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Hemodialysis dependent patient with relapsed acute promyelocytic leukemia treated by arsenic trioxide
06/2020 MUDr. Kateřina Benková; MUDr. Zdeněk Kořístek, Ph.D.; MUDr. Petra Richterová; MUDr. Jana Mihályová; Mgr. Dagmar Zámoravcová; Ing. Karel Lach, CSc.; prof. MUDr. Roman Hájek, CSc.
Arsenic trioxide (ATO) is a drug of choice in the treatment of relapsed acute promyelocytic leukemia (APL). Guidelines for the treatment of hemodialysis dependent patients with APL do not exist. Here we describe the treatment of relapsed APL in a hemodialysis dependent patient by ATO at the dose of 10 mg three times a week after hemodialysis with frequent monitoring of laboratory values and QT interval. Molecular remission was achieved without serious adverse events. The authors further discuss the use of ATO in hemodialysis dependent patients and conclude, that ATO can be safely and effectively used in such patients under the condition of close monitoring of toxicity and adverse events; assessment of the arsenic concentration in blood is not useful for treatment management.
ENTIRE ARTICLE
Arsenic trioxide (ATO) is a drug of choice in the treatment of relapsed acute promyelocytic leukemia (APL). Guidelines for the treatment of hemodialysis dependent patients with APL do not exist. Here we describe the treatment of relapsed APL in a hemodialysis dependent patient by ATO at the dose of 10 mg three times a week after hemodialysis with frequent monitoring of laboratory values and QT interval. Molecular remission was achieved without serious adverse events. The authors further discuss the use of ATO in hemodialysis dependent patients and conclude, that ATO can be safely and effectively used in such patients under the condition of close monitoring of toxicity and adverse events; assessment of the arsenic concentration in blood is not useful for treatment management.
Autoimmune cytopenia in patients with chronic lymphocytic leukemia
05/2020 MUDr. Jana Zuchnická; MUDr. Jana Mihályová; MUDr. Jaromír Gumulec; prof. MUDr. Roman Hájek, CSc.
Chronic lymphocytic leukemia is accompanied by dysfunction of the immune system. Immune dysbalances are manifested, among other things, in an increased incidence of autoimmune cytopenias. In order to choose the right therapeutic procedure, it is important to differentially diagnose other causes of anemia, thrombocytopenia or granulocytopenia. Corticoids, intravenous immunoglobulins, rituximab, or other immunosuppressants are mainly used in therapy. Inadequate response to therapy is an indication to initiate treatment for chronic lymphocytic leukemia.
ENTIRE ARTICLE
Chronic lymphocytic leukemia is accompanied by dysfunction of the immune system. Immune dysbalances are manifested, among other things, in an increased incidence of autoimmune cytopenias. In order to choose the right therapeutic procedure, it is important to differentially diagnose other causes of anemia, thrombocytopenia or granulocytopenia. Corticoids, intravenous immunoglobulins, rituximab, or other immunosuppressants are mainly used in therapy. Inadequate response to therapy is an indication to initiate treatment for chronic lymphocytic leukemia.
Treatment of non-Hodgkin’s lymphomas in elderly patients
01/2020 MUDr. Juraj Ďuraš; MUDr. Michal Kaščák; prof. MUDr. Roman Hájek, CSc.
Recent demographic trends with increasing proportion of elderly people are associated with the higher incidence of hematological malignancies including non-Hodgkin's lymphomas. Higher age is associated with a significantly worse prognosis because of physiological decline of organ functions and increasing incidence of comorbidities that both limit treatment options.
Staging procedures in elderly patients do not differ significantly from younger patients. The standard imaging method is computed tomography (CT), positron emission tomography (PET) / CT is recommended in patients with aggressive lymphoma treated with curative intent. In follicular lymphoma, PET/CT is recommended especially before local radiotherapy to confirm localized disease.
A Geriatric 8 (G8) questionnaire is recommended as a screening tool for geriatric assessment. In the case of score ≤14, a comprehensive geriatric assessment including assessment of performance status, activities of daily life, mental status, possible sensory impairment and comorbidities is recommended.
Treatment of elderly patients with lymphoma requires personalized approach. In fit patients who are able to tolerate standard treatment, the outcomes are similar to outcomes in young patients. In vulnerable patients treatment should be conducted with the aim of prolonging life with respect to its quality while avoiding intensive treatment procedures with risk of toxicity. In terminal patients who won't profit from oncological therapy, only symptomatic supportive treatment is recommended. Treatment options for most common lymphoma subtypes are discussed in second part of the article.
ENTIRE ARTICLE
Recent demographic trends with increasing proportion of elderly people are associated with the higher incidence of hematological malignancies including non-Hodgkin's lymphomas. Higher age is associated with a significantly worse prognosis because of physiological decline of organ functions and increasing incidence of comorbidities that both limit treatment options.
