[Show abstract][Hide abstract] ABSTRACT: Background:
Cancer survivorship has emerged as an important aspect of oncology due to the possibility of physical and psychosocial complications. The purpose of this study was to assess the feasibility of the Ambulatory Medical Assistance for After Cancer (AMA-AC) procedure for monitoring lymphoma survivorship during the first year after chemotherapy.
AMA-AC is based on systematic general practitioner (GP) consultations and telephone interventions conducted by a nurse coordinator (NC) affiliated to the oncology unit, while an oncologist acts only on demand. Patients are regularly monitored for physical, psychological and social events, as well as their health-related quality of life (HRQoL). Inclusion criteria were patients newly diagnosed with non-Hodgkin or Hodgkin lymphomas, who had been treated with anthracycline-based chemotherapy and were in complete remission after treatment.
All 115 patients and 113 collaborating GPs agreed to participate in the study. For patients who achieved one year of disease-free survival (n = 104) their assessments (438 in total) were fully completed. Eleven were excluded from analysis (9 relapses and 2 deaths). The most frequent complications when taking into account all grades were arthralgia (64.3 %) and infections (41.7 %). About one third of patients developed new diseases with cardiovascular complications as the most common. Psychological disorders such as anxiety, depression and post-traumatic stress disorder were diagnosed in 42.6 % of patients. The data collected showed that Hodgkin lymphoma patients, females, and patients with lower HRQoL (mental component) at study entry were at greater risk for developing at least one psychological disorder.
This study showed that AMA-AC is a feasible and efficient procedure for monitoring lymphoma survivorship in terms of GP and patient participation rates and adherence, and provides a high quality of operable data. Hence, the AMA-AC procedure may be transferable into clinical daily practice as an alternative to standard oncologist-based follow-up.
[Show abstract][Hide abstract] ABSTRACT: Findings among a cohort of 26 patients who had hematologic malignancies and hepatitis E virus (HEV) infection support that HEV can induce chronic hepatitis. However, a 3-month course of ribavirin can induce a rapid viral clearance, reducing the risk for chronic hepatitis and enabling continuation of cytotoxic treatments for underlying malignancies.
Preview · Article · Aug 2015 · Emerging Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: Indolent non-hodgkin lymphomas (iNHL) are a rare cause of monoclonal immunoglobulin deposits-related glomerulopathy (mIgGN). In patients with iNHL-related mIgGN, whether treatment should include either single or a combination of drug(s) to target the malignant clone and renal inflammation remains elusive. In this retrospective study, we report a cohort of 14 patients with iNHL-related mIgGN (cryoglobulinemic glomerulonephritis [n=5], membranous nephropathy [n=3], membranoproliferative glomerulonephritis [n=3], AL or AL/AH amyloidosis [n=2] and Light Chain Deposits Disease [n=1]) and who received a treatment combining rituximab, cyclophosphamide and dexamethasone (RCD). After a mean follow-up of 18 ± 4 months, nine patients (63%) had complete haematological response. Renal response was observed in 12 of the 14 patients (86%; complete response: n=9; partial: n=3). Estimated glomerular filtration rate increased from 47±7 to 63±8 mL/min/1.73m2, and proteinuria decreased from 6.5±0.7 to 1.4±0.8 g/24h at one year. Following hematological relapse, renal relapse occurred in two patients suggesting sustained clonal eradication offers the best renal protection. Tolerance of RCD was good and the most frequent adverse event was pneumonia (3/14, 21%). RCD is a promising regimen for patients with iNHL and mIgGN, irrespective of glomerular pathologic pattern. Whether steroids can be avoided or minimized remains to be addressed.
Preview · Article · Oct 2014 · American Journal of Hematology
[Show abstract][Hide abstract] ABSTRACT: Purpose
Salvage of young patients with follicular lymphoma (FL) after R-CHOP includes salvage immunochemotherapy followed by autologous stem cell transplantation (ASCT). Previous studies dealing with relapsed Hodgkin lymphoma have shown the prognostic value of PET/CT prior to ASCT.
We retrospectively analysed 59 patients with refractory/relapsed FL after first-line R-CHOP who were chemosensitive (as evaluated by CT) to the salvage treatment and who proceeded to ASCT. The role of PET/CT in this setting to define chemosensitivity is not definitely established. So we focused on the prognostic value of PET/CT performed after salvage treatment, before ASCT.
