scholarly journals Hemato-oncology Tourism in Israel: A Retrospective Review

2020 ◽  
pp. 1314-1320
Author(s):  
Keren Hod ◽  
Yotam Bronstein ◽  
Gabriel Chodick ◽  
Ofer Shpilberg
Keyword(s):  
Treatment Outcomes ◽  
Hodgkin Lymphoma ◽  
Retrospective Review ◽  
Clinical Characteristics ◽  
Medical Tourism ◽  
Hematologic Malignancy ◽  
Medical Center ◽  
Complete Response ◽  
Response To Treatment ◽  
Control Group

PURPOSE Despite the significant increase in medical tourism worldwide, data on medical tourist (MT) clinical characteristics and treatment outcomes are lacking. Many MTs who choose Israel to receive medical services are individuals diagnosed with hematologic malignancies. The purpose of this study was to describe hemato-oncology MTs and to compare their disease characteristics and treatment outcomes to a control group of local (Israeli) hemato-oncology patients. MATERIALS AND METHODS In this retrospective review, we analyzed hospital records of all hemato-oncology tourists and Israeli patients diagnosed and/or treated at the Institute of Hematology, Assuta Medical Center, between 2014 and 2016. MT and local patient demographics, clinical characteristics, and treatment outcomes were compared. MT data were also analyzed according to their commitment to treatment in Israel. RESULTS Data on 110 MTs (median age, 51.0 years; 53.6% women) and 122 local patients (median age, 65.0 years; 41.8% women) diagnosed with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, and multiple myeloma were analyzed. The most common hematologic malignancy in both MTs and local patients was NHL (54.5% and 73.0%, respectively). Among MTs, 32.7% were fully committed to treatment in Israel, 32.7% were partially committed, and 34.6% were not committed. In 25.9% of MTs, a review of their biopsy resulted in a more definitive or different diagnosis. The percentage of patients who achieved complete response to treatment was similar among MTs and local patients. CONCLUSION MTs often require a pathologic review of their initial diagnosis and are more likely to present with advanced stages of disease. Treatment of MTs according to the appropriate clinical parameters is expected to yield similar outcomes to those of local patients.

Medical Cannabis Use by Hodgkin Lymphoma Patients: Experience of a Single Center

2018 ◽  
Vol 140 (4) ◽  
pp. 194-202 ◽  
Author(s):  
Nadav Sarid ◽  
Mor Zada ◽  
Shaul Lev-Ran ◽  
Eva Yashphe ◽  
Ido Givon ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Medical Center ◽  
Well Being ◽  
Complete Response ◽  
Cannabis Use ◽  
Response To Treatment ◽  
Medical Cannabis ◽  
Baseline Characteristics ◽  
Patients Experience

Hodgkin lymphoma (HL) is one of the most curable malignancies. Despite its effectiveness, chemotherapy is often associated with adverse events (AEs) such as nausea, anorexia, and impairment of general well-being. Our objective was to assess the extent of medical cannabis use among HL patients and evaluate its efficacy in controlling chemotherapy-related AEs. Patterns of medical cannabis use and efficacy were evaluated using physician-completed application forms, medical files, and patient-completed questionnaires, for all consecutive adult HL patients treated at the Tel-Aviv Medical Center between June 2010 and November 2016. One-hundred and thirty-three patients met the inclusion criteria. The median age of the cohort was 37 years, 53% were male, 46% were diagnosed at an early stage, and 88% achieved a complete response to treatment. Fifty-one patients (38%) used medical cannabis. There were no significant differences in baseline characteristics between cannabis users and nonusers. Cannabis users reported improvement in pain, general well-being, appetite, and nausea in 94, 87, 82, and 79% of cases, respectively. Importantly, 81.5% reported a high overall efficacy of cannabis in relieving symptoms. AEs related to cannabis use itself were mild. Thus, medical cannabis use is prevalent in this HL cohort, and appears to be effective in ameliorating chemotherapy-related AEs.

scholarly journals Clinical features and treatment outcomes of Hodgkin lymphoma: A retrospective review in a Malaysian tertiary hospital

2019 ◽  
Vol 54 (3) ◽  
pp. 210-217 ◽  
Author(s):  
Yang Liang Boo ◽  
Helen Siew Yean Ting ◽  
Diana Fui Sing Yap ◽  
See Guan Toh ◽  
Soo Min Lim
Keyword(s):  
Treatment Outcomes ◽  
Hodgkin Lymphoma ◽  
Clinical Features ◽  
Retrospective Review ◽  
Tertiary Hospital

The prognostic significance of residual pigmentation following radiotherapy of epidemic Kaposi's sarcoma.

