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PubMed2006

Home versus outpatient administration of intravenous steroids for multiple-sclerosis relapses: a randomised controlled trial.

BACKGROUND: Intravenous steroids are routinely used to treat disabling relapses in multiple sclerosis, and can be administered in an outpatient or home setting. We developed a rating scale that allowed us to compare the two strategies formally in a trial setting. METHODS: Patients who had a clinically significant multiple-sclerosis relapse within 4 weeks of onset were randomly assigned administration of a 3-day regimen of intravenous methylprednisolone either in an outpatient clinic (n=69) or at home (n=69). The MS relapse management scale (MSRMS) was developed to measure patients' experiences of relapse management as the primary outcome. Efficacy of the two treatment modalities was compared in terms of traditional measures and economic cost. A cost-minimisation analysis was also done. Analysis was by intention to treat. FINDINGS: Of 149 eligible patients, 138 consented to participate in the trial and were randomly assigned to a treatment group. Coordination of care was significantly better in the home-treatment group (median score 4.5 [IQR 3.0-11.4]) than in the hospital-treatment group (12.1 [3.0-18.6]; p=0.024). The other dimensions of the MSRMS did not differ between groups (p>0.10). Administration of steroids was equally safe and effective in either location, and cost was either the same or cheaper when delivered at home than when delivered in hospital. INTERPRETATION: Treatment of relapses in multiple sclerosis with intravenous steroids can be effectively and safely administered at home, from both patient and economic perspectives. Moreover, the trial indicates the importance of explicit and valid outcome measures of all aspects of service delivery when making decisions about health policy. This finding has implications for complex service delivery care models for long-term diseases.

Adult↗
PubMed1990

Relapse prevention and management.

The prevention and management of relapse has become a central theme in the research and literature of the addiction behaviours. The major focus of this work has been on identifying relapse precipitants and equipping clients with appropriate coping strategies. Such a focus either ignores or plays down the importance of the individual's decision-making processes: both the quality of the initial decision to change and the role of decision-making in any return to the behaviour are essential ingredients of an understanding of relapse. In reviewing the process of relapse within a context of 'giving up addiction behaviour', a model can be developed with clear clinical implications. This model emphasizes the role of decision-making interacting with a client's resources and coping skills. The paper includes a summary examination of a clinical programme based on this model.

Journal Article↗
PubMed1993

Management of relapsed prostatic carcinoma following primary treatment.

Early diagnosis and monitoring of progression for relapsed prostatic carcinoma after primary treatment is necessary, and early intervention recommended. This has now been made possible with rising prostate-specific antigen levels as an indication of the endpoint of treatment failure. Patients with relapsed disease can be divided into three groups: those relapsing following curative treatment with surgery or radiotherapy with local or distant metastases; patients who have been treated with primary hormonal palliative therapy or combination hormonal-chemotherapy relapsing after the first palliative treatment, and patients relapsing after all acceptable therapies for the treatment of prostate cancer. The management of these groups of patients is discussed.

Androgen Antagonists↗
PubMedDate not supplied

Prevention and management of relapse of peptic ulcer [review, tutorial].

The dictum, "Once an ulcer, always an ulcer" is most likely true, because recent evidence suggests that peptic ulcers do not burn out. In fact, ulcer relapse and with it the potential complications become the major concern in the management of this condition. Prevention and treatment of a disease depends on the understanding of its aetiology. For peptic ulcer, however, therapeutic advances have outpaced scientific attempts to understand its cause. Even though clinicians have been therapeutically successful, there is no clear answer to the fundamental question as to why ulcers in general heal with the known therapeutic agents including H2-receptor antagonists, antacids, proton pump inhibitors, anticholinergics, site-protective agents, and cytoprotective agents. This review examines this question while at the same time outlining the present day understanding of the prevention and treatment of peptic ulcer relapse.

Anti-Ulcer Agents↗
PubMed1974

Endoscopic pancreatography in management of relapsing acute pancreatitis.

Endoscopic retrograde cholangiopancreatography (E.R.C.P.) was attempted in 31 patients suffering from repeated attacks of acute pancreatitis. Pancreatograms were obtained in 25 patients. Twelve showed definite "surgical lesions" (obstructions, strictures, or pseudocysts). In at least three patients failure to obtain a pancreatogram was due to obstruction of pancreatic duct close to the papilla. Two patients, both with pseudocysts, developed a mild relapse of pancreatitis after the procedure. Surgical intervention based on the x-ray findings seemed beneficial in the short follow-up period.Endoscopic pancreatography can be of value in deciding when surgery is advisable for patients with relapsing acute pancreatitis and in determining the operative appreach. It is an advance in the management of a difficult clinical condition.

Acute Disease↗
PubMed2025

Relapsed rhabdomyosarcoma: treatment recommendations from the European pediatric soft tissue sarcoma study group (EpSSG).

