INTRODUCTION: Chemotherapy during pregnancy can increase the risk of fetal anemia. Severe fetal anemia can lead to the development of hydrops fetalis and potentially fetal demise. Hence, it is imperative to implement consistent monitoring methods in the context of chemotherapy treatment. This study aimed to diagnose and monitor fetal anemia using middle cerebral artery peak systolic velocity (MCA-PSV) as a diagnostic tool during chemotherapy in pregnant women. MATERIAL AND METHODS: The study employed a prospective analysis involving a case series of 15 patients diagnosed with cancer during pregnancy and subsequently underwent chemotherapy. MCA-PSV was used to identify fetal anemia. The patients were scheduled for ultrasound examinations of the MCA-PSV. The first examination was performed on the same day as the administration of chemotherapy, while the second occurred on the 10th day after chemotherapy. The measurement technique used in the study was based on the methodology proposed by Mari and Barr. The multiples of the median were calculated using the calculators provided by Medicina Fetal Barcelona. Based on these values anemia severity was determined. When moderate or severe anemia was identified, chemotherapy was individually modified. Additionally, a blood count analysis was conducted immediately after the delivery of the newborn. RESULTS: Five patients were diagnosed with fetal or newborn anemia. With MCA-PSV, we identified moderate fetal anemia in two patients and severe fetal anemia in one. The complete blood count testing of newborns revealed mild anemia in three patients. One case was unrelated to chemotherapy-induced anemia. During treatment, fetal anemia did not corelate with maternal anemia. CONCLUSIONS: In four cases of anemia the combination of cisplatin and iphosphamide was used as a chemotherapy agent. No anemia was observed in other drug combinations. Our findings suggest that MCA-PSV is a reliable method for identifying anemia and should be included in the treatment protocol for chemotherapy-induced fetal anemia.
- MeSH
- anemie * chemicky indukované diagnóza MeSH
- arteria cerebri media diagnostické zobrazování MeSH
- lidé MeSH
- nemoci plodu * chemicky indukované diagnostické zobrazování MeSH
- novorozenec MeSH
- protinádorové látky * MeSH
- rychlost toku krve MeSH
- těhotenství MeSH
- ultrasonografie prenatální MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Momelotinib is the first inhibitor of Janus kinase 1 (JAK1) and JAK2 shown to also inhibit activin A receptor type 1 (ACVR1), a key regulator of iron homeostasis, and has demonstrated improvements in splenomegaly, constitutional symptoms, and anemia in myelofibrosis (MF). This long-term analysis pooled data from 3 randomized phase 3 studies of momelotinib (MOMENTUM, SIMPLIFY-1, and SIMPLIFY-2), representing MF disease from early (JAK inhibitor-naive) to late (JAK inhibitor-experienced) stages. Patients in the control arms (danazol in MOMENTUM, ruxolitinib in SIMPLIFY-1, and best available therapy in SIMPLIFY-2) could cross over to receive momelotinib at the end of the 24-week randomized period, and all patients could continue momelotinib treatment after the completion of these studies via an extended access protocol (XAP). Across these studies, 725 patients with MF received momelotinib; 12% remained on therapy for ≥5 years, with a median treatment exposure of 11.3 months (range, 0.1-90.4 months). The most common nonhematologic treatment-emergent adverse event (AE) occurring in ≥20% of patients was diarrhea (any grade, 27% and grade ≥3, 3%). Any-grade thrombocytopenia, anemia, and neutropenia occurred in 25%, 23%, and 7% of patients, respectively. The most common reason for momelotinib discontinuation was thrombocytopenia (4% discontinuation rate). The incidence of AEs of clinical importance (eg, infections, malignant transformation, peripheral neuropathy, and hemorrhage) did not increase over time. This analysis of one of the largest randomized trial databases for a JAK inhibitor to date in MF demonstrated a consistent safety profile of momelotinib without long-term or cumulative toxicity. These trials were registered at www.clinicaltrials.gov as: MOMENTUM (#NCT04173494), SIMPLIFY-1 (#NCT01969838), SIMPLIFY-2 (#NCT02101268), and XAP (#NCT03441113).
