Long-term use of sustained-release cytarabine for symptomatic management and treatment of meningeosis neoplastica.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19579-e19579
Author(s):  
Franziska Jahn ◽  
Timo Behlendorf ◽  
Cordula Globig ◽  
Berit Jordan ◽  
Hans-Heinrich Wolf ◽  
...  
Keyword(s):  
Side Effects ◽  
Cauda Equina ◽  
Neurological Symptoms ◽  
Intrathecal Therapy ◽  
Time Interval ◽  
Tumor Type ◽  
Liposomal Cytarabine ◽  
Treatment Burden ◽  
Meningeosis Neoplastica

e19579 Background: Treatment of meningeosis neoplastica remains challenging due to advanced systematic disease and limited treatment options including a high treatment burden. Liposomal Cytarabine (DepoCyte) is a slow-release formulation of cytarabine that maintains cytotoxic concentrations in the Cerebrospinal fluid (CSF) for >14 days following a single injection. This two week interval has potential benefit due to reduced interventions especially in palliative settings. Methods: We reviewed all patients at our institution treated with liposomal cytarabine (LC) between 3/2004 and 9/2011.The data included tumor type, ICF-cell-count, neurologic disorders due to meningeal affection and time interval from intrathecal therapy to progression and to death of the patient.Assessment for meningeosis neoplastica included neurological examination, CSF assessment and brain MR imaging. LC was administered intralumbar at 50 mg every 2-weeks until progression or appearance of severe side effects. Results: To date 51 adult patients eligible for safety evaluation (48 pts. for efficacy evaluation) (median age 61 y [range 23 - 81 y]) were treated with LC. 72.5% of the included patients had lymphoma, 5.9% breast cancer and 21.6% other solid malignancies. Concurrent systemic chemotherapy was given in 82% of the patients. A total of 160 doses were administered (mean 2.9, range 1- 13). The most frequent side effects were mucositis (21.6%), elevated body temperature (15.7%), backpain (9.8%) and nausea/vomiting (7.8/5.9%). In two lymphoma patients with long term use of LC (13/ 4 applications) cauda equina syndroms appeared. In 61.9% of patients a reduction of neurological symptoms could be achieved; 53% of the patients attained a cytological response in CSF. Median overall survival was 20 months. Conclusions: The obtained results are comparable to those previously reported for methotrexate given 3 times a week. Thus our trial indicates that the 14-day dosing interval is on one hand effective to decrease neurological symptoms caused by meningeosis neoplastica with a favourable safety profile and on the other hand is less burdensome for the patients due to reduced manipulation and treatment burden respectively.

scholarly journals DDEL-03. LONG-TERM INTRAVENTRICULAR THERAPY ALTERNATING ETOPOSIDE AND LIPOSOMAL CYTARABINE: EXPERIENCE IN 75 CHILDREN AND ADOLESCENTS WITH MALIGNANT BRAIN TUMORS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii284-iii284
Author(s):  
Natalia Stepien ◽  
Andreas Peyrl ◽  
Amedeo Azizi ◽  
Johannes Gojo ◽  
Lisa Mayr ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Tumor Cells ◽  
Slow Release ◽  
Intrathecal Therapy ◽  
Liposomal Cytarabine ◽  
Release Formulation ◽  
Malignant Brain Tumors ◽  
Slow Release Formulation ◽  
Anti Cancer

Abstract BACKGROUND Malignant brain tumors of childhood carry a high risk for leptomeningeal dissemination and tumor cells floating in the CSF are often not amenable to systemic and/or antiangiogenic chemotherapy. We report on our experience with an intraventricular therapy consisting of alternating cycles of liposomal cytarabine and etoposide. PATIENTS AND METHODS Between 2004 and 2017, 75 patients aged 0.6 to 22 years (median 11) with various malignant brain tumors received intraventricular etoposide 0.25mg (<1year) - 0.5mg on five consecutive days alternating with liposomal cytarabine at a dose of 25mg (<3 years) - 50mg via an Ommaya reservoir. RESULTS 5533 doses of etoposide (5–277/patient, median 141) corresponding to 1–56 five-day-cycles/patient alternating with 534 doses of liposomal cytarabine (1–21/patient, median 11) were administered. Treatment was given over a period of 1 – 146 months (median 73.5). Toxicities did occur but were infrequent and mostly mild. Since all patients received some sort of concurrent anti-cancer therapy, the efficacy of intrathecal therapy cannot be assessed independently. However, 29/75 patients are still alive, and none of the patients had tumor cells in the CSF at their last evaluation. CONCLUSION In conclusion, alternating intraventricular liposomal cytarabine and etoposide produced responses and proved to be an important adjunct for patients receiving drugs with a low penetrance into the CSF. Since production of liposomal cytarabine was discontinued in 2017 it remains to be determined whether substitution of the slow release formulation by aqueous cytarabine on days 1, 4, 8, and 11 may produce similar results.

