scholarly journals How I treat fragile myeloma patients

Blood ◽  
2015 ◽  
Vol 126 (19) ◽  
pp. 2179-2185 ◽  
Author(s):  
Alessandra Larocca ◽  
Antonio Palumbo
Keyword(s):  
Elderly People ◽  
Performance Status ◽  
The Elderly ◽  
New Drugs ◽  
Adequate Treatment ◽  
Treatment Regimens ◽  
High Prevalence ◽  
Choice Of Treatment ◽  
And Performance ◽  
Assessment Strategies

Abstract Multiple myeloma is a disease typical of elderly people, with a median age at diagnosis of 70 years. Much progress has been made in the past few years thanks to the introduction of new drugs. However, increases in survival were much less pronounced in patients aged 60 to 69 years, and no improvement was seen in older patients. Furthermore, the currently approved treatment regimens were tested in clinical trials with stringent inclusion criteria. Aging is associated with a high prevalence of frailty, that is, a state of increased vulnerability to stressors due to a critical decline in physiologic reserves. Elderly people may be categorized as fit or frail according to clinical, functional, cognitive, and socioeconomic criteria. The presence of frailty may complicate the management and outcome of myeloma patients. To date, the choice of treatment of myeloma patients has focused primarily on chronological age and performance status as markers of frailty. However, the elderly population is highly heterogeneous, and improved assessment strategies are needed to define the frailty profile of patients and provide them with the most adequate treatment, thus avoiding the overtreatment of frail patients and the undertreatment of fit patients. The geriatric assessment is a fundamental tool for the evaluation of cognitive and functional status.

Adjuvant Vinorelbine and Cisplatin in Elderly Patients: National Cancer Institute of Canada and Intergroup Study JBR.10

2007 ◽  
Vol 25 (12) ◽  
pp. 1553-1561 ◽  
Author(s):  
Carmela Pepe ◽  
Baktiar Hasan ◽  
Timothy L. Winton ◽  
Lesley Seymour ◽  
Barbara Graham ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Elderly Patients ◽  
National Cancer Institute ◽  
Performance Status ◽  
The Elderly ◽  
Small Cell ◽  
Age Group ◽  
Small Cell Lung ◽  
Significant Survival ◽  
And Performance

PurposeRecent trials have shown significant survival benefit from adjuvant chemotherapy for non–small-cell lung cancer (NSCLC). Whether elderly patients tolerate platinum-based adjuvant chemotherapy and derive the same survival advantage is unknown. This retrospective study evaluated the influence of age on survival, adjuvant chemotherapy delivery, and toxicity in National Cancer Institute of Canada (NCIC) Clinical Trials Group study JBR.10.Patients and MethodsPretreatment characteristics and survival were compared for 327 young (≤ 65 years) and 155 elderly (> 65 years) patients. Chemotherapy delivery and toxicity were compared for 213 treated patients (63 elderly, 150 young).ResultsBaseline demographics by age were similar with the exception of histology (adenocarcinoma: 58% young, 43% elderly; squamous: 32% young, 49% elderly; P = .001) and performance status (PS; PS 0: 53% young, 41% elderly; P = .01). Chemotherapy significantly prolonged overall survival for elderly patients (hazard ratio, 0.61; 95% CI, 0.38 to 0.98; P = .04). This benefit is similar to the effect for all patients in JBR.10. Mean dose-intensities of vinorelbine and cisplatin were 13.2 and 18.0 mg/m2/wk in young, respectively, and 9.9 and 14.1 mg/m2/wk in elderly patients (vinorelbine, P = .0004; cisplatin, P = .001), respectively. The elderly received significantly fewer doses of vinorelbine (P = .014) and cisplatin (P = .006). Fewer elderly patients completed treatment and more refused treatment (P = .03). There were no significant differences in toxicities, hospitalization, or treatment-related death by age group. Fifteen (11.9%) of 126 deaths in the young resulted from nonmalignant causes, and 15 (21.1%) of 71 in the elderly (P = .13).ConclusionDespite elderly patients’ receiving less chemotherapy, adjuvant vinorelbine and cisplatin improves survival in patients older than 65 years with acceptable toxicity. Adjuvant chemotherapy should not be withheld from elderly patients.

