Oncology – ClinCaseQuest

Baseline Cardiovascular Risk Assessment in Cancer Patients Scheduled to Receive Cardiotoxic Cancer Therapies (Anthracycline Chemotherapy) – Online Calculator

Nataliia Lopina — Mon, 03 Jul 2023 18:58:05 +0000

Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies (Anthracycline Chemotherapy) from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society (HFA-ICOS).

Risk factors	Score	Level of evidence
Previous cardiovascular disease
Heart failure or cardiomyopathy	Very high	B
Severe valvular heart disease	High	C
Myocardial infraction or previous coronary revascularization (PCI or CABG)	High	C
Stable angina	High	C
Baseline LVEF <50%	High	B
Borderline LVEF 50-54%	Medium²	C
Cardiac biomarkers (where available)
Elevated baseline troponin	Medium¹	C
Elevated baseline BNP or NT-proBNP	Medium¹	C
Demographic and cardiovascular risk factors
Age ≥80 years	High	B
Age 65–79 years	Medium_²	B
Hypertension	Medium¹	B
Diabetes mellitus	Medium¹	C
Chronic kidney disease	Medium¹	C
Previous cardiotoxic cancer treatment
Previous anthracycline exposure	High	B
Prior radiotherapy to left chest or mediastinum	High	C
Previous non-anthracycline-based chemotherapy	Medium¹	C
Lifestyle risk factors
Current smoker or significant smoking history	Medium¹	C
Obesity (BMI >30 kg/m²)	Medium¹	C

BMI, body mass index; BNP, brain natriuretic peptide; CABG, coronary artery bypass graft; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-brain natriuretic peptide; PCI, percutaneous coronary intervention
^a Elevated above the upper limit of normal for local laboratory reference range.
^b Systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg, or on treatment.
^c Glycated haemoglobin >7.0% or >53 mmol/mol, or on treatment.
^d Estimated glomerular filtration rate <60 mL/min/1.73 m².

HFA-ICOS risk assessment

no risk factor OR one medium¹ risk factor	Low risk	<2%
medium risk factors with a total of 2–4 points	Medium risk	2-9%
medium risk factors with a total of ≥5 points OR any high risk factor	High risk	10-19%
any very high risk factor	Very high risk	>20%

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Сообщение Baseline Cardiovascular Risk Assessment in Cancer Patients Scheduled to Receive Cardiotoxic Cancer Therapies (Anthracycline Chemotherapy) – Online Calculator появились сначала на ClinCaseQuest.

Multiple Myeloma Diagnostic Criteria – Online Calculator

clincasequest — Sun, 05 Feb 2023 18:46:01 +0000

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

Details:

* Required

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the appropriate criteria:

Criteria

(A) Clonal bone marrow plasma cells ≥10% or (B) biopsy-proven bony or extramedullary plasmacytoma

AND

(C1) End organ damage attributable underlying plasma cell proliferative disorder, specifically:
- Hypercalcemia: serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L)
- Renal insufficiency: creatinine clearance <40 mL per min or serum creatinine >2 mg/dL (177 μmol/L)
- Anemia: hemoglobin >2 g/dL (20 g/L) below lower limit of normal, or hemoglobin <10 g/dL (100 g/L)
- Bone lesions: ≥1 osteolytic lesion on skeletal x-ray, CT, or PET-CT
(C2) ≥1 of the following biomarkers of malignancy:
- Clonal bone marrow plasma cells ≥60%
- Involved:uninvolved sFLC ratio ≥100
- >1 focal lesion on MRI

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Literature

Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-48.

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

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Сообщение Multiple Myeloma Diagnostic Criteria – Online Calculator появились сначала на ClinCaseQuest.

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Nataliia Lopina — Tue, 17 Jan 2023 11:32:05 +0000

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on the genetics and other routinely used lab values in conjunction with the original ISS Staging System.

Use only in patients recently diagnosed with multiple myeloma. Do not use in patients with relapsed myeloma, smoldering myeloma or MGUS. Its utility has NOT been validated in relapsed myeloma, smoldering myeloma or MGUS patients.

Provides better discrimination of prognosis for MM by using simple, readily available variables.

Reliable, validated tool that may have a role in upfront risk stratification in future clinical trials, and also may help patients understand their prognosis better.

