scholarly journals The efficacy of colchicine and dapsone combination therapy in relapsed immune thrombocytopenia

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Thanawat Rattanathammethee ◽  
Wasan Theerajangkhaphichai ◽  
Ekarat Rattarittamrong ◽  
Sasinee Hantrakool ◽  
Chatree Chai-Adisaksopha ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Immune Thrombocytopenia ◽  
Response Rate ◽  
Complete Response ◽  
University Hospital ◽  
Common Side Effect ◽  
Chiang Mai ◽  
Steroid Dependent ◽  
Therapy Option ◽  
Acceptable Side

The aim of the present paper is to evaluate the efficacy and safety of colchicine and dapsone combination therapy in cases of steroid-dependent, relapsed and refractory immune thrombocytopenia (ITP). This is a retrospective study of ITP patients who attended the Hematology Clinic at Chiang Mai University Hospital (Thailand) from 1 January 2008 to 30 September 2014. Medical records and clinical data were reviewed for efficacy and adverse effects. Sixty-four ITP patients received the combination therapy. The median age was 46 years and 70.3% were female. The majority (65.6%) were relapsed ITP patients. Median platelet count before starting treatment was 22.6×109/L. The response rate was 82.8%, with 75.0% of patients having a complete response. Median time to response was 8 weeks. The response rate was higher in relapsed patients (90.4%) compared to refractory (61.5%) and steroid-dependent patients (77.8%). Steroid treatment was discontinued in 30 patients (50%) following combination therapy. The most common side effect was hemolysis due to dapsone which was found in eight patients (12.5%). We can therefore conclude that combination therapy with colchicine and dapsone is an alternative second-line therapy option in relapsed ITP cases with acceptable side effects.

scholarly journals Durable complete response to combination nivolumab and ipilimumab in metastatic renal cell carcinoma

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Kenta Takayasu ◽  
Koei Muguruma ◽  
Hidefumi Kinoshita
Keyword(s):  
Renal Cell Carcinoma ◽  
Combination Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Response Rate ◽  
Checkpoint Inhibitors ◽  
Cancer Recurrence ◽  
Complete Response ◽  
Durable Response ◽  
Durable Complete Response

Immune checkpoint inhibitors, which promote or suppress the anti-tumor immune response, are becoming the mainstay of cancer treatment. In 2018, CheckMate 214 study showed a higher response rate with ipilimumab and nivolumab combination therapy compared to conventional therapy for advanced renal cell carcinoma. We report a case of complete response and durable response for two years to ipilimumab and nivolumab combination therapy in a patient with postoperative renal cancer recurrence that caused immune-related adverse events such as interstitial pneumonia and hepatotoxicity.

Bortezomib, Doxorubicin and Dexamethasone (PAD) Combination Therapy for Chinese Relapsed or Refractory Multiple Myeloma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4948-4948
Author(s):  
Yongqing Zhang ◽  
Guangxun Gao ◽  
Jishi Wang ◽  
Xiequn Chen
Keyword(s):  
Multiple Myeloma ◽  
Peripheral Neuropathy ◽  
Partial Response ◽  
Combination Therapy ◽  
Response Rate ◽  
Conflicts Of Interest ◽  
Complete Response ◽  
Extramedullary Plasmacytoma ◽  
Refractory Multiple Myeloma ◽  
Progression Of Disease

