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Advani AS, Tse W, Li H, Jia X, Elson P, Cooper B, Ali-Osman F, Park J, Rao AV, Rizzieri DA, Wang ES, Cotta CV, Kalaycio M, Sobecks RM, Rouphail B, Maciejewski JP, Fensterl J, Carew JS, Foster B, Rush ML, Tripp B, Adams D, Corrigan D, Griffiths EA, Sekeres MA. A Phase II Trial of Imatinib Mesylate as Maintenance Therapy for Patients With Newly Diagnosed C-kit-positive Acute Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2020; 21:113-118. [PMID: 33422470 DOI: 10.1016/j.clml.2020.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adults with acute myeloid leukemia (AML) have a high rate of remission; however, more than 50% relapse. C-kit is expressed in approximately 60% of patients with de novo AML and represents a potential therapeutic target. MATERIALS AND METHODS Patients with newly diagnosed AML received 12 months of imatinib mesylate as maintenance therapy after the completion of post-remission therapy. The primary objective was to determine whether this approach improved progression-free survival (defined as no relapse and no death) compared with historical controls. RESULTS The median progression-free survival of patients < 60 years of age was 52.1 months (historical control, 13 months) and for patients ≥ 60 years of age was 10.7 months (historical control, 8 months). The median level of AF1q expression was high (9.59), and 84% of patients had moderate or high levels of drug-resistance factors. CONCLUSIONS Imatinib maintenance therapy may improve the outcome of newly diagnosed patients with AML who are < 60 years of age.
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Affiliation(s)
- Anjali S Advani
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH.
| | - William Tse
- Department of Hematology/ Oncology, Metro Health, Cleveland, OH
| | - Hong Li
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Xuefei Jia
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Paul Elson
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Brenda Cooper
- Department of Hematology/ Oncology, University Hospitals of Cleveland, Cleveland, OH
| | | | - Jino Park
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Arati V Rao
- Duke Cancer Institute, Duke University, Durham, NC; Current affiliation: PACT Pharma, South San Francisco, CA
| | | | - Eunice S Wang
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Matt Kalaycio
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Ronald M Sobecks
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Basel Rouphail
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Jaroslaw P Maciejewski
- Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Jaime Fensterl
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Jennifer S Carew
- University of Arizona Cancer Center, Leon Levy Cancer Center, Tuscon, AZ
| | - Bethany Foster
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Mary Lynn Rush
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Barbara Tripp
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Donna Adams
- Department of Hematology/ Oncology, Duke University, Durham, NC
| | - Donna Corrigan
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | | | - Mikkael A Sekeres
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
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Poudel SK, Park DY, Jia X, Wilks M, Pinkava V, O'Brien M, Tripp B, Song JM, McCrae KR, Khorana AA, Angelini DE. Clinical outcomes of isolated distal deep vein thrombosis versus proximal venous thromboembolism in cancer patients: The Cleveland Clinic experience. J Thromb Haemost 2020; 18:651-659. [PMID: 31808607 DOI: 10.1111/jth.14700] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previous studies suggest isolated distal deep vein thrombosis (IDDVT) has a self-limited clinical course. However, these studies excluded cancer patients, who remain a high-risk population. In addition, studies to evaluate the long-term clinical outcomes of IDDVT in cancer patients have been limited. Here, we report outcomes from our experience in treating cancer-associated IDDVT versus proximal venous thromboembolism (VTE). METHODS We prospectively evaluated a cohort of patients referred to our cancer-associated thrombosis clinic from August 2014 through May 2018. We compared clinical characteristics, anticoagulation prescription, VTE recurrence, overall survival, major bleeding, and subsequent hospital admission between cancer patients with IDDVT and proximal VTE. A propensity score matching method was used to reduce bias from confounding variables. RESULTS Of 1100 patients referred to the clinic, 124 IDDVT and 178 proximal VTE events were analyzed. After propensity score matching, 96 patients were included in each cohort. There was no difference in the rate of recurrent VTE between cancer patients with proximal VTE vs IDDVT, with or without matching (matched: hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.31-1.92; P = .58). There was no difference in overall survival between cancer patients with proximal VTE vs. IDDVT with or without matching (matched: HR, 1.18; 95% CI, 0.77-1.82; P = .45). Furthermore, subsequent hospital admissions and major bleeding events were similar between patients with proximal VTE events versus IDDVT. CONCLUSIONS Cancer patients with IDDVT have similar outcomes as their proximal counterparts, including rate of recurrence and overall survival. These findings suggest treatment of cancer-associated IDDVT should mirror treatment of proximal events.
