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[PMID]:27779105
[Au] Autor:Oliva S; Gambella M; Gilestro M; Muccio VE; Gay F; Drandi D; Ferrero S; Passera R; Pautasso C; Bernardini A; Genuardi M; Patriarca F; Saraci E; Petrucci MT; Pescosta N; Liberati AM; Caravita T; Conticello C; Rocci A; Musto P; Boccadoro M; Palumbo A; Omedè P
[Ad] Endereço:Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
[Ti] Título:Minimal residual disease after transplantation or lenalidomide-based consolidation in myeloma patients: a prospective analysis.
[So] Source:Oncotarget;8(4):5924-5935, 2017 Jan 24.
[Is] ISSN:1949-2553
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We analyzed 50 patients who achieved at least a very good partial response in the RV-MM-EMN-441 study. Patients received consolidation with autologous stem-cell transplantation (ASCT) or cyclophosphamide-lenalidomide-dexamethasone (CRD), followed by Lenalidomide-based maintenance. We assessed minimal residual disease (MRD) by multi-parameter flow cytometry (MFC) and allelic-specific oligonucleotide real-time quantitative polymerase chain reaction (ASO-RQ-PCR) after consolidation, after 3 and 6 courses of maintenance, and thereafter every 6 months until progression. By MFC analysis, 19/50 patients achieved complete response (CR) after consolidation, and 7 additional patients during maintenance. A molecular marker was identified in 25/50 patients, 4/25 achieved molecular-CR after consolidation, and 3 additional patients during maintenance. A lower MRD value by MFC was found in ASCT patients compared with CRD patients (p=0.0134). Tumor burden reduction was different in patients with high-risk vs standard-risk cytogenetics (3.4 vs 5.2, ln-MFC; 3 vs 6 ln-PCR, respectively) and in patients who relapsed vs those who did not (4 vs 5, ln-MFC; 4.4 vs 7.8 ln-PCR). MRD progression anticipated clinical relapse by a median of 9 months while biochemical relapse by a median of 4 months. MRD allows the identification of a low-risk group, independently of response, and a better characterization of the activity of treatments.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Biomarcadores Tumorais/genética
Mieloma Múltiplo/terapia
Talidomida/análogos & derivados
Transplante Autólogo/métodos
[Mh] Termos MeSH secundário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Quimioterapia de Consolidação
Progressão da Doença
Feminino
Seres Humanos
Quimioterapia de Manutenção
Masculino
Meia-Idade
Mieloma Múltiplo/genética
Mieloma Múltiplo/patologia
Neoplasia Residual
Estudos Prospectivos
Talidomida/administração & dosagem
Talidomida/uso terapêutico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers, Tumor); 4Z8R6ORS6L (Thalidomide); F0P408N6V4 (lenalidomide)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.18632/oncotarget.12641


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[PMID]:28840597
[Au] Autor:Peinemann F; van Dalen EC; Enk H; Berthold F
[Ad] Endereço:Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, Kerpener Str. 62, Cologne, Germany, 50937.
[Ti] Título:Retinoic acid postconsolidation therapy for high-risk neuroblastoma patients treated with autologous haematopoietic stem cell transplantation.
