Biomedical subjects

D K Hogan

Publications and source records attributed to D K Hogan.

5 recordsLinked to original sources

PubMed1998

Oncologic emergencies in the patient with lymphoma.

OBJECTIVES: To provide a brief overview of the oncologic emergencies most commonly occurring in lymphoma patients. DATA SOURCES: Published articles, research studies, and reference books. CONCLUSIONS: As a result of their malignancy and the treatments they receive, lymphoma patients are at an increased risk for the development of the following oncologic emergencies: superior vena cava syndrome, cardiac tamponade, sepsis, acute tumor lysis syndrome, and increased intracranial pressure. If not recognized and treated quickly, these complications can be deadly. With appropriate medical and nursing management, these emergencies either can be prevented or their complications minimized. IMPLICATIONS FOR NURSING PRACTICE: An awareness of which patients are at risk for these complications and the pathophysiology of each emergency will assist nurses in the implementation of treatment measures.

Bacteremia↗

PubMed1995

Cladribine in the treatment of relapsed or refractory chronic lymphocytic leukemia.

PURPOSE: Cladribine (2-CdA), a purine analog resistant to adenosine deaminase, has significant activity in a variety of lymphoproliferative diseases. This study was designed to determine the efficacy of 2-CdA in patients with relapsed or refractory chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS: Twenty-six patients aged 40 to 88 years (median, 64) who either had relapsed after an initial response or were refractory to conventional chemotherapy with at least an alkylating agent were treated with 2-CdA 0.1 mg/kg/d by continuous intravenous infusion for either 5 or 7 days every 28 days for a maximum of six cycles. RESULTS: No complete remissions (CRs) occurred. Eight of 26 patients (31%) achieved a partial remission (PR). The actuarial median time to progression (TTF) in responding patients is 16 months (range, 6 to 22). The actuarial median survival duration of the responding patients is 12 months (range, 8 to 28). Eight of 26 patients (31%) sustained early toxicity. Seven of these eight patients died before the first reevaluation of infection (n = 3), pericardial tamponade (n = 1), Stevens-Johnson syndrome (n = 1), and stroke (n = 2). No nausea, emesis, alopecia, or renal, hepatic, or cardiac toxicity was observed. CONCLUSION: 2-CdA has activity in patients with relapsed or refractory CLL. However, patients who have received multiple prior regimens that included fludarabine are less likely to respond, and there can be significant morbidity. Treatment of patients with less prior therapy earlier in the natural history of the disease may lead to improved and more durable responses.

Actuarial Analysis↗

PubMed1995

The role of cladribine in the treatment of lymphoid malignancies.

PURPOSE/OBJECTIVES: To review clinical applications and nursing care activities for patients receiving cladribine, a synthetic antineoplastic agent used to treat lymphoid malignancies. DATA SOURCES: Clinical trial data, published articles, reports from oncology nurses, and personal observations. DATA SYNTHESIS: Cladribine has shown response rates of nearly 90% in patients with hairy cell leukemia after a single, seven-day continuous infusion. Toxicities generally are mild, predictable, and rapidly reversible after therapy is discontinued. CONCLUSIONS: Currently, cladribine primarily is used in hairy cell leukemia therapy. Clinical trials of cladribine in treating other hematologic malignancies, primarily chronic lymphocytic leukemia and non-Hodgkin's lymphoma, have demonstrated encouraging results. IMPLICATIONS FOR NURSING PRACTICE: Nursing care for patients who receive cladribine involves management of side effects, which commonly include myelosuppression and fever, and monitoring of hemoglobin, platelet levels, and body temperature. Fever develops in most patients receiving cladribine but is usually transient and easily treated with acetaminophen. Infection as a cause of fever must be ruled out, especially in patients with neutropenia.

Antineoplastic Agents↗

PubMed1994

Prospective evaluation of internal adenopathy in a cohort of 43 patients with hairy cell leukemia.

PURPOSE: To determine the role of computed tomography (CT) in patients with hairy cell leukemia (HCL), we report a series of 43 patients prospectively evaluated for internal adenopathy by CT before and after treatment with 2-chlorodeoxyadenosine (2-CdA). PATIENTS AND METHODS: CT was performed on 43 consecutive patients with HCL before and 3 months after a single cycle of 2-CdA. Twenty-four patients were previously diagnosed and 19 were newly diagnosed. Adenopathy was considered bulky if the greatest dimension of any confluent mass was between 5 and 10 cm and massive if greater than 10 cm. RESULTS: Internal adenopathy was present in six of 43 patients (14%). Three of the six patients had massive abdominal adenopathy and one had bulky abdominal adenopathy. All six patients with adenopathy were previously diagnosed, while none of the 19 newly diagnosed patients had internal adenopathy. In those patients previously diagnosed, the six with adenopathy had a median disease duration of 68 months, while the 18 patients without adenopathy had a median disease duration of 24 months (P = .01). Adenopathy was more common in splenectomized patients. In previously diagnosed patients, adenopathy occurred in five of 10 (50%) splenectomized patients and one of 14 (7%) nonsplenectomized patients (P = .05). However, the 10 splenectomized patients had a median disease duration of 56 months, while the 14 nonsplenectomized patients had a median disease duration of 16 months (P = .004). All six patients had significant reduction in adenopathy 3 months after 2-CdA and were without residual HCL in the bone marrow. CONCLUSION: Significant internal adenopathy in patients with HCL is more frequent than previously recognized. Adenopathy is rare at diagnosis and appears to be related to disease duration. As patients treated with 2-CdA have long disease-free survival durations, detection of significant adenopathy by CT scan may be important; however, routine CT scans are not recommended at the time of diagnosis.

Adult↗

PubMedDate not supplied

Oncologic emergencies: implications for nurses.

Oncologic emergencies can be grouped into the following categories: neurologic, cardiopulmonary, metabolic, hematologic, infectious, gastrointestinal, genitourinary, and infusion-related. Each crisis produces characteristic symptoms, physical findings, and laboratory abnormalities. Skills required of nurses include patient assessment by organ system, management of intravenous lines, monitoring of laboratory results, and recognition of allergic reactions and extravasation. Anticipating these clinical syndromes allows for prevention or early detection with better outcomes.

Clinical Competence↗