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Non-Hodgkin Lymphoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Piers Blombery, David C. Linch
The treatment of ATLL is stratified according to clinical subtype. In patients with chronic and smoldering subtypes, a watch-and-wait approach is no longer preferred and treatment upfront with antiviral medication (zidovudine) and alpha-interferon is associated with the most favorable clinical outcomes.133 The lymphomatous subtype of ATLL requires chemotherapy as part of upfront treatment. Chemotherapy regimens in ATLL generally have low response rates and a high frequency of rapid relapse after cessation of treatment. Some of the best results to date (in phase II trials) are with the LSG15 regimen which incorporates ranimustine and carboplatin. These agents were chosen in an attempt to overcome the high expression of the P-glycoprotein drug efflux pump seen in this disorder and the associated chemotherapy resistance to various conventional chemotherapeutic agents.134 Numerous other regimens have been tried, including CHOP and CHOP-like regimens, but these are all associated with modest response rates and poor mean survival. In patients who respond to chemotherapy who are young enough and do not have major organ compromise, allogeneic stem cell transplantation offers the only potential chance of long-term disease control.135 Acute ATLL, which has the worst prognosis of all the subtypes, is managed similarly to lymphomatous presentation with combination chemotherapy plus antiviral therapy/interferon.
Non-Hodgkin lymphoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Piers Blombery, Adrian Bloor, David C. Linch
The treatment of ATLL is stratified according to clinical subtype. In patients with chronic and smouldering subtypes, a watch-and-wait approach is no longer preferred and treatment upfront with antiviral medication (zidovudine) and alpha-interferon is associated with the most favourable clinical outcomes.133 The lymphomatous subtype of ATLL requires chemotherapy as part of upfront treatment. Chemotherapy regimens in ATLL generally have low response rates and a high-frequency of rapid relapse after cessation of treatment. Some of the best results to date (in phase II trials) are with the LSG15 regimen which incorporates ranimustine and carboplatin. These agents were chosen in an attempt to overcome the high expression of the P-glycoprotein drug efflux pump seen in this disorder and the associated chemotherapy resistance to various conventional chemotherapeutic agents.134 Numerous other regimens have been tried, including CHOP and CHOP-like regimens, but these are all associated with modest response rates and poor mean survival. In patients that respond to chemotherapy that are young enough and do not have major organ compromise, allogeneic stem cell transplantation offers the only potential chance of long-term disease control.135 Acute ATLL which has the worst prognosis of all the subtypes is managed similarly to lymphomatous presentation with combination chemotherapy plus antiviral therapy/interferon.
JAK2 mutation–positive polycythaemia vera associated with IgA vasculitis and nephrotic syndrome: a case report
Published in Modern Rheumatology Case Reports, 2020
Hinako Kondo, Ryu Watanabe, Soshi Okazaki, Kaori Kuriyama, Tetsuro Ochi, Gen Yamada, Akira Sugiura, Hiromu Chiba, Akira Tsukada, Shinji Taniuchi, Takehiko Igarashi, Masataka Kudo, Hideo Harigae, Hiroshi Fujii
The prevalence of renal involvement in IgA vasculitis is 30%−50% [18,24]. The most commonly observed urinary finding is microscopic haematuria and/or mild proteinuria. However, some patients progress to renal failure or end-stage renal disease. A recent meta-analysis showed that complications of nephrotic syndrome in IgA vasculitis are associated with unfavourable renal outcomes in children [24]. In our patient, renal biopsy demonstrated mild mesangial cell proliferation, which was compatible with IgA vasculitis, but it was difficult to explain the massive proteinuria. Furthermore, intensified immunosuppressive therapy was not sufficiently effective. Considering that PV is complicated by FSGS, MPGN, and MN [11], steroid-refractory glomerular diseases may exist in our case. Kanauchi et al. reported a case of IgA vasculitis associated with PV that developed during ranimustine therapy for PV [15]. The first renal biopsy showed MPGN, and the second biopsy revealed crescentic formation with IgA deposition [15]. Therefore, proteinuria should be closely monitored, and a second renal biopsy should be considered if the patient relapses.
Current treatment patterns and medical costs for multiple myeloma in Japan: a cross-sectional analysis of a health insurance claims database
Published in Journal of Medical Economics, 2020
Shuji Uno, Rei Goto, Kenshi Suzuki, Kosuke Iwasaki, Tomomi Takeshima, Tomoko Ohtsu
MM drugs were defined as those that have been approved for treatment of MM in Japan, based on generic names. The 17 drugs included were dexamethasone, prednisolone, bortezomib, melphalan, lenalidomide, cyclophosphamide, thalidomide, vincristine, doxorubicin, pomalidomide, etoposide, ranimustine, cisplatin, cytarabine, panobinostat, cytarabine ocfosfate, and carfilzomib. Of these 17 MM drugs, six were classified as novel MM drugs: thalidomide, bortezomib, lenalidomide, pomalidomide, panobinostat, and carfilzomib.
Relationship between renal dysfunction and electrolyte abnormalities in hematopoietic stem cell transplant patients treated with foscarnet
Published in Journal of Chemotherapy, 2021
The baseline characteristics of all study patients are presented in Table 1. The mean age was 52.1 ± 14.0 years. The Japanese approved standard initial doses of foscarnet for CMV disease, which is a condition with organ damage and clinical symptoms are 60 mg/kg thrice daily or 90 mg/kg twice daily. In addition, the Japanese approved standard initial dose of foscarnet for CMV infection, which is a condition detected from blood and other specimens by reactivation in HSCT patients is 60 mg/kg twice daily. All patients were then treated with the approved dosage. The mean daily initial dose was 116.4 ± 43.1 mg/kg. The number of daily doses and infusion rate of foscarnet were 1.9 ± 0.7 (times) and 38.1 ± 12.8 (mg/kg/hr), respectively. At the initiation of foscarnet treatment, patients were taking an average of 2.0 ± 0.9 concomitant drugs that might enhance renal dysfunction. The median periods of foscarnet treatment and from HSCT to the initiation of foscarnet administration were 10.5 (7–25.8) days and 53.5 (28–66) days, respectively. HSCT types were as follows: 1 patient received autologous HSCT and 31 patients received allogeneic HSCT. For allogeneic HSCT, the donor type was sibling donor in 20 patients and matched unrelated donor in 11 patients. Chemotherapy regimens containing the following anticancer drugs were used for HSCT: ranimustine, etoposide, cytarabine, melphalan, fludarabine, melphalan, busulfan, cyclophosphamide, and cytarabine. Tacrolimus + methotrexate (8 patients), tacrolimus + mycophenolate mofetil (13 patients), and cyclosporine + methotrexate (10 patients) were used to prevent graft-versus-host disease. No difference was noted in the characteristics of the patients classified into the renal dysfunction and non-renal dysfunction groups after receiving foscarnet. By the time they received foscarnet treatment, these patients did not develop grade 2 or higher electrolyte abnormalities and had normal renal function.