Abstract Abstract 4948 Objective To investigate the efficacy and safety of PAD (bortezomib, doxorubicin and dexamethasone) combination therapy for Chinese relapsed or refractory multiple myeloma (MM). Methods 31 patients with relapsed or refractory MM received two to eight 21-days cycles of PAD: comprising an intravenous bolus of bortezomib 1.3 mg/m2 (P1,N=13) or 1.0 mg/m2 (P2,N=18) on days 1, 4, 8, and 11, doxorubicin 10mg per day on days 1 to 4, along with dexamethasone 40mg on days 1-4. Response to PAD was evaluated according to International Myeloma Working Group Criteria (IMWG 2006), toxicity was graded according to NCI CTCAE v3.0. Results 25 patients (80.6%) achieved at least a partial response (PR), including complete response (CR) in 9 patients (29%), very good partial response (VGPR) in 7 patients (22.6%), PR in 9 patients (29%) and stable disease (SD) in 4 patients(12.9%), progression of disease (PD) in 2 patients (6.5%); median time to progression was 9.2 months, the median courses to achieve at least PR was 1.6(1-3) cycles, all of 7 patients with extramedullary plasmacytoma achieved at least PR after the first cycle of PAD, extramedullary plasmacytoma disappeared with 1-2 cycles of PAD. The efficacy was independent of traditional prognostic factors such asβ2-MG, Albumin,LDH and Hemoglobin which have previously influenced response to traditional chemotherapy. 1.5 year OS (Overall survival)of CR+VGPR group and PR group were 87.5% vs 46.7% (P=0.09). ≥PR response rate (CR +VGPR +PR) of P1AD and P2AD were 84.6% VS 77.8% (P= 0.501), CR+VGPR rate of P1AD and P2AD were 53.8% vs 50.0% (P=0.561 ). 1 year PFS(Progession-free survival) of P1AD and P2AD were 61.2% vs 55.6%(P=0.638), there were not difference between P1AD and P2AD in response rate(P= 0.501) and 1 year OS (P=0.872). Adverse events included thrombocytopenia in 15 patients ( 48.4% ), leukopenia in 8 patients(25.8%), peripheral neuropathy in 6 patients (19.4% ), varicella herpes zoster in 7 patients (22.6%), fatigue in 11 patients (35.5%) and diarrhea in 5 patients (16.1%), Thrombocytopenia and peripheral neuropathy of P1AD and P2AD were 46.2% vs 11.1%( P=0.037)and 53.8% vs 11.1%(P= 0.014).Common adverse reactions could be controlled with routine supportive treatmemt, one patient (3.2% ) died from respiratory failure during his fifth P1>AD. Conclusions PAD should be considered an appropriate treatment for Chinese relapsed or refractory MM, especially for MM with extramedullary plasmacytoma, its efficacy were independent of traditional prognosis factors, bortezomib dose reduction may reduce toxicities of PAD while retaining the efficacy. Disclosures No relevant conflicts of interest to declare.

Once-Weekly Subcutaneous Bortezomib Plus Oral Cyclophosphamide and Dexamethasone Therapy For Relapsed Or Refractory Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5382-5382 ◽  
Author(s):  
Yasushi Takamatsu ◽  
Yutaka Imamura ◽  
Tomonori Nakazato ◽  
Naokuni Uike ◽  
Kaname Miyashita ◽  
...  
Keyword(s):  
Injection Site ◽  
Medical Information ◽  
Response Rate ◽  
Injection Site Reaction ◽  
Sensory Neuropathy ◽  
Complete Response ◽  
University Hospital ◽  
Weekly Schedule ◽  
Oral Cyclophosphamide ◽  
Grade 3

Abstract Background We previously reported that twice-weekly intravenous bortezomib plus doxorubicin and intermediate-dose dexamethasone (iPAD) therapy induced a high complete response (CR) rate of 30% and prolonged remission duration of median 12.1 months in patients with relapsed or refractory myeloma. However, sensory neuropathy was observed in 78% of the patients with grade 3 neuropathy in 22%. To reduce the toxicity, we conducted once-weekly subcutaneous bortezomib therapy given in combination with oral cyclophosphamide and dexamethasone (sVCD). Methods This was a phase 2 multicenter study conducted by the Kyushu Hematology Organization for Treatment Study Group (K-HOT). sVCD regimen consists of bortezomib 1.3 mg/m2 administered subcutaneously, and cyclophosphamide 300 mg/m2 and dexamethasone 40 mg given orally on days 1, 8, 15 and 22. The treatment was repeated at a 5-week interval for 6 cycles. The primary endpoint was to determine the complete response rate. The toxicities including sensory neuropathy and injection site reaction were analyzed as the secondary endpoint. The study was approved by the Institutional Review Board at each participating center and was registered in University hospital Medical Information Network (UMIN000006490). All patients provided a written-informed consent. Results Thirty-one patients with median age of 69 (range, 43-87) were entered into this study. The numbers of prior chemotherapy line were 1 in 39%, 2 in 23%, and more than 3 in 39% of the patients. Bortezomib, lenalidomide and thalidomide had been given in 52%, 26% and 16%, respectively. CR was achieved in 16%, partial response (PR) in 26%, and minimal response (MR) in 29%, resulting in overall response rate of 71%. Grade 3/4 neutropenia was observed in 35%/3%, thrombocytopenia in 16%/13%, and anemia in 45%/0% of the patients. Grade 3 to 4 non-hematological toxicities were uncommon; the highest incidence of grade 3 events were rash, hyponatremia and hyperglycemia observed in 6%, while no grade 4 events were reported. Grade 3 sensory neuropathy developed in 3% and grade 2 in 19%. Injection site reactions were observed in 39%, but all of them were grade 1. Conclusion sVCD therapy containing bortezomib administered subcutaneously in once-weekly schedule successfully reduced the incidence and severity of sensory neuropathy with moderate response rate. Disclosures: Miyamoto: Kyushu University Hospital: Employment.

