Kings County Hospital Center is a municipal hospital located in the East Flatbush neighborhood of Brooklyn, New York City. It is owned and operated by NYC Health + Hospitals, a municipal agency that runs New York City's public hospitals. It has been affiliated with SUNY Downstate College of Medicine since Downstate's founding as Long Island College Hospital in 1860. Kings County is a member of the New York City Health and Hospitals Corporation. Kings County was named the country's first Level 1 trauma center. It is also a Designated Stroke Center, Level III Perinatal Center, Designated AIDS Center, Parkinson's Disease Center of Excellence, Diabetes Education Center of Excellence, Behavioral Health Center (including inpatient, outpatient with dedicated emergency department) and Sexual Assault Forensic Examiner (SAFE) Program Center of Excellence.Kings County serves the boroughs of Brooklyn and Staten Island, with over 510,000 clinic visits and 140,000 emergency department visits in 2015. The hospital provides services to more than 800,000 people in the surrounding communities, including 415,650 in the primary service area of Bedford–Stuyvesant, Brownsville, Crown Heights, Canarsie, East Flatbush, East New York, Flatbush, and Prospect Lefferts Gardens. Ethnic diversity among the mostly black and Hispanic population served (94%) by Kings County is high, with large populations from the Caribbean as well as South American and African countries. Accordingly, Kings County employees speak 39 different languages to meet this diverse population's needs.
The ABC trials evaluated the efficacy of taxane with cyclophosphamide (TC) vs anthracycline and taxane-based chemotherapy (AC-T) in patients (pts) with clinically high risk, HER2-negative (HER2-) breast cancer (BC), and observed no significant difference between these treatment regimens among pts with hormone receptor-positive (HR+) BC. The MammaPrint® (MP), 70-gene signature, identifies pts with early BC (EBC) who derive (neo)adjuvant chemotherapy (CT) benefit. To examine the utility of MP in identifying pts likely to benefit from AC-T, we provide an updated analysis of data presented at ASCO 2024 and evaluated 3-year (yr) outcomes among propensity-score matched (PSM) pts with MP High Risk, HR+HER2- BC who received adjuvant TC or AC-T on the prospective observational FLEX Study. The FLEX Study (NCT03053193) enrolled EBC pts who received standard of care MP with BluePrint® (BP) intrinsic subtyping. 1261 pts had MP High Risk, BP Luminal B, HR+HER2- EBC and received either adjuvant TC or AC-T (non-randomized) with 3.2 yrs median follow-up. High Risk was further stratified into High Risk 1 (H1) and High Risk 2 (H2). PSM was performed to balance differences in age, tumor size and nodal status between the TC and AC-T-treated pts for the H1 and H2 groups, separately. The 3-yr invasive disease-free survival (IDFS), as defined by STEEP 2.0, was compared within H1 and H2 groups using Kaplan-Meier analysis and log-rank tests, grouped by TC vs AC-T. Cox proportional hazards models were used to evaluate the effect of CT regimen and clinical features on survival within each group. Among 1261 pts, 1107 had H1 and 154 had H2 HR+ HER2- BC. Pts who received TC (H1, n=818; H2, n=103) were PSM with pts who received AC-T (H1, n=289; H2, n=51), yielding a cohort of 578 pts with H1 and 102 with H2 BCs with no significant differences in clinical/pathologic features between the two CT groups within each of the H1 and H2 cohorts. For pts with H1 BC, no significant difference in 3-yr IDFS was observed between AC-T (95.6%) and TC (94.6%) treatment (p = 0.98; Table). In contrast, H2 pts treated with TC had a significantly worse IDFS of 89.3% compared with 100% for AC-T-treated pts, with an absolute benefit of 10.7% (p = 0.048). Multivariate Cox regression analysis within the H1 group showed no association with improved IDFS with AC-T, while the use of AC-T in H2 pts showed a trend towards improved IDFS compared to TC, but did not reach significance likely due to sample size. In this PSM analysis of non-randomized, real-world FLEX Study data with 3.2 yrs median follow-up, pts with H2 HR+HER2- EBC had significantly improved IDFS with AC-T compared to TC. In contrast, pts with H1 disease did not benefit more from AC-T vs TC. These findings further support the utility of MammaPrint in informing prognosis and CT selection in pts with HR+HER2- EBC. J. O'Shaughnessy, A. Brufsky, C. L. Graham, C. R. Osborne, R. L. Rahman, A. Elkhanany, E. A. Brown, L. P. Gold, N. M. Johnson, D. Giffoni, J. Alberty-Oller, R. L. Mahtani, H. Ramaswamy, N. Stivers, A. Menicucci, W. Audeh. Improved 3-year IDFS with anthracycline-based therapy for patients with 70-gene signature High 2, Luminal B, HR+HER2- early-stage breast cancer [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 PS2-07-03.
Background:Candidozyma auris, Candida glabrata, and C. krusei are all fungal pathogens intrinsically resistant to azoles. Patient characteristics and outcomes were compared for patients with cultures positive for these three pathogens. Methods:A retrospective cohort study was performed involving patients from an 11 acute care safety net hospital system in New York City. Echinocandin susceptibility rates and patient outcomes, including overall mortality and lengths of hospital stay, were compared for patients with C. auris versus C glabrata/krusei. Results:Resistance to caspofungin was low in all three pathogens. Compared to patients with C. glabrata/C. krusei, patients with C. auris had similar mortality rates. However, compared to patients harboring C. glabrata/C krusei, those with C. auris had longer hospital stays when discharged to a skilled nursing facility, including from the time from culture positivity to discharge (78 ± 148 vs 33 ± 44 d, P = .06). Multivariate regression analysis revealed two factors associated with length of stay: presence of C. auris (P < .001) and hemodialysis (P = .051). Discussion:Echinocandin resistance was unusual, and overall mortality rates were similar, for patients with C. auris, C. glabrata, and C. krusei. However, for patients discharged to skilled nursing facilities, the length of hospital stay was longer for patients with C. auris. The implementation of lifelong contact precautions for C. auris may be an impediment for discharge planning.
