The Impact of HIV Infection on Neoadjuvant and Adjuvant Chemotherapy Relative Dose Intensity in South African Patients with Breast Cancer
Daniel S. O’NeilOluwatosin A. AyeniHayley A. FarrowWenlong Carl ChenGeorgia DemetriouInes BuccimazzaSharon ČačalaLaura W. StopforthMaureen JoffeMichael H. AntoniGilberto LopesYoanna S PumpalovaWitness MapangaJudith S. JacobsonKatherine D. CrewAlfred I. NeugutPaul RuffHerbert Cubasch
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Abstract Introduction In the South African Breast Cancer and HIV Outcomes (SABCHO) study, we previously found that breast cancer patients living with HIV and treated with neoadjuvant chemotherapy achieve lower rates of complete pathologic response than patients without HIV. We now assess the impact of comorbid HIV on receipt of timely and complete neoadjuvant and adjuvant chemotherapy. Materials and Methods Since June 2015, the SABCHO study has collected data on women diagnosed with breast cancer at 6 South African hospitals. We selected a sample of participants with stages I-III cancer who received ≥2 doses of neoadjuvant or adjuvant chemotherapy. Data on chemotherapies prescribed and received, filgrastim receipt, and laboratory values measured during treatment were captured from patients’ medical records. We calculated the mean relative dose intensity (RDI) for all prescribed chemotherapies. We tested for association between full regimen RDI and HIV status, using linear regression to control for demographic and clinical covariates, and for association of HIV with laboratory abnormalities. Results The 166 participants living with HIV and 159 without HIV did not differ in median chemotherapy RDI: 0.89 (interquartile range (IQR) 0.77-0.95) among those living with HIV and 0.87 (IQR 0.77-0.94) among women without HIV. Patients living with HIV experienced more grade 3+ anemia and leukopenia than those without HIV (anemia: 10.8% vs. 1.9%, P = .001; leukopenia: 8.4% vs. 1.9%, P = .008) and were more likely to receive filgrastim (24.7% vs. 10.7%, P = .001). Conclusions HIV status did not impact neoadjuvant or adjuvant chemotherapy RDI, although patients with breast cancer living with HIV experienced more myelotoxicity during treatment.Keywords:
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Objective To observe the effect of tiopronin in preventing leukopenia during chemotherapy Methods Tiopronin were used for 0.2gram during chemotherapy. The change of leukocyte was observed after and before chemotherapy.(Results)The level and number of leukopenia in the Tiopronin therapeutic group after chemotherapy was obviously lower than that of control group (P0.05). Conclusions Tiopronin can prevent leukopenia during chemotherapy.
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【Objective】To retrospectively analysize the clinical effect of neoadjuvant chemotherapy for 18 children with osteosarcoma.【Methods】Eighteen children with osteosarcoma were classified into type ⅡB by Enneking Surgical Classification.All patients were treated by neoadjuvant chemotherapy regimen that was preoperative chemotherapy、operation and postoperative chemotherapy.At first period,all patients accepted huge-dose MIX regimen(MTX 200 mg/kg or 12 g/m2).At second period,they accepted IFO regimen(2 g/m2) continuously for 5 days.At third Period,they accepted AP regimen(ADM 60mg/m2 and DDP 120 mg/m2).Every period had 12 interval days.Three periods were used as a treatment course.All patients were treated by two chemotherapy courses before operation.After two weeks,they accepted operation and then they were treated by two or three chemotherapy courses after operation.【Results】All patients accepted histological evaluation after operation.Two groups were classified by response.Fourteen patients significantly responsed to chemotherapy,rated 77.8% in all patients.Four patients mildly responsed to chemotherapy rated 22.2%.One-year survival rate of two groups was 92.8%、50%,respectively.Two-year survival rate of two groups was 71.4% 、25%,respectively.【Conclusions】Neoadjuvant chemotherapy has a role in complex therapy for children osteosarcomas.The evaluation by histological method is an important index that would help us to judge prognosis.
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During the period of therapy,leukopenia induced by chemotherapy was less severe and wascured more rapidly in the selected chronomedieation group (CMG) than in the routinemedication group (RMG).The incidence of leukopenia was markedly lower in CMG(12.9%) than in RMG (48.4%),and the rate of uneventful completion of chemotherapy wasalso higher in CMG (96.8%) than in RMG.These results suggest that selectedchronomedication may he beneficial to the successful completion of chemotherapy in pa-tients with malignant tumor.
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Objective: To study the effect of recombinated human granulocyte Colony-stimulating factor(rhG-CSF,Topneuter) on leukopenia caused by chemotherapy.Methods:Thirty cases with leukopenia caused by chemotherapy for patients with lung cancer were treated with rhG-CSF,and compared with 30 cases treated with oral leukopenic medicines.Results:All patients with leukopenia recovered to nomal after treatment either with rhG-CSF or with oral leukopenic medicines,the period of leukopenia recovered to normal was shorter in the group with rhG-CSF treatment than that in the leukopenic drugs group(P0 002) A significant decrease was also shown for rhG-CSF group in the incidence of infection(P=0 03).Conclusion:Topeneuter was effective for the treatment of leukopenia after chemotherapy,and it may decrease infection incidence during chemotherapy.
