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1.
Yakugaku Zasshi ; 139(4): 629-633, 2019.
Article in Japanese | MEDLINE | ID: mdl-30930398

ABSTRACT

The combination of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin with rituximab (DA-EPOCH-R) is used for non-Hodgkin lymphoma patients. Febrile neutropenia (FN) is a common complication of treatment with myelo-suppressive chemotherapy, so preventing FN is important for maintaining chemotherapy dosage. Recently, pegfilgrastim has been used as the primary prophylaxis of FN in Japan, but there have been few cases reported using pegfilgrastim for the primary prophylaxis in DA-EPOCH-R. In this study, we retrospectively compared the efficacy of pegfilgrastim with that of filgrastim in patients receiving DA-EPOCH-R in Hiroshima University Hospital. Efficacy assessment was based on incidence of FN and serious neutropenia (neutrophil count <500/µL), hospitalization days and chemotherapy dosage level. Ten patients met the inclusion criteria: pegfilgrastim (n=5, 30 cycles) or filgrastim (n=5, 16 cycles). No difference in efficacy existed between pegfilgrastim and filgrastim in the first cycle; however, 2 of 5 patients in filgrastim group reduced dose level in the total cycles of chemotherapy, no patients in pegfilgrastim group reduced. In conclusion, pegfilgrastim seemed better than filgrastim for the primary prophylaxis in DA-EPOCH-R.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Febrile Neutropenia/chemically induced , Febrile Neutropenia/prevention & control , Filgrastim/administration & dosage , Polyethylene Glycols/administration & dosage , Rituximab/administration & dosage , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Etoposide/administration & dosage , Female , Humans , Lymphoma, Non-Hodgkin/drug therapy , Male , Middle Aged , Prednisone/administration & dosage , Retrospective Studies , Treatment Outcome , Vincristine/administration & dosage
2.
Yakugaku Zasshi ; 139(1): 131-134, 2019.
Article in English | MEDLINE | ID: mdl-30606920

ABSTRACT

When undergoing 90Y-ibritumomab tiuxetan (90Y-IT) treatment, patients are discharged from hospital soon after initiation of treatment and followed up as outpatients. Thus it is important to apprise patients of the safety information regarding 90Y-IT treatment. However, studies investigating the safety of 90Y-IT in real-world clinical practice are lacking. We sought to investigate the adverse events arising from 90Y-IT administration to patients in our hospital. Patients who received 90Y-IT treatment at Hiroshima University Hospital from April 2010 to December 2014 were eligible for this study. The medical records of the patients were reviewed retrospectively. Eleven patients (median age, 65 years) were enrolled. Patients were classified into 3 groups according to the number of prior regimens: 1, 2-3, or >3, consisting of 5, 4, and 2 patients, respectively. The number of patients with induced grade 3 and 4 hematotoxicity, respectively, was 5 and 0 for leukocytopenia, 3 and 2 for neutropenia, and 3 and 2 for thrombocytopenia. The median nadir time was 37 d for leukocytopenia, 37 d for neutropenia, 36 d for thrombocytopenia, and 43 d for anemia. Patients with 2 or more prior regimens tended to experience grade 3 or 4 hematotoxicity more frequently than those with 1 prior regimen. In conclusion, we showed that hematotoxicity is a major adverse event of 90Y-IT treatment and that the nadir time is later than that with conventional anticancer agents. Medical staff, including pharmacists, should direct attention to the initial symptoms of hematotoxicity, especially in those patients who have received several prior regimens.


Subject(s)
Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/therapeutic use , Lymphoma/drug therapy , Radiopharmaceuticals/adverse effects , Radiopharmaceuticals/therapeutic use , Yttrium Radioisotopes/adverse effects , Yttrium Radioisotopes/therapeutic use , Aged , Aged, 80 and over , Anemia/chemically induced , Antibodies, Monoclonal/administration & dosage , Asian People , Female , Humans , Japan , Leukopenia/chemically induced , Male , Middle Aged , Neutropenia/chemically induced , Retrospective Studies , Safety , Thrombocytopenia/chemically induced , Treatment Outcome
3.
Hiroshima J Med Sci ; 62(1): 7-12, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23600328

ABSTRACT

The appropriate therapeutic serum valproate level in maintenance therapy for bipolar disorder is not well known. We studied the serum valproate levels in seventeen bipolar I and twenty-four bipolar II disorder outpatients who had been treated with stable doses of valproate successfully for at least 12 months as prophylactic therapy. The trough serum valproate levels were 52.2 +/- 20.4 microg/ml in bipolar I, and 41.0 +/- 18.3 microg/ml in bipolar II disorder patients, respectively. A greater trend towards a higher trough level (p = 0.07) was indicated in the bipolar I disorder group. We speculate that these valproate levels may be an approximation to the appropriate valproate levels in maintenance therapy and that there may be a correlation between the level of valproate required for stabilization and the subtype of the bipolar disorder. However, when interpreting these findings, certain limitations to this study? Need to be taken into account as follows. The sample size was small. We could not look at a group on valproate that had relapsed and a group that had dropped out of maintenance therapy. Further studies are needed.


Subject(s)
Antimanic Agents/blood , Antimanic Agents/therapeutic use , Bipolar Disorder/drug therapy , Valproic Acid/blood , Valproic Acid/therapeutic use , Adult , Aged , Ambulatory Care , Antimanic Agents/adverse effects , Bipolar Disorder/blood , Bipolar Disorder/diagnosis , Chi-Square Distribution , Drug Monitoring , Female , Humans , Japan , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome , Valproic Acid/adverse effects
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