AWARENESS OF THE HEALTHCARE PROVIDERS AND FAMILIES ON PNEUMOCOCCAL VACCINATION OF PEDIATRIC PATIENTS IN HIGH RISK GROUPS: A PRELIMINARY PILOT STUDY

Background: The GATLA Collaborative Group has a 50 year (y) long experience of running cooperative trials for lymphomas in Argentina. Aim: Describe the outcome of pediatric patients(pts) treated according to the international cooperative work with AHOPCA and St. Jude Children's Research Hospital (11-EHP-12) adopting OEPA/COPDAC strategy for High Risk (HR) pts and ABVD for Intermediate (IR) and Low Risk (LR) pts. Methods: 11-EHP-12: Risk assignment according Stanford/Danna Farber/ SJCRH Consortium classification. LR: ABVD x 4± IFRT (20 Gy). IR: ABVD x 6 ± IFRT (20 Gy). HR: OEPA-COPDAC+IFRT (20/25 Gy). Response evaluation: LR after 4th cycle, IR and HR after the 2nd cycle. Complete Remission (CR): response > 80% reduction and PET negative. Partial Remission (PR): response >50% and <80% reduction and/or PET positive. 170 pediatric patients (pts) were enrolled since November 2012. 133 evaluable pts. 37 on treatment and/or a follow up of less than 5 years. Sex: M/F: 85 (63,9%) /48. Median age: 13 y (range 4-18 y). Histology: nodular sclerosis 91 (68,4%), mixed celularity 31 (23.3%), lymphocyte rich 1 (0,7%), lymphocyte depleted 1 (0,7%), nodular lymphocyte predominant 8 (6,9%). Stage: I :16 (12%), II: 51 (38.4%), III: 27 (20.3%), IV: 39 (29.3%). B Symptoms: 66 (49.6%). Interim evaluation: PET/TC: 109/133 (82%), TC: 24. Distribution by risk groups: HR pts.: 77 (57,9%), IR: 35 (26,3%), LR: 21 (15,8%). Results: 5 y OS was 94% (100% for LR and IR, and 91% HR) and 5y EFS was 88% (100% for LR, 91% IR, and 84% HR). 95% of the LR pts and 72% of the IR pts did not undergo radiotherapy. 70% of the HR pts achieved CR after the 2nd OEPA and received 20 Gy IFRT. According PR or CR after 2nd OEPA, the 5y EFS in HR pts was 84% and 90% respectively. Conclusion: Thanks to this international cooperation We could significantly improve the results in Argentina compared to our previous experience (7-PHD-96: COPP-ABV x 6 + IFRT Bulky disease or PR (20/25Gy): 5yOS:85%, 5yEFS:67%), reduce the number of patients who required radiotherapy and reproduce the Euronet experience for HR pts in a different context. Figure Disclosures No relevant conflicts of interest to declare.

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A novel rituximab administration protocol to minimize infusion-related adverse reactions in patients with B-cell non-Hodgkin lymphoma

10.21203/rs.3.rs-909741/v1 ◽

2021 ◽

Author(s):

Daisuke Tsutsumi ◽

Tatsuya Hayama ◽

Katsuhiro Miura ◽

Akihiro Uchiike ◽

Shinya Tsuboi ◽

...

Keyword(s):

High Risk ◽

B Cell ◽

Hodgkin Lymphoma ◽

Healthcare Providers ◽

Risk Groups ◽

High Risk Group ◽

The Third ◽

Non Hodgkin Lymphoma ◽

Short Infusion ◽

Grade 3

Abstract Background Rituximab is widely used as a key component of immunochemotherapy to treat B-cell non-Hodgkin lymphoma (B-NHL). However, infusion-related reactions (IRRs) during drug administration are occasionally severe or even life-threatening and thus remain problematic for patients and healthcare providers. Aim To minimize IRRs to rituximab in patients with various types of B-NHL. Method: We stratified patients into low- (n = 39), moderate- (n = 35), and high-risk (n = 7) groups according to the number of risk factors, specifically, an indolent histology and the presence of bulky tumors (> 10 cm). For the first rituximab cycle, the low- and moderate-risk groups underwent conventional infusion #1 (~ 4.3 h), and the high-risk group underwent long infusion (6.8 h). Patients in the low-, moderate-, and high-risk groups without IRRs in the first cycle underwent short infusion (2.3 h), conventional infusion #2 (3.5 h), and conventional infusion #1, respectively. Patients with IRRs in the first cycle received a second rituximab cycle with the same schedule as that in the first cycle. The procedure for the third cycle was at the attending physician’s discretion. Results Among 81 B-NHL patients, the incidences of IRRs in the low-, moderate-, and high-risk groups were 31%, 20%, and 57%, respectively, without any grade ≥ 3 IRRs. The overall conversion rate to short infusion in the third cycle was 54%, without any IRRs. Conclusion Our step-by-step protocol provided safe and comfortable rituximab administration for both patients and practitioners (UMIN-CTR; UMIN000032309, registered on 19th April 2018).

