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1.
Br J Haematol ; 187(4): 470-477, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31298750

RESUMO

Bortezomib in combination with cyclophosphamide and dexamethasone (CyBorD, is a well-established frontline chemotherapy regimen for patients with multiple myeloma, but prospective data on elderly non-transplant eligible patients is limited. A total of 155 patients aged 70 years or older with newly diagnosed multiple myeloma who received at least one cycle of CyBorD chemotherapy in three centres across New Zealand were evaluated. Partial response or better was achieved in 79·4%, of whom 52·9% achieved at least a very good partial response. After a median follow-up of 31·9 months, the median event-free survival (EFS) was 17·0 months (age 70-80 years, 17·7 months; age above 80 years, 8·6 months; P = 0·002). The median overall survival was 45·1 months (age 70-80, 49·8 months; above 80, 33·3 months; P = 0·003). Amongst those who had seven or more cycles of treatment, those who had a pre-planned switch to bortezomib-thalidomide-dexamethasone (VTD) consolidation had a superior median EFS of 25·4 months, compared with 20·3 months in the CyBorD only group (P = 0·028). This is the largest real-world dataset on the efficacy of CyBorD in the elderly population, and pre-planned switch to VTD was associated with better outcomes.


Assuntos
Bortezomib/administração & dosagem , Quimioterapia de Consolidação/métodos , Mieloma Múltiplo/tratamento farmacológico , Talidomida/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Humanos , Masculino , Mieloma Múltiplo/mortalidade , Nova Zelândia , Estudos Retrospectivos , Análise de Sobrevida
2.
Br J Haematol ; 164(5): 694-700, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24313286

RESUMO

There is no consensus regarding optimal follow-up mode for Hodgkin lymphoma (HL) patients that achieve complete remission following chemotherapy or combined chemo- and radiation therapy. Several studies demonstrated high sensitivity of positron emission tomography/computerized tomography (PET/CT) in detecting disease progression; however, these techniques are currently not recommended for routine follow-up. This retrospective study conducted in two Israeli (N = 291) and one New Zealand academic centres (N = 77), compared a group of HL patients, followed-up with routine imaging every 6 months during the first 2 years after achieving remission, once in the third year, with additional dedicated studies performed due to symptoms or physical findings (Group I) to a group of patients without residual masses who underwent clinically-based surveillance with dedicated imaging upon relapse suspicion (Group II). Five-year overall survival (OS) was 94% and median time to relapse was 8·6 months for both modes. Relapse rates in Groups I and II were 13% and 9%, respectively. During the first 3 years of follow-up, 47·5 and 4·7 studies were performed per detected relapse in Groups I and II, respectively. The current study demonstrated no benefit in either progression-free survival (PFS) or OS in HL patients followed by routine imaging versus clinical follow-up. The cost was 10 times higher for routine imaging.


Assuntos
Doença de Hodgkin/diagnóstico , Assistência de Longa Duração/métodos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Feminino , Seguimentos , Custos de Cuidados de Saúde/estatística & dados numéricos , Doença de Hodgkin/economia , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Israel/epidemiologia , Estimativa de Kaplan-Meier , Assistência de Longa Duração/economia , Masculino , Imagem Multimodal/economia , Imagem Multimodal/estatística & dados numéricos , Estadiamento de Neoplasias , Neoplasia Residual , Nova Zelândia/epidemiologia , Vigilância da População/métodos , Tomografia por Emissão de Pósitrons/economia , Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Recidiva , Indução de Remissão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos
3.
J Geriatr Oncol ; 12(4): 515-520, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33046409

RESUMO

INTRODUCTION: Frailty is a known risk factor for older patients with myeloma. Here we present realworld data using a computer-generated frailty assessment score (FRAIL score), based on 5 clinically derived parameters, in predicting patient outcomes. METHODS: Older patients with newly diagnosed multiple myeloma who received frontline treatment with cyclophosphamide-bortezomib-dexamethasone had their FRAIL score retrospectively assessed. Treatment outcomes were assessed using standard IMWG criteria, and event free survival and overall survival determined. RESULTS: 155 patients were analysed. Compared to those who were assessed as non-frail (FRAIL score 0-1) likely-frail patients (score ≥ 2) were less likely to complete the full course of treatment (24.3% vs 53.4%, p = 0.002), and more likely to terminate treatment due to toxicities (35.1% vs 22.0%, p = 0.109), as well as having a greater number of patients stop treatment early for reasons other than toxicity or progression (27.0% vs 10.2%, p = 0.010). After a median follow up of 42.5 months, likely-frail patients were found to have a trend for shorter event-free survival (median EFS, 8.7 vs 17.9 months, p = 0.064) and statistically inferior overall survival (median OS, 30.2 vs 49.8 months, p < 0.001). After adjusting for age, stage, and Charlson comorbidity index, FRAIL score was prognostic for OS (HR = 3.47, 95% CI 1.88-6.4), but not EFS (HR = 1.28, 95%CI 0.79-2.06). CONCLUSION: The FRAIL score is independently predictive of overall survival in older patients with myeloma receiving bortezomib-based induction chemotherapy and can help identify those patients more likely to experience treatment toxicity.


Assuntos
Fragilidade , Mieloma Múltiplo , Idoso , Eletrônica , Idoso Fragilizado , Humanos , Mieloma Múltiplo/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
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