The revised ISS is based on the original ISS for MM and has been refined further to include validated and reliable prognostic factors for MM, including ISS score, cytogenetic abnormalities, and LDH.

It identifies 3 groups with clearly different outcomes and recharacterized ~25% of patients who would have been identified as good risk (misclassified as “good prognosis”) using only one of the validated factors into a higher risk category.

Unlike several other studies, the data set includes many patients (40%) that were not transplant eligible, thus reflecting a “real-world” population.

Serum β2 microglobulin	<3.5 mg/L
	3.5-5.4 mg/L
	>5.4 mg/L
Serum albumin	<3.5 g/dL
	≥3.5 g/dL
CA by iFISH High risk defined as: presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16)	Standard risk
	High risk
LDH	Normal (< upper limit of normal)
	High (> upper limit of normal)

First, assign ISS stage:

		Serum albumin, g/dL
		≥3.5	<3.5
Serum β2 microglobulin, mg/L	<3.5	ISS I	ISS II
	3.5-5.4	ISS II	ISS II
	≥5.5	ISS III	ISS III

Then, stage R-ISS according to iFISH and LDH:

	High-risk cytogenetic abnormalities by iFISH*
	No	Yes
ISS I	R-ISS I	R-ISS II	Normal	LDH
	R-ISS II	R-ISS II	High
ISS IІ	R-ISS II	R-ISS II	Normal
	R-ISS II	R-ISS II	High
ISS IІІ	R-ISS II	R-ISS III	Normal
	R-ISS III	R-ISS III	High

*High-risk = presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16).

R-ISS interpretation:

R-ISS Stage	Median progression-free survival
І	66 months
ІІ	42 months
ІІІ	29 months

Many MM patients are treated through clinical trials. Physicians may consider referring patients to academic treatment centers if they are eligible and willing to receive transplantation, not only to discuss standard treatment options, but also to consider clinical trial options.

Current staging systems provide prognostic information and are useful for stratification and data assessments/comparisons.

The R-ISS, though a more robust powerful prognostic tool compared to ISS, is NOT directly used to alter treatment recommendations outside of a clinical trial at this time.

The revised International Staging System (R-ISS) for multiple myeloma was developed to better prognosticate long term outcomes of myeloma patients using easily obtained and routinely used prognostic variables.

It includes the parameters from the International Staging System (ISS), as well as cytogenetic abnormalities (CA) serum lactate dehydrogenase (LDH).

The R-ISS creates 3 subgroups with significantly different overall survival:

Stage I: 82%
Stage II: 62%
Stage III: 40%

It risk-stratifies multiple myeloma patients better than the original ISS.

40% of patients in the data set were not transplant eligible, which reflects a more real-world population than does previous studies

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LITERATURE

Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

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Сообщение Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator появились сначала на ClinCaseQuest.

Multiple Myeloma International Staging System (ISS) Online Calculator

Nataliia Lopina — Mon, 16 Jan 2023 15:05:06 +0000

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely obtained lab values.

Use only in patients recently diagnosed with multiple myeloma. Do not use in patients with relapsed myeloma, smoldering myeloma or MGUS. Its utility has not been validated in relapsed myeloma, smoldering myeloma or MGUS patients.

Multiple myeloma (MM) is a heterogeneous disease, with prognosis affected by various patient and disease related factors (ISS stage, genetics, performance status and other comorbidities).

The ISS differentiates patients into 3 separate prognostic groups. The staging is prognostic but does not necessarily guide treatment decisions in the upfront setting. It provides survival information to the physician and patient, and helps stratify patients in current clinical trials.

Staging based on serum β2 microglobulin and albumin levels.

Multiple Myeloma ISS interpretation:

Stage	Criteria
I	Serum β2 microglobulin <3.5 mg/L AND serum albumin ≥ 3.5 g/dL
II	Either: serum β2 microglobulin <3.5 mg/L, but serum albumin <3.5 g/dL OR serum β2 microglobulin 3.5 – 5.4 mg/L irrespective of the serum albumin
III	serum β2 microglobulin ≥5.5 mg/L

The International Staging System (ISS) for multiple myeloma defines 3 subgroups with differing overall survival:

Stage I- 62 months
Stage II- 44 months
Stage III- 29 months

The ISS was developed as a simpler, more objective tool to provide prognostic information for newly diagnosed, symptomatic MM patients.

