EDITORIAL

Burnout syndrome in ICU caregivers: Time to extinguish! By Dr. S. Pastores, FCCP

COMMENTARY

An Official Critical Care Societies Collaborative Statement – Burnout syndrome in critical care health-care professionals: A call for action. By Dr. M. Moss et al.

GIANTS IN CHEST MEDICINE

Neil R. MacIntyre, MD, FCCP. By Dr. Lisa K. Moores, FCCP

ORIGINAL RESEARCH

Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation

Syndrome. By Dr. J. R. Masa et al.

Treprostinil administered to treat pulmonary arterial hypertension using a fully implantable programmable intravascular delivery system: Results of the DeliVery for PAH Trial. By Dr. R. C. Bourge et al.

Improving quality of acute asthma care in US hospitals: Changes between 1999-2000 and 2012-2013. By Dr. K. Hasegawa et al.

EDITORIAL

Burnout syndrome in ICU caregivers: Time to extinguish! By Dr. S. Pastores, FCCP

COMMENTARY

An Official Critical Care Societies Collaborative Statement – Burnout syndrome in critical care health-care professionals: A call for action. By Dr. M. Moss et al.

GIANTS IN CHEST MEDICINE

Neil R. MacIntyre, MD, FCCP. By Dr. Lisa K. Moores, FCCP

ORIGINAL RESEARCH

Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation

Syndrome. By Dr. J. R. Masa et al.

Treprostinil administered to treat pulmonary arterial hypertension using a fully implantable programmable intravascular delivery system: Results of the DeliVery for PAH Trial. By Dr. R. C. Bourge et al.

Improving quality of acute asthma care in US hospitals: Changes between 1999-2000 and 2012-2013. By Dr. K. Hasegawa et al.

EDITORIAL

Burnout syndrome in ICU caregivers: Time to extinguish! By Dr. S. Pastores, FCCP

COMMENTARY

An Official Critical Care Societies Collaborative Statement – Burnout syndrome in critical care health-care professionals: A call for action. By Dr. M. Moss et al.

GIANTS IN CHEST MEDICINE

Neil R. MacIntyre, MD, FCCP. By Dr. Lisa K. Moores, FCCP

ORIGINAL RESEARCH

Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation

Syndrome. By Dr. J. R. Masa et al.

Treprostinil administered to treat pulmonary arterial hypertension using a fully implantable programmable intravascular delivery system: Results of the DeliVery for PAH Trial. By Dr. R. C. Bourge et al.

Improving quality of acute asthma care in US hospitals: Changes between 1999-2000 and 2012-2013. By Dr. K. Hasegawa et al.

Do you ever wonder how CHEST decides where to have its annual meeting? It’s a science! We know that venue is an important consideration for busy clinicians who are trying to decide whether to invest time and money in attending a national meeting. Evaluation of criteria that determine the attractiveness of a given location for a national meeting is a job for professionals! At CHEST, we are very fortunate to work with Heather Nash, CMP, who is the senior director, meetings and training center operations, along with her talented meetings team in choosing a top-notch destination for the CHEST Annual Meeting.

The site selection of an annual meeting is a very important decision an association makes for its members. There is a variety of factors considered in making this decision, and the site selection process begins approximately 5-7 years in advance. Why so early, you might ask. The size of the CHEST Annual Meeting is the answer! Our annual meeting requires a significant amount of meeting, exhibits, ballroom, and public foyer space. Additionally, the host city needs a minimum of 3,000 hotel rooms in the vicinity of the Convention Center. What this means is that the CHEST Annual Meeting does not fit into all convention centers and cities within the United States and Canada. Plus, other important criteria that are also considered are cost, travel, weather, and the amenities that a destination offers.

The site selection process starts with each destination’s Convention and Visitors Bureau that is presented with a Request for Proposal, which includes a list of all the CHEST Annual Meeting specifications, requirements, and preferred dates. Based on those specifications, each city will compile a proposal of its full offerings, including meeting space, hotels, air and ground transportation, weather, cost, and key amenities of the destination. The puzzle that each city goes through is to determine whether the destination has all of the requirements needed by CHEST and to submit a complete proposal. It’s fierce competition out there, which is why the process must start 5-7 years prior. The last step is to compile a site selection report that outlines, in order of priority, all components that CHEST needs to create a short list of locations and propose a final decision.

Why is the convention center size so important? The CHEST Meeting Director must determine whether a certain venue and city can accommodate the CHEST Annual Meeting. A few key factors that are reviewed include exhibit space; a minimum of 300,000+ gross square feet, 30+ flexible size meeting rooms that can accommodate 75-400 people each for educational sessions, opening keynote session space for 2,500 people, a Simulation Center space, not to mention the additional needs for registration, self-study stations, games, and other e-learning opportunities. More often than not, the largest convention centers that attract CHEST fall into a category that we refer to as first-tier cities (i.e., Chicago, New Orleans, Toronto, Boston, and Los Angeles). The second category of cities that have smaller convention centers but still may be an option for CHEST are second-tier cities (i.e., Montreal, Austin, Honolulu, and Atlanta).

Of course, there are the other aspects of an annual meeting that are very important to clinicians, guests, and attendees. How easy is it to get a flight at a reasonable cost? How close are the hotels and what are the room rates of the official meeting hotels? Can I walk to the convention center or do we need to get on a bus? Can I walk to a restaurant after a full day of sessions? These are just a few questions we receive often by our CHEST Help Team representatives. We track these types of questions so that when we engage a prospective destination, these questions are answered in the final proposal and site selection report.

The CHEST Annual Meeting 2016 will be held in Los Angeles, California. Los Angeles was confirmed as the location in 2011, based upon the improved infrastructure in the downtown Los Angeles area and the renovations made within the Los Angeles Convention Center. The infrastructure mentioned is an area called L.A. LIVE, which is the sports and entertainment district that surrounds the STAPLES Center and Microsoft Theater, JW Marriott, and the Los Angeles Convention Center. The campus features sports and music venues, nightclubs, restaurants, a bowling alley, the GRAMMY museum, and movie theaters. L.A. LIVE is the premier destination for live entertainment in downtown Los Angeles and very walkable! We hope you have learned a little bit about the process we adhere to in the site selection process of the CHEST Annual Meeting, and we look forward to welcoming you in October.

See you in Los Angeles!

Do you ever wonder how CHEST decides where to have its annual meeting? It’s a science! We know that venue is an important consideration for busy clinicians who are trying to decide whether to invest time and money in attending a national meeting. Evaluation of criteria that determine the attractiveness of a given location for a national meeting is a job for professionals! At CHEST, we are very fortunate to work with Heather Nash, CMP, who is the senior director, meetings and training center operations, along with her talented meetings team in choosing a top-notch destination for the CHEST Annual Meeting.

The site selection of an annual meeting is a very important decision an association makes for its members. There is a variety of factors considered in making this decision, and the site selection process begins approximately 5-7 years in advance. Why so early, you might ask. The size of the CHEST Annual Meeting is the answer! Our annual meeting requires a significant amount of meeting, exhibits, ballroom, and public foyer space. Additionally, the host city needs a minimum of 3,000 hotel rooms in the vicinity of the Convention Center. What this means is that the CHEST Annual Meeting does not fit into all convention centers and cities within the United States and Canada. Plus, other important criteria that are also considered are cost, travel, weather, and the amenities that a destination offers.