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Affiliation(s)
- Shyam K Poudel
- Department of Internal Medicine, Western Reserve Health Education, Youngstown, Ohio
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deborah Y Park
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Xuefei Jia
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mailey Wilks
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vicki Pinkava
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Meghan O'Brien
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Barbara Tripp
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jung-Min Song
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Keith R McCrae
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dana E Angelini
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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Advani AS, Mahfouz RZ, Maciejewski J, Rybicki L, Sekeres M, Tripp B, Kalaycio M, Bates J, Saunthararajah Y. Ribosomal S6 Kinase and AKT Phosphorylation as Pharmacodynamic Biomarkers in Patients With Myelodysplastic Syndrome Treated With RAD001. Clinical Lymphoma Myeloma and Leukemia 2014; 14:172-177.e1. [DOI: 10.1016/j.clml.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 12/20/2022]
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Advani AS, Tiu R, Saunthararajah Y, Maciejewski J, Copelan EA, Sobecks R, Sekeres MA, Bates J, Rush ML, Tripp B, Salvado A, Noon E, Howard M, Jin T, Hsi E, Egorin MJ, Lim K, Cotta CV, Price C, Kalaycio M. A Phase 1 study of imatinib mesylate in combination with cytarabine and daunorubicin for c-kit positive relapsed acute myeloid leukemia. Leuk Res 2010; 34:1622-6. [PMID: 20427086 DOI: 10.1016/j.leukres.2010.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 02/20/2010] [Accepted: 03/09/2010] [Indexed: 11/25/2022]
Abstract
The c-kit receptor is expressed in 95% of relapsed acute myeloid leukemias (AMLs) and mediates leukemic proliferation. We conducted a Phase 1 study of the c-kit inhibitor, imatinib mesylate (IM), in combination with cytarabine and daunorubicin (7+3) in c-kit+ relapsed AML. IM was dose escalated using a 3 by 3 design. Phosphorylated STAT5 was absent to minimally present in residual blasts on day 14 bone marrows. The maximum tolerated dose of IM was 300 mg. The dose-limiting toxicity was Grade 3-4 hepatic toxicity. The CR/CRp rate was 57%. Cytotoxic therapy that includes IM for relapsed AML is well-tolerated and effective.
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Affiliation(s)
- Anjali S Advani
- Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH 44195, USA.
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He J, Bosse Y, Laprise C, Paré P, Sandford A, Kozyrskyj A, Allan Becker A, Chan-Yeung M, Tripp B, Zamar D. Novel Associations of Genetic Polymorphisms in the Interleukin-1 receptor/Toll-like Receptor Signaling Pathways with Atopy and Atopic Asthma. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kalaycio M, Advani A, Pohlman B, Sekeres M, Tripp B, Rybicki L, Sobecks R. Timed sequential induction chemotherapy and risk-adapted postremission therapy for acute myelogenous leukemia. Am J Hematol 2008; 83:831-4. [PMID: 18756545 DOI: 10.1002/ajh.21260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cytogenetic analysis at the time of diagnosis predicts outcome in patients with acute myelogenous leukemia (AML). For those patients with favorable risk cytogenetics, stem cell transplant can be delayed until the time of relapse. For those patients with nonfavorable cytogenetic risk profiles, stem cell transplant may be required for optimal survival benefit. We treated patients with de novo AML and age less than 60 years first with etoposide, mitoxantrone, cytarabine, and G-CSF (EMA-G) to induce remission. Patients in complete remission were assigned to treatment with chemotherapy alone if they had favorable risk cytogenetics defined as the identification of a core-binding factor translocation. Patients with any other cytogenetic profile were assigned to treatment with either autologous or allogeneic stem cell transplant depending on the availability of an HLA-matched donor. Following EMA-G, 33 of 40 patients (83%) achieved CR. Of the 25 patients who actually were treated with postremission chemotherapy, 21 were treated with their assigned risk-adapted therapy. Of the 33 patients in remission, 5 year relapse-free survival (RFS) and overall survival (OS) was 46 and 38%, respectively. Our intensive and risk-adapted, stem cell transplant approach to the treatment of patients with AML requires a better definition of risk and does not appear to substantially improve results compared with more standard approaches.
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Affiliation(s)
- Matt Kalaycio
- Department of Hematologic Malignancies and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio 44195, USA.
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Advani AS, Jin T, Ramsingh G, Tiu R, Saber W, Theil K, Sobecks R, Sekeres M, Copelan E, Sungren S, Tripp B, Kalaycio M. Time to post-remission therapy is an independent prognostic factor in adults with acute lymphoblastic leukemia. Leuk Lymphoma 2008; 49:1560-6. [PMID: 18766970 DOI: 10.1080/10428190802146078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We evaluated patients with newly diagnosed ALL treated at the Cleveland Clinic during the years 1996 through 2005. Cox proportional hazards analysis was used to identify univariate and multivariate correlates of complete remission, overall survival and progression-free survival. On univariate analysis, significant prognostic factors included: age at diagnosis (per 10-year increase), poor risk cytogenetics, time to white blood count recovery, and time from induction chemotherapy (IC) to post-remission therapy (PRT). In patients age <60 years without poor risk cytogenetics, time from IC to PRT (per week increase) was a significant prognostic factor by multivariate analysis and was associated with a decreased progression-free survival [HR 1.27, CI (1.04-1.55), p = 0.019] and decreased overall survival [HR 1.34, CI (1.08-1.67), p = 0.009]. Delayed time from IC to PRT (> or =6.6 weeks) was associated with a statistically worse progression-free and overall survival.
