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Involvement of Dopamine with Various Cancers
Published in Nira Ben-Jonathan, Dopamine, 2020
Multiple myeloma is a progressive plasma cell tumor leading to overproduction of monoclonal immunoglobulins, osteolytic bone lesions, renal disease, and immunodeficiency. It is the second most prevalent hematologic malignancy in the United States. The dysregulated plasma cells can accumulate in the bone marrow, where they crowd out healthy blood cells. Within bones, myeloma cells increase the activity of osteoclasts (which break down bone) and decrease the activity of osteoblasts (which form new bone), causing bones to dissolve at a faster rate than they are formed. This damages and weakens the bones, causing pain and lesions. Multiple myeloma can also form tumors in the skin and other soft tissue.
Unexplained Fever In Hematologic Disorders Section 1. Benign Hematologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The underlying cause of both the fever and the anemia, such as tuberculosis, pyelonephritis, rheumatoid arthritis, collagen disease, renal cell carcinoma, etc., is often disclosed by the patient’s history, physical examination, appropriate cultures, serologic tests and X-ray examination. The possibility of temporal arteritis, in which such tests are negative, should also be looked into. If after a complete investigation, the cause of the fever is still obscure, bone marrow biopsy and aspiration are indicated. By performing both biopsy and aspiration, maximal information, with no additional risk or discomfort to the patient, may be obtained. With local anesthesia, biopsy is performed first and followed immediately by aspiration from the same site. The aspirate is examined for smear morphology and can also be cultured for pathogens such as tubercle bacilli, brucella, etc. The bone marrow histology may reveal a granulomatous process, metastasis, or a primary hematological malignancy, such as leukemia, reticuloendothelial neoplasia, or multiple myeloma.44
Radioimmunotherapy of Hematological Malignancies
Published in Gertjan J. L. Kaspers, Bertrand Coiffier, Michael C. Heinrich, Elihu Estey, Innovative Leukemia and Lymphoma Therapy, 2019
The use of radiation therapy in the treatment of hematological malignancy has been well established and is highly effective if the disease is localized, as both lymphomas and leukemias are exquisitely sensitive to cell death by radiation. The systemic nature of the majority of lymphomas and leukemias, however, makes localized irradiation inappropriate for most patients. Therefore, the systemic delivery of RIT is a logical strategy given that these disseminated diseases are highly radiosensitive. The effective delivery of RIT requires the selection of a suitable tumor antigen target.
Etoposide-containing regimens for the treatment of critically ill patients with hematological malignancy-related hemophagocytic lymphohistiocytosis
Published in Acta Oncologica, 2022
Clara Vigneron, Valentine Le Stang, Justine Decroocq, Edwige Péju, Barbara Burroni, Nicolas Chapuis, Julien Charpentier, Frédéric Pène
This retrospective study was carried out between 2013 and 2020 in a medical ICU within a tertiary care center comprising a department of clinical hematology. Adult patients who received etoposide in the ICU were identified from the pharmacy registry. The diagnosis of HLH was deemed probable by fulfillment of five HLH-2004 criteria or by high probability provided by the H-score. The underlying hematological malignancy was definitely proven by histological or cytological diagnosis. Dose reduction of etoposide was considered owing to organ dysfunctions [4,5]. Body temperature was monitored with an ear thermometer. Organ failures were assessed daily by a modified non-platelet Sequential Organ Failure Assessment score (npSOFA, ranging from 0 to 20) taking into account circulatory, ventilatory, renal, neurological, and hepatic failures, but devoid of its platelet component likely impaired by bone marrow infiltration, cytostatic compounds, and platelet transfusions. The one-year follow-up was available for all patients. The study was approved by the ethics committee of the French Intensive Care Society (#CE-SRLF-17-03). Three patients were already included in a previous report [9]. Continuous variables were expressed as median (interquartile range) and categorical variables as counts (percentages) and compared using paired Wilcoxon test and Fisher test, respectively.
Continuous deep sedation at the end of life in children with cancer: experience at a single center in Japan
Published in Pediatric Hematology and Oncology, 2020
Sayaka Maeda, Itaru Kato, Katsutsugu Umeda, Hidefumi Hiramatsu, Junko Takita, Souichi Adachi, Satoru Tsuneto
Of the 57 patients who died during the study period, 35 had presented with cancer and died of cancer or treatment-related complications. Of these 35 patients, 9 (25.7%) were treated with CDS, and 5 (14.3%) received MV. None of the remaining 21 (60.0%) patients underwent continuous sedation. The demographic data of the 35 patients are summarized in Table 2. The mean age at death in the CDS, non-CDS, and MV groups, respectively, was 11 ± 7.4 years [range: 1–20], 12 ± 4.6 years [range: 3–20], and 9 ± 6.4 years [range: 1–14]. Among the 35 patients, the most common diagnosis was a hematological malignancy. However, in the CDS group, 77.8% of the patients had a solid tumor. Death occurred during the course of cure-oriented treatment in all five patients in the MV group, none of the patients in the CDS group, and only one patient in the non-CDS group. In 33.3% of the patients in the CDS group and 38.1% of the patients in the non-CDS group, the focus of care shifted from prolongation of life to comfort at least 1 week prior to death.
Palliative care in hematologic malignancies: a multidisciplinary approach
Published in Expert Review of Hematology, 2020
Brittany Gatta, Thomas W LeBlanc
Palliative care physicians, advanced practice providers, and nurses are trained to be experts in symptom management, with the ultimate goal of improving ‘physical well-being, functionality, and quality of life to a level acceptable to the patient’ [4,p.13]. Ideally, symptoms associated with both the illness and its treatments would be anticipated and prevented as much as possible. Unfortunately, hematologic malignancy patients are certainly burdened by physical symptoms, both from their disease and from treatments (including stem-cell transplant, or more intensive multiagent chemotherapy regimens) [26,27]. For example, in one prospective study of patients undergoing bone marrow transplant, there was a high degree of physical symptoms such as pain (present in 68%, but severe in 23%), nausea (present in 78% but severe in 21%), and insomnia (present in 89% but severe in 36%) [26]. As we will discuss in greater detail below, this exact population of patients has been shown to benefit from the addition of a palliative care physician and nurse practitioner to co-manage symptoms with their oncologists, suggesting that other hematologic malignancy patients being treated with intensive regimens can likely also benefit from the addition of a specialized symptom-management team to their standard cancer care [6].