It does not reflect disease burden.

Durie-Salmon, a cumbersome staging system used in the past, was based on estimating the disease burden but ultimately did not prove to be prognostic and fell out of favor.

Compared to older staging systems, ISS is a simple prognostic tool and may be used to stratify patients on MM clinical trials.

This system was developed from a database of clinical and laboratory data collected from 10,750 patients treated from 1981 to 2002. All patients were about to start therapy, ~70% through a clinical trial, and were from North America, Europe, and Asia. Approximately 25% received high-dose therapy/stem cell transplant. Median age was 60-63 years.

A randomly selected training set was created and analyzed by univariate and multivariate analysis, selecting serum beta-2 microglobulin and serum albumin as the dominant independent prognostic factors, best utilized in a survival tree model.

This model classified patients in 3 risk groups:

Stage I- median overall survival 62 months;
Stage II- 45 months;
Stage III- 29 months.

The ISS was then validated in a separate group of patients from the same database with virtually identical results. It was validated further by geography, patient age, and treatment type.

This model has been refined further as the Revised ISS (R-ISS). It includes validated and reliable prognostic factors for MM, including ISS score, cytogenetic abnormalities, and LDH. It identifies 3 groups with clearly different outcomes. It recharacterized ~ 25% of patients who would have been identified as good risk using only one of the validated factors into a higher risk category.

Register on our website right now to have access to more learning materials!

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LITERATURE

Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение Multiple Myeloma International Staging System (ISS) Online Calculator появились сначала на ClinCaseQuest.

SAVED VTE Score

Nataliia Lopina — Wed, 11 Jan 2023 14:09:11 +0000

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators.

Variable	Points
Surgery within 90 days	+2
Mongoloid race	-3
History of VTE	+3
Age ≥ 80 years	+1
Dexamethasone (dosage regimen): • Standard dose (120-160 mg/cycle) • High dose (>160 g/cycle)	+1 +2

Calculation

High risk (≥ 2 points). Recommended:

Enoxaparin 40 mg subcutaneously 1 time/day
Dalteparin 5000 units subcutaneously 1 time/day (category 2B)
Warfarin (INR 2-3)

Low risk (< 2 points). Recommended:

Do not prescribe medications
Aspirin 81-325 mg/day

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Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение SAVED VTE Score появились сначала на ClinCaseQuest.

IMPEDE VTE Score

Nataliia Lopina — Wed, 11 Jan 2023 14:06:45 +0000

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators.

*Individual Risk Factors*	Points	Myeloma risk scores	Points
Positive Factors
Central venous catheter/tunneled central catheter	+2	Immunomodulator (IM)	+4
Fracture of the pelvis, hip joint, or femur	+4	A drug that stimulates erythropoiesis	+1
Obesity (body mass index ≥ 25)	+1	Dexamethasone < 160 mg per month	+2
Previous VTE	+5	Dexamethasone > 160 mg per month	+4
		Doxorubicin or multicomponent chemotherapy	+3
Negative Factors
Ethnicity/Race – Mongoloid/Pacific Islander	-3
Current thromboprophylaxis: low molecular weight heparin (LMWH) at prophylactic doses or aspirin	-3
Current thromboprophylaxis: LMWH at prophylactic doses or warfarin	-4

Calculation

High risk (>3 points). An anticoagulant is recommended if it has not been prescribed before:

Enoxaparin 40 mg subcutaneously 1 time/day
Dalteparin 5000 units 1 time/day (category 2B)
Warfarin (INR 2-3)

Low risk (≤3 points). Recommended:

Do not prescribe medications
Aspirin 81-325 mg/day

Register on our website right now to have access to more learning materials!

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Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение IMPEDE VTE Score появились сначала на ClinCaseQuest.

Karnofsky Performance Status Scale Online Calculator

Nataliia Lopina — Mon, 29 Aug 2022 07:21:53 +0000

Karnofsky performance status scale determines ability of patient to tolerate chemotherapy.

For patients ≥ 16 years old.

Useful to use over time to track disease progression.

