Randomized Trial of a Supportive Psychotherapy for Parents of Adolescents and Young Adults With Hematologic Malignancies.

BACKGROUND: Cancer regularly disrupts health and developmental trajectories in adolescents and young adults (AYAs). Parents have been shown to have a substantial impact on the health and cancer survivorship activities of AYA patients in the form of symptom management. However, no randomized controlled trial has evaluated a coping support intervention (CSI) program for parents of AYAs with cancer aged 18 to 40 years. PATIENTS AND METHODS: From November 30, 2012, to August 29, 2016, parents of AYAs with hematologic malignancies were randomized in a phase III controlled trial (1:1 ratio, stratified sampling) to either the research-based CSI AYA-Parents group (CSI group; n=82) or the standard care (SC) group (n=70). CSI consisted of 5 sessions to achieve the enhancement of parental adaptive coping as the primary outcome (per the adaptive coping scale of the 28-item Brief COPE, a validated multidimensional self-assessment-questionnaire recommended for clinical cancer research). Measures of adaptive coping, depression, and mental health were collected at pre-CSI (measurement date T1), at the end of the intervention sessions (measurement date T2), and at follow-up (3 months). We calculated mean change scores in outcomes and estimated intervention effect sizes (Cohen's d) for changes from T1 to T2/T3, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. All statistical tests were 2-sided. RESULTS: In the intention-to-treat analysis, the CSI group significantly improved their adaptive coping compared with the SC group (95% CI, 0.30-2.54; P=.013; d=0.405), whereas adaptive coping in the SC group deteriorated. The CSI group also experienced a significant decrease in depressive symptoms and improved mental health with clinical significance (95% CI, -1.98 to -0.30; P=.008; d=0.433, and 95% CI, -0.19 to 3.97; P=.074; d=0.292, respectively). Sensitivity analyses confirmed the robustness of the main intention-to-treat analysis. CONCLUSIONS: CSI improved effectively adaptive coping and depression in parents of AYAs with hematologic malignancies. It may represent a novel family-based approach in AYA oncology care.

Imino-bridged bisphosphaalkenes (2,4-diphospha-3-azapentadienes).

Deprotonation of aminophosphaalkenes (RMe(2)Si)(2)C=PN(H)(R') (R=Me, iPr; R'=tBu, 1-adamantyl (1-Ada), 2,4,6-tBu(3)C(6)H(2) (Mes*)) followed by reactions of the corresponding Li salts Li[(RMe(2)Si)(2)C=P(M)(R')] with one equivalent of the corresponding P-chlorophosphaalkenes (RMe(2)Si)(2)C=PCl provides bisphosphaalkenes (2,4-diphospha-3-azapentadienes) [(RMe(2)Si)(2)C=P](2)NR'. The thermally unstable tert-butyliminobisphosphaalkene [(Me(3)Si)(2)C=P](2)NtBu (4 a) undergoes isomerisation reactions by Me(3)Si-group migration that lead to mixtures of four-membered heterocyles, but in the presence of an excess amount of (Me(3)Si)(2)C=PCl, 4 a furnishes an azatriphosphabicyclohexene C(3)(SiMe(3))(5)P(3)NtBu (5) that gave red single crystals. Compound 5 contains a diphosphirane ring condensed with an azatriphospholene system that exhibits an endocylic P=C double bond and an exocyclic ylidic P((+))-C((-))(SiMe(3))(2) unit. Using the bulkier iPrMe(2)Si substituents at three-coordinated carbon leads to slightly enhanced thermal stability of 2,4-diphospha-3-azapentadienes [(iPrMe(2)Si)(2)C=P](2)NR' (R'=tBu: 4 b; R'=1-Ada: 8). According to a low-temperature crystal-structure determination, 8 adopts a non-planar structure with two distinctly differently oriented P=C sites, but (31)P NMR spectra in solution exhibit singlet signals. (31)P NMR spectra also reveal that bulky Mes* groups (Mes*=2,4,6-tBu(3)C(6)H(2)) at the central imino function lead to mixtures of symmetric and unsymmetric rotamers, thus implying hindered rotation around the P-N bonds in persistent compounds [(RMe(2)Si)(2)C=P](2)NMes* (11 a, 11 b). DFT calculations for the parent molecule [(H(3)Si)(2)C=P](2)NCH(3) suggest that the non-planar distortion of compound 8 will have steric grounds.

Fludarabine and bendamustine in refractory and relapsed indolent lymphoma--a multicenter phase I/II Trial of the east german society of hematology and oncology (OSHO).

The therapy of patients with relapsed or refractory indolent lymphoma relies on the development of new drug combinations. The drugs bendamustine and fludarabine have cytotoxic activity as monotherapy in indolent lymphoma and show synergism in vitro. In this study, we combined both drugs in a multicenter clinical phase I/II trial to evaluate their toxicity and efficacy. Bendamustine was given at 30 or 40 mg/m2/d (dose levels 1 and 2), fludarabine at 30 mg/m2/d, each drug on days 1 to 3. Six cycles were to be given every 4 weeks. A total of 29 patients with relapsed or refractory indolent lymphoma were included in the study. During phase I, 9 patients were treated at dose level 1 and 7 patients at dose level 2. Thirteen patients were added to the study during phase II. Fourteen patients had follicular lymphoma, 11 patients mantle cell lymphoma, 2 patients lymphoplasmocytic and 2 patients nodal marginal zone lymphoma. Median age was 62 years (range 39-74). All patients were in stages III or IV of their disease and had received prior chemotherapy with or without additional radio- or immunotherapy. The dose limiting toxicity was hematotoxicity in all cases and occurred in 3 of 7 evaluable patients at dose level I and in 3 of 7 patients at dose level 2. One patient at dose level 2 died of sepsis in neutropenia with persistent thrombocytopenia. The study was continued at dose level 1 (phase II). Analysis of 19 evaluable patients treated at dose level 1 reveiled hematotoxicity CTC grade III in 47% and grade IV in 26%. Neutropenic fever occurred in 4 patients (21%). On an intent-to-treat basis, 45% or 32% of all patients at dose level 1 reached CR or PR, respectively. Nine of 9 patients with mantle cell lymphoma responded to therapy. The overall response rate was 77%. Eight of 15 responders relapsed after a median follow-up time of 14 months (range 2-43). The major complication of fludarabine in combination with bendamustine is hematotoxicity. Dose level 1 with 30 mg/m2/d of both drugs on days 1 to 3 was defined as the recommended dose. Despite unfavorable prognostic features (histologic subtype, stage of disease, pretreatment) response rates were good with this regimen.