Staging procedures in elderly patients do not differ significantly from younger patients. The standard imaging method is computed tomography (CT), positron emission tomography (PET) / CT is recommended in patients with aggressive lymphoma treated with curative intent. In follicular lymphoma, PET/CT is recommended especially before local radiotherapy to confirm localized disease.
A Geriatric 8 (G8) questionnaire is recommended as a screening tool for geriatric assessment. In the case of score ≤14, a comprehensive geriatric assessment including assessment of performance status, activities of daily life, mental status, possible sensory impairment and comorbidities is recommended.
Treatment of elderly patients with lymphoma requires personalized approach. In fit patients who are able to tolerate standard treatment, the outcomes are similar to outcomes in young patients. In vulnerable patients treatment should be conducted with the aim of prolonging life with respect to its quality while avoiding intensive treatment procedures with risk of toxicity. In terminal patients who won't profit from oncological therapy, only symptomatic supportive treatment is recommended. Treatment options for most common lymphoma subtypes are discussed in second part of the article.
Atypical chronic myeloid leukemia in patients after breast cancer treatment
02/2019 MUDr. Jana Zuchnická, MUDr. Petra Richterová, MUDr. Zuzana Rusiňáková, prof. MUDr. Edgar Faber, CSc., MUDr. Roman Hájek, CSc.
Atypical chronic myeloid leukemia BCR/ABL1 negative is a rare disease. The prognosis is unfavorable; patients have a high risk of transformation in acute myeloid leukemia. Transplantation of allogeneic haematopoietic stem cells should therefore be considered in younger patients without significant associated illnesses for which a suitable donor has been found early in the course of disease. We use paliative treatment procedures for patients who are unsuitable for transplantation.
ENTIRE ARTICLE
Atypical chronic myeloid leukemia BCR/ABL1 negative is a rare disease. The prognosis is unfavorable; patients have a high risk of transformation in acute myeloid leukemia. Transplantation of allogeneic haematopoietic stem cells should therefore be considered in younger patients without significant associated illnesses for which a suitable donor has been found early in the course of disease. We use paliative treatment procedures for patients who are unsuitable for transplantation.
Obinutuzumab in the treatment of patients with chronic lymphocytic leukemia and follicular lymphoma
03/2017 MUDr. Jana Zuchnická, MUDr. Jana Fečková Mihályová, MUDr. Juraj Ďuraš, prof. MUDr. Roman Hájek, CSc.
Monoclonal antibodies are used in the treatment of chronic lymphocytic leukemia and follicular lymphoma especially in combination with chemotherapy. The introduction of rituximab into clinical practice meant a real turning point, it changed medical procedures and the results of the treatment of both diseases. As of recently new monoclonal antibodies are being introduced into clinical practice which are being developed to enhance the antitumor effect. One of them is a humanized monoclonal antibody obinutuzumab. Obinutuzumab combined with chlorambucil is in the Czech Republic approved for the treatment of chronic lymphocytic leukemia in previously untreated patients with multiple comorbidities, who can't undergo fludarabin based treatment. In follicular lymphoma the indication of using obinutuzumab in combination with bendamustine is used for treating patients with rituximab refractory follicular lymphoma, we refer to the current summary of product characteristics. The use of obinutuzumab for patients with follicular lymphoma in the Czech Republic is still bound to being approved by the payer according to §16 of Act No. 48/1997 Coll.
ENTIRE ARTICLE
Monoclonal antibodies are used in the treatment of chronic lymphocytic leukemia and follicular lymphoma especially in combination with chemotherapy. The introduction of rituximab into clinical practice meant a real turning point, it changed medical procedures and the results of the treatment of both diseases. As of recently new monoclonal antibodies are being introduced into clinical practice which are being developed to enhance the antitumor effect. One of them is a humanized monoclonal antibody obinutuzumab. Obinutuzumab combined with chlorambucil is in the Czech Republic approved for the treatment of chronic lymphocytic leukemia in previously untreated patients with multiple comorbidities, who can't undergo fludarabin based treatment. In follicular lymphoma the indication of using obinutuzumab in combination with bendamustine is used for treating patients with rituximab refractory follicular lymphoma, we refer to the current summary of product characteristics. The use of obinutuzumab for patients with follicular lymphoma in the Czech Republic is still bound to being approved by the payer according to §16 of Act No. 48/1997 Coll.
Optimal treatment approaches for patients with myelodysplastic syndrome
02/2017 MUDr. Petra Richterová, MUDr. Zdeněk Kořistek, Ph.D., MUDr. Lukáš Stejskal, prof. MUDr. Roman Hájek, CSc.
