Assuntos
Institutos de Câncer/normas , Neoplasias Hematológicas/terapia , Institutos de Câncer/organização & administração , Coleta de Dados , Gerenciamento Clínico , Tratamento Farmacológico/enfermagem , Tratamento Farmacológico/normas , Educação de Pós-Graduação em Enfermagem/normas , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Hematologia , Humanos , Oncologia , Corpo Clínico Hospitalar , Enfermagem Oncológica/educação , Equipe de Assistência ao Paciente , Inquéritos e Questionários , Reino UnidoRESUMO
Thalidomide and lenalidomide are immunomodulatory drugs that show promise in mantle cell lymphoma (MCL). In this study, their potential mechanisms of action against MCL cells were investigated, both alone and in combination with rituximab. Thalidomide, lenalidomide and rituximab have no direct effect on MCL cell viability. However, both immunomodulatory drugs indirectly affect viability by enhancing peripheral blood mononuclear cell-mediated cytotoxicity, with lenalidomide inducing significantly higher levels of toxicity than thalidomide. Rituximab induces both complement-dependent and antibody-dependent cellular cytotoxicity (ADCC) against MCL cells. Rituximab-induced ADCC is enhanced by lenalidomide and, to a lesser extent, thalidomide. Preliminary in vivo findings in MCL patients treated with thalidomide support a role for natural killer cells in the efficacy of these drugs. In conclusion, our data support a role for immunomodulatory drugs in the treatment of MCL.
Assuntos
Fatores Imunológicos/farmacologia , Linfoma de Célula do Manto/tratamento farmacológico , Talidomida/análogos & derivados , Talidomida/farmacologia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Citotoxicidade Celular Dependente de Anticorpos/efeitos dos fármacos , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Proteínas do Sistema Complemento/metabolismo , Citotoxicidade Imunológica/efeitos dos fármacos , Sinergismo Farmacológico , Humanos , Fatores Imunológicos/administração & dosagem , Técnicas In Vitro , Lenalidomida , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/imunologia , Linfoma de Célula do Manto/imunologia , Linfoma de Célula do Manto/patologia , Linfoma de Célula do Manto/terapia , Rituximab , Talidomida/administração & dosagemRESUMO
The aim of this study was to compare the outcomes of chemotherapy delivered at a cancer centre with chemotherapy given at a community hospital. The services were compared in terms of safety, preference for location, satisfaction and resource use. Patients were randomly allocated to two groups. One group received their first two cycles of chemotherapy at a community hospital; the other group received theirs at the cancer centre. The patients then crossed over to receive their next two cycles of chemotherapy at outreach or the cancer centre and then chose where they wanted to receive the remaining two cycles of their chemotherapy. Data were collected about patient preference, anxiety and depression, satisfaction and chemotherapy-related toxicity. Forty-two patients were randomized to the study: 38, 31 and 28 patients completed cycles two, four and final chemotherapies respectively. Thirty-one patients reached the end of the crossover period, of which 30 chose the outreach location for the remainder of their chemotherapy treatments. There was strong evidence that patients were more satisfied with outreach location for ease of access and also the environment. Recommendation from this study was that a permanent outreach chemotherapy service to community hospitals be established.