasis to help guide decisions about when to order follow-up imaging. Ultimately, they hope to create an online tool that enables clinicians to describe a primary Merkel cell carcinoma and rapidly receive automated information about the most likely timing and location of metastasis.

The National Institutes of Health supported the study. Mr. Qazi had no conflicts of interest.

SCOTTSDALE, ARIZ. – Distant metastatic sites of Merkel cell carcinoma most often involved the supraclavicular, retroperitoneal, and iliac lymph nodes, in a single center retrospective study of 305 patients.

Merkel cell carcinoma metastases “clearly favored distant nodes, but the distribution of other metastatic sites was distinct from other cancers, such as melanoma,” Jamiluddin Qazi, an undergraduate student at the University of Washington, Seattle, said at the annual meeting of the Society for Investigative Dermatology. The findings could help guide imaging and other surveillance of patients after they develop a primary Merkel cell tumor, he added.

Wikimedia Commons/Ed Uthman/CC BY-SA 2.0

About 2,000 individuals in the United States are diagnosed with Merkel cell carcinoma every year. About 40% of these patients develop metastatic disease, which has a 5-year survival rate of less than 25%, Mr. Qazi noted. Indeed, median survival after diagnosis of metastatic Merkel cell carcinoma was only 9.5 months in one recent study (J Cutan Pathol. 2010;37:20-7). Programmed death 1 (PD-1) blockade with pembrolizumab (Keytruda) can potentially improve survival (N Engl J Med. 2016; 374:2542-52), “but there is no consensus regarding follow-up for Merkel cell carcinoma. The 2016 National Comprehensive Cancer Network (NCCN) guidelines recommend ‘follow up as clinically indicated,’ and a lack of data has led to ambiguity,” Mr. Qazi said.

Working with oncologists and radiologists at the Seattle Cancer Care Alliance, he analyzed a tissue and clinical database of 442 initial distant Merkel cell carcinoma metastases among 305 patients. Initial distant metastases were defined as the first lesions detected beyond the regional lymph nodes of the primary tumor. A total of 69% of patients had one initial distant metastasis, 19% had two concurrently identified lesions, 9% had three lesions, and 4% had at least four lesions, Mr. Qazi reported.

“Merkel cell carcinoma seemed to metastasize to unusual places, but clearly preferred the distant lymph nodes. In all, 26% of metastases localized there, most commonly to the supraclavicular, retroperitoneal, and iliac nodes,” he said. The next most common site of distant metastasis was the liver (15% of lesions), followed by the skin and bone (13% of lesions each), lung (6%), and pancreas (5%). Less common sites included the heart, spleen, abdominal muscle, brain, kidneys, adrenal glands, gonad, chest wall, and stomach.

Comparing these findings with a similar study in melanoma (J Oncol 2012. doi: 10.1155/2012/647684) showed that both cancers have about the same chances of metastasizing to the liver, bone, kidneys, adrenal glands, and stomach, Mr. Qazi said. However, Merkel cell carcinoma was less likely to metastasize to the brain (3% of lesions, vs. 12% for melanoma) and lung (6% vs. 14%), and was more likely to metastasize to the pancreas (5% vs. 1%).

Now the investigators are working to link metastatic sites with factors such as the location of the primary tumor, the presence or absence of lymphovascular invasion, and the status of the immune system and Merkel polyomavirus infection, said Mr. Qazi. They also are analyzing time from diagnosis or treatment to metastasis to help guide decisions about when to order follow-up imaging. Ultimately, they hope to create an online tool that enables clinicians to describe a primary Merkel cell carcinoma and rapidly receive automated information about the most likely timing and location of metastasis.

The National Institutes of Health supported the study. Mr. Qazi had no conflicts of interest.

SCOTTSDALE, ARIZ. – Distant metastatic sites of Merkel cell carcinoma most often involved the supraclavicular, retroperitoneal, and iliac lymph nodes, in a single center retrospective study of 305 patients.

Merkel cell carcinoma metastases “clearly favored distant nodes, but the distribution of other metastatic sites was distinct from other cancers, such as melanoma,” Jamiluddin Qazi, an undergraduate student at the University of Washington, Seattle, said at the annual meeting of the Society for Investigative Dermatology. The findings could help guide imaging and other surveillance of patients after they develop a primary Merkel cell tumor, he added.

Wikimedia Commons/Ed Uthman/CC BY-SA 2.0

About 2,000 individuals in the United States are diagnosed with Merkel cell carcinoma every year. About 40% of these patients develop metastatic disease, which has a 5-year survival rate of less than 25%, Mr. Qazi noted. Indeed, median survival after diagnosis of metastatic Merkel cell carcinoma was only 9.5 months in one recent study (J Cutan Pathol. 2010;37:20-7). Programmed death 1 (PD-1) blockade with pembrolizumab (Keytruda) can potentially improve survival (N Engl J Med. 2016; 374:2542-52), “but there is no consensus regarding follow-up for Merkel cell carcinoma. The 2016 National Comprehensive Cancer Network (NCCN) guidelines recommend ‘follow up as clinically indicated,’ and a lack of data has led to ambiguity,” Mr. Qazi said.

