Role of delayed salvage bevacizumab at symptomatic progression of chemorefractory glioblastoma.

BACKGROUND: Assess benefit of salvage bevacizumab (BEV) at time of symptomatic progression in patients with refractory glioblastoma (GBM). METHODS: Patients managed with adjuvant long course chemo-radiation therapy for GBM were entered into a prospective database. At chemorefractory symptomatic progression, patients were offered BEV or best supportive care. Re-irradiation (ReRT) was used with BEV in selected patients. BEV continued indefinitely until deterioration limited hospital based infusion. The primary endpoint was median survival calculated from date of decision for BEV to proceed (BEVstart), or decision to decline BEV (BEVreject). RESULTS: Fifty-five patients were managed of which 48 patients have relapsed disease. The median survival post relapse was 6 months (95%CI: 4.6-7.4). At relapse, 28 patients received BEV with only 14% delivered at first relapse. The median number of BEV cycles was 8 (range 1-25). ReRT was subsequently used in 16 (33%) relapsed patients. BEV treated patients were associated with improved median survival post relapse with 9 months vs 3 months (p < 0.01). The median survival from BEV related decision-making at symptomatic refractory progression to death was 4 months (95%CI: 2.0-6.0). BEVstart was associated with improved survival from this date with median survival of 6 months vs 1 month with BEVreject (p < 0.01). Median survival with ReRT from this date was 8 months vs 3 months without ReRT (p = 0.01). In the BEV patients at eventual progression, death occurred at a median of 30 days post BEV cessation. CONCLUSION: In this clinic managing selected patients with chemorefractory progressive glioblastoma, delayed salvage bevacizumab, often in combination with re-irradiation, may provide an increase in survival duration compared with best supportive care.

Intensive care unit outcomes in patients with hematological malignancy.

Hematological malignancies are usually life-limiting conditions. Limitations of care need to be decided early, based on acceptability to the patient, family, physician, and community. Inappropriate intensive care unit (ICU) admission is likely to result in significant physical, psychological, and economic burden. There is little published on the impact of non-acute preadmission disease factors on ICU outcomes in hematological malignancies. Aim: To identify baseline performance and disease-associated factors before admission to ICU in patients with hematological malignancy that contribute to subsequent ICU mortality. Methods: A retrospective analysis of electronic medical records, laboratory results, and Intensive Care data for all patients (n = 184) with hematological malignancy admitted to the Calvary Mater Hospital ICU between January 1, 2013 and June 30, 2017 was undertaken. Baseline age, gender, condition, Eastern Cooperative Oncology, and Charlson Comorbidity scores were compared to ICU outcome and overall survival. Disease-specific prognostic risk scores were compared to ICU outcome. Results: Overall, 73.9% survived the ICU admission, with 31.6% surviving at 12 months. Superior ejection fractions (>55%) and prognosis >12 months (based on disease-specific risk scores) were significantly associated with overall survival (P = 0.024 and P = 0.001). Induction and posttransplantation therapy were predictive of poor ICU survival outcome (P < 0.0001 and P = 0.041). APACHE scores were significant predictors of ICU mortality (P = 0.002 for APACHE II and P < 0.0001 for APACHE III). Conclusion: Survival outcomes for patients with hematological malignancy admitted to the ICU correlate with functional and comorbidity status. Disease-specific prognostic scores can assist in recognizing patients likely to benefit from ICU admission.