RESUMO
INTRODUCTION: High-dose melphalan (HDMel) is the most common conditioning chemotherapy regimen for autologous stem cell transplantation (SCT) in patients affected by multiple myeloma (MM). No consensus exists for the emetogenicity or prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in this regimen. METHODS: Data on the incidence and efficacy/safety of CINV prophylaxis among patients affected by MM undergoing autologous SCT with the HDMel regimen was extracted from electronic databases and analyzed. RESULTS: Eleven studies involving multiple CINV prophylaxis regimens were identified and included. No consensus on HDMel emetogenicity was reached, but most studies summarized the emetogenicity as moderate-high risk. An aprepitant-based three-drug regimen (aprepitant + serotonin receptor antagonist (5HT3RA) + dexamethasone) showed better efficacy than a two-drug regimen (5HT3RA + dexamethasone) for CINV prevention without increasing the frequency in adverse events. CONCLUSIONS: The aprepitant-based three-drug regimen should be the regimen of choice for CINV prophylaxis for MM patients undergoing autologous SCT with HDMel conditioning.
Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Melfalan/efeitos adversos , Náusea/prevenção & controle , Vômito/prevenção & controle , Adulto , Antieméticos/uso terapêutico , Antineoplásicos Alquilantes/administração & dosagem , Aprepitanto/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Humanos , Quimioterapia de Indução , Masculino , Melfalan/administração & dosagem , Mieloma Múltiplo/tratamento farmacológico , Náusea/etiologia , Qualidade de Vida , Antagonistas da Serotonina/administração & dosagem , Antagonistas da Serotonina/uso terapêutico , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/métodos , Transplante Autólogo , Vômito/etiologiaRESUMO
Pressure sores are a major complication in the bed-ridden older patient. In this report, we present the case of platelet rich plasma (PRP) application for the treatment of a pressure sore in an 88-year-old female affected by transfusion-dependent chronic inflammatory disease anemia associated with the congenital and inherited condition of thalassemic trait carrier. A weekly application schedule was planned athome, given the patient's debilitation and her decreased performance status as well as personal and family difficulties to go as outpatients at our treatment center. After 9 PRP applications, a remarkable sore improvement was achieved so that PRP was discontinued; nevertheless, sore rapidly improved until the full resolution and the complete closing after 4 months from the start of PRP treatment. Noteworthy, transfusion support was interrupted and a significant recovery and a sustained stabilization of hemoglobin (Hb) level at 1 year after ulcer healing were observed. The present case suggests that PRP application, performed athome in our case, is a feasible and effective treatment for pressure sores and related complications.
Assuntos
Anemia/terapia , Plasma Rico em Plaquetas , Úlcera por Pressão/terapia , Idoso de 80 Anos ou mais , Anemia/complicações , Anemia/metabolismo , Anemia/patologia , Feminino , Serviços de Assistência Domiciliar , Humanos , Plasma Rico em Plaquetas/metabolismo , Úlcera por Pressão/complicações , Úlcera por Pressão/metabolismo , Úlcera por Pressão/patologia , Talassemia/complicações , Resultado do TratamentoRESUMO
Although major therapeutic advances have led to improved survival for many hematologic malignancies in recent years, survival remains poor for some disease subtypes and a substantial proportion of patients are ultimately destined to die from their disease and/or related complications. Despite this, there is evidence that patients are not always referred to palliative/home care services as often as those with other cancers, although this situation may be improving in some areas. More research is needed, however, to explore reasons for this and identify whether patients may consequently have unmet needs that impact on their quality of life at this time.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Serviços de Assistência Domiciliar , Cuidados Paliativos na Terminalidade da Vida , Hematologia , Humanos , Cuidados Paliativos , Qualidade de Vida , Doente TerminalAssuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Azacitidina/uso terapêutico , Adesão à Medicação , Síndromes Mielodisplásicas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes AmbulatoriaisAssuntos
Benzoatos/administração & dosagem , Resistência a Medicamentos/efeitos dos fármacos , Hidrazinas/administração & dosagem , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Pirazóis/administração & dosagem , Receptores Fc/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Trombopoetina/administração & dosagem , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/sangueRESUMO
The management of patients with chronic myeloid leukemia (CML) during pregnancy has become recently a matter of continuous debate. The introduction of the Tyrosine Kinase Inhibitors (TKIs) in clinical practice has dramatically changed the prognosis of CML patients; in fact, patients diagnosed in chronic phase can reasonably expect many years of excellent disease control and good quality of life, as well as a normal life expectancy, including the necessity to address issues relating to fertility and pregnancy. Physicians are frequently being asked for advice regarding the need for, and/or the appropriateness of, stopping treatment in order to conceive. In this report, we will review the data published in terms of fertility, conception, pregnancy, pregnancy outcome and illness control for TKI treated CML patients, as well as how to manage a planned and/or unplanned pregnancy.
RESUMO
Chronic myelomonocytic leukemia (CMML) is an uncommon neoplastic hematological disorder, typically affecting the elderly, and characterized by a marked clinical heterogeneity and a remarkable propensity for transformation into acute myeloid leukemia. Hypomethylating agents represent the most innovative management approach in this difficult setting. At our institution, between 2010 and 2012, we have treated with azacitidine 10 CMML patients with a median age of 75 (62-86) years. The overall response rate of 70% was achieved without remarkable toxicities; in particular, most therapy-induced side effects were managed on outpatient basis. With a median follow-up of 12,5 (2-27) months, 6 patients are alive, and 4 of them continue to receive the treatment; the median survival from the start of therapy was not reached. In conclusion, also in the light of our encouraging experience, azacitidine can offer new chances of treatment also in the difficult setting of elderly CMML.
Assuntos
Síndromes Mielodisplásicas/diagnóstico , Talassemia/genética , alfa-Globinas/genética , Globinas beta/genética , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Transfusão de Sangue , Medula Óssea/patologia , Diagnóstico Tardio , Diagnóstico Diferencial , Eritropoese , Eritropoetina/uso terapêutico , Feminino , Seguimentos , Hemoglobinas/análise , Heterozigoto , Humanos , Achados Incidentais , Masculino , Síndromes Mielodisplásicas/genética , Fenótipo , Talassemia/diagnóstico , Talassemia/terapiaAssuntos
Anemia Refratária/tratamento farmacológico , Eritropoetina/uso terapêutico , Idoso , Anemia Refratária/genética , Anemia Refratária/patologia , Medula Óssea/patologia , Deleção Cromossômica , Cromossomos Humanos Par 20/ultraestrutura , Células Clonais/patologia , Epoetina alfa , Eritropoetina/administração & dosagem , Hemoglobinas/análise , Humanos , Masculino , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Indução de Remissão , Suspensão de TratamentoAssuntos
Anemia Hemolítica/induzido quimicamente , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos/efeitos adversos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Doença Aguda , Idoso , Alemtuzumab , Anemia Hemolítica/imunologia , Anemia Hemolítica/patologia , Antígenos CD55/genética , Antígenos CD55/imunologia , Antígenos CD59/genética , Antígenos CD59/imunologia , Teste de Coombs , Regulação para Baixo , Feminino , Expressão Gênica , Humanos , Leucemia Linfocítica Crônica de Células B/imunologia , Leucemia Linfocítica Crônica de Células B/patologiaRESUMO
The case of an elderly and frail patient affected by simultaneous large B-cell non-Hodgkin lymphoma and acute myeloid leukaemia is reported. The complete remissions of both diseases by azacitidine and rituximab-bendamustine regimen were achieved.