RÉSUMÉ
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.
Sujet(s)
Quinazolines/usage thérapeutique , Thrombocytémie essentielle/traitement médicamenteux , Thrombocytémie essentielle/épidémiologie , Adulte , Facteurs âges , Sujet âgé , Sujet âgé de 80 ans ou plus , Anémie/diagnostic , Anémie/étiologie , Prise en charge de la maladie , Prédisposition aux maladies , Substitution de médicament , Femelle , Études de suivi , Enquêtes sur les soins de santé , Humains , Italie/épidémiologie , Mâle , Adulte d'âge moyen , Grossesse , Complications hématologiques de la grossesse , Pronostic , Quinazolines/administration et posologie , Quinazolines/effets indésirables , Reprise du traitement , Études rétrospectives , Thrombocytémie essentielle/diagnostic , Thrombocytémie essentielle/étiologie , Thrombose , Résultat thérapeutique , Jeune adulteSujet(s)
Atteinte rénale aigüe , Myélome multiple , Atteinte rénale aigüe/diagnostic , Atteinte rénale aigüe/étiologie , Atteinte rénale aigüe/thérapie , Humains , Chaines légères des immunoglobulines , Rein , Myélome multiple/complications , Myélome multiple/diagnostic , Myélome multiple/traitement médicamenteuxSujet(s)
Antinéoplasiques/usage thérapeutique , Composés hétérocycliques bicycliques/usage thérapeutique , Leucémie chronique lymphocytaire à cellules B/traitement médicamenteux , Leucémie aigüe myéloïde/traitement médicamenteux , Tumeurs primitives multiples/traitement médicamenteux , Sulfonamides/usage thérapeutique , Sujet âgé , Femelle , Humains , Leucémie chronique lymphocytaire à cellules B/diagnostic , Leucémie aigüe myéloïde/diagnostic , Syndromes myélodysplasiques/diagnostic , Tumeurs primitives multiples/diagnostic , Induction de rémissionSujet(s)
Décitabine/usage thérapeutique , Leucémie aigüe myéloïde/traitement médicamenteux , Syndromes myéloprolifératifs/anatomopathologie , Sujet âgé , Femelle , Humains , Hydroxy-urée/usage thérapeutique , Kinase Janus-2/génétique , Leucémie aigüe myéloïde/étiologie , Leucémie aigüe myéloïde/génétique , Mâle , Syndromes myéloprolifératifs/complications , Syndromes myéloprolifératifs/traitement médicamenteux , Pipobroman/usage thérapeutique , Résultat thérapeutiqueSujet(s)
Anémie hémolytique auto-immune/diagnostic , Anémie hémolytique auto-immune/thérapie , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Anémie hémolytique auto-immune/économie , Enfant , Enfant d'âge préscolaire , Prestations des soins de santé/économie , Femelle , Ressources en santé/économie , Humains , Mâle , Adulte d'âge moyen , Acceptation des soins par les patients , Pronostic , Études rétrospectives , Facteurs de risque , Jeune adulteSujet(s)
Oxazines/usage thérapeutique , Purpura thrombopénique idiopathique/traitement médicamenteux , Pyridines/usage thérapeutique , Syk kinase/antagonistes et inhibiteurs , Aminopyridines , Essais cliniques de phase III comme sujet , Humains , Morpholines , Promédicaments/usage thérapeutique , Purpura thrombopénique idiopathique/anatomopathologie , Purpura thrombopénique idiopathique/physiopathologie , Pyrimidines , Récidive , Syk kinase/immunologieSujet(s)
Antimétabolites antinéoplasiques/usage thérapeutique , Azacitidine/usage thérapeutique , Leucémie myélomonocytaire chronique/traitement médicamenteux , Sujet âgé , Prise en charge de la maladie , Femelle , Études de suivi , Personne âgée fragile , Humains , Mâle , Adulte d'âge moyen , Études rétrospectives , Analyse de survie , Résultat thérapeutiqueSujet(s)
Antimétabolites antinéoplasiques/usage thérapeutique , Décitabine/usage thérapeutique , Leucémie aigüe myéloïde/traitement médicamenteux , Tumeurs primitives multiples/traitement médicamenteux , Thrombocytémie essentielle/anatomopathologie , Adulte , Femelle , Humains , Kinase Janus-2/génétique , Leucémie aigüe myéloïde/génétique , Leucémie aigüe myéloïde/anatomopathologie , Tumeurs primitives multiples/génétique , Tumeurs primitives multiples/anatomopathologie , Thrombocytémie essentielle/génétique , Résultat thérapeutiqueSujet(s)
Antimétabolites antinéoplasiques/usage thérapeutique , Décitabine/usage thérapeutique , Leucémie aigüe myéloïde/traitement médicamenteux , Thérapie de rattrapage/méthodes , Sujet âgé , Traitement médicamenteux adjuvant , Humains , Chimiothérapie d'induction , Chimiothérapie de maintenance , Mâle , Traitement néoadjuvant , Induction de rémission , Échec thérapeutiqueRÉSUMÉ
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.
Sujet(s)
Fatigue/étiologie , Purpura thrombopénique idiopathique/psychologie , Qualité de vie , Adulte , Sujet âgé , Femelle , Humains , Mâle , Santé mentale , Adulte d'âge moyen , Aptitude physique , Purpura thrombopénique idiopathique/complications , Indice de gravité de la maladie , Enquêtes et questionnairesRÉSUMÉ
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.