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Inoue S, Kata Y, Suido Y, Nakashima K, Otsu Y, Takayasu H, Matsumoto Y, Kaneko T. Limited efficacy of low-dose dexamethasone for the treatment of severe COVID-19 pneumonia: A retrospective study. Respir Investig 2023; 61:760-767. [PMID: 37716284 DOI: 10.1016/j.resinv.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Its symptoms range from mild to severe, with the latter often being life-threatening. This study aims to assess the effects of low-dose dexamethasone (DEX) in mild-to-severe COVID-19 pneumonia and examine the final clinical outcomes to identify the optimal therapeutic dose. METHODS Clinical data from 132 patients hospitalized for COVID-19 pneumonia between January and October 2021 at Yamato Municipal Hospital were retrospectively analyzed. Based on the ratio of peripheral arterial oxygen saturation (SpO2) to inspired fraction of oxygen (FiO2), patients were categorized into the mild (>450, n = 65), moderate (315-450, n = 55), and severe (<315, n = 12) pneumonia groups. The event of interest was defined as the worsening of the patient's condition during treatment (need to increase FiO2 > 0.1). Patients were treated with low-dose DEX (6.6 mg/day) for 10 days. RESULTS The event-free survival rate decreased significantly in patients with severe pneumonia compared with in those with mild and moderate pneumonia (Bonferroni-adjusted p < 0.02). A total of 16 patients were treated with high-dose corticosteroids because of severe hypoxia. Recovery was observed in all discharged patients with respiratory condition improvement. Low SpO2/FiO2 at admission was significantly associated with serum C-reactive protein levels. CONCLUSIONS For Japanese patients with COVID-19, severe pneumonia, and SpO2/FiO2 of <315, it may be necessary to administer a dose of corticosteroids of >6.6 mg DEX.
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Affiliation(s)
- Satoshi Inoue
- Yamato Municipal Hospital, Pulmonary Medicine, Japan.
| | - Yuki Kata
- Yamato Municipal Hospital, Pulmonary Medicine, Japan
| | | | | | - Yukiko Otsu
- Yamato Municipal Hospital, Pulmonary Medicine, Japan
| | | | | | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University, Graduate School of Medicine, Japan
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Kim SJ, Kang D, Park Y, Mun YC, Kim K, Kim JS, Min CK, Cho J. Impact of depression on adherence to lenalidomide plus low-dose dexamethasone in patients with relapsed or refractory myeloma. Support Care Cancer 2021; 29:4969-4977. [PMID: 33575840 DOI: 10.1007/s00520-021-06017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE While continued lenalidomide and low-dose dexamethasone (Rd) treatment could improve survival outcomes for multiple myeloma (MM), the association of depression on the adherence to Rd regimen in myeloma patients has never been studied even though depression is a common symptom among MM patients. This study aims to evaluate the impact of depression prior to Rd treatment on adherence to the treatment among patients with MM. METHODS This multicenter cohort study was conducted from January 2015 to October 2018 at five tertiary hospitals in Korea. Patients who completed fewer than 4 cycles, 4-11 cycles, and more than 12 cycles were categorized as the poor adherence group (PAG), moderate adherence group (MAG), and good adherence group (GAG), respectively. RESULTS Among141 patients, 41.8% of them had depression before beginning Rd treatment and 46% of participants were in the GAG. Compared with patients in the GAG (30.3%), patients in the PAG were more likely to have depression at baseline (90.0%) and had the higher distress scores (6.35 vs. 4.28, P < 0.01). Presence of depression prior to Rd treatment was significantly associated with poor adherence (IRR = 6.67, 95% CI = 1.45, 30.61) after adjusting for age, sex, education, ECOG, ISS stage, number of previous treatments, and disease status prior to Rd treatment. CONCLUSIONS Patients with depression had a substantially high risk of poor adherence compared to patients without depression. Given that Rd treatment is mainly offered by outpatient clinics, active interventions to reduce depression should be considered for MM patients prior to Rd treatment.
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Affiliation(s)
- Seok Jin Kim
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Park
- Divison of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Yeung-Chul Mun
- Department of Hematology, Ewha Womans University, Seoul, South Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Chang-Ki Min
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea. .,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Lee SE, Lim JY, Ryu DB, Kim TW, Park SS, Jeon YW, Yoon JH, Cho BS, Eom KS, Kim YJ, Kim HJ, Lee S, Cho SG, Kim DW, Lee JW, Min CK. Low frequency of CD3 +CD4 +CD161 + T cells correlates with the occurrence of infections in refractory/relapsed multiple myeloma patients receiving lenalidomide plus low-dose dexamethasone treatment. Ann Hematol 2018; 97:2163-71. [PMID: 29938309 DOI: 10.1007/s00277-018-3401-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/17/2018] [Indexed: 02/07/2023]
Abstract
The aim of this study was to explore the predictive implications of the composition of immune cell populations prior to lenalidomide plus high-dose dexamethasone (Len-Dex) initiation for the occurrence of infections. We prospectively examined immune cell populations in peripheral blood taken at baseline of lenalidomide plus low-dose dexamethasone (Len-dex) therapy and reviewed clinical and microbiology records in 90 patients with refractory/relapsed multiple myeloma (RRMM). Risk factors for infection were analyzed using logistic regression. During a median of 11 cycles of Len-dex treatment, 52 (57.8%) patients experienced at least 1 infection episode. Of a total of 92 episodes of infection, 58 (63%) episodes were clinically defined, 29 (31.5%) episodes were microbiologically defined, and 5 (5.4%) episodes were fever of unknown origin. Severe episodes were more frequently observed during the first 3 cycles. After adjusting for risk factors for infection based on univariate analyses, multivariate analyses showed that lower Hb (< 10 g/dL) was a clinically independent factor associated with occurrence of infections. Lower frequency (P = 0.044) and absolute count (P = 0.014) of circulating CD3+CD4+CD161+ cells prior to Len-dex treatment were also associated with the occurrence of infection, especially during the first 3 cycles of Len-dex therapy. In addition to several clinical predictive factors, we found that CD3+CD4+CD161+ cells may provide additional information for predicting the occurrence of infection in the early period of Len-dex therapy.
