scholarly journals Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism：a single-centre study in China

2020 ◽  
Author(s):  
Wang Qimin ◽  
Chen Liangwan ◽  
Chen Daozhong ◽  
Qiu Hanfan ◽  
Huang Zhongyao ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Right Ventricle ◽  
Line Treatment ◽  
First Line ◽  
Single Centre ◽  
Right Ventricle Function ◽  
Systemic Thrombolysis ◽  
Acute Pe ◽  
First Line Treatment ◽  
Ventricle Function

Abstract Background: Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods: A retrospective review of patients who underwent SPE for acute PE was conducted .Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular functionResults: Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2±48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping . Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days).Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups .There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions: SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups . SPE should play the same role as ST in algorithmic acute PE treatment.

scholarly journals Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Wang QiMin ◽  
Chen LiangWan ◽  
Chen DaoZhong ◽  
Qiu HanFan ◽  
Huang ZhongYao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Line Treatment ◽  
First Line ◽  
Single Centre ◽  
Right Ventricle Function ◽  
Systemic Thrombolysis ◽  
Acute Pe ◽  
First Line Treatment ◽  
Ventricle Function

Abstract Background Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods A retrospective review of patients who underwent SPE for acute PE was conducted.Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular function. Results Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2 ± 48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping. Ventilatory support time was 78 h (range, 40–336 h), intensive care unit stay was 7 days (range, 3–13 days), and hospital stay was 16 days (range, 12–23 days). Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups.There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups. SPE should play the same role as ST in algorithmic acute PE treatment.

scholarly journals Single Centre Experience of Managing Patients with Double Hit Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5868-5868
Author(s):  
Shankaranarayana Paneesha ◽  
Iman Qureshi ◽  
Malahat Saeed ◽  
Richard Lovell ◽  
Emmanouil Nikolousis ◽  
...  
Keyword(s):  
Overall Survival ◽  
Complete Remission ◽  
Progressive Disease ◽  
Salvage Chemotherapy ◽  
Line Treatment ◽  
First Line ◽  
Single Centre ◽  
Single Centre Experience ◽  
First Line Treatment

Abstract Double or triple hit Lymphomas (DHL) are characterized by translocation rearrangements of C-MYC with the addition of BCL2 and/or BCL 6, which are associated with a poor outcome due to their genetic complexity . Clinical controversies remain regarding the optimum treatment for patients with DHL due to lack of consensus regarding the optimal management and also age and frailty being a significant obstacle, limiting the role of dose-escalated or intensified therapy. Literature review suggests overall median survival for DHL patients is from 0.2-1.5years2. We report our single centre experience of treating this patient group. Materials & Methods: This single centre retrospective study evaluated the outcome of DHL patients who underwent various lines of treatment including standard R-CHOP chemotherapy, more intensive chemotherapy regimens and allogeneic stem cell transplantation (AlloSCT). Diagnosis of DHL was as per the 2008 WHO classification. Statistical analysis was performed by using SPSS 23®. Results: Our study included fourteen patients (9M; 5F) with a median age 60.5 years (range 33-65). 4 patients had stage 2B disease, 3 had stage 3B and 7 had 4B disease. R-CHOP chemotherapy only was commenced as first line treatment in 4 patients, R-CHOP plus intrathecal chemotherapy was given to 2 patients and 1 patient received R-CEOP. 5 patients received intensive chemotherapy with R-CODOX-M/R-IVAC where as one patient received EPOCH in a different centre prior to transfer. 1 patient received radiotherapy only. 10 patients were in complete remission following first line chemotherapy. One patient progressed following first line treatment and was managed palliatively. One patient relapsed whilst awaiting AlloSCT and was given mini-DEX BEAM salvage chemotherapy prior to transplant. One patient had a partial response to first line treatment and was given further rituximab but had progressive disease and was also managed palliatively. One patient had progressive disease and received GDP chemotherapy. 8 patients underwent AlloSCT with BEAM Alemtuzumab conditioning with cyclosporine as GvHD prophylaxis (6 unrelated and 2 sibling donors). The mean overall survival from starting treatment for DHL for the non-transplant cohort was 18.5 months (Range: 0.5 to 36.5) and the median OS was 8.3 months (Range: 4 to 12.6) as compared to mean overall survival of 44.2 months (Range: 22.2 to 66.35) in the transplant cohort with median overall survival not reached (p value: 0.46, Log Rank). In our patients, there was no progression after 3 months from Allo SCT. One patient progressed 6 weeks and died 8 weeks post AlloSCT, whereas two patients progressed 12 weeks and died 14 weeks post AlloSCT. In the cohort who did not undergo AlloSCT, 3 patients have died and two remain in complete remission and 1 patient is undergoing salvage chemotherapy for refractory disease. Conclusion: Our single centre experience of limited number of patients with DHL suggests AlloSCT as a consolidative treatment in first complete remission, may offer survival benefit as compared to no consolidation. Our data also shows no progression of DHL 3 months post AlloSCT highlighting the potential graft versus lymphoma effect. This requires further evaluation in a larger cohort to confirm our preliminary findings and identify potential biomarkers of best response. Confirmation of this result in larger cohort will identify the role of AlloSCT in DHL and enable to reach consensus in the DHL management. Disclosures Kishore: celgene: Other: travel grant.

