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At least 127 records · Page 7Linked to original sources

PubMed2005

Salvage therapy for CLL and the role of stem cell transplantation.

Chronic lymphocytic leukaemia (CLL) remains an incurable disease and, notwithstanding the excellent remission rates now achieved with purine analogs and monoclonal antibodies, the vast majority of patients with CLL are destined to relapse after primary treatment. The management of relapsed CLL patients is then dependent upon a number of factors, most importantly age, performance status, previous therapy administered, the response and duration of response to such therapy, and time from last therapy. Although prior therapy and response to such therapy are important factors in determining next therapy, it is often difficult to determine their importance from published studies. Furthermore, the goal of therapy, whether palliative or aggressive, must also be weighed into the decision when deciding on the next line of treatment. With many potential treatments available, the sequence of treatments and the timing of procedures such as stem cell transplantation remain controversial and are the focus of ongoing clinical trials.

Antibodies, Monoclonal↗

PubMed1989

Approaches to the therapy of relapsed acute myeloid leukemia.

Managing patients with relapsed acute myeloid leukemia is a major clinical challenge. Although 60-70% of patients with AML achieve complete remission following induction therapy with cytarabine and an anthracycline, at least 70-80% of patients achieving remission eventually relapse. While there are few comparative trials that provide therapeutic guidelines, an initial decision as to treatment can be seen as a choice between reusing previously effective drugs or initiating new classes of drugs. Some of the newer agents which have definite activity include amsacrine, mitoxantrone, diaziquone, idarubicin, homoharringtonine, and carboplatin. Allogeneic, autologous, and syngeneic bone marrow transplantation probably represent the preferred approaches in suitable patients, either in early relapse or after second remission is achieved.

Acute Disease↗

PubMedDate not supplied

Management of patients who have relapses in multiple sclerosis.

Multiple sclerosis (MS) is a chronic neurological condition, which disrupts the typical functions and daily activities of those affected. Approximately 80% of those diagnosed will follow a relapsing/remitting disease course at diagnosis. Patients with relapsing/remitting MS can expect to have episodes of relapse or an exacerbation of the disease and its variety of symptoms. Management of such episodes has always been open to the preferences of the healthcare professionals involved. The aim of this article is to review the evidence that exists to support current practice in the management of patients during a relapse and to evaluate how this evidence can be incorporated into patient care. The article begins by giving an overview of MS, and continues by determining what a relapse is and discussing the speculated triggers of relapse. Methods of treating relapse are then explored. It concludes by highlighting the strongest evidence-based method for treating relapses, and by emphasizing the need for further research into the pharmaceutical and non-pharmaceutical management of MS relapses.

Adrenal Cortex Hormones↗

PubMed1983

Prognosis of children with soft tissue sarcoma who relapse after achieving a complete response. A report from the Intergroup Rhabdomyosarcoma Study I.

Four hundred and twenty-three children with newly-diagnosed soft-tissue sarcoma were treated on the Intergroup Rhabdomyosarcoma Study I from November 1972 through December 1976. After institution of therapy, 341/423 (80.6%) achieved a complete response (no detectable tumor), but 115/341 (33.7%) subsequently relapsed. The types and efficacy of management after relapse were ascertained by questionnaire. Information sufficient for critical analysis was obtained for 98/115 patients (85%). Thirteen of the 98 patients had an isolated local recurrence; the other 85 developed metastases in regional, distant, or multiple sites simultaneously. Patients with distant metastases at diagnosis were most likely to develop recurrence, as were those with sarcoma arising in the perineum-anus, retroperitoneum-pelvis, gastrointestinal tract, or extremity. Those with tumor primary in the orbit or genitourinary tract had the lowest recurrence rate, as did those whose tumor histology was nonalveolar. Individualized treatment was given to 90 of the 98 patients after relapse, and a second complete response was achieved in 33 of them (37%). However, only five of the 90 patients (5.5%) are currently tumor-free. The outlook is poor when recurrence develops in patients still receiving chemotherapy; only two of 74 such patients survive, compared to three of 16 who have relapsed after cessation of treatment. Relapse after initial complete response to therapy has a poor prognosis, regardless of site of recurrence. Although effective retrieval therapy can prolong survival, only 2 of 12 patients (17%) with local recurrence and three of 78 patients (4%) with metastatic recurrence remain free of disease.

Adolescent↗

PubMed1985

Therapy of CNS leukemia with intraventricular chemotherapy and low-dose neuraxis radiotherapy.

