scholarly journals The Impact of COVID-19 on Patients with Hematological Malignancies: The Mixed-Method Analysis of an Israeli National Survey

2021 ◽  
Author(s):  
Ilana Levy ◽  
Giora Sharf ◽  
Shlomit Norman ◽  
Tamar Tadmor
Keyword(s):  
High Risk ◽  
National Survey ◽  
Hematological Malignancies ◽  
Severe Disease ◽  
High Rate ◽  
Hematological Disease ◽  
Patient Health ◽  
Hebrew Version ◽  
The Impact ◽  
Method Analysis

Abstract Background: The COVID-19 pandemic required reevaluation of the therapeutic approach and added emotional stress for patients with hematological malignancies at high risk of contracting the virus. We aimed to evaluate how it affected such patients during the second lockdown in Israel.Methods: This national survey included Hebrew-speaking patients with hematological malignancy. This included three tools with 28 items of socio-demographic and medical baseline characteristics, management of hematological disease, and evaluation of emotional coping during COVID-19 pandemic; the Hebrew version of the Patient Health Questionnaire 9; and 3 qualitative open-ended questions. Data was analyzed by mixed methods which combined both quantitative and qualitative thematic analyses.Results: 408 patients responded to the survey. The management of their hematological disease included a decrease in the number of visits to the hematology clinic (37.0%), delay of some treatment schedules (9.1%), and prescription of replacement therapies permitting less visits to the clinic (2.2%). The frequency and intensity of “feeling afraid” regarding COVID-19 infection was increased (mean±SD: 4±1 to 5±2 in a 1-7 Likert scale), and a high rate of depression was recorded, which appeared to be more evident in patients with chronic myeloid leukemia (CML) (p<0.001).Conclusion: The management of hematological malignancies during pandemics should always take into consideration patients' fears, as well as the development of depression related to isolation and loneliness, in addition to the high risk of severe disease. Patients with CML had a high rate of depression which obviously needs to be managed very carefully during and after the COVID-19 pandemic.

scholarly journals Universal testing for COVID-19 in patients undergoing cancer treatment during the second outbreak in Brescia

2021 ◽  
pp. 030089162110349
Author(s):  
Stefano M. Magrini ◽  
Andrea E. Guerini ◽  
Paolo Borghetti ◽  
Giulia Volpi ◽  
Luca Triggiani ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Severe Disease ◽  
High Rate ◽  
Mild Disease ◽  
Patients With Cancer ◽  
Universal Testing ◽  
Antineoplastic Treatment ◽  
Asymptomatic Infections ◽  
Testing Schedule ◽  
The Impact

Background: The impact of coronavirus disease 2019 (COVID-19) has been overwhelming on patients with cancer, who may be at higher risk of developing severe disease. During the second COVID-19 outbreak in Italy, we planned universal microbiologic screening for patients scheduled for antineoplastic treatment. Methods: All patients with planned active treatment at Brescia University Radiation Oncology Department were screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA with repeated nasopharyngeal swabs (NPS) from October 31, 2020. Treatment continuation, suspension, or delay was modulated for patients testing positive according to clinical presentation. Results: From October 31, 2020, to February 6, 2021, 636 patients were enrolled and 1243 NPS were performed, of which 28 (2.25%) were positive. The infection rate was 2.52%; 81.3% of the patients with a positive NPS were asymptomatic, 2 had mild disease, and 1 severe disease that led to death. All patients already on treatment with mild or asymptomatic COVID-19 carried on the therapy with no or minimal delay. Median delay for patients with infection detected before treatment start was 16.5 days. Conclusions: Detected incidence of COVID-19 was lower during the second outbreak in our patients (2.52% vs 3.23%), despite the extensive testing schedule, and substantiates the high rate of asymptomatic infections and the low mortality among patients with COVID-19 (6.3% vs 38.5% during the first outbreak). Universal SARS-CoV-2 screening for all patients with planned treatment might allow early identification of patients with COVID-19, resulting in timely management that could improve clinical outcomes and prevent spread of the infection.