Liposomal Cytarabine (DepoCyte) Is Effective and Well Tolerated In Prophylaxis of Central Nervous System (CNS) Relapse of High Risk Lymphoma Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4890-4890
Author(s):  
Wojciech Jurczak ◽  
Justyna Dzietczenia ◽  
Beata Piatkowska-Jakubas ◽  
Marcin Sobocinski ◽  
Tomasz Ogorka ◽  
...  
Keyword(s):  
Side Effects ◽  
High Risk ◽  
Adverse Events ◽  
Systemic Disease ◽  
B Cell Lymphoma ◽  
Neurological Symptoms ◽  
Liposomal Cytarabine ◽  
Mediastinal Tumors ◽  
Cns Relapse ◽  
Vena Cava Superior

Abstract Abstract 4890 Background: CNS relapse is a devastating complication in patients with aggressive NHL and occurs in approximately 5 to 20% of cases. Preventing CNS relapse is an important goal of therapy in high-risk patients with aggressive NHL. The aim of this retrospective study was to evaluate safety and efficacy of Liposomal Cytarabine in a prophylaxis of CNS in high risk lymphoma patients. Materials and Methods: Data of patients treated with Liposomal Cytarabine within the last 2 years were retrieved from 2 centres in Poland which routinely administer prophylaxis of CNS in high risk NHL patients. 32 patients were included in this analysis: 26 – DLBCL including Primary Mediastinal B-cell Lymphoma (PMBCL), 2 – PTCL, 2 – LBL and 2 – BL. Demographics: average age: 42 (range 18–75), 12 females and 20 males. High risk was defined as the presence of elevated LDH (average 852 IU/L, range 482–1890 IU/L) and involvement of 2 or more extranodal sites, IPI 3–5 or specific lymphoma localizations (testis, vertebral column, orbits, sinuses, large mediastinal tumors over 10 cm in diameter). None of the patients had neurological symptoms at diagnosis, nor any abnormalities in cerebrospinal fluid analysis (average cellularity 4,7/mm3, range 0–18). Results: Liposomal Cytarabine was incorporated into 1st line systemic chemotherapy. On average, 3,4 doses (range 2–6) were applied every 2 (n=22) or 4 (n=10) weeks. Side effects: 18 out of 32 patients had no side effects. 12 patients experienced transitory, mostly mild, grade 1–2 adverse events; headache (n=10), nausea and vomiting (n=7), dizziness (n=4) or fever (n=3). Only 2 patients developed grade 3 headaches or fever. One patient developed transient neurological symptoms, most likely unrelated to Liposomal Cytarabine (vena cava superior syndrome at diagnosis and cerebralal thromboembolism after systemic immunochemotherapy). After medium observation time of 306 days from the end of therapy (range 36 – 740) 28/32 (87,5%) patients were disease free. Three patients were lost due to systemic disease progression without any signs of CNS relapse on days 36, 101 and 182. One CNS relapse was reported on the day 252 (the patient subsequently died 5 months later). Conclusions: 1) Liposomal Cytarabine is well tolerated, with mild or no adverse events. Its prolonged action allows it to be incorporated into a standard systemic anti-lymphoma therapy, without the necessity of additional hospital admissions. 2) In a described cohort of high risk lymphoma patients, Liposomal Cytarabine reduced the risk of early CNS relapse to 3% at 1 year (1/32 cases) and OS at 1 year 87% (28/32). Disclosures: No relevant conflicts of interest to declare.

Cutaneous ulcers following hydroxyurea therapy

Phlebologie ◽  
2004 ◽  
Vol 33 (06) ◽  
pp. 202-205 ◽  
Author(s):  
K. Hartmann ◽  
S. Nagel ◽  
T. Erichsen ◽  
E. Rabe ◽  
K. H. Grips ◽  
...  
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Antineoplastic Agent ◽  
Limited Time ◽  
Myeloproliferative Diseases ◽  
Dermatological Side Effects ◽  
Chronic Myeloproliferative Diseases ◽  
Hydroxyurea Therapy

SummaryHydroxyurea (HU) is usually a well tolerated antineoplastic agent and is commonly used in the treatment of chronic myeloproliferative diseases. Dermatological side effects are frequently seen in patients receiving longterm HU therapy. Cutaneous ulcers have been reported occasionally.We report on four patients with cutaneous ulcers whilst on long-term hydroxyurea therapy for myeloproliferative diseases. In all patients we were able to reduce the dose, or stop HU altogether and their ulcers markedly improved. Our observations suggest that cutaneous ulcers should be considered as possible side effect of long-term HU therapy and healing of the ulcers can be achieved not only by cessation of the HU treatment, but also by reducing the dose of hydroxyurea for a limited time.

