IGEV regimen and a fixed dose of lenograstim: an effective mobilization regimen in pretreated Hodgkinapos;s lymphoma patients. |
Mon, Jul 26,2010 | ||
We explored the efficacy of the IGEV regimen (ifosfamide, gemcitabine, vinorelbine and prednisone) combined with a fixed dose of lenograstim (263 mug/day) to mobilize peripheral blood stem cells (PBSCs) in 90 Hodgkinamp;apos;s lymphoma patients. The median total CD34+ cells/mul peak, colony-forming units granulocyte-macrophage and white blood cells for all individual collection sets were 85/mul, 12 x 10(4)/kg and 20 700/mul, respectively. An adequate number of CD34+ cells (more than 3 x 10(6) or 6 x 10(6) CD34+ cells/kg depending on whether single or tandem high-dose chemotherapy was used) were collected in 89 out of 90 (98.7) mobilized patients, whereas the only failure reached 2.3 x 10(6) CD34+ cells/kg. The median CD34+ cell collections were 11 x 10(6)/kg (range 2.3-39 x 10(6)/kg) and 10 x 10(6)/kg (range 6-22.0 x 10(6)/kg) with a median of 1 and 2 leukaphereses for patients eligible for single high-dose treatment and for candidates for tandem transplant, respectively. Target yields were reached in 71.43 and 49.09 and additionally in 17.14 and 43.64 of cases after the first and second apheresis procedures, respectively. Hematological and non-hematological side effects were acceptable, and no toxic deaths occurred. Thirty-four patients received a single and 47 received tandem transplantation with rapid engraftment. These results confirm that the IGEV regimen with lenograstim support can be used successfully and safely to mobilize PBSCs.Bone Marrow Transplantation advance online publication, 1 October 2007; doi:10.1038/sj.bmt.1705862.
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Renal function in patients with cadaveric kidney transplants treated with tacrolimus or cyclosporine. |
Mon, Jul 26,2010 | ||
INTRODUCTION: Renal function predicts graft survival in kidney transplant patients. This study compared the 2-year evolution of renal function in patients treated with cyclosporine or tacrolimus in combination with mycophenolate mofetil (MMF) and prednisone. nbsp; METHODS: We studied 1558 cadaveric renal transplant recipients from 14 Spanish hospitals between January 2000 and December 2002. Of these, 1168 were treated with tacrolimus and 390 with cyclosporine. The primary efficacy endpoint was long-term renal function. Renal function was measured by serum creatinine and glomerular filtration rate (GFR) by creatinine clearance calculated from the Cockcroft-Gault formula. This report summarizes the 2-year results. nbsp; RESULTS: At 24 months the tacrolimus group showed significantly better serum creatinine (1.5 +/- 0.7 vs 1.8 +/- 0.8 mg/dL, P amp;lt; .001) and GFR (60.5 +/- 20.9 mL/min vs 47.9 +/- 10.0, P amp;lt; .001) than the cyclosporine group. Additionally, recipients with ideal graft donors (23.5 +/- 2.8 vs 24.0 +/- 2.9 years) had a better serum creatinine at 2 years (1.23 +/- 0.2 vs 1.5 +/- 0.4 mg/dL, P amp;lt; .05). Multivariate analysis showed that tacrolimus was an independent factor associated with better renal function: odds ratio 1.6, 95 confidence interval (1.2 to 2.2), P amp;lt; .001. nbsp; CONCLUSIONS: Patients with a renal transplant treated with tacrolimus in combination with MMF and prednisone displayed better renal function at 2 years than those who received cyclosporine. |
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Two-dose daclizumab, tacrolimus, mycophenolate mofetil, and steroid-free regimen in de novo cardiac transplant recipients: early experience. |
Mon, Jul 26,2010 | ||
BACKGROUND: Tacrolimus (TAC) with mycophenolate mofetil (MMF) and a steroid-free regimen seems to have good efficacy in preventing acute rejection in cardiac transplant recipients, although concern exists about nephrotoxicity. Induction therapy with Daclizumab seems to give protection without side effects. Data are lacking about the outcome of 2-dose Daclizumab+TAC+MMF and a steroid-free regimen. nbsp; MATERIALS AND METHODS: We retrospectively reviewed 28 consecutive de novo heart transplantations performed at a single center between January 2001 and June 2006. Patients received induction therapy with 2-dose Daclizumab. Maintenance immunosuppression included TAC, MMF, and