Working with oncologists and radiologists at the Seattle Cancer Care Alliance, he analyzed a tissue and clinical database of 442 initial distant Merkel cell carcinoma metastases among 305 patients. Initial distant metastases were defined as the first lesions detected beyond the regional lymph nodes of the primary tumor. A total of 69% of patients had one initial distant metastasis, 19% had two concurrently identified lesions, 9% had three lesions, and 4% had at least four lesions, Mr. Qazi reported.

“Merkel cell carcinoma seemed to metastasize to unusual places, but clearly preferred the distant lymph nodes. In all, 26% of metastases localized there, most commonly to the supraclavicular, retroperitoneal, and iliac nodes,” he said. The next most common site of distant metastasis was the liver (15% of lesions), followed by the skin and bone (13% of lesions each), lung (6%), and pancreas (5%). Less common sites included the heart, spleen, abdominal muscle, brain, kidneys, adrenal glands, gonad, chest wall, and stomach.

Comparing these findings with a similar study in melanoma (J Oncol 2012. doi: 10.1155/2012/647684) showed that both cancers have about the same chances of metastasizing to the liver, bone, kidneys, adrenal glands, and stomach, Mr. Qazi said. However, Merkel cell carcinoma was less likely to metastasize to the brain (3% of lesions, vs. 12% for melanoma) and lung (6% vs. 14%), and was more likely to metastasize to the pancreas (5% vs. 1%).

Now the investigators are working to link metastatic sites with factors such as the location of the primary tumor, the presence or absence of lymphovascular invasion, and the status of the immune system and Merkel polyomavirus infection, said Mr. Qazi. They also are analyzing time from diagnosis or treatment to metastasis to help guide decisions about when to order follow-up imaging. Ultimately, they hope to create an online tool that enables clinicians to describe a primary Merkel cell carcinoma and rapidly receive automated information about the most likely timing and location of metastasis.

The National Institutes of Health supported the study. Mr. Qazi had no conflicts of interest.

SCOTTSDALE, ARIZ. – Distant metastatic sites of Merkel cell carcinoma most often involved the supraclavicular, retroperitoneal, and iliac lymph nodes, in a single center retrospective study of 305 patients.

Merkel cell carcinoma metastases “clearly favored distant nodes, but the distribution of other metastatic sites was distinct from other cancers, such as melanoma,” Jamiluddin Qazi, an undergraduate student at the University of Washington, Seattle, said at the annual meeting of the Society for Investigative Dermatology. The findings could help guide imaging and other surveillance of patients after they develop a primary Merkel cell tumor, he added.

Wikimedia Commons/Ed Uthman/CC BY-SA 2.0

About 2,000 individuals in the United States are diagnosed with Merkel cell carcinoma every year. About 40% of these patients develop metastatic disease, which has a 5-year survival rate of less than 25%, Mr. Qazi noted. Indeed, median survival after diagnosis of metastatic Merkel cell carcinoma was only 9.5 months in one recent study (J Cutan Pathol. 2010;37:20-7). Programmed death 1 (PD-1) blockade with pembrolizumab (Keytruda) can potentially improve survival (N Engl J Med. 2016; 374:2542-52), “but there is no consensus regarding follow-up for Merkel cell carcinoma. The 2016 National Comprehensive Cancer Network (NCCN) guidelines recommend ‘follow up as clinically indicated,’ and a lack of data has led to ambiguity,” Mr. Qazi said.

Working with oncologists and radiologists at the Seattle Cancer Care Alliance, he analyzed a tissue and clinical database of 442 initial distant Merkel cell carcinoma metastases among 305 patients. Initial distant metastases were defined as the first lesions detected beyond the regional lymph nodes of the primary tumor. A total of 69% of patients had one initial distant metastasis, 19% had two concurrently identified lesions, 9% had three lesions, and 4% had at least four lesions, Mr. Qazi reported.

“Merkel cell carcinoma seemed to metastasize to unusual places, but clearly preferred the distant lymph nodes. In all, 26% of metastases localized there, most commonly to the supraclavicular, retroperitoneal, and iliac nodes,” he said. The next most common site of distant metastasis was the liver (15% of lesions), followed by the skin and bone (13% of lesions each), lung (6%), and pancreas (5%). Less common sites included the heart, spleen, abdominal muscle, brain, kidneys, adrenal glands, gonad, chest wall, and stomach.