At least one-third of patients with localized rhabdomyosarcoma (RMS) and 60-70% of patients with metastatic RMS experience progressive disease or relapse. Following relapse, outcomes generally remain poor with limited treatment options and a high risk of subsequent recurrence. Optimal treatment requires a multidisciplinary approach incorporating chemotherapy with local control. Given the complexity of managing relapsed RMS and the challenges in developing effective treatment strategies, we aim to present clear and practical recommendations on the management of these patients across Europe. These recommendations were developed collaboratively by a group of pediatric and adolescent sarcoma experts from the European paediatric Soft Tissue Sarcoma Study Group. A careful review of the literature was performed to ensure that wherever possible recommendations are supported by the results of clinical trials or substantive retrospective reports. Such recommendations provide a standardized approach to managing relapsed cases, improving patient outcomes and offering a framework for clinicians to make informed decisions.

Humans↗
PubMed1992

Management of relapsing disease in prostate cancer.

Almost all patients with prostatic cancer will eventually escape the control of the first-line endocrine therapy and relapse. This escape is attributed to selecting and/or cloning preexisting or de novo appearing hormone-independent or resistant cell lines and occurs in most patients after a median time of 12 to 18 months. Currently, there are no generally accepted rules for second-line management, either endocrine or by other means. It seems reasonable to consider length of survival as the only objective response criterion and not to rely on other response criteria. Available second-line therapeutic modalities in relapsed prostatic cancer are alternative endocrine manipulations, chemotherapy, combined endocrine and cytotoxic therapy, new drugs, radiation therapy, and general antitumoral and supportive care. Second-line therapy in relapsed disease makes sense if life can be prolonged while relieving symptoms and maintaining or improving the quality of survival. The capacity to prolong survival is limited. As a result, second-line therapy should aim more at improving the quality rather than the length of survival while considering the specific expectations and wishes of the patient.

Aminoglutethimide↗
PubMed2003

The value of augmented preparative regimens combined with an autologous bone marrow transplant for the management of relapsed or refractory Hodgkin disease: a Southwest Oncology Group phase II trial.

Several single-institution pilot studies have suggested that augmented preparative regimens, including those containing total body irradiation combined with an autologous bone marrow transplantation, are superior to standard regimens for the treatment of relapsed or refractory Hodgkin disease. On the basis of these data, we undertook, in the cooperative group setting, a phase II trial of augmented preparative regimens for patients experiencing treatment failure with conventional chemotherapy. Eighty-one patients with either sensitive or refractory (induction failures or chemoresistant) relapse received etoposide (60 mg/kg), cyclophosphamide (100 mg/kg), and either total body irradiation (12 Gy) or, if previously irradiated, carmustine (15 mg/kg), followed by an autologous bone marrow transplantation. Progression-free (PFS) and overall (OS) survival were estimated, and a Cox regression model was used to assess potential prognostic variables. The 5-year PFS and OS for the 74 eligible patients treated at 20 Southwest Oncology Group centers were 41% (95% confidence interval [CI], 29%-53%) and 54% (95% CI, 43%-65%), respectively, despite a median remission after initial chemotherapy of only 6 months. The 3-year OS for those whose induction therapy failed was 72% (95% CI, 52%-93%). There was 1 (1.4%) early treatment-related death, 2 late deaths due to lung toxicity, and only 1 death due to myelodysplasia. There were no differences in PFS or OS on the basis of regimen or chemosensitivity. A Cox prognostic factor analysis determined that >2 prior regimens, relapse in a radiated field, and extranodal disease were adverse prognostic factors. Among the 46 patients who received prior radiotherapy, the 5-year OS was 38% (95% CI, 14%-61%) for patients with 2 or 3 adverse factors, versus 60% (95% CI, 42%-78%) for those with 0 factors or 1 adverse factor. Augmented preparative regimens seem promising for the treatment of relapsed or refractory Hodgkin disease, without an increase in regimen-related mortality. A poor-prognosis group was identified that should be treated with novel therapies.

Adolescent↗
PubMed1980

[Management and relapse prophylaxis of cerebral transitory ischemic attack (TIA) (author's transl)].

The paper gives a definition of the clinical concept of TIA, pointing out that the difference between TIA and ischemic brain infarction is not a qualitative but a quantitative one. Anatomy, physiology and metabolism of the brain will be discussed and clinical symptoms of TIA in the supply areas of the carotid and the vertebro-basilar arteries will be presented. Pathogenetic factors of TIA mentioned are: cardiac embolism, intravascular microembolism within the framework of cerebrovascular arteriosclerosis and alterations of blood composition, intracerebral steal mechanism, especially in cases of decreased systemic blood pressure and collateral circulation in stenotic or thrombotic vascular diseases. The paper stresses the importance of early diagnosis of TIA in view of the fact that approx. 30% of TIAs are not only followed by recurrent episodes but also develop into brain infarction. Clarification of the pathogenesis by appropriate examinations and causal therapy are therefore of particular importance. The significance of anticoagulant therapy, platelet aggregation inhibitors and cardiac therapy will be stressed and possible surgical management, especially the surgical bypass, will be presented. The curative and preventive effect of these forms of treatment will be evaluated.

Humans↗
PubMed1991

Management of relapse and survival in advanced stage Hodgkin's disease: the EORTC experience.

