Treatment of Hodgkin lymphoma with adriamycin, bleomycin, vinblastine and dacarbazine without routine granulocyte-colony stimulating factor support does not increase the risk of febrile neutropenia: a prospective cohort study.

Although patients with Hodgkin lymphoma treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy frequently develop neutropenia, febrile neutropenia is uncommon. Three retrospective trials reported that ABVD could be safely administered without dose delays or granulocyte-colony stimulating factor (G-CSF) support. We retrospectively reviewed the charts of 89 patients treated with ABVD and found that the incidence of febrile neutropenia was 0.5% (five of 927 treatments). This prompted a change to our institutional policy so that patients receiving ABVD no longer receive routine G-CSF for uncomplicated neutropenia. We then prospectively assessed the safety of this policy change. Thirty-three patients received a total of 327 ABVD treatments, 185 (57%) of which were administered with a neutrophil count <1.5 × 10(9)/L. Febrile neutropenia occurred in 2/33 patients (6%), complicating 0.6% of chemotherapy treatments (2/327). Eliminating routine G-CSF saved $10 241 per patient. Omission of G-CSF for uncomplicated neutropenic patients receiving ABVD for Hodgkin lymphoma is cost-saving and safe.

Attitudes toward vaccination for pandemic H1N1 and seasonal influenza in patients with hematologic malignancies.

BACKGROUND: Patients with hematologic malignancies are at increased risk of influenza and its complications. Despite current health recommendations and evidence favoring influenza vaccination, vaccination rates remain low in cancer patients. OBJECTIVE: The purpose of this study was to determine which factors influenced vaccination rates. METHODS: During the 2009-2010 pandemic H1N1 and seasonal influenza season, we surveyed patients with hematologic malignancies in a Canadian cancer center. Of the patients participating in our study (n = 129), 66% and 57% received the H1N1 pandemic influenza and seasonal influenza vaccines, respectively. RESULTS: A number of reasons for vaccination refusal were reported, most relating to general skepticism about the safety and efficacy of vaccination. Physician advice was also a factor influencing vaccination rates in patients. The vaccination rate for seasonal influenza was 39% in patients < 65 years old, significantly lower than the rate of 73% reported for patients aged > or = 65 years (P < 0.0001). CONCLUSION: Future education programs should target younger patient populations and health-care workers, focusing on vaccine safety and efficacy in the high-risk cancer population.

The pandemic H1N1 influenza vaccine results in low rates of seroconversion for patients with hematological malignancies.

Patients with hematological malignancies are at increased risk of influenza and its complications, but evidence for the efficacy of influenza vaccination in this population is limited. We sought to determine whether patients being treated for hematological malignancies were able to mount protective antibodies to the H1N1 influenza vaccine. Pre- and post-vaccination plasma samples were collected from patients with hematological malignancies during the 2009-2010 influenza season. Seroconversion was defined as a four-fold increase in antibody titer, as measured by the hemagglutinin inhibition test. Sixty-two patients received the H1N1 vaccine and 41 patients were unvaccinated controls. The rate of seroconversion among vaccinated patients was 21%, which was significantly higher than that in unvaccinated patients (0%), but significantly lower than that previously reported for healthy adults. Physicians should be aware that influenza vaccination may not generate an immune response in patients with hematological malignancies. Larger studies are required to confirm these results.

A 10 mg warfarin initiation nomogram is safe and effective in outpatients starting oral anticoagulant therapy for venous thromboembolism.

The optimal means of initiating warfarin therapy for acute venous thromboembolism in the outpatient setting remains controversial. We have previously demonstrated the efficacy of a 10 mg initiation nomogram in a randomized controlled trial; however, some clinicians remain reluctant to use this nomogram due to a fear of potential increased bleeding. To review the safety and efficacy of a 10 mg warfarin nomogram we conducted a retrospective cohort study of patients prospectively treated for venous thromboembolism according to a 10 mg nomogram in an outpatient thrombosis clinic. All patients received standard treatment with low molecular weight heparin for 5 to 7 days and warfarin for at least 3 months. Four-hundred and fourteen patients were included in the analysis, of whom 295 (71%) fully adhered to the nomogram. In the whole cohort, 8 patients (1.9%) experienced recurrent thrombosis, 4 (0.97%) suffered a major bleeding event, and 3 (0.72%) suffered a minor bleeding event. There were no deaths related to thrombosis or bleeding. Four patients (0.97%) died from unrelated causes. Twenty-two (5.3%) patients experienced an INR > or =5.0 in the first 8 days of therapy, and none of these patients experienced a bleeding event. Eighty-four percent of patients achieved a therapeutic INR by day 5. In outpatients, a 10 mg nomogram results in timely achievement of a therapeutic INR with an acceptable incidence of bleeding and recurrent thromboembolism.