Comparing these findings with a similar study in melanoma (J Oncol 2012. doi: 10.1155/2012/647684) showed that both cancers have about the same chances of metastasizing to the liver, bone, kidneys, adrenal glands, and stomach, Mr. Qazi said. However, Merkel cell carcinoma was less likely to metastasize to the brain (3% of lesions, vs. 12% for melanoma) and lung (6% vs. 14%), and was more likely to metastasize to the pancreas (5% vs. 1%).

Now the investigators are working to link metastatic sites with factors such as the location of the primary tumor, the presence or absence of lymphovascular invasion, and the status of the immune system and Merkel polyomavirus infection, said Mr. Qazi. They also are analyzing time from diagnosis or treatment to metastasis to help guide decisions about when to order follow-up imaging. Ultimately, they hope to create an online tool that enables clinicians to describe a primary Merkel cell carcinoma and rapidly receive automated information about the most likely timing and location of metastasis.

The National Institutes of Health supported the study. Mr. Qazi had no conflicts of interest.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. –Among patients with atopic dermatitis, persistently active disease was significantly more common among females of nonwhite race with a history of atopy than among patients without these characteristics, in an analysis of survey data from the Pediatric Elective Eczema Registry.

Annual household income under $50,000 also was a significant predictor of persistently active eczema, according to Katrina Abuabara, MD, of the department of dermatology, University of California, San Francisco, and her associates, who reported their results in a poster at the annual meeting of the Society for Investigative Dermatology.

Atopic dermatitis often persists into adulthood, but few studies have explored contributors to poor disease control. To help fill that gap, the investigators analyzed 65,237 surveys from the Pediatric Eczema Elective Registry (PEER), which tracks children and young adults aged 2-26 years with physician-diagnosed atopic dermatitis. The average age of the 6,237 patients was 7 years at enrollment (standard deviation, 4 years). They were followed at 6-month intervals for up to 10 years, with an average of about 10 surveys per respondent (standard deviation, 6.3 surveys).

In all, 4,607 patients (74% of the cohort) returned surveys spanning early childhood through their mid-20s. Only 15% of patients had “resolving” disease, meaning that as they aged, they increasingly reported complete disease control for periods of 6 months and longer.

The remaining 85% of patients had persistently active disease. In this group, 54% were female, 77% had a household income under $50,000 per year, 71% were nonwhite, and 75% had a history of atopy. Each of these characteristics significantly increased the odds of persistently active atopic dermatitis in the multivariable model (P less than .05 for each association).

Nonwhite race and history of atopy were the strongest predictors of persistently active disease – each lowered the odds of complete disease control by almost 50% (odds ratio, 0.53). Furthermore, females had 37% lower odds of complete disease control compared with males (OR, 0.63), and individuals with household income under $50,000 had 16% lower odds of complete disease control compared with those with higher annual incomes (OR, 0.84).

The link between lower socioeconomic status and persistently active eczema belies previous findings, the researchers noted. Those studies found that individuals of higher socioeconomic status were at greater risk for developing atopic dermatitis, but “failed to account for the chronic nature of the disease. In contrast, our results suggest that atopic dermatitis persistence may be associated with lower income and nonwhite race, and highlight the importance of longitudinal studies that permit analysis of mechanisms of disease control over time.”

Dr. Abuabara received a grant from the Clinical & Translational Science Institute of UCSF. She had no disclosures.

SCOTTSDALE, ARIZ. – Psoriasis of all severities was linked to a 3.5-fold increase in risk of cutaneous T-cell lymphoma, and severe psoriasis upped the associated risk of Hodgkin lymphoma by about 2.5 times, in a large, longitudinal, population-based cohort study.

Psoriasis also was tied to a smaller but statistically significant increase in the risk of non-Hodgkin lymphoma, said Zelma Chiesa Fuxench, MD, of the department of dermatology, the University of Pennsylvania, Philadelphia. Overall, lymphoma risk was highest in people with severe psoriasis, independent of traditional risk factors and exposure to immunosuppressive medications, Dr. Fuxench said at the annual meeting of the Society for Investigative Dermatology.

Courtesy of the Centers for Disease Control and Prevention (CDC)

Psoriasis affects more than 125 million people worldwide, and severe cases are a major cause of cancer-related mortality. “Prior studies have suggested an increased risk of lymphoma in psoriasis patients, but it is unclear if this due to chronic inflammation, exposure to immunosuppressive therapies, or a combination of both factors,” Dr. Fuxench said.

To further explore these links, she and her associates analyzed electronic medical records from THIN (The Health Information Network), which includes about 12 million patients across the United Kingdom. Adults with psoriasis were matched to up to five nonpsoriatic controls based on date and clinic location. Patients who needed systemic medications or phototherapy were categorized as having severe psoriasis. The final dataset included more than 12,000 such patients, as well as 184,000 patients with mild psoriasis and more than 965,000 patients without psoriasis.

