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1.
Proc Natl Acad Sci U S A ; 107(16): 7473-8, 2010 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-20368434

RESUMEN

A phase II clinical trial with single-agent decitabine was conducted in older patients (>or=60 years) with previously untreated acute myeloid leukemia (AML) who were not candidates for or who refused intensive chemotherapy. Subjects received low-dose decitabine at 20 mg/m(2) i.v. over 1 h on days 1 to 10. Fifty-three subjects enrolled with a median age of 74 years (range, 60-85). Nineteen (36%) had antecedent hematologic disorder or therapy-related AML; 16 had complex karyotypes (>or=3 abnormalities). The complete remission rate was 47% (n = 25), achieved after a median of three cycles of therapy. Nine additional subjects had no morphologic evidence of disease with incomplete count recovery, for an overall response rate of 64% (n = 34). Complete remission was achieved in 52% of subjects presenting with normal karyotype and in 50% of those with complex karyotypes. Median overall and disease-free survival durations were 55 and 46 weeks, respectively. Death within 30 days of initiation of treatment occurred in one subject (2%), death within 8 weeks in 15% of subjects. Given the DNA hypomethylating effect of decitabine, we examined the relationship of clinical response and pretreatment level of miR-29b, previously shown to target DNA methyltransferases. Higher levels of miR-29b were associated with clinical response (P = 0.02). In conclusion, this schedule of decitabine was highly active and well tolerated in this poor-risk cohort of older AML patients. Levels of miR-29b should be validated as a predictive factor for stratification of older AML patients to decitabine treatment.


Asunto(s)
Azacitidina/análogos & derivados , Leucemia Mieloide Aguda/metabolismo , MicroARNs/biosíntesis , Anciano , Anciano de 80 o más Años , Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Estudios de Cohortes , Metilación de ADN , Decitabina , Supervivencia sin Enfermedad , Femenino , Humanos , Cariotipificación , Masculino , Persona de Mediana Edad , Inducción de Remisión , Resultado del Tratamiento
2.
Clin J Oncol Nurs ; 11(4): 534-9, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17723966

RESUMEN

Standing orders serve an important role in various healthcare settings by empowering nurses to implement certain procedures and activities on behalf of physicians, enabling more immediate interventions, and ultimately improving patient care. Standing orders are based on established clinical practice guidelines and are well suited for supportive interventions. Several evidence-based clinical practice guidelines are available for the treatment of anemia in patients with cancer. The guidelines can serve as a basis for the development of standing orders for the management of treatment-related anemia in patients with cancer, which will enable the delivery of consistently high-quality care to patients. A major advantage to the implementation of standing orders is that patients with suboptimal hemoglobin levels can be treated by oncology nurses in a timely manner and receive high-quality care that is consistent with available clinical evidence.


Asunto(s)
Anemia/terapia , Neoplasias/complicaciones , Rol de la Enfermera , Enfermería Oncológica/organización & administración , Guías de Práctica Clínica como Asunto , Autonomía Profesional , Algoritmos , Anemia/diagnóstico , Anemia/etiología , Protocolos Clínicos , Árboles de Decisión , Monitoreo de Drogas , Epoetina alfa , Eritropoyetina/uso terapéutico , Medicina Basada en la Evidencia , Ferritinas/sangre , Hematínicos/uso terapéutico , Hemoglobinas , Humanos , Hierro/sangre , Proteínas de Unión a Hierro/sangre , Tamizaje Masivo , Neoplasias/tratamiento farmacológico , Evaluación en Enfermería , Grupo de Atención al Paciente/organización & administración , Garantía de la Calidad de Atención de Salud , Proteínas Recombinantes , Administración de la Seguridad , Transferrina/metabolismo
3.
J Clin Oncol ; 28(33): 4919-25, 2010 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-20956622

RESUMEN

PURPOSE: Lenalidomide is effective in myeloma and low-risk myelodysplastic syndromes with deletion 5q. We report results of a phase I dose-escalation trial of lenalidomide in relapsed or refractory acute leukemia. PATIENTS AND METHODS: Thirty-one adults with acute myeloid leukemia (AML) and four adults with acute lymphoblastic leukemia (ALL) were enrolled. Lenalidomide was given orally at escalating doses of 25 to 75 mg daily on days 1 through 21 of 28-day cycles to determine the dose-limiting toxicity (DLT) and maximum-tolerated dose (MTD), as well as to provide pharmacokinetic and preliminary efficacy data. RESULTS: Patients had a median age of 63 years (range, 22 to 79 years) and a median of two prior therapies (range, one to four therapies). The DLT was fatigue; 50 mg/d was the MTD. Infectious complications were frequent. Plasma lenalidomide concentration increased proportionally with dose. In AML, five (16%) of 31 patients achieved complete remission (CR); three of three patients with cytogenetic abnormalities achieved cytogenetic CR (none with deletion 5q). Response duration ranged from 5.6 to 14 months. All responses occurred in AML with low presenting WBC count. No patient with ALL responded. Two of four patients who received lenalidomide as initial therapy for AML relapse after allogeneic transplantation achieved durable CR after development of cutaneous graft-versus-host disease, without donor leukocyte infusion. CONCLUSION: Lenalidomide was safely escalated to 50 mg daily for 21 days, every 4 weeks, and was active with relatively low toxicity in patients with relapsed/refractory AML. Remissions achieved after transplantation suggest a possible immunomodulatory effect of lenalidomide, and results provide enthusiasm for further studies in AML, either alone or in combination with conventional agents or other immunotherapies.


Asunto(s)
Antineoplásicos/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Talidomida/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Humanos , Lenalidomida , Persona de Mediana Edad , Recurrencia , Lectina 3 Similar a Ig de Unión al Ácido Siálico , Talidomida/efectos adversos , Talidomida/uso terapéutico
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