Successful treatment of CNS leukemic relapse has been frustrated by frequent local recurrence and eventual marrow relapse. We describe the treatment of meningeal leukemia in 39 children with intrathecal remission induction followed by the placement of an Ommaya reservoir to facilitate the administration and distribution of chemotherapeutic agents into the CSF. Six hundred or 900 rad of craniospinal radiation and maintenance intraventricular and intrathecal chemotherapy was then administered. Systemic reinduction therapy was added in the later cases. Sixteen children (41%) experienced no further events, with 17+ months to 13+ years (median, 25 months) follow-up . Eleven patients (28%) had CNS recurrence, nine (23%) bone marrow (BM) relapse, and two (5%) testicular relapse as the next adverse event. The course of patients with first isolated CNS relapse differed from that of the others. Eleven (69%) of 16 patients treated for first isolated CNS relapse are alive and 9 are event free, while only 35% of patients whose CNS relapse occurred simultaneously or after recurrent disease at other sites are alive (P = .04). Seven of 23 in the later group are event free. The difference is due to the increased incidence of BM relapse in the later group (30% v 6%; P = .04). For patients with first isolated CNS relapse, the life-table median CNS remission duration is 42 months. The projected CNS relapse-free survival and event-free survival 8 to 10 years after CNS relapse are 40% and 32%, respectively. Headache, nausea, and emesis of short duration were frequent during therapy. In three patients, the reservoir had to be removed for infection. No patient suffered neurologic deficit related to the reservoir. The therapy described can reduce the CNS relapse rate with manageable toxicity. Systemic relapse is still a major problem after multiple CNS relapse and in those in whom the CNS relapse follows or is simultaneous with relapse at other sites.

Adolescent↗

PubMed1996

The impact of managed care systems on relapse prevention and quality of life for patients with schizophrenia.

In general clinical practice, relapse rates for patients with schizophrenia are worse than well-controlled studies suggest are achievable. This paper discusses the reasons for this shortfall and suggests that properly delivered "managed care" could reduce the gap between theory and practice. Shortsighted attempts to limit expenditure can lead to overall increases in expenditure on the care of patients with severe mental illness, as has happened in New Hampshire, where reducing expenditure on psychiatric drugs led to an increase in other costs that exceeded the savings on drugs by seventeen-fold. Other studies have shown that patients with schizophrenia can be managed in the community, and that the provision of proper community-based support services reduces the overall costs of caring for these patients. An analysis of the overall costs of medical care before and after the introduction of risperidone has also revealed that total health care expenditure fell, even though expenditure on medication increased. Proper managed care should ensure that services are integrated and that the appropriate level is provided for patients with severe mental disorders, such as schizophrenia. Drugs, such as risperidone, which have wider therapeutic spectrums than the older conventional neuroleptics, are likely to enable these co-ordinated services to provide better and more comprehensive care of patients with schizophrenia.

Cost-Benefit Analysis↗

PubMed1999

Solitary bone plasmacytoma: management of isolated local relapse following radiotherapy.

Radiotherapy is the prime treatment modality for solitary plasmacytomas of bone (SPB). Although local control rates are excellent, progression to multiple myeloma is frequent, albeit with varying latency. Local failure in the absence of dissemination is rare and thus management is poorly documented. We discuss such a patient who presented 3 years after local radiation for a pelvic SPB and review the relevant literature. Radiation doses, portals employed and prognostic factors that may predict progression to myeloma are discussed. This report shows that an isolated recurrence of SPB in a previously irradiated field was successfully treated with orthopaedic surgery. This resulted in good pain relief and mobility for the patient, who remains free of disease 6 months after operation.

Acetabulum↗

PubMed2006

[Beneficial and adverse effects of high-dosage MZR therapy in the management of children with frequently relapsing nephrotic syndrome].

