Toranomon Hospital

Although HLA-matched related donor transplantation (MRDT) is considered the preferred graft source when available, cord blood transplantation (CBT) is an alternative source, with several studies suggesting a potent graft-versus-leukemia effect. We compared outcomes between CBT and MRDT in acute myeloid leukemia (AML) not in remission and examined how pre-engraftment immune reaction (PIR), graft-versus-host disease (GVHD), and HLA mismatch affect CBT outcomes. We retrospectively analyzed 334 patients with AML not in remission who underwent first allo-HSCT using either single-unit CBT (n = 309) or MRDT (n = 25). At 5years, CBT recipients showed significantly better leukemia-free survival (LFS) (42.0% vs. 17.6%) and lower relapse rates (24.6% vs. 54.0%), with no difference in NRM. Among CBT recipients, patients who developed mild PIR had a lower relapse rate compared with those without PIR (hazard ratio [HR], 0.48). In contrast, severe PIR was associated with higher NRM (HR, 3.13) and worse overall survival (HR, 2.12). Acute GVHD, chronic GVHD, and HLA disparity were not significantly associated with relapse. CBT was associated with superior LFS compared with MRDT in patients with AML not in remission, and PIR occurrence and severity were associated with CBT outcomes.

Although percutaneous coronary intervention (PCI) has become safer due to advances in devices and procedural standardization, in-hospital outcomes may still vary depending on the involvement of certified interventional cardiologists (ICs). This study evaluated the association between board-certified IC involvement and in-hospital outcomes following PCI using a nationwide Japanese registry. We analyzed PCI cases between 2020 and 2023, classifying them according to the involvement (defined as acting as a primary operator or supervising assistant) of board-certified members of the Japanese Association of Cardiovascular Intervention and Therapeutics (BMCVIT). Among 842,335 PCI cases analyzed, 579,459 (68.8%) were performed with BMCVIT involvement. The frequency of BMCVIT involvement was higher for the treatment of patients with prior revascularization and complex lesions, but lower for patients admitted with acute coronary syndrome (ACS) or hemodynamic instability. After adjusting for baseline characteristics, BMCVIT involvement remained independently associated with lower in-hospital mortality (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.86-0.92; P<0.001), composite in-hospital complications (OR 0.94; 95% CI 0.91-0.97, P<0.001), and access site bleeding (OR 0.88; 95% CI 0.80-0.97, P=0.012). Subgroup analyses revealed consistent mortality benefits across age, sex, dialysis status, lesion complexity, and institutional PCI volume, with stronger protection in patients without ACS or cardiogenic shock. BMCVIT involvement in PCI was independently associated with lower in-hospital mortality and complications, underscoring the quality gains of IC participation.

This study aimed to identify patient groups in which myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC) regimens induced superior progression-free survival (PFS) in patients with acute myeloid leukemia (AML) in complete remission (CR) using a machine-learning approach. Our study included 3273 patients aged 40–69 with AML in CR. The patients were divided into training (N = 2020) and validation cohorts (N = 1253). We employed a machine learning-based group identification model in the training cohort. Subsequently, in the validation cohort, we estimated the impact of the optimal conditioning group compared with the non-optimal conditioning group on PFS using an inverse probability weight analysis. The developed model was consistent with the eight factors and combinations, and the high score suggested that RIC was more appropriate than MAC. In the validation cohort, 127 patients with high scores and who received RIC and 769 patients with low scores and who received MAC were categorized into the optimal conditioning group (896, 71.5%). The weighted hazard ratio for PFS was 0.73 (95% confidence interval: 0.57–0.94) in the optimal conditioning group compared with the non-optimal conditioning group (P = 0.016). In conclusion, we developed an easy-to-use model that helps the physician choose a patient-specific conditioning regimen for patients with AML in CR.

