RESUMEN
BACKGROUND AND AIMS: Anagrelide is a drug effective in reducing platelet counts in essential thrombocythemia (ET) and Ph1-negative myeloproliferative neoplasms. The aim of this study was to evaluate the real-life use of anagrelide in patients with ET followed over 25 years at the Haematological Institutes belonging to "Ph1-negative Myeloproliferative Neoplasms Latium Group." PATIENTS AND METHODS: Eligibility criteria were diagnosis of ET and treatment with anagrelide. Data were collected through an ad hoc case report form. RESULTS: One hundred and fifty patients received anagrelide for a median time of 7.4 years (0.1-23.2). Anagrelide was administered as first-line therapy in 34.7% of patients, as second-line in 52% and as third-line in 13.3%: 85.4% responded to therapy. Sixty-eight/136 evaluable patients reported side effects: palpitations, peripheral vasodilation, anaemia, diarrhoea and gastric distress. Fourteen thrombotic (arterial 10, venous 4) and 51 bleeding events (minor 48, major 3) occurred. Sixteen/150 (10.6%) patients developed secondary myelofibrosis and 3/150 (2%) an acute myeloid leukaemia. CONCLUSIONS: In our experience, anagrelide is an effective drug in reducing platelet levels in a high percentage of patients with ET. It is especially addressed to younger people. A careful assessment of the thrombotic risk and monitoring of cardiac function, at diagnosis and during follow-up, is mandatory.
Asunto(s)
Quinazolinas/uso terapéutico , Trombocitemia Esencial/tratamiento farmacológico , Trombocitemia Esencial/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anemia/diagnóstico , Anemia/etiología , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Sustitución de Medicamentos , Femenino , Estudios de Seguimiento , Encuestas de Atención de la Salud , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Hematológicas del Embarazo , Pronóstico , Quinazolinas/administración & dosificación , Quinazolinas/efectos adversos , Retratamiento , Estudios Retrospectivos , Trombocitemia Esencial/diagnóstico , Trombocitemia Esencial/etiología , Trombosis , Resultado del Tratamiento , Adulto JovenAsunto(s)
Lesión Renal Aguda , Mieloma Múltiple , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Humanos , Cadenas Ligeras de Inmunoglobulina , Riñón , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/tratamiento farmacológicoAsunto(s)
Antineoplásicos/uso terapéutico , Compuestos Bicíclicos Heterocíclicos con Puentes/uso terapéutico , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Leucemia Mieloide Aguda/tratamiento farmacológico , Neoplasias Primarias Múltiples/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Anciano , Femenino , Humanos , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Síndromes Mielodisplásicos/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Inducción de RemisiónAsunto(s)
Decitabina/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Trastornos Mieloproliferativos/patología , Anciano , Femenino , Humanos , Hidroxiurea/uso terapéutico , Janus Quinasa 2/genética , Leucemia Mieloide Aguda/etiología , Leucemia Mieloide Aguda/genética , Masculino , Trastornos Mieloproliferativos/complicaciones , Trastornos Mieloproliferativos/tratamiento farmacológico , Pipobromán/uso terapéutico , Resultado del TratamientoAsunto(s)
Anemia Hemolítica Autoinmune/diagnóstico , Anemia Hemolítica Autoinmune/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anemia Hemolítica Autoinmune/economía , Niño , Preescolar , Atención a la Salud/economía , Femenino , Recursos en Salud/economía , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenAsunto(s)
Oxazinas/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Piridinas/uso terapéutico , Quinasa Syk/antagonistas & inhibidores , Aminopiridinas , Ensayos Clínicos Fase III como Asunto , Humanos , Morfolinas , Profármacos/uso terapéutico , Púrpura Trombocitopénica Idiopática/patología , Púrpura Trombocitopénica Idiopática/fisiopatología , Pirimidinas , Recurrencia , Quinasa Syk/inmunologíaAsunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Leucemia Mielomonocítica Crónica/tratamiento farmacológico , Anciano , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Anciano Frágil , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Decitabina/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Neoplasias Primarias Múltiples/tratamiento farmacológico , Trombocitemia Esencial/patología , Adulto , Femenino , Humanos , Janus Quinasa 2/genética , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/patología , Neoplasias Primarias Múltiples/genética , Neoplasias Primarias Múltiples/patología , Trombocitemia Esencial/genética , Resultado del TratamientoAsunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Decitabina/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Terapia Recuperativa/métodos , Anciano , Quimioterapia Adyuvante , Humanos , Quimioterapia de Inducción , Quimioterapia de Mantención , Masculino , Terapia Neoadyuvante , Inducción de Remisión , Insuficiencia del TratamientoRESUMEN