prednisone during the first 6 months. The endpoints were the incidence of acute rejection, patient and graft survival, and clinical tolerability. nbsp; RESULTS: Among 28 patients of mean age 57 +/- 9 years, 2 subjects (7) died in the perioperative period due to infections. The mean follow-up was 2.8 +/- 1.5 years. There were no late deaths. Six patients experienced acute rejection (International Society of Heart and Lung Transplantation [ISHLT] amp;gt;or=3A) that required treatment during the first 3 months. At follow-up, only 3 patients (amp;gt;or=3A) required treatment. Mean creatinine level increased from 1.08 +/- 0.37 at baseline to 1.08 +/- 0.41 at 1 year (n = 23; P = not significant [NS]) to 1.39 +/- 0.68 (n = 13; P amp;lt; .05) at 4 years, 1.65 +/- 0.51 (n = 8; P amp;lt; .05) at 5 years. No patient required replacement therapy. nbsp; CONCLUSIONS: A steroid-free protocol with 2-dose Daclizumab induction therapy and maintenance with TAC and MMF seemed to be safe to prevent acute rejection. Creatinine levels were slightly but significantly increased. |
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Prednisone is used in the management ..... |
Fri, Jul 23,2010 | ||
Prednisone is used in the management of inflammatory conditions or diseases in which the immune system plays an important role. This particular medicine is most often applied for treating several types of arthritis, ulcerative colitis, Crohn's disease, systemic lupus, allergic reactions, asthma and severe psoriasis. It is also used for treating leukemias, lymphomas, idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia. Additionally, corticosteroids, including prednisone, are commonly used to suppress the immune system and prevent the body from rejecting transplanted organs. Prednisone can also be used as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of cortisol. Please note that this medication can sometimes be prescribed for other uses, but it is strongly recommended that you ask your doctor or pharmacist for more information. nbsp; Prednisonenbsp;is also used to treat many disorders such as lupus, severe psoriasis, severe asthma, ulcerative colitis, and Crohn's disease (as mentioned in the previous section). Additionally, itnbsp;is also sometimes used with antibiotics to treat a certain type of pneumonia in patients with acquired immunodeficiency syndrome (AIDS). Nevertheless, it is important that you talk to your doctor about the possible risks of using this drug for your particular condition. |
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Prednisone comes as.... |
Fri, Jul 23,2010 | ||
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Prednisone comes as a tablet, solution, concentrate, and syrup that are to be administered orally. The initial dose of prednisone varies depending on the condition being treated and the age of the patient. The starting dose may be from 5 to 60 mg per day and is often adjusted based on the response of the condition being treated. Furthermore, it is important that you follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. It is recommended that prednisone be taken with food. Use the specially marked dropper that comes with the concentrate to measure the dose. You may mix it with fruit juice or semisolid food (e.g., applesauce). Please note that corticosteroids typically do not produce immediate effects and must be used for several days before maximal effects are seen. It may take much longer before conditions respond to treatment. Prolonged therapy with prednisone causes the adrenal glands to atrophy and stop producing cortisol. When prednisone is discontinued after a period of prolonged therapy, the dose of prednisone must be tapered (lowered gradually) to allow the adrenal glands time to recover. (See section on side effects for further information.) Additionally, do not stop taking prednisone without talking to your doctor. Stopping the drug abruptly can cause loss of appetite, nausea, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. |
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Before taking prednisone |
Fri, Jul 23,2010 | ||
