Background and importanceIn managing chronic lymphocytic leukaemia (CLL), it is recommended that patients with TP53 deletion/mutation (TP53mut), who have a poor prognosis, are treated with ibrutinib ...as frontline therapy. Because of severe infectious complications, idelalisib combined with rituximab is only recommended for frontline therapy in patients not suitable for ibrutinib, if measures to prevent infection are followed. Patients unsuitable for ibrutinib/idelalisib may otherwise be treated with venetoclax.Aim and objectivesTo evaluate the prescriptions and clinical outcomes of ibrutinib, idelalisib and venetoclax in a third level hospital.Material and methodsAn observational, retrospective study was conducted including any prescriptions of ibrutinib, idelalisib and venetoclax for CLL from November 2015 to June 2019. We focused on TP53 mutation status, drug exposure, survival outcomes and reasons for drug switching or dose reduction, if applicable. Data were collected from electronic medical records.ResultsThirty patients receiving ibrutinib (n=23), idelalisib (n=13) and/or venetoclax (n=5) were recruited. Seventeen patients (56.7%) showed TP53mut. In the ibrutinib cohort, median drug exposure was 10.5 months and most patients (65.2%) had received it after conventional chemotherapy regimens (eg, FCR, R-CHOP, R-bendamustine). Only 5 patients (21.7%) showing TP53mut had taken ibrutinib as firstline therapy and 4 (17.4%) had received it after idelalisib; 2 of these patients because of disease progression and the other 2 because of adverse events (severe infections and colitis with weight loss). In the idelalisib cohort, median drug exposure was 4.45 months. Venetoclax was used for a median of 0.74 months and on ibrutinib failure in 4 patients (the remaining patient received prior idelalisib due to concomitant anticoagulant therapy). Dose reductions were needed in 11 patients on ibrutinib (causes: bruising, respiratory tract infections and neutropenia); in 4 receiving idelalisib due to severe diarrhoea (n=3) and pneumonia (n=1); and in 1 patient on venetoclax due to severe neutropenia. Neither median progression free survival nor median overall survival were reached at the data cut-off date. In fact, 59.5% of patients were still alive.Conclusion and relevanceMost patients received secondline ibrutinib and showed a long term response duration even when TP53mut was absent. Adverse effects resulted in frequent dose reductions/drug switching. However, venetoclax represents an appropriate option for patients whose CLL has failed to respond to ibrutinib/idelalisib.References and/or acknowledgementsNo conflict of interest.
Background and ImportanceThe elderly constitute a large percentage of patients with haematologic malignancies. It is estimated that this percentage will grow due to the ageing of the population and ...the new therapeutic targets that manage to control and chronify the disease. They present cognitive impairment, malnutrition, physical dependence and polymedication, requiring a comprehensive and multidisciplinary approach.Aim and ObjectivesTo design a pharmaceutical care protocol for geriatric haemato-oncology patients and to evaluate the results.Material and MethodsProspective observational study conducted from January 2022 to September 2023 in the Pharmaceutical Care Consultation for oncohaematologic patients of a tertiary hospital. The haematologist selected the most fragile patients with the G8 scale and with the highest number of comorbidities evaluated with the CIRS-G scale and sent them to the Pharmacy consultation, where the pharmacist in charge made a previous evaluation of home medication, self-medication, alternative medicine with the aim of detecting drug interactions, therapeutic duplications, inappropriately prescribed drugs using the START-STOPP criteria, assessing the possible deprescription of polymedication, and lack of adherence using the Morisky-Green test. In the event of detecting any errors in medication intake, interactions of interest. or adverse reactions, pharmaceutical interventions were made in the patient‘s clinical history for consultation by any health professional.ResultsWith this new protocol, 40 patients were attended, with a median age of 80 years, 68% men and 32% women. Adherence to haemato-oncologic treatment was improved by 90%. Thirty-five pharmaceutical interventions were carried out: 3 related to the dosage and way of taking the treatment, 10 with pharmacological interactions in which it was necessary to substitute a drug in the treatment, five therapeutic duplications, eight with the use of herbal products and multivitamin complexes that interacted with their treatment, four for not attending their medical check-up in 2 years and five had prescribed medication of little therapeutic value and with a high anticholinergic load that was suspended from the treatment.Conclusion and RelevanceThe hospital pharmacist has an important role in the pharmaceutical care of geriatric haemato-oncology patients by creating multidisciplinary work protocols offering personalised treatment.References and/or Acknowledgements1. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. JCO. 2018.Conflict of InterestNo conflict of interest.