The site selection process starts with each destination’s Convention and Visitors Bureau that is presented with a Request for Proposal, which includes a list of all the CHEST Annual Meeting specifications, requirements, and preferred dates. Based on those specifications, each city will compile a proposal of its full offerings, including meeting space, hotels, air and ground transportation, weather, cost, and key amenities of the destination. The puzzle that each city goes through is to determine whether the destination has all of the requirements needed by CHEST and to submit a complete proposal. It’s fierce competition out there, which is why the process must start 5-7 years prior. The last step is to compile a site selection report that outlines, in order of priority, all components that CHEST needs to create a short list of locations and propose a final decision.

Why is the convention center size so important? The CHEST Meeting Director must determine whether a certain venue and city can accommodate the CHEST Annual Meeting. A few key factors that are reviewed include exhibit space; a minimum of 300,000+ gross square feet, 30+ flexible size meeting rooms that can accommodate 75-400 people each for educational sessions, opening keynote session space for 2,500 people, a Simulation Center space, not to mention the additional needs for registration, self-study stations, games, and other e-learning opportunities. More often than not, the largest convention centers that attract CHEST fall into a category that we refer to as first-tier cities (i.e., Chicago, New Orleans, Toronto, Boston, and Los Angeles). The second category of cities that have smaller convention centers but still may be an option for CHEST are second-tier cities (i.e., Montreal, Austin, Honolulu, and Atlanta).

Of course, there are the other aspects of an annual meeting that are very important to clinicians, guests, and attendees. How easy is it to get a flight at a reasonable cost? How close are the hotels and what are the room rates of the official meeting hotels? Can I walk to the convention center or do we need to get on a bus? Can I walk to a restaurant after a full day of sessions? These are just a few questions we receive often by our CHEST Help Team representatives. We track these types of questions so that when we engage a prospective destination, these questions are answered in the final proposal and site selection report.

The CHEST Annual Meeting 2016 will be held in Los Angeles, California. Los Angeles was confirmed as the location in 2011, based upon the improved infrastructure in the downtown Los Angeles area and the renovations made within the Los Angeles Convention Center. The infrastructure mentioned is an area called L.A. LIVE, which is the sports and entertainment district that surrounds the STAPLES Center and Microsoft Theater, JW Marriott, and the Los Angeles Convention Center. The campus features sports and music venues, nightclubs, restaurants, a bowling alley, the GRAMMY museum, and movie theaters. L.A. LIVE is the premier destination for live entertainment in downtown Los Angeles and very walkable! We hope you have learned a little bit about the process we adhere to in the site selection process of the CHEST Annual Meeting, and we look forward to welcoming you in October.

See you in Los Angeles!

Do you ever wonder how CHEST decides where to have its annual meeting? It’s a science! We know that venue is an important consideration for busy clinicians who are trying to decide whether to invest time and money in attending a national meeting. Evaluation of criteria that determine the attractiveness of a given location for a national meeting is a job for professionals! At CHEST, we are very fortunate to work with Heather Nash, CMP, who is the senior director, meetings and training center operations, along with her talented meetings team in choosing a top-notch destination for the CHEST Annual Meeting.

The site selection of an annual meeting is a very important decision an association makes for its members. There is a variety of factors considered in making this decision, and the site selection process begins approximately 5-7 years in advance. Why so early, you might ask. The size of the CHEST Annual Meeting is the answer! Our annual meeting requires a significant amount of meeting, exhibits, ballroom, and public foyer space. Additionally, the host city needs a minimum of 3,000 hotel rooms in the vicinity of the Convention Center. What this means is that the CHEST Annual Meeting does not fit into all convention centers and cities within the United States and Canada. Plus, other important criteria that are also considered are cost, travel, weather, and the amenities that a destination offers.

The site selection process starts with each destination’s Convention and Visitors Bureau that is presented with a Request for Proposal, which includes a list of all the CHEST Annual Meeting specifications, requirements, and preferred dates. Based on those specifications, each city will compile a proposal of its full offerings, including meeting space, hotels, air and ground transportation, weather, cost, and key amenities of the destination. The puzzle that each city goes through is to determine whether the destination has all of the requirements needed by CHEST and to submit a complete proposal. It’s fierce competition out there, which is why the process must start 5-7 years prior. The last step is to compile a site selection report that outlines, in order of priority, all components that CHEST needs to create a short list of locations and propose a final decision.

Why is the convention center size so important? The CHEST Meeting Director must determine whether a certain venue and city can accommodate the CHEST Annual Meeting. A few key factors that are reviewed include exhibit space; a minimum of 300,000+ gross square feet, 30+ flexible size meeting rooms that can accommodate 75-400 people each for educational sessions, opening keynote session space for 2,500 people, a Simulation Center space, not to mention the additional needs for registration, self-study stations, games, and other e-learning opportunities. More often than not, the largest convention centers that attract CHEST fall into a category that we refer to as first-tier cities (i.e., Chicago, New Orleans, Toronto, Boston, and Los Angeles). The second category of cities that have smaller convention centers but still may be an option for CHEST are second-tier cities (i.e., Montreal, Austin, Honolulu, and Atlanta).

Of course, there are the other aspects of an annual meeting that are very important to clinicians, guests, and attendees. How easy is it to get a flight at a reasonable cost? How close are the hotels and what are the room rates of the official meeting hotels? Can I walk to the convention center or do we need to get on a bus? Can I walk to a restaurant after a full day of sessions? These are just a few questions we receive often by our CHEST Help Team representatives. We track these types of questions so that when we engage a prospective destination, these questions are answered in the final proposal and site selection report.

The CHEST Annual Meeting 2016 will be held in Los Angeles, California. Los Angeles was confirmed as the location in 2011, based upon the improved infrastructure in the downtown Los Angeles area and the renovations made within the Los Angeles Convention Center. The infrastructure mentioned is an area called L.A. LIVE, which is the sports and entertainment district that surrounds the STAPLES Center and Microsoft Theater, JW Marriott, and the Los Angeles Convention Center. The campus features sports and music venues, nightclubs, restaurants, a bowling alley, the GRAMMY museum, and movie theaters. L.A. LIVE is the premier destination for live entertainment in downtown Los Angeles and very walkable! We hope you have learned a little bit about the process we adhere to in the site selection process of the CHEST Annual Meeting, and we look forward to welcoming you in October.

See you in Los Angeles!

1-Day Registration for CHEST 2016

If you’d like to attend the CHEST Annual Meeting 2016 but have trouble scheduling time away from your practice, consider the 1-day registration. Register for any given day, Sunday through Wednesday. Or attend for the weekend by registering for a postgraduate course on Saturday and 1 day on Sunday. If you come for the weekend, consider bringing your family. You won’t be alone – there’s so much for everyone to do in Los Angeles.

Postgraduate Courses

Saturday, Oct. 22

Attend a postgraduate course for an intensive learning experience. CME/CE credits and MOC points are available. Additional registration is required for all courses:

• Advanced Critical Care Echocardiography

• ICU Management: An Interactive Course for ICU Directors and Their Critical Care Team

• Lung Cancer: Update 2016

• Pulmonary Hypertension Interactive Summit (InPHOCUS)

• Pulmonary Medicine 2016: Year in Review and Clinical Update

• Sleep Medicine 2016: Year in Review and Clinical Update

• 24th Annual Assembly of the American Association for Bronchology and Interventional Pulmonology

Program Highlights

CHEST 2016 is your connection to focused clinical education that will help optimize your patient care. The relevant sessions and community of innovative problem solvers in attendance will be sure to inspire and energize you and your career. Don’t miss these highlights:

• Simulation and interactive learning. Challenge your clinical skills in a hands-on environment or with interactive learning opportunities. Work with expert faculty to sharpen your skills and apply your knowledge.

