DaraRD in systemic AL amyloidosis: high efficacy, relevant toxicity and main adverse effect of gain 1q21

BACKGROUND: High dose chemotherapy followed by autologous peripheral blood stem cell transplantation is an effective treatment for multiple myeloma. However, many patients with newly diagnosed multiple myeloma are transplant-ineligible because of their age and complications, result in a poorer prognosis than transplant-eligible patients. Furthermore, many of them cannot complete normal chemotherapy because of low tolerability. Here, we investigated the efficacy and safety of modified bortezomib with lenalidomide and dexamethasone (mVRD-lite) for transplant-ineligible patients with newly diagnosed multiple myeloma. STUDY DESIGN: A retrospective observational analysis was performed on patients who received mVRd-lite for the first line chemotherapy between Jan. 2016 and Mar. 2020 in our hospital. Patients who received high dose dexamethasone to reduce tumor burden, and patients who received bortezomib with dexamethasone or lenalidomide with dexamethasone as a reduction regimen of mVRd-lite were also included. We evaluated ORR, OS, PFS and adverse effect. mVRD-lite at first was administered over a 28-day cycle. Bortezomib 1.3 mg/m2 weekly was administered subcutaneously on days 1, 8, 15 and 22. Lenalidomide 15 mg was given orally 18 days, omitted on days 1, 8, 15, which are the days of bortezomib administration. Dexamethasone 20 mg was given orally on days 1, 2, 8, 9, 15, 16, 22, which are the day of and day after bortezomib. We also reviewed patients background, especially complication of light-chain amyloidosis and considered the impact of cardiac amyloidosis on patient prognosis. This study was conducted with the permission of the Ethics Review Board in our hospital. RESULTS: The subjects analyzed totaled 40 transplant-ineligible patients. 11(27.5%) patients were AL amyloidosis associated with multiple myeloma and 8(20%) patients had cardiac amyloidosis. Median age at diagnosis was 73 (range 48-86) and Male:Female=1:1. Most of them were judged inadequate to transplantation due to their age, general condition, or complication. One patient was ruled unfit to transplantation, because of his refusion. The Revised International Staging System (R-ISS) were I in 5 (12.5%), II in 25 (62.5%) and III in 8 (20%). 5(25%) patients switched to maintenance therapy. 17(42.5%) patients discontinued treatment, because of adverse effect (cardiac failure 4 ; two of them combined with cardiac amyloidosis, rash 4, peripheral neuropathy 3, infection 3, etc). 2(5%) patients died during treatment by mVRd-lite, because of Grade 4 adverse effect, such as pneumonia. 11(27.5%) patients died during observation period and causes of death were primary disease and TRM. 1(2.5%) patient was died of heart failure associated with cardiac amyloidosis. The overall response rate(ORR) during treatment period of mVRd-lite was obtained in 34(85%), including sCR in 5 (12.5%), VGPR in 13 (32.5%) and PR in 14(30%). 2(5%) patients achieved MRD negative. SD were observed in 3(7.5%) patients. 3(7.5%) patients were not evaluated efficacy because of treatment interruption by adverse effect. Overall survival rate at two year is 64.3%, median OS was not reached, at a median follow-up of 20 months. CONCLUSIONS: Transplant-ineligible multiple myeloma patients are associated with poor prognosis. Modified RVD-lite is one of the appropriate therapeutic options, in the transplant-ineligible multiple myeloma patients. Twenty-five percent of patients with cardiac amyloidosis had treatment discontinued due to cardiac complications. Further study is needed for treatment of patients with multiple myeloma complicated with cardiac amyloidosis. Disclosures Ishida: Janssen: Speakers Bureau; Celgene: Speakers Bureau; Ono pharmaceutical co: Speakers Bureau; Takeda pharmaceutical co: Speakers Bureau. Nashimoto:Janssen: Speakers Bureau; Celgene: Speakers Bureau. Tsukada:Takeda pharmaceutical co: Speakers Bureau. Suzuki:Takeda, Amgen, Janssen and Celgene: Consultancy; Takeda, Celgene, ONO, Amgen, Novartis, Sanofi, Bristol-Myers Squibb, AbbVie and Janssen: Honoraria; Bristol-Myers Squibb, Celgene and Amgen: Research Funding.