- MeSH
- anemie * chemicky indukované MeSH
- inhibitory Janus kinas * terapeutické užití MeSH
- inhibitory proteinkinas škodlivé účinky MeSH
- lidé MeSH
- primární myelofibróza * diagnóza MeSH
- randomizované kontrolované studie jako téma MeSH
- trombocytopenie * chemicky indukované MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- podpůrná léčba,
- MeSH
- anemie chemicky indukované farmakoterapie MeSH
- cytostatické látky MeSH
- denosumab aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- extravazace diagnostických a terapeutických materiálů farmakoterapie MeSH
- lékové roztoky terapeutické užití MeSH
- nádory * farmakoterapie komplikace MeSH
- nedostatek hořčíku chemicky indukované farmakoterapie MeSH
- neutropenie farmakoterapie prevence a kontrola MeSH
- nežádoucí účinky léčiv farmakoterapie MeSH
- ochranné látky aplikace a dávkování MeSH
- probiotika terapeutické užití MeSH
- radiodermatitida chemicky indukované prevence a kontrola MeSH
- ústní sliznice patologie účinky léků MeSH
PURPOSE: Trifluridine/tipiracil (FTD/TPI) is approved for advanced colorectal and gastric/gastroesophageal cancer; however, data in patients with renal impairment (RI) are limited. This phase I study evaluated FTD/TPI in patients with advanced solid tumors and varying degrees of RI to develop dosing guidance. METHODS: Patients were enrolled into normal renal function (CrCl ≥ 90 mL/min), mild RI (CrCl 60-89 mL/min), or moderate RI (CrCl 30-59 mL/min) cohorts and administered the recommended FTD/TPI dose (35 mg/m2 twice daily, days 1-5 and 8-12; 28-day cycle). Based on interim pharmacokinetics/safety data, patients with severe RI (CrCl 15-29 mL/min) were enrolled and received FTD/TPI 20 mg/m2 twice daily. RESULTS: Forty-three patients (normal renal function [n = 12]; mild RI [n = 12]; moderate RI [n = 11]; severe RI [n = 8]) were enrolled and treated. At steady state, compared to values in patients with normal renal function, FTD area under the curve (AUC) was not significantly different in patients with RI, but TPI AUC was significantly higher and increased with RI severity. FTD/TPI safety profile was consistent with prior experience, but grade ≥ 3 adverse events (AEs) were more frequent in the RI cohorts (83.3% [mild], 90.9% [moderate], 75.0% [severe], and normal [50.0%]). Hematologic AEs (anemia and neutropenia) were more frequent with RI. Overall, seven patients discontinued because of unrelated, nonhematologic AEs. CONCLUSION: FTD/TPI is safe and tolerable at the recommended 35 mg/m2 dose in patients with mild/moderate RI and at the reduced 20 mg/m2 dose in patients with severe RI. TRIAL REGISTRATION: NCT02301117, registration date: November 21, 2014.
- MeSH
- anemie chemicky indukované epidemiologie MeSH
- dospělí MeSH
- fixní kombinace léků MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory farmakoterapie MeSH
- nemoci ledvin patofyziologie MeSH
- neutropenie chemicky indukované epidemiologie MeSH
- plocha pod křivkou MeSH
- protokoly protinádorové kombinované chemoterapie aplikace a dávkování škodlivé účinky farmakokinetika MeSH
- pyrrolidiny aplikace a dávkování škodlivé účinky farmakokinetika MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- thymin aplikace a dávkování škodlivé účinky farmakokinetika MeSH
- trifluridin aplikace a dávkování škodlivé účinky farmakokinetika MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze I MeSH
- práce podpořená grantem MeSH
INTRODUCTION: This study evaluated noninferiority of darbepoetin alfa versus placebo for overall survival (OS) and progression-free survival (PFS) in anemic patients with NSCLC treated to a 12.0-g/dL hemoglobin (Hb) ceiling. METHODS: Adults with stage IV NSCLC expected to receive two or more cycles of myelosuppressive chemotherapy and Hb less than or equal to 11.0 g/dL were randomized 2:1 to blinded 500 μg darbepoetin alfa or placebo every 3 weeks. The primary endpoint was OS; a stratified Cox proportional hazards model was used to evaluate noninferiority (upper confidence limit for hazard ratio [HR] < 1.15). Secondary endpoints were PFS and incidence of transfusions or Hb less than or equal to 8.0 g/dL from week 5 to end of the efficacy treatment period. RESULTS: The primary analysis set included 2516 patients: 1680 were randomized