Psoriasis patients were younger and more likely to be overweight, male, and smoke and drink alcohol than patients without psoriasis, Dr. Fuxench said. Almost 80% of patients with severe disease had received systemic therapies, most often methotrexate (70% of systemic treatments) or cyclosporine (10%), while only 1% had received biologics.

Patients with severe psoriasis were more likely to be diagnosed with Hodgkin disease, non-Hodgkin lymphoma, and cutaneous T-cell lymphoma than were patients with mild psoriasis or controls. Over a median follow-up of 5.3 years, 34 patients with severe psoriasis were diagnosed with any type of lymphoma, for an incidence of 5.2 cases per 10,000 person-years (95% confidence interval, 3.7-7.3). In contrast, incidence rates for patients with mild psoriasis and controls were 3.3 and 3.2 cases per 10,000 person-years, respectively, Dr. Fuxench said.

In the multivariable analysis, patients with psoriasis were about 18% more likely to develop any type of lymphoma than were controls, an association that reached statistical significance (adjusted hazard ratio, 1.18; 95% CI, 1.06-1.31). Mild psoriasis increased lymphoma risk by 14%, and severe psoriasis upped it by about 83%, and both associations were statistically significant.

The increase in risk of non-Hodgkin lymphoma was 13% greater with mild psoriasis and 56% greater with severe disease, compared with controls, and these associations also reached statistical significance. Mild psoriasis was not linked to Hodgkin lymphoma, but patients with severe psoriasis were about 250% more likely to develop it than controls, with a trend toward statistical significance (aHR, 2.54; 95% CI, 0.94-6.87).

Finally, severe psoriasis was linked to a more than ninefold increase in risk of cutaneous T-cell lymphoma (aHR, 9.3; 95% CI, 4.1-21.4), while mild psoriasis was linked to about a threefold increase in risk.

“These results were robust in multiple sensitivity analyses, including analyses that excluded patients with rheumatoid arthritis, psoriatic arthritis, or a history of exposure to methotrexate, cyclosporine, or biologics,” Dr. Fuxench said. Future studies should explore the effect of treatment timing and selection on cancer risk, she added. “For those of us who care for these patients, we are increasingly using systemic agents that selectively target the immune system, and these questions will arise in clinics.”

The study’s design made it possible to pinpoint dates of diagnosis more effectively than investigators could estimate disease duration or confirm whether patients initially diagnosed with psoriasis actually had cutaneous T-cell lymphoma, Dr. Fuxench noted. “Ideally, we could have another cohort study of incident psoriasis with prospective follow-up, but lymphoma is so rare that there is currently not enough power [in the THIN database] to determine associations.”

The study was funded by grants from the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Fuxench disclosed unrestricted research funding from Pfizer outside the submitted work.

SCOTTSDALE, ARIZ. – Psoriasis of all severities was linked to a 3.5-fold increase in risk of cutaneous T-cell lymphoma, and severe psoriasis upped the associated risk of Hodgkin lymphoma by about 2.5 times, in a large, longitudinal, population-based cohort study.

Psoriasis also was tied to a smaller but statistically significant increase in the risk of non-Hodgkin lymphoma, said Zelma Chiesa Fuxench, MD, of the department of dermatology, the University of Pennsylvania, Philadelphia. Overall, lymphoma risk was highest in people with severe psoriasis, independent of traditional risk factors and exposure to immunosuppressive medications, Dr. Fuxench said at the annual meeting of the Society for Investigative Dermatology.

Courtesy of the Centers for Disease Control and Prevention (CDC)

Psoriasis affects more than 125 million people worldwide, and severe cases are a major cause of cancer-related mortality. “Prior studies have suggested an increased risk of lymphoma in psoriasis patients, but it is unclear if this due to chronic inflammation, exposure to immunosuppressive therapies, or a combination of both factors,” Dr. Fuxench said.

To further explore these links, she and her associates analyzed electronic medical records from THIN (The Health Information Network), which includes about 12 million patients across the United Kingdom. Adults with psoriasis were matched to up to five nonpsoriatic controls based on date and clinic location. Patients who needed systemic medications or phototherapy were categorized as having severe psoriasis. The final dataset included more than 12,000 such patients, as well as 184,000 patients with mild psoriasis and more than 965,000 patients without psoriasis.

Psoriasis patients were younger and more likely to be overweight, male, and smoke and drink alcohol than patients without psoriasis, Dr. Fuxench said. Almost 80% of patients with severe disease had received systemic therapies, most often methotrexate (70% of systemic treatments) or cyclosporine (10%), while only 1% had received biologics.