The Karnofsky Performance Status Scale (KPS) is widely used for a variety of purposes, including response to chemotherapy for cancer and assessment of chronic disease. This scale can be used to assess patients with advanced cancer or other chronic diseases, as well as progressive debility in the elderly.

The Karnofsky Performance Status Scale quantifies a patient’s functional ability and the effect of treatment, such as chemotherapy, on their basic functional ability. It is sometimes also used for prognostic purposes and to guide treatment.

The score on the scale is highly correlated with survival time and need for home care. It can also help predict the ability to progress with invasive and intensive treatments.

Patient Description	Points*	Result
Normal no complaints; no evidence of disease	100	Able to carry on normal activity and to work; no special care needed.
Able to carry on normal activity; minor signs or symptoms of disease	90	Able to carry on normal activity and to work; no special care needed.
Normal activity with effort; some signs or symptoms of disease	80	Able to carry on normal activity and to work; no special care needed.
Cares for self; unable to carry on normal activity or to do active work	70	Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed.
Requires occasional assistance, but is able to care for most of his personal needs	60	Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed.
Requires considerable assistance and frequent medical care	50	Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed.
Disabled; requires special care and assistance	40	Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly.
Severely disabled; hospital admission is indicated although death not imminent	30	Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly.
Very sick; hospital admission necessary; active supportive treatment necessary	20	Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly.
Moribund; fatal processes progressing rapidly	10	Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly.
Dead	0	Dead.

*% Survival correlates with points assigned

The lower the Karnofsky score, the worse the prognosis, which may be due to:

Intolerance to therapy
Decreased survival rates

ECOG PERFORMANCE STATUS	KARNOFSKY PERFORMANCE STATUS
0—Fully active, able to carry on all pre-disease performance without restriction	100—Normal, no complaints; no evidence of disease
	90—Able to carry on normal activity; minor signs or symptoms of disease
1—Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work	80—Normal activity with effort, some signs or symptoms of disease
	70—Cares for self but unable to carry on normal activity or to do active work
2—Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours	60—Requires occasional assistance but is able to care for most of personal needs
	50—Requires considerable assistance and frequent medical care
3—Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours	40—Disabled; requires special care and assistance
	30—Severely disabled; hospitalization is indicated although death not imminent
4—Completely disabled; cannot carry on any selfcare; totally confined to bed or chair	20—Very ill; hospitalization and active supportive care necessary
	10—Moribund
5—Dead	0—Dead

The Karnofsky Performance Status Scale and other performance scales should be used for the holistic assessment of cancer patients, although its accuracy as a prognostic tool in some cases has not yet been sufficiently proven.

The Karnofsky Performance Status Scale is useful to clinicians in daily clinical practice, and this performance scale should be used to improve understanding of a patient’s needs and abilities, and potentially for prediction.

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Literature

Karnofsky DA Burchenal JH. (1949). ‘The Clinical Evaluation of Chemotherapeutic Agents in Cancer.’ In: MacLeod CM (Ed), Evaluation of Chemotherapeutic Agents. Columbia Univ Press. Page 196.
Crooks, V, Waller S, et al. The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. J Gerontol. 1991; 46: M139-M144.
Hollen PJ, Gralla RJ, et al. Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies. Cancer. 1994; 73: 2087-2098.
O’Toole DM, Golden AM. Evaluating cancer patients for rehabilitation potential. West J Med. 1991; 155:384-387.
Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: Reliability, validity, and guidelines. J Clin Oncology. 1984; 2:187-193.

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Сообщение Karnofsky Performance Status Scale Online Calculator появились сначала на ClinCaseQuest.

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

Nataliia Lopina — Thu, 13 Jan 2022 16:09:57 +0000

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis).

IPSET-thrombosis model provides objective estimates of the probability of thrombotic events in patients with newly diagnosed ET.

The scale consist of the following parameters, listed below:

Patient age
• under 60 years	0
• 60 years or older	1
Prior thrombotic event	2
Cardiovascular risk factors present (One or more of: hypertension, diabetes mellitus, active smoking)	1
Detected JAK2 V617F mutation	2

The primary objective of essential thrombocythemia (ET) management is to prevent thromboembolic complications. In this regard, advanced age and thrombosis history were used to assess this risk. More recently, JAK2V617F and cardiovascular (CV) risk factors were identified as additional modifiers, leading to the development of a 3-tiered International Prognostic Score of Thrombosis for ET (IPSET-thrombosis): “low”, “intermediate”, and “high”.