to darbepoetin alfa; 836 to placebo. The study was stopped early per independent Data Monitoring Committee recommendation after the primary endpoint was met with no new safety concerns. Darbepoetin alfa was noninferior to placebo for OS (stratified HR = 0.92; 95% confidence interval [CI]: 0.83‒1.01) and PFS (stratified HR = 0.95; 95% CI: 0.87‒1.04). Darbepoetin alfa was superior to placebo for transfusion or Hb less than or equal to 8.0 g/dL from week 5 to end of the efficacy treatment period (stratified odds ratio = 0.70; 95% CI: 0.57‒0.86; p < 0.001). Objective tumor response was similar between the groups (darbepoetin alfa, 36.4%; placebo, 32.6%). Incidence of serious adverse events was 31.1% in both groups. No unexpected adverse events were observed. CONCLUSIONS: Darbepoetin alfa dosed to a 12.0-g/dL Hb ceiling was noninferior to placebo for OS and PFS and significantly reduced odds of transfusion or Hb less than or equal to 8.0 g/dL in anemic patients with NSCLC receiving myelosuppressive chemotherapy.
- MeSH
- anemie * chemicky indukované farmakoterapie MeSH
- darbepoetin alfa terapeutické užití MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- erythropoetin * terapeutické užití MeSH
- hemoglobiny MeSH
- lidé MeSH
- nádory plic * farmakoterapie MeSH
- protinádorové látky * terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
Východiska: Chemoterapie (CHT) je důležitou modalitou využívanou v léčbě nádorových onemocnění. V užším smyslu se pod pojmem chemoterapie rozumí léčba cytostatiky. Tato léčba je spojena s množstvím nežádoucích účinků (NÚ), které jsme v současnosti více či méně schopni ovlivňovat a předcházet jim. Mezi nejčastější NÚ patří únava, nauzea a zvracení, vypadávání vlasů, průjem a zácpa, změny v krevním obrazu jako anémie, neutropenie, trombocytopenie a s tím související infekce, horečka nebo krvácení. Mnoho vedlejších účinků chemoterapie se vyskytuje u pacientů jeden až několik dní po podání chemoterapie, pacienti jsou často již v domácím prostředí. Pacienti a jejich rodiny by měli být informováni o tom, jaké vedlejší účinky je u jednotlivých druhů chemoterapie možné očekávat a měli by mít základní informace o způsobu možnosti zvládání těchto nežádoucích obtíží. Velmi důležitá je také pro pacienta informace o tom, v jakých případech je vhodnější vyhledat lékařskou péči a kam se obrátit pro pomoc, když si není jistý, jak vzniklý zdravotní problém řešit. Proto je potřeba pacienty seznamovat s možnými nežádoucími účinky a možností jejich terapie a prevence už v ambulanci před podáním samotné chemoterapie.
Background: Chemotherapy is an important modality used in treating cancer diseases. Strictly speaking, the term chemotherapy refers to treatment with cytostatic drugs. This treatment is associated with a number of adverse effects that, more or less, can currently be managed and prevented. The most common adverse effects include fatigue, nausea and vomiting, hair loss, diarrhoea and constipation, blood count alterations such as anaemia, neutropenia, thrombocytopenia and associated infections, fever, or bleeding. Many side effects of chemotherapy occur in patients within one or several days of chemotherapy administration, after patients have returned home. Patients and their families should be informed on what side effects can be expected with particular types of chemotherapy, and should obtain basic information on how to manage these adverse effects. Of major importance for patients is the information on when they should seek medical attention and where to turn for help when not certain how to manage a health problem that has occurred. Therefore, it is necessary to acquaint patients with possible adverse effects and the ways of treating and preventing them already in the office prior to chemotherapy administration. Purpose: The review article discusses chemotherapy adverse effects, their management and possible prophylaxis. Conclusion: Nowadays, not only the treatment of cancer disease itself, but also the quality of life of the patient treated for the disease are both very important. Hence, adequate attention has to be paid to adverse effects that may occur as a result of treatment, as well as to the use of prophylaxis that is an equally important part of patient care.