• Interdisciplinary programs. Bring your entire care team to attend these very popular programs that address clinical issues across the disciplines. Faculty represent each role on a team and present from their respective perspective.

• Problem-based learning sessions. Study and discuss real clinical cases during small-group, interactive sessions designed to exercise your critical thinking skills.

• Keynotes and honor lectures. Attend our opening sessions to hear featured speakers discuss issues impacting chest medicine. And be sure to attend honor and memorial lectures, where chest medicine professionals will be recognized for their distinguished work.

Sean Pavone/ThinkStock

• Industry-supported sessions. Don’t miss these sessions focusing on current issues impacting the field.

Explore Los Angeles!

Los Angeles is known for its beautiful beaches, moderate temperatures, Hollywood glamour, and ritzy shopping. You’ll enjoy the sunshine, moderate temperatures, and a bevy of sights and activities you can explore. Spend a few hours golfing, attend a TV show taping, shop on Rodeo Drive, or hike Runyon Canyon. During your free time at CHEST 2016, you’ll want to check out everything that Los Angeles has to offer.

Learn more about Los Angeles at discoverlosangeles.com, and find information about CHEST 2016 at chestmeeting.chestnet.org.

1-Day Registration for CHEST 2016

If you’d like to attend the CHEST Annual Meeting 2016 but have trouble scheduling time away from your practice, consider the 1-day registration. Register for any given day, Sunday through Wednesday. Or attend for the weekend by registering for a postgraduate course on Saturday and 1 day on Sunday. If you come for the weekend, consider bringing your family. You won’t be alone – there’s so much for everyone to do in Los Angeles.

Postgraduate Courses

Saturday, Oct. 22

Attend a postgraduate course for an intensive learning experience. CME/CE credits and MOC points are available. Additional registration is required for all courses:

• Advanced Critical Care Echocardiography

• ICU Management: An Interactive Course for ICU Directors and Their Critical Care Team

• Lung Cancer: Update 2016

• Pulmonary Hypertension Interactive Summit (InPHOCUS)

• Pulmonary Medicine 2016: Year in Review and Clinical Update

• Sleep Medicine 2016: Year in Review and Clinical Update

• 24th Annual Assembly of the American Association for Bronchology and Interventional Pulmonology

Program Highlights

CHEST 2016 is your connection to focused clinical education that will help optimize your patient care. The relevant sessions and community of innovative problem solvers in attendance will be sure to inspire and energize you and your career. Don’t miss these highlights:

• Simulation and interactive learning. Challenge your clinical skills in a hands-on environment or with interactive learning opportunities. Work with expert faculty to sharpen your skills and apply your knowledge.

• Interdisciplinary programs. Bring your entire care team to attend these very popular programs that address clinical issues across the disciplines. Faculty represent each role on a team and present from their respective perspective.

• Problem-based learning sessions. Study and discuss real clinical cases during small-group, interactive sessions designed to exercise your critical thinking skills.

• Keynotes and honor lectures. Attend our opening sessions to hear featured speakers discuss issues impacting chest medicine. And be sure to attend honor and memorial lectures, where chest medicine professionals will be recognized for their distinguished work.

Sean Pavone/ThinkStock

• Industry-supported sessions. Don’t miss these sessions focusing on current issues impacting the field.

Explore Los Angeles!

Los Angeles is known for its beautiful beaches, moderate temperatures, Hollywood glamour, and ritzy shopping. You’ll enjoy the sunshine, moderate temperatures, and a bevy of sights and activities you can explore. Spend a few hours golfing, attend a TV show taping, shop on Rodeo Drive, or hike Runyon Canyon. During your free time at CHEST 2016, you’ll want to check out everything that Los Angeles has to offer.

Learn more about Los Angeles at discoverlosangeles.com, and find information about CHEST 2016 at chestmeeting.chestnet.org.

1-Day Registration for CHEST 2016

If you’d like to attend the CHEST Annual Meeting 2016 but have trouble scheduling time away from your practice, consider the 1-day registration. Register for any given day, Sunday through Wednesday. Or attend for the weekend by registering for a postgraduate course on Saturday and 1 day on Sunday. If you come for the weekend, consider bringing your family. You won’t be alone – there’s so much for everyone to do in Los Angeles.

Postgraduate Courses

Saturday, Oct. 22

Attend a postgraduate course for an intensive learning experience. CME/CE credits and MOC points are available. Additional registration is required for all courses:

• Advanced Critical Care Echocardiography

• ICU Management: An Interactive Course for ICU Directors and Their Critical Care Team

• Lung Cancer: Update 2016

• Pulmonary Hypertension Interactive Summit (InPHOCUS)

• Pulmonary Medicine 2016: Year in Review and Clinical Update

• Sleep Medicine 2016: Year in Review and Clinical Update

• 24th Annual Assembly of the American Association for Bronchology and Interventional Pulmonology

Program Highlights

CHEST 2016 is your connection to focused clinical education that will help optimize your patient care. The relevant sessions and community of innovative problem solvers in attendance will be sure to inspire and energize you and your career. Don’t miss these highlights:

• Simulation and interactive learning. Challenge your clinical skills in a hands-on environment or with interactive learning opportunities. Work with expert faculty to sharpen your skills and apply your knowledge.

• Interdisciplinary programs. Bring your entire care team to attend these very popular programs that address clinical issues across the disciplines. Faculty represent each role on a team and present from their respective perspective.

• Problem-based learning sessions. Study and discuss real clinical cases during small-group, interactive sessions designed to exercise your critical thinking skills.

• Keynotes and honor lectures. Attend our opening sessions to hear featured speakers discuss issues impacting chest medicine. And be sure to attend honor and memorial lectures, where chest medicine professionals will be recognized for their distinguished work.

Sean Pavone/ThinkStock

• Industry-supported sessions. Don’t miss these sessions focusing on current issues impacting the field.

Explore Los Angeles!

Los Angeles is known for its beautiful beaches, moderate temperatures, Hollywood glamour, and ritzy shopping. You’ll enjoy the sunshine, moderate temperatures, and a bevy of sights and activities you can explore. Spend a few hours golfing, attend a TV show taping, shop on Rodeo Drive, or hike Runyon Canyon. During your free time at CHEST 2016, you’ll want to check out everything that Los Angeles has to offer.

Learn more about Los Angeles at discoverlosangeles.com, and find information about CHEST 2016 at chestmeeting.chestnet.org.

In 2012, Dr. Renli Qiao, FCCP, won the D. Robert McCaffree, MD, Master FCCP Humanitarian Award for his critical work with village doctors in rural China. Because medical schools in China are located in larger metropolitan areas where graduates are likely to stay, medical resources are unevenly distributed across the country. Physicians with shortened medical education often staff rural hospitals, and smaller villages usually house a single village doctor with a high-school diploma and 3-6 months of medical training.

Inspired by his work with the China California Heart Watch (CCHW), Dr. Qiao created a program to train rural medical professionals so that their efforts would have a sustaining impact on the care that residents of these villages receive. Volunteer physicians traveled through as many villages on foot to spend several days in each village where they would see about 250 villagers a day. In these villages, the doctors were also able to perform heart examinations for hundreds of children in the village schools. The team observed that although hypertension is the leading cause of death in China and the antihypertensive drugs are relatively affordable, there is a high incidence of hypertension, and up to 95% of patients with hypertension were never diagnosed or treated.

