ABSTRACT
We investigated the current role of interferon-alpha (IFNα) in hairy cell leukaemia (HCL) in a retrospective analysis of patients with HCL. A cohort of 74 patients with HCL was divided in to three groups: (A) patients aged >65 years with first-line treatment; (B) patients with comorbidities with first-line treatment; (C) patients who were purine analogues resistant. In total, 94% achieved a response, with a complete response rate of 24%. After a median (range) follow-up of 60 (7-236) months, 55 patients (78%) are still responding. The 5-year progression-free survival was 95%, 68%, and 96% in groups A, B and C respectively. A proportion of patients were monitored through their B-Raf proto-oncogene, serine/threonine kinase (BRAF)-V600E status. IFNα remains a possible option in select patients with HCL, where minimal residual disease negativity is achievable.
Subject(s)
Antineoplastic Agents/therapeutic use , Interferon-alpha/therapeutic use , Leukemia, Hairy Cell/drug therapy , Adult , Aged , Aged, 80 and over , Alopecia/chemically induced , Antineoplastic Agents/adverse effects , Biomarkers, Tumor/blood , Comorbidity , Disease-Free Survival , Drug Resistance, Neoplasm , Drug Substitution , Female , Follow-Up Studies , Humans , Interferon-alpha/adverse effects , Kaplan-Meier Estimate , Leukemia, Hairy Cell/blood , Leukemia, Hairy Cell/mortality , Male , Middle Aged , Mutation, Missense , Point Mutation , Progression-Free Survival , Proto-Oncogene Proteins B-raf/blood , Proto-Oncogene Proteins B-raf/genetics , Retrospective Studies , Salvage TherapySubject(s)
COVID-19 Drug Treatment , COVID-19/blood , Hemostasis , Heparin, Low-Molecular-Weight/administration & dosage , SARS-CoV-2 , Thrombin/metabolism , Adult , Aged , Aged, 80 and over , Critical Illness , Female , Humans , Male , Middle AgedABSTRACT
The anticoagulant treatment for patients with hematologic malignancies is low molecular weight heparin (LMWH), which is considered the safest in this particular patients setting. Although direct oral anticoagulants (DOACs) have proven their efficacy and safety in patients with cancer, their use can be challenging in patients with hematologic malignancies due to the peculiarity of these neoplasms: high thrombotic risk, possible onset of thrombocytopenia and concomitant anticancer therapies. The aim of our study was to evaluate the efficacy and safety of DOACs for venous thromboembolism or atrial fibrillation in patients with hematologic malignancies and plasmatic DOACs level during anticancer therapy and at time of bleeding or thrombotic complications. We evaluated patients with hematologic malignancies treated with DOACs for venous thromboembolism or atrial fibrillation-therapy was maintained until the platelet count was ≥50 × 109 /L. In case of concomitant anticancer treatment and haemorrhagic or thrombotic events, we checked DOACs plasma levels (trough and peak). The patients evaluated were 135: 104/135 were on anticancer therapy. We did not observe either thrombotic or major haemorrhagic adverse events. Minor bleedings occurred in 10 patients and clinical relevant non-major (CRNM) in two patients. There was a statistically significant correlation between bleedings and myelodysplastic syndrome. DOACs resulted effective and safe in patients with hematologic malignancies. DOACs plasma level can be helpful in suggesting an early dose adjustment to prevent haemorrhagic adverse event in patients on concomitant anticancer therapy. Larger prospective studies including hematologic patients are warranted to confirm the safety and efficacy of DOACs.
Subject(s)
Anticoagulants/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Atrial Fibrillation/drug therapy , Hematologic Neoplasms/drug therapy , Hemorrhage/drug therapy , Venous Thromboembolism/drug therapy , Administration, Oral , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/chemically induced , Atrial Fibrillation/pathology , Female , Follow-Up Studies , Hematologic Neoplasms/pathology , Hemorrhage/chemically induced , Hemorrhage/pathology , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Venous Thromboembolism/chemically induced , Venous Thromboembolism/pathologyABSTRACT
INTRODUCTION: In recent years, innovative mechanism-based drugs have enriched the therapeutic armamentarium for patients with chronic lymphocytic leukemia (CLL) and are widely used in the clinical practice. These small molecules targeting the B-cell receptor signaling pathway and the BCL-2 anti-apoptotic protein offer new chemo-free options to both unfit patients and high-risk patients who show a poor response to chemoimmunotherapy. Nonetheless, treatment with ibrutinib, idelalisib and venetoclax is associated with unique side effects. Awareness, prevention and the appropriate management of these specific toxicities are of crucial importance for a successful treatment. Areas covered: The purpose of this review is to discuss the most relevant studies on small molecules in CLL, with particular attention to the emerging toxicity profile of these agents and to the factors that should be considered to address the most appropriate treatment approach for each patient. Expert opinion: The increased knowledge on the biology of CLL has translated into the development of targeted agents that are highly effective and produce deep responses. Toxicities potentially associated with these agents should be known for an optimal management of CLL patients.