1989 ◽  
Vol 7 (5) ◽  
pp. 619-621 ◽  
Author(s):  
J S Cooper ◽  
A D Steinfeld ◽  
I A Lerch
Keyword(s):  
New York ◽  
Kaposi's Sarcoma ◽  
Medical Center ◽  
Prognostic Significance ◽  
Kaposi’S Sarcoma ◽  
Complete Response ◽  
Response To Treatment ◽  
Published Data ◽  
New York University ◽  
Tumor Mass

The response to radiotherapy of epidemic Kaposi's sarcoma (EKS) is unusual in that irradiated regions are frequently left with a persistent purple stain, reminiscent of the color of the original tumor, but with no tumor mass. To date there are no published data to indicate whether the persistence of pigmentation can be predicted beforehand or if it has any prognostic import. We reviewed the response to treatment of 118 EKS lesions that were irradiated at New York University (NYU) Medical Center between 1981 and 1986. A total of 86 responded to treatment by complete clearance of the mass. Of these, 29 left residual purple pigmentation within the treatment portal, while 57 did not. Complete response (CR; without residual pigmentation) occurred more often in patients who had higher Karnofsky scores at the time of treatment. However, in terms of ultimate local control or survival, there were no differences between patients whose lesions cleared completely v those in whom pigmentation remained. We conclude that persistent pigmentation represents only a benign remnant of irradiated EKS and has no prognostic import.

scholarly journals Comparison of the Effect of Combined Treatment with Radiotherapy and Hyperthermia versus Exclusively Radiotherapy to Reduce Pain in Patients with Bone Metastases

2020 ◽  
pp. 23-34
Author(s):  
Baharak Keyvan ◽  
Alireza Nikoofar ◽  
Mastaneh Sanei ◽  
Mohammadreza Barzegar- Tahamtan ◽  
Seyed Rabi Mahdavi ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Combined Treatment ◽  
Complete Response ◽  
Capital City ◽  
Response To Treatment ◽  
Control Group ◽  
Case Group ◽  
Stable Mode ◽  
Significant Difference ◽  
The Difference

Based on the extant studies conducted by scholars, recognizing the best and practical treatment methods in patients with bone metastases is an important and conspicuous focus in improving and amelioration of the treatment and prognosis of patients. Ergo, this study aims to compare the effects of radiotherapy and hyperthermia with radiotherapy only to reduce pain in one of the oncology centers located in Tehran (the capital city of Iran). In this randomized clinical trial study, patients with bone metastases were randomly assigned to one of two group’s radiotherapy and hyperthermia or radiotherapy exclusively and the collected data were processed through Statistical Package of Social Science (SPSS). Thenceforth, findings were evaluated and compared between the two groups. A total of 60 patients inclusive of 34 women and 26 men were investigated. In the baseline, 20 patients in the case group (67%) and 21 patients in the control group (70%) used palliative drugs. At the end of the trial, the consumption of palliative drugs was decreased in the case group (12 patients, 43%) but, no change was observed in the control group. After treatment, complete response to treatment (27% vs. 13%), experienced a decrease in the clinical pain (57% vs. 83%) and did not respond to treatment in a stable mode (17% vs. 4%) of which were different between case and control groups, respectively. Regardless of the difference in the ratio of partial response in two groups, there was no significant difference between the two groups in terms of response to treatment. Although the effect of radiotherapy and hyperthermia in comparison with radiotherapy exclusively was more efficacious in some aspects of the intervention of pain with sleep. However, there was no remarkable and significant difference in other cases.

scholarly journals AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

2019 ◽  
Author(s):  
Kouassi Gustave KOFFI ◽  
DA Silué ◽  
C Laurent ◽  
K Boidy ◽  
S Koui ◽  
...  
Keyword(s):  
Ivory Coast ◽  
Medical Center ◽  
Randomized Study ◽  
Complete Response ◽  
Patient Navigator ◽  
Control Group ◽  
Middle Income ◽  
Low Middle Income Countries ◽  
Set Up ◽  
African Patients