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Evidence that the Main Adverse Effect of Ganirelix on Pregnancy and Implantation Rates is on the Embryo Rather than the Endometrium

Fertility and Sterility ◽

10.1016/j.fertnstert.2009.01.043 ◽

2009 ◽

Vol 91 (3) ◽

pp. S19

Author(s):

M. Press ◽

J.H. Check ◽

J. Amui ◽

J.K. Choe ◽

D. Brasile

Keyword(s):

Adverse Effect ◽

Main Adverse Effect ◽

Implantation Rates

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Experimental studies on seed production of tropical grasses in Kenya. 5. The effect of time of nitrogen top dressing on seed crops of Setaria sphacelata cv. Nandi.

Netherlands Journal of Agricultural Science ◽

10.18174/njas.v20i4.17271 ◽

1972 ◽

Vol 20 (4) ◽

pp. 225-231

Author(s):

J.G. Boonman

Keyword(s):

Adverse Effect ◽

Seed Production ◽

Rainy Season ◽

Seed Set ◽

Experimental Studies ◽

Late Season ◽

Main Adverse Effect ◽

Setaria Sphacelata ◽

Seed Crops ◽

Seed Yields

Effects of date of applying top-dressings of N to early-season and late-season seed crops of Setaria sphacelata cv. Nandi were studied in 4 trials in 1967-71. Highest seed yields were obtained when N was applied as soon as possible after the onset of the rainy season; a delay of 4 weeks reduced yields of pure germinating seed by >60%. Total yields of herbage DM and number of heads were also reduced, but to a lesser extent; the main adverse effect was on seed set/head. In late-season crops, applying N 2 weeks after the earliest possible date proved beneficial in 2 out of 3 years. (Abstract retrieved from CAB Abstracts by CABI’s permission)

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Cannabis Extract CT-921 Has a High Efficacy–Adverse Effect Profile in a Neuropathic Pain Model

Drug Design Development and Therapy ◽

10.2147/dddt.s247584 ◽

2020 ◽

Vol Volume 14 ◽

pp. 3351-3361

Author(s):

Elham Rouhollahi ◽

Bernard A MacLeod ◽

Alasdair M Barr ◽

Ernest Puil

Keyword(s):

Adverse Effect ◽

Neuropathic Pain ◽

Adverse Effect Profile ◽

High Efficacy ◽

Pain Model ◽

Neuropathic Pain Model ◽

Cannabis Extract

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Diffuse Alveolar Hemorrhage Associated with Edoxaban Therapy

Case Reports in Critical Care ◽

10.1155/2016/7938062 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Kenichi Nitta ◽

Hiroshi Imamura ◽

Akihiro Yashio ◽

Satoko Kashima ◽

Katsunori Mochizuki

Keyword(s):

Adverse Effect ◽

Major Bleeding ◽

Serum Levels ◽

Antineutrophil Cytoplasmic Antibody ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Reversal Agent ◽

Lower Limb Fractures ◽

Main Adverse Effect ◽

Limb Fractures

Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures. On day 8, she developed deep venous thrombosis, and edoxaban was administered orally. On day 38, she developed fungemia, which was treated with an antifungal drug. On day 43, she presented with dyspnea. Chest computed tomography scan showed bilateral diffuse ground-glass opacities in the whole lung fields. The results of the subsequent workup (i.e., serum levels of the antineutrophil cytoplasmic antibody, antinuclear antibody, and antiglomerular basement membrane antibody) and microbiological study were unremarkable. Based on these findings, her condition was diagnosed as diffuse alveolar hemorrhage (DAH) associated with edoxaban therapy. The lung opacities disappeared spontaneously after edoxaban therapy was discontinued. Conclusion. DAH is a dangerous complication associated with edoxaban therapy. DOACs, including edoxaban, should be prescribed with caution, especially for patients in a critical condition.

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A RARE COMPLICATION OF BCG IMMUNOTHERAPY

CBU International Conference Proceedings ◽

10.12955/cbup.v5.1061 ◽

2017 ◽

Vol 5 ◽

pp. 1009-1012

Author(s):

Entela Kolovani ◽

Ergys RamosaĂ§o ◽

Rovena Byku ◽

Najada Ă‡omo ◽

Rezart Xhani ◽

...

