COVID-19 in Hematological Malignancies
Sunday OcheniTheresa Ukamaka NwaghaNneka AmuOnochie ObodoKelechi OkerekeKelechi ChikezieChioma Sandra EjezieGladys Udoka IlechukwuChiemelie Obiatuegwu
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Abstract:
Earlier reports suggest that cancer patients were twice more likely to contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this report, we describe two patients with hematological malignancies seen at the peak of the first wave of the coronavirus disease 2019 pandemic. A 61-year-old man was referred to our urology unit he was diagnosed with nodular hyperplasia and multiple myeloma and commenced on bortezomib, thalidomide, and dexamethasone combination chemotherapy. He developed a cough and fever, with SPO 2 86%, He was positive for SARS-CoV-2 and died a few days later. A 42-year-old man with Hodgkin lymphoma on treatment with Adriamycin, bleomycin, vincristine, and dacarbazine with positive SARS-CoV-2 exposure was diagnosed with pleural effusion at A/E. Three days postadmission, his condition worsened with low SPO 2 despite intranasal oxygen. He died after testing positive for SARS-CoV-2. Patients with hematological malignancies tend to have a greater risk of SARS-COV-2 infection and severe disease due to immunosuppression from cancer and its treatment.Keywords:
Immunosuppression
Dacarbazine
A multidrug regimen of doxorubicin, dacarbazine, vincristine, and cyclophosphamide produced response in 33% of patients with advanced gastrointestinal leiomyosarcoma. Except for one patient, the duration of response was short and prolongation of survival was not affected.
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Post-transplant immunosuppression almost always includes a combination of drugs and approaches based on a patient's individual situation, organ transplanted, and current developments in the field. Depending on these factors, approaches could include Induction immunosuppression, Maintenance immunosuppression, or Anti-rejection immunosuppression.
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For children with liver transplants (LT), achieving an "ideal outcome" is a balancing act: too little immunosuppression begets graft injury; too much begets systemic complications. We aimed to delineate the parental perspective on this tightrope.Parents of children with LT completed an internet-based survey about their child's immunosuppression.Children of respondents (n = 82) were a median 4 years from primary LT (range 0-22); 73% were on immunosuppression monotherapy. Parents' top concerns were related to immunosuppression complications; 46% were more concerned about immunosuppression complications than rejection; only 17% were more concerned about rejection than immunosuppression complications. Among parents of children on immunosuppression monotherapy, 29% still worried more about immunosuppression complications than rejection, 48% expressed equal concern for both. Time since LT (0-4 vs. >4 years) was not associated with concern level for rejection or immunosuppression complications. Caregivers were significantly more certain that their child's immunosuppression regimen was correct to prevent rejection than to mitigate complications (p < .005).Caregivers of children with LTs reported higher levels of concern and uncertainty about immunosuppression complications than rejection risk. Understanding parent and patient perspectives on IS, and incorporating them into immunosuppression counseling and decision-making, is critical to achieving truly "ideal" long-term outcomes.
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Retroperitoneal leiomyosarcoma is often too large to be completely removed. We report a 67-year-old woman successfully treated with neoadjuvant CYVADIC (cyclosphosphamide, vincristine, adriamycin and dacarbazine). The tumor was removed with the right kidney and ureter and a part of the vena cava after 2 courses of CYVADIC. The tumor recurred at the duodenum 7 years later and was completely removed following neoadjuvant CYVADIC. Neoadjuvant chemotherapy could be helpful for the complete resection of advanced leiomyosarcoma.
Dacarbazine
Neoadjuvant Therapy
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A study of combination chemotherapy with nitrosomethylurea, vincristine and peplomycin or bleomycetin given an 5-6-day cycles showed the cytotoxic regimens to be more effective than single-agent treatment with dacarbazine for disseminated melanoma of the skin with metastases to the subcutaneous fat, lymph nodes, lungs and other viscera. In a group of 129 such patients, complete (12%) and partial remission (38%) was observed with the former combination whereas with nitrosomethylurea, vincristine and bleomycetin, complete and partial response rates were 7.6 and 26.9%, respectively.