scholarly journals Atopic dermatitis: clinical phenotypes, persistence and comorbidity

2021 ◽  
Vol 16 (4) ◽  
pp. 265-269
Author(s):  
O.P. Volosovets ◽  
S.P. Kryvopustov ◽  
O.V. Mozyrskaya
Keyword(s):  
Atopic Dermatitis ◽  
Family History ◽  
High Risk ◽  
Age Of Onset ◽  
Severe Disease ◽  
Respiratory Allergy ◽  
Severe Atopic Dermatitis ◽  
Respiratory Allergies ◽  
Duration Of Breastfeeding ◽  
The Impact

Background. Atopic dermatitis is the most common skin disease among children. Its natural history is heterogeneous with a difference in age of manifestation, localization of lesions, severity, sensitization profiles, presence of comorbid atopic conditions, and longitudinal trajectories of disease progression. The study aimed to assess the impact of factors such as the onset of the disease, atopic family history, presence of concomitant allergic pathology, duration of breastfeeding on the course of the disease and the development of respiratory allergies, and the impact of environmental factors that aggravate the disease. Materials and methods. Children with atopic dermatitis (n = 88) were included in the study from September 2020 to April 2021 in Kyiv, Ukraine. Symptoms of respiratory allergy in the history of patients have been documented as comorbidity. Results. Total of 88 patients at the time of examination presented with manifestations of atopic dermatitis in the form of a rash, dry skin, scaling, itching, lichenization. The disease severity was significantly related to the age of onset: children with early phenotype had more severe disease (OR = 16.261; 2.056–127.911). There was no statistically significant association of early phenotype of atopic dermatitis with the development of concomitant allergic diseases (OR = 1.813; 0.415–7.916). A severe course was observed in the group of children with atopic family history (OR = 2.750; 1.123–6.735). Children with severe atopic dermatitis had a high risk of concomitant respiratory allergy (OR = 5.604; 1.863–16.863). The duration of breastfeeding did not impact the severity of atopic dermatitis (OR = 0.778; 0.119–5.100) and the risk of concomitant atopic diseases (OR = 1.417; 0.444–4.521). The course of atopic dermatitis was influenced by seasonality in 76 children (86.4 %): the condition of the skin deteriorated in the winter. Contact with the animal was associated with exacerbation of atopic dermatitis in 4 (4.5 %) children, food ingestion — in 20 children (25 %), pollen trees and grasses caused exacerbation in 5 children (5.7 %). Conclusions. Children with a severe phenotype of atopic dermatitis are at risk of developing respiratory allergies. Patients with atopic dermatitis who develop symptoms at the age of under 2 years, as well as those with an atopic family history, are at high risk of developing a severe disease phenotype.

Optimizing the Outcomes of Allogeneic Hematopoietic Stem Cell (HSC) Transplantation for Hematological Malignancies: The Perfect Combination of Conditioning Regimen, Disease Stage and Type of HSC Donor

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4324-4324
Author(s):  
Mauricette Michallet ◽  
Mohamad Sobh ◽  
Hélène Labussière-wallet ◽  
Marie Balsat ◽  
Caroline Lejeune ◽  
...  
Keyword(s):  
High Risk ◽  
Board Of Directors ◽  
Hematological Malignancies ◽  
Conditioning Regimen ◽  
Disease Status ◽  
Disease Stage ◽  
Hla Matching ◽  
Advisory Committees ◽  
Hematopoietic Stem ◽  
The Impact

