ABSTRACT
BACKGROUND AND AIMS: Anagrelide is a drug effective in reducing platelet counts in essential thrombocythemia (ET) and Ph1-negative myeloproliferative neoplasms. The aim of this study was to evaluate the real-life use of anagrelide in patients with ET followed over 25 years at the Haematological Institutes belonging to "Ph1-negative Myeloproliferative Neoplasms Latium Group." PATIENTS AND METHODS: Eligibility criteria were diagnosis of ET and treatment with anagrelide. Data were collected through an ad hoc case report form. RESULTS: One hundred and fifty patients received anagrelide for a median time of 7.4 years (0.1-23.2). Anagrelide was administered as first-line therapy in 34.7% of patients, as second-line in 52% and as third-line in 13.3%: 85.4% responded to therapy. Sixty-eight/136 evaluable patients reported side effects: palpitations, peripheral vasodilation, anaemia, diarrhoea and gastric distress. Fourteen thrombotic (arterial 10, venous 4) and 51 bleeding events (minor 48, major 3) occurred. Sixteen/150 (10.6%) patients developed secondary myelofibrosis and 3/150 (2%) an acute myeloid leukaemia. CONCLUSIONS: In our experience, anagrelide is an effective drug in reducing platelet levels in a high percentage of patients with ET. It is especially addressed to younger people. A careful assessment of the thrombotic risk and monitoring of cardiac function, at diagnosis and during follow-up, is mandatory.
Subject(s)
Quinazolines/therapeutic use , Thrombocythemia, Essential/drug therapy , Thrombocythemia, Essential/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , Anemia/diagnosis , Anemia/etiology , Disease Management , Disease Susceptibility , Drug Substitution , Female , Follow-Up Studies , Health Care Surveys , Humans , Italy/epidemiology , Male , Middle Aged , Pregnancy , Pregnancy Complications, Hematologic , Prognosis , Quinazolines/administration & dosage , Quinazolines/adverse effects , Retreatment , Retrospective Studies , Thrombocythemia, Essential/diagnosis , Thrombocythemia, Essential/etiology , Thrombosis , Treatment Outcome , Young AdultSubject(s)
Antineoplastic Agents/therapeutic use , Bridged Bicyclo Compounds, Heterocyclic/therapeutic use , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Leukemia, Myeloid, Acute/drug therapy , Neoplasms, Multiple Primary/drug therapy , Sulfonamides/therapeutic use , Aged , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukemia, Myeloid, Acute/diagnosis , Myelodysplastic Syndromes/diagnosis , Neoplasms, Multiple Primary/diagnosis , Remission InductionSubject(s)
Decitabine/therapeutic use , Leukemia, Myeloid, Acute/drug therapy , Myeloproliferative Disorders/pathology , Aged , Female , Humans , Hydroxyurea/therapeutic use , Janus Kinase 2/genetics , Leukemia, Myeloid, Acute/etiology , Leukemia, Myeloid, Acute/genetics , Male , Myeloproliferative Disorders/complications , Myeloproliferative Disorders/drug therapy , Pipobroman/therapeutic use , Treatment OutcomeSubject(s)
Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Anemia, Hemolytic, Autoimmune/economics , Child , Child, Preschool , Delivery of Health Care/economics , Female , Health Resources/economics , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Prognosis , Retrospective Studies , Risk Factors , Young AdultSubject(s)
Oxazines/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Pyridines/therapeutic use , Syk Kinase/antagonists & inhibitors , Aminopyridines , Clinical Trials, Phase III as Topic , Humans , Morpholines , Prodrugs/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/pathology , Purpura, Thrombocytopenic, Idiopathic/physiopathology , Pyrimidines , Recurrence , Syk Kinase/immunologySubject(s)
Antimetabolites, Antineoplastic/therapeutic use , Azacitidine/therapeutic use , Leukemia, Myelomonocytic, Chronic/drug therapy , Aged , Disease Management , Female , Follow-Up Studies , Frail Elderly , Humans , Male , Middle Aged , Retrospective Studies , Survival Analysis , Treatment OutcomeSubject(s)
Antimetabolites, Antineoplastic/therapeutic use , Decitabine/therapeutic use , Leukemia, Myeloid, Acute/drug therapy , Neoplasms, Multiple Primary/drug therapy , Thrombocythemia, Essential/pathology , Adult , Female , Humans , Janus Kinase 2/genetics , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/pathology , Neoplasms, Multiple Primary/genetics , Neoplasms, Multiple Primary/pathology , Thrombocythemia, Essential/genetics , Treatment OutcomeSubject(s)
Antimetabolites, Antineoplastic/therapeutic use , Decitabine/therapeutic use , Leukemia, Myeloid, Acute/drug therapy , Salvage Therapy/methods , Aged , Chemotherapy, Adjuvant , Humans , Induction Chemotherapy , Maintenance Chemotherapy , Male , Neoadjuvant Therapy , Remission Induction , Treatment FailureABSTRACT
