Wednesday, March 22, 2006

Hematologic malignancy prognosis; Sex differences in pain

A few things in brief...

Annals of Internal Medicine has an article about the development of a prognostic index for bone marrow transplant patients. It uses 8 variables--age, stem cell donor type, disease risk, conditioning regimen, FEV-1, DLCO, creatinine level, and ALT--and predicts who has a high likelihood (~80% in the highest risk group) of dying within 2 years. It has not been externally validated beyond the cohort in which it was developed. If one was inclined towards such things, this could be used to screen patients receiving BMT's for whom early palliative care referral for advanced care planning, etc. would be indicated.

Along these lines Drugs & Aging recently published a review of trends in the treatment of AML amongst the elderly in the US. Prgnosis remains dismal (>90% 2 year mortality for people over 65 years; median survival is less than 4 months)--but the use of hospice services doubled across the 1990's. (Rates of use of chemotherapy also increased but without evidence of improved survival across the cohort unfortunately.)

Back to Annals of Internal Medicine, there's also an interesting bit about sex differences in pain, involving receptors mu, kappa, and melanocortin. It's mostly basic science stuff, but casually written and an easy read (for those of us whose seizure threshold is lowered by reading basic science research).

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