Realizing the need to train doctors on the importance of preventive care, early diagnoses, and treatment of hypertension, Dr. Qiao led the initiative to educate thousands of doctors in the Yunnan province. His model involved 2-day seminars and included participatory workshops, lectures, group collaboration, and the dissection of clinical cases.

Dr. Qiao’s effort not only improved the lives of thousands of patients but also achieved a lasting model to educate rural doctors. He is now aiding in the China-CHEST PCCM program efforts to establish PCCM as a subspecialty in China.

In 2012, Dr. Renli Qiao, FCCP, won the D. Robert McCaffree, MD, Master FCCP Humanitarian Award for his critical work with village doctors in rural China. Because medical schools in China are located in larger metropolitan areas where graduates are likely to stay, medical resources are unevenly distributed across the country. Physicians with shortened medical education often staff rural hospitals, and smaller villages usually house a single village doctor with a high-school diploma and 3-6 months of medical training.

Inspired by his work with the China California Heart Watch (CCHW), Dr. Qiao created a program to train rural medical professionals so that their efforts would have a sustaining impact on the care that residents of these villages receive. Volunteer physicians traveled through as many villages on foot to spend several days in each village where they would see about 250 villagers a day. In these villages, the doctors were also able to perform heart examinations for hundreds of children in the village schools. The team observed that although hypertension is the leading cause of death in China and the antihypertensive drugs are relatively affordable, there is a high incidence of hypertension, and up to 95% of patients with hypertension were never diagnosed or treated.

Realizing the need to train doctors on the importance of preventive care, early diagnoses, and treatment of hypertension, Dr. Qiao led the initiative to educate thousands of doctors in the Yunnan province. His model involved 2-day seminars and included participatory workshops, lectures, group collaboration, and the dissection of clinical cases.

Dr. Qiao’s effort not only improved the lives of thousands of patients but also achieved a lasting model to educate rural doctors. He is now aiding in the China-CHEST PCCM program efforts to establish PCCM as a subspecialty in China.

In 2012, Dr. Renli Qiao, FCCP, won the D. Robert McCaffree, MD, Master FCCP Humanitarian Award for his critical work with village doctors in rural China. Because medical schools in China are located in larger metropolitan areas where graduates are likely to stay, medical resources are unevenly distributed across the country. Physicians with shortened medical education often staff rural hospitals, and smaller villages usually house a single village doctor with a high-school diploma and 3-6 months of medical training.

Inspired by his work with the China California Heart Watch (CCHW), Dr. Qiao created a program to train rural medical professionals so that their efforts would have a sustaining impact on the care that residents of these villages receive. Volunteer physicians traveled through as many villages on foot to spend several days in each village where they would see about 250 villagers a day. In these villages, the doctors were also able to perform heart examinations for hundreds of children in the village schools. The team observed that although hypertension is the leading cause of death in China and the antihypertensive drugs are relatively affordable, there is a high incidence of hypertension, and up to 95% of patients with hypertension were never diagnosed or treated.

Realizing the need to train doctors on the importance of preventive care, early diagnoses, and treatment of hypertension, Dr. Qiao led the initiative to educate thousands of doctors in the Yunnan province. His model involved 2-day seminars and included participatory workshops, lectures, group collaboration, and the dissection of clinical cases.

Dr. Qiao’s effort not only improved the lives of thousands of patients but also achieved a lasting model to educate rural doctors. He is now aiding in the China-CHEST PCCM program efforts to establish PCCM as a subspecialty in China.

The Lung Association of Saskatchewan has conferred its highest award on Dr. Darcy Marciniuk, FCCP. The Lifetime Achievement Award recognizes 25 years of outstanding service by Dr. Marciniuk to improving respiratory health in Saskatchewan. Dr. Marciniuk is currently associate vice president of research (Acting) at the University of Saskatchewan, Canada, in addition to continuing to serve as professor of medicine in the division of respirology, critical care, and sleep medicine.

Dr. Marciniuk led the development of both respiratory services and chronic disease management in general in the Saskatoon Health Region, which is now spreading to the province as a whole. He began the LiveWell program that started with respiratory health and was used as a model to expand the chronic disease management program to other health areas. He was a leader in the development of the Lung Health Institute and is currently spearheading the establishment of a respiratory research center at the University of Saskatchewan. He has done extensive research in the area of chronic obstructive pulmonary disease, for which he is nationally and internationally recognized with more than 100 peer-reviewed publications. Dr. Marciniuk is currently a leader in the CHEST initiative to develop a national respirology training program in China, which is being implemented in collaboration with the Chinese government.

CHEST congratulates Dr. Marciniuk on this prestigious honor.

The Lung Association of Saskatchewan has conferred its highest award on Dr. Darcy Marciniuk, FCCP. The Lifetime Achievement Award recognizes 25 years of outstanding service by Dr. Marciniuk to improving respiratory health in Saskatchewan. Dr. Marciniuk is currently associate vice president of research (Acting) at the University of Saskatchewan, Canada, in addition to continuing to serve as professor of medicine in the division of respirology, critical care, and sleep medicine.

Dr. Marciniuk led the development of both respiratory services and chronic disease management in general in the Saskatoon Health Region, which is now spreading to the province as a whole. He began the LiveWell program that started with respiratory health and was used as a model to expand the chronic disease management program to other health areas. He was a leader in the development of the Lung Health Institute and is currently spearheading the establishment of a respiratory research center at the University of Saskatchewan. He has done extensive research in the area of chronic obstructive pulmonary disease, for which he is nationally and internationally recognized with more than 100 peer-reviewed publications. Dr. Marciniuk is currently a leader in the CHEST initiative to develop a national respirology training program in China, which is being implemented in collaboration with the Chinese government.

CHEST congratulates Dr. Marciniuk on this prestigious honor.

The Lung Association of Saskatchewan has conferred its highest award on Dr. Darcy Marciniuk, FCCP. The Lifetime Achievement Award recognizes 25 years of outstanding service by Dr. Marciniuk to improving respiratory health in Saskatchewan. Dr. Marciniuk is currently associate vice president of research (Acting) at the University of Saskatchewan, Canada, in addition to continuing to serve as professor of medicine in the division of respirology, critical care, and sleep medicine.

Dr. Marciniuk led the development of both respiratory services and chronic disease management in general in the Saskatoon Health Region, which is now spreading to the province as a whole. He began the LiveWell program that started with respiratory health and was used as a model to expand the chronic disease management program to other health areas. He was a leader in the development of the Lung Health Institute and is currently spearheading the establishment of a respiratory research center at the University of Saskatchewan. He has done extensive research in the area of chronic obstructive pulmonary disease, for which he is nationally and internationally recognized with more than 100 peer-reviewed publications. Dr. Marciniuk is currently a leader in the CHEST initiative to develop a national respirology training program in China, which is being implemented in collaboration with the Chinese government.

CHEST congratulates Dr. Marciniuk on this prestigious honor.

FROM CIRCULATION: CARDIOVASCULAR QUALITY OUTCOMES

Insufficient evidence exists to routinely recommend surgical closure of the left atrial appendage, either surgically or with a LAA exclusion device, for patients who have atrial fibrillation, a large data review has concluded.

None of the devices so far examined is more effective than oral anticoagulation therapy in reducing AF-related stroke risk, but they appear to be riskier, with up to 1 in 15 patients experiencing a serious adverse event during or after percutaneous placement, North Noelck, MD, and his colleagues wrote (Circ Cardiovasc Qual Outcomes. 2016 Jul 12. doi: 10.1161/CIRCOUTCOMES.115.002539).