The main objective of this study was to compare health-related quality of life (HRQOL) of primary immune thrombocytopenia (pITP) patients with that of general population, overall, and by patient group (i.e., newly diagnosed, persistent, and chronic patients). Fatigue was also investigated as a secondary objective. Overall, 424 adult patients were enrolled in a multicenter observational study and the control group consisted of a representative sample from the general population. Propensity score matching plus further multivariate linear regression adjustment was used to compare HRQOL outcomes between pITP patients and general population. Mean age of patients was 54 years. Of those with HRQOL assessment, 99 patients (23.6%) were newly diagnosed, 53 (12.6%) were persistent, and 268 (63.8%) were chronic pITP patients. Comparison by patient group versus their respective peers in the general population revealed greater impairments in persistent pITP patients. Persistent pITP patients reported clinically meaningful impairments in physical functioning (-15; 95% CI -24.1 to -5.8; P = 0.002), social functioning (-15.3; 95% CI -25.5 to -5.1; P = 0.004), role physical (-28.4; 95% CI -43.1 to -13.7; P < 0.001), role emotional (-23.9; 95% CI -40.1 to -7.7; P = 0.004), and mental health scales (-11.3; 95% CI -21.2 to -1.4; P = 0.026) of the SF-36 questionnaire. Higher fatigue severity was associated with lower physical and mental HRQOL outcomes. Our findings suggest that the burden of the disease and treatment might depend on the disease phase and that persistent pITP patients are the most vulnerable subgroup. Am. J. Hematol. 91:995-1001, 2016. © 2016 Wiley Periodicals, Inc.
Subject(s)
Fatigue/etiology , Purpura, Thrombocytopenic, Idiopathic/psychology , Quality of Life , Adult , Aged , Female , Humans , Male , Mental Health , Middle Aged , Physical Fitness , Purpura, Thrombocytopenic, Idiopathic/complications , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
BACKGROUND: More than 50% of oncohematological patients suffer from pain syndrome, mostly originating from the bone, which often include nociceptive and neuropathic complaints. Tapentadol, a recently available treatment option for cancer pain, exerts a dual analgesic mechanisms (opioid and noradrenergic), allowing for a high clinical efficacy as well as for a reduction in adverse events compared to traditional opioids. AIM: To explore the safety and efficacy of tapentadol as a suitable agent for the pain management in the setting of oncohematology. METHODS: Our observational study included 36 patients with basal pain intensity (NRS) ranging from 5 to 10. Tapentadol prolonged release (PR) was given at the initial dose of 50 mg BID and careful titrated according to the achieved pain control. RESULTS: Tapentadol PR was given at the dosages ranging from 200 and 260 mg/day after a careful titration, allowed for a clinically (-7 points NRS) remarkable reduction of pain intensity without any significant side effects. CONCLUSION: In oncohematological patients on pain, tapentadol PR was effective and well tolerated, so representing a suitable treatment option in this difficult setting.
Subject(s)
Analgesics, Opioid/therapeutic use , Hematologic Neoplasms/complications , Pain/complications , Pain/drug therapy , Phenols/therapeutic use , Aged , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Female , Humans , Male , Middle Aged , Pain Management/methods , Phenols/administration & dosage , Retrospective Studies , TapentadolSubject(s)
Benzoates/therapeutic use , Glycogen Storage Disease Type I/complications , Hydrazines/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Pyrazoles/therapeutic use , Blood Platelets/drug effects , Elective Surgical Procedures , Female , Glycogen Storage Disease Type I/genetics , Hemolysis , Heterozygote , Humans , Middle Aged , Platelet Count , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/surgery , SplenectomySubject(s)
Antimetabolites, Antineoplastic/therapeutic use , Azacitidine/therapeutic use , Leukemia, Myelomonocytic, Chronic/complications , Leukemia, Myelomonocytic, Chronic/drug therapy , Paraproteinemias/complications , Paraproteinemias/drug therapy , Aged , Aged, 80 and over , Female , Humans , Leukemia, Myelomonocytic, Chronic/diagnosis , Male , Paraproteinemias/diagnosis , Treatment OutcomeSubject(s)
Antimetabolites, Antineoplastic/therapeutic use , Azacitidine/therapeutic use , Leukemia, Myeloid, Acute/etiology , Leukemia, Myelomonocytic, Chronic/drug therapy , Leukemia, Myelomonocytic, Chronic/pathology , Myelodysplastic Syndromes/drug therapy , Myelodysplastic Syndromes/pathology , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Disease Progression , Female , Hematopoietic Stem Cell Transplantation , Humans , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Male , Middle Aged , Transplantation, Homologous , Treatment FailureABSTRACT
Although major therapeutic advances have led to improved survival for many hematologic malignancies in recent years, survival remains poor for some disease subtypes and a substantial proportion of patients are ultimately destined to die from their disease and/or related complications. Despite this, there is evidence that patients are not always referred to palliative/home care services as often as those with other cancers, although this situation may be improving in some areas. More research is needed, however, to explore reasons for this and identify whether patients may consequently have unmet needs that impact on their quality of life at this time.