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Non-Hodgkin Lymphoma
Published in Tariq I. Mughal, Precision Haematological Cancer Medicine, 2018
Burkitt’s lymphoma (BL) occurs endemically in sub-Saharan Africa, often associated with HIV, and sporadically in other parts of the world. It accounts for about 5% of adults and 40% of childhood NHLs. BL has a very high proliferative index, which underscores the urgency in making an accurate diagnosis and commencing treatment and adjunctive supportive care, such as that for tumour lysis syndrome, in an emergent manner. When treatment is initiated urgently, it enhances the chances of survival. Today, largely in high-income countries, childhood BL has survival rates of >90%, including those with central nervous system (CNS) involvement; the prognosis of adult BL has also improved but still lags considerably with overall survival of around 55%, and considerably less for those with bone marrow or CNS involvement. The clinical outcomes in low-income countries, tragically, remains poor in general, and a significant ‘unmet’ need. The cornerstone of successful chemotherapy in BL has been the maintenance of high-dose intensity and the appropriate use of non-cross-resistant cytotoxic chemotherapeutic regimens, such as CODOX-M/IVAC (cyclophosphamide, vincristine, daunorubicin, methotrexate, ifosfamide, etoposide and cytarabine) to minimize drug-resistance, and the use of high-dose methotrexate and cytarabine to abate risk of CNS relapse. A randomized study demonstrated that the addition of rituximab to a short dose-dense chemotherapy regimen for adults with BL or Burkitt’s leukaemia (see Chapter 5) accorded an improved event-free survival. It is of note that the chemotherapy program used in this study was relatively short, and akin to that used in childhood BL treatments. Very rarely patients with BL present with localized disease of the ileocaecal region, and can be treated successful by surgery, followed by chemotheraphy.
Engaging the Community to Improve Patient-Centered Care for Inflammatory Breast Cancer
Published in Oncology Issues, 2019
Gayathri R. Devi, Holly Hough, Whitney Lane, Kearston L. Ingraham, Larisa Gearhart-Serna, Cynthia Serna, Terry Arnold, Nadine J. Barrett
Guideline-concordant care for breast cancer patients includes multimodal therapy, which translates into a significant number of diagnostic tests, increased risk for potential complications, and prolonged time away from work.10 Two patients described the number of tests and need for support throughout therapy: I had a PowerPort inserted in my left chest wall; had an ECHO [echocardiogram] of my heart; had lab work; had an ultrasound of my right axilla lymph nodes (which resulted in me having a lymph node biopsy—also cancerous); and attempted to have a PET [positron emission tomography] scan, which my insurance denied, so I had CT [computed tomography] scans of chest, abdomen, and pelvis plus a bone scan.I can't deny that the effects of dose-dense chemotherapy were debilitating for me. I am thankful my mom came to stay with us because I could barely take care of myself, let alone my son.
Pegfilgrastim-induced hyperleukocytosis leading to hospitalization of a patient with breast cancer
Published in Baylor University Medical Center Proceedings, 2019
Rihin Chavda, Jon D. Herrington
Dose-dense chemotherapy is an effective treatment that allows for a shorter time interval between treatment cycles and requires the use of pegfilgrastim.8 After pegfilgrastim administration, neutrophil receptor–mediated clearance of the drug occurs as the absolute neutrophil count recovers gradually. Hyperleukocytosis (described with WBC >100 × 109/L) can occur if the clearance is affected, which can present asymptomatically or symptomatically.4 Hyperleukocytosis can cause leukostasis. Neurologic or pulmonary symptoms that arise from leukostasis include somnolence, dizziness, stupor, headache, ataxia, coma, hypoxemia, dyspnea, tachypnea, and lung failure.9 These symptoms are a result of vascular obstructions primarily within the lung parenchyma and the central nervous system. In this case report, the presenting symptoms were primarily of neurologic, pulmonary, or musculoskeletal origin. With a negative infectious workup, the presenting symptoms of this patient were likely due to pegfilgrastim’s adverse effects.
The risk of menopausal symptoms in premenopausal breast cancer patients and current pharmacological prevention strategies
Published in Expert Opinion on Drug Safety, 2021
In recent years, dose-dense adjuvant chemotherapy regimens have become popular in clinical practice, especially one that uses paclitaxel on a weekly basis. Dose-dense chemotherapy, namely the delivery of higher amount of drug per unit of time, as an adjuvant treatment strategy in BC patients has been associated with better overall survival compared to conventional chemotherapy and is considered to be the preferred treatment option for patients with high-risk BC [73]. Theoretically, dose-dense strategies may lead to a higher risk for CRA. However, two studies have investigated the risk of CRA associated with dose-dense chemotherapy, with neither of them having found that such a regimen could lead to an increased risk [60,74].