Patients with severe psoriasis were more likely to be diagnosed with Hodgkin disease, non-Hodgkin lymphoma, and cutaneous T-cell lymphoma than were patients with mild psoriasis or controls. Over a median follow-up of 5.3 years, 34 patients with severe psoriasis were diagnosed with any type of lymphoma, for an incidence of 5.2 cases per 10,000 person-years (95% confidence interval, 3.7-7.3). In contrast, incidence rates for patients with mild psoriasis and controls were 3.3 and 3.2 cases per 10,000 person-years, respectively, Dr. Fuxench said.

In the multivariable analysis, patients with psoriasis were about 18% more likely to develop any type of lymphoma than were controls, an association that reached statistical significance (adjusted hazard ratio, 1.18; 95% CI, 1.06-1.31). Mild psoriasis increased lymphoma risk by 14%, and severe psoriasis upped it by about 83%, and both associations were statistically significant.

The increase in risk of non-Hodgkin lymphoma was 13% greater with mild psoriasis and 56% greater with severe disease, compared with controls, and these associations also reached statistical significance. Mild psoriasis was not linked to Hodgkin lymphoma, but patients with severe psoriasis were about 250% more likely to develop it than controls, with a trend toward statistical significance (aHR, 2.54; 95% CI, 0.94-6.87).

Finally, severe psoriasis was linked to a more than ninefold increase in risk of cutaneous T-cell lymphoma (aHR, 9.3; 95% CI, 4.1-21.4), while mild psoriasis was linked to about a threefold increase in risk.

“These results were robust in multiple sensitivity analyses, including analyses that excluded patients with rheumatoid arthritis, psoriatic arthritis, or a history of exposure to methotrexate, cyclosporine, or biologics,” Dr. Fuxench said. Future studies should explore the effect of treatment timing and selection on cancer risk, she added. “For those of us who care for these patients, we are increasingly using systemic agents that selectively target the immune system, and these questions will arise in clinics.”

The study’s design made it possible to pinpoint dates of diagnosis more effectively than investigators could estimate disease duration or confirm whether patients initially diagnosed with psoriasis actually had cutaneous T-cell lymphoma, Dr. Fuxench noted. “Ideally, we could have another cohort study of incident psoriasis with prospective follow-up, but lymphoma is so rare that there is currently not enough power [in the THIN database] to determine associations.”

The study was funded by grants from the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Fuxench disclosed unrestricted research funding from Pfizer outside the submitted work.

SCOTTSDALE, ARIZ. – Psoriasis of all severities was linked to a 3.5-fold increase in risk of cutaneous T-cell lymphoma, and severe psoriasis upped the associated risk of Hodgkin lymphoma by about 2.5 times, in a large, longitudinal, population-based cohort study.

Psoriasis also was tied to a smaller but statistically significant increase in the risk of non-Hodgkin lymphoma, said Zelma Chiesa Fuxench, MD, of the department of dermatology, the University of Pennsylvania, Philadelphia. Overall, lymphoma risk was highest in people with severe psoriasis, independent of traditional risk factors and exposure to immunosuppressive medications, Dr. Fuxench said at the annual meeting of the Society for Investigative Dermatology.

Courtesy of the Centers for Disease Control and Prevention (CDC)

Psoriasis affects more than 125 million people worldwide, and severe cases are a major cause of cancer-related mortality. “Prior studies have suggested an increased risk of lymphoma in psoriasis patients, but it is unclear if this due to chronic inflammation, exposure to immunosuppressive therapies, or a combination of both factors,” Dr. Fuxench said.

To further explore these links, she and her associates analyzed electronic medical records from THIN (The Health Information Network), which includes about 12 million patients across the United Kingdom. Adults with psoriasis were matched to up to five nonpsoriatic controls based on date and clinic location. Patients who needed systemic medications or phototherapy were categorized as having severe psoriasis. The final dataset included more than 12,000 such patients, as well as 184,000 patients with mild psoriasis and more than 965,000 patients without psoriasis.

Psoriasis patients were younger and more likely to be overweight, male, and smoke and drink alcohol than patients without psoriasis, Dr. Fuxench said. Almost 80% of patients with severe disease had received systemic therapies, most often methotrexate (70% of systemic treatments) or cyclosporine (10%), while only 1% had received biologics.

Patients with severe psoriasis were more likely to be diagnosed with Hodgkin disease, non-Hodgkin lymphoma, and cutaneous T-cell lymphoma than were patients with mild psoriasis or controls. Over a median follow-up of 5.3 years, 34 patients with severe psoriasis were diagnosed with any type of lymphoma, for an incidence of 5.2 cases per 10,000 person-years (95% confidence interval, 3.7-7.3). In contrast, incidence rates for patients with mild psoriasis and controls were 3.3 and 3.2 cases per 10,000 person-years, respectively, Dr. Fuxench said.

In the multivariable analysis, patients with psoriasis were about 18% more likely to develop any type of lymphoma than were controls, an association that reached statistical significance (adjusted hazard ratio, 1.18; 95% CI, 1.06-1.31). Mild psoriasis increased lymphoma risk by 14%, and severe psoriasis upped it by about 83%, and both associations were statistically significant.