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Increasing influenza and pneumococcal vaccination rates in high risk groups in one primary care trust as part of a clinical governance programme

Clinical Governance An International Journal ◽

10.1108/14777270310487002 ◽

2003 ◽

Vol 8 (3) ◽

pp. 200-207 ◽

Cited By ~ 6

Author(s):

A. Niroshan Siriwardena ◽

Tracy Wilburn ◽

Louise Hazelwood

Keyword(s):

Primary Care ◽

High Risk ◽

Primary Care Trust ◽

Pneumococcal Vaccination ◽

Risk Groups ◽

Clinical Governance ◽

Vaccination Rates

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Influenza and Pneumococcal Vaccination Uptake in Adults Aged ?65 Years and High Risk Groups Admitted to Yozgat Bozok University Research and Application Hospital

Klimik Dergisi/Klimik Journal ◽

10.5152/kd.2018.50 ◽

2019 ◽

Vol 31 (3) ◽

pp. 205-209

Author(s):

Ayse Erbay ◽

◽

Cigdem Kader ◽

Huseyin Ede ◽

Murat Suher ◽

...

Keyword(s):

High Risk ◽

Pneumococcal Vaccination ◽

Risk Groups ◽

University Research ◽

Vaccination Uptake

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Pneumococcal Vaccination in High-Risk Individuals: Are We Doing It Right?

Clinical and Vaccine Immunology ◽

10.1128/cvi.00721-15 ◽

2016 ◽

Vol 23 (5) ◽

pp. 388-395 ◽

Cited By ~ 29

Author(s):

Ioanna Papadatou ◽

Vana Spoulou

Keyword(s):

High Risk ◽

Cellular Response ◽

Pneumococcal Disease ◽

Pneumococcal Vaccination ◽

Primary Vaccination ◽

Risk Groups ◽

The Elderly ◽

Polysaccharide Vaccine ◽

Disease Epidemiology ◽

Meta Analyses

ABSTRACTControversy exists regarding the optimal use of the 23-valent pneumococcal conjugate vaccine for the protection of high-risk individuals, such as children and adults with immunocompromising conditions and the elderly. The effectiveness and immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPV23) are limited in such high-risk populations compared to the healthy, with meta-analyses failing to provide robust evidence on vaccine efficacy against invasive pneumococcal disease (IPD) or pneumonia. Moreover, several studies have demonstrated a PPV23-induced state of immune tolerance or hyporesponsiveness to subsequent vaccination, where the response to revaccination does not reach the levels achieved with primary vaccination. The clinical significance of hyporesponsiveness is not yet clarified, but attenuated humoral and cellular response could lead to reduced levels of protection and increased susceptibility to pneumococcal disease. As disease epidemiology among high-risk groups shows that we are still in need of maximum serotype coverage, the optimal use of PPV23 in the context of combined conjugate/polysaccharide vaccine schedules is an important priority. In this minireview, we discuss PPV23-induced hyporesponsiveness and its implications in designing highly effective vaccination schedules for the optimal protection for high-risk individuals.

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Rethinking the Definition of High Risk in Pediatric Salivary Gland Carcinoma

Otolaryngology ◽

10.1177/01945998211020301 ◽

2021 ◽

pp. 019459982110203

Author(s):

Sahaja Acharya ◽

Rebecca N. Sinard ◽

Gustavo Rangel ◽

Jeffrey C. Rastatter ◽

Anthony Sheyn

Keyword(s):

Salivary Gland ◽

Young Adult ◽

High Risk ◽

Pediatric Patients ◽

Risk Groups ◽

Adjuvant Radiation ◽

Salivary Gland Carcinoma ◽

Risk Criteria ◽

Significant Difference ◽

Gland Carcinoma

Objective Indications for adjuvant radiation in pediatric salivary gland carcinoma rely on high-risk criteria extrapolated from adult data. We sought to determine whether adult-derived high-risk criteria were prognostic in children aged ≤21 years or young adults aged 22 to 39 years. Study Design Cross-sectional analysis of a hospital-based national registry. Setting Patients were identified from the National Cancer Database between 2004 and 2015. Methods High-risk criteria were defined as adenoid cystic histology, intermediate/high grade, T3/T4, positive margins, and/or lymph node involvement. Exact matching was used to adjust for differences in baseline characteristics between pediatric and young adult patients. Results We identified 215 pediatric patients aged ≤21 years, 317 patients aged 22 to 30 years, and 466 patients aged 31 to 39 years. Within the pediatric cohort, there was no significant difference in overall survival (OS) between low- and high-risk groups (5-year OS, 100% vs 98.5%; P = .29). In contrast, within the young adult cohorts, there was a significant difference in OS between low- and high-risk groups in patients aged 22 to 30 years (5-year OS, 100% vs 96.1%; P = .01) and 31 to 39 years (5-year OS, 100% vs 88.5%; P < .001). When high-risk patients were matched 1:1 on high-risk criteria and race, pediatric patients were associated with better OS than those aged 22 to 30 years ( P = .044) and those aged 31 to 39 years ( P = .005). Conclusion Children have excellent OS, irrespective of adult-derived high-risk status. These findings underscore the need to understand how age modifies clinicopathologic risk factors.

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