Long-term side effects following pneumonectomy: A case report and review of the literature

2019 ◽  
Author(s):  
BA Högerle ◽  
EL Bulut ◽  
L Klotz ◽  
F Eichhorn ◽  
M Eichhorn ◽  
...  
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Review Of The Literature

Long-Term Follow-Up of Early Cochlear Implant Device Activation

2021 ◽  
pp. 1-11
Author(s):  
Stefanie Bruschke ◽  
Uwe Baumann ◽  
Timo Stöver
Keyword(s):  
Speech Recognition ◽  
Side Effects ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Control Group ◽  
First Year ◽  
Safe Procedure ◽  
Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

scholarly journals Rituximab-Containing Risk-Adapted Treatment Strategy in Nodular Lymphocyte Predominant Hodgkin Lymphoma: 7-Years Follow-Up

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1760
Author(s):  
Novella Pugliese ◽  
Marco Picardi ◽  
Roberta Della Pepa ◽  
Claudia Giordano ◽  
Francesco Muriano ◽  
...  
Keyword(s):  
Side Effects ◽  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Single Agent ◽  
Response To Therapy ◽  
Baseline Risk ◽  
Historical Cohort ◽  
Treatment Groups

Background: Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare variant of HL that accounts for 5% of all HL cases. The expression of CD20 on neoplastic lymphocytes provides a suitable target for novel treatments based on Rituximab. Due to its rarity, consolidated and widely accepted treatment guidelines are still lacking for this disease. Methods: Between 1 December 2007 and 28 February 2018, sixteen consecutive newly diagnosed adult patients with NLPHL received Rituximab (induction ± maintenance)-based therapy, according to the baseline risk of German Hodgkin Study Group prognostic score system. The treatment efficacy and safety of the Rituximab-group were compared to those of a historical cohort of 12 patients with NLPHL who received Doxorubicin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy followed by radiotherapy (RT), if needed, according to a similar baseline risk. The primary outcome was progression-free survival (PFS) and secondary outcomes were overall survival (OS) and side-effects (according to the Common Terminology Criteria for Adverse Events, v4.03). Results: After a 7-year follow-up (range, 1–11 years), PFS was 100% for patients treated with the Rituximab-containing regimen versus 66% for patients of the historical cohort (p = 0.036). Four patients in the latter group showed insufficient response to therapy. The PFS for early favorable and early unfavorable NLPHLs was similar between treatment groups, while a better PFS was recorded for advanced-stages treated with the Rituximab-containing regimen. The OS was similar for the two treatment groups. Short- and long-term side-effects were more frequently observed in the historical cohort. Grade ≥3 neutropenia was more frequent in the historical cohort compared with the Rituximab-group (58.3% vs. 18.7%, respectively; p = 0.03). Long-term non-hematological toxicities were observed more frequently in the historical cohort. Conclusion: Our results confirm the value of Rituximab in NLPHL therapy and show that Rituximab (single-agent) induction and maintenance in a limited-stage, or Rituximab with ABVD only in the presence of risk factors, give excellent results while sparing cytotoxic agent- and/or RT-related damage. Furthermore, Rituximab inclusion in advanced-stage therapeutic strategy seems to improve PFS compared to conventional chemo-radiotherapy.

Physiological Pacing: A New Road to Future

2021 ◽  
pp. 263246362097804
Author(s):  
Vanita Arora ◽  
Pawan Suri
Keyword(s):  
Side Effects ◽  
Fibrous Tissue ◽  
Cardiac Pacing ◽  
His Bundle ◽  
Anatomy And Physiology ◽  
Long Term Follow Up ◽  
Pacing Lead ◽  
The Right

Anatomy and physiology are the basis of human body functioning and as we have progressed in management of various diseases, we have understood that physiological intervention is always better than an anatomical one. For more than 50 years, a standard approach to permanent cardiac pacing has been an anatomical placement of transvenous pacing lead at the right ventricular apex with a proven benefit of restoring the rhythm. However, the resultant ventricular dyssynchrony on the long-term follow-up in patients requiring more than 40% ventricular pacing led to untoward side effects in the form of heart failure and arrhythmias. To counter such adverse side effects, a need for physiological cardiac pacing wherein the electrical impulse be transmitted directly through the normal conduction system was sought. His bundle pacing (HBP) with an intriguing alternative of left bundle branch pacing (LBBP) is aimed at restoring such physiological activation of ventricles. HBP is safe, efficacious, and feasible; however, localization and placement of a pacing lead at the His bundle is challenging with existing transvenous systems due to its small anatomic size, surrounding fibrous tissue, long-learning curve, and the concern remains about lead dislodgement and progressive electrical block distal to the HBP lead. In this article, we aim to take the reader through the challenging journey of HBP with focus upon the hardware and technique, selective versus nonselective HBP, indications and potential disadvantages, and finally the future prospects.