Total 6 points (Age 1, H/O Thrombosis 2, Cardiovascular risk factor 1 and JAK2V617F – 2 points).

Determine risk group and prognosis:

Score	Risk category	Annual thrombosis risk
0 – 1	Low	1.03%
2	Intermediate	2.35%
3 – 6	High	3.56%

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Reference:
Barbui T, Finazzi G, Carobbio A, Thiele J, Passamonti F, Rumi E et al. Development and validation of an International Prognostic Score of thrombosis in World Health Organization-essential thrombocythemia (IPSET-thrombosis). Blood 2012; 12: 5128-33

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Follicular Lymphoma International Prognostic Index (FLIPI). Online calculator

Nataliia Lopina — Mon, 10 Jan 2022 09:27:11 +0000

Follicular Lymphoma International Prognostic Index (FLIPI) estimates overall survival based on clinical information.

FLIPI is designed to be used in patients with follicular lymphoma and to risk stratify patients based on prognosis. This can help guide when and how to treat such patients.

The FLIPI score was developed based on 4,167 patients with follicular lymphoma providing characteristics at diagnosis. Univariate and multivariate analyses were then used to develop a prognostic index. This was then validated in a cohort of 919 patients. Age, Ann Arbor stage, hemoglobin level, number of nodal areas, and serum LDH level were identified as adverse prognostic factors. The FLIPI was validated in a subsequent study and the performance improved by further stratifying age and including the presence of cerebrovascular disease.

The FLIPI, while a useful general prognostic tool, does not reliably predict those at diagnosis who will have an extremely rapid decline. Rather it assists with providing prognostic information. Ultimately, clinical judgement and comprehensive review of the patient’s previous workup are critical to make this assessment.

The GELF Criteria can help identify those patients with follicular lymphoma at higher risk for rapid disease progression and in whom immediate therapy may be needed.

The FLIPI score is easy to use with information most providers will already have available. Clinical evaluation, laboratory testing, and imaging are all that is needed to risk stratify patients and estimate prognosis.

Age > 60 years	No	0
	Yes	+1
>4 nodal sites See Nodal Sites* diagram*	No	0
	Yes	+1
LDH elevated	No	0
	Yes	+1
Hemoglobin <120 g/L or 12 g/dL	No	0
	Yes	+1
Stage III-IV Stage I: disease is located in a single region, usually one lymph node and the surrounding area. Stage II: disease is located in two separate regions, an affected lymph node or organ and a second affected area. Both affected areas are confined to one side of the diaphragm. Stage III: disease involves both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen. Stage IV: diffuse or disseminated involvement of one or more extranodal organs, with or without associated lymph node involvement. See Staging Diagram	No	0
	Yes	+1

Score Interpetation

Score	Risk Group	10-year Overall Survival
≤1	Low	70%
2	Intermediate	50%
≥3	High	35%

Useful Mnemonic – NoLash

Nodal areas
LDH
Age
Stage
Hemoglobin level

Nodal Sites

Staging Diagram

A FLIPI score of 0 to 1 is considered “low risk” with a 10 year overall survival of 70%. A score of 2 is considered “intermediate risk” with a 10 year overall survival of 50%. Finally, a score of ≥ 3 is considered “high risk” with a 10 year overall survival of 35%. Patients with an initial remission duration less than the median progression free survival for a particular treatment regimen and/or with a high FLIPI score are more likely to have a shorter remission duration.

Treatment is varied depending on the stage and tumor burden.

Stages I-II

Treatment options include:
- Involved field radiotherapy (IFRT)
- Clinical trials
- Active surveillance

Stages III-IV or Bulky stage II – asymptomatic

Treatment options include:
- Clinical trials
- Active surveillance

Stages III-IV or Bulky Stage II – with GELF/BNLI risk factors or high-risk FLIPI score

Treatment options include:
- Rituximab + cyclophosphamide, vincristine, doxorubicin, prednisone
- Rituximab alone
- Bendamustine + rituximab
- Rituximab + cyclophosphamide, vincristine, prednisone
- Clinical trials

There is continued controversy around when and how to treat follicular lymphoma, including in patients with relapsed/refractory disease. Questions to consider when making treatment decisions:

When to initiate therapy versus active surveillance
- Deciding amongst various treatment options
- Balancing efficacy and toxicities of treatment options
- Determining what constitutes a complete response/endpoint of treatment
Finally, with follicular lymphoma, a provider should be aware of transformation to diffuse large B-cell lymphoma, which is a more aggressive disease and would require prompt treatment.