[So] Source:Cochrane Database Syst Rev;8:CD010685, 2017 08 25.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Neuroblastoma is a rare malignant disease and mainly affects infants and very young children. The tumours mainly develop in the adrenal medullary tissue, with an abdominal mass as the most common presentation. About 50% of patients have metastatic disease at diagnosis. The high-risk group is characterised by metastasis and other features that increase the risk of an adverse outcome. High-risk patients have a five-year event-free survival of less than 50%. Retinoic acid has been shown to inhibit growth of human neuroblastoma cells and has been considered as a potential candidate for improving the outcome of patients with high-risk neuroblastoma. This review is an update of a previously published Cochrane Review. OBJECTIVES: To evaluate the efficacy and safety of additional retinoic acid as part of a postconsolidation therapy after high-dose chemotherapy (HDCT) followed by autologous haematopoietic stem cell transplantation (HSCT), compared to placebo retinoic acid or to no additional retinoic acid in people with high-risk neuroblastoma (as defined by the International Neuroblastoma Risk Group (INRG) classification system). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2016, Issue 11), MEDLINE in PubMed (1946 to 24 November 2016), and Embase in Ovid (1947 to 24 November 2016). Further searches included trial registries (on 22 December 2016), conference proceedings (on 23 March 2017) and reference lists of recent reviews and relevant studies. We did not apply limits by publication year or languages. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating additional retinoic acid after HDCT followed by HSCT for people with high-risk neuroblastoma compared to placebo retinoic acid or to no additional retinoic acid. Primary outcomes were overall survival and treatment-related mortality. Secondary outcomes were progression-free survival, event-free survival, early toxicity, late toxicity, and health-related quality of life. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: The update search did not identify any additional studies. We identified one RCT that included people with high-risk neuroblastoma who received HDCT followed by autologous HSCT (N = 98) after a first random allocation and who received retinoic acid (13-cis-retinoic acid; N = 50) or no further therapy (N = 48) after a second random allocation. These 98 participants had no progressive disease after HDCT followed by autologous HSCT. There was no clear evidence of difference between the treatment groups either in overall survival (hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.46 to 1.63; one trial; P = 0.66) or in event-free survival (HR 0.86, 95% CI 0.50 to 1.49; one trial; P = 0.59). We calculated the HR values using the complete follow-up period of the trial. The study also reported overall survival estimates at a fixed point in time. At the time point of five years, the survival estimate was reported to be 59% for the retinoic acid group and 41% for the no-further-therapy group (P value not reported). We did not identify results for treatment-related mortality, progression-free survival, early or late toxicity, or health-related quality of life. We could not rule out the possible presence of selection bias, performance bias, attrition bias, and other bias. We judged the evidence to be of low quality for overall survival and event-free survival, downgraded because of study limitations and imprecision. AUTHORS' CONCLUSIONS: We identified one RCT that evaluated additional retinoic acid as part of a postconsolidation therapy after HDCT followed by autologous HSCT versus no further therapy in people with high-risk neuroblastoma. There was no clear evidence of a difference in overall survival and event-free survival between the treatment alternatives. This could be the result of low power. Information on other outcomes was not available. This trial was performed in the 1990s, since when many changes in treatment and risk classification have occurred. Based on the currently available evidence, we are therefore uncertain about the effects of retinoic acid in people with high-risk neuroblastoma. More research is needed for a definitive conclusion.
[Mh] Termos MeSH primário: Neoplasias das Glândulas Suprarrenais/terapia
Antineoplásicos/uso terapêutico
Quimioterapia de Consolidação
Transplante de Células-Tronco Hematopoéticas/métodos
Neuroblastoma/terapia
Tretinoína/uso terapêutico
[Mh] Termos MeSH secundário: Neoplasias das Glândulas Suprarrenais/mortalidade
Antineoplásicos/administração & dosagem
Transplante de Medula Óssea
Intervalo Livre de Doença
Seres Humanos
Lactente
Neuroblastoma/mortalidade
Ensaios Clínicos Controlados Aleatórios como Assunto
Viés de Seleção
Tretinoína/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Antineoplastic Agents); 5688UTC01R (Tretinoin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010685.pub3


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[PMID]:28823212
[Au] Autor:Illés Á; Simon Z; Udvardy M; Magyari F; Jóna Á; Miltényi Z
[Ad] Endereço:Belgyógyászati Intézet, Hematológiai Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032.
[Ti] Título:[Treatment of relapsed Hodgkin lymphoma after autologous stem cell transplantation].
[Ti] Título:Így kezeljük az autológ ossejt-transzplantáció után kiújult Hodgkin-lymphomát..
