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2.
Anticancer Res ; 42(3): 1653-1657, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1716348

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, pedicle flaps instead of free flap transfer were recommended for head and neck reconstruction to reduce infection risk. Boron neutron-capture therapy in Japan was clinically approved in 2020 as a salvage radiotherapy for recurrent head and neck cancer following chemoradiotherapy. The efficacy and safety of salvage surgery following boron neutron-capture therapy remain unclear. CASE REPORT: We describe a 57-year-old male with crT4aN0M0 oral cancer after three different forms of radiotherapy including boron neutron-capture therapy, treated by salvage partial maxillectomy with both buccal fat pad and nasoseptal flaps. His postsurgical course was successful, without tracheostomy, and he had no Clavien- Dindo grade 3 or 4 complications. The pathological diagnosis was T4a squamous cell carcinoma with a negative surgical margin. No recurrence or metastasis had occurred at 113 days postoperatively. No opioid consumption was needed postoperatively. CONCLUSION: Pathological negative margins were achieved in this case and there were no severe complications. Further accrual of cases salvage surgery following boron neutron-capture therapy is required to clarify treatment strategies for recurrent head and neck cancer.


Subject(s)
COVID-19/epidemiology , Mouth Neoplasms/surgery , Neoplasm Recurrence, Local , Salvage Therapy , Squamous Cell Carcinoma of Head and Neck/surgery , Boron Neutron Capture Therapy , Humans , Japan/epidemiology , Male , Margins of Excision , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/radiotherapy , Orthognathic Surgical Procedures , SARS-CoV-2 , Squamous Cell Carcinoma of Head and Neck/pathology , Squamous Cell Carcinoma of Head and Neck/radiotherapy , Surgical Flaps , Treatment Outcome
3.
J Surg Oncol ; 125(2): 290-298, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1439703

ABSTRACT

BACKGROUND AND OBJECTIVES: The role of salvage thoracic surgery in managing advanced-stage lung cancer following treatment with immune checkpoint inhibitors is currently unclear. We present a series of nine patients with advanced non-small-cell lung cancer who underwent pulmonary resection following treatment with pembrolizumab. METHODS: We performed a single-institution retrospective analysis of pulmonary resection undertaken following treatment with pembrolizumab for advanced-stage lung cancer. Nine patients met the inclusion criteria. RESULTS: In six cases, surgery was indicated for persistent localized disease after treatment, and in three cases for nonresponsive synchronous/metachronous lung nodules while on treatment for stage IV lung cancer. Dense hilar fibrosis was present in all patients. Minimal access surgery was achieved in five cases (video-assisted n = 2, robotic-assisted n = 3). There was no in-hospital mortality. One patient died within 60 days from community-acquired COVID-19 pneumonitis. Seven patients remain free of disease between 5 and 22 months follow-up. CONCLUSIONS: Pulmonary resection is safe and technically feasible following treatment with immune checkpoint inhibitors. Surgical challenges relate to postimmunotherapy fibrosis, but with increased experience and a robotic approach, minimal access surgery is achievable. Further prospective studies are required to assess the surgical impact on disease control and overall survival in this patient cohort.


Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Immune Checkpoint Inhibitors/therapeutic use , Lung Neoplasms/surgery , Pneumonectomy , Aged , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Female , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Salvage Therapy
6.
Future Oncol ; 17(33): 4511-4525, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1367736

ABSTRACT

Aim: To understand the economic burden of relapsed and refractory large B-cell lymphoma patients in Japan treated with salvage chemotherapy. Patients & methods: Patients who received systemic therapy after first-line treatment were analyzed to assess its associated cost and resource use using a retrospective claims database. The impact of COVID-19 was assessed separately. Results & conclusion: This study identified 2927 and 1085 patients in the second- (2L) and third-line (3L) cohorts. The median ages for the 2L and 3L cohorts were 71 and 70 years, respectively, with Charlson Comorbidity Score of 3. A majority of the patients had limited stem cell transplant due to advanced age. Median lengths of inpatient stay for the 2L and 3L cohorts were 118 and 116 days, respectively. The majority of costs were attributed to inpatient costs, and limited COVID-19 impact was observed in this study.