Abstract Background: Surgical decision-making in breast cancer involves not only clinical and oncological considerations but also psychosocial factors such as personal values, social support, and anticipated quality of life. Although shared decision-making (SDM) is increasingly emphasized, factors influencing patients’ surgical choices remain unclear. This study aimed to identify determinants associated with the selection of total mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR) using patient-reported outcomes. Patients and Methods: A multicenter study was conducted across six institutions in Japan. We included 577 female patients who underwent breast cancer surgery between 2008 and 2018. Using patient-reported outcomes, we collected data on sociodemographic background and 15 decision-influencing factors, including opinions of healthcare providers, family, and peers; radiation therapy; fear of recurrence; hospitalization; and perceived impacts on childcare, work, and hobbies. Patients were categorized into MT, BCS, or IBR groups. Chi-square tests were used for group comparisons, and multinomial logistic regression was performed using the IBR group as the reference. Results: Among 577 patients, 194 underwent MT, 185 BCS, and 198 IBR. The mean age was 53.6 years (±11.5), with the IBR group significantly younger (48.2) than MT (58.1) and BCS (54.8) (p&amp;lt;0.001). The mean interval from surgery to questionnaire response was 56.0 months. IBR patients were more likely to have avoided chemotherapy (p&amp;lt;0.001), be non-smokers (p&amp;lt;0.001), have smaller tumors (p&amp;lt;0.001), no nodal metastasis (p=0.003), and be full-time employed (p&amp;lt;0.001). The incidence of postoperative complications (grade ≥3) was highest in the IBR group (p&amp;lt;0.001). The most reported influence was the surgeon’s opinion (92.2%), followed by fear of recurrence (43.8%), partner’s opinion (35.5%), family (22.4%), and breast cancer survivors (21.0%). Patients influenced by nurses were more likely to select IBR (MT: 3.1%, BCS: 4.5%, IBR: 10.8%; p=0.004). Other significant differences included partner’s opinion (p=0.012), hospitalization (p=0.022), radiation therapy (p&amp;lt;0.001), recurrence fear (p=0.002), and concerns about hobbies (p=0.004) and work (p=0.025). Univariable analysis showed that IBR was more likely in patients who were younger (p&amp;lt;0.001), had smaller tumors (p&amp;lt;0.001), no nodal metastasis (p=0.036), no chemotherapy (p=0.007), were non-smokers (p=0.001), employed full-time (p&amp;lt;0.001), and had higher income (p=0.004). IBR was also associated with influence from nurses (p=0.005), partners (p=0.005), hospitalization (p=0.009), hobbies (p=0.017), and work concerns (p=0.011). Recurrence fear was associated with higher IBR selection over BCS (p=0.017). In multivariable analysis, independent predictors of selecting IBR over both MT and BCS included younger age (p&amp;lt;0.001), non-smoking status (p=0.012), being influenced by nurses’ opinions (p=0.022), and absence of fear of cancer recurrence (p=0.042). Conclusions: This study is the first large-scale, multicenter collaborative study to identify factors influencing surgical decision-making in Japanese breast cancer patients. Predictors influencing the choice of IBR compared with MT and BCS were age, smoking status, nurses' opinions, and anxiety about recurrence. The results of this study suggest the importance of multidisciplinary collaboration and surgical decision-making support that considers the individual background of patients. Citation Format: H. Seki, T. Komiya, M. Kato, Y. Sowa, J. Takano, Y. Nishida, N. Tamura, M. Saiga. Factors influencing surgical decision-making in breast cancer using patient-reported outcomes- A multicenter collaborative study- [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-01-28.

Long-term follow-up (LTFU) outpatient clinics play a primary role in screening, preventing, and addressing late effects after hematopoietic cell transplantation (HCT). Following the 2018 nationwide survey, which led to the development of standardized nationwide tools to deliver information to HCT survivors, we re-evaluated changes in the current status of LTFU clinics. We targeted 267 HCT centers certified by the Japanese society for transplantation and cellular therapy. Several questionnaire categories were retained from the 2018 survey to compare results (e.g., LTFU clinic establishment and institutional practices for late-effect screening). The response rate was high in both adult (90%) and pediatric HCT centers (88%), and the establishment rate of post-HCT LTFU clinics increased to 82% (adult, 90%; pediatric, 64%). Pediatric centers were more likely to continue follow-up of patients who received HCT beyond 5 years post-HCT. Regarding transitional medical care for long-term survivors at non-HCT institutions, only a few HCT centers conducted routine transitions to specific referral facilities. We observed significant changes in recommendations for secondary cancer screenings compared to 2018, with a substantial decrease in the proportions of "not routinely included as a screening issue." In the future, it is essential to create a sustainable follow-up system, establish networks with non-HCT facilities, and educate patients to encourage behavioral changes for lifelong health screenings.