Abstract Introduction Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative strategy for a majority of patients with high-risk hematological malignancies. Several studies have evaluated the impact of conditioning intensity on the long-term transplantation outcomes, mainly retrospective and derived from large registries or non-randomized trials. These studies showed that more intensive conditioning (MAC) regimens are associated with a reduced risk of relapse, but do not translate into improvement of survival due to increased non-relapse mortality (NRM). Reduced intensity/Non-myeloablative conditioning (RIC/NMA) through graft-versus-leukemia effect has been associated with lower NRM, but higher relapse rates leading to similar overall survival (OS) when compared to MAC. However, in daily clinical practice, these results are difficult to follow because of the combination of important impact of disease stage, the type of HSC donor and its HLA matching with the patient. In addition, the historical nature of the previous studies may lead to the observation of different results today as the experience in drugs toxicities management has changed over time. The objective of this study is to evaluate the impact of the conditioning regimen intensity taking into account the disease stage and the type of HSC donor with its HLA matching on transplantation outcomes in a large population of patients with high-risk hematological malignancies. Material and methods A total of 542 patients who received allo-HSCT between January 2006 and December 2014 in our center were included, 321 (59%) were males, the median age at allo-HSCT was 49 years (range: 18-70). There was 256 (47%) acute leukemia (202 AML, 54 ALL), 61 (11%) MDS, 60 (11%) multiple myeloma, 46 (8%) NHL, 25 (5%) Hodgkin's disease, 23 (4%) myeloproliferative neoplasms, 21 (4%) CML, 12 (2%) CLL and the rest with other hematological diseases. All patients were classified as at high-risk according to either clinical, immunophenotypic, cytogenetic or molecular markers. Conditioning regimen was classified as recently published (Gyurkocza et al. Blood 2014), therefore 282 (52%) received MAC and 260 (48%) received RIC/NMA; at allo-HSCT 320 (59%) patients were in CR and 222 (41%) in less than CR. HSC donor was identical siblings (Sib) for 199 (37%) patients (100 BM, 99 PBSC), 10/10 HLA matched unrelated (MUD) for 159 (29%) (79 BM, 80 PBSC), 6/6 HLA matched double cord blood (CB) units for 12 (2%), 9/10 HLA mismatched unrelated (MMUD) for 114 (21%) (54 BM, 60 PBSC), and the rest of 58 (11%) were 5/6 or 4/6 MM double CB units. For sex mismatching, in 119 (22%), it was female donor to a male patient; 295 (54%) were ABO compatible, 105 (20%) had minor incompatibility and 142 (26%) major incompatibility. Results The median follow-up for surviving patients was 29 months (range: 4-96). We conducted a cox multivariate model for OS including patient age, disease status at allo-HSCT, conditioning regimen, type of donor and HLA matching, in addition to ABO and sex mismatching, with stratification on the type of disease; this model showed a significant impact of disease status in favor of CR (HR=1.5, 95%CI: 1.2-2.0, p=0.001), conditioning regimen in favor of MAC (HR=0.68, 95% CI: 0.53-0.88, p=0.003) and type of donor in favor of Sib (HR=0.68, 95%CI: 0.5-0.9, p=0.01). Interestingly, we were able to find an optimal association between these 3 factors leading to significantly better results in terms of OS and NRM independently of the disease type. When in CR, patients receiving MAC from Sib or from MUD had significant better OS and NRM compared to the rest of patients with 5-years rates of 71% vs 36% (p<0.0001) and 15% vs 37% (p=0.001) respectively. If not in CR, only patients who received HSC from Sib either after RIC or MAC showed significantly better OS and NRM compared to the rest of patients with 5-years rates of 50% vs 26% (p=0.001) and 22% vs 45% (p=0.008) respectively (see Figure). Considering only MMUD, patients receiving CB with RIC had better OS and NRM rates compared to 9/10 MMUD (RIC or MAC) and to MAC CB (p=0.07). Conclusion We provide in this large study, a practical daily clinical practice outcome preview after allo-HSCT, independently of the type of disease, for the combination of significant impacting factors namely disease status at allo-HSCT, conditioning regimen and type of HSC donor with a superiority for MAC when used in CR from Sib or MUD. Figure 1. Figure 1. Disclosures Nicolini: Ariad Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

scholarly journals COVID-19 in Immunosuppressed and Cancer Patients: A review

2020 ◽  
Vol 5 (S1) ◽  
pp. 69-73
Author(s):  
Shirin Haghighat ◽  
Mehdi Dehghani
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Cancer Patients ◽  
Severe Disease ◽  
Review Article ◽  
Epidemic Spread ◽  
Patients With Cancer ◽  
The World ◽  
Novel Coronavirus ◽  
The Impact

