Patients with multiple myeloma frequently present with substantial immune impairment and an increased risk for infections and infection-related mortality. The risk for infection with SARS-CoV-2 virus and resulting mortality is also increased, emphasising the importance of protecting patients by vaccination. Available data in patients with multiple myeloma suggest a suboptimal anti-SARS-CoV-2 immune response, meaning a proportion of patients are unprotected. Factors associated with poor response are uncontrolled disease, immunosuppression, concomitant therapy, more lines of therapy, and CD38 antibody-directed and B-cell maturation antigen-directed therapy. These facts suggest that monitoring the immune response to vaccination in patients with multiple myeloma might provide guidance for clinical management, such as administration of additional doses of the same or another vaccine, or even temporary treatment discontinuation, if possible. In those who do not exhibit a good response, prophylactic treatment with neutralising monoclonal antibody cocktails might be considered. In patients deficient of a SARS-CoV-2 immune response, adherence to measures for infection risk reduction is particularly recommended. This consensus was generated by members of the European Multiple Myeloma Network and some external experts. The panel members convened in virtual meetings and conducted an extensive literature research and evaluated recently published data and work presented at meetings, as well as findings from their own studies. The outcome of the discussions on establishing consensus recommendations for COVID-19 vaccination in patients with multiple myeloma was condensed into this Review.
- MeSH
- COVID-19 prevence a kontrola MeSH
- konsensus MeSH
- lidé MeSH
- mnohočetný myelom komplikace farmakoterapie imunologie MeSH
- SARS-CoV-2 MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- vakcinace MeSH
- vakcíny proti COVID-19 aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Vaccination is one of the most successful medical interventions that has saved the life of millions of people. Vaccination is particularly important in patients with multiple myeloma, who have an increased risk of infections due to the disease-inherent immune suppression, and because of the immune suppressive effects of therapy. Hence, all appropriate measures should be exploited, to elicit an effective immune response to common pathogens like influenza, pneumococci, varicella zoster virus, and to those bacteria and viruses (haemophilus influenzae, meningococci, and hepatitis) that frequently may pose a significant risk to patients with multiple myeloma. Patients after autologous, and specifically after allogeneic transplantation have severely reduced antibody titers, and therefore require a broader spectrum of vaccinations. Response to vaccination in myeloma often is less vigorous than in the general population, mandating either measurement of the postvaccination antibody titers and/or repeating the vaccination. Here, we compile the existing data on vaccination in multiple myeloma and provide recommendations for clinical practice.
- MeSH
- imunosupresiva aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- infekční nemoci etiologie MeSH
- klinické zkoušky jako téma MeSH
- konsensus MeSH
- kontrola infekčních nemocí * MeSH
- lidé MeSH
- mnohočetný myelom komplikace imunologie terapie MeSH
- směrnice pro lékařskou praxi jako téma * MeSH
- vakcinace * MeSH
- vakcíny aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
Importance: Several trials demonstrated the impact of novel agent-based maintenance in newly diagnosed multiple myeloma (NDMM), but there is no current evidence demonstrating the superiority of one regimen over the other, owing to the lack of direct/indirect comparisons. Objective: To analyze and compare the effectiveness of different maintenance regimens in NDMM via a network meta-analysis. Data Sources: We performed 2 independent searches in PubMed and Cochrane databases, and then we identified all the records registered after 1999 and on or before November 20, 2017. Study Selection: By blinded review, we identified prospective phase 3 randomized trials evaluating novel agent-based maintenance in patients with NDMM; the included studies compared at least 2 maintenance approaches; comparators included placebo and no maintenance. From 364 screened records, 11 studies were included. Data Extraction and Synthesis: We followed (independent extraction) the guidelines provided by the PRISMA Report and the EQUATOR Network. The evidence was synthesized using a network meta-analysis (NMA). To allow comparison of all treatments, no maintenance was selected as common comparator and the effect of placebo was assumed to be the same as no treatment. The best option was identified by a Bayesian consistency model based on hazard ratio (HR), 95% credible interval (CrI), probability of being the best treatment (PbBT), and median ranking distribution (MedR). Main Outcomes and Measures: Outcomes of interest were progression-free survival (PFS) and overall survival (OS). Results: Eleven trials and 8 treatments including a total of 5073 participants were included. By PFS analysis, lenalidomide-based regimens (lenalidomide-prednisone, lenalidomide alone) were identified as the most effective options (HR, 0.39 [95% CrI, 0.28-0.53] and 0.47 [95% CrI, 0.39-0.55], respectively; MedR, 1 and 2; overall PbBT, 74%). Four treatments (thalidomide-interferon, thalidomide-bortezomib, bortezomib-prednisone, thalidomide alone) showed an HR in favor of maintenance. By OS analysis, lenalidomide alone was identified as the best option (HR, 0.76; 95% CrI, 0.51-1.16; MedR, 2; PbBT, 38%), followed by bortezomib-thalidomide and bortezomib-prednisone. Similar features were noticed in the restricted network including transplant trials, in the sensitivity analysis, and in most of the prognostic subgroups. Conclusions and Relevance: Based on PFS and OS results of this NMA, lenalidomide maintenance appears to be the best treatment option, by synthesizing the available evidence of novel agent-based maintenance in the past 20 years.