scholarly journals ML-02 MULTIAGENT IMMUNOCHEMOTHERAPY, R-MPV-A, FOR PATIENTS WITH SECONDARY CENTRAL NERVOUS SYSTEM LYMPHOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii32-ii32
Author(s):  
Motoo Nagane ◽  
Keiichi Kobayashi ◽  
Kuniaki Saito ◽  
Daisuke Shimada ◽  
Yoshie Matsumoto ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Response Rate ◽  
Central Nervous System Lymphoma ◽  
Whole Brain Radiotherapy ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
University Hospital ◽  
High Dose ◽  
Serious Adverse Events

Abstract BACKGROUNDS Standard of care (SOC) for primary central nervous system lymphoma (PCNSL) has been induction therapy with high-dose methotrexate (MTX)-based multiagent immunochemotherapies followed by consolidation, and we have shown that one such regimen, R-MPV-A have superior efficacy over HD-MTX alone with whole brain radiotherapy (WBRT). While SOC for secondary CNS involvement of systemic diffuse large B-cell lymphoma (DLBCL)(SCNSL) has not been established. Here we report the outcome of R-MPV-A for patients with SCNSL. PATIENTS AND METHODS Fifteen patients with SCNSL treated with R-MPV-A from January 2014 to January 2019 in Kyorin University Hospital were eligible. Prior treatment for systemic DLBCL was mostly R-CHOP. Response and survival outcomes were evaluated. RESULTS Median age was 68.0 y (55–84), male/female 6/9, median KPS 70 (40–90), histopathological confirmation was achieved in 12 patients (80%; biopsy 11). RMPV (rituximab+MTX+procarbazine+vincristine) 3 cycles in 3, 4–7 cycles in 6, 8 cycles in 5. WBRT and cytarabine were delivered in 6 and 9 patients, respectively. R-MPV resulted in 6 CRs/CRus, 5 PRs, 1 SD, and 2 PDs (Response rate 73%). R-MPV-A including consolidation led to 9 CRs/CRus, 2 PRs, 1 SD, and 2 PDs (complete response rate 60%). With median F/U period of 11.2 m (0.1–51.5), 1y-PFS and 2y-PFS of R-MPV-A were 66.0% and 56.6%, 1y-OS and 2y-OS were 72.2% and 72.2%, respectively. Median PFS/OS were not reached. Consolidation cytarabine was associated with better outcome. Three deaths occurred during the treatment (20%; two during R-MPV with aged 70s, KPS 40 and 50; one presented MTX clearance delay). No other serious adverse events were observed. CONCLUSIONS These results suggest the certain efficacy of R-MPV-A for SCNSL. Being heavily pretreated frequently, precautions should be taken to identify high risk cases.

Optimal combination therapy with tropisetron in 445 patients with incomplete control of chemotherapy-induced nausea and vomiting.

