Toxicity Burden of Bleomycin Treatment in Hodgkin Lymphoma: A Systematic Literature Review

Abstract Introduction: Bleomycin has been a component of chemotherapeutic regimens for decades, typically among young individuals who may survive for long periods. Yet, toxicity from bleomycin may result in short-term and long-term health problems. The study objectives were to characterize the occurrence and severity of bleomycin toxicities and identify risk factors for bleomycin toxicity among patients with Hodgkin lymphoma. Methods: A systematic literature review of the burden of bleomycin treatment in cancer patients was conducted using the PRISMA checklist. PubMed, EMBASE, and Cochrane Database were searched for English language articles between 1980 and March 2016 providing data on bleomycin toxicity in studies with >10 patients. Results: Overall, 18 original research articles of good to moderate quality were included in the systematic review for patients with Hodgkin lymphoma. Pulmonary toxicity ranged from dyspnea, pulmonary fibrosis, and pneumonitis, to acute respiratory distress syndrome and respiratory tract disorders or infections. For Hodgkin lymphoma, the proportion of patients experiencing pulmonary toxicity was >5% in 12 of 17 studies, with 8 studies reporting toxicity in 13% - 28% of patients. Other studies (n=5) reported that 0% - 4.7% of patients experienced pulmonary toxicity. About 4% -5% of Hodgkin lymphoma patients had fatal pulmonary toxicity. Skin toxicity ranged from skin rash to dermatitis and erythema, with 1% - 5% of Hodgkin lymphoma patients experiencing skin toxicity after bleomycin exposure. In the 4 studies that investigated risk factors for bleomycin-induced pulmonary toxicity among patients with Hodgkin lymphoma, low albumin level (<40 g/dL), treatment with anthracycline containing chemotherapy regimens and use of colony granulocyte stimulating factor concomitant with bleomycin were reported to be significant risk factors. No significant difference was found between patients with and without pulmonary toxicity in terms of exposure to radiation therapy, cumulative bleomycin dose, smoking history, or underlying lung involvement. Conclusions: Long-term pulmonary toxicity was not consistently evaluated in the studies and may understate the true burden on patients. Many patients treated with bleomycin may experience toxicity and sometimes fatal toxicity. Since Hodgkin lymphoma is a highly curable malignant disease and to further improve patient outcomes, attention needs to be focused on reducing treatment-related toxicities, particularly long-term morbidity and death associated with pulmonary events. Disclosures Fox: Seattle Genetics: Research Funding. Josephson:Seattle Genetics: Employment. Richhariya:Seattle Genetics, Inc.: Employment.

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Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review

Nutrients ◽

10.3390/nu13124511 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4511

Author(s):

Melani R. Mahanani ◽

Eman Abderbwih ◽

Amanda S. Wendt ◽

Andreas Deckert ◽

Khatia Antia ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Well Being ◽

In Utero ◽

Lower Probability ◽

Original Research ◽

Negative Consequences ◽

Long Term Outcomes ◽

Long Term Outcome

Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores, as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.

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Impact of informal cancer caregiving across the cancer experience: A systematic literature review of quality of life

Palliative & Supportive Care ◽

10.1017/s1478951519000622 ◽

2019 ◽

Vol 18 (2) ◽

pp. 220-240 ◽

Cited By ~ 4

Author(s):

Carol Y. Ochoa ◽

Natasha Buchanan Lunsford ◽

Judith Lee Smith

Keyword(s):