BACKGROUND: Long-term therapy of mizoribine (MZR 2-5 mg/kg/day) has been reported in the management of children with frequently relapsing nephrotic syndrome(FRNS). It had minimum adverse effects, however, MZR therapy does not sufficiently suppress the relapse of FRNS. Previous reports suggested that modification of MZR therapy with a total dosage and administration schedule may improve the therapeutic effect. To elucidate the issue, we retrospectively evaluated the efficacy and safety of high-dose MZR therapy for children with FRNS. METHODS: The subjects comprised 13 affected children with FRNS (9 boys and 4 girls: median age of 11.7 years, ranging from 7.8 to 20.1 years). They were divided into a high dose group (MZR 7-10 mg/kg/ day; Max 400 mg) and a low dose group (MZR 4-6 mg/kg/day). We compared the therapeutic benefits between both groups, including the incidence of relapse(times/year) and daily dosages of prednisolone (PSL, mg/kg/day). The Wilcoxon test was used for statistical analysis. We also evaluated the relationship between the therapeutic effects and serum concentration of MZR two hours after the administration. RESULTS: The low dose and high-dose groups were well matched in terms of baseline characteristics. After the initiation of MZR, beneficial therapeutic effects ensued in the high-dose group (incidence of relapse: 3.61 vs. 1.59 times/year before and after the therapy, p < 0.05), daily dosages of PSL (0.65 vs. 0.29 mg/kg/day before and after therapy, p<0.001), but did not occur in the low-dose group(3.97 vs. 2.84 times/year; 0.84 vs. 0.53 mg/kg/day, n. s.). All patients with a serum MZR concentration of over 3 microg/ml had relapses less than three times a year. One patient in the high-dose group and the other in the low-dose group showed hyperuricemia, and responded well to medical treatment. No other adverse effect was observed. CONCLUSIONS: High-dose MZR therapy in the management for FRNS may provide more beneficial effects without significant adverse effects.

Adolescent↗

PubMed2001

A self-management program for adult asthma. III. Maintenance and relapse of skills.

Patient self-management programs have become an integral part of asthma treatment. The goal of such programs is to strengthen the partnership between patients and health care providers in controlling the condition. The present study analyzed how well patients maintained or relapsed in performing asthma self-management skills over time and across settings. It was conducted by contacting patients who had been involved in a successful self-management program an average of 6 years after their participation or an average of 7 years after they completed training. Seventy percent of the patients agreed to participate and complete, either by themselves or over the telephone, a structured interview regarding their experiences in performing asthma self-management. On the basis of their responses, 53 participants were categorized into two groups: continuers or relapsers, according to previously developed and published criteria for relapse. Characteristics that distinguished the two groups were described. As anticipated, those classified as continuers reportedly exhibited broader repertoires of self-management skills across an array of settings. They credited their performance with maintaining control over their asthma. However, two unexpected findings emerged in the study: First, all patients continued to use self-management skills to one degree or another 7 years after they had acquired these skills. Even patients who were categorized as relapsers regularly performed some self-management skills, often involving self-monitoring of their breathing. Second, half of the patients in the relapse group reported that their asthma was in remission and that they were asymptomatic. The self-management skills they reportedly used were performed to monitor and prevent a return of asthma.

Adult↗

PubMed2001

Therapeutic management of refractory or relapsed primary central nervous system lymphomas.

Despite the high rate of complete remission achieved with first-line therapy, 10-15% of immunocompetent PCNSL patients are treatment refractory while 35-60% relapse and die of lymphoma within a few months. In many cases, salvage therapy produces a second complete remission with consequent symptomatic and survival improvement. Due to the heterogeneity of both first and second line therapies employed, the optimal schedule for salvage therapy can not be identified. Nevertheless, some therapeutic guidelines could be suggested. Radiotherapy is an effective option for both previously irradiated and radiotherapy naïve patients. Some authors have been able to minimize the incidence of actinic toxicity by using chemotherapy alone at failure. In patients that have relapsed after receiving high-dose methotrexate (HD-MTX), the same drug again has been successfully employed while HD-cytarabine has been the most widely used cytostatic. Ocular recurrence can be treated with cytarabine or focal radiotherapy. Meningeal relapse can be treated with spinal cord irradiation, intrathecal and/or systemic chemotherapy. Salvage therapy, beyond improving survival, constitutes the selection ground for testing active agents. The addition of other cytostatics to HD-MTX has been empirically based and without a clear survival benefit, but with a higher toxicity. Intriguing preliminary results from small pilot studies are now available with topotecan, rituximab, temozolomide, PCV regimen and HD-chemotherapy supported by autologous or allogeneic peripheral blood stem cells transplantation. Considering its positive effect on survival and the potential improvement in neurological symptoms and quality of life, salvage therapy seems to be a valuable treatment in PCNSL patients. Finally, the inclusion of relapsing or progressive PCNSL patients into second-line prospective clinical trials for testing therapeutic agents should be strongly encouraged.

Antimetabolites, Antineoplastic↗

PubMed2003