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Please tell your doctor and pharmacist if you are allergic to prednisone, any other medications, or any of the inactive ingredients in prednisone tablets or solutions. Ask your doctor or pharmacist for a list of the inactive ingredients. Moreover, inform your doctor and pharmacist what prescription and non-prescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordaronereg;, Paceronereg;); anticoagulants ('blood thinners') such as warfarin (Coumadinreg;); certain antifungals such as fluconazole (Diflucanreg;), itraconazole (Sporanox), ketoconazole (Nizoralreg;) and voriconazole (Vfendreg;);aprepitant (Emendreg;); aspirin; carbamazepine (Carbatrolreg;, Epitolreg;, Tegretolreg;); cimetidine (Tagametreg;); clarithromycin (Biaxinreg;, Prevpakreg;); cyclosporine (Neoralreg;, Sandimmunereg;); delavirdine (Rescriptorreg;); diltiazem (Cardizemreg;, Dilacorreg;, Tiazacreg;, others); dexamethasone (Decadronreg;, Dexpakreg;); diuretics ('water pills'); efavirenz (Sustivareg;); fluoxetine (Prozacreg;, Sarafemreg;); fluvoxamine (Luvoxreg;); griseofulvin (Fulvicinreg;, Grifulvinreg;, Gris-PEGreg;); HIV protease inhibitors including atazanavir (Reyatazreg;), indinavir (Crixivanreg;), lopinavir (in Kaletrareg;), nelfinavir (Viraceptreg;), ritonavir (Norvirreg;, in Kaletrareg;), and saquinavir (Fortovasereg;, Invirasereg;); hormonal contraceptives (birth control pills, patches, rings, implants, and injections); lovastatin (Altocorreg;, Mevacorreg;); medications for diabetes; nefazodone; nevirapine (Viramunereg;); phenobarbital; phenytoin (Dilantinreg;, Phenytekreg;); rifabutin (Mycobutinreg;), rifampin (Rifadinreg;, Rimactanereg;, in Rifamatereg;); sertraline (Zoloftreg;); troleandomycin (TAOreg;); verapamil (Calanreg;, Coverareg;, Isoptinreg;, Verelanreg;); and zafirlukast (Accolatereg;). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. nbsp; Tell your doctor what herbal products you are taking or plan to take, especially St. John's wort. Additionally, please let your doctor know if you currently have an eye infection or have ever had eye infections that come and go, threadworms (a type of worm that can live inside the body), diabetes, high blood pressure, emotional problems, mental illness, myasthenia gravis (a condition in which the muscles become weak), osteoporosis (condition in which the bones become weak and fragile and can break easily), seizures, tuberculosis (TB), ulcers, or liver, kidney, intestinal, heart, or thyroid disease. Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking prednisone, call your doctor. If you are having surgery, including dental surgery, or need emergency medical treatment, tell the doctor, dentist, or medical staff that you are taking or have recently stopped taking prednisone. You should carry a card or wear a bracelet with this information in case you are unable to speak in a medical emergency. Do not have any vaccinations (shots to prevent diseases) without first talking to your doctor. Furthermore, you should know that prednisone may decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection. Stay away from people who are sick and wash your hands often while you are taking this medication. Be sure to avoid people who have chicken pox or measles. Call your doctor immediately if you think you may have been around someone who had chicken pox or measles. |
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What should I do if I forget a dose? |
Fri, Jul 23,2010 | ||
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If you take one dose daily, take the missed dose as soon as you remember. However, if you don't remember until the next day, skip the dose you missed and take only your regular daily dose. If you take more than one dose daily, you can either take the missed dose as soon as you remember, or you can take two doses at the next dose time. On the other hand, if you take one dose every other day, take the missed dose as soon as you remember, then go back to your regular every-other-day schedule. |
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A Phase II Trial of Bortezomib and Prednisone for Castration Resistant Metastatic Prostate Cancer. |
Fri, Jul 23,2010 | ||
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PURPOSE: We defined the antitumor effects of bortezomib alone and in combination with prednisone in patients with progressive, castration resistant metastatic prostate cancer.