Quality Of Life ◽

Literature Review ◽

Systematic Literature Review ◽

Active Treatment ◽

Financial Burden ◽

The United States ◽

Original Research ◽

Cancer Caregivers

AbstractObjectiveInformal caregiving may likely increase as the number of cancer survivors grows. Caregiving responsibilities can impact caregivers’ quality of life (QOL). Understanding the current state of the science regarding caregiving QOL could help inform future research and intervention development.MethodsA systematic literature review in PubMed/Medline examined research on QOL among informal cancer caregivers and related psychosocial health outcomes. Original research articles in English, published between 2007 and 2017 about caregivers (aged >18 years) of adult cancer patients in the United States were included. Abstracted articles were categorized according to caregiving recipient's phase of survivorship (acute, middle to long-term, end of life/bereavement).ResultsOf 920 articles abstracted, 60 met inclusion criteria. Mean caregiver age ranged from 37 to 68 with the majority being female, non-Hispanic white, with at least a high school degree, and middle income. Almost half of the studies focused on caregivers who provided care for survivors from diagnosis through the end of active treatment. Studies examined physical health, spirituality, psychological distress, and social support. Differences in QOL were noted by caregiver age, sex, and employment status.Significance of ResultsAdditional research includes the examination of the needs of diverse cancer caregivers and determines how additional caregiver characteristics (e.g., physical functioning, financial burden, etc.) affect QOL. This includes studies examining caregiver QOL in the phases following the cessation of active treatment and assessments of health systems, support services, and insurance to determine barriers and facilitators needed to meet the immediate and long-term needs of cancer caregivers.

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Incidence and Predictors of Bleomycin Pulmonary Toxicity in Hodgkin Lymphoma (HL) Patients Treated with Adriamycin, Bleomycin, Vinblastine and Dacarbazine (ABVD),

Blood ◽

10.1182/blood.v118.21.3643.3643 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3643-3643 ◽

Cited By ~ 1

Author(s):

Haowei (Linda) Sun ◽

Eshetu Atenafu ◽

Richard Tsang ◽

Vishal Kukreti ◽

Michael Crump ◽

...

Keyword(s):