The rapidly spreading outbreak of infection by novel coronavirus 2 (SARS-CoV-2) from Wuhan, China around the world has started since December 2019. Since the epidemic spread of this infection, individuals with comorbidities are at high risk of severe disease and increased rate of mortality. As patients with cancer are considered immunosuppressed caused by some host and treatment factors, a more detailed investigation on the impact of cancer on COVID-19 outcome seems to be necessary. This review article provides data on cancer patients affected by SARS-CoV-2 infection. Although underlying immunosuppression has not proven as a risk factor for severe COVID-19 infection, most authors have identified cancer patients as a highly vulnerable population. We need more detailed especially randomized studies to compare the outcome of cancer and non-cancer patients with SARS-CoV-2 infection. The more precise studies would help oncologists to make the best decision in cancer therapy.  

Immunotransplantation for Hematologic Malignancies Using Allogeneic Peripheral Blood Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5060-5060
Author(s):  
Sujal Shah ◽  
Edgardo S. Santos ◽  
John Rink ◽  
Todd Roberts ◽  
Hana Safah
Keyword(s):  
High Risk ◽  
Cell Transplantation ◽  
Median Time ◽  
Hematological Malignancies ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Lymphocytic Leukemia ◽  
High Rate ◽  
Low Grade ◽  
Graft Versus Tumor Effect

Abstract Background: Allogeneic (allo-) transplantation offers a therapeutic option for patients diagnosed with hematological malignancies such as multiple myeloma (MM), chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin’s lymphoma (NHL), and high-risk myelodysplastic syndrome (MDS). Although this approach has shown graft-versus-leukemia effect and potentially being curative, high rate toxicity and treatment-related mortality (TRM) have limited its use other than in the context of clinical trials. The goal of this study was to decrease toxicity of allo- hematopoeitic cell transplantation (HCT) as treatment for patients who had chemosensitive hematological malignancies while allowing the benefit of “graft-versus-tumor” effect by using a non-myeloablative HCT (NM-HCT) approach. Methods: Patients included were newly diagnosed or previously treated MM patients of any stage, NHL patients who failed of ≥ 2 chemotherapies regimens (CHOP and at least one salvage treatment), CLL refractory to standard chemotherapy, and MDS with high-risk cytogenetics. Conditioning regimen consisted of fludarabine at 30 mg/m2/day on days −5, −4, −3 and melphalan at 80 mg/m2 x 2 on days −2 and −1. Graft-versus-host disease (GVHD) prophylaxis included cyclosporine 3 mg/kg intravenous on day −2 and methotrexate at 10 mg/m2 intravenously on days 3, 6, and 11. Results: A total of 17 patients were assessable: 11 MM patients (7 IgG, 1 IgA, 2 light chain restriction, 1 non-secretory MM), 3 NHL patients (1 FL, 1 MCL, 1 LGL-NK cell), 2 CLL, and 1 MDS (with trisomy 8, 5q−) with a median age of 50.4 years old (range, 34 to 60 years). Three patients received more than two regimens prior to NM-HCT. The initial responses to therapy prior to NM-HCT were: 5 CR, 2 nCR, and 10 PR. All patients received identical 6/6 HLA sibling donor stem cells. All patients but one attained CR (94%) after NM-HCT. The median time for ANC engraftment was 15.4 days (range, 10–36 days). Eight patients developed acute GVHD grade I–III (5 skin, 3 gastrointestinal); all of them responded well to methylprednisolone treatment. Nine patients developed chronic GVHD (grade I–II). The 100-day mortality rate was 5.9% (1 patient died at day + 96 without evidence of MM). Post-transplant, all patients have reported a Karnofsky’s scale performance status between 80%–100%. Three patients (all MM) relapsed after 4, 6, and 32 months post-transplantation. Only one patient received auto-HCT, but continues to have progressive disease, and is on thalidomide/dexamethasone. Only 3 patients had relapsed at 5−, 6−, and 25 months (all MM patients). After a median follow-up of 42.5 months (range, 1–78 months), median survival has not been reached. Conclusions: NM-HCT is a feasible treatment option with manageable toxicity profile. TRM was less than those reported for myeloablative HCT, and results suggest a graft-versus-tumor effect on these types of hematological malignancies using a NM-HCT approach based on CR rate observed as well as median time to progression. These encouraging results warrant further investigation.