Haemopoietic diseases: leukaemias and myelomas

2017 ◽  
pp. 721-726
Author(s):  
Roberto Mina ◽  
Alessandra Larocca ◽  
Antonio Palumbo
Keyword(s):  
Older Patients ◽  
Performance Status ◽  
Current Approach ◽  
Chronological Age ◽  
Targeted Drugs ◽  
Therapeutic Landscape ◽  
Choice Of Treatment ◽  
Geriatric Evaluation ◽  
And Performance ◽  
Near Future

The demographic revolution driven by the ageing of the general population is rapidly changing the therapeutic landscape in the onco-haematological setting. Acute and chronic leukaemias and myeloma are typical disorders of older people, and their incidence is expected to rise in the near future. The introduction of new targeted drugs has led to a survival improvement, which is still significantly inferior in elderly patients as compared with younger ones. The current approach to older patients, based on chronological age and performance status, is no longer sufficient to fully characterize patients, whereas comprehensive geriatric assessment (CGA) is a better tool to make a thorough evaluation (physical and cognitive) and to tailor treatment according to patients’ fitness. Since there is evolving consensus about the optimal tools for a geriatric evaluation in the haematological setting, studies aimed at validating CGA are necessary to stratify patients and guide physicians in the choice of treatment.

Impact of Ibruprofen Medication and Prosthetic Esthetical Treatment in Elderly Patients with Temporal Mandibular Joint Disorders and Deppresion

2018 ◽  
Vol 69 (4) ◽  
pp. 831-836
Author(s):  
Laura Checherita ◽  
L. S. Burlea ◽  
O. Stamatin ◽  
D. Manuc
Keyword(s):  
Elderly Patients ◽  
Prospective Study ◽  
Elderly People ◽  
The Elderly ◽  
Male Gender ◽  
Elderly Subjects ◽  
Improved Outcomes ◽  
High Prevalence ◽  
Prevalence Of Pain ◽  
A Prospective Study

Affections of temporomandibular joint (TMJ) can lead to imbalances and disfuntions named temporomandibular desorders (TMDs). Elderly people with TMDs are experiencing more severe phenomena due to instability centric relationship, edentation, hypotonia, and cranio-mandibular malrelations, neurologic and chronic diseases. The aim of this study is to investigate the efficiency of the anti-inflamatory treatment followed by prosthetic, estethic and gnathologic treatment in elderly. This is a prospective study, based on data obtained from 410 elderly people, 74 female and 33 male gender subjects. In the studied group we found a high prevalence of pain (42.99%) and articular affectation (25.23%) which is due both to the grade of edentation and to complications of it, also the muscular affectation, headache, modification of the cranial-mandibular relations, psychological affectation. The prevalence of depressive manifestations was high (35.51%) and after the ibuprofen treatment in association with prosthetic treatment was completed decreased (at 23.36%) in the elderly subjects. In conclusion, the anti-inflamatory treatment followed by prosthetic treatment and also esthetical one determined the improved outcomes of the TMDs in elderly patients, not only in terms of pain and depression but also clinically, meaning at the TMJ function and in all the intraoral and facial as

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

2018 ◽  
Vol 39 (01) ◽  
pp. 043-052 ◽  
Author(s):  
Melody Xu ◽  
Mary Feng
Keyword(s):  
Radiation Therapy ◽  
Performance Status ◽  
Locally Advanced ◽  
Locoregional Therapy ◽  
Severe Toxicity ◽  
Technological Advances ◽  
Wide Range ◽  
Choice Of Treatment ◽  
Transplant Candidates ◽  
And Performance