1994 ◽  
Vol 12 (11) ◽  
pp. 2439-2446 ◽  
Author(s):  
F Hulstaert ◽  
S Van Belle ◽  
H Bleiberg ◽  
J L Canon ◽  
M Dewitte ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Response Rate ◽  
Complete Response Rate ◽  
Complete Response ◽  
Moderate Increase ◽  
Open Label ◽  
Double Blind ◽  
Once Daily ◽  
Antiemetic Agent ◽  
To Receive

PURPOSE This study evaluated tropisetron (Navoban; Sandoz Pharma, Basle, Switzerland)-based combination therapy in patients who had incomplete control of chemotherapy-induced nausea or vomiting when using tropisetron as a single antiemetic agent. PATIENTS AND METHODS One thousand seventy-two patients, who were scheduled to receive at least two identical cycles of emetogenic chemotherapy, were treated with 5 mg tropisetron once daily in their first chemotherapy course. A 2 x 2 x 2 factorial design was used to evaluate three additional treatments to the recommended 5 mg once daily (intravenously [i.v.] on day 1; orally on days 2 through 6) tropisetron regimen during course 2 in those patients who had shown incomplete control of nausea and/or vomiting on any day of course 1. Four hundred forty-five patients were centrally randomized to receive, in addition, open-label dexamethasone (day 1, 0.2 mg/kg i.v.; days 2 through 6, 8 mg orally) and/or open-label alizapride (day 1, 100 mg i.v. and 4 x 50 mg orally; days 2 through 6, 4 x 50 mg orally) and/or double-blind tropisetron (ie, doubling the dose to 10 mg once daily) or corresponding placebo. RESULTS Complete response rates (no nausea and no vomiting) were 72% for day 1 and 48% for days 1 through 6 of course 1. During course 2, more complete responders were observed when dexamethasone was added, both for day 1 (76% v 66%, P = .020) and for days 1 through 6 (50% v 34%, P = .0004). A moderate increase in the complete response rate was seen with the addition of conventional-dose alizapride (day 1, 75% v 68%, P = .14; days 1 through 6: 47% v 37%, P = .041). Doubling the dose of tropisetron did not change the complete response rate. CONCLUSION The addition of dexamethasone significantly increases the complete response rate of both acute and delayed emesis in patients who have incomplete disease control with tropisetron alone.

scholarly journals Chimeric Antigen Receptor T-cell (CAR T) Therapy for Hematologic and Solid Malignancies: Efficacy and Safety—A Systematic Review with Meta-Analysis

Cancers ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 47 ◽  
Author(s):  
Wen-Liang Yu ◽  
Zi-Chun Hua
Keyword(s):  
T Cells ◽  
Response Rate ◽  
Meta Analysis ◽  
Complete Response ◽  
Hematologic Malignancies ◽  
Common Side Effect ◽  
Future Research ◽  
Efficacy And Safety ◽  
Tumor Patients ◽  
Car T

Chimeric antigen receptors T cells (CAR T) had been used for treating various tumor patients in clinic, and owned an incredible efficacy in part of malignancies. However, CAR T therapy remains controversial due to doubts about its efficacy and safety in the clinical treatment of various malignancies. A total of 997 tumor patients from 52 studies were included in this review. Eligible studies were searched and reviewed from the databases of PubMed, Web of Science, Wanfang and Clinicaltrials.gov. Then meta-analysis and subgroup analysis were used to investigate the overall response rate (ORR), complete response rate (CRR), common side effect rate (CSER) and relapse rate (RR) of CAR T therapy for patients in clinical researches, respectively. The results further confirmed that CAR T therapy had a higher response rate for hematologic malignancies. More importantly, CAR T therapy had a higher CSER in patients with hematologic malignancies, and it had a similar RR in patients with different malignancies. Cell cultured without the addition of IL-2 and total administration less than 108 cells were recommended. This study offers a reference for future research regarding the application in solid and hematologic malignancies, side effects and relapse, and even the production processes of CAR T cells.