The increase in risk of non-Hodgkin lymphoma was 13% greater with mild psoriasis and 56% greater with severe disease, compared with controls, and these associations also reached statistical significance. Mild psoriasis was not linked to Hodgkin lymphoma, but patients with severe psoriasis were about 250% more likely to develop it than controls, with a trend toward statistical significance (aHR, 2.54; 95% CI, 0.94-6.87).

Finally, severe psoriasis was linked to a more than ninefold increase in risk of cutaneous T-cell lymphoma (aHR, 9.3; 95% CI, 4.1-21.4), while mild psoriasis was linked to about a threefold increase in risk.

“These results were robust in multiple sensitivity analyses, including analyses that excluded patients with rheumatoid arthritis, psoriatic arthritis, or a history of exposure to methotrexate, cyclosporine, or biologics,” Dr. Fuxench said. Future studies should explore the effect of treatment timing and selection on cancer risk, she added. “For those of us who care for these patients, we are increasingly using systemic agents that selectively target the immune system, and these questions will arise in clinics.”

The study’s design made it possible to pinpoint dates of diagnosis more effectively than investigators could estimate disease duration or confirm whether patients initially diagnosed with psoriasis actually had cutaneous T-cell lymphoma, Dr. Fuxench noted. “Ideally, we could have another cohort study of incident psoriasis with prospective follow-up, but lymphoma is so rare that there is currently not enough power [in the THIN database] to determine associations.”

The study was funded by grants from the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Fuxench disclosed unrestricted research funding from Pfizer outside the submitted work.

SCOTTSDALE, ARIZ. – Psoriasis of all severities was linked to a 3.5-fold increase in risk of cutaneous T-cell lymphoma, and severe psoriasis upped the associated risk of Hodgkin lymphoma by about 2.5 times, in a large, longitudinal, population-based cohort study.

Psoriasis also was tied to a smaller but statistically significant increase in the risk of non-Hodgkin lymphoma, said Zelma Chiesa Fuxench, MD, of the department of dermatology, the University of Pennsylvania, Philadelphia. Overall, lymphoma risk was highest in people with severe psoriasis, independent of traditional risk factors and exposure to immunosuppressive medications, Dr. Fuxench said at the annual meeting of the Society for Investigative Dermatology.

Courtesy of the Centers for Disease Control and Prevention (CDC)

Psoriasis affects more than 125 million people worldwide, and severe cases are a major cause of cancer-related mortality. “Prior studies have suggested an increased risk of lymphoma in psoriasis patients, but it is unclear if this due to chronic inflammation, exposure to immunosuppressive therapies, or a combination of both factors,” Dr. Fuxench said.

To further explore these links, she and her associates analyzed electronic medical records from THIN (The Health Information Network), which includes about 12 million patients across the United Kingdom. Adults with psoriasis were matched to up to five nonpsoriatic controls based on date and clinic location. Patients who needed systemic medications or phototherapy were categorized as having severe psoriasis. The final dataset included more than 12,000 such patients, as well as 184,000 patients with mild psoriasis and more than 965,000 patients without psoriasis.

Psoriasis patients were younger and more likely to be overweight, male, and smoke and drink alcohol than patients without psoriasis, Dr. Fuxench said. Almost 80% of patients with severe disease had received systemic therapies, most often methotrexate (70% of systemic treatments) or cyclosporine (10%), while only 1% had received biologics.

Patients with severe psoriasis were more likely to be diagnosed with Hodgkin disease, non-Hodgkin lymphoma, and cutaneous T-cell lymphoma than were patients with mild psoriasis or controls. Over a median follow-up of 5.3 years, 34 patients with severe psoriasis were diagnosed with any type of lymphoma, for an incidence of 5.2 cases per 10,000 person-years (95% confidence interval, 3.7-7.3). In contrast, incidence rates for patients with mild psoriasis and controls were 3.3 and 3.2 cases per 10,000 person-years, respectively, Dr. Fuxench said.

In the multivariable analysis, patients with psoriasis were about 18% more likely to develop any type of lymphoma than were controls, an association that reached statistical significance (adjusted hazard ratio, 1.18; 95% CI, 1.06-1.31). Mild psoriasis increased lymphoma risk by 14%, and severe psoriasis upped it by about 83%, and both associations were statistically significant.

The increase in risk of non-Hodgkin lymphoma was 13% greater with mild psoriasis and 56% greater with severe disease, compared with controls, and these associations also reached statistical significance. Mild psoriasis was not linked to Hodgkin lymphoma, but patients with severe psoriasis were about 250% more likely to develop it than controls, with a trend toward statistical significance (aHR, 2.54; 95% CI, 0.94-6.87).