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Combination chemotherapy
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배경(Background): Vincristine은 vinca alkaloid계 약물로 세포내 미세소관의 구조를 저해하여 여러 종류의 종양 치료제로 광범위하게 사용된다. 또한 임상의학에서는 황산염의 형태인 항암제로 사용하고 있으며, 특히 조혈기의 종양 즉 급성백혈병, 호지킨병, 림프육종 등에 효과가 있다고 한다. 주로 일반적인 치료에 반응하지 않는 특발성 혈소판감소성자반증에서도 사용된다는 보고도 있다. 이에 저자들은 특발성혈소판감소자반병(ITP)환자에 대해 치료적 목적의 Vincristine을 투입한 성분채집혈소판의 제조경험을 가져 이에 보고하는 바이다. 재료 및 방법(Materials and Methods): 환자와 동일한 혈액형의 성분채집혈소판 1 unit와 신선동결혈장 2 unit를 준비하여, 혈장을 제거하기 위해 성분채집혈소판을 원심을 한다. 여기에 Vincristine 5mg을 주입한 후 어두운 장소내 37℃ 교반기에서 1시간동안 혈소판과Vincristine 반응의 결합력을 극대화 시킨다. 무균적 연결장치를 이용하여 상층을 제거한 후 혈소판내 신선동결혈장을 채워준다. 또한 혈소판 입자을 안정시키기 위해 10분간 방치한 후상층액을 제거한다. 추가로 신선동결혈장을 채워주어 30분동안 혈소판 교반기에 보관한 후30분에 걸쳐 천천히 수혈한다. 결과(Resultss): 특발성혈소판감소자반병(ITP)질환을 가진 62세 여성으로 스테로이드 및 면역글로부린 투여를 꾸준히 실시하였으며, 추가로 치료를 위해 본원에 내원하여 Vincristine을 투입한 성분채집혈소판을 수혈하였다. 투입 전 각각 혈소판수치는 25K, 38K, 15K 이었으며, Vincristine 투입 후 혈소판 수치 결과는 100K로 증가한 후 68K, 48K로 감소하였으나 스테로이드 제제와 병용한 후 118K로 증가하였다. 고찰(Discussion): 특발성혈소판감소자반병(ITP)은 혈액 내 혈소판 수와 골수에서 거대핵세포수가 정상내지 증가된 소견을 보인다. 이러한 환자를 대상으로 Vincristine은 세포 및 면역억제 작용을 하여 혈소판 관련 항체의 생성을 억제하리라 예상되며, 이 약물이 혈소판내의 미세관에 부착되고 혈소판이 대식세포에 탐식됨으로써 혈소판의 피괴가 감소한다고 한다. 또한 Vincristine의 투여로 난치성 특발성혈소판감소자반병(ITP)의 약 80%에서 혈소판 수의 증가를 보인다는 보고도 있다. 이러한 Vincristine은 특발성혈소판감소자반병(ITP)환자의 치료에 효과적이며, 부작용이 적은 치료법으로 이러한 제조과정을 경험하여 이에 보고하는 바이다.
Vinca
Vinca alkaloid
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Objective To explore safe and effective chemotherapy on Hodgykin's lymphomas(HL).Methods 36 patients with HL were treated with COP(CPA + vincristine + prednisone)and ABVD(THP + Bleomytin + vincristine + Dacarbazine)for 3 course,respectively.Radiotherapy was used according the condition of the patients.Result The rate of completely remission),partial remission,non-change and progression were 81%(29/36),11%(4/36),5.4%(2/36)and 2.6%(1/36),respectively.The survival rate 1 and 2 is 92%(33/36)and 88.9%(32/36),respectively.Conclusion It is effective,safe and cheap to treat HL with COP and ABVD for 3 course.
ABVD
Dacarbazine
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A 15 year retrospective study of chemotherapy response to multiple regimens employed in 78 evaluable patients with advanced uterine sarcoma was performed. Single agent activity was noted with doxorubicin, methotrexate, and cisplatin (5-11% response rate). Effective multigent regimens included cyclophosphamide, vincristine, doxorubicin, dacarbazine (CYVADIC) (23% response), cisplatin and dacarbazine (21% response) and vincristine, dactinomycin, and cyclophosphamide (VAC) (18% response). There was no difference in response rate among different histologies. More active agents or combinations are needed.
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Dacarbazine
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Dacarbazine has been on the market for approximately 3 decades but remains the most effective single agent available for the therapy of metastatic malignant melanoma (MMM). Most MMMs, however, respond poorly to dacarbazine therapy. Apart from tumor resistance at a molecular level, several studies support the notion that therapeutic failure in tumor therapy also might be attributed to an impaired transcapillary drug transfer.On the basis of this hypothesis, the authors measured intratumor transcapillary transfer rates of dacarbazine and its active metabolite 5-aminoimidazole-4-carboxamide (AIC) by in vivo microdialysis after intravenous administration of dacarbazine at doses of 200 mg/m(2) to 1000 mg/m(2) (n = 7) in patients suffering from MMM.For all doses, area under the concentration curve (AUC) values for dacarbazine and AIC were not significantly different between plasma and tumor interstitium with AUC(tumor)/AUC(plasma) ratios of 0.97 +/- 0.08 (mean +/- standard error of the mean) for dacarbazine and 0.76 +/- 0.22 for AIC. AUC(0-240) values for dacarbazine and AIC measured in plasma correlated closely with corresponding AUC(0-240)values measured in the interstitium of MMMs with values of r(s) = 0.82 (P = 0.042) and r(s) = 0.90 (P = 0.037), respectively.The results of this study indicate favorable tumor penetration characteristics of dacarbazine and its active metabolite AIC. The relative lack of response to antineoplastic therapy with dacarbazine, thus might be explained by resistance of melanoma cells at a molecular level rather than by an inability of dacarbazine and AIC to penetrate into the interstitium of MMM.
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Microdialysis
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