RESUMEN
To evaluate the safety of direct oral anticoagulants (DOACs) versus low-molecular weight heparin (LMWH) in patients with central nervous system (CNS) malignancies and secondary metastases. All adult patients with CNS malignancies and secondary metastases who were treated with a DOAC or LMWH for any indication from 2018 to 2022 were included. The primary outcome was the incidence of any intracranial hemorrhage (ICH) after anticoagulation initiation. Secondary outcomes included non-ICH bleeding events and thromboembolic events. Tolerability was assessed by any changes in anticoagulant therapy during study period. 153 patients were included; 48 patients received enoxaparin and 105 received DOACs, of which apixaban was used most commonly. The population was predominantly White (74%) and male (59%) with a median age of 65. Data was censored for immortal time bias for outcomes evaluated beyond 3 months. ICH occurred in 7.7% of the population, more frequently in the enoxaparin group (DOACs 4, 4% vs. enoxaparin 7, 16%, p = 0.037). Non-ICH bleeds were predominantly minor and more common in the DOAC group (DOACs 13, 13% vs. enoxaparin 1, 2%, p = 0.037). Thromboembolic events were not different between groups (DOACs 9. 9% vs, enoxaparin 2, 4%, p = 0.503). Anticoagulant switches occurred more in the enoxaparin group (DOACs 12, 12.4% vs. enoxaparin, 37.8%, p < 0.001), primarily due to patient or provider preference. Our data supports DOACs to be preferred over LMWH for the treatment of VTE or for stroke prevention with AF to prevent ICH in patients with brain tumors or metastases.
Asunto(s)
Neoplasias Encefálicas , Tromboembolia , Tromboembolia Venosa , Adulto , Humanos , Masculino , Anticoagulantes/efectos adversos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Enoxaparina/uso terapéutico , Tromboembolia/prevención & control , Hemorragia/inducido químicamente , Hemorragia/tratamiento farmacológico , Hemorragias Intracraneales/inducido químicamente , Hemorragias Intracraneales/complicaciones , Neoplasias Encefálicas/complicaciones , Tromboembolia Venosa/prevención & control , Administración OralRESUMEN
BACKGROUND: Adult survivors of childhood central nervous system (CNS) tumors may be at risk for pulmonary dysfunction. This study enumerates the incidence of pulmonary dysfunction and explores associations between craniospinal irradiation (CSI) and pulmonary dysfunction among survivors of childhood CNS tumors. METHODS: Participants included Childhood Cancer Survivor Study (CCSS) cohort members treated for CNS malignancies when
Asunto(s)
Neoplasias del Sistema Nervioso Central/complicaciones , Enfermedades Pulmonares/etiología , Evaluación de Resultado en la Atención de Salud , Sobrevivientes/estadística & datos numéricos , Adolescente , Adulto , Neoplasias del Sistema Nervioso Central/mortalidad , Neoplasias del Sistema Nervioso Central/terapia , Niño , Preescolar , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Recién Nacido , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Pruebas de Función Respiratoria , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Tasa de Supervivencia , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Temozolomide-induced aplastic anemia (TIAA) is a rare but highly challenging complication of temozolomide (TMZ) therapy. Evidence describing prognosis, clinical characteristics, and treatment of this entity is very limited. METHODS: We performed a multicenter, 22-year observational cohort study of patients with central nervous system (CNS) malignancies treated with temozolomide who developed TIAA, retrospectively analyzing prognosis, complications, and recovery. TIAA was defined using adapted evidence-based severe aplastic anemia criteria incorporating profound cytopenias and a minimum duration (4 weeks) without hematologic recovery. RESULTS: Of 3821 patients with CNS malignancies receiving TMZ, 34 patients (0.89%) met criteria for TIAA. Onset was rapid, with 29 patients (85.3%) developing TIAA before completing a second TMZ cycle. 23 patients (67.6%) ultimately achieved a hematologic recovery. Patients without recovery were more likely to develop febrile neutropenia (72.7% vs. 30.4%, P = .03), infectious complications (45.5% vs. 8.7%, P = .02), require hospitalization (81.8% vs. 43.5%, P = .04), and die (100.0% vs. 60.9%, P = .02). Median overall survival from TIAA diagnosis was 752 days in patients achieving a partial hematologic recovery versus 28 days in those who did not (P < .0001). 29 patients (85.3%) received one or more hematopoietic growth factors; hematologic recovery rates were higher in patients receiving thrombopoietin receptor agonists (81.8% vs. 60.9%) but were not higher in patients receiving granulocyte colony-stimulating factors. CONCLUSIONS: TIAA occurs in <1% of patients receiving TMZ for CNS malignancies, but is highly morbid when it occurs and frequently fatal in the one-third of patients not achieving hematologic recovery. Thrombopoietin receptor agonists may improve the likelihood of a hematologic recovery.
Asunto(s)
Anemia Aplásica , Neoplasias del Sistema Nervioso Central , Anemia Aplásica/inducido químicamente , Anemia Aplásica/tratamiento farmacológico , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Humanos , Pronóstico , Receptores de Trombopoyetina/uso terapéutico , Estudios Retrospectivos , Temozolomida/efectos adversosRESUMEN
Carcinoembryonic antigen(CEA) in blood and CSF was reported to be increased in cases of nervous system neoplasms by some investigators. To evaluate the oncological diagnostic value of CEA in the neurosurgical conditions, this study has been performed on 24 nervous system neoplasms and 8 non-nervous system as well as 49 controls. In addition, alpha-fetoprotein was also measured on the same conditions because of its close oncologic nature and recent diagnostic application on the general surgical conditions. The CEA concentration in blood and CSF were determined by CEA Radioimmunoassay kit, and the alpha-fetoprotein in blood and CSF were determined by GammaDab kit. The result showed that concentration of CEA and alpha-fetoprotein was higher and seemed to diagnostic in Extra-CNS neoplasma. In nerovous system, however, these were the lower than we expected, although were higher than control. Moreever, these levels were not unique on same oncologic condition and rather somewhat variable. From these results, increased concentration of these itself may be considered suggestive of existence of nervous system neoplasm, but it does mean neither degree of malignancy nor its origin.