[So] Source:Orv Hetil;158(34):1338-1345, 2017 Aug.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:Approximately 10-30% of Hodgkin lymphoma patients relapses or experience refractory disease after first line treatment. Nowadays, autologous stem cell transplantation can successfully salvage half of these patients, median overall survival is only 2-2.5 years. Several prognostic factors determine success of autologous stem cell transplantation. Result of transplantation can be improved considering these factors and using consolidation treatment, if necessary. Patients who relapse after autologous transplantation had worse prognosis, treatment of this patient population is unmet clinical need. Several new treatment options became available in the recent years (brentuximab vedotin and immuncheckpoint inhibitors). These new treatment options offer more chance for cure in relapsed/refractory Hodgkin patients. Outcome of allogenic stem cell transplantation can be improved by using haploidentical donors. New therapeutic options will be discussed in this review. Orv Hetil. 2017; 158(34): 1338-1345.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Transplante de Células-Tronco Hematopoéticas
Doença de Hodgkin/terapia
Imunoconjugados/uso terapêutico
[Mh] Termos MeSH secundário: Quimioterapia de Consolidação/métodos
Doença de Hodgkin/tratamento farmacológico
Doença de Hodgkin/imunologia
Seres Humanos
Indução de Remissão
Terapia de Salvação/métodos
Análise de Sobrevida
Transplante Autólogo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Immunoconjugates); 7XL5ISS668 (brentuximab vedotin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170822
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30823


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[PMID]:28800940
[Au] Autor:Altman AD; McGee J; May T; Lane K; Lu L; Xu W; Ghatage P; Rosen B
[Ad] Endereço:Division of Gynecologic Oncology, University of Manitoba, Canada. Electronic address: alon.altman@cancercare.mb.ca.
[Ti] Título:Neoadjuvant chemotherapy and chemotherapy cycle number: A national multicentre study.
[So] Source:Gynecol Oncol;147(2):257-261, 2017 Nov.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Six cycles of consolidation chemotherapy have become the standard for ovarian cancer treatment regimen following primary cytoreduction, yet with neoadjuvant chemotherapy (NAC), only 3 consolidation cycles are used. This study examines the effects of number of chemotherapy cycles in women with ovarian cancer that are being treated with neoadjuvant chemotherapy. In addition, we examined the effect of number of cycles on survival on consolidation and total chemotherapy. METHODS: All patients with stage IIIC and IV high grade serous carcinoma (HGSC) were identified at 4 major Canadian cancer centers treated with NAC. A retrospective chart review was conducted using the medical charts and registry databases. RESULTS: 403 NAC patients were identified. 47% had zero residual disease. Chemotherapy cycles were divided into <3cycles or ≥4cycles for NAC and consolidation treatments and analyzed with multivariate analysis. 139/403 (34.5%) received ≥4cycles of NAC and had a worse prognosis than <3cycles (p=0.011). 70/403 (17.4%) received ≥4cycles of consolidation treatment and there was no difference in survival (p=0.33) CONCLUSION: Women with advanced HGSC are managed with a combination of surgery and chemotherapy. This is a study of a homogenous cohort of patients with stage IIIC or IV high grade serous cancers who received NAC. ≥4cycles of NAC had a worse outcome than <3cycles likely due to poor prognostic factors or poor response. The number of consolidation cycles did not appear to make a difference in overall survival.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Neoplasias Ovarianas/tratamento farmacológico
[Mh] Termos MeSH secundário: Canadá
Quimioterapia Adjuvante
Estudos de Coortes
Quimioterapia de Consolidação
Cistadenocarcinoma Seroso/tratamento farmacológico
Cistadenocarcinoma Seroso/cirurgia
Procedimentos Cirúrgicos de Citorredução
Esquema de Medicação
Feminino
Seres Humanos
Meia-Idade
Terapia Neoadjuvante
Estadiamento de Neoplasias
Compostos Organoplatínicos/administração & dosagem
Neoplasias Ovarianas/cirurgia
Ensaios Clínicos Controlados Aleatórios como Assunto
Estudos Retrospectivos
Taxa de Sobrevida
Taxoides/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Organoplatinum Compounds); 0 (Taxoids)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170813
[St] Status:MEDLINE


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[PMID]:28767288
[Au] Autor:Kutny MA; Alonzo TA; Gerbing RB; Wang YC; Raimondi SC; Hirsch BA; Fu CH; Meshinchi S; Gamis AS; Feusner JH; Gregory JJ
[Ad] Endereço:Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and R
[Ti] Título:Arsenic Trioxide Consolidation Allows Anthracycline Dose Reduction for Pediatric Patients With Acute Promyelocytic Leukemia: Report From the Children's Oncology Group Phase III Historically Controlled Trial AAML0631.
[So] Source:J Clin Oncol;35(26):3021-3029, 2017 Sep 10.