Subject(s)
COVID-19/prevention & control , Cost of Illness , Lymphoma, Large B-Cell, Diffuse/economics , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/economics , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Female , Humans , Japan/epidemiology , Length of Stay/economics , Length of Stay/statistics & numerical data , Lymphoma, Large B-Cell, Diffuse/epidemiology , Lymphoma, Large B-Cell, Diffuse/therapy , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Retrospective Studies , Salvage Therapy/economics , Salvage Therapy/methods , Stem Cell Transplantation/economics , Stem Cell Transplantation/statistics & numerical data
8.
Transfus Apher Sci ; 60(4): 103174, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1251570

ABSTRACT

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is associated with high titers of immunoglobulin G class antibodies directed against the cationic platelet chemokine platelet factor 4 (PF4). These antibodies activate platelets via FcγIIa receptors. VITT closely resembles heparin-induced thrombocytopenia. Inflammation and tissue trauma substantially increase the risk for forming pathogenic PF4 antibodies. We therefore propose the use of therapeutic plasma exchange as rescue therapy in VITT to deplete antibodies plus factors promoting inflammation such as excess cytokines in the circulation as well as extracellular vesicles derived from activated platelets.


Subject(s)
COVID-19 Vaccines/adverse effects , Plasma Exchange , Platelet Factor 4/immunology , Purpura, Thrombotic Thrombocytopenic/therapy , Salvage Therapy , Albumins , Antibody Specificity , Anticoagulants , Autoantibodies/immunology , COVID-19 Vaccines/pharmacology , Citrates , Contraindications, Procedure , Cytokines/blood , Extracellular Vesicles , Humans , Immunoglobulin G/immunology , Inflammation , Plasma Exchange/adverse effects , Plasma Exchange/methods , Platelet Activation , Platelet Transfusion/adverse effects , Purpura, Thrombotic Thrombocytopenic/etiology , Purpura, Thrombotic Thrombocytopenic/immunology , Registries , Thrombocytopenia/etiology , Thrombosis/etiology
9.
Int J Radiat Oncol Biol Phys ; 109(3): 756-763, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1318870

ABSTRACT

PURPOSE: Fewer attendances for radiation therapy results in increased efficiency and less foot traffic within a radiation therapy department. We investigated outcomes after single-fraction (SF) stereotactic body radiation therapy (SBRT) in patients with oligometastatic disease. METHODS AND MATERIALS: Between February 2010 and June 2019, patients who received SF SBRT to 1 to 5 sites of oligometastatic disease were included in this retrospective study. The primary objective was to describe patterns of first failure after SBRT. Secondary objectives included overall survival (OS), progression-free survival (PFS), high-grade treatment-related toxicity (Common Terminology Criteria for Adverse Events grade ≥3), and freedom from systemic therapy (FFST). RESULTS: In total, 371 patients with 494 extracranial oligometastases received SF SBRT ranging from 16 Gy to 28 Gy. The most common primary malignancies were prostate (n = 107), lung (n = 63), kidney (n = 52), gastrointestinal (n = 51), and breast cancers (n = 42). The median follow-up was 3.1 years. The 1-, 3-, and 5-year OS was 93%, 69%, and 55%, respectively; PFS was 48%, 19%, and 14%, respectively; and FFST was 70%, 43%, and 35%, respectively. Twelve patients (3%) developed grade 3 to 4 treatment-related toxicity, with no grade 5 toxicity. As the first site of failure, the cumulative incidence of local failure (irrespective of other failures) at 1, 3 and 5 years was 4%, 8%, and 8%, respectively; locoregional relapse at the primary was 10%, 18%, and 18%, respectively; and distant failure was 45%, 66%, and 70%, respectively. CONCLUSIONS: SF SBRT is safe and effective, and a significant proportion of patients remain FFST for several years after therapy. This approach could be considered in resource-constrained or bundled-payment environments. Locoregional failure of the primary site is the second most common pattern of failure, suggesting a role for optimization of primary control during metastasis-directed therapy.


Subject(s)
Neoplasm Metastasis/radiotherapy , Radiosurgery/methods , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Neoplasms/radiotherapy , Neoplasms/surgery , Pandemics , Progression-Free Survival , Radiation Injuries/pathology , Radiosurgery/adverse effects , Radiotherapy Dosage , Retrospective Studies , Salvage Therapy , Treatment Failure , Young Adult
10.
Rev Esp Quimioter ; 34(4): 337-341, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1317435

ABSTRACT

OBJECTIVE: The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. METHODS: Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. RESULTS: The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). CONCLUSIONS: Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.