Management of Helicobacter pylori in Patients with Immune Thrombocytopenia

2019 ◽  
Vol 39 (03) ◽  
pp. 279-283 ◽  
Author(s):  
Yenny Alejandra Moreno Vanegas ◽  
Prakash Vishnu
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Immune Thrombocytopenia ◽  
Response Rate ◽  
Immunosuppressive Agents ◽  
Complete Response ◽  
Platelet Response ◽  
New Therapeutic Approaches ◽  
Online Databases ◽  
H Pylori

AbstractThere is an association between Helicobacter pylori infection and immune thrombocytopenia (ITP), and few studies have suggested that eradicative treatment of H. pylori infection may improve platelet counts in patients with ITP. Conventional treatments for ITP include immunosuppressive agents, and more recently thrombopoietic agents. However, based on clinical reports of association between H. pylori and ITP, several medical societies increasingly suggest detection and eradication of H. pylori as a treatment for ITP. In this article, we reappraise recent medical literature to determine the effectiveness of platelet response after treatment of H. pylori infection in patients with ITP. We searched two online databases (MEDLINE and Google Scholar) for full articles published between January 2008 and May 2018, and found a total of 11 studies that presented data and outcomes of treatment of H. pylori infection in ITP patients. All the studies administered triple therapy (amoxicillin 500 mg, clarithromycin 250 mg and a proton-pump inhibitor each given twice daily for either 7- or 14-day course) for eradication of H. pylori. Median overall platelet response ranged from 27 to 69.2% with a complete response rate ranging from 0 to 65.4% and a partial response rate ranging from 0 to 29.4%. Although there is variability in the effectiveness between different populations, it appears to be of benefit to ITP patients with concomitant H. pylori infection when treated with triple therapy. However, further studies to understand the pathogenesis of H. pylori-associated ITP is necessary for the development of new therapeutic approaches for ITP.

scholarly journals From chronic immune thrombocytopenia to severe aplastic anemia: recent insights into the evolution of eltrombopag

2017 ◽  
Vol 8 (5) ◽  
pp. 159-174 ◽  
Author(s):  
Harinder Gill ◽  
Raymond S. M. Wong ◽  
Yok-Lam Kwong
Keyword(s):  
Platelet Count ◽  
Aplastic Anemia ◽  
Immune Thrombocytopenia ◽  
Overall Response Rate ◽  
Response Rate ◽  
Single Agent ◽  
Complete Response ◽  
Pegylated Interferon ◽  
Severe Aplastic Anemia ◽  
Overall Response

Thrombopoietin (TPO) is the most potent cytokine stimulating thrombopoiesis. Therapy with exogenous TPO is limited by the formation of antibodies cross-reacting with endogenous TPO. Mimetics of TPO are compounds with no antigenic similarity to TPO. Eltrombopag is an orally-active nonpeptide small molecule that binds to the transmembrane portion of the TPO receptor MPL. Initial trials of eltrombopag have centered on immune thrombocytopenia (ITP), which is due to both increased destruction and decreased production of platelets. Eltrombopag at 25–75 mg/day has been shown to be highly effective in raising the platelet count in ITP with suboptimal response to immunosuppression and splenectomy. These successful results led to the exploration of eltrombopag in other thrombocytopenic disorders. In hepatitis C viral infection, eltrombopag raises the platelet count sufficiently enough to allow treatment with ribavirin and pegylated interferon. Because MPL is expressed on hematopoietic cells, eltrombopag use in myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) might enhance leukemic proliferation. Clinical trials of eltrombopag in MDS and AML, however, have shown amelioration of thrombocytopenia without promoting disease progression. In severe aplastic anemia (SAA) not responding to immunosuppression with anti-thymocyte globulin (ATG) and cyclosporine, eltrombopag as a single agent at 150–300 mg/day results in an overall response rate of 40–70%. At high doses, adverse effects including pigmentation, gastrointestinal upset and hepatic derangement have become evident. Current studies have examined the first-line use of eltrombopag in combination with ATG in SAA. In a recent study, eltrombopag used at 150 mg/day with horse ATG resulted in an overall response rate of 90% in newly diagnosed SAA patients, with a complete response rate of about 50%. Clonal karyotypic aberrations are, however, found in 10–20% of SAA patients treated with eltrombopag. The safety and efficacy of eltrombopag in SAA require further evaluation, particularly when it is used with less intensive immunosuppression.

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