- Klíčová slova
- myelosuprese,
- MeSH
- anemie chemicky indukované etiologie farmakoterapie MeSH
- faktor stimulující kolonie granulocytů terapeutické užití MeSH
- febrilní neutropenie vyvolaná chemoterapií diagnóza prevence a kontrola MeSH
- filgrastim terapeutické užití MeSH
- kožní manifestace MeSH
- lidé MeSH
- nádory farmakoterapie MeSH
- nauzea chemicky indukované farmakoterapie prevence a kontrola MeSH
- nemoci nehtů chemicky indukované prevence a kontrola MeSH
- neurotoxické syndromy etiologie prevence a kontrola MeSH
- nežádoucí účinky léčiv farmakoterapie klasifikace prevence a kontrola terapie MeSH
- průjem chemicky indukované etiologie prevence a kontrola terapie MeSH
- zácpa chemicky indukované prevence a kontrola terapie MeSH
- zvracení chemicky indukované farmakoterapie klasifikace prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- anemie * chemicky indukované MeSH
- klinické lékařství MeSH
- lékařská onkologie MeSH
- lidé MeSH
- protokoly protinádorové léčby MeSH
- transfuze erytrocytů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Idarucizumab, monoklonální protilátka fungující jako antidotum dabigatranu, vykazuje jednu značnou výhodu. Podání idarucizumabu není totiž časově omezené. Jeho účinku v zastavení krvácení může být tedy využito i později v terapeutickém procesu. A to i po několika dnech od příjmu pacienta, po získání validních anamnestických informací, kterých nebylo možné na akutním interním příjmu dosáhnout.
Idarucizumab, a monoclonal antibody designed for the reversal of anticoagulant effects of dabigatran, has one considerable advantage. Idarucizumab can be administered to patients without time limits. therefore this therapy can be used for successful cessation of bleeding even later when we realize taking medical history, especially medication history, was inaccurate.
- Klíčová slova
- idarucizumab,
- MeSH
- akutní poškození ledvin komplikace MeSH
- anemie chemicky indukované MeSH
- angiodysplazie diagnostické zobrazování patologie MeSH
- antidota terapeutické užití MeSH
- antikoagulancia aplikace a dávkování škodlivé účinky MeSH
- aplikace orální MeSH
- dabigatran aplikace a dávkování krev škodlivé účinky MeSH
- endoskopie MeSH
- hemoglobiny analýza MeSH
- humanizované monoklonální protilátky * terapeutické užití MeSH
- INR MeSH
- komorbidita MeSH
- krvácení diagnostické zobrazování farmakoterapie MeSH
- lidé MeSH
- protrombin terapeutické užití MeSH
- senioři MeSH
- warfarin aplikace a dávkování škodlivé účinky MeSH
- žaludek diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
27-yr old female marathon runner presented with profound fatigue and reduced exercise tolerance due to an iron deficiency anemia subsequent to treatment with isoretinoin for acne. Subsequent histologic and serologic studies revealed small bowel biopsies with histopathological features of celiac disease and an increased IgA tissue transglutaminase level. Isoretinoin use was terminated and after treatment with a gluten-free diet and oral iron, her symptoms resolved with normalization of her serological studies. Now, she remains completely well on a gluten-free diet alone and recently completed a full marathon.
- MeSH
- anemie chemicky indukované etiologie MeSH
- celiakie * chemicky indukované diagnóza etiologie MeSH
- dermatologické látky škodlivé účinky MeSH
- dospělí MeSH
- isotretinoin * škodlivé účinky MeSH
- lidé MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- anemie chemicky indukované etiologie farmakoterapie MeSH
- erythropoetin terapeutické užití MeSH
- faktor stimulující kolonie granulocytů terapeutické užití MeSH
- hematopoéza * účinky léků účinky záření MeSH
- krevní nemoci chemicky indukované diagnóza terapie MeSH
- krevní transfuze metody MeSH
- lidé MeSH
- protinádorové látky škodlivé účinky MeSH
- Check Tag
- lidé MeSH