Surgical studies, which also have found no benefit, are poor in quality and provide no strong data in favor of any technique, wrote Dr. Noelck of Oregon Health and Science University, Portland.

The meta-analysis comprised 13 studies of the benefits and risks of percutaneous LAA exclusion and 7 of the benefits and harms of surgical LAA closure.

The team found “limited evidence” that one device, the Watchman (Boston Scientific), may be an effective alternative to long-term oral anticoagulation treatment in some patients. But the Watchman was also associated with “significant, procedural-related harms,” in almost 11% of patients in one large study, PROTECT-AF. These included pericardial effusions with and without associated tamponade, bleeding, device thrombus, and device embolization. However, the benefit conferred by the device appeared marginal. Neither PROTECT-AF nor the subsequent PREVAIL studies of the Watchman found that it conferred significant clinical benefit above the comparator arm of warfarin therapy. Indeed, in PREVAIL, a composite outcome of death, ischemic/hemorrhagic stroke, or systemic embolism occurred in 5.2% of the device group and in 2.9% of the warfarin group.

Three randomized studies and two observational studies examined surgical LAA closure relative to usual medical care. The authors said the randomized studies were underpowered to show clinical benefit. Neither of the observational studies showed significant advantages in stroke-free survival, but the team noted, “data such as information about anticoagulation use among the groups [were] lacking.”

“Overall, there is insufficient evidence to support the routine use of surgical LAA exclusion to reduce stroke risk or the future need for anticoagulant therapy,” wrote Dr. Noelck and his coinvestigators. However, they said, several ongoing studies “should add substantively to this body of evidence during the next several years.”

The study was funded by the Department of Veterans Affairs. None of the authors had any relevant financial disclosure.

[email protected]

FROM CIRCULATION: CARDIOVASCULAR QUALITY OUTCOMES

Insufficient evidence exists to routinely recommend surgical closure of the left atrial appendage, either surgically or with a LAA exclusion device, for patients who have atrial fibrillation, a large data review has concluded.

None of the devices so far examined is more effective than oral anticoagulation therapy in reducing AF-related stroke risk, but they appear to be riskier, with up to 1 in 15 patients experiencing a serious adverse event during or after percutaneous placement, North Noelck, MD, and his colleagues wrote (Circ Cardiovasc Qual Outcomes. 2016 Jul 12. doi: 10.1161/CIRCOUTCOMES.115.002539).

Surgical studies, which also have found no benefit, are poor in quality and provide no strong data in favor of any technique, wrote Dr. Noelck of Oregon Health and Science University, Portland.

The meta-analysis comprised 13 studies of the benefits and risks of percutaneous LAA exclusion and 7 of the benefits and harms of surgical LAA closure.

The team found “limited evidence” that one device, the Watchman (Boston Scientific), may be an effective alternative to long-term oral anticoagulation treatment in some patients. But the Watchman was also associated with “significant, procedural-related harms,” in almost 11% of patients in one large study, PROTECT-AF. These included pericardial effusions with and without associated tamponade, bleeding, device thrombus, and device embolization. However, the benefit conferred by the device appeared marginal. Neither PROTECT-AF nor the subsequent PREVAIL studies of the Watchman found that it conferred significant clinical benefit above the comparator arm of warfarin therapy. Indeed, in PREVAIL, a composite outcome of death, ischemic/hemorrhagic stroke, or systemic embolism occurred in 5.2% of the device group and in 2.9% of the warfarin group.

Three randomized studies and two observational studies examined surgical LAA closure relative to usual medical care. The authors said the randomized studies were underpowered to show clinical benefit. Neither of the observational studies showed significant advantages in stroke-free survival, but the team noted, “data such as information about anticoagulation use among the groups [were] lacking.”

“Overall, there is insufficient evidence to support the routine use of surgical LAA exclusion to reduce stroke risk or the future need for anticoagulant therapy,” wrote Dr. Noelck and his coinvestigators. However, they said, several ongoing studies “should add substantively to this body of evidence during the next several years.”

The study was funded by the Department of Veterans Affairs. None of the authors had any relevant financial disclosure.

[email protected]

FROM CIRCULATION: CARDIOVASCULAR QUALITY OUTCOMES

Insufficient evidence exists to routinely recommend surgical closure of the left atrial appendage, either surgically or with a LAA exclusion device, for patients who have atrial fibrillation, a large data review has concluded.

None of the devices so far examined is more effective than oral anticoagulation therapy in reducing AF-related stroke risk, but they appear to be riskier, with up to 1 in 15 patients experiencing a serious adverse event during or after percutaneous placement, North Noelck, MD, and his colleagues wrote (Circ Cardiovasc Qual Outcomes. 2016 Jul 12. doi: 10.1161/CIRCOUTCOMES.115.002539).

Surgical studies, which also have found no benefit, are poor in quality and provide no strong data in favor of any technique, wrote Dr. Noelck of Oregon Health and Science University, Portland.

The meta-analysis comprised 13 studies of the benefits and risks of percutaneous LAA exclusion and 7 of the benefits and harms of surgical LAA closure.

The team found “limited evidence” that one device, the Watchman (Boston Scientific), may be an effective alternative to long-term oral anticoagulation treatment in some patients. But the Watchman was also associated with “significant, procedural-related harms,” in almost 11% of patients in one large study, PROTECT-AF. These included pericardial effusions with and without associated tamponade, bleeding, device thrombus, and device embolization. However, the benefit conferred by the device appeared marginal. Neither PROTECT-AF nor the subsequent PREVAIL studies of the Watchman found that it conferred significant clinical benefit above the comparator arm of warfarin therapy. Indeed, in PREVAIL, a composite outcome of death, ischemic/hemorrhagic stroke, or systemic embolism occurred in 5.2% of the device group and in 2.9% of the warfarin group.

Three randomized studies and two observational studies examined surgical LAA closure relative to usual medical care. The authors said the randomized studies were underpowered to show clinical benefit. Neither of the observational studies showed significant advantages in stroke-free survival, but the team noted, “data such as information about anticoagulation use among the groups [were] lacking.”

“Overall, there is insufficient evidence to support the routine use of surgical LAA exclusion to reduce stroke risk or the future need for anticoagulant therapy,” wrote Dr. Noelck and his coinvestigators. However, they said, several ongoing studies “should add substantively to this body of evidence during the next several years.”

The study was funded by the Department of Veterans Affairs. None of the authors had any relevant financial disclosure.

[email protected]

The incidence of human papillomavirus–associated cancers is increasing in the United States, but many of these cases could be prevented by the HPV vaccine, investigators from the Centers for Disease Control and Prevention report.

Between 2008 and 2012 the incidence of HPV-associated cancers was 11.7/100,000 persons, up from 10.8/100,000 persons during the previous 4-year period, according to data from population-based cancer registries. An average of 38,793 HPV-associated cancers were diagnosed in the most recent period, 30,700 (79%) of which can be attributed to HPV. Of those, 28,500 cancers are of HPV types that are preventable with the 9-valent HPV vaccine, reported Laura J. Viens, MD, and her associates.

©xrender/Thinkstock

Among the HPV-associated cancers, an average of 11,7771 cervical cancer cases were diagnosed each year. Rates of cervical cancer per 100,000 persons were higher among blacks (9.2) than among whites (7.1), and among Hispanics (9.7) than non-Hispanics (7.1).