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Affiliation(s)
- Anjali S Advani
- Leukemia Program, Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Center, The Cleveland Clinic, Cleveland, OH 44195, USA.
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9
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Advani AS, Rodriguez C, Jin T, Jawde RA, Saber W, Baz R, Kalaycio M, Sobecks R, Sekeres M, Tripp B, Hsi E. Increased C-kit intensity is a poor prognostic factor for progression-free and overall survival in patients with newly diagnosed AML. Leuk Res 2008; 32:913-8. [PMID: 17928050 DOI: 10.1016/j.leukres.2007.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 08/19/2007] [Accepted: 08/21/2007] [Indexed: 11/21/2022]
Abstract
C-kit, a tyrosine kinase receptor, is expressed on most myeloid blasts and is thought to be important in the pathogenesis of AML. Activation of the c-kit receptor leads to phosphorylation and activation of downstream signaling proteins, which are important for cell survival and proliferation. Here, we discuss the prognostic impact of c-kit intensity, measured using the mean fluorescent index (MFI) in patients with newly diagnosed AML. On multivariate analysis, c-kit MFI>20.3 correlated with a decreased progression-free survival and overall survival, independent of known prognostic factors (age, white blood count at diagnosis and cytogenetics). Whether inhibiting c-kit in patients with AML will alter prognosis is the basis of ongoing clinical trials.
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Affiliation(s)
- Anjali S Advani
- Taussig Cancer Center, Leukemia Program, The Cleveland Clinic CCF, Cleveland, OH 44195, USA.
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Tripp B, Ludvik B. [Antihypertensive and metabolic effects of telmisartan in patients with the metabolic syndrome in primary care--a field study]. Wien Med Wochenschr 2007; 157:223-7. [PMID: 17564769 DOI: 10.1007/s10354-007-0407-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 03/12/2007] [Indexed: 12/14/2022]
Abstract
Telmisartan, a highly selective angiotensin-II-receptor antagonist, used for the treatment of hypertension, acts as a partial agonist of the PPAR-gamma (peroxisome proliferator-activated receptor-gamma) receptor, which is involved in the regulation of glucose and lipid metabolism. In the present study the effect of Telmisartan on hypertension, parameters of glucose and lipid metabolism was investigated in 670 patients with the metabolic syndrome. There was a significant (p < 0,05) improvement regarding all parameters involved in the diagnosis of the metabolic syndrome, namely hypertension (systolic: 161,7 +/- 16,3 vs. 136,7 +/- 11,7 mmHg, diastolic: 93,3 +/- 10,1 vs. 80,7 +/- 10,5 mmHg), fasting blood glucose (133,2 +/- 44,1 vs. 116,0 +/- 31,5 mg/dl), triglycerides (227,2 +/- 170,1 vs. 187,8 +/- 94,8 mg/dl), HDL-cholesterin (women: 48,9 +/- 13,1 vs. 51,8 +/- 12,9 mg/dl) and abdominal circumference (women: 101,2 +/- 12,4 vs. 99,3 +/- 12,9 mg/dl, men: 111,9 +/- 14,7 vs. 109,5 +/- 14,4 mg/dl). The number of patients diagnosed with the metabolic syndrome was significantly reduced over the 3 months study duration (38%). The medication was well tolerated and adverse effects were minimal. Thus, Telmisartan can be regarded as an appropriate medication for the therapy of hypertension in patients with the metabolic syndrome with possible additive effects on parameters of glucose and lipid metabolism.
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Affiliation(s)
- Barbara Tripp
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria
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11
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Tripp B, Ludvik B. Pharmacotherapy of obesity. Wien Med Wochenschr 2004; 154:320-8. [PMID: 15368953 DOI: 10.1007/s10354-004-0080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Obesity is a chronic disease with a worldwide increasing incidence. The mainstay of therapy consists in modification of behaviour related to obesity such as overeating and physical inactivity. When these life-style modifying attempts fail, the use of anti-obesity drugs is warranted. The two available drugs, orlistat and sibutramine, are capable of reducing body weight by 10%. Failure of these medications in a subset of patients to achieve adequate weight loss and limited overall efficacy have led to an extensive research on novel anti-obesity agents. This review presents an overview on the current drugs available as well as on potential future candidates.