scholarly journals A Novel Text-Message Reminder System to Address Medication Non-Adherence

2015 ◽  
Vol 8 (1) ◽  
Author(s):  
Avinash Pandey
Keyword(s):  
High Risk ◽  
Healthy Volunteers ◽  
Disease Progression ◽  
Text Message ◽  
High Rate ◽  
Reminder System ◽  
Computer Based ◽  
Text Message Reminder ◽  
Habitudes De Vie ◽  
The Impact

There is a high rate of medication non-adherence, which can lead to disease progression, disability andmortality. This study tested a novel computer-based text message reminder system to improve adherence to medications. This system proved effective in improving adherence to a placebo in healthy volunteers, and to medications in cardiac patients over a two month period. It was especially effective in individuals at prospectively identified to be at high risk of non-adherence. This system represents a simple and scalable method to improve adherence to medications at a clinical or pharmaceutical level. Further research into the impact of repeated reminders is necessary to explore the impacts of text message reminders in other populations and in other lifestyle interventions.Il y a un taux élevé de non-adhérence aux médicaments, ce qui peut provoquer la progression de la maladie, des handicaps et même la mortalité. Cette étude a vérifier un système de rappel fonctionnant par messagerie texte afin d’améliorer l’adhérence aux médicaments. Ce système a été prouvé efficace dans l’amélioration de l’adhérence à un placébo chez des sujets bénévoles, et à des médicaments chez des patients cardiaques, sur une période de 2 mois. Il était particulièrement efficace chez es individus identifiés comme ayant un risqué élevé de non-adhérence. Ce système représente une méthode simple et mesurable utilisée pour améliorer l’adhérence aux médicaments à un niveau pharmaceutique ou clinique. Des recherches plus poussées sur les conséquences de ces rappels répétés sont nécessaires afin d’explorer les impacts des rappels texte chez d’autres populations et dans d’autres interventions concernant les habitudes de vie.

scholarly journals A survey of the burden of allergic rhinitis in Hungary from a specialist’s perspective

2012 ◽  
Vol 7 ◽  
Author(s):  
Mária Szilasi ◽  
Gabriella Gálffy ◽  
Károly Fónay ◽  
Zsuzsa Márk ◽  
Zoltán Rónai ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Everyday Life ◽  
Disease Severity ◽  
Severe Disease ◽  
Significant Proportion ◽  
Well Being ◽  
High Rate ◽  
Cross Sectional ◽  
Intranasal Corticosteroids ◽  
The Impact