The estimated 3-year progression-free survival (PFS) and overall survival were 63.1 % (50.9–78.3 %) and 90.5 % (82.8 – 98.8 %), respectively, and did not differ significantly according to their Follicular Lymphoma International Prognostic Index at relapse, conditioning regimen, or type of salvage. PFS was significantly lower in PET/CT-positive patients, according to the International Harmonization Project revised response criteria, with a 3-year PFS of 45.5 % (26.6 – 77.8 %) versus 72.6 % (58.5 – 90.0 %; p = 0.039). To better refine prognosis, we applied two types of throsholds: a Deauville five-point scale positive threshold of ≥3 (3-year PFS of 74.9 %, range 61.0 – 92.1 % %, versus 42.8 %, range 24.7 – 74.4 %; p = 0.02), and a ≥70 % ∆SUVmax threshold between presalvage and pre-ASCT PET/CT (3-year PFS of 72.4 %, range 57.5 – 91.3 % versus 13.3 %, 2.2 – 81.7 %; p
Full-text · Article · Sep 2014 · European journal of nuclear medicine and molecular imaging
[Show abstract][Hide abstract] ABSTRACT: Optimal treatment strategies are lacking in relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL). Gemcitabine has shown activity and acceptable safety profile in B-cell lymphomas. We present a retrospective case review of gemcitabine and alemtuzumab, every 21 days (for up to six courses) in 27 community-based patients with high risk R/R CLL. Median age was 70 years (44-83y), 55% patients had Binet stage C, deletion 17p (del(17p)) and/or deletion 11q (del(11q)) were found in 65% and 27%, bulky disease in 55.5%, and fludarabine-refractoriness in 48% of cases, respectively. Overall response rate was 63% (29.6% clinical CR and 33.4% PR). At a median follow up of 31 months, median PFS and OS were 15.4 and 24 months. In multivariate analysis, median OS is influenced by prior lines of treatment =3, and bulky disease. Combination of alemtuzumab and gemcitabine appears to be an active, easy to administrate treatment in routine practice, high risk R/R CLL patients. This article is protected by copyright. All rights reserved.
No preview · Article · Jun 2014 · European Journal Of Haematology
[Show abstract][Hide abstract] ABSTRACT: To date, the majority of trials on chronic lymphocytic leukemia (CLL) focused on patients considerably younger than the median age of onset for CLL. As a result, no definitive treatment exists for elderly patients, especially less medically fit patients.
The objectives of this study are to examine the impact of comorbidities on outcome as well as to compare three different therapeutic regimens in outcome efficacy.
We retrospectively identified 143 patients aged >65 years, who received fludarabine, cyclophosphamide, and rituximab (FCR) (n=49), fludarabine and rituximab (FR) (n=74), or rituximab with chlorambucil (R-CLB) (n=20) as first initial immunochemotherapy.
At current follow-up (median: 24 months), the proportion of patients with a clinical response was higher with FCR (75%) than FR (57%) and R-CLB (28%). For FCR, FR, and R-CLB patients, 2-year overall survival (OS) was 94%, 76%, and 73%, respectively, (p=0.14), while 2-year progression-free survival (PFS) was 90%, 58%, and 30% (p<0.001). In the fludarabine based regimen (FR and FCR) population, higher rituximab doses (500mg/m(2) vs. 375mg/m(2)) correlated with prolonged PFS.
Despite the retrospective nature of this study, we demonstrate that elderly patients with CLL benefit from frontline immunochemotherapy, and emphasize the importance of maintaining rituximab dose intensity.
No preview · Article · Apr 2013 · Journal of Geriatric Oncology
[Show abstract][Hide abstract] ABSTRACT: Background. fludarabine-cyclophosphamide-rituximab is the most efficient first-line treatment for chronic lymphocytic leukemia patients. Many dose adjustments of the original MD Anderson Cancer Center regimen have been proposed. However, whether fludarabine-cyclophosphamide-rituximab relative dose intensity may impact outcome has not been investigated before. Design and Methods. we retrospectively assessed relative dose intensity in 106 community-based patients, included in our regional healthcare network from 2004-11, all receiving fludarabine-cyclophosphamide-rituximab first-line outside a clinical trial. Results. Dose reductions were noticed in 51.4% of patients, mainly due to physician's individual decision not based on recommendation (52.7%) while documented toxicity or dose reduction because of impaired renal function played lesser roles. Progression-free survival was significantly reduced in patients who had a reduction of dose intensity greater than 20% in fludarabine-cyclophosphamide and/or rituximab. On multivariate analysis, dose of rituximab has significant impact on was significantly linked to prolonged minimal residual disease and progression-free survival. Though prophylactic gGranulocyte-cColony sStimulating fFactor significantly reduced the rate of grade 3-4 neutropenia and febrile neutropenia, it but had no impact on relative dose intensity and outcome. Conclusions. this study shows that, in routine clinical practice, the adherence rate to the original MD Anderson Cancer Center fludarabine-cyclophosphamide-rituximab schedule is low, mostly due to individual physician's decision based on anticipated toxicity. This study shows that reduction of fludarabine-cyclophosphamide and, more importantly, of rituximab doses seriously interfere with progression-free survival.