scholarly journals Cardiooncology—dealing with modern drug treatment, long-term complications, and cancer survivorship

2021 ◽  
Author(s):  
Claudia de Wall ◽  
Johann Bauersachs ◽  
Dominik Berliner
Keyword(s):  
Side Effects ◽  
Checkpoint Inhibitors ◽  
Heart Diseases ◽  
Tumor Therapy ◽  
Treatment Strategies ◽  
Tumor Treatment ◽  
Cardiac Side Effects ◽  
Cardiovascular Side Effects ◽  
Modern Drug

AbstractModern treatment strategies have improved prognosis and survival of patients with malignant diseases. The key components of tumor treatment are conventional chemotherapy, radiotherapy, targeted therapies, and immunotherapy. Cardiovascular side-effects may occur in the early phase of tumor therapy or even decades later. Therefore, knowledge and awareness of acute and long-lasting cardiac side effects of anti-cancer therapies are essential. Cardiotoxicity impairs quality of life and overall survival. The new cardiologic subspecialty ‘cardio-oncology’ deals with the different cardiovascular problems arising from tumor treatment and the relationship between cancer and heart diseases. Early detection and treatment of cardiotoxicity is of crucial importance. A detailed cardiac assessment of patients prior to administration of cardiotoxic agents, during and after treatment should be performed in all patients. The current review focusses on acute and long-term cardiotoxic side effects of classical cytotoxic and selected modern drug treatments such as immune checkpoint inhibitors and discusses strategies for the diagnosis of treatment-related adverse cardiovascular effects in cancer patients.

scholarly journals Efficacy and Tolerability of Methotrexate and Methylprednisolone in a Comparative Assessment of the Primary and Long-Term Outcomes in Patients with Pulmonary Sarcoidosis

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1289
Author(s):  
Volodymyr Gavrysyuk ◽  
Ievgenia Merenkova ◽  
Yaroslav Dziublyk ◽  
Nataliia Morska ◽  
Nataliia Pendalchuk ◽  
...  
Keyword(s):  
Side Effects ◽  
Relapse Rate ◽  
Total Duration ◽  
Treatment Resistance ◽  
Pulmonary Sarcoidosis ◽  
Long Term Outcomes ◽  
High Resolution Computed Tomography ◽  
Chi Square ◽  
Ct Data

Background: There is insufficient information in the literature on the comparative efficacy and tolerability of methotrexate (MTX) and methylprednisolone (MP) in patients with pulmonary sarcoidosis in assessing primary outcomes and the relapse rate. Purpose: The aim of our study was to evaluate primary and long-term outcomes of using MTX and MP in patients with pulmonary sarcoidosis. Methods: A total of 143 patients with newly diagnosed pulmonary sarcoidosis, verified by high-resolution computed tomography (CT) data, were examined. Corticosteroid (CS) therapy was used in 97 patients using MP at a dose of 0.4 mg/kg body weight for 4 weeks, followed by a dose reduction to 0.1 mg/kg by the end of the sixth month. The total duration of CS therapy was 12 months on average. Forty-six patients were treated with MTX at a dose of 10 mg/week (28) and 15 mg/week (18) per os for 6 to 12 months. The study of the relapse rate was conducted within 12 months after the CT data normalization in 60 patients after CS therapy and in 24 after MTX treatment. Results: MP treatment was successfully completed in 68 (70.1%), and MTX in 29 (60.4%) patients. In five MP patients (5.2%) and in five (10.9%) MTX, treatment was discontinued due to serious side effects. In seven (7.2%) MP patients and ten (21.7%) MTX patients, treatment required additional therapy due to the lack of efficacy. Progression with MP treatment (17–17.5%) was more common than with MTX (2–4.3%; Chi square = 4.703, p = 0.031). Relapses after MP therapy were observed in 26 (43.3%) patients, and after MTX therapy in 2 (8.3%; Chi square = 9.450, p = 0.003). Conclusion: In patients with pulmonary sarcoidosis, MTX monotherapy does not differ significantly from MP monotherapy in terms of the level of efficacy and the rate of serious side effects. Increasing the MTX dose from 10 to 15 mg/week accelerates the rate of regression of sarcoidosis, improves treatment efficacy, and does not affect the rate of serious side effects. When using MTX, there is a significant decrease in the incidence of treatment resistance and the relapse rate.

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