Abstract Background Previous studies have indicated that accompanying socially undeserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improve adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. Methods This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. Hundred African patients were randomly assigned to either AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. Results We found that AMA was feasible and has significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CRR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. Conclusion Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

Regulatory T Lymphocytes and Tumor-Associated Macrophages Have No Impact On Treatment Response and Survival in Brazilian Patients with Classical Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4777-4777
Author(s):  
Mariane Cristina Gennari Assis ◽  
Antonio H. F. M. Campos ◽  
José Salvador Rodrigues de Oliveira ◽  
Fernando A Soares ◽  
Joyce M. K. Silva ◽  
...  
Keyword(s):  
Tumor Microenvironment ◽  
Treatment Response ◽  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Complete Response ◽  
Public Hospitals ◽  
Response To Treatment ◽  
Classical Hodgkin Lymphoma ◽  
Tumor Associated Macrophages ◽  
Different Populations

Abstract Abstract 4777 Understanding the mechanisms of how tumor microenvironment of classical Hodgkin lymphoma (cHL) fosters immune privilege and survival of Hodgkin-Reed-Sternberg (HRS) cells is crucial for the development of new biomarkers and therapy strategies. Recently, infiltrating regulatory T CD4+CD25+FOXP3+ lymphocytes (Tregs) and tumor-associated macrophages CD68+ (TAMs) have been shown to play a role in HRS immune evasion, disease progression and survival. However, data arising from studies of different populations of cHL patients are conflicting. Purpose: In this study, we evaluated the importance of infiltrating Tregs and TAMs in a subset of 130 cHL patients treated in public hospitals in southeast Brazil and correlated these findings with Epstein-Barr virus (EBV) presence in HRS cells. Material and Methods: Tissue microarrays were constructed using diagnostic biopsies available in 130 patients and stained with CD4, CD8, CD25, FOXP3, CD15, CD30, CD68 e LMP1. Quantification of TAMs and Tregs was performed using automated slide scanning and image analysis (Aperio ScanScope XT Slide Scanner and Aperio ImageScope Software with Aperio Positive Pixel Count Sample Macro algorithm). Immunohistochemical scoring ranged from 1 to 4 for the antibodies tested, with higher scores indicating a greater proportion of positive cells. For Tregs and TAMs quantification, score 1 was considered negative (≤ 25 % of Tregs or TAMs) and scores 2, 3, and 4 (more than 25 % of positive cells) were considered positive. All patients underwent similar chemotherapy protocols. For the present study, only cHL patients whose histology could be confirmed and EBV-association established were studied. Results: From the 130 cHL patients selected for this study, 56 (43%) were classified as EBV related and 74 (57%) EBV non-related cHL. The expression of Tregs (CD4/CD25/FOXP3) was more common in the EBV related cHL group (p=0.02). TAMs did not correlate with EBV presence in HRS cells. Response to treatment, either complete response or partial response, and relapse rate were independent of Tregs and TAMs quantification and EBV status. Increased Tregs and TAMs in the tumor microenvironment did not influence event-free survival (EFS) and overall survival (OS). For further analysis, we stratified our patients into 4 groups, according to Tregs and TAMs quantification and EBV status and we still did not find any difference on EFS and OS. Additionally, stratified survival analysis according to age, stage and IPS-risk group did not identify any impact of Tregs and TAMs quantification on EFS and OS. Conclusion: This study demonstrates that increased Tregs and TAMs in the tumor microenvironment of cHL patients neither correlate with treatment response nor survival. Additionally, increased Tregs correlated with EBV presence in HRS cells. It is well known that the incidence of EBV-related cHL in developing countries is different from that in developed ones, as well as the severity of the disease at presentation, with advanced disease being more common at diagnosis. Our results, although different from those recently published, probably reflect the reality of the Brazilian population enrolled in the public health system, highlighting the importance of studying the same disease and their potential biomarkers within different populations. Disclosures: No relevant conflicts of interest to declare.