[Show abstract][Hide abstract] ABSTRACT: Le pronostic des lymphomes B diffus à grandes cellules (LBDGC) a été amélioré par de nouveaux schémas thérapeutiques tels
que le R-CHOP ou dérivés. Toutefois, ces traitements sont associés à des effets secondaires survenant à domicile et qui altèrent
qualité de vie, sécurité des soins et observance thérapeutique. Nous proposons une procédure de surveillance téléphonique
à domicile basée sur l’appel systématique du patient par une infirmière spécialisée. Cette procédure dite Assistance des malades
ambulatoires (AMA) a été évaluée à partir d’une cohorte de 135 LBDGC traités par RCHOP ou dérivés (4 287 appels sur une période
de 42 mois). AMA est faisable, productive (25 % des appels génèrent une intervention), efficace dans sa fonction de tri d’information
et de gain de temps médical. AMA semble aussi améliorer l’observance thérapeutique.
The prognosis of diffuse large B-cell lymphoma (DLBL) has improved with the development of new therapeutic regimes such as
R-CHOP and related chemotherapy. However, these treatments are associated with adverse effects that arise at home and which
can affect quality of life, patient safety and compliance with therapy. We have used a system of monitoring the patient in
the home based on regular telephone calls from a specialist nurse. This method, which we call Outpatient Support (OPS) has
been assessed in a cohort of 135 DLBL patients treated with RCHOP or similar chemotherapy (4 287 calls over a period of 42
months). OPS is feasible, productive (25% of calls result in an intervention) and effective in sorting information and saving
medical time. OPS seems also to improve compliance with therapy.
Mots clésLymphome agressif–Suivi à domicile–Sécurité des soins–Observance
KeywordsAggressive lymphoma–Follow-up at home–Patient safety–Compliance
[Show abstract][Hide abstract] ABSTRACT: During chemotherapy, patients experience disabling side effects or even sometimes life-threatening treatment-related complications, contributing to poor quality of life, reduced therapeutic compliance, decreased relative dose-intensity, and ultimately poorer outcomes.
The Ambulatory Medical Assistance (AMA) project, a monitoring procedure based on a standardized telephone intervention, was aimed to improve ambulatory care quality in aggressive B-cell lymphomas treated with standard front-line R-CHOP therapy.
Non-comparative prospective study.
Over a three-years period, one hundred diffuse large B cell lymphoma (DLBCL) patients were treated in a single hospital and monitored in an ambulatory setting through planned telephone interventions delivered by a single nurse under the supervision of an oncologist.
In addition to biological monitoring, patients received a bi-weekly telephone call from an oncology-certified nurse. All events were recorded on a call form, which was forwarded to a supervisor oncologist. Nurse calls resulted in one of the following: no intervention, grade 1 intervention based on a pre-established protocol managed by the nurse under oncologist supervision, or grade 2 intervention related to more severe complications, managed directly by the oncologist, and mostly resulting in secondary hospitalization.
The AMA procedure consisted of 3592 phone calls (600 h) resulting in 989 interventions (27.5%). Grade 1 intervention represented 950 cases whereas grade 2 intervention was noted in only 39 cases (3.9%). AMA also appeared to improve medical management. Indeed, compared to the literature, we observed lower incidence in secondary hospitalization (6%), delayed treatment (6%), reduced relative dose-intensity (RDI) (no patient with RDI<80%), toxic death (0%), and red blood cell transfusion (13%).
AMA appears to improve R-CHOP therapy management. However, comparative studies are needed to demonstrate the advantage of the AMA over standard management, in terms of therapeutic compliance, progression-free survival, and medico-economics efficacy.
No preview · Article · Feb 2011 · International journal of nursing studies
[Show abstract][Hide abstract] ABSTRACT: We report our experience on rituximab-cyclophosphamide-dexamethasone (RCD) combination therapy for the treatment of autoimmune disorders (AIDs) in 48 chronic lymphocytic leukemia (CLL) patients. Overall, 81% of patients were relapsing for AID after previous treatment with corticosteroids, splenectomy, rituximab or alemtuzumab. Diagnosis of AID was autoimmune hemolytic anemia (AIHA) in 26 (54%), autoimmune thrombocytopenia (AITP) in 9 (18.8%), Evan's syndrome in 8 (16.7%) and pure red cell aplasia (PRCA) in 5 patients (10.5%). Median time of autoimmune disorder (AID) onset from CLL diagnosis was 60 months (range: 0-240), and CLL was considered progressive in 40% of subjects upon AID diagnosis (complex AID). Median hemoglobin pre-treatment was 7.7 g/100 ml, and median platelet count 36.5 × 10(9)/l, returning to a median of 12.5 /100ml and 37.5 × 10(9)/l, respectively. Overall, an 89.5% response rate was obtained with this combination, irrespective of the AID type. Relapse occurred in 19 patients (39.6%). Median duration of response for autoimmunity (DR-AI) was 24 months, but DR-AI was higher for patients presenting: (1) AID early during CLL course (<3 years), or (2) both PRCA and AIHA. Median time to CLL progression in 48 patients was 16 months, but this time was statistically shorter for Evan's syndrome and AITP patients as compared with AIHA and PRCA patients. This study emphasizes the relevance of CLL-directed immune chemotherapy in the management of CLL-associated AID.
No preview · Article · Dec 2010 · Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K