Subject(s)
Antibodies, Monoclonal/therapeutic use , COVID-19/drug therapy , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , C-Reactive Protein/analysis , COVID-19/mortality , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/etiology , Disease Progression , Female , Humans , Hypertension/complications , Interleukin-6/antagonists & inhibitors , Interleukin-6/blood , Male , Middle Aged , Retrospective Studies , Salvage Therapy , Treatment Outcome
11.
Transplant Proc ; 53(8): 2498-2501, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1246217

ABSTRACT

The coronavirus disease 2019 pandemic has made us adjust our standards and cope with unpredictable circumstances affecting the whole world, including the medical field. A 2-year-old boy diagnosed with X-linked lymphoproliferative disease type 2 with concomitant positive polymerase chain reaction test for Epstein-Barr virus-DNA was admitted to our transplant ward. His treatment scheme had to be modified at the last moment because of a donor disqualification due to a positive polymerase chain reaction result for severe acute respiratory syndrome coronavirus 2 just before the apheresis. We decided to perform salvage haploidentical bone marrow transplant from the patient's mother because it was the only possible option. Now, in a 5-month observation period after the hematopoietic stem cell transplantation, our patient is in good general condition. His case convinced us to redirect our approach to transplant procedure preparation. Following the European Group of Blood and Marrow Transplantation recommendations, we use cryopreserved apheresis materials to ensure the availability of stem cell products before the start of a conditioning regimen.


Subject(s)
Bone Marrow Transplantation , COVID-19 , Epstein-Barr Virus Infections , Hematopoietic Stem Cell Transplantation , Lymphohistiocytosis, Hemophagocytic , Salvage Therapy , COVID-19/diagnosis , Child, Preschool , Graft vs Host Disease , Herpesvirus 4, Human , Humans , Lymphohistiocytosis, Hemophagocytic/surgery , Male , Stem Cells , Transplantation Conditioning , Unrelated Donors
15.
Ann R Coll Surg Engl ; 103(5): e141-e143, 2021 May.
Article in English | MEDLINE | ID: covidwho-1121494

ABSTRACT

At the onset of the COVID-19 crisis, a 63-year-old woman with multiple life-limiting comorbidities was referred with a necrotic infected left breast mass on a background of breast cancer treated with conservation surgery and radiotherapy 22 years previously. The clinical diagnosis was locally advanced breast cancer, but four separate biopsies were non-diagnostic. Deteriorating renal function and incipient sepsis and endocarditis resulted in urgent salvage mastectomy during the peak of the COVID19 pandemic. The final diagnosis was infected ischaemic/infarcted breast (wet gangrene) secondary to vascular insufficiency related to diabetes, cardiac revascularisation surgery and breast radiotherapy.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Breast/surgery , Diabetic Angiopathies/therapy , Enterobacteriaceae Infections/therapy , Gangrene/therapy , Mastectomy/methods , Mastitis/therapy , Negative-Pressure Wound Therapy/methods , Breast/blood supply , Breast Neoplasms/diagnosis , COVID-19 , Carcinoma, Ductal, Breast/diagnosis , Coronary Artery Bypass , Debridement/methods , Diabetes Mellitus, Type 2/complications , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/etiology , Diagnosis, Differential , Enterobacteriaceae Infections/diagnosis , Female , Gangrene/diagnosis , Humans , Infarction , Mammary Arteries/surgery , Mastectomy, Segmental , Mastitis/diagnosis , Middle Aged , Morganella morganii , Neoplasm Recurrence, Local/diagnosis , Radiotherapy , SARS-CoV-2 , Salvage Therapy
16.
Int J Infect Dis ; 105: 319-325, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1081278

ABSTRACT

OBJECTIVES: A subgroup of patients with SARS-CoV-2 infection was thought to have developed cytokine release syndrome and were treated with tocilizumab; however, a significant percentage of patients evolved. This study aimed to determine the usefulness of anakinra as a rescue treatment for patients with tocilizumab-refractory COVID-19 disease. METHODS: A prospective cohort of patients with COVID-19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) with selected controls in a historical cohort of patients treated with tocilizumab. Cases and controls were matched by age, comorbidities, pulse oximetry oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at baseline, and time elapsed since the initiation of treatment with tocilizumab. The primary outcome was the improvement in clinical status measured by a 6-point ordinal scale, from baseline to day 21. RESULTS: The study included 20 cases and 20 controls (mean age 65.3 ± 12.8 years, 65% males). No differences were found in the clinical improvement rates at 7, 14 and 21 days of follow-up. The in-hospital mortality rate for patients receiving anakinra was 55% vs. 45% in the control group (P = 0.527). CONCLUSIONS: Treatment with anakinra was not useful in improving the prognosis of patients with tocilizumab-refractory severe COVID-19.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/drug therapy , Cytokine Release Syndrome/drug therapy , Interleukin 1 Receptor Antagonist Protein/therapeutic use , SARS-CoV-2 , Aged , COVID-19/complications , Case-Control Studies , Cohort Studies , Cytokine Release Syndrome/etiology , Female , Hospital Mortality , Humans , Immunomodulation/drug effects , Male , Middle Aged , Retrospective Studies , Salvage Therapy , Spain/epidemiology , Treatment Failure , Treatment Outcome
17.
Chest ; 159(1): e7-e11, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064922