Register on our website right now to have access to more learning materials!

Subscribe to our pages:

Literature:

Solal-Celigny et al. Follicular Lymphoma International Prognostic Index. Blood 104:1258-1265. (2004) https://pubmed.ncbi.nlm.nih.gov/15126323/
van de Schans SAM, et. al. Validation, revision and extension of the Follicular Lymphoma International Prognostic Index (FLIPI) in a population-based settingAnn Oncol (2009) 20 (10): 1697-1702 first published online June 23, 2009 doi:10.1093/annonc/mdp053 https://www.journals.elsevier.com/annals-of-oncology

See also:

Groupe d’Etude des Lymphomes Folliculaires (GELF) Criteria. Online calculator

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Сообщение Follicular Lymphoma International Prognostic Index (FLIPI). Online calculator появились сначала на ClinCaseQuest.

Groupe d’Etude des Lymphomes Folliculaires (GELF) Criteria. Online calculator

Elena Shevchenko — Mon, 10 Jan 2022 08:21:39 +0000

Groupe d’Etude des Lymphomes Folliculaires (GELF) Criteria determines if immediate therapy for follicular lymphoma is required.

The criteria can help identify those patients with follicular lymphoma at higher risk for rapid disease progression and in whom immediate therapy may be needed.

Number of criteria	Feasibility of GELF criteria	Recommendation
0	0	0

Number of criteria	Feasibility of GELF criteria	Recommendation
0	0	0

This tool is best used as an instantaneous assessment of a patient’s disease burden. Ultimately, clinical judgement and comprehensive review of the patient’s previous workup are critical to make this assessment.

For overall prognosis, the FLIPI can risk stratify further than the GELF criteria.

The GELF criteria is easy to use with information most providers will already have available. Clinical evaluation, laboratory testing, and imaging are all that is needed to determine who has a high tumor burden based on the GELF criteria.

Any nodal or extranodal tumor mass >7 cm diameter	No	0
	Yes	+1
Involvement of at least 3 nodal sites, each with diameter >3 cm View more nodal site information in the Nodal Sites section	No	0
	Yes	+1
Presence of any systemic or B symptoms	No	0
	Yes	+1
Splenic enlargement with inferior margin below the umbilical line	No	0
	Yes	+1
Compression syndrome (ureteral, orbital, gastrointestinal)	No	0
	Yes	+1
Pleural or peritoneal serous effusion (irrespective of cell content)	No	0
	Yes	+1
Leukemic phase (>5.0 x10⁹/L circulating malignant cells)	No	0
	Yes	+1
Cytopenia (granulocyte count < 1.0×10⁹/L and/or platelets < 100×10⁹/L)	No	0
	Yes	+1

FORMULA

Patients must meet ≥1 criteria to be considered “high” tumor burden.

Сriteria:

Any nodal or extranodal tumor mass >7 cm diameter
Involvement of at least 3 nodal sites, each with diameter >3 cm
Presence of any systemic or B symptoms
Splenic enlargement with inferior margin below the umbilical line
Compression syndrome (ureteral, orbital, gastrointestinal)
Pleural or peritoneal serous effusion (irrespective of cell content)
Leukemic phase (>5.0 x10⁹/L circulating malignant cells)
Cytopenia (granulocyte count < 1.0 x10⁹/L and/or platelets < 100×10⁹/L)

Nodal Sites

Refer to the staging systems FLIPI and Lugano classification to assist with risk stratifying patients. The GELF criteria is a quick test to determine which patients should be monitored versus treated now.

MANAGEMENT

Treatment is varied depending on the stage and tumor burden.