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Objective:To observe clinical effect of Shen gBaiTang on treating leukopenia caused by cancer chemotherapy.Methods:Thirty－six cases were divided into two groups by a randomiz ed cross over trial,each patient in group A received one cycle of chemotherapy f ollowed ShengBaiTang,batilol and leucogen,another cycle gave batilol and leucogen;for eac h patient in group B,the treatment of 2 cycles of chemotherapy followed was cont ray to that in group A.Chemotherapeutic drugs and dosage were identical in 2 cy cles for each patient in two groups.The change of absolute leucocyte count durin g chemotherapy between the 2 cycles was compared.Results:After chemotherapy,the white blood cell(WBC) was increased( 1.07±0.94)×109/L、(0.88±0.21)×109/L(Ｐ＜0.001)，respectively and the time of WBC lasting less than 4.0×109/L was shortened by 12.31±6.45 days and 13.17±7.58 days(Ｐ＜0.001),respectively between one cycle treated by ShengBaiTang and another cycle treated by westen medicine in group A and B.The infected patients were less during ShengBaiTang treating cycle than another cycle in two groups(Ｐ＜0.05) respecti vely.Conclusions:Oral administration of ShengBaiTang and batilol,leucogen can play an important role in treating leukopenia cau sed by cancer chemotherapy.
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To observe therapeutic effects of Lishengsu (recombinant human granulocyte colony stimulating factor, rhG-CSF) on leukopenia induced by chemotherapy, 40 patients with malignant tumor included in the clinical observation were randomly divided into group A and B (20 patients each). Each patient was received two cycles of chemotherapy. In group A Lishengsu was administered in the first cycle and none in the second cycle, while in group B Lishengsu was given in the second cycle, but not in the first cycle. Lishengsu was subcutaneoasly injected for 5 - 7 days at dosage of 75 micro g or 150 micro g per day 24 - 48 hours after completion of chemotherapy. The results showed that Lishengsu remarkably alleviated the degree of leukopenia and neutropenia, and lower the incidence of infection. The curative effect of Lishengsu is reliable with slight side-effects, and it might assist to completion of chemotherapy in tumor patiants.
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Objective:To observe the clinical significance of leucocytic marginal pool changes in leukopenia patients in diagnosis and differential diagnosis of leukopenia.Method:The counts of white blood cell in marginal pool of health adults and leukopenia patients before and after sports were detected.Result:The ratio of male to female patients with leukopenia was 2.63 to 1.In all leukopenia patients tested,31.4% were granulocytopenia,0.82% were agranulocytosis,the white blood cell count of health adults elevated after sports was(2.92±1.44)×109/L,leukopenia patients was(2.72±0.83)×109/L,and granulocytopenia patients was(1.57±0.96)×109/L,which showed a very significant difference compared to health adults and leukopenia patients(0.001).Conclusion:The incidence of leukopenia in female was obviously higher than that in male,granulocytopenia should be considered when the white blood cell count of leukopenia patients elevated after sports was lower than 1.50×109/L.
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Objective: To explore the clinical features and outcomes in patients with hyperthyroidism complicated with leukopenia. Methods: 201 patients diagnosed as hyperthyroidism from People's Hospital of Zhengzhou University were analyzed. All the patients were divided into three groups according to the white blood cell( WBC) counts and the treatment of antithyroid drug( ATD),133 patients with normal white blood cell counts in group A,32 patients with leukopenia before ATD therapy in group B,36 patients with leukopenia after ATD therapy in group C. The duration of leukopenia and the causes of hyperthyroidism were recorded. Routine WBC counts were detected and compared after an exercise test in group B and group C. Results: There were statistically significant differences in distribution of the causes of hyperthyroidism between patients with normal WBC counts and those with leukopenia( P 0. 05). Leukopenia generally occurred in 3 months after the onset of hyperthyroidism in group B and 4 weeks after the treatment with ATD in group C. There were statistically distinctive differences of the increased counts of WBC and neutrophile granulocyte between group B and group C( P 0. 05). Conclusions: Leukopenia occurred in 3 months after the onset of hyperthyroidism in patients untreated with ATD,while those occurred in 4 weeks after ATD therapy. Leukoupenia caused by hyperthyroidism and ATD is concerned with the abnormal distribution of granulocytes in circulating pool and marginating pool. The patients with Graves' disease are apt to suffer from leukopenia in all patients with hyperthyroidism.
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The efficacy and safety of Lishengsu (a rhG-CSF preparation) were evaluated for treatment of chemotherapy-induced leukopenia. 327 cases of leukopenia with grade I-IV induced by chemotherapy were subcutaneously administered at 2.5 - 5.0 micro g/(kg x d) of Lishengsu, and hemogram and the side effects were observed. The results showed that Lishengsu had satisfactory effect to cure leukopenia after chemtherapy, with an effective rate of 99.4% (325/327), the side effects were quite slight. It is concluded that Lishengsu is efficient and safe for patients with leukopenia, and can be used as an adjuvant drug for treatment of leukopenia after chemotherapy.
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