10 year outcomes from a single-centre experience of sunitinib and pazopanib as first-line treatment of metastatic renal-cell carcinoma (mRCC).

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e16085-e16085 ◽  
Author(s):  
Shien Chow ◽  
Manon Rhys Pillai ◽  
Victoria Galvis ◽  
Rebecca Leach ◽  
Elizabeth Keene ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Line Treatment ◽  
First Line ◽  
Single Centre ◽  
Single Centre Experience ◽  
First Line Treatment

Dose Escalation of Caspofungin for Invasive Aspergillosis - A Phase II Trial

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2309-2309
Author(s):  
O. A Cornely ◽  
J. J Vehreschild ◽  
M. J Rüping ◽  
S. Schwartz ◽  
C. Heussel ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Invasive Aspergillosis ◽  
Board Of Directors ◽  
Liposomal Amphotericin ◽  
Pharmacokinetic Analysis ◽  
Line Treatment ◽  
First Line ◽  
Advisory Committees ◽  
Dose Limiting Toxicity ◽  
First Line Treatment

Abstract Abstract 2309 Objectives. Treatment of invasive aspergillosis (IA) fails in up to 50% of all cases and the mortality rate is at least 30%. Antifungal combination treatment has not been proven to be beneficial and dose escalation with liposomal amphotericin B did not improve outcome. New approaches are needed for patients with severe immunosuppression. Methods. Escalating high dosages of caspofungin were investigated in IA defined according to modified EORTC/MSG criteria. The tested cohort of patients received 70mg, 100mg, 150mg or 200mg QD, 8 patients each were to receive caspofungin first-line treatment for proven/probable IA for up to 28 days. Dose limiting toxicity was defined as 2 of 8 patients in the same cohort with the same grade ≥4 non-hematological treatment-related adverse event (TRAE), or 4 of 8 patients with a grade ≥3 non-hematological TRAE. If no dose-limiting toxicity was reached, 12 additional patients were to be enrolled in the 200mg cohort. Patients unevaluable for toxicity or pharmacokinetic analysis were replaced. Results. A total of 46 patients were treated in the 4 cohorts (9, 8, 9, 20 pts). IA was proven in 2.2% and probable in 97.8%. Patient characteristics were as follows: Median age 61 years (min 18.3, max 73.7); 21/46 (45.7%) female. Underlying disease distribution was: AML 50%, ALL 8.7%, lymphoma 19.6%, chronic lymphocytic leukaemia 10.9%, other 10.9%. Median duration of treatment was 24.5 days. Two (4.3%) patients with treatment durations ≤5 days were replaced for pharmacokinetic analysis, but evaluated for safety and efficacy. No dose-limiting toxicity was found by investigator or DSMB assessment. At end of treatment (EOT) complete plus partial response was achieved in the 4 cohorts in 4/9, 3/8, 6/9, 12/20 patients, i.e. 25/46 (54.3%) of the total population. Stable disease was achieved in 4 patients (8.7%), 17 (37%) patients failed treatment. Overall survival at 12 weeks was 76.1%. After a 12 week follow-up attributable mortality was 8.7%. Death due to malignancy occurred in 10.9%, to sepsis in 8.7%. Conclusions. In the first-line treatment of proven or probable invasive aspergillosis no dose-limiting toxicity of caspofungin at doses up to 200 mg QD was found. Complete plus partial response rates at EOT were 54.3% after dose-escalated caspofungin treatment, and thus in the range of the success rates previously reported with voriconazole and liposomal amphotericin B. Twelve weeks after start of treatment the 23.9% overall mortality rate was lower than that found in the literature. Disclosures: Cornely: MSD: Consultancy, Honoraria. Vehreschild: MSD: Honoraria. Rüping: MSD: Honoraria. Silling: MSD: Membership on an entity's Board of Directors or advisory committees. Lehrnbecher: MSD: Membership on an entity's Board of Directors or advisory committees. Ullmann: MSD: Honoraria. Groll: MSD: Membership on an entity's Board of Directors or advisory committees. Karthaus: MSD: Membership on an entity's Board of Directors or advisory committees.

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