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Hewamana S, Skandarajah T, Jayasinghe C, Deshapriya S, Gayashan D, Peiris N, Harischandra M, Gunasena P, Somasundaram G, Srinivasan V, Somiah S, Wickramarathna C, Hewawasam S, Balawardena J, Arseculeratne G, Wadanamby R, Galagoda G, Wijesiriwardana B. Successful Management of Neutropenic Sepsis Is Key to Better Survival of Patients With Blood Cancer in Sri Lanka: Real-World Data From the Resource-Limited Setting. JCO Glob Oncol 2024; 10:e2300412. [PMID: 38484192 PMCID: PMC10954079 DOI: 10.1200/go.23.00412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/25/2023] [Accepted: 02/02/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Sepsis is the main cause of nonrelapse mortality, and there are no published data on applicability of supportive care protocols from high-income countries such as Sri Lanka. The aim of the study was to investigate management and mortality of neutropenic episodes among Hemato-Oncology patients. MATERIALS AND METHODS Retrospective analysis of clinical characteristics, management, morbidity, and mortality of neutropenic Hemato-Oncology patients presented to the Lanka Hospital Blood Cancer Centre from January 1, 2019 to December 31, 2019 was performed. RESULTS A total of 169 neutropenic episodes were identified; 115 (68%) of such episodes were related to chemotherapy. Acute leukemia, lymphoproliferative disorders, and plasma cell disorders accounted for 23%, 69%, and 8% of patients, respectively. The median age of patients who had sepsis was 56 years, whereas that of those who had no sepsis was 53 years (P = .49). The median time to neutropenia was 9 days for those in the sepsis group compared with 8 days in the group that had no sepsis (0.64). The median neutrophil count in the group that had sepsis was 0.06, whereas it was 0.69 in the group that had no sepsis (P ≤ .05). The median time to commencement of antibiotics was 20 minutes. CONCLUSION To our knowledge, this is the only documented study related to outcome and successful applicability of western supportive care protocols to Sri Lankan patients with neutropenia. In this study, we have shown that neutropenic sepsis can be successfully managed in the setting of limited resources with service development, following guidelines and staff training.
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Affiliation(s)
| | | | - Chathuri Jayasinghe
- Department of Statistics, University of Sri Jayewardenepura, Colombo, Sri Lanka
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Hewamana S, Gunasena P, Jayasinghe C, Skandarajah T, Harischandra M, Abeyaratne S, Ekanayake L, Somasundaram G, Somiah S, Srinivasan V, Arseculeratne G, Perera N, Fernando J, Faiz M, Munasinghe N, Mowlana A, Deshapriya S, Mawathakubura S, Wickramarathna C, Wijewickrama A, Jayawardena P, Perera E, Peiris N, Paranawithane S, Perera C, Kariyawasam C, Munasinghe S, De Silva C, Wadanamby R, Galagoda G, Lin TT, Wijesiriwardena B, Balawardena J. Response and Survival Estimates of Patients With Plasma Cell Myeloma in a Resource-Constrained Setting Using Protocols From High-Income Countries: A Single-Center Experience From Sri Lanka. JCO Glob Oncol 2022; 8:e2100352. [PMID: 35772042 PMCID: PMC9276119 DOI: 10.1200/go.21.00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries. Is it possible to set up dedicated hemato-oncology centers and use protocols from high-income countries in a resource-constrained setting? It is possible to successfully apply treatment and supportive care protocols in the correct setting of dedicated hemato-oncology centers. Patients with plasma cell myeloma were treated with thalidomide- and/or bortezomib-containing regimens adapted from high-income countries. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival (OS) was 84.2 months (95% CI, 60.87 to NA) and the 5-year estimated OS was 65%, comparable to parameters in phase III randomized trials in high-income countries.![]()
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Affiliation(s)
- Saman Hewamana
- Clinical Haematology Unit, Lanka Hospitals, Colombo, Sri Lanka
- Asiri Surgical Hospital, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chandu De Silva
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Thet Thet Lin
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
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