“Increasing [HPV] vaccination coverage could decrease the cancer incidence and disparities in the United States,” the investigators concluded.

Find the full report from Morbidity and Mortality Weekly Report here.

The incidence of human papillomavirus–associated cancers is increasing in the United States, but many of these cases could be prevented by the HPV vaccine, investigators from the Centers for Disease Control and Prevention report.

Between 2008 and 2012 the incidence of HPV-associated cancers was 11.7/100,000 persons, up from 10.8/100,000 persons during the previous 4-year period, according to data from population-based cancer registries. An average of 38,793 HPV-associated cancers were diagnosed in the most recent period, 30,700 (79%) of which can be attributed to HPV. Of those, 28,500 cancers are of HPV types that are preventable with the 9-valent HPV vaccine, reported Laura J. Viens, MD, and her associates.

©xrender/Thinkstock

Among the HPV-associated cancers, an average of 11,7771 cervical cancer cases were diagnosed each year. Rates of cervical cancer per 100,000 persons were higher among blacks (9.2) than among whites (7.1), and among Hispanics (9.7) than non-Hispanics (7.1).

“Increasing [HPV] vaccination coverage could decrease the cancer incidence and disparities in the United States,” the investigators concluded.

Find the full report from Morbidity and Mortality Weekly Report here.

The incidence of human papillomavirus–associated cancers is increasing in the United States, but many of these cases could be prevented by the HPV vaccine, investigators from the Centers for Disease Control and Prevention report.

Between 2008 and 2012 the incidence of HPV-associated cancers was 11.7/100,000 persons, up from 10.8/100,000 persons during the previous 4-year period, according to data from population-based cancer registries. An average of 38,793 HPV-associated cancers were diagnosed in the most recent period, 30,700 (79%) of which can be attributed to HPV. Of those, 28,500 cancers are of HPV types that are preventable with the 9-valent HPV vaccine, reported Laura J. Viens, MD, and her associates.

©xrender/Thinkstock

Among the HPV-associated cancers, an average of 11,7771 cervical cancer cases were diagnosed each year. Rates of cervical cancer per 100,000 persons were higher among blacks (9.2) than among whites (7.1), and among Hispanics (9.7) than non-Hispanics (7.1).

“Increasing [HPV] vaccination coverage could decrease the cancer incidence and disparities in the United States,” the investigators concluded.

Find the full report from Morbidity and Mortality Weekly Report here.

The incidence of human papillomavirus–associated cancers is increasing in the United States, but many of these cases could be prevented by the HPV vaccine, investigators from the Centers for Disease Control and Prevention report.

Between 2008 and 2012 the incidence of HPV-associated cancers was 11.7/100,000 persons, up from 10.8/100,000 persons during the previous 4-year period, according to data from population-based cancer registries. An average of 38,793 HPV-associated cancers were diagnosed in the most recent period, 30,700 (79%) of which can be attributed to HPV. Of those, 28,500 cancers are of HPV types that are preventable with the 9-valent HPV vaccine, reported Laura J. Viens, MD, and her associates.

©xrender/Thinkstock

Among the HPV-associated cancers, an average of 11,7771 cervical cancer cases were diagnosed each year. Rates of cervical cancer per 100,000 persons were higher among blacks (9.2) than among whites (7.1), and among Hispanics (9.7) than non-Hispanics (7.1).

“Increasing [HPV] vaccination coverage could decrease the cancer incidence and disparities in the United States,” the investigators concluded.

Find the full report from Morbidity and Mortality Weekly Report here

[email protected]

The incidence of human papillomavirus–associated cancers is increasing in the United States, but many of these cases could be prevented by the HPV vaccine, investigators from the Centers for Disease Control and Prevention report.

Between 2008 and 2012 the incidence of HPV-associated cancers was 11.7/100,000 persons, up from 10.8/100,000 persons during the previous 4-year period, according to data from population-based cancer registries. An average of 38,793 HPV-associated cancers were diagnosed in the most recent period, 30,700 (79%) of which can be attributed to HPV. Of those, 28,500 cancers are of HPV types that are preventable with the 9-valent HPV vaccine, reported Laura J. Viens, MD, and her associates.

©xrender/Thinkstock

Among the HPV-associated cancers, an average of 11,7771 cervical cancer cases were diagnosed each year. Rates of cervical cancer per 100,000 persons were higher among blacks (9.2) than among whites (7.1), and among Hispanics (9.7) than non-Hispanics (7.1).

“Increasing [HPV] vaccination coverage could decrease the cancer incidence and disparities in the United States,” the investigators concluded.

Find the full report from Morbidity and Mortality Weekly Report here

[email protected]

The incidence of human papillomavirus–associated cancers is increasing in the United States, but many of these cases could be prevented by the HPV vaccine, investigators from the Centers for Disease Control and Prevention report.

Between 2008 and 2012 the incidence of HPV-associated cancers was 11.7/100,000 persons, up from 10.8/100,000 persons during the previous 4-year period, according to data from population-based cancer registries. An average of 38,793 HPV-associated cancers were diagnosed in the most recent period, 30,700 (79%) of which can be attributed to HPV. Of those, 28,500 cancers are of HPV types that are preventable with the 9-valent HPV vaccine, reported Laura J. Viens, MD, and her associates.

©xrender/Thinkstock

Among the HPV-associated cancers, an average of 11,7771 cervical cancer cases were diagnosed each year. Rates of cervical cancer per 100,000 persons were higher among blacks (9.2) than among whites (7.1), and among Hispanics (9.7) than non-Hispanics (7.1).

“Increasing [HPV] vaccination coverage could decrease the cancer incidence and disparities in the United States,” the investigators concluded.

Find the full report from Morbidity and Mortality Weekly Report here

[email protected]

Irinotecan plus cisplatin is no better than paclitaxel plus carboplatin for women with ovarian clear cell carcinoma, according to an international study led by Japanese investigators.

Clear cell carcinoma (CCC) accounts for approximately 10% of epithelial ovarian cancers (EOCs) in Europe and the United States, but is more prevalent in Asia; In Japan CCC accounts for 24% of all EOCs.

In the first phase III, CCC-specific clinical trial, 667 women with stage I to IV CCC were randomized to receive one of two treatment regimens: irinotecan at a dose of 60 mg/m² on days 1, 8, and 15 plus cisplatin at 60 mg/m² on day 1 every 4 weeks for six cycles (n = 332) or paclitaxel at a dose of 175 mg/m² plus carboplatin on day 1 every 3 weeks for six cycles (n = 335).

Japanese women made up 93.5% of the study population, the median age was 53 years, and 6.4% of patients had stage I cancer. Median follow-up time was 44.3 months.

No difference was found between the groups in progression-free or overall survival, Toru Sugiyama, MD, of Iwate Medical University, Morioka, Japan, and associates reported (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.66.9010).

Both regimens were well tolerated, though the toxicity profiles were different, investigators wrote.

Overall, 72% of patients received all six cycles of their respective chemotherapy treatments. Two-year progression-free survival rates were 73.0% (95% confidence interval, 67.7%-77.5%) among patients receiving irinotecan plus cisplatin, 77.6% (95% CI, 72.4%-81.9%) among patients receiving paclitaxel plus carboplatin, and were not significantly different (HR, 1.17; 95% CI, 0.87-1.58; P = .30).

There was also no significant difference in overall survival between the two treatment arms.

In subgroup analyses, there was no significant difference in progression-free or overall survival by disease stage or tumor size.