[Is] ISSN:1527-7755
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Purpose The Children's Oncology Group AAML0631 trial for newly diagnosed pediatric acute promyelocytic leukemia (APL) was a phase III historically controlled trial to determine the survival of patients receiving arsenic trioxide (ATO) consolidation and reduced doses of anthracyclines. Patients and Methods Patients age 2 to 21 years with de novo APL confirmed by PML-RARα polymerase chain reaction were stratified as standard risk (SR) or high risk (HR) on the basis of diagnostic WBC count. All patients received all-trans retinoic acid (ATRA) during induction, each consolidation course, and maintenance. All patients received two cycles of ATO therapy during consolidation 1, an additional two (SR) or three (HR) consolidation courses that included high-dose cytarabine and anthracycline, and maintenance therapy comprising ATRA, oral methotrexate, and mercaptopurine. Results One hundred one patients (66 SR and 35 HR) were evaluable for outcome. The 3-year overall survival was 94%, and event-free survival (EFS) was 91%. For SR and HR patients with APL, the overall survival was 98% versus 86% ( P = .003), and EFS was 95% versus 83% ( P = .03), respectively. The EFS for SR patients in AAML0631 was noninferior to that of patients in the AIDA 0493 historical control, which used a significantly higher anthracycline dose and did not include ATO consolidation. Relapse risk for patients in AAML0631 from end consolidation 1 (after ATO treatment) was only 4% at 3 years and did not differ significantly between SR and HR patients. Conclusion ATO consolidation cycles were well tolerated in pediatric patients with APL and allowed significant reduction in cumulative anthracycline doses while maintaining excellent survival and a low relapse risk for both SR and HR patients with APL.
[Mh] Termos MeSH primário: Antraciclinas/administração & dosagem
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Arsenicais/administração & dosagem
Leucemia Promielocítica Aguda/tratamento farmacológico
Óxidos/administração & dosagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Pré-Escolar
Quimioterapia de Consolidação
Citarabina/administração & dosagem
Intervalo Livre de Doença
Feminino
Estudo Historicamente Controlado
Seres Humanos
Masculino
Mercaptopurina/administração & dosagem
Metotrexato/administração & dosagem
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Anthracyclines); 0 (Arsenicals); 0 (Oxides); 04079A1RDZ (Cytarabine); E7WED276I5 (Mercaptopurine); S7V92P67HO (arsenic trioxide); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1200/JCO.2016.71.6183


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[PMID]:28701367
[Au] Autor:Casasnovas RO; Ysebaert L; Thieblemont C; Bachy E; Feugier P; Delmer A; Tricot S; Gabarre J; Andre M; Fruchart C; Mounier N; Delarue R; Meignan M; Berriolo-Riedinger A; Bardet S; Emile JF; Jais JP; Haioun C; Tilly H; Morschhauser F
[Ad] Endereço:Department of Hematology, Hôpital Le Bocage and INSERM Unité Mixte de Recherche1231, Dijon, France.
[Ti] Título:FDG-PET-driven consolidation strategy in diffuse large B-cell lymphoma: final results of a randomized phase 2 study.
[So] Source:Blood;130(11):1315-1326, 2017 Sep 14.