The main objective of this study was to compare health-related quality of life (HRQOL) of primary immune thrombocytopenia (pITP) patients with that of general population, overall, and by patient group (i.e., newly diagnosed, persistent, and chronic patients). Fatigue was also investigated as a secondary objective. Overall, 424 adult patients were enrolled in a multicenter observational study and the control group consisted of a representative sample from the general population. Propensity score matching plus further multivariate linear regression adjustment was used to compare HRQOL outcomes between pITP patients and general population. Mean age of patients was 54 years. Of those with HRQOL assessment, 99 patients (23.6%) were newly diagnosed, 53 (12.6%) were persistent, and 268 (63.8%) were chronic pITP patients. Comparison by patient group versus their respective peers in the general population revealed greater impairments in persistent pITP patients. Persistent pITP patients reported clinically meaningful impairments in physical functioning (-15; 95% CI -24.1 to -5.8; P = 0.002), social functioning (-15.3; 95% CI -25.5 to -5.1; P = 0.004), role physical (-28.4; 95% CI -43.1 to -13.7; P < 0.001), role emotional (-23.9; 95% CI -40.1 to -7.7; P = 0.004), and mental health scales (-11.3; 95% CI -21.2 to -1.4; P = 0.026) of the SF-36 questionnaire. Higher fatigue severity was associated with lower physical and mental HRQOL outcomes. Our findings suggest that the burden of the disease and treatment might depend on the disease phase and that persistent pITP patients are the most vulnerable subgroup. Am. J. Hematol. 91:995-1001, 2016. © 2016 Wiley Periodicals, Inc.
Asunto(s)
Fatiga/etiología , Púrpura Trombocitopénica Idiopática/psicología , Calidad de Vida , Adulto , Anciano , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Aptitud Física , Púrpura Trombocitopénica Idiopática/complicaciones , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosAsunto(s)
Benzoatos/uso terapéutico , Enfermedad del Almacenamiento de Glucógeno Tipo I/complicaciones , Hidrazinas/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Pirazoles/uso terapéutico , Plaquetas/efectos de los fármacos , Procedimientos Quirúrgicos Electivos , Femenino , Enfermedad del Almacenamiento de Glucógeno Tipo I/genética , Hemólisis , Heterocigoto , Humanos , Persona de Mediana Edad , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/complicaciones , Púrpura Trombocitopénica Idiopática/cirugía , EsplenectomíaRESUMEN
BACKGROUND: More than 50% of oncohematological patients suffer from pain syndrome, mostly originating from the bone, which often include nociceptive and neuropathic complaints. Tapentadol, a recently available treatment option for cancer pain, exerts a dual analgesic mechanisms (opioid and noradrenergic), allowing for a high clinical efficacy as well as for a reduction in adverse events compared to traditional opioids. AIM: To explore the safety and efficacy of tapentadol as a suitable agent for the pain management in the setting of oncohematology. METHODS: Our observational study included 36 patients with basal pain intensity (NRS) ranging from 5 to 10. Tapentadol prolonged release (PR) was given at the initial dose of 50 mg BID and careful titrated according to the achieved pain control. RESULTS: Tapentadol PR was given at the dosages ranging from 200 and 260 mg/day after a careful titration, allowed for a clinically (-7 points NRS) remarkable reduction of pain intensity without any significant side effects. CONCLUSION: In oncohematological patients on pain, tapentadol PR was effective and well tolerated, so representing a suitable treatment option in this difficult setting.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Neoplasias Hematológicas/complicaciones , Dolor/complicaciones , Dolor/tratamiento farmacológico , Fenoles/uso terapéutico , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Fenoles/administración & dosificación , Estudios Retrospectivos , TapentadolAsunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Leucemia Mielomonocítica Crónica/complicaciones , Leucemia Mielomonocítica Crónica/tratamiento farmacológico , Paraproteinemias/complicaciones , Paraproteinemias/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Leucemia Mielomonocítica Crónica/diagnóstico , Masculino , Paraproteinemias/diagnóstico , Resultado del TratamientoRESUMEN
Although major therapeutic advances have led to improved survival for many hematologic malignancies in recent years, survival remains poor for some disease subtypes and a substantial proportion of patients are ultimately destined to die from their disease and/or related complications. Despite this, there is evidence that patients are not always referred to palliative/home care services as often as those with other cancers, although this situation may be improving in some areas. More research is needed, however, to explore reasons for this and identify whether patients may consequently have unmet needs that impact on their quality of life at this time.