scholarly journals AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
K. G. Koffi ◽  
D. A. Silué ◽  
C. Laurent ◽  
K. Boidy ◽  
S. Koui ◽  
...  
Keyword(s):  
Ivory Coast ◽  
Medical Center ◽  
Randomized Study ◽  
Complete Response ◽  
Patient Navigator ◽  
Control Group ◽  
Middle Income ◽  
Low Middle Income Countries ◽  
Set Up ◽  
African Patients

Abstract Background Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. Methods This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. Results We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. Conclusion Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

scholarly journals Real-World Data with the Use of Caplacizumab in the Treatment of Acquired Thrombotic Thrombocytopenic Purpura (aTTP)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 14-16
Author(s):  
M Moraima Jimenez ◽  
Sabela Bobillo ◽  
Ana Pérez ◽  
Pamela Arenas ◽  
Alba Cabirta ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Characteristics ◽  
Randomized Clinical Trials ◽  
Immunosuppressive Agents ◽  
Response To Treatment ◽  
Lower Percentage ◽  
Neurological Involvement ◽  
Control Group ◽  
Real World Data

INTRODUCTION For more than two decades, the treatment of aTTPconsisted of therapeutic plasma exchange (TPE) and immunosuppressive agents. The addition of caplacizumab, a nano-antibody that binds to the A1 domain of the von Willebrand factor, inhibiting platelet aggregation, has been shown to reduce the time to resolution of thrombocytopenia, the rate of recurrence and the aTTP-related death. Real-world evidence of the effectiveness of caplacizumab is limited yet. The objective of our study was to assess the results of the introduction of caplacizumab in our internal protocol and to compare those results with the patients treated before the drug was available. METHODS A single-center retrospective observational study that evaluates the clinical characteristics and response to treatment of 18 consecutively diagnosed aTTP patients between May/14 to May/20. All patients received initial treatment with TPE and prednisone (PDN) 1 mg/Kg; the control group did not receive any other initial therapy, whereas nine patients received caplacizumab in addition to PEX and PDN once ADAMTS-13 deficiency was confirmed. Complete response (CR) was defined as the second of two consecutive days with platelets ≥150x109/L, refractoriness as the lack of platelet increase despite optimal therapy after 7 days, exacerbation as the decrease in platelet count during the first 30 days of discontinuation of TPE, and relapse as a new episode of aTTP beyond 30 days after the last TPE. All results are given as median (interquartile range). Statistical analysis was conducted using STATA/IC software. RESULTS The clinical characteristics at diagnosis of patients treated with or without caplacizumab were similar, except for a lower percentage of males and lower neurological involvement in the caplacizumab group (Table 1). Caplacizumab was started at a median of 3 days after diagnosis following ADAMTS-13 deficiency determination, and was administered during a median of 39 days (IQR 33-39). Adverse events related to caplacizumab were mild: 1 patient presented mild metrorrhagia, 1 developed pain and erythema at the puncture area and 1 suffered an urticarial dermatitis, the last case leading to the suspension of the drug since levels of ADAMTS-13 were recovered. The caplacizumab group achieved CR after a median of 4 days (IQR 3-4) vs. 6 days (IQR 5-14) in the control group (p = 0.016). Likewise, the number of TPE was lower with caplacizumab (Figure 1), with a median of 10 TPE (IQR 9-11) vs. 19 (IQR 16-23) (p = 0.001). Hospitalization time was also shorter in the caplacizumab group with a median of 12 days (IQR 12-14) vs. 26 (IQR 20-27) (p = 0.002). Finally the time of hospitalization into the intensive care unit was shorter in the caplacizumab group with a median of 3 days (IQR 2-4) vs. 4 (IQR 3-13) (p=0.1). In the caplacizumab group (median follow-up of 6.8 months), there were no refractory cases. There was 1 exacerbation before initiation of caplacizumab and 1 relapse. Both cases were treated with rituximab. In contrast, in the control group (median follow-up of 51.8 months), we observed 4 refractory cases (1 aTTP-related death), 3 exacerbations and 1 relapse; rituximab was necessary in 8 patients and a 3rd line with vincristine was administered in 4 cases. CONCLUSIONS The observed benefits of caplacizumab in our series are in line with the ones identified in randomized clinical trials. Caplacizumab can be used in combination with other therapies to attain a faster response and reduce aTTP-related complications. Disclosures Bosch: Hoffmann-La Roche: Research Funding.

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