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Lee SE, Lim JY, Ryu DB, Kim TW, Yoon JH, Cho BS, Eom KS, Kim YJ, Kim HJ, Lee S, Cho SG, Kim DW, Lee JW, Min WS, Kim M, Min CK. Circulating immune cell phenotype can predict the outcome of lenalidomide plus low-dose dexamethasone treatment in patients with refractory/relapsed multiple myeloma. Cancer Immunol Immunother 2016; 65:983-94. [PMID: 27342591 PMCID: PMC11029332 DOI: 10.1007/s00262-016-1861-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 09/25/2015] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Abstract
Although the antimyeloma effect of lenalidomide is associated with activation of the immune system, the exact in vivo immunomodulatory mechanisms of lenalidomide combined with low-dose dexamethasone (Len-dex) in refractory/relapsed multiple myeloma (RRMM) patients remain unclear. In this study, we analyzed the association between immune cell populations and clinical outcomes in patients receiving Len-dex for the treatment of RRMM. Peripheral blood samples from 90 RRMM patients were taken on day 1 of cycles 1 (baseline), 2, 3, and 4 of Len-dex therapy. Peripheral blood CD3(+), CD4(+), and CD8(+) cell frequencies were significantly decreased by 3 cycles of therapy, whereas NK cell frequency was significantly increased after the 3rd cycle. For the myeloid-derived suppressor cell (MDSC) subset, the frequency of granulocytic MDSCs transiently increased after the 1st cycle, whereas there was an increase in monocytic MDSC (M-MDSC) frequency after the 1st and 3rd cycles. Among 81 evaluable patients, failure to achieve a response of VGPR or greater was associated with a decrease in CD8(+) cell frequency and increase in M-MDSC frequency after 3 cycles of Len-dex treatment. A high proportion of natural killer T (NKT)-like cells (CD3(+)/CD56(+)) prior to Len-dex treatment might predict a longer time to progression. In addition, patients with a smaller decrease in the frequency of both CD3(+) cells and CD8(+) cells by 3 cycles exhibited a longer time to the next treatment. These results demonstrated that early changes in immune cell subsets are useful immunologic indicators of the efficacy of Len-dex treatment in RRMM.
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Affiliation(s)
- Sung-Eun Lee
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Ji-Young Lim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Da-Bin Ryu
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Tae Woo Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Jae-Ho Yoon
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Byung-Sik Cho
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Yoo-Jin Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Dong-Wook Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Jong-Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Woo-Sung Min
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea.
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea.
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Yoshimura K, Minami T, Nozawa M, Kimura T, Egawa S, Fujimoto H, Yamada A, Itoh K, Uemura H. A Phase 2 Randomized Controlled Trial of Personalized Peptide Vaccine Immunotherapy with Low-dose Dexamethasone Versus Dexamethasone Alone in Chemotherapy-naive Castration-resistant Prostate Cancer. Eur Urol 2016; 70:35-41. [PMID: 26782346 DOI: 10.1016/j.eururo.2015.12.050] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/29/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is well known that the prognosis of castration-resistant prostate cancer (CRPC) is poor, and several immunotherapeutic strategies have been applied to the clinical trials. Research on immunotherapy has been of special interest for the treatment of CRPC for years. OBJECTIVE To evaluate the safety of personalized peptide vaccine (PPV) immunotherapy and its clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS A phase 2 randomized controlled trial of PPV immunotherapy with low-dose dexamethasone versus dexamethasone alone for chemotherapy-naive CRPC began in 2008. Eligible patients (prostate-specific antigen [PSA] <10 ng/ml) were human leukocyte antigen (HLA) A02, A24, or A03 superfamily positive and had asymptomatic or minimally symptomatic CRPC. Patients were allocated (1:1) to PPV plus dexamethasone (1mg/d) or to dexamethasone (1mg/d) alone. A maximum of four HLA-matched peptides (each 3mg) was selected based on the preexisting immunoglobulin G responses against the 24 warehouse peptides and administered every 2 wk. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PSA, progression-free survival (PFS), time to initiation of chemotherapy, and overall survival (OS) were analyzed using the Kaplan-Meier method, a log-rank test, and proportional hazard analysis. RESULTS AND LIMITATIONS Overall, 37 patients received peptide vaccinations and 35 received dexamethasone alone. The primary end point was PSA PFS, which was significantly longer in the vaccination group than in the dexamethasone group (22.0 vs 7.0 mo; p=0.0076). Median OS was also significantly longer in the vaccination group (73.9 vs 34.9 mo; p=0.00084). The relatively small number of patients enrolled is the major limitation of the study. CONCLUSIONS PPV immunotherapy was well tolerated and associated with longer PSA PFS and OS in men with chemotherapy-naive CRPC. A larger phase 3 study is needed to confirm our findings. PATIENT SUMMARY We compared clinical outcomes of the treatment with personalized peptide vaccine plus dexamethasone versus dexamethasone alone. Our data provide promising evidence of clinical benefit for peptide vaccines. TRIAL REGISTRATION UMIN-CTR: 000000959.
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Affiliation(s)
- Kazuhiro Yoshimura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Takafumi Minami
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Masahiro Nozawa
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Hiroyuki Fujimoto
- Department of Urology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Akira Yamada
- Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan
| | - Kyogo Itoh
- Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
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