Prognostic analysis of adjuvant chemotherapy in patients with nasopharyngeal carcinoma.

BACKGROUND: Concurrent chemoradiation has become the standard of treatment in locally advanced nasopharyngeal carcinoma. However, the exact magnitude of the benefits of adjuvant chemotherapy is still unclear. MATERIALS & METHODS: This is a retrospective assessment of 181 patients with newly diagnosed, locally advanced nasopharygeal carcinoma who received concurrent chemoradiation followed by adjuvant chemotherapy with cisplatin plus fluorouracil in one institution between 2004 and 2010. RESULTS: The median follow-up period was 40 months (range: 2.1-96.6 months). The estimated 5-year survival rate of patients with and without adjuvant chemotherapy were 83.6 and 66.7%, respectively (p = 0.027). Patients receiving two to three cycles of adjuvant chemotherapy had improved outcomes compared with those without adjuvant chemotherapy or who had received one cycle. Multivariate analysis showed that both advanced stage and suboptimal treatment of adjuvant chemotherapy were adverse risk factors in terms of overall survival and disease-specific survival. CONCLUSION: Adjuvant chemotherapy with two to three cycles of cisplatin plus fluorouracil improved the survival of nasopharyngeal carcinoma patients.

Guadecitabine vs treatment choice in newly diagnosed acute myeloid leukemia: a global phase 3 randomized study.

This phase 3 study evaluated the efficacy and safety of the new hypomethylating agent guadecitabine (n = 408) vs a preselected treatment choice (TC; n = 407) of azacitidine, decitabine, or low-dose cytarabine in patients with acute myeloid leukemia unfit to receive intensive induction chemotherapy. Half of the patients (50%) had poor Eastern Cooperative Oncology Group Performance Status (2-3). The coprimary end points were complete remission (19% and 17% of patients for guadecitabine and TC, respectively [stratified P = .48]) and overall survival (median survival 7.1 and 8.5 months for guadecitabine and TC, respectively [hazard ratio, 0.97; 95% confidence interval, 0.83-1.14; stratified log-rank P = .73]). One- and 2-year survival estimates were 37% and 18% for guadecitabine and 36% and 14% for TC, respectively. A large proportion of patients (42%) received <4 cycles of treatment in both the arms. In a post hoc analysis of patients who received ≥4 treatment cycles, guadecitabine was associated with longer median survival vs TC (15.6 vs 13.0 months [hazard ratio, 0.78; 95% confidence interval, 0.64-0.96; log-rank P = .02]). There was no significant difference in the proportion of patients with grade ≥3 adverse events (AEs) between guadecitabine (92%) and TC (88%); however, grade ≥3 AEs of febrile neutropenia, neutropenia, and pneumonia were higher with guadecitabine. In conclusion, no significant difference was observed in the efficacy of guadecitabine and TC in the overall population. This trial was registered at www.clinicaltrials.gov as #NCT02348489.

A well-designed online transfusion reaction reporting system improves the estimation of transfusion reaction incidence and quality of care in transfusion practice.

Recognizing and reporting a transfusion reaction is important in transfusion practice. However, the actual incidence of transfusion reactions is frequently underestimated. We designed an online transfusion reaction reporting system for nurses who take care of transfusion recipients. The common management before and after transfusion and the 18 most common transfusion reactions were itemized as tick boxes. We found the overall documented incidence of transfusion reaction increased dramatically, from 0.21% to 0.61% per unit of blood, after we started using an online reporting system. Overall, 94% (30/32) of nurses took only 1 week to become familiar with the new system, and 88% (28/32) considered the new system helpful in improving the quality of clinical transfusion care. By using an intranet connection, blood bank physicians can also identify patients who are having a reaction and provide appropriate recommendations immediately. A well-designed online reporting system may improve the ability to estimate the incidence of transfusion reactions and the quality of transfusion care.