Grade 3 or 4 anorexia, diarrhea, nausea, vomiting, and febrile neutropenia were the most common adverse events among women receiving irinotecan plus cisplatin. Grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, and joint pain were the most common adverse events among women receiving paclitaxel plus carboplatin. No treatment-related deaths occurred in either treatment arm.

This study was funded by the Japanese Gynecologic Oncology Group. Dr. Sugiyama and 18 other investigators had no disclosures to report. Six investigators reported serving in advisory roles for or receiving financial compensation or honoraria from multiple companies.

[email protected]

On Twitter @jessnicolecraig

Irinotecan plus cisplatin is no better than paclitaxel plus carboplatin for women with ovarian clear cell carcinoma, according to an international study led by Japanese investigators.

Clear cell carcinoma (CCC) accounts for approximately 10% of epithelial ovarian cancers (EOCs) in Europe and the United States, but is more prevalent in Asia; In Japan CCC accounts for 24% of all EOCs.

In the first phase III, CCC-specific clinical trial, 667 women with stage I to IV CCC were randomized to receive one of two treatment regimens: irinotecan at a dose of 60 mg/m² on days 1, 8, and 15 plus cisplatin at 60 mg/m² on day 1 every 4 weeks for six cycles (n = 332) or paclitaxel at a dose of 175 mg/m² plus carboplatin on day 1 every 3 weeks for six cycles (n = 335).

Japanese women made up 93.5% of the study population, the median age was 53 years, and 6.4% of patients had stage I cancer. Median follow-up time was 44.3 months.

No difference was found between the groups in progression-free or overall survival, Toru Sugiyama, MD, of Iwate Medical University, Morioka, Japan, and associates reported (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.66.9010).

Both regimens were well tolerated, though the toxicity profiles were different, investigators wrote.

Overall, 72% of patients received all six cycles of their respective chemotherapy treatments. Two-year progression-free survival rates were 73.0% (95% confidence interval, 67.7%-77.5%) among patients receiving irinotecan plus cisplatin, 77.6% (95% CI, 72.4%-81.9%) among patients receiving paclitaxel plus carboplatin, and were not significantly different (HR, 1.17; 95% CI, 0.87-1.58; P = .30).

There was also no significant difference in overall survival between the two treatment arms.

In subgroup analyses, there was no significant difference in progression-free or overall survival by disease stage or tumor size.

Grade 3 or 4 anorexia, diarrhea, nausea, vomiting, and febrile neutropenia were the most common adverse events among women receiving irinotecan plus cisplatin. Grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, and joint pain were the most common adverse events among women receiving paclitaxel plus carboplatin. No treatment-related deaths occurred in either treatment arm.

This study was funded by the Japanese Gynecologic Oncology Group. Dr. Sugiyama and 18 other investigators had no disclosures to report. Six investigators reported serving in advisory roles for or receiving financial compensation or honoraria from multiple companies.

[email protected]

On Twitter @jessnicolecraig

Irinotecan plus cisplatin is no better than paclitaxel plus carboplatin for women with ovarian clear cell carcinoma, according to an international study led by Japanese investigators.

Clear cell carcinoma (CCC) accounts for approximately 10% of epithelial ovarian cancers (EOCs) in Europe and the United States, but is more prevalent in Asia; In Japan CCC accounts for 24% of all EOCs.

In the first phase III, CCC-specific clinical trial, 667 women with stage I to IV CCC were randomized to receive one of two treatment regimens: irinotecan at a dose of 60 mg/m² on days 1, 8, and 15 plus cisplatin at 60 mg/m² on day 1 every 4 weeks for six cycles (n = 332) or paclitaxel at a dose of 175 mg/m² plus carboplatin on day 1 every 3 weeks for six cycles (n = 335).

Japanese women made up 93.5% of the study population, the median age was 53 years, and 6.4% of patients had stage I cancer. Median follow-up time was 44.3 months.

No difference was found between the groups in progression-free or overall survival, Toru Sugiyama, MD, of Iwate Medical University, Morioka, Japan, and associates reported (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.66.9010).

Both regimens were well tolerated, though the toxicity profiles were different, investigators wrote.

Overall, 72% of patients received all six cycles of their respective chemotherapy treatments. Two-year progression-free survival rates were 73.0% (95% confidence interval, 67.7%-77.5%) among patients receiving irinotecan plus cisplatin, 77.6% (95% CI, 72.4%-81.9%) among patients receiving paclitaxel plus carboplatin, and were not significantly different (HR, 1.17; 95% CI, 0.87-1.58; P = .30).

There was also no significant difference in overall survival between the two treatment arms.

In subgroup analyses, there was no significant difference in progression-free or overall survival by disease stage or tumor size.

Grade 3 or 4 anorexia, diarrhea, nausea, vomiting, and febrile neutropenia were the most common adverse events among women receiving irinotecan plus cisplatin. Grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, and joint pain were the most common adverse events among women receiving paclitaxel plus carboplatin. No treatment-related deaths occurred in either treatment arm.

This study was funded by the Japanese Gynecologic Oncology Group. Dr. Sugiyama and 18 other investigators had no disclosures to report. Six investigators reported serving in advisory roles for or receiving financial compensation or honoraria from multiple companies.

[email protected]

On Twitter @jessnicolecraig

The combination of all-trans­-retinoic acid (ATRA) and arsenic trioxide continues to show advantages over ATRA and chemotherapy as first-line therapy for patients with low- or intermediate-risk acute promyelocytic leukemia (APL), investigators report.

The final analysis of theAPL046 study, a noninferiority trial of ATRA plus arsenic trioxide (ATRA-ATO) vs. ATRA and standard chemotherapy, showed that event-free survival (EFS) and overall survival (OS) were significantly better among patients assigned to ATRA-ATO. Patients in this group also had a significantly lower cumulative incidence of relapse, reported Francesco Lo-Coco, MD, of University Tor Vergata in Rome and colleagues.

“Our results support the use of ATRA-ATO in patients with newly diagnosed APL and point to this strategy as the new standard of care for low- or intermediate-risk patients. Studies exploring the role of ATRA-ATO are warranted in other APL subsets including high-risk, pediatric, and elderly patients,” they wrote (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.67.1982).

In the trial, 276 patients with newly diagnosed APL were randomly assigned to receive either ATRA-ATO or ATRA plus chemotherapy with idarubicin, mercaptopurine, and methotrexate.

A total of 263 patients were evaluable for response to induction, including 127 assigned to ATRA-ATO and 136 assigned to ATRA-chemotherapy. Following induction, all patients assigned to ATRA-ATO and 127 assigned to chemotherapy (97%) achieved a complete remission (CR).

After a median follow-up of 40.6 months, the rate of EFS, the primary outcome, was 97.3% for ATRA-ATO vs. 80% for ATRA-chemotherapy (P less than .001). The cumulative incidences of relapse were 1.9% and 13.9%, respectively (P = .0013), and overall survival rates at 50 months were 99.2% vs. 92.6% (P = . 0073).

Hematologic toxicities were more frequent among patients assigned to chemotherapy, while liver function abnormalities occurred more often among those assigned to ATO.

One patient assigned to ATRA-ATO died while in CR, from bronchopneumonia caused by the H1N1 (influenza) virus. Five patients assigned to chemotherapy died in CR, from hemorrhagic shock, pulmonary embolism, bronchopneumonia (two patients) and secondary myelodysplastic syndrome.

Of the 17 patients who experienced relapses during follow-up, 2 assigned to ATRA-ATO had relapses at 22 and 27 months. The remaining 15 relapses were among patients assigned to ATRA-chemotherapy, occurring at a median of 14 months.