ABSTRACT

Coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality because of a lack of effective therapies. Therapeutic strategies under investigation target the overactive cytokine response with anti-cytokine or immunomodulators therapies. We present a unique case of severe cytokine storm resistant to multiple anti-cytokine therapies, but eventually responsive to etoposide. Thus, etoposide may have a role as salvage therapy in treatment of cytokine storm in COVID-19. To our knowledge, this is the first reported case of use of etoposide in COVID-19.


Subject(s)
COVID-19/complications , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/etiology , Etoposide/therapeutic use , Aged , Female , Humans , Salvage Therapy/methods , Severity of Illness Index
18.
Nurs Inq ; 28(1): e12389, 2021 01.
Article in English | MEDLINE | ID: covidwho-1060488

ABSTRACT

The prioritisation of scarce resources has a particular urgency within the context of the COVID-19 pandemic crisis. This paper sets out a hypothetical case of Patient X (who is a nurse) and Patient Y (who is a non-health care worker). They are both in need of a ventilator due to COVID-19 with the same clinical situation and expected outcomes. However, there is only one ventilator available. In addressing the question of who should get priority, the proposal is made that the answer may lie in how the pandemic is metaphorically described using military terms. If nursing is understood to take place at the 'frontline' in the 'battle' against COVID-19, a principle of military medical ethics-namely the principle of salvage-can offer guidance on how to prioritise access to a life-saving resource in such a situation. This principle of salvage purports a moral direction to return wounded soldiers back to duty on the battlefield. Applying this principle to the hypothetical case, this paper proposes that Patient X (who is a nurse) should get priority of access to the ventilator so that he/she can return to the 'frontline' in the fight against COVID-19.


Subject(s)
COVID-19/prevention & control , Resource Allocation/standards , Salvage Therapy/trends , COVID-19/psychology , COVID-19/transmission , Humans , Intensive Care Units/organization & administration , Intensive Care Units/trends , Military Medicine/methods , Pandemics/prevention & control , Resource Allocation/methods , Salvage Therapy/psychology , Salvage Therapy/standards , Ventilators, Mechanical/supply & distribution
19.
Eur J Haematol ; 106(5): 654-661, 2021 May.
Article in English | MEDLINE | ID: covidwho-1057986

ABSTRACT

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a cytokine storm syndrome associated with mortality rates of up to 88%. Standard therapy with high-dose glucocorticoids and etoposide used in adults is extrapolated from pediatric trials, with significant toxicity in older patients and those with poor performance status. The JAK1/2 inhibitor ruxolitinib has recently gained attention as a treatment option for HLH due to its broad cytokine-modulating abilities and safety profile. Herein we report our center's experience using ruxolitinib in the treatment of adult-onset secondary HLH. CASE SERIES: We report four patients with profound secondary HLH provoked by diverse triggers, including invasive pulmonary aspergillosis on background systemic lupus erythematosus, disseminated tuberculosis, and T-cell lymphoma treated with ruxolitinib as monotherapy or combination therapy in upfront and salvage settings. RESULTS: All four patients had rapid, sustained improvement in clinical status, inflammatory markers, and hematological cell counts followed by durable remission. Three patients developed manageable infectious complications postruxolitinib. CONCLUSIONS: This series demonstrates the effective use of JAK inhibition with ruxolitinib to control pathological immune activation in critically ill patients with secondary HLH and otherwise limited therapeutic options. JAK inhibition is also an area of urgent investigation for the treatment of cytokine storm associated with COVID-19.


Subject(s)
Janus Kinases/antagonists & inhibitors , Lymphohistiocytosis, Hemophagocytic/drug therapy , Protein Kinase Inhibitors/therapeutic use , Pyrazoles/therapeutic use , Adult , COVID-19/complications , Combined Modality Therapy , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/etiology , Cytokines/blood , Female , Humans , Invasive Pulmonary Aspergillosis/complications , Lupus Erythematosus, Systemic/complications , Lymphohistiocytosis, Hemophagocytic/etiology , Lymphoma, T-Cell/complications , Male , Middle Aged , Nitriles , Pyrimidines , SARS-CoV-2 , Salvage Therapy , Tuberculosis/complications , Young Adult
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