AbstractHepatocellular carcinoma (HCC) is a complex and diverse disease, with choice of treatment dependent on a patient's disease burden, location of disease, underlying liver function, and performance status. While radiation therapy (RT) was historically omitted from treatment algorithms, immense technological advances over the past several decades have enabled introduction of RT as an effective and safe treatment option for patients with HCC. Growing prospective and retrospective evidence supports the use of RT, particularly stereotactic body radiotherapy (SBRT), for a wide range of indications in HCC from locally advanced unresectable disease to bridge therapy for liver transplant candidates. SBRT is associated with excellent local control, even for patients refractory to or ineligible for other forms of locoregional therapy. Treatment is well-tolerated and associated with low rates of severe toxicity. Randomized trials are needed to define the role of SBRT in HCC treatment relative to other established locoregional treatments.

scholarly journals Perspectives for treating Alzheimer's disease: a review on promising pharmacological substances

2016 ◽  
Vol 134 (4) ◽  
pp. 342-354 ◽  
Author(s):  
Maurílio de Souza Cazarim ◽  
Julio Cesar Moriguti ◽  
Abayomi Tolulope Ogunjimi ◽  
Leonardo Régis Leira Pereira
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Molecular Mechanisms ◽  
The Elderly ◽  
Pharmacological Action ◽  
New Drugs ◽  
Cochrane Library ◽  
High Prevalence ◽  
Common Causes ◽  
Unclear Risk

ABSTRACT CONTEXT AND OBJECTIVE: Dementia is a syndrome characterized by functional and cognitive decline. Alzheimer's disease (AD) is one of the most common causes of dementia and has high prevalence among the elderly. It is known that there is no drug capable of interfering with the course of the disease. Research on treatments for AD has been marked by the appearance of new drugs and their abandonment. This study aimed to describe drugs that have been studied with regard to treating AD and which are capable of influencing the course of the disease. DESIGN AND SETTING: Narrative review on original articles published worldwide. METHODS: A systematized search was conducted in the PubMed/MEDLINE, Cochrane Library/Cochrane and SciELO/Bireme databases. The descriptors "Molecular Mechanisms of Pharmacological Action" and "Drug Therapy" were each combined with the descriptor "Alzheimer disease". All of these can be found in MeSH and DeCS. These descriptors were used alone or in combination, and a filter specifying publication between January 2009 and October 2015 in English, Spanish or Portuguese was set. RESULTS: 6,888 articles were found, of which 37 were included in this review; 70.3% of the articles selected were of good quality with low or unclear risk of bias. 86 drugs were considered promising for AD treatment and these were classified into 20 pharmacological categories. CONCLUSION: There are no drugs capable of influencing the course of AD such that treatments are safe and effective. However, immunomodulators stood out as promising, given their effectiveness and quality in the articles analyzed.

scholarly journals PROGNOSTIC MARKERS IN PATIENTS WITH THYMUS-INDEPENDENT AND THYMUS-DEPENDENT MYASTHENIA GRAVIS

2021 ◽  
Vol 29 (4) ◽  
pp. 426-433
Author(s):  
O.M. Klimova ◽  
◽  
V.V. Boyko ◽  
L.A. Drozdova ◽  
O.V. Lavinska ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Elderly People ◽  
Nicotinic Acetylcholine Receptors ◽  
Acetylcholine Receptors ◽  
Antinuclear Antibodies ◽  
Young Patients ◽  
The Elderly ◽  
Hla Dr ◽  
Choice Of Treatment ◽  
The Relationship