Risk Factors ◽

Board Of Directors ◽

Hodgkin Lymphoma ◽

Pulmonary Toxicity ◽

Multivariable Analysis ◽

Smoking History ◽

Sufficient Evidence ◽

Advanced Stage ◽

Advisory Committees ◽

Ecog Ps

Abstract Abstract 3643 Background: Bleomycin pulmonary toxicity (BPT) is a well described complication of bleomycin-containing chemotherapy regimens, with a reported incidence of 0–46%. Prior data in Hodgkin Lymphoma (HL) have been heterogeneous with some series reporting inferior survival in patients (pts) with BPT. We reviewed the outcome of ABVD treated pts at our institution with the goals of determining the incidence and risk factors for BPT, as well as the effect of BPT on overall and progression-free survival (OS and PFS). Methods: We retrospectively reviewed 253 newly diagnosed pts with HL treated with ABVD at Princess Margaret Hospital from 1999–2009. Pts typically received 3 cycles of ABVD + IFRT for localized disease and 6–8 cycles for advanced stage or bulky disease. BPT was defined by the presence of symptoms (fever, cough, dyspnea), bilateral interstitial infiltrates on CT, and no evidence of infection. Predictors of BPT were identified in bivariate followed by multivariable logistic regression analysis. Kaplan-Meier estimates as well as Cox proportional hazards model were used to compare OS and PFS between groups. Results: Median age at HL diagnosis was 34 years (range 17–77); 129 (51%) were male, 49% had advanced stage disease, while localized presentations were favourable: 25% and unfavourable: 26% by NCIC criteria. 77 (30%) patients had a smoking history, 121 (48%) received thoracic radiation for HL and 27(11%) had underlying lung disease. BPT was observed in 29 (11%) patients, with a median onset time of 4 months from initiation of ABVD. Bleomycin was discontinued in 20/29 patients (69%) and 19/29 (66%) patients were treated for BPT with corticosteroids (median duration: 11 weeks (range 3–23)). On bivariate analysis, risk factors associated with increased risk of BPT include age ≥45 years (55% BPT vs 28% non-BPT, p=0.003), G-CSF use (90% vs.71%, p=0.043), and ECOG PS ≥2 (24% vs.10%, p=0.02). On multivariable analysis, age ≥45 years (HR=3.1, p=0.005) and G-CSF use (HR=3.5, p=0.045) remained as independent predictors of BPT development. There was no sufficient evidence of a statistically significant difference in pulmonary risk factors in patients with or without BPT. There was a trend towards lower baseline serum albumin in BPT group, although this did not reach statistical significance (p=0.052). At a median follow-up of 5 years, OS and PFS for all 253 pts were 88% and 82%. 30 pts died due to disease progression (15), treatment-related complications (5; 3 secondary malignancies), and other causes (4). Only 3 deaths occurred among the 29 pts with BPT (2 unrelated, 1 from concomitant BPT and sepsis with multiorgan failure). On multivariable analysis, age≥60 (HR 3.7 for OS, p=0.003; HR 2.5 for PFS, p=0.019) and ECOG PS≥2 (HR 3.1 for OS, p=0.009; HR 3.0 for PFS, p=0.003) were identified as predictors of inferior survival in advanced stage HL. Increased age was associated with inferior OS (HR 1.05, p=0.031) and PFS (HR 1.06, p=0.004) in limited stage HL. Development of BPT had no significant impact on CR (97% BPT vs. 89% in non-BPT, p=0.77), 5-year OS (93% vs. 87%, p=0.80) or PFS (83% vs. 82%, p=0.98) in multivariate analysis. Bleomycin discontinuation (66 pts, 27%; 20 due to BPT, 5 skin toxicity, 36 non-BPT respiratory symptoms, 5 other) had no impact on CR rate (88% vs. 91%, p=0.19), 5-year PFS (81% vs. 83%, p=0.98), or 5-year OS (85% vs. 89%, p=0.89). Conclusions: The incidence of BPT in this series is low at 11%. Our study confirms advanced age and G-CSF usage as risk factors for BPT and identified poor PS as an independent predictor of BPT. In contrast to some prior studies, we demonstrate similar OS and PFS for pts who developed BPT or had bleomycin discontinued. This may be attributed to earlier recognition and management for suspected BPT in the past decade. Disclosures: Kukreti: Celgene: Honoraria; Ortho Biotech: Honoraria; Roche: Honoraria. Crump:Millennium Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Ortho Johnson & Johnson: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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Risk factors for orthodontic mini-implants in skeletal anchorage biological stability: a systematic literature review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-62838-7 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

María Dolores Casaña-Ruiz ◽

Carlos Bellot-Arcís ◽

Vanessa Paredes-Gallardo ◽

Verónica García-Sanz ◽

José Manuel Almerich-Silla ◽

...

Keyword(s):

Risk Factors ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Skeletal Anchorage ◽

Biological Stability ◽

Mini Implants

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Ankylosing spondylitis risk factors: a systematic literature review

Clinical Rheumatology ◽

10.1007/s10067-021-05679-7 ◽

2021 ◽

Author(s):

Mark C. Hwang ◽

Lauren Ridley ◽

John D. Reveille

Keyword(s):

Risk Factors ◽

Ankylosing Spondylitis ◽

Literature Review ◽

Systematic Literature Review

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AB0602 IMPACT OF SOCIOECONOMIC FACTORS ON PAIN AND FUNCTION IN KNEE OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3634 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1337.2-1337

Author(s):

T. W. Swinnen ◽

M. Willems ◽

I. Jonkers ◽

F. P. Luyten ◽

J. Vanrenterghem ◽

...

Keyword(s):

