Results from Treatment of a Large Cohort of ATL Patients from a Country with High HTLV1 Prevalence
Horia BumbeaAmbroise MarçaisDaniel CoriuAlina TănaseAndrei ColițăAlexandru BardaşAnca Roxana LupuAna‐Maria VlădăreanuMinodora OnisâiViola Maria PopovIuliana IordanMagda Diana CisleanuD. VasileCristina CiufuZsofia VáradyOana Gabriela CraciunD. GeorgescuMihaela AndreescuCristina MambetCarmen C. DiaconuLaura NeculaMonica BunaciuAdriana NeculaStefan N. ConstantinescuOlivier Hermine
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Immunizations in solid organ and hematopoeitic stem cell transplant patients: A comprehensive review
The Solid Organ Transplantation (SOT) and Haematopoietic Stem Cell Transplantation (HSCT) population is continuously increasing as a result of broader indications for transplant and improved survival. Infectious diseases, including vaccine-preventable diseases, are a significant threat for this population, primarily after but also prior to transplantation. As a consequence, clinicians must ensure that patients are optimally immunized before transplantation, to provide the best protection during the early post-transplantation period, when immunosuppression is the strongest and vaccine responses are poor. After 3–6 months, inactivated vaccines immunization can be resumed. By contrast, live-attenuated vaccines are lifelong contraindicated in SOT patients, but can be considered in HSCT patients at least 2 years after transplantation, if there is no immunosuppression or graft-versus-host-disease. However, because of the advantages of live-attenuated over inactivated vaccines - and also sometimes the absence of an inactivated alternative - an increasing number of prospective studies on live vaccine immunization after transplantation are performed and give new insights about safety and immunogenicity in this population.
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To analyse the outcome of adult patients who developed a first relapse of acute lymphoblastic leukaemia (ALL), we collected the clinical data of 332 patients with Philadelphia-chromosome (Ph) negative ALL, aged 16-65 years, who relapsed after first complete remission (CR1) between 1998 and 2008 in 69 institutions all over Japan, including 58 patients who relapsed after allogeneic haematopoietic stem cell transplantation (Allo-HSCT) in CR1. The overall survival (OS) was 43·4% at 1 year, and 16·3% at 5 years from relapse in patients who received chemotherapy alone in CR1. Among patients who relapsed after chemotherapy alone in CR1, 123 (52·5%) achieved a second remission (CR2) following salvage chemotherapy, of whom 62 subsequently underwent Allo-HSCT during CR2. Allo-HSCT in CR2 was significantly associated with better OS. Moreover, the type of salvage chemotherapy influenced OS from relapse. A doxorubicin, vincristine, and predonisone-based (AdVP-type) regimen was related to better OS in patients with longer CR1 (more than 1 year), but was related to worse OS in patients with shorter CR1. In conclusion, the prognosis of patients with relapsed Ph-negative ALL is poor. Allo-HSCT after a first relapse could improve the prognosis. Selection of the optimal salvage chemotherapy might depend on the duration of CR1.
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Invasive aspergillosis remains the primary cause of death from infection following allogeneic stem cell transplantation. Most cases occur during the second or third month after transplantation, during graft-versus-host disease or immunosuppression. Strategies for management of these cases include the development of more effective antifungals for prophylaxis, the use of biological markers to improve the early diagnosis of aspergillosis, new approaches to transplantation to reduce the risk of infection, and the emerging area of targeted cellular therapy.
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We retrospectively analyzed the efficacy of chemotherapy in patients whose gastric cancer recurred after adjuvant chemotherapy with S-1. A total of 51 patients were evaluated. Twenty-one patients received S-1-containing chemotherapy as first-line treatment after recurrence [cohort A: S-1 plus cisplatin (n = 10), S-1 monotherapy (n = 7), S-1 plus irinotecan (n = 3) and S-1 plus docetaxel (n = 1)]. The other 30 patients received a non-S-1-containing regimen [cohort B: paclitaxel or docetaxel (n = 22), irinotecan plus cisplatin (n = 6) and other drugs (n = 2)]. No objective responses occurred in cohort A, while five patients achieved a partial response in cohort B (response rate, 0 versus 16%; P = 0.04). Median progression-free survival was significantly longer in cohort B than in cohort A (4.3 versus 2.3 months, P = 0.02). S-1-containing chemotherapy does not appear to be effective in patients whose gastric cancer recurs after adjuvant S-1 chemotherapy. Other chemotherapeutic agents should be evaluated in this setting.