Objective. To assess the presence of specific markers in patients with thymus-independent and thymus-dependent myasthenia gravis for choosing treatment tactics. Methods. The presence of specific markers was assessed in 138 patients with thymus-independent (M - myasthenia gravis without thymus changes) and thymus-dependent (MH - myasthenia gravis with thymus hyperplasia, MT - myasthenia gravis with thymoma). The method ELISA (the content of antibodies to subunits 1 and 7 nAChR in blood serum, to 7 nAChR subunit in thymocyte mitochondria, a detectablelevel of antinuclear antibody(ANA), immunofluorescence (ANA glow) and flow cytometry (expression of CD14+CD11c+and CD14 + HLA-DR +) has been used. Results. The relationship between the clinical phenotypes of myasthenia gravis and the variants of HLA diplotypes was revealed: in young patients with thymus-independent myasthenia gravis (M), a high heterogeneity of the genotypic markers HLA-DR (DR1, DR2, DR3, DR5, DR7) was detected. Patients with thymus-dependent myasthenia (MT) had only the HLA DR2 and HLA DR7 diplo- and haplotypes. The presence of HLA DR2 and HLA DR7 haplotypes in some young patients with progressive thymus-independent myasthenia gravis (M) led to the development of myasthenia gravis with thymoma (MT) in the elderly people. The pathogenic role also belongs to infection (СMV, EBV, HBV, HCV, HSV-1, HSV-2, HHV-6, mycoplasma) and food intolerance (IgE and IgG4) in the development and progression of myasthenia gravis. A four-fold prevalence of α7 subunit nicotinic acetylcholine receptors on the thymocyte mitochondria as an additional targets of autoimmune aggression in myasthenia gravis was determined. Specific antinuclear antibodies to centromere chromosome proteins were visualized in the elderly people with thymoma. Conclusion. The prognosis of the myasthenia gravis progression and the development of remission can be made using genomic (the presence of certain HLA-DR haplotypes) and molecular (ANA antibodies to centromere chromosome proteins, expression of CD20+, CD14+CD11c+, CD14+HLA-DR+) biomarkers, that can be used for the choice of treatment tactics. What this paper adds The change of complex biomarkers has been firstly studied for prognosis and choice of complex treatment tactics for young patients with progressive thymus-independent myasthenia gravis and for the elderly patients with thymus-dependent myasthenia gravis. In the presence of certain HLA-DR haplotypes, antinuclear antibodies to centromere chromosome proteins, an increasing expression of CD20+, CD14+CD11c+ and CD14+HLADR+ in some young patients with thymus-independent myasthenia gravis, analogically to biomarkers in thymus-dependent myasthenia gravis with thymoma, to perform a thymectomy is of high dangerous. potentialrisksof the procedure.

scholarly journals A Percepção do Engasgo por Idosos Institucionalizados

2005 ◽  
Vol 7 ◽  
Author(s):  
Maira Rozenfeld
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Literature Review ◽  
Elderly People ◽  
The Elderly ◽  
Swallowing Disorders ◽  
Home Education ◽  
High Prevalence

Resumo: Existe uma alta incidência de alterações de deglutição em idosos institucionalizados. Os sentidos associados a essa queixa, com base nas representações e significados que os idosos atribuem a este sintoma, apontam um caminho para uma proposta educativa. Esta proposta tem por objetivo desmistificar o engasgo como algo inerente à velhice, possibilitando assim um novo olhar que permita a redução deste sintoma através do esclarecimento não só aos idosos, que tenham a queixa, mas a toda a população. Desta forma, uma ressignificação do sintoma implica em uma melhor qualidade de vida. Este trabalho inicialmente realiza uma revisão de literatura a respeito das alterações de deglutição, suas questões objetivas e subjetivas (as marcas que este sintoma traz para o idoso), logo após é realizada uma discussão a respeito das representações que um grupo de idosos institucionalizados atribui a este sintoma e finaliza com uma proposta educativa. Palavras-chave: Idosos. Alterações de Deglutição. Engasgos. Institucionalização. Educação. Abstract: Being known as the high prevalence of swallowing disorders on the elderly at a nursing home. I realized that the meaning related with this symptom show us a way to do an educative proposed. This is necessary to give more information to the elderly and to the population in general. The nature of swallowing disorders and the means of minimizing them improve their quality of life. This work starts with a literature review about swallowing disorders, recognizing how elderly people at nursing home perceive their problem symptom and finishes with an educative proposed to the population. Keywords: Elderly. Swallowing Disorders. Gagging. Nursing Home. Education.

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