The EORTC Lymphoma Cooperative Group and the Pierre and Marie Curie Group conducted a multicentre randomised trial on clinical stages IIIB-IV Hodgkin's disease from 1981-1986. Two hundred seven patients were registered and 192 randomised. Actuarial survival at five years for the whole group was 68%. Induction chemotherapy with eight cycles of MOPP resulted in more patients with progressive disease and fewer partial responders than a combination of MOPP and ABVD, for an equal complete remission rate. Half of the partial responders went into complete remission after radiotherapy. At five years there was no significant survival difference between the arms. Progression was recorded in 39 patients of whom only 4 survived. Relapses were most frequent in previously involved unirradiated areas. For 46 relapsed patients, including 21 early relapses within 18 months of start of treatment, the four-year survival rate was 53%. When complete remission was reached, whether early or late with combination chemotherapy or after additional radiotherapy, prognosis was independent of the way in which it was achieved. All efforts should be taken to reach a complete remission for initially progressing patients and for partial responders.

Adolescent↗
PubMed1991

The role of surgical excision in the management of relapsed Wilms' tumor patients with pulmonary metastases: a report from the National Wilms' Tumor Study.

To determine the effect of surgical excision of pulmonary metastases from Wilms' tumor on postrelapse survival, we retrospectively analyzed the clinical courses of 211 patients with stages I to III, favorable or unfavorable histology Wilms' tumor entered on National Wilms' Tumor Study-1, -2, or -3 whose first recurrence was limited to the lungs. There was no difference in the 4-year postrelapse survival percentage of favorable-histology patients with a solitary pulmonary metastasis who did or did not undergo surgical removal of the metastasis in addition to pulmonary irradiation and chemotherapy. Although histological confirmation of pulmonary relapse is frequently indicated, the present data suggest that therapeutic removal of pulmonary metastases from patients with relapsed Wilms' tumor does not increase the percentage of patients who survive for 4 years postrelapse, compared with treatment with whole-lung irradiation and chemotherapy.

Child↗
PubMed2004

Pharmacologic management of relapse prevention in addictive disorders.

Substance use disorders are an important public health problem associated with significant mortality and morbidity. Effective maintenance pharmacotherapies are available for tobacco, alcohol, and opioid use disorders. For optimum treatment response, these medications should be used in conjunction with behavioral interventions. For other drugs of abuse, especially for cocaine, medication development is an active area of research. Further research is needed to develop new pharmacotherapies for substance use disorders and establish clinical guidelines on how to use these medications most effectively.

Administration, Cutaneous↗
PubMed1993

Double hemibody irradiation (DHBI) in the management of relapsed and primary chemoresistant multiple myeloma.

In view of increasing controversy regarding the role of double hemibody irradiation (DHBI) in the treatment of multiple myeloma, we have analysed the use of this technique at our institution over a 6-year period. Fifty-five patients with multiple myeloma were treated with both upper and lower hemibody irradiation between January 1985 and January 1991; 42 had relapsed post-plateau and 13 were chemoresistant to initial therapy. Fifteen patients received alpha IFN-2b maintenance therapy post-DHBI, at a dose of 3 Mu three times per week, as part of a randomized trial. Ninety-five per cent of patients experienced symptomatic improvement in bone pain post-DHBI, 21% of whom discontinued opiate analgesics altogether; 63% had a minor biochemical response and 38% had a partial biochemical response. The overall survival (OS) and progression free survivals (PFS) in all patients were 11 months and 8 months respectively. No significant difference was noted in either OS or PFS, according to whether patients were chemoresistant or had relapsed post-plateau. alpha IFN did not appear to prolong survival (OS or PFS) post-DHBI. Cytopenia was a significant problem, such that only 60% of patients had counts adequate enough to be eligible for alpha IFN. We conclude that DHBI is an effective treatment in patients with relapsed multiple myeloma and in those who are chemoresistant to initial therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Delayed stem cell transplantation for the management of relapsed or refractory multiple myeloma.

The optimal timing of stem cell transplantation for multiple myeloma is controversial. Late stem cell collection is undesirable because of the inability to mobilize stem cells. We report on 64 recipients of stem cells collected within 1 year after diagnosis, none of whom had transplantation in plateau phase of their disease. Patients seen within 12 months after diagnosis received four cycles of standard vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy and then had stem cells mobilized. Patients were then placed on maintenance vincristine, BCNU, melphalan, cyclophosphamide, and prednisone or melphalan and prednisone chemotherapy for 12 cycles. At the sign of first progression, transplantation occurred. Fourteen patients were refractory to VAD chemotherapy, 20 relapsed on maintenance chemotherapy, and 30 relapsed off chemotherapy. The time to platelet engraftment was not affected by the duration of stem cell cryopreservation or extent of chemotherapy exposure after mobilization. The complete response rate was 34%. The actuarial median survival from initial diagnosis, from transplant day 0, and post-transplant progression-free survival was 51, 20 and 11.4 months, respectively. The patient status at transplantation and percentage of plasma cells circulating in the blood at apheresis influenced post-transplant survival; circulating plasma cells, status at transplantation and plasma cell labeling index influenced progression-free survival. Response duration was shorter in patients relapsing on chemotherapy.

Adult↗