Stages I-II

Treatment options include:
- Involved field radiotherapy (IFRT)
- Clinical trials
- Active surveillance

Stages III-IV or Bulky Stage II – asymptomatic

Treatment options include:
- Clinical trials
- Active surveillance

Stages III-IV or Bulky Stage II – with GELF/BNLI risk factors or high-risk FLIPI score

Treatment options include:
- RiTUXimab + cyclophosphamide, vinCRIStine, DOXOrubicin, predniSONE
- RiTUXimab alone
- Bendamustine + riTUXimab
- RiTUXimab + cyclophosphamide, vinCRIStine, predniSONE
- Clinical trials

CRITICAL ACTIONS

There is continued controversy around when and how to treat follicular lymphoma, including in patients with relapsed/refractory disease. Questions to consider when making treatment decisions:

When to initiate therapy versus active surveillance
Deciding amongst various treatment options
Balancing efficacy and toxicities of treatment options
Determining what constitutes a complete response/endpoint of treatment
Finally, with follicular lymphoma, a provider should be aware of transformation to diffuse large B-cell lymphoma, which is a more aggressive disease and would require prompt treatment.

EVIDENCE APPRAISAL

The original study compared three different intervention arms: active surveillance until clinical progression, immediate treatment with an oral alkylating agent (prednimustine), or treatment with a biologic response modifier (interferon-alpha). 193 in total were enrolled. The overall response rate of deferred treatment was 70%, with prednimustine was 78%, and with interferon-alpha was 70%. Similarly, the overall survival time at 5 years was 78%, 70%, and 84%, respectively. This showed that delayed treatment was a viable option for such an indolent lymphoma. However, those with early progression warrant treatment sooner.

Register on our website right now to have access to more learning materials!

Subscribe to our pages:

LITERATURE
Brice P, Bastion Y, Lepage E, et al. Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: a randomized study from the Groupe d’Etude des Lymphomes Folliculaires. J Clin Oncol. 1997. 15:1110-7. https://pubmed.ncbi.nlm.nih.gov/9060552/
Solal-Céligny P, Lepage E, Brousse N, Tendler CL, Brice P, Haïoun C, Gabarre J, Pignon B, Tertian G,Bouabdallah R, Rossi JF, Doyen C, Coiffier B. DOXOrubicin-containing regimen with or without interferon alfa-2b for advanced follicular lymphomas: final analysis of survival and toxicity in the Groupe https://pubmed.ncbi.nlm.nih.gov/9667247/

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Multiple Myeloma Diagnostic Criteria – Online Calculator

February 5, 2023

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Сообщение Groupe d’Etude des Lymphomes Folliculaires (GELF) Criteria. Online calculator появились сначала на ClinCaseQuest.

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Previous cardiovascular disease

Cardiac biomarkers (where available)

Demographic and cardiovascular risk factors

Previous cardiotoxic cancer treatment

Lifestyle risk factors

Multiple Myeloma Diagnostic Criteria – Online Calculator

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

R-ISS interpretation:

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma ISS interpretation:

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

SAVED VTE Score

Calculation

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

IMPEDE VTE Score

Individual Risk Factors

Positive Factors

Negative Factors

Myeloma risk scores

Calculation

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

Karnofsky Performance Status Scale Online Calculator

• Opening the consultation

• Availability of a defibrillator

• Presenting complaint

• History of presenting complaint

• Past medical history

• Drug history

• Physical examination

• Intravenous access

• Registration of a 12-channel ECG

• Express test for the determination of cardiac troponin, myoglobin, creatine phosphokinase-MB, if possible

• Making preliminary diagnosis

• Drug therapy (basic)

• Evaluation of the door-balloon time (the choice of further reperfusion strategy aimed as soon as possible to restore the coronary blood flow in the infarct-dependent artery)

• Call the nearest reperfusion center

• P2Y12 receptor inhibitor prescription depending on the chosen strategy of reperfusion therapy

• Carrying out thrombolytic therapy as needed

• Transportation to the nearest reperfusion center

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

Follicular Lymphoma International Prognostic Index (FLIPI). Online calculator

Useful Mnemonic – NoLash

Nodal Sites

Staging Diagram

Groupe d’Etude des Lymphomes Folliculaires (GELF) Criteria. Online calculator

FORMULA

Сriteria:

Nodal Sites

MANAGEMENT

CRITICAL ACTIONS

EVIDENCE APPRAISAL

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)