Phase 2 study of two sequential three-drug combinations containing bortezomib, cyclophosphamide and dexamethasone, followed by bortezomib, thalidomide and dexamethasone as frontline therapy for multiple myeloma.

Novel sequential combination therapy for induction may improve the quality of response and therefore prolong survival in newly diagnosed multiple myeloma (MM) patients. We report results from a phase 2 study of two sequential three-drug combinations. Forty-four previously untreated, symptomatic MM patients received: bortezomib 1.3 mg/m(2) (days 1, 4, 8, 11), cyclophosphamide 300 mg/m(2) (days 1, 8), plus dexamethasone 40 mg (day of and day after bortezomib) for three 21-day cycles, followed by bortezomib 1.0 mg/m(2), dexamethasone 40 mg and thalidomide 100 mg daily for three cycles. Overall response rate for 42 evaluable patients was 95%, including 19% stringent complete response (sCR), 26% CR, and 57%>/= very good partial response. Twenty-two patients have undergone stem-cell transplantation. After a median follow-up of 20.9 months, five patients have died; none was induction therapy-related. Median event-free survival (EFS) and overall survival (OS) have not been reached; estimated 1-year EFS and OS rates were 81% and 91% respectively. Both three-drug combinations were well tolerated; 82% of patients completed all six cycles. Toxicities were predictable and manageable; the most-commonly reported grade 3/4 toxicity was neuropathy (11%). This novel sequential three-drug combination therapy is effective and well-tolerated in previously untreated MM patients.

Playground usability: what do playground users say?

Play, specifically outdoor play, is crucial for a child's development. However, not all playgrounds are designed to provide usable space for children with disabilities. The aim of the study was to gain an understanding of the experiences of playground use for children with disabilities and their caregivers. Using a qualitative descriptive design, interviews were conducted with children with disabilities and their caregivers. Interview transcripts were reviewed and coded. The analysis process resulted in three overarching themes. Playground Experiences addressed the sensory experiences that children seek at playgrounds, the importance of creating environments that promote imaginative play and the need to provide an appropriate level of challenge. In the second theme, Playground Usability, participants described barriers that prevent access and features that promote use. The third theme, Inclusivity, focused on equal access and the importance of providing options in design. The Person-Environment-Occupation model was used to frame the findings and to identify practice and research recommendations. Outdoor play is a key occupation of children, and occupational therapists have a role in promoting usable environments for all children.