Finally, severe psoriasis was linked to a more than ninefold increase in risk of cutaneous T-cell lymphoma (aHR, 9.3; 95% CI, 4.1-21.4), while mild psoriasis was linked to about a threefold increase in risk.

“These results were robust in multiple sensitivity analyses, including analyses that excluded patients with rheumatoid arthritis, psoriatic arthritis, or a history of exposure to methotrexate, cyclosporine, or biologics,” Dr. Fuxench said. Future studies should explore the effect of treatment timing and selection on cancer risk, she added. “For those of us who care for these patients, we are increasingly using systemic agents that selectively target the immune system, and these questions will arise in clinics.”

The study’s design made it possible to pinpoint dates of diagnosis more effectively than investigators could estimate disease duration or confirm whether patients initially diagnosed with psoriasis actually had cutaneous T-cell lymphoma, Dr. Fuxench noted. “Ideally, we could have another cohort study of incident psoriasis with prospective follow-up, but lymphoma is so rare that there is currently not enough power [in the THIN database] to determine associations.”

The study was funded by grants from the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Fuxench disclosed unrestricted research funding from Pfizer outside the submitted work.

SCOTTSDALE, ARIZ. – Psoriasis of all severities was linked to a 3.5-fold increase in risk of cutaneous T-cell lymphoma, and severe psoriasis upped the associated risk of Hodgkin lymphoma by about 2.5 times, in a large, longitudinal, population-based cohort study.

Psoriasis also was tied to a smaller but statistically significant increase in the risk of non-Hodgkin lymphoma, said Zelma Chiesa Fuxench, MD, of the department of dermatology, the University of Pennsylvania, Philadelphia. Overall, lymphoma risk was highest in people with severe psoriasis, independent of traditional risk factors and exposure to immunosuppressive medications, Dr. Fuxench said at the annual meeting of the Society for Investigative Dermatology.

Courtesy of the Centers for Disease Control and Prevention (CDC)

Psoriasis affects more than 125 million people worldwide, and severe cases are a major cause of cancer-related mortality. “Prior studies have suggested an increased risk of lymphoma in psoriasis patients, but it is unclear if this due to chronic inflammation, exposure to immunosuppressive therapies, or a combination of both factors,” Dr. Fuxench said.

To further explore these links, she and her associates analyzed electronic medical records from THIN (The Health Information Network), which includes about 12 million patients across the United Kingdom. Adults with psoriasis were matched to up to five nonpsoriatic controls based on date and clinic location. Patients who needed systemic medications or phototherapy were categorized as having severe psoriasis. The final dataset included more than 12,000 such patients, as well as 184,000 patients with mild psoriasis and more than 965,000 patients without psoriasis.

Psoriasis patients were younger and more likely to be overweight, male, and smoke and drink alcohol than patients without psoriasis, Dr. Fuxench said. Almost 80% of patients with severe disease had received systemic therapies, most often methotrexate (70% of systemic treatments) or cyclosporine (10%), while only 1% had received biologics.

Patients with severe psoriasis were more likely to be diagnosed with Hodgkin disease, non-Hodgkin lymphoma, and cutaneous T-cell lymphoma than were patients with mild psoriasis or controls. Over a median follow-up of 5.3 years, 34 patients with severe psoriasis were diagnosed with any type of lymphoma, for an incidence of 5.2 cases per 10,000 person-years (95% confidence interval, 3.7-7.3). In contrast, incidence rates for patients with mild psoriasis and controls were 3.3 and 3.2 cases per 10,000 person-years, respectively, Dr. Fuxench said.

In the multivariable analysis, patients with psoriasis were about 18% more likely to develop any type of lymphoma than were controls, an association that reached statistical significance (adjusted hazard ratio, 1.18; 95% CI, 1.06-1.31). Mild psoriasis increased lymphoma risk by 14%, and severe psoriasis upped it by about 83%, and both associations were statistically significant.

The increase in risk of non-Hodgkin lymphoma was 13% greater with mild psoriasis and 56% greater with severe disease, compared with controls, and these associations also reached statistical significance. Mild psoriasis was not linked to Hodgkin lymphoma, but patients with severe psoriasis were about 250% more likely to develop it than controls, with a trend toward statistical significance (aHR, 2.54; 95% CI, 0.94-6.87).

Finally, severe psoriasis was linked to a more than ninefold increase in risk of cutaneous T-cell lymphoma (aHR, 9.3; 95% CI, 4.1-21.4), while mild psoriasis was linked to about a threefold increase in risk.

“These results were robust in multiple sensitivity analyses, including analyses that excluded patients with rheumatoid arthritis, psoriatic arthritis, or a history of exposure to methotrexate, cyclosporine, or biologics,” Dr. Fuxench said. Future studies should explore the effect of treatment timing and selection on cancer risk, she added. “For those of us who care for these patients, we are increasingly using systemic agents that selectively target the immune system, and these questions will arise in clinics.”

