Multiple myeloma (MM) is a plasma-cell neoplasm that is treated with high-dose chemotherapy, autologous stem cell transplant (ASCT) and long-term immunomodulatory drug (IMiD) maintenance. The presence of somatic mutations in the peripheral blood is termed clonal hematopoiesis of indeterminate potential (CHIP) and is associated with adverse outcomes. Targeted sequencing of the stem cell product from 629 MM patients treated by ASCT at the Dana-Farber Cancer Institute (2003–2011) detects CHIP in 136/629 patients (21.6%). The most commonly mutated genes are DNMT3A, TET2, TP53, ASXL1 and PPM1D. Twenty-one from fifty-six patients (3.3%) receiving first-line IMiD maintenance develop a therapy-related myeloid neoplasm (TMN). However, regardless of CHIP status, the use of IMiD maintenance associates with improved PFS and OS. In those not receiving IMiD maintenance, CHIP is associated with decreased overall survival (OS) (HR:1.34, p = 0.02) and progression free survival (PFS) (HR:1.45, p < 0.001) due to an increase in MM progression.

Background. Epidemiological studies have shown a strong association between systemic inflammatory diseases, particularly allergic diseases, and cardiovascular diseases. However, the relationship between atopic dermatitis (AD) and ischemic stroke remains unclear. Method. The study identified 20,323 AD patients and 20,323 comorbidity-matched subjects between 2005 and 2008. The two cohorts were followed until 31 December 2009. Ischemic stroke and other cardiovascular events were determined. Results. During the follow-up period, 301 (1.48%) patients in the AD cohort and 228 (1.12%) matched subjects experienced ischemic stroke. After multivariate adjustment, patients with AD had a 1.33-fold (95% confidence interval (CI), 1.12–1.59; P = 0.001) increased incidence of ischemic stroke. Adjusted hazard ratios for the risk of ischemic stroke in patients with mild, moderate, and severe AD were 1.20 (95% CI, 1.00–1.45; P = 0.052), 1.64 (95% CI, 1.23–2.19; P = 0.001), and 1.71 (95% CI, 1.15–2.56; P = 0.008), respectively. The log-rank test showed a higher cumulative incidence of ischemic stroke in the severe AD group than in the moderate and mild AD groups during the follow-up period (P < 0.001). Conclusions. AD may be an independent risk factor for ischemic stroke, and risk of ischemic stroke increases with AD severity.

Background: Radioactive iodine (RAI) is widely used for the treatment of thyroid cancers. However, information on associations between RAI dose and second primary malignancy (SPM) is lacking. Methods: Patients without antecedent cancer age 20 years or older and newly diagnosed with thyroid cancer were recruited from the Taiwan National Health Insurance database between 1997 and 2010. Standardized incidence ratios (SIRs) for the cancers were calculated to compare the incidence of thyroid cancer with the general population. The association between RAI dosage and cancer development was estimated using time-dependent Cox regression analysis. All statistical tests were two-sided. Results: A total of 692 cases of SPM were identified among 20 235 patients with thyroid cancer. Regarding the latter, 79.7% of the patients were women, the median age was 46 years, and the follow-up period included 134 178 person-years. The SIR for any SPM was 1.41 (95% confidence interval [CI] = 1.31 to 1.52). A statistically significantly higher SIR was observed in leukemia (2.74), non-Hodgkin’s lymphoma (2.38), prostate (2.30), lung and mediastinum (1.93), pancreas (1.83), kidney (1.81), breast (1.48), and colon-rectum (1.31) cancers. Cumulative RAI dose (per 30 mCi increase) conferred a strong risk for SPM (adjusted hazard ratio [aHR] = 1.01, 95% CI = 1.01 to 1.02, P < .001) and leukemia (aHR = 1.03, 95% CI = 1.02 to 1.04, P < .001) occurrences. A cumulative RAI dose greater than 150 mCi possessed a statistically significant risk for all cancer combined (aHR = 1.30) and leukemia (aHR = 6.03). Conclusions: An increased risk of SPM was observed for thyroid cancer patients, especially with cumulative RAI doses over 150 mCi.

Background: There is evidence suggesting that migraine may be associated with vertigo. The aim of this study was to assess the risk of benign paroxysmal positional vertigo (BPPV), the most common form of vertigo, in patients with migraine using a population-based dataset. Methods: The National Health Insurance Research Database in Taiwan was searched for migraine patients and was also used to select an age- and sex-matched cohort of subjects without migraine. The analyses included 8266 migraine patients and 8266 controls. The incidence rates of BPPV in the two cohorts were compared. Cox proportional hazard models were used to identify risk factors for BPPV in migraine patients. Results: In the migraine cohort, 1.11 % of the patients developed BPPV compared to 0.5 % of the controls. The incidence rate ratio was 2.03 (95 % CI 1.41–2.97; p 0.001) were associated with an increased risk for BPPV. Conclusion: The results showed that patients with migraine had a 2.03-fold increased risk of developing BPPV compared with age- and sex-matched controls. Although BPPV may not be a common condition in migraine patients, migraine sufferers with vestibular symptoms should alert physicians to the possibility of BPPV, particularly if patients are aged ≥40 years, have a history of coronary artery disease, or have frequent visits to neurologists clinics because of migraine.