[Is] ISSN:1528-0020
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Dose-dense induction and up-front consolidation with autologous stem cell transplantation (ASCT) remain controversial issues when treating patients with high-risk diffuse large B-cell lymphoma. GELA designed a randomized phase 2 trial evaluating the efficacy of either rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone (R-ACVBP) or rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP14) induction and a positron emission tomography (PET)-driven ASCT or standard immunochemotherapy (SIC) consolidation in age-adjusted international prognosis index 2 (aaIPI2)-aaIPI3 patients. PET was performed at baseline, after 2 (PET2) and 4 (PET4) induction cycles, and centrally assessed using international harmonization project (IHP) criteria. PET2 /PET4 patients were assigned SIC, PET2 /PET4 patients were assigned ASCT, and PET4 patients were treated with the investigator's choice. The primary end-point was the 2007 international working group complete response (CR) rate after induction. Change in maximum standard uptake value (ΔSUVmax) after PET assessment was explored. Two hundred eleven patients were randomly assigned to R-ACVBP (n = 109) or R-CHOP14 (n = 102). PET4 /CR rates were 53%/47% with R-ACVBP and 41%/39% with R-CHOP14 (CR 95% confidence interval [CI], 38%-67% and 28%-54%, respectively; = .076). Consolidation in the R-ACVBP and R-CHOP14 groups was SIC in 26% and 23% of patients and ASCT in 28% and 18% of patients, respectively. PET4 positivity was higher with R-CHOP14 vs R-ACVBP (54% vs 41%; = .08), leading to more salvage therapy (37% vs 26%; = .07) and lower event-free survival (EFS; 4-year EFS, 31% vs 43%; < .01), but progression-free survival (PFS) and overall survival (OS) were similar in both groups. PET2 /PET4 and PET2 /PET4 patients had similar outcomes. Using ΔSUVmax, 79% of the patients were PET2 /PET4 ΔSUVmaxPET0-4 >70% was associated with better outcome (4-year PFS, 84% vs 35%; 4-year OS, 91% vs 57%; < .0001), whatever the consolidation. Superiority of R-ACVBP over R-CHOP14 was not established, as IHP criteria did not properly reflect disease control. ΔSUVmax may help better select patients needing an alternative to SIC, including ASCT.
[Mh] Termos MeSH primário: Quimioterapia de Consolidação
Fluordesoxiglucose F18/química
Linfoma Difuso de Grandes Células B/tratamento farmacológico
Tomografia por Emissão de Pósitrons
[Mh] Termos MeSH secundário: Adulto
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Determinação de Ponto Final
Feminino
Transplante de Células-Tronco Hematopoéticas
Seres Humanos
Linfoma Difuso de Grandes Células B/diagnóstico por imagem
Masculino
Meia-Idade
Reprodutibilidade dos Testes
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0Z5B2CJX4D (Fluorodeoxyglucose F18)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1182/blood-2017-02-766691


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[PMID]:28699225
[Au] Autor:Sperr WR; Herndlhofer S; Gleixner K; Girschikofsky M; Weltermann A; Machherndl-Spandl S; Sliwa T; Poehnl R; Buxhofer-Ausch V; Strecker K; Hoermann G; Knoebl P; Jaeger U; Geissler K; Kundi M; Valent P
[Ad] Endereço:Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Wien, Austria.
[Ti] Título:Intensive consolidation with G-CSF support: Tolerability, safety, reduced hospitalization, and efficacy in acute myeloid leukemia patients ≥60 years.
[So] Source:Am J Hematol;92(10):E567-E574, 2017 Oct.
[Is] ISSN:1096-8652
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to evaluate the efficacy and feasibility of intensified consolidation therapy employing fludarabine and ARA-C in cycle 1 and intermediate-dose ARA-C (IDAC) in cycles 2 through 4, in elderly acute myeloid leukemia (AML) patients and to analyze the effects of pegfilgrastim on the duration of neutropenia, overall toxicity, and hospitalization-time during consolidation in these patients. Thirty nine elderly patients with de novo AML (median age 69.9 years) who achieved complete remission (CR) after induction-chemotherapy were analyzed. To examine the effect of pegfilgrastim on neutropenia and hospitalization, we compared cycles 2 and 4 where pegfilgrastim was given routinely from day 6 (IDAC-P) with cycle 3 where pegfilgrastim was only administered in case of severe infections and/or prolonged neutropenia. All four planned cycles were administered in 23/39 patients (59.0%); 5/39 patients (12.8%) received 3 cycles, 3/39 (7.7%) 2 cycles, and 8/39 (20.5%) one consolidation-cycle. The median duration of severe neutropenia was 7 days in cycle 2 (IDAC-P), 11.5 days in cycle 3 (IDAC), and 7.5 days in cycle 4 (IDAC-P) (P < .05). Median overall survival was 1.1 years and differed significantly between patients aged <75 and ≥75 years (P < .05). The probability to be alive after 5 years was 32%. Together, intensified consolidation can be administered in AML patients ≥60, and those who are <75 may benefit from this therapy. Routine administration of pegfilgrastim during consolidation shortens the time of neutropenia and hospitalization in these patients.