The study’s design made it possible to pinpoint dates of diagnosis more effectively than investigators could estimate disease duration or confirm whether patients initially diagnosed with psoriasis actually had cutaneous T-cell lymphoma, Dr. Fuxench noted. “Ideally, we could have another cohort study of incident psoriasis with prospective follow-up, but lymphoma is so rare that there is currently not enough power [in the THIN database] to determine associations.”

The study was funded by grants from the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Fuxench disclosed unrestricted research funding from Pfizer outside the submitted work.

SCOTTSDALE, ARIZ. – Psoriasis of all severities was linked to a 3.5-fold increase in risk of cutaneous T-cell lymphoma, and severe psoriasis upped the associated risk of Hodgkin lymphoma by about 2.5 times, in a large, longitudinal, population-based cohort study.

Psoriasis also was tied to a smaller but statistically significant increase in the risk of non-Hodgkin lymphoma, said Zelma Chiesa Fuxench, MD, of the department of dermatology, the University of Pennsylvania, Philadelphia. Overall, lymphoma risk was highest in people with severe psoriasis, independent of traditional risk factors and exposure to immunosuppressive medications, Dr. Fuxench said at the annual meeting of the Society for Investigative Dermatology.

Courtesy of the Centers for Disease Control and Prevention (CDC)

Psoriasis affects more than 125 million people worldwide, and severe cases are a major cause of cancer-related mortality. “Prior studies have suggested an increased risk of lymphoma in psoriasis patients, but it is unclear if this due to chronic inflammation, exposure to immunosuppressive therapies, or a combination of both factors,” Dr. Fuxench said.

To further explore these links, she and her associates analyzed electronic medical records from THIN (The Health Information Network), which includes about 12 million patients across the United Kingdom. Adults with psoriasis were matched to up to five nonpsoriatic controls based on date and clinic location. Patients who needed systemic medications or phototherapy were categorized as having severe psoriasis. The final dataset included more than 12,000 such patients, as well as 184,000 patients with mild psoriasis and more than 965,000 patients without psoriasis.

Psoriasis patients were younger and more likely to be overweight, male, and smoke and drink alcohol than patients without psoriasis, Dr. Fuxench said. Almost 80% of patients with severe disease had received systemic therapies, most often methotrexate (70% of systemic treatments) or cyclosporine (10%), while only 1% had received biologics.

Patients with severe psoriasis were more likely to be diagnosed with Hodgkin disease, non-Hodgkin lymphoma, and cutaneous T-cell lymphoma than were patients with mild psoriasis or controls. Over a median follow-up of 5.3 years, 34 patients with severe psoriasis were diagnosed with any type of lymphoma, for an incidence of 5.2 cases per 10,000 person-years (95% confidence interval, 3.7-7.3). In contrast, incidence rates for patients with mild psoriasis and controls were 3.3 and 3.2 cases per 10,000 person-years, respectively, Dr. Fuxench said.

In the multivariable analysis, patients with psoriasis were about 18% more likely to develop any type of lymphoma than were controls, an association that reached statistical significance (adjusted hazard ratio, 1.18; 95% CI, 1.06-1.31). Mild psoriasis increased lymphoma risk by 14%, and severe psoriasis upped it by about 83%, and both associations were statistically significant.

The increase in risk of non-Hodgkin lymphoma was 13% greater with mild psoriasis and 56% greater with severe disease, compared with controls, and these associations also reached statistical significance. Mild psoriasis was not linked to Hodgkin lymphoma, but patients with severe psoriasis were about 250% more likely to develop it than controls, with a trend toward statistical significance (aHR, 2.54; 95% CI, 0.94-6.87).

Finally, severe psoriasis was linked to a more than ninefold increase in risk of cutaneous T-cell lymphoma (aHR, 9.3; 95% CI, 4.1-21.4), while mild psoriasis was linked to about a threefold increase in risk.

“These results were robust in multiple sensitivity analyses, including analyses that excluded patients with rheumatoid arthritis, psoriatic arthritis, or a history of exposure to methotrexate, cyclosporine, or biologics,” Dr. Fuxench said. Future studies should explore the effect of treatment timing and selection on cancer risk, she added. “For those of us who care for these patients, we are increasingly using systemic agents that selectively target the immune system, and these questions will arise in clinics.”

The study’s design made it possible to pinpoint dates of diagnosis more effectively than investigators could estimate disease duration or confirm whether patients initially diagnosed with psoriasis actually had cutaneous T-cell lymphoma, Dr. Fuxench noted. “Ideally, we could have another cohort study of incident psoriasis with prospective follow-up, but lymphoma is so rare that there is currently not enough power [in the THIN database] to determine associations.”

The study was funded by grants from the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Fuxench disclosed unrestricted research funding from Pfizer outside the submitted work.