Risk Factors ◽

Literature Review ◽

Knee Osteoarthritis ◽

Socioeconomic Factors ◽

Systematic Literature Review ◽

Intervention Effects ◽

Socioeconomic Outcomes ◽

And Function ◽

The Impact

Background:The personal and societal burden of knee osteoarthritis (KOA) urges the research community to identify factors that predict its onset and progression. A mechanistic understanding of disease is currently lacking but needed to develop targeted interventions. Traditionally, risk factors for KOA are termed ‘local’ to the joint or ‘systemic’ referring to whole-body systems. There are however clear indications in the scientific literature that contextual factors such as socioeconomic position merit further scientific scrutiny, in order to justify a more biopsychosocial view on risk factors in KOA.Objectives:The aims of this systematic literature review were to assess the inclusion of socioeconomic factors in KOA research and to identify the impact of socioeconomic factors on pain and function in KOA.Methods:Major bibliographic databases, namely Medline, Embase, CINAHL, Web of Science and Cochrane, were independently screened by two reviewers (plus one to resolve conflicts) to identify research articles dealing with socioeconomic factors in the KOA population without arthroplasty. Included studies had to quantify the relationship between socioeconomic factors and pain or function. Main exclusion criteria were: a qualitative design, subject age below 16 years and articles not written in English or Dutch. Methodological quality was assessed via the Cochrane risk of bias tools for randomized (ROB-II) and non-randomized intervention studies (ROBIN-I) and the Newcastle-Ottawa Scale for assessing the quality of non-randomised studies. Due to heterogeneity of studies with respect to outcomes assessed and analyses performed, no meta-analysis was performed.Results:Following de-duplication, 7639 articles were available for screening (120 conflicts resolved without a third reader). In 4112 articles, the KOA population was confirmed. 1906 (25%) were excluded because of knee arthroplasty and 1621 (21%) because of other issues related to the population definition. Socioeconomic factors could not be identified in 4058 (53%) papers and were adjusted for in 211 (3%) articles. In the remaining papers covering pain (n=110) and/or function (n=81), education (62%) and race (37%) were most frequently assessed as socioeconomic factors. A huge variety of mainly dichotomous or ordinal socioeconomic outcomes was found without further methodological justification nor sensitivity analysis to unravel the impact of selected categories. Although the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was the most popular instrument to assess pain and function, data pooling was not possible as socioeconomic factors estimates were part of multilevel models in most studies. Overall results showed that lower education and African American race were consistent predictors of pain and poor function, but those effects diminished or disappeared when psychological aspects (e.g. discrimination) or poverty estimates were taken into account. When function was assessed using self-reported outcomes, the impact of socioeconomic factors was more clear versus performance-based instruments. Quality of research was low to moderate and the moderating or mediating impact of socioeconomic factors on intervention effects in KOA is understudied.Conclusion:Research on contextual socioeconomic factors in KOA is insufficiently addressed and their assessment is highly variable methodologically. Following this systematic literature review, we can highlight the importance of implementing a standardised and feasible set of socioeconomic outcomes in KOA trials1, as well as the importance of public availability of research databases including these factors. Future research should prioritise the underlying mechanisms in the effect of especially education and race on pain and function and assess its impact on intervention effects to fuel novel (non-)pharmacological approaches in KOA.References:[1]Smith TO et al. The OMERACT-OARSI Core Domain Set for Measurement in Clinical Trials of Hip and/or Knee Osteoarthritis J Rheumatol 2019. 46:981–9.Disclosure of Interests:None declared.

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Risk factors for accidental falls during pregnancy – a systematic literature review

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2021.1935849 ◽

2021 ◽

pp. 1-10

Author(s):

Ivana Hrvatin ◽

Darja Rugelj

Keyword(s):

Risk Factors ◽

Literature Review ◽

Systematic Literature Review ◽

Accidental Falls

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Prevalence of Polypharmacy and Risks of Potentially Inappropriate Medication Use in the Older Population in a Developing Country: A Systematic Review and Meta-Analysis

Gerontology ◽

10.1159/000516075 ◽

2021 ◽

pp. 1-10

Author(s):

Akshaya Srikanth Bhagavathula ◽

Eyob Alemayehu Gebreyohannes ◽

Daniela Fialova

Keyword(s):

Risk Factors ◽

Developing Countries ◽

Literature Review ◽

Developing Country ◽

Systematic Literature Review ◽

Meta Analysis ◽

Inappropriate Medication ◽

Older Age ◽

Potentially Inappropriate Medication ◽

Older Population

Background and Aim: Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia. Methods: We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI). Results: We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16–2.51) was significantly associated with PIM use. Conclusion: This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.

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