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Quimioterapia de Consolidação/métodos
Citarabina/uso terapêutico
Fator Estimulador de Colônias de Granulócitos/uso terapêutico
Leucemia Mieloide Aguda/tratamento farmacológico
Vidarabina/análogos & derivados
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Quimioterapia de Consolidação/efeitos adversos
Citarabina/administração & dosagem
Citarabina/efeitos adversos
Intervalo Livre de Doença
Esquema de Medicação
Estudos de Viabilidade
Filgrastim
Fator Estimulador de Colônias de Granulócitos/administração & dosagem
Fator Estimulador de Colônias de Granulócitos/efeitos adversos
Hospitalização/estatística & dados numéricos
Seres Humanos
Meia-Idade
Neutropenia/induzido quimicamente
Neutropenia/epidemiologia
Polietilenoglicóis
Prognóstico
Proteínas Recombinantes/administração & dosagem
Proteínas Recombinantes/efeitos adversos
Proteínas Recombinantes/uso terapêutico
Vidarabina/administração & dosagem
Vidarabina/efeitos adversos
Vidarabina/uso terapêutico
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE IV; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Recombinant Proteins); 04079A1RDZ (Cytarabine); 143011-72-7 (Granulocyte Colony-Stimulating Factor); 30IQX730WE (Polyethylene Glycols); 3A58010674 (pegfilgrastim); FA2DM6879K (Vidarabine); P2K93U8740 (fludarabine); PVI5M0M1GW (Filgrastim)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1002/ajh.24847


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[PMID]:28668386
[Au] Autor:Chiappella A; Martelli M; Angelucci E; Brusamolino E; Evangelista A; Carella AM; Stelitano C; Rossi G; Balzarotti M; Merli F; Gaidano G; Pavone V; Rigacci L; Zaja F; D'Arco A; Cascavilla N; Russo E; Castellino A; Gotti M; Congiu AG; Cabras MG; Tucci A; Agostinelli C; Ciccone G; Pileri SA; Vitolo U
[Ad] Endereço:Department of Haematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy. Electronic address: achiappella@cittadellasalute.to.it.
[Ti] Título:Rituximab-dose-dense chemotherapy with or without high-dose chemotherapy plus autologous stem-cell transplantation in high-risk diffuse large B-cell lymphoma (DLCL04): final results of a multicentre, open-label, randomised, controlled, phase 3 study.
[So] Source:Lancet Oncol;18(8):1076-1088, 2017 Aug.
[Is] ISSN:1474-5488
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prognosis of young patients with diffuse large B-cell lymphoma at high risk (age-adjusted International Prognostic Index [aa-IPI] score 2 or 3) treated with R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone) is poor. The aim of this study was to investigate the possible benefit of intensification with high-dose chemotherapy and autologous stem-cell transplantation as part of first-line treatment in these patients. METHODS: We did a multicentre, open-label, randomised, controlled, phase 3 trial with a 2 × 2 factorial design to compare, at two different R-CHOP dose levels, a full course of rituximab-dose-dense chemotherapy (no transplantation group) versus an abbreviated course of rituximab-dose-dense chemotherapy followed by consolidation with R-MAD (rituximab plus high-dose cytarabine plus mitoxantrone plus dexamethasone) and high-dose BEAM chemotherapy (carmustine, etoposide, cytarabine, and melphalan) plus autologous stem-cell transplantation (transplantation group) in young patients (18-65 years) with untreated high-risk diffuse large B-cell lymphoma (aa-IPI score 2-3). At enrolment, patients were stratified according to aa-IPI score and randomly assigned (1:1:1:1) to receive R-CHOP (intravenous rituximab 375 mg/m , cyclophosphamide 750 mg/m , doxorubicin 50 mg/m , and vincristine 1·4 mg/m on day 1, plus oral prednisone 100 mg on days 1-5) delivered in a 14-day cycle (R-CHOP-14) for eight cycles; high-dose R-CHOP-14 (R-MegaCHOP-14; R-CHOP-14 except for cyclophosphamide 1200 mg/m and doxorubicin 70 mg/m ) for