The authors noted that the superior EFS and cumulative incidence of relapse with ATRA-ATO emerged only after longer follow-up, indicating that the advantage of ATRA-ATO over ATRA-chemotherapy increases over time and that “the inclusion of ATO in the treatment of low- or intermediate-risk APL not only reduces mortality and hematologic toxicity, but also results in improved and sustained antileukemic activity.”

The study was supported by the Gruppo Italiano Malattie Ematologiche dell’Adulto Foundation; the Associazione Italiana Contro le Leucemie, Linfomi e Mieloma, Associazione Italiana per la Ricerca sul Cancro, and the German Federal Ministry of Education and Research. Dr. Lo-Coco disclosed honoraria, consulting, and speakers’ bureau activities with Teva Pharmaceutical, Lundbeck, Novartis, Baxalta, and Pfizer. Several other coauthors disclosed similar relationships.

[email protected]

The combination of all-trans­-retinoic acid (ATRA) and arsenic trioxide continues to show advantages over ATRA and chemotherapy as first-line therapy for patients with low- or intermediate-risk acute promyelocytic leukemia (APL), investigators report.

The final analysis of theAPL046 study, a noninferiority trial of ATRA plus arsenic trioxide (ATRA-ATO) vs. ATRA and standard chemotherapy, showed that event-free survival (EFS) and overall survival (OS) were significantly better among patients assigned to ATRA-ATO. Patients in this group also had a significantly lower cumulative incidence of relapse, reported Francesco Lo-Coco, MD, of University Tor Vergata in Rome and colleagues.

“Our results support the use of ATRA-ATO in patients with newly diagnosed APL and point to this strategy as the new standard of care for low- or intermediate-risk patients. Studies exploring the role of ATRA-ATO are warranted in other APL subsets including high-risk, pediatric, and elderly patients,” they wrote (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.67.1982).

In the trial, 276 patients with newly diagnosed APL were randomly assigned to receive either ATRA-ATO or ATRA plus chemotherapy with idarubicin, mercaptopurine, and methotrexate.

A total of 263 patients were evaluable for response to induction, including 127 assigned to ATRA-ATO and 136 assigned to ATRA-chemotherapy. Following induction, all patients assigned to ATRA-ATO and 127 assigned to chemotherapy (97%) achieved a complete remission (CR).

After a median follow-up of 40.6 months, the rate of EFS, the primary outcome, was 97.3% for ATRA-ATO vs. 80% for ATRA-chemotherapy (P less than .001). The cumulative incidences of relapse were 1.9% and 13.9%, respectively (P = .0013), and overall survival rates at 50 months were 99.2% vs. 92.6% (P = . 0073).

Hematologic toxicities were more frequent among patients assigned to chemotherapy, while liver function abnormalities occurred more often among those assigned to ATO.

One patient assigned to ATRA-ATO died while in CR, from bronchopneumonia caused by the H1N1 (influenza) virus. Five patients assigned to chemotherapy died in CR, from hemorrhagic shock, pulmonary embolism, bronchopneumonia (two patients) and secondary myelodysplastic syndrome.

Of the 17 patients who experienced relapses during follow-up, 2 assigned to ATRA-ATO had relapses at 22 and 27 months. The remaining 15 relapses were among patients assigned to ATRA-chemotherapy, occurring at a median of 14 months.

The authors noted that the superior EFS and cumulative incidence of relapse with ATRA-ATO emerged only after longer follow-up, indicating that the advantage of ATRA-ATO over ATRA-chemotherapy increases over time and that “the inclusion of ATO in the treatment of low- or intermediate-risk APL not only reduces mortality and hematologic toxicity, but also results in improved and sustained antileukemic activity.”

The study was supported by the Gruppo Italiano Malattie Ematologiche dell’Adulto Foundation; the Associazione Italiana Contro le Leucemie, Linfomi e Mieloma, Associazione Italiana per la Ricerca sul Cancro, and the German Federal Ministry of Education and Research. Dr. Lo-Coco disclosed honoraria, consulting, and speakers’ bureau activities with Teva Pharmaceutical, Lundbeck, Novartis, Baxalta, and Pfizer. Several other coauthors disclosed similar relationships.

[email protected]

The combination of all-trans­-retinoic acid (ATRA) and arsenic trioxide continues to show advantages over ATRA and chemotherapy as first-line therapy for patients with low- or intermediate-risk acute promyelocytic leukemia (APL), investigators report.

The final analysis of theAPL046 study, a noninferiority trial of ATRA plus arsenic trioxide (ATRA-ATO) vs. ATRA and standard chemotherapy, showed that event-free survival (EFS) and overall survival (OS) were significantly better among patients assigned to ATRA-ATO. Patients in this group also had a significantly lower cumulative incidence of relapse, reported Francesco Lo-Coco, MD, of University Tor Vergata in Rome and colleagues.

“Our results support the use of ATRA-ATO in patients with newly diagnosed APL and point to this strategy as the new standard of care for low- or intermediate-risk patients. Studies exploring the role of ATRA-ATO are warranted in other APL subsets including high-risk, pediatric, and elderly patients,” they wrote (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.67.1982).

In the trial, 276 patients with newly diagnosed APL were randomly assigned to receive either ATRA-ATO or ATRA plus chemotherapy with idarubicin, mercaptopurine, and methotrexate.

A total of 263 patients were evaluable for response to induction, including 127 assigned to ATRA-ATO and 136 assigned to ATRA-chemotherapy. Following induction, all patients assigned to ATRA-ATO and 127 assigned to chemotherapy (97%) achieved a complete remission (CR).

After a median follow-up of 40.6 months, the rate of EFS, the primary outcome, was 97.3% for ATRA-ATO vs. 80% for ATRA-chemotherapy (P less than .001). The cumulative incidences of relapse were 1.9% and 13.9%, respectively (P = .0013), and overall survival rates at 50 months were 99.2% vs. 92.6% (P = . 0073).

Hematologic toxicities were more frequent among patients assigned to chemotherapy, while liver function abnormalities occurred more often among those assigned to ATO.

One patient assigned to ATRA-ATO died while in CR, from bronchopneumonia caused by the H1N1 (influenza) virus. Five patients assigned to chemotherapy died in CR, from hemorrhagic shock, pulmonary embolism, bronchopneumonia (two patients) and secondary myelodysplastic syndrome.

Of the 17 patients who experienced relapses during follow-up, 2 assigned to ATRA-ATO had relapses at 22 and 27 months. The remaining 15 relapses were among patients assigned to ATRA-chemotherapy, occurring at a median of 14 months.

The authors noted that the superior EFS and cumulative incidence of relapse with ATRA-ATO emerged only after longer follow-up, indicating that the advantage of ATRA-ATO over ATRA-chemotherapy increases over time and that “the inclusion of ATO in the treatment of low- or intermediate-risk APL not only reduces mortality and hematologic toxicity, but also results in improved and sustained antileukemic activity.”

The study was supported by the Gruppo Italiano Malattie Ematologiche dell’Adulto Foundation; the Associazione Italiana Contro le Leucemie, Linfomi e Mieloma, Associazione Italiana per la Ricerca sul Cancro, and the German Federal Ministry of Education and Research. Dr. Lo-Coco disclosed honoraria, consulting, and speakers’ bureau activities with Teva Pharmaceutical, Lundbeck, Novartis, Baxalta, and Pfizer. Several other coauthors disclosed similar relationships.

[email protected]