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Affiliation(s)
- Barbara Tripp
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Wien, Osterreich.
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12
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Tripp B, Ludvik B. [Novel anti-obesity drugs]. Acta Med Austriaca 2004; 31:133-8. [PMID: 15732249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Obesity is a chronic disease with a worldwide increasing incidence. The mainstay of therapy consists in modification of behaviour related to obesity such as overeating and physical inactivity. When these life-style modifying attempts fail, the use of anti-obesity drugs is warranted. Public health efforts and current anti-obesity agents have not controlled the increasing epidemic of obesity, which has led to an extensive research on novel anti-obesity agents. This review presents an overview on potential future candidates.
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Affiliation(s)
- Barbara Tripp
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin II, Wien, Osterreich
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Kalaycio M, Pohlman B, Elson P, Lichtin A, Hussein M, Tripp B, Andresen S. Chemotherapy for acute myelogenous leukemia in the elderly with cytarabine, mitoxantrone, and granulocyte-macrophage colony-stimulating factor. Am J Clin Oncol 2001; 24:58-63. [PMID: 11232951 DOI: 10.1097/00000421-200102000-00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Remission induction chemotherapy for acute myelogenous leukemia typically combines cytarabine with an anthracycline or anthracycline derivative. To date, no specific combination has emerged as more efficacious than any other. To reduce toxicity and shorten the duration of neutropenia, hematopoietic growth factors are often added to the chemotherapy regimen, especially in elderly patients. In all prospective, randomized, growth factor trials to date, daunorubicin has been the drug selected for combination with cytarabine. We hypothesized that mitoxantrone might be as efficacious in this patient population with perhaps less toxicity when combined with granulocyte-macrophage colony-stimulating factor (GM-CSF). Patients older than age 55 years with a diagnosis of either de novo or secondary, untreated acute myelogenous leukemia were eligible for this clinical trial. Eligible patients were treated with cytarabine 100 mg/m2 infused as a continuous infusion daily for 7 days and mitoxantrone 12 mg/m2 bolus intravenously for the first 3 days of cytarabine. A second cycle of chemotherapy was administered on the fourteenth day of treatment if marrow aplasia was not achieved with the first cycle. Once aplasia was achieved, GM-CSF 250 microg/m2 was given subcutaneously daily until neutrophil recovery. Those patients who achieved complete remission were treated with two cycles of intermediate-dose cytarabine (400 mg/m2 daily for 5 days) and with GM-CSF as consolidation therapy. Of the 30 patients treated, the median age was 69 years (range: 55-76 years) and 18 patients were older than 65 years of age. Seven (23%) patients had secondary acute leukemia and 12 (40%) had poor-risk cytogenetics. Nineteen (63%) achieved a complete remission. Eleven patients were either refractory to treatment or died during their treatment. The toxicity encountered was no more than that reported in similar studies using daunorubicin in combination with cytarabine. Long-term survival was poor, with a median disease-free survival of only 8.1 months in patients who achieved complete remission. In this elderly population of patients with high-risk acute myelogenous leukemia, this combination of cytarabine, mitoxantrone, and GM-CSF resulted in an adequate remission rate with acceptable toxicity. Long-term survival, however, was poor and innovative treatment approaches to maintain remission are needed.
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Affiliation(s)
- M Kalaycio
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Ohio 44195, USA.
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Ebidia A, Mulder C, Tripp B, Morgan MW. Getting data out of the electronic patient record: critical steps in building a data warehouse for decision support. Proc AMIA Symp 1999:745-9. [PMID: 10566459 PMCID: PMC2232504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Health care has taken advantage of computers to streamline many clinical and administrative processes. However, the potential of health care information technology as a source of data for clinical and administrative decision support has not been fully explored. This paper describes the process of developing on-line analytical processing (OLAP) capacity from data generated in an on-line transaction processing (OLTP) system (the electronic patient record). We discuss the steps used to evaluate the EPR system, retrieve the data, and create an analytical data warehouse accessible for analysis. We also summarize studies based on the data (lab re-engineering, practice variation in diagnostic decision-making and evaluation of a clinical alert). Besides producing a useful data warehouse, the process also increased understanding of organizational and cost considerations in purchasing OLAP tools. We discuss the limitations of our approach and ways in which these limitations can be addressed.
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Affiliation(s)
- A Ebidia
- Shared Information Management Services (SIMS) University Health Network, University of Toronto, Ontario, Canada
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Tripp B, Bishop C, Lipshultz LI, Lamb DJ. The disappearing Y chromosome--"I told you so!". Fertil Steril 1997; 67:408-11. [PMID: 9022625 DOI: 10.1016/s0015-0282(97)81933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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