six cycles; R-CHOP-14 for four cycles followed by R-MAD (intravenous rituximab 375 mg/m on day 1 or 4 plus intravenous cytarabine 2000 mg/m and dexamethasone 4 mg/m every 12 h on days 1-3 plus intravenous mitoxantrone 8 mg/m on days 1-3) plus BEAM (intravenous carmustine 300 mg/m on day -7, intravenous cytarabine 200 mg/m twice a day on days -6 to -3, intravenous etoposide 100 mg/m twice a day on days -6 to -3, plus intravenous melphalan 140 mg/m on day -2) and autologous stem-cell transplantation (day 0); or R-MegaCHOP-14 for four cycles followed by R-MAD plus BEAM and autologous stem-cell transplantation. The primary endpoint was failure-free survival at 2 years in the intention-to-treat population. This study is registered with EudraCT (2005-002181-14; 2007-000275-42) and with ClinicalTrials.gov, number NCT00499018. FINDINGS: Between Jan 10, 2006, and Sept 8, 2010, 399 patients were randomly assigned to receive transplantation (n=199) or no transplantation (n=200); 203 patients were assigned to receive R-CHOP-14 and 196 were assigned to receive R-MegaCHOP-14. With a median follow-up of 72 months (IQR 57-88), 2-year failure-free survival was 71% (95% CI 64-77) in the transplantation group versus 62% (95% CI 55-68) in the no transplantation group (hazard ratio [HR] 0·65 [95% CI 0·47-0·91]; stratified log-rank test p=0·012). No difference in 5-year overall survival was observed between these groups (78% [95% CI 71-83] versus 77% [71-83]; HR 0·98 [0·65-1·48]; stratified log-rank test p=0·91). Grade 3 or worse haematological adverse events were reported in 183 (92%) of 199 patients in the transplantation group versus 135 (68%) of 200 patients in the no transplantation group. Grade 3 or worse non-haematological adverse events were reported in 90 (45%) versus 31 (16%); the most common grade 3 or worse non-haematological adverse event was gastrointestinal (49 [25%] vs 19 [10%]). Treatment-related deaths occurred in 13 (3%) patients; eight in the transplantation group and five in the no transplantation group. INTERPRETATION: Abbreviated rituximab-dose-dense chemotherapy plus R-MAD plus BEAM and autologous stem-cell transplantation reduced the risk of treatment failure compared with full course rituximab-dose-dense chemotherapy in young patients with diffuse large B-cell lymphoma at high risk. However, these results might not be clinically meaningful, since this improvement did not reflect an improvement in overall survival. These results do not support further consideration of the use of intensification of R-CHOP as an upfront strategy in patients with diffuse large B-cell lymphoma with poor prognosis. FUNDING: Fondazione Italiana Linfomi.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Linfoma Difuso de Grandes Células B/terapia
Rituximab/administração & dosagem
Transplante de Células-Tronco
[Mh] Termos MeSH secundário: Adulto
Anticorpos Monoclonais Murinos/administração & dosagem
Anticorpos Monoclonais Murinos/efeitos adversos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Carmustina/administração & dosagem
Quimioterapia de Consolidação
Ciclofosfamida/administração & dosagem
Ciclofosfamida/efeitos adversos
Citarabina/administração & dosagem
Dexametasona/administração & dosagem
Intervalo Livre de Doença
Doxorrubicina/administração & dosagem
Doxorrubicina/efeitos adversos
Etoposídeo/administração & dosagem
Feminino
Seguimentos
Doenças Hematológicas/induzido quimicamente
Seres Humanos
Quimioterapia de Indução
Análise de Intenção de Tratamento
Masculino
Melfalan/administração & dosagem
Meia-Idade
Mitoxantrona/administração & dosagem
Prednisona/administração & dosagem
Prednisona/efeitos adversos
Fatores de Risco
Transplante de Células-Tronco/efeitos adversos
Taxa de Sobrevida
Transplante Autólogo
Vincristina/administração & dosagem
Vincristina/efeitos adversos
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Murine-Derived); 0 (R-CHOP protocol); 04079A1RDZ (Cytarabine); 4F4X42SYQ6 (Rituximab); 5J49Q6B70F (Vincristine); 6PLQ3CP4P3 (Etoposide); 7S5I7G3JQL (Dexamethasone); 80168379AG (Doxorubicin); 8N3DW7272P (Cyclophosphamide); BZ114NVM5P (Mitoxantrone); Q41OR9510P (Melphalan); U68WG3173Y (Carmustine); VB0R961HZT (Prednisone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170703
[St] Status:MEDLINE


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[PMID]:28651117
[Au] Autor:Martin P; Ghione P; Dreyling M
[Ad] Endereço:Division of Hematology and Medical Oncology, Weill Cornell Medical College, NY, United States.