Objectives Afro-Caribbean patients are underrepresented in acute myeloid leukemia (AML) outcomes research, and the impact of socioeconomic and structural barriers on survival in this population remains poorly defined. We aimed to characterize clinicopathologic features, treatment utilization, and outcomes among Afro-Caribbean adults with AML treated at an urban safety-net hospital. Methods We conducted a retrospective cohort study of adults diagnosed with AML and treated at a large urban safety-net hospital in Brooklyn, New York, between 2012 and 2022. Demographic, clinical, and treatment variables were abstracted from electronic medical records. Outcomes were summarized descriptively, including treatment intensity, transplant eligibility and receipt, and survival. Results Among 47 patients (median age 66 years), 85% identified as Afro-Caribbean. At presentation, 38% were uninsured. Ten patients (21%) received supportive care only. Among treated patients (n = 37), 78% received intensive anthracycline+cytarabine–based induction chemotherapy. Twenty-seven patients (57%) were considered appropriate candidates for allogeneic transplantation based on disease risk and performance status; however, only 3 (11%) ultimately underwent the procedure. Complete remission was achieved in 51%, with 58% subsequently relapsing. Median progression-free survival was 8 months, and median overall survival was 9 months. Three-year progression-free and overall survival were 12.8% and 17.0%, respectively. Conclusions In this single-center safety-net cohort, long-term survival was limited and receipt of allogeneic transplantation was low despite documented eligibility in more than half of the patients. These findings provide descriptive insight into post-remission therapy patterns in an understudied population and identify areas for further investigation.
Latin American (LA) women are more likely to be diagnosed with aggressive early-stage breast cancer (EBC) compared to Non-Hispanic White (NHW) women, yet population-specific tumor biology remains underexplored. Previously, we reported elevated immune gene expression in BluePrint® (BP) Luminal B tumors in LA patients (pts) with EBC and obesity compared to Black and NHW cohorts. Here, we present updated clinical comparisons between LA, NHW and Black pts with EBC and whole transcriptome analysis (WTA) between BP Luminal B and Basal BC in pts with obesity. Clinical and WT data were analyzed from 15,577 EBC pts self-identified as LA, Black, or NHW enrolled in FLEX (NCT03053193), a prospective observational study with MammaPrint® risk of recurrence and BP molecular subtyping assays, and WT profiles. ImPrint, 53-gene immune signature, results (+/-) were generated for pts with hormone receptor positive (HR+) EBC. Chi-square and t-tests were conducted on clinical groups using arsenal R package. For WT comparisons, 215 obese LA pts with BP Luminal B and 77 with BP Basal EBC were matched to corresponding NHW and Black pts by age, T and N status. Differentially expressed genes (DEGs) were evaluated using limma, and pathway enrichment was performed using gene set enrichment analysis with Hallmark gene sets. Significant results were reported with adjusted p < 0.05. Compared to Black and NHW pts, LA pts were younger and more often premenopausal (Table). Both LA and Black pts had statistically significantly higher rates of obesity compared to NHW pts. Significantly higher rates of MP High Risk 2, BP Basal and ImPrint+ tumors were observed in LA and Black pts vs NHW. WT comparisons among the obese subpopulations revealed that metabolic pathways, including adipogenesis, angiogenesis, epithelial-mesenchymal transition, and oxidative phosphorylation were significantly downregulated in EBC in LA pts vs NHW and Black cohorts. Conversely, immune-related pathways such as allograft rejection and interferon gamma response were enriched among LA pts with Basal cancers compared to NHW and Black groups. These coordinated pathway alterations suggest unique metabolic and immune profiles in LA EBC subtypes with a median absolute fold change of 1.3 among DEGs. The data suggest that signals from metabolic pathway alterations from modest immune-related gene upregulation may contribute to more aggressive tumor behavior in obese LA pts with EBC. Clinical and transcriptomic analyses demonstrated differences in Luminal B and Basal EBC biology among self-identified LA pts compared to NHW and Black cohorts, consistent with prior research. With further research, these findings may offer treatment targets which may enhance outcomes and reflect the importance of including racially and ethnically diverse pts in clinical trials to characterize population-specific differences in EBC outcomes. M. Mazo Canola, A. Santillan, J. Alberty-Oller, E. Dias, V. Kaklamani, A. Elkhanany, K. Hoskins, M. Habibi, R. Hampton, J. L. Barone, N. M. Johnson, N. Gordon, N. Sookhan, T. Bah, P. John, E. Aponte, S. Diab, V. Klimberg, N. Stivers, C. Page, S. Uygun, W. Audeh, J. O'Shaughnessy. Distinct Immune and Metabolic profiles in Latin American breast cancer patients with obesity enrolled in FLEX [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 PS4-09-09.
Hairy cell leukemia (HCL) is a rare indolent B-cell leukemia. It is characterized by distinctive morphologic, immunophenotypic, and molecular features. These features include the expression of typical surface markers such as CD25, CD11c, CD103, and CD123. It also includes the detection of the BRAFV600E mutation. Aberrant expression of CD5 and CD23 is extremely rare. We present a case of classical HCL expressing both markers, along with a brief review of the literature emphasizing the diagnostic complexities associated with such aberrancy.