Background: The casual and severity distribution of allergic rhinitis (AR) in Hungary is unknown. The aim of this survey was to evaluate symptom perception, disease severity, concomitant asthma frequency and the impact of AR on everyday life activities in a cross-sectional, multicenter study in Hungary under the supervision of Hungarian Respiratory Society. Methods: Data were recorded by 933 AR patients (65.93% women) and their treating specialists. The perceptions of patients regarding the symptoms (nasal, ocular and others) of AR and its severity, together with its impact on everyday life were assessed. Physicians recorded data regarding the diagnosis and severity of AR, and comorbidities. Results: 52.5% of patients suffered from seasonal AR, 35.1% from perennial AR. A large proportion of patients had moderate to severe disease (MS-AR) (57.34%), persistent disease (98.0%) and concomitant asthma (53.32% in the mild, 57.52% in the MS-AR group). MS-AR was more frequent among women. Despite the treatment used, in MS-AR the proportions of patients reporting moderate to severe rhinorrhoea, nasal obstruction, ocular itching/redness, watering, itchy throat and sneezing were as high as 52.0%, 54.0%, 33.8%, 26.5%, 44.0% and 31.2%, respectively. Overall, there was a poor agreement between disease severity reported by patients and specialists. The adherence to oral antihistamines and intranasal corticosteroids was found to be between 50 and 65%; mostly depending on the dosage form. Conclusions: AR remains a significant health problem in Hungary because of the burden of symptoms, high rate of concomitant asthma and the significant proportion of MS-AR affecting general well being.

scholarly journals COVID19 Infection in A Patient Undergoing Treatment for Paroxysmal Nocturnal Hemoglobinuria (PNH) with Ravulizumab

2020 ◽  
Author(s):  
Sufana Shikdar ◽  
Azra Borogovac ◽  
Elabdallah Mohamad ◽  
Mohamad Khawandanah
Keyword(s):  
High Risk ◽  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Hematological Malignancies ◽  
Severe Disease ◽  
Rapid Recovery ◽  
Limited Data ◽  
Case Presentation ◽  
Beneficial Effects ◽  
Inflammatory Damage

Abstract Background: In the recent COVID19 pandemic, patients with hematological malignancies were considered high risk for severe disease. Limited data is available regarding course of COVID19 infection in this subgroup. Case Presentation: We describe a case of 32-year‐old man with paroxysmal nocturnal hemoglobinuria (PNH) undergoing treatment with ravulizumab (Ultomiris) who presented with COVID19 infection. He experienced only mild symptoms and had a rapid recovery from COVID19 infection. Conclusion: This case may demonstrate the beneficial effects of ravulizumab on complement mediated inflammatory damage linked with COVID19 infection especially in PNH patients.

Evidence-Based Prevention Strategies of Suicide Behavior in the World: Implications for Slovenia

Crisis ◽  
2002 ◽  
Vol 23 (3) ◽  
pp. 121-126
Author(s):  
Claire Henderson ◽  
Paola Dazzan ◽  
Mojca Dernovsek ◽  
Rok Tavcar ◽  
Marija Brecelj
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Mental Health Services ◽  
Health Services ◽  
Community Mental Health Services ◽  
Population Level ◽  
Risk Groups ◽  
High Rate ◽  
The Baltic ◽  
The Impact

Abstract: In this review we consider how Slovenia could consider tackling its high rate of suicide (overall 29 per 100,000, 46 in males, 13 in females). First, we consider the evidence for risk factors that may contribute to Slovenia's high rate of suicide. Second, we describe the interventions to try to reduce the impact of these factors and the evidence for such interventions. We categorize interventions in terms of their operation at either the population level or that of high-risk groups. However, it should be borne in mind that settings often assumed to provide access to population groups, such as general practice and schools, do not reach some people who are likely to be at high risk; for example those who have dropped out of school or who have been excluded from a GP's list. We focus particularly on those for high-risk groups, as a number of East-European countries with high suicide rates such as Slovenia, Hungary, and the Baltic republics are currently considering a shift toward more community-based mental health services. The provision of community mental health services in Slovenia would provide an opportunity to study their impact on the suicide rate. However, we conclude that their development should be accompanied by other initiatives operating at population levels. This multilevel approach acknowledges the complexity of the etiology of suicide, the impossibility of reaching all those at risk through services and the lack of strong evidence for any one intervention.

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