[Ti] Título:Mantle cell lymphoma - Current standards of care and future directions.
[So] Source:Cancer Treat Rev;58:51-60, 2017 Jul.
[Is] ISSN:1532-1967
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Over the past decade we have seen significant changes in the biological characterization and strategies for treatment of mantle cell lymphoma (MCL). MCL is heterogeneous a disease, and so are the people that have it; although guidelines are appropriate, therapeutic approaches must be individualized based on a variety of factors. In this review, we summarize data on the range of therapeutic options, from observation in patients with slowly progressive low-tumor-burden MCL, to bendamustine-based regimens in typical MCL, to high-dose cytarabine-based regimens in young, fit patients. The management of previously treated MCL is evolving with the availability of new agents and more changes are expected. Several recent and ongoing clinical trials have the potential to provide new options for patients and are discussed as future directions. Additionally, prognostic tools, measurement of minimal residual disease, and assessment of toxicity are already common research tools and may soon impact therapeutic strategies as a standard of care. Indeed, there has never been a time that management of MCL was as complicated while the promise for real improvements in outcomes is so great.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Linfoma de Célula do Manto/terapia
[Mh] Termos MeSH secundário: Quimioterapia de Consolidação
Seres Humanos
Quimioterapia de Indução
Quimioterapia de Manutenção
Neoplasia Residual
Prognóstico
Retratamento
Conduta Expectante
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170627
[St] Status:MEDLINE


  10 / 344 MEDLINE  
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[PMID]:28646534
[Au] Autor:Rashidi A; Linden MA; DeFor TE; Warlick E; Bejanyan N; Yohe S; Weisdorf DJ; Ustun C
[Ad] Endereço:Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
[Ti] Título:History of consolidation is prognostic in acute myeloid leukemia patients undergoing allogeneic hematopoietic cell transplantation in minimal residual disease-negative first complete remission.
[So] Source:Am J Hematol;92(10):1032-1036, 2017 Oct.
[Is] ISSN:1096-8652
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Prognostic factors among acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) in minimal residual disease (MRD)-negative first complete remission (CR1) are unknown. We retrospectively attempted to answer the following question: In AML patients undergoing allo-HCT in MRD-negative CR1, does a history of prior consolidation provide additional prognostic information? METHODS: The inclusion criteria were: (i) Age > 18 years, (ii) AML in CR1 after 1-2 cycles of intensive induction chemotherapy, with or without consolidation, (iii) Allo-HCT between 1/2003 and 4/2016 at our institution, (iv) Available standard-sensitivity 4-color flow cytometry results from a bone marrow aspiration at diagnosis and after completion of all previous chemotherapy within one month prior to HCT, (v) Flow cytometry-based MRD-negative status at the time of HCT. RESULTS: A history of prior consolidation was associated with favorable overall survival (Hazard Ratio [95% Confidence Interval]: 0.59 [0.35-0.99], P = .046), relapse-free survival (0.60 [0.37-0.96], P = .036), and relapse (0.50 [0.27-0.92], P = .025). Analysis of potential sources of bias was unrevealing. CONCLUSIONS: In AML patients undergoing allo-HCT in MRD-negative CR1, a history of prior consolidation was associated with favorable outcomes. If the path to pre-HCT MRD negativity includes consolidation, it may identify patients with improved prognosis following HCT in MRD-negative state. These results warrant validation in larger cohorts.
[Mh] Termos MeSH primário: Quimioterapia de Consolidação/métodos
Transplante de Células-Tronco Hematopoéticas
Leucemia Mieloide Aguda/patologia
Leucemia Mieloide Aguda/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Quimioterapia de Consolidação/estatística & dados numéricos
Seres Humanos
Estimativa de Kaplan-Meier
Leucemia Mieloide Aguda/mortalidade
Meia-Idade
Neoplasia Residual
Prognóstico
Recidiva
Indução de Remissão
Estudos Retrospectivos
Transplante Homólogo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170625
[St] Status:MEDLINE
[do] DOI:10.1002/ajh.24834



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