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Background: Atrial Fibrillation (AF) ablations are performed in pts of all age groups. No data exists on the outcomes or Quality of Life (QOL) specific to the octogenarian population undergoing this procedure. We hypothesize the outcomes and risks would not be too dissimilar when compared to a younger cohort between 65-79 years. Methods: From a retrospective database we selected octogenarian pts compared to an age and sex matched control group, ages 65-79. Pre-ablation tests were performed as well as quality of life (QoL) and symptom inventories. Results of the ablation procedure, follow up QoL and symptom inventories, peri-procedure morbidity and freedom from AF or control of AF with anti-arrhythmic agents were compared between the 2 groups. Results: During follow-up (mean 2.3 ± 2.2 years), AF elimination (70% vs 81%, p 0.942) and AF control including those on antiarrhythmic agents (86% vs 86%, p 0.249) were compared. Conclusion: Outcomes of ablation in the octogenarians are highly favorable with no increase in procedural complications. Improvement in QOL scores is impressive in patients with advancing age. Comparison of variables between the Young-Old and the Octagenerian cohort of patients undergoing ablation of drug-refractory AF Comparison of variables between the Young-Old and the Octagenerian cohort of patients undergoing ablation of drug-refractory AF
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e16004 Background: The effect of prior immune checkpoint inhibition therapy (CI) on the efficacy of subsequent chemotherapy is largely unknown in MUC. The identification of the optimal sequence of chemotherapy and IO is yet to be determined, but may influence outcomes. Methods: A retrospective audit and comparison of patients who progressed after first and second line CI and received subsequent standard chemotherapy was performed. Date was collected across a broad spectrum of CI. We report on patient’s characteristics and response rates of 28 sequential patients collected from two institutions who received chemotherapy after CI. Patients were separated into 2 cohorts. Cohort A had not previously received chemotherapy (n = 14), cohort B had previously received at least 1 chemotherapy regimen (n = 14). Central radiology review was performed. We assessed objective response rate by RECIST v 1.1. Kaplan Meier method was used. Results: Median age for the whole cohort was 64 yrs (45-80). ECOG was 0/1 in 89,3% and 2 in 10,7% at the time of starting chemotherapy. The commonest chemotherapy regimen in cohort A and B were carboplatin-gemcitabine (71%) and carboplatin paclitaxel (50%) respectively. 75% of the patients were intermediate risk group. In Cohort A 63% responded to chemotherapy whereas in cohort B only 3 patients showed response. The median change in target lesions in the front line immunotherapy cohort was -60% (-81 to +1%). Both patients who responded to 2 nd line chemotherapy after CI had a long interval between first and 2 nd line chemotherapy (9-24 months). Conclusions: Chemotherapy maintains its efficacy after front line CI with deep responses. Although numbers are modest, results strongly suggest patients should be offered chemotherapy in this setting.
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[Objective]Explore Breast cancer surgery Kangai injection Chemotherapy combined application of the clinical curative effect.[Methods]Breast cancer surgery will be 60 cases were randomly divided into trial group and control group each 30 cases,the observation group application Kangai injection combination Chemotherapy treatment,the control group limited to Chemotherapy treatment,compared between the two groups of patients with clinical symptoms improved.[Results]The observation group of patients GaiShanLv for 90.00%,in the patients in the GaiShanLv is 73.33%,the observation group significantly better than control group,two groups of comparisons,the difference was statistically significant(P 0.05).[Conclusion]Breast cancer postoperative Chemotherapy combined application Kangai injection treatment,curative effect is distinct,Chemotherapy drugs significantly reduce the side effects on the body,increase the body's immune function,and can effectively improve the quality of life of the patients,and the use of safe,convenient.
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Objective To improve the patients with advanced lung cancer quality of life,reduce the chemotherapy-induced side effects,thereby enhancing immune function. Methods The treatment group Kangai injection 60 ml in 5% glucose or 0.9% NS 250~500 ml diluted intravenous drip,once/d,30 d for a course of treatment,combined with chemotherapy. The control group alone with chemotherapy. Results 47.5% effective in the treatment group,37.5% effective in the control group. Conclusion Kangai injection combined with chemotherapy can improve the quality of life of patients and reduce the toxicity,and enhance immune function in patients.
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Adrenoleukodystrophy
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