MATERIALS AND METHODS: A total of 30 men with progressive castration resistant disease were treated in 2 groups. Cohort 1 received 1.5 mg/m(2) bortezomib intravenously twice weekly for 2 cycles (2 weeks on and 1 week off), followed by 1.6 mg/m(2) weekly (4 weeks on and 2 weeks off). Prednisone (10 mg) was given orally throughout. Cohort 2 comprised patients with limited chemotherapy exposure who received a decreased dose of bortezomib (1.3 mg/m(2)) during the induction period with prednisone added only at disease progression. The primary end point was no evidence of disease progression at 12 weeks, defined as no increase in prostate specific antigen from baseline and no radiographic progression. Interleukin-6 was assessed to correlate with antitumor effects. RESULTS: One of 24 evaluable patients (4) achieved the primary end point. In cohort 1, 18 patients were treated, 13 were evaluable for response and 4 discontinued treatment due to toxicities, including 3 before attaining the point of being evaluable. No patient achieved the primary end point. In cohort 2, 12 patients were treated and 11 were evaluable for response. Toxicity was slightly mitigated compared with that in cohort 1. One patient achieved the primary end point. Interleukin-6 did not correlate with posttreatment prostate specific antigen changes in either cohort. CONCLUSIONS: Although interleukin-6 and other pathways regulated by nuclear factor-kappa B may be legitimate targets, treatment with bortezomib alone and with prednisone does not appear to have significant antitumor effects in patients with castration resistant metastatic prostate cancer. |
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Melphalan, prednisone, and lenalidomide treatment for newly diagnosed myeloma: a report from the GIMEMA--Italian Multiple Myeloma Network. |
Fri, Jul 23,2010 | ||
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PURPOSE: Lenalidomide has shown significant antimyeloma activity in clinical studies. Oral melphalan, prednisone, and thalidomide have been regarded as the standard of care in elderly multiple myeloma patients. We assessed dosing, efficacy, and safety of melphalan, prednisone, and lenalidomide (MPR) in newly diagnosed elderly myeloma patients.
PATIENTS AND METHODS: Oral melphalan was administered in doses ranging from 0.18 to 0.25 mg/kg on days 1 to 4, prednisone at a 2-mg/kg dose on days 1 to 4, and lenalidomide at doses ranging from 5 to 10 mg on days 1 to 21, every 28 days for nine cycles, followed by maintenance therapy with lenalidomide alone. Aspirin was given as a prophylaxis for thrombosis. RESULTS: Fifty-four patients were enrolled and evaluated after completing the assigned treatment schedule. The maximum tolerated dose was defined as 0.18 mg/kg melphalan and 10 mg lenalidomide. With these doses, 81 of patients achieved at least a partial response, 47.6 achieved a very good partial response, and 23.8 achieved a complete immunofixation-negative response. In all patients, 1-year event-free and overall survival rates were 92 and 100, respectively. At the maximum tolerated dose, grade 3 adverse events included neutropenia (38.1), thrombocytopenia (14.2), febrile neutropenia (9.5), vasculitis (9.5), and thromboembolism (4.8); grade 4 adverse events were neutropenia (14.2) and thrombocytopenia (9.5). CONCLUSION: Oral MPR therapy is a promising first-line treatment for elderly myeloma patients. Hematologic adverse events were frequent but manageable. A low incidence of nonhematologic adverse events was noted. Aspirin appears to provide adequate antithrombosis prophylaxis. |
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Outcome of children with aplastic anemia treated with immunosuppressive therapy. |
Fri, Jul 23,2010 | ||
BACKGROUND: Immunosuppressive therapy (IST) is the alternative treatment in children with aplastic anemia (AA) who do not have an HLA-matched sibling. The aim of this study is to evaluate the outcome of children with AA treated with IST.
nbsp; METHODS: We retrospectively reviewed the hospital records of children with AA from 1984 to 2004, treated at our institution with antithymocyte globulin (ATG), cyclosporine (CS), and short course of prednisone. nbsp; RESULT: Forty-two patients were treated with IST (24 boys, 18 girls); of whom 26 received G-CSF. The median age at diagnosis was 8.5 years. Sixty-nine, 19, and 12 were diagnosed with severe, very severe, and moderate AA, respectively. Twenty-one percent had hepatitis-associated AA. Median follow-up time was 53.3 months. Sixty-two percent had complete response; 19 had partial response. Two patients relapsed and received a second course of ATG; both had a partial response. The actuarial 5 years survival rate was 67.5. Two patients developed myelodysplastic syndrome (MDS); both received long-term G-CSF and had partial response after two courses of IST. Fifteen percent of survivors had significant hypertension which persisted after CS was discontinued. nbsp; CONCLUSIONS: This study shows promising response in children with AA treated with IST; however, the outcome was inferior to our institutional results with hematopoietic stem cell transplantation from a sibling donor. Hypertension and MDS are late complications. Longer follow-up, larger cohorts, and prospective studies are warranted to evaluate late complications and risk factors. Pediatr. Blood Cancer (c) 2007 Wiley-Liss, Inc. |
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