Background and ImportanceHome-based chemotherapy is becoming a valid alternative to hospital-based treatment for patients with malignant haematological disorders.Aim and ObjectivesTo evaluate the ...benefits of implementing a home infusion chemotherapy treatment for patients with malignant haematological disorders.Material and MethodsProspective observational study from February 2016 to September 2023 in a tertiary hospital. The haematologist selected patients with autonomy for self-care and good family support. The chemotherapy protocols administered at home were: ESHAP: Etoposide 40 mg/m2 IV over 2 h days 1 to 4 – Cytarabine 2000 mg/m2IV over 2 h on day 5 – Cisplatin 25 mg/m2 in 22 h continuous IV infusion days 1 to 4 – Prednisone 60 mg/m2 oral days 1 to 5, DHAOx: Oxaliplatin 130 mg/m2 IV over 2h day 1- Cytarabine 2000mg/m2/12h IV in 2h day 2 – Dexamethasone 40mg oral days 1 to 4 and EPOCH: Etoposide 50 mg/m2+Doxorubicine 10mg/m2+Vincristine 0, 4 mg/m2 continuous IV infusion 24h days 1–4, cyclophosphamide 750mg/m2 IV day 5, Prednisone 60mg/m2 oral days 1 to 5. Patients were infused at home using an elastomeric infuser. Home treatment was prepared individually by the pharmacist.ResultsHome infusion chemotherapy treatment was performed in 46 patients. 43,4% with non-Hodgkin’s lymphoma received ESHAP in second-line, with a median age of 51 years, and 32,6% with mantle cell lymphoma received DHAOX in first-line with a median age of 46 years and 23,9% with aggressive non-Hodgkin’s lymphoma were treated with EPOCH in first-line with median age 42 years. This allowed an optimisation of waiting lists by 90%, treating more patients requiring admission to the inpatient ward with less delay. Acceptance of the procedure increased in 92% of patients. The risk of infection by nosocomial microorganisms was reduced. A saving of 2500 euros per patient was achieved. 95% of patients said they were very satisfied receiving their chemotherapy treatment, being more comfortable.Conclusion and RelevanceHome Infusion Chemotherapy Treatment for ESHAP, DHAOX and EPOCH has been an effective, safe and feasible process. It has managed to avoid hospitalisation of haemato-oncology patients receiving IV chemotherapy, saving hospital stays, reducing nosocomial infections and improving quality of life.References and/or Acknowledgements1. Am J Health Syst Pharm. 2018 May 1;75(9):246–258.Conflict of InterestNo conflict of interest.
A metallurgical analysis on chips obtained by high speed machining of a Ti–6wt.%Al–4wt.%V alloy has been performed to provide a better understanding of chip formation mechanisms. For this purpose, ...X-ray diffraction, energy dispersive X-ray analysis, scanning electron microscopy and electron backscattering technique were employed. The titanium β phase was observed in all chips for any tested cutting speeds. No evidence of phase transformation was found in the shear bands. Microscopical observations are in agreement with the catastrophic thermoplastic shear model for saw-tooth chip formation, instead of the periodic crack initiation one.
Introduction This study aims to describe the clinical characteristics, disease activity, and structural damage in patients with axial spondyloarthritis (axSpA) who receive chronic treatment with ...nonsteroideal anti-inflammatory drugs (NSAIDs) or advanced therapies in a clinical setting. Methods Cross-sectional study on axSpA patients consecutively recruited from the outpatient clinic of a tertiary hospital. We collected data on clinical and demographic characteristics, as well as treatment patterns involving NSAIDs and advanced therapies. Structural damage was assessed using mSASSS. Results Overall, data from 193 axSpA patients (83% ankylosing spondylitis) were gathered, with a mean disease duration of 21.4 years. Of these, 85 patients (44%) were exclusively taking NSAIDs, while 108 (56%) were receiving advanced therapies, with TNF inhibitors being the predominant choice (93 out of 108, 86.1%). Among patients using NSAIDs, 64.7% followed an on-demand dosing regimen, while only 17.6% used full doses. Disease activity was low, with a mean BASDAI of 3.1 and a mean ASDAS-CRP of 1.8. In comparison to patients under chronic NSAID treatment, those taking advanced therapies were primarily male (69.4% versus 51.8%, p = 0.025) and significantly younger (mean age of 49 versus 53.9 years, p = 0.033). Additionally, patients on advanced therapies exhibited lower ASDAS-CRP ( p = 0.046), although CRP serum levels and BASDAI scores did not differ between the two groups. In the multivariable analysis, therapy (NSAID versus biological treatment) was not independently associated with ASDAS-CRP, BASDAI or mSASSS. Conclusion This cross-sectional analysis of a real-world cohort of axSpA patients shows positive clinical and radiological outcomes for both NSAIDs and advanced therapies.
Background: The acute respiratory distress syndrome (ARDS) is a non-cardiogenic form of pulmonary oedema characterised by severe hypoxaemia refractory to oxygen therapy, with diffuse pulmonary ...infiltrates on chest radiographs. It can be precipitated by various serious medical and surgical conditions, including systemic autoimmune diseases. The “catastrophic” variant of the antiphospholipid syndrome (APS) is an accelerated form of this systemic autoimmune condition which results in multiorgan failure because of multiple small vessel occlusions. Objective: To analyse the clinical and laboratory characteristics of patients with catastrophic APS who develop ARDS. Methods: Cases with ARDS were selected from the web site based international registry of patients with catastrophic APS (CAPS registry) (http://www.med.ub.es/MIMMUN/FORUM/CAPS.HTM) and their characteristics examined. Results: Pulmonary involvement was reported in 150 of 220 patients with catastrophic APS (68%) and 47 patients (21%) were diagnosed as having ARDS. Nineteen (40%) of these patients died. Pathological studies were undertaken in 10 patients and thrombotic microangiopathy was present in seven. There were no differences in age, sex, precipitating factors, clinical manifestations, or mortality between catastrophic APS patients with and without ARDS. Conclusions: ARDS is the dominant pulmonary manifestation of catastrophic APS. Thus the existence of ARDS in the context of an APS makes it necessary to rule out the presence of the catastrophic variant of this syndrome.
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