- MeSH
- klinické zkoušky, fáze III jako téma MeSH
- lenalidomid aplikace a dávkování MeSH
- mnohočetný myelom diagnóza farmakoterapie MeSH
- přežití bez známek nemoci MeSH
- protokoly protinádorové kombinované chemoterapie terapeutické užití MeSH
- randomizované kontrolované studie jako téma MeSH
- síťová metaanalýza MeSH
- udržovací chemoterapie metody MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved the treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drug classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.
- MeSH
- cílená molekulární terapie škodlivé účinky MeSH
- hodnocení rizik MeSH
- incidence MeSH
- lidé MeSH
- management nemoci MeSH
- mnohočetný myelom komplikace farmakoterapie MeSH
- nežádoucí účinky léčiv diagnóza epidemiologie prevence a kontrola terapie MeSH
- protinádorové látky škodlivé účinky terapeutické užití MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- konsensus - konference MeSH
- přehledy MeSH
Vytvoření Zásad dobré praxe je jedním z klíčových cílů projektu Dementia Palliare, který se uskutečňuje v rámci programu Erasmus+ (klíčová aktivita 2 – KA 2). Dementia Palliare je novým konceptem a snahou o pozitivní rozvoj v praxi a podporu lidí s pokročilou demencí, nikoli však přímo v terminálních stadiích demence. Projekt Palliare je zaměřen na interprofesionální spolupráci a vzdělávání v problematice pokročilé demence. Jeho cílem je poskytnout nové informace a mezinárodní zkušenosti nejen odborníkům, profesionálním pečujícím o osoby s demencí, ale i všem dalším, kteří mají o tuto problematiku zájem. To by mělo přispět nejen ke zlepšení péče o lidi s demencí v Evropě, ale i k lepší podpoře jejich rodinných pečujících a spolupráci mezi profesionály a všemi dalšími zúčastněnými. Zásady dobré praxe jako otevřený dokument tímto předkládáme k diskusi všem, kdo mají o danou problematiku zájem.
Dementia Palliare is a new concept of positive practice development regarding the support of a person with advanced but not end stage dementia, who has limited opportunities for self-realisation and is increasingly reliant on the support of others for their health and wellbeing. PALLIARE Project is funded by the ERASMUS+ Programme. The project aims to strengthen inter-professional collaboration in dementia care; this will be facilitated through a virtual international Community of Practice (CoP). This learning environment will bring together people with a common interest to share and learn from one another to champion evidence informed improvements in advanced dementia care and family caring. Palliare Project team is led by Professor Debbie Tolson PhD MSc BSc (Hons) RGN FRCN Alzheimer Scotland Centre for Policy and Practice at University of the West of Scotland. The PALLIARE team is made up from seven European countries: Scotland, Czech Republic, Spain, Finland, Sweden, Slovenia and Portugal.
- Klíčová slova
- projekt PALLIARE,
- MeSH
- demence * ošetřování MeSH
- Evropská unie MeSH
- komunikace MeSH
- kvalita života MeSH
- lidé MeSH
- lidská práva MeSH
- ošetřovatelská péče metody MeSH
- ošetřovatelství - vzorové postupy * MeSH
- senioři MeSH
- směrnice jako téma MeSH
- výzkumný projekt MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
1st ed. xiv, 205 s. : il., tab.
- MeSH
- nemoc štěpu proti hostiteli komplikace prevence a kontrola MeSH
- pooperační komplikace prevence a kontrola psychologie MeSH
- transplantace hematopoetických kmenových buněk ošetřování MeSH
- Publikační typ
- monografie MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- hematologie a transfuzní lékařství
- transplantologie
xiv, 205 s. : il. ; 26 cm
- MeSH
- nemoc štěpu proti hostiteli prevence a kontrola MeSH
- peroperační komplikace prevence a kontrola MeSH
- pooperační komplikace prevence a kontrola MeSH
- transplantace hematopoetických kmenových buněk * kontraindikace ošetřování MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- hematologie a transfuzní lékařství
- transplantologie
- NLK Publikační typ
- kolektivní monografie
European heart journal, ISSN 1520-765X vol. 4, suppl. H, December 2002
H47 s. : tab., grafy ; 30 cm