Keyword(s):

Adverse Effect ◽

Rare Complication ◽

Effective Agent ◽

Adequate Treatment ◽

Bcg Immunotherapy ◽

Main Adverse Effect ◽

Superficial Bladder Carcinoma ◽

Inflammatory Drugs ◽

Recovery Result ◽

Reiter Syndrome

Intravesical Bacillus Calmette-GuĂ©rin immunotherapy is an effective agent for superficial bladder carcinoma. The main adverse effect of this treatment is cystitis. Arthralgia and migratory arthritis occur only in 0.5% of patients. Reiter syndrome is a very rare complication that can occur after intravesical apply of Bacillus Calmette-GuĂ©rin Immunotherapy. We report the first Albanian patient who developed Reiterâ€™s syndrome, following intravesical Bacillus Calmette-GuĂ©rin. Diagnose of Reiterâ€™s Syndrome was clinically based, excluding every other reason that could have caused it. Treatment was made with non-steroid and steroid anti-inflammatory drugs, followed by a full recovery result. Even though Reiter's Syndrome is a rare, but significant complication of BCG immunotherapy, itâ€™s important to identify it in time, in order we to offer an adequate treatment.

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Perception of the risk of adverse reactions to analgesics: Differences between medical students and residents

10.7287/peerj.preprints.1890 ◽

2016 ◽

Author(s):

Sandra Castillo-Guzman ◽

Omar González-Santiago ◽

Ismael A Delgado-Leal ◽

Gerardo E Lozano-Luévano ◽

Misael J Reyes-Rodríguez ◽

...

Keyword(s):

Adverse Effect ◽

Medical Students ◽

Adverse Effects ◽

Prescription Drugs ◽

Adverse Reactions ◽

Risk Scores ◽

Gi Bleeding ◽

Drug Reactions ◽

Main Adverse Effect ◽

Prescription Behavior

Background. Medications are not exempt from adverse drug reactions (ADR) and how the physician perceives the risk of prescription drugs could influence their availability to report ADR and their prescription behavior. Methods. We assess the perception of risk and the occurrence of ADR associated with COX2-Inbitors, paracetamol, NSAIDs, and morphine in medical students and residents. Results. The analgesic with the highest risk perception was morphine, while the drug with the least risk perceived was paracetamol. Addiction was perceived as the most probable adverse effects developed by morphine. In the case of NSAIDs, the main adverse effect perceived was GI bleeding. Discussion. Our findings show that medical students give higher risk scores than residents toward risk due to analgesics. It is probable that both groups of students have morphinophobia, although more studies are necessary to confirm this. Continuing training and informing physicians about ADRs is necessary since the lack of training is known to induce inadequate use of drugs.

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Perception of the risk of adverse reactions to analgesics: Differences between medical students and residents

10.7287/peerj.preprints.1890v1 ◽

2016 ◽

Author(s):

Sandra Castillo-Guzman ◽

Omar González-Santiago ◽

Ismael A Delgado-Leal ◽

Gerardo E Lozano-Luévano ◽

Misael J Reyes-Rodríguez ◽

...

Keyword(s):

Adverse Effect ◽

Medical Students ◽

Adverse Effects ◽

Prescription Drugs ◽

Adverse Reactions ◽

Risk Scores ◽

Gi Bleeding ◽

Drug Reactions ◽

Main Adverse Effect ◽

Prescription Behavior

Background. Medications are not exempt from adverse drug reactions (ADR) and how the physician perceives the risk of prescription drugs could influence their availability to report ADR and their prescription behavior. Methods. We assess the perception of risk and the occurrence of ADR associated with COX2-Inbitors, paracetamol, NSAIDs, and morphine in medical students and residents. Results. The analgesic with the highest risk perception was morphine, while the drug with the least risk perceived was paracetamol. Addiction was perceived as the most probable adverse effects developed by morphine. In the case of NSAIDs, the main adverse effect perceived was GI bleeding. Discussion. Our findings show that medical students give higher risk scores than residents toward risk due to analgesics. It is probable that both groups of students have morphinophobia, although more studies are necessary to confirm this. Continuing training and informing physicians about ADRs is necessary since the lack of training is known to induce inadequate use of drugs.

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