Myelodysplastic syndrome is a clonal disorder of the bone marrow caused by damage to the genetic information myeloid stem cell. It represents a heterogeneous group of disorders characterized by ineffective hematopoiesis with dysplasia of one or more myeloid lineage leading to cytopenia (or cytopenias) and the high incidence of progression to acute myeloid leukemia (about 1/3 cases). The blood count is most prevalently represented by anemia alone, in combination with thrombocytopenia or leucopenia, neutropenia. Clinical symptoms are consistent with the type and depth of the cytopenia – anemic syndrome, bleeding manifestation from thrombocytopenia or infectious complications in neutropenic patients. Myelodysplastic syndrome is a disease occurring almost solely in patients of older age (most frequent occurrence between 65–70 years), with an incidence of 3–5 new cases per 100,000 population per year. The incidence of myelodysplastic syndrome increases with age rapidly and in a group of people over 70 years amounts to 20 to 40 new cases per 100,000 inhabitants. Myelodysplastic syndrome is diagnosed as in the case of primary – unknown etiology, or secondary – often after chemotherapy or radiotherapy for an other cancer or after exposure to a known toxic agent.
ENTIRE ARTICLE
Myelodysplastic syndrome is a clonal disorder of the bone marrow caused by damage to the genetic information myeloid stem cell. It represents a heterogeneous group of disorders characterized by ineffective hematopoiesis with dysplasia of one or more myeloid lineage leading to cytopenia (or cytopenias) and the high incidence of progression to acute myeloid leukemia (about 1/3 cases). The blood count is most prevalently represented by anemia alone, in combination with thrombocytopenia or leucopenia, neutropenia. Clinical symptoms are consistent with the type and depth of the cytopenia – anemic syndrome, bleeding manifestation from thrombocytopenia or infectious complications in neutropenic patients. Myelodysplastic syndrome is a disease occurring almost solely in patients of older age (most frequent occurrence between 65–70 years), with an incidence of 3–5 new cases per 100,000 population per year. The incidence of myelodysplastic syndrome increases with age rapidly and in a group of people over 70 years amounts to 20 to 40 new cases per 100,000 inhabitants. Myelodysplastic syndrome is diagnosed as in the case of primary – unknown etiology, or secondary – often after chemotherapy or radiotherapy for an other cancer or after exposure to a known toxic agent.
Pixantrone in the treatment of non‑Hodgkin lymphoma
02/2017 MUDr. Juraj Ďuraš, MUDr. Michal Kaščák, MUDr. Milan Navrátil, prof. MUDr. Roman Hájek, CSc.
Pixantrone is a novel aza-anthracenedione developed with aim of reducing cardiac toxicity whilst preserving the efficacy of anthracyclines. Pixantrone acts as an intercalating and an alkylating agent and weak topoisomerase II inhibitor. Unlike anthracycline pixantrone has reduced potential for the production of oxygen free radicals, which are probably the main factor of anthracycline’s cardiotoxicity. The maximum tolerated dose identified in the phase I study in relapsed and refractory aggressive non-Hodgkin’s lymphoma was 56 mg/m2 i.v. day 1, 8 and 15 in a 28day cycle. In Phase II and III was observed overall response in 27–40 %, complete remission in approximately 15 % of patients. In a randomized phase III study PIX 301 chieved overall response rate (40 %), complete or unconfirmed complete remission (24 %) and median time to progression (5,3 months) in the pixantrone arm was significantly higher than in the arm with single agent investigator choice. The main side effect of drug is haematotoxicity, primarily neutropenia. The risk of cardiotoxicity is not completely eliminated, but unlike in anthracyclines involves mainly subclinical decrease in left ventricular ejection fraction, symptomatic congestive hear failure has been observed only rarely. Based on the study PIX 301 pixantrone was approved in monotherapy in the treatment of multiple relapsed or refractory aggressive B-non-Hodgkin lymphomas. Efficacy of pixantrone combined with rituximab vs. gemcitabine + rituximab in rituximab pretreated patients is investigated in the ongoing PIX 306 study.
ENTIRE ARTICLE
Pixantrone is a novel aza-anthracenedione developed with aim of reducing cardiac toxicity whilst preserving the efficacy of anthracyclines. Pixantrone acts as an intercalating and an alkylating agent and weak topoisomerase II inhibitor. Unlike anthracycline pixantrone has reduced potential for the production of oxygen free radicals, which are probably the main factor of anthracycline’s cardiotoxicity. The maximum tolerated dose identified in the phase I study in relapsed and refractory aggressive non-Hodgkin’s lymphoma was 56 mg/m2 i.v. day 1, 8 and 15 in a 28day cycle. In Phase II and III was observed overall response in 27–40 %, complete remission in approximately 15 % of patients. In a randomized phase III study PIX 301 chieved overall response rate (40 %), complete or unconfirmed complete remission (24 %) and median time to progression (5,3 months) in the pixantrone arm was significantly higher than in the arm with single agent investigator choice. The main side effect of drug is haematotoxicity, primarily neutropenia. The risk of cardiotoxicity is not completely eliminated, but unlike in anthracyclines involves mainly subclinical decrease in left ventricular ejection fraction, symptomatic congestive hear failure has been observed only rarely. Based on the study PIX 301 pixantrone was approved in monotherapy in the treatment of multiple relapsed or refractory aggressive B-non-Hodgkin lymphomas. Efficacy of pixantrone combined with rituximab vs. gemcitabine + rituximab in rituximab pretreated patients is investigated in the ongoing PIX 306 study.