The outcome of sequential azacitidine with lenalidomide has not been reported in previously treated patients with acute myeloid leukemia (AML) and higher risk myelodysplastic syndrome (MDS). This ...study describes a phase 2 study evaluating the safety and efficacy of this combination in elderly patients with AML and MDS with prior hypomethylating agent (HMA) and/or immunomodulatory agent exposure. Patients were treated on a 42-day cycle with azacitidine at 75 mg/m
2
SQ/IV daily on days 1-7, followed by lenalidomide 50 mg orally daily on days 8-28. The median number of treatment cycles on study was two (range = 1-11). Of 32 evaluable patients, the overall response rate was 25%. Neutropenic fever was the most common serious adverse event, but overall the combination was well-tolerated. The median overall survival (OS) for responders vs non-responders was 9.8 vs 4.0 months, respectively (HR = 0.36, p = 0.016). In conclusion, this combination demonstrated modest clinical activity in this poor risk population.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Hypereosinophilic Syndrome Stover, Elizabeth H.; Gotlib, Jason; Cools, Jan ...
Myeloproliferative Disorders
Book Chapter
Hypereosinophilic syndrome (HES) is characterized by persistent overproduction of eosinophils, and the exclusion of other known causes of eosinophilia. Clinical manifestations of HES are related to ...eosinophilic infiltration of end organs that may include the skin, heart, lung, central nervous system, and gastrointestinal tract. Treatment has been largely empirically derived, and may include steroids, cytotoxic agents, and immunomodulatory agents. It was recently observed that a subset of patients diagnosed with HES demonstrated remarkable clinical responses to empiric treatment with the small molecule tyrosine kinase inhibitor imatinib. These responses suggested that an imatinib-sensitive tyrosine kinase contributed to pathogenesis of HES in these cases, and led to the cloning of FIP1L1-PDGFRA. FIP1L1-PPDGFRA is a constitutively activated tyrosine kinase that is imatinib sensitive, and is expressed as a consequence of an interstitial chromosomal deletion on chromosome 4. In addition to imatinib, other targeted therapies have evolved for treatment of HES, including monoclonal antibody therapy directed against IL-5. Thus, significant progress has been made in our understanding of the pathogenesis and therapy of HES in recent years, and has had an impact on approach to classification and clinical management.
BACKGROUND:Enhanced Recovery After Surgery (ERAS) protocols have been shown to increase recovery, decrease complications, and reduce length of stay. However, they are difficult to implement.
...OBJECTIVE:To develop and implement an ERAS clinical practice guideline (CPG) at multiple hospitals.
METHODS:A tailored strategy based on the Knowledge-to-action (KTA) cycle was used to develop and implement an ERAS CPG at 15 academic hospitals in Canada. This included an initial audit to identify gaps and interviews to assess barriers and enablers to implementation. Implementation included development of an ERAS guideline by a multidisciplinary group, communities of practice led by multidiscipline champions (surgeons, anesthesiologists, and nurses) both provincially and locally, educational tools, and clinical pathways as well as audit and feedback.
RESULTS:The initial audit revealed there was greater than 75% compliance in only 2 of 18 CPG recommendations. Main themes identified by stakeholders were that the CPG must be based on best evidence, there must be increased communication and collaboration among perioperative team members, and patient education is essential. ERAS and Pain Management CPGs were developed by a multidisciplinary team and have been adopted at all hospitals. Preliminary data from more than 1000 patients show that the uptake of recommended interventions varies but despite this, mean length of stay has decreased with low readmission rates and adverse events.
CONCLUSIONS:On the basis of short-term findings, our results suggest that a tailored implementation strategy based on the KTA cycle can be used to successfully implement an ERAS program at multiple sites.
This systematic review explores the sociodemographic factors associated with the utilization of bariatric surgery among eligible patients. Electronic databases were searched for population-based ...studies that explored the relationship between sociodemographic characteristics of patients eligible for bariatric surgery to those who actually received the procedure. Twelve retrospective cohort studies were retrieved, of which the results of 9 studies were pooled using a random effects model. Patients who received bariatric surgery were significantly more likely to be white versus non-white (OR 1.54; 95 % CI 1.08, 2.19), female versus male (OR 2.80; 95 % CI 2.46, 3.22), and have private versus government or public insurance (OR 2.51; 95 % CI 1.04, 6.05). Prospective cohort studies are warranted to further determine the relative effect of these factors, adjusting for confounding factors.
